Changes in serum adiponectin concentrations and endothelial function after intensive insulin treatment in people with newly diagnosed type 2 diabetes: a pilot study

Aims

We aimed to assess changes in serum adiponectin and endothelial function after intensive insulin treatment in patients with newly diagnosed type 2 diabetes mellitus (T2DM).

Methods

Patients with newly diagnosed T2DM were randomly assigned to Group A (intensive insulin treatment) or Group B (conventional insulin treatment). Before treatment and 2 weeks after plasma glucose concentrations had been maintained at the specified concentrations, blood samples were obtained to measure serum adiponectin and nitric oxide (NO) concentrations. A total of 21 patients were randomized to each Group.

Results

Adiponectin, NO, endothelium-dependent vasodilation (EDD), and endothelium-independent vasodilation (EID) measures were significantly higher post-treatment than pre-treatment in Group A (all P < 0.05). Only EID was significantly higher in Group B (P < 0.05). Post-treatment adiponectin and NO concentrations, and EDD were significantly higher in Group A compared with Group B (all P < 0.05). Both treatment regimens were well tolerated (all patients completed the study). The most common adverse event was hypoglycemia. Thus, early intensive insulin therapy can increase serum adiponectin and NO concentrations and improve endothelial function in patients with newly diagnosed T2DM.

Conclusions

These effects may underlie the reduced incidence of microvascular and macrovascular in patients who receive early intensive hypoglycemic therapy.     

使用腰围身高比检测重庆市成年人正常体重中心肥胖和心血管疾病危险因素

目的 使用腰围身高比(WHR)来探测重庆市成年人正常体重中心肥胖和心血管疾病危险因素.方法 在重庆市"一小时经济圈"内采用整群抽样的方法抽取了20000名18～59岁的在职正常成年人,测量其身高、腰围(WC)、体重,计算体质指数(BMI)和WHR,检测血压、血脂和血糖水平.分析正常体重[18.5≤BMI(kg/m2)＜24]非中心肥胖组(WHR＜0.5)与中心肥胖组(WHR≥0.5)相关指标的差异,用logistic回归分析中心肥胖和心血管各危险因素之间的关系.结果 在11 612名正常体重者中,1801(15.51%)名为正常体重中心肥胖.正常体重非中心肥胖组与中心肥胖组WC水平分别为(73.71±5.91)、(84.47±4.58)cm(F=328.74,P＜0.01);舒张压水平分别为(72.85±10.30)、(78.22±11.90)m Hg(1 mm Hg=0.133 kPa,F=23.62,P＜0.01);甘油三酯分别为(1.22±0.95)、(1. 97±1. 91)mmol/L(F=114.70,P＜0.01);总胆固醇含量分别为(4.66±0.84)、(5.04±0.92)mmol/L(F=13.10,P＜0.01);高密度脂蛋白分别为(1.41±0.31)、(1.25±0.29)mmol/L(F=29.44,P＜0.01);低密度脂蛋白含量分别为(2.65±0.74)、(3.03±0.77)mmol/L(F=9.98,P＜0:01);血糖水平分别为(4.94±0.82)、(5.25±1.37)mmol/L(F=47.21,P＜0.01).logistic 回归分析结果显示,与非中心肥胖组相比,正常体重中心肥胖组的收缩压、舒张压、甘油三酯、高密度脂蛋白、低密度脂蛋白和血糖的OR值(95%CI值)分别是1.28(1.02～1.60)、1.49(1.20～1.84)、2.24(1.92～2.60)、1.77(1.53～2.05)、1.58(1.15～2.16)和1.31(1.06～1.63).结论 WHR能够较有效的分析正常体重中心肥胖和各心血管疾病危险因素;中心肥胖患者心血管疾病风险较高.     

Maternal and paternal family history of diabetes in second-degree relatives and metabolic outcomes at age 5–6 years: The ABCD Study

AimTo investigate whether children with a family history of diabetes (FHD) in second-degree relatives (grandparents, aunts/uncles) are at increased risk of developing obesity and diabetes, and whether the risk differs between maternal or paternal transmission.MethodsIn the multiethnic population-based cohort Amsterdam-Born Children and Their Development (ABCD) Study, body mass index (BMI), waist-to-height ratio (WHR), fat percentage (fat%), fasting glucose and C-peptide in 5- or 6-year-old children with no second-degree FHD (n = 2226) were compared with children with maternal-only (n = 353), paternal-only (n = 281) or both maternal and paternal (n = 164) second-degree FHD. Children of diabetic mothers or fathers were excluded.ResultsNone of the children in any of our FHD categories differed in body composition after adjusting for maternal, paternal and childhood lifestyle covariates. However, children with both maternal and paternal second-degree FHD had increased C-peptide levels (0.03 nmol, 95% CI: 0.01–0.05) compared with those in the other three study groups. Results were similar when analyses were restricted to only the Dutch children.ConclusionChildren with FHD in second-degree relatives on both maternal and paternal sides already have higher C-peptide levels at an early age. This might be the result of a double burden of a shared obesogenic lifestyle, or of more diverse diabetogenic genes compared to children without FHD or with only FHD in one side of the family. In any case, second-degree FHD could be used as a public-health screening tool to identify children at risk of adverse metabolic outcomes and of possible future disease.     

Association between anthropometric measures of obesity and subclinical atherosclerosis in Bangladesh

Background

Anthropometric measures such as waist–hip-ratio (WHR), waist-height-ratio (WHtR), waist circumference, Mid-upper arm circumference (MUAC), and upper thigh circumference, have been linked to the risk of cardiovascular disease (CVD). However, their relationships with subclinical atherosclerosis are unclear. Studies in normal-weight populations, especially in Asian countries where leanness is prevalent, are lacking.

Methods

We conducted a cross-sectional study to assess the associations of WHR, WHtR, waist circumference, hip circumference, body mass index (BMI), MUAC and upper thigh circumference with carotid intima-media thickness (cIMT) among 562 middle-aged participants free of CVD in rural Bangladesh.

Results

After adjusting for age and sex, WHR and waist circumference but not BMI showed a positive significant association with cIMT. In multivariate analysis, each standard deviation (SD) increase of WHR (0.08) or WHtR (0.07) was associated with an 8.96 μm (95% CI, 1.12–16.81) or 11.45 μm (95%CI, 0.86–22.04) difference in cIMT, respectively, after controlling for age, sex, BMI, smoking status, education level, and systolic blood pressure (SBP). The associations of WHR and WHtR with cIMT were independent of the influence of other anthropometric measures. The associations of other anthropometric measures and cIMT were not apparent.

Conclusions

In our relatively lean, healthy Asian population, WHR and WHtR appear to be better predictors of early atherosclerosis than other common surrogates of adiposity.     

腰/臀比值与糖、脂代谢相关性研究

测定２２６例ＮＩＤＤＭ、３８９例ＩＧＴ患者体质指数（ＢＭＩ）及腰／臀比值（ＷＨＲ），并与１５３例糖耐量正常对照组作了比较。结果显示：ＮＩＤＤＭ组、ＩＧＴ组ＢＭＩ、ＷＨＲ均显著高于对照组（Ｐ＜０．０１）；ＮＩＤＤＭ组ＷＨＲ显著高于ＩＧＴ组（Ｐ＜０．０１），两组间ＢＭＩ无显著性差异（Ｐ＞０．０５）。另外，ＮＩＤＤＭ组、ＩＧＴ组的ＦＩｎｓ、２ｈＢＧ、２ｈＩｎｓ、ＴＧ、ＳＢＰ、ＤＢＰ及高血压患病率均显著高于正常组（Ｐ＜０．０１）；ＮＩＤＤＭ组ＦＢＧ、ＦＩｎｓ、２ｈＢＧ、ＴＧ及高血压患病率显著高于ＩＧＴ组（Ｐ＜０．０１），而ＩＤ１、２ｈＩｎｓ、ＩＤ２显著低于ＩＧＴ组（Ｐ＜０．０１）。ＮＩＤＤＭ组Ｃｈ明显高于对照组（Ｐ＜０．０５），而ＩＧＴ组Ｃｈ与对照组相比无显著性差异（Ｐ＞０．０５）。相关分析结果示ＷＨＲ与ＩＤ１、ＩＤ２、Ｃｈ、ＴＧ、ＳＢＰ、ＤＢＰ，均呈正相关。提示ＷＨＲ是体脂分布对糖、脂及胰岛素代谢影响较重要的指标。     

成都地区40～79岁常住人群糖代谢异常亚组分析

目的了解成都地区40～79岁不同年龄段糖代谢异常（GA）的发生与文化程度、收入、体重指数（BMI）和腰臀比WHR的关系。方法利用2008年成都地区40～79岁常住人群GA流调数据进行亚组分析及Logistic回归分析。结果文化程度：40～49岁（A组）,50～59岁（B组）的正常对照（NC）组高于糖调节异常（IGR）组和糖尿病（DM）组（P〈0.05）;收入：A组的NC高于IGR,B组的NC高于IGR和DM（P〈0.05）,60～69岁（C组）DM的高于NC和IGR（P〈0.05）;BMI：四组NC均小于IGR和DM（P〈0.05）;WHR：A组和C组的NC小于IGR及DM,70～79岁（D组）的NC小于DM（P〈0.05）。Logistic回归分析：GA的发生机会在A组和C组中随着WHR增加而升高,在B组和D组中随着BMI增加而升高。结论不同年龄段具有相应高危文化程度、收入、BMI和WHR因素的人群是GA筛查的重点。     

Fermented kimchi reduces body weight and improves metabolic parameters in overweight and obese patients

Kimchi is a traditional fermented Korean food that has garnered international interest due to its various beneficial effects. Focusing on the effect of fermentation, this study hypothesized that consumption of fermented kimchi would have more beneficial effects compared with that of fresh kimchi on metabolic parameters that are related to cardiovascular disease and metabolic syndrome risks in overweight and obese subjects. Twenty-two overweight and obese patients with body mass indexes greater than 25 kg/m² were randomly assigned to two 4-week diet phases separated by a 2-week washout period (crossover design). During each diet phase, the subjects consumed either fresh or fermented kimchi. Anthropometric data showed significant decreases in body weight, body mass index, and body fat in both groups, and the fermented kimchi group showed a significant decrease in the waist-hip ratio and fasting blood glucose. Net differences in the systolic blood pressure, diastolic blood pressure, percent body fat, fasting glucose, and total cholesterol in the fermented kimchi group were significantly greater than those in the fresh kimchi group. There was also a tendency for a decrease in fasting insulin after consumption of fermented kimchi. Therefore, the ingestion of fermented kimchi had positive effects on various factors associated with metabolic syndrome, including systolic and diastolic blood pressures, percent body fat, fasting glucose, and total cholesterol, compared with the fresh kimchi. These results suggest that the maturity of kimchi (fresh vs fermented) may affect obesity, lipid metabolism, and inflammatory processes.     

Plasminogen activator inhibitor-1 levels in severe and morbid obesity. Effect of weight loss and influence of 4G/5G polymorphism

INTRODUCTION: An association between an increase in plasminogen activator inhibitor type 1 and obesity has been described. It has also been shown that a decrease in adiposity has beneficial effects. However, less information is available regarding morbid obesity and hypofibrinolysis. The aim of the present study was to evaluate the effect of weight loss and the influence of the plasminogen activator inhibitor type 1 promoter 4G/5G genotype on plasminogen activator inhibitor type 1 levels in severe and morbid obesity. MATERIALS AND METHODS: Sixty-seven obese patients were studied before and three months after a weight reduction program, and compared with 67 controls. We determined plasminogen activator inhibitor type 1 antigen and activity levels, tissue type plasminogen activator antigen levels, 4G/5G genotype and biochemical parameters in both groups. RESULTS: A significant increase in plasminogen activator inhibitor type 1 antigen and activity was observed in obese patients in comparison with the control group (P<0.001). No significant differences in plasminogen activator inhibitor type 1 levels among 4G/5G genotypes were obtained. After weight loss, a significant decrease in plasminogen activator inhibitor type 1 antigen and activity was observed (P<0.001). A significant and positive correlation was observed in percentage changes in plasminogen activator inhibitor type 1 and body mass index (P=0.02). CONCLUSIONS: A decrease in body mass index in severe and morbid obesity shows a favourable effect on the fibrinolytic system due to a decrease in plasminogen activator inhibitor type 1 levels. However, no influence of 4G/5G polymorphism has been observed in this setting.     

糖尿病前期中医体质及相关指标的研究

目的 探讨糖尿病前期(IGR)中医体质及与相关指标的关系.方法 用前瞻性研究方法,采集517例IGR患者信息,进行中医体质辨识和相关指标的分析.结果 ①517例IGR人群中,单一体质类型者、二种体质类型相兼者、三种体质类型相兼者分别占25.8％、66.5％、7.7％;前3位的体质类型分别是痰湿兼湿热质、痰湿兼气虚质、湿热质,共占64.8％.②痰湿兼涅热质、痰湿兼气虚质、湿热质体质量指数(BMI)、腰臀比(WHR)、血脂TC、TG、LDL-C显著高于其他体质组,差异有统计学意义(P＜0.01).结论 ①IGR人群体质可表现为单一体质,也可表现为复合型体质,其中以痰湿兼湿热质、痰湿兼气虚质、湿热质为主,提示痰湿和湿热是IGR人群的重要因素.②BMI、WHR、血脂TC、TG、LDL-C是IGR痰湿和湿热体质的辩识和疗效判断的参考指标.     

A 12-week worksite health promotion program reduces cardiovascular risk factors in male workers with the apolipoprotein E2 and apolipoprotein E3 genotypes,but not in apolipoprotein E4 genotype

Worksite health promotion programs focusing on diet and lifestyle modification have been shown to improve health outcomes in workers. The purpose of this study was to investigate whether a 12-week worksite health promotion program shows different response of cardiovascular risk factors in subjects according to apolipoprotein E (Apo E) genotype and obesity level in 141 male Korean industrial workers. We hypothesized that the health changes of a 12-week intervention may not be the same within Apo E genotypes in nonobese and obese subjects. They received 5 face-to-face meetings based on their health profiles. In obese group carrying Apo E3 genotype, body mass index, body fat (%), waist circumference, waist-hip ratio, and systolic blood pressure were decreased, as well as intakes of energy (P = .000) and carbohydrate (P = .005). High-density lipoprotein cholesterol (P = .004) level was improved in individuals with the Apo E2 genotype. These beneficial effects were only observed in individuals with the Apo E2 or Apo E3 genotype. Multiple linear regression revealed that obesity was strongly correlated with waist circumference (P = .002), plasma total cholesterol (P = .037), and changes in dietary cholesterol intake (P = .011) in individuals with the Apo E3 genotype, whereas only changes in dietary fat intake (P = .044) was correlated in those with the Apo E4 genotype. Overall, the results of this study suggest that a health promotion program can be a useful method of improving cardiovascular risk factors and dietary intake in industrial workers with certain genotypes only. Therefore, further research is needed to develop a tailored, long-term worksite health promotion program based on genetic background.