Cinnamon Use in Type 2 Diabetes: An Updated Systematic Review and Meta-Analysis

PURPOSE

Cinnamon has been studied in randomized controlled trials (RCTs) for its glycemic-lowering effects, but studies have been small and show conflicting results. A prior meta-analysis did not show significant results, but several RCTs have been published since then. We conducted an updated systematic review and meta-analysis of RCTs evaluating cinnamon’s effect on glycemia and lipid levels.

METHODS

MEDLINE, Embase, and Cochrane Central Register of Controlled Trials (CENTRAL) were searched through February 2012. Included RCTs evaluated cinnamon compared with control in patients with type 2 diabetes and reported at least one of the following: glycated hemoglobin (A_1c), fasting plasma glucose, total cholesterol, low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), or triglycerides. Weighted mean differences (with 95% confidence intervals) for endpoints were calculated using random-effects models.

RESULTS

In a meta-analysis of 10 RCTs (n = 543 patients), cinnamon doses of 120 mg/d to 6 g/d for 4 to 18 weeks reduced levels of fasting plasma glucose (−24.59 mg/dL; 95% CI, −40.52 to −8.67 mg/dL), total cholesterol (−15.60 mg/dL; 95% CI, −29.76 to −1.44 mg/dL), LDL-C (−9.42 mg/dL; 95% CI, −17.21 to −1.63 mg/dL), and triglycerides (−29.59 mg/dL; 95% CI, −48.27 to −10.91 mg/dL). Cinnamon also increased levels of HDL-C (1.66 mg/dL; 95% CI, 1.09 to 2.24 mg/dL). No significant effect on hemoglobin A_1c levels (−0.16%; 95%, CI −0.39% to 0.02%) was seen. High degrees of heterogeneity were present for all analyses except HDL-C (I² ranging from 66.5% to 94.72%).

CONCLUSIONS

The consumption of cinnamon is associated with a statistically significant decrease in levels of fasting plasma glucose, total cholesterol, LDL-C, and triglyceride levels, and an increase in HDL-C levels; however, no significant effect on hemoglobin A_1c was found. The high degree of heterogeneity may limit the ability to apply these results to patient care, because the preferred dose and duration of therapy are unclear.     

A ketogenic diet reduces amyloid beta 40 and 42 in a mouse model of Alzheimer's disease

Background

Plasma total homocysteine (tHcy) is commonly elevated in persons with diabetes. This may be due to effects of insulin and/or glucose and/or metabolic control on the metabolism or plasma levels of tHcy. This study examined the effects of fasting plasma glucose status on fasting tHcy levels among adults without diabetes, and diabetes per se among adults with a self-report history of diabetes.

Methods

Analysis of data on adults (≥ 20y) who had fasted at least 8 hours, from the National Health and Nutrition Examination Survey (1999–2000 and 2001–2002). Subjects with no self-report history of diabetes were grouped according to fasting plasma glucose status as normal (< 100 mg/dL = NFG, n = 2,244), impaired (≥ 100 < 126 mg/dL = IFG, n = 1,108), or a provisional diagnosis of diabetes (≥ 126 mg/dL = DFG, n = 133). Subjects with a self-report history of diabetes (n = 275) were examined separately.

Results

Fasting tHcy was higher (Ps < 0.01) among non-diabetic subjects with DFG and IFG, compared to NFG (median [95% confidence interval] = 8.6 [8.0–9.2], 8.3 [8.1–8.5], and 7.4 [7.3–7.5] μmol/L, respectively). Diabetic subjects had levels similar to non-diabetic subjects with DFG and IFG (8.3 [7.9–8.6] μmol/L). Age and estimated creatinine clearance were strong correlates of fasting tHcy among non-diabetic subjects (r = 0.38 to 0.44 and r = -0.35 to -0.46, respectively) and diabetic subjects (r = 0.41 and r = -0.46, respectively) (Ps < 0.001), while fasting glucose and glycohemoglobin (HbA_1c) were weaker (but still significant) correlates of tHcy in non-diabetic and diabetic subjects. Fasting glucose status was not a significant independent predictor of fasting tHcy levels in non-diabetic subjects, and HbA_1c was not a significant independent predictor of tHcy in diabetic subjects (Ps > 0.05).

Conclusion

Fasting tHcy levels are elevated among non-diabetic adults with elevated fasting glucose levels, compared to persons with normal fasting glucose levels, and among diabetic adults. However, elevations in fasting tHcy appear to be mediated primarily by age and kidney function, and not by measures of glucose metabolism.     

Effects of cardiorespiratory fitness on aging: glucose trajectory in a cohort of healthy men

PurposeWe modeled the age-related trajectory of glucose and determined whether cardiorespiratory fitness altered the trajectory in a cohort of men from the Aerobics Center Longitudinal Study.MethodsA total of 10,092 men free of diagnosed diabetes, cardiovascular disease, and cancer, ages 20 to 90 years, completed from 2 to 21 health examinations between 1977 and 2005. Cardiorespiratory fitness was measured by a maximal treadmill exercise test and normalized for age. The covariates included waist circumference, hypertension, elevated cholesterol, smoking behavior, and physical activity.ResultsLinear mixed models regression analysis showed that fasting glucose increased at a linear rate with aging. Glucose increased at a yearly rate of 0.17 mg/dL (95% confidence interval: 0.16–0.19). Fitness had little influence on the aging glucose trajectory below age 35, but significantly influenced the trend after age 35 (P for interaction < .001). The aging-related glucose increases in low-fitness men (0.25 mg/dL per year) was greater than average-fitness (0.15 mg/dL per year) and high-fitness (0.13 mg/dL per year) men.ConclusionsThe aging-related fasting glucose increases in low-fitness men was nearly double that of high-fitness men. Our results may suggest that it is possible to delay the age-related glucose impairment through increasing one's fitness level.     

Plasma lactate and diabetes risk in 8045 participants of the Atherosclerosis Risk in Communities Study

PurposeDeterminants of oxidative capacity, such as fitness and level of adiposity, are strongly associated with type 2 diabetes. Whether decreased oxidative capacity itself is a cause or consequence of insulin resistance and diabetes is unknown.MethodsWe examined the association of plasma lactate, a marker of oxidative capacity, with incident diabetes in 8045 participants from the Atherosclerosis Risk in Communities (ARIC) Study with no history of subclinical or diagnosed diabetes at baseline (1996–1998). Incident diabetes was self-reported during annual telephone calls.ResultsDuring a median follow-up of 12 years, there were 1513 new cases of diabetes. In Cox proportional hazards models, baseline plasma lactate (per 10 mg/dL) was significantly associated with diabetes (hazard ratio, 1.20; 95% confidence interval, 1.01–1.43), even after adjustment for diabetes risk factors, fasting glucose, and insulin. The upper quartile of baseline lactate (≥8.1 mg/dL) was also significantly associated with diabetes risk (hazard ratio, 1.20; 95% confidence interval, 1.02–1.41) compared with the lowest quartile (≤5.1 mg/dL). Significant associations persisted among persons without insulin resistance (homeostatic model assessment insulin resistance index < 2.6 U) (P-trend < .01).ConclusionsThese findings suggest that low oxidative capacity may precede diabetes. Future studies should evaluate the physiological origins of elevated lactate to better understand its possible role in the pathogenesis of diabetes.     

Dietary Iron Intake and Risk of Endometrial Cancer: A Population-Based Case-Control Study in Shanghai,China

Dietary red meat and animal fat have been linked to endometrial cancer (EC) risk, but the impact of bioavailable iron in animal-derived foods has been less well studied. Our objective was to investigate the effects of iron and fats on the risk of EC in a large, population-based, case-control study. The Shanghai Endometrial Cancer Study enrolled 1,204 EC cases and 1,212 controls who completed in-person interviews, including a food frequency questionnaire. Animal-derived iron and fat intakes were calculated from dietary intakes and food composition tables. Logistic regression models were used to evaluate independent and joint effects of iron and fat on EC risk. Animal-derived iron intake was positively associated with EC risk [adjusted OR = 1.9; 95% CI = 1.4–2.7, P _trend < 0.01, highest vs. lowest quartile], predominantly after menopause (OR = 2.2; 95%CI = 1.4–3.4, P _trend < 0.01) and in women with BMI ≥ 25 kg/m ² (OR = 3.2; 95% CI = 1.4–7.5 in postmenopausal obese women, P _trend < 0.01). Animal-derived fat was also associated with postmenopausal EC risk (OR = 1.7; 95% CI = 1.2–2.5, P _trend < 0.01). Multiplicative interactions between animal-derived iron and BMI or animal-derived fat intake were not observed. Animal-derived iron intake is associated with increased risk of EC after menopause and among obese women. Avoidance of animal-derived (heme) iron may reduce the risk of EC in these women.     

Improving Glucose Homeostasis after Parathyroidectomy for Normocalcemic Primary Hyperparathyroidism with Co-Existing Prediabetes

We have previously described increased fasting plasma glucose levels in patients with normocalcemic primary hyperparathyroidism (NPHPT) and co-existing prediabetes, compared to prediabetes per se. This study evaluated the effect of parathyroidectomy (PTx) (Group A), versus conservative follow-up (Group B), in a small cohort of patients with co-existing NPHPT and prediabetes. Sixteen patients were categorized in each group. Glycemic parameters (levels of fasting glucose (fGlu), glycosylated hemoglobin (HbA1c), and fasting insulin (fIns)), the homeostasis model assessment for estimating insulin secretion (HOMA-B) and resistance (HOMA-IR), and a 75-g oral glucose tolerance test were evaluated at baseline and after 32 weeks for both groups. Measurements at baseline were not significantly different between Groups A and B, respectively: fGlu (119.4 ± 2.8 vs. 118.2 ± 1.8 mg/dL, p = 0.451), HbA_1c (5.84 ± 0.3 %vs. 5.86 ± 0.4%, p = 0.411), HOMA-IR (3.1 ± 1.2 vs. 2.9 ± 0.2, p = 0.213), HOMA-B (112.9 ± 31.8 vs. 116.9 ± 21.0%, p = 0.312), fIns (11.0 ± 2.3 vs. 12.8 ± 1.4 μIU/mL, p = 0.731), and 2-h post-load glucose concentrations (163.2 ± 3.2 vs. 167.2 ± 3.2 mg/dL, p = 0.371). fGlu levels demonstrated a positive correlation with PTH concentrations for both groups (Group A, rho = 0.374, p = 0.005, and Group B, rho = 0.359, p = 0.008). At the end of follow-up, Group A demonstrated significant improvements after PTx compared to the baseline: fGlu ((119.4 ± 2.8 vs. 111.2 ± 1.9 mg/dL, p = 0.021) (−8.2 ± 0.6 mg/dL)), and 2-h post-load glucose concentrations ((163.2 ± 3.2 vs. 144.4 ± 3.2 mg/dL, p = 0.041), (−18.8 ± 0.3 mg/dL)). For Group B, results demonstrated non-significant differences: fGlu ((118.2 ± 1.8 vs. 117.6 ± 2.3 mg/dL, p = 0.031), (−0.6 ± 0.2 mg/dL)), and 2-h post-load glucose concentrations ((167.2 ± 2.7 vs. 176.2 ± 3.2 mg/dL, p = 0.781), (+9.0 ± 0.8 mg/dL)). We conclude that PTx for individuals with NPHPT and prediabetes may improve their glucose homeostasis when compared with conservative follow-up, after 8 months of follow-up.     

The effects of folate supplementation on glucose metabolism and risk of type 2 diabetes: a systematic review and meta-analysis of randomized controlled trials

Purpose: Observationally, homocysteine is associated with higher risk of diabetes. Folate, which reduces homocysteine, is promising for the prevention and treatment of diabetes. Previous meta-analysis of three trials suggested folate might lower hemoglobin A_1c (HbA_1c). Methods: An updated systematic review and meta-analysis of placebo-controlled randomized trials was conducted. We searched PubMed using (“folate” or “folic acid”) and trial and (“glucose” or “diabetes” or “insulin” or “hemoglobin A_1c” or “HbA_1c”) in any field until February 3, 2017. We also conducted a bibliographic search of selected studies and relevant reviews. Relative risk of diabetes and mean differences in indicators of glucose metabolism between folate and placebo were summarized in a meta-analysis using inverse variance weighting with random effects. Heterogeneity, publication bias, and risk of bias were also assessed. Results: Eighteen trials of 21,081 people with/without diabetes were identified. Folate decreased fasting glucose (?0.15 mmol/L, 95% confidence interval [CI] ?0.29 to ?0.01), homeostatic model assessment–insulin resistance (?0.83, 95% CI ?1.31 to ?0.34), and insulin (?1.94 μIU/mL, 95% CI ?3.28 to ?0.61) but had no clear effect on diabetes or HbA_1c. Conclusions: Our study suggests a potential benefit of folate on insulin resistance and glycemic control; the latter requires examination in more high-quality trials.     

Randomized Placebo-Controlled Trial of Guava Juice as a Source of Ascorbic Acid to Reduce Iron Deficiency in Tarahumara Indigenous Schoolchildren of Northern Mexico

Objective: Assess the efficacy of a 10-week consumption of guava juice on the iron status of children with mild iron deficiency anemia.

Methods: Ninety-five boarding school children aged 6–9 years identified as anemic were randomly allocated to receive 300 mL of natural guava juice containing ～200 mg of ascorbic acid (AA) or placebo (guava-flavored juice free of AA) with the main meal (5 d/wk). Information about dietary intake was collected at weeks 3, 5, and 7 at school and household levels. Changes in hemoglobin (Hb) and plasma ferritin (PF) among the subsample iron deficient at baseline (n = 33) were the main outcomes.

Results: Iron and phytic acid intakes at school and at home did not differ between groups. Baseline Hb and PF were 11.9 ± 0.5 g/dL and 8.2 ± 3.6 ng/mL for the guava, and 11.4 ± 1.1 g/dL and 7.4 ± 4.6 ng/mL for the placebo group (Hb: p = 0.08; PF: p = 0.31); at week 10 of the study, corresponding values were 13.1 ± 0.9 g/dL and 17.9 ± 10.3 ng/mL (n = 16), and 12.3 ± 1.3 g/dL and 15.4 ± 5.8 ng/mL (n = 12) (Hb: p = 0.05; PF: p = 0.21). With analysis of variance (ANOVA) for repeated measures, the guava group had 0.64 g/dL higher Hb (CI₉₅, 0.18–1.11; p = 0.01) and 2.47 ng/mL higher PF (CI₉₅, ?1.04 to 5.98; p = 0.12) compared with the placebo group.

Conclusion: Guava juice providing 200 mg AA at one meal on each school day had a marginal effect on Hb and PF concentrations in children consuming high-phytate diets fortified with iron.     

Soy isoflavone supplementation could reduce body weight and improve glucose metabolism in non-Asian postmenopausal women—A meta-analysis

ObjectiveThe objective of this study was to conduct a systematic review and a meta-analysis to confirm the effects of soy isoflavone supplementation on body weight, fasting glucose, and insulin level in non-Asian postmenopausal women.MethodsWe searched the PubMed, EMBASE, and Cochrane databases up to October 2010 for randomized controlled trials regarding the effects of isoflavone supplementation on body weight, fasting glucose, and insulin level. Pooled estimates and 95% confidence intervals (CIs) were calculated by the fixed-and-random-effects model.ResultsNine studies with 528 participants for body weight, 11 studies with 1182 participants for fasting glucose, and 11 studies with 1142 participants for fasting insulin were included, respectively. Significant reductions were found in body weight [weighted mean difference (WMD), ?0.515; 95%CI: ?0.895 to ?0.134; P = 0.008), glucose level (WMD, ?0.189; 95%CI: ?0.344 to ?0.033), and fasting insulin level (WMD, ?0.940; 95%CI: ?1.721 to ?0.159) with soy isoflavone supplementation compared with placebo control group in non-Asian postmenopausal women after adjusted by unpublished studies. Furthermore, isoflavone supplementation in shorter duration (<6 mo) could significantly reduce body weight (WMD, ?0.506; 95%CI: ?0.888 to ?0.124; P = 0.009) and longer duration (≥6 mo) could significantly reduce blood glucose in postmenopausal women (WMD, ?0.270; 95%CI: ?0.430 to ?0.110; P = 0.001). Meanwhile, more reduction in body weight was observed in the lower dose subgroup (dose < 100 mg). Moreover, it is more effective to reduce body weight and fasting insulin level with soy isoflavone supplementation in normal weight (body mass index < 30) than obese (body mass index ≥ 30) women.ConclusionsThis meta-analysis showed soy isoflavone supplementation could be beneficial for body weight reduction, glucose, and insulin control in plasma. Large and well-designed studies are recommended to confirm this conclusion.     

Effect of zinc supplementation on blood sugar control in the overweight and obese population: A systematic review and meta-analysis of randomized controlled trials

BackgroundAlthough overweight and obese people have a higher risk of type 2 diabetes incidence than normal-weight individuals, the efficacy of zinc supplementation in blood sugar control in overweight and obese people remained unknown. This meta-analysis attempted to address this issue.MethodsDatabases including PubMed, Embase, and the Cochrane Library were searched from inception until May 2022 to identify randomized controlled trials (RCTs) investigating the effects of zinc supplementation among participants who were overweight or obese without language restriction. It is a random-effect meta-analysis that analyzed the impact of zinc supplementation on fasting glucose (FG) (i.e., primary outcome) and other variables including fasting insulin (FI), homeostasis model assessment-insulin resistance index (HOMA-IR), glycated hemoglobin (HbA1c), high-sensitivity C-reactive protein (hs-CRP), and 2-hour postprandial glucose (2 h- PG).ResultsAnalysis of 12 eligible RCTs involving 651 overweight/obese participants demonstrated that zinc supplementation significantly improves FG (weighted mean difference [WMD]: −8.57 mg/dL; 95% confidence interval [CI]: −14.04 to −3.09 mg/dL, p = 0.002), HOMA-IR (WMD: −0.54; 95% CI: −0.78 to −0.30, p < 0.001), HbA1c (WMD: −0.25%; 95% CI: −0.43% to −0.07%, p = 0.006), and 2 h-PG (WMD: −18.42 mg/dL; 95% CI: −25.04 to −11.79 mg/dL, p < 0.001) compared to those in the control group. After conducting subgroup analyses, we found that the primary outcome, FG, showed more significant results in the subgroups with Asia, Zinc supplementation alone, higher dose (≥30 mg) and patients with diabetes.ConclusionOur meta-analysis indicated that zinc supplementation benefits blood sugar control in overweight and obese populations, with an especially significant reduction in FG.     

Association of fructose consumption and components of metabolic syndrome in human studies: A systematic review and meta-analysis

ObjectiveThe aim of this study was to review the current corpus of human studies to determine the association of various doses and durations of fructose consumption on metabolic syndrome.MethodsWe searched human studies in PubMed, Scopus, Ovid, ISI Web of Science, Cochrane library, and Google Scholar databases. We searched for the following keywords in each paper: metabolic syndrome x, insulin resistance, blood glucose, blood sugar, fasting blood sugar, triglycerides, lipoproteins, HDL, cholesterol, LDL, blood pressure, mean arterial pressure, systolic blood pressure, diastolic blood pressure, hypertens*, waist circumference, and fructose, sucrose, high-fructose corn syrup, or sugar.ResultsOverall, 3102 articles were gathered. We excluded studies on natural fructose content of foods, non-clinical trials, and trials in which fructose was recommended exclusively as sucrose or high-fructose corn syrup. Overall, 3069 articles were excluded. After review by independent reviewers, 15 studies were included in the meta-analysis. Fructose consumption was positively associated with increased fasting blood sugar (FBS; summary mean difference, 0.307; 95% confidence interval [CI], 0.149–0.465; P = 0.002), elevated triglycerides (TG; 0.275; 95% CI, 0.014–0.408; P = 0.002); and elevated systolic blood pressure (SBP; 0.297; 95% CI, 0.144–0.451; P = 0.002). The corresponding figure was inverse for high-density lipoprotein (HDL) cholesterol (−0.267; 95% CI, −0.406 to −0.128; P = 0.001). Significant heterogeneity existed between studies, except for FBS. After excluding studies that led to the highest effect on the heterogeneity test, the association between fructose consumption and TG, SBP, and HDL became non-significant. The results did not show any evidence of publication bias. No missing studies were identified with the trim-and-fill method.ConclusionFructose consumption from industrialized foods has significant effects on most components of metabolic syndrome.     

Protein Supplementation Increases Muscle Mass Gain During Prolonged Resistance-Type Exercise Training in Frail Elderly People: A Randomized,Double-Blind,Placebo-Controlled Trial

ObjectivesProtein supplementation has been proposed as an effective dietary strategy to augment the skeletal muscle adaptive response to prolonged resistance-type exercise training in elderly people. Our objective was to assess the impact of protein supplementation on muscle mass, strength, and physical performance during prolonged resistance-type exercise training in frail elderly men and women.Design/setting/participantsA randomized, double-blind, placebo-controlled trial with 2 arms in parallel among 62 frail elderly subjects (78 ± 1 year). These elderly subjects participated in a progressive resistance-type exercise training program (2 sessions per week for 24 weeks) during which they were supplemented twice daily with either protein (2 1 15 g) or a placebo.MeasurementsLean body mass (DXA), strength (1-RM), and physical performance (SPPB) were assessed at baseline, and after 12 and 24 weeks of intervention.ResultsLean body mass increased from 47.2 kg (95% CI, 43.5–50.9) to 48.5 kg (95% CI, 44.8–52.1) in the protein group and did not change in the placebo group (from 45.7 kg, 95% CI, 42.1–49.2 to 45.4 kg, 95% CI, 41.8–48.9) following the intervention (P value for treatment × time interaction = .006). Strength and physical performance improved significantly in both groups (P = .000) with no interaction effect of dietary protein supplementation.ConclusionsProlonged resistance-type exercise training represents an effective strategy to improve strength and physical performance in frail elderly people. Dietary protein supplementation is required to allow muscle mass gain during exercise training in frail elderly people. Trial Registration: clinicaltrials.gov identifier: NCT01110369.     

Association Between the Hypertriglyceridemic Waist Phenotype,Prediabetes, and Diabetes Mellitus Among Adults in Puerto Rico

This study assessed the association of the hypertriglyceridemic waist (HTGW) phenotype with prediabetes and diabetes (DM) in a group of Hispanics. Analysis of a cross-sectional study of 858 adults residing in Puerto Rico that collected data on blood pressure, biochemical, and anthropometric measurements was performed. HTGW phenotype was defined as elevated triglycerides and elevated waist circumference. Prediabetes was defined as a fasting glucose of 100–125 mg/dL and DM as a fasting glucose ≥126 mg/dL or prior diagnosis. Prevalence of HTGW, prediabetes, and DM was 27.9, 38.0, and 21.6 %, respectively. Subjects with the HTGW phenotype had higher adjusted odds of prediabetes (POR 5.55; 95 % CI 3.38–9.13) and DM (POR 7.28; 95 % CI 3.63–14.63) compared to those without the phenotype. The association for prediabetes was stronger for women than among men. HTGW phenotype was strongly associated with prediabetes and DM, reinforcing the need to further assess its performance as a screening tool to identify at-risk individuals for cardiometabolic conditions.     

Health services utilization associated with cognitive impairment and dementia in older patients undergoing post-acute rehabilitation

ObjectiveTo investigate the relationship between levels of cognitive impairment and health services utilization in older patients undergoing post-acute rehabilitation.DesignCross-sectional study.SettingPost-acute rehabilitation facility.ParticipantsPatients (N = 1764) aged 70 years and older admitted over 3 years.MeasurementsSociodemographic, medical, and functional data were collected upon admission. Based on discharge diagnoses, patients were classified as cognitively intact, cognitively impaired with no dementia (CIND), and demented.ResultsDementia and CIND were diagnosed in 425 (24.1%) and 301 (17.1%) patients, respectively. Gradients from cognitively intact to cognitively impaired to demented patients were observed in median length of stay (19, 22, and 25 days, P < .001), and institutionalization rates at discharge (4.2%, 7.6%, and 28.8%, P < .001). Among patients discharged home, similar gradients were observed in utilization of home care (68.2%, 79.7%, and 83.3%, P < .001) and day care (3.1%, 7.1%, and 14.3%, P < .001). After adjustment, compared with cognitively intact patients, only those with dementia still had longer stays (+2.7 days) and increased odds of institutionalization (adjOR 6.1, 95% CI 4.0–9.3, P < .001). Among patients discharged home, use of home and day care remained higher in those with dementia (adjOR 1.8, 95% CI 1.2–2.7, P = .005, and adjOR 1.8, 95% CI 1.2–2.7, P = .005, respectively), while CIND patients had higher odds of using home care (adjOR 1.6, 95% CI 1.1–2.4, P = .028).ConclusionAmong patients undergoing post-acute rehabilitation, those with dementia had increased use of both institutional and community care, whereas those with CIND had increased use of home care services only. Future studies should investigate specific strategies susceptible to reduce the related burden on health care systems.     

Sociodemographic,clinical, and psychological factors associated with attrition in a prospective study of cardiovascular prevention: the Heart Strategies Concentrating on Risk Evaluation study

PurposeTo identify factors associated with attrition in a longitudinal study of cardiovascular prevention.MethodsDemographic, clinical, and psychosocial variables potentially associated with attrition were investigated in 1841 subjects enrolled in the southwestern Pennsylvania Heart Strategies Concentrating on Risk Evaluation study. Attrition was defined as study withdrawal, loss to follow-up, or missing 50% or more of study visits.ResultsOver 4 years of follow-up, 291 subjects (15.8%) met criteria for attrition. In multivariable regression models, factors that were independently associated with attrition were black race (odds ratio [OR], 2.21; 95% confidence interval [CI], 1.55–3.16; P < .001), younger age (OR per 5-year increment, 0.88; 95% CI, 0.79–0.99; P < .05), male gender (OR, 1.79; 95% CI, 1.27–2.54; P < .05), no health insurance (OR, 2.04; 95% CI, 1.20–3.47; P < .05), obesity (OR, 1.80; 95% CI, 1.07–3.02; P < .05), CES-D depression score 16 or higher (OR, 2.02; 95% CI, 1.29–3.19; P < .05), and higher ongoing life events questionnaire score (OR, 1.09; 95% CI, 1.04–1.13; P < .001). Having a spouse/partner participating in the study was associated with lower odds of attrition (OR, 0.60; 95% CI, 0.37–0.97; P < .05). A synergistic interaction was identified between black race and depression.ConclusionsAttrition over 4 years was influenced by sociodemographic, clinical, and psychological factors that can be readily identified at study entry. Recruitment and retention strategies targeting these factors may improve participant follow-up in longitudinal cardiovascular prevention studies.     

Prognostic association of HbA1c and fasting plasma glucose with reduced kidney function in subjects with and without diabetes mellitus. Results from a population-based cohort study from Germany

Objective

To determine the risk for incident reduced kidney function (RKF) of subjects with pre-diabetes (impaired fasting glucose (IFG, 5.6–6.9 mmol/L)) or HbA_1c-defined pre-diabetes (5.7%–6.4%) and to determine dose–response relationships of fasting glucose and HbA_1c with RKF in subjects with manifest diabetes mellitus.

Method

In a German population-based cohort, recruited 2000–2002 with ages 50–74 years, log-binomial regression was used to estimate relative risks (RR) with 95% confidence intervals (95%CI) and restricted cubic splines to plot dose–response relationships.

Results

During 8 years of follow-up, 678 of 3538 study participants developed primary RKF. Although RKF risk factor prevalences and RKF incidences were higher in subjects with pre-diabetes than in subjects with normal FPG and/or HbA_1c levels, an increased risk did not persist after adjusting for established cardiovascular risk factors (RR(IFG): 0.97 (95% CI: 0.75–1.25) and RR(HbA_1c-defined pre-diabetes): 1.03 (95% CI: 0.86–1.23)). In subjects with manifest diabetes, RKF risk increased linearly to a more than three-fold risk with increasing fasting glucose and HbA_1c levels (at HbA_1c > 6.4%).

Conclusion

This study provides further evidence that pre-diabetes may not directly contribute to the development of kidney disease. Subjects with pre-diabetes might nevertheless profit from preventive efforts reducing their cardiovascular risk profile because cardiovascular and kidney disease share common risk factors.     

A Softgel Dietary Supplement Containing Esterified Plant Sterols and Stanols Improves the Blood Lipid Profile of Adults with Primary Hypercholesterolemia: A Randomized,Double-Blind,Placebo-Controlled Replication Study

A well-controlled clinical trial previously demonstrated the efficacy of a novel softgel dietary supplement providing 1.8 g/day esterified plant sterols and stanols, as part of the National Cholesterol Education Program Therapeutic Lifestyle Changes diet, to improve the fasting lipid profile of men and women with primary hypercholesterolemia (fasting low-density lipoprotein [LDL] cholesterol ≥130 and <220 mg/dL [≥3.37 and <5.70 mmol/L]). The purpose of this randomized, double blind, placebo-controlled crossover study (conducted July 2011 to January 2012) was to support these previous findings in a similar, but independent, sample with a different lead investigator and research site. Repeated measures analysis of covariance was used to compare outcomes for sterol/stanol and placebo treatment conditions using the baseline value as a covariate. Forty-nine subjects were screened and 30 (8 men and 22 women) were randomized to treatment (all completed the trial). Baseline (mean±standard error of the mean) plasma lipid concentrations were: total cholesterol 236.6±4.2 mg/dL (6.11±0.11 mmol/L), high-density lipoprotein (HDL) cholesterol 56.8±3.0 mg/dL (1.47±0.08 mmol/L), LDL cholesterol 151.6±3.3 mg/dL (3.92±0.09 mmol/L), non-HDL cholesterol 179.7±4.6 mg/dL (4.64±0.12 mmol/L), and triglycerides 144.5±14.3 mg/dL (1.63±0.16 mmol/L). Mean placebo-adjusted reductions in plasma lipid levels were significant (P<0.01) for LDL cholesterol (–4.3%), non-HDL cholesterol (–4.1%), and total cholesterol (–3.5%), but not for triglycerides or HDL cholesterol. These results support the efficacy of 1.8 g/day esterified plant sterols/stanols in softgel capsules, administered as an adjunct to the National Cholesterol Education Program Therapeutic Lifestyle Changes diet, to augment reductions in atherogenic lipid levels in individuals with hypercholesterolemia.     

Effect of Dietary Acetic Acid Supplementation on Plasma Glucose,Lipid Profiles,and Body Mass Index in Human Adults: A Systematic Review and Meta-analysis

BackgroundAcetic acid is a short-chain fatty acid that has demonstrated biomedical potential as a dietary therapeutic agent for the management of chronic and metabolic illness comorbidities. In human beings, its consumption may improve glucose regulation and insulin sensitivity in individuals with cardiometabolic conditions and type 2 diabetes mellitus. Published clinical trial evidence evaluating its sustained supplementation effects on metabolic outcomes is inconsistent.ObjectiveThis systematic review and meta-analysis summarized available evidence on potential therapeutic effects of dietary acetic acid supplementation via consumption of acetic acid–rich beverages and food sources on metabolic and anthropometric outcomes.MethodsA systematic search was conducted in Medline, Scopus, EMBASE, CINAHL Plus, and Web of Science from database inception until October 2020. Randomized controlled trials conducted in adults evaluating the effect of dietary acetic acid supplementation for a minimum of 1 week were included. Meta-analyses were performed using a random-effects model on fasting blood glucose (FBG), triacylglycerol (TAG), high-density lipoprotein (HDL), low-density lipoprotein (LDL), glycated hemoglobin (HbA1c), body mass index (BMI), and body fat percentage. Statistical heterogeneity was assessed by calculation of Q and I² statistics, and publication bias was assessed by calculation of Egger’s regression asymmetry and Begg’s test.ResultsSixteen studies were included, involving 910 participants who consumed between 750 and 3600 mg acetic acid daily in interventions lasting an average of 8 weeks. Dietary acetic acid supplementation resulted in significant reductions in TAG concentrations in overweight and obese but otherwise healthy individuals (mean difference [MD] = −20.51 mg/dL [95% confidence intervals = −32.98, −8.04], P = .001) and people with type 2 diabetes (MD = −7.37 mg/dL [−10.15, −4.59], P < .001). Additionally, acetic acid supplementation significantly reduced FBG levels (MD = −35.73 mg/dL [−63.79, −7.67], P = .01) in subjects with type 2 diabetes compared with placebo and low-dose comparators. No other changes were seen for other metabolic or anthropometric outcomes assessed. Five of the 16 studies did not specify the dose of acetic acid delivered, and no studies measured blood acetate concentrations. Only one study controlled for background acetic acid-rich food consumption during intervention periods. Most studies had an unclear or high risk of bias.ConclusionSupplementation with dietary acetic acid is well tolerated, has no adverse side effects, and has clinical potential to reduce plasma TAG and FBG concentrations in individuals with type 2 diabetes, and to reduce TAG levels in people who are overweight or obese. No significant effects of dietary acetic acid consumption were seen on HbA1c, HDL, or anthropometric markers. High-quality, longer-term studies in larger cohorts are required to confirm whether dietary acetic acid can act as an adjuvant therapeutic agent in metabolic comorbidities management.     

Improved safety with intravenous insulin therapy for critically ill patients with renal failure

ObjectiveThe aim of this study was to evaluate the safety and efficacy of a new intravenous (IV) regular human insulin infusion (RHI) algorithm for glycemic control in critically ill patients with renal failure.MethodsAdult trauma patients with renal failure who received a new RHI algorithm were compared with those who received the discontinued RHI algorithm (historical control). Target blood glucose (BG) concentration was 70 to 149 mg/dL (3.9–8.3 mmol/L). Patients were evaluated for 7 d while receiving the RHI infusion and continuous enteral or parenteral nutrition.ResultsMean BG was higher for the new RHI algorithm group (n = 25) compared with control (n = 21): 145 ± 10 mg/dL or 8.1 ± 0.6 mmol/L versus 133 ± 14 mg/dL or 7.4 ± 0.8 mmol/L (P = 0.001). The new RHI algorithm resulted in less time within the target BG range (11.9 ± 2.5 h/d versus 16.1 ± 3.3 h/d; P = 0.001); however, BGs were within 70 to 179 mg/dL (or 3.9–10 mmol/L) for 16.3 ± 2.6 h/d. The proportion of patients who experienced an episode of moderate hypoglycemia (BG 40–60 mg/dL or 2.2–3.3 mmol/L) or severe hypoglycemia (BG < 40 mg/dL or 2.2 mmol/L) was decreased (32% versus 76%; P = 0.001) and eliminated (0% versus 29%, P = 0.006), respectively.ConclusionsThe new RHI algorithm improved patient safety by decreasing the prevalence of moderate hypoglycemia and eliminating severe hypoglycemia. The duration of glycemic control within the target BG range was decreased, but acceptable within a higher target BG ceiling.     

Predictors of Insulin Requirements Among Hospitalized Adults Receiving Parenteral Nutrition

Objective: The objective of this quality improvement project was to determine factors predictive of parenteral nutrition (PN) insulin therapy. Methods: Patients receiving PN at a tertiary care academic medical center between January 1, 2009, and December 1, 2012, 18 years or older were included. Variables collected included demographics, medical information, and PN‐specific data. χ² and Student t tests were used to determine differences between patients who did and did not require PN insulin. Odds ratios (ORs) with 95% confidence intervals (CIs) were used to determine associations between characteristics. Stepwise forward logistic regression was used determine the best predictors of PN insulin. Results: A total of 1388 patients were started on PN. After adjusting for potential confounders, strong associations existed between PN insulin requirements and diabetes mellitus (DM) diagnosis (OR, 8.90; 95% CI, 4.98–15.90, P < .001), overweight/obese status (body mass index ≥25.0 kg/m²) (OR, 2.12; 95% CI, 1.04–4.30, P = .04), intensive care unit (ICU) admission (OR, 1.79; 95% CI, 1.03–3.11, P = .04), blood glucose (BG) on day of PN start >120 mg/dL (OR, 2.32; 95% CI, 1.32–4.05, P = .003), mean BG >180 mg/dL while receiving PN (OR, 6.10; 95% CI, 2.18–17.04, P = .001), and hemoglobin A1c (A1c) ≥5.7% (OR, 3.18; 95% CI, 1.84–5.50, P < .001). Among variables available at PN initiation, DM diagnosis (P < .001), A1c ≥5.7% (P < .001), BG >120 mg/dL on PN start day (P < .001), and ICU admission (P < .001) predicted the need for PN insulin.