Glucagon-like peptide-1 secretion in people with versus without type 2 diabetes: a systematic review and meta-analysis of cross-sectional studies

AIMS/HYPOTHESIS

The aim of this systematic review was to synthesise the study findings on whether GLP-1 secretion in response to a meal tolerance test is affected by the presence of type 2 diabetes (T2D). The influence of putative moderators such as age, sex, meal type, meal form, and assay type were also explored.

METHODS

A literature search identified 32 relevant studies. The sample mean and SD for fasting GLP-1TOTAL and GLP-1TOTAL iAUC were extracted and used to calculate between-group standardised mean differences (SMD), which were meta-analysed using a random-effects model to derive pooled estimates of Hedges' g and 95 % prediction intervals (PI).

RESULTS

Pooled across 18 studies, the overall SMD in GLP-1TOTAL iAUC between individuals with T2D (n = 270, 1047 ± 930 pmol·L-1·min) and individuals without T2D (n = 402, 1204 ± 937 pmol·L-1·min) was very small, not statistically significant and heterogenous across studies (g = -0.15, p = 0.43, PI: -1.53, 1.23). Subgroup analyses demonstrated an effect of assay type whereby Hedges' g for GLP-1 iAUC was greater in individuals with, versus those without T2D when using ELISA or Mesoscale (g = 0.67 [moderate], p = 0.009), but not when using RIA (g = -0.30 [small], p = 0.10). Pooled across 30 studies, the SMD in fasting GLP-1TOTAL between individuals with T2D (n = 580, 16.2 ± 6.9 pmol·L-1) versus individuals without T2D (n = 1363, 12.4 ± 5.7 pmol·L-1) was small and heterogenous between studies (g = 0.24, p = 0.21, PI: -1.55, 2.02).

CONCLUSIONS

Differences in fasting GLP-1TOTAL and GLP-1TOTAL iAUC between individuals with, versus those without T2D were generally small and inconsistent between studies. Factors influencing study heterogeneity such as small sample sizes and poor matching of groups may help to explain the wide prediction intervals observed. Considerations to improve comparisons of GLP-1 secretion in T2D and potential mediating factors more important than T2D diagnosis per se are outlined.

PROSPERO ID

CRD42020195612.

Mobilising vitamin D from adipose tissue: The potential impact of exercise

Vitamin D is lipophilic and accumulates substantially in adipose tissue. Even without supplementation, the amount of vitamin D in the adipose of a typical adult is equivalent to several months of the daily reference nutrient intake (RNI). Paradoxically, despite the large amounts of vitamin D located in adipose tissue, individuals with obesity are often vitamin D deficient according to consensus measures of vitamin D status (serum 25-hydroxyvitamin D concentrations). Thus, it appears that vitamin D can become 'trapped' in adipose tissue, potentially due to insufficient lipolytic stimulation and/or due to tissue dysfunction/adaptation resulting from adipose expansion. Emerging evidence suggests that exercise may mobilise vitamin D from adipose (even in the absence of weight loss). If exercise helps to mobilise vitamin D from adipose tissue, then this could have important ramifications for practitioners and policymakers regarding the management of low circulating levels of vitamin D, as well as chronically low levels of physical activity, obesity and associated health conditions. This perspective led us to design a study to examine the impact of exercise on vitamin D status, vitamin D turnover and adipose tissue vitamin D content (the VitaDEx project). The VitaDEx project will determine whether increasing physical activity (via exercise) represents a potentially useful strategy to mobilise vitamin D from adipose tissue.

Neuromuscular changes and the rapid adaptation following a bout of damaging eccentric exercise

INTRODUCTION

An initial bout of eccentric exercise is known to protect against muscle damage following a repeated bout of the same exercise; however, the neuromuscular adaptations owing to this phenomenon are unknown.

AIM

To determine whether neuromuscular disturbances are modulated following a repeated bout of eccentric exercise.

METHODS

Following eccentric exercise performed with the elbow flexors, we measured maximal voluntary force, resting twitch force, muscle soreness, creatine kinase (CK) and voluntary activation (VA) using motor point and motor cortex stimulation at baseline, immediately post-exercise and at 1, 2, 3, 4 and 7 days post-exercise on two occasions, separated by 3 weeks.

RESULTS

Significant muscle damage and fatigue were evident following the first exercise bout; maximal voluntary contraction (MVC) was reduced immediately by 35% and remained depressed at 7 days post-exercise. Soreness and CK release peaked at 3 and 4 days post-exercise respectively. Resting twitch force remained significantly reduced at 7 days (-48%), whilst VA measured with motor point and motor cortex stimulation was reduced until 2 and 3 days respectively. A repeated bout effect (RBE) was observed with attenuated soreness and CK release and a quicker recovery of MVC and resting twitch force. A similar decrement in VA was observed following both bouts; however, following the repeated bout there was a significantly smaller reduction in, and a faster recovery of, VA measured using motor cortical stimulation.

CONCLUSION

Our data suggest that the RBE may be explained, partly, by a modification in motor corticospinal drive.

Inspiratory muscle warm-up does not improve cycling time-trial performance

PURPOSE

This study examined the effects of an active cycling warm-up, with and without the addition of an inspiratory muscle warm-up (IMW), on 10-km cycling time-trial performance.

METHODS

Ten cyclists (VO₂ = 65 ± 9 mL kg(-1) min(-1)) performed a habituation 10-km cycling time-trial and three further time-trials preceded by either no warm-up (CONT), a cycling-specific warm-up (CYC) comprising three consecutive 5-min bouts at powers corresponding to 70, 80, and 90% of the gas exchange threshold, or a cycling-specific warm-up preceded by an IMW (CYC + IMW) comprising two sets of 30 inspiratory efforts against a pressure-threshold load of 40% maximal inspiratory pressure (MIP). The cycling warm-up was followed by 2-min rest before the start of the time-trial.

RESULTS

Time-trial performance times during CYC (14.75 ± 0.79 min) and CYC + IMW (14.70 ± 0.75 min) were not different, although both were faster than CONT (14.99 ± 0.90 min) (P < 0.05). Throughout the time-trial, physiological (minute ventilation, breathing pattern, pulmonary gas exchange, heart rate, blood lactate concentration and pH) and perceptual (limb discomfort and dyspnoea) responses were not different between CYC and CYC + IMW. Baseline MIP during CONT and CYC was 151 ± 31 and 156 ± 39 cmH₂O, respectively, and was unchanged following the time-trial. MIP increased by 8% after IMW (152 ± 27 vs. 164 ± 27 cmH2O, P < 0.05) and returned to baseline after the time-trial.

CONCLUSIONS

Improvements in 10-km cycling time-trial performance following an active cycling warm-up were not magnified by the addition of an IMW. Therefore, an appropriately designed active whole-body warm-up does adequately prepare the inspiratory muscles for cycling time-trials lasting approximately 15 min.

Breakfast consumption and exercise interact to affect cognitive performance and mood later in the day. A randomized controlled trial

The current study assessed the interactive effect of breakfast and exercise on cognition and mood. Twelve active males completed four trials; no breakfast-rest, breakfast-rest, no breakfast-exercise or breakfast-exercise in a randomized, cross-over design. The trials consisted of; breakfast or fast, a 2h rest, exercise (treadmill run) or equivalent rest, a chocolate milk drink, a 90 min rest and an ad libitum lunch. Cognitive performance and mood were recorded frequently throughout each trial. Data was analysed as pre-exercise/rest, during and immediately post exercise/rest and post-drink. No effects were found prior to consumption of the drink. Post-drink, fasting before exercise increased mental fatigue compared to consuming breakfast before exercise and fasting before rest. Tension increased when breakfast was consumed at rest and when exercise was undertaken fasted compared to omitting breakfast before rest. Breakfast before rest decreased rapid visual information processing task speed and impaired Stroop performance. Breakfast omission improved Four Choice Reaction Time performance. To conclude, breakfast before exercise appeared beneficial for post-exercise mood even when a post-exercise snack was consumed. Exercise reversed post-breakfast cognitive impairment in active males.

Effect of calcium intake on fat oxidation in adults: a meta-analysis of randomized, controlled trials

Calcium intake is likely to increase body fat loss during energy restriction. Part of this effect may be explained by increased fat oxidation in the presence of a similar energy balance, yet studies have not provided a conclusive answer. Therefore a meta-analysis was performed to determine whether chronic or acute high calcium intake increases fat oxidation. Randomized controlled trials of high calcium intake in human adults where measures of fat oxidation were taken were included. A random-effects meta-analysis was performed on outcomes expressed as standardized mean differences. Chronic high calcium intake increased fat oxidation by a standardized mean difference of 0.42 (95% confidence intervals: 0.14, 0.69; P= 0.003; estimated to correspond to an 11% increase), displaying low heterogeneity (I(2) = 18%), which was more prominent when habitual calcium intake was low (<700 mg d(-1) ). Acute high calcium intake increased fat oxidation by a standardized mean difference of 0.41 (0.04, 0.77; P = 0.03), with low heterogeneity (I(2) = 19%), yet sensitivity analysis revealed that this effect was relatively weak. In conclusion, chronic high calcium intake is likely to increase rates of fat oxidation. The effects of acute high calcium intake appear to point in the same direction, but further work is needed to permit a greater degree of certainty.

Factors relating to frequency of breast self-examination among low-income Mexican American women. Implications for nursing practice

This descriptive study of low-income Mexican American women examined the central role of self-efficacy, or perceived capacity to perform a given activity, as it related to the frequency of breast self-examination (BSE), an important health practice for the early detection of breast cancer. Previous studies document the importance of self-efficacy as a predictor of health status, preventive self-care, and disease self-management. In turn, social support from others is a factor relating to self-efficacy. For Mexican Americans, previous research substantiates English language proficiency and barriers to access of health care as other predictors of compliance with recommended health care behaviors. Using bivariate correlations and analysis of variance, the findings revealed a strong relationship between self-efficacy and frequency of BSE. Neither social support nor barriers to health care had a significant effect on self-efficacy or frequency of BSE. The effects of English language proficiency are indirect and mediated by self-efficacy. This paper describes how these findings can be applied to the clinical practice goal of facilitating consistent and correct usage of BSE in the Mexican American community.

Hispanics and cancer preventive behavior: the development of a behavioral model and its policy implications

This paper presents the theoretical development of a model that predicts the conditions under which Hispanics will seek preventive health care. Research trends, however, show that Hispanics tend to delay preventive care, resulting in higher morbidity and mortality rates for serious diseases such as cancer. Since many serious diseases, such as heart disease, diabetes and cancer can be prevented or treated more effectively if detected early, it is crucial to understand the motivating forces behind Hispanics' preventive health behavior. The Hispanic model, which is an extension of the Health Behavior in Cancer Prevention Model developed by Atwood (1986), includes as core variables environmental barriers to access and English language proficiency, as well as social support, health beliefs, self-efficacy, or perceived skill, health locus of control, and health values. The practical health policy applications of the model are also discussed.