Independent Risk Factor For Type Research Articles

Effects of a 12‐week Telenutrition Weight Loss Intervention on Diet Quality in Men

Poor diet and obesity are independent risk factors for type 2 diabetes, hypertension and cardiovascular disease. This study used a randomized controlled trial design to pilot test the effect of a 12‐week home‐delivered telenutrition weight loss program on diet quality in 40–70 year old men with obesity, waist circumference >40 inches and at least one chronic health condition. Both the control (n=29) and the intervention group (n=27) received diet‐related educational materials. Only the intervention group received individualized, weekly support by a Registered Dietitian Nutritionist (RDN) via telephone and videoconferencing. Diet was assessed using 4‐day food records and Nutrition Data Systems for Research (NDSR) software at weeks 0, 6, and 12. Diet quality was determined using the Healthy Eating Index (HEI‐2010). Diet quality significantly increased 9.5 points in both groups (95% CI: 3.7, 15.2) at week 6. The telenutrition group scores further increased by 9.3 points (95% CI 1.0, 17.6). No additional increase occurred at week 12 (control p‐value: 0.22; telenutrition p‐value: 0.55). A 10‐point improvement in diet quality was, on average, associated with a 0.7% reduction in body weight (95% CI: 0.4, 1.0; p‐value < 0.001). Weight loss programs delivered via videoconferencing can be effective for improving diet quality in men in health disparate areas like Appalachia.Support or Funding InformationWest Virginia Clinical and Translational Science Institute's Health Outcomes and Policy Evaluation (HOPE) Funding Opportunity with funds made available from the Claude Worthington Benedum Foundation.

Effect of antiplatelet therapy on aneurysmal sac expansion associated with type II endoleaks after endovascular aneurysm repair

ObjectiveEndovascular aneurysm repair (EVAR) of abdominal aortic aneurysms (AAAs) has gained widespread use through a solid reputation of safety and effectiveness. However, some issues, such as endoleaks and sac growth over time, still arise as important concerns. Antiplatelet therapy, mandatory as secondary prevention of cardiovascular disease, may play a role in both phenomena by interfering with blood clotting properties and the inflammatory process associated with AAA. We analyzed whether different antiplatelet therapies were independent risk factors for type II endoleak (T2E) persistence and midterm sac growth after EVAR. MethodsAll patients with T2E detected in the first post-EVAR control were included, except those without at least 1 year of complete follow-up. Data for demographics, clinical comorbidities, EVAR devices, and antiplatelet therapies were recorded. All patients underwent routine follow-up with contrast-enhanced tomography at 1 month, 6 months, 12 months, and annually thereafter. A three-dimensional rendering of each endoleak was performed for detailed volumetry. Main outcomes were endoleak persistence at 6 months and sac growth >5 mm at end of follow-up. ResultsDuring a 9-year period, 87 patients with initial T2E were monitored for a mean of 41.5 months. On discharge, salicylates were prescribed to 50, clopidogrel to 16, and multiagent therapy or anticoagulation to 9; no therapy was given to 12. No significant differences in comorbidities or baseline AAA characteristics were found between groups. At 6 months thereafter, 59% (n = 51) of the initial T2Es persisted. At end of follow-up, 32 patients had sac growth >5 mm (37%). Sac growth was significantly less frequent in the group treated with salicylates (26% vs 60%; P = .004). Cox proportional hazards model reinforced the role of salicylates as protectors for sac growth over time (hazard ratio, 0.34; 95% confidence interval, 0.13-0.87; P = .024), whereas T2E nidus volume and endoleak complexity behaved like independent risk factors. ConclusionsAntiplatelet therapy with salicylates appears to be linked to a decreased risk of sac growth >5 mm over time in patients with T2Es detected right after EVAR. Population-based cohort studies are mandatory to confirm this finding and to guide a potential recommendation.

Residential Proximity to Major Roadways and Risk of Type 2 Diabetes Mellitus: A Meta-Analysis.

Research indicates that higher levels of traffic-related pollution exposure increase the risk of diabetes, but the association between road proximity and diabetes risk remains unclear. To assess and quantify the association between residential proximity to major roadways and type 2 diabetes, a systematic review and meta-analysis was performed. Embase, Medline, and Web of Science were searched for eligible studies. Using a random-effects meta-analysis, the summary relative risks (RRs) were calculated. Bayesian meta-analysis was also performed. Eight studies (6 cohort and 2 cross-sectional) with 158,576 participants were finally included. The summary unadjusted RR for type 2 diabetes associated with residential proximity to major roadways was 1.24 (95% confidence interval [CI]: 1.07–1.44, p = 0.001, I2 = 48.1%). The summary adjusted RR of type 2 diabetes associated with residential proximity to major roadways was 1.12 (95% CI: 1.03–1.22, p = 0.01, I2 = 17.9%). After excluding two cross-sectional studies, the summary results suggested that residential proximity to major roadways could increase type 2 diabetes risk (Adjusted RR = 1.13; 95% CI: 1.02–1.27, p = 0.025, I2 = 36.6%). Bayesian meta-analysis showed that the unadjusted RR and adjusted RR of type 2 diabetes associated with residential proximity to major roadways were 1.22 (95% credibility interval: 1.06–1.55) and 1.13 (95% credibility interval: 1.01–1.31), respectively. The meta-analysis suggested that residential proximity to major roadways could significantly increase risk of type 2 diabetes, and it is an independent risk factor of type 2 diabetes. More well-designed studies are needed to further strengthen the evidence.

Global region of birth is an independent risk factor for type 2 diabetes in Stockholm, Sweden.

In Stockholm, type 2 diabetes (T2D) is a public health concern and much more prevalent in areas with a high proportion of foreign-born individuals. One in five individuals in Stockholm County are born outside of Sweden, and we therefore investigated if global region of birth was associated with diabetes risk, adjusting for established risk factors. Cross-sectional data from the population-based Stockholm Public Health Survey 2010 ( N = 69 115) was combined with registry-based information on country of birth grouped into eight global geographical regions. Cases of T2D were identified through self-reported physician-diagnosed diabetes and age at diagnosis. Region of birth was the independent risk factor and multivariable logistic regression analysis was performed adjusting for the risk factors age, sex, weight status, educational level, multiple dietary factors, tobacco, alcohol and physical activity. T2D prevalence was 5.1% in the sample. Relative to Swedish-born participants, higher odds ratio (OR) were found in those born in Asia [OR 3.2, 95% confidence interval (CI) 2.2-4.7], Sub-Saharan Africa (OR 2.5, 95% CI 1.5-4.1) and North Africa/the Middle East (OR 2.1, 95% CI 1.6-2.8), after adjustment for established risk factors. Participants from Eastern Europe and Latin America had an elevated risk but this did not remain after adjustment for other risk factors. Region of birth was found to be an independent risk factor for T2D for participants born in Asia, Africa and the Middle East. This increased risk should be taken into consideration when allocating resources for prevention, detection and care.

Elevated homocysteine levels in type 2 diabetes induce constitutive neutrophil extracellular traps.

Constitutively active neutrophil extracellular traps (NETs) and elevated plasma homocysteine are independent risk factors for Type 2 Diabetes (T2D) associated vascular diseases. Here, we show robust NETosis due to elevated plasma homocysteine levels in T2D subjects and increased components of NETs such as neutrophil elastase and cell free DNA. Cooperative NETs formation was observed in neutrophils exposed to homocysteine, IL-6 and high glucose suggesting acute temporal changes tightly regulate constitutive NETosis. Homocysteine induced NETs by NADPH oxidase dependent and independent mechanisms. Constitutively higher levels of calcium and mitochondrial superoxides under hyperglycemic conditions were further elevated in response to homocysteine leading to accelerated NETosis. Homocysteine showed robust interaction between neutrophils and platelets by inducing platelet aggregation and NETosis in an interdependent manner. Our data demonstrates that homocysteine can alter innate immune function by promoting NETs formation and disturbs homeostasis between platelets and neutrophils which may lead to T2D associated vascular diseases.

Association Between Gout and Incident Type 2 Diabetes Mellitus: A Retrospective Cohort Study

ObjectiveWe investigated the association between gout and the risk of type 2 diabetes mellitus. MethodsPopulation-based representative insurance (outpatient and inpatient) claims data of 29,765 patients with gout and 59,530 controls without gout (1:2 case:control ratio) between 1998 and 2010 in Taiwan were identified. The association between gout and type 2 diabetes was evaluated using the Cox proportional hazards model. Moreover, the combined effects of sex and incident gout on the risk of type 2 diabetes were estimated. ResultsIn total, 3940 patients (13.24%) with gout and 6334 controls (10.64%) developed type 2 diabetes in the follow-up period. Multivariate analyses revealed a significant association between gout and type 2 diabetes. Compared with the control group, the adjusted hazard ratios (95% confidence intervals) for type 2 diabetes were 1.62 (1.54-1.70) in men, 1.97 (1.81-2.14) in women, and 1.70 (1.62-1.77) overall. The multiplicative interaction was β = 0.18 and P = .0001, suggesting a positive interaction between sex and incident gout. Moreover, compared with men without gout, a significantly higher risk of type 2 diabetes was noted in women without gout (adjusted relative risk [95% confidence interval], 1.17 [1.10-1.24]), men with gout (1.11 [1.06-1.16]), and women with gout (1.47 [1.37-1.57]) (P for interaction = .0058). ConclusionsGout is a strong and independent risk factor for type 2 diabetes, and female patients with gout are at a higher risk of type 2 diabetes than are male patients with gout.

Is Uric Acid a Missing Link between Previous Gestational Diabetes Mellitus and the Development of Type 2 Diabetes at a Later Time of Life?

IntroductionA high level of uric acid (UA) is a strong, independent risk factor for type 2 diabetes mellitus. The relationship between UA levels and the development of type 2 diabetes in women with previous gestational diabetes mellitus (pGDM) remains unclear. The aim of study was to evaluate the UA levels in pGDM women in relation to their current nutritional status and carbohydrate metabolism.Material and Methods199 women with pGDM diagnoses based on oral glucose tolerance tests (OGTTs) 5–12 years previously and a control group of 50 women without pGDM. The assessment included anthropometric parameters, body composition (Tanita SC-330S), current OGTT, insulin resistance index (HOMA-IR), β-cell function (HOMA-%B), HbA1c, lipids, and uric acid.ResultsNo differences between groups were found in terms of age, time from the index pregnancy, anthropometric parameters, lipids or creatinine levels. The incidences of overweight and obesity were similar. Carbohydrate abnormalities were more frequent in the pGDM group than the control group (43.2% vs 12.0% p<0.001). The women with pGDM had significantly higher fasting glucose, HbA1c, glucose and insulin levels in the OGTTs, but similar HOMA-IR values. Their UA levels were significantly higher (258±58 vs 230±50 μmol/L, p<0.005) and correlated with BMI and the severity of carbohydrate disorders. The normal weight and normoglycemic pGDM women also demonstrated higher UA levels than a similar control subgroup (232±48 vs 208±48 μmol/L, p<0.05). Multivariate analysis revealed significant correlations of UA level with BMI (β = 0.38, 95% CI 0.25–0.51, p<0.0001), creatinine level (β = 0.23, 95% CI 0.11–0.35, p<0.0005), triglycerides (β = 0.20, 95% CI 0.07–0.33, p<0.005) and family history of diabetes (β = 0.13, 95% CI 0.01–0.25, p<0.05). In logistic regression analysis, the association between higher UA level (defined as value ≥297 μmol/L) and presence of any carbohydrate metabolism disorder (IFG, IGT or diabetes) was statistically significant (odds ratio 3.62 [95% CI 1.8–7.3], p<0.001).ConclusionsHigher UA levels may be associated with the development of type 2 diabetes in pGDM women, also in these with normal body weights.

Associations Between Antioxidant Capacity And Insulin Sensitivity At Baseline But Not Following Six-weeks Of HIIT Or MIT In Obese Males.

Obesity is an independent risk factor for type 2 diabetes and cardiovascular disease. Oxidative stress or low total antioxidant capacity has been shown to be associated with decreased insulin sensitivity (SI) in overweight/obese individuals. Exercise training has been shown to improve systemic antioxidant capacity (TAC) and SI; however whether or not correlations between SI and TAC observed under untrained conditions are associated following exercise training is less clear. PURPOSE: The purpose of this study was twofold: 1) to determine if SI was correlated with serum TAC in a cohort of overweight/obese men at baseline and following six-weeks of exercise training; and 2) to determine if the relationships between SI and TAC responded differently following High Intensity Interval (HIIT) vs Moderate Intensity-Training (MIT). METHODS: 16 sedentary, overweight/obese young men (age = 20 ± 1.5 years, body mass index = 29.5 ± 3.3 kg/m2) were randomly assigned to HIIT or MIT and evaluated at baseline and post-training. Baseline and post training assessments included DXA for body composition assessment, oral glucose tolerance test to measure SI, and the oxygen radical absorbance capacity assay to assess TAC. Additionally, acute serum TAC responses were assessed at pre-exercise (PRE), immediately post exercise (IPE) and 30 minutes post exercise (30min-Post) at baseline and six-weeks post training. RESULTS: A significant correlation was observed between SI and TAC at baseline (R2=0.548, P=0.001). SI significantly improved from baseline to post-training in both groups (P=0.037), with no significant time x group interactions for HIIT or MIT. No significant changes in TAC were found from baseline to post-training. No significant correlations were found between SI and TAC in the trained condition. A significant increase in TAC was observed IPE compared to pre-exercise at baseline and six-weeks post training following HIIT (P<0.05). A significant decrease in TAC was found 30min-Post compared to IPE six-weeks post training in HIIT and MIT. CONCLUSION: The observed baseline correlation between SI and TAC did not persist after training, which suggests that factors other than changes in TAC may be mediating the exercise-induced improvement in SI. Ongoing studies will attempt to identify exercise-induced mediators in SI.

Association between Helicobacter pylori infection and prevalence of type 2 diabetes

To investigate the association between Helicobacter pylori (Hp) infection and type 2 diabetes.Total 4 129 health check up subjects aged (49.1±11.3) years (18-92 years), including 2 649 males and 1 480 females were enrolled in this cross-section study.Hp infection was confirmed by 13C-urea breath test; type 2 diabetes mellitus was diagnosed according to WHO criteria (1999). Single factor analysis and multiple regression analysis were used to evaluate the association between Hp affection and the prevalence of type 2 diabetes.Hp infection rate in diabetic group was significantly higher than that in non-diabetic group (45.6% vs. 39.0%, P<0.05). Hp infection rate in subjects with newly diagnosed diabetes was highest than those with previously diagnosed diabetes and non-diabetic subjects (P<0.05). The glycosylated hemoglobin level in Hp infection group was higher than that in non infection group [(5.88±0.64)% vs. (5.62±0.88)%, P<0.05]; the fasting plasma glucose and postprandial blood glucose levels in Hp infection group were also higher than those in non-infection group (P<0.05). Logistic regression analysis showed that Hp infection was one of the independent risk factors of type 2 diabetes (OR=2.002, 95%CI: 1.564-2.563, P<0.05). The study indicates that Hp infection is closely associated with type 2 diabetes mellitus. Key words: Helicobacter pylori; Diabetes mellitus, type 2; Cross-sectional studies

Risk factors for type 2 diabetes complicated with hypertension in adult residents in Liuyang

To investigate the risk factors for type 2 diabetes complicated with hypertension in adult residents in Liuyang, Hunan Province, P. R. China. The residents aged at or over 18 were selected through a method of multi-stage cluster random sampling from 10 towns in Liuyang. Questionnaires, physical measurements and laboratory tests were conducted. Type 2 diabetes complicated with hypertension were served as an experimental group, while simple diabetes, non-diabetes and non-hypertension (healthy control), or non-complication and healthy group (simple hypertension, simple diabetes, and healthy group) were served as control group, respectively. Three kinds of logistic regression model were used to analyze the risk factors for type 2 diabetes complicated with hypertension. A total of 5 669 residents were included in the analysis, and the response rate was 97.74%. The results showed that the prevalence of type 2 diabetes complicated with hypertension of residents at or over 18 years old in Liuyang was 2.6% (95%CI: 2.2%, 3.1%). Logistic regression analyses demonstrated that for people at or over 60 years old, obesity and abnormal triglyceride were the independent risk factors for type 2 diabetes complicated with hypertension. Aging, obesity and abnormal triglyceride can increase the risk of type 2 diabetes complicated with hypertension in adult residents in Liuyang.

Weight cycling and the risk of type 2 diabetes in the EPIC-Germany cohort.

Studies on weight cycling and the risk of type 2 diabetes have revealed inconsistent results, possibly due to differences in the definition of weight fluctuations. Here, we investigated whether weight cycling during adulthood is related to diabetes risk in a large cohort study, using a complementary approach to define patterns of weight development. Weight cycling, weight loss and weight gain were defined (1) a priori, using distinct categories, and (2) by functional principal component analysis (FPCA) to capture weight patterns in greater detail. Associations of weight cycling, weight loss and weight gain with the risk of type 2 diabetes were evaluated by Cox regression models. A priori defined weight cycling was associated with increased diabetes risk, compared with stable weight (HR 1.36 [95% CI 1.09, 1.68]). No significant association between FPCA-derived weight cycling and risk of diabetes was observed after adjustment for concurrent weight patterns (HR 1.19 [95% CI 0.89, 1.60]). Subgroup analyses showed that FPCA-derived weight cycling during net weight gain was associated with a higher risk of diabetes (HR 1.68 [95% CI 1.14, 2.48]). A priori defined weight gain (HR 2.08 [95% CI 1.60, 2.70]) was more clearly related to the risk of diabetes than FPCA-derived weight gain (HR 1.20 [95% CI 0.95, 1.51]), while no significant associations were observed for weight loss. Overall, weight cycling may not be an independent risk factor for type 2 diabetes when accounting for concurrent patterns of weight development. However, weight cycling may pose a stronger risk of diabetes than non-cycling during net weight gain.

Effects of Breaking Sitting by Standing and Acute Exercise on Postprandial Oxidative Stress.

Background:Sedentary behavior, which includes sitting and TV viewing, has been identified as an independent risk factor for type 2 diabetes and cardiovascular disease. Breaking sedentary behavior improves metabolic health such as postprandial glycaemia and insulinemia. However, the mechanisms underlying this effect are unclear.Objectives:Here, we examined whether breaking sitting by standing and acute exercise reduces postprandial oxidative stress.Patient and Methods:Fifteen participants performed 3 trials (sitting, standing, and exercise), each lasting 2 days, in a randomised order. On day one of sitting trial, participants sat in a chair. For the standing trial, the participants stood 6 times, for a 45-minute period each time. For the exercise trial, the participants walked or ran at approximately 60% of age-predicted maximum heart rate for 30 minutes. On day two of each trial, participants rested and consumed the standardised breakfast and lunch. Blood samples were collected in the morning and afternoon on day one, and fasting and at 2, 4, and 6 hours postprandially on day two.Results:The concentrations of serum derivatives of reactive oxygen metabolites (d-ROMs) measured at 4 hours (P = 0.064) and 6 hours (P = 0.071) tended to be higher than that in the fasting state in the sitting trial, but not standing and exercise trial (two-factor analysis of variance (ANOVA), trial × time interaction, P = 0.006).Conclusions:Our results indicate the importance of reducing sitting time for improving postprandial oxidative stress status.

Hypertension is an independent risk factor for type 2 diabetes: the Korean genome and epidemiology study.

Hypertension and diabetes share common risk factors and frequently co-occur. Although high blood pressure (BP) was reported as a significant predictor of type 2 diabetes, little is known about this association in Korea. This study investigated the relationship of prehypertension and hypertension with type 2 diabetes in 7150 middle-aged Koreans, as well as the effect of BP control on diabetes development over 8 years. At 8 years, 1049 (14.7%) of the 7150 participants had newly developed diabetes, including 11.2, 16.7 and 21.5% of baseline normotensive, prehypertensive and hypertensive subjects, respectively. The overall incidence rate of diabetes was 22.3 events per 1000 person-years. Subjects with baseline prehypertension (hazard ratio (HR), 1.27; 95% confidence interval (CI), 1.09–1.48) and hypertension (HR 1.51; 95% CI, 1.29–1.76) were at higher risk of diabetes than normotensive subjects after controlling for potential confounders (P-value for trend <0.001). These associations persisted even when subjects were stratified by baseline glucose status, sex and body mass index (BMI). The risk of diabetes was significantly higher in subjects who had normal BP at baseline and progressed to prehypertention or hypertension at 8 years (HR, 1.48; 95% CI, 1.20–1.83) than those with controlled BP, but these associations were not observed in subjects with baseline prehypertension and hypertension. These findings showed that prehypertension and hypertension are significantly associated with the development of diabetes, independent of baseline glucose status, sex and BMI. Active BP control reduced incident diabetes only in normotensive individuals, suggesting the need for early BP management.

Fetuin-A (AHSG) and its usefulness in clinical practice. Review of the literature.

Fetuin-A, also called Alpha 2-Heremans Schmid Glycoprotein, is a multifunctional plasma agent what has been proven in animal and human studies. It plays a role as a physiological inhibitor of insulin receptor tyrosine kinase associated with insulin resistance and a negative acute phase reactant. It also regulates bone remodeling and calcium metabolism being an important inhibitor of calcium salt precipitation and vascular calcifications. PubMed database was searched for articles from 2002 up to December 2014 to identify the role of fetuin-A in the pathogenesis of selected internal diseases. Due to secretion of fetuin-A mainly by the liver, it may be a marker of liver function and predictor of mortality in patients with cirrhosis and hepatocellular cancer. The associations between high fetuin-A and metabolic syndrome as well as its hepatic manifestation- nonalcoholic fatty liver disease and atherogenic lipid profile have been well proven. However, fetuin-A relation with BMI is not so clear. Contrary to few reports, many authors suggest that fetuin-A may be an independent risk factor for type 2 diabetes and marker of diabetic complications. Close associations of high and low fetuin-A concentrations with cardiovascular diseases and mortality risk have been reported which is explained by differences in analyzed populations, stages of atherosclerosis and calcifications, coexistence of type 2 diabetes or kidney dysfunction and different main pathways of fetuin-A actions in various diseases. Fetuin-A has a diagnostic potential as a biomarker for liver dysfunction, cardiovascular diseases and disorders associated with metabolic syndrome.

RGC32 deficiency protects against high-fat diet-induced obesity and insulin resistance in mice.

Obesity is an important independent risk factor for type 2 diabetes, cardiovascular diseases and many other chronic diseases. Adipose tissue inflammation is a critical link between obesity and insulin resistance and type 2 diabetes and a contributor to disease susceptibility and progression. The objective of this study was to determine the role of response gene to complement 32 (RGC32) in the development of obesity and insulin resistance. WT and RGC32 knockout (Rgc32(-/-) (Rgcc)) mice were fed normal chow or high-fat diet (HFD) for 12 weeks. Metabolic, biochemical, and histologic analyses were performed. 3T3-L1 preadipocytes were used to study the role of RGC32 in adipocytes in vitro. Rgc32(-/-) mice fed with HFD exhibited a lean phenotype with reduced epididymal fat weight compared with WT controls. Blood biochemical analysis and insulin tolerance test showed that RGC32 deficiency improved HFD-induced dyslipidemia and insulin resistance. Although it had no effect on adipocyte differentiation, RGC32 deficiency ameliorated adipose tissue and systemic inflammation. Moreover, Rgc32(-/-) induced browning of adipose tissues and increased energy expenditure. Our data indicated that RGC32 plays an important role in diet-induced obesity and insulin resistance, and thus it may serve as a potential novel drug target for developing therapeutics to treat obesity and metabolic disorders.

Analysis of the risk factors of type 2 diabetic nephropathy

Objective To explore the related risk factors of type 2 diabetic nephropathy,and to provide theoretical basis to make the strategy of prevention of diabetic nephropathy.Methods By case-control study method,98 patients with type 2 diabetic nephropathy were selected as the observation group.98 diabetes mellitus patients without kidney disease were selected as control group.Single factor analysis and non-conditional logistic regression analysis were conducted in two groups.Results The results of single factor analysis showed that type 2 diabetic nephropathy was closely related to family history of diabetes,course of diabetes,high blood pressure,diabetic retinopathy,BMI,coronary heart disease,HbAlc,FPG,2hPG,CRP (P ＜ 0.05).The results of multiple factors of logistic regression showed that type 2 diabetic nephropathy was closely related to course of diabetes and diabetic retinopathy,CRP,HbA1c,FPG(P ＜0.05).Conclusion Course of diabetes and diabetic retinopathy,CRP,HbA1c,FPG are independent risk factors for type 2 diabetic nephropathy. Key words: Diabetic nephropathy; Logistic regression analysis ; Risk factors

Design and rationale of the WELCOME trial: A randomised, placebo controlled study to test the efficacy of purified long chain omega-3 fatty treatment in non-alcoholic fatty liver disease

BackgroundNon-alcoholic fatty liver disease (NAFLD) represents a range of liver conditions from simple fatty liver to progressive end stage liver disease requiring liver transplantation. NAFLD is common in the population and in certain sub groups (e.g. type 2 diabetes) up to 70% of patients may be affected. NAFLD is not only a cause of end stage liver disease and hepatocellular carcinoma, but is also an independent risk factor for type 2 diabetes and cardiovascular disease. Consequently, effective treatments for NAFLD are urgently needed. ObjectivesThe WELCOME study is testing the hypothesis that treatment with high dose purified long chain omega-3 fatty acids will have a beneficial effect on a) liver fat percentage and b) two histologically validated algorithmically-derived biomarker scores for liver fibrosis. DesignIn a randomised double blind placebo controlled trial, 103 participants with NAFLD were randomised to 15–18months treatment with either 4g/day purified long chain omega-3 fatty acids (Omacor) or 4g/day olive oil as placebo. Erythrocyte percentage DHA and EPA enrichment (a validated proxy for hepatic enrichment) was determined by gas chromatography. Liver fat percentage was measured in three discrete liver zones by magnetic resonance spectroscopy (MRS). We also measured body fat distribution, physical activity and a range of cardiometabolic risk factors. MethodsRecruitment started in January 2010 and ended in June 2011. We identified 178 potential participants, and randomised 103 participants who met the inclusion criteria. The WELCOME study was approved by the local ethics committee (REC: 08/H0502/165; www.clinicalTrials.gov registration number NCT00760513).

High HbA1C in anemic patients: Is hypovitaminosis D that link?

Context: Glycated hemoglobin is a form of hemoglobin that is measured primarily to identify the average plasma glucose concentration over prolonged periods of time, formed due to non-enzymatic glycation. Previous studies have suggested increased glycated hemoglobin levels in anemic patients despite the shortened life span of the erythrocytes. Several reports have suggested an active role of vitamin D in the functional regulation of pancreatic β-cells. Hypovitaminosis D may be an independent risk factor for type 2 diabetes mellitus (T2DM) with higher HbA1c levels. Studies have also demonstrate association of vitamin D deficiency and greater risk of anemia in children. Aims: The aim of this study is to estimate and analyse hemoglobin A1c, vitamin D and hemoglobin levels in non diabetic anemic adults and assess the relationship between above mentioned parameters. Materials and Methods: The study was conducted at Kasturba Medical College, Manipal. Serum vitamin D, hemoglobin and HbA1c measured in 187 non-diabetic anemic adults of 25-55 years of age, glycated hemoglobin measured in BIORAD variant turbo II using ion exchange HPLC method, and vitamin D by Eletrochemiluminescene method. Hemoglobin estimation was done by Drabkin's method. Results and Conclusion: The study found negative correlation between vitamin D and HbA1c in both males and females (r = -0.5, r = -0.4 P ≤ 0.001), HbA1c and hemoglobin (r = -0.4, r = -0.3 P ≤ 0.002). Also, there was significant positive correlation between the vit D and hemoglobin (r = 0.4, r = 0.3 P ≤ 0.001) values in the study population. Thus, there could be a role of vitamin D in the management of anemia. Since the sample size was small further study is recommended with larger sample size for reliable results.

The relationship between exercise,nutrition and type 2 diabetes.

Type 2 diabetes mellitus and its precursor, insulin resistance, are metabolic disease states characterized by impaired regulation in the delivery, transport, and/or storage of energy substrates (primarily carbohydrate- and fat-based fuels). A hallmark feature of patients with type 2 diabetes is prolonged periods of hyperglycemia due to a decreased responsiveness of metabolically active peripheral tissues to the actions of insulin (i.e., metabolic inflexibility). Accordingly, efforts to modify skeletal muscle substrate handling in type 2 diabetes patients so that the capacity for fat oxidation and metabolic flexibility is improved should be a primary goal for the treatment of these disorders. Two potent interventions for improving whole-body glucose homeostasis are exercise and diet. A single bout of either resistance or endurance exercise reduces the prevalence and duration of hyperglycemic excursions in patients with type 2 diabetes, an effect lasting well into the next day. With regard to diet, the carbohydrate content of a meal and the glycemic index (GI) of the carbohydrate consumed are both major determinants of the postprandial glycemic response. Diets containing high-GI carbohydrates have been shown to be independent risk factors for type 2 diabetes onset, while in obese insulin-resistant individuals, low-GI diets are effective for inducing both weight loss and improving insulin action and glucose tolerance. The implementation of physical activity and dietary modifications are effective low-cost treatment options for controlling hyperglycemic episodes in patients with type 2 diabetes.

Antidepressant Medication as a Risk Factor for Type 2 Diabetes and Impaired Glucose Regulation

OBJECTIVEAntidepressant use has risen sharply over recent years. Recent concerns that antidepressants may adversely affect glucose metabolism require investigation. Our aim was to assess the risk of type 2 diabetes associated with antidepressants through a systematic review.RESEARCH DESIGN AND METHODSData sources were MEDLINE, Embase, PsycINFO, The Cochrane Library, Web of Science, meeting abstracts of the European Association for the Study of Diabetes, American Diabetes Association, and Diabetes UK, Current Controlled Trials, ClinicalTrials.gov, U.K. Clinical Research Network, scrutiny of bibliographies of retrieved articles, and contact with relevant experts. Relevant studies of antidepressant effects were included. Key outcomes were diabetes incidence and change in blood glucose (fasting and random).RESULTSThree systemic reviews and 22 studies met the inclusion criteria. Research designs included 1 case series and 21 observational studies comprising 4 cross-sectional, 5 case-control, and 12 cohort studies. There was evidence that antidepressant use is associated with type 2 diabetes. Causality is not established, but rather, the picture is confused, with some antidepressants linked to worsening glucose control, particularly with higher doses and longer duration, others linked with improved control, and yet more with mixed results. The more recent, larger studies, however, suggest a modest effect. Study quality was variable.CONCLUSIONSAlthough evidence exists that antidepressant use may be an independent risk factor for type 2 diabetes, long-term prospective studies of the effects of individual antidepressants rather than class effects are required. Heightened alertness to potential risks is necessary until these are complete.