Analysis of influencing factors and interaction of body weight and disease outcome in patients with prediabetes

BACKGROUND The trend of prediabetes progressing to type 2 diabetes mellitus(T2DM)is prominent,and effective intervention can lead to a return to prediabetes.Exploring the factors influencing the outcome of prediabetes is helpful to guide clinical intervention.The weight change in patients with prediabetes has not attracted much attention.AIM To explore the interaction between body weight and the factors affecting the progression of prediabetes to T2DM.METHODS We performed a retrospective analysis of 236 patients with prediabetes and 50 with normal glucose tolerance(NGT),and collected clinical data and follow-up results of all patients.Based on natural blood glucose outcomes,we classified 66 patients with progression to T2DM into the disease progression(DP)group,and 170 patients without progression to T2DM into the disease outcome(DO)group.We analyzed the factors that influenced prediabetes outcome and the influence of body weight on prediabetes blood glucose outcome by unconditional logistic regression.A general linear model(univariate)was used to analyze the interaction between body weight and independent influencing factors.RESULTS There were 98 cases of impaired fasting glucose(IFG),90 cases of impaired glucose tolerance(IGT),and 48 cases of coexistent IFG and IGT.The body weight,waist circumference,body mass index,fasting blood glucose,and 2 h plasma glucose of patients with IFG,IGT,and coexistent IFG and IGT were higher than those in patients with NGT(P<0.05).Logistic regression analysis showed that body weight,glycosylated hemoglobin,uric acid,fasting insulin,and homeostatic model assessment for insulin resistance were independent factors affecting progression of prediabetes to T2DM(P<0.05).Receiver operating characteristic curve analysis showed that the area under the curve predicted by the above indicators combined was 0.905[95%confidence interval(CI):0.863-0.948],which was greater than that predicted by each indicator alone.Logistic regression analysis with baseline body weight as an independent variable showed that compared with body weight 1,the odds ratio(95%CI)of body weight 3 was 1.399(1.142-2.126)(P=0.033).There was a multiplicative interaction between body weight and uric acid(β=1.953,P=0.005).CONCLUSION High body weight in patients with prediabetes is an independent risk factor for progression to T2DM,and the risk of progression is increased when coexisting with high uric acid level.

The Relation of Standard Metabolic Rate to Water Temperature and Body Weight of Schlegels Black Rockfish(Sebastodes Fuscescens)

Standard metabolic rates of Schlegels black rockfish with different body weights are determined in laboratory by using the flow-through respirometer at 11.2 ℃, 14.7℃ , 18.0 ℃ and 23.6 ℃ . The results indicate that the standard metabolic rates increase with the increase of body weight at different temperatures. Relationship between them could be described as Rs = a ln W b. The mean of standard metabolic rate is significantly different among groups, but the b values are not. The standard metabolic rates of amended standard body weights decrease with the increase of temperature, and the mean of standard metabolic rate is also significantly different among groups when the standard body weights are 48.6 g, 147.9 g, and 243.1 g. Relationship between them could be described as Rsw = m e-b/T. The relations of standard metabolic rate ( Rs ) or relative metabolic rate ( Rs ) to body weight and temperature yield the following equations: Rs = 1.160 W 0.752 e -9.494/ T and Rs’= 1.160 W 0.254 e -9.494/ T.

EFFECTS OF RATION, TEMPERATURE AND BODY WEIGHT ON METABOLISM IN YOUNG BLACK PORGY

Feeding growth experiments on black porgy, Sparus macrocephalus , were carried out at four ration levels from starvation to satiation and four temperatures ranging from 14.8° to 26.8℃. The energy budget was used to calculate the metabolism in black porgy. Resting metabolism correlated significantly with body weight in power function at 24.4°, 20.1° and 14.8℃ ( R S=aW b ). The model predicting resting metabolism was obtained as: R S=0.0834W 0.8763 ·e 0.0319T . The feeding metabolism correlated linearly with ration level and food consumption. The predicting model of feeding metabolism is: R F=0.5631+0.0341·T-0.0013C·W·T+0.0010W ·T+0.0219C ·W-0.3335C. Using ln( RL+1 ), ln W , ln T and their interaction terms as independent variables, the prediction model of total daily metabolism was obtained by stepwise regression as: ln R T =-1.7328+0.3936ln W +1.1882ln( RL +1)-0.2823ln( RL +1)ln T +0.1555ln W ln T .

Risk factors related to acute renal failure after cardiac surgery for congenital heart disease in low body weight infants

Background Acute renal failure （ARF） is a common complication and a very important cause of postoperative death in children with congenital heart disease. Large cohort investigation of the morbidity and related risk factors for ARF in very young and low-body-weight children in China is still absent. Methods Data of 518 infants after cardiac surgery were analyzed retrospectively. The correlation between multivariate risk factors and ARF after cardiac surgery was analyzed by logistic regression. Results The incidence of postoperative ARF within 30 days was 6.9% （n = 36）. High RACHS-1 Score, long duration of CPB, rethoracotomy exploration and postoperative low cardiac output were independent risk factors of ARF. There were statistical significances in intensive care unit staying [（21.73 ± 7.28） days vs （7.41 ± 3.76） days], P 0. 001] and mortality （27.8% vs 7.5%, P 0. 001） between the patients with or without ARF. Conclusions Acute renal failure is a key negative factor for the survivors after cardiac surgery for congenital heart disease in very young patients with low body weight. High RACHS-1 Score, long duration of CPB, rethoracotomy exploration and postoperative low cardiac output are independent risk factors for development of ARF.

The Main and Interactive Effects of Fat and Salt Contents of the Diet on Characteristics of Metabolic Syndrome in Male Wistar Rats

The current Western diet contains high amounts of salt and fat. High salt and fat diets are known to have negative impacts on food intake (FI), body weight (BW), body composition (BC), glucose metabolism, and blood pressure. These factors have been studied as separate entities, but the main and interactive effects of dietary salt and fat received little study. The objective of this study was to examine the effect of sodium and fat content of the diet on FI, BW, and BC in male Wistar rats. Male Wistar Rats (n = 48) were allocated into 4 groups (n = 12) and received the following diets: 1. Normal sodium normal fat, 2. Normal sodium high fat, 3. High sodium normal fat, and 4. High sodium high-fat diet for 12 weeks. BW and FI were measured weekly. BC and organs’ weight were recorded post-termination. Regardless of sodium content, a greater FI was observed in normal-fat diet groups compared with high-fat diet groups. However, higher BW and fat (%) were observed in high-fat diet groups. Fasting blood glucose was higher in rats fed normal fat diets compared with those fed high-fat diets. Systolic and diastolic blood pressure was lower in rats fed either high fat, high salt, or normal fat, normal salt diet. In conclusion, fat but not salt content in the diet is a determining factor in the regulation of FI and body weight. Moreover, glucose metabolism can be influenced by both the fat and salt content of the diet.

Body Composition and Energy Expenditure Changes during Weight Loss: An Exploratory Study

The objective of this exploratory study was to describe changes in body composition and resting energy expenditure (REE) in adult women during weight reduction. A total of 69 client records were collected retrospectively from a 25 week commercial weight loss program that restricted calories to 90% of measured REE. Data analyzed included total body mass (TBM), fat mass (FM) and fat-free mass (FFM) from air displacement plethysmography;measured REE from indirect calorimetry;and predicted REE from linear regression. From baseline to week 25, there were significant declines in TBM (95.0 ± 24.1 kg to 87.2 ± 22.9 kg;P < 0.001) and FM (47.5 ± 18.5 kg to 39.9 ± 17.6 kg;P < 0.001). During the same time period, FFM remained unchanged (47.5 ± 7.3 kg to 47.2 ± 7.0 kg;P ≥ 0.05). REE was signify- cantly lower at weeks 13 (6595.2 ± 1312.1 kJ) and 25 (6608.2 ± 1404.6 kJ) compared to baseline (7117.4 ± 1471.5 kJ) (P < 0.001);however, REE at weeks 13 and 25 were similar (P ≥ 0.05). At weeks 13 and 25, predicted REE (6992.7 ± 1065.7 and 6939.2 ± 1056.0 kJ, respectively) was significantly higher than measured REE (6595.2 ± 1312.1 and 6608.2 ± 1404.6 kJ, respectively) (P < 0.001). The results of this study suggest that significant reduction in TBM is possible without the loss of FFM and that metabolic adaptation may occur during the process.

Prevalence and Incidence of Metabolic Syndrome in a Cohort of Patients with Rheumatoid Arthritis: A Correlation between Body Mass Index and Disease Activity

Rheumatoid Arthritis (RA) is an inflammatory disease associated with high morbidity and increased cardiovascular disease, and Metabolic Syndrome (MS) is understood as a set of metabolic disorders that correlates with obesity and sedentary lifestyle. The aim of this study is to evaluate the prevalence of MS in a cohort of patients with RA and its correlation to specific factors of the disease. A retrospective cohort study was conducted with 283 patients with RA, followed at the Rheumatology Outpatient Clinic of the Hospital de Clínicas de Porto Alegre (HCPA) between 2008 and 2016;187 continued to be followed and agreed to be reevaluated between January and November 2016. MS was defined according to the National Cholesterol Education Program and disease activity was assessed using the Disease Activity Score (DAS28). Clinical, biochemical, and anthropometric evaluations were conducted. The prevalence of MS in the first evaluation was 43.9% and, after 8 years, 59.4%. Increased waist circumference and blood pressures, elevated triglycerides and low High-Density Lipoprotein were the most frequent features of MS. The DAS28 was significantly lower in the reevaluation (p = 0.006). The prevalence of MS was higher at the end of 8 years;disease activity, as well as blood pressure, decreased during this period. Steroid use had also decreased at the end of follow-up. There was an increase of 15% of cases with MS in an 8-year follow-up cohort of patients, which was in agreement with the current literature and showed how the inflammatory process in RA is correlated to MS. The parameters of MS that varied the most were blood pressure, cholesterol and triglycerides. Ultimately, these parameters and disease activity must be observed closely in order to improve the prognosis of patients with RA.

New Mathematical Modelling on BMR and Weight Prediction for Ghanaians

Background: Basal Metabolic Rate (BMR) is the quantum of calories needed for optimum body function when at rest. This has long been an indicator of one’s health and the basis for determining the metabolic age of individuals. Many scholastic projects have led to the establishment of mathematical models and inventions that measure the BMR and other body composition parameters. However, existing computations have limitations as they do not offer accurate results for Ghanaians. Aim: The purpose of the study was to model BMR metrics that are most suitable for Ghanaians and to investigate the effect of caloric difference on weight, Lean Body Mass (LBM) and % fat composition that can be implemented with Information Technology. Research Methods and Procedures: This was an experimental study that adopted a quantitative approach. BMR and body composition were measured in a sample of 242 Ghanaian adults (141 males and 101 females) from 19 to 30 years of age. Body composition was measured using bioelectrical impendence analysis (BIA) in all participants. Each participant was under study for 7 days. A simple linear regression model was used to examine associations between BMR/calorie intake and total body weight and LBM. Results: There was a significant statistical relation between BMR and LBM and between BMR and weight of both men and women. Equations for BMR and weight were established for males and females. Furthermore, caloric intake differences affected changes in total weight as well as differences in % fat composition. Caloric intake however did not affect the difference in LBM. Conclusion: Caloric difference had an impact on total body weight and Lean Body Mass. The model derived from the study predicts weight change and BMR of Ghanaians from 19 to 30 years of age. It is termed the Health and Age Monitoring System (HAMS).

Refining a Church-Based Lifestyle Intervention Targeting African-American Adults at Risk for Cardiometabolic Diseases: A Pilot Study

Objective: The pilot study was intended to test the feasibility of a multiple-component lifestyle intervention targeting African American adults in a weight control and cardiometabolic risk reduction program on diet, activity, and stress, using community-engagement principles. Methods: Applying mixed qualitative and quantitative measures, the intervention had a two-part sequential study design consisting of 12 weekly small group sessions that provided individual and group counseling in nutrition, exercise, and mindfulness, while incorporating focus group and interactive techniques to learn about barriers and acceptable practices for this population. The program was implemented at an African-American church in Nashville, Tennessee. Results: Thirty-four participants (aged 56.1 ± 11 years, body mass index (BMI) 36.7 ± 6.6 kg/m2) completed the intervention. Lifestyle changes after the 12 weekly sessions showed some positive trends including reduced sodium intake (from 2725.3 ± 326.5 to 2132 ± 330, mg/day, P = 0.008), increased walking steps (from 4392.1 ± 497.2 to 4895.3 ± 497.9, steps/day, not significant), and slightly decreased Perceived Stress Scale (PSS) scores (from 13.7 ± 1.4 to 12.4 ± 1.5, not significant). Body fat % among male participants decreased significantly (from 33.8 ± 2.6 to 28 ± 2.6, %, P = 0.043). Among cardiometabolic risk biomarkers, hemoglobin A1c (HbA1c) decreased significantly (from 6.6 ± 0.2 to 6.1 ± 0.2, %, P β = 2.4, P = 0.006). Twenty-one participants took part in focus groups during the program to identify barriers to healthy lifestyle changes. Primary barriers reported were price, time for preparing healthy meals, unfamiliarity with mindfulness activities, their health condition, and daily schedule available for physical activities. Conclusions: This church-based pilot intervention was proven feasible by showing modest progress in reducing adiposity and decreasing HbA1c levels. The focus group and interactive methods facilitated program direction. Future full-scale studies are warranted to identify key strategies that provide more personalized approaches and supportive environments to sustain a healthy lifestyle among these at risk minorities with limited resources.

老年人群体质量指数与慢性代谢性疾病的关系

目的·评估老年人群体质量指数(body mass index,BMI)与慢性代谢性疾病发生风险的关系。方法·以2014—2021年在上海交通大学医学院附属仁济医院体检中心进行体检的老年人(≥60岁)为研究对象。收集其各项生化指标。由经过培训的护士测量其身高、体质量和血压。采用问卷法收集研究对象既往慢性代谢性疾病史。收缩压≥140 mmHg(1 mmHg=0.133 kPa)、舒张压≥90 mmHg或既往有高血压病史,定义为高血压。空腹血糖≥7.0 mmol/L或既往有糖尿病病史,定义为糖尿病。总胆固醇≥6.2 mmol/L、三酰甘油≥2.3 mmol/L或既往有脂代谢异常病史,定义为脂质代谢紊乱。BMI与高血压、糖尿病和脂质代谢紊乱之间的关系采用受试者操作特征(receiver operator characteristic,ROC)曲线和二元Logistic回归进行分析评估。结果·共收集59083例研究对象的资料,其中男性30807例,女性28276例,平均年龄(67.9±6.3)岁。高血压、糖尿病和脂质代谢紊乱的发生率分别为76.5%(45219/59083)、24.1%(14225/59083)和50.0%(29544/59083)。与60~74岁的老年人群相比,75岁及以上的老年人患高血压和糖尿病的比例更高,患脂质代谢紊乱和无代谢异常的比例更低。通过ROC曲线分析,BMI对于高血压、糖尿病和脂质代谢紊乱的切点值分别为24.3、23.9和23.9 kg/m^(2)。老年男性高血压和糖尿病的BMI切点值和老年女性十分接近(高血压BMI切点值:老年男性24.3 kg/m^(2)vs老年女性24.2 kg/m^(2);糖尿病BMI切点值:老年男性24.0 kg/m^(2)vs老年女性23.7 kg/m^(2)),但老年男性脂质代谢紊乱的BMI切点值明显高于老年女性(老年男性24.0 kg/m^(2)vs老年女性22.5 kg/m^(2))。60~74岁老年人的BMI对慢性代谢性疾病的切点值(24.2~24.7 kg/m^(2))高于75岁及以上的老年人(22.9~23.8 kg/m^(2))。结论·60~74岁老年人群应将BMI控制在24.0 kg/m^(2)以下,而75岁及以上老年人群应将BMI控制在23.0 kg/m^(2)以下,则有利于降低其慢性代谢性疾病的风险。

代谢健康状态转变及其与BMI的交互作用对心血管疾病发生的影响

目的探讨代谢健康状态转变与体质指数(BMI)交互作用及与心血管疾病(CVD)的关联。方法基于“新疆多民族自然人群队列建设及健康随访研究”和田调查现场,进行前瞻性队列研究。经过3年随访,根据代谢状态转变将研究对象分为保持代谢健康(MH)、代谢健康转为代谢不健康(MH-MU)、保持代谢不健康(MU)、代谢不健康转为代谢健康(MU-MH)4组,多因素Logistic回归分析不同组代谢状态对CVD发生的影响。应用限制性立方样条探讨BMI为连续变量与CVD风险的关联,分析代谢状态转变和BMI交互作用与CVD的关联。结果共10232人纳入本研究,平均年龄为(52.43±10.29)岁。在随访3年期间新发心血管疾病349例(3.41%);其中MH、MH-MU、MU和MU-MH 4组心血管疾病发生率分别为2.48%、4.21%、5.13%、3.30%。与MH组相比,MH-MU、MU组心血管疾病发生风险分别为OR=1.42(95%CI:1.05~1.93)和OR=1.41(95%CI:1.03~1.92)。限制性立方样条分析表明,基线BMI与心血管疾病发生为非线性关联(P=0.023)。BMI分组与代谢状态转变存在交互作用(χ2=26.025,P=0.001),其归因于交互效应比例为3%[RERI=0.032(95%CI:0.005~0.06)、AP=0.031(95%CI:0.007~0.05)、S=2.157(95%CI:1.194~3.897)]。结论保持或转变为代谢不健康状态均可增加心血管疾病的风险。保持或转为代谢不健康状态与超重、肥胖交互作用能够增加心血管疾病的风险。

不同性别老年人群身体圆度指数与体质量正常代谢异常表型的相关性研究:以三酰甘油葡萄糖乘积指数为潜在影响因素

背景身体圆度指数(BRI)是一种衡量中心性肥胖的简易指标,与心血管疾病密切相关。体质量正常代谢异常(MONW)人群患心血管疾病的风险较高,且与中心性肥胖显著相关。三酰甘油葡萄糖乘积(TyG)指数是反映胰岛素抵抗的指标。目前在不同性别老年人群中BRI、TyG指数和MONW表型的关系研究较为有限。目的探讨老年人群BRI与MONW表型患病风险在不同性别中的差异,探究TyG指数作为其不同性别中差异的潜在因素。方法选取2017-07-01—2021-06-30在安徽省10个市县区体检的≥60岁的常住居民为研究对象。采用统一的调查表收集研究对象的性别、年龄、疾病史等资料,收集体格检查和实验室检查资料,并计算BRI、TyG指数。将根据代谢状态和BMI水平分别将男性和女性分为体质量正常代谢正常(MHNW)表型和MONW表型:男性MHNW表型(n=5384)、男性MONW表型(n=6251);女性MHNW表型(n=4498)、女性MONW表型(n=8264)。根据BRI四分位数分别将男性和女性分为4个水平,即男性:M1、M2、M3、M4,女性:F1、F2、F3、F4。采用Logistic回归分析分别探讨BRI四分位水平与TyG指数升高风险以及MONW表型患病风险的关系,采用R(version 4.1.1)软件中的Z检验比较男性和女性OR值之间的差异。结果本研究共纳入24397例调查对象,其中男11635例(47.7%)、女12762例(52.3%),中位年龄67(64,70)岁,MHNW表型9882例(40.5%)、MONW表型14515例(59.5%)。不同性别MONW表型老年人群高血压比例、糖尿病比例、血脂异常比例、收缩压、舒张压、TyG指数、BRI、空腹血糖(FPG)、总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)高于MHNW表型,吸烟比例、高密度脂蛋白胆固醇(HDL-C)低于MHNW表型(P<0.05);不同性别高水平BRI老年人群MONW表型患病、高血压比例、糖尿病比例、血脂异常比例、TyG指数、FPG、TG高于低水平BRI,HDL-C低于低水平BRI(P<0.05)。单因素Logistic回归分析结果显示,与BRI M1/F1水平相比,不同性别老年人群BRI M2/F2、M3/F3、M4/F4水平TyG指数升高风险均增加(P<0.05);且TyG指数升高风险随着BRI水平升高而增加(男性P_(趋势)<0.001,女性P_(趋势)<0.001);老年男性BRI M2、M3、M4水平TyG指数升高风险高于老年女性BRI F2、F3、F4水平(P<0.05)。校正混杂因素后进行多因素Logistic回归分析结果显示,与BRI M1/F1水平相比,不同性别老年人群BRI M2/F2、M3/F3、M4/F4水平MONW表型患病风险均增加(P<0.05);且MONW表型患病风险随着BRI水平升高而增加(男性P_(趋势)<0.001,女性P_(趋势)<0.001);老年男性BRI M2、M4水平MONW表型患病风险高于老年女性BRI F2、F4水平(P<0.05)。结论在不同性别老年人群中,BRI水平与MONW表型患病风险呈正相关,其中老年男性高水平BRI与MONW表型患病风险关联更为密切,TyG指数是引起其性别差异的潜在因素。

β羟丁酸在心血管疾病中的作用及意义

羟丁酸是酮体的主要成分,在肝脏生成,肝外组织代谢。心脏是重要的酮体消耗器官,病理条件下酮体氧化贡献着超过心脏所需20%的能量。近年来β羟丁酸在心血管疾病中的作用成为研究热点,由于其不仅是能量底物,还作为信号分子调节细胞代谢、炎症、细胞间相互作用和生物能量,这些功能使其在不同心血管疾病中发挥复杂多样的作用。本文对近几年β羟丁酸在心力衰竭、病理性心肌肥大、糖尿病心肌损伤、心肌缺血与再灌注损伤、心房颤动、高血压、动脉粥样硬化及钙化等疾病中的研究成果进行综述,为β羟丁酸成为心血管疾病新的干预靶点提供依据。

Hepatic steatosis in overweight/obese females: New screening method for those at risk

AIM: To identify which parameters could help to distinguish the "metabolically benign obesity", which is not accompanied by insulin resistance (IR) and early atherosclerosis.METHODS: Eighty two of 124 overweight/obese females formed the study population, which was divided into two groups (52 and 30 subjects, respectively) with and without IR according to a HO meostatic Metabolic Assessment (HOMA) cut-off of 2, and were studied in a cross-sectional manner. The main outcome measures were waist circumference, serum uric acid, high-density lipoprotein-cholesterol and triglycerides, alanine amino-transferase, blood pressure and the two imaging para-meters, hepatic steatosis and longitudinal diameter of the spleen, which were measured in relation to the presence/absence of IR. RESULTS: A variable grade of visceral obesity was observed in all subjects with the exception of three.Obesity of a severe grade was represented more in the group of IR individuals (P = 0.01). Hepatic steatosis, revealed at ultrasound, was more pronounced in IR than in non-IR subjects (P = 0.005). The two groups also demonstrated a clear difference in longitudinal spleen diameter and blood pressure, with raised and signif icant values in the IR group. Metabolic syndrome was frequent in the IR group, and was not modified when adjusted for menopause (P = 0.001). At linear regression, the β values of waist circumference and body mass index predicting HOMA were 0.295, P = 0.007 and 0.41, P = 0.0001, respectively. Measures of spleen longitudinal diameter were well predicted by body mass index (BMI) values, β = 0.35, P = 0.01, and by HOMA, β = 0.41, P = 0.0001. Blood pressure was predicted by HOMA values, β = 0.39, P = 0.0001). HOMA and hepatic steatosis were highly associated (rho = 0.34, P = 0.002). Interestingly, IR patients were almost twice as likely to have hepatic steatosis as non-IR patients. Among the MS criteria, blood pressure was very accurate in identifying the presence of IR (AUROC for systolic blood pressure 0.66, cut-off 125 mm of Hg, sensibility 64%, specif icity 75%; AUROC for diastolic blood pressure 0.70, cut-off 85 mm of Hg, sensibility 54.5%, specif icity 75%). CONCLUSION: As health care costs are skyrocketing, reliable and mainly inexpensive tools are advisable to better defi ne subjects who really need to lose weight.

Glucagon-like peptide-1 receptor agonists favorably address all components of metabolic syndrome

Cardiovascular death is the leading cause of mortality for patients with type 2 diabetes mellitus. The etiologyof cardiovascular disease in diabetes may be divided into hyperglycemia per se and factors operating through components of metabolic syndrome(Met S). Hyperglycemia causes direct injury to vascular endothelium and possibly on cardiac myocytes. Met S is a cluster of risk factors like obesity, hyperglycemia, hypertension and dyslipidemia. The incidence of this syndrome is rising globally. Glucagon-like peptide-1 receptor agonists(GLP-1RA) are a group of drugs, which address all components of this syndrome favorably. Experimental evidence suggests that they have favorable actions on myocardium as well. Several compounds belonging to GLP-1RA class are in market now and a large number awaiting their entry. Although, originally this class of drugs emerged as a treatment for type 2 diabetes mellitus, more recent data generated revealed beneficial effects on multiple metabolic parameters. We have studied literature published between 2000 and 2016 to look into effects of GLP-1RA on components of Met S. Results from recently concluded clinical trials suggest that some of the molecules in this class may have favorable effects on cardiovascular outcome.

Is perinatal neuroendocrine programming involved in the developmental origins of metabolic disorders?

The discovery that small size at birth and during infancy are associated with a higher risk of diabetes and related metabolic disease in later life has pointed to the importance of developmental factors in these conditions. The birth size associations are thought to refl ect exposure to adverse environmental factors during early development but the mechanisms involved are still not fully understood. Animal and human work has pointed to the importance of changes in the setpoint of a number of key hormonal systems controlling growth and development. These include the IGF-1/GH axis, gonadal hormones and, in particular, the systems mediating the classical stress response. Several studies show that small size at birth is linked with increased activity of the hypothalamic-pituitary-adrenal axis and sympathoadrenal system in adult life. More recent human studies have shown associations between specif ic adverse experiences during pregnancy, such as famine or the consumption of adverse diets, and enhanced stress responses many decades later. The mediators of these neuroendocrine responses are biologically potent and are likely to have a direct infl uence on the risk of metabolic disease. These neuroendocrine changes may also have an evolutionary basis being part of broader process, termed phenotypic plasticity, by which adverse environmental cues experienced during development modify the structure and physiology of the adult towards a phenotype adapted for adversity. The changes are clearly advantageous if they lead to a phenotype which is well-adapted for the adult environment, but may lead to disease if there is subsequent overnutrition or other unexpected environmental conditions.

Validation of genetic variants associated with metabolic dysfunctionassociated fatty liver disease in an ethnic Chinese population

BACKGROUND Genetic factors play an important role in the pathogenesis and development of metabolic dysfunction-associated fatty liver disease(MAFLD).AIM To study the association of single nucleotide polymorphisms(SNPs),previously identified in Western populations,with the risk of MAFLD in a Singapore Chinese population and their interactions with environmental and medical risk factors.METHODS A retrospective case-control study was conducted with 72 MAFLD cases and 72 controls with no hepatic steatosis on computed tomography,magnetic resonance imaging,or controlled attenuation parameter score.Subjects were recruited from two tertiary hospitals.Genetic alleles such as NCAN,GCKR,LYPLAL1,PNPLA3,PPP1R3B,FDFT1,COL13A1,EFCAB4B,PZP,and TM6SF2 were genotyped using the TaqMan®Predesigned SNP Genotyping Assay.RESULTS Weight and body mass index(BMI)were 1.2-times higher in patients(70.6 kg,95%confidence interval[CI]:57.1-84.1 vs 60.8 kg,95%CI:48.5-73.1,P<0.001 and 26.9 kg,95%CI:23-40.8 vs 23.3 kg 95%CI:19-27.6,P<0.001 respectively).The prevalence of diabetes mellitus in patients was 40.3%and 20.8%in controls(P=0.011).Patients had higher mean triglycerides than controls(P<0.001).PNPLA3 GG was more likely to be associated with MAFLD(43.4%CC vs 69.7%GG,P=0.017,and 44.8%CG vs 69.7%GG,P=0.022).In multivariable analysis,hypertriglyceridemia(odds ratio[OR]:2.0495%CI:1.3-3.1,P=0.001),BMI(OR:1.295%CI:1.1-1.4,P<0.001)and PNPLA3 GG(OR:3.495%CI:1.3-9.2,P=0.014)were associated with MAFLD(area under the receiver operating characteristic curve of 0.823).CONCLUSION Among the Chinese population of Singapore,PNPLA3 homozygous GG allele is a strong predictor of MAFLD,whereas LYPLAL1,GCKR,FDFT1,COL13A1,PZP,and TM6SF2 are not significantly associated.Hypertriglyceridemia,high BMI,and PNPLA3 GG are independent predictors of MAFLD.

Role of nutritional ketosis in the improvement of metabolic parameters following bariatric surgery

BACKGROUND Ketone bodies(KB)might act as potential metabolic modulators besides serving as energy substrates.Bariatric metabolic surgery(BMS)offers a unique opportunity to study nutritional ketosis,as acute postoperative caloric restriction leads to increased lipolysis and circulating free fatty acids.AIM To characterize the relationship between KB production,weight loss(WL)and metabolic changes following BMS.METHODS For this retrospective study we enrolled male and female subjects aged 18-65 years who underwent BMS at a single Institution.Data on demographics,anthropometrics,body composition,laboratory values and urinary KB were collected.RESULTS Thirty-nine patients had data available for analyses[74.4%women,mean age 46.5±9.0 years,median body mass index 41.0(38.5;45.4)kg/m^(2),fat mass 45.2%±6.2%,23.1%had diabetes,43.6%arterial hypertension and 74.4%liver steatosis].At 46.0±13.6 d post-surgery,subjects had lost 12.0%±3.6%of pre-operative weight.Sixty-nine percent developed ketonuria.Those with nutritional ketosis were significantly younger[42.9(37.6;50.7)years vs 51.9(48.3;59.9)years,P=0.018],and had significantly lower fasting glucose[89.5(82.5;96.3)mg/dL vs 96.0(91.0;105.3)mg/dL,P=0.025]and triglyceride levels[108.0(84.5;152.5)mg/dL vs 152.0(124.0;186.0)mg/dL,P=0.045]vs those with ketosis.At 6 mo,percent WL was greater in those with postoperative ketosis(-27.5%±5.1%vs 23.8%±4.3%,P=0.035).Urinary KBs correlated with percent WL at 6 and 12 mo.Other metabolic changes were similar.CONCLUSION Our data support the hypothesis that subjects with worse metabolic status have reduced ketogenic capacity and,thereby,exhibit a lower WL following BMS.

不同剂量的托吡酯联合奥氮平治疗精神分裂症的效果及对体重指数、糖脂代谢的影响

目的探究不同剂量托吡酯联合奥氮平治疗精神分裂症的效果及对体重指数(BMI)、糖脂代谢的影响。方法选取2020年11月至2022年2月浙江省湖州市第三人民医院精神科门诊及住院治疗的120例精神分裂症患者,按随机数字表法将其分为对照组、试验1组、试验2组,各40例。对照组给予奥氮平治疗,试验1组给予托吡酯(100 mg最大剂量)+奥氮平治疗,试验2组给予托吡酯(200 mg最大剂量)+奥氮平治疗,均持续治疗12周。比较三组阳性和阴性症状量表(PANSS)评分、BMI、糖脂代谢指标[空腹血糖(FBG)、空腹胰岛素(FINS)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)、总胆固醇(TC)]水平、安全性。结果治疗前,三组PANSS评分比较,差异无统计学意义(P>0.05)。试验1组与对照组比较:治疗4周时PANSS评分比较,差异无统计学意义(P>0.05);治疗8、12周,试验1组PANSS评分低于对照组,差异有统计学意义(P<0.05)。试验2组与对照组比较:治疗4、8、12周,试验2组PANSS评分低于对照组,差异有统计学意义(P<0.05)。试验1组与试验2组比较:治疗4、8、12周,试验2组PANSS评分低于试验1组,差异有统计学意义(P<0.05)。三组组内比较:与治疗前比较,治疗4、8、12周,三组PANSS评分均降低,差异有统计学意义(P<0.05)。治疗后,试验1组、试验2组BMI、FBG、FINS、TG、LDL-C、TC水平均低于对照组(P<0.05),但试验1组与试验2组各指标比较差异无统计学意义(P>0.05)。三组不良反应总发生率比较,差异无统计学意义(P>0.05);三组感觉异常发生率比较,差异有统计学意义(P<0.05)。结论托吡酯治疗精神分裂症患者能够改善奥氮平引起的体重增加,并调节糖脂代谢,缓解精神症状;200 mg剂量的托吡酯改善效果更明显,但可增加感觉异常发生率。

Effects of intragastric balloon placement in metabolic dysfunctionassociated fatty liver disease: A systematic review and metaanalysis

BACKGROUND Metabolic dysfunction-associated fatty liver disease corresponds to a clinical entity that affects liver function triggered by the accumulation of fat in the liver and is linked with metabolic dysregulation.AIM To evaluate the effects of the intragastric balloon(IGB)in patients with metabolic dysfunction-associated fatty liver disease through the assessment of liver enzymes,imaging and several metabolic markers.METHODS A comprehensive search was done of multiple electronic databases(MEDLINE,EMBASE,LILACS,Cochrane and Google Scholar)and grey literature from their inception until February 2021.Inclusion criteria involved patients with a body mass index>25 kg/m2 with evidence or previous diagnosis of hepatic steatosis.Outcomes analyzed before and after 6 mo of IGB removal were alanine aminotransferase(IU/L),gamma-glutamyltransferase(IU/L),glycated hemoglobin(%),triglycerides(mg/dL),systolic blood pressure(mmHg),homeostatic model assessment,abdominal circumference(cm),body mass index(kg/m2)and liver volume(cm3).RESULTS Ten retrospective cohort studies evaluating a total of 508 patients were included.After 6 mo of IGB placement,this significantly reduced alanine aminotransferase[mean difference(MD):10.2,95%confidence interval(CI):8.12-12.3],gammaglutamyltransferase(MD:9.41,95%CI:6.94-11.88),glycated hemoglobin(MD:0.17%,95%CI:0.03-0.31),triglycerides(MD:38.58,95%CI:26.65-50.51),systolic pressure(MD:7.27,95%CI:4.79-9.76),homeostatic model assessment(MD:2.23%,95%CI:1.41-3.04),abdominal circumference(MD:12.12,95%CI:9.82-14.41)and body mass index(MD:5.07,95%CI:4.21-5.94).CONCLUSION IGB placement showed significant efficacy in improving alanine aminotransferase and gamma-glutamyltransferase levels in patients with metabolic dysfunctionassociated fatty liver disease as well as improving metabolic markers related to disease progression.