Smoking and alcohol consumption influence the risk of cardiovascular diseases in Korean adults with elevated blood pressure

Background and aimsCardiovascular disease (CVD) and hypertension are the main causes of global death. We aimed to investigate the independent and combined effects of smoking and alcohol consumption on CVD risk among Koreans with elevated blood pressure (BP).Methods and resultsAdults aged 20–65 years with elevated BP and without pre-existing CVDs were selected from the National Health Insurance Service-National Sample Cohort version 2.0. We followed up 59,391 men and 35,253 women between 2009 and 2015. The association of CVD incidence with smoking pack-years and alcohol consumption was investigated using the multivariate Cox proportional hazard model. Among women, smokers (10.1–20.0 pack-years) and alcohol drinkers (≥30.0 g/day) had higher CVD risks (hazard ratio [HR] = 1.15, 95% confidence intervals [CI] 1.06–1.25, HR = 1.06, 95% CI 1.00–1.12, respectively) compared to each referent group. However, men who smoked exhibited an increased CVD risk only with pack-years >20.0 (HR = 1.09, 1.03–1.14 and HR = 1.18, 1.11–1.26 for smokers with 20.1–30.0 and ≥ 30.1 pack-years, respectively) compared to nonsmokers. In the combined groups of those smoking and consuming alcohol, only nonsmoking men consuming alcohol 1.0–29.9 g/day had a lower CVD risk than did nonsmoking, nondrinking men (HR = 0.90, 0.83–0.97). Women smoking 1.0-10.0 pack-years and consuming alcohol ≥30.0 g/day had a higher CVD risk (HR = 1.25, 1.11–1.41) than nonsmoking and nondrinking women.ConclusionSmoking and alcohol consumption, independently and jointly, were associated with CVD risk in men and women. Women had a greater CVD risk than did men among Korean adults with elevated BP.     

Inverse relationship between obesity and <Emphasis Type="Italic">FTO</Emphasis> gene expression in visceral adipose tissue in humans

Aims/hypothesis

Recently, FTO was identified as a candidate gene contributing to both childhood and severe adult obesity. We tested the hypothesis that mRNA expression of FTO and/or of the neighbouring RPGRIP1L in adipose tissue correlates with measures of obesity and fat distribution. We also investigated whether the FTO obesity risk alleles might explain variability in FTO and RPGRIP1L mRNA expression.

Methods

In paired samples of visceral and subcutaneous adipose tissue from 55 lean and obese participants, we investigated whether FTO and RPGRIP1L mRNA expression is fat depot-specific, altered in obesity and related to measures of fat accumulation, insulin sensitivity and glucose metabolism. All participants were genotyped for the obesity-associated rs8050136 FTO variant.

Results

FTO mRNA expression was threefold higher in subcutaneous than in visceral adipose tissue. Subcutaneous FTO expression correlated with visceral FTO expression. FTO gene expression in both depots correlated with age and was negatively correlated to BMI and per cent body fat. FTO mRNA levels were not related to measures of insulin sensitivity and glucose metabolism. RPGRIP1L mRNA expression was 1.6-fold higher in visceral than in subcutaneous adipose tissue, but did not correlate with anthropometric and metabolic characteristics. There was no association between rs8050136 and FTO or RPGRIP1L mRNA expression in adipose tissue.

Conclusions/interpretation

Expression of adipose tissue FTO mRNA is fat depot-specific and negatively correlates with measures of obesity. However, the direction of this relationship still needs to be elucidated.

     

Short‐term food deprivation increases amplitudes of heartbeat‐evoked potentials

Nutritional state (i.e., fasting or nonfasting) may affect the processing of interoceptive signals, but mechanisms underlying this effect remain unclear. We investigated 16 healthy women on two separate days: when satiated (standardized food intake) and after an 18‐h food deprivation period. On both days, heartbeat‐evoked potentials (HEPs) and cardiac and autonomic nervous system activation indices (heart rate, normalized low frequency heart rate variability [nLF HRV]) were assessed. The HEP is an EEG pattern that is considered an index of cortical representation of afferent cardiovascular signals. Average HEP activity (R wave +455–595 ms) was enhanced during food deprivation compared to normal food intake. Cardiac activation did not differ between nutritional conditions. Our results indicate that short‐term food deprivation amplifies an electrophysiological correlate of the cortical representation of visceral‐afferent signals originating from the cardiovascular system. This effect could not be attributed to increased cardiac activation, as estimated by heart rate and nLF HRV, after food deprivation.     

Creating a pandemic of prediabetes: the proposed new diagnostic criteria for impaired fasting glycaemia

Aims/hypothesis In November 2003 the American Diabetes Association expert committee on the diagnosis and classification of diabetes mellitus suggested a revision of the diagnostic criteria for IFG, lowering the diagnostic threshold from 6.1 to 5.6 mmol/l. The aim of the present study was to evaluate the consequences of this change with respect to: (i) the prevalence of IFG in five different countries; (ii) the concordance between IFG and IGT (classification of individuals); and (iii) the cardiovascular risk profile of these groups. Finally we discuss the likelihood that intervention for cardiovascular risk and prevention strategies developed for individuals with IGT are applicable to subjects with IFG.Methods The first part of the study is based on the population-based Danish Inter99 study, where 6265 individuals, aged 30 to 60 years and without previously diagnosed diabetes, underwent an oral glucose tolerance test. The second part is based on the DETECT-2 project, in which studies from China, India, France and USA were used to analyse the impact of the proposed revision of the diagnostic criteria in different ethnic groups.Results The proposed change in diagnostic criteria would increase the prevalence of IFG in Denmark from 11.8 to 37.6%. The proposed IFG category would identify 60.0% of all subjects with IGT compared to 29.2% with the old criteria, but among individuals with the new IFG category only 18.5% would also have IGT. Individuals with isolated IFG had lower insulin levels and a lower cardiovascular risk profile with the proposed criteria compared with the current WHO criteria. Data from the DETECT-2 study confirmed the marked increase in the prevalence of IFG, and the estimated number of individuals in the age range 40 to 64 years with IFG in urban India, urban China and the USA would increase by 78%, 135% and 193% respectively.Conclusions/interpretation The proposed revised diagnostic criteria will lead to a dramatic increase in the prevalence of IFG, but the concordance rate between IFG and IGT remains low. This new IFG group will have a more favourable cardiovascular risk profile than the current IFG group as defined by the WHO. This seriously questions whether the existing intervention strategies are applicable to the new category of individuals with IFG.Abbreviations ADA American Diabetes Association - FPG fasting plasma glucose - NHANES III Third National Health and Nutrition Survey - WHO World Health Organization     

不同处理因素对大鼠肠道菌群的影响

目的:探讨抗生素、肠道准备以及饮食对大鼠肠道菌群的影响。方法:将60只SD大鼠随机分为对照组;单因素处理组(3个亚组:抗生素组,肠道准备组,禁饮食组);双因素处理组(3个亚组:抗生素+肠道准备组,肠道准备+禁饮食组,抗生素+禁饮食组);三因素处理组(抗生素+肠道准备+禁饮食组);手术处理组(2个亚组:肠道准备+抗生素+手术处理+术后早期进食组,肠道准备+抗生素+手术处理+术后禁饮食组)。各组均处理4 d,第5天脱颈椎处死,无菌条件下取回盲部粪便进行细菌培养并计数。结果:单因素处理组与对照组比较,双因素组与单因素组比较,以及三因素组与双因素组比较,大肠杆菌数量明显增加,双歧杆菌、乳酸杆菌数量明显减少,双歧杆菌/大肠杆菌比值明显降低,差异均有统计学意义(均P<0.05),且含抗生素处理的亚组上述变化较同组中不含抗生素处理的亚组明显(均P<0.05)。术后早期进食组大肠杆菌数量较术后禁饮食组有所减少,而双歧杆菌、乳酸杆菌数量有所增加,差异有统计学意义(P<0.05)。结论:抗生素、肠道准备以及禁饮食均可引起大鼠肠道菌群失调,其中抗生素的影响最大;处理因素越多,影响越大。术后早期进食对肠道菌群数量的影响小于术后禁饮食。     

禁食禁水时间对妇科腹腔镜手术患者不良反应的影响

目的：探讨妇科腹腔镜手术患者不同禁食禁水时间对不良反应的影响。方法选取2011年1月-2012年12月进行妇科腹腔镜手术的400例患者为研究对象。按照不同禁食禁水时间随机分为4组,每组各100例。常规1组患者采用传统术前12 h禁食,6 h禁水方法;常规2组采用术前10h禁食,4h禁水法;常规3组采用术前8h禁食,3h禁水法;改良组采用术前6h禁食,2h禁水法。术前1 h采用医院用焦虑亚量表[ HAD（ a）]和抑郁亚量表[ HAD（ d）]比较4组患者术前焦虑抑郁程度,并比较术前术中胃液量、术后24 h恶心呕吐情况。结果4组患者术前、术中胃液量比较及术后恶心呕吐得分比较差异均无统计学意义（P＞0．05）;改良组患者HAD（a）评分为（8．37±1．65）分,HAD（d）评分为（9．01±1．87）分,均低于其他3组[HAD（a）评分分别为（14．52±2．57）,（12．34±2．18）,（10．26±1．76）分;HAD（d）评分分别为（14．59±2．69）,（12．02±2．11）,（10．97±1．77）分],差异均有统计学意义（F值分别为4．912,4．160;P＜0．05）。改良组患者术前饥饿、口渴程度,均低于其他3组,差异均有统计学意义（Z值分别为26．247,18．431;P＜0．01）。结论妇科腹腔镜手术患者在术前6 h禁食,2 h禁水可有效控制术前术中胃液量,同时对缓解患者焦虑抑郁情绪及饥饿口渴程度有积极的作用。     

Effects of free fatty acids on carbohydrate metabolism and insulin signalling in perfused rat liver

BACKGROUND: Elevated circulating free fatty acids (FFAs) induce insulin resistance and play a crucial role in the development of type 2 diabetes, in which fasting hepatic glucose production (HGP) is increased. However, direct effects of FFAs on fasting HGP are still unclear because indirect endocrine and metabolic effects contribute to FFA action. Thus, we aimed to investigate acute direct effects of specific FFAs on fasting HGP, lactate uptake, and insulin signalling. MATERIALS AND METHODS: Isolated livers obtained from 20 h fasted rats were perfused with albumin-bound palmitate or oleate (200 micromol L(-1) each) or vehicle (control) for 180 min (n = 5-7/group). RESULTS: Compared to control, hepatic lactate uptake was increased by palmitate and oleate (~+40%; P < 0.05), while HGP from lactate (~3 mmol L(-1)) and liver glycogen content were similar. Tyrosine phosphorylation (pY) of insulin-receptor-substrate-(IRS)-2 and p70S6-kinase phosphorylation were not affected by FFAs. Palmitate decreased insulin-receptor-beta pY, IRS-1 pY and phosphoinositol-3-kinase expression by 46 +/- 16%, 46 +/- 11% and 20 +/- 9%, respectively (P < 0.03), while oleate reduced Akt phosphorylation by 85 +/- 7% (P < 0.006). CONCLUSIONS: Isolated liver perfusion with saturated or unsaturated FFAs reduced insulin signalling protein phosphorylation at different sites and increased lactate uptake without affecting HGP or glycogen content. These results suggest that at fasting, both saturated and unsaturated FFAs increase hepatic glucose precursor uptake and may, independently of insulin's presence, accelerate protein dephosphorylation of the insulin signalling cascade at different sites.     

Old as mature LOU/c/jall rats enhance protein selection in response to a protein deprivation

Previous experiments have shown a strong decrease in protein consumption as rats grow old. This result could be induced by an impaired regulation of feeding behaviour. Present study investigated the ability of ageing rats to adapt their protein intake to protein requirements. Four groups of self-selecting LOU/c/jall male and female rats (4, 16, 22, 28 months at the beginning of the experiments) were submitted to 4-days of protein deprivation periods while their macronutrient intakes were monitored. Moreover, they were submitted to a 4-day fasting period. After reintroduction of proteins, old and senescent rats were able to increase their protein intake in response to the specific protein need created by the protein deprivation. They were also able to increase caloric intake after the fasting period. These results led to the conclusion that the loss of appetite for protein observed with ageing reflects rather an adaptation than an impairment of the regulation of macronutrient choice. Another important observation was that older animals did not recover initial body weight after a body weight loss even if they ate as many calories as younger animals. This data supports a decrease in the efficacious utilization of body fuels in old and senescent rats.     

空腹血糖及糖化血红蛋白用于筛查糖耐量减退的比较性研究

目的比较空腹血糖（FPG）和糖化血红蛋白（HbAlc）在筛查糖耐量减退（IGT）中的应用价值。方法到我院门诊为明确有无血糖异常而就诊者336人，测定空腹血糖、糖化血红蛋白，并行口服葡萄糖耐量试验（OGTT）。结果按照1999年WHO的DM诊断标准，本研究人群空腹血糖〈6．1者124例，≥6．1-〈7．0者56例，≥7．0者156例；糖化血红蛋白〈6．1者84例，≥6．1者252例；OGTT2 hPG〈7．8者92例，≥7．8-〈11．1者99例，≥11．1者145例。结论糖化血红蛋白和空腹血糖均不适用于筛查IGT人群，但糖化血红蛋白比空腹血糖提示病人是否存在血糖异常更敏感。     

Real-world safety and effectiveness of iGlarLixi in people with type 2 diabetes who fast during Ramadan: The SoliRam observational study

Background and aimsTo evaluate the safety and effectiveness of iGlarLixi in adults with type 2 diabetes (T2D) fasting during Ramadan.MethodsSoliRam was a multinational, prospective, single-arm, real-world observational study conducted during Ramadan 2020 and 2021 in adults with T2D treated with iGlarLixi ≥3 months at study entry. The primary endpoint was the percentage of participants experiencing ≥1 episode of severe and/or symptomatic documented hypoglycemia (<70 mg/dL [<3.9 mmol/L]).ResultsAmong the 409 eligible participants followed during Ramadan, 96.8% fasted for ≥25 days and 92.4% did not break fasting during Ramadan. Four participants broke their fast due to hypoglycemia. Minimal adjustments were seen in antihyperglycemic therapies from pre to during Ramadan. Documented symptomatic hypoglycemia was experienced by 1.0%, 2.3%, and 0.3% of participants, respectively, during the last month of pre-Ramadan, Ramadan, and first month post-Ramadan. Mean change in HbA_1c from pre-to post-Ramadan periods was ?0.75% (?8.2 mmol/mol), and participants with HbA_1c <7% (<53 mmol/mol) increased from 7.9% pre-Ramadan to 28.6% post-Ramadan.ConclusionsiGlarLixi is an effective and well-tolerated therapy for people with T2D, including those who intend to fast during Ramadan, and is associated with a low risk of hypoglycemia; benefits were observed both during and after Ramadan.