Successful therapy with tenofovir disoproxil fumarate (TDF) in patients with chronic hepatitis B (CHB) does not guarantee amelioration of liver damage assessing by transient elastography. A retrospective - prospective multicenter study

BACKGROUND

Preventing disease progression and viral suppression are the main goals of antiviral therapy in chronic hepatitis B (CHB). Liver stiffness measurement (LSM) by transient elastography is a reliable non-invasive method to assess liver fibrosis in patients with CHB. Our aim was to explore factors that may affect changes in LSMs during long term tenofovir (TDF) monotherapy in a well characterized cohort of patients with compensated CHB.

METHODS

We analyzed serial LSMs in 103 adult patients with CHB who were on TDF monotherapy and had at least three LSMs over a period of 90 months.

RESULTS

Twenty-five (24%) patients had advanced fibrosis at baseline. A significant decline in mean LSM between baseline and last visit (8.7 ± 6.2 kPa vs. 6.7 ± 3.3, p = 10- 3) was observed. Twenty-four (23%) patients had progression of liver fibrosis with mean increase in liver stiffness of 2.8 kPa (range: 0.2-10.2 kPa). Multivariate analysis showed that BMI ≥ 25 (OR, 0.014; 95% CI, 0.001-0.157; p = 0.001) and advanced fibrosis (OR, 5.169; 95% CI, 1.240-21.540; p = 0.024) were independently associated with a fibrosis regression of > 30% of liver stiffness compared to baseline value.

CONCLUSIONS

In CHB patients TDF monotherapy resulted in liver fibrosis regression, especially in patients with advanced fibrosis. Despite the successful antiviral effect of TDF, 1 out of 4 patients had liver fibrosis progression. Obesity and advanced fibrosis at baseline were independently associated with significant liver fibrosis regression.

The effects of zinc supplementation on the metabolic factors in patients with non-alcoholic fatty liver disease: a randomized, double-blinded, placebo-controlled clinical trial

BACKGROUND

Non-alcoholic fatty liver disease (NAFLD) is associated with metabolic factors including obesity, dyslipidemia, insulin resistance, oxidative stress, and elevated inflammatory factors. Zinc (Zn) supplementation has been investigated as a potential adjunctive therapy in managing NAFLD outcomes.

METHODS

In this randomized, double-blinded, controlled clinical trial, 50 overweight or obese participants with NAFLD were randomized into 2 groups of 25 and received either 30 mg of daily Zn or a placebo for 8 weeks. Both groups were invited to follow a balanced energy-restricted diet and physical activity recommendations.

RESULTS

Based on the between-group comparison, Zn supplementation caused a significant increase in the Zn level (P < 0.001) and a significant decrease in weight (P = 0.004), body mass index (BMI) (P = 0.002), waist circumference (P = 0.010), aspartate transaminase (AST) (P = 0.033), total cholesterol (TC) (P = 0.045), and low-density lipoprotein cholesterol (LDL-C) (P = 0.014), but it had no significant effect on alanine transaminase (ALT), fasting blood sugar (FBS), insulin, homeostasis model assessment of insulin resistance (HOMA-IR), high-density lipoprotein (HDL), triglyceride (TG), high-sensitivity C-reactive protein (hs-CRP), malondialdehyde (MDA), and total antioxidant capacity (TAC) (P > 0.05).

CONCLUSION

The results of the present study indicated that 8-week supplementation of 30 mg daily Zn may increase the Zn serum level and decline anthropometric parameters, AST, TC, and LDL-C in NAFLD patients, so further research is suggested in the future.

TRIAL REGISTRATION

The trial was retrospectively registered at IRCT.ir as IRCT20191015045113N1 (December/8/2019).

Prevalence and associated factors of female sexual dysfunction among type 2 diabetes patients in Indonesia: A systematic review and meta-analysis

BACKGROUND AND AIMS

Female sexual dysfunction (FSD) is a neglected chronic complication of diabetes. However, there is a scarcity of data in Indonesia, which is currently ranked as the 5th in the world for the number of people with Type 2 Diabetes (T2D). Our study aims to analyze the prevalence and factors of FSD among T2D patients in Indonesia.

METHOD

Literature searching was performed in PubMed/Medline®, CINAHL®, Embase®, Proquest®, Scopus®, local journals and libraries. All studies in searching keywords "sexual", "diabetes" and "Indonesia" with Medical Subject Headings (MeSH) terms were included, without time or language restriction. Pooled prevalence and odds ratio of associated factors of FSD were analyzed using STATA.

RESULTS

Ten studies comprised 572 females with T2D were included in this review. The pooled prevalence of FSD reached 52% (95% CI = 0.49-0.56; I2 93.9%, p < 0.001). After removing one study that was conducted with an unstandardized questionnaire cut-off value, the pooled prevalence of FSD was 62% (95% CI = 0.58-0.66; I2 68.7%, p = 0.001). Age more than 45 years old and or menopause, and the use of antihypertensives were associated with FSD. While Hemoglobin A1c (HbA1c) is only correlated with a desire for sexual dysfunction.

CONCLUSION

FSD was prevalent among T2D patients in Indonesia and was associated with age more than 45 years old, menopause, and the use of antihypertensive medications.

Associations between chronic widespread pain, pressure pain thresholds, leptin, and metabolic factors in individuals with knee pain

OBJECTIVE

The aim was to study associations between chronic widespread pain, widespread pain sensitivity, leptin, and metabolic factors in individuals with knee pain. A secondary aim was to study these associations in a subgroup of individuals with normal BMI.

METHOD

This cross-sectional study included 265 individuals. The participants were categorised into three different pain groups: Chronic widespread pain (CWP), chronic regional pain (ChRP), or no chronic pain (NCP). The pressure pain thresholds (PPTs) were assessed using computerised pressure algometry. Low PPTs were defined as having PPTs in the lowest third of all tender points. Leptin and metabolic factors such as BMI, visceral fat area (VFA), lipids, and glucose were also assessed.

RESULT

Sixteen per cent reported CWP, 15% had low PPTs, and 4% fulfilled both criteria. Those who fulfilled the criteria for CWP were more often women, more obese, and had increased leptin levels. In logistic regression, adjusted for age and gender, leptin was associated with fulfilling criteria for CWP, OR 1.015 (95% CI 1.004-1.027, p = 0.008). In logistic regression, adjusted for age and gender, leptin was associated with low PPTs, OR 1.016 (95% CI 1.004-1.029, p = 0.012). Leptin was also associated with fulfilling both criteria, adjusted for age, sex, and visceral fat area (VFA), OR 1.030 (95% CI 1.001-1.060), p = 0.040.

CONCLUSION

Leptin was associated with fulfilling the combined criteria for chronic widespread pain and low PPTs, even after adjusting for the visceral fat area (VFA). Longitudinal studies are needed to study the causal relationships between leptin and the development of widespread pain.

TRIAL REGISTRATION

clinicalTrials.gov Identifier: NCT04928170.

Lifestyle factors, metabolic factors and socioeconomic status for pelvic organ prolapse: a Mendelian randomization study

BACKGROUND

Previous observational studies have reported that lifestyle factors, metabolic factors and socioeconomic status are associated with the development of female pelvic organ prolapse (POP); however, whether these associations are causal remains unclear. The current study aimed to assess the causal effect of lifestyle factors, metabolic factors and socioeconomic status on POP risk.

METHODS

We conducted a two-sample Mendelian randomization (MR) study based on summary-level data from the largest available genome-wide association studies (GWAS) to evaluate whether lifestyle factors, metabolic factors and socioeconomic status are causally related to POP. We used single nucleotide polymorphisms that are strongly associated with exposure at the genome-wide significance level (P < 5 × 10-8) as instrumental variables from genome-wide association studies. The method of random-effect inverse-variance weighting (IVW) was used as the primary analysis method, supplemented with the weighted median, MR-Egger and the MR pleiotropy residual sum and outlier applied to verify the MR assumptions. Two-step MR was conducted to investigate potential intermediate factors that are on the causal pathway from exposure to POP.

RESULTS

There were associations with POP for genetically predicted waist-to-hip ratio (WHR) (odds ratio (OR) 1.02, 95% confidence interval (CI) 1.01-1.03 per SD-increase, P < 0.001), WHR adjusted for body mass index (WHRadjBMI) (OR 1.017, 95% CI 1.01-1.025 per SD-increase, P < 0.001) and education attainment (OR 0.986, 95% CI 0.98-0.991 per SD-increase) in the meta-analysis. Additionally, genetically predicted coffee consumption (OR per 50% increase 0.67, 95% CI 0.47-0.96, P = 0.03), vigorous physical activity (OR 0.83, 95% CI 0.69-0.98, P = 0.043) and high-density lipoprotein cholesterol (HDL-C) (OR 0.91, 95% CI 0.84-0.98 per SD-increase, P = 0.049) were inversely associated with POP in the FinnGen Consortium. The mediation analysis showed that the indirect effects of education attainment on POP were partly mediated by WHR and WHRadjBMI, with a mediated proportion of 27% and 13% in the UK Biobank study, respectively.

CONCLUSIONS

Our study provides MR evidence of a robust causal association of WHR, WHRadjBMI and education attainment with POP.

The mediation effects of metabolic and immune-inflammation factors on the depression-premature coronary heart disease association

BACKGROUND

Accumulated evidence confirmed depression was positively associated with CHD. But evidence of the association between depression and premature CHD is still unknown.

OBJECTIVES

To explore the association between depression and premature CHD, and to investigate whether and to what extent the association is mediated by metabolic factors and systemic immune-inflammation index (SII).

METHODS

In this large population-based cohort study based on the UK Biobank, 176,428 CHD-free (mean age: 52.70) adults were followed up for 15 years to detect incident premature CHD. Depression and premature CHD (mean age: female, 54.53; male, 48.13) were ascertained from self-report data and linked hospital-based clinical diagnosis. Metabolic factors included central obesity, hypertension, dyslipidemia, hypertriglyceridemia, hyperglycemia, and hyperuricemia. Systemic inflammation was evaluated by calculating SII, which equals platelet count (/L) × neutrophil count (/L) / lymphocyte count (/L). Data were analyzed using Cox proportional hazards models and generalized structural equation model (GSEM).

RESULTS

During follow-up (median: 8.0 years, interquartile range: 4.0 to 14.0 years), 2990 participants developed premature CHD (1.7 %). The adjusted hazard ratio (HR) and 95 % confidence interval (CI) of premature CHD related to depression were 1.72 (1.44-2.05). The association between depression and premature CHD was 32.9 % mediated by comprehensive metabolic factors (β = 0.24, 95 % CI: 0.17-0.32) and 2.7 % by SII (β = 0.02, 95 % CI = 0.01-0.04), respectively. Concerning metabolic factors, the strongest indirect association was for central obesity, accounting for 11.0 % of the association between depression and premature CHD (β = 0.08, 95 % CI: 0.05-0.11).

CONCLUSIONS

Depression was associated with an increased risk of premature CHD. Our study provided evidence that metabolic and inflammatory factors might play a mediating role in the association between depression and premature CHD, especially central obesity.

Dietary total antioxidant capacity interacts with a variant of chromosome 5q13-14 locus to influence cardio-metabolic risk factors among obese adults

Background

The association between cocaine- and amphetamine-regulated transcript prepropeptide gene (CARTPT) and obesity-related outcomes has shown in the epidemiological studies. Nevertheless, there is lack of data regarding the CARTPT gene-diet interactions in terms of antioxidant potential of diet. So, this study aimed to test CARTPT gene-dietary non-enzymatic antioxidant capacity (NEAC) interactions on cardio-metabolic risk factors in obese individuals.

Methods and material

The present cross-sectional study was carried out among 288 apparently healthy obese adults within age range of 20-50 years. Antioxidant capacity of diet was estimated by calculating the oxygen radical absorbance capacity (ORAC), ferric reducing antioxidant power (FRAP), total radical-trapping antioxidant parameter (TRAP) and Trolox equivalent antioxidant capacity (TEAC) using a semiquantitative food frequency questionnaire (FFQ). Genotyping for CARTPT rs2239670 polymorphism was conducted by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method.

Results

A significant interaction was revealed between CARTPT rs2239670 and dietary ORAC on BMI (PInteraction = 0.048) and fat mass percent (FM%) (PInteraction = 0.008); in A allele carriers, higher adherence to the dietary ORAC was related to lower level of BMI and FM%. And, the significant interactions were observed between FRAP index and rs2239670 in relation to HOMA (PInteraction = 0.049) and QUICKI (PInteraction = 0.048). Moreover, there were significant interactions of rs2239670 with TRAP (PInteraction = 0.029) and TEAC (PInteraction = 0.034) on the serum glucose level; individuals with AG genotype were more respondent to higher intake of TRAP.

Conclusion

The present study indicated that the relationships between CARTPT rs2239670 and obesity and its-related metabolic parameters depend on adherence to the dietary NEAC. Large prospective studies are needed to confirm our findings.

Metabolic aspects of hepatitis C virus

Many metabolic factors are associated with chronic hepatitis C virus (HCV) infection and can influence the course of the illness and impact the progression of liver and non-liver-related diseases through complex interactions. Several of these factors impact the course of chronic HCV (CHC) and result in the conceptual translation of CHC from a localized to systemic disease. Besides the traditional liver manifestations associated with CHC infection, such as cirrhosis and hepatocellular carcinoma, various extrahepatic disorders are associated with HCV infection, including atherosclerosis, glucose and lipid metabolic disturbances, alterations in the iron metabolic pathways, and lymphoproliferative diseases. The coexistence of metabolic disorders and CHC is known to influence the chronicity and virulence of HCV and accelerates the progression to liver fibrosis and hepatocellular carcinoma. Insulin resistance is one of the key factors that have a tremendous metabolic impact on CHC. Therefore, there is a great need to properly evaluate patients with CHC infection and correct the modifiable metabolic risk factors. Furthermore, patients with HCV who achieved a sustained virological response showed an overall improvement in glucose metabolism, but the exact evidence still requires further studies with long-term follow-up. This review delineates the most recent evidence on the main metabolic factors associated with CHC and the possible influence of chronic HCV infection on metabolic features.

Effect of cardamom supplementation on a number of metabolic factors: A systematic review and meta-analysis

BACKGROUND & AIMS

Cardamom known as "queen of spice" seems to be an anti-diabetic agent due to its poly phenolic content. Since, recent studies reported controversial results related to its effect on metabolic factors, present meta-analysis examined the effect of cardamom supplementation on glycemic indices and weight profile of randomized controlled clinical trials (RCTs).

METHODS

A wide search was done on biomedical electronic databases including Scopus, PubMed, Cochrane, EMBASE and Iranian databases, for all relevant literature published up to May 2021. Our search strategy included: [HbA1C, Blood Sugar, glycemic index, glucose tolerance test, insulin, insulin resistance, insulin sensitivity, body weight, BMI, body composition, waist circumferences] added to searched queries based on scientific Mesh terms. The included papers required to be RCTs that reported the effect of cardamom on glycemic and weight indices. We excluded studies with: a) non-randomized or non-controlled trials, b) animal studies, c) not available full text articles d) duplicate citations and e) not available full text articles. The risk of bias was assessed based on the Cochrane Risk of Bias tool. The effects of cardamom supplementation were assessed using standardized mean difference (SMD) statistics. The SMD of metabolic risk factors were pooled together using random effect meta-analysis method.

RESULTS

Totally, six publications enrolling 410 participants was included in present meta-analysis. Daily 3 g supplementation of cardamom from 8 weeks to 3 months showed no significant effect on BMI (WMD: 0.07; 95% CI: [-0.12, 0.27]; P:0.5), weight (WMD: 0.01; 95% CI: [-0.22, 0.21]; P:0.95) and WC (WMD: 0.09; 95% CI: [-0.34, 0.17]; P:0.63), FBS (WMD: 0.10; 95% CI: [ -0.32, 0.12]; P:0.37), insulin (WMD: 0.83; 95% CI: [-2.07, 0.40]; P:0.19) and QUICKI (WMD: 1.14; 95% CI: [-1.11, 3.39]; P:0.32). However, significant effect occurred on HOMA-IR (WMD: 0.40; 95% CI: [-0.65, -0.15]; P:0.00), and HbA1C (WMD: 0.48; 95% CI: [-0.80, -0.16]; P:0.00).

CONCLUSION

Final findings suggest ameliorative effect of cardamom on metabolism of glucose.

Saturated Fat and Cardiovascular Health: Phenotype and Dietary Factors Influencing Interindividual Responsiveness

PURPOSE OF REVIEW

Recent inconsistencies in nutrition research studies examining the influence of saturated fat (SFA) on cardiovascular disease (CVD) risk have led to substantial scientific debate and increased public confusion. This review will summarize metabolic characteristics and food-based factors that underlie interindividual responsiveness to SFA consumption.

RECENT FINDINGS

The magnitude of postprandial blood lipid responses to SFA intake is dependent on a number of individual factors including age, sex, and adiposity status. Further, the metabolic effects of SFA intake are influenced by the specific types of SFAs and the food matrix within which they are contained. Importantly, results from research examining the effects of SFA on CVD risk should be interpreted with consideration of the comparator nutrient (i.e., carbohydrate, monounsaturated fat, polyunsaturated fat). A more nuanced understanding of the multitude of factors mediating the influence of SFA on lipid metabolism and CVD risk might help resolve the current controversy and inform more precise personalized recommendations for future dietary guidelines.

Short-term and long-term effects of major depressive disorder subtypes on obesity markers and impact of sex on these associations

BACKGROUND

Only a few studies with conflicting results have examined the effects of sex on the prospective association between depression and subsequent obesity.

OBJECTIVE

(1) To simultaneously assess the associations of the subtypes (atypical, melancholic, unspecified) of major depressive disorder (MDD) measured at baseline and subtypes of major depressive episodes (MDE) that emerged during a 5.5-year follow-up with changes in obesity markers (body mass index, waist circumference, fat mass) during this follow-up, and (2) to test the effect of sex on these associations.

METHODS

Data from CoLaus|PsyCoLaus, a population-based cohort study including 2702 participants (50.1% women, mean age 49.6 years). Criteria for mental disorders were elicited using semi-structured interviews.

RESULTS

History of atypical MDD at baseline was associated with a steeper increase in BMI and waist circumference, whereas atypical MDE during follow-up was associated with a steeper increase in the three studied obesity markers. Melancholic MDD at baseline was associated with a steeper increase in BMI. Several significant interactions with sex were found indicating higher increase in fat mass in men than in women following melancholic MDD reported at baseline, higher decrease in BMI and fat mass in women than in men related to melancholic MDE emerging during follow-up and higher increase in waist circumference in men than in women following unspecified MDD reported at baseline.

LIMITATIONS

Urban sample which may not be representative for the whole population.

CONCLUSIONS

Our results further advocate for the specific need of a thorough monitoring of obesity markers in patients with atypical MDD and suggest less favorable obesity marker changes mainly related to melancholic MDE in men.

Prevalence and associated metabolic factors for thyroid nodules: a cross-sectional study in Southwest of China with more than 120 thousand populations

OBJECTIVE

To explore the prevalence and its associated metabolic factors of thyroid nodules (TNs) among subjects who participated in the physical examinations in Chongqing, China.

METHODS

The participants from the Health Management Center of JinShan Hospital of Chongqing Medical University, between September 2015 and May 2020, were included in this study. All of the participants underwent thyroid ultrasonography, anthropometric measurements, and serum examinations. Differences in the TNs prevalence were compared with the chi-square test or Wilcoxon rang-sum test. Multivariable logistic regression analyses were used to estimate the metabolic factors associated with TNs and multiple thyroid nodules (MTNs).

RESULTS

Of the included 121,702 participants, 41,547 had TNs, and 20,899 had MTNs, with the prevalence of 34.1 and 17.0 %, respectively. Women had a significantly higher prevalence of TNs than men (40.6 % vs. 29.8 %; χ² = 1517.33, P < 0.001), and TNs prevalence was gradually increased with age (P for trend < 0.001). Female gender, advanced age, and metabolic factors including central obesity, hypertension, diabetes and fatty liver were positively associated with TNs; BMI, hyperlipoidemia and hyperuricemia were not independent risk factors of TNs. While female gender, advanced age, central obesity, hypertension and diabetes were independent risk factors of MTNs.

CONCLUSIONS

The prevalence of thyroid nodules was relatively high. The associated factors identified in this study could help the clinicians to detect the high-risk patients and make targeted screening strategies for the preventing of the occurrence of TNs.

Enolase inhibition alters metabolic hormones and inflammatory factors to promote neuroprotection in spinal cord injury

Enolase inhibition is a potential therapeutic strategy currently being investigated for treatment of spinal cord injury (SCI) as it reduces pro-inflammatory cytokines and chemokines, alters metabolic factors, and reduces gliosis in acute SCI. Herein, the role of enolase in SCI has been examined to better understand the effects of this enzyme on inflammation, metabolic hormones, glial cell activation, and neuroprotection under these shorter injury conditions. Immunohistochemical analyses of inflammatory markers vimentin, Cox-2, and caspase-1 indicated that enolase inhibition attenuated the elevated levels of inflammation seen following SCI. Iba1, GFAP, NFP, and CSPG staining indicated that enolase inhibition with prolonged administration of ENOblock reduced microglia/astrocyte activation and lead to enhanced neuroprotection in SCI. An analysis of metabolic hormones revealed that ENOblock treatment significantly upregulated plasma concentrations of peptide YY, glucagon-like peptide 1, glucose-dependent insulinotropic peptide, glucagon, and insulin hormones as compared to vehicle-treated controls (Mann-Whitney, p ≤ 0.05). ENOblock did not have a significant effect on plasma concentrations of pancreatic polypeptide. Interestingly, ENOblock treatment inhibited chondroitin sulfate proteoglycan (CSPG), which is produced by activated glia and serves to block regrowth of axons across the lesion site following injury. An increased level of NeuN and MBP with reduced caspase-1 was detected in SCI tissues after ENOblock treatment, suggesting preservation of myelin and induction of neuroprotection. ENOblock also induced improved motor function in SCI rats, indicating a role for enolase in modulating inflammatory and metabolic factors in SCI with important implications for clinical consideration.

The contribution of cerebrovascular risk factors, metabolic and inflammatory changes to cognitive decline in Parkinson's disease: preliminary observations

To determine whether systemic medical factors, such as vascular risk factors, metabolic and inflammatory markers contribute to cognitive decline in Parkinson's disease (PD); if confirmed to determine whether a clinically applicable risk factor model can predict the conversion from normal cognition (NC) to mild cognitive impairment (MCI). 58 patients who met the UK Brain Bank Criteria for PD underwent clinical and laboratory assessment at study entry; 47 patients were re-assessed after 2 years. Medical history, vascular risk (QRISK2), blood metabolic and inflammatory factors, brain vessel examinations, activity of daily living, and neuropsychological testing were performed. Forty patients had NC and 18 patients had MCI at baseline. Patients with MCI had higher level of interleukin 6, folic acid below normal range and higher L-dopa equivalent dose compared to cognitive normal patients at baseline. Patients with NC at baseline were classified into two groups: patients who remained cognitively normal (non-converters, n = 23) and patients who progressed to MCI (converters, n = 11). MCI converters were older at baseline and had higher QRISK2 than the non-converters. Patients with higher QRISK2, lower uric acid level and lower activity of daily living scale at baseline had a higher risk of converting from NC to MCI with a sensitivity of 72.2%, a specificity of 87%, and an overall accuracy of 82.4%. Systemic medical factors are associated with cognitive impairment in PD both cross-sectionally and longitudinally. A risk factor model predicting the decline from NC to MCI could be constructed.

Mediation of the effect of serum uric acid on the risk of developing hypertension: a population-based cohort study

Background

Serum uric acid (SUA) had been associated with incident hypertension, but it is uncertain whether and to what extent the effect of SUA is mediated by other metabolic factors.

Methods

Data from the China Health and Retirement Longitudinal Study (CHARLS) during 2011 to 2015 was employed for this study. A total of 7639 participants aged between 35 and 96 years without hypertension was included. Cox proportional hazards model was used to investigate the association between elevated SUA and hypertension. A mediation model was used to separately explore mediating effects (MEs) of metabolic factors on the association between SUA and incident hypertension.

Results

During a median 4.0 years of follow-up, 2348 individuals were diagnosed with hypertension. After adjustment for metabolic confounders, participants with the highest SUA quartile had a hazard ratio of 1.16 (1.02–1.33) compared with the lowest category for incident hypertension. The association between SUA and incident hypertension were partially mediated by waist circumference (WC; ME = 0.034), body mass index (BMI; ME = 0.016), triglycerides (TG; ME = 0.024), total cholesterol (TC; ME = 0.009), high density lipoprotein cholesterol (HDL-C; ME = 0.009), fasting plasma glucose (FPG; ME = 0.005), and glycated hemoglobin (HbA1c; ME = − 0.002). Additionally, proportional mediation was 32.7% by WC and 15.4% by BMI for obesity indicators; 23.1% by TG, 8.7% by TC, and 8.7% by HDL-C for blood lipid; and 4.8% by FPG and − 1.9% by HbA1c for blood glucose.

Conclusions

The positive association between elevated SUA concentration and hypertension was reconfirmed in a Chinese population. Obesity indicators, blood lipids, and blood glucose may play important mediating roles in the pathways.

Obesity and Liver Cancer

Obesity and related metabolic disorders have become globally prevalent posing a challenge for the chronically damaged liver and predisposing the development and progression of cancer. The rising phenomenon of "obesity epidemic" may provide means for understanding why liver cancer is one of the few malignancies with rising incidence in developed countries over the last decades. Non-alcoholic fatty liver disease associated with obesity, insulin resistance, and type 2 diabetes is an increasingly recognized trigger for liver cancer in Western populations characterized by low prevalence of established risk factors for liver cancer such as viral hepatitis and hepatotoxin exposure. Accumulating evidence has established an association between higher body mass index as an indicator of general obesity and higher risk of primary liver cancer. The associations are stronger in men, in patients with underlying liver disease and in white ethnic groups. Abdominal obesity, weight gain in adult life and metabolic factors related to visceral fat accumulation were also suggested as important risk factors for liver cancer; however, more studies are needed to evaluate these associations. The association of obesity and metabolic parameters with liver cancer survival remains controversial. It is unclear which exact mechanisms could provide links between obesity and liver cancer risk. Recent evidence has implicated several molecular pathways in obesity-associated liver cancer. These include insulin resistance leading to increased levels of insulin and insulin-like growth factors, chronic inflammation, adipose tissue remodeling, pro-inflammatory cytokine and adipokine secretion, and altered gut microbiota. These mechanisms coincide with inflammatory and metabolic processes occurring in non-alcoholic fatty liver disease predisposing cancer development and progression. In the context of the current evidence, better understanding of the role of obesity and related metabolic factors may help in improving current strategies for liver cancer prevention.

Association of Serum Ferritin Level with Risk of Incident Abnormal Glucose Metabolism in Southwestern China: a Prospective Cohort Study

This prospective cohort study aimed to analyze the association between serum ferritin levels and the risk of abnormal glucose metabolism (AGM) in Southwestern Chinese population. The 383 subjects who are aged ≥20 years and free of AGM at baseline between in 2007 and in 2008 were included in Southwestern China, and their baseline serum ferritin levels were measured. Among these subjects, 140 subjects were developed into AGM during the follow-up (2008-2012). In logistic regression models, the relative risk in the top versus that in the lowest quartile of serum ferritin levels was 2.86 (p = 0.013) in females and 3.50 (p = 0.029) in males after adjusting the age, gender, family history of diabetes, current smoking, and alcohol; however, serum ferritin levels were not significantly associated with incident of AGM after controlling for metabolic factors (waist circumference, systolic pressure (SBP), triglyceride (TG), and homeostasis model assessment formula insulin resistance (HOMA-IR)). Elevated serum ferritin levels are associated with AGM but not an independent risk factor.

Metabolic factors-triggered inflammatory response drives antidepressant effects of exercise in CUMS rats

Chronic stress is a potential contributing factor for depression, accompanying with metabolic and inflammatory response. Exercise is considered as a treatment for depression, but mechanisms underlying its beneficial effects still remain unknown. The objectives of present study were to confirm that metabolic factors-triggered inflammatory response mediates the antidepressant actions of exercise in chronic unpredictable mild stress (CUMS) rats. It has been found that CUMS stimulated expression of ghrelin and its receptor Ghsr, but inhibited expression of leptin and its receptor LepRb. Ghrelin, via binding to Ghsr, induced phosphorylation of GSK-3β on Tyr216 and decreased phosphorylation on Ser9, thus increasing GSK-3β activity. Conversely, ghrelin binding to Ghsr decreased STAT3 activity, through decreasing phosphorylation of STAT3 on Tyr705 and increasing Ser727 phosphorylation. Negatively correlated with ghrelin, leptin binding to LepRb had opposite effects on the activity of GSK-3β and STAT3 via phosphorylation. In addition, decreased leptin level initiated NLRP3 activity via LepRb. Furthermore, GSK-3β inhibited STAT3 activation, thus promoting the expression of NLRP3. Meanwhile, swim improved metabolic and inflammatory response both in CUMS and control rats. Our findings suggest that exercise not only ameliorates metabolic disturbance and inflammatory response in depression, but also contributes to metabolic and inflammatory function in normal conditions.

Association between dietary patterns and metabolic syndrome in a sample of Tehranian adults

AIM

Metabolic syndrome is one of the most known risk factors of cardiovascular disease. The aim of the current study was to investigate relationships between major dietary patterns and cardio-metabolic risk factors in patients with metabolic syndrome.

METHODS

This cross-sectional study was conducted among patients with metabolic syndrome. All of the participants underwent anthropometric and blood pressure measurements. Biochemical assessments including serum aspartate aminotransferase (AST), alanine amino transferase (ALT), fating serum glucose (FSG), serum lipids, insulin and adiponectin concentrations were performed by enzymatic methods. Dietary patterns were obtained by factor analysis procedure using principal component method. Nutrient intakes were analyzed by a semi-quantitative food frequency questionnaire (FFQ).

RESULTS

Four major dietary patterns including healthy, meats and fats, sweets, potatoes and refined grains were extracted in the current study. Higher healthy pattern score was in relation with higher concentrations of AST and lower systolic blood pressure. Lower diastolic blood pressure and higher serum triglyceride concentrations were also observed in upper quintiles of meat and fats pattern (P<0.05). Upper quintile of sweet pattern was accompanied with higher serum FSG and insulin concentrations (P<0.05).

CONCLUSIONS

The independent associations between dietary patterns and blood pressure and serum lipids further support the protective role of healthy diet with fruits, vegetables and fish as predominant food items and an un-favorable effect of unhealthy diets with meat, fats and sweets as major ingredients.

Exposure to increased levels of estradiol during development can have long-term effects on the response to undernutrition in female rats

OBJECTIVES

Undernutrition during development alters the expression of peptides that control energy expenditure and feeding behavior. Estrogens can also modulate these peptides. Here, we analyze whether the early postnatal administration of estradiol modulates the effects of undernutrition on neuroendocrine parameters in adult female Wistar rats.

METHODS

Control rats were fed a control diet. Undernourished pups were submitted to a restricted diet with half of the undernourished rats receiving 0.4 mg/kg s.c. of estradiol benzoate (EB) from postnatal day (P) 6 until P13. Quantitative real-time polymerase chain reaction was performed to determine expression in the hypothalamus of agouti-related peptide (AgRP), proopiomelanocortin (POMC), neuropeptide Y (NPY), and cocaine- and amphetamine-regulated transcript. Plasma estradiol, testosterone, and adiponectin levels were measured by enzyme-linked immunosorbent assay. Total and acylated ghrelin levels were measured in plasma by radioimmunoassay. Insulin and leptin were measured by mulitplex immunoassays.

RESULTS

Undernourishment decreased body weight, fat mass, plasma leptin and insulin levels, and hypothalamic POMC mRNA levels. An increase in orexigenic signals AgRP and NPY mRNA levels, and in plasma adiponectin levels were found in undernourished animals. Early postnatal treatment with EB to undernourished female rats reversed the effects of undernutrition on adult hypothalamic POMC mRNA levels. In addition, neonatal EB treatment to undernourished females significantly decreased adult plasma testosterone, estradiol, and acylated ghrelin levels.

DISCUSSION

Our results suggest that increased estradiol during a critical period of development has the capacity to modulate the alterations that undernutrition produces on energy metabolism.

Metabolic triggered inflammation in osteoarthritis

Osteoarthritis (OA) is a common chronic joint disorder with a multifactorial etiology including genetic and environmental factors. Metabolic triggered inflammation, induced by nutrient overload and metabolic surplus, consists of components such as obesity, pro-inflammatory cytokines and adipokines, abnormal metabolites, acute phase proteins, vitamin D deficiency, and deregulated microRNAs that may play a role in OA pathophysiology. Obesity-related metabolic factors, especially adipokines, contribute to OA development by inducing pro-inflammatory cytokines and degradative enzymes, leading to cartilage matrix impairment and subchondral bone remodeling. Ectopic metabolite deposition and low-grade systemic inflammation can contribute to a toxic internal environment that exacerbates OA. Complement components highly expressed in osteoarthritic joints have also been proposed as causative factors. Vitamin D deficiency has been associated with obesity and is implicated to be associated with cartilage loss in OA. Metabolic microRNAs may explain the inflammatory link between obesity and OA. Therapies targeting metabolic-triggered inflammation and its components are anticipated to have potential for the treatment of OA.

The changing characteristics of hepatocellular cancer in Hawaii over time

BACKGROUND

The incidence of hepatocellular cancer (HCC) is increasing, and we sought to characterize the differences and trends in HCC over 2 decades in Hawaii.

METHODS

This retrospective study of 821 HCC cases analyzed risk factors, diabetes, alpha-fetoprotein (AFP), tumor characteristics, and treatment, comparing 5-year eras (1993 to 2012).

RESULTS

With succeeding eras, there were fewer Asians, immigrants, and hepatitis B-related HCC. Hepatitis C, diabetes, hyperlipidemia, and body mass index have increased. Over time, more patients had normal AFP, and normal AFP was seen more often in nonviral HCC (49.6% vs 33.2%, P = .007). Over time, the proportion of patients who underwent resection or transplant was stable, but fewer patients underwent no therapy.

CONCLUSIONS

Characteristics of HCC are changing, and diagnosis may be more difficult as metabolic factors are becoming more important than viral factors. AFP seems to be a less important biomarker, and clearly, better diagnostic tools will be necessary to identify HCC in the future.

Nutritional signals and reproduction

There is extensive evidence that nutrition influences reproductive function in various mammalian species (agricultural animals, rodents and human). However, the mechanisms underlying the relationship between nutrition, energy metabolism and reproductive function are poorly understood. This review considers nutrient sensors as a molecular link between food molecules and consequences for female and male fertility. It focuses on the roles and the molecular mechanisms of some of the relevant hormones, such as insulin and adipokines, and of energy substrates (glucose, fatty acids and amino acids), in the gonadotropic axis (central nervous system and gonads). A greater understanding of the interactions between nutrition and fertility is required for both better management of the physiological processes and the development of new molecules to prevent or cure metabolic diseases and their consequences for fertility.

Associations of ghrelin with eating behaviors, stress, metabolic factors, and telomere length among overweight and obese women: preliminary evidence of attenuated ghrelin effects in obesity?

Ghrelin regulates homeostatic food intake, hedonic eating, and is a mediator in the stress response. In addition, ghrelin has metabolic, cardiovascular, and anti-aging effects. This cross-sectional study examined associations between total plasma ghrelin, caloric intake based on 3day diet diaries, hedonic eating attitudes, stress-related and metabolic factors, and leukocyte telomere length in overweight (n=25) and obese women (n=22). We hypothesized associations between total plasma ghrelin and eating behaviors, stress, metabolic, cardiovascular, and cell aging factors among overweight women, but not among obese women due to lower circulating ghrelin levels and/or central resistance to ghrelin. Confirming previous studies demonstrating lowered plasma ghrelin in obesity, ghrelin levels were lower in the obese compared with overweight women. Among the overweight, ghrelin was positively correlated with caloric intake, giving in to cravings for highly palatable foods, and a flatter diurnal cortisol slope across 3days. These relationships were non-significant among the obese group. Among overweight women, ghrelin was negatively correlated with insulin resistance, systolic blood pressure, and heart rate, and positively correlated with telomere length. Among the obese subjects, plasma ghrelin concentrations were negatively correlated with insulin resistance, but were not significantly correlated with blood pressure, heart rate or telomere length. Total plasma ghrelin and its associations with food intake, hedonic eating, and stress are decreased in obesity, providing evidence consistent with the theory that central resistance to ghrelin develops in obesity and ghrelin's function in appetite regulation may have evolved to prevent starvation in food scarcity rather than cope with modern food excess. Furthermore, ghrelin is associated with metabolic and cardiovascular health, and may have anti-aging effects, but these effects may be attenuated in obesity.

Are metabolic factors still important in the era of direct antiviral agents in patients with chronic hepatitis C?

The high rate of sustained viral response (SVR) to boceprevir or telaprevir-based triple therapy in hepatitis C (HCV)-related, non-cirrhotic naïve patients or relapsers to previous antiviral treatment leads clinicians to believe that the impact of metabolic host factors on SVR is minimal when triple therapy is used, unlike what is observed with the peginterferon and ribavirin schedules. This concept is strongly expressed by some opinion leaders on the basis of the data derived from sub-analyses of registrative trials as well as from a post-hoc analysis of the phase II C208 clinical trial. The perception of unrestrainable therapeutic success with the use of newer, more powerful antivirals is now reinforced by the brilliant results obtained with sofosbuvir, an HCV NS5B polymerase inhibitor, as well as by the data from the phase II and III studies on the various combinations of second-generation NS3/4A inhibitors and NS5A and/or NS5B inhibitors. However, a great deal of concern has emerged from the real world scenario in which patients are often older and have more comorbidities than patients in the “world of trials”. Furthermore, many of them have advanced fibrosis and previous failure with peginterferon and ribavirin treatment. Some data from the recent literature suggest that the host metabolic factors may play a minor but non-negligible role in these difficult-to-treat patients, an issue that will hopefully be investigated in further studies. This editorial aims to provide a detailed analysis of the role that host metabolic factors played in the past and what role they may play in the era of direct antiviral agents.

Long-term effect of the Go4it group treatment for obese adolescents: a randomised controlled trial

BACKGROUND & AIMS

Few studies evaluating treatment of adolescent obesity have been published. Therefore, long-term effects of the Go4it group treatment for obese adolescents were examined.

METHODS

Obese adolescents (11-18 years) visiting an outpatient paediatric obesity clinic were randomly assigned to 1) intervention group (Go4it) or 2) current regular care i.e. referral to a dietician in the home care setting (controls). Linear mixed models analysis was performed to evaluate intervention effects. Effect modification by sex, age and ethnicity was checked. Outcome measures included body mass index standard deviation score (BMIsds), body composition and metabolic components at 6 and 18 months follow-up.

RESULTS

122 adolescents, 71 Go4it and 51 controls, with a mean BMIsds of 2.9 ± 0.5 were randomised. At 18 months a modest significant reduction in BMIsds (between group difference: -0.16; 95%CI: -0.30, -0.02; p = .028) was observed. None of the other body composition or metabolic components showed significant treatment effects. Ethnicity was a significant effect modifier. Posthoc analysis showed a large significant reduction on BMIsds (between group difference: -0.35; 95%CI: -0.64, -0.07) at 18 months for obese adolescents from western descent, while no effect was observed for adolescents from non-western descent. Significant treatment effects were also observed for systolic and diastolic blood pressure, as well as HDL cholesterol level, but only for obese adolescents from western descent.

CONCLUSIONS

Go4it showed promising long-term effects on BMIsds compared with regular care in obese adolescents. Larger benefits were achieved for adolescents of western ethnicity. This trial was registered at www.trialregister.nl with the Netherlands Trial Register as ISRCTN27626398.

An epidemiological survey of benign gallbladder disease in Songjiang District of Shanghai, China

AIM: To investigate the epidemiological characteristics of benign gallbladder disease in Songjiang District of Shanghai, China.

METHODS: The clinical data for 30 901 patients with benign gallbladder disease who underwent physical examination at our hospital in 2009 were retrospectively analyzed. The relationship of cholelithiasis with obesity, blood sugar, blood lipid was analyzed.

RESULTS: The incidence of benign gallbladder disease was 15.87%, increasing with the age. The male/female ratio was 1.252. Gallbladder stones, polypoid lesions of gallbladder (PLG) and cholecystitis were common benign gallbladder disease, with an incidence of 5.94%, 5.23% and 3.91%, respectively. The sex ratio of patients with these three diseases were 0.998：1, 1.678：1 and 1.518：1, respectively. The incidence of gallbladder stone increased with age, while that of PLG decreased with age. Both diseases had little relationship with sex. The percentages of patients with cholelithiasis who had obesity, high blood sugar, high triglycerides and low high-density lipoprotein were 10.73%, 21.73%, 19,66% and 2.07%, respectively, while the percentages for non-gallstone patients were 7.04%, 13.37%, 16.56% and 1.45%, with significant differences between the two groups (all P < 0.05).

CONCLUSION: The prevalence of benign gallbladder disease in Songjiang District increases with age. Gallstones and PLG are common benign gallbladder disease. Obesity, high blood sugar, high triglycerides, low high-density lipoprotein are risk factors for gallstones. Cholesterol has no significant correlation with the incidence of cholelithiasis.