Hypertriglyceridemia is associated with development of metabolic glucose disorders, irrespective of glucose and insulin levels: a 15-year follow-up study

Integrated biomarker profiling of the metabolome associated with type 2 diabetes mellitus among Tibetan in China

INTRODUCTION

Metabolomic signatures of type 2 diabetes mellitus (T2DM) in Tibetan Chinese population, a group with high diabetes burden, remain largely unclear. Identifying the serum metabolite profile of Tibetan T2DM (T-T2DM) individuals may provide novel insights into early T2DM diagnosis and intervention.

METHODS

Hence, we conducted untargeted metabolomics analysis of plasma samples from a retrospective cohort study with 100 healthy controls and 100 T-T2DM patients by using liquid chromatography-mass spectrometry.

RESULTS

The T-T2DM group had significant metabolic alterations that are distinct from known diabetes risk indicators, such as body mass index, fasting plasma glucose, and glycosylated hemoglobin levels. The optimal metabolite panels for predicting T-T2DM were selected using a tenfold cross-validation random forest classification model. Compared with the clinical features, the metabolite prediction model provided a better predictive value. We also analyzed the correlation of metabolites with clinical indices and found 10 metabolites that were independently predictive of T-T2DM.

CONCLUSION

By using the metabolites identified in this study, we may provide stable and accurate biomarkers for early T-T2DM warning and diagnosis. Our study also provides a rich and open-access data resource for optimizing T-T2DM management.

Effect of hypertriglyceridemia in dyslipidemia-induced impaired glucose tolerance and sex differences in dietary features associated with hypertriglyceridemia among the Japanese population: The Gifu Diabetes Study

AIMS/INTRODUCTION

The mechanisms underlying hypertriglyceridemia-induced impaired glucose tolerance in Japanese individuals remain unclear. We aimed to evaluate the effect of hypertriglyceridemia on glucose metabolism in comparison with that of increased low-density lipoprotein or decreased high-density lipoprotein levels and to elucidate the sex differences in hypertriglyceridemia-related dietary intake among Japanese individuals.

MATERIALS AND METHODS

We randomly selected 898 (384 men and 514 women) participants aged 40-78 years in the Gifu Diabetes Study; those taking medication for dyslipidemia or diabetes mellitus were excluded. Serum levels of glucose metabolism parameters and the food frequency were measured cross-sectionally. The glycated hemoglobin was measured again after 5 years.

RESULTS

Glucose metabolism parameters and the percentage of individuals with impaired glucose tolerance were significantly higher in the high triglyceride group in men and women. Similar trends were observed in the low high-density lipoprotein group, but only in men. Meanwhile, only the homeostasis model assessment of insulin resistance was higher in the high low-density lipoprotein group. In non-obese men, the percentage of energy intake from alcohol per total daily energy intake was significantly greater in the high triglyceride group. In obese women, the total energy intake was significantly greater in the high triglyceride group. At the 5-year follow up, the risk of elevated glycated hemoglobin levels with hypertriglyceridemia was increased in men.

CONCLUSIONS

Hypertriglyceridemia is a stronger risk factor for impaired glucose tolerance than increased low-density lipoprotein or decreased high-density lipoprotein. For dietary habits, increased daily alcohol energy intake in non-obese men and increased total energy intake in obese women were associated with hypertriglyceridemia.

Transition of Hypertriglyceridemic-Waist Phenotypes and the Risk of Type 2 Diabetes Mellitus among Middle-Aged and Older Chinese: A National Cohort Study

The rapid economic growth and nutritional changes in China have brought an increased burden of type 2 diabetes mellitus (T2DM). This study aimed to assess the effects of hypertriglyceridemic-waist (HTW) and its dynamic transitions on incident T2DM among middle-aged and older Chinese. Data were extracted from the China Health and Retirement Longitudinal Study (CHARLS). Participants were classified into three HTW phenotypes, namely NTNW (normal triglyceride (TG) and waist circumference (WC)), NTEW/ETNW (normal TG and enlarged WC, or elevated TG and normal WC) and ETEW (elevated TG and enlarged WC). Multivariable Cox frailty models were used to assess the associations of HTW phenotypes and their transitions over time with the risk of T2DM. A total of 7397 subjects without T2DM were included, of which 849 developed T2DM during 2011-2018. Compared with individuals with NTNW, people in the NTEW/ETNW group and ETEW group were at a significantly higher risk of T2DM (HR_NTEW/ETNW = 1.28, 95% CI: 1.06-1.54 and HR_ETEW = 1.61, 95% CI: 1.26-2.06). For subjects with NTNW at baseline, the risk of developing T2DM increased by 38% and 83% if their metabolic status changed to NTEW/ETNW and ETEW, respectively. For subjects with NTEW/ETNW, the risk of T2DM decreased by 33% when their metabolic status changed to normal (NTNW); but the risk increased by 49% if the status became more serious (ETEW). NTEW/ETNW, ETEW and their transitions to adverse states were risk factors for T2DM.

Epidemiology of Isolated Impaired Glucose Tolerance Among Adults Aged Above 50 Years in Rural China

INTRODUCTION

Isolated impaired glucose tolerance (i-IGT) is a subtype of prediabetes in which an individual demonstrates elevated 2-h post-glucose load glucose levels but normal fasting plasma glucose levels. However, few studies have explored the prevalence and risk factors of i-IGT among adults in rural China. Thus, we aimed to explore the prevalence and risk factors of i-IGT among adults ≥50 years old in a low-income, rural population in China.

MATERIALS AND METHODS

Individuals aged ≥50 years with normal fasting plasma glucose levels were included in the final analysis. Fasting and 2-h venous blood samples were collected to assess the selected parameter measurements.

RESULTS

A total of 2175 individuals were included in this study. The i-IGT prevalence was 22.9% and significantly higher among females than among males (P<0.05). Older age [odds ratio (OR), 1.606; 95% confidence interval (CI), 1.101-2.342; P=0.014), hypertension (OR, 1.554; 95% CI, 1.152-2.019; P=0.004), and central obesity (OR, 1.395; 95% CI, 1.099-1.771; P=0.006) were associated with i-IGT. Moreover, white blood cell (OR, 1.089; 95% CI, 1.009-1.175; P=0.029), high-sensitivity C-reactive protein (OR, 1.049; 95% CI, 1.020-1.078; P=0.001), serum uric acid (OR, 1.0003; 95% CI, 1.001-1.004; P=0.001), triglyceride (OR, 1.540; 95% CI, 1.105-2.147; P=0.011), and alanine aminotransferase (OR, 1.012; 95% CI, 1.004-1.021; P=0.004) levels were also linked to i-IGT in the analyzed population.

CONCLUSION

Health promotion education and a standardized approach to managing body weight, BP, and lipid and uric acid levels would benefit this low-income population in rural China for reducing the risk of cardiovascular disease.

Effect of intermittent versus continuous calorie restriction on body weight and cardiometabolic risk markers in subjects with overweight or obesity and mild-to-moderate hypertriglyceridemia: a randomized trial

Background

Intermittent calorie restriction (ICR) is a novel method of dietary restriction for body weight control with the potential to improve obesity-related cardiometabolic markers, but the impact of this diet on subjects with hypertriglyceridemia (HTG) remains unknown.

Methods

Eighty-eight subjects with overweight or obesity and mild-to-moderate HTG were randomized to the continuous calorie restriction (CCR) group, or ICR group (a very low-calorie diet during 3 days of the week) for 8 weeks (44 patients in each group). Body composition, plasma lipids, glucose, insulin, adiponectin, and liver enzymes were measured at baseline and after 8 weeks. An intention-to-treat analysis was performed.

Results

The body weight decreased in both groups (4.07 ± 1.83 kg in the CCR group and 4.57 ± 2.21 kg in the ICR group) with no significant difference between the groups. There was no significant difference between the two groups in the reduced amount of fat mass, fat-free mass, and waist circumference. Both groups achieved a significant reduction in plasma triglycerides after 8 weeks (by 15.6 and 6.3% in ICR and CCR groups, respectively) with no difference between treatment groups. HOMA-IR improved significantly in ICR compared to the CCR group (P = 0.03). Plasma glucose, insulin, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, liver enzyme, and adiponectin were not different between the two groups.

Conclusions

The results of this short-term study suggest that three-days a week of the ICR is comparable to a CCR diet for the reduction of triglycerides level in patients with HTG and in the short-term it appears to be more effective than continuous dieting in improving insulin resistance. However, longer-term studies are needed to confirm these findings.

Trial registration

Trial registration number:NCT04143971.

Hypertriglyceridemic waist phenotype and abnormal glucose metabolism: a system review and meta-analysis

OBJECTIVE

This study was to perform a meta-analysis to assess the relationship between hypertriglyceridemic-waist (HTW) phenotype and abnormal glucose metabolism.

METHODS

The data sources were PubMed and EMBASE up to June 2018. Studies providing the relationship between HTW phenotype and abnormal glucose metabolism were included.

RESULTS

In total, 48 eligible studies that evaluated 2,42,879 subjects were included in the meta-analysis. In the general population, the pooled odds ratios (ORs) for elevated blood glucose and diabetes related to HTW phenotype was 2.32 (95% confidence interval (CI): 1.98-2.71) and 2.69 (95% CI: 2.40-3.01), respectively. In cohort studies, the pooled OR for diabetes related to HTW phenotype was 2.89 (95% CI: 1.97-4.25) in subjects without diabetes. The levels of homeostasis model assessment of insulin resistance (HOMA-IR) in the HTW population were increased with values of mean differences (MD) 1.12 (95% CI: 0.81-1.43. P < 0.00001, I² = 99%) in the general population and 0.89 (95% CI: 0.75-1.04, P < 0.00001, I² = 67%) in subjects without diabetes.

CONCLUSION

HTW phenotype was closely associated with increased risk of abnormal glucose metabolism. There was also a significant correlation between HTW phenotype and insulin resistance.

Hypertriglyceridemia is associated with impaired fasting glucose in normal-weight children

BACKGROUND

Previous studies have suggested that elevated triglyceride levels may precede the appearance of glucose metabolic disturbances in adults; nonetheless, this hypothesis has not been tested in children. Hence, we evaluated whether hypertriglyceridemia is associated with impaired fasting glucose (IFG) in normal-weight children.

METHODS

Normal-weight healthy children aged 7-15 years were enrolled in a population-based cross-sectional population study and allocated into groups with and without hypertriglyceridemia. Hypertriglyceridemia was defined by serum triglyceride levels ≥100 and ≥130 mg/dL for children aged 7-9 and 10-15 years, respectively, and IFG by fasting plasma glucose levels ≥100 and <126 mg/dL.

RESULTS

A total of 1453 children with average age of 11.3 ± 2.4 years were enrolled in the study and allocated into the groups with (n = 172) and without (n = 1281) hypertriglyceridemia. In the overall population, the prevalence of hypertriglyceridemia and IFG was 11.8% and 11.2%, respectively. The logistic regression analysis adjusted by age, gender, BMI, waist circumference, and insulin levels showed that hypertriglyceridemia is associated with IFG in children aged 10-15 years (odds ratio (OR) = 1.67; 95% confidence interval (CI): 1.02-2.77, p = 0.04) but not in those aged 7-9 years (OR = 1.48; 95% CI: 0.39-5.58, p = 0.55).

CONCLUSION

Hypertriglyceridemia is associated with IFG in normal-weight children aged 10-15 years, but not in those aged 7-9 years.

Hypoglycemic, hypolipidemic and antioxidant effects of iridoid glycosides extracted from Corni fructus: possible involvement of the PI3K-Akt/PKB signaling pathway

Iridoid glycosides (CIG) are the major component of Corni fructus. In this work, we researched the antioxidative, hypoglycemic and lowering blood lipids effects of CIG on diabetic mice induced by a high-fat diet (HFD) and streptozotocin (STZ). Furthermore, to investigate the molecular mechanism of action, the phosphorylation and protein expression of phosphoinositide 3-kinase (PI3K) and its downstream proteins, such as insulin receptor (INSR), protein kinase B (Akt/PKB) and glucose transporter 4 (GLUT4) have been detected. The results showed that CIG significantly improved oral glucose tolerance in diabetic mice. Biochemical indices also revealed that CIG had a positive effect on lipid metabolism and oxidative stress. In addition, CIG can significantly enhance the expression level of the PI3K-Akt/PKB pathway related proteins in skeletal muscle, which is the key pathway of insulin metabolism. These findings show that CIG can improve the hyperglycemia and hyperlipidemia of HFD-STZ-induced diabetic mice through the PI3K-Akt/PKB signaling pathway, and CIG might be a potential medicine or functional food for type 2 diabetes mellitus remedies.

Zinc supplementation in prediabetes: A randomized double-blind placebo-controlled clinical trial

BACKGROUND

This study evaluated the effects of zinc supplementation on glycemic control, other cardiometabolic and anthropometric parameters, and disease progression in prediabetes.

METHODS

A randomized double-blind placebo-controlled Phase 2 clinical trial was conducted over a 12-month period in 200 subjects (43% male; mean [± SD] age 51.8 ± 7.3 years), randomly assigned (1:  1) to the treatment or control group. The treatment group received zinc (20 mg daily). Subjects were evaluated at baseline and at 1, 3, 6, and 12 months. The primary outcome was the change in glycemic control from baseline. Multiple regression analyses were performed, with change in outcome variables after intervention from baseline used as continuous dependent variables.

RESULTS

In both groups, mean serum zinc concentrations prior to the trial were below normal (15.29-21.41 μmol/L). During the 12-month follow-up, a significantly higher percentage of participants developed type 2 diabetes in the control compared with zinc-treated group (25.0% vs 11.0% respectively; P = 0.016). Fasting plasma glucose (FPG), 2-h glucose levels in the oral glucose tolerance test (OGTT), homeostasis model assessment of insulin resistance (HOMA-IR), total cholesterol (TC), and low-density lipoprotein cholesterol (LDL-C) were significantly lower in the treated group, with significant improvement in β-cell function. In all four regression models, the best predictor of the dependent variables (i.e. change in FPG, 2-h glucose in the OGTT, HOMA-IR, and homeostatic model assessment of β-cell function) was zinc treatment.

CONCLUSIONS

Zinc supplementation reduced blood glucose and insulin resistance while improving β-cell function. Furthermore, supplementation reduced disease progression to diabetes and had beneficial effects on TC and LDL-C.

The prevalence of and risk factors for diabetes mellitus and impaired glucose tolerance among Tibetans in China: a cross-sectional study

The prevalence of diabetes mellitus (DM) and impaired glucose tolerance (IGT) has increased worldwide, although their prevalence and determinants among Tibetans are currently unknown. We thus aimed to explore the prevalence of and risk factors for DM and IGT among Tibetans in China. In 2011, 1659 Tibetan adults (aged ≥ 18 years) from Changdu, China, were recruited to this cross-sectional study. They completed a questionnaire and underwent physical examinations and laboratory testing to assess risk factors for DM and IGT. The age-standardized prevalence of DM and IGT among Tibetans was 6.2% and 19.7%, respectively. A higher annual family income, alcohol consumption, and higher fasting plasma glucose (FPG) level were risk factors for DM, with odds ratio (ORs) and 95% confidence intervals (CIs) of 3.48 (1.43-8.48; P = 0.006) for those with family incomes of > 1600 USD/year, 3.06 (1.31-7.17; P = 0.010) for alcohol consumption, and 13.99 (7.76-25.22; P < 0.001) for FPG level. However, altitude was found to be negatively associated with the risk of DM; compared to individuals living at < 3500 meters, the risk of DM decreased by 65% for those living at 3500-3999 meters (P = 0.034) and by 89% for those living at ≥ 4000 meters (P = 0.015). Age, FPG levels, and low-density lipoprotein cholesterol levels were significantly associated with IGT among Tibetans aged ≥ 18 years. These findings suggest that the prevalence of DM in Tibetans may continue to increase in future decades following rapid economic development, and it is crucial to address the management of conventional risk factors for reducing the disease burden of DM among Tibetans.

Hyperhomocysteinemia as a Metabolic Risk Factor for Glucose Intolerance Among High-Risk Groups of Chinese Adults

BACKGROUND Impaired glucose tolerance (IGT) is characterized by insulin resistance and causes atherosclerosis. Hyperhomocysteinemia is associated with insulin resistance and predicts cardiovascular diseases. In this study, we assessed the possible association between homocysteine and IGT. MATERIAL AND METHODS This was a cross-sectional study of 118 consecutive subjects with IGT (IGT group) and 128 consecutive subjects with normal glucose tolerance (NGT group). Homocysteine and clinical characteristics were measured. RESULTS The IGT group had higher homocysteine than the NGT group [18.00 (14.00, 22.25) vs. 12.50 (9.00, 15.00) μmol/L, p<0.001]. Homocysteine was positively associated with body mass index (BMI) (r=0.178, p=0.005), triglycerides (r=0.306, p<0.001), fasting blood glucose (FBG) (r=0.312, p<0.001), 2-hour postchallenge glucose (2hPG) (r=0.363, p<0.001), fasting insulin (FINS) (r=0.655, p<0.001), and homeostasis model assessment for insulin resistance (HOMA-IR) (r=0.643, p<0.001), and was negatively correlated with high-density lipoprotein cholesterol (HDL-C) (r=-0.250, p<0.001). After controlling for confounders, hyperinsulinemia (β=7.430, p<0.001) was independently related to hyperhomocysteinemia. In a logistic regression analysis, high triglycerides (OR=1.177, p<0.001) and homocysteine (OR=1.508, p=0.007), and low HDL-C (OR=0.315, p=0.026) were associated with IGT. CONCLUSIONS Patients with IGT have higher homocysteine levels compared with subjects with normal glucose tolerance, and hyperhomocysteinemia might be correlated with IGT.

Serum Uric Acid and Impaired Glucose Tolerance: The Cardiometabolic Risk in Chinese (CRC) Study

Serum uric acid (SUA) elevation has been previously related to impaired fasting glucose and type 2 diabetes. The present study was comprehensive to examine the associations between SUA and impaired glucose tolerance (IGT) in Chinese adults. For this purpose, data were collected from a community-based health examination survey conducted in Central China; 2-h glucose (OGTT) and SUA were measured in 1956 men and women. In multivariate models, SUA levels were significantly associated with an increasing trend of 2-h glucose (OGTT) (P for trend < 0.0001). The odds ratios (OR; 95 % CI) of IGT across increasing quartiles of SUA were 1.0, 1.354 (0.948-2.087), 1.337 (0.959-2.251), and 2.192 (1.407-3.416), after adjusting for age, sex, body mass index, waist circumference, fasting insulin, blood pressure, serum lipids, serum creatinine, and estimated glomerular filtration rate. (P for trend = 0.001). In addition, we found an additive pattern between SUA and triglyceride (TG; P = 0.038) or between SUA and low-density lipoprotein cholesterol (LDL-C; P = 0.041) in relation to IGT. SUA was related to IGT in the Chinese adults, independent of other conventional metabolic risk factors. TG and LDL-C might modify the associations.