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Jensen MM, Færch K, Brock C, Quist JS. Reply to M Yildiz et al. J Nutr 2024:S0022-3166(24)00213-X. [PMID: 38615732 DOI: 10.1016/j.tjnut.2024.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Accepted: 04/05/2024] [Indexed: 04/16/2024] Open
Affiliation(s)
- Marie M Jensen
- Clinical and Translational Research, Copenhagen University Hospital - Steno Diabetes Center Copenhagen, Herlev, Denmark
| | - Kristine Færch
- Clinical and Translational Research, Copenhagen University Hospital - Steno Diabetes Center Copenhagen, Herlev, Denmark; Novo Nordisk A/S, Søborg, Denmark; Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Christina Brock
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark; Mech-Sense, Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark; Steno Diabetes Center North Jutland, Aalborg, Denmark
| | - Jonas S Quist
- Clinical and Translational Research, Copenhagen University Hospital - Steno Diabetes Center Copenhagen, Herlev, Denmark; Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark; School of Psychology, University of Leeds, Leeds, UK.
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Quist JS, Pedersen HE, Jensen MM, Clemmensen KKB, Bjerre N, Ekblond TS, Uldal S, Størling J, Wewer Albrechtsen NJ, Holst JJ, Torekov SS, Nyeland ME, Vistisen D, Jørgensen ME, Panda S, Brock C, Finlayson G, Blond MB, Færch K. Effects of 3 months of 10-h per-day time-restricted eating and 3 months of follow-up on bodyweight and cardiometabolic health in Danish individuals at high risk of type 2 diabetes: the RESET single-centre, parallel, superiority, open-label, randomised controlled trial. Lancet Healthy Longev 2024:S2666-7568(24)00028-X. [PMID: 38588687 DOI: 10.1016/s2666-7568(24)00028-x] [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] [Received: 09/05/2023] [Revised: 02/08/2024] [Accepted: 02/08/2024] [Indexed: 04/10/2024] Open
Abstract
BACKGROUND Time-restricted eating (TRE) has been suggested to be a simple, feasible, and effective dietary strategy for individuals with overweight or obesity. We aimed to investigate the effects of 3 months of 10-h per-day TRE and 3 months of follow-up on bodyweight and cardiometabolic risk factors in individuals at high risk of type 2 diabetes. METHODS This was a single-centre, parallel, superiority, open-label randomised controlled clinical trial conducted at Steno Diabetes Center Copenhagen (Denmark). The inclusion criteria were age 30-70 years with either overweight (ie, BMI ≥25 kg/m2) and concomitant prediabetes (ie, glycated haemoglobin [HbA1c] 39-47 mmol/mol) or obesity (ie, BMI ≥30 kg/m2) with or without prediabetes and a habitual self-reported eating window (eating and drinking [except for water]) of 12 h per day or more every day and of 14 h per day or more at least 1 day per week. Individuals were randomly assigned 1:1 to 3 months of habitual living (hereafter referred to as the control group) or TRE, which was a self-selected 10-h per-day eating window placed between 0600 h and 2000 h. Randomisation was done in blocks varying in size and was open for participants and research staff, but outcome assessors were masked during statistical analyses. The randomisation list was generated by an external statistician. The primary outcome was change in bodyweight, assessed after 3 months (12 weeks) of the intervention and after 3 months (13 weeks) of follow-up. Adverse events were reported and registered at study visits or if participants contacted study staff to report events between visits. This trial is registered on ClinicalTrials.gov (NCT03854656). FINDINGS Between March 12, 2019, and March 2, 2022, 100 participants (66 [66%] were female and 34 [34%] were male; median age 59 years [IQR 52-65]) were enrolled and randomly assigned (50 to each group). Of those 100, 46 (92%) in the TRE group and 46 (92%) in the control group completed the intervention period. After 3 months of the intervention, there was no difference in bodyweight between the TRE group and the control group (-0·8 kg, 95% CI -1·7 to 0·2; p=0·099). Being in the TRE group was not associated with a lower bodyweight compared with the control group after subsequent 3-month follow-up (-0·2 kg, -1·6 to 1·2). In the per-protocol analysis, participants who completed the intervention in the TRE group lost 1·0 kg (-1·9 to -0·0; p=0·040) bodyweight compared with the control group after 3 months of intervention, which was not maintained after the 3-month follow-up period (-0·4 kg, -1·8 to 1·0). During the trial and follow-up period, one participant in the TRE group reported a severe adverse event: development of a subcutaneous nodule and pain when the arm was in use. This side-effect was evaluated to be related to the trial procedures. INTERPRETATION 3 months of 10-h per-day TRE did not lead to clinically relevant effects on bodyweight in middle-aged to older individuals at high risk of type 2 diabetes. FUNDING Novo Nordisk Foundation, Aalborg University, Helsefonden, and Innovation Fund Denmark.
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Affiliation(s)
- Jonas Salling Quist
- Steno Diabetes Center Copenhagen, Copenhagen University Hospital, Herlev, Denmark; Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark; School of Psychology, University of Leeds, Leeds, UK.
| | - Hanne Enghoff Pedersen
- Steno Diabetes Center Copenhagen, Copenhagen University Hospital, Herlev, Denmark; National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark; iMotions, Copenhagen, Denmark; Novo Nordisk, Søborg, Denmark
| | - Marie Møller Jensen
- Steno Diabetes Center Copenhagen, Copenhagen University Hospital, Herlev, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | | | - Natasja Bjerre
- Steno Diabetes Center Copenhagen, Copenhagen University Hospital, Herlev, Denmark; Department of Food and Resource Economics, University of Copenhagen, Copenhagen, Denmark
| | | | - Sarah Uldal
- Steno Diabetes Center Copenhagen, Copenhagen University Hospital, Herlev, Denmark
| | - Joachim Størling
- Steno Diabetes Center Copenhagen, Copenhagen University Hospital, Herlev, Denmark; Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Nicolai J Wewer Albrechtsen
- Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark; Department of Clinical Biochemistry, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Jens Juul Holst
- Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark; Novo Nordisk Foundation Center for Basic Metabolic Research, University of Copenhagen, Copenhagen, Denmark
| | | | - Martin Erik Nyeland
- Steno Diabetes Center Copenhagen, Copenhagen University Hospital, Herlev, Denmark
| | - Dorte Vistisen
- Steno Diabetes Center Copenhagen, Copenhagen University Hospital, Herlev, Denmark; Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Marit Eika Jørgensen
- Steno Diabetes Center Copenhagen, Copenhagen University Hospital, Herlev, Denmark; National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark; Steno Diabetes Center Greenland, Nuuk, Greenland
| | | | - Christina Brock
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark; Mech-Sense, Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark; Steno Diabetes Center Northern Jutland, Aalborg, Denmark
| | - Graham Finlayson
- Steno Diabetes Center Copenhagen, Copenhagen University Hospital, Herlev, Denmark; School of Psychology, University of Leeds, Leeds, UK
| | - Martin Bæk Blond
- Steno Diabetes Center Copenhagen, Copenhagen University Hospital, Herlev, Denmark
| | - Kristine Færch
- Steno Diabetes Center Copenhagen, Copenhagen University Hospital, Herlev, Denmark; Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark; Novo Nordisk, Søborg, Denmark
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Holm TF, Udsen FW, Færch K, Jensen MH, von Scholten BJ, Hejlesen OK, Hangaard S. The Effectiveness of Digital Health Lifestyle Interventions on People With Prediabetes: Protocol for a Systematic Review, Meta-Analysis, and Meta-Regression. JMIR Res Protoc 2024; 13:e50340. [PMID: 38335018 PMCID: PMC10891485 DOI: 10.2196/50340] [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] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 12/15/2023] [Accepted: 12/17/2023] [Indexed: 02/10/2024] Open
Abstract
BACKGROUND There has been an increasing interest in the use of digital health lifestyle interventions for people with prediabetes, as these interventions may offer a scalable approach to preventing type 2 diabetes. Previous systematic reviews on digital health lifestyle interventions for people with prediabetes had limitations, such as a narrow focus on certain types of interventions, a lack of statistical pooling, and no broader subgroup analysis of intervention characteristics. The identified limitations observed in previous systematic reviews substantiate the necessity of conducting a comprehensive review to address these gaps within the field. This will enable a comprehensive understanding of the effectiveness of digital health lifestyle interventions for people with prediabetes. OBJECTIVE The objective of this systematic review, meta-analysis, and meta-regression is to systematically investigate the effectiveness of digital health lifestyle interventions on prediabetes-related outcomes in comparison with any comparator without a digital component among adults with prediabetes. METHODS This systematic review will include randomized controlled trials that investigate the effectiveness of digital health lifestyle interventions on adults (aged 18 years or older) with prediabetes and compare the digital interventions with nondigital interventions. The primary outcome will be change in body weight (kg). Secondary outcomes include, among others, change in glycemic status, markers of cardiometabolic health, feasibility outcomes, and incidence of type 2 diabetes. Embase, PubMed, CINAHL, and CENTRAL (Cochrane Central Register of Controlled Trials) will be systematically searched. The data items to be extracted include study characteristics, participant characteristics, intervention characteristics, and relevant outcomes. To estimate the overall effect size, a meta-analysis will be conducted using the mean difference. Additionally, if feasible, meta-regression on study, intervention, and participant characteristics will be performed. The Cochrane risk of bias tool will be applied to assess study quality, and the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach will be used to assess the certainty of evidence. RESULTS The results are projected to yield an overall estimate of the effectiveness of digital health lifestyle interventions on adults with prediabetes and elucidate the characteristics that contribute to their effectiveness. CONCLUSIONS The insights gained from this study may help clarify the potential of digital health lifestyle interventions for people with prediabetes and guide the decision-making regarding future intervention components. TRIAL REGISTRATION PROSPERO CRD42023426919; http://tinyurl.com/d3enrw9j. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/50340.
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Affiliation(s)
- Tanja Fredensborg Holm
- Department of Health Science and Technology, Aalborg University, Gistrup, Denmark
- Steno Diabetes Center North Jutland, Aalborg University Hospital, Aalborg, Denmark
| | - Flemming Witt Udsen
- Department of Health Science and Technology, Aalborg University, Gistrup, Denmark
| | - Kristine Færch
- Data Science, Novo Nordisk A/S, Søborg, Denmark
- Clinical Research, Copenhagen University Hospital - Steno Diabetes Center Copenhagen, Herlev, Denmark
| | - Morten Hasselstrøm Jensen
- Department of Health Science and Technology, Aalborg University, Gistrup, Denmark
- Data Science, Novo Nordisk A/S, Søborg, Denmark
| | | | | | - Stine Hangaard
- Department of Health Science and Technology, Aalborg University, Gistrup, Denmark
- Steno Diabetes Center North Jutland, Aalborg University Hospital, Aalborg, Denmark
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Jensen MM, Pedersen HE, Clemmensen KKB, Ekblond TS, Ried-Larsen M, Færch K, Brock C, Quist JS. Associations Between Physical Activity and Gastrointestinal Transit Times in People with Normal Weight, Overweight, and Obesity. J Nutr 2024; 154:41-48. [PMID: 37315794 DOI: 10.1016/j.tjnut.2023.06.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 05/09/2023] [Accepted: 06/06/2023] [Indexed: 06/16/2023] Open
Abstract
BACKGROUND Rapid gastric emptying is associated with obesity and overeating, whereas delayed gastric emptying is associated with anorexia. Acute effects of exercise on gastric emptying have been investigated extensively, but the influence of habitual physical activity on gastric emptying and transit time in other regions of the gastrointestinal tract is poorly understood. OBJECTIVE The objective was to investigate associations between objectively measured habitual physical activity and gastrointestinal transit times in adults with varying degrees of adiposity. METHODS 50 adults (58% women) were included in this cross-sectional study. Physical activity was measured by an accelerometer placed on the lower back for 7 d. Gastric emptying time, small bowel transit time, colonic transit time, and whole gut transit time were simultaneously evaluated by a wireless motility capsule, which was ingested together with a standardized mixed meal. Linear regression models were applied to assess the associations of total activity counts and time spent at different intensities-sedentary activity (0-100 counts/min), low light activity (101-759 counts/min), high light activity (760-1951 counts/min); moderate and vigorous activity (≥1952 counts/min)) with gastrointestinal transit times. RESULTS Median [Q1; Q3] age was 56.5 [46.6-65.5] y, and body mass index (BMI) was 32.1 [28.5-35.1] kg/m2. For every additional hour spent performing high light intensity physical activity, colonic transit time was 25.5 % [95% CI: 3.10, 42.7] more rapid (P = 0.028), and whole gut transit time was 16.2 % [95% CI: 1.84, 28.4] more rapid (P = 0.028) when adjusted for sex, age, and body fat. No other associations were observed. CONCLUSIONS More time spent on physical activity at high light intensity was associated with more rapid colonic and whole gut transit time, independent of age, sex, and body fat, whereas other intensities of physical activity and gastrointestinal transit times were not associated. TRIAL REGISTRATION Clinicaltrials.gov IDs (NCT03894670, NCT03854656).
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Affiliation(s)
- Marie M Jensen
- Clinical Research, Copenhagen University Hospital - Steno Diabetes Center Copenhagen, Herlev, Denmark
| | - Hanne E Pedersen
- Clinical Research, Copenhagen University Hospital - Steno Diabetes Center Copenhagen, Herlev, Denmark
| | - Kim K B Clemmensen
- Clinical Research, Copenhagen University Hospital - Steno Diabetes Center Copenhagen, Herlev, Denmark
| | - Trine S Ekblond
- Clinical Research, Copenhagen University Hospital - Steno Diabetes Center Copenhagen, Herlev, Denmark
| | - Mathias Ried-Larsen
- the Center of Inflammation and Metabolism and the Center for Physical Activity Research, Copenhagen University Hospital - Rigshospitalet, Denmark; Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Denmark
| | - Kristine Færch
- Clinical Research, Copenhagen University Hospital - Steno Diabetes Center Copenhagen, Herlev, Denmark; Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Christina Brock
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark; Mech-Sense, Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark; Steno Diabetes Center North Jutland, Aalborg, Denmark
| | - Jonas S Quist
- Clinical Research, Copenhagen University Hospital - Steno Diabetes Center Copenhagen, Herlev, Denmark; Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark; School of Psychology, University of Leeds, Leeds, UK.
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Karstoft K, Ried-Larsen M, Bruhn L, Pilmark NS, Hansen KB, Persson F, Jørgensen ME, Blond MB, Færch K. The effect of metformin treatment on volumes of free-living physical activity and sedentary behaviour: A post-hoc analysis of the PRE-D trial. J Sports Sci 2023; 41:1687-1691. [PMID: 38053246 DOI: 10.1080/02640414.2023.2291737] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 11/28/2023] [Indexed: 12/07/2023]
Abstract
Perceived physical exertion is increased when exercise is performed on metformin treatment, but the clinical relevance of this is unknown. In this post hoc analysis of a randomized, controlled trial, we investigated whether metformin treatment was associated with lower levels of free-living physical activity. Ninety individuals with overweight/obesity (BMI>25 m2/kg) and HbA1c-defined prediabetes (39-47 mmol/mol) were randomized to treatment with dapagliflozin (SGLT2-inhibitor; 10 mg once daily, n=30), metformin (850 mg twice daily, n=30) or no treatment (control, n=30) for 13 weeks in a parallel-group, open-label trial. Before (baseline), during (6 weeks) and immediately after (13 weeks) cessation of treatment, a 6-day assessment of physical activity and sedentary behaviour was performed using accelerometer-based physical activity monitors. Intention-to-treat analyses revealed no within-group changes or differences in change between the groups for any measures of physical activity or sedentary behaviour at neither 6 nor 13 weeks. Short-term metformin treatment does not reduce free-living physical activity level in individuals with overweight/obesity and HbA1c-defined prediabetes.
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Affiliation(s)
- Kristian Karstoft
- Centre for Physical Activity Research (CFAS), Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Pharmacology, Bispebjerg-Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Mathias Ried-Larsen
- Centre for Physical Activity Research (CFAS), Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- Department of Sports Science and Clinical Biomechanics, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Lea Bruhn
- Department of Clinical Research, Steno Diabetes Center Copenhagen (SDCC), Copenhagen, Denmark
| | - Nanna Skytt Pilmark
- Centre for Physical Activity Research (CFAS), Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Katrine Bagge Hansen
- Department of Clinical Research, Steno Diabetes Center Copenhagen (SDCC), Copenhagen, Denmark
| | - Frederik Persson
- Department of Clinical Research, Steno Diabetes Center Copenhagen (SDCC), Copenhagen, Denmark
| | - Marit Eika Jørgensen
- Department of Clinical Research, Steno Diabetes Center Copenhagen (SDCC), Copenhagen, Denmark
- Steno Diabetes Center Greenland (SDCG), Nuuk, Greenland
| | - Martin Bæk Blond
- Department of Clinical Research, Steno Diabetes Center Copenhagen (SDCC), Copenhagen, Denmark
| | - Kristine Færch
- Department of Clinical Research, Steno Diabetes Center Copenhagen (SDCC), Copenhagen, Denmark
- Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
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Byberg S, Blond MB, Holm S, Amadid H, Nielsen LB, Clemmensen KKB, Færch K, Holst B. LEAP2 is associated with cardiometabolic markers but is unchanged by antidiabetic treatment in people with prediabetes. Am J Physiol Endocrinol Metab 2023; 325:E244-E251. [PMID: 37436962 DOI: 10.1152/ajpendo.00023.2023] [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: 01/20/2023] [Revised: 07/05/2023] [Accepted: 07/06/2023] [Indexed: 07/14/2023]
Abstract
To examine whether fasting plasma liver-expressed antimicrobial peptide 2 (FP-LEAP2) is associated with markers of cardiometabolic disease susceptibility in a cohort with prediabetes and overweight/obesity and whether antidiabetic interventions affect FP-LEAP2 levels. The analysis included 115 individuals with prediabetes [hemoglobin A1c (HbA1c) 39-47 mmol/mol, 5.7%-6.4%] and overweight/obesity [body mass index (BMI) ≥ 25 kg/m2] from a randomized controlled trial. Changes in FP-LEAP2 levels were assessed in relation to treatment with dapagliflozin (10 mg once daily), metformin (1,700 mg daily), or interval-based exercise (5 days/wk, 30 min/session) compared with control (habitual lifestyle) after 6 and 13 wk of treatment. FP-LEAP2 levels were positively associated with [standardized beta coefficient (95% CI)]: BMI 0.22 (0.03:0.41), P = 0.027; body weight 0.27 (0.06:0.48), P = 0.013; fat mass 0.2 (0.00:0.4), P = 0.048; lean mass 0.47 (0.13:0.8), P = 0.008; HbA1c 0.35 (0.17:0.53), P < 0.001; fasting plasma glucose (FPG) 0.32 (0.12:0.51), P = 0.001; fasting serum insulin 0.28 (0.09:0.47), P = 0.005; total cholesterol 0.19 (0.01:0.38), P = 0.043; triglycerides 0.31 (0.13:0.5), P < 0.001; and transaminases and fatty liver index (standardized beta coefficients 0.23-0.32), all P < 0.020. FP-LEAP2 levels were inversely associated with insulin sensitivity [-0.22 (-0.41: -0.03), P = 0.022] and kidney function [estimated glomerular filtration rate (eGFR) -0.34 (-0.56: -0.12), P = 0.003]. FP-LEAP2 levels were not associated with fat distribution or body fat percentage, fasting glucagon, postload glucose, β-cell function, or low-density lipoprotein. The interventions were not associated with changes in FP-LEAP2. FP-LEAP2 is associated with body mass, impaired insulin sensitivity, liver-specific enzymes, and kidney function. The findings highlight the importance of studying LEAP2 in obesity, type 2 diabetes, and nonalcoholic fatty liver disease. FP-LEAP2 was not affected by metformin, dapaglifloxin, or exercise in this population.NEW & NOTEWORTHY LEAP2, primarily secreted by the liver, increases with greater body mass, insulin resistance, and liver-specific enzymes in individuals with prediabetes and overweight or obesity. Fasting glucose, body mass, and alanine aminotransferase independently predict LEAP2 levels. LEAP2 is inversely linked to impaired kidney function. Elevated LEAP2 levels might indicate an increased metabolic risk, warranting further investigation into its potential involvement in glucose and body weight control.
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Affiliation(s)
- Sarah Byberg
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Martin Bæk Blond
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Research, Copenhagen University Hospital - Steno Diabetes Center Copenhagen, Herlev, Denmark
| | - Stephanie Holm
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Hanan Amadid
- Department of Data Science, Novo Nordisk, Herlev, Denmark
| | | | | | - Kristine Færch
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Research, Copenhagen University Hospital - Steno Diabetes Center Copenhagen, Herlev, Denmark
| | - Birgitte Holst
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Blond MB, Færch K, Herder C, Ziegler D, Stehouwer CDA. The prediabetes conundrum: striking the balance between risk and resources. Diabetologia 2023; 66:1016-1023. [PMID: 36897357 PMCID: PMC10163079 DOI: 10.1007/s00125-023-05890-y] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 01/18/2023] [Indexed: 03/11/2023]
Abstract
The current definition of prediabetes is controversial and subject to continuous debate. Nonetheless, prediabetes is a risk factor for type 2 diabetes, is highly prevalent and is associated with diabetic complications and mortality. Thereby, it has the potential to become a huge strain on healthcare systems in the future, necessitating action from legislators and healthcare providers. But how do we best reduce its associated burden on health? As a compromise between differing opinions in the literature and among the authors of this article, we suggest stratifying individuals with prediabetes according to estimated risk and only offering individual-level preventive interventions to those at high risk. At the same time, we argue to identify those with prediabetes and already established diabetes-related complications and treat them as we would treat individuals with established type 2 diabetes.
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Affiliation(s)
- Martin B Blond
- Clinical Prevention Research, Steno Diabetes Center Copenhagen, Herlev, Denmark.
| | - Kristine Færch
- Clinical Prevention Research, Steno Diabetes Center Copenhagen, Herlev, Denmark.
- Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark.
| | - Christian Herder
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany.
- German Center for Diabetes Research (DZD), Partner Düsseldorf, München-Neuherberg, Germany.
- Department of Endocrinology and Diabetology, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Düsseldorf, Germany.
| | - Dan Ziegler
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany.
| | - Coen D A Stehouwer
- CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, the Netherlands.
- Department of Internal Medicine, Maastricht University Medical Centre+, Maastricht, the Netherlands.
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Bruhn L, Vistisen D, Amadid H, Clemmensen KKB, Karstoft K, Ried-Larsen M, Persson F, Jørgensen ME, Møller CL, Stallknecht B, Færch K, Blond MB. Predicting the HbA 1c level following glucose-lowering interventions in individuals with HbA 1c-defined prediabetes: a post-hoc analysis from the randomized controlled PRE-D trial. Endocrine 2023:10.1007/s12020-023-03384-w. [PMID: 37198379 DOI: 10.1007/s12020-023-03384-w] [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: 02/15/2023] [Accepted: 04/23/2023] [Indexed: 05/19/2023]
Abstract
PURPOSE To investigate whether the prediction of post-treatment HbA1c levels can be improved by adding an additional biomarker of the glucose metabolism in addition to baseline HbA1c. METHODS We performed an exploratory analysis based on data from 112 individuals with prediabetes (HbA1c 39-47 mmol) and overweight/obesity (BMI ≥ 25 kg/m2), who completed 13 weeks of glucose-lowering interventions (exercise, dapagliflozin, or metformin) or control (habitual living) in the PRE-D trial. Seven prediction models were tested; one basic model with baseline HbA1c as the sole glucometabolic marker and six models each containing one additional glucometabolic biomarker in addition to baseline HbA1c. The additional glucometabolic biomarkers included: 1) plasma fructosamine, 2) fasting plasma glucose, 3) fasting plasma glucose × fasting serum insulin, 4) mean glucose during a 6-day free-living period measured by a continuous glucose monitor 5) mean glucose during an oral glucose tolerance test, and 6) mean plasma glucose × mean serum insulin during the oral glucose tolerance test. The primary outcome was overall goodness of fit (R2) from the internal validation step in bootstrap-based analysis using general linear models. RESULTS The prediction models explained 46-50% of the variation (R2) in post-treatment HbA1c with standard deviations of the estimates of ~2 mmol/mol. R2 was not statistically significantly different in the models containing an additional glucometabolic biomarker when compared to the basic model. CONCLUSION Adding an additional biomarker of the glucose metabolism did not improve the prediction of post-treatment HbA1c in individuals with HbA1c-defined prediabetes.
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Affiliation(s)
- Lea Bruhn
- Steno Diabetes Center Copenhagen, Herlev, Denmark
| | | | - Hanan Amadid
- Steno Diabetes Center Copenhagen, Herlev, Denmark
| | | | - Kristian Karstoft
- The Centre of Inflammation and Metabolism and the Centre for Physical Activity Research, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Pharmacology, Bispebjerg-Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Mathias Ried-Larsen
- The Centre of Inflammation and Metabolism and the Centre for Physical Activity Research, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | | | - Marit E Jørgensen
- Steno Diabetes Center Copenhagen, Herlev, Denmark
- National Institute of Public Health, University of Southern Denmark, Odense, Denmark
| | | | - Bente Stallknecht
- Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Kristine Færch
- Steno Diabetes Center Copenhagen, Herlev, Denmark
- Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
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Hempler NF, Bjerre N, Varming AR, Termannsen AD, Ringgaard LW, Jensen TH, Færch K, Quist JS. Designing a Co-created Intervention to Promote Motivation and Maintenance of Time-Restricted Eating in Individuals With Overweight and Type 2 Diabetes. J Nutr Educ Behav 2023; 55:371-380. [PMID: 37164552 DOI: 10.1016/j.jneb.2023.03.001] [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] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 02/14/2023] [Accepted: 03/02/2023] [Indexed: 05/12/2023]
Abstract
OBJECTIVE To design an appealing time-restricted eating (TRE) intervention by exploring behavioral and social mechanisms to improve TRE adoption and maintenance among people with type 2 diabetes (T2D) and overweight. Time-restricted eating is an intermittent fasting regimen suggested to improve glycemic control and body weight. METHODS Intervention development combined coherence theory and empirical data (workshops and semistructured interviews with the target group, their relatives, and health care professionals [HCPs]). Abductive analysis was applied. RESULTS The analysis suggested designing the TRE intervention in 2 phases: a short period with strict TRE, followed by a longer period focusing on adapting TRE to individual needs with support from HCPs, relatives, and peers. To reinforce TRE motivation and maintenance, HCPs should adopt a whole-person approach that focuses on participants' previous experiences. CONCLUSIONS AND IMPLICATIONS Important intervention elements to promote TRE adoption and maintenance are suggested to include a 2-phase design and support from professionals, family, and peers.
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Affiliation(s)
- Nana Folmann Hempler
- Health Promotion Research, Copenhagen University Hospital, Steno Diabetes Center Copenhagen, Herlev, Denmark.
| | - Natasja Bjerre
- Health Promotion Research, Copenhagen University Hospital, Steno Diabetes Center Copenhagen, Herlev, Denmark; Department of Food and Resource Economics, University of Copenhagen, Frederiksberg, Denmark
| | - Annemarie Reinhardt Varming
- Health Promotion Research, Copenhagen University Hospital, Steno Diabetes Center Copenhagen, Herlev, Denmark
| | - Anne-Ditte Termannsen
- Clinical Research, Copenhagen University Hospital, Steno Diabetes Center Copenhagen, Herlev, Denmark
| | - Lene Winther Ringgaard
- Health Promotion Research, Copenhagen University Hospital, Steno Diabetes Center Copenhagen, Herlev, Denmark
| | - Thit Hjortskov Jensen
- Health Promotion Research, Copenhagen University Hospital, Steno Diabetes Center Copenhagen, Herlev, Denmark
| | - Kristine Færch
- Clinical Research, Copenhagen University Hospital, Steno Diabetes Center Copenhagen, Herlev, Denmark; Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jonas Salling Quist
- Clinical Research, Copenhagen University Hospital, Steno Diabetes Center Copenhagen, Herlev, Denmark; Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark; School of Psychology, University of Leeds, Leeds, United Kingdom.
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10
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Umapathysivam MM, Araldi E, Hastoy B, Dawed AY, Vatandaslar H, Sengupta S, Kaufmann A, Thomsen S, Hartmann B, Jonsson AE, Kabakci H, Thaman S, Grarup N, Have CT, Færch K, Gjesing AP, Nawaz S, Cheeseman J, Neville MJ, Pedersen O, Walker M, Jennison C, Hattersley AT, Hansen T, Karpe F, Holst JJ, Jones AG, Ristow M, McCarthy MI, Pearson ER, Stoffel M, Gloyn AL. Type 2 Diabetes risk alleles in Peptidyl-glycine Alpha-amidating Monooxygenase influence GLP-1 levels and response to GLP-1 Receptor Agonists. medRxiv 2023:2023.04.07.23288197. [PMID: 37090505 PMCID: PMC10120798 DOI: 10.1101/2023.04.07.23288197] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
Abstract
Patients with type 2 diabetes vary in their response to currently available therapeutic agents (including GLP-1 receptor agonists) leading to suboptimal glycemic control and increased risk of complications. We show that human carriers of hypomorphic T2D-risk alleles in the gene encoding peptidyl-glycine alpha-amidating monooxygenase (PAM), as well as Pam-knockout mice, display increased resistance to GLP-1 in vivo. Pam inactivation in mice leads to reduced gastric GLP-1R expression and faster gastric emptying: this persists during GLP-1R agonist treatment and is rescued when GLP-1R activity is antagonized, indicating resistance to GLP-1's gastric slowing properties. Meta-analysis of human data from studies examining GLP-1R agonist response (including RCTs) reveals a relative loss of 44% and 20% of glucose lowering (measured by glycated hemoglobin) in individuals with hypomorphic PAM alleles p.S539W and p.D536G treated with GLP-1R agonist. Genetic variation in PAM has effects on incretin signaling that alters response to medication used commonly for treatment of T2D.
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Affiliation(s)
- Mahesh M Umapathysivam
- Oxford Centre for Diabetes, Endocrinology & Metabolism, University of Oxford, UK
- Department of Endocrinology, Queen Elizabeth Hospital, SA Health, Australia
- Southern Adelaide and Diabetes and Endocrinology Service, Bedford Park, Australia
- NHRMC Centre of Clinical research Excellence in Nutritional Physiology, Interventions and outcomes University of Adelaide, South Australia, Australia
| | - Elisa Araldi
- Institute of Molecular Health Sciences, Department of Biology, ETH Zurich, Zürich, Switzerland
- Institute of Translational Medicine, Department of Health Sciences and Technology, ETH Zurich, Zürich, Switzerland
- Department of Cardiology and Center for Thrombosis and Hemostasis, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Benoit Hastoy
- Oxford Centre for Diabetes, Endocrinology & Metabolism, University of Oxford, UK
| | - Adem Y Dawed
- Division of Population Health & Genomics, School of Medicine, University of Dundee, UK
| | - Hasan Vatandaslar
- Institute of Molecular Health Sciences, Department of Biology, ETH Zurich, Zürich, Switzerland
| | - Shahana Sengupta
- Oxford Centre for Diabetes, Endocrinology & Metabolism, University of Oxford, UK
| | - Adrian Kaufmann
- Institute of Molecular Health Sciences, Department of Biology, ETH Zurich, Zürich, Switzerland
| | - Søren Thomsen
- Oxford Centre for Diabetes, Endocrinology & Metabolism, University of Oxford, UK
| | - Bolette Hartmann
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University Copenhagen, Denmark
| | - Anna E Jonsson
- Copenhagen University Hospital - Steno Diabetes Center Copenhagen, Herlev, Denmark
| | - Hasan Kabakci
- Institute of Molecular Health Sciences, Department of Biology, ETH Zurich, Zürich, Switzerland
| | - Swaraj Thaman
- Division of Endocrinology, Department of Pediatrics, Stanford School of Medicine, Stanford, USA
| | - Niels Grarup
- Copenhagen University Hospital - Steno Diabetes Center Copenhagen, Herlev, Denmark
| | - Christian T Have
- Copenhagen University Hospital - Steno Diabetes Center Copenhagen, Herlev, Denmark
| | - Kristine Færch
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University Copenhagen, Denmark
- Copenhagen University Hospital - Steno Diabetes Center Copenhagen, Herlev, Denmark
| | - Anette P Gjesing
- Copenhagen University Hospital - Steno Diabetes Center Copenhagen, Herlev, Denmark
| | - Sameena Nawaz
- Oxford Centre for Diabetes, Endocrinology & Metabolism, University of Oxford, UK
| | - Jane Cheeseman
- Oxford Centre for Diabetes, Endocrinology & Metabolism, University of Oxford, UK
- National Institute of Health Research, Oxford Biomedical Research Centre, Churchill Hospital, Headington, Oxford, UK
| | - Matthew J Neville
- Oxford Centre for Diabetes, Endocrinology & Metabolism, University of Oxford, UK
- National Institute of Health Research, Oxford Biomedical Research Centre, Churchill Hospital, Headington, Oxford, UK
| | - Oluf Pedersen
- Novo Nordisk Foundation Center for Basic Metabolic Research, University of Copenhagen, Denmark
| | - Mark Walker
- Translational and Clinical Research Institute, Newcastle University, UK
| | | | | | - Torben Hansen
- Novo Nordisk Foundation Center for Basic Metabolic Research, University of Copenhagen, Denmark
| | - Fredrik Karpe
- Oxford Centre for Diabetes, Endocrinology & Metabolism, University of Oxford, UK
- National Institute of Health Research, Oxford Biomedical Research Centre, Churchill Hospital, Headington, Oxford, UK
| | - Jens J Holst
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University Copenhagen, Denmark
- Novo Nordisk Foundation Center for Basic Metabolic Research, University of Copenhagen, Denmark
| | - Angus G Jones
- University of Exeter College of Medicine & Health, Exeter, UK
| | - Michael Ristow
- Institute of Molecular Health Sciences, Department of Biology, ETH Zurich, Zürich, Switzerland
| | - Mark I McCarthy
- Oxford Centre for Diabetes, Endocrinology & Metabolism, University of Oxford, UK
- National Institute of Health Research, Oxford Biomedical Research Centre, Churchill Hospital, Headington, Oxford, UK
- Wellcome Trust Centre for Human Genetics, University of Oxford, UK
| | - Ewan R Pearson
- Division of Population Health & Genomics, School of Medicine, University of Dundee, UK
| | - Markus Stoffel
- Institute of Molecular Health Sciences, Department of Biology, ETH Zurich, Zürich, Switzerland
- Medical Faculty, University of Zürich, Zürich, Switzerland
| | - Anna L Gloyn
- Oxford Centre for Diabetes, Endocrinology & Metabolism, University of Oxford, UK
- Division of Endocrinology, Department of Pediatrics, Stanford School of Medicine, Stanford, USA
- National Institute of Health Research, Oxford Biomedical Research Centre, Churchill Hospital, Headington, Oxford, UK
- Wellcome Trust Centre for Human Genetics, University of Oxford, UK
- Stanford Diabetes Research Centre, Stanford, USA
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11
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Quist JS, Klein AB, Færch K, Beaulieu K, Rosenkilde M, Gram AS, Sjödin A, Torekov S, Stallknecht B, Clemmensen C, Blond MB. Effects of acute exercise and exercise training on plasma GDF15 concentrations and associations with appetite and cardiometabolic health in individuals with overweight or obesity - A secondary analysis of a randomized controlled trial. Appetite 2023; 182:106423. [PMID: 36563967 DOI: 10.1016/j.appet.2022.106423] [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: 07/27/2022] [Revised: 11/09/2022] [Accepted: 12/14/2022] [Indexed: 12/25/2022]
Abstract
Growth Differentiation Factor 15 (GDF15) is seemingly involved in appetite control. Acute exercise increases GDF15 concentrations in lean humans, but acute and long-term effects of exercise on GDF15 in individuals with overweight/obesity are unknown. We investigated the effects of acute exercise and exercise training on GDF15 concentrations in individuals with overweight/obesity and associations with appetite and cardiometabolic markers. 90 physically inactive adults (20-45 years) with overweight/obesity were randomized to 6-months habitual lifestyle (CON, n=16), or isocaloric exercise of moderate (MOD, n=37) or vigorous intensity (VIG, n=37), 5 days/week. Testing was performed at baseline, 3, and 6 months. Plasma GDF15 concentrations, other metabolic markers, and subjective appetite were assessed fasted and in response to acute exercise before an ad libitum meal. Cardiorespiratory fitness, body composition, insulin sensitivity, and intraabdominal adipose tissue were measured. At baseline, GDF15 increased 18% (95%CI: 4; 34) immediately after acute exercise and 32% (16; 50) 60 min post-exercise. Fasting GDF15 increased 21% (0; 46) in VIG after 3 months (p=0.045), but this attenuated at 6 months (13% (-11; 43), p=0.316) and was unchanged in MOD (11% (-6; 32), p=0.224, across 3 and 6 months). Post-exercise GDF15 did not change in MOD or VIG. GDF15 was not associated with appetite or energy intake. Higher GDF15 was associated with lower cardiorespiratory fitness, central obesity, dyslipidemia, and poorer glycemic control. In conclusion, GDF15 increased in response to acute exercise but was unaffected by exercise training. Higher GDF15 concentrations were associated with a less favorable cardiometabolic profile but not with markers of appetite. This suggests that GDF15 increases in response to acute exercise independent of training state. Whether this has an impact on free-living energy intake and body weight management needs investigation.
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Affiliation(s)
- Jonas Salling Quist
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, DK-2200, Copenhagen N, Denmark; Clinical Research, Copenhagen University Hospital - Steno Diabetes Center Copenhagen, Borgmester Ib Juuls Vej 83, DK-2730, Herlev, Denmark; School of Psychology, Faculty of Medicine & Health, University of Leeds, Woodhouse Lane, West Yorkshire, LS2 9JT, Leeds, United Kingdom.
| | - Anders Bue Klein
- Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3A, DK-2200, Copenhagen N, Denmark
| | - Kristine Færch
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, DK-2200, Copenhagen N, Denmark; Clinical Research, Copenhagen University Hospital - Steno Diabetes Center Copenhagen, Borgmester Ib Juuls Vej 83, DK-2730, Herlev, Denmark
| | - Kristine Beaulieu
- Clinical Research, Copenhagen University Hospital - Steno Diabetes Center Copenhagen, Borgmester Ib Juuls Vej 83, DK-2730, Herlev, Denmark; School of Psychology, Faculty of Medicine & Health, University of Leeds, Woodhouse Lane, West Yorkshire, LS2 9JT, Leeds, United Kingdom
| | - Mads Rosenkilde
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, DK-2200, Copenhagen N, Denmark
| | - Anne Sofie Gram
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, DK-2200, Copenhagen N, Denmark
| | - Anders Sjödin
- Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Rolighedsvej 26, DK-1958, Fredederiksberg C, Denmark
| | - Signe Torekov
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, DK-2200, Copenhagen N, Denmark
| | - Bente Stallknecht
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, DK-2200, Copenhagen N, Denmark
| | - Christoffer Clemmensen
- Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3A, DK-2200, Copenhagen N, Denmark
| | - Martin Bæk Blond
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, DK-2200, Copenhagen N, Denmark; Clinical Research, Copenhagen University Hospital - Steno Diabetes Center Copenhagen, Borgmester Ib Juuls Vej 83, DK-2730, Herlev, Denmark
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12
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Zhu R, Jalo E, Silvestre MP, Poppitt SD, Handjieva-Darlenska T, Handjiev S, Huttunen-Lenz M, Mackintosh K, Stratton G, Navas-Carretero S, Pietiläinen KH, Simpson E, Macdonald IA, Muirhead R, Brand-Miller J, Fogelholm M, Færch K, Martinez JA, Westerterp-Plantenga MS, Adam TC, Raben A. Does the Effect of a 3-Year Lifestyle Intervention on Body Weight and Cardiometabolic Health Differ by Prediabetes Metabolic Phenotype? A Post Hoc Analysis of the PREVIEW Study. Diabetes Care 2022; 45:2698-2708. [PMID: 35696263 DOI: 10.2337/dc22-0549] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 04/25/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To examine whether the effect of a 3-year lifestyle intervention on body weight and cardiometabolic risk factors differs by prediabetes metabolic phenotype. RESEARCH DESIGN AND METHODS This post hoc analysis of the multicenter, randomized trial, PREVention of diabetes through lifestyle interventions and population studies In Europe and around the World (PREVIEW), included 1,510 participants with prediabetes (BMI ≥25 kg ⋅ m-2; defined using oral glucose tolerance tests). Of these, 58% had isolated impaired fasting glucose (iIFG), 6% had isolated impaired glucose tolerance (iIGT), and 36% had IFG+IGT; 73% had normal hemoglobin A1c (HbA1c; <39 mmol ⋅ mol-1) and 25% had intermediate HbA1c (39-47 mmol ⋅ mol-1). Participants underwent an 8-week diet-induced rapid weight loss, followed by a 148-week lifestyle-based weight maintenance intervention. Linear mixed models adjusted for intervention arm and other confounders were used. RESULTS In the available-case and complete-case analyses, participants with IFG+IGT had greater sustained weight loss after lifestyle intervention (adjusted mean at 156 weeks -3.5% [95% CI, -4.7%, -2.3%]) than those with iIFG (mean -2.5% [-3.6%, -1.3%]) relative to baseline (P = 0.011). Participants with IFG+IGT and iIFG had similar cardiometabolic benefits from the lifestyle intervention. The differences in cardiometabolic benefits between those with iIGT and IFG+IGT were minor or inconsistent in different analyses. Participants with normal versus intermediate HbA1c had similar weight loss over 3 years and minor differences in cardiometabolic benefits during weight loss, whereas those with normal HbA1c had greater improvements in fasting glucose, 2-h glucose (adjusted between-group difference at 156 weeks -0.54 mmol ⋅ L-1 [95% CI -0.70, -0.39], P < 0.001), and triglycerides (difference -0.07 mmol ⋅ L-1 [-0.11, -0.03], P < 0.001) during the lifestyle intervention. CONCLUSIONS Individuals with iIFG and IFG+IGT had similar improvements in cardiometabolic health from a lifestyle intervention. Those with normal HbA1c had greater improvements than those with intermediate HbA1c.
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Affiliation(s)
- Ruixin Zhu
- Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Copenhagen, Denmark
| | - Elli Jalo
- Department of Food and Nutrition, University of Helsinki, Helsinki, Finland
| | - Marta P Silvestre
- Human Nutrition Unit, Department of Medicine, School of Biological Sciences, University of Auckland, Auckland, New Zealand.,Center for Health Technology and Services Research (CINTESIS), NOVA Medical School (NMS), Universidade Nova de Lisboa, Lisboa, Portugal
| | - Sally D Poppitt
- Human Nutrition Unit, Department of Medicine, School of Biological Sciences, University of Auckland, Auckland, New Zealand
| | | | - Svetoslav Handjiev
- Department of Pharmacology and Toxicology, Medical University of Sofia, Sofia, Bulgaria
| | - Maija Huttunen-Lenz
- Institute for Nursing Science, University of Education Schwäbisch Gmünd, Schwäbisch Gmünd, Germany
| | - Kelly Mackintosh
- Applied Sports, Technology, Exercise and Medicine (A-STEM) Research Centre, Swansea University, Swansea, U.K
| | - Gareth Stratton
- Applied Sports, Technology, Exercise and Medicine (A-STEM) Research Centre, Swansea University, Swansea, U.K
| | - Santiago Navas-Carretero
- Centre for Nutrition Research, University of Navarra, Pamplona, Spain.,Centro de Investigacion Biomedica en Red Area de Fisiologia de la Obesidad y la Nutricion (CIBEROBN), Madrid, Spain.,Instituto de Investigación Sanitaria de Navarra (IdiSNA) Instituto for Health Research, Pamplona, Spain
| | - Kirsi H Pietiläinen
- Obesity Research Unit, Research Program for Clinical and Molecular Metabolism, Faculty of Medicine, University of Helsinki, Helsinki, Finland.,Abdominal Center, Endocrinology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Elizabeth Simpson
- Division of Physiology, Pharmacology and Neuroscience, School of Life Sciences, Queen's Medical Centre, Medical Research Council (MRC)/Alzheimer's Research UK (ARUK) Centre for Musculoskeletal Ageing Research, ARUK Centre for Sport, Exercise and Osteoarthritis, National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham, U.K
| | - Ian A Macdonald
- Division of Physiology, Pharmacology and Neuroscience, School of Life Sciences, Queen's Medical Centre, Medical Research Council (MRC)/Alzheimer's Research UK (ARUK) Centre for Musculoskeletal Ageing Research, ARUK Centre for Sport, Exercise and Osteoarthritis, National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham, U.K
| | - Roslyn Muirhead
- School of Life and Environmental Sciences and Charles Perkins Centre, The University of Sydney, Sydney, Australia
| | - Jennie Brand-Miller
- School of Life and Environmental Sciences and Charles Perkins Centre, The University of Sydney, Sydney, Australia
| | - Mikael Fogelholm
- Department of Food and Nutrition, University of Helsinki, Helsinki, Finland
| | - Kristine Færch
- Clinical Research, Copenhagen University Hospital-Steno Diabetes Center Copenhagen, Herlev, Denmark.,Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - J Alfredo Martinez
- Centro de Investigacion Biomedica en Red Area de Fisiologia de la Obesidad y la Nutricion (CIBEROBN), Madrid, Spain.,Department of Nutrition and Physiology, University of Navarra, Pamplona, Spain.,Precision Nutrition and Cardiometabolic Health Program, IMDEA-Food Institute (Madrid Institute for Advanced Studies), Campus of International Excellence (CEI) Universidad Autónoma de Madrid (UAM) + Consejo Superior de Investigaciones Científicas (CSIC), Madrid, Spain
| | - Margriet S Westerterp-Plantenga
- Department of Nutrition and Movement Sciences, NUTRIM, School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands
| | - Tanja C Adam
- Department of Nutrition and Movement Sciences, NUTRIM, School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands
| | - Anne Raben
- Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Copenhagen, Denmark.,Clinical Research, Copenhagen University Hospital-Steno Diabetes Center Copenhagen, Herlev, Denmark
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13
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Bjerre N, Holm L, Quist JS, Færch K, Hempler NF. Is time-restricted eating a robust eating regimen during periods of disruptions in daily life? A qualitative study of perspectives of people with overweight during COVID-19. BMC Public Health 2022; 22:1718. [PMID: 36088358 PMCID: PMC9463056 DOI: 10.1186/s12889-022-13856-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 07/20/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Time-restricted eating (TRE) has been suggested as a feasible dietary strategy in individuals with overweight. Disruptions in daily life e.g., severe illness can affect engagement in lifestyle interventions to obtain healthier body weight. This study examined if and how the engagement with TRE among people with overweight was affected by the Danish COVID-19 lockdowns as an example of disruptions in daily life.
Methods
Fifteen participants with overweight enrolled in a TRE intervention, i.e. restricting all eating and drinking except water to the same daily ten-hour window, were interviewed about their experiences and engagement with TRE during COVID-19 lockdowns. Interviews were semi-structured and conducted by phone or face-to-face with safe social distancing. Data analysis was grounded in a reflexive thematic analysis approach.
Results
Daily life rhythms were disrupted by lockdowns by preventing participants from performing ordinary daily activities such as going to work, socialising, eating out or exercising. For some, this challenged their TRE engagement, while most were able to undertake the TRE eating window but reported increased snacking and consumption of take-away food within their eating window. For all, exercise habits became unhealthier. The negative impact on TRE engagement primarily occurred during daytime, as social distancing made it easier to engage with TRE during evenings.
Conclusions
This study showed that even people highly motivated to obtain healthier lifestyles practices struggled to maintain engagement with healthy behaviours, whereas sticking to the TRE window was manageable during COVID-19. TRE as a weight loss strategy was challenged which calls for more attention to supporting people in daily life to obtain healthier practices, also in case of periods of other disruptions such as divorce, serious illness etc.
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14
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Zhu R, Craciun I, Bernhards-Werge J, Jalo E, Poppitt SD, Silvestre MP, Huttunen-Lenz M, McNarry MA, Stratton G, Handjiev S, Handjieva-Darlenska T, Navas-Carretero S, Sundvall J, Adam TC, Drummen M, Simpson EJ, Macdonald IA, Brand-Miller J, Muirhead R, Lam T, Vestentoft PS, Færch K, Martinez JA, Fogelholm M, Raben A. Age- and sex-specific effects of a long-term lifestyle intervention on body weight and cardiometabolic health markers in adults with prediabetes: results from the diabetes prevention study PREVIEW. Diabetologia 2022; 65:1262-1277. [PMID: 35610522 PMCID: PMC9283166 DOI: 10.1007/s00125-022-05716-3] [Citation(s) in RCA: 2] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 03/31/2022] [Indexed: 02/05/2023]
Abstract
AIMS/HYPOTHESIS Lifestyle interventions are the first-line treatment option for body weight and cardiometabolic health management. However, whether age groups or women and men respond differently to lifestyle interventions is under debate. We aimed to examine age- and sex-specific effects of a low-energy diet (LED) followed by a long-term lifestyle intervention on body weight, body composition and cardiometabolic health markers in adults with prediabetes (i.e. impaired fasting glucose and/or impaired glucose tolerance). METHODS This observational study used longitudinal data from 2223 overweight participants with prediabetes in the multicentre diabetes prevention study PREVIEW. The participants underwent a LED-induced rapid weight loss (WL) period followed by a 3 year lifestyle-based weight maintenance (WM) intervention. Changes in outcomes of interest in prespecified age (younger: 25-45 years; middle-aged: 46-54 years; older: 55-70 years) or sex (women and men) groups were compared. RESULTS In total, 783 younger, 319 middle-aged and 1121 older adults and 1503 women and 720 men were included in the analysis. In the available case and complete case analyses, multivariable-adjusted linear mixed models showed that younger and older adults had similar weight loss after the LED, whereas older adults had greater sustained weight loss after the WM intervention (adjusted difference for older vs younger adults -1.25% [95% CI -1.92, -0.58], p<0.001). After the WM intervention, older adults lost more fat-free mass and bone mass and had smaller improvements in 2 h plasma glucose (adjusted difference for older vs younger adults 0.65 mmol/l [95% CI 0.50, 0.80], p<0.001) and systolic blood pressure (adjusted difference for older vs younger adults 2.57 mmHg [95% CI 1.37, 3.77], p<0.001) than younger adults. Older adults had smaller decreases in fasting and 2 h glucose, HbA1c and systolic blood pressure after the WM intervention than middle-aged adults. In the complete case analysis, the above-mentioned differences between middle-aged and older adults disappeared, but the direction of the effect size did not change. After the WL period, compared with men, women had less weight loss (adjusted difference for women vs men 1.78% [95% CI 1.12, 2.43], p<0.001) with greater fat-free mass and bone mass loss and smaller improvements in HbA1c, LDL-cholesterol and diastolic blood pressure. After the WM intervention, women had greater fat-free mass and bone mass loss and smaller improvements in HbA1c and LDL-cholesterol, while they had greater improvements in fasting glucose, triacylglycerol (adjusted difference for women vs men -0.08 mmol/l [-0.11, -0.04], p<0.001) and HDL-cholesterol. CONCLUSIONS/INTERPRETATION Older adults benefited less from a lifestyle intervention in relation to body composition and cardiometabolic health markers than younger adults, despite greater sustained weight loss. Women benefited less from a LED followed by a lifestyle intervention in relation to body weight and body composition than men. Future interventions targeting older adults or women should take prevention of fat-free mass and bone mass loss into consideration. CLINICAL TRIAL REGISTRATION NUMBER ClinicalTrials.gov NCT01777893.
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Affiliation(s)
- Ruixin Zhu
- Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Copenhagen, Denmark
| | - Ionut Craciun
- Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Copenhagen, Denmark
| | - Jan Bernhards-Werge
- Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Copenhagen, Denmark
| | - Elli Jalo
- Department of Food and Nutrition, University of Helsinki, Helsinki, Finland
| | - Sally D Poppitt
- Human Nutrition Unit, School of Biological Sciences, Department of Medicine, University of Auckland, Auckland, New Zealand
| | - Marta P Silvestre
- Human Nutrition Unit, School of Biological Sciences, Department of Medicine, University of Auckland, Auckland, New Zealand
- CINTESIS, NOVA Medical School (NMS), Universidade Nova de Lisboa, Lisboa, Portugal
| | - Maija Huttunen-Lenz
- Institute for Nursing Science, University of Education Schwäbisch Gmünd, Schwäbisch Gmünd, Germany
| | - Melitta A McNarry
- Applied Sports, Technology, Exercise and Medicine (A-STEM) Research Centre, Swansea University, Swansea, UK
| | - Gareth Stratton
- Applied Sports, Technology, Exercise and Medicine (A-STEM) Research Centre, Swansea University, Swansea, UK
| | - Svetoslav Handjiev
- Department of Pharmacology and Toxicology, Medical University of Sofia, Sofia, Bulgaria
| | | | - Santiago Navas-Carretero
- Centre for Nutrition Research, University of Navarra, Pamplona, Spain
- Centro de Investigacion Biomedica en Red Area de Fisiologia de la Obesidad y la Nutricion (CIBEROBN), Instituto de Salud Carlos III (ISCII), Madrid, Spain
- IdisNA Instituto for Health Research, Pamplona, Spain
| | - Jouko Sundvall
- Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Tanja C Adam
- Department of Nutrition and Movement Sciences, NUTRIM, School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands
| | - Mathijs Drummen
- Department of Nutrition and Movement Sciences, NUTRIM, School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands
| | - Elizabeth J Simpson
- MRC/ARUK Centre for Musculoskeletal Ageing Research, National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, School of Life Sciences, University of Nottingham, Nottingham, UK
| | - Ian A Macdonald
- MRC/ARUK Centre for Musculoskeletal Ageing Research, National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, School of Life Sciences, University of Nottingham, Nottingham, UK
| | - Jennie Brand-Miller
- School of Life and Environmental Sciences and Charles Perkins Centre, University of Sydney, Sydney, Australia
| | - Roslyn Muirhead
- School of Life and Environmental Sciences and Charles Perkins Centre, University of Sydney, Sydney, Australia
| | | | - Pia S Vestentoft
- Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Copenhagen, Denmark
| | - Kristine Færch
- Clinical Research, Copenhagen University Hospital - Steno Diabetes Center Copenhagen, Herlev, Denmark
- Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - J Alfredo Martinez
- Centro de Investigacion Biomedica en Red Area de Fisiologia de la Obesidad y la Nutricion (CIBEROBN), Instituto de Salud Carlos III (ISCII), Madrid, Spain
- Department of Nutrition and Physiology, University of Navarra, Pamplona, Spain
- Precision Nutrition and Cardiometabolic Health Program, IMDEA-Food Institute, Madrid Institute for Advanced Studies, CEI UAM + CSIC, Madrid, Spain
| | - Mikael Fogelholm
- Department of Food and Nutrition, University of Helsinki, Helsinki, Finland.
| | - Anne Raben
- Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Copenhagen, Denmark.
- Clinical Research, Copenhagen University Hospital - Steno Diabetes Center Copenhagen, Herlev, Denmark.
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15
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Clemmensen KKB, Koster A, Nielen YTH, Dagnelie PC, Stehouwer CDA, Bosma H, Wesselius A, Færch K, Eussen SJPM. Role of Weekday Variation on Glucose, Insulin, and Triglyceride: A Cross-Sectional Analysis From the Maastricht Study. J Clin Endocrinol Metab 2022; 107:e3145-e3151. [PMID: 35575196 PMCID: PMC9797041 DOI: 10.1210/clinem/dgac286] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Indexed: 01/05/2023]
Abstract
CONTEXT The timing of sleep, physical activity, and dietary intake show variation over the week, with different timings in the weekend compared to the weekdays, which may potentially lead to impaired glucose and lipid regulation on Mondays compared to other weekdays. OBJECTIVE The aim of the study was to investigate differences in glucose metabolism and fasting triglyceride concentrations on Mondays compared to the rest of the week. DESIGN, SETTING AND PARTICIPANTS This cross-sectional study is based on data from the Maastricht Study, including 6067 participants without known diabetes and 1568 previously diagnosed with type 2 diabetes. MAIN OUTCOME MEASURES Confounder-adjusted linear regression analysis was applied to study the associations of day of the week of examination with glucose and insulin responses to an oral glucose tolerance test and fasting triglyceride concentrations. RESULTS In fully confounder-adjusted models, mean (95% CI) concentrations of fasting glucose, insulin, and triglycerides were slightly higher on Mondays compared with the other weekdays [glucose: 1% (0-2); insulin: 9% (1-18); triglycerides: 5% (2-8)]. Interaction analyses revealed that the association of weekday with insulin was only pronounced in men [18% (3-35)], but not in women [1% (-8-10)], whereas the associations with glucose and triglycerides were only apparent for individuals with known type 2 diabetes [glucose: 4% (0-7); triglycerides: 14% (6-23)] compared to the background population [glucose: 0% (0-1); triglycerides: 3% (0-6)]. DISCUSSION Being examined on a Monday was associated with higher fasting insulin concentrations among men but not women.
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Affiliation(s)
| | - Annemarie Koster
- Department of Social Medicine, Maastricht University, Maastricht, The Netherlands
- School for Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Yannick T H Nielen
- Department of Clinical Pharmacy and Toxicology, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Pieter C Dagnelie
- School for Cardiovascular Diseases (CARIM), Maastricht University, Maastricht, The Netherlands
| | - Coen D A Stehouwer
- School for Cardiovascular Diseases (CARIM), Maastricht University, Maastricht, The Netherlands
- Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Hans Bosma
- Department of Social Medicine, Maastricht University, Maastricht, The Netherlands
- School for Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Anke Wesselius
- Department of Complex Genetics and Epidemiology, School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
| | - Kristine Færch
- Steno Diabetes Center Copenhagen, Gentofte, Denmark
- Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Simone J P M Eussen
- Correspondence: Simone JPM Eussen, PhD, Department of Epidemiology, School for Cardiovascular Diseases (CARIM), Faculty of Health, Medicine and Life Sciences, Maastricht University, The Netherlands. E-mail:
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16
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Pedersen H, Diaz LJ, Clemmensen KKB, Jensen MM, Jørgensen ME, Finlayson G, Quist JS, Vistisen D, Færch K. Predicting Food Intake from Food Reward and Biometric Responses to Food Cues in Adults with Normal Weight Using Machine Learning. J Nutr 2022; 152:1574-1581. [PMID: 35325189 DOI: 10.1093/jn/nxac053] [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] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 12/21/2021] [Accepted: 03/03/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Eating behaviors are determined by a complex interplay between behavioral and physiologic signaling occurring before, during, and after eating. OBJECTIVES The aim was to explore how selected behavioral and physiologic variables separately and grouped together predicted intake of 8 different foods. METHODS One hundred adults with normal weight performed a food preference task combined with biometric measurements (the Steno Biometric Food Preference Task) in the fasting state. The task measured food reward as well as biometric (eye tracking, electrodermal activity, and facial expressions) responses to images of foods varying in fat content and taste. Energy intake from an ad libitum buffet of the same 8 foods as assessed in the preference task was subsequently assessed. A mixed-effects random forest approach was applied to explore how individual and combined measures of food reward and biometric responses predicted energy intake of the 8 single foods. The performance of the different prediction models was compared with the predictions from a linear model including only an intercept (naïve model) using bootstrap cross-validation. RESULTS Participants had a median [IQR] intake of 369 kJ [126-472 kJ] per food. Combined or separate measures of food reward or biometric responses did not predict energy intake better than the naïve model. CONCLUSIONS We did not find that the reward or biometric responses to food cues assessed in a clinical setting were useful in predicting energy intake of single foods. However, this study provides a framework in the field of behavioral nutrition for applying machine learning with a focus on individual predictions. This is necessary on the road toward personalized nutrition and provides great potential for handling complex data with multiple variables.This trial was registered at clinicaltrials.gov as NCT03986619.
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Affiliation(s)
- Hanne Pedersen
- Clinical Research, Copenhagen University Hospital - Steno Diabetes Center Copenhagen, Herlev, Denmark.,National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Lars Jorge Diaz
- Clinical Research, Copenhagen University Hospital - Steno Diabetes Center Copenhagen, Herlev, Denmark
| | | | - Marie Mølle Jensen
- Clinical Research, Copenhagen University Hospital - Steno Diabetes Center Copenhagen, Herlev, Denmark
| | - Marit Eika Jørgensen
- Clinical Research, Copenhagen University Hospital - Steno Diabetes Center Copenhagen, Herlev, Denmark.,National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark.,Steno Diabetes Center Greenland, Nuuk, Greenland
| | - Graham Finlayson
- Appetite Control and Energy Balance Research Group, School of Psychology, University of Leeds, Leeds, United Kingdom
| | - Jonas Salling Quist
- Appetite Control and Energy Balance Research Group, School of Psychology, University of Leeds, Leeds, United Kingdom
| | - Dorte Vistisen
- Clinical Research, Copenhagen University Hospital - Steno Diabetes Center Copenhagen, Herlev, Denmark.,Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Kristine Færch
- Clinical Research, Copenhagen University Hospital - Steno Diabetes Center Copenhagen, Herlev, Denmark.,Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
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17
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Vazquez Rocha L, Macdonald I, Alssema M, Færch K. The Use and Effectiveness of Selected Alternative Markers for Insulin Sensitivity and Secretion Compared with Gold Standard Markers in Dietary Intervention Studies in Individuals without Diabetes: Results of a Systematic Review. Nutrients 2022; 14:nu14102036. [PMID: 35631177 PMCID: PMC9143618 DOI: 10.3390/nu14102036] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 05/02/2022] [Accepted: 05/10/2022] [Indexed: 12/10/2022] Open
Abstract
Background: The gold-standard techniques for measuring insulin sensitivity and secretion are well established. However, they may be perceived as invasive and expensive for use in dietary intervention studies. Thus, surrogate markers have been proposed as alternative markers for insulin sensitivity and secretion. This systematic review aimed to identify markers of insulin sensitivity and secretion in response to dietary intervention and assess their suitability as surrogates for the gold-standard methodology. Methods: Three databases, PubMed, Scopus, and Cochrane were searched, intervention studies and randomised controlled trials reporting data on dietary intake, a gold standard of analysis of insulin sensitivity (either euglycaemic-hyperinsulinaemic clamp or intravenous glucose tolerance test and secretion (acute insulin response to glucose), as well as surrogate markers for insulin sensitivity (either fasting insulin, area under the curve oral glucose tolerance tests and HOMA-IR) and insulin secretion (disposition index), were selected. Results: We identified thirty-five studies that were eligible for inclusion. We found insufficient evidence to predict insulin sensitivity and secretion with surrogate markers when compared to gold standards in nutritional intervention studies. Conclusions: Future research is needed to investigate if surrogate measures of insulin sensitivity and secretion can be repeatable and reproducible in the same way as gold standards.
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Affiliation(s)
- Lucia Vazquez Rocha
- School of Biosciences, University of Nottingham, Loughborough LE12 5RD, UK
- Correspondence:
| | - Ian Macdonald
- School of Life Sciences, University of Nottingham, Nottingham NG7 2UH, UK;
- Nestle Institute of Health Sciences, 1015 Lausanne, Switzerland
| | - Marjan Alssema
- Unilever Research and Development, 3133 AT Vlaardingen, The Netherlands;
| | - Kristine Færch
- Steno Diabetes Center Copenhagen, 2730 Herlev, Denmark;
- Department of Biomedical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark
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18
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Jensen MM, Pedersen H, Clemmensen KKB, Wegeberg AM, Jensen NW, Quist JS, Færch K, Brock C. Human Gastrointestinal Transit and Hormonal Response to Different Meal Types: A Randomized Crossover Study. J Nutr 2022; 152:1358-1369. [PMID: 35020932 DOI: 10.1093/jn/nxac002] [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] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 12/02/2021] [Accepted: 01/04/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND The wireless motility capsule (WMC) technique is a noninvasive and radiation-free method for measuring regional and whole gut transit in response to ingestion of a granola bar (SmartBar) or an eggbeater meal. The WMC has the potential to measure gastrointestinal transit in metabolic research as part of a standardized mixed meal tolerance test. OBJECTIVES To evaluate gastrointestinal transit with the WMC and postprandial plasma/serum concentrations of metabolites and gastrointestinal hormones as well as subjective appetite following ingestion of a SmartBar compared with a standardized mixed meal. METHODS Fourteen healthy participants [3 men, median (IQR) age 53.8 (45.8; 64.50) y, body weight 63.9 (59.9; 69.7) kg, BMI 23.1 (21.8; 23.9) kg/m2] completed a 2-d crossover study. Following ingestion of either a SmartBar (260 kcal, 7 energy percent (E%) fat, 74E% carbohydrate, and 19E% protein) or a standardized mixed meal (498 kcal, 34E% fat, 49E% carbohydrate, and 17E% protein), participants swallowed the WMC. Blood samples were drawn in the fasted state and postprandially for analyses of gastrointestinal hormones and metabolites. The primary outcome was difference in gastric emptying time between the 2 test days. Wilcoxon signed rank tests were used to test differences between test days. RESULTS Median (IQR) gastric emptying time was 98.0 (70.0; 113.0) min longer (P = 0.001) and incremental area under the curve of triglyceride, glucose-dependent insulinotropic polypeptide, and peptide YY were 40 mmol/L × min, 45.7%, and 63.7% greater after the standardized mixed meal compared with the SmartBar (all P < 0.001). CONCLUSIONS The WMC can be used in combination with a standardized mixed meal for evaluation of gastrointestinal transit in healthy men and women. Gastric emptying time was prolonged in response to the standardized mixed meal whereas transit times of the small bowel, colon, and whole gut did not differ between the test meals.
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Affiliation(s)
- Marie Møller Jensen
- Copenhagen University Hospital - Steno Diabetes Center Copenhagen, Clinical Research, Herlev, Denmark
| | - Hanne Pedersen
- Copenhagen University Hospital - Steno Diabetes Center Copenhagen, Clinical Research, Herlev, Denmark.,iMotions A/S, Frederiksberg, Denmark
| | | | - Anne-Marie Wegeberg
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.,Mech-Sense, Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark
| | - Nina Wittorff Jensen
- Copenhagen University Hospital - Steno Diabetes Center Copenhagen, Clinical Research, Herlev, Denmark
| | - Jonas Salling Quist
- Copenhagen University Hospital - Steno Diabetes Center Copenhagen, Clinical Research, Herlev, Denmark
| | - Kristine Færch
- Copenhagen University Hospital - Steno Diabetes Center Copenhagen, Clinical Research, Herlev, Denmark.,Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Christina Brock
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.,Mech-Sense, Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark.,Steno Diabetes Center North Jutland, Aalborg, Denmark
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19
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Bjerre N, Holm L, Veje N, Quist JS, Færch K, Hempler NF. What happens after a weight loss intervention? A qualitative study of drivers and challenges of maintaining time-restricted eating among people with overweight at high risk of type 2 diabetes. Appetite 2022; 174:106034. [PMID: 35378218 DOI: 10.1016/j.appet.2022.106034] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 03/29/2022] [Accepted: 03/30/2022] [Indexed: 11/18/2022]
Abstract
Time-restricted eating (TRE)1 has been conceptualised as a strategy for achieving weight loss and improving metabolic health, but limited knowledge exists about how people can maintain TRE in daily life. This study examined how TRE was maintainable in daily life after a three-month intervention (the RESET study) in which participants were encouraged to consume all food and beverages except water within a 10-hour daily window. Specifically, we examined TRE maintenance patterns across participants, including drivers and challenges for maintenance success. A qualitative longitudinal study was conducted, and twenty participants with overweight at high risk of type 2 diabetes were interviewed using a semi-structured interview guide at the end of the intervention and after a three-month follow-up period. Data were analysed longitudinally in two steps inspired by a pattern-oriented longitudinal analysis approach. Seven participants maintained a strict 10-hour window, ten maintained an adjusted TRE regimen (e.g., taking days off), and three did not attempt maintenance. Maintenance drivers included consistent daily rhythms and regular meal patterns, subjective experiences (e.g., feeling healthier), making flexible adjustments to the TRE regimen, family support and avoiding feelings of guilt. Maintenance challenges included social evening events, inconsistent daily rhythms and eating patterns, preoccupation with losing weight, lack of family support and self-blame. TRE was manageable for most participants; however, personalised support for adjusting TRE to daily life is needed to ensure long-term maintenance. Future studies should explore the effectiveness of a personalised TRE concept to determine the usefulness of TRE in real-life settings.
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Affiliation(s)
- Natasja Bjerre
- Health Promotion Research, Copenhagen University Hospital - Steno Diabetes Center Copenhagen, Borgmester Ib Juuls Vej 83, 2730, Herlev, Denmark; Department of Food and Resource Economics, University of Copenhagen, Rolighedsvej 25, 1958, Frederiksberg, Denmark.
| | - Lotte Holm
- Department of Food and Resource Economics, University of Copenhagen, Rolighedsvej 25, 1958, Frederiksberg, Denmark.
| | - Nanna Veje
- Health Promotion Research, Copenhagen University Hospital - Steno Diabetes Center Copenhagen, Borgmester Ib Juuls Vej 83, 2730, Herlev, Denmark.
| | - Jonas Salling Quist
- Clinical Research, Copenhagen University Hospital - Steno Diabetes Center Copenhagen, Borgmester Ib Juuls Vej 83, 2730, Herlev, Denmark.
| | - Kristine Færch
- Clinical Research, Copenhagen University Hospital - Steno Diabetes Center Copenhagen, Borgmester Ib Juuls Vej 83, 2730, Herlev, Denmark; Department of Biomedical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200, Copenhagen, Denmark.
| | - Nana Folmann Hempler
- Health Promotion Research, Copenhagen University Hospital - Steno Diabetes Center Copenhagen, Borgmester Ib Juuls Vej 83, 2730, Herlev, Denmark.
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20
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Pedersen H, Beaulieu K, Finlayson G, Færch K, Jørgensen ME, Lewis JI, Lind MV, Lauritzen L, Quist JS. Food Reward after a Traditional Inuit or a Westernised Diet in an Inuit Population in Greenland. Nutrients 2022; 14:nu14030561. [PMID: 35276918 PMCID: PMC8839061 DOI: 10.3390/nu14030561] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 01/14/2022] [Accepted: 01/22/2022] [Indexed: 12/17/2022] Open
Abstract
The food availability and dietary behaviours in Greenland have changed with increasing Westernisation. Food reward is an important driver of food choice and intake, which has not previously been explored in the Arctic population. The aim of this study was to explore differences in food reward after a four-week intervention period with a traditional Inuit diet (TID) or Westernised diet (WD) in Inuit populations in Northern and Western Greenland. This cross-sectional analysis included 44 adults (n = 20 after TID and n = 24 after WD). We assessed the food reward components, explicit liking and implicit wanting, using the Leeds Food Preference Questionnaire under standardised conditions 60 min after drinking a glucose drink as part of an oral glucose tolerance test after four weeks following a TID or WD. The food intake was assessed using food frequency questionnaires. The intervention groups differed only in implicit wanting for high-fat sweet foods, with higher implicit wanting among the participants following TID compared to WD. Both groups had lower explicit liking and implicit wanting for sweet relative to savoury foods and for high-fat relative to low-fat foods. This exploratory study can guide future studies in Inuit populations to include measures of food reward to better understand food intake in the Arctic.
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Affiliation(s)
- Hanne Pedersen
- Clinical Research, Copenhagen University Hospital—Steno Diabetes Center Copenahgen, Borgmester Ib Juuls Vej 83, DK-2730 Herlev, Denmark; (K.B.); (G.F.); (K.F.); (J.S.Q.)
- National Institute of Public Health, University of Southern Denmark, Studiestræde 6, DK-1455 Copenhagen, Denmark;
- Correspondence:
| | - Kristine Beaulieu
- Clinical Research, Copenhagen University Hospital—Steno Diabetes Center Copenahgen, Borgmester Ib Juuls Vej 83, DK-2730 Herlev, Denmark; (K.B.); (G.F.); (K.F.); (J.S.Q.)
- Appetite Control and Energy Balance Research, School of Psychology, University of Leeds, Leeds LS2 9JT, UK
| | - Graham Finlayson
- Clinical Research, Copenhagen University Hospital—Steno Diabetes Center Copenahgen, Borgmester Ib Juuls Vej 83, DK-2730 Herlev, Denmark; (K.B.); (G.F.); (K.F.); (J.S.Q.)
- Appetite Control and Energy Balance Research, School of Psychology, University of Leeds, Leeds LS2 9JT, UK
| | - Kristine Færch
- Clinical Research, Copenhagen University Hospital—Steno Diabetes Center Copenahgen, Borgmester Ib Juuls Vej 83, DK-2730 Herlev, Denmark; (K.B.); (G.F.); (K.F.); (J.S.Q.)
- Department of Biomedical Sciences, University of Copenhagen, DK-2200 Copenhagen, Denmark
| | - Marit Eika Jørgensen
- National Institute of Public Health, University of Southern Denmark, Studiestræde 6, DK-1455 Copenhagen, Denmark;
- Clinical Epidemiology, Steno Diabetes Center Copenhagen, Borgmester Ib Juuls Vej 83, DK-2730 Herlev, Denmark
- Steno Diabetes Center Greenland, Dronning Ingrids Vej, Nuuk 3900, Greenland
| | - Jack Ivor Lewis
- Department of Nutrition, Exercise and Sports, University of Copenhagen, DK-2200 Copenhagen N, Denmark; (J.I.L.); (M.V.L.); (L.L.)
| | - Mads Vendelbo Lind
- Department of Nutrition, Exercise and Sports, University of Copenhagen, DK-2200 Copenhagen N, Denmark; (J.I.L.); (M.V.L.); (L.L.)
| | - Lotte Lauritzen
- Department of Nutrition, Exercise and Sports, University of Copenhagen, DK-2200 Copenhagen N, Denmark; (J.I.L.); (M.V.L.); (L.L.)
| | - Jonas Salling Quist
- Clinical Research, Copenhagen University Hospital—Steno Diabetes Center Copenahgen, Borgmester Ib Juuls Vej 83, DK-2730 Herlev, Denmark; (K.B.); (G.F.); (K.F.); (J.S.Q.)
- Appetite Control and Energy Balance Research, School of Psychology, University of Leeds, Leeds LS2 9JT, UK
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21
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Pedersen H, Quist JS, Jensen MM, Clemmensen KKB, Vistisen D, Jørgensen ME, Færch K, Finlayson G. Investigation of eye tracking, electrodermal activity and facial expressions as biometric signatures of food reward and intake in normal weight adults. Food Qual Prefer 2021. [DOI: 10.1016/j.foodqual.2021.104248] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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22
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Pedersen H, Beaulieu K, Jørgensen ME, Færch K, Lauritzen L, Lewis J, Finlayson G, Quist JS. Food Preferences in a Greenlandic Population. Curr Dev Nutr 2021. [DOI: 10.1093/cdn/nzab038_052] [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: 11/12/2022] Open
Abstract
Abstract
Objectives
The overall aim was to describe food reward in an Inuit population in Greenland. More specifically, the objective was to first test the differences in food reward for sweet relative to savory food (taste bias) after four weeks on a traditionally Inuit diet (TID) vs a Westernized diet (WD). If no differences in taste bias were found between diet groups, we aimed to describe food reward in a pooled sample (median [IQR]). We hypothesized that participants would have higher preferences for sweet compared to savory foods.
Methods
After a dietary intervention in Greenland (20% of foods provided), we measured behavioral components of food reward using the Leeds Food Preference Questionnaire. The reward components, explicit liking and implicit wanting, were measured in response to images of Western foods varying in fat content and taste after four weeks on either TID or WD. A positive bias score reflected preference for sweet over savory, and oppositely a negative bias score reflected preference for savory over sweet foods.
Results
Participant characteristics were similar in the two diet groups (age (mean (SD): TID = 58.1 (11.5) vs. WD = 55.4 (9.5) years); sex: TID = 50% vs. WD = 54% women; body mass index (mean (SD): TID = 26.6 (5.5) vs. WD = 27.9 (4.7) kg/m2). In these preliminary, unadjusted analyses, we found no differences in explicit liking (P = 0.77) or implicit wanting (P = 0.70) bias score for sweet over savory foods after four weeks following either TID (n = 26) or WID (n = 24). Altogether, participants in the two diet groups had a greater explicit liking (−11.5 [−19.9; −2.8]) and implicit wanting (−21.6 [−44.2; −5.2]) for savory compared to sweet foods.
Conclusions
This is the first study to examine explicit and implicit aspects of food reward in an Inuit population. Contrary to our hypothesis, this population did not prefer sweet over savory Western foods.
Funding Sources
The study was supported by unrestricted grants from The Novo Nordisk Foundation. Royal Greenland and the supermarket chains Kalaallit Nunaanni Brugseni & Pilersuisoq supported the study with foods and food logistics.
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Affiliation(s)
| | - Kristine Beaulieu
- Appetite Control & Energy Balance Research, School of Psychology, Faculty of Medicine & Health, University of Leeds
| | | | | | | | | | - Graham Finlayson
- Appetite Control & Energy Balance Research, School of Psychology, Faculty of Medicine & Health, University of Leeds
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23
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Bruhn L, Kjøbsted R, Quist JS, Gram AS, Rosenkilde M, Færch K, Wojtaszewski JF, Stallknecht B, Blond MB. Effect of exercise training on skeletal muscle protein expression in relation to insulin sensitivity: Per-protocol analysis of a randomized controlled trial (GO-ACTIWE). Physiol Rep 2021; 9:e14850. [PMID: 34042297 PMCID: PMC8157763 DOI: 10.14814/phy2.14850] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Accepted: 04/08/2021] [Indexed: 12/14/2022] Open
Abstract
Exercise training improves peripheral insulin sensitivity and leads to molecular adaptations in the skeletal muscle. We investigated changes in the expression of key muscle proteins in the glucose metabolic pathway following active commuting by bike or leisure-time exercise at two different intensities. In addition, potential associations between insulin sensitivity and muscle protein expression were examined. This per-protocol analysis included 72 out of 130 physically inactive, healthy women and men (20-45 years) with overweight/obesity (BMI: 25-35 kg/m2 ) who completed 6 months of no intervention (CON, n = 12), active commuting by bike (BIKE, n = 14), or leisure-time exercise of moderate (MOD, n = 28) or vigorous (VIG, n = 18) intensity. Exercise was prescribed 5 days/week with a weekly exercise energy expenditure of 1,600 kcal for women and 2,100 kcal for men. Insulin sensitivity was determined by a hyperinsulinemic euglycemic clamp and skeletal muscle biopsies were obtained from m. vastus lateralis and analyzed for protein expression at baseline and after 3 and 6 months of intervention. We found an increased expression of pyruvate dehydrogenase (PDH) in the exercise groups compared with the control group following 6 months of training. No differential effects were observed on the protein expression following moderate versus vigorous intensity exercise. In addition, we found a positive association between insulin sensitivity and the expression of glucose transporter type 4 as well as PDH. The positive association and the increase in expression of PDH after exercise training points toward a role for PDH in the training-induced enhancement of insulin sensitivity.
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Affiliation(s)
- Lea Bruhn
- Department of Biomedical SciencesFaculty of Health and Medical SciencesUniversity of CopenhagenCopenhagenDenmark
- Steno Diabetes Center CopenhagenGentofteDenmark
| | - Rasmus Kjøbsted
- Section of Molecular PhysiologyAugust Krogh ClubDepartment of Nutrition, Exercise and SportsUniversity of CopenhagenCopenhagenDenmark
| | - Jonas Salling Quist
- Department of Biomedical SciencesFaculty of Health and Medical SciencesUniversity of CopenhagenCopenhagenDenmark
- Steno Diabetes Center CopenhagenGentofteDenmark
| | - Anne Sofie Gram
- Department of Biomedical SciencesFaculty of Health and Medical SciencesUniversity of CopenhagenCopenhagenDenmark
| | - Mads Rosenkilde
- Department of Biomedical SciencesFaculty of Health and Medical SciencesUniversity of CopenhagenCopenhagenDenmark
| | - Kristine Færch
- Department of Biomedical SciencesFaculty of Health and Medical SciencesUniversity of CopenhagenCopenhagenDenmark
- Steno Diabetes Center CopenhagenGentofteDenmark
| | - Jørgen F.P. Wojtaszewski
- Section of Molecular PhysiologyAugust Krogh ClubDepartment of Nutrition, Exercise and SportsUniversity of CopenhagenCopenhagenDenmark
| | - Bente Stallknecht
- Department of Biomedical SciencesFaculty of Health and Medical SciencesUniversity of CopenhagenCopenhagenDenmark
| | - Martin Bæk Blond
- Department of Biomedical SciencesFaculty of Health and Medical SciencesUniversity of CopenhagenCopenhagenDenmark
- Steno Diabetes Center CopenhagenGentofteDenmark
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24
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Jensen MM, Wegeberg AML, Jensen SL, Sørensen PS, Wigh IMN, Zaugg VS, Færch K, Quist JS, Brock C. The day-night pattern of colonic contractility is not impaired in type 1 diabetes and distal symmetric polyneuropathy. Chronobiol Int 2021; 38:801-806. [PMID: 33706631 DOI: 10.1080/07420528.2021.1890761] [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] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Colonic contractility normally shows circadian variability regulated by sleep and especially food intake. However, individuals with type 1 diabetes have a reduced or even absent gastrocolic response to a meal, indicating that colonic contractility may be affected by the disease. We hypothesized that individuals with type 1 diabetes and distal symmetric polyneuropathy (DSPN) have decreased motility (expressed as the motility index) and contractility of the colon and a reduced increase in motility index from night to morning compared to healthy controls and individuals with type 1 diabetes without DSPN. Cohorts of 35 individuals with type 1 diabetes and DSPN, 40 individuals with type 1 diabetes without DSPN, and 28 healthy controls were included in this post-hoc, cross-sectional analysis. We investigated, using a wireless motility capsule that measures pH, temperature, and pressure throughout the gastrointestinal tract, whether individuals with type 1 diabetes with and without DSPN, compared to healthy controls, exhibit altered colonic contractility in the evening, night, and morning. Max amplitude, mean peak amplitude, mean contraction, and motility index of the colon were calculated at the afore-designated times. Motility index of the colon tended to be higher in individuals with type 1 diabetes and DSPN compared to controls in the evening (P = .064), but the effect size was small (1.74%). There was no difference in motility index between the groups in the morning or evening. Furthermore, there was no difference in max amplitude, mean peak amplitude, or mean contraction between groups in the morning, evening, and night. As expected, overall contractility increased from night to morning in all groups, but there was no difference between groups in the increase in contractility from night to morning. Colonic contractility generally peaked in the morning, decreased in the evening, and was almost absent at night. Type 1 diabetes and/or DSPN did not impair contractility of the colon at any time point. Contractility and motility increased from morning to night unaffected by type 1 diabetes and/or DSPN.
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Affiliation(s)
- Marie M Jensen
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.,Clinical Prevention Research, Clinical Research, Steno Diabetes Center Copenhagen, Gentofte, Denmark
| | - Anne-Marie L Wegeberg
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.,Mech-Sense, Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark
| | - Sine L Jensen
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.,Mech-Sense, Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark
| | - Peter S Sørensen
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.,Mech-Sense, Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark
| | - Ida M N Wigh
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.,Mech-Sense, Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark
| | - Victoria S Zaugg
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.,Mech-Sense, Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark
| | - Kristine Færch
- Clinical Prevention Research, Clinical Research, Steno Diabetes Center Copenhagen, Gentofte, Denmark
| | - Jonas S Quist
- Clinical Prevention Research, Clinical Research, Steno Diabetes Center Copenhagen, Gentofte, Denmark
| | - Christina Brock
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.,Mech-Sense, Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark
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25
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Alvarez-Silva C, Kashani A, Hansen TH, Pinna NK, Anjana RM, Dutta A, Saxena S, Støy J, Kampmann U, Nielsen T, Jørgensen T, Gnanaprakash V, Gnanavadivel R, Sukumaran A, Rani CSS, Færch K, Radha V, Balasubramanyam M, Nair GB, Das B, Vestergaard H, Hansen T, Mande SS, Mohan V, Arumugam M, Pedersen O. Trans-ethnic gut microbiota signatures of type 2 diabetes in Denmark and India. Genome Med 2021; 13:37. [PMID: 33658058 PMCID: PMC7931542 DOI: 10.1186/s13073-021-00856-4] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [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: 04/27/2020] [Accepted: 02/12/2021] [Indexed: 12/15/2022] Open
Abstract
Background Type 2 diabetes (T2D), a multifactorial disease influenced by host genetics and environmental factors, is the most common endocrine disease. Several studies have shown that the gut microbiota as a close-up environmental mediator influences host physiology including metabolism. The aim of the present study is to examine the compositional and functional potential of the gut microbiota across individuals from Denmark and South India with a focus on T2D. Many earlier studies have investigated the microbiome aspects of T2D, and it has also been anticipated that such microbial associations would be dependent on diet and ethnic origin. However, there has been no large scale trans-ethnic microbiome study earlier in this direction aimed at evaluating any “universal” microbiome signature of T2D. Methods 16S ribosomal RNA gene amplicon sequencing was performed on stool samples from 279 Danish and 294 Indian study participants. Any differences between the gut microbiota of both populations were explored using diversity measures and negative binomial Wald tests. Study samples were stratified to discover global and country-specific microbial signatures for T2D and treatment with the anti-hyperglycemic drug, metformin. To identify taxonomical and functional signatures of the gut microbiota for T2D and metformin treatment, we used alpha and beta diversity measures and differential abundances analysis, comparing metformin-naive T2D patients, metformin-treated T2D patients, and normoglycemic individuals. Results Overall, the gut microbial communities of Danes and Indians are compositionally very different. By analyzing the combined study materials, we identify microbial taxonomic and functional signatures for T2D and metformin treatment. T2D patients have an increased relative abundance of two operational taxonomic units (OTUs) from the Lachnospiraceae family, and a decreased abundance of Subdoligranulum and Butyricicoccus. Studying each population per se, we identified T2D-related microbial changes at the taxonomic level within the Danish population only. Alpha diversity indices show that there is no significant difference between normoglycemic individuals and metformin-naive T2D patients, whereas microbial richness is significantly decreased in metformin-treated T2D patients compared to metformin-naive T2D patients and normoglycemic individuals. Enrichment of two OTUs from Bacteroides and depletion of Faecalibacterium constitute a trans-ethnic signature of metformin treatment. Conclusions We demonstrate major compositional differences of the gut microbiota between Danish and South Indian individuals, some of which may relate to differences in ethnicity, lifestyle, and demography. By comparing metformin-naive T2D patients and normoglycemic individuals, we identify T2D-related microbiota changes in the Danish and Indian study samples. In the present trans-ethnic study, we confirm that metformin changes the taxonomic profile and functional potential of the gut microbiota. Supplementary Information The online version contains supplementary material available at 10.1186/s13073-021-00856-4.
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Affiliation(s)
- Camila Alvarez-Silva
- Novo Nordisk Foundation Center for Basic Metabolic Research, University of Copenhagen, Blegdamsvej 3B, DK-2200, Copenhagen N, Denmark
| | - Alireza Kashani
- Novo Nordisk Foundation Center for Basic Metabolic Research, University of Copenhagen, Blegdamsvej 3B, DK-2200, Copenhagen N, Denmark.,Danish Academy of Diabetes, Odense University Hospital, DK-5000 Odense C, Kløvervænget 6, Odense, Denmark
| | - Tue Haldor Hansen
- Novo Nordisk Foundation Center for Basic Metabolic Research, University of Copenhagen, Blegdamsvej 3B, DK-2200, Copenhagen N, Denmark.,Department of Cardiology and Endocrinology, Slagelse Hospital, Slagelse, Denmark
| | - Nishal Kumar Pinna
- TCS Research, Tata Consultancy Services Limited, 54B Hadapsar Industrial Estate, Pune, 411013, India
| | - Ranjit Mohan Anjana
- Madras Diabetes Research Foundation, No. 4, Conran Smith Road, Gopalapuram, Chennai, 600 086, India
| | - Anirban Dutta
- TCS Research, Tata Consultancy Services Limited, 54B Hadapsar Industrial Estate, Pune, 411013, India
| | - Shruti Saxena
- Molecular Genetics Laboratory, Infections and Immunology, Translational Health Science and Technology Institute, NCR Biotech Science Cluster, Faridabad, 121001, India
| | - Julie Støy
- Steno Diabetes Center Aarhus, Aarhus Universitetshospital, Hedeager 3, 2. sal, Aarhus, 8200, Denmark
| | - Ulla Kampmann
- Steno Diabetes Center Aarhus, Aarhus Universitetshospital, Hedeager 3, 2. sal, Aarhus, 8200, Denmark
| | - Trine Nielsen
- Danish Academy of Diabetes, Odense University Hospital, DK-5000 Odense C, Kløvervænget 6, Odense, Denmark
| | - Torben Jørgensen
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospitals, University of Copenhagen, Copenhagen, Denmark
| | - Visvanathan Gnanaprakash
- Madras Diabetes Research Foundation, No. 4, Conran Smith Road, Gopalapuram, Chennai, 600 086, India
| | - Rameshkumar Gnanavadivel
- Madras Diabetes Research Foundation, No. 4, Conran Smith Road, Gopalapuram, Chennai, 600 086, India
| | - Aswath Sukumaran
- Madras Diabetes Research Foundation, No. 4, Conran Smith Road, Gopalapuram, Chennai, 600 086, India
| | | | - Kristine Færch
- Steno Diabetes Center Aarhus, Aarhus Universitetshospital, Hedeager 3, 2. sal, Aarhus, 8200, Denmark
| | - Venkatesan Radha
- Madras Diabetes Research Foundation, No. 4, Conran Smith Road, Gopalapuram, Chennai, 600 086, India
| | | | - Gopinath Balakrish Nair
- Molecular Genetics Laboratory, Infections and Immunology, Translational Health Science and Technology Institute, NCR Biotech Science Cluster, Faridabad, 121001, India
| | - Bhabatosh Das
- Molecular Genetics Laboratory, Infections and Immunology, Translational Health Science and Technology Institute, NCR Biotech Science Cluster, Faridabad, 121001, India
| | - Henrik Vestergaard
- Novo Nordisk Foundation Center for Basic Metabolic Research, University of Copenhagen, Blegdamsvej 3B, DK-2200, Copenhagen N, Denmark
| | - Torben Hansen
- Novo Nordisk Foundation Center for Basic Metabolic Research, University of Copenhagen, Blegdamsvej 3B, DK-2200, Copenhagen N, Denmark
| | - Sharmila Shekhar Mande
- TCS Research, Tata Consultancy Services Limited, 54B Hadapsar Industrial Estate, Pune, 411013, India.
| | - Viswanathan Mohan
- Madras Diabetes Research Foundation, No. 4, Conran Smith Road, Gopalapuram, Chennai, 600 086, India.
| | - Manimozhiyan Arumugam
- Novo Nordisk Foundation Center for Basic Metabolic Research, University of Copenhagen, Blegdamsvej 3B, DK-2200, Copenhagen N, Denmark. .,Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark.
| | - Oluf Pedersen
- Novo Nordisk Foundation Center for Basic Metabolic Research, University of Copenhagen, Blegdamsvej 3B, DK-2200, Copenhagen N, Denmark.
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26
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Pinna NK, Anjana RM, Saxena S, Dutta A, Gnanaprakash V, Rameshkumar G, Aswath S, Raghavan S, Rani CSS, Radha V, Balasubramanyam M, Pant A, Nielsen T, Jørgensen T, Færch K, Kashani A, Silva MCA, Vestergaard H, Hansen TH, Hansen T, Arumugam M, Nair GB, Das B, Pedersen O, Mohan V, Mande SS. Trans-ethnic gut microbial signatures of prediabetic subjects from India and Denmark. Genome Med 2021; 13:36. [PMID: 33658065 PMCID: PMC7931552 DOI: 10.1186/s13073-021-00851-9] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 02/11/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Recent studies have indicated an association of gut microbiota and microbial metabolites with type 2 diabetes mellitus (T2D). However, large-scale investigation of the gut microbiota of "prediabetic" (PD) subjects has not been reported. Identifying robust gut microbiome signatures of prediabetes and characterizing early prediabetic stages is important for the understanding of disease development and could be crucial in early diagnosis and prevention. METHODS The current study performed amplification and sequencing on the variable regions (V1-V5) of the 16S rRNA genes to profile and compare gut microbiota of prediabetic individuals (N = 262) with normoglycemic individuals (N = 275) from two cohorts in India and Denmark. Similarly, fasting serum inflammatory biomarkers were profiled from the study participants. RESULTS After correcting for strong country-specific cohort effect, 16 operational taxonomic units (OTUs) including members from the genera Prevotella9, Phascolarctobacterium, Barnesiella, Flavonifractor, Tyzzerella_4, Bacteroides, Faecalibacterium, and Agathobacter were identified as enriched in normoglycaemic subjects with respect to the subjects with prediabetes using a negative binomial Wald test. We also identified 144 OTUs enriched in the prediabetic subjects, which included members from the genera Megasphaera, Streptococcus, Prevotella9, Alistipes, Mitsuokella, Escherichia/Shigella, Prevotella2, Vibrio, Lactobacillus, Alloprevotella, Rhodococcus, and Klebsiella. Comparative analyses of relative abundance of bacterial taxa revealed that the Streptococcus, Escherichia/Shigella, Prevotella2, Vibrio, and Alloprevotella OTUs exhibited more than fourfold enrichment in the gut microbiota of prediabetic subjects. When considering subjects from the two geographies separately, we were able to identify additional gut microbiome signatures of prediabetes. The study reports a probable association of Megasphaera OTU(s) with impaired glucose tolerance, which is significantly pronounced in Indian subjects. While the overall results confirm a state of proinflammation as early as in prediabetes, the Indian cohort exhibited a characteristic pattern of abundance of inflammatory markers indicating low-grade intestinal inflammation at an overall population level, irrespective of glycemic status. CONCLUSIONS The results present trans-ethnic gut microbiome and inflammation signatures associated with prediabetes, in Indian and Danish populations. The identified associations may be explored further as potential early indicators for individuals at risk of dysglycemia.
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Affiliation(s)
- Nishal Kumar Pinna
- TCS Research, Tata Consultancy Services Limited, 54B Hadapsar Industrial Estate, Pune, 411013, India
| | - Ranjit Mohan Anjana
- Madras Diabetes Research Foundation, No. 4, Conran Smith Road, Gopalapuram, Chennai, 600 086, India
| | - Shruti Saxena
- Molecular Genetics Laboratory, Infections and Immunology, Translational Health Science and Technology Institute, NCR Biotech Science Cluster, 3rd Milestone, Faridabad - Gurgaon Expressway, PO box #04, Faridabad, 121001, India
| | - Anirban Dutta
- TCS Research, Tata Consultancy Services Limited, 54B Hadapsar Industrial Estate, Pune, 411013, India
| | - Visvanathan Gnanaprakash
- Madras Diabetes Research Foundation, No. 4, Conran Smith Road, Gopalapuram, Chennai, 600 086, India
| | - Gnanavadivel Rameshkumar
- Madras Diabetes Research Foundation, No. 4, Conran Smith Road, Gopalapuram, Chennai, 600 086, India
| | - Sukumaran Aswath
- Madras Diabetes Research Foundation, No. 4, Conran Smith Road, Gopalapuram, Chennai, 600 086, India
| | - Srividhya Raghavan
- Madras Diabetes Research Foundation, No. 4, Conran Smith Road, Gopalapuram, Chennai, 600 086, India
| | | | - Venkatesan Radha
- Madras Diabetes Research Foundation, No. 4, Conran Smith Road, Gopalapuram, Chennai, 600 086, India
| | - Muthuswamy Balasubramanyam
- Madras Diabetes Research Foundation, No. 4, Conran Smith Road, Gopalapuram, Chennai, 600 086, India.,Present address: SRM Medical College Hospital & Research Centre, SRM Institute of Science & Technology (SRMIST), Kattankulathur, Chennai, India
| | - Archana Pant
- Molecular Genetics Laboratory, Infections and Immunology, Translational Health Science and Technology Institute, NCR Biotech Science Cluster, 3rd Milestone, Faridabad - Gurgaon Expressway, PO box #04, Faridabad, 121001, India
| | - Trine Nielsen
- Novo Nordisk Foundation Center for Basic Metabolic Research, University of Copenhagen, Blegdamsvej 3B, Maersk Tower, Building: 07-8-55, DK-2200, Copenhagen N, Denmark
| | - Torben Jørgensen
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospitals, University of Copenhagen, Copenhagen, Denmark
| | | | - Alireza Kashani
- Novo Nordisk Foundation Center for Basic Metabolic Research, University of Copenhagen, Blegdamsvej 3B, Maersk Tower, Building: 07-8-55, DK-2200, Copenhagen N, Denmark.,Current affiliation: Qbiom, Microbiome Consultancy Service, Copenhagen, Denmark
| | - Maria Camila Alvarez Silva
- Novo Nordisk Foundation Center for Basic Metabolic Research, University of Copenhagen, Blegdamsvej 3B, Maersk Tower, Building: 07-8-55, DK-2200, Copenhagen N, Denmark
| | - Henrik Vestergaard
- Novo Nordisk Foundation Center for Basic Metabolic Research, University of Copenhagen, Blegdamsvej 3B, Maersk Tower, Building: 07-8-55, DK-2200, Copenhagen N, Denmark
| | - Tue Haldor Hansen
- Novo Nordisk Foundation Center for Basic Metabolic Research, University of Copenhagen, Blegdamsvej 3B, Maersk Tower, Building: 07-8-55, DK-2200, Copenhagen N, Denmark.,Department of Cardiology and Endocrinology, Slagelse Hospital, Slagelse, Denmark
| | - Torben Hansen
- Novo Nordisk Foundation Center for Basic Metabolic Research, University of Copenhagen, Blegdamsvej 3B, Maersk Tower, Building: 07-8-55, DK-2200, Copenhagen N, Denmark
| | - Manimozhiyan Arumugam
- Novo Nordisk Foundation Center for Basic Metabolic Research, University of Copenhagen, Blegdamsvej 3B, Maersk Tower, Building: 07-8-55, DK-2200, Copenhagen N, Denmark
| | - Gopinath Balakrish Nair
- Molecular Genetics Laboratory, Infections and Immunology, Translational Health Science and Technology Institute, NCR Biotech Science Cluster, 3rd Milestone, Faridabad - Gurgaon Expressway, PO box #04, Faridabad, 121001, India
| | - Bhabatosh Das
- Molecular Genetics Laboratory, Infections and Immunology, Translational Health Science and Technology Institute, NCR Biotech Science Cluster, 3rd Milestone, Faridabad - Gurgaon Expressway, PO box #04, Faridabad, 121001, India.
| | - Oluf Pedersen
- Novo Nordisk Foundation Center for Basic Metabolic Research, University of Copenhagen, Blegdamsvej 3B, Maersk Tower, Building: 07-8-55, DK-2200, Copenhagen N, Denmark.
| | - Viswanathan Mohan
- Madras Diabetes Research Foundation, No. 4, Conran Smith Road, Gopalapuram, Chennai, 600 086, India.
| | - Sharmila Shekhar Mande
- TCS Research, Tata Consultancy Services Limited, 54B Hadapsar Industrial Estate, Pune, 411013, India.
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27
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Jonsson A, Stinson SE, Torekov SS, Clausen TD, Færch K, Kelstrup L, Grarup N, Mathiesen ER, Damm P, Witte DR, Jørgensen ME, Pedersen O, Holst JJ, Hansen T. Genome-wide association study of circulating levels of glucagon during an oral glucose tolerance test. BMC Med Genomics 2021; 14:3. [PMID: 33407418 PMCID: PMC7788944 DOI: 10.1186/s12920-020-00841-7] [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] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 11/30/2020] [Indexed: 11/23/2022] Open
Abstract
Background In order to explore the pathophysiology underlying type 2 diabetes we examined the impact of gene variants associated with type 2 diabetes on circulating levels of glucagon during an oral glucose tolerance test (OGTT). Furthermore, we performed a genome-wide association study (GWAS) aiming to identify novel genomic loci affecting plasma glucagon levels.
Methods Plasma levels of glucagon were examined in samples obtained at three time points during an OGTT; 0, 30 and 120 min, in two separate cohorts with a total of up to 1899 individuals. Cross-sectional analyses were performed separately in the two cohorts and the results were combined in a meta-analysis. Results A known type 2 diabetes variant in EYA2 was significantly associated with higher plasma glucagon level at 30 min during the OGTT (Beta 0.145, SE 0.038, P = 1.2 × 10–4) corresponding to a 7.4% increase in plasma glucagon level per effect allele. In the GWAS, we identified a marker in the MARCH1 locus, which was genome-wide significantly associated with reduced suppression of glucagon during the first 30 min of the OGTT (Beta − 0.210, SE 0.037, P = 1.9 × 10–8), equivalent to 8.2% less suppression per effect allele. Nine additional independent markers, not previously associated with type 2 diabetes, showed suggestive associations with reduced glucagon suppression during the first 30 min of the OGTT (P < 1.0 × 10–5). Conclusions A type 2 diabetes risk variant in the EYA2 locus was associated with higher plasma glucagon levels at 30 min. Ten additional variants were suggestively associated with reduced glucagon suppression without conferring increased type 2 diabetes risk.
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Affiliation(s)
- Anna Jonsson
- The Novo Nordisk Foundation Center for Basic Metabolic Research, University of Copenhagen, Blegdamsvej 3B, 2200, Copenhagen, Denmark.
| | - Sara E Stinson
- The Novo Nordisk Foundation Center for Basic Metabolic Research, University of Copenhagen, Blegdamsvej 3B, 2200, Copenhagen, Denmark
| | - Signe S Torekov
- The Novo Nordisk Foundation Center for Basic Metabolic Research, University of Copenhagen, Blegdamsvej 3B, 2200, Copenhagen, Denmark.,Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Tine D Clausen
- Department of Gynecology and Obstetrics, Nordsjaellands Hospital, University of Copenhagen, 3400, Hilleroed, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, 2200, Copenhagen, Denmark
| | | | - Louise Kelstrup
- Department of Obstetrics, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Niels Grarup
- The Novo Nordisk Foundation Center for Basic Metabolic Research, University of Copenhagen, Blegdamsvej 3B, 2200, Copenhagen, Denmark
| | - Elisabeth R Mathiesen
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, 2200, Copenhagen, Denmark.,Department of Obstetrics, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,Center for Pregnant Women with Diabetes, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,Department of Endocrinology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,The Danish Diabetes Academy, Odense, Denmark
| | - Peter Damm
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, 2200, Copenhagen, Denmark.,Department of Obstetrics, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Daniel R Witte
- The Danish Diabetes Academy, Odense, Denmark.,Institute of Public Health, University of Aarhus, Aarhus, Denmark.,Steno Diabetes Center Aarhus, Aarhus, Denmark
| | - Marit E Jørgensen
- Steno Diabetes Center Copenhagen, Gentofte, Denmark.,National Institute of Public Health, University of Southern Denmark, Odense, Denmark
| | - Oluf Pedersen
- The Novo Nordisk Foundation Center for Basic Metabolic Research, University of Copenhagen, Blegdamsvej 3B, 2200, Copenhagen, Denmark
| | - Jens Juul Holst
- The Novo Nordisk Foundation Center for Basic Metabolic Research, University of Copenhagen, Blegdamsvej 3B, 2200, Copenhagen, Denmark.,Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Torben Hansen
- The Novo Nordisk Foundation Center for Basic Metabolic Research, University of Copenhagen, Blegdamsvej 3B, 2200, Copenhagen, Denmark
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28
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Færch K, Blond MB, Bruhn L, Amadid H, Vistisen D, Clemmensen KKB, Vainø CTR, Pedersen C, Tvermosegaard M, Dejgaard TF, Karstoft K, Ried-Larsen M, Persson F, Jørgensen ME. The effects of dapagliflozin, metformin or exercise on glycaemic variability in overweight or obese individuals with prediabetes (the PRE-D Trial): a multi-arm, randomised, controlled trial. Diabetologia 2021; 64:42-55. [PMID: 33064182 DOI: 10.1007/s00125-020-05306-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [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: 05/22/2020] [Accepted: 08/28/2020] [Indexed: 02/07/2023]
Abstract
AIMS/HYPOTHESIS We aimed to investigate the short-term efficacy and safety of three glucose-lowering interventions in overweight or obese individuals with prediabetes defined by HbA1c. METHODS The PRE-D Trial was a randomised, controlled, parallel, multi-arm, open-label, non-blinded trial performed at Steno Diabetes Center Copenhagen, Gentofte, Denmark. One hundred and twenty participants with BMI ≥25 kg/m2, 30-70 years of age, and prediabetes (HbA1c 39-47 mmol/mol [5.7-6.4%]) were randomised 1:1:1:1 to dapagliflozin (10 mg once daily), metformin (1700 mg daily), interval-based exercise (5 days/week, 30 min/session) or control (habitual lifestyle). Participants were examined at baseline and at 6, 13 and 26 weeks after randomisation. The primary outcome was the 13 week change in glycaemic variability (calculated as mean amplitude of glycaemic excursions [MAGE]) determined using a continuous glucose monitoring system (pre-specified minimal clinically important difference in MAGE ∼30%). RESULTS One hundred and twelve participants attended the examination at 13 weeks and 111 attended the follow-up visit at 26 weeks. Compared with the control group, there was a small decrease in MAGE in the dapagliflozin group (17.1% [95% CI 0.7, 30.8], p = 0.042) and a small, non-significant, reduction in the exercise group (15.3% [95% CI -1.2, 29.1], p = 0.067), whereas MAGE was unchanged in the metformin group (0.1% [95% CI -16.1, 19.4], p = 0.991)). Compared with the metformin group, MAGE was 17.2% (95% CI 0.8, 30.9; p = 0.041) lower in the dapagliflozin group and 15.4% (95% CI -1.1, 29.1; p = 0.065) lower in the exercise group after 13 weeks, with no difference between exercise and dapagliflozin (2.2% [95% CI -14.8, 22.5], p = 0.815). One serious adverse event occurred in the control group (lung cancer). CONCLUSIONS/INTERPRETATION Treatment with dapagliflozin and interval-based exercise lead to similar but small improvements in glycaemic variability compared with control and metformin therapy. The clinical importance of these findings in prediabetes is uncertain. TRIAL REGISTRATION ClinicalTrials.gov NCT02695810 FUNDING: The study was funded by the Novo Nordisk Foundation, AstraZeneca AB, the Danish Innovation Foundation, the University of Copenhagen and Ascensia Diabetes Care Denmark ApS Graphical abstract.
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Affiliation(s)
| | | | - Lea Bruhn
- Steno Diabetes Center Copenhagen, Gentofte, Denmark
| | - Hanan Amadid
- Steno Diabetes Center Copenhagen, Gentofte, Denmark
| | | | | | | | | | - Maria Tvermosegaard
- Steno Diabetes Center Copenhagen, Gentofte, Denmark
- University of Southern Denmark, Copenhagen, Denmark
| | | | - Kristian Karstoft
- The Centre of Inflammation and Metabolism and the Centre for Physical Activity Research, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Mathias Ried-Larsen
- The Centre of Inflammation and Metabolism and the Centre for Physical Activity Research, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- The Danish Diabetes Academy, Odense, Denmark
| | | | - Marit E Jørgensen
- Steno Diabetes Center Copenhagen, Gentofte, Denmark
- University of Southern Denmark, Copenhagen, Denmark
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Færch K, Amadid H, Bruhn L, Clemmensen KKB, Hulman A, Ried-Larsen M, Blond MB, Jørgensen ME, Vistisen D. Discordance Between Glucose Levels Measured in Interstitial Fluid vs in Venous Plasma After Oral Glucose Administration: A Post-Hoc Analysis From the Randomised Controlled PRE-D Trial. Front Endocrinol (Lausanne) 2021; 12:753810. [PMID: 34675886 PMCID: PMC8525890 DOI: 10.3389/fendo.2021.753810] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 09/15/2021] [Indexed: 01/08/2023] Open
Abstract
AIMS The oral glucose tolerance test (OGTT) is together with haemoglobin A1c (HbA1c) gold standard for diagnosing prediabetes and diabetes. The objective of this study was to assess the concordance between glucose values obtained from venous plasma versus interstitial fluid after oral glucose administration in 120 individuals with prediabetes and overweight/obesity. METHODS 120 adults with prediabetes defined by HbA1c 39-47 mmol/mol and overweight or obesity who participated in the randomised controlled PRE-D trial were included in the study. Venous plasma glucose concentrations were measured at 0, 30, 60 and 120 minutes during a 75 g oral glucose tolerance test (OGTT) performed on three different occasions within a 26 weeks period. During the OGTT, the participants wore a CGM device (IPro2, Medtronic), which assessed glucose concentrations every five minutes. RESULTS A total of 306 OGTTs with simultaneous CGM measurements were obtained. Except in fasting, the CGM glucose values were below the OGTT values throughout the OGTT period with mean (SD) differences of 0.2 (0.7) mmol/L at time 0 min, -1.1 (1.3) at 30 min, -1.4 (1.8) at 60 min, and -0.5 (1.1) at 120 min). For measurements at 0 and 120 min, there was a proportional bias with an increasing mean difference between CGM and OGTT values with increasing mean of the two measurements. CONCLUSIONS Due to poor agreement between the OGTT and CGM with wide 95% limits of agreement and proportional bias at 0 and 120 min, the potential for assessing glucose tolerance in prediabetes using CGM is questionable.
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Affiliation(s)
- Kristine Færch
- Steno Diabetes Center Copenhagen, Gentofte, Denmark
- Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
- *Correspondence: Kristine Færch,
| | - Hanan Amadid
- Steno Diabetes Center Copenhagen, Gentofte, Denmark
| | - Lea Bruhn
- Steno Diabetes Center Copenhagen, Gentofte, Denmark
| | | | - Adam Hulman
- Steno Diabetes Center Aarhus, Aarhus, Denmark
| | - Mathias Ried-Larsen
- Centre for Physical Activity Research, Rigshospitalet, Copenhagen, Denmark
- Institute of Sports and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Martin Bæk Blond
- Steno Diabetes Center Copenhagen, Gentofte, Denmark
- Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Marit Eika Jørgensen
- Steno Diabetes Center Copenhagen, Gentofte, Denmark
- University of Southern Denmark, Copenhagen, Denmark
| | - Dorte Vistisen
- Steno Diabetes Center Copenhagen, Gentofte, Denmark
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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Mogensen CS, Færch K, Bruhn L, Amadid H, Tetens I, Quist JS, Clemmensen KKB. Timing and Frequency of Daily Energy Intake in Adults with Prediabetes and Overweight or Obesity and Their Associations with Body Fat. Nutrients 2020; 12:nu12113484. [PMID: 33202807 PMCID: PMC7698054 DOI: 10.3390/nu12113484] [Citation(s) in RCA: 4] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 11/10/2020] [Accepted: 11/11/2020] [Indexed: 12/29/2022] Open
Abstract
Knowledge on how energy intake and macronutrients are distributed during the day and the role of daily eating patterns in body composition among adults with overweight/obesity and prediabetes is lacking. Therefore, we evaluated the diurnal dietary intake and studied the associations of daily eating patterns with body fat percentage. A total of 119 adults with prediabetes were included (mean (SD) HbA1c 41 (2.3) mmol/mol, BMI 31.5 (5.0) kg/m2, age 57.8 (9.3) years, 44% men). Information on dietary intake was obtained from self-reported food records for three consecutive days. All foods and beverages (except water) were registered with information on time of ingestion. Body fat was measured by dual-energy X-ray absorptiometry. A total of 60.5% of the participants reported a daily eating window of 12 or more hours/day, and almost half of the daily total energy intake was reported in the evening. In analyses adjusted for age, gender, and total daily energy intake, having the first daily energy intake one hour later was associated with slightly higher body fat percentage (0.64% per hour, 95% CI: 0.28; 1.01; p < 0.001), whereas higher meal frequency was associated with slightly lower body fat percentage (0.49% per extra daily meal, 95% CI: −0.81; −0.18; p = 0.002). Prospective studies are warranted to address the clinical implications of daily eating patterns on body fat and cardiometabolic health.
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Affiliation(s)
- Christina Sonne Mogensen
- Steno Diabetes Center Copenhagen, DK-2820 Gentofte, Denmark; (K.F.); (L.B.); (H.A.); (J.S.Q.); (K.K.B.C.)
- Correspondence: ; Tel.: +45-2670-8961
| | - Kristine Færch
- Steno Diabetes Center Copenhagen, DK-2820 Gentofte, Denmark; (K.F.); (L.B.); (H.A.); (J.S.Q.); (K.K.B.C.)
- Department of Biomedical Sciences, University of Copenhagen, DK-2200 Copenhagen N, Denmark
| | - Lea Bruhn
- Steno Diabetes Center Copenhagen, DK-2820 Gentofte, Denmark; (K.F.); (L.B.); (H.A.); (J.S.Q.); (K.K.B.C.)
| | - Hanan Amadid
- Steno Diabetes Center Copenhagen, DK-2820 Gentofte, Denmark; (K.F.); (L.B.); (H.A.); (J.S.Q.); (K.K.B.C.)
| | - Inge Tetens
- Department of Nutrition, Exercise and Sports Copenhagen University, DK-2000 Frederiksberg, Denmark;
| | - Jonas Salling Quist
- Steno Diabetes Center Copenhagen, DK-2820 Gentofte, Denmark; (K.F.); (L.B.); (H.A.); (J.S.Q.); (K.K.B.C.)
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Quist JS, Jensen MM, Clemmensen KKB, Pedersen H, Bjerre N, Størling J, Blond MB, Wewer Albrechtsen NJ, Holst JJ, Torekov SS, Vistisen D, Jørgensen ME, Panda S, Brock C, Finlayson G, Færch K. Protocol for a single-centre, parallel-group, randomised, controlled, superiority trial on the effects of time-restricted eating on body weight, behaviour and metabolism in individuals at high risk of type 2 diabetes: the REStricted Eating Time (RESET) study. BMJ Open 2020; 10:e037166. [PMID: 32847912 PMCID: PMC7451453 DOI: 10.1136/bmjopen-2020-037166] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION The aim of this study is to investigate the effects of time-restricted eating (TRE) on change in body weight and describe changes in behaviour and metabolism in individuals at high risk of type 2 diabetes. METHODS AND ANALYSIS The REStricted Eating Time (RESET) study is a randomised controlled parallel-group open-label trial. 100 women and men with (1) overweight (body mass index (BMI)≥25 kg/m2) and prediabetes (glycated haemoglobin 39-47 mmol/mol); or (2) obesity (BMI≥30 kg/m2) will be randomised to a control group (habitual living) or TRE (self-selected 10-hours eating window within the period from 06:00 to 20:00 in a 1:1 ratio. Testing is scheduled at baseline and after 6 weeks (mid-intervention), 3 months (post-intervention) and 6 months (follow-up). The primary outcome is change in body weight after 3 months of intervention. Secondary outcomes include changes in body composition; measures of glucose metabolism including glycaemic variability, hormones and metabolites; subjective and metabolic markers of appetite, food preferences and reward; dietary intake; physical activity, sleep, chronotype; gastric emptying, gastrointestinal transit time and motility; respiratory and glycolytic capacities; the plasma proteome and metabolome; blood pressure, resting heart rate and heart rate variability; and resting energy expenditure and substrate oxidation. Motivation and feasibility will be examined based on interviews at baseline and after 3 months. After the 3-month intervention, a 3-month follow-up period and subsequent testing are scheduled to assess maintenance and longer-term effects. ETHICS AND DISSEMINATION The study has been approved by the Ethics Committee of the Capital Region of Denmark (H-18059188) and the Danish Data Protection Agency. The study will be conducted in accordance with the Declaration of Helsinki. Results from the study will address whether TRE is effective and feasible in improving health outcomes in individuals at risk of lifestyle-related diseases and can potentially inform the design of feasible health recommendations. TRIAL REGISTRATION NUMBER NCT03854656.
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Affiliation(s)
| | | | | | - Hanne Pedersen
- Steno Diabetes Center Copenhagen, Gentofte, Denmark
- iMotions A/S, Frederiksberg, Denmark
| | | | - Joachim Størling
- Steno Diabetes Center Copenhagen, Gentofte, Denmark
- Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
| | | | - Nicolai J Wewer Albrechtsen
- Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Biochemistry, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- Novo Nordisk Foundation Center for Protein Research, University of Copenhagen, Copenhagen, Denmark
- Novo Nordisk Foundation Center for Basic Metabolic Research, University of Copenhagen, Copenhagen, Denmark
| | - Jens J Holst
- Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
- Novo Nordisk Foundation Center for Basic Metabolic Research, University of Copenhagen, Copenhagen, Denmark
| | - Signe S Torekov
- Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
- Novo Nordisk Foundation Center for Basic Metabolic Research, University of Copenhagen, Copenhagen, Denmark
| | | | - Marit E Jørgensen
- Steno Diabetes Center Copenhagen, Gentofte, Denmark
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | | | - Christina Brock
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
- Mech-Sense, Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark
| | | | - Kristine Færch
- Steno Diabetes Center Copenhagen, Gentofte, Denmark
- Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
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Bruhn L, Vistisen D, Vainø CTR, Perreault L, Færch K. Physiological factors contributing to HbA 1c in the normal and pre-diabetic range: a cross-sectional analysis. Endocrine 2020; 68:306-311. [PMID: 32112239 DOI: 10.1007/s12020-020-02234-3] [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] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 02/18/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE Little is known about the underlying physiology that contributes to Haemoglobin A1c (HbA1c) in the normal and pre-diabetic range. We determined the contribution of fasting plasma glucose (FPG), 2-h plasma glucose (2hPG), insulin secretion, insulin sensitivity and endogenous glucose production to HbA1c levels in the normal and pre-diabetic range. METHODS A total of 62 Danish men and women with normal or impaired glucose regulation were studied. HbA1c levels were measured and participants underwent an oral glucose tolerance test with measurements of FPG and 2hPG, an intravenous glucose tolerance test for determination of first-phase insulin release, and a hyperinsulinaemic euglycaemic clamp for estimation of peripheral and hepatic insulin sensitivity. Associations of HbA1c with the different measures of glucose metabolism were analysed by linear regression analysis. RESULTS HbA1c levels ranged from 28 to 45 mmol/mol (4.7-6.3%) in the study population. 1 SD higher (log) FPG concentration (~1 mmol/L) was associated with 2 mmol/mol higher HbA1c concentration (P < 0.001). In comparison, 1 SD higher levels of (log) first-phase insulin secretion or (log) disposition index were associated with 1.5 mmol/mol lower HbA1c levels (P < 0.05). HbA1c was not associated with peripheral or hepatic insulin sensitivity, endogenous glucose production or 2hPG levels. CONCLUSION HbA1c levels within the normal and pre-diabetic range seem to reflect decreased insulin secretion to a higher extent than insulin resistance. Therefore, early prevention strategies for high-risk individuals identified by HbA1c are not straightforward. More research on how to improve the health of beta cells either directly or indirectly in high-risk individuals is needed.
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Affiliation(s)
- Lea Bruhn
- Steno Diabetes Center Copenhagen, Gentofte, Denmark
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Clemmensen KKB, Quist JS, Vistisen D, Witte DR, Jonsson A, Pedersen O, Hansen T, Holst JJ, Lauritzen T, Jørgensen ME, Torekov S, Færch K. Role of fasting duration and weekday in incretin and glucose regulation. Endocr Connect 2020; 9:279-288. [PMID: 32163918 PMCID: PMC7159259 DOI: 10.1530/ec-20-0009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 02/19/2020] [Accepted: 03/11/2020] [Indexed: 11/08/2022]
Abstract
Fasting duration has been associated with lower fasting blood glucose levels, but higher 2-h post-load levels, and research has indicated an adverse effect of 'weekend behavior' on human metabolism. We investigated associations of fasting duration and weekday of examination with glucose, insulin, glucagon and incretin responses to an oral glucose tolerance test (OGTT). This cross-sectional study is based on data from the ADDITION-PRO study, where 2082 individuals attended a health examination including an OGTT. Linear regression analysis was applied to study the associations of overnight fasting duration and day of the week with glucose, insulin, glucagon, glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide 1 (GLP-1) responses to an OGTT. We found that a 1 h longer fasting duration was associated with 1.7% (95% CI: 0.8,2.5) higher 2-h glucose levels, as well as a 3.0% (95% CI: 1.3,4.7) higher GIP and 2.3% (95% CI: 0.3,4.4) higher GLP-1 response. Fasting insulin levels were 20.6% (95% CI: 11.2,30.7) higher on Mondays compared to the other weekdays, with similar fasting glucose levels (1.7%, 95% CI: 0.0,3.4). In this study, longer overnight fasting duration was associated with a worsening of glucose tolerance and increased incretin response to oral glucose. We found higher fasting insulin levels on Mondays compared to the other days of the week, potentially indicating a worsened glucose regulation after the weekend.
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Affiliation(s)
- Kim K B Clemmensen
- Department of Clinical Epidemiology, Steno Diabetes Center Copenhagen, Gentofte, Denmark
- Correspondence should be addressed to K K Clemmensen:
| | - Jonas S Quist
- Department of Clinical Epidemiology, Steno Diabetes Center Copenhagen, Gentofte, Denmark
| | - Dorte Vistisen
- Department of Clinical Epidemiology, Steno Diabetes Center Copenhagen, Gentofte, Denmark
| | - Daniel R Witte
- Department of Public Health, Aarhus University, Aarhus, Denmark
- Danish Diabetes Academy, Odense, Denmark
| | - Anna Jonsson
- NNF Center for Basic Metabolic Research, University of Copenhagen, Copenhagen, Denmark
| | - Oluf Pedersen
- NNF Center for Basic Metabolic Research, University of Copenhagen, Copenhagen, Denmark
| | - Torben Hansen
- NNF Center for Basic Metabolic Research, University of Copenhagen, Copenhagen, Denmark
| | - Jens J Holst
- NNF Center for Basic Metabolic Research, University of Copenhagen, Copenhagen, Denmark
- Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Torsten Lauritzen
- Section for General Practice, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Marit E Jørgensen
- Department of Clinical Epidemiology, Steno Diabetes Center Copenhagen, Gentofte, Denmark
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Signe Torekov
- NNF Center for Basic Metabolic Research, University of Copenhagen, Copenhagen, Denmark
- Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Kristine Færch
- Department of Clinical Epidemiology, Steno Diabetes Center Copenhagen, Gentofte, Denmark
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Janus C, Vistisen D, Amadid H, Witte DR, Lauritzen T, Brage S, Bjerregaard AL, Hansen T, Holst JJ, Jørgensen ME, Pedersen O, Færch K, Torekov SS. Habitual physical activity is associated with lower fasting and greater glucose-induced GLP-1 response in men. Endocr Connect 2019; 8:1607-1617. [PMID: 31804964 PMCID: PMC6933827 DOI: 10.1530/ec-19-0408] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 11/21/2019] [Indexed: 12/28/2022]
Abstract
RATIONALE The hormone glucagon-like peptide-1 (GLP-1) decreases blood glucose and appetite. Greater physical activity (PA) is associated with lower incidence of type 2 diabetes. While acute exercise may increase glucose-induced response of GLP-1, it is unknown how habitual PA affects GLP-1 secretion. We hypothesised that habitual PA associates with greater glucose-induced GLP-1 responses in overweight individuals. METHODS Cross-sectional analysis of habitual PA levels and GLP-1 concentrations in 1326 individuals (mean (s.d.) age 66 (7) years, BMI 27.1 (4.5) kg/m2) from the ADDITION-PRO cohort. Fasting and oral glucose-stimulated GLP-1 responses were measured using validated radioimmunoassay. PA was measured using 7-day combined accelerometry and heart rate monitoring. From this, energy expenditure (PAEE; kJ/kg/day) and fractions of time spent in activity intensities (h/day) were calculated. Cardiorespiratory fitness (CRF; mL O2/kg/min) was calculated using step tests. Age-, BMI- and insulin sensitivity-adjusted associations between PA and GLP-1, stratified by sex, were evaluated by linear regression analysis. RESULTS In 703 men, fasting GLP-1 concentrations were 20% lower (95% CI: -33; -3%, P = 0.02) for every hour of moderate-intensity PA performed. Higher CRF and PAEE were associated with 1-2% lower fasting GLP-1 (P = 0.01). For every hour of moderate-intensity PA, the glucose-stimulated GLP-1 response was 16% greater at peak 30 min (1; 33%, P rAUC0-30 = 0.04) and 20% greater at full response (3; 40%, P rAUC0-120 = 0.02). No associations were found in women who performed PA 22 min/day vs 32 min/day for men. CONCLUSION Moderate-intensity PA is associated with lower fasting and greater glucose-induced GLP-1 responses in overweight men, possibly contributing to improved glucose and appetite regulation with increased habitual PA.
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Affiliation(s)
- Charlotte Janus
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Danish Diabetes Academy, Odense University Hospital, Odense, Denmark
| | | | - Hanan Amadid
- Steno Diabetes Center Copenhagen, Gentofte, Denmark
- Department of Public Health, Research Unit of Epidemiology, Aarhus University, Aarhus, Denmark
| | - Daniel R Witte
- Danish Diabetes Academy, Odense University Hospital, Odense, Denmark
- Department of Public Health, Research Unit of Epidemiology, Aarhus University, Aarhus, Denmark
- Steno Diabetes Center Aarhus, Aarhus, Denmark
| | - Torsten Lauritzen
- Department of Public Health, Research Unit of Epidemiology, Aarhus University, Aarhus, Denmark
| | - Søren Brage
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Anne-Louise Bjerregaard
- Department of Public Health, Research Unit of Epidemiology, Aarhus University, Aarhus, Denmark
| | - Torben Hansen
- Novo Nordisk Foundation Center for Basic Metabolic Research, University of Copenhagen, Copenhagen, Denmark
| | - Jens J Holst
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Novo Nordisk Foundation Center for Basic Metabolic Research, University of Copenhagen, Copenhagen, Denmark
| | - Marit E Jørgensen
- Steno Diabetes Center Copenhagen, Gentofte, Denmark
- National Institute of Public Health, University of Southern Denmark, Odense, Denmark
| | - Oluf Pedersen
- Novo Nordisk Foundation Center for Basic Metabolic Research, University of Copenhagen, Copenhagen, Denmark
| | | | - Signe S Torekov
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Novo Nordisk Foundation Center for Basic Metabolic Research, University of Copenhagen, Copenhagen, Denmark
- Correspondence should be addressed to S S Torekov:
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Lundgren JR, Færch K, Witte DR, Jonsson AE, Pedersen O, Hansen T, Lauritzen T, Holst JJ, Vistisen D, Jørgensen ME, Torekov SS, Johansen NB. Greater glucagon-like peptide-1 responses to oral glucose are associated with lower central and peripheral blood pressures. Cardiovasc Diabetol 2019; 18:130. [PMID: 31586493 PMCID: PMC6778378 DOI: 10.1186/s12933-019-0937-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 07/08/2019] [Accepted: 09/27/2019] [Indexed: 12/25/2022] Open
Abstract
Background and aim Cardiovascular diseases (CVDs) are globally the leading cause of death and hypertension is a significant risk factor. Treatment with glucagon-like peptide-1 (GLP-1) receptor agonists has been associated with decreases in blood pressure and CVD risk. Our aim was to investigate the association between endogenous GLP-1 responses to oral glucose and peripheral and central haemodynamic measures in a population at risk of diabetes and CVD. Methods This cross-sectional study included 837 Danish individuals from the ADDITION-PRO cohort (52% men, median (interquartile range) age 65.5 (59.8 to 70.7) years, BMI 26.1 (23.4 to 28.5) kg/m2, without antihypertensive treatment and known diabetes). All participants received an oral glucose tolerance test with measurements of GLP-1 at 0, 30 and 120 min. Aortic stiffness was assessed by pulse wave velocity (PWV). The associations between GLP-1 response and central and brachial blood pressure (BP) and PWV were assessed in linear regression models adjusting for age and sex. Results A greater GLP-1 response was associated with lower central systolic and diastolic BP of − 1.17 mmHg (95% confidence interval (CI) − 2.07 to − 0.27 mmHg, P = 0.011) and − 0.74 mmHg (95% CI − 1.29 to − 0.18 mmHg, P = 0.009), respectively, as well as lower brachial systolic and diastolic BP of − 1.27 mmHg (95% CI − 2.20 to − 0.33 mmHg, P = 0.008) and − 1.00 (95% CI − 1.56 to − 0.44 mmHg, P = 0.001), respectively. PWV was not associated with GLP-1 release (P = 0.3). Individuals with the greatest quartile of GLP-1 response had clinically relevant lower BP measures compared to individuals with the lowest quartile of GLP-1 response (central systolic BP: − 4.94 (95% CI − 8.56 to − 1.31) mmHg, central diastolic BP: − 3.05 (95% CI − 5.29 to − 0.80) mmHg, brachial systolic BP: − 5.18 (95% CI − 8.94 to − 1.42) mmHg, and brachial diastolic BP: − 2.96 (95% CI − 5.26 to − 0.67) mmHg). Conclusion Greater glucose-stimulated GLP-1 responses were associated with clinically relevant lower central and peripheral blood pressures, consistent with beneficial effects on the cardiovascular system and reduced risk of CVD and mortality. Trial registration ClinicalTrials.gov Identifier: NCT00237549. Retrospectively registered 10 October 2005
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Affiliation(s)
- Julie R Lundgren
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200, Copenhagen N, Denmark. .,Novo Nordisk Foundation Center for Basic Metabolic Research, University of Copenhagen, Copenhagen, Denmark.
| | | | - Daniel R Witte
- Aarhus University, Aarhus, Denmark.,Danish Diabetes Academy, Odense, Denmark
| | - Anna E Jonsson
- Novo Nordisk Foundation Center for Basic Metabolic Research, University of Copenhagen, Copenhagen, Denmark
| | - Oluf Pedersen
- Novo Nordisk Foundation Center for Basic Metabolic Research, University of Copenhagen, Copenhagen, Denmark
| | - Torben Hansen
- Novo Nordisk Foundation Center for Basic Metabolic Research, University of Copenhagen, Copenhagen, Denmark
| | | | - Jens J Holst
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200, Copenhagen N, Denmark.,Novo Nordisk Foundation Center for Basic Metabolic Research, University of Copenhagen, Copenhagen, Denmark
| | | | | | - Signe S Torekov
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200, Copenhagen N, Denmark. .,Novo Nordisk Foundation Center for Basic Metabolic Research, University of Copenhagen, Copenhagen, Denmark.
| | - Nanna B Johansen
- Steno Diabetes Center Copenhagen, Gentofte, Denmark.,Danish Diabetes Academy, Odense, Denmark
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Vistisen D, Kivimäki M, Perreault L, Hulman A, Witte DR, Brunner EJ, Tabák A, Jørgensen ME, Færch K. Reversion from prediabetes to normoglycaemia and risk of cardiovascular disease and mortality: the Whitehall II cohort study. Diabetologia 2019; 62:1385-1390. [PMID: 31123789 PMCID: PMC6647230 DOI: 10.1007/s00125-019-4895-0] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 04/10/2019] [Indexed: 02/06/2023]
Abstract
AIMS/HYPOTHESIS Reversion from prediabetes to normoglycaemia is accompanied by an improvement in cardiovascular risk factors, but it is unclear whether this translates into a reduction in risk of cardiovascular disease (CVD) events or death. Hence, we studied the probability of reversion from prediabetes to normoglycaemia and the associated risk of future CVD and death using data from the Whitehall II observational cohort study. METHODS Three glycaemic criteria for prediabetes (fasting plasma glucose [FPG] 5.6-6.9 mmol/l, 2 h plasma glucose [2hPG] 7.8-11.0 mmol/l, and HbA1c 39-47 mmol/mol [5.7-6.4%]) were assessed in 2002-2004 and 2007-2009 for 5193 participants free of known diabetes at enrolment. Among participants with prediabetes in the first examination, we calculated the probability of reversion to normoglycaemia by re-examination according to each glycaemic criterion. Poisson regression analysis was used to estimate and compare incidence rates of a composite endpoint of a CVD event or death in participants with prediabetes who did vs did not revert to normoglycaemia. Analyses were adjusted for age, sex, ethnicity and previous CVD. RESULTS Based on the FPG criterion, 820 participants had prediabetes and 365 (45%) of them had reverted to normoglycaemia in 5 years. The corresponding numbers were 324 and 120 (37%) for the 2hPG criterion and 1709 and 297 (17%) for the HbA1c criterion. During a median follow-up of 6.7 (interquartile range 6.3-7.2) years, 668 events of non-fatal CVD or death occurred among the 5193 participants. Reverting from 2hPG-defined prediabetes to normoglycaemia vs remaining prediabetic or progressing to diabetes was associated with a halving in event rate (12.7 vs 29.1 per 1000 person-years, p = 0.020). No association with event rate was observed for reverting from FPG-defined (18.6 vs 18.2 per 1000 person-years, p = 0.910) or HbA1c-defined prediabetes to normoglycaemia (24.5 vs 22.9 per 1000 person-years, p = 0.962). CONCLUSIONS/INTERPRETATION Most people with HbA1c-defined prediabetes remained prediabetic or progressed to diabetes during 5 years of follow-up. In contrast, reversion to normoglycaemia was frequent among people with FPG- or 2hPG-defined prediabetes. Only reversion from 2hPG-defined prediabetes to normoglycaemia was associated with a reduction in future risk of CVD and death.
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Affiliation(s)
- Dorte Vistisen
- Department of Clinical Epidemiology, Steno Diabetes Center Copenhagen, Niels Steensens Vej 6, DK-2820, Gentofte, Denmark.
| | - Mika Kivimäki
- Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK.
| | - Leigh Perreault
- Department of Medicine, Division of Endocrinology, Metabolism and Diabetes, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA
| | - Adam Hulman
- Department of Public Health, Aarhus University, Aarhus, Denmark
- Danish Diabetes Academy, Odense, Denmark
- Steno Diabetes Center Aarhus, Aarhus, Denmark
| | - Daniel R Witte
- Department of Public Health, Aarhus University, Aarhus, Denmark
- Danish Diabetes Academy, Odense, Denmark
- Steno Diabetes Center Aarhus, Aarhus, Denmark
| | - Eric J Brunner
- Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK
| | - Adam Tabák
- Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK
- First Department of Medicine, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Marit E Jørgensen
- Department of Clinical Epidemiology, Steno Diabetes Center Copenhagen, Niels Steensens Vej 6, DK-2820, Gentofte, Denmark
- The Research Department for Health and Morbidity in the Population, Southern Denmark University, Copenhagen, Denmark
| | - Kristine Færch
- Department of Clinical Epidemiology, Steno Diabetes Center Copenhagen, Niels Steensens Vej 6, DK-2820, Gentofte, Denmark
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37
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Xu C, Furuya-Kanamori L, Liu Y, Færch K, Aadahl M, A Seguin R, LaCroix A, Basterra-Gortari FJ, Dunstan DW, Owen N, Doi SAR. Sedentary Behavior, Physical Activity, and All-Cause Mortality: Dose-Response and Intensity Weighted Time-Use Meta-analysis. J Am Med Dir Assoc 2019; 20:1206-1212.e3. [PMID: 31272857 DOI: 10.1016/j.jamda.2019.05.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [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: 01/26/2019] [Revised: 05/04/2019] [Accepted: 05/07/2019] [Indexed: 02/05/2023]
Abstract
OBJECTIVES Previous studies have placed those with excessive sedentary behavior at increased risk of all-cause mortality. There is evidence of interdependency of sedentary behavior with physical activity, and its elucidation will have implications for guidelines and practice. This study investigated if sedentary behavior-related mortality risk can be offset by moderate- to vigorous-intensity physical activity (MVPA) considered in a time-use fashion. DESIGN PubMed was searched (from its inception till May 2018) for studies or meta-analyses that used data harmonized for MVPA. Of the 17 data-custodians located, 7 provided data on sitting time or TV viewing time, or both. A dose-response meta-analysis modeling log relative risks of all-cause mortality against uncompensated sedentary behavior metabolic equivalent hours (USMh) was run using the robust error meta-regression method. (Registration: CRD42017062439) SETTING: Individual subject data held by data custodians on this topic. PARTICIPANTS General adults. MEASUREMENTS Sedentary time, MVPA. RESULTS Five harmonized cohorts of sitting time (258,688 participants) and 4 of TV viewing time (156,593 participants) demonstrated that sedentary behavior was significantly associated with mortality, but this risk was attenuated with increasing energy expenditure through MVPA modeled in a time-use fashion. The average increment in mortality per USMh spent on sitting was 1% [relative risk (RR) 1.01, 95% confidence interval (CI) 1.00, 1.02; P = .01] and that per USMh spent on TV viewing was 7% (RR 1.07, 95% CI 1.04, 1.10; P < .001). The thresholds for risk started at 7 USMh for sitting and 3 USMh for TV viewing. CONCLUSIONS/IMPLICATIONS Our findings suggest that overall daily sitting time energy expenditure of 7 MET-hours (or TV viewing of 3 MET-hours) in excess of that expended on MVPA is independently related to all-cause mortality. These findings support the view that sitting is strongly influenced by consideration of concurrent MVPA in its impact on adverse health consequences and that the USMh is a more practical metric of sedentary behavior.
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Affiliation(s)
- Chang Xu
- Chinese Evidence-based Medicine Center, West China Hospital, Sichuan University, Chengdu, China
| | - Luis Furuya-Kanamori
- Department of Population Medicine, College of Medicine, Qatar University, Doha, Qatar; Research School of Population Health, ANU College of Health and Medicine, Australian National University, Acton, Australia
| | - Yu Liu
- Gansu Provincial Maternity and Child-Care Hospital, Lanzhou, Gansu, China
| | | | - Mette Aadahl
- Centre for Clinical Research and Prevention, Bispebjerg og Frederiksberg Hospital, Frederiksberg, Denmark; Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Rebecca A Seguin
- Division of Nutritional Sciences, Cornell University, Ithaca, NY; Fred Hutchinson Cancer Research Center, Seattle, WA
| | | | | | - David W Dunstan
- Baker Heart & Diabetes Institute, Melbourne, Victoria, Australia; Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia
| | - Neville Owen
- Baker Heart & Diabetes Institute, Melbourne, Victoria, Australia; Swinburne University of Technology, Hawthorn, Victoria, Australia; Central Clinical School, Medicine, Monash University, Melbourne, Victoria, Australia
| | - Suhail A R Doi
- Department of Population Medicine, College of Medicine, Qatar University, Doha, Qatar.
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38
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Hansen CS, Færch K, Jørgensen ME, Malik M, Witte DR, Brunner EJ, Tabák AG, Kivimäki M, Vistisen D. Heart Rate, Autonomic Function, and Future Changes in Glucose Metabolism in Individuals Without Diabetes: The Whitehall II Cohort Study. Diabetes Care 2019; 42:867-874. [PMID: 30940642 PMCID: PMC6905499 DOI: 10.2337/dc18-1838] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 01/22/2019] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Autonomic nervous system dysfunction is associated with impaired glucose metabolism, but the temporality of this association remains unclear in individuals without diabetes. We investigated the association of autonomic function with 5-year changes in glucose metabolism in individuals without diabetes. RESEARCH DESIGN AND METHODS Analyses were based on 9,000 person-examinations for 3,631 participants without diabetes in the Whitehall II cohort. Measures of autonomic function included 5-min resting heart rate and six heart rate variability (HRV) indices. Associations between baseline autonomic function measures and 5-year changes in fasting and 2-h plasma glucose, serum insulin concentrations, insulin sensitivity (insulin sensitivity index [ISI0-120] and HOMA of insulin sensitivity), and β-cell function (HOMA of β-cell function) were estimated in models adjusting for age, sex, ethnicity, metabolic factors, and medication. RESULTS A 10-bpm higher resting heart rate was associated with 5-year changes in fasting and 2-h insulin and ISI0-120 of 3.3% change (95% CI 1.8; 4.8), P < 0.001; 3.3% change (1.3; 5.3), P = 0.001; and -1.4% change (-2.4; -0.3), P = 0.009, respectively. In models adjusted for age, sex, and ethnicity, higher baseline values of several HRV indices were associated with a 5-year decrease in fasting and 2-h insulin and ISI0-120. However, significance was lost by full adjustment. A majority of HRV indices exhibited a trend toward higher values being associated with lower insulin levels and higher insulin sensitivity. CONCLUSIONS Higher resting heart rate in individuals without diabetes is associated with future unfavorable changes in insulin levels and insulin sensitivity. Associations may be mediated via autonomic function; however, results are inconclusive. Resting heart rate may be a risk marker for future pathophysiological changes in glucose metabolism.
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Affiliation(s)
| | | | - Marit Eika Jørgensen
- Steno Diabetes Center Copenhagen, Gentofte, Denmark
- National Institute of Public Health, Southern Denmark University, Odense, Denmark
| | - Marek Malik
- National Heart and Lung Institute, Imperial College, London, U.K
| | - Daniel R Witte
- Department of Public Health, Aarhus University, Aarhus, Denmark
- Danish Diabetes Academy, Odense, Denmark
| | - Eric J Brunner
- Department of Epidemiology and Public Health, University College London, London, U.K
| | - Adam G Tabák
- Department of Epidemiology and Public Health, University College London, London, U.K
- Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Mika Kivimäki
- Department of Epidemiology and Public Health, University College London, London, U.K
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39
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Hulman A, Wagner R, Vistisen D, Færch K, Balkau B, Manco M, Golay A, Häring HU, Heni M, Fritsche A, Witte DR. Glucose Measurements at Various Time Points During the OGTT and Their Role in Capturing Glucose Response Patterns. Diabetes Care 2019; 42:e56-e57. [PMID: 30692243 DOI: 10.2337/dc18-2397] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 12/25/2018] [Indexed: 02/03/2023]
Affiliation(s)
- Adam Hulman
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark .,Aarhus University, Aarhus, Denmark.,Danish Diabetes Academy, Odense, Denmark
| | - Róbert Wagner
- Division of Endocrinology, Diabetology, Nephrology, Vascular Disease, and Clinical Chemistry, Department of Internal Medicine IV, University Hospital of Tübingen, Tübingen, Germany.,Institute for Diabetes Research and Metabolic Diseases, Helmholtz Centre Munich, University of Tübingen, Tübingen, Germany.,German Center for Diabetes Research (DZD), Neuherberg, Germany
| | | | | | - Beverley Balkau
- Centre for Research in Epidemiology and Population Health, University Paris-South, Paris, France.,Faculty of Medicine, University of Versailles-St. Quentin, Versailles, France.,INSERM U1018, University Paris-Saclay, Villejuif, France
| | - Melania Manco
- Research Unit for Multi-factorial Diseases, Obesity and Diabetes, Istituto di Ricovero e Cura a Carattere Scientifico, Bambino Gesù Children's Hospital,Rome, Italy
| | - Alain Golay
- Division of Therapeutic Education for Chronic Diseases, University Hospitals of Geneva and University of Geneva, Geneva, Switzerland
| | - Hans-Ulrich Häring
- Division of Endocrinology, Diabetology, Nephrology, Vascular Disease, and Clinical Chemistry, Department of Internal Medicine IV, University Hospital of Tübingen, Tübingen, Germany.,Institute for Diabetes Research and Metabolic Diseases, Helmholtz Centre Munich, University of Tübingen, Tübingen, Germany.,German Center for Diabetes Research (DZD), Neuherberg, Germany
| | - Martin Heni
- Division of Endocrinology, Diabetology, Nephrology, Vascular Disease, and Clinical Chemistry, Department of Internal Medicine IV, University Hospital of Tübingen, Tübingen, Germany.,Institute for Diabetes Research and Metabolic Diseases, Helmholtz Centre Munich, University of Tübingen, Tübingen, Germany.,German Center for Diabetes Research (DZD), Neuherberg, Germany
| | - Andreas Fritsche
- Division of Endocrinology, Diabetology, Nephrology, Vascular Disease, and Clinical Chemistry, Department of Internal Medicine IV, University Hospital of Tübingen, Tübingen, Germany.,Institute for Diabetes Research and Metabolic Diseases, Helmholtz Centre Munich, University of Tübingen, Tübingen, Germany.,German Center for Diabetes Research (DZD), Neuherberg, Germany
| | - Daniel R Witte
- Aarhus University, Aarhus, Denmark.,Danish Diabetes Academy, Odense, Denmark
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40
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O'Donoghue G, Kennedy A, Andersen GS, Carr B, Cleary S, Durkan E, Davis H, Færch K, Fitzpatrick P, Kenny H, McCaffrey N, Monedero J, Murphy E, Noone J, Suvitaival T, Thybo T, Wheeler M, Vistisen D, Nolan JJ, O'Gorman DJ. Phenotypic Responses to a Lifestyle Intervention Do Not Account for Inter-Individual Variability in Glucose Tolerance for Individuals at High Risk of Type 2 Diabetes. Front Physiol 2019; 10:317. [PMID: 30971951 PMCID: PMC6443958 DOI: 10.3389/fphys.2019.00317] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [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: 11/05/2018] [Accepted: 03/07/2019] [Indexed: 01/17/2023] Open
Abstract
Background: Lifestyle interventions have been shown to delay or prevent the onset of type 2 diabetes among high risk adults. A better understanding of the variability in physiological responses would support the matching of individuals with the best type of intervention in future prevention programmes, in order to optimize risk reduction. The purpose of this study was to determine if phenotypic characteristics at baseline or following a 12 weeks lifestyle intervention could explain the inter-individual variability in change in glucose tolerance in individuals with high risk for type 2 diabetes. Methods: In total, 285 subjects with normal glucose tolerance (NGT, FINDRISC score > 12), impaired fasting glucose (IFG) and impaired glucose tolerance (IGT) were recruited for a 12 weeks lifestyle intervention. Glucose tolerance, insulin sensitivity, anthropometric characteristics and aerobic fitness were measured. Variability of responses was examined by grouping participants by baseline glycemic status, by cluster analysis based on the change in glucose tolerance and by Principal Component Analysis (PCA). Results: In agreement with other studies, the mean response to the 12 weeks intervention was positive for the majority of parameters. Overall, 89% improved BMI, 80% waist circumference, and 81% body fat while only 64% improved fasting plasma glucose and 60% 2 h glucose. The impact of the intervention by glycaemic group did not show any phenotypic differences in response between NGT, IFG, and IGT. A hierarchical cluster analysis of change in glucose tolerance identified four sub-groups of "responders" (high and moderate) and "non-responders" (no response or deteriorated) but there were few differences in baseline clincal and physiological parameters or in response to the intervention to explain the overall variance. A further PCA analysis of 19 clinical and physiological univariables could explain less than half (48%) of total variability. Conclusion: We found that phenotypic characteristics from standard clinical and physiological parameters were not sufficient to account for the inter-individual variability in glucose tolerance following a 12 weeks lifestyle intervention in inidivuals at high risk for type 2 diabetes. Further work is required to identify biomarkers that complement phenotypic traits and better predict the response to glucose tolerance.
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Affiliation(s)
- Grainne O'Donoghue
- School of Health and Human Performance, Dublin City University, Dublin, Ireland.,Steno Diabetes Center Copenhagen, Gentofte, Denmark
| | - Aileen Kennedy
- School of Health and Human Performance, Dublin City University, Dublin, Ireland
| | | | | | - Stephen Cleary
- School of Health and Human Performance, Dublin City University, Dublin, Ireland
| | - Eoin Durkan
- School of Health and Human Performance, Dublin City University, Dublin, Ireland
| | - Heidi Davis
- School of Health and Human Performance, Dublin City University, Dublin, Ireland
| | | | - Paula Fitzpatrick
- School of Health and Human Performance, Dublin City University, Dublin, Ireland
| | - Helena Kenny
- School of Health and Human Performance, Dublin City University, Dublin, Ireland
| | - Noel McCaffrey
- School of Health and Human Performance, Dublin City University, Dublin, Ireland
| | - Javier Monedero
- School of Health and Human Performance, Dublin City University, Dublin, Ireland
| | - Enda Murphy
- School of Health and Human Performance, Dublin City University, Dublin, Ireland
| | - John Noone
- School of Health and Human Performance, Dublin City University, Dublin, Ireland
| | | | - Tanja Thybo
- Steno Diabetes Center Copenhagen, Gentofte, Denmark
| | - Michael Wheeler
- School of Health and Human Performance, Dublin City University, Dublin, Ireland
| | | | - John J Nolan
- Steno Diabetes Center Copenhagen, Gentofte, Denmark.,Trinity College Dublin, Dublin, Ireland
| | - Donal J O'Gorman
- School of Health and Human Performance, Dublin City University, Dublin, Ireland.,National Institute for Cellular Biotechnology, Dublin City University, Dublin, Ireland
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41
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Hulman A, Færch K, Witte DR. Letter to the Editor: "One-Hour Postload Hyperglycemia: Implications for Prediction and Prevention of Type 2 Diabetes". J Clin Endocrinol Metab 2019; 104:674-675. [PMID: 30239758 DOI: 10.1210/jc.2018-01699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Accepted: 09/10/2018] [Indexed: 11/19/2022]
Affiliation(s)
- Adam Hulman
- Department of Public Health, Aarhus University, Aarhus, Denmark
- Danish Diabetes Academy, Odense, Denmark
| | | | - Daniel R Witte
- Department of Public Health, Aarhus University, Aarhus, Denmark
- Danish Diabetes Academy, Odense, Denmark
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42
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Hulman A, Witte DR, Vistisen D, Balkau B, Dekker JM, Herder C, Hatunic M, Konrad T, Færch K, Manco M. Pathophysiological Characteristics Underlying Different Glucose Response Curves: A Latent Class Trajectory Analysis From the Prospective EGIR-RISC Study. Diabetes Care 2018; 41:1740-1748. [PMID: 29853473 DOI: 10.2337/dc18-0279] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [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: 02/06/2018] [Accepted: 05/02/2018] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Glucose measurements during an oral glucose tolerance test (OGTT) are useful in predicting diabetes and its complications. However, knowledge of the pathophysiology underlying differences in glucose curve shapes is sparse. We examined the pathophysiological characteristics that create different glucose curve patterns and studied their stability and reproducibility over 3 years of follow-up. RESEARCH DESIGN AND METHODS We analyzed data from participants without diabetes from the observational cohort from the European Group for the Study of Insulin Resistance: Relationship between Insulin Sensitivity and Cardiovascular Disease study; participants had a five-time point OGTT at baseline (n = 1,443) and after 3 years (n = 1,045). Measures of insulin sensitivity and secretion were assessed at baseline with a euglycemic-hyperinsulinemic clamp and intravenous glucose tolerance test. Heterogeneous glucose response patterns during the OGTT were identified using latent class trajectory analysis at baseline and at follow-up. Transitions between classes were analyzed with multinomial logistic regression models. RESULTS We identified four different glucose response patterns, which differed with regard to insulin sensitivity and acute insulin response, obesity, and plasma levels of lipids and inflammatory markers. Some of these associations were confirmed prospectively. Time to glucose peak was driven mainly by insulin sensitivity, whereas glucose peak size was related to both insulin sensitivity and secretion. The glucose patterns identified at follow-up were similar to those at baseline, suggesting that the latent class method is robust. We integrated our classification model into an easy-to-use online application that facilitates the assessment of glucose curve patterns for other studies. CONCLUSIONS The latent class analysis approach is a pathophysiologically insightful way to classify individuals without diabetes based on their response to glucose during an OGTT.
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Affiliation(s)
- Adam Hulman
- Department of Public Health, Aarhus University, Aarhus, Denmark .,Danish Diabetes Academy, Odense, Denmark
| | - Daniel R Witte
- Department of Public Health, Aarhus University, Aarhus, Denmark.,Danish Diabetes Academy, Odense, Denmark
| | | | - Beverley Balkau
- Centre for Research in Epidemiology and Population Health, Faculty of Medicine, University Paris-South, Paris, France.,Faculty of Medicine, University of Versailles-St. Quentin, Versailles, France.,INSERM U1018, University Paris-Saclay, Villejuif, France
| | - Jacqueline M Dekker
- Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, the Netherlands
| | - Christian Herder
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research, Heinrich Heine University Düsseldorf, Düsseldorf, Germany.,German Center for Diabetes Research (DZD), München-Neuherberg, Germany
| | - Mensud Hatunic
- Department of Endocrinology, Mater Misericordiae University Hospital, University College Dublin School of Medicine, Dublin, Ireland
| | - Thomas Konrad
- Institute for Metabolic Research, Goethe University, Frankfurt am Main, Germany
| | | | - Melania Manco
- Research Unit for Multi-factorial Diseases, Obesity and Diabetes, Istituti di Ricovero e Cura a Carattere Scientifico, Bambino Gesù Children's Hospital, Rome, Italy
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43
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Tura A, Chemello G, Szendroedi J, Göbl C, Færch K, Vrbíková J, Pacini G, Ferrannini E, Roden M. Prediction of clamp-derived insulin sensitivity from the oral glucose insulin sensitivity index. Diabetologia 2018; 61:1135-1141. [PMID: 29484470 DOI: 10.1007/s00125-018-4568-4] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Accepted: 01/18/2018] [Indexed: 10/17/2022]
Abstract
AIMS/HYPOTHESIS The euglycaemic-hyperinsulinaemic clamp is the gold-standard method for measuring insulin sensitivity, but is less suitable for large clinical trials. Thus, several indices have been developed for evaluating insulin sensitivity from the oral glucose tolerance test (OGTT). However, most of them yield values different from those obtained by the clamp method. The aim of this study was to develop a new index to predict clamp-derived insulin sensitivity (M value) from the OGTT-derived oral glucose insulin sensitivity index (OGIS). METHODS We analysed datasets of people that underwent both a clamp and an OGTT or meal test, thereby allowing calculation of both the M value and OGIS. The population was divided into a training and a validation cohort (n = 359 and n = 154, respectively). After a stepwise selection approach, the best model for M value prediction was applied to the validation cohort. This cohort was also divided into subgroups according to glucose tolerance, obesity category and age. RESULTS The new index, called PREDIcted M (PREDIM), was based on OGIS, BMI, 2 h glucose during OGTT and fasting insulin. Bland-Altman analysis revealed a good relationship between the M value and PREDIM in the validation dataset (only 9 of 154 observations outside limits of agreement). Also, no significant differences were found between the M value and PREDIM (equivalence test: p < 0.0063). Subgroup stratification showed that measured M value and PREDIM have a similar ability to detect intergroup differences (p < 0.02, both M value and PREDIM). CONCLUSIONS/INTERPRETATION The new index PREDIM provides excellent prediction of M values from OGTT or meal data, thereby allowing comparison of insulin sensitivity between studies using different tests.
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Affiliation(s)
- Andrea Tura
- Metabolic Unit, CNR Institute of Neuroscience, Corso Stati Uniti 4, 35127, Padova, Italy.
| | - Gaetano Chemello
- Metabolic Unit, CNR Institute of Neuroscience, Corso Stati Uniti 4, 35127, Padova, Italy
| | - Julia Szendroedi
- Division of Endocrinology and Diabetology, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
- Institute for Clinical Diabetology, German Diabetes Center (DDZ), Leibniz Center for Diabetes Research, Düsseldorf, Germany
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany
| | - Christian Göbl
- Department of Obstetrics and Gynecology, Division of Obstetrics and Feto-maternal Medicine, Medical University of Vienna, Vienna, Austria
| | | | | | - Giovanni Pacini
- Metabolic Unit, CNR Institute of Neuroscience, Corso Stati Uniti 4, 35127, Padova, Italy
| | | | - Michael Roden
- Division of Endocrinology and Diabetology, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
- Institute for Clinical Diabetology, German Diabetes Center (DDZ), Leibniz Center for Diabetes Research, Düsseldorf, Germany
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany
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44
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Hulman A, Vistisen D, Glümer C, Bergman M, Witte DR, Færch K. Can insulin response patterns predict metabolic disease risk in individuals with normal glucose tolerance? Reply to Crofts CAP, Brookler K, Henderson G [letter]. Diabetologia 2018; 61:1234-1235. [PMID: 29502267 DOI: 10.1007/s00125-018-4589-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 02/14/2018] [Indexed: 10/17/2022]
Affiliation(s)
- Adam Hulman
- Department of Public Health, Aarhus University, Bartholins Allé 2, Building 1260, DK-8000, Aarhus C, Denmark.
- Danish Diabetes Academy, Odense, Denmark.
- Department of Medical Physics and Informatics, University of Szeged, Szeged, Hungary.
| | | | - Charlotte Glümer
- Research Center for Prevention and Health, Glostrup Hospital, Glostrup, Denmark
| | - Michael Bergman
- Division of Endocrinology, Diabetes and Metabolism, NYU School of Medicine, NYU Langone Diabetes Prevention Program, New York, NY, USA
| | - Daniel R Witte
- Department of Public Health, Aarhus University, Bartholins Allé 2, Building 1260, DK-8000, Aarhus C, Denmark
- Danish Diabetes Academy, Odense, Denmark
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45
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Vistisen D, Witte DR, Brunner EJ, Kivimäki M, Tabák A, Jørgensen ME, Færch K. Risk of Cardiovascular Disease and Death in Individuals With Prediabetes Defined by Different Criteria: The Whitehall II Study. Diabetes Care 2018; 41:899-906. [PMID: 29453200 PMCID: PMC6463620 DOI: 10.2337/dc17-2530] [Citation(s) in RCA: 95] [Impact Index Per Article: 15.8] [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: 12/05/2017] [Accepted: 01/18/2018] [Indexed: 02/03/2023]
Abstract
OBJECTIVE We compared the risk of cardiovascular disease (CVD) and all-cause mortality in subgroups of prediabetes defined by fasting plasma glucose (FPG), 2-h plasma glucose (2hPG), or HbA1c. RESEARCH DESIGN AND METHODS In the Whitehall II cohort, 5,427 participants aged 50-79 years and without diabetes were followed for a median of 11.5 years. A total of 628 (11.6%) had prediabetes by the World Health Organization (WHO)/International Expert Committee (IEC) criteria (FPG 6.1-6.9 mmol/L and/or HbA1c 6.0-6.4%), and 1,996 (36.8%) by the American Diabetes Association (ADA) criteria (FPG 5.6-6.9 mmol/L and/or HbA1c 5.7-6.4%). In a subset of 4,730 individuals with additional measures of 2hPG, 663 (14.0%) had prediabetes by 2hPG. Incidence rates of a major event (nonfatal/fatal CVD or all-cause mortality) were compared for different definitions of prediabetes, with adjustment for relevant confounders. RESULTS Compared with that for normoglycemia, incidence rate in the context of prediabetes was 54% higher with the WHO/IEC definition and 37% higher with the ADA definition (P < 0.001) but declining to 17% and 12% after confounder adjustment (P ≥ 0.111). Prediabetes by HbA1c was associated with a doubling in incidence rate for both the IEC and ADA criteria. However, upon adjustment, excess risk was reduced to 13% and 17% (P ≥ 0.055), respectively. Prediabetes by FPG or 2hPG was not associated with an excess risk in the adjusted analysis. CONCLUSIONS Prediabetes defined by HbA1c was associated with a worse prognosis than prediabetes defined by FPG or 2hPG. However, the excess risk among individuals with prediabetes is mainly explained by the clustering of other cardiometabolic risk factors associated with hyperglycemia.
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Affiliation(s)
| | - Daniel R Witte
- Department of Public Health, Aarhus University, Aarhus, Denmark.,Danish Diabetes Academy, Odense, Denmark
| | - Eric J Brunner
- Department of Epidemiology and Public Health, University College London, London, U.K
| | - Mika Kivimäki
- Department of Epidemiology and Public Health, University College London, London, U.K
| | - Adam Tabák
- Department of Epidemiology and Public Health, University College London, London, U.K.,1st Department of Medicine, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Marit E Jørgensen
- Steno Diabetes Center Copenhagen, Gentofte, Denmark.,National Institute of Public Health, Southern Denmark University, Copenhagen, Denmark
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Engelbrechtsen L, Mahendran Y, Jonsson A, Gjesing AP, Weeke PE, Jørgensen ME, Færch K, Witte DR, Holst JJ, Jørgensen T, Grarup N, Pedersen O, Vestergaard H, Torekov S, Kanters JK, Hansen T. Common variants in the hERG (KCNH2) voltage-gated potassium channel are associated with altered fasting and glucose-stimulated plasma incretin and glucagon responses. BMC Genet 2018; 19:15. [PMID: 29548277 PMCID: PMC5857134 DOI: 10.1186/s12863-018-0602-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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: 10/11/2017] [Accepted: 03/13/2018] [Indexed: 01/29/2023] Open
Abstract
Background Patients with long QT syndrome due to rare loss-of-function mutations in the human ether-á-go-go-related gene (hERG) have prolonged QT interval, risk of arrhythmias, increased secretion of insulin and incretins and impaired glucagon response to hypoglycemia. This is caused by a dysfunctional Kv11.1 voltage-gated potassium channel. Based on these findings in patients with rare variants in hERG, we hypothesized that common variants in hERG may also lead to alterations in glucose homeostasis. Subsequently, we aimed to evaluate the effect of two common gain-of-function variants in hERG (rs36210421 and rs1805123) on QT interval and plasma levels of glucagon-like peptide-1 (GLP-1), glucose-dependent insulinotropic polypeptide (GIP), insulin and glucagon during an oral glucose tolerance test (OGTT). We used two population-based cohorts for evaluation of the effect of common variants in hERG on QT-interval and circulation levels of incretins, insulin and glucagon. The Danish population-based Inter99 cohort (n = 5895) was used to assess the effect of common variants on QT-interval. The Danish ADDITION-PRO cohort was used (n = 1329) to study genetic associations with levels of GLP-1, GIP, insulin and glucagon during an OGTT. Results Carriers of either the minor A-allele of rs36210421 or the minor G-allele of rs1805123 had ~ 2 ms shorter QT interval per risk allele (p = 0.025 and p = 1.9 × 10− 7). Additionally, both variants were associated with alterations in pancreatic and gut hormone release among carriers. The minor A- allele of rs36210421 was associated with increased GLP-1 and decreased GIP response to oral glucose stimulation, whereas the minor G-allele of rs1805123 is associated with decreased fasting plasma insulin and glucagon release. A genetic risk score combining the two gene variants revealed reductions in glucose-stimulated GIP, as well as suppressed glucagon response to increased glucose levels during an OGTT. Conclusions Two common missense polymorphisms of the Kv11.1 voltage-gated hERG potassium channel are associated with alterations in circulating levels of GIP and glucagon, suggesting that hERG potassium channels play a role in fasting and glucose-stimulated release of GIP and glucagon. Trial registration ClinicalTrials.gov (NCT00289237). Trial retrospectively registered at February 9, 2006. Studies were approved by the Ethical Committee of the Central Denmark Region (journal no. 20080229) and by the Copenhagen County Ethical Committee (KA 98155). Electronic supplementary material The online version of this article (10.1186/s12863-018-0602-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Line Engelbrechtsen
- Novo Nordisk Foundation Center for Basic Metabolic Research, Section of Metabolic Genetics, University of Copenhagen, Faculty of Health and Medical Sciences, Blegdamsvej 3B, Maersk Tower 8. floor, -2200, Copenhagen, DK, Denmark. .,Danish Diabetes Academy, Odense, Denmark.
| | - Yuvaraj Mahendran
- Novo Nordisk Foundation Center for Basic Metabolic Research, Section of Metabolic Genetics, University of Copenhagen, Faculty of Health and Medical Sciences, Blegdamsvej 3B, Maersk Tower 8. floor, -2200, Copenhagen, DK, Denmark.,Danish Diabetes Academy, Odense, Denmark
| | - Anna Jonsson
- Novo Nordisk Foundation Center for Basic Metabolic Research, Section of Metabolic Genetics, University of Copenhagen, Faculty of Health and Medical Sciences, Blegdamsvej 3B, Maersk Tower 8. floor, -2200, Copenhagen, DK, Denmark
| | - Anette Prior Gjesing
- Novo Nordisk Foundation Center for Basic Metabolic Research, Section of Metabolic Genetics, University of Copenhagen, Faculty of Health and Medical Sciences, Blegdamsvej 3B, Maersk Tower 8. floor, -2200, Copenhagen, DK, Denmark
| | - Peter E Weeke
- Department of Cardiology, Rigshospitalet, Copenhagen, Denmark
| | - Marit E Jørgensen
- National Institute of Public Health, University of Southern Denmark, Odense, Denmark.,Steno Diabetes Center, Gentofte, Denmark
| | | | - Daniel R Witte
- Section of General Practice, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Jens J Holst
- Novo Nordisk Foundation Center for Basic Metabolic Research, Section of Metabolic Genetics, University of Copenhagen, Faculty of Health and Medical Sciences, Blegdamsvej 3B, Maersk Tower 8. floor, -2200, Copenhagen, DK, Denmark.,Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Torben Jørgensen
- Research Centre for Prevention and Health, The Capital Region of Denmark, Hillerød, Denmark.,Department of Public health, Faculty of Health Science, University of Copenhagen, Copenhagen, Denmark.,Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - Niels Grarup
- Novo Nordisk Foundation Center for Basic Metabolic Research, Section of Metabolic Genetics, University of Copenhagen, Faculty of Health and Medical Sciences, Blegdamsvej 3B, Maersk Tower 8. floor, -2200, Copenhagen, DK, Denmark
| | - Oluf Pedersen
- Novo Nordisk Foundation Center for Basic Metabolic Research, Section of Metabolic Genetics, University of Copenhagen, Faculty of Health and Medical Sciences, Blegdamsvej 3B, Maersk Tower 8. floor, -2200, Copenhagen, DK, Denmark
| | - Henrik Vestergaard
- Novo Nordisk Foundation Center for Basic Metabolic Research, Section of Metabolic Genetics, University of Copenhagen, Faculty of Health and Medical Sciences, Blegdamsvej 3B, Maersk Tower 8. floor, -2200, Copenhagen, DK, Denmark.,Steno Diabetes Center, Gentofte, Denmark
| | - Signe Torekov
- Novo Nordisk Foundation Center for Basic Metabolic Research, Section of Metabolic Genetics, University of Copenhagen, Faculty of Health and Medical Sciences, Blegdamsvej 3B, Maersk Tower 8. floor, -2200, Copenhagen, DK, Denmark.,Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jørgen K Kanters
- Novo Nordisk Foundation Center for Basic Metabolic Research, Section of Metabolic Genetics, University of Copenhagen, Faculty of Health and Medical Sciences, Blegdamsvej 3B, Maersk Tower 8. floor, -2200, Copenhagen, DK, Denmark.,Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Torben Hansen
- Novo Nordisk Foundation Center for Basic Metabolic Research, Section of Metabolic Genetics, University of Copenhagen, Faculty of Health and Medical Sciences, Blegdamsvej 3B, Maersk Tower 8. floor, -2200, Copenhagen, DK, Denmark
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47
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Wewer Albrechtsen NJ, Færch K, Jensen TM, Witte DR, Pedersen J, Mahendran Y, Jonsson AE, Galsgaard KD, Winther-Sørensen M, Torekov SS, Lauritzen T, Pedersen O, Knop FK, Hansen T, Jørgensen ME, Vistisen D, Holst JJ. Evidence of a liver-alpha cell axis in humans: hepatic insulin resistance attenuates relationship between fasting plasma glucagon and glucagonotropic amino acids. Diabetologia 2018; 61:671-680. [PMID: 29305624 DOI: 10.1007/s00125-017-4535-5] [Citation(s) in RCA: 66] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Accepted: 11/23/2017] [Indexed: 12/14/2022]
Abstract
AIMS/HYPOTHESIS The secretion of glucagon is controlled by blood glucose and inappropriate secretion of glucagon contributes to hyperglycaemia in diabetes. Besides its role in glucose regulation, glucagon regulates amino acid metabolism in hepatocytes by increasing ureagenesis. Disruption of this mechanism causes hyperaminoacidaemia, which in turn increases glucagon secretion. We hypothesised that hepatic insulin resistance (secondary to hepatic steatosis) via defective glucagon signalling/glucagon resistance would lead to impaired ureagenesis and, hence, increased plasma concentrations of glucagonotropic amino acids and, subsequently, glucagon. METHODS To examine the association between glucagon and amino acids, and to explore whether this relationship was modified by hepatic insulin resistance, we studied a well-characterised cohort of 1408 individuals with normal and impaired glucose regulation. In this cohort, we have previously reported insulin resistance to be accompanied by increased plasma concentrations of glucagon. We now measure plasma levels of amino acids in the same cohort. HOMA-IR was calculated as a marker of hepatic insulin resistance. RESULTS Fasting levels of glucagonotropic amino acids and glucagon were significantly and inversely associated in linear regression models (persisting after adjustment for age, sex and BMI). Increasing levels of hepatic, but not peripheral insulin resistance (p > 0.166) attenuated the association between glucagon and circulating levels of alanine, glutamine and tyrosine, and was significantly associated with hyperaminoacidaemia and hyperglucagonaemia. A doubling of the calculated glucagon-alanine index was significantly associated with a 30% increase in hepatic insulin resistance, a 7% increase in plasma alanine aminotransferase levels, and a 14% increase in plasma γ-glutamyltransferase levels. CONCLUSIONS/INTERPRETATION This cross-sectional study supports the existence of a liver-alpha cell axis in humans: glucagon regulates plasma levels of amino acids, which in turn feedback to regulate the secretion of glucagon. With hepatic insulin resistance, reflecting hepatic steatosis, the feedback cycle is disrupted, leading to hyperaminoacidaemia and hyperglucagonaemia. The glucagon-alanine index is suggested as a relevant marker for hepatic glucagon signalling.
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Affiliation(s)
- Nicolai J Wewer Albrechtsen
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200, Copenhagen, Denmark
- NNF Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | | | | | - Daniel R Witte
- The Danish Diabetes Academy, Odense, Denmark
- Department of Public Health, Section of General Practice, Aarhus University, Aarhus, Denmark
| | - Jens Pedersen
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200, Copenhagen, Denmark
- NNF Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Yuvaraj Mahendran
- NNF Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Anna E Jonsson
- NNF Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Katrine D Galsgaard
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200, Copenhagen, Denmark
- NNF Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Marie Winther-Sørensen
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200, Copenhagen, Denmark
- NNF Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Signe S Torekov
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200, Copenhagen, Denmark
- NNF Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Torsten Lauritzen
- Department of Public Health, Section of General Practice, Aarhus University, Aarhus, Denmark
| | - Oluf Pedersen
- NNF Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Filip K Knop
- NNF Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Center for Diabetes Research, Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Torben Hansen
- NNF Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Marit E Jørgensen
- Steno Diabetes Center Copenhagen, Gentofte, Denmark
- National Institute of Public Health, Southern Denmark University, Odense, Denmark
| | | | - Jens J Holst
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200, Copenhagen, Denmark.
- NNF Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
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Amadid H, Johansen NB, Bjerregaard AL, Vistisen D, Færch K, Brage S, Lauritzen T, Witte DR, Sandbæk A, Jørgensen ME. Physical Activity Dimensions Associated with Impaired Glucose Metabolism. Med Sci Sports Exerc 2018; 49:2176-2184. [PMID: 28692629 DOI: 10.1249/mss.0000000000001362] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [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
PURPOSE Physical activity (PA) is important in the prevention of Type 2 diabetes, yet little is known about the role of specific dimensions of PA, including sedentary time in subgroups at risk for impaired glucose metabolism (IGM). We applied a data-driven decision tool to identify dimensions of PA associated with IGM across age, sex, and body mass index (BMI) groups. METHODS This cross-sectional study included 1501 individuals (mean (SD) age, 65.6 (6.8) yr) at high risk for Type 2 diabetes from the ADDITION-PRO study. PA was measured by an individually calibrated combined accelerometer and heart rate monitor worn for 7 d. PA energy expenditure, time spent in different activity intensities, bout duration, and sedentary time were considered determinants of IGM together with age, sex, and BMI. Decision tree analysis was applied to identify subgroup-specific dimensions of PA associated with IGM. IGM was based on oral glucose tolerance test results and defined as a fasting plasma glucose level of ≥6.1 mmol·L and/or a 2-h plasma glucose level of ≥7.8 mmol·L. RESULTS Among overweight (BMI ≥25 kg·m) men, accumulating less than 30 min·d of moderate-to-vigorous PA was associated with IGM, whereas among overweight women, sedentary time was associated with IGM. Among individuals older than 53 yr with normal weight (BMI <25 kg·m), time spent in light PA was associated with IGM. None of the dimensions of PA were associated with IGM among individuals ≤53 yr of age with normal weight. CONCLUSIONS We identified subgroups in which different activity dimensions were associated with IGM. Methodology and results from this study may suggest a preliminary step toward the goal of tailoring and targeting PA interventions aimed at Type 2 diabetes prevention.
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Affiliation(s)
- Hanan Amadid
- 1Department of Clinical Epidemiology, Steno Diabetes Center Copenhagen, Gentofte, DENMARK; 2Department of Public Health, Research Unit and Section of General Practice, University of Aarhus, Aarhus, DENMARK; 3Research Centre for Prevention and Health, Capital Region, Glostrup, DENMARK; 4MRC Epidemiology Unit, University of Cambridge, Cambridge, UNITED KINGDOM; 5Danish Diabetes Academy, Odense, Denmark; and 6National Institute of Public Health, University of Southern Denmark, Odense, DENMARK
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49
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Hulman A, Vistisen D, Glümer C, Bergman M, Witte DR, Færch K. Glucose patterns during an oral glucose tolerance test and associations with future diabetes, cardiovascular disease and all-cause mortality rate. Diabetologia 2018; 61:101-107. [PMID: 28983719 DOI: 10.1007/s00125-017-4468-z] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [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: 05/24/2017] [Accepted: 09/07/2017] [Indexed: 10/18/2022]
Abstract
AIMS/HYPOTHESIS In addition to blood glucose concentrations measured in the fasting state and 2 h after an OGTT, intermediate measures during an OGTT may provide additional information regarding a person's risk of future diabetes and cardiovascular disease (CVD). First, we aimed to characterise heterogeneity of glycaemic patterns based on three time points during an OGTT. Second, we compared the incidences of diabetes and CVD and all-cause mortality rates among those with different patterns. METHODS Our cohort study included 5861 participants without diabetes at baseline from the Danish Inter99 study. At baseline, all participants underwent an OGTT with measurements of plasma glucose levels at 0, 30 and 120 min. Latent class mixed-effects models were fitted to identify distinct patterns of glycaemic response during the OGTT. Information regarding incident diabetes, CVD and all-cause mortality rates during a median follow-up time of 11, 12 and 13 years, respectively, was extracted from national registers. Cox proportional hazard models with adjustment for several cardiometabolic risk factors were used to compare the risk of diabetes, CVD and all-cause mortality among individuals in the different latent classes. RESULTS Four distinct glucose patterns during the OGTT were identified. One pattern was characterised by high 30 min but low 2 h glucose values. Participants with this pattern had an increased risk of developing diabetes compared with participants with lower 30 min and 2 h glucose levels (HR 4.1 [95% CI 2.2, 7.6]) and participants with higher 2 h but lower 30 min glucose levels (HR 1.5 [95% CI 1.0, 2.2]). Furthermore, the all-cause mortality rate differed between the groups with significantly higher rates in the two groups with elevated 30 min glucose. Only small non-significant differences in risk of future CVD were observed across latent classes after confounder adjustment. CONCLUSIONS/INTERPRETATION Elevated 30 min glucose is associated with increased risk of diabetes and all-cause mortality rate independent of fasting and 2 h glucose levels. Therefore, subgroups at high risk may not be revealed when considering only fasting and 2 h glucose levels during an OGTT.
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Affiliation(s)
- Adam Hulman
- Department of Public Health, Aarhus University, Bartholins Allé 2, Building 1260, DK-8000, Aarhus C, Denmark.
- Danish Diabetes Academy, Odense, Denmark.
- Department of Medical Physics and Informatics, University of Szeged, Szeged, Hungary.
| | | | - Charlotte Glümer
- Research Centre for Prevention and Health, Glostrup Hospital, Glostrup, Denmark
| | - Michael Bergman
- Division of Endocrinology, Diabetes and Metabolism, NYU School of Medicine, NYU Langone Diabetes Prevention Program, New York, NY, USA
| | - Daniel R Witte
- Department of Public Health, Aarhus University, Bartholins Allé 2, Building 1260, DK-8000, Aarhus C, Denmark
- Danish Diabetes Academy, Odense, Denmark
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50
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Færch K, Witte DR, Brunner EJ, Kivimäki M, Tabák A, Jørgensen ME, Ekelund U, Vistisen D. Physical Activity and Improvement of Glycemia in Prediabetes by Different Diagnostic Criteria. J Clin Endocrinol Metab 2017; 102:3712-3721. [PMID: 28973497 PMCID: PMC5630255 DOI: 10.1210/jc.2017-00990] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Accepted: 07/19/2017] [Indexed: 01/14/2023]
Abstract
Context The effects of physical activity (PA) on improvement of glycemia may differ between prediabetic individuals defined by oral glucose tolerance test vs glycated hemoglobin (HbA1c). Objective We studied the association between PA and improvement of glycemia in individuals with prediabetes defined by glucose vs HbA1c criteria. Design, Setting, and Participants From the Whitehall II study, 957 participants with prediabetes defined by isolated impaired fasting glucose (i-IFG), isolated impaired glucose tolerance (i-IGT), or both and 457 with prediabetes defined by HbA1c were included. Main Outcome Measures The associations of PA with concomitant changes in glucose-related outcomes during 5 years of follow-up were analyzed. A recursive partitioning analysis was performed to study heterogeneity in the association between baseline PA and the probability of reversion to normoglycemia. Results After 5 years of follow-up, 405 (42%) individuals with glucose-defined prediabetes reverted to normal glucose tolerance (NGT). A 5-year increase in moderate-to-vigorous-intensity PA was associated with improvements in insulin sensitivity and β-cell function, but PA was not generally associated with reversion to NGT. Only among women ≥50 years with i-IFG or i-IGT, higher amounts of PA were associated with higher probability of reversion to NGT. In HbA1c-defined prediabetes, only 20 individuals (4.4%) reverted to normoglycemia, and PA was not associated with improvement in glycemic markers. Conclusions PA may be particularly important for reversion to normoglycemia among older women with i-IFG or i-IGT. Individuals with prediabetes identified by HbA1c have a low probability of reversion to normoglycemia, and their changes in glycemia are not related to PA.
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Affiliation(s)
- Kristine Færch
- Steno Diabetes Center Copenhagen, 2820 Gentofte, Denmark
| | - Daniel Rinse Witte
- Department of Public Health, Aarhus University, 8000 Aarhus, Denmark
- Danish Diabetes Academy, 5000 Odense, Denmark
| | - Eric John Brunner
- Department of Epidemiology and Public Health, University College London, London WC1E 6BT, United Kingdom
| | - Mika Kivimäki
- Department of Epidemiology and Public Health, University College London, London WC1E 6BT, United Kingdom
| | - Adam Tabák
- Department of Epidemiology and Public Health, University College London, London WC1E 6BT, United Kingdom
- First Department of Medicine, Faculty of Medicine, Semmelweis University, 1083 Budapest, Hungary
| | - Marit Eika Jørgensen
- Steno Diabetes Center Copenhagen, 2820 Gentofte, Denmark
- National Institute of Public Health, Southern Denmark University, 1353 Copenhagen, Denmark
| | - Ulf Ekelund
- Department of Sport Medicine, Norwegian School of Sport Sciences, 0806 Oslo, Norway
- Norwegian Institute of Public Health, 0403 Oslo, Norway
| | - Dorte Vistisen
- Steno Diabetes Center Copenhagen, 2820 Gentofte, Denmark
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