Postprandial Blood Lipid Research Articles

Postprandial lipaemia following consumption of a meal enriched with medium chain saturated and/or long chain omega-3 polyunsaturated fatty acids. A randomised cross-over study.

Postprandial lipaemic response has emerged as a risk factor for cardiovascular disease. Dietary fats such as medium-chain saturated fatty acids (MCSFA) and long-chain omega-3 polyunsaturated fatty acids (LCn-3PUFA) are known to reduce postprandial lipaemic responses. The combination of the two could potentially have complementary and/or synergistic effects for optimising cardiovascular health. This study aims to investigate the effects of MCSFA (coconut oil) with or without LCn-3PUFA (fish oil) inclusion in the test meal on postprandial blood lipids in healthy adults. In a randomised, double-blinded, placebo-controlled, 2×2 factorial cross-over study, participants (n=15) were randomised to receive four standardised isocaloric test meals. Test meals include: placebo [PL, containing no fish oil (0g EPA & DHA) or coconut oil (0g MCSFA)], fish oil [FO, 6g fish oil (3.85g EPA & DHA), containing no coconut oil (0g MCSFA)], coconut oil [CO, 18.65g coconut oil (15g MCSFA), containing no fish oil (0g EPA & DHA)] and coconut oil+fish oil [COFO, 18.65g coconut oil (15g MCSFA)+6g fish oil (3.85g EPA & DHA)]; all providing a total fat content of 33.5g. Participants received all four treatments on four separate test days with at least 3 days washout in between. Blood parameters were measured by finger pricks at 7 timepoints between 0 and 300min. The primary outcome of this study was the change in postprandial triglycerides (TG) concentrations with secondary outcomes as total cholesterol, high-density lipoprotein cholesterol and blood glucose concentrations. TG area under the curve (AUC) (mmol/L/min) was significantly lower for FO (383.67, p=0.0125) and COFO (299.12, p=0.0186) in comparison to PL (409.17) only. TG incremental area under the curve (iAUC) (mmol/L/min) was significantly lower with COFO (59.67) in comparison to CO (99.86), (p=0.0480). Compared to PL, the change in absolute TG concentrations (mmol/L) from baseline to post TG peak time (180min) after FO were significantly less at 240min (0.39 vs 0.15), 270min (0.2 vs 0.1), and 300min (0.28 vs 0.06), and after COFO was significantly less at 300min (0.28 vs 0.16) (p<0.05). No significant differences in postprandial AUC and iAUC for any other blood parameters were reported. Our study demonstrated that LCn-3PUFA with or without MCSFA but not MCSFA alone are effective in reducing postprandial TG in healthy individuals.

Study of Neurocognitive Function in Type 2 Diabetes Mellitus Patients Using P300 Event-Related Potential

Background:Diabetes mellitus is the most prevailing metabolic disease. It causes structural and functional alterations in several organs, including the central nervous system. Altered glucose metabolism, atherosclerosis, and inflammation of blood vessels are seen in diabetes. This may lead to neuronal degeneration and decline in cognition. Event-related potential P300 can detect cognitive decline before the emergence of obvious neurological manifestations.Objective:The aim of this study is to assess and compare the P300 latencies in subjects with type 2 diabetes mellitus and in nondiabetic subjects and to determine the influence of type 2 diabetes mellitus on cognitive functions.Materials and Methods:In this study our sample size was 248 subjects, with type 2 diabetes mellitus patients (n = 124) and healthy controls (n = 124) between the age group of 31 and 60 years. This cross-sectional comparative study was conducted at SRM Medical College Hospital and Research Centre. The subjects were evaluated by a structured interview and they were assessed with a general health questionnaire to rule out any subpsychiatric illness. Fasting and postprandial blood glucose, HbA1c level, lipid profile, and creatinine were estimated. P300 amplitude and peak latencies were recorded using the standard auditory oddball paradigm.Results:The latencies of P300 were significantly increased and the amplitude of P300 was significantly reduced in the diabetic group when compared to the control group (P < .001). P300 latency has a positive correlation with the HbA1c levels (r = 0.136) and the duration of diabetes (r = 0.231).Conclusion:Prolongation of P300 latencies and the decreased amplitude in diabetic subjects may suggest the existence of a cognitive decline in individuals with type 2 diabetes compared to healthy individuals.

Danggui Sini decoction for treating diabetic peripheral neuropathy: A protocol of systematic review and meta-analysis of randomized controlled trials.

Background:Diabetic peripheral neuropathy (DPN) is one of the most common chronic complications of diabetic patients, which seriously affects the quality of life of patients. At present, mainstream drugs have problems such as poor efficacy and side effects. Traditional Chinese medicine (TCM) has extensive clinical experience in the prevention and treatment of diabetes and chronic complications, and it also shows clear advantages in the treatment of DPN. Clinical studies have confirmed that Danggui Sini decoction (DSD), a TCM decoction, can improve the clinical symptoms and signs of DPN patients. Therefore, we will conduct a systematic review to clarify the effectiveness and safety of DSD for DPN.Methods:We will search every database from the built-in to October 2020. Chinese literature comes from CNKI, Wanfang, VIP, and CBM databases. English literature mainly searches Cochrane Library, PubMed, Web of Science, and EMBASE. At the same time, we will also search for clinical registration tests and gray literatures. This study only screened clinical randomized controlled trials (RCT) for DSD for DPN. The two researchers independently conducted literature selection, data extraction and quality assessment. Dichotomous data is represented by relative risk (RR), continuous data is represented by mean difference (MD) or standard mean deviation (SMD), and the final data is fixed effect model (FEM) or random effect model (REM), depending on whether it exists Heterogeneity. The main result is clinical efficacy and nerve conduction velocity. Fasting blood glucose, 2 hours postprandial blood glucose, blood lipid, hemorheology, and adverse events are secondary results. Finally, a meta-analysis was conducted through Review Manager software version 5.3.Results:This study will conduct a comprehensive analysis based on the currently released DSD data for the treatment of DPN and provide high-quality evidence of clinical efficacy and safety.Conclusion:This systematic review aims to provide new options for DSD treatment of DPN in terms of its efficacy and safety.Ethics and dissemination:The review is based solely on a secondary study of published literatures and does not require ethics committee approval. Its conclusion will be disseminated in conference papers, magazines, or peer-reviewed journals.INPLASY registration number:INPLASY202040157.

Hyperglycaemia and Inflammation are Prime Factors to Persuade Endothelial Dysfunction in Patients with Type 2 Diabetes Mellitus

Introduction: Inflammation and hyperglycaemia are known factors to influence on endothelial dysfunction&#x0D; (ED) in type 2 diabetic subjects. Endothelial dysfunction is a first stage indication for the development of&#x0D; atherosclerosis. Hence, ED plays a major role to enhance pathological changes and progression of micro and&#x0D; macrovascular complications in type 2 diabetes.&#x0D; Aim and Objective: The study has been designed to assess inflammation, glycemic control and endothelial&#x0D; function in type 2 diabetic subjects, which makes us to understand the cause of endothelial dysfunction in&#x0D; T2DM.&#x0D; Materials and Method: Sixty type 2 diabetic subjects with the age of 39 – 60 years and 60 healthy controls&#x0D; with the same age group were enrolled in this study. Fasting and post-prandial blood samples were collected&#x0D; to estimate Fasting and post-prandial blood sugar, lipid profile, inflammatory markers (like hsCRP &amp;&#x0D; fibrinogen) and nitric oxide (NO) for endothelial function.&#x0D; Result: The present study was identified significant high level of fasting and post-prandial blood sugar, lipid&#x0D; profile, fibrinogen and hsCRP in type 2 diabetic subjects. The study also found reduced NO level in type&#x0D; 2 diabetic subjects than healthy control, which indicates that significant correlation of hyperglycaemia and&#x0D; inflammation with endothelial dysfunction in type 2 diabetes.&#x0D; Conclusion: We have found that significant elevation of inflammation and glucose level (hyperglycaemia)&#x0D; might play a major role to develop endothelial dysfunction in type 2 diabetic subjects, it further extends the&#x0D; process of pathogenesis and development of vascular complications.

Effects of fatty acids composition in a breakfast meal on the postprandial lipid responses: a systematic review and meta-analysis of randomised controlled trials

Replacement of food rich in saturated fatty acids (SFAs) with unsaturated fatty acids (UFAs) is a well-known dietary strategy to reduce the risk of cardiovascular disease while its impact on postprandial blood lipids is less examined. This study assessed the effects of fatty acids composition on the postprandial triglycerides and cholesterol responses. Seventeen randomised controlled trials were identified and pooled analysis results revealed that consumption of a UFAs-rich or an SFAs-rich breakfast meal did not acutely affect postprandial triglycerides and cholesterol responses. However, subgroup analysis observed that triglycerides incremental area under the curve was lower with an SFAs-rich meal (SMD: −0.36; 95% CI: −0.57, −0.15) over a less than 8 h duration, while was higher (SMD: 0.59; 95% CI: 0.05, 1.23) over a longer postprandial duration. It suggests that the postprandial duration is of importance when evaluating the effects of fatty acids composition on blood lipid responses.

Effect of obstructive sleep apnea syndrome on glycolipid metabolism and early atherosclerosis in diabetics

ObjectiveTo study the changes in glucose and lipid metabolism indexes and the condition of early atherosclerosis in patients with diabetes with and without obstructive sleep apnea syndrome (OSAS). MethodsPatients with type 2 diabetes mellitus (DM) aged 32–50 years who did not have significant complications were included. A total of 42 patients with DM with OSAS and 46 patients with DM without OSAS were chosen according to their sleep monitoring indexes. Height and weight were measured, and fasting blood glucose, postprandial blood glucose, endothelin (ET), nitric oxide (NO) and lipid profile were tested. Then, all the subjects were subjected to the pulse wave velocity (PWV) test. ResultsThe levels of glycated haemoglobin and triglycerides were significantly higher in patients with DM with OSAS than those in patients with DM without OSAS. ET, NO and PWV changed significantly. ConclusionPatients with diabetes with OSAS are more likely to have complications related to arteriosclerosis and aggravation of glycolipid metabolism disorder. Early intervention is recommended.

A descriptive case-Control study of 100 patients of acanthosis nigricans and its utility to detect metabolic syndrome

Background: Acanthosis nigricans (AN) is a dermatosis that manifests as asymptomatic and symmetrical darkening in intertriginous areas and is associated with endocrine disturbances or malignancy. The features of metabolic syndrome (MetS) include hyperglycemia, hypertriglyceridemia, low high-density lipoprotein (HDL) cholesterol, central obesity, and hypertension. Aims and Objectives: (1) To study the fasting and postprandial blood sugar level, lipid profile, blood pressure, and waist circumference (WC) in patients with AN and compare the values in healthy controls.(2) To determine the association between the presence of benign acquired AN and MetS (biochemical parameters and anthropometric variables). Materials and Methods: A descriptive case–control study with 100 cases of AN and 100 healthy controls without AN was conducted between December 2016 and November 2017 to assess the association between AN and metabolic variables. Results: In this study, out of the 100 cases evaluated, 57% had MetS diagnosed by the National Cholesterol Education Program and Adult Treatment Panel III, of which 35 were females and 22 males. Among 100 cases of AN, 31 had hypertension (P = 0.438), 57 had elevated triglycerides (P = 0.007), 33 had elevated fasting blood sugar (P = 0.061), 76 had decreased HDL cholesterol (P = 0.000045), and 78 had increased WC (P = 0.00463). The association of AN with MetS was highly significant in the study population (P = 0.000017; as P < 0.05-significant; P < 0.01-highly significant). Conclusion: In this study, 57 patients with AN had deranged metabolic variables suggesting the presence of MetS. This study shows that AN could be a marker for MetS. Hence, clinicians should assess patients with AN for metabolic and biochemical parameters to advise regarding lifestyle modification and prevent future cardiovascular complications.

Fasting and postprandial lipid parameters: A comparative evaluation of cardiovascular risk assessment in prediabetes and diabetes.

Context:Dyslipidemia plays a crucial role in atherogenesis, in both prediabetes and diabetes. There persists a lacuna in the evaluation of postprandial lipid parameters in prediabetes.Aims:To comparatively evaluate fasting and postprandial blood lipid parameters and atherogenic lipid ratios for cardiovascular risk assessment, in prediabetes and diabetes.Materials and Methods:Fifty-one patients diagnosed with diabetes mellitus and thirty-two with prediabetes were selected for the study. Lipid profile and blood glucose were analyzed in fasting and postprandial blood samples.Statistical Analysis Used:Kolmogorov–Smirnov test, Shapiro–Wilk test, one-way ANOVA, and Pearson's regression analysis were applied.Results:Postprandially, triglycerides (TG) was increased significantly in diabetes compared to controls (P < 0.01) and prediabetics (P < 0.05). Among the lipid ratios, triglyceride/high density lipoprotein (TG/HDLc) was significantly increased postprandially in diabetes compared to controls (P < 0.05). A comparative analysis of fasting and postprandial parameters within each group showed a significant increase in postprandial TG/HDLc compared to the fasting state in prediabetes (P < 0.001) and diabetes (P < 0.001). Postprandial TG (P < 0.01) and TG/HDLc (P < 0.01) showed a stronger correlation with HbA1c compared to fasting TG (P < 0.05) and TG/HDLc (P > 0.05). The prevalence of dyslipidemia and insulin resistance was higher in postprandial state than the fasting state in prediabetes and diabetes.Conclusions:Postprandial TG and the TG/HDLc reflect lipid abnormalities than the corresponding fasting variables in diabetes and prediabetes. Postprandial TG and TG/HDLc are better reflectors of cardiovascular status in prediabetes and diabetes.

Integrating Metagenomic Information into Personalized Nutrition Tools: The PREDICT I Study (P20-005-19)

ObjectivesThe existence of a link between the intestinal microbiome and diet is well established. The demonstration that the microbiome information increases the prediction accuracy of postprandial blood glucose levels (Zeevi et al, 2015) is opening intriguing perspectives for developing personalized nutrition tools. However, reproducibly inferring the diet-induced microbiome changes and stratifying individual responses to dietary interventions based on the microbiome remain open challenges. The PREDICT I study aims to develop: (i) a protocol for gut microbiome sampling and analysis for large-scale nutritional studies and (ii) a microbiome-based machine learning integrative component for predictive personalized nutrition tools. MethodsWe performed three metagenomic investigations to; (i) identify the best combination for stool collection, sample storage, DNA extraction, and sequencing (n = 45); (ii) develop and validate the computational pipeline on an exploratory dietary interventional cohort (n = 1000); (iii) apply the validated pipeline on an independent validation cohort (n = 100). The generated total dataset (>8x10^12 sequenced bases) was analyzed with existing and newly developed computational tools and integrated with the metagenomic profiles of >10,000 samples processed from public repositories. ResultsOur resulting validated protocol involves a minimally time-demanding procedure for at-home sample collection, sample storage in a preservation buffer, and DNA extraction with a recently commercialized kit (Qiagen). Metagenomic sequencing proved substantially more accurate than 16S rRNA sequencing and was able to perfectly capture subject-specific strain-level features with longitudinal sampling. This method was also able to stratify by pre-intervention habitual dietary regimes. Our prediction algorithm showed that embedding the microbiome features in a 50-dimension space was sufficient to improve the prediction performance of postprandial blood glucose levels. ConclusionsWe present the largest investigation to date on the reproducible connections between the gut microbiome and dietary interventions. Further we describe our methods and results in using the microbiome as a component of a precise integrated postprandial blood glucose and blood lipid level predictor. Funding SourcesZoe Global Limited, National Institute for Health Research (NIHR), Wellcome Trust.

Medium-chain fatty acids lower postprandial lipemia: A randomized crossover trial

Epidemiological and interventional studies have linked saturated fatty acids (SFA) with elevated levels of low-density lipoprotein cholesterol (LDL-C) and increased CVD risk. However, the effects of the SFA chain length on postprandial lipemia in humans are not well elucidated. The aim of this study was to investigate the impact of short, medium and long-chain SFA on postprandial blood lipids in healthy volunteers. Sixteen healthy volunteers consumed test biscuits containing 40g of either butter (BB), coconut oil (CB) or lard (LB) in a single-blinded, randomized crossover design. Blood samples were collected fasting and 2, 3, 4, and 6 hours postprandially and assessed for blood lipids (total cholesterol, TC; high-density lipoprotein cholesterol, HDL-C; LDL-C and triglyceride, TG). The postprandial TG response following CB was 59.8% lower than following BB (p<0.01) and 58.8% lower than LB (p<0.01), although no difference was observed between the BB and the LB responses. The net area under the LDL-C concentration curve was significantly larger after consumption of the CB compared to the BB, despite no significant differences in postprandial net area under the TC and HDL-C concentration curves. Consumption of medium-chain SFA as CB resulted in lower postprandial TG excursions compared to short-chain SFA as BB and long-chain SFA as LB, despite their identical fat and caloric content. These results suggest that SFA differ in their potential to elevate postprandial lipid levels, and that coconut oil, a rich source of medium-chain SFA may not be as hyperlipidemic as animal fats rich in long chain SFA. ANZCTR IDENTIFIER: 12617000903381. CLINICAL TRIAL REGISTRY NUMBER: The study was registered with the Australia New Zealand Trial registry as ACTRN12617000903381.

Comparison of Three Types of Low-calorie Diets on Blood Glucose and Lipid Control in Diabetic Patients

BACKGROUND: Serum glucose levels can get close to a normal level by an appropriate diet. The present study aims to investigate the effect of low-calorie diets (1200, 1500, 1800 Kcal) on glucose and lipid levels, and HbA1C serum levels of newly diagnosed type II diabetic patients.MATERIALS AND METHODS: This prospective cross-sectional study was conducted among 68 patients with type II diabetes mellitus, whose disease was recently diagnosed. The study criteria included fasting blood glucose higher than 126 mg/dL, HbA1c higher than 7% and BMI higher than 25. Fasting blood glucose levels, 2-hour post-prandial blood sugar and blood lipids were measured before and after intervention. Then, the patients were trained by an expert. After completing the questionnaires, the data were analyzed.RESULTS: In this study, the mean fasting blood glucose level in patients who used 1200, 1500 and 1800 kcal diets decreased significantly after intervention (p<0.05). In addition, fasting blood glucose levels and 2-hour post-prandial blood sugar decreased significantly using 1500 and 1800 kcal diets, while the1200 kcal diet significantly reduced fasting blood glucose, triglyceride (TG), cholesterol (Chol), LDL, and hemoglobin A1C (HbA1c). There was a significant decrease in triglyceride based on the 1500 kcal diet in terms of gender.CONCLUSION: Using low-calorie diets (1200, 1500 and 1800 kcal) in newly diagnosed diabetic patients can lead to blood sugar and lipid control in these patients, and among these diets, the use of a 1500 kcal diet can be more useful because of lower limitation and better tolerance and acceptance.

Plant sterols lower LDL-cholesterol and triglycerides in dyslipidemic individuals with or at risk of developing type 2 diabetes; a randomized, double-blind, placebo-controlled study

BackgroundManaging cardiovascular disease (CVD) risk factors, e.g., dyslipidemia in type-2 diabetes mellitus (T2DM) is critically important as CVD is the most common cause of death in T2DM patients. This study aimed to investigate the effect of plant sterols (PS) on lowering both elevated low-density lipoprotein cholesterol (LDL-C) and triglycerides (TG).MethodsIn a double-blind, randomized, placebo-controlled, parallel study, 161 individuals at increased risk of and with established T2DM, consumed low-fat spreads without or with added PS (2 g/d) for 6 weeks after a 2-week run-in period. Increased risk of developing T2DM was defined by the Australian T2DM Risk Assessment Tool (AUSDRISK). Fasting serum/plasma total cholesterol (TC), LDL-C, TG, high-density lipoprotein cholesterol (HDL-C), glucose and insulin were measured at baseline and after 6 weeks. Effects on acute and chronic postprandial blood lipids, glucose and insulin were measured over 4-h in 39 individuals with T2DM following a mixed meal challenge without and with added 2 g/d PS at week 6. The study was registered at clinicaltrials.gov (NCT02288585).ResultsHundred fifty-one individuals completed the study and 138 (57% men, 43% women; 44 with and 94 at risk of T2DM) were included in per protocol analysis. Baseline LDL-C and TG were 3.8 ± 1.0 and 2.5 ± 0.8 mmol/l, respectively. PS intake significantly lowered fasting LDL-C (−4.6%, 95%CI −1.2; −8.0; p = 0.009), TC (−4.2%, 95%CI −1.2; −7.1; p = 0.006) and TG (−8.3%, 95% −1.1, −15.0; p = 0.024) with no significant changes in HDL-C, glucose or insulin. Postprandial lipid (TG, TC, LDL-C, HDL-C, remnant cholesterol), glucose and insulin responses did not differ.ConclusionsIn individuals at risk of and with established T2DM and with elevated TG and LDL-C, 2 g/d of PS results in dual LDL-C plus TG lowering. Postprandial lipid or glycemic responses did not differ between PS and control treatment.

Influence Of Short, Disrupted Sleep And High-intensity Interval Exercise On Fasting And Post-prandial Blood Lipid And Lipid-related Antioxidant Responses In Healthy Men

Exercise is known to impart transient blood lipid responses that appear consistent with reduced cardiovascular disease risk; yet, it is unclear how short, disrupted sleep (SDS) modifies post-exercise fasting and postprandial blood lipid and lipid-related antioxidant responses to a single episode of exercise. PURPOSE: To determine the influence of a single night of SDS on fasting and postprandial blood lipid and lipid-related antioxidant responses after HIIE. METHODS: Fifteen male participants (age 31.1 ± 5.3 yr; weight 83.5 ± 11.4 kg; BMI 25.8 ± 2.7 kg/m2; VO max 49.1 ± 8.5 ml/kg/min) completed a non-exercise control trial after 9 to 9.5 hrs of reference sleep (REF), HIIE by treadmill running (90% and 40% of VO2reserve in 3:2 min ratio) to expend 500 kcals after reference sleep (REF+EX) and HIIE after 3 to 3.5 hrs of short and disrupted sleep (SDS+EX) in a randomized crossover design. Blood samples were obtained by the same technician under standardized conditions just before, immediately after (IPE), 1 hr after exercise (1 HR) and just before a high-fat meal - 1240 kcals (56 g fat; 145 g carbohydrate; 38 g protein) and again 2, 4 and 6hrs after meal ingestion and at equal intervals during REF. Total, high-density and low-density lipoprotein cholesterol (HDLC and LDLC) and paraoxonase-1 concentration were measured up to 1 hr post-exercise. Post-prandial triglyceride was measured and area under the curves - total (AUCt) and incremental (AUCi) were calculated. Lipid and lipid-related antioxidant responses were analyzed using 3 (condition) by 3 (sample point) repeated measures ANOVAs. AUCt and AUCi were measured using one-way, 3 (condition) repeated measures ANOVAs. RESULTS: HDLC (+6.3%, p = 0.0023) and paraoxonase-1 (+10.8%, p <0.0001) increased and triglyceride (-18.5%, p <0.0001) decreased after REF+EX and SDS+EX; TAUCt and AUCi remained refractory to exercise and short, disrupted sleep. SUMMARY: Exercise transiently increased fasting HDL cholesterol and related antioxidant concentrations and reduced triglyceride levels, but did not modify total or incremental triglyceride AUC in response to a post-exercise high-fat meal. Short, disrupted sleep did not influence these responses.

Efficacy and safety of Vidangadi Yoga (ayurvedic polyherbal medicine) in type 2 diabetes mellitus: A randomized controlled clinical study

Background and objectives: Incidence of diabetes mellitus is increasing due to genetic predisposition, high body fat, and insulin resistance. Though multiple oral hypoglycaemic agents and insulin are available, these are associated with side effects, primary and secondary failure. Hence, evaluation of antidiabetic potential of medicines described in traditional health sciences such as Ayurveda (Indian system of medicine) is also important. This study aimed to assess the efficacy and safety of Vidangadi Yoga (ayurvedic polyherbal medicine) and metformin in the management of type 2 diabetes mellitus (T2DM) based on biochemical parameters and adverse events. Methods: In this prospective, randomized, open-label, active-controlled, two-arm study, 61 patients with T2DM were included and randomly divided two groups. Patients in the Vidangadi Yoga group received Vidangadi Yoga tablet 500 mg thrice daily before food with water, while patients in the metformin group received metformin 500 mg after food twice daily for 90 days. Subjects were asked to undergo follow-up at the interval of 15 days until the completion of 90 days. Assessment was done on changes observed in fasting and postprandial blood glucose, glycosylated haemoglobin, lipid profile, haemogram, hepatic, renal profile, and clinical symptoms. Results: After 90 days of medication, fasting and postprandial blood glucose levels in both groups were significantly decreased when compared with baseline (P Conclusion: Vidangadi Yoga exhibits equivalent efficacy to metformin and is safe in lowering fasting and postprandial blood glucose levels. Ethics and trial registration: This study was approved by the institutional ethics committee of PDEA’s College of Ayurved and Research Centre, Pune, Maharashtra, India (approval number 6833) on March 22, 2014 and was registered with Clinical Trials Registry- India (CTRI) (No. CTRI/2015/04/005719) on April 25, 2015.

Pancreatic-like enzymes of microbial origin restore growth and normalize lipid absorption in a pig model with exocrine pancreatic insufficiency.

IntroductionThe standard therapy for exocrine pancreatic insufficiency (EPI) is porcine-derived pancreatic enzyme replacement therapy (PERT). In the present study we tested a new approach with a mixture of pancreatic-like enzymes of microbial origin (PLEM) in a 1-week efficacy study in EPI pigs. In addition to the conventionally used coefficient of fat and nitrogen absorption (CFA and CNA), parameters that more accurately reflect the nutritional and health status, such as changes in the lipemic index (LI), plasma triglyceride (TG) and non-esterified fatty acid (NEFA) levels, and somatic growth, were determined.Material and methodsA PLEM dose containing 120 000 active lipase units, 80 000 active protease units and 12 000 active amylase units (all from Sigma, St. Louis, MO) was given as a powder, twice daily with a meal (40 g fat/meal) to 8 EPI pigs for 7 days. Ten healthy pigs were used as a comparator.ResultsThe PLEM enhanced fat and protein digestion, and reversed growth impairment in EPI pigs. With treatment, CFA and CNA increased by 59% and 43% (p < 0.05), respectively. Although fat and protein absorption were lower than in the comparator, the postprandial blood lipid profile was normal as in healthy pigs. The mucosal thickness significantly increased by 27%, 50% and 26%, in the proximal, middle, and distal jejunum (p < 0.05) with treatment and resembled that of healthy animals.ConclusionsPancreatic-like enzymes of microbial origin supported somatic growth and normalized the postprandial lipid profile. As a measure of efficacy, postprandial LI, TG and NEFA are viable endpoints to be explored in human trials.

Assessment of left ventricular functions in patients with type 2 diabetes mellitus using tissue Doppler imaging and its correlation with a novel cardiac biomarker

IntroductionCardiovascular diseases account for about 65% of diabetes-related mortality.ObjectiveNoninvasive assessment of left ventricular functions in asymptomatic nonhypertensive nonischemic type 2 diabetics using echo heart and tissue Doppler imaging (TDI) for detecting structural and functional cardiac abnormalities, and correlating them with levels of Brain natriuretic peptide (BNP) for early planning of management before passing into overt heart failure (HF) were the objectives of this study.Patients and methodsWe studied 55 patients with type 2 diabetes and classified them into two groups: 26 patients with less than 10 years diabetes duration and 29 patients with more than 10 years duration. Full history, fasting blood glucose, postprandial blood glucose, glycated hemoglobin, creatinine, lipid profile, BNP, ECG, conventional echo, and TDI were performed for all patients.ResultsIn all, 45 (80%) patients out of 55 patients have diastolic dysfunction, classified as 15 (27%) with type 1 diastolic dysfunction, 26 (47%) with type 2 pseudonormal diastolic dysfunction, and four (7%) patients with type 3 diastolic dysfunction. Systolic dysfunction (ejection fraction <55) was present in nine (16%) patients despite absent HF. BNP was significantly high in patients with longer diabetes duration (P=0.008). There was a statistically significant difference in the BNP level between those with diminished systolic function and those with normal systolic function, P=0.001; yet no statistically significant difference was found between BNP and different groups of diastolic dysfunction (P=0.7).ConclusionDiabetic cardiomyopathy is an important diabetes complication. It varies from subclinical ventricular dysfunction to overt HF. Echocardiography is the standard diagnostic tool for diabetic cardiomyopathy. TDI can be used to quantitatively assess global, regional, systolic, and diastolic myocardial functions. Plasma BNP can be a prognostic rather than diagnostic test.

Nutrition management in obese patients with type 2 diabetes mellitus after laparoscopic sleeve gastrectomy

To explore the value of nutrition management in obese patients with type 2 diabetes mellitus(T2DM) after laparoscopic sleeve gastrectomy(LSG). Clinical data of 22 obese T2DM patients undergoing LSG from March 2013 to July 2015 in Fudan University Pudong Medical Center were collected. All the patients strictly followed the specialized instruction by nutritionists: diabetic and low calorie diet 3347.2 to 5020.8 kJ (800 to 1200 kcal) per day before the operation; low calorie liquid diet 2510.4 kJ(600 kcal) per day before operation for promoting gastric emptying; fasting diet before postoperative ventilation; clear liquid diet 1673.6 to 2510.4 kJ (400 to 600 kcal) per day after postoperative ventilation (liquid intake >2000 ml); low fat liquid diet 2928.8 to 3765.6 kJ (700 to 900 kcal) per day (protein 60 g per day at least, 2000 ml liquid) 2 weeks after the operation; semi-liquid diet 1 month after operation and gradually normal diet. All the 22 patients were followed up at 1 week, 1, 3, 6 months after operation on time. Changes of body weight, waist circumference, hip circumference, body mass index(BMI), blood glucose indexes induding fasting blood glucose(FBG), 2-hour postparandial blood glucose(PBG), fasting C-peptide, 2-hour postprandial C-peptide, fasting serum inculin(FINS), 2-hour postprandial inculin(INS), HbAlc, blood pressure and blood lipid indexes were observed and analyzed before and 1 week, 1, 3, 6 months after operation. The average age of 22 patients (10 men and 12 women) was 38.6 years (18 to 66 years). The duration of diabetes varied from 1 month to 15 years. Comorbidity included 12 patients of high blood pressure, 14 of fatty liver, 1 of coronary heart disease, 1 of gout, 1 of chronic thyroiditis and 1 of menstrual disorder. LSG was performed successfully in all the patients and no severe complications and transference to laparotomy occurred. As compared to pre-operation, at 6 months after operation, the average body weight decreased from (103.9±20.2) kg to (80.9±12.6) kg (t=6.294, P=0.000), waist circumference from (118.6±13.8) cm to (96.4±8.0) cm (t=6.331, P=0.000), hip circumference from (116.9±12.6) cm to (104.0±7.7) cm (t=3.854, P=0.000), BMI from (36.2±5.9) kg/m2 to (27.9±3.5) kg/m2 (t=5.630, P=0.000), showing a decreasing trend over time. There was no underweight patient after 6 months follow-up. As compared to pre-operation, at 6 months after operation, the average FBG reduced from (7.4±1.4) mmol/L to (6.0±0.9) mmol/L (t=3.172, P=0.003), 2 h PBG from (14.1±4.9) mmol/L to (7.5±2.2) mmol/L (t=7.026, P=0.000), FINS from (160.0±71.9) mIU/L to (43.8±20.8) mIU/L (t=7.259, P=0.000), 2-hour postprandial INS from (437.6±261.4) mIU/L to (140.5±104.6) mIU/L (t=5.858, P=0.000), fasting C-peptide from (1.1±0.6) μg/L to (0.7±0.3) μg/L (t=3.560, P=0.000), 2-hour postprandial C-peptide from (2.5±0.9) μg/L to (1.5±0.7) μg/L (t=3.865, P=0.000), HbAlc from (8.0±1.6)% to (5.9±0.6)% (t=5.953, P=0.000), showing a decreasing trend over time except FBG, 2h postprandial C-peptide and HbAlc(all P<0.05). FBG and 2-hour PBG of 16 patients returned to normal 3 months after the operation. Blood pressure and trigly ceride decreased obviously 6 months after operation compared to pre-operation with significant difference(P<0.05). At 6 months after operation, blood pressure of 8 comorbidity patients with high blood pressure became normal (8/12, 66.7%) and of 4 patients improved(4/12, 33.3%); B ultrasound examination revealed normal in 11 comorbidity patients with fatty liver(11/14,78.6%) and improvement in 3 patients (3/14,15.4%). Blood uric acid of the gout patient and the menstruation of the menstrual disorder patient returned to normal 3 months and 1 month after the operation respectively. As for obese patients with T2DM undergoing LSG, reasonable nutrition management is helpful to decrease body weight, and to obtain an ideal improvement of blood glucose and blood lipid levels.

Comparative Study between Oral Hypoglycemic Drugs Repaglinide, Glibenclamide and Rosiglitazone on Some Biochemical Parameters in Type 2 Diabetic Patients

Type 2 diabetes mellitus is often characterized by hyperglycemia as a result of increased insulin resistance in hepatic/peripheral tissues and pancreactic B-cell dysfunction. Approximately 92% of patients with type 2 diabetes mellitus demonstrate insulin resistance, however hyperglycemia is always a consequence of insulin deficiency. This study was done on 120 patients newly diagnosed diabetes type 2 characterized by dyslipidemia that is increased triglycerides and decreased HDL. Hypoglycemia and weight gain are common problem with oral sulfonyl urea drugs. In this work three different oral hypoglycemic drugs repaglinide and glibenclamide (insulin secretagogues) and rosiglitazone (insulin sensitizer) were used for treatment of patients with type 2 diabetes mellitus. The effect of these drugs on fasting and postprandial blood glucose levels, lipid profiles, alanine aminotransferase and serum creatinine were studied.Three groups of newly diagnosed type 2 diabetic patients ,group 1 (40 patients) were subjected to treatment with repaglinide (2 mg three time daily) ,group 2(45 patients) were subjected to treatment with glibenclamide (5 mg once daily) ,group 3,(35 patients) were subjected to treatment with rosiglitazone (4 mg twice daily) . Fasting and postprandial blood glucose levels, lipid profiles (TC, TG, HDL and atherogenic index), alanine aminotransferase and serum creatinine were analyzed for these patients before and 4 and 8 weeks after oral hypoglycemic drug treatment. The same parameters were recorded for 40 normal individuals as control.The results demonstrated that repaglinide has a greater postprandial glucose regulator effect than glibenclamide and rosiglitazone. In addition the hypoglycemic episode and weight gain were less in patients treated with repaglinide than those treated with glibenclamide. Repaglinide produces greater percent reduction with respect to fasting blood glucose levels, postprandial blood glucose levels and atherogenic index compared to glibenclamide and rosiglitazone.&#x0D; Key words: oral hypoglycemic, repaglinide, glibenclamide, rosiglitazone.

Effect of a single bout of aerobic exercise on high-fat meal-induced inflammation

Background and aimsChronic low-grade inflammation is involved in the development of metabolic disorders including atherosclerosis, type 2 diabetes (T2D) and metabolic syndrome. Aerobic exercise has been shown to be anti-inflammatory and attenuate postprandial blood lipids, however, the effect of exercise on postprandial inflammation remains unclear. The aim of this study was to determine the protective effect of a single bout of aerobic exercise against postprandial lipemia and peripheral blood mononuclear cell (PBMC) inflammation and to evaluate associations with changes in the energy-sensing enzyme, AMP-activated protein kinase (AMPK). Materials and methodsHealthy male subjects (n=12, age=23±2, %Fat=19±2) reported to the laboratory following an overnight fast (12–14h) on two separate occasions for consumption of a high-fat meal (HFM). Participants completed an acute bout of aerobic exercise the afternoon prior to one of the HFM visits. Results and conclusionResults indicate that the single bout of moderate aerobic exercise increased AMPK signaling in PBMCs, as shown by increased phosphorylated acetyl-CoA carboxylase (p-ACC). This may be due to decreases in the AMPK inhibitory kinases PKD and GSK3β. Additionally, prior moderate intensity exercise decreased postprandial lipemia (PPL) and some mediators of the inflammatory pathway, such as p-NF-κB. These findings that acute aerobic exercise improves AMPK and NF-κB signaling in human PBMCs contribute support to the anti-inflammatory roles of exercise.

Correlation study of adenosine deaminase and its isoenzymes in type 2 diabetes mellitus

ObjectiveAdenosine deaminase (ADA) plays an important role in cell-mediated immunity and modulation of insulin activity. Its clinical and diagnostic significance in Nepalese type 2 diabetes is not yet characterized. So,...