Asociación de obesidad general y abdominal con hipertensión,dislipemia y presencia de prediabetes en el estudio PREDAPS

Introduction and objectives

Some anthropometric measurements show a greater capacity than others to identify the presence of cardiovascular risk factors. This study estimated the magnitude of the association of different anthropometric indicators of obesity with hypertension, dyslipidemia, and prediabetes (altered fasting plasma glucose and/or glycosylated hemoglobin).

Joint association of body mass index and central obesity with cardiovascular events and all-cause mortality in prediabetic population: A prospective cohort study

ObjectiveTo assess the joint association of body mass index (BMI) and central obesity with cardiovascular events and all-cause mortality in prediabetic population.MethodsAltogether 18,703 participants with prediabetes completed follow-up between June 2006 and December 2015 were included in the analyses. Prediabetes was defined as fasting plasma glucose level 5.6–6.9 mmol/L, and without history of diabetes or currently use of hypoglycemic agents. Participants were classified according to the baseline status of BMI as well as the absence/presence of central obesity. We examined these associations in men and women separately.ResultsThe mean age was 51.5 ± 11.1 years, and 85.6% (N = 16,002) were male. During a median follow up of 9.0 (interquartile range 8.7–9.2) years, 848 and 88 major CV events occurred in men and women, respectively. Besides, 1111 men and 89 women died. Compared with men of BMI 22–23.9 kg/m² and without central obesity, the risk of CV events was increased among men with higher BMI and central obesity (HR 1.32 (95% CI: 1.05–1.67) for BMI 24–27.9 kg/m² and 1.31 (1.03–1.66) for BMI ≥ 28 kg/m², respectively); and the risk of all-cause mortality was the lowest among men of BMI 24–27.9 kg/m² but without central obesity (0.75, 0.61–0.92). We found no such association in women.ConclusionAmong men with prediabetes, both BMI and waist circumference should be included when evaluating the risks of major CV events and mortality. Measurement of adiposity constitutes a simple and cost-effective strategy to identify those at high-risk population in prediabetes.     

湖南益阳农村老年人糖尿病前期人群代谢综合征及其影响因素分析

目的 了解湖南益阳农村地区老年糖尿病前期人群代谢综合征（metabolic syndrome,MS）的患病率水平和影响因素。方法 2015年4~7月期间,通过问卷调查和实验室检测收集研究对象的社会人口学特征和实验室指标。描述分析老年人糖尿病前期人群MS的患病率;采用二分类非条件Logistic回归模型分析老年人糖尿病前期人群MS的影响因素。结果 湖南益阳农村地区老年糖尿病前期人群MS的患病率为31.6%（95%CI：27.2%~36.0%）。二分类非条件Logistic回归模型分析结果显示性别、年龄、身体质量指数（body mass index,BMI）、体力活动水平、是否饮酒是老年糖尿病前期人群MS发生的影响因素（均有P<0.05）。结论 湖南益阳老年人糖尿病前期人群MS的患病率较高,应及时给予关注和干预。     

High glomerular filtration rate is associated with impaired arterial stiffness and subendocardial viability ratio in prediabetic subjects

Background and aimsHigh glomerular filtration rate (HGFR) is associated with cardiovascular damage in the setting of various conditions such as obesity and diabetes. Prediabetes was also associated with increased GFR, however, the association between prediabetes, HGFR and cardiovascular damage has not been investigated. In this study, we investigated the association between HGFR and early markers of cardiovascular disease in subjects with prediabetes.Methods and resultsAugmentation pressure (Aug), augmentation index (AIx), subendocardial viability ratio (SEVR), pulse wave velocity (PWV), intima-media thickness (IMT) and estimated GFR (eGFR) were evaluated in 230 subjects with prediabetes. The eGFR was assessed using the Chronic Kidney Disease Epidemiology Collaboration formula. HGFR was defined as an eGFR above the 75th percentile.Prediabetic subjects were divided into two groups according to presence/absence of HGFR: 61 subjects with HGFR and 169 subjects without HGFR. Subjects with HGFR showed higher Aug, AIx and lower SEVR compared with prediabetic subjects with lower eGFR (14.1 ± 7.2 vs 10.8 ± 6.2, 32.9 ± 12.7 vs 27.6 ± 11.7, 153.5 ± 27.8 vs 162 ± 30.2, p < 0.05). No differences were found in PWV and IMT values between the two groups. Then, we performed multiple regression analysis to test the relationship between Aug, SEVR and several cardiovascular risk factors. In multiple regression analysis Aug was associated with age, systolic blood pressure (BP), HOMA-IR and eGFR; the major determinants of SEVR were systolic BP, HOMA-IR and eGFR.ConclusionSubjects with prediabetes and HGFR exhibited an increased Aug, AIx and a reduced SEVR. These alterations are associated with eGFR, insulin resistance and systolic BP.     

Irisin plays an important role in the outcomes of newly diagnosed prediabetes in adults in Guiyang,China

Aims/IntroductionTo explore the potential role of irisin in the outcomes of newly diagnosed prediabetes.Materials and MethodsData were obtained from the Guiyang subcenter of the Risk Evaluation of cAncers in Chinese diabeTic Individuals: a lONgitudinal (REACTION) study. A total of 2,530 participants had newly diagnosed prediabetes at baseline and completed follow up. The nested 1:1 case–control study included 161 participants who developed diabetes mellitus at follow up, and 161 age‐ and sex‐matched controls. The follow‐up study included 86 matched case–control pairs. Fasting serum irisin levels were measured using enzyme‐linked immunosorbent assay.ResultsBaseline serum irisin levels were higher in the cases than in the controls (P = 0.002); high baseline serum irisin levels were an independent risk factor for the development of diabetes (odds ratio 1.235, 95% confidence interval 1.025–1.488). After adjustment for age, sex, body mass index, glycated hemoglobin (HbA1c), smoking, exercise, and family history of diabetes, subjects in the highest quartile of irisin levels had a higher risk of diabetes than those in the lowest quartile (odds ratio 3.065, 95% confidence interval 1.511–6.218). The extent of decrease in irisin levels during follow‐up was greater in the cases than in the controls (P < 0.001). Baseline serum irisin levels were positively correlated with the extent of decrease in irisin during follow‐up (r = 0.773, P < 0.001). After adjustment for confounding factors, subjects with a decrease of irisin above the median had much higher risk for diabetes (odds ratio 5.077, 95% confidence interval 2.112–12.206).ConclusionsIrisin might play an important role in the outcomes of newly diagnosed prediabetes in adults in Guiyang, and can predict the risk for developing diabetes in these individuals.     

Comparing the effects of 12 months aerobic exercise and resistance training on glucose metabolism among prediabetes phenotype: A explorative randomized controlled trial

AimsThe pathophysiology of each phenotype of prediabetes is unique that promotes different levels of diabetes and cardiovascular disease risks. Exercise guidelines for individuals with prediabetes including both aerobic and resistance training could improve metabolic control, but its effects on different prediabetes subtypes are unclear. The aim of this explorative randomized controlled trial was to evaluate the effects of aerobic training (AT) or resistance training (RT) on glucose metabolism and lipid profile by different prediabetes subtypes with.MethodsA randomized controlled trial in which 128 individuals with isolated impaired fasting glucose (i-IFG; n = 39), isolated impaired glucose tolerance (i-IGT; n = 29), combined glucose tolerance (CGI; n = 27) and isolated elevated HbA_1c (n = 33) were randomly assigned to the control group, AT group and RT group, respectively. Supervised exercise training, including AT and RT were completed at moderate intensity for 60 min per day, three non-consecutive days per week for 12 months. The primary outcome was improvement in glucose metabolism. Secondary outcomes included measure of lipid profile and if these effects were moderated by the prediabetes phenotype.ResultsOf the initial 128 participants, 118 finished the study, but all participants were included in the intention-to-treat analyses. The improvement in 2 h postprandial plasma glucose (2 hPG) between group difference (AT vs. RT) at 12 months was 0.87 (95% CI, -1.59 to-0.16; p < 0.05). Compared with RT group, AT significantly decreased the 2hPG in participants with i-IGT at 12 months (-1.66, 95% CI -3.04 to -0.28; p < 0.05).ConclusionsAT program conferred benefits in improving 2 h PG and HbA_1c compared with RT for prediabetes. These findings may moderate by prediabetes phenotype, and AT appeared more effective in i-IGT. A future trial with large sample size and long time follow up of prediabetes phenotype groups are needed.     

Prediabetes and mild hepatosteatosis are associated with blunted cortisol response to glucagon but not to growth hormone

BackgroundAlthough there is a close relationship between cortisol and growth hormone (GH) levels, glucose intolerance and hepatosteatosis, changes in GH and the hypothalamo-pituitary-adrenal (HPA) axis were not previously studied in prediabetes. The main purpose of the present study was to assess changes in GH and HPA axis and their relationship with hepatosteatosis in prediabetic patients.MethodsForty prediabetic patients, with body-mass index (BMI) 25–35 kg/m², and 23 healthy individuals, with normal glucose tolerance and similar age and BMI, were included. The 75 g oral glucose tolerance test and glucagon stimulation test (GST) were used.ResultsNo significant differences were detected between prediabetic patients and healthy individuals in terms of insulin-like growth factor-1 (IGF-1), insulin-like growth factor-binding protein-3 (IGFBP-3), IGF-1/IGFBP3 ratio or adrenocorticotropic hormone (ACTH). GH responses to GST did not differ between groups. On the other hand, peak cortisol and area under the curve (AUC) _(cortisol) response on GST were significantly lower in prediabetic patients. Both peak GH and AUC _(GH) response on GST correlated negatively with waist circumference and body weight. The degree of hepatosteatosis correlated negatively with peak cortisol, GH, AUC (cortisol) and AUC (GH) response on GST.ConclusionCortisol response to GST is decreased in prediabetic patients, with relatively well conserved GH response. This suggests altered HPA axis responsiveness in prediabetes, as is known in diabetes. Thus, HPA axis changes in patients with diabetes probably start before the development of diabetes as such.     

The association of prediabetes with dietary patterns,life behavior and cardiovascular risk factors among adult population without previously diagnosed non-communicable diseases

Background and aimsPrediabetes and its risk factors are difficult to recognize because there may be no clear symptoms in that stage of diabetes mellitus (DM) progression. This cross-sectional study aims to examine associations between prediabetes and potential risk factors among adult population without previously diagnosed non-communicable diseases.Methods and resultsStudy participants (n = 30823) were selected all over China. Their dietary, life behavior and laboratory data were obtained through questionnaires, physical examination or biochemical measurement. Factor analysis was applied to identify dietary patterns. Non-proportional odds model was applied to analyze associations between those data and stages of DM progression. The prevalence of prediabetes and DM was 20.6% and 4.5%, respectively. Two dietary patterns were identified: the first pattern was characterized by high consumption of diverse plant- and animal-based food items, and the second pattern was characterized by high consumption of starchy food items. The risk of prediabetes was inversely associated with sufficient sleep duration (OR: 0.939, 95% CI: 0.888–0.993) and the second pattern (OR: 0.882, 95% CI: 0.850–0.914), but not significantly associated with the first pattern (OR: 1.030, 95% CI: 0.995–1.067). High density lipoprotein cholesterol was inversely associated with DM risk (OR: 0.811, 95% CI: 0.667–0.986) but not prediabetes (OR: 1.035, 95% CI: 0.942–1.137).ConclusionsThe prevalence of undetected prediabetes was high among adult population, and some factors may exert different effects on different stages of DM progression. Dietary diversity, which was reflected by the first pattern to a certain extent, may be not significantly associated with risk of prediabetes.