Association of Elevated Serum Branched-chain Amino Acid Levels With Longitudinal Skeletal Muscle Loss

Context

Branched-chain amino acids (BCAA) are substrates for protein synthesis. Although their intake may contribute to an increase in skeletal muscle mass, elevated serum BCAA levels have been reported to be associated with insulin resistance, potentially resulting in decreased skeletal muscle mass.

Objective

This study aimed to explore the association between elevated serum BCAA levels and longitudinal skeletal muscle loss.

Design and Setting

A cohort analysis was conducted, in which serum amino acids were analyzed in healthy individuals who underwent a medical health checkup at Kameoka Municipal Hospital (HOZUGAWA study), Japan.

Patients

Seventy-one participants (37 men and 34 women) underwent follow-up checkups after the baseline visit. The follow-up duration was 1.2 ± .4 years.

Main Outcome Measures

The relationship between fasting baseline serum BCAA levels and lifestyle factors, body composition, blood test results, dietary history, and changes in skeletal muscle mass was evaluated.

Results

In both men and women, serum BCAA levels were positively correlated with body weight, body mass index, skeletal muscle mass index (SMI), and serum triglycerides but inversely correlated with serum high-density lipoprotein cholesterol. In men, fasting serum BCAA levels were inversely associated with the rate of change in SMI (adjusted β = -.529, P = .006), and elevated BCAA levels were independently associated with a longitudinal decrease in skeletal muscle mass (odds ratio: 1.740; 95% confidence interval: 1.023-2.960 per 50 nmol/mL serum BCAAs increase).

Conclusion

Increased circulating BCAAs could be an indicator of skeletal muscle loss in men.

Miso, fermented soybean paste, suppresses high-fat/high-sucrose diet-induced muscle atrophy in mice

This study investigated the effects of miso, a traditional fermented soybean food in Japan, on muscle mass atrophy. Eight week old male C57BL/6J mice were fed high fat/high sucrose diet with or without miso for 12 weeks. A miso diet increased soleus muscle weights (p<0.05) and reduced intraperitoneal glucose tolerance and insulin tolerance (p<0.05). The miso diet downregulated the Tnfα and Ccl2 expression, related to inflammation, and Trim63 and Fbxo32 expression, related to muscle atrophy, in the soleus muscle (p<0.05). The miso diet increased short-chain fatty acids levels, including acetic, propanoic, and butanoic acids, in the feces, serum, and soleus muscle (p<0.05). According to the LEfSe analysis, the miso diet increased family Prevotellaceae, family Christensenellaceae, family Dehalobacterium, family Desulfitibacter; family Deferribacteraceae, order Deferribacterales, class Deferribacteres; and family Gemmatimonadaceae, order Gemmatimonadetes, and class Gemmatimonadales, whereas the miso diet decreased family Microbacteriaceae, order Micrococcales, class Actinobacteria, and family Lactobacillaceae. Miso suppressed high fat/high sucrose diet induced impaired glucose tolerance, low muscle strength, and muscle atrophy by improving dysbiosis and increasing short-chain fatty acids production and provides new insights into the preventive effects of fermented foods on sarcopenia.

Effect of Teriparatide on Bone Mineral Density and Trabecular Bone Score in Type 2 Diabetic Patients with Osteoporosis: A Retrospective Cohort Study

The BMDs of the lumbar spine, whole femur, and femoral neck and TBS were measured. Change in BMD or TBS was defined as the BMD or TBS at follow-up, performed 1 year after baseline, minus baseline BMD or TBS. Results: This retrospective cohort study included 93 patients, of whom 52 received no medication, 26 received bisphosphonates, and 15 received weekly teriparatide. BMD of the lumbar spine increased in all three groups. There was no change in BMD of the whole femur and femoral neck in the no medication and bisphosphonates groups, whereas the BMD of the whole femur (from 0.73 (0.15) to 0.74 (0.15) g/cm², p = 0.011) and femoral neck (from 0.59 (0.16) to 0.60 (0.16) g/cm², p = 0.011) in the teriparatide group increased. The change in BMD of the femoral neck (no medication; −0.002 (0.034) g/cm², bisphosphonates; −0.0001 (0.024) g/cm², and teriparatide; 0.017 (0.022) g/cm², p = 0.091) or TBS (no medication; −0.007 (0.051), bisphosphonates; −0.058 (0.258), and teriparatide; 0.021 (0.044), p = 0.191) in the teriparatide group tended to be higher than that in the other groups, although there was no statistically significant difference. Conclusions: Teriparatide increased the BMD of the femoral neck and TBS in osteoporosis patients with type 2 diabetes mellitus, compared to bisphosphonates and no medication.

Fasting plasma glucose level in the range of 90-99 mg/dL and the risk of the onset of type 2 diabetes: Population-based Panasonic cohort study 2

Aim/Introduction

As the association between a fasting glucose concentration of 90–99 mg/dL and the onset of type 2 diabetes is still controversial, we aimed to assess it in 37,148 Japanese individuals with a normal plasma glucose concentration.

Materials and Methods

This long‐term retrospective cohort study included individuals having a medical checkup at Panasonic Corporation from 2008 to 2018. In total, 1,028 participants developed type 2 diabetes.

Results

Cox regression analyses revealed that the risk for the onset of diabetes increased by 9.0% per 1 mg/dL increase in fasting plasma glucose concentration in subjects with the concentration ranging from 90 to 99 mg/dL. Compared with individuals with a fasting glucose concentration of ≤89 mg/dL, the adjusted hazard ratios for developing diabetes were 1.53 (95% CI; 1.22–1.91), 1.76 (95% CI; 1.41–2.18), 1.89 (95% CI; 1.52–2.35), 3.17 (95% CI; 2.61–3.84), and 3.41 (95% CI; 2.79–4.15) at fasting plasma glucose concentrations of 90–91, 92–93, 94–95, 96–97, and 98–99 mg/dL, respectively. In populations with obesity, the adjusted hazards ratios for developing diabetes were 1.56 (95% CI; 1.15–2.09), 1.82 (95% CI; 1.37–2.40), 2.05 (95% CI; 1.55–2.69), 3.53 (95% CI; 2.79–4.46), and 3.28 (95% CI; 2.53–4.22) at fasting plasma glucose concentrations of 90–91, 92–93, 94–95, 96–97, and 98–99 mg/dL, respectively.

Conclusions

This study demonstrates that the risk of type 2 diabetes among subjects having a fasting plasma glucose concentration of 90–99 mg/dL, is progressively higher with an increasing level of fasting plasma glucose concentration in a Japanese people.

Development of application to automatically calculate mean amplitude of glycaemic excursions using intermittently scanned continuous glucose monitoring data

AIM

We aimed to develop an application to calculate mean amplitude of glycaemic excursions (MAGE) automatically and to evaluate its accuracy.

MATERIALS AND METHODS

We named the application intermittently scanned continuous glucose monitoring (isCGM) calculator KAMOGAWA (Kyoto Auto MAGE Of Glucose cAlcutator With isCGM Application). The isCGM data from 20 patients, 10 with and 10 without diabetes, were used to compare manually calculated MAGE values with those calculated using KAMOGAWA. The rate of agreement for the MAGE values was calculated.

RESULTS

Comparing the MAGE values calculated manually with those calculated using KAMOGAWA, the total mean rate of agreement was 81.6%. Nonmatching values were checked and it was found that the inconsistencies were all attributable to errors in manual calculations. After correcting errors in the manual calculation, the MAGE values matched to one decimal place for all data in the manual and KAMOGAWA calculations.

CONCLUSIONS

KAMOGAWA can help diabetologists use MAGE in clinical practice, which could contribute to improving glycaemic control in patients who use isCGM.

Effect of COVID-19 Pandemic on the Change in Skeletal Muscle Mass in Older Patients with Type 2 Diabetes: A Retrospective Cohort Study

Background: The aim of this study was to investigate the effect of the coronavirus disease (COVID-19) pandemic restrictions on the change in muscle mass in older patients with type 2 diabetes (T2D), who were not infected with COVID-19. Methods: In this retrospective cohort study, data were obtained from outpatients who underwent bioelectrical impedance analysis at least twice before April 2020 and at least once thereafter. Skeletal muscle mass index (SMI, kg/m²) was calculated as appendicular muscle mass (kg) divided by height squared (m²). Change in SMI (kg/m²/year) was calculated as (follow-up SMI-baseline SMI/follow-up period). The differences between the changes in SMI before and after the start of the COVID-19 pandemic were evaluated using paired t test. Results: This study recruited 56 patients, with a mean (SD) age of 75.2 (7.1) years. SMI changed from 6.7 (0.9) to 6.8 (0.9) kg/m² before the COVID-19 pandemic, whereas SMI changed from 6.8 (0.9) to 6.6 (0.9) kg/m² after the start of the COVID-19 pandemic. SMI decreased after the start of the COVID-19 pandemic compared with before the pandemic (-0.117 (0.240) vs. 0.005 (0.289) kg/m²/year, p = 0.049). This decrease was observed in men (-0.159 (0.257) vs. 0.031 (0.325) kg/m²/year, p = 0.038), patients with poor glycemic control (-0.170 (0.264) vs. 0.031 (0.285) kg/m²/year, p = 0.042), and those with a long diabetes duration (-0.153 (0.229) vs. 0.082 (0.291) kg/m², p = 0.049). Conclusions: The COVID-19 pandemic restrictions caused muscle mass loss in older patents with T2D. Actions, including recommendation of exercise and adequate diet intake, are needed to prevent loss of muscle mass.

Effect of coronavirus disease 2019 pandemic on the lifestyle and glycemic control in patients with type 2 diabetes: a cross-section and retrospective cohort study

To investigate the acute effects of the coronavirus disease 2019 (COVID-19) on the lifestyle and metabolic parameters in patients with type 2 diabetes mellites. This cross-sectional and retrospective cohort study induced 203 patients who completed a questionnaire regarding stress levels and lifestyles. Data regarding stress levels, sleep time, exercise, and total diet, snack, and prepared food intake were obtained from the questionnaires. The changes in the body weight or HbA1c levels were determined by comparing the values at the time the questionnaire was administered to those noted 3 months ago. Increased levels of stress and decreased exercise levels were reported in approximately 40% and >50%. During the COVID-19 pandemic. There was a negative correlation between stress and exercise (r = -0.285, p < 0.001) and a positive correlation between stress and prepared food intake (r = 0.193, p = 0.009). Decreased exercise levels (r = -0.33, p < 0.001) and increased snack consumption (r = 0.24, p = 0.002) were associated with increased body weight. Furthermore, increased total diet intake (r = 0.16, p = 0.031) was associated with increased HbA1c levels. These relationships remained significant for patients aged <65 years and patients who did not engage in regular exercise. Many patients experienced stress and lifestyle changes due to the COVID-19 pandemic, and these changes were associated with increased body weight and HbA1c levels.

Effect of matcha consumption on gut microbiota in healthy Japanese individuals: study protocol for a double-blind crossover interventional study

This study compares and clarifies the changes in intestinal flora resulting from the continuous consumption of two types of matcha. Healthy adults will consume two types of matcha tea for four weeks, and differences in the intestinal microflora before and after drinking will be compared. Gut microbiota will be identified using next-generation sequencing. Phylogenetic classification of the enterobacteria will be performed based on sequence similarities. The relative proportions of the classified enterobacteria to the total nucleotide sequences will be compared between the samples obtained from the two groups consuming different matcha. The continuous consumption of matcha may improve dysbiosis and prevent atherosclerosis. The effects may vary according to the type of matcha used. Trial registration: The study was registered with university hospital medical information network (UMIN) (UMIN000040303), and all participants gave their written informed consent. Registered 1 November 2020, https://upload.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000045982.

Acute Bromide Intoxication in a Patient with Preserved Renal Function

Patient: Female, 70-year-old

Final Diagnosis: Bromide intoxication

Symptoms: Fatigue

Medication: Naron Ace

Clinical Procedure: —

Specialty: Toxicology