Risk factors for carbohydrate metabolism disorders from a chronobiological position

Abstract

steady increase in the prevalence of carbohydrate metabolism disorders is closely related to overweight and obesity. Obesity is associated with a sedentary lifestyle, poor diet, sleep disturbance, which can lead to dysfunction of circadian rhythms with a decrease in the production of the hormone melatonin. The aim of the study is to clarify the most significant risk factors for carbohydrate metabolism disorders in obese patients from the standpoint of chronobiology. Material and methods. The retrospective study involved 120 patients with obesity (body mass index 31.35±3.80 kg/m2) with early disorders of carbohydrate metabolism (EDCM), type 2 diabetes mellitus (T2DM) and without disorders of carbohydrate metabolism (n=40 in each group). The age of the patients was 40-69 years, of which 75% were women and 25% were men. The patients' food diaries (for 24 hours) and Horne-Ostberg tests were analyzed. Fasting glucose, glycated hemoglobin, leptin, insulin were determined in the venous blood plasma; the insulin resistance index (HOMA-IR) was calculated, anthropometric indicators, basal body temperature (BT) were measured. Results and discussion. Patients of all groups were comparable in age, sex, BMI. The patients had an irrational distribution of the amount of calories consumed during the day, frequent meals, and a tendency to late breakfast (9:30-10:00 h) and dinner (19:00-20:00). In all 3 groups, leptin and insulin resistance was determined. In patients with DM2 leptin and insulin deficiency was revealed, which was confirmed by the presence of negative correlations between insulin concentration and energy consumption (r=-0.817, p<0.001) and carbohydrates intake (r=-0.299, p<0.001), as well as between carbohydrate intake and leptin concentration (r=-0.221, p<0.01) and HOMA-IR (r=-0.257, p<0.005). The duration of sleep averaged 7±1 h per day, and bedtime using artificial illumination, on average, varied in the range of 22:00-23:30, which can lead to circadian mismatch, with the progression of insulin resistance. The decrease in the amplitude of the BT circadian rhythm in patients with EDCM and T2DM, as well as the presence of an inverse correlation between BT and energy consumption (r=-0.531, p<0.0001) and fat intake (r=-0.533, p<0.0001), and a positive correlation between BT and protein consumption (r=0.533, p<0.0001), may indicate the involvement of melatonin in the development and progression of disorders of carbohydrate metabolism. Conclusion. The most significant risk factors for the development of disorders of carbohydrate metabolism, accompanied by circadian dysfunction in the surveyed, include irrational distribution of the energy value of food during the day, frequent meals, late breakfast and dinner; shifting the time of going to bed, shortening the duration of sleep, exposure to artificial lighting in the evening.