Abnormal Carbohydrate Metabolism Research Articles

ISPAD Clinical Practice Consensus Guidelines 2006?2007 Definition, epidemiology and classification

Pediatric DiabetesVolume 7, Issue 6 p. 343-351 ISPAD Clinical Practice Consensus Guidelines 2006–2007Definition, epidemiology and classification Maria E Craig, Maria E Craig University of NSW, University of Sydney, The Children’s Hospital at Westmead, AustraliaSearch for more papers by this authorAndrew Hattersley, Andrew Hattersley Institute of Biomedical and Clinical Sciences, Peninsula Medical School, Exeter, UKSearch for more papers by this authorKim Donaghue, Kim Donaghue University of Sydney, The Children’s Hospital at Westmead, NSW, Australiae-mail [email protected]Search for more papers by this author Maria E Craig, Maria E Craig University of NSW, University of Sydney, The Children’s Hospital at Westmead, AustraliaSearch for more papers by this authorAndrew Hattersley, Andrew Hattersley Institute of Biomedical and Clinical Sciences, Peninsula Medical School, Exeter, UKSearch for more papers by this authorKim Donaghue, Kim Donaghue University of Sydney, The Children’s Hospital at Westmead, NSW, Australiae-mail [email protected]Search for more papers by this author First published: 12 December 2006 https://doi.org/10.1111/j.1399-5448.2006.00216.xCitations: 48 Acknowledgements: Denis Daneman, Zvi Laron, Shin Amemiya, Shigetaka Sugihara, Tatsuhiko Urakami, Gun Forsander Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Citing Literature Volume7, Issue6December 2006Pages 343-351 RelatedInformation

Glicemia de ayuno versus prueba de tolerancia oral a la glucosa en la detección de intolerancia a la glucosa en niños y adolescentes obesos

Recently, the cut-off point for normal fasting glucose (FG) level, was decreased to 100 mg/dl. To determine the frequency of abnormal carbohydrate abnormalities in children with obesity and evaluate if the fasting glucose level is a useful tool for the screening of glucose intolerance (GI). Children and adolescents, referred for evaluation of obesity were evaluated with an oral glucose tolerance test (OGTT) and FG. The sensitivity of FG for detection of GI, using the 100 and 110 mg/dl cut-off point, was evaluated. We studied 186 patients (125 females) aged 12.1 (range: 5.4-19.3) years with a body mass index (BMI) of 29.9 (18.3-44.6) kg/mt2 and a BMI Z score of 2.1 (1.7-3.2). Seven patients (3.8%) had abnormalities in the carbohydrate metabolism. The sensitivity of FG for the detection of GI using the 100 and 110 mg/dl cut-off values was 42.9 and 14.3%, respectively. Receiver operating characteristic (ROC) curves showed that the optimal diagnostic level for FG corresponds to 80 mg/dl (sensitivity: 85.7% and specificity of 74.9%). An abnormal carbohydrate metabolism was detected in 3.8% of the obese children and adolescents in this sample. FG of 100 mg/dl does not detect 57.1% of the patients with glucose intolerance. These data suggest that FG is not a useful screening tool for glucose intolerance in young patients.

Evidence for the association of the SLC22A4 and SLC22A5 genes with Type 1 Diabetes: a case control study

BackgroundType 1 diabetes (T1D) is a chronic, autoimmune and multifactorial disease characterized by abnormal metabolism of carbohydrate and fat. Diminished carnitine plasma levels have been previously reported in T1D patients and carnitine increases the sensitivity of the cells to insulin. Polymorphisms in the carnitine transporters, encoded by the SLC22A4 and SLC22A5 genes, have been involved in susceptibility to two other autoimmune diseases, rheumatoid arthritis and Crohn's disease. For these reasons, we investigated for the first time the association with T1D of six single nucleotide polymorphisms (SNPs) mapping to these candidate genes: slc2F2, slc2F11, T306I, L503F, OCTN2-promoter and OCTN2-intron.MethodsA case-control study was performed in the Spanish population with 295 T1D patients and 508 healthy control subjects. Maximum-likelihood haplotype frequencies were estimated by applying the Expectation-Maximization (EM) algorithm implemented by the Arlequin software.ResultsWhen independently analyzed, one of the tested polymorphisms in the SLC22A4 gene at 1672 showed significant association with T1D in our Spanish cohort. The overall comparison of the inferred haplotypes was significantly different between patients and controls (χ2 = 10.43; p = 0.034) with one of the haplotypes showing a protective effect for T1D (rs3792876/rs1050152/rs2631367/rs274559, CCGA: OR = 0.62 (0.41–0.93); p = 0.02).ConclusionThe haplotype distribution in the carnitine transporter locus seems to be significantly different between T1D patients and controls; however, additional studies in independent populations would allow to confirm the role of these genes in T1D risk.

Clinical irrelevance of the current diagnostic criteria for abnormal carbohydrate metabolism in asymptomatic individuals

Clinical irrelevance of the current diagnostic criteria for abnormal carbohydrate metabolism in asymptomatic individuals

Evaluation of a noninvasive blood glucose monitoring device for critically ill patients

Critically ill patients frequently experience abnormalities in carbohydrate metabolism and a severe insulin resistance state. Hyperglycemia is a negative predictor of outcome in these patients, as high blood glucose (BG) values are associated with an increased risk of morbidity and mortality. Currently, BG monitoring methods cannot fulfill the need for continuous glucose monitoring in order to safely implement tight glucose control protocols. The purpose of this study is to evaluate the feasibility of the NBM-100 device (OrSense Ltd) for non-invasive (NI) continuous glucose monitoring in critically ill patients.

Nutrition for the liver transplant patient

Patients with end-stage liver disease (ESLD) frequently have diverse abnormalities of carbohydrate, lipid, and protein metabolism that cause progressive deterioration of their clinical condition and lead to malnutrition. Malnutrition is almost universally present in patients with ESLD undergoing liver transplantation and has been associated with increased morbidity and mortality. It is essential to identify and correct nutritional deficiencies in this population and provide an adequate nutritional support during all phases of liver transplantation. In conclusion, this article reviews the etiologic factors, prevalence, assessment and management guidelines of nutritional disorders seen in patients with ESLD undergoing liver transplantation.

Insulin Signal Mimicry as a Mechanism for the Insulin-Like Effects of Vanadium

Among several metals, vanadium has emerged as an extremely potent agent with insulin-like properties. These insulin-like properties have been demonstrated in isolated cells, tissues, different animal models of type I and type II diabetes as well as a limited number of human subjects. Vanadium treatment has been found to improve abnormalities of carbohydrate and lipid metabolism and of gene expression in rodent models of diabetes. In isolated cells, it enhances glucose transport, glycogen and lipid synthesis, and inhibits gluconeogenesis and lipolysis. The molecular mechanism responsible for the insulin-like effects of vanadium compounds have been shown to involve the activation of several key components of insulin-signaling pathways that include the mitogen-activated-protein kinases (MAPKs) extracellular signal-regulated kinase 1/2 (ERK1/2) and p38MAPK, and phosphatidylinositol 3-kinase (PI3-K)/protein kinase B (PKB). It is interesting that the vanadium effect on these signaling systems is independent of insulin receptor protein tyrosine kinase activity, but it is associated with enhanced tyrosine phosphorylation of insulin receptor substrate-1. These actions seem to be secondary to vanadium-induced inhibition of protein tyrosine phosphatases. Because MAPK and PI3-K/PKB pathways are implicated in mediating the mitogenic and metabolic effects of insulin, respectively, it is plausible that mimicry of these pathways by vanadium serves as a mechanism for its insulin-like responses.

294: Outcome of Pregnancy with Metformin on Patient with Recurrent Spontaneous Abortion who Have Abnormal Carbohydrate Metabolism

To determine the incidence of abnormal glucose tolerance test (GTT) in recurrent spontaneous aborters including PCO and non-PCO patients, and also whether metformin would safety reduce the rate of first trimester spontaneous abortions without teratogenisity in patients with abnormal GTT. Prospective pilot study. University related clinic. One hundred sixty-two patients with history of recurrent spontaneous abortions and 74 patients with previous term deliveries as control. Performing GTT on all patients administering metformin 1500 mg/day in patients with abnormal GTT. Continuation of pregnancy above first trimester. Out of 162 patients with previous abortions 29 (17.9%) and out of 74 women in control group, 4 (5.4%) patients had abnormal GTT respectively (p=0.017). Also 7 (24.1%) women in abnormal GTT group and 8 (6.1%) in normal GTT group were PCO. Among 29 patients with abnormal GTT, 17 patients were given metformin and 12 women receive nothing during pregnancy. Pregnancy outcome: Three of 17 (17.64%) patients in metformin group and 8 of 12 (66.6%) patients group II (non metformin group) aborted before 13 weeks respectively (p=0.04). No anomaly was seen in newborn of patients when delivered at term. It was shown that there is association between abnormal GTT and history of recurrent abortion including PCO and non PCO patients. Also improved outcome of pregnancy was seen with metformin therapy among those with abnormal GTT.

Frequency of Abnormal Carbohydrate Metabolism and Diabetes in a Population-based Screening of Adolescents

To document the frequency of glucose intolerance in adolescents in a population-based study of primarily African-American/Non-Hispanic whites in an urban-suburban school district. Measurement of fasting and 2-hour post-glucose load plasma glucose concentrations. Carbohydrate intolerance (either impaired fasting glucose, impaired glucose tolerance, or both) was identified in 8.0%, near-diabetes (1 fasting glucose > or = 126 mg/dL [7.0 mmol/L] and/or 2-hour glucose > or = 200 mg/dL [11.1 mmol/L]) in 0.3%, and diabetes in 0.36% (type 1A = 0.24%; type 2 = 0.08%; undiagnosed type 2 = 0.04%). A model for abnormal carbohydrate metabolism was constructed with regression analysis in the Carbohydrate Intolerance (CI)/near-diabetes group and with logistic regression in the entire study population. Risk factors for the development of CI/near-diabetes included having a 1 unit increase in body mass index (BMI) z-score and either being non-Hispanic white or in the pubertal group. Increased fasting glucose correlated with having puberty and decreased BMI z-score, whereas 2-hour glucose correlated with increased BMI z-score. By using National Health and Nutrition Survey (NHANES) III (1988-1994) definitions, impaired fasting glucose was present in 2.0% in this study versus 1.7% (NHANES III). The prevalence of CI/near-diabetes was 8.3%. Undiagnosed diabetes mellitus was rare. One third of adolescents with diabetes mellitus could be classified as having type 2 diabetes mellitus. The adult model of the progression of insulin resistance to type 2 diabetes mellitus in adolescents may be valid. Despite the increase in the overweight population since NHANES III, abnormalities in glucose metabolism have not changed significantly.

Screening for gestational diabetes mellitus

The term 'gestational diabetes mellitus' is unsatisfactory as it refers to a heterogeneous group of women, including those with minimal abnormality of carbohydrate metabolism and those with undiagnosed type II diabetes. However, perinatal morbidity is increased even in the group of women who have only impaired glucose tolerance; the mothers are at increased risk of subsequent development of diabetes, and there may also be long-term implications for the offspring. Current research is aiming to define the blood glucose levels at which risks increase so that clinical management can be appropriately directed. When available, the criteria required to justify population screening in pregnancy should be satisfied. The glucose challenge and fasting glucose tests are the leading contenders as appropriate screening tests to determine who should have the diagnostic glucose tolerance test. However, until this is reviewed, the widely used scheme of risk factors as a screening method should continue, as it detects at least 50% of women with gestational diabetes.

Skin Tags and Atherosclerotic Risk Factors

An association between skin tags and insulin resistance, obesity, impaired carbohydrate and lipid metabolism has been suggested. However, there still is a need for comprehensive and controlled clinical studies. We aimed to evaluate the atherogenic risk factors in patients with skin tags. Thirty-six patients with skin tags who were admitted to the dermatology department and 22 healthy controls were included in this study. Possible subjects who were taking systemic drugs or who had a systemic disease that may be associated with lipid or carbohydrate metabolism abnormalities were excluded from the study. All the measurements were completed in 26 patients. Standard oral glucose tolerance tests were performed on the patient and control groups. Serum insulin, total cholesterol, triglyceride and HDL-cholesterol levels were measured. LDL-cholesterol and VLDL-cholesterol ratios and HOMA-IR and body mass indices were calculated. The mean levels of body mass index, HOMA-IR, and total cholesterol were significantly higher in patients than in controls. In conclusion, skin tags may not be innocent tumoral proliferations; instead, follow-up of such patients with regard to the development of diseases associated with atherosclerosis may be beneficial.

The abnormalities of carbohydrate metabolism in Turner syndrome: analysis of risk factors associated with impaired glucose tolerance

An oral glucose tolerance test (OGTT) was performed in 103 patients with Turner syndrome (TS) who had normal fasting and postprandial glucose levels. The plasma glucose, insulin, C-peptide and proinsulin levels were measured every 30 min during the test. Using a homeostatic model assessment (HOMA) and a quantitative insulin sensitivity check index (QUICKI), the insulin resistance in TS patients was investigated. Diabetes mellitus and impaired glucose tolerance (IGT) were newly diagnosed in two and 18 patients respectively. There was a significant increase in mean plasma glucose, insulin, C-peptide and proinsulin response during an OGTT in the IGT group in contrast to the normal glucose tolerance (NGT) group ( P < 0.05). There was a significant decrease in the quantitative insulin sensitivity check index (QUICKI) in the IGT group in contrast to the NGT group ( P < 0.05). The fasting insulin and triglyceride levels strongly predicted the 2 h glucose level during the OGTT ( P < 0.05). The oral glucose tolerance test is superior to the fasting and postprandial plasma glucose test for the early detection of abnormalities of carbohydrate metabolism in patients with Turner syndrome.

Association of Apolipoproteins C3 and E with Metabolic Changes in HIV-Infected Adults Treated with a Protease-Inhibitor-Containing Antiretroviral Therapy

To examine the relationship between plasma levels of apolipoproteins C3 (APOC3) and E (APOE) and the presence of lipid and carbohydrate metabolism abnormalities or clinical signs of lipodystrophy in HIV-1-infected patients started with a protease-inhibitor-containing antiretroviral therapy. The Aproco (Antiproteases Cohort) Study enrolled 1,181 HIV-1-infected adults in 47 French healthcare centres from May 1997 to June 1998. From December 1998 through July 1999, the APROCO-Metabolic Complications (APROCO-MC) cross-sectional study was performed at the month 20 visit for those patients enrolled in 1997 and at the month 12 visit for those enrolled in 1998. The current analysis presents results from a subset of patients who had undergone additional tests to measure APOC3 and APOE in order to study their relationship with metabolic syndrome (n=157) and abnormal results in an oral glucose tolerance test (n=135). Increases in triglycerides and non-high-density lipoprotein (HDL) cholesterol were associated with significantly higher levels of APOC3, in both Lp B (lipoproteins containing apolipoprotein B) and Lp non-B (lipoproteins free of apolipoprotein B), and a significant higher level of APOE Lp B. APOC3 and APOC3 Lp non-B were increased when glucose metabolism abnormalities were more severe. The presence of a metabolic syndrome was associated with increased plasma APOC3, APOC3 Lp B and APOC3 Lp non-B levels. In a multiple regression analysis, high levels of APOC3 in Lp B and APOC3 Lp non-B were associated with the presence of clinical signs of lipodystrophy, even after adjustment for triglycerides and HDL-cholesterol levels. Lipid and/or glucose metabolism abnormalities in treated HIV-1-infected patients are associated with increased levels of APOC3 and, to a lesser extent, APOE plasma concentrations. Increased values are also related to clinical signs of insulin resistance and lipodystrophy.

Influences of abnormal carbohydrate metabolism during pregnancy

目的 通过大样本资料研究妊娠期糖代谢异常对巨大儿发生的影响.方法回顾性研究1995年1月至2001年3月在北京大学第一医院妇产科产前进行了妊娠糖尿病(gestational dia-betes mellitus,GDM)的相关检查并分娩的8656例孕妇的临床资料.结果(1)8656例孕妇分娩巨大儿700例,发生率8.1%.(2)糖代谢异常孕妇巨大儿发生率为12.5%(69/552),显著高于糖代谢正常孕妇的7.8%(631/8104)(P＜0.01).(3)非GDM孕妇中,50g葡萄糖负荷试验(glucose chal-lenge test,GCT)异常孕妇的巨大儿发生率为10.7%(177/1651),GCT正常者为7.0%(454/6453),二者比较差异有显著性(P＜0.01).(4)A2型GDM孕妇巨大儿发生率为13.8%,显著高于A1型的6.0%(P＜0.01).(5)25岁以下孕妇巨大儿发生率为5.9%,35岁以上孕妇的巨大儿发生率为9.9%,糖代谢异常的高龄孕妇巨大儿发生率为18.2%.(6)孕26～28周时孕妇的平均体重指数(BMI)为(24.9±2.9),BMI≥27.8组孕妇巨大儿发生率为16.2%,显著高于其他孕妇的6.3%,糖代谢正常但BMI≥27.8的孕妇巨大儿发生率为15.9%,与同时为GDM的18.3%的巨大儿率无统计学差异.结论(1)尽管对妊娠期糖尿病进行了严格的诊治,糖代谢异常孕妇巨大儿发生率仍明显高于其他孕妇,其中主要发生于A2型GDM孕妇,应高度重视其治疗和监测.(2)除了妊娠期的糖代谢异常外,50 g糖负荷试验异常、高龄和肥胖是巨大儿的重要高危因素。

The metabolic syndrome: A growing problem for the pediatrician

The increased prevalence of obesity in the pediatric population has been associated with an increase in the metabolic syndrome, a constellation of findings associated with increased risk of cardiovascular disease and Type 2 diabetes. Both the National Cholesterol Education Program Adult Treatment Panel III (NCEP) and the World Health Organization (WHO) criteria for metabolic syndrome predict cardiovascular disease in adults. In this issue of The Journal, Goodman et al clearly demonstrate that these criteria identify different populations. Only the WHO criteria require evidence of insulin resistance or abnormality in carbohydrate metabolism. Goodman et al indicate that only 63% of the patients in the NHANES III database had hyperinsulinemia, yet application of the WHO guidelines classified approximately twice as many children as having metabolic syndrome compared to the NCEP guidelines. Which factors in the constellation of signs and symptoms are most important predictors of risk? Which definition of metabolic syndrome is most helpful for tracking future cardiovascular disease? These questions are unanswered. By the time children have insulin resistance, they already have vascular inflammation. The earlier we, as practicing pediatricians, identify these patients, the greater the chance of reversing or slowing the progression of the vascular abnormalities that are the precursors to atherosclerosis. How do we accomplish this? Waist circumference is associated with insulin resistance, and has been shown to predict cardiovascular disease and visceral fat better than BMI in adults. Using NHANES III data, Fernandez et al has developed tables published in this issue of The Journal in which waist circumference is stratified according to gender, race and age (2-18 years). This provides important normative data for practitioners to use to stratify risk in their patients. Those children who have waist circumferences on the 75th and 90th percentile for age, sex, and race are at increased risk for the co-morbidities of hypertension, dyslipidemia, and diabetes. They should be monitored and treated aggressively with diet and exercise, and potentially with medication if diet and exercise alone fail to improve these risk factors. As Louis Pasteur said in 1884, “Whenever thinking about a disease, I rather think of ways of preventing it than curing it.” We must do whatever we can to stem the tide of increasing numbers of children with Type 2 diabetes and likely early cardiovascular disease.

Medical Complications After Spinal Cord Injury: Spasticity, Pain, and Endrocrine/Metabolic Changes

Recognition and proper management of medical complications after spinal cord injury (SCI) will improve both quality of life and health. Spasticity often interferes with comfort, function, and quality of life after SCI. Spasticity can be effectively reduced by various therapies that may be applied by the pyramid approach, starting with nonpharmacologic and noninvasive methods before proceeding to treatments with systemic medications, intrathecal administration of drugs, or nerve blocks by injection of chemicals. Pain is also a common complaint after SCI but has multiple causes, and consequently diverse treatment approaches are needed. Accurate classification of pain in persons with SCI is essential to select the appropriate management and to evaluate results of treatment. In recent years, two classification systems have emerged that address nociceptive and neuropathic pain and, to various extent, categorize pain according to its location. Based on the specific pain type, different treatment strategies are subsequently selected. The abnormalities in carbohydrate and lipid metabolism in persons with SCI are atherogenic. Disorders of carbohydrate metabolism occur with increased frequency in persons with SCI compared to those who are able-bodied. Persons with SCI generally have adverse body composition changes (increased adiposity and decreased lean tissue mass) and are less active than the general population, which are the determinants of insulin resistance. The deterioration in carbohydrate handling is associated with insulin resistance and compensatory hyperinsulinemia. Patients with the greatest neurological deficits (complete tetraplegia) have worse carbohydrate tolerance and higher plasma insulin levels than other neurological subgroups. A low serum HDL cholesterol level is an independent risk factor for coronary heart disease, and the prevalence of low serum HDL cholesterol levels is greater in persons with SCI than in those who are able-bodied. Individuals with complete, higher lesions tend to have lower levels of serum HDL cholesterol. However, men with SCI had lower serum HDL cholesterol levels than able-bodied control participants, but women with SCI did not have an adverse lipid profile. A relationship exists between insulin resistance and HDL cholesterol: the greater the insulin resistance, the lower the serum HDL cholesterol level. An indirect relationship has been demonstrated between abdominal circumference and serum HDL cholesterol levels and a direct relationship with serum triglycerides. Increased cardiopulmonary fitness has been shown to favorably affect the lipid profile. Persons with SCI should have a complete lipid profile at least once every 5 years and therapeutic intervention with diet and/or exercise should be begun, if indicated.

Regulation of D-fructose transporter GLUT5 in the ileum of spontaneously hypertensive rats.

Abnormalities in carbohydrate metabolism and the insulin resistance status have been associated with hypertension. We have previously described alterations in the sodium-coupled sugar absorption in an experimental model of hypertension; in the present work, we studied the regulation of the sodium-independent, GLUT5-facilitated D-fructose intestinal transport in this pathology. Spontaneously hypertensive rats (SHR) and their normotensive, genetic control Wistar-Kyoto (WKY) rats, were used. Kinetic studies, carried out in ileal brush-border membrane vesicles (BBMVs), revealed a significant reduction (P < 0.05) in the maximal rate of transport (Vmax) for D-fructose in SHR, which, on the other hand, showed unaltered values for the Michaelis constant (Km) and the diffusion constant (Kd). Immunoblotting analysis revealed the existence of lower (P< 0.05) levels of GLUT5 in apical membranes from SHR, this reduction being similar to that of Vmax. Similarly, Northern blot studies on the abundance of GLUT5 mRNA from ileal enterocytes showed a decrease (P< 0.05) in hypertensive rats, following the same pattern mentioned above. Therefore, the impaired D-fructose intestinal absorption is another feature of SHR, and this decrease in D-fructose uptake correlates with a reduction in the abundance of the apical GLUT5 transporter, which is controlled at a transcriptional level.

Metabolic syndrome and other factors associated with increased risk of diabetes

The prevalence of diabetes has increased dramatically in the last 3 decades. Metabolic syndrome is a strong risk factor for incident diabetes. Among components of metabolic syndrome, obesity and abnormal carbohydrate metabolism are the most significant predictors. Primary care physicians should identify patients at risk and monitor their fasting glucose and/or postprandial glucose to enable timely diagnosis of diabetes and appropriate interventions. Lifestyle interventions that help reduce body weight and pharmacologic interventions that address insulin resistance and/or postprandial glycemia may help prevent diabetes. Intensive cardiovascular risk factor management should be an integral component of any diabetes prevention plan.

PATHOPHYSIOLOGY OF TYPE 2 DIABETES

Type 2 diabetes mellitus is a heterogeneous syndrome characterized by abnormalities in carbohydrate and fat metabolism. The causes of type 2 diabetes are multifactorial and include both genetic and environmental elements that affect beta-cell function and tissue (muscle, liver, adipose tissue, pancreas) insulin sensitivity. Although there is considerable debate as to the relative contributions of beta-cell dysfunction and reduced insulin sensitivity to the pathogenesis of diabetes, it is generally agreed that both these factors play important roles. However, the mechanisms controlling the interplay of these two impairments are unclear. A number of factors have been suggested as possibly linking insulin resistance and beta-cell dysfunction in the pathogenesis of type 2 diabetes. A majority of individuals suffering from type 2 diabetes are obese, with central visceral adiposity. Therefore, the adipose tissue should play a crucial role in the pathogenesis of type 2 diabetes. Although the predominant paradigm used to explain this link is the portal/visceral hypothesis giving a key role in elevated non-esterified fatty acid concentrations, two new emerging paradigms are the ectopic fat storage syndrome (deposition of triglycerides in muscle, liver and pancreatic cells) and the adipose tissue as endocrine organ hypothesis (secretion of various adipocytokins, i.e. leptin, TNF-α, resistin, adiponectin, implicated in insulin resistance and possibly beta-cell dysfunction). These two paradigms constitute the framework for the study of the interplay between insulin resistance and beta-cell dysfunction in type 2 diabetes as well as between our obesogenic environment and diabetes risk in the next decade.

Psyllium fibre and the metabolic control of obese children and adolescents.

In children and adolescents from developed countries, obesity prevalence has strongly increased in the last decades and insulin resistance and impaired glucose tolerance are frequently observed. Some dietary components such as low glycemic index foods and dietary fibre could be used in order to improve glucose homeostasis in these children. Psyllium or ispaghula husk (the husk of the seeds of Plantago ovata) is a mixture of neutral and acid polysaccharides containing galacturonic acid with a ratio of soluble/insoluble fibre of 70/30. Some foods could potentially be enriched with psyllium, like breads, breakfast cereals, pasta and snack foods. The aim of this review was to assess the usefulness of psyllium in the management of obese children and adolescents with abnormalities of carbohydrate and lipid metabolism. After psyllium supplementation, the percentage change in postprandial glucose in type 2 diabetes patients, ranged from -12.2 to -20.2%. In hypercholesterolemic children, the effect of psyllium in LDL-cholesterol serum concentrations ranged from 2.78 to -22.8%; the effect in HDL-cholesterol from -4.16 to 3.05%; and the effect on triglycerides from 8.49 to -19.54%. The reviewed evidence seems to show that psyllium improves glucose homeostasis and the lipid and lipoprotein profile; however, more well controlled trials and further studies are needed to clarify it's effects and the mechanisms involved.