Cardiometabolic Complications Research Articles

Prevalence of abdominal obesity and its association with cardiovascular risk among the adult population in Burkina Faso: findings from a nationwide cross-sectional study

ObjectiveThe objective of this study is to determine the prevalence of abdominal obesity, its predictors and its association with cardiovascular risk among adults in Burkina Faso.DesignWe performed a secondary analysis...

Role of natriuretic peptides in the cardiovascular-adipose communication: a tale of two organs.

Natriuretic peptides have long been known for their cardiovascular function. However, a growing body of evidence emphasizes the role of natriuretic peptides in the energy metabolism of several substrates in humans and animals, thus interrelating the heart, as an endocrine organ, with various insulin-sensitive tissues and organs such as adipose tissue, muscle skeletal, and liver. Adipose tissue dysfunction is associated with altered regulation of the natriuretic peptide system, also indicated as a natriuretic disability. Evidence points to a contribution of this natriuretic disability to the development of obesity, type 2 diabetes mellitus, and cardiometabolic complications; although the causal relationship is not fully understood at present. However, targeting the natriuretic peptide pathway may improve metabolic health in obesity and type 2 diabetes mellitus. This review will focus on the current literature on the metabolic functions of natriuretic peptides with emphasis on lipid metabolism and insulin sensitivity. Natriuretic peptide system alterations could be proposed as one of the linking mechanisms between adipose tissue dysfunction and cardiovascular disease.

Zymbilan®-PSO cream with nano-encapsulated RetileX-A®-PRO mitigates the clinical severity and relieves the symptoms of chronic plaque psoriasis: an interventional clinical study

<p><strong>Background:</strong> Skin psoriasis is a serious inflammatory disorder with increased risk of rheumatic, cardiometabolic and psychosocial complications. At present, >50% of patients are dissatisfied with their treatment; thus, novel approaches are in high clinical demand. Retinoids are a major group of anti-psoriatic compounds; nonetheless, dose-dependent topical side effects have limited their effective topical application. RetileX-A<sup>®</sup>-PRO (Pharma Medico, Aarhus, Denmark) is a novel nano-encapsulated retinol ester designed to minimise the risk of skin irritation. The proprietary nano-encapsulation technology used in this compound can protect retinoid molecules from degradation, and thereby prolong and stabilise its release profile. The safety and efficacy of RetileX-A<sup>®</sup>-PRO were evaluated in this study.</p><p><strong>Methods:</strong> 45 patients (58% female, aged 18-80 years) with mild to moderate skin psoriasis were enrolled in a 4-week interventional study. Participants were treated once daily with Zymbilan<sup>®</sup>-PSO cream with RetileX-A<sup>®</sup>-PRO and evaluated both objectively and subjectively at baseline, after 8 hours and at endpoint.</p><p><strong>Results:</strong> Our observations demonstrated that Zymbilan<sup>®</sup>-PSO cream possesses both short-term and long-term anti-psoriatic effects. Shortly after application, objective skin characteristics were improved, and itching reduced in >84% of subjects. At endpoint, 87% of skin lesions improved, 9% did not change and 4% progressed as assessed by a dermatologist. Patients’ self-evaluation yielded similar results: 78% judged Zymbilan<sup>®</sup>-PSO cream as a ‘good’ to ‘very good’ skin care product with suitable cosmetic parameters. No side effects recorded in 95% of participants.</p><p><strong>Conclusions:</strong> In conclusion, Zymbilan<sup>®</sup>-PSO cream is a well-tolerated treatment that can mitigate both clinical severity and subjective symptoms of chronic skin psoriasis.</p>

The Postprandial Glycaemic and Hormonal Responses Following the Ingestion of a Novel, Ready-to-Drink Shot Containing a Low Dose of Whey Protein in Centrally Obese and Lean Adult Males: A Randomised Controlled Trial.

PurposeElevated postprandial glycaemia [PPG] increases the risk of cardiometabolic complications in insulin-resistant, centrally obese individuals. Therefore, strategies that improve PPG are of importance for this population. Consuming large doses of whey protein [WP] before meals reduces PPG by delaying gastric emptying and stimulating the secretion of the incretin peptides, glucose-dependent insulinotropic polypeptide [GIP] and glucagon-like peptide 1 [GLP-1]. It is unclear if these effects are observed after smaller amounts of WP and what impact central adiposity has on these gastrointestinal processes.MethodsIn a randomised-crossover design, 12 lean and 12 centrally obese adult males performed two 240 min mixed-meal tests, ~5–10 d apart. After an overnight fast, participants consumed a novel, ready-to-drink WP shot (15 g) or volume-matched water (100 ml; PLA) 10 min before a mixed-nutrient meal. Gastric emptying was estimated by oral acetaminophen absorbance. Interval blood samples were collected to measure glucose, insulin, GIP, GLP-1, and acetaminophen.ResultsWP reduced PPG area under the curve [AUC0–60] by 13 and 18.2% in the centrally obese and lean cohorts, respectively (both p <0.001). In both groups, the reduction in PPG was accompanied by a two-three-fold increase in GLP-1 and delayed gastric emptying. Despite similar GLP-1 responses during PLA, GLP-1 secretion during the WP trial was ~27% lower in centrally obese individuals compared to lean (p = 0.001). In lean participants, WP increased the GLP-1ACTIVE/TOTAL ratio comparative to PLA (p = 0.004), indicative of reduced GLP-1 degradation. Conversely, no treatment effects for GLP-1ACTIVE/TOTAL were seen in obese subjects.ConclusionPre-meal ingestion of a novel, ready-to-drink WP shot containing just 15 g of dietary protein reduced PPG in lean and centrally obese males. However, an attenuated GLP-1 response to mealtime WP and increased incretin degradation might impact the efficacy of nutritional strategies utilising the actions of GLP-1 to regulate PPG in centrally obese populations. Whether these defects are caused by an individual’s insulin resistance, their obese state, or other obesity-related ailments needs further investigation.Clinical Trial RegistrationISRCTN.com, identifier [ISRCTN95281775]. https://www.isrctn.com/.

Chronic Dietary Erythritol Exposure Elevates Plasma Erythritol Concentration in Mice but Does Not Cause Weight Gain or Modify Glucose Homeostasis.

Erythritol is both a common nonnutritive sweetener and an endogenous product of glucose metabolism. Recent reports suggest that elevated plasma erythritol is a predictive biomarker of cardiometabolic disease onset and complications. Although short-term erythritol consumption has been evaluated, the effect of chronically elevated circulating erythritol on adiposity and glucose metabolism has not. This study investigated the effect of longer-term erythritol consumption on weight gain and glucose tolerance in young/adolescent mice. Four erythritol supplementation experiments were completed and analyzed separately in male C57BL/6J mice. In experiments 1 and 2, mice aged 8 wk or 20 wk, respectively, were randomly allocated to consume 16% fat diet (LFD) or LFD with 40 g/kg erythritol. In experiments 3 and 4, mice aged 8 wk or 20 wk were fed 45% fat diet (HFD) or HFD with 40 g/kg erythritol (HFD+ERY). In each experiment, we compared the effect of erythritol consumption on plasma erythritol, body weight and composition, glucose tolerance, and brown adipose tissue (BAT) uncoupling protein 1 (UCP1) expression. We also investigated relative endogenous tissue erythritol concentrations in a subset of control (LFD or HFD) mice in experiments 1 and 3. There was no effect of erythritol supplementation on body weight or glucose tolerance in experiments 1-3. In experiment 4, in the 20-wk-old mice fed HFD or HFD+ERY, there was a significant interaction of time and erythritol on body weight (P <0.0001), but the main effect of diet was not significant. Plasma erythritol was elevated 40-fold in mice consuming erythritol-supplemented diets relative to mice consuming LFD or HFD controls. We found no effect of chronic erythritol consumption on BAT UCP1 protein concentrations. Liver and kidney tissue contained significantly higher endogenous erythritol than quadriceps and visceral adipose (P <0.001) in young mice fed LFD and HFD. In young/adolescent mice, prolonged erythritol consumption did not significantly affect body weight, composition, or glucose tolerance.

151-LB: Impact of Concurrent Use of Selective Serotonin Reuptake Inhibitors and Second-Generation Antipsychotic Medications on Cardiometabolic Health in Children

Around 20% of Canadian children are diagnosed with a mental health disorder. Selective serotonin reuptake inhibitors (SSRIs) and second-generation antipsychotics (SGAs) are common treatments. Treatment with SSRIs or SGAs is associated with increased cardiometabolic complications, and risk for type 2 diabetes in children. Little is known about the metabolic effects of concurrent use of SSRIs with SGAs. Our aim was to determine if the combination of SSRI and SGA treatment was associated with cardiometabolic complications in children. Cross-sectional data were collected from children with mental health disorders (aged 5-18 years), recruited from Child and Adolescent Psychiatry at BC Children’s Hospital. Children were classified as naïve (n=242), SSRI-treated (n=123), SGA-treated (n=112), or SSRI+SGA treated (n=98). Anthropometric data and a fasting blood sample were collected. Relationships between treatment groups and cardiometabolic risk factors were determined by adjusted linear and logistic regression models. SSRI+SGA-treated children had higher waist circumference z-scores (0.91 ± 0.89 vs. 0.48 ± 0.95; P&amp;lt;0.05) and a greater odds of waist circumference ≥90th percentile (OR=2.63, 95% CI: 1.34, 5.18; P&amp;lt;0.05) compared to SSRI-treated children. SSRI+SGA-treated children had higher plasma total cholesterol (4.63 ± 0.93 vs. 4.34 ± 0.84 mmol/L; P&amp;lt;0.05, adjusted by age, sex, and BMI z-scores) and a greater odds of plasma total cholesterol ≥5.18 mmol/L (OR=2.36, 95% CI: 1.05, 5.30; P&amp;lt;0.05, adjusted by age, sex, and BMI z-scores) than SGA-treated children. No differences in plasma fasting glucose, insulin, or insulin resistance (HOMA-IR) were observed between the treatment groups. Concurrent SSRI+SGA treatment is associated with elevated waist circumference and plasma total cholesterol in children. Our findings suggest greater cardiometabolic complications in children concurrently treated with SSRIs and SGAs. Disclosure R. Thandi: None. A. M. Wiedeman: None. A. M. Devlin: None. C. Panagiotopoulos: Advisory Panel; Self; Dexcom, Inc., Speaker’s Bureau; Self; Eli Lilly and Company. Funding BC Mental Health and Substance Use Services

Association of pre-pregnancy body mass index and rate of weight gain during pregnancy with maternal indicators of cardiometabolic risk

Background/objectiveChanges in metabolism and extensive hemodynamic adjustments occur during normal pregnancy. The presence of maternal obesity imposes an overload to these physiological adaptations that may result in increased risk for the development of cardiometabolic complications during and after pregnancy. The aim of this study is to describe total cholesterol (TC), triglycerides (TG), glucose, and arterial blood pressure (BP) trajectories and to analyze the association of these cardiometabolic risk indicators during pregnancy with pre-pregnancy body mass index (pBMI) and monthly gestational weight gain (MGWG).Subjects/methodsA prospective cohort study of pregnant women was conducted in Mexico City. Monthly samples of blood were taken during clinical follow-up and biochemical and blood pressure were measured during each visit. Adjusted linear mixed-effect regression models were fit to describe the trajectories of these biomarkers during pregnancy and to analyze the association with pBMI and MGWG.ResultsSeven hundred and twenty women were included of which 16.6% had pre-gestational obesity, 33.2% had pre-gestational overweight, 45.8% had normal pBMI and 4.4% had pre-gestational underweight. Women with pre-gestational obesity had higher lipids concentrations in the beginning of pregnancy (TC: hat beta = 33.08, p = 0.010; TG: hat beta = 31.29, p = <0.001) but the concentrations increased less than in women with normal pBMI (TC: hat beta = −14.18, p = 0.001; TG: hat beta = −5.42, p < 0.001). By the end of pregnancy, women with pre-gestational obesity had lower concentrations of lipids than women with normal pBMI. By contrast, women with pre-gestational obesity had higher glucose concentrations and higher BP levels than women with normal pBMI over pregnancy.ConclusionspBMI is differentially associated with longitudinal trajectories of maternal biochemical markers of cardiometabolic risk. MGWG did not significantly affect the biochemical indicators or BP trajectories. Our results suggest that pBMI is more relevant to predicting adverse cardiometabolic markers trajectories during pregnancy than MGWG.

Short-Term Changes in Metabolically Healthy Overweight/Obesity Status Impact the Susceptibility to Type 2 Diabetes in Chinese Adults.

PurposeChanges in transition from metabolically healthy overweight/obesity (MHO) to metabolically unhealthy overweight/obesity (MUO) are associated with the risk for cardiometabolic complications. This study aims to investigate the effects of short-term dynamic changes in body mass index (BMI) and metabolic status on the risk of type 2 diabetes (T2D) and to identify biological predictors for the MHO-to-MUO transition.Patients and MethodsA total of 4604 subjects from the REACTION study were included for a 3-year follow-up. Subjects were categorized based on their BMI and metabolic syndrome status. Overweight/obesity was defined as BMI ≥ 24 kg/m2. Metabolically healthy was defined as having two or fewer of the metabolic syndrome components proposed by the Chinese Diabetes Society. Thus, subjects were divided into four groups: metabolically healthy normal weight (MHNW), MHO, metabolically unhealthy normal weight (MUNW), and MUO.ResultsCompared with MHNW, MHO was not predisposed to an increased risk for T2D (OR 1.08, 95% CI 0.64–1.83, P = 0.762). However, a 3-year transition probability of 20.6% was identified for subjects who shifted from MHO to MUO; this conversion increased the risk of T2D by 3-fold (OR 3.04, 95% CI 1.21–7.68, P = 0.018). The fatty liver index independently predicted the MHO-to-MUO transition with an OR 3.14 (95% CI 1.56–7.46, P = 0.002) when comparing the fourth quartile to the first quartile.ConclusionThis study reveals that metabolic changes affect the short-term susceptibility to T2D in the overweight/obese Chinese population, and the fatty liver index is an efficient clinical parameter for identifying those with a metabolic deterioration risk.

The associations of leptin and adiponectin with the metabolic syndrome in an Indonesian and a Dutch population

Background and aimsAt the same BMI, Asian populations develop cardiometabolic complications earlier than Western populations. We hypothesized that a different secretion of the adipocyte-derived hormones leptin and adiponectin plays a role and investigated the associations of the two hormones with the metabolic syndrome (MetS) in an Indonesian and a Dutch population. Methods and resultsWe performed cross-sectional analyses of the Netherlands Epidemiology of Obesity Study (n = 6602) and the SUGAR Scientific Programme Indonesia–Netherlands Study (n = 1461). We examined sex-stratified associations of leptin and adiponectin with MetS, using multivariate logistic regression including adjustment for total body fat. The mean (SD) leptin (mcg/L) were 4.7 (6.0) in Indonesian men, 18.6 (12.0) in Indonesian women, 9.1 (7.7) in Dutch men, and 23.4 (17.4) in Dutch women. The mean (SD) adiponectin (mg/L) were 5.7 (5.4), 7.5 (7.1), 6.6 (3.3), and 11.3 (4.9), respectively. Within the same BMI category, leptin concentrations were similar in the two populations, whereas adiponectin was lower in the Indonesian population. Per SD of leptin, adjusted prevalence odds ratios (ORs, 95%CI) of MetS were 0.9 (0.6–1.2) in Indonesian men, 1.1 (0.9–1.4) in Indonesian women, 2.2 (1.6–2.8) in Dutch men, and 1.2 (1.0–1.5) in Dutch women. Per SD of adiponectin, the ORs were 0.9 (0.7–1.2), 0.8 (0.7–1.0), 0.6 (0.6–0.8), and 0.4 (0.4–0.5), respectively. ConclusionsDespite lower adiponectin levels, adiponectin was not related to the MetS in the Indonesian population and can not explain their increased cardiometabolic risk at the same BMI.

Reduction of Cardio-Metabolic Risk and Body Weight through a Multiphasic Very-Low Calorie Ketogenic Diet Program in Women with Overweight/Obesity: A Study in a Real-World Setting.

Background: The prevention and treatment of obesity and its cardio-metabolic complications are relevant issues worldwide. Among lifestyle approaches, very low-calorie ketogenic diets (VLCKD) have been shown to lead to rapid initial weight loss, resulting in better long-term weight loss maintenance. As no information on VLCKD studies carried on in a real-world setting are available, we conducted this multi-centre study in a real-world setting, aiming at assessing the efficacy and the safety of a specific multiphasic VLCKD program in women with overweight or obesity. Methods: A multi-center, prospective, uncontrolled trial was conducted in 33 outpatient women (age range 27–60 y) with overweight or obesity (BMI: 30.9 ± 2.7 kg/m2; waist circumference: 96.0 ± 9.4 cm) who started a VLCKD dietary program (duration: 24 weeks), divided into four phases. The efficacy of VLCKD was assessed by evaluating anthropometric measures and cardiometabolic markers; liver and kidney function biomarkers were assessed as safety parameters. Results: The VLCKD program resulted in a significant decrease of body weight and BMI (−14.6%) and waist circumference (−12.4%). At the end of the protocol, 33.3% of the participants reached a normal weight and the subjects in the obesity range were reduced from 70% to 16.7%. HOMA-IR was markedly reduced from 3.17 ± 2.67 to 1.73 ± 1.23 already after phase 2 and was unchanged thereafter. Systolic blood pressure decreased after phase 1 (−3.5 mmHg) and remained unchanged until the end of the program. Total and LDL cholesterol and triglycerides were significantly reduced by VLCKD along with a significant HDL cholesterol increase. Liver, kidney and thyroid function markers did not change and remained within the reference range. Conclusions: The findings of a multi-center VLCKD program conducted in a real-world setting in a cohort of overweight/obese women indicate that it is safe and effective, as it results in a major improvement of cardiometabolic parameters, thus leading to benefits that span well beyond the mere body weight/adiposity reduction.

Validation of the Dallas Steatosis Index to Predict Nonalcoholic Fatty Liver Disease in the UK Biobank Population

Nonalcoholic fatty liver disease (NAFLD) is a global public health crisis that affects one quarter of the world population.1 Preventing either cardiometabolic or liver-related complications by achieving weight loss and resolving hepatic steatosis would be the central goal of a NAFLD screening program in the primary care setting. Despite the overwhelming prevalence and the multimodal impact on health posed by NAFLD, specialty society guidelines do not recommend screening for NAFLD in the general population,2 partly owing to the as-yet unproven cost benefit.

Prevalence of Metabolic Syndrome in Children and Adolescents with Type 1 Diabetes Mellitus and Possibilities of Prevention and Treatment: A Systematic Review.

Overweight and obesity are an increasingly common problem, not only among the healthy population, but also in adolescents with type 1 diabetes (T1DM). Excess body weight is related to many cardiometabolic complications as well as a high risk of metabolic syndrome (MetS). The purpose of this systematic review is to provide a concise and critical overview of the prevalence of MetS in children and adolescents with T1DM and, ultimately, to discuss prevention and treatment options. The study was conducted in accordance with PRISMA guidelines. This review shows that, apart from the growing percentage of overweight and obese children and adolescents with T1DM (on average 20.1% and 9.5%, respectively), the problem of the increasing incidence of MetS (range from 3.2 to 29.9%, depending on the criteria used) is one of the most important phenomena of our time. One of the methods of prevention and treatment is a combined approach: changing eating habits and lifestyle, but there are also reports about the beneficial effects of the gut microflora.

Quinoa’s Potential to Enhance Dietary Management of Obesity and Type-2 Diabetes: A Review of the Current Evidence

The prevalence of diet-induced obesity and type-2 diabetes remains a growing concern in the United States. As best management practices still include improved diet and physical activity, bioactive food components, contained within functional foods, show promise in curbing the cardiometabolic complications associated with excess weight and diabetes. Quinoa is an emerging candidate crop for its versatility in wide-ranging growing conditions as one approach to address food security, but it also contains several components that may serve as a dietary tool for post-industrial countries struggling with the health complications of caloric excess. Preliminary rodent feeding studies demonstrate that components within quinoa, namely, phytosteroids, phenolics, polysaccharides, and peptides, can prevent adiposity, dyslipidemia, and hyperglycemia. Mechanistic activity may involve reduced lipid absorption and adipogenesis, increased energy expenditure and glucose oxidation and corrected gut microbiota. Other intestinal actions may include blocked carbohydrate digestion with enhanced incretin signaling. Evidence in clinical trials is lacking and future research spanning cells to the clinic is needed to further elucidate the interesting preliminary reports reviewed here. Quinoa offers several unique attributes that could be harnessed to improve the dietary management of obesity and diabetes.

Ethnic Disparities in Cardio-Metabolic and Reproductive Profiles in Women With Polycystic Ovary Syndrome per the New International Guideline: A United-States Based Multi-Center Study

The magnitude and direction to which cardio-metabolic and reproductive aberrations may disproportionately impact diverse populations of women with PCOS are relevant yet unclear. The uncertainty stems, in part, from heterogeneity in PCOS diagnostic criteria used and technical challenges in the reliable assessment of this clinical population. We evaluated whether cardio-metabolic (abdominal adiposity, hypertension, impaired glucoregulatory status) and reproductive (hyperandrogenism, polycystic ovarian morphology [PCOM], menstrual irregularity) outcomes were different in PCOS (n = 120, 18-36 yrs.) across 4 groups: (1) Non-Hispanic White (n = 76); (2) Non-Hispanic Black (n = 14); (3) Non-Hispanic Asian (n = 15); and, (4) Hispanic White (n = 15). Women were prospectively recruited across 3 academic medical centers in New York State and were matched for age and body mass index. PCOS was defined by the Rotterdam criteria using the recommended thresholds of the 2018 International Evidence-based Guideline for the Assessment and Management of PCOS. Concerning abdominal adiposity, the Asian group (mean ± standard deviation; 0.78 ± 0.06) had a lower waist to hip ratio (WHR) compared to the White group (0.85 ± 0.09; P = 0.01). Also, the Asian group had a higher sex hormone binding globulin (SHBG, 65.9 ± 23.4 nmol/L) compared to all other groups (White [40.5 ± 22.3]; Black [43.8 ± 21.9]; Hispanic [36.8 ± 18.8] nmol/L; All: P < 0.04). In contrast, the White group were most hyperandrogenic, evidenced by their higher modified Ferriman-Gallwey (mFG) scores (10 ± 4) compared to other groups (Black [4 ± 0]; Asian [2 ± 0]; Hispanic [4 ± 1]; All: P ≤ 0.001). Consistently, the White group (1.0 ± 0.5 ng/dL) exhibited increased free testosterone (FT) compared to other groups (Black [0.5 ± 0]; Asian [0.4 ± 0]; Hispanic [0.6 ± 0.1] ng/dL; All: P ≤ 0.001), unlike total testosterone (P = 0.12). Regarding PCOM, the White group exhibited higher follicle numbers per ovary (FNPO 2-9 mm, 48 ± 22) compared to other groups (Black [30 ± 16]; Asian [26 ± 5]; Hispanic [22 ± 17]; All: P ≤ 0.05). Unlike Black (12.4 ± 1.3 mm; P = 0.05) and Hispanic (13.5 ± 1.1 mm; P = 0.89) groups, the White group (13.9 ± 2.1 mm) also exhibited larger ovarian volume (OV) compared to Asian group (12.4 ± 1.5 mm; P = 0.03). Women had comparable blood pressure (systolic, diastolic), fasting glucose, homeostatic model assessment of insulin resistance, or intermenstrual interval length (All: P ≥ 0.09). Overall, Asian women in the US likely exhibit the mildest PCOS metabolic (decreased WHR, increased SHBG) phenotype, whereas White women show the most severe reproductive (increased mFG, FT, FNPO, OV) phenotype. If confirmed by larger studies, our observations warrant additional population-specific diagnostic considerations to prevent and manage PCOS cardio-metabolic (e.g., metabolic syndrome risk) and reproductive (e.g., hirsutism, PCOM) complications across ethnicities.

Effect of Angiotensin‐converting Enzyme Inhibition on Systemic and Renal RAS Components in a Hyperandrogenemic Rat Model of PCOS

Polycystic Ovary Syndrome (PCOS) is characterized by androgen excess, oligo/anovulation, and polycystic ovaries. Obesity, insulin resistance (IR) and increased blood pressure (BP) are associated with PCOS. Therapeutic options for PCOS are limited and the mechanisms responsible for the cardiometabolic complications seen in PCOS are uncertain. It is unclear if androgen-mediated increases in BP contribute to obesity and/or IR in PCOS. The renin angiotensin system (RAS), a regulator of BP, is affected by androgens and is associated with increased BP in PCOS. To investigate the role of androgens and the contribution of the RAS in PCOS, RAS inhibition via an angiotensin-converting enzyme inhibitor (ACEi) was performed in a PCOS-like rat model. We hypothesized that ACEi would attenuate obesity and IR in PCOS. Female SD rats (4 week old) received dihydrotestosterone (DHT, 7.5 mg/ 90 days) pellets (HAF) subcutaneously or sham surgeries (CON). The rats were then assigned tap water or tap water with the ACEi, enalapril (ENA) (250mg/L) for n=10/group. At the end of the study (16 week old) body weight (BW), body composition by EchoMRI, and IR by HOMA-IR were assessed. Renal RAS gene expression was assessed by qPCR. BP was measured by radiotelemetry and plasma and renal ACE and ACE2 activities were assessed. HAF had increased BW, fat mass and IR vs CON. ENA reduced BW in only HAF. Overall, ENA decreased fat mass, and the decrease in HAF neared significance. ENA did not attenuate IR in HAF. In HAF, angiotensinogen (Agt) mRNA was increased in the renal cortex and medulla, while ACE and angiotensin II receptor type 1a (Atr1a) mRNA was increased in the medulla vs CON. In HAF, ENA had no impact on renal Agt, ACE or Atr1a mRNA. ACE2 mRNA was increased in the medulla of HAF vs CON, and ENA increased medulla ACE2 mRNA in both HAF and CON. HAF had increased BP, and ENA decreased BP in both HAF and CON by a similar degree. Overall, ENA decreased plasma ACE activity but only increased plasma ACE2 activity in HAF. ENA increased cortical ACE2 activity in both HAF and CON. In summary, ACEi therapy in a PCOS model reduced BW, BP and adiposity but had no impact on IR. Renal classic RAS gene expression is upregulated in the HAF but unchanged by ENA. Furthermore, only ACE2 mRNA expression was altered in the HAF with ENA. In addition, the expression of other RAS component genes that were unchanged by ACEi in HAF were significantly impacted by ACEi in CON. This reveals a complex interaction between androgen exposure and renal RAS component gene expression. Increased BP in the HAF did not correlate with plasma or renal ACE or ACE2 activities. Chronic RAS inhibition may be a promising therapeutic approach for androgen-mediated increases in BP and obesity in AE-PCOS, though additional therapy would be needed for IR.

Interpregnancy Care: An Opportunity to Improve Women's Health and Reduce the Risk of Maternal Morbidity and Mortality.

Interpregnancy care is the health care provided to a woman during the postpartum and preconception periods between pregnancies. Half of maternal deaths occur postpartum and cardiometabolic complications of pregnancy increase the risk for maternal morbidity and mortality and development of chronic conditions. By improving women's health between and beyond pregnancies, interpregnancy care has the potential to improve pregnancy outcomes and women's long-term health. This practice brief report summarizes evidence regarding the impact of interpregnancy care on pregnancy and long-term health outcomes for women with hypertension, diabetes, substance use, and mental health disorders. Existing evidence is limited but demonstrates that the utilization of interventions during this period may result in improved health outcomes. Additional research efforts are needed to better understand the impact of interpregnancy care on women's health throughout the life course.

Characteristics of the colonic microbiome in patients with different obesity phenotypes (the original article)

Introduction. The concept of heterogeneity in obesity depending on the risk of developing cardiometabolic complications has garnered attention in recent decades, since not everyone with obesity goes on to develop metabolic dysfunction.The aim of the work is to study specific characteristics of colonic microbial communities in patients with different obesity phenotypes and in healthy individuals by employing metagenomics methods.Materials and methods. A total of 265 individuals (44 men and 221 women; mean age 47.1 ± 4.8 years) were enrolled in the study. They were further divided into clinical groups: Healthy normal-weight individuals (n = 129); patients with obesity (n = 136), including metabolically healthy obesity (n = 40) and metabolically unhealthy obesity (n = 55). Quantitative and qualitative assessment of the intestinal microbiome was based on metagenomic analysis. Fecal samples were used to isolate DNA and perform sequencing of the variable v3-v4 region of the 16S rRNA gene.Results. The study revealed statistically significant (p 0.05) differences between quantitative and qualitative variables in studied phylotypes of colonic microorganisms in healthy individuals without obesity and in patients with different obesity phenotypes.Discussion. Patients with obesity had higher levels of Bacteroidetes, Proteobacteria and lower levels of Actinobacteria, Firmicutes, TM7 (Saccharibacteria), Fusobacteria, and more frequently detected phyla Tenericutes, Planctomycetes and Lentisphaerae compared to healthy individuals. Metabolically healthy obese patients had more rarely detected phylum Lentisphaerae in their colonic microbiome, increased numbers of Firmicutes and reduced numbers of Bacteroidetes compared to metabolically unhealthy obese patients.Conclusion. The findings demonstrate alterations in the colonic microbiome in patients with different obesity phenotypes.

Natural course of metabolically healthy phenotype and risk of developing Cardiometabolic diseases: a three years follow-up study

BackgroundWhether the metabolically healthy obese (MHO) phenotype is a single, stable or a transitional, fluctuating state is currently unknown. The Mexican-Mestizo population has a genetic predisposition for the development of type 2 diabetes (T2D) and other cardiometabolic complications. Little is known about the natural history of metabolic health in this population. The aim of this study was to analyze the transitions over time among individuals with different degrees of metabolic health and body mass index, and evaluate the incidence of cardiometabolic outcomes according to phenotype.MethodsThe study population consisted of a metabolic syndrome cohort with at least 3 years of follow up. Participants were apparently-healthy urban Mexican adults ≥20 years with a body mass index (BMI) ≥20 kg/m2. Metabolically healthy phenotype was defined using the criteria of the National Cholesterol Education Program (NCEP) Adult Treatment Panel III (ATP III) metabolic syndrome criteria and the subjects were stratified into 4 groups according to their BMI and metabolic health. For cardiometabolic outcomes we estimated the incidence of cardiometabolic outcomes and standardized them per 1, 000 person-years of follow-up. Finally, to evaluate the risk for transition and development of cardiometabolic outcomes, we fitted Cox Proportional Hazard regression models.ResultsAmongst the 5541 subjects, 54.2% were classified as metabolically healthy and 45.8% as unhealthy. The MHO prevalence was 39.3%. Up to a third of the population changed from their initial category to another and the higher transition rate was observed in MHO (42.9%). We also found several novel factors associated to transition to metabolically unhealthy phenotype; socioeconomic status, number of pregnancies, a high carbohydrate intake, history of obesity and consumption of sweetened beverages. Similarly, visceral adipose tissue (VAT) was a main predictor of transition; loss of VAT ≥5% was associated with reversion from metabolically unhealthy to metabolically healthy phenotype (hazard ratio (HR) 1.545, 95%CI 1.266–1.886). Finally, we observed higher incidence rates and risk of incident T2D and hypertension in the metabolically unhealthy obesity (MUHO) and metabolically unhealthy lean (MUHL) phenotypes compared to MHO.ConclusionsMetabolic health is a dynamic and continuous process, at high risk of transition to metabolically unhealthy phenotypes over time. It is imperative to establish effective processes in primary care to prevent such transitions.

Cardiometabolic Risk Factors leading to Diabetes Mellitus among the Young (YOD) from the 8th Philippine National Nutrition Survey.

ObjectivesThis study looked into the prevalence of diabetes mellitus (DM) and risks for cardiovascular and metabolic diseases among young adults with diabetes (age 20-44 years old, YOD) and late-onset DM (≥45 years old, LOD) in Filipinos.MethodologyWeighted data from 546,580 adults with DM from the 8th Philippine National Nutrition and Health Survey (NNHeS) were utilized. Differences in sociodemographic, anthropometric, clinical profiles and metabolic risks were compared between YOD and LOD.ResultsThe aggregated prevalence of DM is 5.43% (95%CI, 5.10–5.79), YOD were 2.64% (95% CI, 2.32–3.00) and LOD 9.85% (95%CI, 9.18–10.56). Mean age of YOD was 37,6 years, LOD 59,9 years. The YOD were mostly males (56%), with higher BMI (26.24 kg/m2 vs 25 kg/m2, p=0.002), lower mean SBP (122.41±19.17 mmHg vs 135.45±22.47 mmHg, p<0.001), more daily smokers (23% vs 14%), and alcoholic beverage drinkers (39% vs 31%). Physical activity was similar between groups (44% vs 51%, p=0.078). However, average total caloric intake (1776.78±758.38 kcal vs 1596.88±639.16 kcal, p=0.023) and carbohydrate intake (306.13±142.16 grams vs 270.53±104.74 g, p=0.014) were higher in YOD. Dietary carbohydrate proportions were higher than recommended (69% vs 68%) for both groups. Young Filipinos had higher risk to develop diabetes when they are obese II (22% vs 12%), current drinker (56% vs 37%), and current smoker (28% vs 18%). Eighty percent of YOD and LOD had metabolic syndrome (MetS). With every unit increase in age and fat intake, the odds of having MetS were raised by 5.4% (95%CI 1%–10%, p=0.029) and 1.6% (95%CI 0.04%-3%, p=0.044), respectively.ConclusionEarly-onset diabetes mellitus appears to be driven by obesity, MetS and social behaviors. Modifiable risk factors can be improved early to decrease hazards to develop cardiometabolic complications.

Prevalence of obstructive sleep apnea in polycystic ovary syndrome

Background: There are many risk factors for obstructive sleep apnea syndrome (OSAS) which is a relatively widespread and chronic sleep problem that is recognized by recurrent partial or total obstruction in upper airway during sleep leading to interrupted hypoxia, arousals, excessive daytime sleepiness and increased sympathetic activity. One of these risk factors is polycystic ovary syndrome (PCOS) which is one of the commonest endocrine diseases at females’ reproductive age, multiple questionnaires were used to estimate the prevalence of obstructive sleep apnea syndrome in polycystic ovary syndrome patients as Stop Bang questionnaire and Epworth sleepiness scale that used to estimate excessive daytime sleepiness in those patients. Aim of the review is to screen for obstructive sleep apnea syndrome in patients with PCOS, prompt evaluation of both diseases and therefore decrease their serious cardio-metabolic complications. Conclusion: There is significant association between OSAS and PCOS. Therapeutic complete interventions of PCOS may reduce the seriousness of OSA.