Plasma adiponectin concentration is strongly associated with VLDL-TG catabolism in postmenopausal women

Background and aims

To investigate associations between plasma adiponectin concentration and very-low density lipoprotein-triglyceride (VLDL-TG) secretion and catabolism in postmenopausal women.

Methods and results

This cross-sectional study included 30 postmenopausal women. Plasma adiponectin concentration was measured by ELISA. Insulin sensitivity was assessed by a 2-h euglycemic-hyperinsulinemic clamp. Fasting plasma glucose (FPG) and 2-hour plasma glucose (2hPG) were measured during an oral glucose tolerance test. The calculation of VLDL-TG fractional catabolic rate (FCR) and VLDL-TG total secretion rate (TSR) were based on the monoexponential decrease of TG-[²H₅] glycerol values obtained following the administration of a ²H₅-glycerol bolus. Plasma adiponectin concentration was negatively associated with VLDL-TG TSR (r = −0.50; p = 0.005) and positively associated with VLDL-TG FCR (r = 0.54; p < 0.002). This latter association remained significant after further adjustments for insulin sensitivity, visceral adipose tissue, HDL-C, FPG and 2hPG concentrations. In a multivariate model including adiponectin, insulin sensitivity and 2hPG, plasma adiponectin level was the strongest correlate of VLDL-TG FCR.

Conclusions

Elevated plasma adiponectin concentration is associated with a favourable VLDL-TG metabolism.     

Factors contributing to the risk of cardiovascular disease reflected by plasma adiponectin: data from the coronary risk factors for atherosclerosis in women (CORA) study

Objective

An inverse association of adiponectin with coronary heart disease (CHD) has been reported, but the results are inconsistent. We used data from the CORA study to investigate into plasma concentrations of adiponectin and factors that may mediate the link to incident CHD.

Design

The CORA study is a population-based case-control study on 200 women with incident CHD and 255 age-matched controls.

Results

Plasma concentrations of adiponectin were significantly lower in women with CHD (p < 0.0001), and in women with BMI ≥25 kg/m² (p < 0.02), even more so with central obesity (WHR ≥0.85), prevalent diabetes or insulin resistance (HOMA-IR ≥3.8), or low HDL-cholesterol (<50 mg/dl), and in smokers (each p < 0.0001). Adiponectin also correlated with intake of fruit and vegetables, meat and sausage and alcohol as dietary markers of cardiovascular risk. Strikingly, the trend towards lower adiponectin concentrations with increasing BMI or waist circumference was less marked than the difference of adiponectin between CHD cases and controls. In a logistic regression model the odds ratio of adiponectin of 0.943 per 1 μg/ml (CI 0.919-0.968, p < 0.0001) for risk of CHD was progressively reduced by elevated WHR, obesity-related risk factors, smoking, and dietary parameters.

Conclusions

Plasma adiponectin indicates protection from CHD in women that is attenuated by combined effects of central obesity and dependent risk factors, parameters of nutrition and smoking. Thus, the impact of adiponectin goes beyond its relation to central adiposity, but may also reflect independent effects of lifestyle.     

Association of homocysteine with peripheral neuropathy in Chinese patients with type 2 diabetes

Aim

To explore the relationship between plasma total homocysteine concentration and diabetic neuropathy in Chinese patients with type 2 diabetes.

Methods

Chinese patients with type 2 diabetes (n = 249) were enrolled in a cross-sectional hospital based study. Diabetic neuropathy status was documented by presence of clinical signs and confirmed by electromyography. Plasma total homocysteine concentration was measured using fluorescence polarization immunoassay. Traditional risk factors for diabetic neuropathy were obtained from fasting blood samples and interviewer-questionnaire.

Results

Plasma total homocysteine levels were higher in subjects with diabetic neuropathy than without (12.8 (9.2-14.8) μmol/l vs. 8.0 (7.7-9.1) μmol/l, p = 0.005). The association of homocysteine with diabetic neuropathy was independent of major traditional risk factors for diabetic neuropathy (duration of diabetes, HbA1c) and determinants of higher homocysteine concentration (age, gender, serum folate and vitamin B12, renal status, and Biguanide use) (OR: 1.12 (1.00-1.25), p = 0.042). Furthermore, per increase of 4.0 μmol/l plasma homocysteine was related to neuropathy, after controlling for per unit increase of other factors (OR: 1.17 (0.94-1.33), p = 0.045).

Conclusion

Plasma total homocysteine concentration was independently associated with occurrence of diabetic neuropathy in Chinese people. Future prospective studies are warranted to clarify the relationship.     

Effect of pharmacist intervention on glycemic control in diabetes

Aim

To conduct a meta-analysis evaluating the effect of pharmacist intervention on glycemic control.

Methods

A systematic search of Medline and CENTRAL was conducted from the earliest possible date through June 2010. Trials were included if they were randomized controlled trials in a diabetic population, evaluated any form of pharmacist intervention and reported data on hemoglobin A1C (A1C). A random-effects model was used to calculate weighted mean differences (WMDs) and 95% confidence intervals.

Results

Fourteen trials (n = 2073) evaluating the effect of pharmacist intervention on glycemic control were identified. Pharmacist intervention significantly lowered A1C (n = 14 trials, WMD −0.76%, 95%CI −1.06 to −0.47) and fasting blood glucose (FBG) (n = 4 trials, WMD −29.32 mg/dL, 95%CI −39.54 to −19.10). A moderate to high degree of statistical heterogeneity was observed in these analyses (I² ≥ 44.1% for both).

Conclusions

Our findings demonstrate statistically and clinically significant associations between pharmacist intervention and improvement in glycemic control.     

Fasting and postprandial adiponectin alterations anticipate NEFA and TNF-α changes in prepubertal obese children

Background and aims

It has been suggested that adipokine changes might precede changes in plasma non-esterified fatty acids and other obesity metabolic biomarkers. The aim of the present study was to evaluate changes in fasting and postprandial plasma levels of adiponectin, non-esterified fatty acids, and tumor necrosis factor-alpha in prepubertal obese children and age-matched normal-weight children.

Methods and results

Fifty-four children of prepubertal age (34 obese, comprising 23 males and 11 females, and 20 normal-weight comprising 11 males and 9 females) were studied. A standard 438 kcal breakfast was given to both groups. Baseline measurements included anthropometry and plasma lipids. The following parameters were determined in plasma before and after breakfast: glucose, insulin, and C-peptide at baseline and 2 h and non-esterified fatty acids, adiponectin, and tumor necrosis factor-alpha at baseline and 1, 2, and 3 h. Fasting plasma non-esterified fatty acid levels were lower in the obese versus normal-weight children (P = 0.021). Both at baseline and postprandially, plasma adiponectin levels were lower in the obese versus normal-weight children (P < 0.001). A trend was observed (P = 0.06) that levels of tumor necrosis factor-alpha were lower in the obese versus normal-weight children. Adiponectin was inversely associated with insulin in the obese children after adjustment for BMI and sex (r = −0.401, P = 0.025).

Conclusion

At prepubertal age, obese children show lower fasting and postprandial plasma adiponectin levels in comparison to normal-weight children, whereas non-esterified fatty acids and tumor necrosis factor-alpha were not yet increased. Therefore, adiponectin appears to be a good marker of early metabolic alterations associated with childhood obesity.     

Erythrocyte Na+-Li+ counter-transport activity and digoxin-like substances in insulin dependent diabetic women with preexisting preeclampsia

Aim of the study

To determine whether there is pathogenetic link between red cells sodium-lithium counter-transport activity and digoxin-like immunoreactive substances (DLIS) in plasma of insulin-dependent diabetic (IDDM) and non-diabetic women with preexisting preeclampsia (PE).

Subjects and methods

We studied Na⁺/Li⁺ CT activity in red cells and plasma levels of DLIS in 11 IDDM women with preexisting PE (Group 1), 13 IDDM without preexisting PE (Group 2) 23 non-diabetic women with preexisting PE (Group 3) and 12 non-diabetic women with normal pregnancy (Group 4) at least 4 months after delivery.

Results

Na⁺/Li⁺ CT activity was higher in Group 1 compared to Group 2 (mean ± SEM 0.316 ± 0.05 vs 0.190 ± 0.02 mmol/LRBC/hr p < 0.05) and in Group 3 compared to Group 4 (0.365 ± 0.004 vs 0.168 ± 0.01 mmol/LRBC/hr, p < 0.01). Plasma levels of DLIS were higher in Group 3 compared to Group 4 (0.727 ± 0.189 vs 0.295 ± 0.066 ng/ml; p < 0.05); there was no statistically significant difference between the two diabetic groups. In Groups 1 and 3, Na⁺/Li⁺ CT activity was correlated to the plasma levels of DLIS (r = 0.927; p < 0.001 and r = 0.485; p < 0.05 respectively).

Conclusion

Increased Na⁺/Li⁺ CT activity and increased plasma levels of DLIS may contribute to PE in IDDM and non-diabetic women.     

The association between in utero hyperinsulinemia and adolescent arterial stiffness

Aim

To determine the relationship between in utero hyperinsulinemia and children's arterial stiffness at adolescence.

Methods

Indices of arterial stiffness were measured using the SphygmoCor apparatus in 129 adolescents (42 offsprings of mother with gestational diabetes and 87 offsprings of mother with normal glucose tolerance during pregnancy) at 15 years of age.

Results

Adolescent of mothers with gestational diabetes had similar central aortic blood pressure, augmentation pressure (AP), augmentation index (AI), and carotid-femoral pulse wave velocity (PWV) as that of controls. However, both umbilical cord C-peptide and insulin levels correlated positively AI (R = 0.28 and 0.24; p = 0.011 and 0.035, respectively), and umbilical insulin level correlated positively with AP (R = 0.25; p = 0.025). The correlations were significant between umbilical cord C-peptide and AP (R = 0.24; p = 0.035) and AI (R = 0.29; p = 0.011) after adjustment for subjects’ age, sex, body weight and height. Adolescents who had umbilical cord C-peptide levels at highest quartile (n = 25), based on the reference ranges of the original cohort, had a significant greater PWV (5.26 ± 0.12 m/s vs 4.98 ± 0.12 m/s; p = 0.0049) than those with C-peptide levels at the lower 3 quartiles (n = 57) after adjustment for age, sex, body weight and height.

Conclusions

In utero hyperinsulinemia appears to increase the offspring's arterial stiffness at early adolescence.     

Daily consumption of milk enriched with fish oil, oleic acid, minerals and vitamins reduces cell adhesion molecules in healthy children

Background and aims

Several studies have suggested that polyunsaturated fatty acids, vitamins and minerals have beneficial effects on lipid profile and systemic inflammation in adults.

Methods and results

We examined the effects of a daily intake of milk enriched with long-chain polyunsaturated fatty acids, oleic acid, carbohydrates, vitamins, minerals and low in saturated fatty acids (SFAs) for 5 months, on several cardiovascular (CVD) risk biomarkers in healthy children aged 8-14 years. In a randomized double-blind placebo-controlled trial, a total of 107 children of both genders were assigned to two study groups: 1) a supplemented group (SG, n = 53) who consumed 0.6 L/day of an enriched dairy product, and 2) a control group (CG, n = 54) who consumed 0.6 L/day of standard whole milk. Both groups consumed the dairy drinks for 5 months, in addition to their usual diet. Serum levels of adhesion molecules as indices of vascular endothelial cell activation were assessed in both groups at 0 and 5 months as well as white blood cell counts, lipid profile, serum proteins, total serum calcium, 25-OH vitamin D, glucose, insulin and adiponectin. In the enriched dairy drink supplemented group, adhesion molecules E-selectin and ICAM-1 as well as lymphocyte levels decreased while plasma docosahexaenoic acid (DHA) and serum calcium concentrations increased. In the control group, serum total protein, transferrin, total cholesterol, HDL-cholesterol and adiponectin concentrations decreased.

Conclusion

The consumption of a milk enriched with fish oil, oleic acid, minerals and vitamins reduced indices of endothelial cell activation in the studied group of healthy children.     

Effect of sitagliptin monotherapy on serum total ghrelin levels in people with type 2 diabetes

Aim

Sitagliptin is not associated with weight gain and has neutral effects on body weight. It is unclear whether sitagliptin treatment alters serum ghrelin levels in people with type 2 diabetes.

Methods

Forty-four subjects with type 2 diabetes were randomly assigned to receive sitagliptin or medical nutrition therapy (MNT) for 12 weeks. Changes in anthropometric variables, glycemic control, insulin resistance, lipid parameters, and total ghrelin levels were evaluated at baseline and following 12 weeks of treatment.

Results

Significant decreases in body weight and body mass index were observed over the entire study period in both treatment groups. Glycosylated hemoglobin and postprandial plasma glucose levels were statistically significant decreased in the groups receiving sitagliptin compared with baseline values (p = 0.021 and p = 0.021, respectively), while they were unchanged in the groups receiving MNT. There was a significant decrease in total ghrelin in the groups receiving sitagliptin (p = 0.04) compared with baseline values but not in the groups receiving MNT (p = 0.46) at the end of the 12 weeks.

Conclusions

In this study of patients with type 2 diabetes, treatment with sitagliptin was associated with a significant decrease in serum ghrelin levels. These results suggest that the neutral effect of sitagliptin on weight might be associated with the suppression of fasting serum ghrelin levels.     

Serotonin levels in platelet-poor plasma and whole blood in people with type 2 diabetes with chronic kidney disease

Aims

Patients with diabetes mellitus (DM) are prone to atherosclerosis. Atherosclerosis activates platelets; activated platelets release serotonin, and therefore, evaluation of serotonin levels in blood could be a valuable biomarker for future risk of cardiovascular events.

Methods

Plasma serotonin levels obtained from patients with DM complicated with chronic kidney disease were measured using HPLC and were compared to serotonin levels of healthy control subjects. Patients with DM were classified into 2 subgroups of mildly (group 1) and moderately/severely (group 2) impaired renal function.

Results

Serotonin concentration in platelet-poor plasma for group 1 was significantly higher than that of healthy control subjects (p < 0.01), and was significantly higher than that of patients from group 2 (p < 0.05). The concentration of serotonin in whole blood for group 2 patients was significantly lower than that measured from healthy control subjects (p < 0.01). The ratio of the plasma to whole blood level was significantly elevated in both groups 1 and 2 compared with healthy controls (p < 0.01).

Conclusions

Our results indicate that platelets are activated to release serotonin into plasma in diabetic patients with mildly impaired renal function. When renal damage is advanced, platelets are over-activated to release serotonin.     

Does Vitamin D Modulate Asymmetric Dimethylarginine and C-Reactive Protein Concentrations?

Background

Vitamin D deficiency is associated with significant increases in the incidence of cardiovascular risk factors and mortality. However, the mechanisms underlying this association remain unclear. The current study evaluated the possible relationships among vitamin D status, endothelial dysfunction, and inflammation.

Methods

Plasma concentrations of 25-hydroxyvitamin D₃ were determined by radioimmunoassay in a normal population cohort (n = 253) aged 51 to 77 years (mean 63.4 ± 6 years). Asymmetric dimethylarginine, a marker/mediator of endothelial dysfunction, was assayed by high-performance liquid chromatography. High-sensitivity C-reactive protein levels were used as a marker of inflammatory activation.

Results

On univariate analyses, low 25-hydroxyvitamin D₃ levels were inversely correlated with asymmetric dimethylarginine concentrations, high-sensitivity C-reactive protein levels, and body mass index. Seasonal fluctuations in 25-hydroxyvitamin D₃ levels were associated with reciprocal asymmetric dimethylarginine concentration fluctuations. Hypertension and treatment with an angiotensin-converting enzyme inhibitor/angiotensin receptor blocker also were associated with low 25-hydroxyvitamin D₃ levels. On multiple linear analysis, both asymmetric dimethylarginine (β = −0.19, P = .003) and high-sensitivity C-reactive protein (β = −0.14, P = .03) concentrations were inversely correlated with plasma 25-hydroxyvitamin D₃ concentrations; other significant correlates were male gender (β = 0.19, P = .003), calcium levels (β = 0.14, P = .03), and use of angiotensin-converting enzyme inhibitor (β = −0.17, P = .007).

Conclusion

Low 25-hydroxyvitamin D₃ levels are associated with markers of endothelial dysfunction and inflammatory activation, representing potential mechanisms for incremental coronary risk.     

Effect of folic acid supplementation on biochemical indices in overweight and obese men with type 2 diabetes

Aims

This study performed to determine the effects of folate supplementation on indices of glycemic control, insulin resistance and lipid profile in overweight and obese men with type 2 diabetes under metformin (at least 1500 mg daily) treatment.

Methods

The study was a double-blind randomized controlled clinical trial. Forty-eight overweight and obese men (aged 58.2 ± 8.9 years; BMI = 28.6 ± 2.9 kg/m²) with type 2 diabetes participated in the study. Patients were divided randomly into two groups of folic acid (5 mg/d) and placebo. All patients received the tablets for eight weeks.

Results

Supplementation with folic acid led to 8% decrease in HbA1C (p = 0.048), 7.5% in fasting blood glucose (p = 0.051), 16.2% in serum insulin (p = 0.021), 20.5% in insulin resistance (p = 0.041) and 21.2% in plasma homocysteine (p = 0.000). A significant increase in serum folate and B12 levels (19% and 17.3%, p = 0.000, respectively) were observed in the folic acid group, whereas no significant changes occurred in the placebo group. Also, in the folic acid and placebo groups, there were no significant changes in body weight.

Conclusions

Folic acid supplementation lowered plasma level of homocysteine, improved glycemic control and insulin resistance in patients with type 2 diabetes.     

Dietary salt restriction increases plasma lipoprotein and inflammatory marker concentrations in hypertensive patients

Background

Dietary salt restriction has been reported to adversely modify the plasma lipoprotein profile in hypertensive and in normotensive subjects. We investigated the effects of the low sodium intake (LSI) on the plasma lipoprotein profile and on inflammation and thrombosis biomarkers during the fasting and postprandial periods.

Methods

Non-obese, non-treated hypertensive adults (n = 41) were fed strictly controlled diets. An initial week on a control diet (CD, Na = 160 mmol/day) was followed by 3 weeks on LSI (Na = 60 mmol/day). At admission and on the last day of each period, the 24-h ambulatory blood pressure was monitored and blood was drawn after an overnight fasting period and after a fat-rich test meal.

Results

The dietary adherence was confirmed by 24-h urinary sodium excretion. Fasting triglyceride (TG), chylomicron-cholesterol, hsC-reactive protein (CRP), tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6) concentrations, renin activity, aldosterone, insulin, and homeostasis model assessment insulin resistance (HOMA-IR) values were higher, but non-esterified fatty acids (NEFA) were lower on LSI than on CD. For LSI, areas under the curve (AUC) of TG, chylomicron-cholesterol, apoB and the cholesterol/apoB ratio were increased, whereas AUC-NEFA was lowered. LSI did not modify body weight, hematocrit, fasting plasma cholesterol, glucose, adiponectin, leptin, fibrinogen and factor VII (FVII), and AUC of lipoprotein lipase and of lipoprotein remnants.

Conclusion

LSI induced alterations in the plasma lipoproteins and in inflammatory markers that are common features of the metabolic syndrome.     

Blood glucose and nocturnal blood pressure in African and Caucasian men: The SABPA study

Aim

To investigate the relationship between nocturnal blood pressure and chronically elevated blood glucose to determine if these elevated blood glucose concentrations contribute to a non-dipping blood pressure, especially in high-risk groups such as Africans.

Methods

Nocturnal blood pressures and blood glucose levels of 41 non-dipping African and 28 non-dipping Caucasian men were investigated. Ambulatory systolic (SBP) and diastolic blood pressure (DBP) were measured and blood collected in sodium fluoride tubes from the antebrachial vein to determine serum glucose and glycosylated hemoglobin A1c (HbA1c) percentage. The estimated average glucose (eAG) was determined from HbA1c percentage with a regression formula.

Results

The African non-dippers had higher blood pressures (p < 0.001) and elevated HbA1c (p = 0.037) and eAG (p = 0.041) levels compared to the Caucasians. In single, partial and multiple regression analyses nighttime (00:00-04:00) SBP correlated positively with HbA1c (p = 0.069) and eAG (p < 0.001) in the African men. No correlations were found in the Caucasian men. Sensitivity analysis confirmed that the association between nighttime SBP (00:00-04:00) and eAG was independent of carotid intima-media thickness in the African men (R² = 0.617; β = 0.438; p = 0.008).

Conclusion

The blunted nocturnal decline in SBP during the early morning hours is associated with chronically elevated blood glucose in non-dipper African men.     

Increased epicardial adipose tissue in type 1 diabetes is associated with central obesity and metabolic syndrome

Aims

The present study evaluated the relationship between metabolic syndrome (MS), body fat composition and epicardial adipose tissue (EAT) in type 1 diabetes. Epicardial adipose tissue is a new independent marker of coronary artery disease (CAD).

Methods

Forty-five type 1 diabetic women were evaluated (age 36 ± 9 years; body mass index 24.6 ± 4.4 kg/m²). Metabolic syndrome was defined by the World Health Organization criteria. Body fat composition and EAT were analyzed by dual-energy-X-ray absorptiometry and echocardiogram, respectively.

Results

Twenty patients (45%) had MS. Patients with MS had greater android (central) fat deposition than patients without MS (41.9 ± 2.0% vs. 33.7 ± 1.8%, p = 0.004). Total body fat and gynoid (peripheric) fat distribution were similar between the groups. Mean EAT was higher in patients with MS (6.15 ± 0.34 mm vs. 4.96 ± 0.25 mm; p = 0.006) and EAT was positively correlated with android (central) fat distribution (r = 0.44; p = 0.002), however no correlation was found with gynoid (peripheric) fat distribution.

Conclusions

There was a high incidence of MS in type 1 diabetes related to increased central adiposity, despite the absence of obesity. Metabolic syndrome and central obesity were associated with increased EAT. Thus, young non-obese type 1 diabetic women with central adiposity and/or MS may have increased EAT, what may predict CAD risk.     

Two-month effects of individualized exercise training with or without caloric restriction on plasma adipocytokine levels in obese female adolescents

Objectives

To examine if, in young obese patients, an individualized training programme in association with a caloric restriction programme which had an effect on whole-body lipid oxidation, was able to induce changes on plasma adipocytokine concentrations.

Materials and methods

Twenty-seven obese female adolescents participated in the study. Whole-body lipid oxidation during exercise was assessed by indirect calorimetry during a graded cycle ergometer test. Body mass (BM), body mass index (BMI), percentage of body fat (%BF), insulin homeostasis model assessment (HOMA-IR) and fasting levels of circulating adipocytokines were assessed prior and after a two-month diet programme, individualized training programme targeted at Lipox_max corresponded to the power at which the highest rate of lipids was oxidized and combined diet/training programme.

Results

The diet/training programme induced both a shift to a higher-power intensity of Lipox_max (+27.8 ± 5.1 W; p < 0.01) and an increase of lipid oxidation at Lipox_max (+96.8 ± 16.2 mg/min; p < 0.01). The enhancement in lipid oxidation was significantly (p < 0.01) correlated with the diet/training-induced improvement in %BF (r = −0.47), HOMA-IR (r = −0.66), leptin (r = −0.41), TNF-α (r = −0.48), IL-6 (r = −0.38), adiponectin (r = 0.43) and resistin (r = 0.51).

Conclusion

This study showed that in obese female adolescents a moderate training protocol targeted at Lipox_max and combined with a diet programme improved their ability to oxidize lipids during exercise, and that this improvement was associated with changes in plasma adipocytokine concentrations.     

Type 2 diabetes does not attenuate racial differences in coronary calcification

Aims

Coronary artery calcification (CAC) is a strong predictor of atherosclerotic cardiovascular disease (CVD). Whites appear to have a higher prevalence of CAC than African-Americans (AAs), but it is unknown if type 2 diabetes, a major cardiovascular risk factor, attenuates this difference. We investigated the relationship of race and CAC in a sample of patients with type 2 diabetes without clinical CVD.

Methods

Multivariable analyses of self-reported ethnicity and CAC scores, stratified by gender, in 861 subjects [32% AA, 66.9% male] with type 2 diabetes.

Results

AA race was associated with lower CAC scores in age-adjusted models in males [Tobit ratio for AAs vs. Whites 0.14 (95% CI 0.08-0.24, p < 0.001)] and females [Tobit ratio 0.26 (95% CI 0.09-0.77, p = 0.015)]. This persisted in men after adjustment for traditional, metabolic and inflammatory risk factors, but adjustment for plasma triglycerides [0.48 (95% CI 0.15-1.49, p = 0.201)] and HOMA-IR [0.28 (95% CI 0.08-1.03, p = 0.055)] partially attenuated the association in women.

Conclusions

Relative to African-Americans, White race is a strong predictor of CAC, even in the presence of type 2 diabetes. The relationship in women appears less robust possibly due to gender differences in metabolic risk factors.     

Changes in dietary habits and their association with metabolic markers after a non-intensive, community-based lifestyle intervention to prevent type 2 diabetes, in Greece. The DEPLAN study

Aims

The aim of the present study was to evaluate the impact on dietary and activity habits of a non-intensive, community based lifestyle intervention for type 2 diabetes prevention, in high-risk Greek individuals.

Methods

A total of 191 high-risk persons were invited to participate in a one-year lifestyle intervention program, consisting of six bi-monthly sessions with a dietician. The dietary aims of the intervention were: reduction of saturated fat, sugars and refined cereals intake and at least five servings of fruits and vegetables, daily. Demographic, dietary, anthropometric, medical and biochemical indices were recorded at baseline and at the end of the intervention.

Results

The intervention was completed by 126 participants. At study end, participants reported decreased whole fat dairies and processed meats consumption (p = 0.018 and 0.016, respectively), sugars (p = 0.006) and refined cereals (p = 0.045). Participants who improved their diet, decreased body weight (p = 0.040), plasma triglycerides (p = 0.020) and 2-h post-load plasma glucose (p = 0.05) compared to those who had worsened their dietary habits. Total time spent daily on physical activity, remained unchanged throughout the intervention.

Conclusions

The implementation of a group-based, non-intensive dietary counseling proved to be practical and feasible in “real-world” community settings and was accompanied by favorable dietary changes and health benefits.     

Outcome of in-hospital adult cardiopulmonary resuscitation assisted with portable auto-priming percutaneous cardiopulmonary support

Background

Outcome from in-hospital cardiopulmonary resuscitation (CPR) is still unsatisfactory. CPR assisted with percutaneous cardiopulmonary support (PCPS) is expected to improve the outcome of in-hospital CPR.

Methods

We retrospectively analyzed 83 consecutive cases of adult in-hospital CPR assisted by a portable pre-assembled auto-priming PCPS system (EBS, Terumo, Japan) from January 2004 to December 2007.

Results

PCPS was successfully performed in 97.6% of the patients and could be weaned in 57.8% of the patients. The survival-to-discharge rate was 41.0% with an acceptable neurological status in 85.3% of the patients. The 6-month survival was 38.6%. Survival-to-discharge decreased about 1% for each 1 min increase in the duration of CPR. The probability of survival was about 65%, 45%, and 19% when the duration of CPR was 10, 30, or 60 min, respectively. Multivariate analysis adjusted with clinical factors including organ dysfunction severity scores revealed that defibrillation and CPR duration less than 35 min were independent predictors for both survival-to-discharge (odds ratio = 8.0, 95% CI = 2.8-23.0, p < 0.001) and 6-month survival (hazard ratio = 3.3, 95% CI = 1.9-5.9, p < 0.001).

Conclusions

Our results showed that CPR assisted with PCPS results in an acceptable survival-to-discharge rate and mid-term prognosis.     

Relationship between bone biochemical markers versus glucose/lipid metabolism and atherosclerosis; a longitudinal study in type 2 diabetes mellitus

Aim

Although accumulating evidence suggests that osteocalcin, which is secreted in circulation specifically from osteoblasts, is involved in glucose and lipid metabolism, it is unclear whether serum osteocalcin is associated with atherosclerosis parameter in humans.

Subjects and methods

We monitored chronological changes in bone turnover markers and a parameter of atherosclerosis, plaque score (PS), during glycemic control in Japanese patients with type 2 diabetes, and analyzed relationships among these parameters.

Results

Multiple regression analysis showed that changes in osteocalcin were negatively correlated with changes in HbA_1c (β = −0.38, p = 0.01). Baseline osteocalcin was negatively correlated with changes in triglycerides (β = −0.29, p = 0.03) and positively with changes in HDL-cholesterol (β = 0.31, p = 0.03), and that changes in osteocalcin were negatively correlated with baseline triglyceride (β = −0.35, p = 0.02). Changes in osteocalcin were positively correlated with baseline PS (β = 0.35, p = 0.01) and negatively with changes in PS (β = −0.30, p < 0.05) independent of other conventional risk factors of atherosclerosis.

Conclusion

These findings indicated the association between serum osteocalcin and glucose and lipid metabolism as well as an atherosclerosis parameter independently of other atherosclerosis-related risk factors in patients with type 2 diabetes, suggesting that osteocalcin is important for not only bone metabolism but also glucose and lipid metabolism as well as atherosclerosis.