Higher Levels Of Insulin Resistance Research Articles

Understanding the Role of the Complement System in Insulin Resistance and Metabolic Syndrome in Patients With Rheumatoid Arthritis.

The complement system has been associated with the etiopathogenesis of rheumatoid arthritis (RA). Insulin resistance (IR) and metabolic syndrome (MetS) are prevalent among patients with RA. The aim of this study was to explore the relationship between a comprehensive evaluation of the complement system and IR, as well as MetS, in patients with RA. A total of 339 nondiabetic patients with RA were recruited. Functional assays of the 3 complement pathways were assessed. Additionally, serum levels of the following individual components of the complement system were measured: C1q (classical); lectin (lectin); C2, C4, and C4b (classical lectin); factor D and properdin (alternative); C3 and C3a (common); C5, C5a, and C9 (terminal); as well as the factor I and C1 inhibitor regulators. IR and β cell function indices were calculated using the homeostatic model assessment. Criteria for MetS were applied. Multivariable linear regression analysis was performed to investigate the association between the complement system and IR in patients with RA. Many elements of the upstream and common complement pathways, but not the functional tests of the 3 routes, correlated positively with higher levels of IR and β cell function. However, after multivariable adjustment for factors associated with IR, these relationships were lost. Conversely, the presence of MetS in patients with RA maintained a relationship with higher levels of C1q, C4, C3, properdin, and factor I after adjusting for confounders. There is a positive correlation between the complement system and MetS among nondiabetic patients with RA. This association is independent of traditional IR factors.

The effect of non-insulin-based insulin resistance indices on the prediction of recurrence in patients with atrial fibrillation undergoing radiofrequency catheter ablation

BackgroundAtrial fibrillation (AF) is acknowledged as a disease continuum. Despite catheter ablation being recommended as a primary therapy for AF, the high recurrence rates have tempered the initial enthusiasm. Insulin resistance (IR) has been established as an independent predictor for the onset of AF. However, the correlation between non-insulin-based IR indices and late AF recurrence in patients undergoing radiofrequency catheter ablation remains unknown.MethodsA retrospective cohort of 910 AF patients who underwent radiofrequency catheter ablation was included in the analysis. The primary endpoint was late AF recurrence during the follow-up period after a defined blank period. The relationship between non-insulin-based IR indices and the primary endpoint was assessed using multivariate Cox hazards regression models and restricted cubic splines (RCS). Additionally, the net reclassification improvement and integrated discrimination improvement index were calculated to further evaluate the additional predictive value of the four IR indices beyond established risk factors for the primary outcome.ResultsDuring a median follow-up period of 12.00 months, 189 patients (20.77%) experienced late AF recurrence, which was more prevalent among patients with higher levels of IR. The multivariate Cox hazards regression analysis revealed a significant association between these IR indices and late AF recurrence. Among the four indices, METS-IR provided the most significant incremental effect on the basic model for predicting late AF recurrence. Multivariable-adjusted RCS curves illustrated a nonlinear correlation between METS-IR and late AF recurrence. In subgroup analysis, METS-IR exhibited a significant correlation with late AF recurrence in patients with diabetes mellitus (HR: 1.697, 95% CI 1.397 − 2.063, P < 0.001).ConclusionAll the four non-insulin-based IR indices were significantly associated with late AF recurrence in patients undergoing radiofrequency catheter ablation. Addressing IR could potentially serve as a viable strategy for reducing the late AF recurrence rate.

Peripheral insulin resistance attenuates cerebral glucose metabolism and impairs working memory in healthy adults

People with insulin resistance are at increased risk for cognitive decline. Insulin resistance has previously been considered primarily a condition of ageing but it is increasingly seen in younger adults. It is possible that impaired insulin function in early adulthood has both proximal effects and moderates or even accelerates changes in cerebral metabolism in ageing. Thirty-six younger (mean 27.8 years) and 43 older (mean 75.5) participants completed a battery of tests, including blood sampling, cognitive assessment and a simultaneous PET/MR scan. Cortical thickness and cerebral metabolic rates of glucose were derived for 100 regions and 17 functional networks. Older adults had lower rates of regional cerebral glucose metabolism than younger adults across the brain even after adjusting for lower cortical thickness in older adults. Higher fasting blood glucose was also associated with lower regional cerebral glucose metabolism in older adults. In younger adults, higher insulin resistance was associated with lower rates of regional cerebral glucose metabolism but this was not seen in older adults. The largest effects of insulin resistance in younger adults were in prefrontal, parietal and temporal regions; and in the control, salience ventral attention, default and somatomotor networks. Higher rates of network glucose metabolism were associated with lower reaction time and psychomotor speed. Higher levels of insulin resistance were associated with lower working memory. Our results underscore the importance of insulin sensitivity and glycaemic control to brain health and cognitive function across the adult lifespan, even in early adulthood.

Long-term insulin resistance is associated with frailty, frailty progression, and cardiovascular disease.

Insulin resistance and diabetes are associated with an increased risk of frailty, and frailty is associated with cardiovascular disease and premature mortality. We aim to investigate the impact of long-term insulin resistance trajectories on future frailty and cardiovascular risk among young adults. In total, 3168 participants with a 30-year follow-up period. The baseline period covered the first 15years as the exposure period. Insulin resistance was determined using the homeostasis model assessment for insulin resistance (HOMA-IR), and three trajectories (low, moderate, and high) were constructed. The subsequent 15years constituted the event accrual period. Frailty was assessed using a deficit accumulation mode, and cardiovascular outcomes were obtained from the 15-year event accrual period. The mean age of all 3168 participants was 41.0 (37.0-43.0) years, with 1750 (55.2%) being women. Participants in the high level of insulin resistance trajectory had an increased prevalence of frailty (OR: 1.55, 95% CI: 1.05-2.30, P=0.028). Although no statistically significant associations were observed after full adjustment, single-factor analysis indicated association between the moderate and high trajectories and frailty progression. Additionally, participants with high level of insulin resistance trajectory were associated with an increased risk of cardiovascular disease, coronary heart disease, and stroke. A notable correlation between HOMA-IR trajectory and cardiovascular diseases was still discernible within the subgroup where the frailty index ≥0.12 (HR: 2.12, 95% CI: 1.17-3.83, P=0.013) (P for interaction >0.05). Long-term high level of insulin resistance is associated with high prevalence of frailty, and an increased risk of cardiovascular events. Emphasizing the importance of early prevention and intervention for abnormal glucose metabolism in young adults to prevent frailty and cardiovascular disease.

The Effect of Menopausal Status, Insulin Resistance and Body Mass Index on the Prevalence of Non-Alcoholic Fatty Liver Disease.

Non-alcoholic fatty liver disease (NAFLD) is common and presents in a large proportion-up to 30%-of the global adult female population. Several factors have been linked with NAFLD in women, such as age, obesity, and metabolic syndrome. To extract appropriate details about the topic, we conducted an extensive search using various medical subject headings and entry terms including 'Menopause', 'Non-alcoholic fatty liver disease', 'Insulin resistance', and 'BMI'. This exhaustive search resulted in a total of 180 studies, among which only 19 were able to meet the inclusion criteria. While most of these studies indicated a significant rise in NAFLD prevalence among postmenopausal women, two did not find strong evidence linking menopause with NAFLD. Moreover, it was observed that women with NAFLD had higher insulin resistance levels and BMIs compared to those without the condition. In summary, it is important to consider specific factors like risk profile, hormonal status, and age along with metabolic components when treating women presenting with NAFLD. There is need for data-driven research on how gender affects the sensitivity of biomarkers towards NAFLD as well as the development of sex-specific prediction models-this would help personalize management approaches for women, who stand to benefit greatly from such tailored interventions.

Prognostic significance of glucose-lipid metabolic index in pancreatic cancer patients with diabetes mellitus.

The incidence of pancreatic cancer (PC) is higher in diabetic patients due to disturbances in glucose and lipid metabolism caused by insulin resistance (IR). However, the effect of diabetes as well as IR on the prognosis of PC patients remains inconclusive. Our study aims to assess the impact of IR on the prognosis of PC patients with diabetes. We conducted a retrospective analysis of 172 PC patients with diabetes in our institute from 2015 to 2021. Prognostic assessment was performed using univariate/multifactorial analysis and survival analysis. The predictive efficacy of metabolic indices was compared using receiver operator characteristic (ROC) curve analysis. One hundred twenty-one of 172 patients died during follow-up, with a median follow-up of 477 days and a median overall survival (OS) of 270 days. Survival analysis showed a significant difference in OS by IR related parameters, which were triglyceride-glucose index (TyG), triglyceride-glucose index-body mass index (TyG-BMI), and triglyceride/high-density lipoprotein cholesterol ratio (TG/HDL-c). The ROC curve indicated that TyG, TyG-BMI, and TG/HDL-c had prognostic efficacy for PC with diabetes. We next optimized TyG-BMI and obtained a new parameter, namely glucose-lipid metabolism index (GLMI), and the patients were classified into GLMI low group and high group based on the calculated cutoff value. The GLMI high group had higher TyG, TyG-BMI, TyG/HDL-c, BMI, TG, total cholesterol (TC), TC/HDL-c, fasting plasma glucose, CA199, and more advanced tumor stage compared to low group. Univariate and multivariate analyses showed that GLMI was an independent prognostic factor. Furthermore, the patients of GLMI high group had worse OS compared to low group and the ROC curves showed GLMI had better predictive ability than TyG and TyG-BMI. IR is associated with the outcome of PC patients with diabetes and higher level of IR indicates worse prognosis. GLMI has a good predictive value for PC with diabetes.

Correlation Between Insulin Resistance and Urinary Incontinence in Female Patients with Type 2 Diabetes Mellitus.

Patients with type 2 diabetes mellitus (T2DM) are at a high risk of developing urinary incontinence; however, its pathogenesis is unclear. The purpose of this study is to explore the relationship between insulin resistance and urinary incontinence and its severity in female patients with T2DM. A total of 366 women with T2DM aged ≥18 years were enrolled in this study. Insulin resistance was evaluated by the homeostasis model insulin resistance (HOMA-IR) index and urinary incontinence was assessed by the International Consultation on Incontinence Questionnaire Short Form (ICIQ-SF). All subjects were divided into four groups according to HOMA-IR quartiles. Logistic regression analysis was performed to investigate the relationship between insulin resistance and urinary incontinence and its severity. Among the 366 patients, 186 (50.8%) had urinary incontinence. The prevalence of urinary incontinence increased significantly with HOMA-IR quartiles (p < 0.001). Adjusted logistic regression analysis showed that compared with HOMA-IR ≤ 1.76, 2.81 ≤ HOMA-IR ≤ 4.27 was associated with a significantly increased risk of moderate incontinence (OR = 2.197, 95% CI 1.031-4.683, p = 0.041), and HOMA-IR ≥ 4.28 was associated with a significantly increased risk of severe incontinence (OR = 5.699, 95% CI 1.685-19.276, p = 0.005). Binary logistic regression analysis showed that HOMA-IR was the independent risk factor for urinary incontinence (p < 0.001). Higher levels of insulin resistance are associated with urinary incontinence and its severity in female patients with type 2 diabetes mellitus.

Ameliorating Effect of Aqueous Ginger Extract And Exercise On Insulin Resistance in Fructose Induced Type 2 Diabetic Rats Through Upregulation of Serum Sirtuin-1

Introduction:The mounting prevalence of type 2 diabetes mellitus (T2DM) in developing countries calls for an immediate need to find novel treatment strategies that not only target its underlying pathological process but are also safe and cost effective. Aims &amp;Objectives:To determine the effect of ginger supplementation, exercise and their combination on insulin resistance (IR) and levels of serum sirtuin 1 (SIRT1) in fructose induced type 2 diabetic rat model. Material &amp;Methods:This randomized controlled trial was conducted at animal laboratory of Postgraduate Medical Institute Lahore, Pakistan, from January 2021 to June 2021, in which thirty rats were randomly allocated to five groups with six rats in each.Rats belonging to group1 (Normal Control) were given normal rat chow diet. Diabetes was induced in groups 2, 3 and 4 by administering 25% fructose diet, following which, group 2 was reserved as diabetic/positive control (PC) and continued to receive 25 %fructose diet only. Animals of group 3 received aqueous ginger extract (GE), group 4 underwent swimming exercise (EX) and group 5 received their combination (GE+EX) for 8 weeks. Aqueous ginger extract was prepared in the Pharmacology lab at PGMI where 50 gm of fresh ginger was blended with 75ml of 0.9% NaCl and filtered thrice. The obtained filtrate was centrifuged at a speed of 2000 rpm for ten minutes. The clear supernatant fraction was made to reach 100 ml mark using NaCl resulting in a concentration of 500 mg/ml which was used for oral administration. Data was entered and analyzed using SPSS version 26, a p-value of ?0.05 was considered significant. Results:The results of the current study showed development of T2DM with 25% fructose supplementation in PC group, resulting in significantly high level of IR along with a significant reduction in levels of serum SIRT1. Aqueousginger extract group as well as the exercise group, both individually showed a significant reduction in IR as compared to the diabetic group and this was associated with significantly increased level of serum SIRT1 (p&lt;0.05). However, most pronounced effect was seen in the combination group having lowest level of IR associated with a statistically significant increase in SIRT1 levels (p&lt;0.05). Conclusion: Aqueousginger extract supplementation and exercise training, alone and in combination have the potential to significantly ameliorate IR in T2DM through its positive influence on serum SIRT1.However, the combination group has the most pronounced effect reflecting a potential synergistic effect of both interventions. Ginger supplementation and exercise may be introduced as safer, cost effective and natural adjunct to anti diabetic drugs hence lowering their potentially harmful side effects.

Association of insulin resistance with intra- and extra-cranial atherosclerotic burden in the nondiabetic community population

AimsFew population-based studies have investigated the association between insulin resistance and atherosclerotic burden in intra- and extra-cranial arteries. The purpose of this study is to explore the relationship between insulin resistance and intra- and extra-cranial atherosclerotic burden in community-based nondiabetic participants. MethodsThis is a cross-sectional analysis from a population-based prospective cohort-PolyvasculaR Evaluation for Cognitive Impairment and vaScular Events (PRECISE) study in China. The homeostasis model assessment of insulin resistance (HOMA-IR) and insulin sensitivity indices (ISI0–120) were stratified by the quartiles, respectively. The atherosclerotic presence of plaques and burden was evaluated by high-resolution MRI. Binary or ordinal logistic regression was performed to assess the association between HOMA-IR or ISI0–120 and the presence and burden of atherosclerosis. ResultsAmong the 2754 participants, the mean age was 60.9 ± 6.6 years, and 1296 (47.1%) were males. Compared with the lowest quartile of HOMR-IR, the highest quartile of HOMA-IR (indicating a higher level of insulin resistance) was associated with an increased presence of plaques (OR:1.54, 95% CI:1.14–2.08), and atherosclerotic burden (OR:1.53, 95%CI:1.14–2.07) in intracranial arteries. Meanwhile, we observed a similar relationship between HOMA-IR and the presence or burden in extracranial atherosclerosis. The first (indicating a higher level of insulin resistance) quartiles of ISI0–120 were associated with the intracranial plaques (Q1, OR:1.56, 95%CI:1.16–2.11) and atherosclerotic burden (Q1, OR:1.57, 95%CI:1.17–2.12), but not extracranial plaques or atherosclerotic burden, compared with the fourth quartile of ISI0–120. ConclusionsInsulin resistance was associated with an increased intra-and extra-cranial atherosclerotic burden in the nondiabetic elderly Chinese population.

Bifidobacterium animalis subspecies lactis HN019 can reduce the sequelae of experimental periodontitis in rats modulating intestinal parameters, expression of lipogenic genes, and levels of hepatic steatosis.

To determine whether Bifidobacterium animalis subspecies lactis HN019 (B. lactis HN019) can reduce the sequelae of experimental periodontitis (EP) in rats modulating systemic parameters. This study evaluated the effects of probiotic therapy (PROB) in the prevention of local and systemic damage resulting from EP. Forty-eight rats were allocated into four groups: C (control), PROB, EP, and EP-PROB. PROB (1 × 1010 CFU/mL) administration lasted 8 weeks and PE was induced on the 7th week by placing ligature on the animals' lower first molars. All animals were euthanized in the 9th week of the experiment. Biomolecular analyses, RT-PCR, and histomorphometric analyses were performed. The data obtained were analyzed statistically (ANOVA, Tukey, p < .05). The EP group had higher dyslipidemia when compared to the C group, as well as higher levels of insulin resistance, proteinuria levels, percentages of systolic blood pressure, percentage of fatty hepatocytes in the liver, and expression of adipokines was up-regulated (LEPR, NAMPT, and FABP4). All these parameters (except insulin resistance, systolic blood pressure, LEPR and FABP4 gene expression) were reduced in the EP-PROB group when compared to the EP group. The EP group had lower villus height and crypt depth, as well as a greater reduction in Bacteroidetes and a greater increase in Firmicutes when compared to the EP-PROB group. Greater alveolar bone loss was observed in the EP group when compared to the EP-PROB group. Bifidobacterium lactis HN019 can reduce the sequelae of EP in rats modulating intestinal parameters, attenuating expression of lipogenic genes and hepatic steatosis.

The Association of Surrogates of Insulin Resistance with Hyperuricemia among Middle-Aged and Older Individuals: A Population-Based Nationwide Cohort Study.

The triglyceride-glucose (TyG) index, triglyceride-to-high-density-lipoprotein-cholesterol (TG/HDL-C) ratio, metabolic score for insulin resistance (METS-IR) and TyG with body mass index (TyG-BMI) have been proposed as indicators of insulin resistance (IR). This study aimed to explore the association between these IR surrogates and their longitudinal variation with the development of hyperuricemia in a middle-aged and older Chinese population. Data from the China Health and Retirement Longitudinal Study (CHARLS) was used to identify 5269 participants aged ≥45 years. Logistic regression was used to assess the effect of IR surrogates and their variations on the risk of hyperuricemia. After four years of follow-up, 517 (9.81%) participants developed incident hyperuricemia. Increased baseline values of TyG, TG/HDL, METS-IR, and TyG-BMI were all significantly associated with higher risks of hyperuricemia. Compared to individuals with maintained low levels of IR surrogates, those with low-to-high and maintained high variation patterns had a significantly higher risk of hyperuricemia. These four IR surrogates have comparable predictive ability for hyperuricemia. This study provides evidence of the associations between IR and hyperuricemia. Early intervention among middle-aged and elderly Chinese individuals with high IR levels may effectively reduce the burden of hyperuricemia.

Long-Term High Level of Insulin Resistance Is Associated With an Increased Prevalence of Coronary Artery Calcification: The CARDIA Study.

Background Coronary artery calcification (CAC) is a crucial indicator of subclinical atherosclerotic cardiovascular disease. The relationship between long-term insulin resistance (IR) trajectory and CAC has been explored in few studies. Therefore, this study aimed to investigate whether the long-term IR time series of young adults are associated with the incidence of CAC in midlife. Methods and Results In a cohort study comprising 2777 participants from the CARDIA (Coronary Artery Risk Development in Young Adults) study, the homeostasis model assessment for IR was used to measure IR levels, and group-based trajectory modeling was used to fit three 25-year homeostasis model assessments for IR trajectories. Logistic regression was used to estimate the association between the 3 homeostasis model assessments for IR trajectories and CAC events at year 25. The results showed that among 2777 participants (mean age, 50.10±3.58 years; 56.2% women; 46.4% Black), there were 780 incident CAC events after a 25-year follow-up. After full adjustment, the prevalence of CAC was higher in the moderate- (odds ratio [OR], 1.40 [1.10-1.76]) and the high-level homeostasis model assessments for IR trajectories (OR, 1.84 [1.21-2.78]) than in the low-level trajectory. This association was observed in obese individuals despite the negative interaction between IR and different types of obesity (all P interactions >0.05). Conclusions Our study revealed that young adults with a higher level of IR were more likely to develop CAC in middle age. Furthermore, this association persisted in obese individuals. These findings highlight the importance of identifying subclinical cardiovascular risk factors and implementing primary prevention measures.

Polycystic Ovaries and Associated Clinical and Biochemical Features in Young Women

Background: The aetiology of polycystic ovarian syndrome (PCOS) is unknown, even though it is the most frequent endocrine disorder in women of reproductive age. Previous community-based studies were unable to directly estimate the prevalence of PCOS in these communities since they did not conduct comprehensive biochemical and clinical screening. Objective: This research focused on polycystic ovaries and associated clinical and biochemical features in young women. Study Design: Cross-sectional study Study Setting: This study was conducted in Department of Biochemistry Central Park Medical College, Lahore from 1st August 2022 1st February 2023. Methodology: During the study period, volunteers were recruited from hospitals and requested their consent. While women were informed specifically that ovaries scan (ultrasound) would be used to detect polycystic ovaries. After the confirmation of polycystic ovaries, they were taken 201 as a case group. To compare the data, we also recruited 233 healthy participants as a control group. After taking consent and filling the questionnaire both cases and controls participants were requested for biochemical and hormonal analysis. SPSS version 20 was used for data analysis. Results: The mean age of control 25.83 ± 4.6 years and 27.12 ± 5.52 years of with significantly increased BMI in the women with PCO as compared to controls (p = 0.001). Insulin and resistance are significantly increased in those women suffering from PCO. LH, oestradiol are significantly increased and FSH is significantly decreased in cases as compared to control. The level of testosterone is not significant in this cohort. SHBG and also free testosterone index are also not significantly different. Practical implication: Even though many women in rural areas experience signs of a disease, they are hesitant to see a gynecologist or endocrinologist for treatment due to a lack of disease awareness, management, and medical therapy that conforms to criteria. Most patients don't get treatment because of this hesitation, which can cause a host of problems down the road. This study was done to better understand the clinical and biochemical characteristics of polycystic ovary syndrome in young women. Conclusion: Most women with infertility in Pakistan's leading medical centers have polycystic ovaries. Women with polycystic ovaries may not always experience the symptoms of polycystic ovarian syndrome. However, 26 percent of women in this research had PCOS. Women with polycystic ovaries often have hyperinsulinemia and high levels of insulin resistance. While LH and FSH are both considerably higher in cases than in controls, they are unrelated. The results of this investigation showed that although testosterone levels did not influence PCO, a negative correlation between insulin levels and SHBG hormone was seen in individuals with elevated insulin. Hence, the management of insulin can reduce the risk of PCO. Keywords: PCO, PCOS, LH, FSH, oestradiole, hyperinsulinemia, HOMA-IR

Abstract 09: Trajectories of Insulin Resistance, Incident Heart Failure and All-Cause Death in Nondiabetics: The Atherosclerosis Risk in Communities Study

Introduction: Previous studies have suggested an association between insulin resistance (IR) trajectories and adverse changes in cardiac structure and function in nondiabetic populations. We studied the associations between IR trajectories and incident heart failure (HF) and all-cause death in nondiabetic participants of the Atherosclerosis Risk in Communities (ARIC) study. We hypothesized that long-term moderate and high IR levels would increase the risk of incident HF and all-cause death. Methods: We included 7,835 participants (3,505 men and 4,330 women) aged 45-64 from the ARIC study without diabetes mellitus at any visit, and no history of prevalent HF, myocardial infarction, stroke, arterial or coronary surgery, or cancer at baseline. We estimated IR using Homeostatic Model Assessment-Insulin Resistance (HOMA-IR), triglyceride to high-density lipoprotein cholesterol ratio (TG/HDL-C), triglyceride glucose (TyG) index and metabolic score for IR (METS-IR). Serum insulin was not available at visits 2 and 3, so HOMA-IR was calculated for visits 1, 4, and 5. Latent class analysis identified two HOMA-IR trajectories, low-increasing and high-increasing, and three trajectories for TG/HDL-C, TyG index, and METS-IR: low-increasing, moderate-stable, and high-decreasing. We employed Cox proportional-hazards models to examine the associations of IR trajectories with incident HF and all-cause death adjusting for potential confounders. Results: Compared to participants in the low-increasing group, those in the high-increasing group of HOMA-IR were more likely to have incident HF and all-cause death (Table 1). For TG/HDL-C, TyG index and METS-IR, we found an increased risk of incident HF in the moderate-stable and high-decreasing groups relative to the low-increasing group. For all-cause death, consistent associations were found only in women (Table 1). Conclusions: Reduction of insulin resistance in nondiabetic individuals may be a suitable target for prevention strategies to reduce cardiovascular disease.

Leptin Resistance as a Risk Marker of Type 2 Diabetes Mellitus in Obese Patients

The purpose of the study was to investigate the influence of leptin resistance on the formation of the risk of type 2 diabetes mellitus in obese patients. Materials and methods. We monitored 50 obese patients who consulted an endocrinologist and a gastroenterologist-nutritionist during 2021-2022. The diagnosis of obesity was made on the basis of bioimpedance examination, as well as by calculating the body mass index. Results and discussion. The article describes and analyzes the level of leptin and leptin resistance as a marker of the risk of type 2 diabetes mellitus in obese patients. To establish the diagnosis of obesity, all patients underwent a bioimpedance examination, and the body mass index was also calculated. Obesity was diagnosed when the body fat content of women was more than 40%, men – more than 28%, and body mass index – more than 30 kg/m2. To identify the syndrome of insulin resistance, the index of insulin resistance was calculated according to the formula: HOMA-IR = fasting insulin (μIU/ml) x fasting glucose (mmol/l) / 22.5. Values exceeding 2.0 were considered insulin resistance. Leptin resistance was diagnosed by determining the presence of the leptin receptor gene and leptin level in blood serum. Leptin resistance was considered to be values of leptin indicators for men more than 5.6 ng/ml, for women – more than 11.1 ng/ml. The level of leptin in blood serum in the group of healthy individuals was within the range of 6.36 ± 2.09 ng/ml in women and 2.96 ± 1.84 ng/ml in men. On the other hand, in obese patients, the serum leptin concentration was 51.49 ± 8.33 ng/ml and 29.71 ± 6.93 ng/ml, respectively. Also, according to the results of the study, a significantly higher level of insulin resistance was observed in all obese patients compared to the control group. These values were at the level of 6.64 ± 2.81 and 7.11 ± 3.52, respectively. Analyzing the results of the study, a reliable relationship between the level of leptin and the severity of obesity was found in all patients. A clear relationship between leptin level and the degree of insulin resistance was also determined. A correlation between the level of leptin and HOMA-IR (r=0.70333; p=0.052) was established, as well as a correlation between fat content, body mass index, leptin level and HOMA-IR (r=0.86187, р=0.0086; r=0.93595, р=0.009; r=0.78098, р=0.007). The detected changes indicate a possible role of leptin and leptin resistance in the pathogenesis of type 2 diabetes mellitus and indicate that the level of leptin can be used as a predictor of the risk of developing type 2 diabetes mellitus in obese patients. Conclusion. An increase in leptin level in blood serum is observed in obese patients. The level of leptin affects the degree of insulin resistance and can be an additional marker of the risk of type 2 diabetes mellitus in obese patients

A follow-up study to explore factors associated with rapid kidney function decline and new-onset kidney disease among Chinese elderly population.

To explore potential factors associated with rapid kidney function decline and new-onset kidney disease among a Chinese elderly population, and to examine the relationships between baseline serum uric acid (SUA), longitudinal change in SUA and rapid estimated glomerular filtration rate (eGFR) decline over 5 years for this Chinese elderly population. A 5-year follow-up study was conducted from 2016 to 2020 in Xiamen City, China; and 2436 elderly people with normal kidney function at baseline was included. The multivariable logistic regressions were used to explore risk factors for rapid eGFR decline and new-onset kidney disease. The median age of subjects was 65 years, and 38.5% were men. These elderly people experienced a median 5-year decrease in eGFR of 14.50 mL/min/1.73 m2 , and 11.2% of them had developed new-onset kidney disease after 5-year follow-up. Participants with elevated SUA change from the normal group to the hyperuricemia group witnessed the highest decrease of eGFR after a 5-year follow-up than other groups. Multivariate analysis found advanced age, female, elevated baseline SUA, elevated SUA change, hypertension and triglyceride-glucose index were risk factors for rapid eGFR decline and new-onset kidney disease. The Chinese elderly population was more likely to encounter rapid renal function decline and new-onset kidney disease. A regular test for kidney disease was strongly recommended for these elderly people who were female, with advanced age, with elevated baseline SUA and elevated SUA change; and had high levels of insulin resistance, and blood pressure. The derived findings can offer significant evidence for targeted prevention for the Chinese elderly population. Geriatr Gerontol Int 2022; 22: 968-975.

Combined caloric restriction and exercise provides greater metabolic and neurocognitive benefits than either as a monotherapy in obesity with or without estrogen deprivation

Neurodegeneration, as indicated by brain dysfunction and cognitive decline, is one of the complications associated with obesity and estrogen deprivation. Calorie restriction and exercise regimes improved brain function in neurodegenerative diseases. However, the comparative effects of a combination of calorie restriction with exercise, calorie restriction, and an exercise regime alone on brain/cognitive function in obesity with or without estrogen deprivation have not been investigated. Sixty female rats were fed a normal diet (ND) or a high-fat diet (HFD) for 27 weeks. At week 13, the ND-fed rats underwent a sham operation with sedentary lifestyle, HFD-fed rats were divided into two groups: each having either a sham operation (HFS) or ovariectomy (HFO). At week 20, HFD-fed rats in each group were divided into four subgroups undergoing either a sedentary lifestyle, calorie restriction, exercise regime or a combination of calorie restriction and exercise for 7 weeks. Insulin resistance, cognitive decline and hippocampal pathologies were found in both HFS and HFO rats. HFO rats had higher levels of insulin resistance and hippocampal reactive oxygen species levels than HFS rats. Calorie restriction decreased metabolic disturbance and hippocampal oxidative stress but failed to attenuate cognitive decline in HFS and HFO rats. Exercise attenuated metabolic/hippocampal dysfunctions, resulting in improved cognition only in HFS rats. Combined therapies restored brain function, and cognitive function in HFS and HFO rats. Therefore, a combination of calorie restriction with exercise is probably the greatest lifestyle modification to diminish the brain pathologies and cognitive decline in obesity with or without estrogen deprivation.

Persistence exposure to toxic oil and gas flaring pollutants-mediated insulin resistance and hyperinsulinemia among populations in the Niger Delta

Environmental pollutants of oil and gas flaring are fast emerging major threats to the global health communities and environmental authorities; and also, an important source of morbidity and mortality. From purposively selected 94 volunteers exposed to toxic oil and gas flared pollutants in Ogoni land, Niger Delta, Nigeria, serum samples were used to evaluate possible association between non-communicable diseases (NCDs) and insulin resistance using C-peptide and Insulin kits. Volunteer’s age ranged 18 to 50 years, and were exclusively females resident consistently, in the various communities, in the order of 10 years and above. When compared to control, the outcomes of this study indicated high levels of insulin resistance, insulin, beta cell function, blood glucose of 78%, 76.2%, 71.6%, 52.5%with corresponding decrease in connecting peptide value of 43.2% was associated within creases in various physio-metabolic risk factors including low density lipoprotein, triglyceride, total cholesterol, high density lipoprotein and body mass index of 64.9%, 62.4%, 60.6%, 52.5% and 52% respectively in the exposed population to oil and gas flaring pollutants. Meanwhile, the prevalence of cardio-metabolic risk factor ratio (TG/HDL-C) was higher for the exposed population (63.6 %.) than the control (36.4%); while the prevalence of hyperinsulinemia/insulin resistance showed age and time dependent increase of exposure. This study validates both insulin resistance and toxic pollutions of oil and gas flaring as sensitive indicators of multiple metabolic abnormalities. Further, the inherent capacity of toxic oil and gas flared pollutants to elicit detectable pathologies in various tissues and organ induced-insulin resistance, might plausibly be the mechanist-link, in metabolic derangements, in the development and progression of a number of chronic non-communicable diseases, including diabetes, dyslipidaemia, hypertension, cardiovascular diseases, cancers, respiratory diseases, obesity and complications and disabilities and even death.

Use of the new guidelines on an earlier age threshold of 35 years for diabetes screening can identify an additional 6.3 million undiagnosed individuals with diabetes and 72.3 million individuals with prediabetes among Chinese adults: An analysis of a nationally representative survey

BackgroundYoung-onset diabetes has been increasingly prevalent in China and most of the young patients with diabetes remain undiagnosed. Recently, the American Diabetes Association (ADA) updated their screening criteria and turned down the age threshold of diabetes screening from 45 years to 35 years, which highlighted the importance of identifying young individuals with diabetes. Herein, we aimed to evaluate the clinical relevance of updated ADA screening recommendations in Chinese adults and the metabolic features and risk factor profiles of these newly diagnosed individuals. Study design and methodsUsing a complex, multistage, probability sampling design, we analyzed data from a nationally representative sample of 98,658 Chinese adults in 2010. Participants without previously diagnosed diabetes were included into the present study. We calculated the proportion of individuals with diabetes eligible for screening and the number needed to screen (NNS) to identify one patient with diabetes by age groups. ResultsSetting an earlier age threshold of diabetes screening can identify additional 6.3 million patients with diabetes and 72.3 million individuals with prediabetes, and the proportion of identified individuals increased more in rural, underdeveloped, and central areas. The NNS in Chinese adults dropped significantly from 28 in 30–34 age group to 15 in 35–45 years of age and remained low afterwards. The undiagnosed patients with diabetes who met the new screening age threshold of ADA recommendation were characterized by younger age, lower blood pressure and blood lipids, but higher proportion of overweight and higher level of insulin resistance, and tended to have an unhealthy diet habit, including low intake of fruits and vegetables and high intake of sugar-sweetened beverages, compared to those aged over 45 years. ConclusionsThe new age threshold of 35 years for diabetes screening would reduce the proportion of undiagnosed diabetes with high cost-effectiveness, given the NNS for a positive test result was much lower in 35–45 age group comparing to the lower age group in Chinese adults.

Acne and insulin resistance: A systematic review and meta-analysis

To the Editor: Acne is more common in westernized societies, suggesting that environmental factors likely contribute to acne pathogenesis.1Cordain L. Lindeberg S. Hurtado M. Hill K. Eaton S.B. Brand-Miller J. Acne vulgaris: a disease of western civilization.Arch Dermatol. 2002; 138: 1584-1590Crossref PubMed Google Scholar Metabolic abnormalities may influence key factors in the development of acne, such as the proliferation of basal keratinocytes in the sebaceous-pilosebaceous unit and abnormal desquamation of follicular corneocytes.2Del Prete M. Mauriello M.C. Faggiano A. et al.Insulin resistance and acne: a new risk factor for men?.Endocrine. 2012; 42: 555-560Crossref PubMed Scopus (50) Google Scholar Therefore, we hypothesized that patients with acne would demonstrate higher levels of insulin resistance. In this systematic review and meta-analysis, we examined the relationship between insulin resistance and acne, as it may have important therapeutic and diagnostic implications, such as exploring insulin modifiers as an adjunctive acne treatment and screening acne patients for metabolic syndrome. PubMed and Embase were systematically searched for studies published prior to March 17, 2021 that evaluated insulin resistance in patients with acne. In PubMed and Embase (acne OR acne vulgaris) AND (insulin resistance OR diabetes OR blood glucose) were searched as Medical Subject Heading terms and keywords, respectively. Only clinical studies measuring values for Homeostatic Model Assessment for Insulin Resistance (HOMA-IR), a validated laboratory measure of insulin resistance, in acne patients and control subjects were included.3Muniyappa R. Madan R. Assessing insulin sensitivity and resistance in humans.in: Feingold K.R. Anawalt B. Boyce A. Endotext [Internet]. MDText.com, Inc, 2000Google Scholar Studies were excluded if they were unpublished, abstracts, not written in English, or included patients with polycystic ovarian syndrome in order to exclude hyperandrogenism as a potential confounding variable. Database searches yielded 136 unique results. Thirteen articles met inclusion criteria and were included in the analysis (Supplementary Fig 1, available via Mendeley at https://data.mendeley.com/datasets/bfrm4wbdrz/2). The following data were extracted from each article: number of acne subjects, mean age of acne subjects, mean body mass index of acne subjects, acne severity, other acne qualifiers (postadolescent acne or treatment nonresponders), control subjects, mean HOMA-IR value in both acne and control groups, and quality assessment score (Supplementary Table 1, available via Mendeley at https://data.mendeley.com/datasets/bfrm4wbdrz/2). Meta-analysis compared the differences between acne and control patients. Hedges' g standardized mean difference between HOMA-IR values in acne patients and controls was calculated as the summary statistic. Results are reported from a random effects model. An I2 statistic was calculated to estimate heterogeneity across studies.4Egger M. Davey Smith G. Schneider M. Minder C. Bias in meta-analysis detected by a simple, graphical test.BMJ. 1997; 315: 629-634Crossref PubMed Scopus (32351) Google Scholar Moderating variables were studied in a mixed-effects model. Statistical analyses were conducted with R statistical software (version 4.0.5) using the meta package.5Balduzzi S. Rücker G. Schwarzer G. How to perform a meta-analysis with R: a practical tutorial.Evid Based Ment Health. 2019; 22: 153-160Crossref PubMed Scopus (952) Google Scholar Acne patients had higher HOMA-IR values than controls (standardized mean difference = 0.60; 95% CI, 0.33-0.88; P < .001) (Supplementary Fig 2, available via Mendeley at https://data.mendeley.com/datasets/bfrm4wbdrz/2). Onset of acne in the postadolescent period, average age of participants, sex of participants, average body mass index, publication year, or quality score were not significant modifying variables in our model. There was heterogeneity between studies (P < .001), which was a limitation of our study. Publication bias was assessed visually using a funnel plot and quantitatively with Egger's regression test of asymmetry (Supplementary Fig 3, available via Mendeley at https://data.mendeley.com/datasets/bfrm4wbdrz/2). Although some asymmetry exists, the large effect size of study 13 appears to mitigate the asymmetry (P = .47). However, due to the small number of studies with a large variation in effect sizes and standard errors, we do not have enough evidence that publication bias does not exist in this study. Dermatologists should be aware of the potential relationship between acne and insulin resistance and consider referring acne patients to primary care for further evaluation. Early treatment of insulin resistance can prevent the development of diabetes and cardiovascular disease. None disclosed.