Poor Metabolic Health Research Articles

Treating Insulin Resistance with Intermittent Personalized Nutrition to Sustain Metabolic Health and Functioning Immune System for Risk Reduction of Viral Diseases Especially COVID-19 and Long-COVID.

The Covid-19 pandemic has provided new and strong evidence for poor outcomes of viral infection in patients with poor metabolic health. Insulin resistance is at the root of many metabolic conditions and a key driver of their progression as it promotes ineffectual inflammation whilst impairing immune functions. In a vicious circle, insulin resistance facilitates SARS-CoV-2 infection, whilst infection drives insulin resistance. We discuss the underlying mechanisms and explore ways to improve metabolic health and prevent insulin resistance through early detection and targeted nutritional interventions. With proven efficacy in prediabetes, type 2 diabetes, and their cardiovascular and organ complications, as much as non-alcoholic liver disease, we argue to extend such approaches to ensure resilience to the current pandemic and viral challenges beyond.

Planful Self-Control, Metabolic Risk, and Psychosocial Outcomes Among Young, Black Men: A Test of Skin-Deep Resilience Theory.

Research on skin-deep resilience suggests that for youth and young adults from disadvantaged backgrounds, high levels of planful self-control may promote positive psychosocial outcomes while simultaneously conferring vulnerabilities to chronic diseases related to aging. In this study, we investigated the divergent effects of planful self-control on young Black American men’s psychosocial well-being and their metabolic risk. We expected that high levels of planful self-control in emerging adulthood would predict positive outcomes in young adulthood (educational attainment, low depressive symptoms, job satisfaction); however, the combination of high levels of planful self-control and the experience of contextual adversity either in emerging adulthood or in childhood would forecast poor metabolic health. Hypotheses were tested with prospective data from 504 Black American men followed from age 20 to age 26. Planful self-control in emerging adulthood directly forecasted low levels of depressive symptoms, one’s likelihood of obtaining a bachelor’s degree, increased job satisfaction, and increases in metabolic risk. Exposure to childhood deprivation moderated the influence of planful self-control on metabolic risk. Men with high levels of deprivation and high levels of planful self-control exhibited the worst metabolic profiles in the sample. In contrast, men with high levels of childhood deprivation and low levels of planful self-control exhibited the best metabolic profiles. Documenting the health consequences associated with planful self-control provides a foundation from which to identify modifiable psychosocial factors that affect the course of psychosocial problems and health.

Supplemental Nutritional Assistance Program Participation and Relationship With Obesity and Metabolic Syndrome: NHANES Adults, 2013–2018

ObjectivesThe Supplemental Nutrition Assistance Program (SNAP) is the largest food insecurity safety net program in America. Previous research suggests that participation in SNAP is associated with obesity and poor metabolic health. In recent years, there have been extensive federal nutrition education efforts to promote healthier food choices and increase access to healthier foods among SNAP participants. The purpose of this study was to assess the association between SNAP participation, obesity, and metabolic syndrome using recent data from the National Health and Nutrition Examination Surveys (NHANES). MethodsA cross-sectional analysis was performed using data from the 2013–2018 NHANES. The study population included 4165 adults aged 18 to 65 with household incomes ≤130% of the federal poverty level. The association between SNAP participation and body mass index (BMI) was modeled using multinomial logistic regression while the association between SNAP participation and risk factors for metabolic syndrome was modeled using Poisson regression. ResultsOut of the 4165 individuals who met the inclusion/exclusion criteria, SNAP participation status was available for 2766. Among these, 80.4% received household SNAP benefits. After adjusting for sociodemographic differences, there was no statistically significant association between SNAP participation and obesity (prevalence ratio (PR): 1.15, 95% CI: 0.428, 3.1, p = 0.779), elevated waist circumference (PR: 1.01, 95% CI: 0.989, 1.04, p = 0.296), elevated blood pressure (PR: 0.999, 95% CI: 0.96, 1.04, p = 0.943), elevated fasting glucose (PR: 0.963, 95% CI: 0.909, 1.021, p = 0.229), elevated triglycerides (PR: 1.029, 95% CI: 0.965, 1.098, p = 0.39), or reduced HDL (PR: 1.017, 95% CI: 0.99, 1.046, p = 0.235). SNAP participation was not associated with metabolic syndrome (PR: 1.002, 95% CI: 0.978, 1.026, p = 0.887). ConclusionsSNAP participation is not associated with an increased risk of obesity or risk factors for metabolic syndrome among low-income adults. Funding SourcesNone.

Impact of circuit, interval-based exercise on insulin resistance and adiponectin among minority cancer survivors.

12059 Background: Hispanic and Black adults have a heightened risk of metabolic syndrome compared to non-Hispanic white adults, increasing the risk of cardiovascular disease, diabetes, and co-morbid outcomes. Further, Hispanic and Black adults are more likely to be sedentary and obese than non-Hispanic white adults, leading to an increased risk of insulin resistance and poor metabolic health. Exercise improves cardiometabolic health, including insulin sensitivity and adiponectin, however few studies have focused on minority cancer survivors. The aim of our (NCT03284346) was to determine whether a 4-month circuit-based aerobic and resistance exercise intervention can improve insulin resistance and adiponectin levels in breast, prostate, and colorectal Hispanic and Black cancer survivors. Methods: Overweight or obese (BMI > 25.0 kg/m2), sedentary breast, prostate or colorectal cancer survivors who self-identified as Hispanic or Black were randomized to exercise (n = 30) or usual care (n = 10). Survivors in the 4-month supervised exercise intervention participated in a thrice weekly, circuit, interval-based moderate-vigorous aerobic (65-85% of VO2max) and resistance (65-85% of 1-repetition maximum). Insulin resistance, assessed by Homeostasis Model of Assessment (HOMA-IR), and adiponectin levels were collected at baseline and post-intervention from fasting blood sample collection. Repeated-measures analysis of variance and t-tests were performed to assess within- and between-group differences. Results: The study sample was 66 ± 10.4 years old, Hispanic (55%), Black (45%), overweight (78%), and female (60%). Adherence to the intervention was 90% and post-intervention outcome measures were available on 100% of participants. Post-intervention, insulin resistance (within group mean difference: -3.2, p < 0.01; between group mean difference: -4.5, p < 0.01) and adiponectin levels (6.1 ug/mg, p < 0.01; 8.6 ug/mg, p < 0.01) significantly improved in the exercise group when compared to baseline and to usual care, respectively. Conclusions: A circuit, interval-based aerobic and resistance exercise intervention improved insulin resistance and adiponectin levels in breast, prostate, and colorectal minority cancer survivors. Accessible exercise interventions for minority cancer survivors may be effective to mitigate metabolic dysregulation and co-morbid conditions in survivorship and support cardiometabolic health. Clinical trial information: NCT03284346.

Reducing Metabolic Dysregulation in Obese Latina and/or Hispanic Breast Cancer Survivors Using Physical Activity (ROSA) Trial: A Study Protocol.

BackgroundLatina and Hispanic breast cancer survivors (LHBCS) are at increased risk for long-term complications and poorer metabolic health, including metabolic dysregulation (MetD) before and following breast cancer diagnosis. MetD can increase risk of cancer recurrence, death, and comorbid conditions by increasing inflammation and cancer cell proliferation. While exercise improves physical fitness and metabolic outcomes in breast cancer survivors, there is a lack of studies including underrepresented and disadvantaged minority groups such as LHBCS.MethodsOur 12-month randomized (exercise or attention control) controlled trial (the ROSA trial) aims to utilize a progressive combined aerobic and resistance exercise program to improve MetD, insulin resistance, and visceral adiposity among obese LHBCS. We aim to recruit 160 women with Stage I-III breast cancer who are sedentary, centrally obese, and have completed treatment (e.g., surgery, radiation, chemotherapy) prior to enrollment. Participants randomized to the exercise group receive 16-weeks of virtually supervised aerobic and resistance training, followed by 16-weeks of unsupervised home-based aerobic and resistance exercise, and 16-weeks of follow-up. The attention control group receive a 12-month home-based stretching program. Primary and secondary outcomes are measured every 4-weeks during study visits.DiscussionThe ROSA trial is the first exercise oncology trial targeting high-risk sedentary, obese LHBCS to improve MetD-related outcomes. Results of this trial will help illuminate how exercise impacts health-related outcomes, survivorship, and recurrence, and inform future exercise oncology guidelines to reduce health disparities among minority cancer survivors.

Sex differences in the intergenerational inheritance of metabolic traits.

Strong evidence suggests that early-life exposures to suboptimal environmental factors, including those in utero, influence our long-term metabolic health. This has been termed developmental programming. Mounting evidence suggests that the growth and metabolism of male and female fetuses differ. Therefore, sexual dimorphism in response to pre-conception or early-life exposures could contribute to known sex differences in susceptibility to poor metabolic health in adulthood. However, until recently, many studies, especially those in animal models, focused on a single sex, or, often in the case of studies performed during intrauterine development, did not report the sex of the animal at all. In this review, we (a) summarize the evidence that male and females respond differently to a suboptimal pre-conceptional or in utero environment, (b) explore the potential biological mechanisms that underlie these differences and (c) review the consequences of these differences for long-term metabolic health, including that of subsequent generations.

Measures of Maternal Metabolic Health as Predictors of Severely Low Milk Production.

Background:A comprehensive approach to breastfeeding support requires elucidation of how metabolic health influences milk production.Objective:We compared metabolic health indicators in women with severely low milk output versus those with moderate/normal milk output using a case–control study design, with nested and external control groups.Design:Cases and nested controls were derived from women screened for a low milk supply trial, with cases defined as severely low milk output (<300 mL/24 hours), and nested controls defined as moderate/normal milk output (>300 mL/24 hours). In addition, we included an external control group of exclusively breastfeeding women. All were enrolled at 2–10 weeks postdelivery of a healthy term infant. Milk output and breast emptying frequency were recorded through test-weigh. Metabolic health variables included all components of the metabolic syndrome, homeostatic model assessment of insulin resistance (HOMA-IR), and diagnosis of gestational diabetes mellitus (GDM).Results:Maximum milk output, mL/24 hours, ranged as follows: 30–281 in cases (n = 18), 372–801 in nested controls (n = 12), and 661–915 in external controls (n = 12). Mean breast emptying frequency in cases was not significantly different from nested or external controls. All metabolic syndrome components and HOMA-IR were significantly worse in cases as compared with both nested and external control groups (p < 0.05). There was no significant difference between the nested and external control groups for these variables. GDM prevalence was 39%, 0%, and 8%, across cases, nested control, and external control groups, respectively (chi-square p-value = 0.02).Conclusion:Results from this small case–control study identify class 2+ obesity and poor metabolic health as strong risk factors for severely low milk production. These findings should be further validated in larger prospective cohort studies designed to identify individuals at risk for metabolically driven low milk supply. In addition, clinical and qualitative research studies aimed at improving patient-centered approaches to the management of persistent low milk supply are needed.

Investigation of 1H nuclear magnetic resonance relaxometry to screen metabolic syndrome and diabetes.

The purpose of this study was to investigate and compare the abilities of 1H nuclear magnetic resonance (NMR) transverse relaxation constant time (T2) and longitudinal relaxation constant time (T1) to screen people at the risk of diabetes and metabolic syndrome. Human blood samples were collected for NMR detection and biochemical examinations. Bivariate correlations, categorical analyses were performed to explore the relationship between NMR relaxation time and metabolic biomarkers. Results show that NMR relaxation time of human serum correlated well with some biomarkers associated with diabetes and metabolic syndrome. Statistically significant differences in NMR relaxation time between subjects with normal and poor metabolic health were observed. NMR relaxation time, especially T2, can be used to screen people at risk of diabetes and metabolic syndrome.

A multidisciplinary approach to paediatric and adolescent metabolic health.

Poor metabolic health in paediatric and adolescent populations describe a wide range of conditions that can negatively impact the development and quality of life of children and young people. Prevention, management, and treatment of these conditions can be particularly challenging as they often simultaneously affect a variety of organs and body compartments, highlighting the need for multidisciplinary care teams and interventions. To bring together the latest thinking in these areas, The Lancet Diabetes & Endocrinology, The Lancet Child & Adolescent Health, EClinicalMedicine, and EBioMedicine present a cross-journal Series of five Reviews highlighting the efforts and progress being made in several areas of childhood metabolic health and disease.

Relations of Metabolic Health and Obesity to Brain Aging in Young to Middle-Aged Adults.

BackgroundWe aimed to evaluate the association between metabolic health and obesity and brain health measured via magnetic resonance imaging and neurocognitive testing in community dwelling adults.Methods and ResultsFramingham Heart Study Third Generation Cohort members (n=2170, 46±9 years of age, 54% women) without prevalent diabetes, stroke, dementia, or other neurologic conditions were grouped by metabolic unhealthiness (≥2 criteria for metabolic syndrome) and obesity (body mass index ≥30 kg/m2): metabolically healthy (MH) nonobese, MH obese, metabolically unhealthy (MU) nonobese, and MU obese. We evaluated the relationships of these groups with brain structure (magnetic resonance imaging) and function (neurocognitive tests). In multivariable‐adjusted analyses, metabolically unhealthy individuals (MU nonobese and MU obese) had lower total cerebral brain volume compared with the MH nonobese referent group (both P<0.05). Additionally, the MU obese group had greater white matter hyperintensity volume (P=0.004), whereas no association was noted between white matter hyperintensity volume and either groups of metabolic health or obesity alone. Obese individuals had less favorable cognitive scores: MH obese had lower scores on global cognition, Logical Memory‐Delayed Recall and Similarities tests, and MU obese had lower scores on Similarities and Visual Reproductions‐Delayed tests (all P≤0.04). MU and obese groups had higher free water content and lower fractional anisotropy in several brain regions, consistent with loss of white matter integrity.ConclusionsIn this cross‐sectional cohort study of younger to middle‐aged adults, poor metabolic health and obesity were associated with structural and functional evidence of brain aging. Improvement in metabolic health and obesity may present opportunities to improve long‐term brain health.

Abstract WMP104: Race And Regional Disparities In Prevalence Of Poor Metabolic Health Among Community Dwelling Adults With Stroke: Nationwide Analysis Of 2019 BRFSS Data

Introduction: High burden of Metabolic Syndrome (MS) results in incident stroke and poor outcomes. We report contemporary national estimates of stroke prevalence and quantify MS burden and its socio-demographic associates among stroke individuals. Methods: We analyzed 2019 Behavioral Risk Factor Surveillance System data; a nationally representative survey of health-related conditions and behaviors among community dwelling adults. We identified individuals with self-reported stroke and flagged 4 MS indicators (diabetes, hypertension, BMI ≥ 25 kg/m 2 , hypercholesterolemia). Individuals with ≥ 2 features were categorized as High MS (HMS). We compared socio-demographic characteristics (age, sex, race, education, income, marital and employment status, stroke belt residence) and healthcare utilization (insurance status and frequency of healthcare visits) among HMS and no-HMS groups. We fit survey design logistic regression models with appropriate sampling weights and report national estimates of stroke prevalence and HMS associates. Results: In 2019, there were 8,570,876 adults (≥ 18 years) with stroke in the US; translating into a nationwide prevalence of 3.4% (7.9% among ≥ 65 years). Overall, 94.4% had at least one MS feature; 77.4% had HMS. Advanced age, male sex, non-Hispanic Black (NHB) race and residence in stroke belt region were associated with HMS. Participants with high income (≥ $75,000) and health insurance coverage were less likely to have HMS. In the fully adjusted model, advanced age; Asian American / Pacific Islander race and Hispanic ethnicity (vs. Non-Hispanic White) and residence in the US stroke belt had higher likelihood of HMS (Figure). Healthcare utilization patterns and sex were not significantly associated with HMS. Updated 2020 BRFSS data will be presented. Conclusion: Racial and regional disparities exist in HMS burden among stroke individuals. Targeted MS prevention and management measures are needed for high-risk populations.

Determinants of Obesity and Metabolic Health in the Afghan Population: Protocol, Methodology, and Preliminary Results

BackgroundNon-communicable diseases (NCDs) cause more than 70% of deaths worldwide and share modifiable risk factors including obesity and metabolic abnormalities. Over the past 15 years, many changes in lifestyle, dietary patterns, physical activity, and socioeconomic status have been observed in the Afghan population. This study aims to investigate which specific lifestyle factors, dietary patterns, and characteristics of Westernization are associated with an increased risk of being overweight or obese and with poor metabolic health in the Afghan population.MethodsA population-based cross-sectional study was conducted where a total of 729 male and female participants were recruited. Face-to-face interviews and anthropometric measurements were conducted by trained health staff using standardized questionnaires which included information on socio-demographic and housing characteristics, income, occupation, ethnicity, personal and family medical history, stress, anthropometry, diet, and physical activity. Bioelectric impedance analysis (BIA) was used to estimate body composition, including overall body fatness. Physical activity was measured using the short version of the International Physical Activity Questionnaire (IPAQ). For a comprehensive assessment of dietary intake, a food-frequency questionnaire (FFQ) specific to the Afghan population was developed which included all local food items relevant to the population. Lipid profile and fasting glucose were measured in a local laboratory. Biospecimens were collected using dried blood spots (DBS) and dried stool cards to perform microbiome and biomarker-based research.DiscussionThis is the first study which will assess dietary patterns, lifestyle factors, and their association with obesity and metabolic health in Afghanistan. Such a study will aid the development of dietary and lifestyle guidelines in Afghanistan which will promote better health and educate people to make healthy food choices. The findings will also help in designing and implementing effective public health strategies to promote a healthy lifestyle and prevent the epidemic of overweight and obesity, and, hence, reduce the burden of non-communicable diseases in the region.

Host Predictors of Broadly Cross-Reactive Antibodies Against Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Variants of Concern Differ Between Infection and Vaccination.

BackgroundFollowing severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection or vaccination there is significant variability between individuals in protective antibody levels against SARS-CoV-2, and within individuals against different virus variants. However, host demographic or clinical characteristics that predict variability in cross-reactive antibody levels are not well-described. These data could inform clinicians, researchers, and policymakers on the populations most likely to require vaccine booster shots.MethodsIn an institutional review board–approved prospective observational cohort study of staff at St. Jude Children’s Research Hospital, we identified participants with plasma samples collected after SARS-CoV-2 infection, after mRNA vaccination, and after vaccination following infection, and quantitated immunoglobulin G (IgG) levels by enzyme-linked immunosorbent assay to the spike receptor binding domain (RBD) from 5 important SARS-CoV-2 variants (Wuhan Hu-1, B.1.1.7, B.1.351, P.1, and B.1.617.2). We used regression models to identify factors that contributed to cross-reactive IgG against 1 or multiple viral variants.ResultsFollowing infection, a minority of the cohort generated cross-reactive antibodies, IgG antibodies that bound all tested variants. Those who did had increased disease severity, poor metabolic health, and were of a particular ancestry. Vaccination increased the levels of cross-reactive IgG levels in all populations, including immunocompromised, elderly, and persons with poor metabolic health. Younger people with a healthy weight mounted the highest responses.ConclusionsOur findings provide important new information on individual antibody responses to infection/vaccination that could inform clinicians on populations that may require follow-on immunization.

Prenatal and postnatal exposure to PFAS and cardiometabolic factors and inflammation status in children from six European cohorts.

Developing children are particularly vulnerable to the effects of exposure to per- and polyfluoroalkyl substances (PFAS), a group of endocrine disrupting chemicals. We hypothesized that early life exposure to PFASs is associated with poor metabolic health in children. We studied the association between prenatal and postnatal PFASs mixture exposure and cardiometabolic health in children, and the role of inflammatory proteins. In 1,101 mothers-child pairs from the Human Early Life Exposome project, we measured the concentrations of PFAS in blood collected in pregnancy and at 8years (range=6-12years). We applied Bayesian Kernel Machine regression (BKMR) to estimate the associations between exposure to PFAS mixture and the cardiometabolic factors as age and sex- specific z-scores of waist circumference (WC), systolic and diastolic blood pressures (BP), and concentrations of triglycerides (TG), high-density lipoprotein (HDL-C) and low-density lipoprotein (LDL-C) cholesterol. We measured thirty six inflammatory biomarkers in child plasma and examined the underlying role of inflammatory status for the exposure-outcome association by integrating the three panels into a network. Exposure to the PFAS mixture was positively associated with HDL-C and systolic BP, and negatively associated with WC, LDL-C and TG. When we examined the independent effects of the individual chemicals in the mixture, prenatal PFHxS was negatively associated with HDL-C and prenatal PFNA was positively associated with WC and these were opposing directions from the overall mixture. Further, the network consisted of five distinct communities connected with positive and negative correlations. The selected inflammatory biomarkers were positively, while the postnatal PFAS were negatively related with the included cardiometabolic factors, and only prenatal PFOA was positively related with the pro-inflammatory cytokine IL-1beta and WC. Our study supports that prenatal, rather than postnatal, PFAS exposure might contribute to an unfavorable lipidemic profile and adiposity in childhood.

Metabolic function in patients with bipolar depression receiving anti-inflammatory agents: Findings from the MINDCARE study, a multicentre, randomised controlled trial

BackgroundMetabolic dysfunction is prevalent in bipolar disorder (BD) and associated with illness severity and treatment outcomes. There is little research exploring this relationship in low and middle-income countries (LMICs) and little is known about the moderating effect of metabolic health on treatment response to anti-inflammatory drugs in BD. MethodsMINDCARE, a randomized-controlled-trial conducted in Pakistan, investigated the efficacy of minocycline and celecoxib in 266 adults with bipolar depression. This secondary analysis evaluated the association between depression severity at baseline and treatment outcome with metabolic parameters including body mass index (BMI), waist circumference (WC), heart rate (HR), systolic blood pressure (s-BP), and diastolic blood pressure (d-BP). Depression severity was measured using the Hamilton Depression Rating Scale-17. The exploratory aim was to assess whether treatment impacted change in metabolic variables. Associations were evaluated using linear regression. ResultsHigher BMI (B=-0.38, 95%CI: -0.55 to -0.21) and WC (B=-0.68, 95%CI: -0.97 to -0.39) were associated with lower baseline depression severity in both the unadjusted and the adjusted models. Baseline metabolic parameters were not associated with treatment response to minocycline or celecoxib nor did treatment significantly impact metabolic variables. LimitationsOur sample represents patients in an RCT and may not be fully representative of the overall BD population in Pakistan. ConclusionsOur findings indicate a potential association of poor metabolic health and lower severity of bipolar depression but not treatment outcomes. Future work should evaluate potential relationships of metabolic parameters and BD in diverse populations to increase the transferability of this line of work.

Obesity measures, metabolic health and their association with 15-year all-cause and cardiovascular mortality in the SAMINOR 1 Survey: a population-based cohort study

BackgroundThe mortality of metabolic-obesity phenotypes has been thoroughly studied, but it is not known if or how the association between mortality and body mass index (BMI), waist circumference or a body shape index (ABSI) differ in strata of cardiometabolic health status.MethodsWe linked data on 12,815 men and women aged 36–79 years from the SAMINOR 1 Survey with mortality data from the Norwegian Cause of Death Registry. We defined metabolically healthy and unhealthy as having zero and ≥ 1, respectively, of the following: MetS, pre-existing diabetes or cardiovascular disease (CVD), or prescribed drugs for high blood pressure, hyperglycaemia or dyslipidaemia. We defined general and abdominal obesity as BMI ≥ 30 kg/m2 and waist circumference ≥ 88 cm (women) or 102 cm (men), respectively, and cross-classified these categories with metabolic status to create metabolically healthy non-obese and obese (MHNO and MHO) and metabolically unhealthy non-obese and obese (MUNO and MUO) phenotypes. We used Cox regression to estimate the hazard ratio (HR) for all-cause and CVD mortality for 1) the four phenotypes and 2) BMI, waist circumference and ABSI fitted with restricted cubic splines. We adjusted for age and lifestyle, and tested for interactions with sex and metabolic status (only continuous measures).ResultsThe MHO phenotype was present in 7.8% of women and 5.8% of men. During a median follow-up of 15.3/15.2 years, 596/938 women/men had died, respectively. The MUNO and MUO groups had higher mortality than the MHNO group. Sex and phenotypes interacted with respect to CVD mortality: relative to the MHNO group, the MHO group had an adjusted HR (95% confidence interval) for CVD mortality of 1.05 (0.38–2.88) in women and 2.92 (1.71–5.01) in men. We found curvilinear associations between BMI/waist circumference and all-cause mortality irrespective of metabolic status. Corresponding relationships with CVD mortality were linear and the slope differed by sex and metabolic status. ABSI was linearly and positively associated with all-cause and CVD mortality in men.ConclusionThe relationships between BMI, waist circumference or ABSI and mortality differed by sex, metabolic status and cause of death. Poor metabolic health substantially increases mortality regardless of obesity status.

Exploration of Sleep as a Specific Risk Factor for Poor Metabolic and Mental Health: A UK Biobank Study of 84,404 Participants.

PurposeShort and long sleep durations have adverse effects on physical and mental health. However, most studies are based on self-reported sleep duration and health status. Therefore, this longitudinal study aims to investigate objectively measured sleep duration and subsequent primary health care records in older adults to investigate the impact of sleep duration and fragmentation on physical and mental health.MethodsData on objective sleep duration were measured using accelerometry. Primary care health records were then obtained from the UK Biobank (n=84,404). Participants (mean age, 62.4 years) were divided into five groups according to their sleep duration derived from the accelerometry data: <5 hours, 5–6 hours, 6–7 hours, 7–8 hours and >8 hours. ICD-10 codes were used for the analysis of primary care data. Wake after sleep onset, activity level during the least active 5 hours and episodes of movement during sleep were analysed as an indication for sleep fragmentation. Binary regression models were adjusted for age, gender and Townsend deprivation score.ResultsA “U-shaped” relationship was found between sleep duration and diseases including diabetes, hypertension and heart disease and depression. Short and long sleep durations and fragmented sleep were associated with increased odds of disease.ConclusionSix to eight hours of sleep, as well as less fragmented sleep, predicted better long-term metabolic and mental health.

Updates in fatty liver disease: Pathophysiology, diagnosis and management.

Metabolic (dysfunction) associated fatty liver disease (MAFLD; previously non-alcoholic fatty liver disease [NAFLD]) affects one in four Australian adults andmany children. The disease is a consequence of poor metabolic health resulting from lifestyle choices. The aim of this article is to outline recent advances in MAFLD pathophysiology, diagnosis and management. All patients with evidence of metabolic dysregulation are at risk of MAFLD. Diagnosis requires fulfillment of the newdiagnostic criteria for MAFLD. Most patients with MAFLD die as a result of cardiovascular disease or extrahepatic cancer, but liver-related outcomes including cancer can develop, especially inthose with more advanced stages of fibrosis. There is no approved medication therapy for MAFLD, and so management focuses on lifestyle intervention, diabetes control, treatment to target of risk factors such as dyslipidaemia, and avoidance of smoking and alcohol. Most patients with MAFLD are best managed in primary care.

Maternal but not fetoplacental health can be improved by metformin in a murine diet-induced model of maternal obesity and glucose intolerance.

Maternal obesity is a global problem that increases the risk of short- and long-term adverse outcomes for mother and child, many of which are linked to gestational diabetes mellitus. Effective treatments are essential to prevent the transmission of poor metabolic health from mother to child. Metformin is an effective glucose lowering drug commonly used to treat gestational diabetes mellitus; however, its wider effects on maternal and fetal health are poorly explored. In this study we used a mouse (C57Bl6/J) model of diet-induced (high sugar/high fat) maternal obesity to explore the impact of metformin on maternal and feto-placental health. Metformin (300 mg/kg/day) was given to obese females via the diet and was shown to achieve clinically relevant concentrations in maternal serum (1669±568 nM in late pregnancy). Obese dams developed glucose intolerance during pregnancy and had reduced uterine artery compliance. Metformin treatment of obese dams improved maternal glucose tolerance, reduced maternal fat mass, and restored uterine artery function. Placental efficiency was reduced in obese dams, with increased calcification and reduced labyrinthine area. Consequently, fetuses from obese dams weighed less (p<0.001) at the end of gestation. Despite normalisation of maternal parameters, metformin did not correct placental structure or fetal growth restriction. Metformin levels were substantial in the placenta and fetal circulation (109.7±125.4 nmol/g in the placenta and 2063±2327 nM in fetal plasma). These findings reveal the distinct effects of metformin administration during pregnancy on mother and fetus and highlight the complex balance of risk versus benefits that are weighed in obstetric medical treatments.

High-Intensity Multimodal Training for Young People: It's Time to Think Inside the Box!

Studies comparing children and adolescents from different periods have shown a decrease in physical activity and fitness in the last decades (Moliner-Urdiales et al., 2010; Runhaar et al., 2010; Cohen et al., 2011; Hardy et al., 2013; Santtila et al., 2018; Masanovic et al., 2020; Fuhner et al., 2021). Low physical fitness is associated with poor metabolic health, independent of central adiposity (Latt et al., 2018). Moreover, changes in physical fitness from childhood and adolescence to adulthood are related to metabolic health, physical activity levels, and bone mineral density (Garcia-Hermoso et al., 2019; Maestu et al., 2020), while both low cardiorespiratory fitness and muscle strength are associated with higher risk of premature death and disability (Ortega et al., 2012; Henriksson et al., 2019a,b). Obesity is another important concern (Wijnhoven et al., 2014; Ogden et al., 2016; Bentham et al., 2017), but previous studies have shown that increased physical activity might be associated with decreased adiposity (Hui et al., 2021) and can modulate the effects of genetic predisposition to obesity in young people (Todendi et al., 2021). The negative impact of a sedentary lifestyle during early life has been largely debated (Faigenbaum et al., 2011; Faigenbaum and Myer, 2012; Stracciolini et al., 2013). In the early 60s, Kraus and Raab (1961) stressed the importance of physical activity for preventing diseases and suggested that the adverse health effect of physical inactivity was comparable to lack of vitamins or contagious diseases. Based on this, Faigenbaum et al. (2013) proposed a population-wide approach for identifying inactive children, prescribing interventions and raising public awareness. Notwithstanding, some important barriers for physical activity adoption among children and adolescents might be considered, like perception of lack of safety, physical environment and lack of support (Stankov et al., 2012; Lu et al., 2014; Martins et al., 2014). It is also important to consider children and adolescents particularities (e.g., biological and behavior characteristics) when prescribing and evaluating exercise programs, since exercise programs designed for adults might be inadequate for them (Faigenbaum et al., 2013). Previous studies suggested that young people naturally engage in intermittent activities (Bailey et al., 1995) and high intensity activities might be particularly beneficial to improve cardiorespiratory fitness (Baquet et al., 2003; Costigan et al., 2015), mental health (Leahy et al., 2020), body composition (Costigan et al., 2015; D et al., 2019) cardiovascular risk and metabolic health (Cooper et al., 2016; Garcia-Hermoso et al., 2016; MA et al., 2021) in children and adolescents. The purpose of the current article is to present the benefits of high-intensity multimodal training (HIMT) programs, such as CrossFit, to the youth, with a critical discussion about its potential benefits and concerns.