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Pan XH, Tan B, Chin YH, Lee ECZ, Kong G, Chong B, Kueh M, Khoo CM, Mehta A, Majety P, Grandhi GR, Dimitriadis GK, Foo R, Chew NWS, Le Roux CW, Mamas MA, Chan MY. Efficacy and safety of tirzepatide, GLP-1 receptor agonists, and other weight loss drugs in overweight and obesity: a network meta-analysis. Obesity (Silver Spring) 2024. [PMID: 38413012 DOI: 10.1002/oby.24002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 12/14/2023] [Accepted: 12/27/2023] [Indexed: 02/29/2024]
Abstract
OBJECTIVE This network meta-analysis evaluates the efficacy and safety of tirzepatide compared to glucagon-like peptide-1 receptor agonists (GLP-1 RA) and other weight loss drugs in the treatment of overweight and obesity. METHODS MEDLINE, Embase, and Cochrane CENTRAL were searched for randomized controlled trials on tirzepatide, GLP-1 RA, and weight loss drugs approved by the US Food and Drug Administration. A network meta-analysis was performed, drawing direct and indirect comparisons between treatment groups. Network diagrams and surface under the cumulative ranking curve analysis were performed for primary (≥5%, ≥10%, ≥15%, absolute weight loss) and secondary outcomes and adverse effects. RESULTS Thirty-one randomized controlled trials, involving more than 35,000 patients, were included in this study. Tirzepatide 15 mg ranked in the top three across weight-related parameters, glycemic profile (glycated hemoglobin), lipid parameters (total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, triglycerides), and blood pressure. Tirzepatide 15 mg had the highest efficacy compared with placebo for achieving ≥15% weight loss (risk ratio 10.24, 95% CI: 6.42-16.34). As compared to placebo, tirzepatide and GLP-1 RA across all doses had significant increases in gastrointestinal adverse effects. CONCLUSIONS The superiority of tirzepatide and GLP-1 RA in inducing weight loss and their ability to target multiple metabolic parameters render them promising candidates in the treatment of patients with overweight and obesity.
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Affiliation(s)
- Xin-Hui Pan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Bryan Tan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Yip Han Chin
- Ministry of Health Holdings, Ministry of Health, Singapore
| | - Ethan Cheng Zhe Lee
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Gwyneth Kong
- Ministry of Health Holdings, Ministry of Health, Singapore
| | - Bryan Chong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Martin Kueh
- Royal College of Surgeons in Ireland & University College Dublin Malaysia Campus, George Town, Malaysia
| | - Chin Meng Khoo
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Department of Endocrinology, National University Hospital, Singapore
| | - Anurag Mehta
- VCU Health Pauley Heart Center, Division of Cardiology, Department of Internal Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Priyanka Majety
- Department of Endocrinology, Diabetes and Metabolism, Virginia Commonwealth University Health, Richmond, Virginia, USA
| | - Gowtham R Grandhi
- VCU Health Pauley Heart Center, Division of Cardiology, Department of Internal Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Georgios K Dimitriadis
- Faculty of Life Sciences and Medicine, School of Life Course Sciences, King's College London, London, UK
- Department of Endocrinology, King's College Hospital NHS Foundation Trust, Denmark Hill, London, UK
| | - Roger Foo
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Department of Cardiology, National University Heart Centre, Singapore
| | - Nicholas W S Chew
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Department of Cardiology, National University Heart Centre, Singapore
| | - Carel W Le Roux
- Diabetes Complications Research Centre, University College Dublin, Dublin, Ireland
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Keele University, Keele, UK
- Department of Cardiology, Royal Stoke University Hospital, Stoke-on-Trent, UK
| | - Mark Y Chan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Department of Cardiology, National University Heart Centre, Singapore
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2
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Kway YM, Thirumurugan K, Michael N, Tan KH, Godfrey KM, Gluckman P, Chong YS, Venkataraman K, Khoo EYH, Khoo CM, Leow MKS, Tai ES, Chan JK, Chan SY, Eriksson JG, Fortier MV, Lee YS, Velan SS, Feng M, Sadananthan SA. A fully convolutional neural network for comprehensive compartmentalization of abdominal adipose tissue compartments in MRI. Comput Biol Med 2023; 167:107608. [PMID: 37897959 DOI: 10.1016/j.compbiomed.2023.107608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 09/18/2023] [Accepted: 10/17/2023] [Indexed: 10/30/2023]
Abstract
BACKGROUND Existing literature has highlighted structural, physiological, and pathological disparities among abdominal adipose tissue (AAT) sub-depots. Accurate separation and quantification of these sub-depots are crucial for advancing our understanding of obesity and its comorbidities. However, the absence of clear boundaries between the sub-depots in medical imaging data has challenged their separation, particularly for internal adipose tissue (IAT) sub-depots. To date, the quantification of AAT sub-depots remains challenging, marked by a time-consuming, costly, and complex process. PURPOSE To implement and evaluate a convolutional neural network to enable granular assessment of AAT by compartmentalization of subcutaneous adipose tissue (SAT) into superficial subcutaneous (SSAT) and deep subcutaneous (DSAT) adipose tissue, and IAT into intraperitoneal (IPAT), retroperitoneal (RPAT), and paraspinal (PSAT) adipose tissue. MATERIAL AND METHODS MRI datasets were retrospectively collected from Singapore Preconception Study for Long-Term Maternal and Child Outcomes (S-PRESTO: 389 women aged 31.4 ± 3.9 years) and Singapore Adult Metabolism Study (SAMS: 50 men aged 28.7 ± 5.7 years). For all datasets, ground truth segmentation masks were created through manual segmentation. A Res-Net based 3D-UNet was trained and evaluated via 5-fold cross-validation on S-PRESTO data (N = 300). The model's final performance was assessed on a hold-out (N = 89) and an external test set (N = 50, SAMS). RESULTS The proposed method enabled reliable segmentation of individual AAT sub-depots in 3D MRI volumes with high mean Dice similarity scores of 98.3%, 97.2%, 96.5%, 96.3%, and 95.9% for SSAT, DSAT, IPAT, RPAT, and PSAT respectively. CONCLUSION Convolutional neural networks can accurately sub-divide abdominal SAT into SSAT and DSAT, and abdominal IAT into IPAT, RPAT, and PSAT with high accuracy. The presented method has the potential to significantly contribute to advancements in the field of obesity imaging and precision medicine.
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Affiliation(s)
- Yeshe M Kway
- Singapore Institute for Clinical Sciences, Agency for Science Technology, and Research, Singapore; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Kashthuri Thirumurugan
- Singapore Institute for Clinical Sciences, Agency for Science Technology, and Research, Singapore
| | - Navin Michael
- Singapore Institute for Clinical Sciences, Agency for Science Technology, and Research, Singapore
| | - Kok Hian Tan
- Duke-National University of Singapore Graduate Medical School, Singapore; Department of Maternal Fetal Medicine, KK Women's and Children's Hospital, Singapore
| | - Keith M Godfrey
- MRC Lifecourse Epidemiology Centre & NIHR Southampton Biomedical Research Centre, University of Southampton & University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Peter Gluckman
- Singapore Institute for Clinical Sciences, Agency for Science Technology, and Research, Singapore
| | - Yap Seng Chong
- Singapore Institute for Clinical Sciences, Agency for Science Technology, and Research, Singapore; Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Kavita Venkataraman
- Saw Swee Hock School of Public Health, National University of Singapore, National University Health System, Singapore
| | - Eric Yin Hao Khoo
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Chin Meng Khoo
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Medicine, National University Health System, Singapore
| | - Melvin Khee-Shing Leow
- Singapore Institute for Clinical Sciences, Agency for Science Technology, and Research, Singapore; Lee Kong Chian School of Medicine, Nanyang Technological University (NTU), Singapore; Human Potential Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Endocrinology, Division of Medicine, Tan Tock Seng Hospital (TTSH), Singapore
| | - E Shyong Tai
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Division of Endocrinology, University Medicine Cluster, National University Health System, Singapore
| | - Jerry Ky Chan
- Department of Reproductive Medicine, KK Women's and Children's Hospital, Singapore; Experimental Fetal Medicine Group, Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University Health System, Singapore
| | - Shiao-Yng Chan
- Singapore Institute for Clinical Sciences, Agency for Science Technology, and Research, Singapore; Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Johan G Eriksson
- Singapore Institute for Clinical Sciences, Agency for Science Technology, and Research, Singapore; Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland; Folkhälsan Research Center, Helsinki, Finland
| | - Marielle V Fortier
- Singapore Institute for Clinical Sciences, Agency for Science Technology, and Research, Singapore; Department of Diagnostic and Interventional Imaging, KK Women's and Children's Hospital, Singapore
| | - Yung Seng Lee
- Singapore Institute for Clinical Sciences, Agency for Science Technology, and Research, Singapore; Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Division of Paediatric Endocrinology, Department of Paediatrics, Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, National University Health System, Singapore
| | - S Sendhil Velan
- Singapore Institute for Clinical Sciences, Agency for Science Technology, and Research, Singapore
| | - Mengling Feng
- Saw Swee Hock School of Public Health, National University of Singapore, National University Health System, Singapore; Institute of Data Science, National University of Singapore, Singapore
| | - Suresh Anand Sadananthan
- Singapore Institute for Clinical Sciences, Agency for Science Technology, and Research, Singapore.
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3
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Dalakoti M, Leow MKS, Khoo CM, Yang H, Ling LH, Muthiah M, Tan E, Lee J, Dan YY, Chew N, Seow WQ, Soong PL, Gan L, Gurung R, Ackers-Johnson M, Hou HW, Sachaphibulkij K, MacAry P, Low G, Ang C, Yeo TJ, Djohan AH, Li T, Yeung W, Soh R, Sia CH, Panday V, Loong SSE, Tan BYQ, Yeo LLL, Teo L, Chow P, Foo R. Platform for the interdisciplinary study of cardiovascular, metabolic and neurovascular diseases (PICMAN) protocol. Sci Rep 2023; 13:20521. [PMID: 37993612 PMCID: PMC10665389 DOI: 10.1038/s41598-023-47407-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 11/13/2023] [Indexed: 11/24/2023] Open
Abstract
Through extensive multisystem phenotyping, the central aim of Project PICMAN is to correlate metabolic flexibility to measures of cardiometabolic health, including myocardial diastolic dysfunction, coronary and cerebral atherosclerosis, body fat distribution and severity of non-alcoholic fatty liver disease. This cohort will form the basis of larger interventional trials targeting metabolic inflexibility in the prevention of cardiovascular disease. Participants aged 21-72 years with no prior manifest atherosclerotic cardiovascular disease (ASCVD) are being recruited from a preventive cardiology clinic and an existing cohort of non-alcoholic fatty liver disease (NAFLD) in an academic medical centre. A total of 120 patients will be recruited in the pilot phase of this study and followed up for 5 years. Those with 10-year ASCVD risk ≥ 5% as per the QRISK3 calculator are eligible. Those with established diabetes mellitus are excluded. Participants recruited undergo a detailed assessment of health behaviours and physical measurements. Participants also undergo a series of multimodality clinical phenotyping comprising cardiac tests, vascular assessments, metabolic tests, liver and neurovascular testing. Blood samples are also being collected and banked for plasma biomarkers, 'multi-omics analyses' and for generation of induced pluripotent stem cells (iPSC). Extensive evidence points to metabolic dysregulation as an early precursor of cardiovascular disease, particularly in Asia. We hypothesise that quantifiable metabolic inflexibility may be representative of an individual in his/her silent, but high-risk progression towards insulin resistance, diabetes and cardiovascular disease. The platform for interdisciplinary cardiovascular-metabolic-neurovascular diseases (PICMAN) is a pilot, prospective, multi-ethnic cohort study.
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Affiliation(s)
- Mayank Dalakoti
- Department of Cardiology, National University Heart Centre, Singapore, Singapore.
- Department of Medicine, Ng Teng Fong General Hospital, Singapore, Singapore.
- National University of Singapore Cardiovascular Disease Translational Research Program, Singapore, Singapore.
| | - Melvin Khee Shing Leow
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Chin Meng Khoo
- Department of Medicine, National University Health System, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Hayang Yang
- National University of Singapore Cardiovascular Disease Translational Research Program, Singapore, Singapore
| | - Lieng Hsi Ling
- Department of Cardiology, National University Heart Centre, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Mark Muthiah
- Department of Medicine, National University Health System, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Eunice Tan
- Department of Medicine, National University Health System, Singapore, Singapore
| | - Jonathan Lee
- Department of Medicine, National University Health System, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Yock Young Dan
- Department of Medicine, National University Health System, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Nicholas Chew
- Department of Cardiology, National University Heart Centre, Singapore, Singapore
- National University of Singapore Cardiovascular Disease Translational Research Program, Singapore, Singapore
| | - Wei Qiang Seow
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- National University of Singapore Cardiovascular Disease Translational Research Program, Singapore, Singapore
| | - Poh Loong Soong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- National University of Singapore Cardiovascular Disease Translational Research Program, Singapore, Singapore
| | - Louis Gan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- National University of Singapore Cardiovascular Disease Translational Research Program, Singapore, Singapore
| | - Rijan Gurung
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- National University of Singapore Cardiovascular Disease Translational Research Program, Singapore, Singapore
| | - Matthew Ackers-Johnson
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- National University of Singapore Cardiovascular Disease Translational Research Program, Singapore, Singapore
| | - Han Wei Hou
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Karishma Sachaphibulkij
- Center for Life Sciences, National University of Singapore-Cambridge Cell Phenotyping Centre, Singapore, Singapore
| | - Paul MacAry
- Center for Life Sciences, National University of Singapore-Cambridge Cell Phenotyping Centre, Singapore, Singapore
| | - Gwen Low
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- National University of Singapore Cardiovascular Disease Translational Research Program, Singapore, Singapore
| | - Christy Ang
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- National University of Singapore Cardiovascular Disease Translational Research Program, Singapore, Singapore
| | - Tee Joo Yeo
- Department of Cardiology, National University Heart Centre, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Andie Hartanto Djohan
- Department of Cardiology, National University Heart Centre, Singapore, Singapore
- Department of Medicine, Ng Teng Fong General Hospital, Singapore, Singapore
| | - Tony Li
- Department of Cardiology, National University Heart Centre, Singapore, Singapore
| | - Wesley Yeung
- Department of Cardiology, National University Heart Centre, Singapore, Singapore
| | - Rodney Soh
- Department of Cardiology, National University Heart Centre, Singapore, Singapore
| | - Ching Hui Sia
- Department of Cardiology, National University Heart Centre, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- National University of Singapore Cardiovascular Disease Translational Research Program, Singapore, Singapore
| | - Vinay Panday
- Department of Cardiology, National University Heart Centre, Singapore, Singapore
| | - Shaun S E Loong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- National University of Singapore Cardiovascular Disease Translational Research Program, Singapore, Singapore
| | - Benjamin Y Q Tan
- Department of Medicine, National University Health System, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Leonard L L Yeo
- Department of Medicine, National University Health System, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Lynette Teo
- Department of Radiology, National University Health System, Singapore, Singapore
| | - Pierce Chow
- Duke-NUS Medical School, Singapore, Singapore
| | - Roger Foo
- Department of Cardiology, National University Heart Centre, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- National University of Singapore Cardiovascular Disease Translational Research Program, Singapore, Singapore
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4
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Lim WH, Lin SY, Ng CH, Tan DJH, Xiao J, Yong JN, Tay PWL, Syn N, Chin YH, Chan KE, Khoo CM, Chew N, Foo RSY, Shabbir A, Tan EX, Huang DQ, Noureddin M, Sanyal AJ, Siddiqui MS, Muthiah MD. Foregut bypass vs. restrictive bariatric procedures for nonalcoholic fatty liver disease: a meta-analysis of 3,355 individuals. Hepatobiliary Surg Nutr 2023; 12:658-670. [PMID: 37886204 PMCID: PMC10598314 DOI: 10.21037/hbsn-21-520] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 04/12/2022] [Indexed: 10/28/2023]
Abstract
Background Bariatric surgery represents an important treatment option for severely obese patients with nonalcoholic fatty liver disease (NAFLD). However, there remains inadequate data regarding the effects of different bariatric procedures on various NAFLD parameters, especially for histological outcomes. Thus, this meta-analysis aimed to compare the effects of restrictive bariatric procedures and foregut bypass on the metabolic, biochemical, and histological parameters for patients with NAFLD. Methods Medline and Embase were searched for articles relating to bariatric procedures and NAFLD. Pairwise meta-analysis was conducted to compare efficacy of bariatric procedures pre- vs. post-procedure with subgroup analysis to further compare restrictive against foregut bypass procedures. Results Thirty-one articles involving 3,355 patients who underwent restrictive bariatric procedures (n=1,460) and foregut bypass (n=1,895) were included. Both foregut bypass (P<0.01) and restrictive procedures (P=0.03) significantly increased odds of fibrosis resolution. Compared to restrictive procedures, foregut bypass resulted in a borderline non-significant decrease in fibrosis score (P=0.06) and significantly lower steatosis score (P<0.001). For metabolic parameters, foregut bypass significantly lowered body mass index (P=0.003) and low-density lipoprotein (P=0.008) compared to restrictive procedures. No significant differences were observed between both procedures for aspartate aminotransferase (P=0.17) and alkaline phosphatase (P=0.61). However, foregut bypass resulted in significantly lower gamma-glutamyl transferase than restrictive procedures (P=0.01) while restrictive procedures resulted in significantly lower alanine transaminase than foregut bypass (P=0.02). Conclusions The significant histological and metabolic advantages and comparable improvements in biochemical outcomes support the choice of foregut bypass over restrictive bariatric procedures in NAFLD management.
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Affiliation(s)
- Wen Hui Lim
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Snow Yunni Lin
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Cheng Han Ng
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Darren Jun Hao Tan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Jieling Xiao
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Jie Ning Yong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Phoebe Wen Lin Tay
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Nicholas Syn
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Yip Han Chin
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Kai En Chan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Chin Meng Khoo
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Division of Endocrinology, Department of Medicine, National University Hospital, Singapore, Singapore
| | - Nicholas Chew
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Department of Cardiology, National University Heart Centre, National University Hospital, Singapore, Singapore
| | - Roger S. Y. Foo
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Department of Cardiology, National University Heart Centre, National University Hospital, Singapore, Singapore
| | - Asim Shabbir
- Division of General Surgery (Upper Gastrointestinal Surgery), Department of Surgery, National University Hospital, Singapore, Singapore
| | - Eunice X. Tan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore, Singapore
- National University Centre for Organ Transplantation, National University Health System, Singapore, Singapore
| | - Daniel Q. Huang
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore, Singapore
- National University Centre for Organ Transplantation, National University Health System, Singapore, Singapore
| | - Mazen Noureddin
- Cedars-Sinai Fatty Liver Program, Division of Digestive and Liver Diseases, Department of Medicine, Comprehensive Transplant Center, Cedars-Sinai Medical Centre, Los Angeles, CA, USA
| | - Arun J. Sanyal
- Division of Gastroenterology, Hepatology and Nutrition, Department of Internal Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | - Mohammad Shadab Siddiqui
- Division of Gastroenterology, Hepatology and Nutrition, Department of Internal Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | - Mark D. Muthiah
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore, Singapore
- National University Centre for Organ Transplantation, National University Health System, Singapore, Singapore
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5
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Yaow CYL, Chong B, Chin YH, Kueh MTW, Ng CH, Chan KE, Tang ASP, Chung C, Goh R, Kong G, Muthiah M, Sukmawati I, Lukito AA, Chan MY, Khoo CM, Mehta A, Mamas MA, Dimitriadis GK, Chew NWS. Higher risk of adverse cardiovascular outcomes in females with type 2 diabetes Mellitus: an Umbrella review of systematic reviews. Eur J Prev Cardiol 2023; 30:1227-1235. [PMID: 37185913 DOI: 10.1093/eurjpc/zwad133] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 03/20/2023] [Accepted: 04/15/2023] [Indexed: 05/17/2023]
Abstract
BACKGROUND Previous studies have shown that females with type 2 diabetes mellitus (T2DM) may have excess mortality risk compared to their male counterparts. An important next step to address the high global burden of T2DM and cardiovascular disease (CVD) is an umbrella review to summarize data on sex differences in cardiovascular outcomes for patients with T2DM and assess the strength of the evidence observed. METHODS AND RESULTS Medline and Embase were searched from inception till 7 August 2022 for systematic reviews and meta-analyses studying the effects of sex on cardiovascular outcomes in T2DM patients. Results from reviews were synthesized with a narrative synthesis, with a tabular presentation of findings and forest plots for reviews that performed a meta-analysis. 27 review articles evaluating sex differences in cardiovascular outcomes were included. Females with T2DM had a higher risk of developing coronary heart disease (CHD; RRR: 1.52, 95%CI: 1.32-1.76, P < 0.001), acute coronary syndrome (ACS; RRR: 1.38, 95%CI: 1.25-1.52, P < 0.001), heart failure (RRR: 1.09, 95%CI: 1.05-1.13, P < 0.001) than males. Females had a higher risk of all-cause mortality (RRR: 1.13, 95%CI: 1.07-1.19, P < 0.001), cardiac mortality (RRR: 1.49, 95%CI: 1.11-2.00, P = 0.009) and CHD mortality (RRR: 1.44, 95%CI: 1.20-1.73, P < 0.001) as compared to males. CONCLUSIONS This umbrella review demonstrates that females with T2DM have a higher risk of cardiovascular outcomes than their male counterparts. Future research should address the basis of this heterogeneity and epidemiological factors for better quality of evidence, and identify actionable interventions that will narrow these sex disparities.
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Affiliation(s)
- Clyve Yu Leon Yaow
- Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, Singapore 117597
| | - Bryan Chong
- Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, Singapore 117597
| | - Yip Han Chin
- Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, Singapore 117597
| | - Martin Tze Wah Kueh
- Royal College of Surgeons in Ireland, 123 St Stephen's Green, Dublin 2, D02 YN77, Ireland
- University College Dublin Malaysia Campus, George Town, Malaysia
| | - Cheng Han Ng
- Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, Singapore 117597
| | - Kai En Chan
- Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, Singapore 117597
| | - Ansel Shao Pin Tang
- Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, Singapore 117597
| | - Charlotte Chung
- Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, Singapore 117597
| | - Rachel Goh
- Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, Singapore 117597
| | - Gwyneth Kong
- Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, Singapore 117597
| | - Mark Muthiah
- Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, Singapore 117597
- Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore, Singapore
- National University Centre for Organ Transplantation, National University Health System, Singapore
| | - Indah Sukmawati
- Cardiovascular Department, Siloam Hospitals Lippo Village, Pelita Harapan University, Tangerang, Indonesia
| | - Antonia Anna Lukito
- National University Centre for Organ Transplantation, National University Health System, Singapore
| | - Mark Y Chan
- Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, Singapore 117597
- Department of Cardiology, National University Heart Centre, National University Health System, Singapore
| | - Chin Meng Khoo
- Division of Endocrinology, Department of Medicine, National University Hospital, Singapore
| | - Anurag Mehta
- VCU Health Pauley Heart Center, Division of Cardiology, Department of Internal Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | - Mamas A Mamas
- Institute of Population Health, University of Manchester, Manchester, UK
- Keele Cardiac Research Group, Centre for Prognosis Research, Keele University, Stoke-on-Trent, UK
| | - Georgios K Dimitriadis
- Department of Endocrinology ASO/EASO COM, King's College Hospital NHS Foundation Trust, Denmark Hill, London SE5 9RS, UK
- Obesity, Type 2 Diabetes and Immunometabolism Research Group, Department of Diabetes, Faculty of Cardiovascular Medicine & Sciences, School of Life Course Sciences, King's College London, London SE1 9RT, UK
| | - Nicholas W S Chew
- Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, Singapore 117597
- Cardiovascular Department, Siloam Hospitals Lippo Village, Pelita Harapan University, Tangerang, Indonesia
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Seah JYH, Sim X, Khoo CM, Tai ES, van Dam RM. Differences in type 2 diabetes risk between East, South, and Southeast Asians living in Singapore: the multi-ethnic cohort. BMJ Open Diabetes Res Care 2023; 11:e003385. [PMID: 37507146 PMCID: PMC10387644 DOI: 10.1136/bmjdrc-2023-003385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 07/14/2023] [Indexed: 07/30/2023] Open
Abstract
INTRODUCTION Prospective data on differences in type two diabetes (T2D) risk between Asian ethnic groups are sparse. We, therefore, compared T2D risk for East (Chinese), South (Indian), and Southeast (Malay) Asians and examined biological factors that may contribute to ethnic differences. RESEARCH DESIGN AND METHODS We included 7427 adults of Chinese, Malay, and Indian origin participating in the Singapore multi-ethnic cohort. Information on sociodemographic, lifestyle, and biological risk factors (body mass index (BMI), waist circumference, blood lipids, blood pressure, C reactive protein, adiponectin, and homeostasis model assessment for insulin resistance and beta-cell function) were collected using standardized interviews and physical examinations. T2D cases were based on physician diagnoses, a national medical registry, fasting plasma glucose, or glycated hemoglobin A1c. We used multivariable logistic association and mediation analyses. RESULTS During an average follow-up of 7.2 years (SD 2.2 years), we documented 595 cases of incident diabetes. Ethnic Malays (OR 2.08, 95% CI 1.69 to 2.56) and Indians (OR 2.22, 95% CI 1.80 to 2.74) had an approximately twofold higher risk of T2D compared with ethnic Chinese. Higher BMI explained the higher risk for Malay compared with Chinese ethnicity. Higher BMI, waist circumference, inflammation, and insulin resistance, and lower beta-cell function and high-density lipoprotein-cholesterol significantly contributed to the higher T2D risk for Indian compared with Chinese ethnicity. However, part of the higher T2D risk associated with Indian ethnicity remained unexplained. Despite their lower diabetes risk, Chinese participants had the lowest adiponectin levels. CONCLUSIONS Different Asian ethnic groups have unique biological risk factor profiles related to T2D development that may warrant targeted approaches for prevention and treatment.
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Affiliation(s)
- Jowy Yi Hoong Seah
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - Xueling Sim
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - Chin Meng Khoo
- Division of Endocrinology, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore
| | - E Shyong Tai
- Division of Endocrinology, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore
- Duke-NUS Medical School, Singapore
| | - Rob M van Dam
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
- Departments of Exercise and Nutrition Sciences and Epidemiology, The George Washington University, Washington, District of Columbia, USA
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Tan B, Pan XH, Chew HSJ, Goh RSJ, Lin C, Anand VV, Lee ECZ, Chan KE, Kong G, Ong CEY, Chung HC, Young DY, Chan MY, Khoo CM, Mehta A, Muthiah MD, Noureddin M, Ng CH, Chew NWS, Chin YH. Efficacy and safety of tirzepatide for treatment of overweight or obesity. A systematic review and meta-analysis. Int J Obes (Lond) 2023:10.1038/s41366-023-01321-5. [PMID: 37253796 DOI: 10.1038/s41366-023-01321-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 04/23/2023] [Accepted: 04/26/2023] [Indexed: 06/01/2023]
Abstract
BACKGROUND Recent studies suggest that tirzepatide, a dual glucose-dependent insulinotropic-peptide (GIP) and glucagon-like peptide-1 receptor agonist (GLP-1 RA), has significant weight loss effects. This systematic review and meta-analysis aims to assess the efficacy and safety of tirzepatide for weight loss in patients with overweight or obesity. METHODS Medline, Embase and Cochrane CENTRAL were searched for randomized controlled trials (RCTs) on tirzepatide's weight loss efficacy for these patients. A single arm meta-analysis of proportions estimated primary outcomes, ≥5%, ≥10%, and ≥15% weight loss, and adverse events (AEs); while meta-analysis of means estimated secondary outcomes. Comparative meta-analysis was conducted between tirzepatide and control arms where mean differences and odds ratios were estimated for continuous and dichotomous outcomes respectively. RESULTS RCTs included in this study revealed that among 5800 patients, 78.22% (95% CI: 72.15% to 83.73%), 55.60% (95% CI: 46.54% to 64.47%), 32.28% (95% CI: 23.17% to 42.12%) achieved ≥5%, ≥10%, and ≥15% weight loss, respectively. Tirzepatide 5 mg demonstrated weight loss superiority relative to placebo (MD: -12.47 kg, 95% CI: -13.94 kg to -11.00 kg) and semaglutide (n = 1409, MD: -1.90 kg, 95% CI: -2.97 kg to -0.83 kg) with dose-dependent increase for 10 mg and 15 mg doses. The comparison between tirzepatide and semaglutide was examined in the SURPASS-2 trial that was included in this systematic review. For AEs, there was increase odds of experiencing gastrointestinal AEs with tirzepatide compared to placebo, but no significant difference with semaglutide. CONCLUSION Tirzepatide has significant potential as a weight loss drug in patients with overweight and obesity, with little increase in AEs compared to other weight loss drugs. With its ability to concurrently target multiple aspects of metabolic syndrome, it should be considered as the next helm of weight loss therapies.
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Affiliation(s)
- Bryan Tan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Xin-Hui Pan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Han Shi Jocelyn Chew
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Rachel Sze Jen Goh
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Chaoxing Lin
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Vickram Vijay Anand
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Ethan Cheng Zhe Lee
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Kai En Chan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Gwyneth Kong
- Ministry of Health Holdings, Ministry of Health, Singapore, Singapore
| | - Christen En Ya Ong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Hui Charlotte Chung
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Dan Yock Young
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Mark Y Chan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Department of Cardiology, National University Heart Centre, Singapore, Singapore
| | - Chin Meng Khoo
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Department of Endocrinology, National University Hospital, Singapore, Singapore
| | - Anurag Mehta
- VCU Health Pauley Heart Center, Division of Cardiology, Department of Internal Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | - Mark Dhinesh Muthiah
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore, Singapore
- National University Centre for Organ Transplantation, National University Health System, Singapore, Singapore
| | - Mazen Noureddin
- Cedars-Sinai Fatty Liver Program, Division of Digestive and Liver Diseases, Department of Medicine, Comprehensive Transplant Centre, Cedars-Sinai Medical Centre, Los Angeles, CA, USA
| | - Cheng Han Ng
- Ministry of Health Holdings, Ministry of Health, Singapore, Singapore.
| | - Nicholas W S Chew
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Department of Cardiology, National University Heart Centre, Singapore, Singapore
| | - Yip Han Chin
- Ministry of Health Holdings, Ministry of Health, Singapore, Singapore.
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8
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Tan WX, Sim X, Khoo CM, Teo AKK. Prioritization of genes associated with type 2 diabetes mellitus for functional studies. Nat Rev Endocrinol 2023:10.1038/s41574-023-00836-1. [PMID: 37169822 DOI: 10.1038/s41574-023-00836-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/28/2023] [Indexed: 05/13/2023]
Abstract
Existing therapies for type 2 diabetes mellitus (T2DM) show limited efficacy or have adverse effects. Numerous genetic variants associated with T2DM have been identified, but progress in translating these findings into potential drug targets has been limited. Here, we describe the tools and platforms available to identify effector genes from T2DM-associated coding and non-coding variants and prioritize them for functional studies. We discuss QSER1 and SLC12A8 as examples of genes that have been identified as possible T2DM candidate genes using these tools and platforms. We suggest further approaches, including the use of sequencing data with increased sample size and ethnic diversity, single-cell omics data for analyses, glycaemic trait associations to predict gene function and, potentially, human induced pluripotent stem cell 'village' cultures, to strengthen current gene functionalization workflows. Effective prioritization of T2DM-associated genes for experimental validation could expedite our understanding of the genetic mechanisms responsible for T2DM to facilitate the use of precision medicine in its treatment.
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Affiliation(s)
- Wei Xuan Tan
- Stem Cells and Diabetes Laboratory, Institute of Molecular and Cell Biology (IMCB), Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Xueling Sim
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Chin Meng Khoo
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Adrian K K Teo
- Stem Cells and Diabetes Laboratory, Institute of Molecular and Cell Biology (IMCB), Agency for Science, Technology and Research (A*STAR), Singapore, Singapore.
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
- Precision Medicine Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
- Department of Biochemistry, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
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9
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Chong B, Jayabaskaran J, Ruban J, Goh R, Chin YH, Kong G, Ng CH, Lin C, Loong S, Muthiah MD, Khoo CM, Shariff E, Chan MY, Lajeunesse-Trempe F, Tchernof A, Chevli P, Mehta A, Mamas MA, Dimitriadis GK, Chew NWS. Epicardial Adipose Tissue Assessed by Computed Tomography and Echocardiography Are Associated With Adverse Cardiovascular Outcomes: A Systematic Review and Meta-Analysis. Circ Cardiovasc Imaging 2023; 16:e015159. [PMID: 37192298 DOI: 10.1161/circimaging.122.015159] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 04/11/2023] [Indexed: 05/18/2023]
Abstract
BACKGROUND Epicardial adipose tissue (EAT) has garnered attention as a prognostic and risk stratification factor for cardiovascular disease. This study, via meta-analyses, evaluates the associations between EAT and cardiovascular outcomes stratified across imaging modalities, ethnic groups, and study protocols. METHODS Medline and Embase databases were searched without date restriction on May 2022 for articles that examined EAT and cardiovascular outcomes. The inclusion criteria were (1) studies measuring EAT of adult patients at baseline and (2) reporting follow-up data on study outcomes of interest. The primary study outcome was major adverse cardiovascular events. Secondary study outcomes included cardiac death, myocardial infarction, coronary revascularization, and atrial fibrillation. RESULTS Twenty-nine articles published between 2012 and 2022, comprising 19 709 patients, were included in our analysis. Increased EAT thickness and volume were associated with higher risks of cardiac death (odds ratio, 2.53 [95% CI, 1.17-5.44]; P=0.020; n=4), myocardial infarction (odds ratio, 2.63 [95% CI, 1.39-4.96]; P=0.003; n=5), coronary revascularization (odds ratio, 2.99 [95% CI, 1.64-5.44]; P<0.001; n=5), and atrial fibrillation (adjusted odds ratio, 4.04 [95% CI, 3.06-5.32]; P<0.001; n=3). For 1 unit increment in the continuous measure of EAT, computed tomography volumetric quantification (adjusted hazard ratio, 1.74 [95% CI, 1.42-2.13]; P<0.001) and echocardiographic thickness quantification (adjusted hazard ratio, 1.20 [95% CI, 1.09-1.32]; P<0.001) conferred an increased risk of major adverse cardiovascular events. CONCLUSIONS The utility of EAT as an imaging biomarker for predicting and prognosticating cardiovascular disease is promising, with increased EAT thickness and volume being identified as independent predictors of major adverse cardiovascular events. REGISTRATION URL: https://www.crd.york.ac.uk/prospero; Unique identifier: CRD42022338075.
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Affiliation(s)
- Bryan Chong
- Yong Loo Lin School of Medicine, National University of Singapore (B.C., J.J., J.R., R.G., Y.H.C., G.K., C.H.N., C.L., S.L., M.D.M., M.Y.C.)
| | - Jayanth Jayabaskaran
- Yong Loo Lin School of Medicine, National University of Singapore (B.C., J.J., J.R., R.G., Y.H.C., G.K., C.H.N., C.L., S.L., M.D.M., M.Y.C.)
| | - Jitesh Ruban
- Yong Loo Lin School of Medicine, National University of Singapore (B.C., J.J., J.R., R.G., Y.H.C., G.K., C.H.N., C.L., S.L., M.D.M., M.Y.C.)
| | - Rachel Goh
- Yong Loo Lin School of Medicine, National University of Singapore (B.C., J.J., J.R., R.G., Y.H.C., G.K., C.H.N., C.L., S.L., M.D.M., M.Y.C.)
| | - Yip Han Chin
- Yong Loo Lin School of Medicine, National University of Singapore (B.C., J.J., J.R., R.G., Y.H.C., G.K., C.H.N., C.L., S.L., M.D.M., M.Y.C.)
| | - Gwyneth Kong
- Yong Loo Lin School of Medicine, National University of Singapore (B.C., J.J., J.R., R.G., Y.H.C., G.K., C.H.N., C.L., S.L., M.D.M., M.Y.C.)
| | - Cheng Han Ng
- Yong Loo Lin School of Medicine, National University of Singapore (B.C., J.J., J.R., R.G., Y.H.C., G.K., C.H.N., C.L., S.L., M.D.M., M.Y.C.)
| | - Chaoxing Lin
- Yong Loo Lin School of Medicine, National University of Singapore (B.C., J.J., J.R., R.G., Y.H.C., G.K., C.H.N., C.L., S.L., M.D.M., M.Y.C.)
| | - Shaun Loong
- Yong Loo Lin School of Medicine, National University of Singapore (B.C., J.J., J.R., R.G., Y.H.C., G.K., C.H.N., C.L., S.L., M.D.M., M.Y.C.)
| | - Mark D Muthiah
- Yong Loo Lin School of Medicine, National University of Singapore (B.C., J.J., J.R., R.G., Y.H.C., G.K., C.H.N., C.L., S.L., M.D.M., M.Y.C.)
- Division of Gastroenterology and Hepatology, Department of Medicine (M.D.M.), National University Hospital, Singapore
- National University Centre for Organ Transplantation (M.D.M.), National University Health System, Singapore
| | - Chin Meng Khoo
- Division of Endocrinology, Department of Medicine (C.M.K.), National University Hospital, Singapore
| | - Ezman Shariff
- Universiti Teknologi MARA (UiTM) Sungai Buloh, Selangor, Malaysia (E.S.)
| | - Mark Y Chan
- Yong Loo Lin School of Medicine, National University of Singapore (B.C., J.J., J.R., R.G., Y.H.C., G.K., C.H.N., C.L., S.L., M.D.M., M.Y.C.)
- Department of Cardiology, National University Heart Centre (M.Y.C., N.W.S.C.), National University Health System, Singapore
| | - Fannie Lajeunesse-Trempe
- Quebec Heart and Lung Institute (F.L.-T., A.T.), Quebec City, Canada
- Department of Nutrition, Laval University (F.L.-T.), Quebec City, Canada
- Department of Endocrinology ASO/EASO COM, King's College Hospital NHS Foundation Trust, Denmark Hill, London, United Kingdom (F.L.-T., G.K.D.)
| | - Andre Tchernof
- Quebec Heart and Lung Institute (F.L.-T., A.T.), Quebec City, Canada
| | - Parag Chevli
- Section on Hospital Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC (P.C.)
| | - Anurag Mehta
- VCU Health Pauley Heart Center, Division of Cardiology, Department of Internal Medicine, Virginia Commonwealth University, Richmond (A.M.)
| | - Mamas A Mamas
- Institute of Population Health, University of Manchester, United Kingdom (M.A.M.)
- Keele Cardiac Research Group, Centre for Prognosis Research, Keele University, Stoke-on-Trent (M.A.M.)
| | - Georgios K Dimitriadis
- Department of Endocrinology ASO/EASO COM, King's College Hospital NHS Foundation Trust, Denmark Hill, London, United Kingdom (F.L.-T., G.K.D.)
- Obesity, Type 2 Diabetes and Immunometabolism Research Group, Department of Diabetes, Faculty of Cardiovascular Medicine & Sciences, School of Life Course Sciences, King's College London, United Kingdom (G.K.D.)
| | - Nicholas W S Chew
- Department of Cardiology, National University Heart Centre (M.Y.C., N.W.S.C.), National University Health System, Singapore
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10
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Lin C, Loke WH, Ng BH, Chin YH, Chong B, Goh RSJ, Kong G, Ong CEY, Chan KE, Fu C, Idnani T, Muthiah MD, Khoo CM, Foo R, Loh PH, Chan MY, Brown A, Dimitriadis GK, Chew NWS. Mortality, Cardiovascular, and Medication Outcomes in Patients With Myocardial Infarction and Underweight in a Meta-Analysis of 6.3 Million Patients. Am J Cardiol 2023; 196:1-10. [PMID: 37023510 DOI: 10.1016/j.amjcard.2023.02.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 02/16/2023] [Accepted: 02/28/2023] [Indexed: 04/08/2023]
Abstract
Although most of the current evidence on myocardial infarction focuses on obesity, there is growing evidence that patients who are underweight have unfavorable prognosis. This study aimed to explore the prevalence, clinical characteristics, and prognosis of this population at risk. Embase and Medline were searched for studies reporting outcomes in populations who were underweight with myocardial infarction. Underweight and normal weight were defined according to the World Health Organization criteria. A single-arm meta-analysis of proportions was used to estimate the prevalence of underweight in patients with myocardial infarction, whereas a meta-analysis of proportions was used to estimate the odds ratio of all-cause mortality, medications prescribed, and cardiovascular outcomes. Twenty-one studies involving 6,368,225 patients were included, of whom 47,866 were underweight. The prevalence of underweight in patients with myocardial infarction was 2.96% (95% confidence interval 1.96% to 4.47%). Despite having fewer classical cardiovascular risk factors, patients who were underweight had 66% greater hazard for mortality (hazard ratio 1.66, 95% confidence interval 1.44 to 1.92, p <0.0001). The mortality of patients who were underweight increased from 14.1% at 30 days to 52.6% at 5 years. Nevertheless, they were less likely to receive guideline-directed medical therapy. Relative to subjects with normal weight, Asian populations who were underweight had greater mortality risks than those of their Caucasian counterparts (p = 0.0062). In conclusion, in patients with myocardial infarction, those who were underweight tend to have poorer prognostic outcomes. A lower body mass index is an independent predictor of mortality, which calls for global efforts in addressing this modifiable risk factor in clinical practice guidelines.
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Affiliation(s)
- Chaoxing Lin
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Wan Hsien Loke
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Bing Han Ng
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Yip Han Chin
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
| | - Bryan Chong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Rachel Sze Jen Goh
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Gwyneth Kong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Christen En Ya Ong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Kai En Chan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Clarissa Fu
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Tasha Idnani
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Mark D Muthiah
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Divisions of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore; National University Centre for Organ Transplantation, National University Heart Centre, National University Health System, Singapore
| | - Chin Meng Khoo
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Divisions of Endocrinology, Department of Medicine, National University Hospital, Singapore
| | - Roger Foo
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Cardiology, National University Heart Centre, National University Health System, Singapore
| | - Poay Huan Loh
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Cardiology, National University Heart Centre, National University Health System, Singapore
| | - Mark Y Chan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Cardiology, National University Heart Centre, National University Health System, Singapore
| | - Adrian Brown
- University College London Centre for Obesity Research, University College London, London, United Kingdom; Bariatric Centre for Weight Management and Metabolic Surgery, University College London Hospital National Health Service Trust, London, United Kingdom; National Institute of Health Research, University College London Hospitals Biomedical Research Centre, London, United Kingdom
| | - Georgios K Dimitriadis
- Department of Endocrinology Association for the Study of Obesity/European Association for the Study of Obesity Collaborating Centres for Obesity Management, King's College Hospital National Health Service Foundation Trust, London, United Kingdom; Obesity, Type 2 Diabetes and Immunometabolism Research Group, Department of Diabetes, Faculty of Cardiovascular Medicine & Sciences, School of Life Course Sciences, King's College London, London, United Kingdom
| | - Nicholas W S Chew
- Department of Cardiology, National University Heart Centre, National University Health System, Singapore
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11
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Chong B, Kong G, Shankar K, Chew HSJ, Lin C, Goh R, Chin YH, Tan DJH, Chan KE, Lim WH, Syn N, Chan SP, Wang JW, Khoo CM, Dimitriadis GK, Wijarnpreecha K, Sanyal A, Noureddin M, Siddiqui MS, Foo R, Mehta A, Figtree GA, Hausenloy DJ, Chan MY, Ng CH, Muthiah M, Mamas MA, Chew NWS. The global syndemic of metabolic diseases in the young adult population: A consortium of trends and projections from the Global Burden of Disease 2000-2019. Metabolism 2023; 141:155402. [PMID: 36717058 DOI: 10.1016/j.metabol.2023.155402] [Citation(s) in RCA: 29] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Revised: 01/17/2023] [Accepted: 01/17/2023] [Indexed: 01/30/2023]
Abstract
BACKGROUND A significant proportion of premature deaths globally are related to metabolic diseases in young adults. We examined the global trends and mortality of metabolic diseases in individuals aged below 40 years using data from the Global Burden of Diseases, Injuries and Risk Factors Study (GBD) 2019. METHODS From 2000 to 2019, global estimates of deaths and disability-adjusted life years (DALYs) were described for metabolic diseases (type 2 diabetes mellitus [T2DM], hyperlipidemia, hypertension, obesity, non-alcoholic fatty liver disease [NAFLD]). Subgroup analyses were performed based on sex, geographical regions and Socio-Demographic Index (SDI). Age-standardised death and DALYs were presented per 100,000 population with 95 % uncertainty intervals (UI). Projections of mortality and DALYs were estimated using regression models based on the GBD 2019 data and combining them with Institute for Health Metrics and Evaluation projection counts for years up to 2050. RESULTS In 2019, the highest age-standardised death rates were observed in hypertension (133·88 [121·25-155·73]), followed by obesity (62·59 [39·92-89·13]), hyperlipidemia (56·51 [41·83-73·62]), T2DM (18·49 [17·18-19·66]) and NAFLD (2·09 [1·61-2·60]). Similarly, obesity (1932·54 [1276·61-2639·74]) had the highest age-standardised DALYs, followed by hypertension (2885·57 [2580·75-3201·05]), hyperlipidemia (1207·15 [975·07-1461·11]), T2DM (801·55 [670·58-954·43]) and NAFLD (53·33 [40·73-68·29]). Mortality rates decreased over time in hyperlipidemia (-0·6 %), hypertension (-0·47 %), NAFLD (-0·31 %) and T2DM (-0·20 %), but not in obesity (1·07 % increase). The highest metabolic-related mortality was observed in Eastern Mediterranean and low SDI countries. By 2050, obesity is projected to contribute to the largest number of deaths (102·8 % increase from 2019), followed by hypertension (61·4 % increase), hyperlipidemia (60·8 % increase), T2DM (158·6 % increase) and NAFLD (158·4 % increase), with males continuing to bear the greatest burden across all metabolic diseases. CONCLUSION The growing burden of metabolic diseases, increasing obesity-related mortality trends, and the sex-regional-socioeconomic disparities evident in young adulthood, underlie the concerning growing global burden of metabolic diseases now and in future.
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Affiliation(s)
- Bryan Chong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Gwyneth Kong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Kannan Shankar
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - H S Jocelyn Chew
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Chaoxing Lin
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Rachel Goh
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Yip Han Chin
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Darren Jun Hao Tan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Kai En Chan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Wen Hui Lim
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Nicholas Syn
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Division of General Surgery, University Surgical Cluster, National University Hospital, Singapore, Singapore
| | - Siew Pang Chan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Biostatistics, Cardiovascular Research Institute, National University Heart Centre, NUHS, Singapore; Department of Cardiology, National University Heart Centre, National University Health System, Singapore
| | - Jiong-Wei Wang
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Surgery, Cardiovascular Research Institute (CVRI), National University Heart Centre, Singapore; Nanomedicine Translational Research Programme, Centre for NanoMedicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Chin Meng Khoo
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Division of Endocrinology, Department of Medicine, National University Hospital, Singapore
| | - Georgios K Dimitriadis
- Department of Endocrinology ASO/EASO COM, King's College Hospital NHS Foundation Trust, Denmark Hill, London, United Kingdom; Obesity, Type 2 Diabetes and Immunometabolism Research Group, Department of Diabetes, Faculty of Cardiovascular Medicine & Sciences, School of Life Course Sciences, King's College London, London, United Kingdom
| | - Karn Wijarnpreecha
- Division of Gastroenterology and Hepatology, University of Arizona College of Medicine Phoenix, USA
| | - Arun Sanyal
- Division of Gastroenterology, Hepatology and Nutrition, Department of Internal Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | | | - Mohammad Shadab Siddiqui
- Division of Gastroenterology, Hepatology and Nutrition, Department of Internal Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | - Roger Foo
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Cardiology, National University Heart Centre, National University Health System, Singapore
| | - Anurag Mehta
- Division of Cardiology, Virginia Commonwealth University, Richmond, VA, USA
| | - Gemma A Figtree
- Northern Clinical School, Kolling Institute of Medical Research, University of Sydney, Sydney, New South Wales, Australia; Department of Cardiology, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Derek J Hausenloy
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Cardiovascular & Metabolic Disorders Program, Duke-National University of Singapore Medical School, Singapore; National Heart Research Institute Singapore, National Heart Centre, Singapore; The Hatter Cardiovascular Institute, University College London, London, UK; Cardiovascular Research Center, College of Medical and Health Sciences, Asia University, Taiwan
| | - Mark Y Chan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Cardiology, National University Heart Centre, National University Health System, Singapore
| | - Cheng Han Ng
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Mark Muthiah
- Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore, Singapore; National University Centre for Organ Transplantation, National University Health System, Singapore
| | - Mamas A Mamas
- Institute of Population Health, University of Manchester, Manchester, UK; Keele Cardiac Research Group, Centre for Prognosis Research, Keele University, Stoke-on-Trent, UK
| | - Nicholas W S Chew
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Cardiology, National University Heart Centre, National University Health System, Singapore.
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12
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Chew NWS, Ng CH, Tan DJH, Kong G, Lin C, Chin YH, Lim WH, Huang DQ, Quek J, Fu CE, Xiao J, Syn N, Foo R, Khoo CM, Wang JW, Dimitriadis GK, Young DY, Siddiqui MS, Lam CSP, Wang Y, Figtree GA, Chan MY, Cummings DE, Noureddin M, Wong VWS, Ma RCW, Mantzoros CS, Sanyal A, Muthiah MD. The global burden of metabolic disease: Data from 2000 to 2019. Cell Metab 2023; 35:414-428.e3. [PMID: 36889281 DOI: 10.1016/j.cmet.2023.02.003] [Citation(s) in RCA: 82] [Impact Index Per Article: 82.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Revised: 12/19/2022] [Accepted: 02/03/2023] [Indexed: 03/09/2023]
Abstract
Global estimates of prevalence, deaths, and disability-adjusted life years (DALYs) from the Global Burden of Diseases, Injuries, and Risk Factors Study 2019 were examined for metabolic diseases (type 2 diabetes mellitus [T2DM], hypertension, and non-alcoholic fatty liver disease [NAFLD]). For metabolic risk factors (hyperlipidemia and obesity), estimates were limited to mortality and DALYs. From 2000 to 2019, prevalence rates increased for all metabolic diseases, with the greatest increase in high socio-demographic index (SDI) countries. Mortality rates decreased over time in hyperlipidemia, hypertension, and NAFLD, but not in T2DM and obesity. The highest mortality was found in the World Health Organization Eastern Mediterranean region, and low to low-middle SDI countries. The global prevalence of metabolic diseases has risen over the past two decades regardless of SDI. Urgent attention is needed to address the unchanging mortality rates attributed to metabolic disease and the entrenched sex-regional-socioeconomic disparities in mortality.
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Affiliation(s)
- Nicholas W S Chew
- Department of Cardiology, National University Heart Centre, National University Health System, Singapore, Singapore.
| | - Cheng Han Ng
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
| | - Darren Jun Hao Tan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Gwyneth Kong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Chaoxing Lin
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Yip Han Chin
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Wen Hui Lim
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Daniel Q Huang
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore; Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore, Singapore; National University Centre for Organ Transplantation, National University Health System, Singapore, Singapore
| | - Jingxuan Quek
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Clarissa Elysia Fu
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Jieling Xiao
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Nicholas Syn
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore; Division of General Surgery, University Surgical Cluster, National University Hospital, Singapore, Singapore
| | - Roger Foo
- Department of Cardiology, National University Heart Centre, National University Health System, Singapore, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Chin Meng Khoo
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore; Division of Endocrinology, Department of Medicine, National University Hospital, Singapore, Singapore
| | - Jiong-Wei Wang
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore; Cardiovascular Research Institute, National University Heart Centre, National University Health System, Singapore, Singapore; Nanomedicine Translational Research Programme, Centre for NanoMedicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Georgios K Dimitriadis
- Department of Endocrinology ASO/Easo COM, King's College Hospital NHS Foundation Trust, Denmark Hill, London, UK; Obesity, Type 2 Diabetes and Immunometabolism Research Group, Department of Diabetes, Faculty of Cardiovascular Medicine & Sciences, School of Life Course Sciences, King's College London, London, UK
| | - Dan Yock Young
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore; Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore, Singapore; National University Centre for Organ Transplantation, National University Health System, Singapore, Singapore
| | - Mohammad Shadab Siddiqui
- Division of Gastroenterology, Hepatology and Nutrition, Department of Internal Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | - Carolyn S P Lam
- National Heart Centre Singapore, Singapore, Singapore; Duke-NUS Medical School, Singapore, Singapore
| | - Yibin Wang
- Duke-NUS Medical School, Singapore, Singapore
| | - Gemma A Figtree
- Northern Clinical School, Kolling Institute of Medical Research, University of Sydney, Sydney, NSW, Australia; Department of Cardiology, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Mark Y Chan
- Department of Cardiology, National University Heart Centre, National University Health System, Singapore, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - David E Cummings
- UW Medicine Diabetes Institute, VA Puget Sound Health Care System, University of Washington, Seattle, WA, USA
| | | | - Vincent Wai-Sun Wong
- Department of Medicine and Therapeutics, Chinese University of Hong Kong, Hong Kong, China
| | - Ronald Ching Wan Ma
- Department of Medicine and Therapeutics, Chinese University of Hong Kong, Hong Kong, China; Li Ka Shing Institute of Health Sciences, Chinese University of Hong Kong, Hong Kong, China; Hong Kong Institute of Diabetes and Obesity, Chinese University of Hong Kong, Hong Kong, China
| | - Christos S Mantzoros
- Section of Endocrinology, Boston VA Healthcare System, Boston, MA, USA; Faculty of Medicine, Harvard University, Boston, MA, USA
| | - Arun Sanyal
- Division of Gastroenterology, Hepatology and Nutrition, Department of Internal Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | - Mark Dhinesh Muthiah
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore; Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore, Singapore; National University Centre for Organ Transplantation, National University Health System, Singapore, Singapore
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13
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Kong G, Zhang A, Chong B, Lim J, Kannan S, Han Chin Y, Ng CH, Lin C, Khoo CM, Muthiah M, Dalakoti M, Kristanto W, Wang Y, Kong W, Poh KK, Chai P, Foo R, Chan MYY, Loh PH, Chew NWS. Long-Term Prognosis of Patients With Coexisting Obesity and Malnutrition After Acute Myocardial Infarction: A Cohort Study. Circ Cardiovasc Qual Outcomes 2023; 16:e009340. [PMID: 36866663 DOI: 10.1161/circoutcomes.122.009340] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
BACKGROUND The double burden of malnutrition, described as the coexistence of malnutrition and obesity, is a growing global health issue. This study examines the combined effects of obesity and malnutrition on patients with acute myocardial infarction (AMI). METHODS Patients presenting with AMI to a percutaneous coronary intervention-capable hospital in Singapore between January 2014 and March 2021 were retrospectively studied. Patients were stratified into the following: (1) nourished nonobese, (2) malnourished nonobese, (3) nourished obese, and (4) malnourished obese. Obesity and malnutrition were defined according to the World Health Organization definition (body mass index ≥27.5 kg/m2) and Controlling Nutritional Status score, respectively. The primary outcome was all-cause mortality. The association between combined obesity and nutritional status with mortality was examined using Cox regression, adjusted for age, sex, AMI type, previous AMI, ejection fraction, and chronic kidney disease. Kaplan-Meier curves for all-cause mortality were constructed. RESULTS The study included 1829 AMI patients, of which 75.7% were male and mean age was 66 years. Over 75% of patients were malnourished. Majority were malnourished nonobese (57.7%), followed by malnourished obese (18.8%), nourished nonobese (16.9%), and nourished obese (6.6%). Malnourished nonobese had highest all-cause mortality (38.6%), followed by the malnourished obese (35.8%), nourished nonobese (21.4%), and nourished obese (9.9%, P<0.001). Kaplan-Meier curves demonstrated least favorable survival in malnourished nonobese group, followed by malnourished obese, nourished nonobese, and nourished obese. With nourished nonobese group as the reference, malnourished nonobese had higher all-cause mortality (hazard ratio, 1.46 [95% CI, 1.10-1.96], P=0.010), but only a nonsignificant increase in mortality was observed in the malnourished obese (hazard ratio, 1.31 [95% CI, 0.94-1.83], P=0.112). CONCLUSIONS Among AMI patients, malnutrition is prevalent even in the obese. Compared to nourished patients, malnourished AMI patients have a more unfavorable prognosis especially in those with severe malnutrition regardless of obesity status, but long-term survival is the most favorable among nourished obese patients.
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Affiliation(s)
- Gwyneth Kong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore (G.K., B.C., J.L., S.K., Y.H.C., C.H.N., C.L., M.D., W. Kristanto, W. Kong, K.K., P.C., R.F., M.Y.-Y.C., P.-H.L.)
| | - Audrey Zhang
- Department of Medicine, National University Hospital, Singapore (A.Z.)
| | - Bryan Chong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore (G.K., B.C., J.L., S.K., Y.H.C., C.H.N., C.L., M.D., W. Kristanto, W. Kong, K.K., P.C., R.F., M.Y.-Y.C., P.-H.L.)
| | - Jieyu Lim
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore (G.K., B.C., J.L., S.K., Y.H.C., C.H.N., C.L., M.D., W. Kristanto, W. Kong, K.K., P.C., R.F., M.Y.-Y.C., P.-H.L.)
| | - Shankar Kannan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore (G.K., B.C., J.L., S.K., Y.H.C., C.H.N., C.L., M.D., W. Kristanto, W. Kong, K.K., P.C., R.F., M.Y.-Y.C., P.-H.L.)
| | - Yip Han Chin
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore (G.K., B.C., J.L., S.K., Y.H.C., C.H.N., C.L., M.D., W. Kristanto, W. Kong, K.K., P.C., R.F., M.Y.-Y.C., P.-H.L.)
| | - Cheng Han Ng
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore (G.K., B.C., J.L., S.K., Y.H.C., C.H.N., C.L., M.D., W. Kristanto, W. Kong, K.K., P.C., R.F., M.Y.-Y.C., P.-H.L.)
| | - Chaoxing Lin
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore (G.K., B.C., J.L., S.K., Y.H.C., C.H.N., C.L., M.D., W. Kristanto, W. Kong, K.K., P.C., R.F., M.Y.-Y.C., P.-H.L.)
| | - Chin Meng Khoo
- Division of Endocrinology, Department of Medicine, National University Hospital, Singapore (C.M.K.)
| | - Mark Muthiah
- Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore (M.M.)
| | - Mayank Dalakoti
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore (G.K., B.C., J.L., S.K., Y.H.C., C.H.N., C.L., M.D., W. Kristanto, W. Kong, K.K., P.C., R.F., M.Y.-Y.C., P.-H.L.).,Department of Cardiology, National University Heart Centre, National University Health System, Singapore (M.D., W. Kristanto, W. Kong, K.K.P., P.C., R.F., M.Y.-Y.C., P.-H.L., N.W.S.C.).,Department of Cardiology, Ng Teng Fong General Hospital, Singapore (M.D., W.K., P.-H.L.)
| | - William Kristanto
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore (G.K., B.C., J.L., S.K., Y.H.C., C.H.N., C.L., M.D., W. Kristanto, W. Kong, K.K., P.C., R.F., M.Y.-Y.C., P.-H.L.).,Department of Cardiology, National University Heart Centre, National University Health System, Singapore (M.D., W. Kristanto, W. Kong, K.K.P., P.C., R.F., M.Y.-Y.C., P.-H.L., N.W.S.C.).,Department of Cardiology, Ng Teng Fong General Hospital, Singapore (M.D., W.K., P.-H.L.)
| | - Yibin Wang
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore (G.K., B.C., J.L., S.K., Y.H.C., C.H.N., C.L., M.D., W. Kristanto, W. Kong, K.K., P.C., R.F., M.Y.-Y.C., P.-H.L.).,National University Centre for Organ Transplantation, National University Health System, Singapore (M.M.). Duke-NUS Medical School, Singapore (Y.W.)
| | - William Kong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore (G.K., B.C., J.L., S.K., Y.H.C., C.H.N., C.L., M.D., W. Kristanto, W. Kong, K.K., P.C., R.F., M.Y.-Y.C., P.-H.L.).,Department of Cardiology, National University Heart Centre, National University Health System, Singapore (M.D., W. Kristanto, W. Kong, K.K.P., P.C., R.F., M.Y.-Y.C., P.-H.L., N.W.S.C.)
| | - Kian Keong Poh
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore (G.K., B.C., J.L., S.K., Y.H.C., C.H.N., C.L., M.D., W. Kristanto, W. Kong, K.K., P.C., R.F., M.Y.-Y.C., P.-H.L.).,Department of Cardiology, National University Heart Centre, National University Health System, Singapore (M.D., W. Kristanto, W. Kong, K.K.P., P.C., R.F., M.Y.-Y.C., P.-H.L., N.W.S.C.)
| | - Ping Chai
- Department of Cardiology, National University Heart Centre, National University Health System, Singapore (M.D., W. Kristanto, W. Kong, K.K.P., P.C., R.F., M.Y.-Y.C., P.-H.L., N.W.S.C.)
| | - Roger Foo
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore (G.K., B.C., J.L., S.K., Y.H.C., C.H.N., C.L., M.D., W. Kristanto, W. Kong, K.K., P.C., R.F., M.Y.-Y.C., P.-H.L.).,Department of Cardiology, National University Heart Centre, National University Health System, Singapore (M.D., W. Kristanto, W. Kong, K.K.P., P.C., R.F., M.Y.-Y.C., P.-H.L., N.W.S.C.)
| | - Mark Yan-Yee Chan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore (G.K., B.C., J.L., S.K., Y.H.C., C.H.N., C.L., M.D., W. Kristanto, W. Kong, K.K., P.C., R.F., M.Y.-Y.C., P.-H.L.).,Department of Cardiology, National University Heart Centre, National University Health System, Singapore (M.D., W. Kristanto, W. Kong, K.K.P., P.C., R.F., M.Y.-Y.C., P.-H.L., N.W.S.C.)
| | - Poay-Huan Loh
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore (G.K., B.C., J.L., S.K., Y.H.C., C.H.N., C.L., M.D., W. Kristanto, W. Kong, K.K., P.C., R.F., M.Y.-Y.C., P.-H.L.).,Department of Cardiology, National University Heart Centre, National University Health System, Singapore (M.D., W. Kristanto, W. Kong, K.K.P., P.C., R.F., M.Y.-Y.C., P.-H.L., N.W.S.C.).,Department of Cardiology, Ng Teng Fong General Hospital, Singapore (M.D., W.K., P.-H.L.)
| | - Nicholas W S Chew
- Department of Cardiology, National University Heart Centre, National University Health System, Singapore (M.D., W. Kristanto, W. Kong, K.K.P., P.C., R.F., M.Y.-Y.C., P.-H.L., N.W.S.C.)
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14
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Fu CE, Yong JN, Ng CH, Nah B, Chew NWS, Chin YH, Kong G, Tan DJH, Lim WH, Lim LKE, Zeng RW, Shabbir A, Tan EXX, Huang DQ, Khoo CM, Siddqui MS, Chan MYY, Noureddin M, Mamas MA, Muthiah M. Original article: The prognostic value of including non-alcoholic fatty liver disease in the definition of metabolic syndrome. Aliment Pharmacol Ther 2023; 57:979-987. [PMID: 36710531 DOI: 10.1111/apt.17397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 12/05/2022] [Accepted: 01/08/2023] [Indexed: 01/31/2023]
Abstract
BACKGROUND/AIMS Metabolic syndrome (MetS) affects over one third of the US adult population. Despite its close association with non-alcoholic fatty liver disease (NAFLD), the traditional definition of MetS does not account for the presence of NAFLD. The present study thus aims to evaluate the inclusion of NAFLD in the diagnostic criteria of metabolic syndrome on its accuracy of capturing individuals with metabolic dysregulation and its prediction of adverse events. METHODS Data collected from NHANES between 1999 and 2018 was analysed. Clinical characteristics and outcomes between individuals with metabolic syndrome from both the American Heart Association/National Heart, Lung, and Blood Institute (MetS) and the study's proposed diagnostic criteria (MetS2) were evaluated. Outcomes in both groups were evaluated with multivariate analyses, and further subgroup analysis on individuals matched with Coarsened Exact Matching was performed. RESULTS Of 46,184 individuals included, 32.54% and 40.54% fulfilled MetS and MetS2 criteria respectively. Considering NAFLD in the definition of metabolic syndrome, a further 8.00% (n = 3694) were included. MetS was significantly associated with all-cause (HR: 1.184, 95% CI: 1.110-1.263, p < 0.001) and cardiovascular disease (CVD) mortality (SHR: 1.288, 95% CI: 1.233-1.347, p < 0.001), and major adverse cardiovascular events (MACE). MetS2 was similarly associated with all-cause (HR: 1.175, 95% CI: 1.088-1.269, p < 0.001), CVD mortality (SHR: 1.283, 95% CI: 1.245-1.323, p < 0.001) and MACE. CONCLUSION Inclusion of NAFLD allows for identification a greater proportion of the population with metabolic risk. This allows for early intervention and potential to lift some burden off the global healthcare system.
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Affiliation(s)
- Clarissa Elysia Fu
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Jie Ning Yong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Cheng Han Ng
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Benjamin Nah
- Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore, Singapore
| | - Nicholas W S Chew
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Department of Cardiology, National University Heart Centre, National University Hospital, Singapore, Singapore
| | - Yip Han Chin
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Gwyneth Kong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Darren Jun Hao Tan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Wen Hui Lim
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Lincoln Kai En Lim
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | | - Asim Shabbir
- Division of General Surgery (Upper Gastrointestinal Surgery), Department of Surgery, National University Hospital, Singapore, Singapore
| | - Eunice X X Tan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore, Singapore.,National University Centre for Organ Transplantation, National University Health System, Singapore, Singapore
| | - Daniel Q Huang
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore, Singapore.,National University Centre for Organ Transplantation, National University Health System, Singapore, Singapore
| | - Chin Meng Khoo
- Division of Endocrinology, Department of Medicine, National University Hospital, Singapore, Singapore
| | - Mohammad Shadab Siddqui
- Division of Gastroenterology, Hepatology and Nutrition, Department of Internal Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Mark Y Y Chan
- Department of Cardiology, National University Heart Centre, National University Hospital, Singapore, Singapore
| | | | - Mamas A Mamas
- Keele Cardiac Research Group, Keele University, Stroke-on-Trent, UK
| | - Mark Muthiah
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore, Singapore.,National University Centre for Organ Transplantation, National University Health System, Singapore, Singapore
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15
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Chong B, Yaow C, Chin YH, Ng CH, Goh R, Kong G, Muthiah M, Sukmawati I, Lukito AA, Chan MY, Khoo CM, Mehta A, Dimitriadis GK, Chew NWS. Higher risk of adverse cardiovascular outcomes in women with type 2 diabetes mellitus: an umbrella review of systematic reviews. Eur Heart J 2023. [DOI: 10.1093/eurheartj/ehac779.106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Previous studies have shown that females with type 2 diabetes mellitus (T2DM) may have an excess mortality risk compared to males. Furthermore, other studies have reported sex differences in managing cardiovascular risk factors, such as controlling hypertension and hypercholesterolemia.
Purpose
With the growing evidence from systematic reviews examining the sex differences in cardiovascular outcomes for patients with T2DM, an umbrella review is an essential next step to synthesising and assessing the strength of the available evidence.
Methods
Medline and Embase were searched from inception till 7th August 2022 for systematic reviews and meta-analyses studying the effects of sex on cardiovascular outcomes in T2DM patients. Results from reviews were synthesised with a narrative synthesis, with a tabular presentation of findings and forest plots for reviews that performed a meta-analysis. AMSTAR 2 tool was used to assess the methodological quality of included reviews, while the GRADE assessment was used to assess the quality of evidence for outcomes.
Results
A total of 28 studies evaluating sex differences in cardiovascular outcomes were included. Females with T2DM had a higher risk of developing coronary heart disease (CHD; RRR 1.52, 95%CI 1.32–1.76, p<0.001), acute coronary syndrome (ACS; RRR 1.38, 95%CI 1.25–1.52, p<0.001), and heart failure (RRR 1.09, 95%CI 1.05–1.13, p<0.001) than males. In terms of mortality outcomes, females had a higher risk of all-cause mortality (RRR 1.13, 95%CI 1.07–1.19, p<0.001), cardiac mortality (RRR 1.49, 95%CI 1.11–2.00, p=0.009) and CHD mortality (RRR 1.44, 95%CI 1.20–1.73, p<0.001) as compared to males. In patients undergoing percutaneous coronary intervention, females reported higher odds of MACE (OR 1.49, 95%CI 1.07–2.07, p=0.020) and all-cause mortality (OR 1.71, 95%CI 1.46–2.00, p<0.001) compared to males. Females in Asia (RRR 1.12, 95%CI 1.03–1.21, p=0.006) and North America (RRR 1.10, 95%CI 1.08–1.12, p<0.001) were at increased risk of all-cause mortality while females in Western countries had an increased risk for cardiac death (RRR 1.84, 95%CI 1.45–2.32, p<0.001) compared to males. Six reviews were rated as high in quality; eight reviews were rated as moderate, and fourteen reviews were rated as low in quality. Regarding the quality of outcomes, all outcomes in non-interventional studies had a moderate quality of evidence, while all outcomes in interventional studies achieved a high quality of evidence.
Conclusions
This umbrella review evaluated the quality of meta-analyses and demonstrated that females with T2DM have a higher risk of cardiovascular outcomes than their male counterparts. Future studies examining the sex differences in outcomes should attempt to address the heterogeneity and epidemiological factors for a better quality of evidence. Policymakers should consider sex-specific differences in implementing effective tailored strategies to tackle T2DM.
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Affiliation(s)
- B Chong
- National University of Singapore , Singapore , Singapore
| | - C Yaow
- National University of Singapore , Singapore , Singapore
| | - Y H Chin
- National University of Singapore , Singapore , Singapore
| | - C H Ng
- National University of Singapore , Singapore , Singapore
| | - R Goh
- National University of Singapore , Singapore , Singapore
| | - G Kong
- National University of Singapore , Singapore , Singapore
| | - M Muthiah
- National University Hospital , Singapore , Singapore
| | - I Sukmawati
- Pelita Harapan University, Department of Cardiology , Tangerang , Indonesia
| | - A A Lukito
- Pelita Harapan University, Department of Cardiology , Tangerang , Indonesia
| | - M Y Chan
- National University Heart Centre, Department of Cardiology , Singapore , Singapore
| | - C M Khoo
- National University Hospital, Division of Endocrinology, Department of Medicine , Singapore , Singapore
| | - A Mehta
- VCU Health Pauley Heart Center, Division of Cardiology, Department of Internal Medicine , Richmond , United States of America
| | - G K Dimitriadis
- King's College London, Obesity, Type 2 Diabetes and Immunometabolism Research Group, Department of Diabetes , London , United Kingdom of Great Britain & Northern Ireland
| | - N W S Chew
- National University Heart Centre, Department of Cardiology , Singapore , Singapore
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16
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Anand VV, Goh RSJ, Nah B, Koh SWC, Lim J, Neo NWS, Chew J, Lee YY, Chin YH, Chong B, Kong G, Tan B, Low Z, Khoo CM, Goh LH, Loh PH, Chai P, Dalakoti M, Chan M, Foo R, Muthiah M, Chew NWS. General Public's knowledge, awareness, and perception of Cardiometabolic diseases: data from a Singapore study population. Front Med (Lausanne) 2023; 10:1193829. [PMID: 37168269 PMCID: PMC10165106 DOI: 10.3389/fmed.2023.1193829] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Accepted: 04/06/2023] [Indexed: 05/13/2023] Open
Abstract
Background Health literacy and illness perception play crucial roles in tackling the cardiometabolic disease epidemic. We aim to compare the attitudes, knowledge, self-perceived risks and actions taken, between individuals with and without metabolic risk factors (MFs). Methods From 5 June to 5 October 2022, participants of the general public were invited to complete a self-administered questionnaire. MF status was defined as the presence of hypertension, hyperlipidemia, diabetes mellitus and/or current/previous smoking. Participants were assessed based on four categories (knowledge-based, attitude-based, perceived risk, and action-based) of questions pertaining to four cardiometabolic diseases - diabetes mellitus, hypertension, hyperlipidemia, and non-alcoholic fatty liver disease. Results A total of 345 participants were enrolled, of whom 34.5% had at least one MF. Compared to those without MFs, participants with MFs had lower knowledge scores, but higher perceived risk scores across all cardiometabolic diseases. The largest knowledge gap pertained to hypertension-related questions. After adjustment, linear regression demonstrated that the presence of MFs (β:2.752, 95%CI: 0.772-4.733, p = 0.007) and higher knowledge scores (β:0.418, 95%CI: 0.236-0.600, p < 0.001) were associated with higher perceived risk. Despite increased perceived risk in those with MFs, this translated to only few increased self-reported preventive actions, when compared to those without MFs, namely the reduction in red meat/processed food consumption (p = 0.045) and increase in fruits/vegetables consumption (p = 0.009). Conclusion This study identified a vulnerable subpopulation living with MFs, with high perceived risks, and discordant levels of knowledge and preventive actions taken. Nationwide efforts should be channeled into addressing the knowledge-to-action gap.
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Affiliation(s)
- Vickram Vijay Anand
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Rachel Sze Jen Goh
- Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore
| | - Benjamin Nah
- Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore, Singapore
| | - Sky Wei Chee Koh
- National University Polyclinics, National University Health System, Singapore, Singapore
- Division of Family Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Jieyu Lim
- Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore
| | - Nicholas W. S. Neo
- Nursing Department, National University Heart Centre, Singapore, Singapore
| | - Jocelyn Chew
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore
| | - Yuan Ying Lee
- Nursing Department, National University Heart Centre, Singapore, Singapore
| | - Yip Han Chin
- Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore
| | - Bryan Chong
- Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore
| | - Gwyneth Kong
- Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore
| | - Bryan Tan
- Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore
| | - Zhiwen Low
- Faculty of Science, Monash University, Melbourne, VIC, Australia
| | - Chin Meng Khoo
- Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore
- Department of Endocrinology, National University Hospital, Singapore, Singapore
| | - Lay Hoon Goh
- National University Polyclinics, National University Health System, Singapore, Singapore
- Division of Family Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Poay Huan Loh
- Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore
- Department of Cardiology, National University Heart Centre, National University Health System, Singapore, Singapore
- Division of Cardiology, Department of Medicine, Ng Teng Fong General Hospital, Singapore, Singapore
| | - Ping Chai
- Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore
- Department of Cardiology, National University Heart Centre, National University Health System, Singapore, Singapore
| | - Mayank Dalakoti
- Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore
- Department of Cardiology, National University Heart Centre, National University Health System, Singapore, Singapore
| | - Mark Chan
- Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore
- Department of Cardiology, National University Heart Centre, National University Health System, Singapore, Singapore
| | - Roger Foo
- Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore
- Department of Cardiology, National University Heart Centre, National University Health System, Singapore, Singapore
| | - Mark Muthiah
- Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore
- Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore, Singapore
- National University Centre for Organ Transplantation, National University Health System, Singapore, Singapore
| | - Nicholas W. S. Chew
- Department of Cardiology, National University Heart Centre, National University Health System, Singapore, Singapore
- *Correspondence: Nicholas W. S. Chew,
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17
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Chin YH, Ng CH, Chew NWS, Kong G, Lim WH, Tan DJH, Chan KE, Tang A, Huang DQ, Chan MY, Figtree G, Wang JW, Shabbir A, Khoo CM, Wong VWS, Young DY, Siddiqui MS, Noureddin M, Sanyal A, Cummings DE, Syn N, Muthiah MD. The placebo response rate and nocebo events in obesity pharmacological trials. A systematic review and meta-analysis. EClinicalMedicine 2022; 54:101685. [PMID: 36193169 PMCID: PMC9526167 DOI: 10.1016/j.eclinm.2022.101685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 09/13/2022] [Accepted: 09/13/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND There is a growing number of trials examining the effectiveness of pharmacotherapies for obesity, however, little is known about placebo and nocebo effect in these trials. Hence, we sought to examine the effect of placebo in obesity trials, to better understand the potential factors affecting clinical endpoints in them. METHODS Medline, Embase, and Cochrane CENTRAL were searched for articles examining weight-loss RCTs examining patients with overweight or obesity in placebo-controlled arms from inception till 25 June 2022. This paper was registered online with PROSPERO (CRD42022302482). A single arm meta-analysis of proportions was used to estimate the primary outcomes, ≥5%, ≥10%, and ≥15% total weight loss - and the adverse effects that patients experienced during the trial. A meta-analysis of means was used to estimate the pooled mean differences of the secondary outcomes including, body weight measurements, lipid levels, glycemic indices, and blood pressure over time. FINDINGS A total of 63 papers involving 20,454 patients and 69 trials were included. The proportion of patients that had ≥5%, ≥10%, and ≥15% weight loss was 20·4% (CI:16·1% to 25·0%), 8·3% (CI:6·1% to 10·9%), and 6·2% (CI:3·8% to 9·7%), respectively. Analysis by duration of trials showed stepwise increase in proportion of patients with ≥5% and ≥10% weight loss with increasing duration of study. Analysis of secondary outcomes found modest improvement in all analyses. The pooled average rate of overall AEs, serious AEs, and discontinuation was 73·7% (CI:68·0% to 79·0%), 3·4% (CI:2·4% to 4·5%), and 5·2% (CI:4·0% to 6·5%), respectively. In psychiatric complications, the pooled rates of anxiety and depression were 2·7% (CI:1·8% to 3·7%) and 2·5 (CI:1·7% to 3·3%). INTERPRETATION Our meta-analysis of placebo-treated participants in weight-loss RCTs indicate a significant placebo and nocebo effect. These findings are important to quantify their effect and may inform the design of future RCTs. FUNDING This research did not receive additional support from organizations beyond the authors' academic institutions.
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Affiliation(s)
- Yip Han Chin
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Cheng Han Ng
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Corresponding author at: Yong Loo Lin School of Medicine, National University of Singapore, Singapore 10 Medical Dr, 117597 Singapore.
| | - Nicholas WS Chew
- Department of Cardiology, National University Heart Centre, Singapore
| | - Gwyneth Kong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Wen Hui Lim
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Darren Jun Hao Tan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Kai En Chan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Ansel Tang
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Daniel Q Huang
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore
- National University Centre for Organ Transplantation, National University Health System, Singapore
| | - Mark Y Chan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Department of Cardiology, National University Heart Centre, Singapore
| | - Gemma Figtree
- Northern Clinical School, Kolling Institute of Medical Research, University of Sydney, Sydney, NSW, Australia
- Department of Cardiology, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Jiong-Wei Wang
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Department of Medicine, National University Hospital, Singapore
| | - Asim Shabbir
- Division of General Surgery (Upper Gastrointestinal Surgery), Department of Surgery, National University Hospital
| | - Chin Meng Khoo
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Department of Endocrinology, National University Hospital, Singapore
| | | | - Dan Yock Young
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Mohammad Shadab Siddiqui
- Division of Gastroenterology, Hepatology and Nutrition, Department of Internal Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | - Mazen Noureddin
- Cedars-Sinai Fatty Liver Program, Division of Digestive and Liver Diseases, Department of Medicine, Comprehensive Transplant Centre, Cedars-Sinai Medical Centre, Los Angeles, CA, USA
| | - Arun Sanyal
- Division of Gastroenterology, Hepatology and Nutrition, Department of Internal Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | - David E. Cummings
- UW Medicine Diabetes Institute, VA Puget Sound Health Care System, University of Washington, Seattle, WA, USA
| | - Nicholas Syn
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Mark Dhinesh Muthiah
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore
- National University Centre for Organ Transplantation, National University Health System, Singapore
- Corresponding author at: Consultant Gastroenterologist and Hepatologist, Division of Gastroenterology and Hepatology, Tower Block Level 10, 1E Kent Ridge Road, 119228 Singapore.
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18
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Anand VV, Zhe ELC, Chin YH, Lim WH, Goh RSJ, Lin C, Ng CH, Kong G, Tay PWL, Devi K, Muthiah M, Singh V, Chu DT, Khoo CM, Chan MY, Dimitriadis GK, Foo R, Chew NWS. Barriers and Facilitators to Engagement With a Weight Management Intervention in Asian Patients With Overweight or Obesity: A Systematic Review. Endocr Pract 2022; 29:398-407. [PMID: 36396016 DOI: 10.1016/j.eprac.2022.10.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 09/08/2022] [Accepted: 10/12/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The obesity epidemic is a global health concern with Asian countries facing one of the most rapid rises in obesity rates. However, given the underwhelming long-term efficacy of weight loss strategies, especially in Asia, this review aimed to explore barriers and facilitators to weight management of patients with overweight and obesity in Asia. METHODS Medline, CINAHL, PsycINFO, and Web of Science were searched for articles discussing barriers and facilitators of treatment to obesity from the perspectives of both health care professionals (HCPs) and patients. Qualitative and mixed method studies from Asia were included. Key quotes were extracted, coded, and thematically analyzed according to the methodology of Thomas and Harden. RESULTS A total of 26 articles were included in this review. From patient perspectives, 3 main themes were identified: factors influencing poor eating behavior, inhibiting lifestyle modifications, and facilitating lifestyle modifications. Patients highlighted several barriers including the lack of social support, physiologic limitations to exercise, and low health literacy. Rigid sociocultural norms and lack of accessible health care services, exercise facilities, and healthy food exacerbated the barriers. Facilitators to lifestyle modifications consisted of strong support systems and high health literacy. HCPs agreed that low health literacy, lack of social support, and patient motivation impeded patients' weight loss attempts but were unaware of the other barriers they faced. CONCLUSION There are discrepancies between ideas of barriers and facilitators of HCPs and patients. A mixture of population level, primary care, and personal interventions are required to address this disparity, and enhanced health literacy can improve weight loss outcomes.
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Affiliation(s)
- Vickram Vijay Anand
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Ethan Lee Cheng Zhe
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Yip Han Chin
- Yong Loo Lin School of Medicine, National University Singapore, Singapore.
| | - Wen Hui Lim
- Yong Loo Lin School of Medicine, National University Singapore, Singapore
| | - Rachel Sze Jen Goh
- Yong Loo Lin School of Medicine, National University Singapore, Singapore
| | - Chaoxing Lin
- Yong Loo Lin School of Medicine, National University Singapore, Singapore
| | - Cheng Han Ng
- Yong Loo Lin School of Medicine, National University Singapore, Singapore
| | - Gwyneth Kong
- Yong Loo Lin School of Medicine, National University Singapore, Singapore
| | - Phoebe Wen Lin Tay
- Yong Loo Lin School of Medicine, National University Singapore, Singapore
| | - Kamala Devi
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University Singapore, Singapore
| | - Mark Muthiah
- Yong Loo Lin School of Medicine, National University Singapore, Singapore; Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore; National University Centre for Organ Transplantation, National University Health System, Singapore
| | - Vijai Singh
- Department of Biosciences, School of Science, Indrashil University, Rajpur, Mehsana, Gujarat, India
| | - Dinh-Toi Chu
- Center for Biomedicine and Community Health, International School, Vietnam National University, Hanoi, Vietnam; Department of Natural Science and Technology, International School, Vietnam National University, Hanoi, Vietnam
| | - Chin Meng Khoo
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore; Department of Endocrinology, National University Hospital, Singapore
| | - Mark Y Chan
- Yong Loo Lin School of Medicine, National University Singapore, Singapore; Department of Cardiology, National University Heart Centre, National University Health System, Singapore
| | - Georgios K Dimitriadis
- Faculty of Life Sciences and Medicine, School of Life Course Sciences, King's College London, London, United Kingdom; Department of Endocrinology ASO/EASO COM, King's College Hospital NHS Foundation Trust, Denmark Hill, London, United Kingdom
| | - Roger Foo
- Yong Loo Lin School of Medicine, National University Singapore, Singapore; Department of Cardiology, National University Heart Centre, National University Health System, Singapore
| | - Nicholas W S Chew
- Department of Cardiology, National University Heart Centre, National University Health System, Singapore.
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19
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Chew N, Ng CH, Kong G, Chin YH, Lim O, Lim WH, Dalakoti M, Khoo CM, Kong W, Poh KK, Foo R, Lee CH, Chan MY, Muthiah M, Loh PH. Metabolic associated fatty liver disease increases risk of adverse events after acute coronary syndrome. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Metabolic Associated Fatty Liver Disease (MAFLD) was recently introduced as an alternative definition for fatty liver, that has been linked to an increased risk of systemic end-organ damage. However, current studies have not examined the impact of MAFLD on patients presenting with acute coronary syndrome (ACS). Here, we present a retrospective analysis on the short and long-term outcomes of ACS patients with MAFLD.
Methods
A retrospective analysis was conducted in a tertiary care centre. Hepatic steatosis and fibrosis was examined with hepatic steatosis index and fibrosis-4 (FIB-4) index. The primary and secondary outcomes of the analysis were long term all-cause mortality, and in-hospital all-cause mortality, stroke, heart failure and cardiogenic shock respectively. Adjusted analysis was conducted for primary and secondary outcomes with covariates including age, sex, race, type of ACS and previous myocardial infarction.
Results
A total of 5770 patients were included in the analysis, and 21% of ACS patients had concomitant MAFLD. MAFLD resulted in a 23% increase in long-term all-cause mortality compared to non-MAFLD (HR: 1.230, CI: 1.065 to 1.420, p=0.005). MAFLD increased the risk of in-hospital mortality, stroke, heart failure and cardiogenic shock compared to non-MAFLD. A sensitivity analysis conducted based on MAFLD with advance fibrosis, chronic kidney disease and diabetes also demonstrated significantly increased effect size magnitude of all-cause mortality, compared to non-MAFLD.
Conclusion
MAFLD represents an encapsulation of metabolism dysregulation and has been associated with increased risk of systematic disease. The present study shows that MAFLD is associated with significantly increased adverse prognostic outcomes after ACS compared to non-MAFLD. An increase in awareness of MAFLD is required beyond the field of hepatology for improvements in multidisciplinary care and management.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- N Chew
- National University Heart Centre , Singapore , Singapore
| | - C H Ng
- National University Health System , Singapore , Singapore
| | - G Kong
- National University Health System , Singapore , Singapore
| | - Y H Chin
- National University Health System , Singapore , Singapore
| | - O Lim
- National University of Singapore , Singapore , Singapore
| | - W H Lim
- National University of Singapore , Singapore , Singapore
| | - M Dalakoti
- National University of Singapore , Singapore , Singapore
| | - C M Khoo
- National University Health System , Singapore , Singapore
| | - W Kong
- National University Heart Centre , Singapore , Singapore
| | - K K Poh
- National University Heart Centre , Singapore , Singapore
| | - R Foo
- National University Heart Centre , Singapore , Singapore
| | - C H Lee
- National University Heart Centre , Singapore , Singapore
| | - M Y Chan
- National University Heart Centre , Singapore , Singapore
| | - M Muthiah
- National University Health System , Singapore , Singapore
| | - P H Loh
- National University Heart Centre , Singapore , Singapore
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20
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Chew N, Kong G, Ng CH, S V, Chin YH, Muthiah MY, Khoo CM, Chai PH, Foo R, Chan MY, Loh PH. The prognostic outcomes of acute myocardial infarction stratified according to metabolic health and obesity status. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
There has been emerging evidence on the favourable cardiovascular disease incidence in non-obese subjects with healthy metabolism. However, little is known regarding the prognosis across the metabolic phenotypes once cardiovascular disease is established. This study examines the prognosis of patients with acute myocardial infarction (AMI) stratified according to metabolic health and obesity status.
Methods
A retrospective study conducted in a tertiary hospital between 2014–2021. Consecutive patients with AMI were allocated into 4 groups based on metabolic and obesity profile: metabolically healthy obesity (MHO), metabolically healthy non-obesity (MHNO), metabolically unhealthy obesity (MUO) and metabolically unhealthy non-obesity (MUNO). The primary outcome was all-cause mortality. Cox regression examined the independent association between mortality and metabolic phenotypes, adjusting for age, sex, AMI type and ejection fraction.
Results
A total of 9958 patients were studied with majority (68.5%) in the MUNO group, followed by MUO (25.1%), MHNO (5.6%), and MHO (0.8%). MHO patients had lowest mortality (7.4%), followed by MHNO (9.7%), MUO (19.2%) and MUNO (22.6%, p<0.001). Relative to MHNO, MUO (HR 1.610, 95% CI 1.198–2.163, p=0.002) and MUNO (HR 1.383, 95% CI 1.043–1.835, p=0.024) had significantly higher mortality risk, but not MHO (HR 1.514, 95% CI 0.649–3.534, p=0.337), after adjusting for confounders. Kaplan-Meier curves showed favourable survival in metabolically healthy groups with clear divergence from metabolically unhealthy groups (p<0.001). There were stepwise increments in mortality with increasing number of metabolic risk factors regardless of obesity status (p<0.001). Favourable survival was observed in overweight and obese versus normal weight patients regardless of metabolic health.
Conclusion
Metabolically healthy AMI patients had favourable prognosis compared to metabolically unhealthy patients. The obesity paradox was observed in the AMI cohort, but the beneficial effects of obesity appeared not as pronounced in magnitude as in metabolically healthy groups.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- N Chew
- National University Heart Centre , Singapore , Singapore
| | - G Kong
- National University of Singapore , Singapore , Singapore
| | - C H Ng
- National University of Singapore , Singapore , Singapore
| | - V S
- National University of Singapore , Singapore , Singapore
| | - Y H Chin
- National University of Singapore , Singapore , Singapore
| | - M Y Muthiah
- National University Health System , Singapore , Singapore
| | - C M Khoo
- National University Health System , Singapore , Singapore
| | - P H Chai
- National University Heart Centre , Singapore , Singapore
| | - R Foo
- National University Heart Centre , Singapore , Singapore
| | - M Y Chan
- National University Hospital, Division of Gastroenterology and Hepatology , Singapore , Singapore
| | - P H Loh
- National University Heart Centre , Singapore , Singapore
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21
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Lim SL, Tay MHJ, Ong KW, Johal J, Yap QV, Chan YH, Yeo GKN, Khoo CM, Yaxley A. Association Between Mobile Health App Engagement and Weight Loss and Glycemic Control in Adults With Type 2 Diabetes and Prediabetes (D'LITE Study): Prospective Cohort Study. JMIR Diabetes 2022; 7:e35039. [PMID: 36178718 PMCID: PMC9568822 DOI: 10.2196/35039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 07/04/2022] [Accepted: 07/15/2022] [Indexed: 11/13/2022] Open
Abstract
Background Mobile health apps are increasingly used as early intervention to support behavior change for diabetes prevention and control, with the overarching goal of lowering the overall disease burden. Objective This prospective cohort study conducted in Singapore aimed to investigate app engagement features and their association with weight loss and improved glycemic control among adults with diabetes and prediabetes from the intervention arm of the Diabetes Lifestyle Intervention using Technology Empowerment randomized controlled trial. Methods Diabetes and prediabetes participants (N=171) with a median age of 52 years, BMI of 29.3 kg/m2, and glycated hemoglobin (HbA1c) level of 6.5% and who were being assigned the Nutritionist Buddy Diabetes app were included. Body weight and HbA1c were measured at baseline, 3 months, and 6 months. A total of 476,300 data points on daily app engagement were tracked via the backend dashboard and developer’s report. The app engagement data were analyzed by quartiles and weekly means expressed in days per week. Linear mixed model analysis was used to determine the associations between the app engagements with percentage weight and HbA1c change. Results The median overall app engagement rate was maintained above 90% at 6 months. Participants who were actively engaged in ≥5 app features were associated with the greatest overall weight reduction of 10.6% from baseline (mean difference −6, 95% CI −8.9 to −3.2; P<.001) at 6 months. Adhering to the carbohydrate limit of >5.9 days per week and choosing healthier food options for >4.3 days per week had the most impact, eliciting weight loss of 9.1% (mean difference −5.2, 95% CI −8.2 to −2.2; P=.001) and 8.8% (mean difference −4.2, 95% CI −7.1 to −1.3; P=.005), respectively. Among the participants with diabetes, those who had a complete meal log for >5.1 days per week or kept within their carbohydrate limit for >5.9 days per week each achieved greater HbA1c reductions of 1.2% (SD 1.3%; SD 1.5%), as compared with 0.2% (SD 1%; SD 0.6%). in the reference groups who used the features <1.1 or ≤2.5 days per week, respectively. Conclusions Higher app engagement led to greater weight loss and HbA1c reduction among adults with overweight or obesity with type 2 diabetes or prediabetes. Trial Registration Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12617001112358; https://anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12617001112358
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Affiliation(s)
- Su Lin Lim
- Department of Dietetics, National University Hospital, Singapore, Singapore
| | | | - Kai Wen Ong
- Department of Dietetics, National University Hospital, Singapore, Singapore
| | - Jolyn Johal
- Department of Dietetics, National University Hospital, Singapore, Singapore
| | - Qai Ven Yap
- Biostaistics Unit, Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore
| | - Yiong Huak Chan
- Biostaistics Unit, Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore
| | | | - Chin Meng Khoo
- Division of Endocrinology, Department of Medicine, National University Hospital, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore
| | - Alison Yaxley
- Nutrition and Dietetics, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
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22
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Lee DPS, Gan AX, Sutanto CN, Toh KQX, Khoo CM, Kim JE. Postprandial glycemic and circulating SCFA concentrations following okara- and biovalorized okara-containing biscuit consumption in middle-aged and older adults: a crossover randomized controlled trial. Food Funct 2022; 13:9687-9699. [PMID: 36040444 DOI: 10.1039/d2fo00526c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Okara is a high-fiber food by-product that can be biotransformed with Rhizopus oligosporus to improve its nutritional value and palatability. This research aims to assess postprandial changes in glycemic-related and lipid-related outcomes in middle-aged and older Singaporeans following okara- and biovalorized okara-containing biscuit consumption. Fifteen participants (58 ± 6 years old, mean ± SD) completed the randomized crossover study. Participants were provided control (C), okara (AOK)-, and biovalorized okara (RO)-containing biscuits in separate 4 h mixed meal tolerance tests. Serum glucose and insulin, insulin indices, serum short-chain fatty acids (SCFA) and lipid-lipoprotein panels, and sensory analysis were assessed. Glucose-stimulated insulin secretion was significantly lower for RO than for C (p: 0.035) while log insulin incremental area under the curve (AUC) was significantly lower for AOK compared to that for C (p: 0.023). The estimated insulin sensitivity index and estimated metabolic clearance rate were significantly higher for AOK compared to that for C (p: 0.025 and 0.016 respectively). Normalized AUC for total SCFA was significantly higher for RO compared to that for C (p: 0.038). Normalized AUC for LDL-cholesterol was significantly higher for AOK than for C (p: 0.010). No significant difference was noted for glucose, total cholesterol, HDL-cholesterol, and triglyceride concentrations. RO had greater flavor and overall liking than AOK (p: 0.007 and 0.017 respectively). Biscuits incorporated with okara or biovalorized okara can attenuate postprandial insulin responses. RO offered a greater SCFA response than C, indicating improved SCFA concentrations upon consumption of okara improved with fermentation. The trial was registered under https://www.clinicaltrials.gov (NCT03978104, 25 May 2019).
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Affiliation(s)
- Delia Pei Shan Lee
- Department of Food Science and Technology, Faculty of Science, National University of Singapore, S14 Science Drive 2, Singapore 117542.
| | - Alicia Xinli Gan
- Department of Food Science and Technology, Faculty of Science, National University of Singapore, S14 Science Drive 2, Singapore 117542.
| | - Clarinda Nataria Sutanto
- Department of Food Science and Technology, Faculty of Science, National University of Singapore, S14 Science Drive 2, Singapore 117542.
| | - Kate Qi Xuan Toh
- Department of Food Science and Technology, Faculty of Science, National University of Singapore, S14 Science Drive 2, Singapore 117542.
| | - Chin Meng Khoo
- Division of Endocrinology, University Medicine Cluster, National University Hospital, 5 Lower Kent Ridge Road, Singapore 119074
| | - Jung Eun Kim
- Department of Food Science and Technology, Faculty of Science, National University of Singapore, S14 Science Drive 2, Singapore 117542.
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23
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Chan KE, Koh TJL, Tang ASP, Quek J, Yong JN, Tay P, Tan DJH, Lim WH, Lin SY, Huang D, Chan M, Khoo CM, Chew NWS, Kaewdech A, Chamroonkul N, Dan YY, Noureddin M, Muthiah M, Eslam M, Ng CH. Global Prevalence and Clinical Characteristics of Metabolic-associated Fatty Liver Disease: A Meta-Analysis and Systematic Review of 10 739 607 Individuals. J Clin Endocrinol Metab 2022; 107:2691-2700. [PMID: 35587339 DOI: 10.1210/clinem/dgac321] [Citation(s) in RCA: 76] [Impact Index Per Article: 38.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIMS Metabolic-associated fatty liver disease (MAFLD) was proposed as a better definition of nonalcoholic fatty liver disease (NAFLD) to encompass the metabolic dysregulation associated with NAFLD. This redefinition challenges our understanding of the disease. Hence, this study sought to conduct an updated analysis of the prevalence, clinical characteristics, and associated factors of MAFLD, with a further sensitivity analysis done based on lean and nonobese MAFLD individuals. METHODS Medline and Embase databases were searched to include articles on MAFLD. Meta-analysis of proportions was conducted using the generalized linear mix model. Associating factors were evaluated in conventional pairwise meta-analysis with sensitivity analysis on lean and nonobese MAFLD. RESULTS From pooled analysis involving 3 320 108 individuals, the overall prevalence of MAFLD was 38.77% (95% CI 32.94% to 44.95%); 5.37% (95% CI 4.36% to 6.59%) and 29.78% (95% CI 26.06% to 33.79%) of lean and nonobese individuals, respectively, had MAFLD. Metabolic complications such as hypertension [odds ratio (OR) 2.63, 95% CI 1.85 to 3.74, P < 0.0001 and OR 2.03; 95% CI 1.74 to 2.38, P < 0.0001, respectively] and diabetes (OR 3.80, 95% CI 2.65 to 5.43, P < 0.0001 and OR 3.46, 95% CI 2.81 to 4.27, P < 0.0001, respectively) were found as significant associating factors associated with lean and nonobese MAFLD. CONCLUSIONS This meta-analysis supports previous studies in reporting MAFLD to affect more than a third of the global population. While exploration of the pathogenic basis of fatty liver disease without metabolic dysregulation is required, the emphasis on management of concomitant metabolic disease in MAFLD can improve multidisciplinary efforts in managing the complex disease.
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Affiliation(s)
- Kai En Chan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Tiffany Jia Ling Koh
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, Australia
| | - Ansel Shao Pin Tang
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Jingxuan Quek
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Jie Ning Yong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Phoebe Tay
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Darren Jun Hao Tan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Wen Hui Lim
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Snow Yunni Lin
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Daniel Huang
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore
- National University Centre for Organ Transplantation, National University Health System, Singapore
| | - Mark Chan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Department of Cardiology, National University Heart Centre, National University Hospital, Singapore
| | - Chin Meng Khoo
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Endocrinology, Department of Medicine, National University Hospital, Singapore
| | - Nicholas W S Chew
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Department of Cardiology, National University Heart Centre, National University Hospital, Singapore
| | - Apichat Kaewdech
- Division of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Thailand
| | - Naichaya Chamroonkul
- Division of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Thailand
| | - Yock Young Dan
- Cancer Science Institute of Singapore, National University of Singapore, Singapore
- Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore
| | - Mazen Noureddin
- Cedars-Sinai Fatty Liver Program, Division of Digestive and Liver Diseases, Department of Medicine, Comprehensive Transplant Center, Cedars-Sinai Medical Centre, Los Angeles, CA,USA
| | - Mark Muthiah
- Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore
- National University Centre for Organ Transplantation, National University Health System, Singapore
| | - Mohammed Eslam
- Storr Liver Centre, Westmead Institute for Medical Research, Westmead Hospital and University of Sydney, Sydney, Australia
| | - Cheng Han Ng
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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24
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Lin C, Yeong TJJM, Lim WH, Ng CH, Yau CE, Chin YH, Muthiah MD, Loh PH, Foo RSY, Mok SF, Shabbir A, Dimitriadis GK, Khoo CM, Chew NWS. Comparison of mechanistic pathways of bariatric surgery in patients with diabetes mellitus: A Bayesian network meta-analysis. Obesity (Silver Spring) 2022; 30:1380-1390. [PMID: 35715979 DOI: 10.1002/oby.23453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 03/09/2022] [Accepted: 03/25/2022] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Metabolic bariatric procedures are potentially efficacious treatment options in patients with type 2 diabetes mellitus (T2DM). Previous meta-analyses focused on individual operative approaches rather than the mechanistic pathways behind different bariatric procedures. This updated network meta-analysis aimed to synthesize new evidence and comparatively evaluate the efficacy of metabolic surgery against restrictive procedures and standard first-line treatment for patients with T2DM. METHODS Embase, MEDLINE, and trial registries were searched for randomized controlled trials on bariatric surgeries in patients with T2DM on September 3, 2021. A Bayesian network meta-analysis was conducted. The primary outcome was T2DM remission. Secondary outcomes included changes in BMI, lipoprotein levels, and blood pressure. RESULTS Thirty-two articles were included. Metabolic surgery was statistically superior to restrictive procedures (risk ratio [RR]: 2.57, 95% credibility intervals [CrI]: 1.36-5.43), medical therapy (RR: 35.29, 95% Crl: 10.56-183.23), and lifestyle intervention (RR: 40.51, 95% Crl: 5.32-402.59) in T2DM remission. Metabolic surgery significantly lowered BMI and blood pressure compared with other interventions. Restrictive procedures significantly increased high-density lipoprotein compared with metabolic surgery. Lifestyle intervention and metabolic surgery were statistically superior to restrictive procedures in reducing low-density lipoprotein. CONCLUSIONS The superiority in diabetes remission and favorable metabolic profile support the choice of metabolic surgery over restrictive bariatric procedures.
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Affiliation(s)
- Chaoxing Lin
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | | - Wen Hui Lim
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Cheng Han Ng
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Chun En Yau
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Yip Han Chin
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Mark D Muthiah
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore
- National University Centre for Organ Transplantation, National University Health System, Singapore
| | - Poay Huan Loh
- Department of Cardiology, National University Heart Centre, National University Hospital, Singapore
| | - Roger S Y Foo
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Department of Cardiology, National University Heart Centre, National University Hospital, Singapore
| | - Shao Feng Mok
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Endocrinology, Department of Medicine, National University Hospital, Singapore
| | - Asim Shabbir
- Division of General Surgery (Upper Gastrointestinal Surgery), Department of Surgery, National University Hospital, Singapore
| | - Georgios K Dimitriadis
- Department of Endocrinology, King's College Hospital NHS Foundation Trust, London, UK
- Obesity, Type 2 Diabetes and Immunometabolism Research Group, Department of Diabetes, Faculty of Cardiovascular Medicine & Sciences, School of Life Course Sciences, King's College London, London, UK
| | - Chin Meng Khoo
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Endocrinology, Department of Medicine, National University Hospital, Singapore
| | - Nicholas W S Chew
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Department of Cardiology, National University Heart Centre, National University Hospital, Singapore
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25
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Puar TH, Khoo CM, Tan CJ, Tong AKT, Tan MCS, Teo AED, Ng KS, Wong KM, Reilhac A, O'Doherty J, Gomez-Sanchez CE, Kek PC, Yee S, Tan AWK, Chuah MB, Lee DHM, Wang KW, Zheng CQ, Shi L, Robins EG, Foo RSY. 11C-Metomidate PET-CT versus adrenal vein sampling to subtype primary aldosteronism: a prospective clinical trial. J Hypertens 2022; 40:1179-1188. [PMID: 35703880 DOI: 10.1097/hjh.0000000000003132] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Adrenal vein sampling (AVS) is recommended to subtype primary aldosteronism, but it is technically challenging. We compared 11C-Metomidate-PET-computed tomography (PET-CT) and AVS for subtyping of primary aldosteronism. METHODS Patients with confirmed primary aldosteronism underwent both AVS and 11C-Metomidate PET-CT (post-dexamethasone). All results were reviewed at a multidisciplinary meeting to decide on final subtype diagnosis. Primary outcome was accuracy of PET versus AVS to diagnosis of unilateral primary aldosteronism based on post-surgical biochemical cure. Secondary outcome was accuracy of both tests to final subtype diagnosis. RESULTS All 25 patients recruited underwent PET and successful AVS (100%). Final diagnosis was unilateral in 22 patients, bilateral in two and indeterminate in one due to discordant lateralization. Twenty patients with unilateral primary aldosteronism underwent surgery, with 100% complete biochemical success, and 75% complete/partial clinical success. For the primary outcome, sensitivity of PET was 80% [95% confidence interval (95% CI): 56.3-94.3] and AVS was 75% (95% CI: 50.9-91.3). For the secondary outcome, sensitivity and specificity of PET was 81.9% (95% CI: 59.7-94.8) and 100% (95% CI: 15.8-100), and AVS was 68.2% (95% CI: 45.1-86.1) and 100% (95% CI: 15.8-100), respectively. Twelve out of 20 (60%) patients had both PET and AVS lateralization, four (20%) PET-only, three (15%) AVS-only, while one patient did not lateralize on PET or AVS. Post-surgery outcomes did not differ between patients identified by either test. CONCLUSION In our pilot study, 11C-Metomidate PET-CT performed comparably to AVS, and this should be validated in larger studies. PET identified patients with unilateral primary aldosteronism missed on AVS, and these tests could be used together to identify more patients with unilateral primary aldosteronism. VIDEO ABSTRACT http://links.lww.com/HJH/B918.
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Affiliation(s)
- Troy H Puar
- Department of Endocrinology, Changi General Hospital (CGH)
- Duke-NUS Medical School
| | - Chin Meng Khoo
- Division of Endocrinology, National University Health System (NUHS)
- Yong Loo Lin School of Medicine, National University of Singapore (NUS)
| | | | - Aaron Kian Ti Tong
- Department of Nuclear Medicine and Molecular Imaging, Singapore General Hospital (SGH)
| | | | | | - Keng Sin Ng
- Department of Radiology, CGH
- Department of Diagnostic Radiology, Mount Alvernia Hospital
| | | | | | - Jim O'Doherty
- Clinical Imaging Research Centre (CIRC), NUS, Singapore
| | - Celso E Gomez-Sanchez
- Division of Endocrinology, Medical Service, G.V. (Sonny) Montgomery VA Medical Center and Department of Pharmacology and Medicine, University of Mississippi Medical Centre, Mississippi, USA
| | | | - Szemen Yee
- Division of Endocrinology, Ng Teng Fong General Hospital
| | | | | | | | - Kuo Weng Wang
- Wang Kuo Weng Diabetes and Endocrine Practice, Gleneagles Medical Center
| | - Charles Qishi Zheng
- Duke-NUS Medical School
- Department of Epidemiology, Singapore Clinical Research Institute
| | - Luming Shi
- Duke-NUS Medical School
- Department of Epidemiology, Singapore Clinical Research Institute
| | - Edward George Robins
- Clinical Imaging Research Centre (CIRC), NUS, Singapore
- Department of Radiochemistry, Singapore Bioimaging Consortium
| | - Roger Sik Yin Foo
- Yong Loo Lin School of Medicine, National University of Singapore (NUS)
- Cardiovascular Research Institute, NUHS
- Genome Institute of Singapore
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26
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Chew NW, Kong G, Venisha S, Chin YH, Ng CH, Lin C, Muthiah M, Khoo CM, Chai P, Kong W, Poh KK, Foo R, Yeo TC, Chan MY, Loh PH. Long-term Prognosis of Acute Myocardial Infarction Associated with Metabolic Health and Obesity Status. Endocr Pract 2022; 28:802-810. [PMID: 35654337 DOI: 10.1016/j.eprac.2022.05.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 05/21/2022] [Accepted: 05/23/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Emerging evidence supports the favourable cardiovascular health in non-obese subjects with healthy metabolism. However, little is known regarding the prognosis across the range of metabolic phenotypes once cardiovascular disease is established. We examined the prognosis of patients with acute myocardial infarction (AMI) stratified according to metabolic health and obesity status. METHODS This is a retrospective study on consecutive patients with AMI admitted to a tertiary hospital between 2014-2021. Patients were allocated into 4 groups based on metabolic and obesity profile: metabolically healthy obese (MHO), metabolically healthy non-obese (MHNO), metabolically unhealthy obese (MUO) and metabolically unhealthy non-obese (MUNO). Metabolic health was defined in accordance to the BioSHARE-EU Healthy Obese Project. The primary outcome was all-cause mortality. Cox regression analysis examined the independent association between mortality and metabolic phenotypes, adjusting for age, sex, AMI type, chronic kidney disease, smoking status and left ventricular ejection fraction. RESULTS Of 9958 patients, the majority (68.5%) were MUNO, followed by MUO (25.1%), MHNO (5.6%), and MHO (0.8%). MHO had the lowest mortality (7.4%), followed by MHNO (9.7%), MUO (19.2%) and MUNO (22.6%) (p<0.001). Compared to MHNO, MUO (HR 1.737, 95%CI 1.282-2.355, p<0.001) and MUNO (HR 1.482, 95%CI 1.108-1.981, p=0.008) had significantly higher mortality risk, but not MHO (HR 1.390, 95%CI 0.594-3.251, p=0.447), after adjusting for confounders. Kaplan-Meier curves showed favourable survival in the metabolically healthy and obesity groups, with the highest overall survival in the MHO followed by MHNO, MUO and MUNO (p<0.001). CONCLUSION Metabolically healthy and obese AMI patients have favourable prognosis compared to metabolically unhealthy and non-obese patients. It is equally important to prioritize intensive metabolic risk factor management to weight reduction in the early phase after AMI.
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Affiliation(s)
- Nicholas Ws Chew
- Department of Cardiology, National University Heart Centre, National University Hospital, Singapore.
| | - Gwyneth Kong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - S Venisha
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Yip Han Chin
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
| | - Cheng Han Ng
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Chaoxing Lin
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Mark Muthiah
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore, Singapore; National University Centre for Organ Transplantation, National University Health System, Singapore
| | - Chin Meng Khoo
- Division of Endocrinology, Department of Medicine, National University Hospital, Singapore
| | - Ping Chai
- Department of Cardiology, National University Heart Centre, National University Hospital, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - William Kong
- Department of Cardiology, National University Heart Centre, National University Hospital, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Kian-Keong Poh
- Department of Cardiology, National University Heart Centre, National University Hospital, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Roger Foo
- Department of Cardiology, National University Heart Centre, National University Hospital, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Tiong-Cheng Yeo
- Department of Cardiology, National University Heart Centre, National University Hospital, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Mark Y Chan
- Department of Cardiology, National University Heart Centre, National University Hospital, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Poay Huan Loh
- Department of Cardiology, National University Heart Centre, National University Hospital, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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27
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Ng CH, Chan KE, Chin YH, Zeng RW, Tsai PC, Lim WH, Tan DJH, Khoo CM, Goh LH, Ling ZJ, Kulkarni A, Mak LYL, Huang DQ, Chan M, Chew NW, Siddiqui MS, Sanyal AJ, Muthiah M. The Effect of Diabetes and Prediabetes on the Prevalence, Complications and Mortality in Non-alcoholic Fatty Liver Disease. Clin Mol Hepatol 2022; 28:565-574. [PMID: 35585687 PMCID: PMC9293620 DOI: 10.3350/cmh.2022.0096] [Citation(s) in RCA: 40] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 05/16/2022] [Indexed: 11/17/2022] Open
Abstract
Background/Aims Nonalcoholic fatty liver disease (NAFLD) is closely associated with diabetes. The cumulative impact of both diseases synergistically increases risk of adverse events. However, present population analysis is predominantly conducted with reference to non-NAFLD individuals and has not yet examined the impact of prediabetes. Hence, we sought to conduct a retrospective analysis on the impact of diabetic status in NAFLD patients, referencing non-diabetic NAFLD individuals. Methods Data from the National Health and Nutrition Examination Survey 1999–2018 was used. Hepatic steatosis was defined with United States Fatty Liver Index (US-FLI) and FLI at a cut-off of 30 and 60 respectively, in absence of substantial alcohol use. A multivariate generalized linear model was used for risk ratios of binary outcomes while survival analysis was conducted with Cox regression and Fine Gray model for competing risk. Results Of 32,234 patients, 28.92% were identified to have NAFLD. 36.04%, 38.32% and 25.63% were non-diabetic, prediabetic and diabetic respectively. Diabetic NAFLD significantly increased risk of cardiovascular disease (CVD), stroke, chronic kidney disease, all-cause and CVD mortality compared to non-diabetic NAFLD. However, prediabetic NAFLD only significantly increased the risk of CVD and did not result in a higher risk of mortality. Conclusions Given the increased risk of adverse outcomes, this study highlights the importance of regular diabetes screening in NAFLD and adoption of prompt lifestyle modifications to reduce disease progression. Facing high cardiovascular burden, prediabetic and diabetic NAFLD individuals can benefit from early cardiovascular referrals to reduce risk of CVD events and mortality.
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Affiliation(s)
- Cheng Han Ng
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Kai En Chan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Yip Han Chin
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | | - Pei Chen Tsai
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Wen Hui Lim
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Darren Jun Hao Tan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Chin Meng Khoo
- Division of Endocrinology, Department of Medicine, National University Hospital, Singapore
| | - Lay Hoon Goh
- Division of Family Medicine, Yong Loo Lin School of Medicine, National University of Singapore.,Department of Family Medicine, National University Health System, Singapore
| | - Zheng Jye Ling
- Department of Family Medicine, National University Health System, Singapore.,Medical Informatics, Regional Health System, National University Health System, Singapore
| | - Anand Kulkarni
- Department of Hepatology, AIG Hospitals,Hyderabad, India
| | - Lung-Yi Loey Mak
- Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, Hong Kong
| | - Daniel Q Huang
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore, Singapore.,National University Centre for Organ Transplantation, National University Health System, Singapore
| | - Mark Chan
- Department of Cardiology, National University Heart Centre, National University Hospital, Singapore
| | - Nicholas Ws Chew
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Department of Cardiology, National University Heart Centre, National University Hospital, Singapore
| | - Mohammad Shadab Siddiqui
- Cedars-Sinai Fatty Liver Program, Division of Digestive and Liver Diseases, Department of Medicine, Comprehensive Transplant Centre, Cedars-Sinai Medical Centre, Los Angeles, CA, USA
| | - Arun J Sanyal
- Division of Gastroenterology, Hepatology and Nutrition, Department of Internal Medicine, Virginia Commonwealth University, Richmond, Virginia
| | - Mark Muthiah
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore, Singapore.,National University Centre for Organ Transplantation, National University Health System, Singapore
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28
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Yeong T, Mai AS, Lim OZ, Ng CH, Chin YH, Tay P, Lin C, Muthiah M, Khoo CM, Dalakoti M, Loh P, Chan M, Yeo T, Foo R, Wong R, Chew NW, Lin W. Can glucose-lowering medications improve outcomes in non-diabetic heart failure patients? A Bayesian network meta-analysis. ESC Heart Fail 2022; 9:1338-1350. [PMID: 35092176 PMCID: PMC8934935 DOI: 10.1002/ehf2.13822] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 01/11/2022] [Accepted: 01/16/2022] [Indexed: 12/20/2022] Open
Abstract
AIMS The cardioprotective effects of glucose-lowering medications in diabetic patients with heart failure (HF) are well known. Several large randomized controlled trials (RCTs) have recently suggested that the cardioprotective effects of glucose-lowering medications extend to HF patients regardless of diabetic status. The aim of this study was to conduct a Bayesian network meta-analysis to evaluate the impact of various glucose-lowering medications on the outcomes of non-diabetic HF patients. METHODS AND RESULTS Medline and Embase were searched for RCTs investigating the use of glucose-lowering medications in non-diabetic HF patients in August 2021. Studies were included in accordance with the inclusion and exclusion criteria, and data were extracted with a pre-defined datasheet. Primary outcomes include serum N-terminal prohormone of brain natriuretic peptide (NT-proBNP) levels, left ventricular ejection fraction (LVEF), and maximal oxygen consumption (PVO2 ). A Bayesian network meta-analysis was performed to compare the effectiveness of different classes of glucose-lowering medications in improving HF outcomes. Risk-of-bias was assessed using Cochrane Risk-of-Bias tool 2.0 for randomized trials (ROB2). Seven RCTs involving 2897 patients were included. Sodium-glucose transporter 2 inhibitor (SGLT2i) was the most favourable in lowering NT-proBNP, with the significant reduction in NT-proBNP when compared with glucagon-like peptide-1 receptor agonists (GLP1-RA) [mean differences (MD): -229.59 pg/mL, 95%-credible intervals (95%-CrI): -238.31 to -220.91], metformin (MD: -237.15 pg/mL, 95%-CrI: -256.19 to -218.14), and placebo (MD: -228.00 pg/mL, 95%-CrI: -233.99 to -221.99). SGLT2i was more effective in improving LVEF for HF with reduced ejection fraction patients relative to GLP1-RA (MD: 8.09%, 95%-CrI: 6.30 to 9.88) and placebo (MD: 6.10%, 95%-CrI: 4.37 to 7.84). SGLT2i and GLP1-RA were more favourable to placebo in improving PVO2 , with significant increase of PVO2 at a MD of 1.60 mL/kg/min (95%-CrI: 0.63 to 2.57) and 0.86 mL/kg/min (95%-CrI: 0.66 to 1.06), respectively. All three drugs had comparable safety profiles when compared with placebo. CONCLUSIONS This Bayesian network meta-analysis demonstrated that SGLT2i, when compared with GLP1-RA and metformin, was superior in improving LVEF in HF with reduced ejection fraction patients, as well as improving PVO2 and NT-proBNP in non-diabetic HF patients. Further large-scale prospective studies are needed to confirm these preliminary findings.
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Affiliation(s)
- Trevor Yeong
- Yong Loo Lin School of MedicineNational University of Singapore10 Medical Dr117597Singapore
| | - Aaron Shengting Mai
- Yong Loo Lin School of MedicineNational University of Singapore10 Medical Dr117597Singapore
| | - Oliver Z.H. Lim
- Yong Loo Lin School of MedicineNational University of Singapore10 Medical Dr117597Singapore
| | - Cheng Han Ng
- Yong Loo Lin School of MedicineNational University of Singapore10 Medical Dr117597Singapore
| | - Yip Han Chin
- Yong Loo Lin School of MedicineNational University of Singapore10 Medical Dr117597Singapore
| | - Phoebe Tay
- Yong Loo Lin School of MedicineNational University of Singapore10 Medical Dr117597Singapore
| | - Chaoxing Lin
- Yong Loo Lin School of MedicineNational University of Singapore10 Medical Dr117597Singapore
| | - Mark Muthiah
- Yong Loo Lin School of MedicineNational University of Singapore10 Medical Dr117597Singapore
- Division of Gastroenterology and Hepatology, Department of MedicineNational University HospitalSingapore
| | - Chin Meng Khoo
- Division of Endocrinology, Department of MedicineNational University HospitalSingapore
| | - Mayank Dalakoti
- Department of CardiologyNational University Heart CentreTower Block Level 9, 1E Kent Ridge Road119228Singapore
| | - Poay‐Huan Loh
- Yong Loo Lin School of MedicineNational University of Singapore10 Medical Dr117597Singapore
- Department of CardiologyNational University Heart CentreTower Block Level 9, 1E Kent Ridge Road119228Singapore
| | - Mark Chan
- Yong Loo Lin School of MedicineNational University of Singapore10 Medical Dr117597Singapore
- Department of CardiologyNational University Heart CentreTower Block Level 9, 1E Kent Ridge Road119228Singapore
| | - Tiong‐Cheng Yeo
- Yong Loo Lin School of MedicineNational University of Singapore10 Medical Dr117597Singapore
- Department of CardiologyNational University Heart CentreTower Block Level 9, 1E Kent Ridge Road119228Singapore
| | - Roger Foo
- Yong Loo Lin School of MedicineNational University of Singapore10 Medical Dr117597Singapore
- Department of CardiologyNational University Heart CentreTower Block Level 9, 1E Kent Ridge Road119228Singapore
| | - Raymond Wong
- Yong Loo Lin School of MedicineNational University of Singapore10 Medical Dr117597Singapore
- Department of CardiologyNational University Heart CentreTower Block Level 9, 1E Kent Ridge Road119228Singapore
| | - Nicholas W.S. Chew
- Department of CardiologyNational University Heart CentreTower Block Level 9, 1E Kent Ridge Road119228Singapore
| | - Weiqin Lin
- Yong Loo Lin School of MedicineNational University of Singapore10 Medical Dr117597Singapore
- Department of CardiologyNational University Heart CentreTower Block Level 9, 1E Kent Ridge Road119228Singapore
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Quek J, Ng CH, Tang ASP, Chew N, Chan M, Khoo CM, Wei CP, Chin YH, Tay P, Lim G, Tan DJH, Lim WH, Chan KE, Teng M, Tan E, Tamaki N, Huang DQ, Siddiqui MS, Young DY, Noureddin M, Muthiah MD. Metabolic Associated Fatty Liver Disease (MAFLD) Increases the Risk of Systemic Complications and Mortality. A Meta-Analysis and Systematic Review of 12,620,736 Individuals. Endocr Pract 2022; 28:667-672. [PMID: 35364328 DOI: 10.1016/j.eprac.2022.03.016] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 03/24/2022] [Accepted: 03/24/2022] [Indexed: 02/06/2023]
Abstract
INTRODUCTION The recent introduction of the definition "metabolic associated fatty liver disease" (MAFLD) sought to reclassify non-alcoholic fatty liver disease (NAFLD). MAFLD is thought to improve the encapsulation of metabolic dysregulation. However, recent evidence has found significant differences between MAFLD and NAFLD and prevailing knowledge has largely arisen from studies in NAFLD. Hence, we conducted a meta-analysis and systematic review on the outcomes associated with MAFLD. METHODS Medline and Embase database were searched for articles relating to outcomes in MAFLD. Analysis was conducted in random effects with hazard ratios to account for longitudinal risk assessment of mortality and systemic complications. RESULTS A total of 554 articles were identified and a final total of 17 articles were included. MAFLD resulted in an increase of overall mortality (HR 1.24, CI: 1.13 - 1.34), cancer related mortality (HR: 1.27, CI: 1.01 - 1.54) and CVD mortality (HR: 1.28, 1.03 - 1.53, p=0.04) compared to non MAFLD. MAFLD also increases the risk of cardiovascular events (HR: 1.49, CI: 1.34 - 1.64, p<0.01), stroke (HR: 1.55, CI: 1.37 - 1.73, p<0.01) and chronic kidney disease (HR: 1.53, CI: 1.38 - 1.68). The presence of MAFLD was also associated with an increased risk of heart failure, obstructive sleep apnoea and malignancy. CONCLUSIONS MAFLD can significantly elevate the risk of systemic diseases and mortality. The care of MAFLD thus requires interdisciplinary collaboration and future clinical trials conducted in MAFLD should aim to reducing the incidence of end organ damage aside from improving liver histology.
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Affiliation(s)
- Jingxuan Quek
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Cheng Han Ng
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
| | - Ansel Shao Pin Tang
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Nicholas Chew
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Cardiology, National University Heart Centre, National University Hospital, Singapore
| | - Mark Chan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Cardiology, National University Heart Centre, National University Hospital, Singapore
| | - Chin Meng Khoo
- Division of Endocrinology, Department of Medicine, National University Hospital, Singapore
| | - Chen Poh Wei
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Yip Han Chin
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Phoebe Tay
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Grace Lim
- Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore
| | - Darren Jun Hao Tan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Wen Hui Lim
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Kai En Chan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Margaret Teng
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore
| | - Eunice Tan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore; National University Centre for Organ Transplantation, National University Health System, Singapore
| | - Nobuharu Tamaki
- NAFLD Research Center, Division of Medicine, University of California San Diego, La Jolla, California, USA; Department of Gastroenterology and Hepatology, Musashino Red Cross Hospital, Tokyo, Japan
| | - Daniel Q Huang
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore; National University Centre for Organ Transplantation, National University Health System, Singapore
| | - Mohammad Shadab Siddiqui
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Internal Medicine, Virginia Commonwealth University, Virginia, United States of America
| | - Dan Yock Young
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore
| | - Mazen Noureddin
- Cedars-Sinai Fatty Liver Program, Division of Digestive and Liver Diseases, Department of Medicine, Comprehensive Transplant Center, Cedars-Sinai Medical Centre, Los Angeles, CA, USA
| | - Mark D Muthiah
- Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore; National University Centre for Organ Transplantation, National University Health System, Singapore.
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Magkos F, Lee MH, Lim M, Cook AR, Chhay V, Loh TP, Chia KS, Baig S, Ang IYH, Tay JYY, Khoo CM, Halter JB, Toh SA. Dynamic assessment of insulin secretion and insulin resistance in Asians with prediabetes. Metabolism 2022; 128:154957. [PMID: 34942192 DOI: 10.1016/j.metabol.2021.154957] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Revised: 12/03/2021] [Accepted: 12/13/2021] [Indexed: 11/18/2022]
Abstract
AIMS/HYPOTHESIS Prediabetes and type 2 diabetes are highly prevalent in Asia. Understanding the pathophysiology of abnormal glucose homeostasis in Asians will have important implications for reducing disease burden, but there have been conflicting reports on the relative contributions of insulin secretion and action in disease progression. In this study, we aimed to assess the contribution of β-cell dysfunction and insulin resistance in the Asian prediabetes phenotype. METHODS We recruited 1679 Asians with prediabetes (n = 659) or normoglycemia (n = 1020) from a multi-ethnic population in Singapore. Participants underwent an oral glucose tolerance test, an intravenous glucose challenge, and a hyperinsulinemic-euglycemic clamp procedure to determine glucose tolerance, β-cell responsivity, insulin secretion, insulin clearance and insulin sensitivity. RESULTS Participants with prediabetes had significantly higher glucose concentrations in the fasting state and after glucose ingestion than did normoglycemic participants. Insulin sensitivity (M/I ratio) was ~15% lower, acute insulin response (AIR) to intravenous glucose and β-cell responsivity to oral glucose were ~35% lower, but total insulin secretion rate in the fasting state and after glucose ingestion was ~10% greater in prediabetic than in normoglycemic participants. The decrease in β-cell function with worsening glucose homeostasis in Asians with prediabetes was associated with progressively greater defects in AIR rather than M/I. However, analysis using static surrogate measures (HOMA indices) of insulin resistance and β-cell function revealed a different pattern. CONCLUSIONS Lower AIR to intravenous glucose and β-cell responsivity to oral glucose, on a background of mild insulin resistance, are the major contributors to the dysregulation of glucose homeostasis in Asians with prediabetes.
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Affiliation(s)
- Faidon Magkos
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Denmark
| | - Michelle H Lee
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Maybritte Lim
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Alex R Cook
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - Vanna Chhay
- Department of Biochemistry, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Tze Ping Loh
- Department of Laboratory Medicine, National University Hospital, Singapore
| | - Kee Seng Chia
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - Sonia Baig
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Ian Yi Han Ang
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | | | - Chin Meng Khoo
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Medicine, National University Hospital, Singapore
| | - Jeffrey B Halter
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Division of Geriatric and Palliative Medicine, University of Michigan, USA
| | - Sue-Anne Toh
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; NOVI Health, Singapore; Department of Medicine, National University Hospital, Singapore; Regional Health System Office, National University Health System, Singapore; Singapore Population HEalth ImpRovement Centre (SPHERiC), National University Health System, Singapore.
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Lim SL, Ong KW, Johal J, Han CY, Yap QV, Chan YH, Zhang ZP, Chandra CC, Thiagarajah AG, Khoo CM. A Smartphone App-Based Lifestyle Change Program for Prediabetes (D'LITE Study) in a Multiethnic Asian Population: A Randomized Controlled Trial. Front Nutr 2022; 8:780567. [PMID: 35141265 PMCID: PMC8819073 DOI: 10.3389/fnut.2021.780567] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 12/29/2021] [Indexed: 12/20/2022] Open
Abstract
Introduction Landmark studies have established that lifestyle interventions focused on weight loss, diet modification and physical activity can prevent diabetes progression. However, the effectiveness of mobile health application among Asians with prediabetes remains largely unexamined. We aimed to assess whether a smartphone app-based lifestyle intervention program would lead to weight loss, normoglycemia and improved metabolic indices in a multiethnic Asian population with prediabetes. Research Design and Methods This multicentre prediabetes RCT is part of the Diabetes Lifestyle Intervention using Technology Empowerment (D'LITE) trial. Adults (n = 148) with prediabetes and BMI ≥ 23 kg/m2 were randomly allocated either to the intervention group (n = 72) empowered by self-monitoring features of the Nutritionist Buddy Diabetes app with in-app dietitian coaching for 6 months, or the control group (n = 76) receiving standard diet counseling at baseline. Primary outcome was defined as change in body weight at 6 months, while secondary outcomes included glycemic control and other metabolic indices analyzed using Generalized Linear Mixed Model analysis with intention-to-treat approach. Results Intervention group achieved a significantly greater weight loss of 4.2 vs. 1.3 kg [mean difference of −3.1 kg (95% CI −4.5 to −1.7), p < 0.001], and a 4.3-fold increased likelihood of achieving ≥ 5% weight loss, as compared to the control group at 6 months. The likelihood of achieving normoglycemia (defined as HbA1c < 5.7%) was 2.1 times higher in intervention group than in the control group (p < 0.018). Changes to blood pressure, total and LDL cholesterol were not statistically significant. Conclusion An app-based lifestyle program led to clinically significant weight loss and improved glycemia, and can potentially augment current standard care in the prevention of diabetes among an Asian multiethnic population. Clinical Trial Registration anzctr.org.au, identifier: ACTRN12617001112358.
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Affiliation(s)
- Su Lin Lim
- Department of Dietetics, National University Hospital, Singapore, Singapore
- *Correspondence: Su Lin Lim
| | - Kai Wen Ong
- Department of Dietetics, National University Hospital, Singapore, Singapore
| | - Jolyn Johal
- Department of Dietetics, National University Hospital, Singapore, Singapore
| | - Chad Yixian Han
- Department of Dietetics, National University Hospital, Singapore, Singapore
| | - Qai Ven Yap
- Biostatistics Unit, Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore
| | - Yiong Huak Chan
- Biostatistics Unit, Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore
| | - Zhi Peng Zhang
- Department of Family Medicine, National University Polyclinics, Singapore, Singapore
| | | | | | - Chin Meng Khoo
- Division of Endocrinology, National University Hospital, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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32
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Kiat Whye K, ShyongTai E, Shabbir A, Khoo CM, Koh W. Non-Invasive Characterization of the Pancreas During Bariatric Surgery via Circulating Pancreatic Specific Cell-free Messenger RNA. Front Genet 2021; 12:742496. [PMID: 34707641 PMCID: PMC8542674 DOI: 10.3389/fgene.2021.742496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 09/10/2021] [Indexed: 11/30/2022] Open
Abstract
Bariatric surgery results in sustained weight loss and improvement in glucose homeostasis. However, the lack of accessible non-invasive tools to examine molecular alterations occurring in the pancreas limits our understanding of the causes and recovery of glucose homeostasis. Here, we describe the use of a circulating cell free mRNA (cfmRNA) based multiplex qPCR assay to selectively amplify and quantify circulating pancreatic specific transcripts levels within plasma. We applied this assay to a cohort of 58 plasma samples consisting of 10 patients that tracks multiple time points including pre and post-bariatric surgery. In our targeted multiplex screen of 14 selected pancreatic specific circulating transcripts, we identified 13 pancreatic specific transcripts that can be amplified from plasma. Furthermore, when quantifying the amplicons obtained in the short-term post-surgery (2 weeks–1 month) and long-term (3–12 months), we observed a consistent reduction of circulating GCG transcripts during short term post-surgery. Across the cohort, GCG cfmRNA levels correlated significantly with common metrics of improvement following bariatric surgery such as: haemoglobin A1c levels (R: −0.41, p-value: 0.0039) and percentage of excess weight loss (R: 0.29, p-value: 0.046).
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Affiliation(s)
- Kong Kiat Whye
- Molecular Engineering Lab, Institute of Molecular and Cell Biology, ASTAR, Singapore, Singapore
| | - E ShyongTai
- Division of Endocrinology, Department of Medicine, National University Hospital, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Asim Shabbir
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Department of Surgery, National University Hospital, Singapore, Singapore
| | - Chin Meng Khoo
- Division of Endocrinology, Department of Medicine, National University Hospital, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Winston Koh
- Molecular Engineering Lab, Institute of Molecular and Cell Biology, ASTAR, Singapore, Singapore
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33
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Loy SL, Lin J, Cheung YB, Sreedharan AV, Chin X, Godfrey KM, Tan KH, Shek LPC, Chong YS, Leow MKS, Khoo CM, Lee YS, Chan SY, Lek N, Chan JKY, Yap F. Influence of red blood cell indices on HbA1c performance in detecting dysglycaemia in a Singapore preconception cohort study. Sci Rep 2021; 11:20850. [PMID: 34675297 PMCID: PMC8531017 DOI: 10.1038/s41598-021-00445-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Accepted: 10/12/2021] [Indexed: 12/16/2022] Open
Abstract
Abnormalities of red blood cell (RBC) indices may affect glycated haemoglobin (HbA1c) levels. We assessed the influence of haemoglobin (Hb) and mean corpuscular volume (MCV) on the performance of HbA1c in detecting dysglycaemia among reproductive aged women planning to conceive. Women aged 18-45 years (n = 985) were classified as normal (12 ≤ Hb ≤ 16 g/dL and 80 ≤ MCV ≤ 100 fL) and abnormal (Hb < 12 g/dL and/or MCV < 80 fL). The Area Under the Receiver Operating Characteristic (AUROC) curve was used to determine the performance of HbA1c in detecting dysglycaemic status (prediabetes and diabetes). There were 771 (78.3%) women with normal RBC indices. The AUROCs for the normal and abnormal groups were 0.75 (95% confidence interval 0.69, 0.81) and 0.80 (0.70, 0.90), respectively, and were not statistically different from one another [difference 0.04 (- 0.16, 0.08)]. Further stratification by ethnicity showed no difference between the two groups among Chinese and Indian women. However, Malay women with normal RBC indices displayed lower AUROC compared to those with abnormal RBC indices (0.71 (0.55, 0.87) vs. 0.98 (0.93, 1.00), p = 0.002). The results suggest that the performance of HbA1c in detecting dysglycaemia was not influenced by abnormal RBC indices based on low Hb and/or low MCV. However, there may be ethnic variations among them.
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Affiliation(s)
- See Ling Loy
- Department of Reproductive Medicine, KK Women's and Children's Hospital, Singapore, 229899, Singapore.
- Duke-NUS Medical School, Singapore, 169857, Singapore.
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR), Singapore, 117609, Singapore.
| | - Jinjie Lin
- Department of Paediatrics, KK Women's and Children's Hospital, Singapore, 229899, Singapore
| | - Yin Bun Cheung
- Program in Health Services and Systems Research and Center for Quantitative Medicine, Duke-NUS Medical School, Singapore, 169857, Singapore
- Tampere Center for Child, Adolescent and Maternal Health Research, Tampere University, 33014, Tampere, Finland
| | | | - Xinyi Chin
- Duke-NUS Medical School, Singapore, 169857, Singapore
- Department of Paediatrics, KK Women's and Children's Hospital, Singapore, 229899, Singapore
| | - Keith M Godfrey
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton, SO16 6YD, UK
- National Institute for Health Research Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton National Health Service Foundation Trust, Southampton, SO16 6YD, UK
| | - Kok Hian Tan
- Duke-NUS Medical School, Singapore, 169857, Singapore
- Department of Maternal Fetal Medicine, KK Women's and Children's Hospital, Singapore, 229899, Singapore
| | - Lynette Pei-Chi Shek
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR), Singapore, 117609, Singapore
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 119228, Singapore
- Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, National University Health System, Singapore, 119074, Singapore
| | - Yap Seng Chong
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR), Singapore, 117609, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore, 119228, Singapore
| | - Melvin Khee-Shing Leow
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR), Singapore, 117609, Singapore
- Cardiovascular and Metabolic Disorder Programme, Duke-NUS Medical School, Singapore, 169857, Singapore
- Department of Endocrinology, Tan Tock Seng Hospital, Singapore, 308433, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, 636921, Singapore
| | - Chin Meng Khoo
- Cardiovascular and Metabolic Disorder Programme, Duke-NUS Medical School, Singapore, 169857, Singapore
- Department of Medicine, National University Hospital, Singapore, 119074, Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 117597, Singapore
| | - Yung Seng Lee
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR), Singapore, 117609, Singapore
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 119228, Singapore
- Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, National University Health System, Singapore, 119074, Singapore
| | - Shiao-Yng Chan
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR), Singapore, 117609, Singapore
- Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 119228, Singapore
| | - Ngee Lek
- Duke-NUS Medical School, Singapore, 169857, Singapore
- Department of Paediatrics, KK Women's and Children's Hospital, Singapore, 229899, Singapore
| | - Jerry Kok Yen Chan
- Department of Reproductive Medicine, KK Women's and Children's Hospital, Singapore, 229899, Singapore
- Duke-NUS Medical School, Singapore, 169857, Singapore
| | - Fabian Yap
- Duke-NUS Medical School, Singapore, 169857, Singapore.
- Department of Paediatrics, KK Women's and Children's Hospital, Singapore, 229899, Singapore.
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, 636921, Singapore.
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Ng CH, Lin SY, Chin YH, Lee MH, Syn N, Goh XL, Koh JH, Quek J, Hao Tan DJ, Mok SF, Tan E, Dan YY, Chew N, Khoo CM, Siddiqui MS, Muthiah M. Antidiabetic Medications for Type 2 Diabetics with Nonalcoholic Fatty Liver Disease: Evidence From a Network Meta-Analysis of Randomized Controlled Trials. Endocr Pract 2021; 28:223-230. [PMID: 34606980 DOI: 10.1016/j.eprac.2021.09.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 09/17/2021] [Accepted: 09/25/2021] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Type 2 diabetes mellitus and nonalcoholic fatty liver disease (NAFLD) are closely related, and antidiabetic medications have been shown to be potential therapeutics in NAFLD. Using a network meta-analysis, we sought to examine the effectiveness of antidiabetic agents for the treatment of NAFLD in patients with type 2 diabetes mellitus. METHODS Medline and Embase were searched for randomized controlled trials relating to the use of antidiabetic agents, including sodium-glucose transport protein 2 (SGLT2) inhibitors, glucagon-like peptide-1 receptor agonists, and peroxisome proliferator-activated receptor gamma (PPARγ) agonists, biguanides, sulfonylureas and insulin, on NAFLD in patients with diabetes. The p-score was used as a surrogate marker of effectiveness. RESULTS A total of 14 articles were included in the analysis. PPARγ agonists were ranked as the best treatment in steatosis reduction, resulting in the greatest reduction of steatosis. There was statistical significance between PPARγ agonists [mean difference (MD): -6.02%, confidence interval (CI): -10.37% to -1.67%] and SGLT2 inhibitors (MD: -2.60%, CI: -4.87% to -0.33%) compared with standard of care for steatosis reduction. Compared with PPARγ agonists, SGLT2 inhibitors resulted in a statistical significant reduction in fibrosis (MD: -0.06, CI: -0.10 to -0.02). Body mass index reduction was highest in SGLT2 inhibitors and glucagon-like peptide-1 receptor agonists. Additionally, SGLT2 inhibitors were ranked as the best treatment for increasing high-density lipoprotein and reducing low-density lipoprotein. CONCLUSION Glucagon-like peptide-1 receptor agonists and SGLT2 inhibitors were suitable alternatives for the treatment of NAFLD in those with type 2 diabetes mellitus with a reduction in body mass index, fibrosis, and steatosis. SGLT2 inhibitors also have the added benefit of lipid modulation.
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Affiliation(s)
- Cheng Han Ng
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
| | - Snow Yunni Lin
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Yip Han Chin
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Ming Hui Lee
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Nicholas Syn
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore; Biostatistics & Modelling Domain, Saw Swee Hock School of Public Health, Singapore
| | - Xin Lei Goh
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Jin Hean Koh
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Jingxuan Quek
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Darren Jun Hao Tan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Shao Feng Mok
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore; Division of Endocrinology, Department of Medicine, National University Hospital, Singapore, Singapore
| | - Eunice Tan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore; National University Centre for Organ Transplantation, National University Health System, Singapore; Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore, Singapore
| | - Yock Young Dan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore; National University Centre for Organ Transplantation, National University Health System, Singapore; Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore, Singapore
| | - Nicholas Chew
- Division of Cardiology, Department of Medicine, National University Hospital, Singapore, Singapore
| | - Chin Meng Khoo
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore; Division of Endocrinology, Department of Medicine, National University Hospital, Singapore, Singapore
| | - Mohammad Shadab Siddiqui
- Department of Internal Medicine, Division of Gastroenterology, Hepatology and Nutrition, Virginia Commonwealth University, Virginia
| | - Mark Muthiah
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore; National University Centre for Organ Transplantation, National University Health System, Singapore; Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore, Singapore.
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35
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Tint MT, Michael N, Sadananthan SA, Huang JY, Khoo CM, Godfrey KM, Shek LPC, Lek N, Tan KH, Yap F, Velan SS, Gluckman PD, Chong YS, Karnani N, Chan SY, Leow MKS, Lee KJ, Lee YS, Hu HH, Zhang C, Fortier MV, Eriksson JG. Brown Adipose Tissue, Adiposity, and Metabolic Profile in Preschool Children. J Clin Endocrinol Metab 2021; 106:2901-2914. [PMID: 34143868 PMCID: PMC8475202 DOI: 10.1210/clinem/dgab447] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Indexed: 02/08/2023]
Abstract
CONTEXT An inverse relationship between brown adipose tissue (BAT) and obesity has previously been reported in older children and adults but is unknown in young children. OBJECTIVE We investigated the influence of BAT in thermoneutral condition on adiposity and metabolic profile in Asian preschool children. DESIGN, SETTING, AND PARTICIPANTS A total of 198 children aged 4.5 years from a prospective birth cohort study, Growing Up in Singapore Towards Healthy Outcomes (GUSTO) were successfully studied with water-fat magnetic resonance imaging of the supraclavicular and axillary fat depot (FDSA). Regions within FDSA with fat-signal-fraction between 20% and 80% were considered BAT, and percentage BAT (%BAT; 100*BAT volume/ FDSA volume) was calculated. MAIN OUTCOME MEASURES Abdominal adipose tissue compartment volumes, ectopic fat in the soleus muscle and liver, fatty liver index, metabolic syndrome scores, and markers of insulin sensitivity. RESULTS A 1% unit increase in %BAT was associated with lower body mass index, difference (95% CI), -0.08 (-0.10, -0.06) kg/m2 and smaller abdominal adipose tissue compartment volumes. Ethnicity and sex modified these associations. In addition, each unit increase in %BAT was associated with lower ectopic fat at 4.5 years in the liver, -0.008% (-0.013%, -0.003%); soleus muscle, -0.003% (-0.006%, -0.001%) of water content and lower fatty liver index at 6 years. CONCLUSIONS Higher %BAT is associated with a more favorable metabolic profile. BAT may thus play a role in the pathophysiology of obesity and related metabolic disorders. The observed ethnic and sex differences imply that the protective effect of BAT may vary among different groups.
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Affiliation(s)
- Mya Thway Tint
- Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (A*STAR), Singapore
- Department of Obstetrics & Gynecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Navin Michael
- Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (A*STAR), Singapore
| | - Suresh Anand Sadananthan
- Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (A*STAR), Singapore
| | - Jonathan Yinhao Huang
- Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (A*STAR), Singapore
| | - Chin Meng Khoo
- Division of Endocrinology, Department of Medicine, National University Health System, Singapore
| | - Keith M Godfrey
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton, NHS Foundation Trust, Southampton, UK
| | - Lynette Pei-Chi Shek
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Ngee Lek
- Department of Pediatric Endocrinology, KK Women’s and Children’s Hospital, Singapore
| | - Kok Hian Tan
- Department of Obstetrics and Gynaecology, KK Women’s and Children’s Hospital, Singapore
| | - Fabian Yap
- Department of Pediatric Endocrinology, KK Women’s and Children’s Hospital, Singapore
- Duke-NUS Graduate Medical School, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - S Sendhil Velan
- Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (A*STAR), Singapore
- Singapore Bioimaging Consortium (SBIC), Agency for Science, Technology and Research (A*STAR), Singapore
| | - Peter D Gluckman
- Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (A*STAR), Singapore
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Yap-Seng Chong
- Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (A*STAR), Singapore
- Department of Obstetrics & Gynecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Neerja Karnani
- Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (A*STAR), Singapore
- Department of Biochemistry, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Shiao-Yng Chan
- Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (A*STAR), Singapore
- Department of Obstetrics & Gynecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Melvin Khee-Shing Leow
- Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (A*STAR), Singapore
- Department of Endocrinology, Tan Tock Seng Hospital, Singapore
- Metabolic Disorders Research Programme, Lee Kong Chian School of Medicine, Singapore
- Cardiovascular and Metabolic Disorders Program, Duke-NUS Medical School, Singapore
| | - Kuan Jin Lee
- Singapore Bioimaging Consortium (SBIC), Agency for Science, Technology and Research (A*STAR), Singapore
| | - Yung-Seng Lee
- Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (A*STAR), Singapore
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Paediatric Endocrinology, Department of Paediatrics, Khoo Teck Puat–National University Children’s Medical Institute, National University Health System, Singapore
| | - Houchun Harry Hu
- Department of Radiology, Nationwide Children’s Hospital, Columbus, OH, USA
| | - Cuilin Zhang
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Rockville, MD, USA
| | - Marielle V Fortier
- Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (A*STAR), Singapore
- Department of Diagnostic and Interventional Imaging, KK Women’s and Children’s Hospital, Singapore
| | - Johan G Eriksson
- Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (A*STAR), Singapore
- Department of Obstetrics & Gynecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Department of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Folkhälsan Research Center, Helsinki, Finland
- Correspondence: Johan G. Eriksson, Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, MD1, Tahir Foundation Building, Level 12, #12-02/03, 12 Science Drive 2, Singapore 117549, Singapore. ;
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Sim W, Lim WH, Ng CH, Chin YH, Yaow CYL, Cheong CWZ, Khoo CM, Samarasekera DD, Devi MK, Chong CS. The perspectives of health professionals and patients on racism in healthcare: A qualitative systematic review. PLoS One 2021; 16:e0255936. [PMID: 34464395 PMCID: PMC8407537 DOI: 10.1371/journal.pone.0255936] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 07/27/2021] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To understand racial bias in clinical settings from the perspectives of minority patients and healthcare providers to inspire changes in the way healthcare providers interact with their patients. METHODS Articles on racial bias were searched on Medline, CINAHL, PsycINFO, Web of Science. Full text review and quality appraisal was conducted, before data was synthesized and analytically themed using the Thomas and Harden methodology. RESULTS 23 articles were included, involving 1,006 participants. From minority patients' perspectives, two themes were generated: 1) alienation of minorities due to racial supremacism and lack of empathy, resulting in inadequate medical treatment; 2) labelling of minority patients who were stereotyped as belonging to a lower socio-economic class and having negative behaviors. From providers' perspectives, one theme recurred: the perpetuation of racial fault lines by providers. However, some patients and providers denied racism in the healthcare setting. CONCLUSION Implicit racial bias is pervasive and manifests in patient-provider interactions, exacerbating health disparities in minorities. Beyond targeted anti-racism measures in healthcare settings, wider national measures to reduce housing, education and income inequality may mitigate racism in healthcare and improve minority patient care.
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Affiliation(s)
- Wilson Sim
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Wen Hui Lim
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Cheng Han Ng
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Yip Han Chin
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Clyve Yu Leon Yaow
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Clare Wei Zhen Cheong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Chin Meng Khoo
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Division of Endocrinology, Department of Medicine, National University Hospital, Singapore, Singapore
| | - Dujeepa D. Samarasekera
- Centre for Medical Education, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - M. Kamala Devi
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Choon Seng Chong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Division of Colorectal Surgery, Department of Surgery, University Surgical Cluster, National University Hospital, Singapore, Singapore
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Goh AT, Choy JYM, Chua XH, Ponnalagu S, Khoo CM, Whitton C, van Dam RM, Forde CG. Increased oral processing and a slower eating rate increase glycaemic, insulin and satiety responses to a mixed meal tolerance test. Eur J Nutr 2021; 60:2719-2733. [PMID: 33389082 DOI: 10.1007/s00394-020-02466-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Accepted: 12/11/2020] [Indexed: 12/21/2022]
Abstract
PURPOSE Variations in specific oral processing behaviours may contribute to differences in glucose, insulin and satiety responses to a standardised test meal. This study tested how natural variations in oral processing between slower and faster eaters contribute to differences in post-prandial glucose (PP glucose), insulin response (PP insulin) and post-meal satiety for a standardised test meal. METHODS Thirty-three participants with higher risk for type 2 diabetes consumed a standardised test-meal while being video recorded to derive specific oral processing behaviours. Plasma glucose, insulin and satiety measures were collected at baseline, during and post meal. Participants were split into slower and faster eaters using median split based on their eating rates and individual bolus properties were analysed at the point of swallow. RESULTS There were large variations in eating rate (p < 0.001). While there was no significant difference in PP glucose response (p > 0.05), slower eaters showed significantly higher PP insulin between 45 and 60 min (p < 0.001). Slower eaters had longer oro-sensory exposure and increased bolus saliva uptake which was associated with higher PP glucose iAUC. Faster eating rate and larger bolus particle size at swallow correlated with lower PP glucose iAUC. A slower eating rate with greater chews per bite significantly increased insulin iAUC. Faster eaters also consistently rated their hunger and desire to eat higher than slower eaters (p < 0.05). CONCLUSIONS Natural variations in eating rate and the associated oral processing contributed to differences in PP glucose, PP insulin and satiety responses. Encouraging increased chewing and longer oral-exposure time during consumption, may promote early glucose absorption and greater insulin and satiety responses, and help support euglycaemia. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT04522063.
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Affiliation(s)
- Ai Ting Goh
- Clinical Nutrition Research Centre (CNRC), Singapore Institute for Food and Biotechnology Innovation, Agency for Science, Technology and Research (A*STAR), Singapore, 117599, Singapore
| | - Jie Ying Michelle Choy
- Clinical Nutrition Research Centre (CNRC), Singapore Institute for Food and Biotechnology Innovation, Agency for Science, Technology and Research (A*STAR), Singapore, 117599, Singapore
| | - Xin Hui Chua
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Shalini Ponnalagu
- Clinical Nutrition Research Centre (CNRC), Singapore Institute for Food and Biotechnology Innovation, Agency for Science, Technology and Research (A*STAR), Singapore, 117599, Singapore
| | - Chin Meng Khoo
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Department of Medicine, National University Hospital, Singapore, Singapore
| | - Clare Whitton
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Rob Martinus van Dam
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Ciarán Gerard Forde
- Clinical Nutrition Research Centre (CNRC), Singapore Institute for Food and Biotechnology Innovation, Agency for Science, Technology and Research (A*STAR), Singapore, 117599, Singapore.
- Department of Physiology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 117593, Singapore.
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Hoong JSY, Chew WS, Torta F, Khoo CM, Wenk MR, Herr DR, Tai ES, van Dam RM. Dietary Fat and Protein Intakes in Relation to Plasma Sphingolipids As Determined by a Large-Scale Lipidomic Analysis. Curr Dev Nutr 2021. [DOI: 10.1093/cdn/nzab047_024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Objectives
Sphingolipid concentrations have been associated with risk of type 2 diabetes and cardiovascular diseases. Because sphingolipids can be synthesized de novo from saturated fatty acids (SFA), dietary fatty acids may affect plasma sphingolipid concentrations. We aimed to evaluate dietary fat and protein intakes in relation to circulating sphingolipid levels.
Methods
We used cross-sectional data from 2860 ethnic Chinese Singaporeans collected from 2004–2007. Nutrient intakes were estimated on the basis of a validated 159-item food frequency questionnaire. We quantified 79 molecularly distinct sphingolipids in a large-scale lipidomic evaluation from plasma samples.
Results
Higher saturated fat intake was associated with higher concentrations of 16:1; O2 sphingolipids including ceramides, monohexosylcermides, dihexosylceramides, sphingomyelins, and sphingosine 1-phosphates. Higher polyunsaturated fat intake was associated with lower plasma long-chain ceramides and long-chain monohexosylcermide concentrations. Protein intake was inversely associated with concentrations of most subclasses of sphingolipids, with the exception of sphingolipids containing a 16:1; O2 sphingoid base. Lower intake of saturated fat and higher intake of polyunsaturated fat and protein may decrease plasma concentrations of several sphingolipid classes.
Conclusions
These findings may represent a novel biological mechanism for the impact of nutrient intakes on cardio-metabolic health.
Funding Sources
This work was supported by the National Research Foundation Investigatorship grant (NRF-NRFI2015–05, to MRW), A*STAR (I1901E0040), and the National University Health System (NUHSRO/2014/085/AF-Partner/01, DRH). FT was supported by the NRF and A*STAR IAF-ICP I1901E0040.
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Lim SL, Ong KW, Johal J, Han CY, Yap QV, Chan YH, Chooi YC, Zhang ZP, Chandra CC, Thiagarajah AG, Khoo CM. Effect of a Smartphone App on Weight Change and Metabolic Outcomes in Asian Adults With Type 2 Diabetes: A Randomized Clinical Trial. JAMA Netw Open 2021; 4:e2112417. [PMID: 34081137 PMCID: PMC8176331 DOI: 10.1001/jamanetworkopen.2021.12417] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
IMPORTANCE Lifestyle interventions are effective in diabetes management, with smartphone apps that manage health data and dietary and exercise schedules gaining popularity. However, limited evidence from randomized clinical trials exists regarding the effectiveness of smartphone-based interventions among Asian adults with type 2 diabetes. OBJECTIVE To compare the effects of a culturally contextualized smartphone-based intervention with usual care on weight and metabolic outcomes. DESIGN, SETTING, AND PARTICIPANTS This randomized clinical trial conducted at multiple primary care centers in Singapore included 305 adults with type 2 diabetes and body mass index (BMI) of 23 or greater who had literacy in English and smartphone access. Participants were recruited between October 3, 2017, and September 9, 2019, and were randomly assigned (1:1; stratified by gender, age, and BMI) to intervention (99 participants) or control (105 participants) groups. Participants' data were analyzed using intention-to-treat analysis. INTERVENTIONS Both control and intervention participants received diet and physical activity advice from a dietitian at a baseline face-to-face visit. Intervention participants additionally used a smartphone app to track weight, diet, physical activity, and blood glucose and then communicated with dietitians for 6 months. MAIN OUTCOMES AND MEASURES Primary outcome was change in body weight, while secondary outcomes were changes in hemoglobin A1c (HbA1c), fasting blood glucose, blood pressure, lipids, and diet. Post hoc analyses included glycemic changes in the subgroup with HbA1c levels of 8% or greater and diabetes medication changes. RESULTS Among the 204 randomized participants (mean [SD] age, 51.2 [9.7] years; 132 [64.7%] men), baseline mean (SD) BMI was 30.6 (4.3). Compared with the control group, intervention participants achieved significantly greater reductions in weight (mean [SD] change, -3.6 [4.7] kg vs -1.2 [3.6] kg) and HbA1c levels (mean [SD] change, -0.7% [1.2] vs -0.3% [1.0]), with a greater proportion having a reduction in diabetes medications (17 participants [23.3%] vs 4 participants [5.4%]) at 6 months. The intervention led to a greater HbA1c reduction among participants with HbA1c levels of 8% or higher (mean [SD] change, -1.8% [1.4] vs -1.0% [1.4]; P = .001). Intergroup differences favoring the intervention were also noted for fasting blood glucose, diastolic blood pressure, and dietary changes. CONCLUSIONS AND RELEVANCE In this study, a smartphone-based lifestyle intervention was more effective in achieving weight and glycemic reductions among Asian adults with type 2 diabetes compared with usual care, supporting the use of apps in lifestyle intervention delivery. TRIAL REGISTRATION anzctr.org.au Identifier: ACTRN12617001112358.
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Affiliation(s)
- Su Lin Lim
- Department of Dietetics, National University Hospital, Singapore
| | - Kai Wen Ong
- Department of Dietetics, National University Hospital, Singapore
| | - Jolyn Johal
- Faculty of Health Sciences, University of Adelaide, Australia
| | - Chad Yixian Han
- Caring Future Institute, College of Nursing and Health Sciences, Flinders University, Australia
| | - Qai Ven Yap
- Biostatistics Unit, Yong Loo Lin School of Medicine, National University Health System, Singapore
| | - Yiong Huak Chan
- Biostatistics Unit, Yong Loo Lin School of Medicine, National University Health System, Singapore
| | - Yu Chung Chooi
- Singapore Institute for Clinical Services, Agency for Science, Technology and Research, Singapore
| | | | | | | | - Chin Meng Khoo
- Division of Endocrinology, National University Hospital, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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Tan YM, Gao Y, Teo G, Koh HW, Tai ES, Khoo CM, Choi KP, Zhou L, Choi H. Plasma Metabolome and Lipidome Associations with Type 2 Diabetes and Diabetic Nephropathy. Metabolites 2021; 11:metabo11040228. [PMID: 33918080 PMCID: PMC8069978 DOI: 10.3390/metabo11040228] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 04/05/2021] [Accepted: 04/07/2021] [Indexed: 12/15/2022] Open
Abstract
We conducted untargeted metabolomics analysis of plasma samples from a cross-sectional case–control study with 30 healthy controls, 30 patients with diabetes mellitus and normal renal function (DM-N), and 30 early diabetic nephropathy (DKD) patients using liquid chromatography-mass spectrometry (LC-MS). We employed two different modes of MS acquisition on a high-resolution MS instrument for identification and semi-quantification, and analyzed data using an advanced multivariate method for prioritizing differentially abundant metabolites. We obtained semi-quantification data for 1088 unique compounds (~55% lipids), excluding compounds that may be either exogenous compounds or treated as medication. Supervised classification analysis over a confounding-free partial correlation network shows that prostaglandins, phospholipids, nucleotides, sugars, and glycans are elevated in the DM-N and DKD patients, whereas glutamine, phenylacetylglutamine, 3-indoxyl sulfate, acetylphenylalanine, xanthine, dimethyluric acid, and asymmetric dimethylarginine are increased in DKD compared to DM-N. The data recapitulate the well-established plasma metabolome changes associated with DM-N and suggest uremic solutes and oxidative stress markers as the compounds indicating early renal function decline in DM patients.
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Affiliation(s)
- Yan Ming Tan
- Department of Statistics and Applied Probability, Faculty of Science, National University of Singapore, Singapore 117546, Singapore; (Y.M.T.); (K.P.C.)
| | - Yan Gao
- Singapore Eye Research Institute, The Academia, 20 College Road, Singapore 169856, Singapore;
| | - Guoshou Teo
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore; (G.T.); (H.W.L.K.); (E.S.T.); (C.M.K.)
| | - Hiromi W.L. Koh
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore; (G.T.); (H.W.L.K.); (E.S.T.); (C.M.K.)
| | - E Shyong Tai
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore; (G.T.); (H.W.L.K.); (E.S.T.); (C.M.K.)
| | - Chin Meng Khoo
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore; (G.T.); (H.W.L.K.); (E.S.T.); (C.M.K.)
| | - Kwok Pui Choi
- Department of Statistics and Applied Probability, Faculty of Science, National University of Singapore, Singapore 117546, Singapore; (Y.M.T.); (K.P.C.)
| | - Lei Zhou
- Singapore Eye Research Institute, The Academia, 20 College Road, Singapore 169856, Singapore;
- Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore
- Ophthalmology and Visual Sciences Academic Clinical Research Program, Duke-NUS Medical School, National University of Singapore, Singapore 169857, Singapore
- Correspondence: (L.Z.); (H.C.)
| | - Hyungwon Choi
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore; (G.T.); (H.W.L.K.); (E.S.T.); (C.M.K.)
- Correspondence: (L.Z.); (H.C.)
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Ooi DSQ, Ling JQR, Sadananthan SA, Velan SS, Ong FY, Khoo CM, Tai ES, Henry CJ, Leow MKS, Khoo EYH, Tan CS, Lee YS, Chong MFF. Branched-Chain Amino Acid Supplementation Does Not Preserve Lean Mass or Affect Metabolic Profile in Adults with Overweight or Obesity in a Randomized Controlled Weight Loss Intervention. J Nutr 2021; 151:911-920. [PMID: 33537760 DOI: 10.1093/jn/nxaa414] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 06/18/2020] [Accepted: 12/01/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Branched-chain amino acid (BCAA) supplementation has been shown to increase muscle mass or prevent muscle loss during weight loss. OBJECTIVE We aimed to investigate the effects of a BCAA-supplemented hypocaloric diet on lean mass preservation and insulin sensitivity. METHODS A total of 132 Chinese adults (63 men and 69 women aged 21-45 y, BMI 25-36 kg/m2) were block randomly assigned by gender and BMI into 3 hypocaloric diet (deficit of 500 kcal/d) groups: standard-protein (14%) with placebo (control, CT) or BCAA supplements at 0.1 g · kg-1 body weight · d-1 (BCAA) or high-protein (27%) with placebo (HP). The subjects underwent 16 wk of dietary intervention with provision of meals and supplements, followed by 8 wk of weight maintenance with provision of supplements only. One-way ANOVA analysis was conducted to analyze the primary (lean mass and insulin sensitivity) and secondary outcomes (anthropometric and metabolic parameters) among the 3 groups. Paired t-test was used to analyze the change in each group. RESULTS The 3 groups demonstrated similar significant reductions in body weight (7.97%), fat mass (13.8%), and waist circumference (7.27%) after 16 wk of energy deficit. Lean mass loss in BCAA (4.39%) tended to be lower than in CT (5.39%) and higher compared with HP (3.67%) (P = 0.06). Calf muscle volume increased 3.4% in BCAA and intramyocellular lipids (IMCLs) decreased in BCAA (17%) and HP (18%) (P < 0.05) over 16 wk. During the 8 wk weight maintenance period, lean mass gain in BCAA (1.03%) tended to be lower compared with CT (1.58%) and higher than in HP (-0.002%) (P = 0.04). Lean mass gain differed significantly between CT and HP (P = 0.03). Insulin sensitivity and metabolic profiles did not differ among the groups throughout the study period. CONCLUSIONS BCAA supplementation does not preserve lean mass or affect insulin sensitivity in overweight and obese adults during weight loss. A higher protein diet may be more advantageous for lean mass preservation.
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Affiliation(s)
- Delicia S Q Ooi
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Khoo Teck Puat-National University Children's Medical Institute, National University Health System, Singapore
| | - Jennifer Q R Ling
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Khoo Teck Puat-National University Children's Medical Institute, National University Health System, Singapore
| | - Suresh Anand Sadananthan
- Clinical Nutrition Research Center, Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore
| | - S Sendhil Velan
- Clinical Nutrition Research Center, Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore.,Singapore Bioimaging Consortium, Agency for Science, Technology and Research, Singapore
| | - Fang Yi Ong
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Khoo Teck Puat-National University Children's Medical Institute, National University Health System, Singapore
| | - Chin Meng Khoo
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - E Shyong Tai
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Christiani Jeyakumar Henry
- Clinical Nutrition Research Center, Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore
| | - Melvin K S Leow
- Clinical Nutrition Research Center, Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore.,Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore.,Department of Endocrinology, Division of Medicine, Tan Tock Seng Hospital, Singapore
| | - Eric Y H Khoo
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Chuen Seng Tan
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Yung Seng Lee
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Khoo Teck Puat-National University Children's Medical Institute, National University Health System, Singapore.,Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore
| | - Mary F F Chong
- Clinical Nutrition Research Center, Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore.,Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore.,Saw Swee Hock School of Public Health, National University of Singapore, Singapore
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Chin YH, Tan HQM, Ng CH, Tan DJH, Lin SY, Huang DQ, Khoo CM, Muthiah MD. A Time-Based Meta-Analysis on the Incidence of New Onset Diabetes after Liver Transplantation. J Clin Med 2021; 10:jcm10051045. [PMID: 33802465 PMCID: PMC7959476 DOI: 10.3390/jcm10051045] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 02/08/2021] [Accepted: 02/24/2021] [Indexed: 12/29/2022] Open
Abstract
NODAT (new-onset diabetes after transplantation) is an important complication after liver transplant, however, there is variation in the reported incidence of NODAT. Therefore, a meta-analysis was performed to estimate the incidence of NODAT in liver transplant. Electronic databases were searched for articles regarding NODAT incidence after liver transplantation. Incidence of NODAT were analyzed at six different timepoints. Summary statistics were calculated using a generalized linear mixed model in random effects. 28 articles were included and out of a pooled population of 71,257 patients, overall incidence of NODAT was found to be 15.51%, 16.09%, 18.30%, 20.86%, 18.08%, 25.05% for three-months, six-months, one-year, three-year, five-year, and ten-year timepoints respectively. After a sensitivity analysis which only included articles with clear definitions of NODAT, the incidence of NODAT was found to be higher at three-year (21.79%), five-year (25.82%), and ten-year (44.95%) timepoints. Subgroup analysis according to ethnicity found no significant differences for all timepoints. However, studies with predominantly Asian participants generally had a higher incidence of NODAT. In conclusion, this meta-analysis provides a pooled estimate of the incidence of NODAT following liver transplantation. Further studies are required to provide a more comprehensive understanding on how ethnicity can affect the incidence of NODAT.
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Affiliation(s)
- Yip Han Chin
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore; (Y.H.C.); (H.Q.M.T.); (D.J.H.T.); (S.Y.L.); (D.Q.H.); (C.M.K.)
| | - Hon Qin Marcus Tan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore; (Y.H.C.); (H.Q.M.T.); (D.J.H.T.); (S.Y.L.); (D.Q.H.); (C.M.K.)
| | - Cheng Han Ng
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore; (Y.H.C.); (H.Q.M.T.); (D.J.H.T.); (S.Y.L.); (D.Q.H.); (C.M.K.)
- Correspondence: or (C.H.N.); (M.D.M.)
| | - Darren Jun Hao Tan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore; (Y.H.C.); (H.Q.M.T.); (D.J.H.T.); (S.Y.L.); (D.Q.H.); (C.M.K.)
| | - Snow Yunni Lin
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore; (Y.H.C.); (H.Q.M.T.); (D.J.H.T.); (S.Y.L.); (D.Q.H.); (C.M.K.)
| | - Daniel Q. Huang
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore; (Y.H.C.); (H.Q.M.T.); (D.J.H.T.); (S.Y.L.); (D.Q.H.); (C.M.K.)
- Department of Medicine, National University Hospital, Singapore 119074, Singapore
- National University Centre for Organ Transplantation, National University Hospital, Singapore 119074, Singapore
| | - Chin Meng Khoo
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore; (Y.H.C.); (H.Q.M.T.); (D.J.H.T.); (S.Y.L.); (D.Q.H.); (C.M.K.)
- Department of Medicine, National University Hospital, Singapore 119074, Singapore
| | - Mark Dhinesh Muthiah
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore; (Y.H.C.); (H.Q.M.T.); (D.J.H.T.); (S.Y.L.); (D.Q.H.); (C.M.K.)
- Department of Medicine, National University Hospital, Singapore 119074, Singapore
- National University Centre for Organ Transplantation, National University Hospital, Singapore 119074, Singapore
- Correspondence: or (C.H.N.); (M.D.M.)
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Lim WH, Sim W, Ng CH, Chin YH, Leon C, Samarasekera DD, Devi MK, Khoo CM, Chong CS. Racism in patient care: a call to translate concerns into actions. The Lancet Global Health 2021. [DOI: 10.1016/s2214-109x(21)00118-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Seah JYH, Chew WS, Torta F, Khoo CM, Wenk MR, Herr DR, Tai ES, van Dam RM. Dietary Fat and Protein Intake in Relation to Plasma Sphingolipids as Determined by a Large-Scale Lipidomic Analysis. Metabolites 2021; 11:metabo11020093. [PMID: 33567768 PMCID: PMC7915172 DOI: 10.3390/metabo11020093] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 02/04/2021] [Accepted: 02/05/2021] [Indexed: 11/24/2022] Open
Abstract
Sphingolipid concentrations have been associated with risk of type 2 diabetes and cardiovascular diseases. Because sphingolipids can be synthesized de novo from saturated fatty acids (SFA), dietary fatty acids may affect plasma sphingolipid concentrations. We aimed to evaluate dietary fat and protein intakes in relation to circulating sphingolipid levels. We used cross-sectional data from 2860 ethnic Chinese Singaporeans collected from 2004–2007. Nutrient intakes were estimated on the basis of a validated 159-item food frequency questionnaire. We quantified 79 molecularly distinct sphingolipids in a large-scale lipidomic evaluation from plasma samples. Higher saturated fat intake was associated with higher concentrations of 16:1;O2 sphingolipids including ceramides, monohexosylcermides, dihexosylceramides, sphingomyelins, and sphingosine 1-phosphates. Higher polyunsaturated fat intake was associated with lower plasma long-chain ceramides and long-chain monohexosylcermide concentrations. Protein intake was inversely associated with concentrations of most subclasses of sphingolipids, with the exception of sphingolipids containing a 16:1;O2 sphingoid base. Lower intake of saturated fat and higher intake of polyunsaturated fat and protein may decrease plasma concentrations of several sphingolipid classes. These findings may represent a novel biological mechanism for the impact of nutrient intakes on cardio-metabolic health.
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Affiliation(s)
- Jowy Yi Hoong Seah
- Saw Swee Hock School of Public Health, National University of Singapore (NUS), Singapore 117549, Singapore;
- NUS Graduate School for Integrative Sciences and Engineering, NUS, Singapore 119077, Singapore
- Correspondence: (J.Y.H.S.); (R.M.v.D.); Tel.: +65-6516-4980 (R.M.v.D.)
| | - Wee Siong Chew
- Department of Pharmacology, Yong Loo Lin School of Medicine, NUS, Singapore 117600, Singapore; (W.S.C.); (D.R.H.)
| | - Federico Torta
- Department of Biochemistry, Yong Loo Lin School of Medicine, NUS, Singapore 117596, Singapore; (F.T.); (M.R.W.)
- Singapore Lipidomics Incubator, Life Sciences Institute, NUS, Singapore 117456, Singapore
| | - Chin Meng Khoo
- Department of Medicine, Yong Loo Lin School of Medicine, NUS and National University Health System, Singapore 119228, Singapore;
| | - Markus R. Wenk
- Department of Biochemistry, Yong Loo Lin School of Medicine, NUS, Singapore 117596, Singapore; (F.T.); (M.R.W.)
- Singapore Lipidomics Incubator, Life Sciences Institute, NUS, Singapore 117456, Singapore
| | - Deron R. Herr
- Department of Pharmacology, Yong Loo Lin School of Medicine, NUS, Singapore 117600, Singapore; (W.S.C.); (D.R.H.)
- Department of Biology, San Diego State University, San Diego, CA 92182, USA
| | - E. Shyong Tai
- Saw Swee Hock School of Public Health, National University of Singapore (NUS), Singapore 117549, Singapore;
- Department of Medicine, Yong Loo Lin School of Medicine, NUS and National University Health System, Singapore 119228, Singapore;
- Duke-NUS Graduate Medical School, Singapore 169857, Singapore
| | - Rob M. van Dam
- Saw Swee Hock School of Public Health, National University of Singapore (NUS), Singapore 117549, Singapore;
- NUS Graduate School for Integrative Sciences and Engineering, NUS, Singapore 119077, Singapore
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
- Correspondence: (J.Y.H.S.); (R.M.v.D.); Tel.: +65-6516-4980 (R.M.v.D.)
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45
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Khoo CM, Deerochanawong C, Chan SP, Matawaran B, Sheu WH, Chan J, Mithal A, Luk A, Suastika K, Yoon K, Ji L, Man NH, Pollock C. Use of sodium-glucose co-transporter-2 inhibitors in Asian patients with type 2 diabetes and kidney disease: An Asian perspective and expert recommendations. Diabetes Obes Metab 2021; 23:299-317. [PMID: 33155749 PMCID: PMC7839543 DOI: 10.1111/dom.14251] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 10/17/2020] [Accepted: 11/01/2020] [Indexed: 12/14/2022]
Abstract
Early onset of type 2 diabetes and a high prevalence of co-morbidities predispose the Asian population to a high risk for, and rapid progression of, diabetic kidney disease (DKD). Apart from renin-angiotensin system inhibitors, sodium-glucose co-transporter-2 (SGLT-2) inhibitors have been shown to delay renal disease progression in patients with DKD. In this review article, we consolidate the existing literature on SGLT-2 inhibitor use in Asian patients with DKD to establish contemporary guidance for clinicians. We extensively reviewed recommendations from international and regional guidelines, data from studies on Asian patients with DKD, global trials (DAPA-CKD, CREDENCE and DELIGHT) and cardiovascular outcomes trials. In patients with DKD, SGLT-2 inhibitor therapy significantly reduced albuminuria and the risk of hard renal outcomes (defined as the onset of end-stage kidney disease, substantial decline in renal function from baseline and renal death), cardiovascular outcomes and hospitalization for heart failure. In all the cardiovascular and renal outcomes trials, there was an initial decline in the estimated glomerular filtration rate (eGFR), which was followed by a slowing in the decline of renal function compared with that seen with placebo. Despite an attenuation in glucose-lowering efficacy in patients with low eGFR, there were sustained reductions in body weight and blood pressure, and an increase in haematocrit. Based on the available evidence, we conclude that SGLT-2 inhibitors represent an evidence-based therapeutic option for delaying the progression of renal disease in Asian patients with DKD and preserving renal function in patients at high risk of kidney disease.
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Affiliation(s)
| | | | - Siew Pheng Chan
- Department of MedicineUniversity of Malaya Medical CenterKuala LumpurMalaysia
| | - Bien Matawaran
- Department of Medicine, Section of Endocrinology, Diabetes and MetabolismUniversity of Santo Tomas HospitalManilaPhilippines
| | - Wayne Huey‐Herng Sheu
- Division of Endocrinology and Metabolism, Department of Internal MedicineTaichung Veterans General HospitalTaichungTaiwan
| | - Juliana Chan
- Department of Medicine and TherapeuticsHong Kong Institute of Diabetes and Obesity and Li Ka Shing Institute of Health Science, The Chinese University of Hong Kong, Prince of Wales HospitalHong Kong
| | | | - Andrea Luk
- Department of Medicine and TherapeuticsHong Kong Institute of Diabetes and Obesity and Li Ka Shing Institute of Health Science, The Chinese University of Hong Kong, Prince of Wales HospitalHong Kong
| | - Ketut Suastika
- Faculty of MedicineUdayana University, Sanglah General HospitalBaliIndonesia
| | - Kun‐Ho Yoon
- Department of Endocrinology & Metabolism, Seoul St Maryʼs HospitalThe Catholic University of KoreaSeoulSouth Korea
| | - Linong Ji
- Peking University Peopleʼs HospitalPekingChina
| | | | - Carol Pollock
- The University of Sydney School of MedicineSydneyNew South WalesAustralia
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46
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Wong C, Lee MH, Yaow CYL, Chin YH, Goh XL, Ng CH, Lim AYL, Muthiah MD, Khoo CM. Glucagon-Like Peptide-1 Receptor Agonists for Non-Alcoholic Fatty Liver Disease in Type 2 Diabetes: A Meta-Analysis. Front Endocrinol (Lausanne) 2021; 12:609110. [PMID: 33897616 PMCID: PMC8063104 DOI: 10.3389/fendo.2021.609110] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 03/17/2021] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE Non-alcoholic fatty liver disease is highly prevalent in patients with type 2 diabetes mellitus. Studies on glucagon-like peptide-1 receptor agonists for the treatment of non-alcoholic fatty liver disease have reported promising results. Despite this, there has been limited evidence of its efficacy in non-alcoholic fatty liver disease patients with type 2 diabetes mellitus. This meta-analysis examined existing evidence on the efficacy of glucagon-like peptide-1 receptor agonists on the management of non-alcoholic fatty liver disease in patients with type 2 diabetes mellitus. METHODS Medline, Embase and Cochrane Central Register of Controlled Trials (CENTRAL) were searched for articles discussing the efficacy of glucagon-like peptide-1 receptor agonists on non-alcoholic fatty liver disease in patients with type 2 diabetes mellitus. Values of standardized mean differences (SMD) and risk ratio (RR) were determined for continuous outcomes and dichotomous outcomes respectively. RESULTS 8 studies involving 1,454 patients from 5 randomized controlled trials and 3 cohort studies were included in the analysis. Our analysis found significant improvements in hepatic fat content, liver biochemistry, body composition, glucose parameters, lipid parameters, insulin sensitivity and inflammatory markers following glucagon-like peptide-1 receptor agonist treatment. Glucagon-like peptide-1 receptor agonists significantly decreased hepatic fat content compared to metformin and insulin-based therapies. Glucagon-like peptide-1 receptor agonists also improved fibrosis markers, but this did not reach statistical significance. CONCLUSION With a high prevalence of obesity and non-alcoholic fatty liver disease among patients with type 2 diabetes mellitus, glucagon-like peptide-1 receptor agonist treatment shows promise in improving both diabetes and non-alcoholic fatty liver disease phenotype.
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Affiliation(s)
- Chloe Wong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Ming Hui Lee
- Department of Biological Sciences, Faculty of Science, National University of Singapore, Singapore, Singapore
| | - Clyve Yu Leon Yaow
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Yip Han Chin
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Xin Lei Goh
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Cheng Han Ng
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Amanda Yuan Ling Lim
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Department of Medicine, National University Hospital, Singapore, Singapore
| | - Mark Dhinesh Muthiah
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Department of Medicine, National University Hospital, Singapore, Singapore
- National University Centre for Organ Transplantation, National University Hospital, Singapore, Singapore
| | - Chin Meng Khoo
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Department of Medicine, National University Hospital, Singapore, Singapore
- *Correspondence: Chin Meng Khoo,
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47
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Ting KR, Ong PY, Wei SOG, Parameswaran R, Khoo CM, Deepak DS, Lee SC. Characteristics and genetic testing outcomes of patients with clinically suspected paraganglioma/pheochromocytoma (PGL/PCC) syndrome in Singapore. Hered Cancer Clin Pract 2020; 18:24. [PMID: 33308260 PMCID: PMC7731464 DOI: 10.1186/s13053-020-00156-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 11/26/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Hereditary paraganglioma (PGL) and pheochromocytoma (PCC) syndromes are rare conditions, with limited data on spectrum of causative gene variants of these syndromes in Asian patients. METHODS We describe the clinical characteristics and genetic testing outcomes of patients with suspected hereditary PGL/PCC who were referred to a tertiary cancer genetics clinic in Singapore. RESULTS Among 2196 patients with suspected hereditary cancer syndrome evaluated at the cancer genetics clinic from 2000 to 2019, 13/2196 (0.6%) patients fulfilled clinical suspicion for hereditary PGL/PCC syndrome. After genetic counselling, 10 patients underwent multi-gene next generation sequencing and deletion/duplication analysis, including SDHAF2, SDHA, SDHB, SDHC, SDHD, VHL, NF1, RET, MAX, and TMEM127. Seven of 10 patients (70%) were identified to carry pathogenic variants, including 3 unrelated Chinese patients with head and neck PGL who carried the same SDHD: c.3G > C (p.Met1Ile) variant that was previously reported to be a possible founder variant in Chinese, and 3 patients with urogenital PGL and 1 patient with retroperitoneal PGL who carried different SDHB variants. Variant carriers were younger, more likely to present with multiple tumours, or have family history of paraganglioma or pheochromocytoma, than non- variant carriers. CONCLUSION Hereditary PGL/PCC accounts for only 0.6% of patients seen in an adult cancer genetics clinic in Asia. SDHD and SDHB genes remain the most important causative genes of hereditary PGL/PCC in Asia even when patients are tested with multi-gene NGS panel.
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Affiliation(s)
- Kay Reen Ting
- Department of Haematology-Oncology, National University Cancer Institute, Singapore (NCIS), National University Health System, 1E Kent Ridge Road, Singapore, 119228, Singapore
| | - Pei Yi Ong
- Department of Haematology-Oncology, National University Cancer Institute, Singapore (NCIS), National University Health System, 1E Kent Ridge Road, Singapore, 119228, Singapore
| | - Samuel Ow Guan Wei
- Department of Haematology-Oncology, National University Cancer Institute, Singapore (NCIS), National University Health System, 1E Kent Ridge Road, Singapore, 119228, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Rajeev Parameswaran
- Department of Surgery, Division of General Surgery (Thyroid and Endocrine Surgery), National University Hospital, Singapore, Singapore
| | - Chin Meng Khoo
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Department of Medicine, Division of Endocrinology, National University Hospital, Singapore, Singapore
| | | | - Soo-Chin Lee
- Department of Haematology-Oncology, National University Cancer Institute, Singapore (NCIS), National University Health System, 1E Kent Ridge Road, Singapore, 119228, Singapore. .,Cancer Science Institute, Singapore, Singapore.
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48
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Tan HC, Hsu JW, Kovalik JP, Eng A, Chan WH, Khoo CM, Tai ES, Chacko S, Jahoor F. Branched-Chain Amino Acid Oxidation Is Elevated in Adults with Morbid Obesity and Decreases Significantly after Sleeve Gastrectomy. J Nutr 2020; 150:3180-3189. [PMID: 33097955 DOI: 10.1093/jn/nxaa298] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 08/07/2020] [Accepted: 09/09/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Plasma concentrations of branched-chain amino acids (BCAAs) are elevated in obese individuals with insulin resistance (IR) and decrease after bariatric surgery. However, the metabolic mechanisms are unclear. OBJECTIVES Our objectives are to compare leucine kinetics between morbidly obese and healthy-weight individuals cross-sectionally, and to prospectively evaluate changes in the morbidly obese after sleeve gastrectomy. We hypothesized that leucine oxidation is slower in obese individuals and increases after surgery. METHODS Ten morbidly obese [BMI (in kg/m2) ≥32.5, age 21-50 y] and 10 healthy-weight participants (BMI <25), matched for age (median ∼30 y) but not gender, were infused with [U-13C6] leucine and [2H5] glycerol to quantify leucine and glycerol kinetics. Morbidly obese participants were studied again 6 mo postsurgery. Primary outcomes were kinetic parameters related to BCAA metabolism. Data were analyzed by nonparametric methods and presented as median (IQR). RESULTS Participants with obesity had IR with an HOMA-IR (4.89; 4.36-8.76) greater than that of healthy-weight participants (1.32; 0.99-1.49; P < 0.001) and had significantly faster leucine flux [218; 196-259 compared with 145; 138-149 μmol · kg fat-free mass (FFM)-1 · h-1], oxidation (24.0; 17.9-29.8 compared with 16.1; 14.3-18.5 μmol · kg FFM-1 · h-1), and nonoxidative disposal (204; 190-247 compared with 138; 129-140 μmol · kg FFM-1 · h-1) (P < 0.017 for all). After surgery, the morbidly obese had a marked improvement in IR (3.54; 3.06-6.08; P = 0.008) and significant reductions in BCAA concentrations (113; 95-157 μmol/L) and leucine oxidation (9.37; 6.85-15.2 μmol · kg FFM-1 · h-1) (P = 0.017 for both). Further, leucine flux in this group correlated significantly with IR (r = 0.78, P < 0.001). CONCLUSIONS BCAA oxidation is not impaired but elevated in individuals with morbid obesity. Plasma BCAA concentrations are lowered after surgery owing to slower breakdown of body proteins as insulin's ability to suppress proteolysis is restored. These findings suggest that IR is the underlying cause and not the consequence of elevated BCAAs in obesity.
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Affiliation(s)
- Hong Chang Tan
- Department of Endocrinology, Singapore General Hospital, Singapore
| | - Jean W Hsu
- USDA/Agricultural Research Service Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Jean-Paul Kovalik
- Cardiovascular and Metabolic Disease Program, Duke-NUS Medical School, Singapore
| | - Alvin Eng
- Department of Upper GI and Bariatric Surgery, Singapore General Hospital, Singapore
| | - Weng Hoong Chan
- Department of Upper GI and Bariatric Surgery, Singapore General Hospital, Singapore
| | - Chin Meng Khoo
- Department of Medicine, National University Health System, Singapore
| | - E Shyong Tai
- Department of Medicine, National University Health System, Singapore
| | - Shaji Chacko
- USDA/Agricultural Research Service Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Farook Jahoor
- USDA/Agricultural Research Service Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
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49
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Seow WJ, Low DY, Pan WC, Gunther SH, Sim X, Torta F, Herr DR, Kovalik JP, Ching J, Khoo CM, Wenk MR, Tai ES, van Dam RM. Coffee, Black Tea, and Green Tea Consumption in Relation to Plasma Metabolites in an Asian Population. Mol Nutr Food Res 2020; 64:e2000527. [PMID: 33120436 DOI: 10.1002/mnfr.202000527] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 10/06/2020] [Indexed: 12/14/2022]
Abstract
SCOPE Coffee and tea are among the most popular beverages in the world. However, the association between habitual coffee, green tea, and black tea consumption with metabolomics profiles in Asian populations remain largely unknown. METHODS AND RESULTS 158 metabolites (14 amino acids, 45 acylcarnitines, and 99 sphingolipids) in the blood plasma of participants are measured from the population-based Singapore Prospective Study Program cohort using mass spectrometry (MS). Linear regression models are used to obtain the estimates for the association between coffee and tea consumption with metabolite levels, adjusted for potential confounders and false discovery rate (FDR). Coffee consumption is significantly associated with higher levels of 63 sphingolipids (29 sphingomyelins, 32 ceramides, a sphingosine-1-phosphate, and a sphingosine) and lower levels of 13 acylcarnitines and alanine. Black tea consumption is significantly associated with higher levels of eight sphingolipids, and lower levels of an amino acid, whereas green tea is significantly inversely associated with four metabolites (C8:1-OH acylcarnitine, ganglioside GM3 d18:1/16:0, sphingomyelins d18:2/18:0 and d18:1/14:0). CONCLUSIONS Coffee, black tea, and green tea consumption are associated with plasma levels of certain classes of sphingolipids and acylcarnitines in an Asian population, particularly sphingomyelins, which may mediate the health benefits of these beverages.
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Affiliation(s)
- Wei Jie Seow
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, 117549, Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore, 119228, Singapore
| | - Dorrain Yanwen Low
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, 636921, Singapore
| | - Wen-Chi Pan
- Institute of Environmental and Occupational Health Science, School of Medicine, National Yang-Ming University, Taipei, 11221, Taiwan
| | - Samuel H Gunther
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, 117549, Singapore
| | - Xueling Sim
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, 117549, Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore, 119228, Singapore
| | - Federico Torta
- Singapore Lipidomics Incubator, Department of Biochemistry, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 119228, Singapore
| | - Deron R Herr
- Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 119228, Singapore
- Department of Biology, San Diego State University, San Diego, CA, 92182, USA
| | - Jean-Paul Kovalik
- Cardiovascular and Metabolic Disorders Programme, Duke-NUS Medical School, Singapore, 169857, Singapore
| | - Jianhong Ching
- Cardiovascular and Metabolic Disorders Programme, Duke-NUS Medical School, Singapore, 169857, Singapore
| | - Chin Meng Khoo
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore, 119228, Singapore
| | - Markus R Wenk
- Singapore Lipidomics Incubator, Department of Biochemistry, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 119228, Singapore
| | - E Shyong Tai
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, 117549, Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore, 119228, Singapore
| | - Rob M van Dam
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, 117549, Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore, 119228, Singapore
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50
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Chai JF, Raichur S, Khor IW, Torta F, Chew WS, Herr DR, Ching J, Kovalik JP, Khoo CM, Wenk MR, Tai ES, Sim X. Associations with metabolites in Chinese suggest new metabolic roles in Alzheimer's and Parkinson's diseases. Hum Mol Genet 2020; 29:189-201. [PMID: 31628463 DOI: 10.1093/hmg/ddz246] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 09/19/2019] [Accepted: 10/08/2019] [Indexed: 11/14/2022] Open
Abstract
Metabolites are small intermediate products of cellular metabolism perturbed in a variety of complex disorders. Identifying genetic markers associated with metabolite concentrations could delineate disease-related metabolic pathways in humans. We tested genetic variants for associations with 136 metabolites in 1954 Chinese from Singapore. At a conservative genome-wide threshold (3.7 × 10-10), we detected 1899 variant-metabolite associations at 16 genetic loci. Three loci (ABCA7, A4GALT, GSTM2) represented novel associations with metabolites, with the strongest association observed between ABCA7 and d18:1/24:1 dihexosylceramide. Among 13 replicated loci, we identified six new variants independent of previously reported metabolite or lipid signals. We observed variant-metabolite associations at two loci (ABCA7, CHCHD2) that have been linked to neurodegenerative diseases. At SGPP1 and SPTLC3 loci, genetic variants showed preferential selectivity for sphingolipids with d16 (rather than d18) sphingosine backbone, including sphingosine-1-phosphate (S1P). Our results provide new genetic associations for metabolites and highlight the role of metabolites as intermediate modulators in disease metabolic pathways.
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Affiliation(s)
- Jin-Fang Chai
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | | | - Ing Wei Khor
- Department of Medicine, Yong Loo Lin School of Medicine, National University Health System, Singapore, Singapore
| | - Federico Torta
- Singapore Lipidomics Incubator (SLING), Department of Biochemistry, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Wee Siong Chew
- Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Deron Raymond Herr
- Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Jianhong Ching
- Programme in Cardiovascular and Metabolic Disorders, Duke-NUS Medical School, Singapore, Singapore
| | - Jean-Paul Kovalik
- Programme in Cardiovascular and Metabolic Disorders, Duke-NUS Medical School, Singapore, Singapore
| | - Chin Meng Khoo
- Department of Medicine, Yong Loo Lin School of Medicine, National University Health System, Singapore, Singapore
| | - Markus R Wenk
- Singapore Lipidomics Incubator (SLING), Department of Biochemistry, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - E Shyong Tai
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore.,Department of Medicine, Yong Loo Lin School of Medicine, National University Health System, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - Xueling Sim
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
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