Polyunsaturated fatty acids balance affects platelet NOX2 activity in patients with liver cirrhosis

BackgroundNADPH-oxidase-2 up-regulation has been suggested in liver damage perpetuation via an oxidative stress-mediated mechanism. n-6/n-3 polyunsaturated fatty acids ratio derangement has been reported in liver disease.AimTo explore polyunsaturated fatty acids balance and its interplay with platelet oxidative stress in liver cirrhosis.MethodsA cross-sectional study in 51 cirrhotic patients and sex- and age-matched controls was performed. Serum polyunsaturated fatty acids and oxidative stress markers (urinary isoprostanes and serum soluble NADPH-oxidase-2-derived peptide) were measured. The effect on platelet oxidative stress of n-6/n-3 polyunsaturated fatty acids ratio in vitro and in vivo (1-week supplementation with 3 g/daily n-3-polyunsaturated fatty acids) was tested.ResultsCompared to controls, cirrhotic patients had significantly higher n-6/n-3 polyunsaturated fatty acids ratio. n-6/n-3 polyunsaturated fatty acids ratio correlated significantly with disease severity and oxidative stress markers. In vitro experiments showed that in Child–Pugh C patients’ platelets incubation with low n-6/n-3 polyunsaturated fatty acids ratio resulted in dose-dependent decrease of radical oxigen species (−39%), isoprostanes (−25%) and NADPH-oxidase-2 regulation (−51%). n-3 polyunsaturated fatty acids supplemented patients showed significant oxidative stress indexes reduction.ConclusionsIn cirrhosis, n-6/n-3 polyunsaturated fatty acids imbalance up-regulates platelet NADPH-oxidase-2 with ensuing oxidative stress. Further study to evaluate if n-3 supplementation may reduce disease progression is warranted.     

Polyunsaturated fatty acids and their effects on cardiovascular disease

Dietary polyunsaturated fatty acids (PUFAs) affect a wide variety of physiological processes. Much attention has been given to the n-3 PUFAs and their role in the prevention and treatment of cardiovascular disease, stemming from evidence obtained through a number of epidemiological studies and clinical trials. Investigators are now focused on elucidating the pathways and mechanisms for the biological action of n-3 PUFAs. Dietary intervention is recognized as a key measure in patient therapy and in the maintenance of human health in general. This review provides a summary of several important clinical trials, and while the exact modes of action of n-3 PUFA are not known, current viewpoints regarding the mechanisms of these fatty acids on atherosclerosis, circulating lipid profile, cell membranes, cell proliferation, platelet aggregation and cardiac arrhythmias are discussed.     

Plasma fatty acids and lipoproteins in type 2 diabetic patients

BACKGROUND: The dyslipidemia of type 2 diabetic patients is characterized by high VLDL, abnormal LDL composition and low HDL cholesterol concentrations. The aim of this study was to establish whether the type of dietary fats affects LDL size and density and HDL cholesterol concentrations in these patients. METHODS: Plasma phospholipid fatty acid composition, which reflects the type of dietary fatty acids, was quantified by gas chromatography. LDL relative flotation (LDL-Rf), a measure of LDL particle size and density, was determined by single vertical spin density gradient ultracentrifugation in 97 type 2 diabetic patients. RESULTS: By linear regression analysis of the data, plasma fatty acids were associated neither with LDL-cholesterol levels nor with LDL-Rf. The HDL cholesterol concentrations were negatively related with saturated fatty acids (r = -0.23; p = 0.02) but positively related with monounsaturated fatty acids (r = +0.20; p = 0.00). Furthermore, higher HDL concentrations were associated with large and buoyant LDL particles (HDL cholesterol vs LDL-Rf: r = +0.47; p = 0.00). In the multiple regression analysis, the LDL-Rf was significantly related both to triglycerides (beta coefficient = -0.55, p = 0.000) and HDL cholesterol (beta coefficient = 0.19, p = 0.034) concentrations. In a stepwise regression analysis including both triglycerides and HDL cholesterol, triglycerides alone explained the 43.0% of the LDL-Rf variability. CONCLUSIONS: A reduction of the dietary saturated fats and an increment of monounsaturated fats might increase HDL cholesterol concentrations in type 2 diabetic patients. Modifications of LDL composition might be expected from interventions aimed to reduce plasma triglycerides.     

Polyunsaturated omega-3 fatty acids reduce lipoprotein-associated phospholipase A2 in patients with stable angina

Background and AimsIncreased consumption of omega-3 polyunsaturated fatty acids (PUFA) together with lifestyle measures and medications is recommended for the prevention of cardiovascular diseases. However, the exact mechanisms underlying observed benefits are not well defined. To this aim, we evaluated the effects of omega-3 PUFA in stable coronary artery disease (CAD) patients undergoing percutaneous coronary intervention (PCI) on lipoprotein associated phospholipase A2 (Lp-PLA2) mass and activity and their relation to oxidized low-density lipoproteins (oxy-LDL).Methods and ResultsIn a prospective, double-blind, placebo-controlled, randomized study Lp-PLA2, oxy-LDL, myeloperoxidase and interleukin-6 were determined at baseline, 3–5 days and 30 days during administration of omega-3 PUFA 1 g/day (n = 30) or placebo (n = 24). Treatment with omega-3 PUFA resulted in reduction of Lp-PLA2 mass by 10.7%, activity by 9.3 (p = 0.026 for both) and oxy-LDL by 10.9% (p = 0.014) at 30 days, with no change in myeloperoxidase and interleukin-6. Compared with placebo, patients receiving omega-3 PUFA had lower Lp-PLA2 mass by 9.42%, activity by 9.2 (p = 0.041 for both) and oxy-LDL by 12.3% (p = 0.10) after one month, but not at 3–5 days. There were no correlations between Lp-PLA2 and both myeloperoxidase and oxy-LDL throughout the study. The multivariate model showed that only treatment with omega-3 PUFA and baseline myeloperoxidase levels were independent predictors of Lp-PLA2 mass changes at one month (R² = 0.37, P = 0.005).ConclusionsAdministration of omega-3 PUFA can decrease Lp-PLA2 in patients with stable angina undergoing PCI. This novel effect may contribute to the benefits derived from omega-3 PUF.     

Dietary supplementation with n-3 fatty acids may impair glucose homeostasis in patients with non-insulin-dependent diabetes mellitus

The effects on lipoprotein and glucose metabolism of addition of n-3 fatty acids were studied in 14 non-insulin-dependent diabetic patients who were given 10 g of MaxEPA (3 g n-3 fatty acids) or placebo (olive oil) per day in a randomized double-blind cross-over study during two consecutive 8-week periods. After MaxEPA treatment, there was a marked increase in long-chain polyunsaturated fatty acids of the n-3 series in the plasma lipid esters and in the platelet phospholipids, while the n-6 fatty acid content decreased. The very low density lipoprotein (VLDL) triglyceride concentrations decreased significantly (by 22%) on MaxEPA treatment. However, these changes were not significantly different from those observed during the placebo period. The blood glucose concentration tended to increase during MaxEPA treatment, and to decrease during the placebo period, the changes under the two regimes being significantly different (P less than 0.01). In addition, the rate constant for glucose disappearance (k value) for the intravenous insulin-tolerance test, which reflected the peripheral insulin sensitivity, tended to decrease during MaxEPA treatment and increase during administration of the placebo, there being a significant difference (P less than 0.03) between the changes during the two treatments. The reason for the observed changes in blood glucose concentration and peripheral insulin sensitivity is still unclear.     

单不饱和脂肪酸膳食通过缓解氧化应激改善糖耐量正常人群的胰岛素敏感性

20例健康受试者分别接受单不饱和脂肪酸饮食、多不饱和脂肪酸饮食、饱和脂肪酸饮食3d,单不饱和脂肪酸可以改善机体的氧化应激状态,从而改善胰岛素敏感性.     

Polyunsaturated fatty acids for the prevention of atrial fibrillation after cardiac surgery: An updated meta-analysis of randomized controlled trials

BackgroundSeveral clinical trials showed inconsistent results of the effect of polyunsaturated fatty acids (PUFA) on the incidence of post-operative atrial fibrillation (POAF). The aim of this meta-analysis is to investigate the effect of PUFA on the incidence of POAF in patients undergoing cardiac surgery.Methods and resultsPUBMED, EMBASE, Cochrane Library, and Google Scholar databases were searched for randomized controlled trials. Statistical heterogeneity was assessed using I² statistic and Cochran's Q statistic. The effect of PUFA on the incidence of POAF was presented as risk ratio (RR) with 95% confidence intervals (CIs) using a fixed effect model or random effect model depending on statistical heterogeneity. Subgroup analyses were conducted based on the baseline characteristics of patients, types of surgery, the ratio of eicosapentaenoic acid (EPA)/docosahexaenoic acid (DHA), and the quality of the studies. Eight trials with 2687 patients were included in the analysis. Treatment with PUFA had no effect on the incidence of POAF in patients undergoing cardiac surgery compared to placebo [RR 0.86; 95% CI 0.71–1.04, p = 0.110]. Subgroup analyses showed the quality of the studies, the ratio of EPA/DHA, accompanied with diabetes might impact the effect of PUFA on POAF. No evidence of publication bias was detected.ConclusionsThe present analysis suggests that treatment with PUFA preoperatively has no effect on the incidence of POAF in patients undergoing open heart surgery. However, patients with diabetes might get benefits from the treatment with PUFA preoperatively.     

Dietary polyunsaturated fatty acids may increase plasma LDL-cholesterol and plasma cholesterol concentrations in carriers of an ABCG1 gene single nucleotide polymorphism: study in two Spanish populations

Background

ABCG1 mediates cellular cholesterol transport, but there is very little known about the influence of ABCG1 polymorphisms on human plasma lipoprotein cholesterol concentrations or on the interactions of these polymorphisms with diet.

Objective

Our objective was to investigate whether interactions between PUFA intake and ABCG1 polymorphisms modulate associations with plasma total cholesterol (TC), LDL- and HDL-cholesterol in two Spanish populations.

Methods

We grounded our investigation on two general population-based studies: the Hortega study (population A) and the Pizarra study (population B). Participants included 1178 individuals (50.0% women, age range 21–85 years) and 763 individuals (66% women, age range 23–73 years) from populations A and B, respectively, without lipid lowering drugs. Subjects were genotyped for ABCG1 variants. Biochemical measurements were taken by standard procedures. Dietary intakes were estimated with a validated questionnaire.

Results

In population A, the A allele homozygotes of SNP rs4148102 had higher TC and LDLc concentrations in subjects on a high PUFA diet than did the carriers of the G allele (242.1 ± 38.9 vs. 198.0 ± 36.0 mg/dL, p = 0.003, and 149.8 ± 37.9 vs. 111.4 ± 32.1 mg/dL, p = 0.005, respectively), and significant gene–diet interactions were observed (p = 0.020 and p = 0.013, respectively). In population B, similar differences in TC and LDLc concentrations were also found in association with this SNP under a high PUFA diet (253.2 ± 24.9 vs. 197.7 ± 39.9 mg/dL, p = 0.009, and 171.8 ± 20.5 vs. 120.4 ± 34.2 mg/dL, p = 0.004, respectively), but the gene–diet interactions observed were not significant (p = 0.379 and p = 0.422, respectively). In the pooled populations, differences in the TC and LDLc concentrations increased (246.8 ± 32.9 vs. 198.0 ± 37.5, p = 6 × 10⁻⁵, and 159.0 ± 32.6 vs. 114.3 ± 33.1, p = 3 × 10⁻⁵, respectively), and significant gene–diet interactions were maintained (p = 0.006 and p = 0.003, respectively).

Conclusion

In two Spanish populations, the ABCG1 polymorphism rs4148102 was associated with variations in plasma lipoprotein cholesterol concentrations in subjects with high PUFA intakes. Carriers of the AA genotype consuming high PUFA diet showed higher plasma LDLc concentrations.     

Intravenous AICAR administration reduces hepatic glucose output and inhibits whole body lipolysis in type 2 diabetic patients

AIMS/HYPOTHESIS: The 5'-AMP-activated protein kinase (AMPK) pathway is intact in type 2 diabetic patients and is seen as a target for diabetes treatment. In this study, we aimed to assess the impact of the AMPK activator 5-aminoimidazole-4-carboxamide riboside (AICAR) on both glucose and fatty acid metabolism in vivo in type 2 diabetic patients. METHODS: Stable isotope methodology and blood and muscle biopsy sampling were applied to assess blood glucose and fatty acid kinetics following continuous i.v. infusion of AICAR (0.75 mg kg(-1) min(-1)) and/or NaCl (0.9%) in ten male type 2 diabetic patients (age 64 +/- 2 years; BMI 28 +/- 1 kg/m(2)). RESULTS: Plasma glucose rate of appearance (R (a)) was reduced following AICAR administration, while plasma glucose rate of disappearance (R (d)) was similar in the AICAR and control test. Consequently, blood glucose disposal (R (d) expressed as a percentage of R (a)) was increased following AICAR infusion (p < 0.001). Accordingly, a greater decline in plasma glucose concentration was observed following AICAR infusion (p < 0.001). Plasma NEFA R (a) and R (d) were both significantly reduced in response to AICAR infusion, and were accompanied by a significant decline in plasma NEFA concentration. Although AMPK phosphorylation in skeletal muscle was not increased, we observed a significant increase in acetyl-CoA carboxylase phosphorylation (p < 0.001). CONCLUSIONS/INTERPRETATION: The i.v. administration of AICAR reduces hepatic glucose output, thereby lowering blood glucose concentrations in vivo in type 2 diabetic patients. Furthermore, AICAR administration stimulates hepatic fatty acid oxidation and/or inhibits whole body lipolysis, thereby reducing plasma NEFA concentration.     

The effects of fatty acids on apolipoprotein B secretion by human hepatoma cells (HEP G2)

We have investigated the effect of fatty acids on the rate of apolipoprotein B (apo B) secretion by human hepatoma cells (Hep G2). When Hep G2 cells were maintained in tissue culture flasks oleic acid up to 0.4 mM increased apo B secretion in a dose-dependent manner, whereas increases in triacylglycerol (TG) were smaller and dose dependency was less evident. In the absence of oleic acid, apo B accumulating in the tissue culture medium was predominantly in lipoproteins of higher density than very low density lipoproteins (VLDL). However, when the rate of secretion was stimulated with oleic acid the apo B-containing lipoproteins became lower in density. We postulated that there was a high rate of lipolysis of newly secreted VLDL by Hep G2 cells, which would account both for the relatively smaller effect of oleic acid on TG as opposed to apo B accumulating in the culture medium and the predominance of apo B in lipoproteins of a higher density than VLDL, which became less evident when VLDL secretory rates were stimulated by oleic acid. To test this hypothesis, cultured Hep G2 cells were transferred to columns containing Cytodex beads, permitting their continuous perfusion with culture medium so that newly secreted VLDL did not remain in contact with the cells. Apo B recovered from the perfusate was largely in VLDL range lipoproteins and the TG measured in the perfusate indicated that the true secretory rate of TG-rich lipoproteins was substantially higher than had been reflected by TG accumulating in culture medium left in contact with cells. Apo B measured in the culture medium of Hep G2 cells may thus be a better reflection of VLDL secretion, even though it is contained in higher density lipoproteins due to removal of TG by lipolysis. The effects of saturated fatty acids (SFA), monounsaturated fatty acids (MUFA) and polyunsaturated fatty acids (PUFA) on apo B (apo B) secretion by Hep G2 cells maintained in tissue culture flasks were next investigated. SFA (0.4 mM), with the exception of stearic acid (C18:0), increased apo B secretion. Lauric acid (C12:0) increased apo B secretion by 32%, myristic acid (C14:0) by 41% (P<0.005), palmitic acid (C16:0) by 154% (P<0.025), and arachidic acid (C20:0) by 186% (P<0.005). The effect of MUFA (0.4 mM) was to increase apo B secretion, oleic acid (C18:1) by 239% ((P<0.0005) and palmitoleic acid (C16: 1) by 125% (P<0.005). Of the PUFA investigated, linolenic acid (C18:3) (0.4 mM) did not have any significant effect on apo B secretion, whereas linoleic acid (C18:2) (0.4mM) arachidonic acid (C20:4) (0.1 mM) and eicosapentaenoic acid (C20:5) (0.1 mM) caused significant increases of 164, 171 and 171%, respectively (P<0.005). The fatty acids studied increased intracellular TG and cholesteryl ester concentrations to varying extents. The increase in intracellular TG produced by the different fatty acids correlated with the rate of apo B secretion (r=0.6; P<0.05). In this human hepatoma cell line, with the exception of the saturated fatty acids, the rate of secretion of apo B-containing lipoproteins does not follow the same pattern as changes in circulating low density lipoprotein (LDL) concentrations reported with dietary manipulation in man. If our findings reflect the in vivo situation, we suggest that whilst the dietary effects of SFA on serum LDL may in part be determined by the hepatic apo B secretory rate, the effects of MUFA and PUFA must be largely mediated through a catabolic effect rather than an effect on hepatic secretion. The marked increase in apo B secretion with the more highly polyunsaturated fatty acids, such as eicosapentaenoic acid, may also explain why they do not lower circulating LDL, despite reports of their apparently favourable effect on LDL-receptor mediated clearance.     

Modulation of plasma cholesteryl ester transfer protein activity by unsaturated fatty acids in Tunisian type 2 diabetic women

BACKGROUND AND AIM: Type 2 diabetes mellitus is associated with atherosclerosis, which has been, in part, ascribed to abnormalities in the reverse cholesterol transport system. Among the key actors involved in this pathway is cholesteryl ester transfer protein (CETP) which mediates the transfer of cholesteryl esters (CE) from HDL to apoB-containing lipoproteins. METHODS AND RESULTS: The purpose of this study was to examine CETP activity in 220 patients with type 2 diabetes mellitus (type 2 DM) treated with diet alone or diet and sulphonylurea drugs and to identify the factors that may regulate it in the diabetic state. We also examined the effect of diet on the activity of plasma CETP in a subgroup of type 2 DM women. CETP activity was assessed by measuring plasma-mediated cholesteryl ester transfer (CET) between pooled exogenous HDL and apoB-containing lipoproteins. In 220 patients with type 2 DM, CET was significantly higher in conjunction with higher plasma triglycerides and lower HDL-cholesterol compared to 100 matched healthy controls. Correlation analysis showed that CETP activity was significantly correlated with the HDL-C to apoA1 ratio (r = -0.205, P = 0.003) and to LDL-C to HDL-C ratio in diabetic women (P = 0.010). Furthermore, CETP activity was correlated marginally with total energy intake (P = 0.052) but to a statistically significant extent with the amount of fat consumed daily (P = 0.008). A significant negative correlation was found between plasma CETP activity and MUFA of plasma phospholipids or free PUFA (P = 0.032), especially with omega3-fatty acids (P = 0.001). CONCLUSION: Our findings indicate that CET is accelerated in patients with type 2 DM and that this may be regulated by dietary fatty acids in the diabetic state.     

新诊断2型糖尿病患者血清磷脂脂肪酸谱与血脂代谢有关

探讨新诊断2型糖尿病患者血清磷脂脂肪酸谱组分与血脂的相关性.新诊断2型糖尿病患者血清饱和脂肪酸升高(48.79±1.55 vs 42.58±1.96,P<0.01),而单不饱和脂肪酸、多不饱和脂肪酸下降(10.72±1.53 vs 12.09±1.32,33.41±2.16 vs 35.79±2.41,6.08±1.66 vs 9.54v1.54,均P<0.01).     

2型糖尿病患者血浆皮质醇、游离脂肪酸水平和胰岛素抵抗

测定新诊断的 2型糖尿病患者与正常对照者空腹游离脂肪酸 (FFA )、血浆皮质醇 (F)的水平。结果显示 2型糖尿病患者的空腹FFA、F和胰岛素抵抗指数HOMA IR较对照显著升高 (均P <0 .0 1) ,F与FFA正相关、FFA与HOMA IR正相关、F与HOMA IR没有明显相关关系     

Polyunsaturated fatty acids reduce non-receptor-mediated transcellular permeation of protein across a model of intestinal epithelium in vitro

BACKGROUND: Dietary polyunsaturated fatty acids influence the natural history of intestinal inflammatory diseases. Varying the types of long-chain fatty acids that are exposed to cells alters the physicochemical properties of cell membranes. This study aimed to determine whether such variations alter transcellular and paracellular permeability in intestinal epithelium. METHODS: Monolayers of Caco-2 cells, allowed to differentiate by culturing for 7 days following confluence, were used as the model for intestinal epithelium. Paracellular permeability was assessed by measurement of transepithelial resistance, while transcellular permeability was assessed by the transepithelial flux of horseradish peroxidase. RESULTS: Exposure of the cells to 100 micromol/L of palmitic acid, oleic acid, eicosapentaenoic acid, or linoleic acid, was not toxic to cells (measured by leakage of lactate dehydrogenase), and altered cell membrane fatty acid composition (as measured by gas chromatography). Flux of horseradish peroxidase was significantly affected by 24 h fatty acid exposure (P= 0.038, ANOVA), being decreased by 23 +/- 6% (mean +/- SEM) by eicosapentaenoic acid and 25 +/- 3% by linoleic acid. Oleic acid, palmitic acid and butyrate, had no effect. Transepithelial resistance also varied significantly across the treatment groups (P< 0.001) due to a 28 +/- 5% increase induced by butyrate. The long-chain fatty acids had no effect. CONCLUSIONS: Both omega-3 and omega-6 polyunsaturated fatty acids reduce transcellular, non-receptor-mediated permeation of proteins across differentiated Caco2 cell monolayers, without altering paracellular permeability. Alteration of intestinal barrier function should be considered as a possible mechanism of action of dietary polyunsaturated fatty acids.     

Relationship of serum polyunsaturated fatty acids with cytokines in colorectal cancer

AIM: To investigate the relationship of serum levels of polyunsaturated fatty acid(PUFA) with kinds of cytokines in colorectal cancer(CRC).METHODS: Serum samples of 100 CRC patients were collected. The concentration of total n-3 PUFA which included C18:3 n-3, C20:5 n-3, C22:5 n-3, C22:6 n-3 and the total n-6 PUFA included C18:2 n-6, C18:3 n-6, C20:3 n-6, C20:4 n-6, and C22:5 n-6 were detected onGC-2010 Plus Gas Chromatograph with a Omegawax TM 250 column. Cytokines were detected by Mag Plex TM-C microspheres. P values for the trend were estimated by creating a continuous variable using the median value within quartiles.RESULTS: Interleukin-6(IL-6) showed significantly positive association with the C20:4 n-6(P for trend = 0.004). Interferon gamma(IFN-γ) showed significant positive association with the C22:5 n-3(P for trend = 0.035). IL-8 and matrix metalloproteinase-9(MMP-9) showed significant inverse association with the C22:6 n-3(P for trend = 0.049, and 0.021). MMP-2 showed significant inverse association with the C20:5 n-3(P for trend = 0.008). MMP-7 showed significantly positive association with the ratio of n-6 PUFA and n-3 PUFA(P for trend = 0.008). MMP-7 also showed significantly inverse association with the ratio of C20:4 n-6 and(n-6 PUFA + n-3 PUFA)(P for trend = 0.024). IL-10(P for trend = 0.023) and IL-6(P for trend = 0.036) showed significantly positive association with the ratio of C20:4 n-6 and C20:5 n-3.CONCLUSION: Our data suggested that serum levels of PUFA is related to the inflammation of CRC, and also play different role in regulation of immune response.     

老年2型糖尿病患者血糖控制全面评估

目的对老年2型糖尿病患者血糖控制情况进行全面评估,并探讨糖化血红蛋白（HbAlc）与血糖波动的相关性;方法选取老年糖尿病患者共284名,测定空腹血糖（FPG）、餐后2h血糖（PPG）、HbAlc水平,进一步采用动态血糖监测系统（CGMS）评估血糖波动情况。按照HbAlc水平分为两组（HbAlc≤7％组和HbAlc〈7％组）,比较两组间血糖控制水平及血糖波动情况。结果本研究中老年糖尿病患者FPG达标率为67．6％,PPG为34．9％,HbAlc为42．9％,血糖波动正常范围内的患者占28．6％,血糖波动大的患者占71．4％。两组间比较,FPG、PPG、MBG差异有统计学意义（P〈0．01）;但两组间代表血糖波动的各参数平均血糖标准差（SDBG）、最大血糖波动幅度（LAGE）、平均血糖波动幅度（MAGE）、日间血糖波动幅度（MODD）相比,差异无统计学意义（P〉0．05）。相关性分析表明,MAGE及MODD均与HbAlc水平无关（P〉0．05）。结论大多数老年糖尿病患者的血糖控制未达标,且约70％的老年糖尿病患者血糖波动大。HbAlc与血糖波动无关,HbAlc和血糖波动是评价血糖控制的独立指标。     

80岁及以上2型糖尿病患者血糖控制情况和并发症观察

目的 观察年龄80岁及以上2型糖尿病(T2DM)患者血糖控制水平、并发症及治疗方案的特点.方法 119例于2010年8月至2011年7月在我院就诊的年龄≥80岁T2DM患者,记录性别、年龄、身高、体质量、病程和基础疾病,检测糖化血红蛋白(HbA1c)、空腹C肽(FC-P)及餐后2hC肽(2 hC-P)、尿白蛋白排泄率(UAER)水平,行双下肢动脉超声多普勒、非散瞳彩色眼底照相检查,采用糖尿病神经病变评价系统评估外周神经病变.结果 119例患者根据HbA1c水平分为HbA1c＜7.0％组65例(54.6％)和HbA1c≥7.0％组54例(45.4％).HbA1c＜7.0％组和≥7.0％组患者病程、UAER、糖尿病肾病分别为(12.1±8.5)年与(16.6±7.5)年(t=3.01,P=0.003)、(20.2±11.9)μg/min与(47.0±21.4)μg/min(t=2.48,P=0.015)、23.1％(15例)与50.0％(27例)(x2=9.36,P=0.002);HbA1c ＜7.0％组FC-P和2 hC-P高于HbA1c≥7.0％组,分别为(2.1±1.2)μg/L与(1.5±1.0)μg /L(t=1.87,P=0.042)、(6.5±3.3)μg/L与(4.3±2.9)μg /L(t=2.10,P=0.037).HbA1c＜7.0％组患者应用口服降糖药的比例高,应用胰岛素的比例少(均P=0.000);口服药中α糖苷酶抑制剂使用率在两组均最高,其次为双胍类和胰岛素促泌剂,格列酮类使用率最低,但两组间同类药物使用率差异无统计学意义(均P＞0.05).症状性低血糖发病率为23.5％(28/119),其中HbA1c≥7.0％组的发病率(18例,33.3％)高于HbA1c ＜7.0％组(10例,15.4％),差异有统计学意义(x2=5.20,P=0.022),但71.4％(5/7)的低血糖昏迷患者发生于HbA1c＜7.0％组.结论 T2DM患者个体差异较大,用药应考虑老年人的特点,警惕低血糖事件.     

2型糖尿病患者应用自我血糖监测评估格列齐特缓释片减少血糖波动的研究

123例2型糖尿病患者分为格列齐特缓释片(达美康(R)MR)组、格列齐特(达美康(R))组、格列本脲组,治疗16周,同时自我血糖监测 (SMBG).3组降糖效果相似.但反映血糖波动的最高血糖最低血糖差值、反映餐后血糖波动的全天平均餐后最高血糖、餐后2 h血糖、餐后2 h胰岛素和低血糖事件,格列齐特缓释片组均明显低于格列本脲组(均P＜0.01).提示SMBG是评估血糖波动的实用方法.     

A protein-enriched low glycemic index diet with omega-3 polyunsaturated fatty acid supplementation exerts beneficial effects on metabolic control in type 2 diabetes

AimsThe current study aims to investigate practicability and effects of a combined dietary intervention with increased relative protein content supplemented with omega-3 polyunsaturated fatty acids (PUFA) on metabolic control and inflammatory parameters in a real life situation in type 2 diabetes patients.MethodsIn this observational study we advised thirty mostly obese patients with type 2 diabetes to follow a protein-enriched diet with carbohydrates of low glycemic index (low GI) and moderate fat reduction supplemented with omega-3 PUFA for 24 weeks. Primary efficacy parameter was the change in HbA1c; secondary parameters included changes in systemic inflammation (measured by ultrasensitive C-reactive protein, usCRP), body weight, waist circumference, fat mass. The study is registered at clinicaltrials.gov (NCT01474603).ResultsThe dietary intervention significantly reduced the primary efficacy variable HbA1c from a baseline value of 63 ± 11 mmol/mol to 59 ± 14 mmol/mol (P = 0.033) and 56 ± 12 mmol/mol (P = 0.001) after 12 and 24 weeks, respectively. In addition, usCRP decreased significantly at 24 weeks (P = 0.039). Waist circumference, an important indicator for cardiometabolic-risk and silent inflammation, decreased from baseline 116.0 ± 14.1 cm to 114.9 ± 13.5 cm (P = 0.019), 114.0 ± 14.4 cm (P = 0.001), and 112.7 ± 13.4 cm (P = 0.049), after 3, 12 and 24 weeks, respectively.ConclusionCounseling a protein enriched and low glycemic index diet supplemented with long-chain omega-3 PUFA in a real-life clinical setting improves glycemic control and also reduces waist circumference and silent inflammation in overweight or obese patients with type 2 diabetes.