Long-term effects of advice to consume a high-protein,low-fat diet,rather than a conventional weight-loss diet,in obese adults with Type 2 diabetes: one-year follow-up of a randomised trial

Aims/hypothesis This study compared the long-term weight loss and health outcomes at 1-year follow-up, after a 12-week intensive intervention consisting of two low-fat, weight-loss diets, which differed in protein content.Methods We randomly assigned 66 obese patients (BMI: 27–40 kg/m²) with Type 2 diabetes to either a low-protein (15% protein, 55% carbohydrate) or high-protein diet (30% protein, 40% carbohydrate) for 8 weeks of energy restriction (~6.7 MJ/day) and 4 weeks of energy balance. Subjects were asked to maintain the same dietary pattern for a further 12 months of follow-up.Results The study was completed by 38 of the subjects, with equal dropouts in each group. At Week 64, weight reductions against baseline were –2.2±1.1 kg (low protein) and –3.7±1.0 kg (high protein), p<0.01, with no diet effect. Fat mass was not different from baseline in either group. At Week 12, both diets reduced systolic and diastolic blood pressure by 6 and 3 mm Hg respectively, but blood pressure increased more with weight regain during follow-up in the low-protein group (p0.04). At Week 64, both diets significantly increased HDL cholesterol and lowered C-reactive protein concentrations. There was no difference in the urinary urea : creatinine ratio at baseline between the two groups, but this ratio increased at Week 12 (in the high-protein group only, p<0.001, diet effect), remaining stable during follow-up in both diets.Conclusions/interpretation A high-protein weight-reduction diet may in the long term have a more favourable cardiovascular risk profile than a low-protein diet with similar weight reduction in people with Type 2 diabetes.Conflict of Interest Statement. The authors have declared that there are no conflicts of interest regarding this work.     

老年高血压病患者血胰岛素水平与糖、脂代谢异常的关系

目的：探讨老年高血压患高胰岛素症与血糖、血清脂质水平的关系。方法：对86例老年高血压病患（观察组）及50例老年对照组,进行了血清甘油三酯（TG）、总胆固醇（TC）、高密度脂蛋白胆固醇（HDL－C）、低密度脂蛋白胆固醇（LDL－C）、载脂蛋白AI（Apo AI)、载脂蛋白B（Apo B)、脂蛋白（a)[Lp(a)]、空腹血糖(FPG）及胰岛素（INS）的测定。结果：观察组血清TG、LDL－C、Lp(a)、INS,FBG含量明显高于对照组;观察组血清HDL－C、Apo AI水平和胰岛素敏感性指数（ISI）明显低于对照组。结论：老年高血压病患胰岛素,血脂和血糖代谢异常的共存是该病发生、发展的危险因素,也是心、脑血管疾病的危险因素,故在降压治疗的同时,应考虑纠正其胰岛素,糖及脂代谢的异常。     

A pilot comprehensive lifestyle intervention program (CLIP) - Comparison with qualitative lifestyle advice and simvastatin on cardiovascular risk factors in overweight hypercholesterolaemic individuals

Background and Aims

Escalating costs of pharmaceuticals for cardiovascular management highlight the need to develop effective lifestyle intervention programs to reduce reliance on these agents. The aim of this pilot study was to evaluate the efficacy of a Comprehensive Lifestyle Intervention Program (CLIP) compared with qualitative lifestyle advice (L) and Simvastatin plus qualitative lifestyle (S + L) on cardiovascular risk factors.

Methods and Results

Sixty-five overweight adults with hypercholesterolemia were randomised to either L (qualitative advice on diet, exercise), S + L (20 mg/day Simvastatin plus L) or CLIP (6500 kJ structured menu plan: conventional and functional foods contributing <10% energy from saturated fat, ≥3 g soluble fibre, 2.4 g plant sterols, oily fish ≥2 times/week at lunch and dinner, plus exercise advice and self monitoring) for 6 weeks. LDL-cholesterol was lowered in CLIP (−0.57 ± 0.67 mmol/L, 15%) and S + L (−1.43 ± 0.59 mmol/L, 37%), but did not change significantly in L (−0.17 ± 0.59, 4%) (P < 0.001 time-by-treatment interaction). Weight and waist circumference were significantly lowered by CLIP (−4.2 ± 2.2 kg; −5.1 ± 2.3 cm) compared to L (−1.0 ± 1.6 kg; −2.7 ± 3.3 cm) and L + S (−0.7 ± 1.4 kg; −2.4 ± 2.3 cm), (P ≤ 0.003 time-by-treatment interactions). B-carotene levels within treatment groups did not change over time and were not lowered by the CLIP diet compared to L (P > 0.05, all). Blood pressure changes were not different between groups.

Conclusions

The structured CLIP program was more effective than qualitative lifestyle advice in improving weight, waist circumference and LDL-cholesterol without adverse effects on plasma carotenoids over a 6 week period. This program may therefore assist in comprehensive risk factor management, although the sustainability of these benefits needs confirmation.     

脂质诱导的胰岛素抵抗对大鼠糖代谢的影响

用正糖高胰岛素钳夹术估计脂质灌注大鼠胰岛素介导的外周组织和肝糖代谢。脂质组血浆游离脂肪酸明显升高 ,葡萄糖输注率明显降低 ,胰岛素对肝糖生成的抑制作用明显障碍 ,葡萄糖清除率轻度降低。脂质损害了胰岛素抗脂解和肝糖输出能力及其介导的外周葡萄糖利用     

运动对老年高血压患者血压和糖,脂代谢的影响

目的探讨运动对老年高血压患者血压和糖、脂代谢的影响。方法将４３例老年高血压患者随机分为运动组和对照组，两组均接受尼群地平降压治疗，同时运动组进行为期３个月的体育运动。测量两组入组时和３个月后血压、血脂、空腹血糖、胰岛素及负荷后１ｈ和２ｈ血糖及血胰岛素。结果经过３个月规则运动，运动组空腹及糖负荷后１ｈ、２ｈ胰岛素水平、血胆固醇、甘油三酯及低密度脂蛋白较对照组降低（Ｐ值均＜０．０５），高密度脂蛋白较对照组增高（Ｐ＜０．０５）；试验后两组血压均较入组时降低，而运动组服药量较对照组减少（Ｐ＜０．０５）。结论规则的体育运动能降低老年高血压患者空腹及糖负荷后血胰岛素水平，并有利于血脂代谢紊乱的纠正和血压的控制     

Effects of insulin sensitizers on plaque vulnerability associated with elevated lipid content in atheroma in ApoE-knockout mice

Abstract. Acute coronary syndromes are generally precipitated by rupture of lipid-laden, relatively acellular, vulnerable atherosclerotic plaques with thin fibrous caps. We investigated whether a high-fat diet alters insulin sensitivity and whether insulin sensitizers (troglitazone and rosiglitazone) alter the composition of otherwise lipidladen atherosclerotic plaques in mice deficient in apolipoprotein E (ApoE). ApoE-knockout mice were fed a high-fat (n=30) or standard chow (n=10) diet for two weeks. Thereafter, those fed the high-fat diet were treated with troglitazone (n=10), rosiglitazone (n=10) or no drug (n=10) for 16 weeks beginning at 8 weeks of age. Carbohydrate metabolism was assessed with intraperitoneal glucose tolerance tests and insulin tolerance tests. Plaque composition was characterised with confocal laser scanning microscopy. The high-fat diet induced insulin resistance in the absence of weight gain. Compared with control animals on the high-fat diet, animals given troglitazone (400 mg/kg/day) or rosiglitazone (4 mg/kg/day) had significantly less area under the curve (AUC) for insulin (p<0.05) and glucose disposal (p<0.05). Despite significant increases in insulin sensitivity with drug treatment, no change in HDL-cholesterol and triglyceride levels, nor reduction in atheroma size or lipid content was noted. Thus, improvement in insulin resistance induced by a high-fat diet in this animal model of vasculopathy did not alter plaque composition.     

老年高血压患者血清抵抗素水平的初步研究

目的　检测老年高血压患者血清抵抗素浓度 ,探讨抵抗素在老年人糖耐量降低中的意义。　方法　酶免疫测定法检测 5 5例高血压患者 (老年组 2 5例 ,非老年组 30例 )和 13例正常血压非老年者 (对照组 )的空腹血清抵抗素水平 ,口服葡萄糖耐量试验 (OGTT) ,胰岛素释放试验测定血浆葡萄糖浓度和血清胰岛素浓度 ,计算葡萄糖曲线下面积 (AUCG) ,根据Cederholm公式计算胰岛素敏感指数 (ISI)和OGTT开始 30min胰岛素和血糖变化的比值 (△I3 0 /△G3 0 ) ;测定体重指数 (BMI)及腰臀比 (WHR)。　结果　空腹血清抵抗素浓度老年组显著高于非老年组 (P <0 0 5 )和对照组 (P <0 0 5 ) ,分别为 (2 9 6± 12 4 )、(2 3 1± 8 9)和 (19 7± 5 3) μg/L ;空腹血糖 (FPG)老年组显著高于非老年组 (P <0 0 5 )和对照组 (P <0 0 5 ) ,分别为 (6 4± 1 2 )、(4 8± 0 4 )和 (4 9± 0 6 )mmol/L ;ISI老年组 (32 8± 10 8)显著低于非老年组 (4 8 8± 15 8) (P <0 0 5 ) ;△I3 0 /△G3 0 老年组 (8 6± 7 2 )显著低于非老年组 (14 0± 10 5 ) (P <0 0 5 )。年龄与抵抗素浓度呈显著正相关 ,FPG与年龄及抵抗素浓度呈显著正相关 ,年龄与ISI及△I3 0 /△G3 0 呈显著负相关 ,抵抗素浓度与ISI及△I3 0 /△G3 0 呈显著负相     

Prehypertension: an opportunity for a new public health paradigm

From 2005 to 2006, approximately 3 of 8 adults in the United States had blood pressure (BP) in the prehypertensive range of 120 to 139/80 to 89 mm Hg and roughly 1 in 8 adults had BP in the range of 130 to 139/85 to 89 mm Hg, which is referred to as high normal BP or stage 2 prehypertension. Adults with stage 2 prehypertension are also roughly twice as likely as adults with normotension to suffer cardiovascular disease. The Seventh Report of the Joint National Committee on Hypertension recommended only lifestyle changes for most prehypertensive patients. BP in the range of 120 to 129/80 to 84 mm Hg is also associated with increased risk but roughly half of that of stage 2 prehypertension.     

Treatment and control of high blood pressure in adults

Hypertension and prehypertension are major public health challenges. Prevention and control of prehypertension through lifestyle changes and the treatment of hypertension to goal blood pressure (BP) are important objectives. In most patients, 2 or more medications with complementary mechanisms of action should be used in combination. Referral for evaluation of resistant hypertension should be made when goal BP is not attained while patients are adherent on 3 or more appropriately dosed antihypertensive medications, including a diuretic. There are compelling indications for the use of specific drugs in patients with underlying ischemic heart disease, chronic heart failure, diabetes, chronic kidney disease, stroke, peripheral arterial disease, left ventricular hypertrophy, obesity, and metabolic syndrome. Adverse drug effects should be identified early and managed promptly to address patient safety and adherence. Other factors that affect adherence include the patient's health literacy level and ability to self-manage. The social, environmental, cultural, and financial sources of support in care must be addressed to achieve the full benefits of treatment and control of hypertension and prehypertension.     

Leptin receptor Gln223Arg variant is associated with a cluster of metabolic abnormalities in response to long-term overfeeding

OBJECTIVES: The role of the leptin receptor (LEPR) gene Gln223Arg polymorphism on the metabolic and body composition changes in response to overfeeding was studied. SUBJECTS: Twelve pairs of male monozygotic twins ate a 4.2 MJ day-1 energy surplus, 6 days week-1, during a period of 100 days. RESULTS: Overfeeding induced a significantly greater increase in glucose (P = 0.001 for percentage change) and insulin (P = 0.038) areas under the curve during oral glucose tolerance tests (OGTTs) in the GlnGln (n = 10) than in the GlnArg/ArgArg (n = 14) subjects. In addition, the GlnGln genotype was associated with a greater increase in plasma levels of leptin (P = 0.037) and total triglycerides (P = 0.003), as well as a greater decrease in high-density lipoprotein cholesterol (P = 0.010), than for the combined GlnArg/ArgArg genotypes. Body composition changes were not different between the genotypes. CONCLUSIONS: We conclude that the GlnGln subjects of the LEPR gene polymorphism are more susceptible to metabolic abnormalities when they are exposed to long-term positive energy balance. These findings provide new information on the genetic basis of individual differences in response to chronically elevated food intake.     

高血压病患者动脉顺应性改变及其影响因素的研究

目的 探讨高血压病(EH)患者动脉顺应性的改变及其与血压、糖代谢、脂代谢之间的关系。方法 采用美国HDI公司CVProfilorTM DO-2020型动脉弹性功能测定仪检测133例EH患者和147例正常人大动脉顺应性(C1)、小动脉顺应性(C2)、糖代谢、脂代谢,并对可能影响动脉顺应性的因素进行多元逐步回归分析与偏相关分析。结果 不同年龄与性别组中,EH患者的C1和C2均较正常对照组降低;EH患者体重指数及空腹血糖增高,胰岛素敏感指数(ISI)下降(P<0.05);EH组中脉压、脉率、体表面积(BSA)和ISI是C1的决定因素,平均动脉压、BSA、血清总胆固醇是C2的决定因素,而在正常人群中年龄与ISI是正常人群C2的决定因素。结论 动脉顺应性在EH时降低,除受血压水平影响外,还与年龄、体表面积、血糖、脂代谢等因素有关。     

高血压患者ACE基因多态性与血清ACE及血脂关系

目的探讨老年高血压病患者血管紧张素转化酶（ＡＣＥ）基因插入／缺失（Ｉ／Ｄ）多态性与其血清水平及血脂水平的关系。方法应用聚合酶链反应技术（ＰＣＲ）检测４１例正常老年人和３５例老年高血压病患者的ＡＣＥ基因型，同时测定其血脂水平，并用分光光度法检测其中２９例老年高血压病患者的血清ＡＣＥ水平。结果正常对照组与高血压病组ＡＣＥ基因型分布无显著差异。ＡＣＥ基因Ｉ／Ｄ多态性与血脂水平无关，但与ＡＣＥ血清浓度显著相关，ＤＤ基因型者血清ＡＣＥ水平最高（３７５０±１５１）Ｕ·ｍｌ－１，显著高于ＩＤ型（２３１１±３０３）Ｕ·ｍｌ－１和ＩＩ型者（２０５９±２８７）Ｕ·ｍｌ－１（Ｐ均＜００５）。结论老年高血压患者血清ＡＣＥ水平受ＡＣＥ基因型的遗传调控，ＡＣＥ基因缺失型者血清ＡＣＥ水平显著增高，这可能是缺失型与多种心血管病相关联的机制所在。     

Factors associated with the maintenance or achievement of the weight loss goal at follow-up among participants completing an adapted diabetes prevention program

Aims

This study evaluated factors associated with achievement or maintenance of a 7% weight loss goal post intervention among adults at high-risk for cardiovascular disease (CVD) and diabetes who participated in an adapted Diabetes Prevention Program (DPP) intervention.

Materials and methods

High-risk adults completed the intervention in 2008 or 2009 (N = 466). In 2010, we conducted a follow-up survey of participants to assess characteristics, behaviors and barriers associated with the maintenance or achievement of the weight loss goal.

Results

Thirty-nine percent of respondents (73/188) maintained or achieved the goal post intervention. Participants who achieved the goal were more likely to have attended more intervention sessions, and to have lost more weight during the intervention compared to participants who did not achieve the goal. Participants who achieved or maintained the goal post intervention were more likely to engage in behaviors related to weight loss maintenance.

Discussion

Our findings suggest maintenance or achievement of a weight loss goal post intervention among participants in an adapted lifestyle intervention is consistent with the original DPP. Our findings also highlight the relationship between maintaining or achieving a weight loss goal post intervention and behaviors that can be reinforced and barriers that can be mitigated.     

小檗碱对实验大鼠糖脂代谢的影响

目的探讨小檗碱对实验大鼠胰岛素敏感性和血糖血脂的影响。方法实验大鼠分7组：普食对照组和小檗碱治疗组，高脂对照组和小檗碱治疗组，高脂饮食与极小剂量链脲佐菌素(STZ)诱导的糖尿病对照组，糖尿病小檗碱治疗组和二甲双胍治疗组。疗程为5周。以糖耐量试验评估胰岛功能，以胰岛素耐量试验中的降糖率检测胰岛素敏感性。结果(1)小檗碱使糖尿病鼠的降糖率升高48％，疗效较二甲双胍为好；小檗碱使高脂鼠的胰岛素敏感因子升高78％，延缓了普食鼠降糖率的下降；(2)小檗碱显著降低了高脂大鼠的空腹血糖和负荷血糖；(3)小檗碱使普食鼠、高脂鼠和糖尿病鼠的血清游离脂肪酸分别下调14％、24％和20％，使高脂鼠的血清甘油三酯降低57％。结论小檗碱有显著的胰岛素增敏和降低血清游离脂肪酸的作用，并能降低高脂大鼠的血糖。     

Long-term follow-up of a longitudinal faculty development program in teaching skills

BACKGROUND: The long-term impact of longitudinal faculty development programs (FDPs) is not well understood. OBJECTIVE: To follow up past participants in the Johns Hopkins Faculty Development Program in Teaching Skills and members of a comparison group in an effort to describe the long-term impact of the program. DESIGN AND PARTICIPANTS: In July 2002, we surveyed all 242 participants in the program from 1987 through 2000, and 121 members of a comparison group selected by participants as they entered the program from 1988 through 1995. MEASUREMENTS: Professional characteristics, scholarly activity, teaching activity, teaching proficiency, and teaching behaviors. RESULTS: Two hundred participants (83%) and 99 nonparticipants (82%) responded. When participants and nonparticipants from 1988 to 1995 were compared, participants were more likely to have taught medical students and house officers in the last year (both P<.05). Participants rated their proficiency for giving feedback more highly (P<.05). Participants scored higher than nonparticipants for 14 out of 15 behaviors related to being learner centered, building a supportive learning environment, giving and receiving feedback, and being effective leaders, half of which were statistically significant (P<.05). When remote and recent participants from 1987 through 2000 were compared with each other, few differences were found. CONCLUSIONS: Participation in the longitudinal FDP was associated with continued teaching activities, desirable teaching behaviors, and higher self-assessments related to giving feedback and learner centeredness. Institutions should consider supporting faculty wishing to participate in FDPs in teaching skills.     

Implementation and effectiveness of a community-based health promotion program for older adults

BACKGROUND: Because preventing functional decline in older adults is a national priority and senior centers have been identified as potentially important venues for health-promotion activities, a trial of a multicomponent disability prevention program was conducted at a senior center. METHODS: One hundred older adults were recruited for a 6-month randomized clinical trial. All members of the experimental group received an exercise intervention, nutrition counseling, and a home safety assessment. Smoking and alcohol interventions were delivered to at-risk subjects. Outcome variables included the Medical Outcomes Study Short Form (SF-36) health survey, the CES-Depression scale, bed days, and restricted-activity days. RESULTS: A single study announcement resulted in a response sufficient to recruit 100 subjects. The exercise program was well received: 85% of intervention subjects completed the 6-month program and adherence was excellent, with over 90% attendance at exercise classes. After 6 months the intervention group had significantly better scores on 7 of 8 SF-36 subscales and fewer depressive symptoms than controls. CONCLUSIONS: Senior centers may be excellent sites for community-based health promotion interventions: participation and adherence rates may be acceptable, interventions can be designed that are feasible in this setting, and these interventions appear to affect health status positively. The study program improved physical and psychosocial functioning and is a promising model for preventing functional decline through activities based at senior centers.     

高血压病患者t－PA及其抑制物与胰岛素抵抗的关系

本文采用发色底物法及放免法检测了４７例老年及老年前期原发性高血压病（ＥＨ）患者和２５例健康老年人血浆组织型纤溶酶原激活物（ｔ－ＰＡ）、纤溶酶原激活的抑制因子（ＰＡＩ）、空腹血浆胰岛素（Ｉｎ）及血糖水平（Ｇ），分析了胰岛素敏感性（ＩＳ）与纤溶活性、体重指数（ＢＭＩ）、血压（ＢＰ）的相关性。结果显示：ＥＨ患者血浆ＰＡＩ活性明显高于对照组，血浆ｔ－ＰＡ活性、ＩＳ明显低于对照组；ＩＳ与ＢＭＩ、ＰＡＩ、ＢＰ呈显著负相关，与ｔ－ＰＡ呈显著正相关。提示纤溶活性异常与胰岛素抵抗共同在高血压病的发生发展中起重要作用。     

Long-term follow-up of a high-intensity exercise program in patients with rheumatoid arthritis

The aims of this study were to describe rheumatoid arthritis patients’ compliance with continued exercise after participation in a 2-year supervised high-intensity exercise program and to investigate if the initially achieved effectiveness and safety were sustained. Data were gathered by follow-up of the participants who completed the 2-year high-intensity intervention in a randomized controlled trial (Rheumatoid Arthritis Patient In Training study). Eighteen months thereafter, measurements of compliance, aerobic capacity, muscle strength, functional ability, disease activity, and radiological damage of the large joints were performed. Seventy-one patients were available for follow-up at 18 months, of whom 60 (84%) were still exercising (exercise group: EG), with average similar intensity but at a lower frequency as the initial intervention. Eleven patients (16%) reported low intensity or no exercises (no-exercise group: no-EG). Patients in the EG had better aerobic fitness and functional ability, lower disease activity, and higher attendance rate after the initial 2-year intervention. At follow-up, both groups showed a deterioration of aerobic fitness and only patients in the EG were able to behold their muscle strength gains. Functional ability, gained during the previous participation in high-intensity exercises, remained stable in both groups. Importantly, no detrimental effects on disease activity or radiological damage of the large joints were found in either group. In conclusion, the majority of the patients who participated in the 24-month high-intensity exercise program continued exercising in the ensuing 18 months. In contrast to those who did not continue exercising, they were able to preserve their gains in muscle strength without increased disease activity or progression of radiological damage.