Postprandial State Research Articles

Spontaneous and iatrogenic hypoglycemia in cystic fibrosis

Spontaneous episodes of hypoglycemia can occur in people with cystic fibrosis (CF) without diabetes, who are not on glucose lowering medications. Spontaneous hypoglycemia in CF could occur both in the fasting or postprandial state (reactive hypoglycemia). The pathophysiology of fasting hypoglycemia is thought to be related to malnutrition and increased energy expenditure in the setting of inflammation and acute infections. Reactive hypoglycemia is thought to be due to impaired first phase insulin release in response to a glucose load, followed by a delayed and extended second phase insulin secretion; ineffective counterregulatory response to dropping glucose levels may also play a role. The overall prevalence of spontaneous hypoglycemia varies from 7 to 69% as examined with oral glucose tolerance test (OGTT) or with continuous glucose monitoring (CGM) under free living conditions. Spontaneous hypoglycemia in CF is associated with worse lung function, higher hospitalization rates, and worse clinical status. In addition, patients with CF related diabetes on glucose-lowering therapies are at risk for iatrogenic hypoglycemia. In this article, we will review the pathophysiology, prevalence, risk factors, clinical implications, and management of spontaneous and iatrogenic hypoglycemia in patients with CF.

Slow deep breathing modulates cardiac vagal activity but does not affect peripheral glucose metabolism in healthy men

Parasympathetic nervous system innervates peripheral organs including pancreas, hepatic portal system, and gastrointestinal tract. It thereby contributes to the regulation of whole-body glucose metabolism especially in the postprandial state when it promotes secretion of insulin and enhances its action in major target organs. We now aimed to evaluate the effect of parasympathetic modulation on human glucose metabolism. We used slow deep breathing maneuvers to activate the parasympathetic nervous system and tested for effects on metabolism during an oral glucose tolerance test in a randomized, controlled, cross-over trial in 15 healthy young men. We used projections towards the heart as a readout for parasympathetic activity. When analyzing heart rate variability, there was a significant increase of RMSSD (root mean square of successive differences) when participants performed slow deep breathing compared to the control condition, indicating a modulation of parasympathetic activity. However, no statistically significant effects on peripheral glucose metabolism or energy expenditure after the glucose tolerance test were detected. Of note, we detected a significant association between mean heart rate and serum insulin and C-peptide concentrations. While we did not find major effects of slow deep breathing on glucose metabolism, our correlational results suggest a link between the autonomic nervous system and insulin secretion after oral glucose intake. Future studies need to unravel involved mechanisms and develop potential novel treatment approaches for impaired insulin secretion in diabetes.

Mediterranean meal favorably effects postprandial oxidative stress response compared with a Western meal in healthy women.

Oxidative stress and inflammation are underlying factors in the pathogenesis of chronic diseases. The postprandial state is characterized by low-grade oxidative and inflammatory responses, but the impact of different dietary patterns on these responses is unclear. The objective of this study was to investigate postprandial oxidative and inflammatory responses to Mediterranean diet (MED) and Western diet (WD) meals. In a randomised crossover design, eleven healthy women, aged between 19-45 years with a body mass index of 20.0-24.9 kg/m2, consumed two different isocaloric meals: MED and WD. Blood samples were collected at fasting and 2, 3, 4 h postprandially and analyzed for oxidative [total antioxidant status (TAS), total oxidant status (TOS), total thiol, native thiol, malondialdehyde (MDA)] and inflammatory [high sensitivity C-reactive protein (hs-CRP), interleukin (IL)-6, IL-17, IL-23, tumor necrosis factor alpha (TNF-α) and nuclear factor kappa B (NF-κB)] markers. MED meal intake resulted in increases in TAS (0.05±0.02 mmol/L; p=0.017), total thiol (23.00±7.69 μmol/L; p=0.013) and native thiol (12.82±4.94 μmol/L; p=0.027), while a decrease in MDA (-0.17±0.06 nmol/L; p=0.022) at 2 h. On the other hand, TAS reduced significantly overall (p=0.005) after WD meal intake. There was a significant increase after WD meal intake for IL-6 (1.39±0.49 pg/mL; p=0.017), IL-17 (4.30±1.50 pg/mL; p=0.017), IL-23 (8.38±3.51 pg/mL; p=0.038) at 4 h. However, serum hs-CRP, TNF-α and NF-κB levels were not changed significantly by meal intake. The results indicate that MED meal induces favorable effects on oxidative stress, while WD meal partially increases inflammation in daily life.

Relationship between Energy Balance and Circulating Levels of Hepcidin and Ferritin in the Fasted and Postprandial States.

Markers of iron metabolism are altered in new-onset diabetes, but their relationship with metabolic signals involved in the maintenance of energy balance is poorly understood. The primary aim was to explore the associations between markers of iron metabolism (hepcidin and ferritin) and markers of energy balance (leptin, ghrelin, and the leptin/ghrelin ratio) in both the fasted and postprandial states. These associations were also studied in the sub-groups stratified by diabetes status. This was a cross-sectional study of individuals without disorders of iron metabolism who were investigated after an overnight fast and, in addition, some of these individuals underwent a mixed meal test to determine postprandial responses of metabolic signals. The associations between hepcidin, ferritin, and leptin, ghrelin, leptin/ghrelin ratio were studied using several multiple linear regression models. A total of 76 individuals in the fasted state and 34 individuals in the postprandial state were included. In the overall cohort, hepcidin was significantly inversely associated with leptin (in the most adjusted model, the β coefficient ± SE was −883.45 ± 400.94; p = 0.031) and the leptin/ghrelin ratio (in the most adjusted model, the β coefficient ± SE was −148.26 ± 61.20; p = 0.018) in the fasted state. The same associations were not statistically significant in the postprandial state. In individuals with new-onset prediabetes or diabetes (but not in those with normoglycaemia or longstanding prediabetes or diabetes), hepcidin was significantly inversely associated with leptin (in the most adjusted model, the β coefficient ± SE was −806.09 ± 395.44; p = 0.050) and the leptin/ghrelin ratio (in the most adjusted model, the β coefficient ± SE was −129.40 ± 59.14; p = 0.037). Leptin appears to be a mediator in the link between iron metabolism and new-onset diabetes mellitus. These findings add to the growing understanding of mechanisms underlying the derangements of glucose metabolism.

Recent dynamic studies of the metabolism of atherogenic lipoproteins: elucidating the mode of action of new therapies.

LDL, triglyceride-rich lipoprotein (TRL) and lipoprotein(a) [Lp(a)] particles are the key atherogenic lipoproteins. Deranged metabolism of these lipoproteins accounts for a spectrum of clinically important dyslipidemias, such as FH, elevated Lp(a) and diabetic dyslipidemia. We review the findings from recent dynamic and tracer studies that have contributed to expanding knowledge in this field. Deficiency in LDL receptor activity does not only impair the catabolism of LDL-apoB-100 in FH, but also induces hepatic overproduction and decreases catabolism of TRLs. Patients with elevated Lp(a) are characterized by increased hepatic secretion of Lp(a) particles. Elevation of TRLs in diabetes is partly mediated by increased production of apoB-48 and apoC-III, and impaired clearance of apoB-48 in the postprandial state. Tracer kinetic studies show that proprotein convertase subtilisin/kexin type 9 mAbs alone or in combination with statin can increase the catabolism and decrease production of LDL and Lp(a) particles. By contrast, angiopoietin-like protein 3 inhibitors (e.g. evinacumab) reduce VLDL production and increase LDL clearance in FH. Glucagon-like peptide-1 receptor agonists can improve diabetic dyslipidemia by increasing the catabolism of apoB-48 and decreasing the production of apoB-48 and apoC-III. Dynamic studies of the metabolism of atherogenic lipoproteins provide new insight into the nature of dyslipidemias and point to how new therapies with complementary modes of action may have maximal clinical impact.

Synthesis of Pyrazolo[1,2-b]phthalazine-5,10- dione Derivatives: A New Class of α –Glucosidase Inhibitors

Background: Hyperglycemia is a metabolic disorder that refers to an increase in blood sugar in diabetic patients. α-Glucosidase has been introduced as a membrane-bound enzyme, and it is the main enzyme for carbohydrate digestion in some parts of the intestine. Inhibition of α -glucosidase enzyme activity is a reliable approach to control post-prandial hyperglycemia condition.
 Objectives: In this study, a series of Pyrazolo[1,2-b]phthalazine-5,10-dione derivatives 5a–t were synthesized via a multicomponent reaction and evaluated as new inhibitors for α-glucosidase.
 Methods: The biological activity of the synthesized compounds was studied using a source of the α-glucosidase enzyme (EC3.2.1.20, Saccharomyces cerevisiae) at 20 U/mg concentration.
 Results: Four compounds showed higher α-glucosidase inhibitory activity in comparison to a standard, i.e., Acarbose. Compound 5q displays the most potent α-glucosidase inhibitory activity (IC50 = 155.4 ± 6.0 μM).
 Conclusion: In conclusion, some of the synthesized compounds, including heterocyclic core molecules, have shown remarkable activity that could be considered as subjects for the development of new, more efficient inhibitors of the α-glucosidase enzyme.

PSVI-9 Effects of dietary boron supplementation on growth performance, fasting and postprandial serum insulin, and glucose concentration of pigs

Abstract A 49-d experiment evaluated the effects of supplemental boron (B) on growth, and serum insulin and glucose concentration of pigs. Crossbred pigs [n = 48; initial body weight (BW) 19.18 ± 0.29 kg] were randomly allotted to 1 of 4 diets based on BW and sex. Diets were corn-SBM-based, formulated to meet NRC (2012) nutrient requirement estimates, and were supplemented with 0, 25, 50, or 100 mg B/kg diet as sodium tetraborate decahydrate. On d 20 and 41, blood samples were collected. Fasting samples were collected following an overnight fast; then a postprandial sample was taken approximately 50 minutes after the pigs had 10 minutes of ad libitum access to feed. Samples were processed and serum analyzed for insulin and glucose concentration. Increasing B levels resulted in a linear decrease for overall ADG (0.87, 0.86, 0.85, and 0.82 kg, P = 0.02). On d 20, supplemental B resulted in a quadratic response on fasting serum glucose concentration (5.25, 4.80, 4.65, and 5.01, P = 0.03) and a linear decrease in postprandial serum insulin concentration (29.1, 25.5, 18.2, and 18.1 µU/mL, P = 0.02). Furthermore, there was a tendency for a linear decrease in fasting insulin:glucose ratio (0.85, 0.84, 0.42, and 0.59, P = 0.08), which became more noticeable during the postprandial state (3.96, 3.63, 2.63, and 2.73, P = 0.02). Again on d 41, there was a quadratic response on fasting serum glucose concentration (4.32, 4.07, 3.91, and 4.68, P = 0.01) with supplemental B. Results suggest that supplemental boron may impact serum insulin and glucose concentrations by reducing the amount of insulin needed to maintain glucose concentrations. However, higher levels of supplemental boron did result in suppressed growth performance. Thus, additional research is warranted to determine the optimum level of supplemental B.

Role of hepatic PKCβ in nutritional regulation of hepatic glycogen synthesis.

The signaling mechanisms by which dietary fat and cholesterol signals regulate central pathways of glucose homeostasis are not completely understood. By using a hepatocyte-specific PKCβ-deficient (PKCβHep–/–) mouse model, we demonstrated the role of hepatic PKCβ in slowing disposal of glucose overload by suppressing glycogenesis and increasing hepatic glucose output. PKCβHep–/– mice exhibited lower plasma glucose under the fed condition, modestly improved systemic glucose tolerance and mildly suppressed gluconeogenesis, increased hepatic glycogen accumulation and synthesis due to elevated glucokinase expression and activated glycogen synthase (GS), and suppressed glucose-6-phosphatase expression compared with controls. These events were independent of hepatic AKT/GSK-3α/β signaling and were accompanied by increased HNF-4α transactivation, reduced FoxO1 protein abundance, and elevated expression of GS targeting protein phosphatase 1 regulatory subunit 3C in the PKCβHep–/– liver compared with controls. The above data strongly imply that hepatic PKCβ deficiency causes hypoglycemia postprandially by promoting glucose phosphorylation via upregulating glucokinase and subsequently redirecting more glucose-6-phosphate to glycogen via activating GS. In summary, hepatic PKCβ has a unique and essential ability to induce a coordinated response that negatively affects glycogenesis at multiple levels under physiological postprandial conditions, thereby integrating nutritional fat intake with dysregulation of glucose homeostasis.

Transorgan short-chain fatty acid fluxes in the fasted and postprandial state in the pig.

The short-chain fatty acids (SCFAs) acetate, propionate, butyrate, isovalerate, and valerate are end products of intestinal bacterial fermentation and important mediators in the interplay between the intestine and peripheral organs. To unravel the transorgan fluxes and mass balance comparisons of SCFAs, we measured their net fluxes across several organs in a translational pig model. In multicatheterized conscious pigs [n = 12, 25.6 (95% CI [24.2, 26.9]) kg, 8-12 wk old], SCFA fluxes across portal-drained viscera (PDV), liver, kidneys, and hindquarter (muscle compartment) were measured after an overnight fast and in the postprandial state, 4 h after administration of a fiber-free, mixed meal. PDV was the main releasing compartment of acetate, propionate, butyrate, isovalerate, and valerate during fasting and in the postprandial state (all P = 0.001). Splanchnic acetate release was high due to the absence of hepatic clearance. All other SCFAs were extensively taken up by the liver (all P < 0.05). Even though only 7% [4, 10] (propionate), 42% [23, 60] (butyrate), 26% [12, 39] (isovalerate), and 3% [0.4, 5] (valerate) of PDV release were excreted from the splanchnic area in the fasted state, splanchnic release of all SCFAs was significant (all P values ≤0.01). Splanchnic propionate, butyrate, isovalerate, and valerate release remained low but significant in the postprandial state (all P values <0.01). We identified muscle and kidneys as main peripheral SCFA metabolizing organs, taking up the majority of all splanchnically released SCFAs in the fasted state and in the postprandial state. We conclude that the PDV is the main SCFA releasing and the liver the main SCFA metabolizing organ. Splanchnically released SCFAs appear to be important energy substrates to peripheral organs not only in the fasted but also in the postprandial state.NEW & NOTEWORTHY Using a multicatheterized pig model, we identified the portal-drained viscera as the main releasing compartment of the short-chain fatty acids acetate, propionate, butyrate, isovalerate, and valerate in the fasted and postprandial states. Low hepatic acetate metabolism resulted in a high splanchnic release, whereas all other SCFAs were extensively cleared resulting in low but significant splanchnic releases. Muscle and kidneys are the main peripheral SCFA metabolizing organs during fasting and in the postprandial state.

Effect of water salinity on the oxidative system of juveniles of the North Atlantic white shrimp Litopenaeus setiferus reared in biofloc technology

AbstractThis study evaluated the effect of biofloc technology (BFT) at 3 (lsBFT) and 35 (hsBFT) practice salinity units (psu) on the zootechnical performance, oxygen consumption, antioxidant activity, and oxidative damage of Litopenaeus setiferus juveniles reared in outdoor tanks. After 90 days, no significant differences were observed in terms of survival (p &gt; .05). The final weight as well as wet weight gain, final biomass, and feeding conversion ratio (FCR) showed higher values for shrimp reared with hsBFT than those reared with lsBFT (p &lt; .05). Compared to that for the hsBFT treatment, high oxygen consumption (VO2) was observed for the lsBFT treatment under fasting and postprandial conditions (p &lt; .05). The activity of the enzymes catalase, superoxide dismutase, and glutathione‐S‐transferase from shrimp muscle did not show significant differences between the treatments (p &gt; .05). Regarding the lipid peroxidation (LPO) and oxidized protein (PO) in muscle samples, no significant differences were observed in LPO, whereas the PO was significantly higher for the lsBFT treatment (p &lt; .05), which was related to higher fasting and postprandial oxygen consumption of the juveniles (p &lt; .05). The adaptation of L. setiferus juveniles reared in BFT at low salinity is relatively weak because of their low growth and excessive oxygen consumption and the oxidative damage (PO) produced.

The bioequivalence of a single dose of a generic solifenacin succinate tablet or Vesicare in fasting or postprandial healthy Chinese adults.

The present study evaluated the bioequivalence of the test preparation (5mg generic solifenacin succinate tablet, produced by Jiangsu Deyuan Pharmaceutical Co., Ltd.) or the reference preparation (5mg solifenacin succinate tablets with the trade name Vesicare, produced by Astellas Pharma Europe B.V.) in either fasting or postprandial states in healthy Chinese subjects. The present study was designed as an open-label, randomized, single-center, single-dose, dual-cycle, dual-crossover, fasting/postprandial study. 56 healthy Chinese subjects (28 each in the fasting and postprandial groups) were enrolled. WinNolin software (version 7.0 or above) was used to calculate the pharmacokinetic parameters. In the fasting and postprandial group, pharmacokinetic analysis and bioequivalence analysis were carried out based on the blood concentration-time data. The 90% confidence interval of the geometric mean ratio of Cmax, AUC0-t, and AUC0-∞ of the test preparation and the reference preparation were both within the acceptance range of 80.00-125.00%. A single administration of a 5-mg tablet of either the test preparation, generic solifenacin succinate, or the reference preparation, solifenacin succinate with the brand-name Vesicare, was safe and bioequivalent in healthy Chinese subjects in either fasting or postprandial states according to the criteria of bioequivalence of the State Drug Administration of China.

LEFT VENTRICULAR DYSFUNCTION SECONDARY TO LARGE HIATAL HERNIA COMPLICATED BY GASTRIC OUTLET OBSTRUCTION

TOPIC: Cardiovascular Disease TYPE: Medical Student/Resident Case Reports INTRODUCTION: A hiatal hernia is an anatomical abnormality in which abdominal contents displace into the thoracic cavity through a diaphragmatic defect and can result in GERD, bronchiectasis, and rarely cardiac compression. We describe a case of a large hiatal hernia in an advanced age female in whom the hernia compressed the left ventricle resulting in significant cardiac dysfunction. CASE PRESENTATION: An advanced age female with a past history of diabetes, hypertension, hypothyroidism, and large hiatal hernia repaired in 2017 presented with nausea and bloody/bilious vomiting with food intolerance and was found to have a gastric outlet obstruction. The patient's case was complicated by aspiration pneumonia and cardiac sequelae. Patient exhibited soft pressures and sinus tachycardia in the 120 to 140 range with frequent atrial and ventricular ectopy and a left bundle branch block. Echocardiogram noted that her left ventricle was small and compressed secondary to bowel from the hiatal hernia. Given patient's advanced age, the plan was to treat conservatively with beta blockers. Patient then had rhythmic change to new atrial fibrillation with rapid ventricular response. Ultimately patient had cardiorespiratory compromise secondary to decreased preload from cardiac compression from her large hiatal hernia and expired. DISCUSSION: There are a few case reports of cardiac sequelae such as ST elevation and decreased preload from left atrial and ventricular compression due to large hiatal hernias, especially in the post prandial state in which the mass effect increases. In this patient's case, the patient's mass effect of her large hiatal hernia was exacerbated by her gastric outlet obstruction. She had recurrence of her hiatal hernia despite two repair procedures in the past and given her advanced age, she was a poor surgical candidate for surgery of her hernia. She had conservative management with beta blockers and NG tube placement for gastric decompression, but she ultimately had complicated course with increased ectopy, new arrhythmia, and left ventricular compression caused by mass effect of the massive hernia. CONCLUSIONS: The patient's mass effect of her large hiatal hernia was exacerbated by her gastric outlet obstruction which led to increased ectopy, new arrhythmia, and decreased preload from left ventricular compression. In an advanced age patient with gastric outlet obstruction and a history of large hiatal hernia, the treatment options were limited. In cases of patients who are able to undergo more aggressive management, it is advisable to closely monitor and intervene on large hiatal hernias and relieve the cause of gastric outlet obstructions as they can have significant cardiopulmonary effects secondary to their mass effect as seen in this case. REFERENCE #1: Umemura, A. et al. Cardiopulmonary Impairments Caused by a Large Hiatal Hernia with Organoaxial Gastric Volvulus Showing Upside-Down Stomach: A Case Report. The American journal of case reports, [s. l.], v. 20, p. 1530–1535, 2019. DOI 10.12659/AJCR.918191 REFERENCE #2: Gnanenthiran, S. et al. Feeding Inducses Left Atrial Compression and Impedes Cardiac Filling in Patients with Large Haital Hernia. Journal of the American Society of Echocardiography. V.32, iss. 3, p. 375-384, 2019. DOI 10.1016/j.echo.2018.09.017 REFERENCE #3: Harada, K. et al. Left ventricular obstruction caused by a large hiatal hernia. Echocardiography (Mount Kisco, N.Y.), [s. l.], v. 34, n. 8, p. 1254–1256, 2017. DOI 10.1111/echo.13563. Disponível em: https://search-ebscohost-com.ezproxy.libraries.wright.edu/login.aspx?direct=true&db=mnh&AN=28497506&site=eds-live. Acesso em: 11 set. 2020. DISCLOSURES: No relevant relationships by Anas Ahmed, source=Web Response No relevant relationships by Amie Kim, source=Web Response No relevant relationships by Steven Young, source=Web Response

Postbariatric hypoglycemia: symptom patterns and associated risk factors in the Longitudinal Assessment of Bariatric Surgery study.

Postbariatric hypoglycemia (PBH) can be a devastating complication for which current therapies are often incompletely effective. More information is needed regarding frequency, incidence, and risk factors for PBH. To examine hypoglycemia symptoms following Roux-en-Y gastric bypass (RYGB) and laparoscopic adjustable gastric banding (LAGB) and baseline and in-study risk factors. Multicenter, at 10 US hospitals in 6 geographically diverse clinical centers. A prospective, longitudinal cohort study of adults undergoing RYGB or LAGB as part of clinical care between 2006 and 2009 were recruited and followed until January 31, 2015, with baseline and annual postoperative research assessments. We analyzed baseline prevalence and post-operative incidence and frequency of self-reported hypoglycemia symptoms as well as potential preoperative risk factors. In all groups, postoperative prevalence of hypoglycemia symptoms was 38.5%. Symptom prevalence increased postoperatively from 2.8%-36.4% after RYGB in patients without preoperative diabetes (T2D), with similar patterns in prediabetes (4.9%-29.1%). Individuals with T2D had higher baseline hypoglycemia symptoms (28.9%), increasing after RYGB (57.9%). Hypoglycemia symptoms were lower after LAGB, with 39.1% reported hypoglycemia symptoms at only 1 postoperative visit with few (4.0%) having persistent symptoms at 6 or more annual visits. Timing of symptoms was not restricted to the postprandial state. Symptoms of severe hypoglycemia were reported in 2.6-3.6% after RYGB. The dominant risk factor for postoperative symptoms was preoperative symptoms; additionally, baseline selective serotonin (SSRI) and serotonin-norepinephrine (SNRI) reuptake inhibitor use was also associated with increased risk in multivariable analysis. Weight loss and regain were not related to hypoglycemia symptom reporting. Hypoglycemia symptoms increase over time after RYGB, particularly in patients without diabetes. In a small percentage, symptoms can be persistent or severe and require hospitalization. Preoperative hypoglycemia symptoms and SSRI/SNRI use in RYGB patients without diabetes is associated with increased risk of symptoms.

Effects of phloridzin on blood glucose and key enzyme G-6-Pase of gluconeogenesis in mice.

The effects of phloridzin (PHL), main component of Malus hupehensis (MH) tea leaves, on blood glucose (BG) and glucose-6-phosphatase (G-6-Pase) were investigated to provide a basis for finding a scheme of stabilizing BG. Glucose uptake of insulin resistant HepG2 cells was measured by glucose oxidase method. Glucose tolerance, fasting BG (FBG) and postprandial BG (PBG) were determined by BG test strips. The expression of G-6-Pase was detected by Western blot. The results showed that glucose uptake was enhanced and the expression of G-6-Pase was inhibited by PHL in insulin resistant HepG2 cells. Glucose tolerance was enhanced, FBG level was increased and PBG level was decreased by PHL in mice. The expression of G-6-Pase in the liver was enhanced under fasting state, and was inhibited by the low and medium dose under postprandial state. It indicated that PHL has a positive effect on stabilizing BG in mice, which is related to bidirectional regulation of G-6-Pase activity. PRACTICAL APPLICATIONS: Malus hupehensis, edible and medicinal plant, which has been proved by long-term application and experiments that it has a good effect on stabilizing blood glucose, preventing diabetes and adjuvant treatment. Its effect is closely related to its main component PHL. Thus, MH can be used as a dietary regulating drink for daily life to maintain blood glucose. Its main ingredient is PHL, which can be developed as a candidate drug for diabetes treatment.

English

BACKGROUND Type 2 diabetes mellitus (DM) is characterized by insulin resistance which is associated with glucose intolerance, hypertension, dyslipidaemia, a procoagulant state, and an increase in the microvascular and the macrovascular disease. The high cardiovascular mortality which is associated with type 2 DM is due to a prolonged, exaggerated, postprandial state. The abnormal lipid profile in the postprandial state is more significant than the abnormal lipid profile in the fasting state in causing atherosclerotic complications in type 2 diabetes. Very few studies are available on the estimation of the postprandial lipid profile in type 2 diabetes patients. The purpose of this study was to compare fasting and postprandial lipid levels among patients with and without diabetes mellitus and find out the correlation between duration of detection of diabetes mellitus and postprandial lipid levels among patients with diabetes mellitus. METHODS This is a cross sectional analytical study of a study population of 200 subjects including in patients and out patients of wards and diabetic clinic of Government Medical College, Kottayam from April 2017 to March 2018. Data was coded and entered in Microsoft Excel and IBM Statistical Package for Social Sciences (SPSS version 22) for statistical analysis. RESULTS Diabetic patients had impaired fasting and postprandial lipid profiles. Impairment in postprandial lipid profile when compared to non-diabetics was statistically significant. Duration of detection of diabetes and postprandial lipid levels showed weak positive correlation. CONCLUSIONS The postprandial lipid profile in diabetes mellitus patients is significantly deranged compared to fasting state and is an important factor in assessing their cardiovascular risk. Hence, there is a need to stress on postprandial lipid profile estimation in diabetic patients. KEYWORDS Fasting Lipid Profile, Postprandial Lipid Profile, Type 2 Diabetics, Nondiabetics

The effects of acute exercise on appetite and energy intake in men and women

PurposeTo compare energy intake (EI) and appetite regulation responses between men and women following acute bouts of aerobic (AEx), resistance exercise (REx), and a sedentary control (CON). MethodsMen and women (n = 24; 50% male) with overweight/obesity, matched on age (32.3 ± 2 vs. 36.8 ± 2 yrs, p = 0.14) and BMI (28.1 ± 1.2 vs 29.0 ± 1.5 kg/m2, p = 0.64) completed 3 conditions: 1) AEx (65–70% of age-predicted maximum heart rate for 45 min); 2) REx (1-set to failure on 12 exercises); and 3) CON. Each condition was initiated in the post-prandial state (35 min following consumption of a standardized breakfast). Appetite (visual analog scale for hunger, satiety, and prospective food consumption [PFC]) and hormones (ghrelin, PYY, and GLP-1) were measured in the fasted state and every 30 min post-prandially for 3 h. Post-exercise ad libitum EI at the lunch meal was also measured. ResultsMen reported higher levels of hunger compared to women across all study conditions (AEx: Men: 7815.00 ± 368.3; Women: 5428.50 ± 440.0 mm x 180 min; p = 0.025; REx: Men: 7110.00 ± 548.4; Women: 6086.25 ± 482.9 mm x 180 min; p = 0.427; CON: Men: 8315.00 ± 429.8; Women: 5311.25 ± 543.1 mm x 180 min; p = 0.021) and consumed a greater absolute caloric load than women at the ad libitum lunch meal (AEx: Men: 1021.6 ± 105.4; Women: 851.7 ± 70.5 kcals; p = 0.20; REx: Men: 1114.7 ± 104.0; Women: 867.7 ± 76.4 kcals; p = 0.07; CON: Men: 1087.0 ± 98.8; Women: 800.5 ± 102.3 kcals; p = 0.06). However, when adjusted for relative energy needs, there was no difference in relative ad libitum EI observed between men and women. No differences in Area Under the Curve for Satiety, PFC, ghrelin, PYY, and GLP-1 were noted between men and women following acute exercise (all p > 0.05). ConclusionsThese data suggest that women report lower ratings of appetite following an acute bout of exercise or sedentary time when compared to men, yet have similar relative EI. Future work is needed to examine whether sex-based differences in appetite regulation and EI are present with chronic exercise of differing modalities.

Effects of Acute Fructose Loading on Markers of Inflammation-A Pilot Study.

Inflammation plays a role in development of diabetic complications. The postprandial state has been linked to chronic low grade inflammation. We therefore aimed to investigate the acute effects of fructose loading, with and without a pizza, on metabolic and inflammatory markers in patients with type 2 diabetes (T2D) (n = 7) and in healthy subjects (HS) (n = 6), age 47–76 years. Drinks consumed were blueberry drink (18 g fructose), Coca-Cola (17.5 g fructose), and fructose drink (35 g fructose). The levels of glucose, insulin, insulin-like growth factor binding protein-1 (IGFBP-1) and inflammatory markers: Interleukin-6 (IL-6), Monocyte chemoattractant protein-1 (MCP-1), Interleukin-18 (IL-18), Intercellular Adhesion Molecule 1 (ICAM-1), vascular cell adhesion molecule 1 (VCAM-1), and bacterial lipopolysaccharides (LPS) were analyzed in blood. The postprandial responses were assessed using Wilcoxon’s matched-pairs test, Friedman’s ANOVA and Mann–Whitney U test. There was no difference in baseline levels of inflammatory markers between the groups. In T2D, MCP-1 decreased following blueberry drink and Coca-Cola (p = 0.02), Coca-Cola + pizza and fructose + pizza (p = 0.03). In HS, IL-6 increased following blueberry + pizza and fructose + pizza (p = 0.03), there was a decrease in MCP-1 following blueberry drink and Coca-Cola (p = 0.03), and in ICAM-1 following blueberry + pizza (p = 0.03). These results may indicate a role for MCP-1 as a link between postprandial state and diabetes complications, however further mechanistic studies on larger population of patients with T2D are needed for confirmation of these results.

Pharmacokinetics of Flunarizine Hydrochloride After Single Oral Doses in Healthy Subjects: Bioequivalence Study and Food Effects.

We designed a study to compare the newly developed 5-mg flunarizine hydrochloride capsules (test) to that of its marketed counterpart (5-mg; reference) among healthy adult Chinese volunteers. We performed an open-label, single-center study that consisted of 2 randomized, crossover trials, including a fasting trial and a fed trial. In each part of the study, the subjects were randomly assigned to either receive the test or reference products (5-mg flunarizine) in a 1:1 ratio. Subjects then received the alternative products, following a 14-day washout period. Concentrations of plasma flunarizine were analyzed using liquid chromatography-tandem mass spectrometry. Pharmacokinetic parameters (noncompartmental model) were evaluated using the WinNonlin software. The analysis of variance and Food and Drug Administration bioequivalence statistical criterion of 90% confidence interval for 80% to 125% range (set at P ≤ .05) of geometric means ratios of test: reference product for peak plasma concentration, area under the plasma concentration-time curve (AUC) from time 0 to time t, and AUC from time 0 to infinity were determined. Tolerability was evaluated during the entire study period. Overall, 23 volunteers completed the fasting study, while 40 volunteers completed the fed study. The test formulation was found to be bioequivalent to the marketed formulation, as the 90% confidence interval for the ratio of geometric means of peak plasma concentration (fasting: 87.61%-101.67%; fed: 87.38%-104.06%), AUC from time 0 to time t (fasting: 89.44%-99.92%; fed: 92.65%-98.28%), and AUC from time 0 to infinity (fasting: 95.02%-104.33%; fed: 90.41%-96.96%) were within equivalence limits (80-125%) under both the fasting and fed conditions. When flunarizine was given alongside high-fat meals, time to maximum concentration was delayed ≈3.5 hours compared to fasting conditions. Meantime, high-fat meals increased its exposure by nearly 50%. Furthermore, there were no serious adverse events found among the subjects. This study confirmed that test and reference flunarizine hydrochloride capsules were bioequivalent under fasting and postprandial conditions.

Malnutrition, Frailty, and Sarcopenia in Patients With Cirrhosis: 2021 Practice Guidance by the American Association for the Study of Liver Diseases.

Malnutrition, Frailty, and Sarcopenia in Patients With Cirrhosis: 2021 Practice Guidance by the American Association for the Study of Liver Diseases.

Bioequivalence of daclatasvir hydrochloride tablets in healthy Chinese subjects.

The aim of the present study was to evaluate the bioequivalence and safety of two types of daclatasvir hydrochloride tablets administered to healthy Chinese subjects under fasting and postprandial conditions. A total of 72 healthy Chinese subjects were randomly divided into two groups: the fasting group (n= 36) and the postprandial group (n = 36). A dose of 60 mg of both the test and reference preparations of the daclatasvir hydrochloride tablets was taken orally under fasting and postprandial conditions. The main plasma pharmacokinetic parameters of the test and reference preparations in the fasting group were as follows: T1/2 was 9.82 ± 1.00 and 9.67 ± 0.99 hours, respectively; tmax was 1.00 hour in both; Cmax was 1,528.25 ± 428.80 and 1,504.25 ± 414.50 ng/mL-1, respectively; AUC0-t was 14,553.04 ± 4,013.26 and 14,391.97 ± 4,078.18 h/ng/mL-1, respectively; the AUC0-∞ was 14,660.80 ± 4,018.37 and 14,494.85 ± 4,095.57 ng/mL-1, respectively. Meanwhile, the main plasma pharmacokinetic parameters of the test and reference preparations in the postprandial group were as follows: T1/2 was 10.18 ± 1.38 and 10.18 ± 1.69 hours, respectively; tmax was 2.00 and 1.75 hours, respectively; Cmax was 974.92 ± 248.50 and 981.44 ± 237.11 ng/mL-1, respectively; AUC0-t was 9,597.00 ± 3,094.28 and 9,982.83 ± 3,512.07 h/ng/mL-1, respectively; AUC0-∞ was 9,712.92 ± 3,130.43 and 10,113.97 ± 3,593.47 ng/mL-1, respectively. Both types of daclatasvir hydrochloride tablets demonstrated good safety levels in healthy Chinese subjects under both fasting and postprandial conditions. Moreover, the two preparations were bioequivalent.