Metabolic syndrome, dyslipidemia, hypertension and type 2 diabetes in youth: from diagnosis to treatment

Differential effect of nonpharmacological interventions according to prediabetes phenotype: Systematic review and meta-analysis of randomized clinical trials

BACKGROUND AND AIMS

Impaired glucose intolerance (IGT) and impaired fasting glucose (IFG) are totally different. Lifestyle modification is effective in moving from prediabetes to normoglycaemia. There is a lack of information showing the effect of lifestyle modification according to each prediabetes and assessing its effect on the degree of reversibility to normoglycaemia and on cardiometabolic markers.

METHODS AND RESULTS

We searched for randomized controlled trials (RCT) that enrolled individuals with IGT or IFG. Meta-analysis was performed to compare the proportion of subjects progressing to type 2 diabetes mellitus (T2DM); proportion reversing to normoglycaemia and mean differences in glucose level and cardiometabolic parameters. Thirty-six RCTs were included. The proportion of subjects progressing from impaired glycaemia to T2DM was higher among those with IGT (16.3% vs. 10.9%), whereas reversion to normoglycaemia was higher in subjects with IFG (27.2% vs. 24.8%). The effect of lifestyle modification on glucose level was significant on those with IFG (mean difference [MD] = -1.56 mg/dL, 95% CI: -2.71, -0.40), but not on those with IGT of (MD = 1.47 mg/dL, 95% CI: -1.33, 4.28).

CONCLUSION

Diverse lifestyle modification interventions improved glucose levels in people with IFG, but not in those with IGT. Our findings imply that different non-pharmacological interventions are warranted for IGT and IFG.

Vitamin D Deficiency and Cardiovascular Disease Risk Factors Among American Indian Adolescents: The Strong Heart Family Study

Introduction

We aimed to describe the prevalence of vitamin D deficiency among American Indian adolescents and determine its association with cardiovascular disease (CVD) risk factors.

Methods

Our study population consisted of 307 adolescents (aged ≤20 years) participating in the Strong Heart Family Study with serum 25-hydroxyvitamin D (25[OH]D) measured on samples collected during baseline examinations (2001-2003). We defined baseline prevalence of vitamin D deficiency as 25(OH)D ≤20 ng/mL. We evaluated outcomes related to obesity (BMI, waist circumference, wait-to-hip ratio, and body fat percentage), diabetes, cholesterol, and metabolic syndrome. We used generalized estimating equations to determine whether the prevalence of the outcomes differed according to vitamin D deficiency status, while controlling for covariates. To determine incidence, we conducted a follow-up examination a median 5.8 years after baseline (2006-2009) and a second follow-up a median of 13.3 years after baseline (2014-2018). We calculated incidence rates (IR) per 100 person-years for the total group and stratified by vitamin D deficiency status at baseline. Finally we used shared frailty cox proportional hazards models to determine if the risk of the outcomes differed according to vitamin D deficiency status, while controlling for covariates.

Results

The prevalence of vitamin D deficiency was 50.8% at baseline, and it was associated with the prevalence of obesity, low HDL-C, and metabolic syndrome, while controlling for covariates. By the first follow-up, the IRs per 100 person-years were the following: obesity (5.03), diabetes (1.07), any dyslipidemia (10.80), and metabolic syndrome (3.31). By the second follow-up, the IR of diabetes was significantly higher among those with (vs without) baseline vitamin D deficiency (1.32 vs 0.68 per 100 person-years; P = .02), although the association was not significant after adjusting for covariates.

Conclusion

Vitamin D deficiency in adolescence may be associated with the CVD risk factors obesity, low HDL-C, and metabolic syndrome and may also contribute to the development of diabetes later in life.

Metabolic syndrome therapy in pediatric age - between classic and modern. From diets to pipeline drugs

The metabolic syndrome, made up of the sum of the entities that define it (obesity, hypertension, dyslipidemias and non-alcoholic hepatic steatosis) has gained an important place in the research of the last decades. This aspect is mainly due to the complexity of management in pediatric practice. The main directions in his approach therefore bring together the concern of counteracting the noise or systemic, of the multiple intercurrents at the physiopathological level, as well as the negative imprint exerted on the quality of life. Its appearance and evolution are currently controversial topics, but the influence of genetic predisposition and lifestyle (diet, physical activity, psychological balance) are certainties. Considering the escalation of the incident at the global level, it is self-evident that it is necessary to know the pathogenesis and practice countermeasures for prophylactic or therapeutic purposes. The present work aims to summarize general aspects related to the metabolic syndrome encountered in pediatric age, with an emphasis on complementary therapeutic perspectives and their effectiveness, by analyzing the latest data from the specialized literature, accessed with the help of international databases (e.g., PubMed, Web of Science, Scopus, Embase, Google Scholar).

Similarities in B Cell Defects between Aging and Obesity

The aging population is increasing worldwide, and there is also an increase in the aging population living with overweight and obesity, due to changes in lifestyle and in dietary patterns that elderly individuals experience later in life. Both aging and obesity are conditions of accelerated metabolic dysfunction and dysregulated immune responses. In this review, we summarize published findings showing that obesity induces changes in humoral immunity similar to those induced by aging and that the age-associated B cell defects are mainly due to metabolic changes. We discuss the role of the obese adipose tissue in inducing dysfunctional humoral responses and autoimmune Ab secretion.

Targeting Apolipoprotein C-III for the Management of Severe Hypertriglyceridemia: Current Research and Future Directions

Hypertriglyceridemia is characterized by elevated triglyceride levels in the blood, which increases the risk of cardiovascular disease and pancreatitis. This condition stems from multiple factors including lifestyle choices, genetics, and conditions such as diabetes and metabolic syndrome. Apolipoprotein C-III (APOC3), a protein for lipid metabolism, hinders enzymes necessary for breaking down triglycerides and thus plays a key role in hypertriglyceridemia. Variations in the APOC3 gene are associated with varying triglyceride levels among individuals. Recent genetic studies and clinical trials have shed light on the potential of targeting APOC3 as a potentially promising therapeutic modality of hypertriglyceridemia. Antisense oligonucleotides like volanesorsen have displayed effectiveness in lowering triglyceride levels in individuals with severe hypertriglyceridemia. This review article delves into how APOC3 influences triglyceride control and its potential use in targeting APOC3 to manage severe hypertriglyceridemia.

Metabolic Syndrome and Biotherapeutic Activity of Dairy (Cow and Buffalo) Milk Proteins and Peptides: Fast Food-Induced Obesity Perspective-A Narrative Review

Metabolic syndrome (MS) is defined by the outcome of interconnected metabolic factors that directly increase the prevalence of obesity and other metabolic diseases. Currently, obesity is considered one of the most relevant topics of discussion because an epidemic heave of the incidence of obesity in both developing and underdeveloped countries has been reached. According to the World Obesity Atlas 2023 report, 38% of the world population are presently either obese or overweight. One of the causes of obesity is an imbalance of energy intake and energy expenditure, where nutritional imbalance due to consumption of high-calorie fast foods play a pivotal role. The dynamic interactions among different risk factors of obesity are highly complex; however, the underpinnings of hyperglycemia and dyslipidemia for obesity incidence are recognized. Fast foods, primarily composed of soluble carbohydrates, non-nutritive artificial sweeteners, saturated fats, and complexes of macronutrients (protein-carbohydrate, starch-lipid, starch-lipid-protein) provide high metabolic calories. Several experimental studies have pointed out that dairy proteins and peptides may modulate the activities of risk factors of obesity. To justify the results precisely, peptides from dairy milk proteins were synthesized under in vitro conditions and their contributions to biomarkers of obesity were assessed. Comprehensive information about the impact of proteins and peptides from dairy milks on fast food-induced obesity is presented in this narrative review article.

Dyslipidemia in American Indian Adolescents and Young Adults: Strong Heart Family Study

BACKGROUND

Although many studies on the association between dyslipidemia and cardiovascular disease (CVD) exist in older adults, data on the association among adolescents and young adults living with disproportionate burden of cardiometabolic disorders are scarce.

METHODS AND RESULTS

The SHFS (Strong Heart Family Study) is a multicenter, family-based, prospective cohort study of CVD in an American Indian populations, including 12 communities in central Arizona, southwestern Oklahoma, and the Dakotas. We evaluated SHFS participants, who were 15 to 39 years old at the baseline examination in 2001 to 2003 (n=1440). Lipids were measured after a 12-hour fast. We used carotid ultrasounds to detect plaque at baseline and follow-up in 2006 to 2009 (median follow-up=5.5 years). We identified incident CVD events through 2020 with a median follow-up of 18.5 years. We used shared frailty proportional hazards models to assess the association between dyslipidemia and subclinical or clinical CVD, while controlling for covariates. Baseline dyslipidemia prevalence was 55.2%, 73.6%, and 78.0% for participants 15 to 19, 20 to 29, and 30 to 39 years old, respectively. Approximately 2.8% had low-density lipoprotein cholesterol ≥160 mg/dL, which is higher than the recommended threshold for lifestyle or medical interventions in young adults of 20 to 39 years old. During follow-up, 9.9% had incident plaque (109/1104 plaque-free participants with baseline and follow-up ultrasounds), 11.0% had plaque progression (128/1165 with both baseline and follow-up ultrasounds), and 9% had incident CVD (127/1416 CVD-free participants at baseline). Plaque incidence and progression were higher in participants with total cholesterol ≥200 mg/dL, low-density lipoprotein cholesterol ≥160 mg/dL, or non-high-density lipoprotein cholesterol ≥130 mg/dL, while controlling for covariates. CVD risk was independently associated with low-density lipoprotein cholesterol ≥160 mg/dL.

CONCLUSIONS

Dyslipidemia is a modifiable risk factor that is associated with both subclinical and clinical CVD, even among the younger American Indian population who have unexpectedly high rates of significant CVD events. Therefore, this population is likely to benefit from a variety of evidence-based interventions including screening, educational, lifestyle, and guideline-directed medical therapy at an early age.

Control Level of Type 2 Diabetes Mellitus in the Elderly Is Associated with Polypharmacy, Accompanied Comorbidities, and Various Increased Risks According to the Beers Criteria

Comorbidity rates in the geriatric population have increased because of rising life expectancy; thus, patients have had to use more medications. Type 2 diabetes mellitus, one of the most common diseases, may influence the number of drugs used in geriatric patients. The present study was designed to investigate the association between the level of type 2 DM and polypharmacy. Fifty patients with type 2 diabetes over the age of 65 were included according to the inclusion criteria; 23 were well-controlled and 27 had poorly controlled diabetes. The groups were similar in terms of age, sex, WBC, Hb, Plt, AST, ALT, serum creatinine, fasting glucose, and eGFR levels. Patients with HbA1c values above 7.5 were classified as poorly controlled diabetes patients, and those below were considered well-controlled diabetes patients and were evaluated for inappropriate medication use. The number of medications used daily by the cases (p < 0.001), the number of concomitant diseases (p = 0.001), and the number of increased risks according to the Beers Criteria (p = 0.02) were observed to be high in poorly controlled type 2 diabetes mellitus subjects. HbA1c levels were related to the number of medications (r = 0.4, p = 0.004), comorbidities (r = 0.28, p = 0.04), and the number of increased risks according to the Beers Criteria (r = 0.31, p = 0.014). In conclusion, the number of medications used in patients with poorly controlled type 2 diabetes mellitus was found to be more elevated than in individuals with well-controlled type 2 diabetes mellitus. The HbA1c values varied among patients regarding polypharmacy, comorbidities, and increased risks according to the Beers Criteria.

Mitochondrial transfer restores impaired liver functions by AMPK/ mTOR/PI3K-AKT pathways in metabolic syndrome

AIM

We investigated the effect of mitochondria transfer in high fat diet and streptozotocin (HFD + STZ) induced metabolic syndrome (MeS) in rats. The effect of mitochondria transfer in MeS with co-existing hypertension, hyperlipidaemia, diabetes and fatty liver together, has not been reported.

MATERIALS AND METHODS

Heathy mitochondria was transferred intravenously and the effect on several physiological parameters and biochemical parameters were examined in HFD + STZ rats. In addition, RNA-sequencing of healthy liver tissues was performed to elucidate the molecular pathways affected by mitochondria transfer in restoring metabolic health.

KEY FINDINGS

We observed reduction in both systolic and diastolic blood pressure levels, reduced blood glucose levels, and a marked reduction in serum lipid profiles. The levels of alanine transaminase (ALT) and aspartate transaminase (AST) also improved along with evident restoration of liver morphology demonstrated by histopathological analysis. Enhanced mitochondrial biogenetics and reduction in oxidative stress and inflammatory markers was also observed. The pathway enrichment analysis revealed reduction in insulin resistance, inflammatory markers, regulation of mitochondrial bioenergetics, calcium ion homeostasis, fatty-acid β-oxidation, cytokine immune regulators, and enhanced lipid solubilisation. The significant effect of healthy mitochondria transfer in restoration of metabolic functions was observed by the activation of PI3K-AKT, AMPK/mTOR pathways and cytokine immune regulators, suggesting that inflammatory mediators were also significantly affected after mitochondria transfer.

SIGNIFICANCE

This study, provides insights on molecular processes triggered by mitochondria transfer in fatty liver regeneration and improvement of overall metabolic health.

General and central obesity prevalence in young adult: a study based on the Rafsanjan youth cohort study

Growing prevalence of obesity among youth would have adverse consequences and increased risk of developing chronic diseases at older ages. This study explored the prevalence of obesity and its association with relevant risk factors in the Rafsanjan youth cohort population. This cross-sectional study was done on 3006 individuals from the 15-35-year-old population included in the Rafsanjan youth cohort study. The data were extracted from the youth cohort databases, which had been collected through in-person interview and standard questionnaires. Definition of general obesity was considered as body mass index ≤ 30 and that of central obesity as waist to hip ratio (WHR) ≥ 0.9 for men and ≥ 0.85 for women. Multivariate stepwise proportional odds model and multivariable stepwise logistic regression models were done to explore the factors associated with general obesity and central obesity. The mean age was 25.78 ± 6.06 years with 56% (n = 1683) female. The prevalence of general obesity was 15.80% (95% CI 14.50-17.11) and central obesity was 28.41% (95% CI 26.80-30.02). The risk of general obesity increased with increasing age (OR = 1.053, P < 0.0001), being married (OR = 1.658, P < 0.0001), history of diabetes (OR = 1.609, P = 0.0185), history of hypertension (OR = 1.609, P < 0.0001), elevated triglyceride (OR = 1.007, P < 0.0001) and LDL (OR = 1.015, P < 0.0001), while decreasing with being employed (OR = 0.748, P = 0.0002) and elevated HDL (OR = 0.975, P < 0.0001). Prevalence of obesity was high in study population. Marital status, increasing age, and history of chronic diseases were associated with obesity. Preventing programs should be developed against obesity and for promoting healthy habits in young adult especially during education at schools.

Prediction of diabetes disease using an ensemble of machine learning multi-classifier models

BACKGROUND AND OBJECTIVE

Diabetes is a life-threatening chronic disease with a growing global prevalence, necessitating early diagnosis and treatment to prevent severe complications. Machine learning has emerged as a promising approach for diabetes diagnosis, but challenges such as limited labeled data, frequent missing values, and dataset imbalance hinder the development of accurate prediction models. Therefore, a novel framework is required to address these challenges and improve performance.

METHODS

In this study, we propose an innovative pipeline-based multi-classification framework to predict diabetes in three classes: diabetic, non-diabetic, and prediabetes, using the imbalanced Iraqi Patient Dataset of Diabetes. Our framework incorporates various pre-processing techniques, including duplicate sample removal, attribute conversion, missing value imputation, data normalization and standardization, feature selection, and k-fold cross-validation. Furthermore, we implement multiple machine learning models, such as k-NN, SVM, DT, RF, AdaBoost, and GNB, and introduce a weighted ensemble approach based on the Area Under the Receiver Operating Characteristic Curve (AUC) to address dataset imbalance. Performance optimization is achieved through grid search and Bayesian optimization for hyper-parameter tuning.

RESULTS

Our proposed model outperforms other machine learning models, including k-NN, SVM, DT, RF, AdaBoost, and GNB, in predicting diabetes. The model achieves high average accuracy, precision, recall, F1-score, and AUC values of 0.9887, 0.9861, 0.9792, 0.9851, and 0.999, respectively.

CONCLUSION

Our pipeline-based multi-classification framework demonstrates promising results in accurately predicting diabetes using an imbalanced dataset of Iraqi diabetic patients. The proposed framework addresses the challenges associated with limited labeled data, missing values, and dataset imbalance, leading to improved prediction performance. This study highlights the potential of machine learning techniques in diabetes diagnosis and management, and the proposed framework can serve as a valuable tool for accurate prediction and improved patient care. Further research can build upon our work to refine and optimize the framework and explore its applicability in diverse datasets and populations.

Cumulative effects of exercise training and consumption of propolis on managing diabetic dyslipidemia in adult women: a single-blind, randomized, controlled trial with pre-post-intervention assessments

Dyslipidemia is an imbalance of various lipids, and propolis, as a natural resinous viscos mixture made by Apis mellifera L. could improve in this condition. In this single-blind, randomized trial, 60 women with type 2 diabetes and dyslipidemia were divided into four groups: (1) the patients who did not apply the combined training and 500 mg propolis capsules supplement (Control group); (2) subjects performed combined training, including aerobic and resistance training (EXR); (3) subjects received the 500 mg propolis supplement capsules (SUPP); (4) Subjects performed combined training along with receiving the 500 mg propolis supplement capsules (EXR + SUPP). We evaluated the concentration of CTRP12, SFRP5, interleukin-6 (IL6), superoxide dismutase (SOD), malondialdehyde (MDA), adiponectin, and total antioxidant capacity (TAC) before and after the intervention. MDA, TAC, IL6, CTRP12, SFRP5 IL6, adiponectin, and lipid profile levels ameliorated in the EXR + SUPP group. We found that 8 weeks of treatment by combined exercise training and propolis supplement decreased inflammation activity and increased antioxidant defense in women with diabetic dyslipidemia.Trial registration This study was registered in the Iranian Registry of Clinical Trials; IRCT code: IRCT20211229053561N1.

Risk of dyslipidemia in chronic hepatitis B patients taking tenofovir alafenamide: a systematic review and meta-analysis

BACKGROUND

The aim of this study was to demonstrate how tenofovir alafenamide (TAF) and other hepatitis B treatment drugs differentially impact lipid profiles in chronic hepatitis B patients.

METHODS

We searched PubMed, Ovid MEDLINE, EMBASE, and the Cochrane Library to identify studies on the changes in cholesterol level in hepatitis B patients who underwent TAF therapy. The changes in lipid profiles (e.g., HDL-c, LDL-c, total cholesterol [TC], and triglyceride [TG]) were compared between the TAF treatment group and the baseline, other nucleoside analogs (NAs), and tenofovir disoproxil fumarate (TDF)-only treatment groups. In addition, risk factors for worsening cholesterol level when treated with TAF were examined.

RESULTS

Twelve studies involving 6,127 patients were selected. After 6 months of TAF treatment, LDL-c, TC, and TG were increased by 5.69 mg/dL, 7.89 mg/dL, and 9.25 mg/dL, respectively, from the baseline level. In particular, with the treatment of TAF, levels of LDL, TC, and TG rose by 8.71 mg/dL, 18.34 mg/dL, and 13.68 mg/dL, respectively, showing a greater deterioration of cholesterol when the TAF treatment was implemented compared to other NAs (e.g., TDF or entecavir). When TAF was compared to TDF, LDL-c, TC, and TG worsened with a mean difference of 14.52 mg/dL, 23.72 mg/dL, and 14.25 mg/dL, respectively. As a result of a meta-regression analysis, risk factors for worsening lipid profiles were found to be treatment-experienced, previous diabetes, and hypertension.

CONCLUSIONS

TAF continues to worsen lipid profiles including LDL-c, TC, and TG after 6 months of use compared to the other NAs.

Efficacy of fermented grain using Bacillus coagulans in reducing visceral fat among people with obesity: a randomized controlled trial

Background

Obesity is a socioeconomic problem, and visceral obesity, in particular, is related to cardiovascular diseases or metabolic syndrome. Fermented grains and various microorganisms are known to help with anti-obesity effects and weight management. Studies on the relationship between Bacillus coagulans and anti-obesity effects are not well known, and studies on the application of fermented grains and microorganisms to the human body are also insufficient.

Objectives

This study aimed to evaluate the efficacy of Curezyme-LAC, an ingredient mixed with six-grain types fermented by B. coagulans, in reducing fat mass in adults with obesity.

Methods

In this randomized double-blinded placebo-controlled study, 100 participants [aged 40-65 years; body mass index (BMI) ≥ 25 to ≤ 33 kg/m²) were randomly allocated to two groups: 4 g/day Curezyme-LAC administered as a granulated powder or placebo (steamed grain powder mixture).

Results

After 12 weeks, visceral adipose tissue decreased significantly in the Curezyme-LAC group compared with that in the placebo group (mean ± standard error, SE of -9.3 cm² ± 5.1) vs. (6.8 cm² ± 3.4; p = 0.008). Compared to the placebo group, the Curezyme-LAC group also showed significant reductions in total fat mass (-0.43 ± 0.24 kg vs. 0.31 ± 0.19 kg, p = 0.011), body weight (-0.4 ± 0.3 kg vs. 0.3 ± 0.2 kg, p = 0.021), BMI (-0.14 ± 0.12 vs. 0.10 ± 0.07, p = 0.028), and waist circumference (-0.6 ± 0.2 cm vs. -0.1 ± 0.2 cm, p = 0.018) without a change in dietary intake and physical activity.

Conclusion

Curezyme-LAC supplementation for 12 weeks may benefit individuals with obesity by reducing visceral fat mass.

Gut Microbiome: The Interplay of an "Invisible Organ" with Herbal Medicine and Its Derived Compounds in Chronic Metabolic Disorders

Resembling a concealed "organ" in a holobiont, trillions of gut microbes play complex roles in the maintenance of homeostasis, including participating in drug metabolism. The conventional opinion is that most of any drug is metabolized by the host and that individual differences are principally due to host genetic factors. However, current evidence indicates that only about 60% of the individual differences in drug metabolism are attributable to host genetics. Although most common chemical drugs regulate the gut microbiota, the gut microbiota is also known to be involved in drug metabolism, like the host. Interestingly, many traditional herbal medicines and derived compounds are biotransformed by gut microbiota, manipulating the compounds' effects. Accordingly, the gut microbiota and its specified metabolic pathways can be deemed a promising target for promoting drug efficacy and safety. However, the evidence regarding causality and the corresponding mechanisms concerning gut microbiota and drug metabolism remains insufficient, especially regarding drugs used to treat metabolic disorders. Therefore, the present review aims to comprehensively summarize the bidirectional roles of gut microbiota in the effects of herbal medicine in metabolic diseases to provide vital clues for guiding the clinical application of precision medicine and personalized drug development.

Effects of curcumin and/or coenzyme Q10 supplementation on metabolic control in subjects with metabolic syndrome: a randomized clinical trial

Background

Metabolic syndrome (MetS) as a cluster of conditions including hyperlipidemia, hypertension, hyperglycemia, insulin resistance, and abdominal obesity is linked to cardiovascular diseases and type 2 diabetes. Evidence suggested that intake of curcumin and coenzyme Q10 may have therapeutic effects in the management of MetS.

Aims

We investigated the effects of curcumin and/or coenzyme Q10 supplementation on metabolic syndrome components including systolic blood pressure (SBP), diastolic blood pressure (DBP), waist circumference (WC), triglyceride (TG), high density lipoprotein-cholesterol (HDL-c) and fasting plasma glucose (FPG) as primary outcomes, and total cholesterol (TC), low density lipoprotein-cholesterol (LDL-c) and body mass index (BMI) as secondary outcomes in subjects with MetS.

Methods

In this 2 × 2 factorial, randomized, double-blinded, placebo-controlled study, 88 subjects with MetS were randomly assigned into four groups including curcumin plus placebo (CP), or coenzyme Q10 plus placebo (QP), or curcumin plus coenzyme Q10 (CQ), or double placebo (DP) for 12 weeks.

Results

The CP group compared with the three other groups showed a significant reduction in HDL-c (P = 0.001), TG (P <  0.001), TC (P <  0.001), and LDL-c (P <  0.001). No significant differences were seen between the four groups in terms of SBP, DBP, FPG, WC, BMI and weight.

Conclusion

Curcumin improved dyslipidemia, but had no effect on body composition, hypertension and glycemic control. Furthermore, coenzyme Q10 as well as the combination of curcumin and coenzyme Q10 showed no therapeutic effects in subjects with MetS. The trial was registered on 09/21/2018 at the Iranian clinical trials website (IRCT20180201038585N2), URL: https://www.irct.ir/trial/32518.

Subclinical atherosclerosis in adolescents and young adults and the risk of cardiovascular disease: The Strong Heart Family Study (SHFS)

BACKGROUND AND AIMS

Rates of cardiovascular disease (CVD) among American Indians (AI) have been increasing. Although we have observed an association between atherosclerosis and CVD in older adults, the potential association among young AI is unclear. Therefore, we aim to describe the prevalence of atherosclerosis among young AI and determine its association with CVD and all-cause mortality.

METHODS AND RESULTS

We evaluated AI participants from the Strong Heart Family Study (SHFS), who were <40 years old and CVD free at the baseline examination, 2001-2003 (n = 1376). We used carotid ultrasound to detect baseline atherosclerotic plaque. We identified CVD events and all-cause mortality through 2019, with a median follow-up of 17.8 years. We used shared frailty Cox Proportional Hazards models to assess the association between atherosclerosis and time to CVD event or all-cause mortality, while controlling for covariates. Among 1376 participants, 71 (5.2%) had atherosclerosis at baseline. During follow-up, 120 (8.7%) had CVD events and 104 (7.6%) died from any cause. CVD incidence was higher in participants who had baseline atherosclerosis (13.51/1000 person-years) than in those who did not (4.95/1000 person-years, p = 0.0003). CVD risk and all-cause mortality were higher in participants with atherosclerosis, while controlling for covariates (CVD HR = 1.85, 95%CI = 1.02-3.37, p = 0.0420; all-cause mortality HR = 2.04, 95%CI = 1.07-3.89, p = 0.0291).

CONCLUSIONS

Among young AI, atherosclerosis was independently associated with incident CVD and all-cause mortality later in life. Thus, atherosclerosis begins early in life and interventions in adolescents and young adults to slow the progression of disease could prevent or delay CVD events later in life.

Different Seasonal Collections of Ficus carica L. Leaves Diversely Modulate Lipid Metabolism and Adipogenesis in 3T3-L1 Adipocytes

Due to the high prevalence of obesity and type 2 diabetes, adipogenesis dysfunction and metabolic disorders are common features in the elderly population. Thus, the identification of novel compounds with anti-adipogenic and lipolytic effects is highly desirable to reduce diabetes complications. Plants represent an important source of bioactive compounds. To date, the antidiabetic potential of several traditional plants has been reported, among which Ficus carica L. is one of the most promising. Considering that plant metabolome changes in response to a number of factors including seasonality, the aim of this study was to evaluate whether Ficus carica leaves extracts collected in autumn (FCa) and spring (FCs) differently modulate lipid metabolism and adipogenesis in 3T3-L1 adipocytes. The 1H-NMR profile of the extracts showed that FCs have a higher content of caffeic acid derivatives, glucose, and sucrose than FCa. In contrast, FCa showed a higher concentration of malic acid and furanocoumarins, identified as psoralen and bergapten. In vitro testing showed that only FCa treatments were able to significantly decrease the lipid content (Ctrl vs. FCa 25 μg/mL, 50 μg/mL and 80 μg/mL; p < 0.05, p < 0.01 and p < 0.001, respectively). Furthermore, FCa treatments were able to downregulate the transcriptional pathway of adipogenesis and insulin sensitivity in 3T3-L1 adipocytes. In more detail, FCa 80 μg/mL significantly decreased the gene expression of PPARγ (p < 0.05), C/EBPα (p < 0.05), Leptin (p < 0.0001), adiponectin (p < 0.05) and GLUT4 (p < 0.01). In conclusion, this study further supports an in-depth investigation of F. carica leaves extracts as a promising source of active compounds useful for targeting obesity and diabetes.

Lactobacillus plantarum 23-1 improves intestinal inflammation and barrier function through the TLR4/NF-κB signaling pathway in obese mice

As a natural active ingredient, lactic acid bacteria have potential anti-inflammatory effects. In this study, male C57BL/6J mice were given a high-fat diet (HFD) to establish an obese mouse model. Lactobacillus plantarum 23-1 (LP23-1) with prebiotic characteristics was intervened for 8 weeks to evaluate its remission effect on obese animals and related mechanisms. The effects of LP23-1 on lipid accumulation and intestinal inflammation in HFD-fed mice were systematically evaluated by detecting lipid accumulation, blood lipid level, pathological changes in the liver and small intestine, oxidative stress and inflammatory cell level, lipid transport-related gene expression, the inflammatory signaling pathway, and intestinal tight junction (TJ) mRNA and protein expression. The results showed that LP23-1 could significantly reduce the body weight and fat index of HFD-fed mice, improve the lipid levels of serum and liver, reduce the histopathological damage to the liver and small intestine, and alleviate oxidative stress and inflammatory response caused by obesity. In addition, reverse transcription-polymerase chain reaction and western blot analysis showed that LP23-1 could regulate the mRNA expression of lipid transport-related genes; activate the TLR4/NF-κB signaling pathway; reduce intestinal inflammation; improve the mRNA and protein expression of intestinal TJ proteins zona occludens-1 (ZO-1), occludin, claudin-1, and Muc2; repair intestinal mucosal injury; and enhance intestinal barrier function. The aforementioned results showed that LP23-1 through the TLR4/NF-κB signaling pathway and intestinal barrier function reduced obesity symptoms. This study provided new insights into the mechanism of LP23-1 in reducing obesity and provided a theoretical basis for developing new functional foods.

The effects of ginger and its constituents in the prevention of metabolic syndrome: A review

Metabolic syndrome is a multifactorial disorder characterized by hyperglycemia, hyperlipidemia, obesity, and hypertension risk factors. Moreover, metabolic syndrome is the most ordinary risk factor for cardiovascular disease (CVD). Numerous chemical drugs are being synthesized to heal metabolic risk factors. Still, due to their abundant side effects, herbal medicines have a vital role in the treatment of these abnormalities. Ginger (Zingiber officinale Roscoe, Zingiberaceae) plant has been traditionally used in medicine to treat disorders, including CVD. The unique ginger properties are attributed to the presence of [6]-gingerol, [8]-gingerol, [10]-gingerol, and [6]-shogaol, which through different mechanisms can be beneficial in metabolic syndrome. Ginger has a beneficial role in metabolic syndrome treatment due to its hypotensive, anti-obesity, hypoglycemic, and hypolipidemic effects. It can significantly reduce atherosclerotic lesion areas, VLDL and LDL cholesterol levels, and elevate adenosine deaminase activity in platelet and lymphocytes. Also, it promotes ATP/ADP hydrolysis. In the current article review, the critical properties of ginger and its constituents' effects on the metabolic syndrome with a special focus on different molecular and cellular mechanisms have been discussed. This article also suggests that ginger may be introduced as a therapeutic or preventive agent against metabolic syndrome after randomized clinical trials.

Lactobacillus paracasei 24 Attenuates Lipid Accumulation in High-Fat Diet-Induced Obese Mice by Regulating the Gut Microbiota

Obesity has become a worldwide public health problem. Lactic acid bacteria have attracted extensive attention for alleviating obesity and fat accumulation. This study aimed to evaluate the alleviating effects of Lactobacillus paracasei 24 (LP24) on lipid accumulation in an obese mouse model induced by a high-fat diet (HFD). The results showed that LP24 treatment significantly reduced body weight and fat deposition in HFD mice, improved blood lipid levels and liver steatosis, reduced liver oxidative stress injury and the inflammatory response, and regulated fat metabolism-related factors. Moreover, LP24 regulated the abundance and diversity of the gut microbiota, reduced the abundance of Firmicutes and the ratio of Firmicutes/Bacteroidetes (F/B), and increased the abundance of Akkermansia. In summary, LP24 regulates lipid metabolism by activating the expression level of related genes and regulating the gut microbiota through the gut-liver axis to attenuate the development of obesity. This study provides a theoretical basis for probiotics to regulate gut microbiota to reduce lipid accumulation.

Nanomedicine of Plant Origin for the Treatment of Metabolic Disorders

Metabolic disorders are major clinical challenges of health that are progressing globally. A concurrence of metabolic disorders such as obesity, insulin resistance, atherogenic dyslipidemia, and systematic hypertension leads to metabolic syndrome. Over the past years, the metabolic syndrome leads to a five- and two-fold rise in diabetes mellitus type II and cardiovascular diseases. Natural products specifically plant extracts have insulin-sensitizing, anti-inflammatory, and antioxidant properties and are also considered as an alternative option due to few adverse effects. Nanotechnology is one of the promising strategies, which improves the effectiveness of treatment and limits side effects. This review mainly focuses on plant extract-based nanosystems in the management of the metabolic syndrome. Numerous nano-drug delivery systems, i.e., liposomes, hydrogel nanocomposites, nanoemulsions, micelles, solid lipid, and core–shell nanoparticles, have been designed using plant extracts. It has been found that most of the nano-formulations successfully reduced oxidative stress, insulin resistance, chronic inflammation, and lipid profile in in vitro and in vivo studies as plant extracts interfere with the pathways of metabolic syndrome. Thus, these novel plant-based nanosystems could act as a promising candidate for clinical applications.

Structural homology between 11 beta-hydroxysteroid dehydrogenase and Mycobacterium tuberculosis Inh-A enzyme: Dehydroepiandrosterone as a potential co-adjuvant treatment in diabetes-tuberculosis comorbidity

Metabolic syndrome is considered the precursor of type 2 diabetes mellitus. Tuberculosis is a leading infection that constitutes a global threat remaining a major cause of morbi-mortality in developing countries. People with type 2 diabetes mellitus are more likely to suffer from infection with Mycobacterium tuberculosis. For both type 2 diabetes mellitus and tuberculosis, there is pulmonary production of anti-inflammatory glucocorticoids mediated by the enzyme 11β-hydroxysteroid dehydrogenase type 1 (11β-HSD1). The adrenal hormone dehydroepiandrosterone (DHEA) counteracts the glucocorticoid effects of cytokine production due to the inhibition of 11β-HSD1. Late advanced tuberculosis has been associated with the suppression of the Th1 response, evidenced by a high ratio of cortisol/DHEA. In a murine model of metabolic syndrome, we determined whether DHEA treatment modifies the pro-inflammatory cytokines due to the inhibition of the 11β-HSD1 expression. Since macrophages express 11β-HSD1, our second goal was incubating them with DHEA and Mycobacterium tuberculosis to show that the microbicide effect was increased by DHEA. Enoyl-acyl carrier protein reductase (InhA) is an essential enzyme of Mycobacterium tuberculosis involved in the mycolic acid synthesis. Because 11β-HSD1 and InhA are members of a short-chain dehydrogenase/reductase family of enzymes, we hypothesize that DHEA could be an antagonist of InhA. Our results demonstrate that DHEA has a direct microbicide effect against Mycobacterium tuberculosis; this effect was supported by in silico docking analysis and the molecular dynamic simulation studies between DHEA and InhA. Thus, DHEA increases the production of pro-inflammatory cytokines in the lung, inactivates GC by 11β-HSD1, and inhibits mycobacterial InhA. The multiple functions of DHEA suggest that this hormone or its synthetic analogs could be an efficient co-adjuvant for tuberculosis treatment.

HDL subgroups and their paraoxonase-1 activity in the obese, overweight and normal weight subjects

BACKGROUND

Obesity and overweight are significant public health problems because of higher risk for coronary artery disease (CAD). It is very important to determine new predictive markers to identify the CAD risk in obese and overweight. To aim this, we analysed HDL-C subgroups (HDL2-C and HDL3-C) and their paraoxonase-1 (PON-1) activity in obese, overweight and normal weight subjects.

METHOD

71 obese, 40 overweight and 30 healthy subjects as a control group were enrolled the study. Serum lipids levels were determined with enzymatic colorimetric method. Further, PON-1 activities and HDL-C levels were determined by spectrophotometric methods. Non-HDL3-C concentrations were calculated with the subtraction of HDL3-C from total HDL-C.

RESULTS

The mean serum levels of total HDL-C, HDL3-C, Non-HDL3-C and ApoA1 were higher in control group than obese and overweight groups. There were a statistically significant difference between obese and control group in terms of Lp(a), hsCRP and HOMA index. Higher total PON-1, non-HDL3 PON-1 and HDL3 PON-1 activities were found in the control group compared with obese and overweight groups. Total HDL was weakly negative correlated with the HOMA index, BMI and waist circumference. There was a weak negative correlation between non-HDL3-C and waist circumference.

CONCLUSION

Altered HDL-subgroups pattern and decreased PON-1 activities may cause increased risk for CVD in obese and overweight individuals. Therefore determination of HDL subgroups and their PON-1 activity may improve risk prediction compared with measuring total HDL-C levels and its PON-1 activity alone. Body weight and insulin resistance appear to have a role in the decreased HDL-C levels and PON-1activity in obese. Further studies should be conducted to shed more light on impacts of these markers in CVD.

Intelligent type 2 diabetes risk prediction from administrative claim data

Type 2 diabetes is a chronic, costly disease and is a serious global population health problem. Yet, the disease is well manageable and preventable if there is an early warning. This study aims to apply supervised machine learning algorithms for developing predictive models for type 2 diabetes using administrative claim data. Following guidelines from the Elixhauser Comorbidity Index, 31 variables were considered. Five supervised machine learning algorithms were used for developing type 2 diabetes prediction models. Principal component analysis was applied to rank variables' importance in predictive models. Random forest (RF) showed the highest accuracy (85.06%) among the algorithms, closely followed by the k-nearest neighbor (84.48%). The analysis further revealed RF as a high performing algorithm irrespective of data imbalance. As revealed by the principal component analysis, patient age is the most important predictor for type 2 diabetes, followed by a comorbid condition (i.e., solid tumor without metastasis). This study's finding of RF as the best performing classifier is consistent with the promise of tree-based algorithms for public data in other works. Thus, the outcome can guide in designing automated surveillance of patients at risk of forming diabetes from administrative claim information and will be useful to health regulators and insurers.

1α,25-(OH)2 vitamin D3 prevents insulin resistance and regulates coordinated exocytosis and insulin secretion

Vitamin D₃ is associated with improvements in insulin resistance and glycemia. In this study, we investigated the short-term effect of 1α,25(OH)₂ Vitamin D₃ (1,25-D₃) and cholecalciferol (vitamin D₃) on the glycemia and insulin sensitivity of control and dexamethasone-induced insulin-resistance rats. ⁴⁵Ca²⁺ influx responses to 1,25-D₃ and its role in insulin secretion were investigated in isolated pancreatic islets from control rats. In vivo, 5 d treatment with 1,25-D₃ (i.p.) prevented insulin resistance in dexamethasone-treated rats. Treatment with 1,25-D₃ improved the activities of hepatic enzymes, serum lipids and calcium concentrations in insulin-resistant rats. 25-D₃ (o.g.) does not affect insulin resistance. In pancreatic islets, 1,25-D₃ increased insulin secretion and stimulated rapid response ⁴⁵Ca²⁺ influx. The stimulatory effect of 1,25-D₃ on ⁴⁵Ca²⁺ influx was decreased by diazoxide, apamine, thapsigargin, dantrolene, 2-APB, nifedipine, TEA, PKA, PKC, and cytoskeleton inhibitor, while it was increased by glibenclamide and N-ethylmaleimide. The stimulatory effect of 1,25-D₃ on ⁴⁵Ca²⁺ influx involves the activation of L-type VDCC, K⁺-ATP, K⁺-Ca^2+, and Kv channels, which augment cytosolic calcium. These ionic changes mobilize calcium from stores and downstream activation of PKC, PKA tethering vesicle traffic and fusion at the plasma membrane for insulin secretion. This is the first study highlighting the unprecedented role of 1,25-D₃ (short-term effect) in the regulation of glucose homeostasis and on prevention of insulin resistance. Furthermore, this study shows the intracellular β-cell signal transduction of 1,25-D₃ through the modulation of pivotal ionic channels and proteins exhibiting a coordinated exocytosis of vesicles for insulin secretion.

Predictors of Lipid Profile Abnormalities Among Patients with Metabolic Syndrome in Southwest Ethiopia: A Cross-Sectional Study

BACKGROUND

Lipid profile abnormalities are an integral part of metabolic syndrome (MetS) and major underlying causes of cardiovascular disease (CVD) and type-2 diabetes mellitus (T2DM). Lipid profile abnormalities in a patient with MetS are resulted due to the presence of central obesity and insulin resistance. In Ethiopia, the burden and predictors of lipid profile abnormalities in a patient with MetS are not well known. Thus, this study aimed to determine the prevalence of lipid profile abnormalities and predictors among patients with MetS in southwest Ethiopia.

METHODS AND MATERIALS

A cross-sectional study was conducted among 381 patients with MetS from September to December 2019 with a response rate of 100%. A structured questionnaire was used to collect data on socio-demographic and behavioral factors. Waist circumference, height, weight, and blood pressures were measured. The venous blood sample was collected for glucose and lipid profile determination. Data were entered and analyzed by using SPSS version 21. Binary logistic regression and Pearson's correlation analyses were performed. A p-value was set at a <0.05 for statistical significance.

RESULTS

In this study, about 58% of participants were at least one or more lipid profile abnormalities with the 95% CI (52.8-62.7). About 67.2%, 44.6%,18.4%, and 14.2% of study participants were low HDL, high TG, LDL, and TC, respectively. Central obesity (adjusted odds ratio (AOR): 1.89, 95% CI: 1.14-3.14), increasing age (AOR: 2.08, 95% CI: 1.27-3.4), higher BMI (AOR: 2.06, 95% CI: 1.23-3.4), being hypertensive (AOR: 3.48, 95% CI: 2.12-5.7) and increasing blood glucose level (AOR: 2.34, 95% CI: 1.36-4.03) were independent predictors of lipid profile abnormalities (dyslipidemia).

CONCLUSION

In this study area, a high (58%) prevalence of dyslipidemia was observed in study participants, and increasing age, higher BMI, central obesity, hypertension, and high blood glucose level were identified as independent predictors of dyslipidemia among patients with MetS. Prevention and control of dyslipidemia and its predictors among patients with MetS were recommended.

Investigation of the prevalence of cardiovascular risk factors in obese patients diagnosed with metabolic syndrome in childhood and examination of left ventricular function by echocardiography

OBJECTIVES

The objective of this study is to investigate the cardiovascular risk factors associated with metabolic syndrome (MetS), which is increasingly becoming prevalent in childhood obesity.

METHODS

A total of 113 patients, 76 of whom were between the ages of 10 and 17 (mean age: 14.5 ± 1.8 years) and diagnosed with obesity (30 non-MetS and 46 MetS using IDF) and 37 of whom constituted the control group, participated in the study. Echocardiographic examination and atherogenicity parameters (Atherogenic index of plasma [AIP: logTG/HDL], total cholesterol/HDL, and TG/HDL ratio and non-HDL) were evaluated.

RESULTS

The most common component accompanying obese MetS was found to be hypertension and low HDL. While obesity duration, body mass index (BMI), blood pressure, fasting insulin, insulin resistance, atherogenicity parameters were determined to be significantly higher in the obese-MetS group. Echocardiography showed that while the thickness, volume, and diameter of LV end-diastolic wall, left ventricular mass (LVM), LVM index (LVMI g/m²) and relative wall thickness (RWT) were significantly high in the MetS group, however, mitral E/A ratio was significantly lower (p<0.05). Change in LV geometry consistent with concentric remodeling (increased RWT, normal LVMI) was visible in obese groups. LVM were positively significantly related to BMI, waist circumference, insulin resistance, blood pressure, LDL level, and negative to mitral E/A ratio. In the obese-MetS group, LVMI was positively correlated to office systolic BP, left atrium end-diastolic volume/index.

CONCLUSIONS

LVMI and atherogenicity parameters that were found to be significantly higher in obese MetS exhibit increased cardiovascular risk in childhood.

Effects of early-life exposure to Western diet and voluntary exercise on adult activity levels, exercise physiology, and associated traits in selectively bred High Runner mice

Exercise behavior is under partial genetic control, but it is also affected by numerous environmental factors, potentially including early-life experiences whose effects persist into adulthood. We studied genetic and early-life environmental effects on wheel-running behavior in a mouse model that includes four replicate high runner (HR) lines selectively bred for increased voluntary wheel running as young adults and four non-selected control (C) lines. In a full factorial design, mice from each line were granted wheel access or not and administered either standard or Western diet (WD) from weaning (3 weeks old) to 6 weeks of age (sexual maturity). In addition to acute effects, after a washout period of 8 weeks (∼6 human years) in which all mice had standard diet and no wheel access, we found both beneficial and detrimental effects of these early-life exposures. During the first week of treatments, WD increased distance run by 29% in C mice and 48% in HR mice (significant Diet × Linetype interaction), but diet effects disappeared by the third week. Across the three weeks of juvenile treatment, WD significantly increased fat mass (with lean mass as a covariate). Tested as adults, early-life exercise increased wheel running of C mice but not HR mice in the first week. Early-life exercise also reduced adult anxiety-like behavior and increased adult fasted blood glucose levels, triceps surae mass, subdermal fat pad mass, and brain mass, but decreased heart ventricle mass. Using fat mass as a covariate, early-life exercise treatment increased adult leptin concentration. In contrast, early-life WD increased adult wheel running of HR mice but not C mice. Early-life WD also increased adult lean mass and adult preference for Western diet in all groups. Surprisingly, early-life treatment had no significant effect on adult body fat or maximal aerobic capacity (VO2max). No previous study has tested for combined or interactive effects of early-life WD and exercise. Our results demonstrate that both factors can have long-lasting effects on adult voluntary exercise and related phenotypes, and that these effects are modulated by genetic background. Overall, the long-lasting effects of early-life exercise were more pervasive than those of WD, suggesting critical opportunities for health intervention in childhood habits, as well as possible threats from modern challenges. These results may be relevant for understanding potential effects of activity reductions and dietary changes associated with the obesity epidemic and COVID-19 pandemic.

Sex difference in blood pressure, a combinatorial consequence of the differential in RAAS components, sex hormones and time course

The longitudinal increment of blood pressure (BP) with age is attributed to lifestyle, internal and external environments. It is not limited to systemic brain-derived neurotrophic factor (BDNF), signaling to allow the individuals to better adapt to the developmental and environmental change. This regulation is necessary for all lives, regardless of sex. Basic levels of renin-angiotensin- aldosterone system (RAAS) components in males and females define the fundamental sex difference in BP, which may be set by prenatal programming and profoundly influence BP after birth. The innate sex difference in BP is magnified during puberty growth and further modified by menopause. At the age of 70 or older, blood pressure was similar in men and women. The understanding of the prenatal setup and development of sexual dimorphism in BP may provide preventative therapeutic strategies, including timing and drugs, for individuals with abnormal BP.

Association of Metabolic Comorbidities with Pediatric Psoriasis: A Systematic Review and Meta-Analysis

Background

An evident relationship has been shown between psoriasis and metabolic comorbidities. However, the results in pediatric psoriasis vary from study to study, and no meta-analysis exists on the association of metabolic comorbidities with pediatric psoriasis.

Objective

To evaluate the association between psoriasis and metabolic comorbidities in pediatric patients.

Methods

We searched articles published in PubMed, EMBASE, and Cochrane Library databases from inception to April 30, 2019. All observational studies reporting the prevalence of obesity or metabolic comorbidities in pediatric patients with psoriasis were included.

Results

The meta-analysis included 16 unique studies meeting the inclusion criteria. The pooled odds ratios in pediatric patients with psoriasis was 2.40 (95% confidence interval [CI], 1.60~3.59) for obesity (13 studies), 2.73 (95% CI, 1.79~4.17) for hypertension (8 studies), 2.01 (95% CI, 1.09~3.73) for diabetes mellitus (8 studies), 1.67 (95% CI, 1.42~1.97) for dyslipidemia (7 studies), and 7.49 (95% CI, 1.86~30.07) for metabolic syndrome (4 studies).

Conclusion

Pediatric patients with psoriasis showed a significantly higher prevalence of obesity, hypertension, diabetes, dyslipidemia, and metabolic syndrome. Adequate monitoring and timely management of metabolic comorbidities should be considered in these patients.

Metforminium Decavanadate (MetfDeca) Treatment Ameliorates Hippocampal Neurodegeneration and Recognition Memory in a Metabolic Syndrome Model

The consumption of foods rich in carbohydrates, saturated fat, and sodium, accompanied by a sedentary routine, are factors that contribute to the progress of metabolic syndrome (MS). In this way, they cause the accumulation of body fat, hypertension, dyslipidemia, and hyperglycemia. Additionally, MS has been shown to cause oxidative stress, inflammation, and death of neurons in the hippocampus. Consequently, spatial and recognition memory is affected. It has recently been proposed that metformin decavanadate (MetfDeca) exerts insulin mimetic effects that enhance metabolism in MS animals; however, what effects it can cause on the hippocampal neurons of rats with MS are unknown. The objective of the work was to evaluate the effect of MetfDeca on hippocampal neurodegeneration and recognition memory in rats with MS. Administration of MetfDeca for 60 days in MS rats improved object recognition memory (NORt). In addition, MetfDeca reduced markers of oxidative stress and hippocampal neuroinflammation. Accompanied by an increase in the density and length of the dendritic spines of the hippocampus of rats with MS. We conclude that MetfDeca represents an important therapeutic agent to treat MS and induce neuronal and cognitive restoration mechanisms.

Toxicity profiling of the ethanolic extract of Citrullus lanatus seed in rats: behavioral, biochemical and histopathological aspects

Citrullus lanatus (Cucurbitaceae) is conventionally used for the treatment of urinary tract infection, renal stones, hypertension, diabetes and diarrhoea. Current study evaluates acute and 28 days repeated toxicity ethanolic extract of C. lanatus seed (EECLS) in Wistar rats to measure its safety profile. The single dose (2000 mg/kg BW) of EECLS was administered while in 28 days repeated study 250, 500 and 1000 mg/kg BW were administered orally in rats. Parameters such as biochemical, haematological and histopathological were analysed in subacute toxicity study. During study, no apparent sign of toxicity, behavioural changes and mortality were detected in acutely exposed animals. In 28 days repeated toxicity study, rats did not show significant changes in behaviour, gross pathology, body weight, biochemical and haematological parameters. Abridged serum glucose and cholesterol levels during the study designate their roles in treatment of hyperglycaemic and hyperlipidaemic conditions. No significant difference was observed in histopathology of liver and kidneys of treated rats. The current investigation demonstrated that EECLS is non-toxic below 1000 mg/kg BW and provides protection to some body organs. The data propose that LD₅₀ of EECLS was greater than 2000 mg/kg BW and the no observed adverse effect level (NOAEL) of EECLS was at the dose of 1000 mg/kg in rats. Taken together, our finding suggests that, EECLS is safe and provides some protection to body organs; also, its extract can be used for further preclinical and clinical evaluation for its therapeutic activity.

The Effect of Curcumin in Improving Lipid Profile in Patients with Cardiovascular Risk Factors: A Systematic Review of Clinical Trials

Cardiovascular disease (CVD) is a major cause of death worldwide. Lipid abnormalities are one of the major risk factors for CVD. Curcumin is a natural polyphenol with lipid-lowering properties. Therefore, we carried out a systematic review to summarize the randomized controlled trials (RCTs) investigating the effect of curcumin on lipid profile in patients at risk of CVD. A comprehensive systematic search was conducted in PubMed, Scopus, Web of Science, and Google Scholar up to March 1, 2020, to identify controlled clinical trials assessing the effects of curcumin on lipid profile in patients at risk of CVD. From 1051 initially identified studies, 22 met the eligibility criteria. Curcumin supplementation significantly reduced at least one of the lipid profile indices (triglycerides, total cholesterol, low-density lipoprotein-cholesterol, and high-density lipoprotein-cholesterol) in 15 studies and improved more than one index in five studies. However, curcumin had no effect on any of lipid profile indices in seven studies. Overall, studies using a bioavailable formulation of curcumin had a better impact on the lipid profile. The findings of this systematic review showed that curcumin supplementation significantly reduced at least one of the lipid profile indices in more than two-thirds of the included studies. Curcumin might be used as an accessible, inexpensive, and safe agent to reduce risk of CVD. More randomized, clinical controlled trials are needed to verify these results.

Tri-Ponderal Mass Index Reference Values for Screening Metabolic Syndrome in Children and Adolescents: Results From Two National-Representative Cross-Sectional Studies in China and America

INTRODUCTION

To ascertain the possible cut point of tri-ponderal mass index (TMI) in discriminating metabolic syndrome (MetS) and related cardio-metabolic risk factors in Chinese and American children and adolescents.

METHODS

A total of 57,201 Chinese children aged 7-18 recruited in 2012 and and 10,441 American children aged 12-18 from National Health and Nutrition Examination Survey (NHANES 2001-2014) were included to fit TMI percentiles. Participants were randomly assigned to a derivation set (75%) and validation set (25%). The cut points of TMI with the lowest misclassification rate under the premise of the highest area under curves (AUC) were selected for each sex, which were additionally examined in the validation set. All of data analysis was conducted between September and December in 2019.

RESULTS

TMI showed good capacity on discriminating MetS, with AUC of 0.7658 (95% CI: 0.7544-0.7770) to 0.8445 (95% CI: 0.8349-0.8537) in Chinese and 0.8871 (95% CI: 0.8663-0.9056) to 0.9329 (95% CI: 0.9166-0.9469) in American children. The optimal cut points were 14.46 kg/m³ and 13.91 kg/m³ for Chinese boys and girls, and 17.08 kg/m³ and 18.89 kg/m³ for American boys and girls, respectively. The corresponding misclassification rates were 17.1% (95% CI: 16.4-17.8) and 11.2% (95% CI: 9.9-12.6), respectively. Performance of these cut points were also examined in the validation set (sensitivity 67.7%, specificity 82.4% in Chinese; sensitivity 84.4%, specificity 88.7% in American children).

CONCLUSIONS

A sex- and ethnicity- specific single cut point of TMI could be used to distinguish MetS and elevated risk of cardio-metabolic factors in children and adolescents.

Flavonoids in the Treatment of Diabetes: Clinical Outcomes and Mechanism to Ameliorate Blood Glucose Levels

BACKGROUND

For thousands of years, natural food products have been used as a medicine for treating diseases that affect the human body, including diabetes mellitus (DM). Lately, several investigations have been performed on the flavonoid derivatives of plant origin, and their biological activity has been extensively studied.

METHODS

Given our need to know more mechanisms for treating DM, we performed a thorough research review on treating diabetes mellitus based on flavonoids, their therapeutic potential, and biological action.

RESULTS

Flavonoids reduce complications in addition to their vital role as effective supplements for preventing diabetes mellitus by regulating glucose metabolism, lipid profile, liver enzyme activity, a protein kinase inhibitor, PPAR, and AMPK with NF-κB.

CONCLUSION

The articles that we reviewed showed the positive role of flavonoids, which in a certain way reduce diabetes, but their side effects still need to be studied further.This review is focused on describing the different types of dietary flavonoids along with their mechanisms of reducing blood glucose and enhancing insulin sensitivity, as well as their side effects.

Comparative analysis of fecal metabolite profiles in HFD-induced obese mice after oral administration of huangjinya green tea extract

To explore the impact of Huangjinya on metabolic disorders and host endogenous metabolite profiles, high-fat diet (HFD)-fed mice were administrated with Huangjinya green tea extract (HGT) at the dose of 150 or 300 mg/kg for 9 weeks. Epigallocatechin gallate was the main catechin derivative, followed by epigallocatechin and catechin presented in HGT, which contained high levels of free amino acids (50.30 ± 0.60 mg/g). HGT significantly alleviated glucose and insulin intolerance, reduced hepatic lipid accumulation and liver steatosis, and prevented white adipose tissue expansion in HFD-fed mice. Untargeted mass spectrometry-based metabolomics analysis revealed that HGT reduced the abundance of fecal branched-chain amino acids, aromatic amino acids, sphingolipids, and most acyl cholines, modulated bile acid metabolism by increasing chenodeoxycholate and reducing cholic acid content, and increased unsaturated fatty acids content. Fatherly, HGT activated insulin/PI3K/Akt and AMPK signaling pathways in the liver, reduced adipogenic and lipogenic genes expression, and promoted the genes expression related to lipolysis and adipocyte browning in white adipose tissue, contributed to improving metabolic syndrome in HFD-fed mice. The current study reported the impact of HGT supplementation on endogenous metabolite profiles, and highlights the positive roles of HGT in preventing diet-induced obesity and the related metabolic disorders.

Markers of cholesterol synthesis are elevated in adolescents and young adults with type 2 diabetes

BACKGROUND

Changes in cholesterol absorption and cholesterol synthesis may promote dyslipidemia and cardiovascular disease in individuals with type 2 diabetes mellitus (T2DM).

OBJECTIVE

To assess cholesterol synthesis and absorption in lean individuals, obese individuals, and individuals with T2DM.

METHODS

We measured lathosterol and lanosterol (markers of cholesterol synthesis) as well as campesterol and β-sitosterol (markers of cholesterol absorption) in the serum of 15 to 26 years old individuals with T2DM (n = 95), as well as their lean (n = 98) and obese (n = 92) controls.

RESULTS

Individuals with T2DM showed a 51% increase in lathosterol and a 65% increase in lanosterol compared to lean controls. Similarly, obese individuals showed a 31% increase in lathosterol compared to lean controls. Lathosterol and lanosterol were positively correlated with body mass index, fasting insulin and glucose, serum triglycerides, and C-reactive protein, and negatively correlated with HDL-cholesterol. In contrast, campesterol and β-sitosterol were not altered in individuals with T2DM. Moreover, campesterol and β-sitosterol were negatively correlated with body mass index, fasting insulin, and C-reactive protein and were positively correlated with HDL-cholesterol.

CONCLUSIONS

Adolescents and young adults with T2DM show evidence of increased cholesterol synthesis compared to non-diabetic lean controls. These findings suggest that T2DM may promote cardiovascular disease by increasing cholesterol synthesis, and provide additional rationale for the use of cholesterol synthesis inhibitors in this group.

Nobiletin ameliorates high-fat diet-induced vascular and renal changes by reducing inflammation with modulating AdipoR1 and TGF-β1 expression in rats

AIMS

We investigate the effect of nobiletin on vascular and renal alterations and possible mechanisms involved in high-fat diet (HFD)-fed rats.

MAIN METHODS

Male Sprague-Dawley rats were fed a HFD with fructose 15% in drinking water for 16 weeks. HFD-fed rats were treated with nobiletin (20 or 40 mg/kg/day) or vehicle for the last 4 weeks.

KEY FINDINGS

HFD-fed rats treated with nobiletin was significantly reduced obesity, hypertension, dyslipidemia and hyperinsulinemia. Nobiletin improved vascular endothelial function, restored creatinine clearance, and reduced plasma urea and creatinine levels, as well as urinary protein excretion. Nobiletin markedly alleviated vascular medial cross-sectional area (CSA) and collagen deposition, glomerular extracellular matrix (ECM) accumulation, and renal fibrosis. Nobiletin significantly elevated plasma adiponectin levels, together with upregulated adiponectin receptor 1 (AdipoR1) and suppressed transforming growth factor-β1 (TGF-β1) expression in kidney. In addition, an increase of plasma tumor necrosis factor alpha (TNF-α) and interleukin 6 (IL-6) was significantly attenuated after nobiletin treatment.

SIGNIFICANCE

Our results suggest that nobiletin attenuates HFD-induced vascular and renal alterations in rats, which is possibly related to the modulation of AdipoR1 and TGF-β1expression, and suppression of inflammation.

Triterpene saponins from Barringtonia acutangula (L.) Gaertn as a potent inhibitor of 11β-HSD1 for type 2 diabetes mellitus, obesity, and metabolic syndrome

Background

Barringtonia acutangula (L.) Gaertn, Garcinia indica (Thouars) Choisy, and Feronia limonia (L.) Swingle is widely utilized in traditional folk medicine against diabetes, obesity, and metabolic syndrome but lacks the evidence of compound-protein interaction for the treatment.

Methods

Phytocompounds were retrieved from herbs databases and public repositories. Probable protein targets were predicted using BindingDB (p ≥ 0.7). The pathways modulated by compounds were analyzed using the STRING and KEGG pathways. The compound-protein-pathway network was constructed using Cytoscape v3.6.1. Druglikeness was predicted by Molsoft. Docking was performed by AutoDock vina by PyRx 0.8v.

Results

Among three plants, eleven triterpene saponins from B. acutangula showed druggable characteristics and identified to inhibit the 11β-hydroxysteroid dehydrogenase type 1 (11β-HSD1/HSD11B1) as a key protein target and also inhibit/modulate other 27 protein molecules involved in the 3 major pathways i.e. Metabolic syndrome, cGMP-PKG signaling, and insulin resistance pathways and also these compounds showed interactions with the active site amino acid residues of 11β-HSD1. Among eleven compounds Barringtogenol B scored the highest binding affinity by forming a hydrogen bond with Ile218 active site residue of 11β-HSD1.

Conclusion

Triterpene saponins contained in B. acutangula bark and seed inhibits 11Β-HSD1 and this multi-compound contained enriched fraction could be the potent treatment regimen for T2DM, obesity, and MetS.

Incorporating Risk Stratification Into the Practice of Pediatric Preventive Cardiology

Atherosclerosis in its earliest stages is associated with the same traditional cardiovascular disease (CVD) risk factors as are associated with manifest CVD events in adulthood. Clustering of risk factors is associated with exponential increases in atherosclerotic burden from a young age. Some medical conditions and risk behaviours occurring in children can either increase the likelihood of higher levels of risk factors (such as chronic kidney disease) or the presence of risk factor clustering (such as obesity and cardiometabolic syndrome) or are associated with acquired coronary artery pathology (such as Kawasaki disease). This creates a milieu for-or increases the impact of-accelerated atherosclerosis that, in turn, increases the likelihood of premature CVD. This review highlights the importance of considering the total risk factor and risk-condition profile of pediatric patients. An algorithm is provided for stratifying patients into high-, moderate-, and at-risk categories, and practical examples are provided as to how the evaluation and management of 1 risk factor or risk condition might need to be intensified in the context of additional risk factors or risk conditions. For example, for treatment of an adolescent with familial hypercholesterolemia, the target low-density lipoprotein cholesterol level might be lowered by the concomitant presence of low high-density lipoprotein cholesterol or elevated lipoprotein(a) levels. As awareness of cardiovascular risk and atherosclerosis in pediatric patients increases, new at-risk conditions that warrant consideration are emerging. The identification and management of high-risk individuals is an important part of the overall practice of pediatric preventive cardiology.

Prediction of hypertension, hyperglycemia and dyslipidemia from retinal fundus photographs via deep learning: A cross-sectional study of chronic diseases in central China

Retinal fundus photography provides a non-invasive approach for identifying early microcirculatory alterations of chronic diseases prior to the onset of overt clinical complications. Here, we developed neural network models to predict hypertension, hyperglycemia, dyslipidemia, and a range of risk factors from retinal fundus images obtained from a cross-sectional study of chronic diseases in rural areas of Xinxiang County, Henan, in central China. 1222 high-quality retinal images and over 50 measurements of anthropometry and biochemical parameters were generated from 625 subjects. The models in this study achieved an area under the ROC curve (AUC) of 0.880 in predicting hyperglycemia, of 0.766 in predicting hypertension, and of 0.703 in predicting dyslipidemia. In addition, these models can predict with AUC>0.7 several blood test erythrocyte parameters, including hematocrit (HCT), mean corpuscular hemoglobin concentration (MCHC), and a cluster of cardiovascular disease (CVD) risk factors. Taken together, deep learning approaches are feasible for predicting hypertension, dyslipidemia, diabetes, and risks of other chronic diseases.

Effects of metformin administration on endocrine-metabolic parameters, visceral adiposity and cardiovascular risk factors in children with obesity and risk markers for metabolic syndrome: A pilot study

Background

Metformin treatment (1000–2000 mg/day) over 6 months in pubertal children and/or adolescents with obesity and hyperinsulinism is associated with a reduction in body mass index (BMI) and the insulin resistance index (HOMA-IR). We aimed to ascertain if long-term treatment (24 months) with lower doses of metformin (850 mg/day) normalizes the endocrine-metabolic abnormalities, improves body composition, and reduces the carotid intima-media thickness (cIMT) in pre-puberal and early pubertal children with obesity.

Methods

A pilot double-blind, placebo-controlled trial was conducted on 18 pre-puberal and early pubertal (Tanner stage I-II) children with obesity and risk markers for metabolic syndrome. Patients were randomly assigned (1:1) to receive metformin (850 mg/day) or placebo for 24 months. Clinical, biochemical (insulin, lipids, leptin, and high-sensitivity C-reactive protein [hsCRP]), and imaging (body composition [dual-energy X-ray absorptiometry and magnetic resonance imaging]) parameters as well as cIMT (ultrasonography) were assessed at baseline and at 6, 12, and 24 months.

Results

The 12-month treatment tend to cause a reduction in weight standard deviation scores (SDS), BMI-SDS, leptin, leptin–to–high-molecular-weight (HMW) adiponectin ratio, hsCRP, cIMT, fat mass, and liver fat in metformin-treated children compared with placebo. The effect of metformin on the reduction of BMI-SDS, leptin, leptin-to-HMW adiponectin ratio, hsCRP, and liver fat seemed to be maintained after completing the 24 months of treatment. No changes in insulin sensitivity (HOMA-IR) or adverse effects were detected.

Conclusion

In this pilot study, metformin treatment in pre-puberal and early pubertal children with obesity seemed to improve body composition and inflammation markers. Our data encourage the development of future fully powered trials using 850 mg/day metformin in young children, highlighting its excellent tolerance and potential long-term benefits.

Nanoformulations of natural products for management of metabolic syndrome

Metabolic syndrome is a common metabolic disorder which has become a public health challenge worldwide. There has been growing interest in medications including natural products as complementary or alternative choices for common chemical therapeutics regarding their limited side effects and ease of access. Nanosizing these compounds may help to increase their solubility, bioavailability, and promisingly enhance their efficacy. This study, for the first time, provides a comprehensive overview of the application of natural-products-based nanoformulations in the management of metabolic syndrome. Different phytochemicals including curcumin, berberine, Capsicum oleoresin, naringenin, emodin, gymnemic acid, resveratrol, quercetin, scutellarin, stevioside, silybin, baicalin, and others have been nanosized hitherto, and their nanosizing method and effect in treatment and alleviating metabolic syndrome have been reviewed and discussed in this study. It has been discovered that there are several pathways or molecular targets relevant to metabolic disorders which are affected by these compounds. Various natural-based nanoformulations have shown promising effect in treatment of metabolic syndrome, and therefore can be considered as future candidates instead of or in conjunction with pharmaceutical drugs if they pass clinical trials successfully.

Acute and 28-day oral toxicity studies of methanolic extract of Lagenaria siceraria (Cucurbitaceae) fruit in rats

Lagenaria siceraria (Cucurbitaceae) is traditionally known to be used for the treatment of diabetes, ulcer, jaundice, cardiovascular disease, hemorrhoids, and colitis. This study involves evaluation of acute and subacute toxicity of methanolic extract of L. siceraria fruit (MELSF) in rats for assessment of its safety profile. For acute oral toxicity, single dose (2000 mg/kg body weight) of extract was administered in female Wister rats while in the subacute study the extract was given at doses of 250, 500, and 1000 mg/kg orally over 28 d in male and female rats. No evidence of toxicity was observed in animals when acutely exposed to MELSF, implying that the LD₅₀ is higher than 2000 mg/kg body weight. Further, repeated administration of the extract for 28 d did not alter any hematological and biochemical parameters and no significant changes were observed in organ and body weight of control and treated groups. Histopathological assessment was normal in kidney and liver. Thus, the present investigation shows that MELSF, at dosage levels up to 1000 mg/kg, is nontoxic and can show protection of some body tissues when administered for 28 d and therefore can be considered safe. This study supports the application of L. siceraria in traditional medicine.

Suppression of Obesity by an Intestinal Helminth through Interactions with Intestinal Microbiota

Obesity is increasingly causing lifestyle diseases in developed countries where helminthic infections are rarely seen. Here, we investigated whether an intestinal nematode, Heligmosomoides polygyrus, has a suppressive role in diet-induced obesity in mice. Infection with H. polygyrus suppressed weight gain in obese mice, which was associated with increased uncoupling protein 1 (UCP1) expression in adipocytes and a higher serum norepinephrine (NE) concentration. Blocking interactions of NE with its receptor on adipocytes resulted in the failure to prevent weight gain and to enhance UCP1 expression in obese mice infected with H. polygyrus, indicating that NE is responsible for the protective effects of H. polygyrus on obesity. In addition to sympathetic nerve-derived NE, the intestinal microbiota was involved in the increase in NE. Infection with H. polygyrus altered the composition of intestinal bacteria, and antibiotic treatment to reduce intestinal bacteria reversed the higher NE concentration, UCP1 expression, and prevention of the weight gain observed after H. polygyrus infection. Our data indicate that H. polygyrus exerts suppressive roles on obesity through modulation of microbiota that produce NE.

Evaluation of Metabolic Syndrome and Its Associated Risk Factors in Type 2 Diabetes: A Descriptive Cross-Sectional Study at the Komfo Anokye Teaching Hospital, Kumasi, Ghana

Background. Metabolic syndrome (MS) is a collection of cardiovascular risk factors comprising insulin resistance, dyslipidemia, obesity, and hypertension, which may cause further complications in diabetes. Although metabolic syndrome (MS) is increasing in incidence in diabetics and leading to significant cardiovascular diseases and mortality, there is dearth of data in Ghana. This study investigated metabolic syndrome, its prevalence, and its associated risk factors in type 2 diabetes at the Komfo Anokye Teaching Hospital, Kumasi, Ghana. Methods. The study involved 405 diabetic patients attending the Diabetic Clinic of the Komfo Anokye Teaching Hospital (KATH) Kumasi, in the Ashanti Region of Ghana. A well-structured questionnaire was used to obtain demographic background such as their age and gender. Anthropometric measurements were obtained using the Body Composition Monitor (Omron ® 500, Germany) which generated digital results on a screen and also by manual methods. Fasting venous blood was collected for the measurement of biochemical parameters comprising fasting plasma glucose (FPG), glycated haemoglobin (HbA1c), high density lipoprotein cholesterol (HDL-c), and triglyceride (TG). Metabolic syndrome was defined according to the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III). Results. Out of the total of 405 participants, 81 were males and 324 were females, and the estimated mean age was 58.5 ± 9.9 years. The female patients exhibited higher mean waist circumference (WC) and mean hip circumference (HC) as well as an approximately higher body mass index than males (28.3 ± 5.1, 26.5 ± 4.2 for the female and male respectively). Overall, the prevalence of metabolic syndrome observed among the study population was 90.6%. Conclusions. The prevalence of metabolic syndrome observed among the study population was 90.6%, with a higher percentage in females than males. High triglyceride levels and high waist circumference were the main risk factors for MS in the diabetic population.