Insulin Values Research Articles

Associations between avocado intake and measures of glucose and insulin homeostasis in Hispanic individuals with and without type 2 diabetes: Results from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL)

Background and AimsTo investigate associations between avocado intake and glycemia in adults with Hispanic/Latino ancestry. Methods and ResultsThe associations of avocado intake with measures of insulin and glucose homeostasis were evaluated in a cross-sectional analysis of up to 14,591 Hispanic/Latino adults, using measures of: average glucose levels (hemoglobin A1c; HbA1c), fasting glucose and insulin, glucose and insulin levels after an oral glucose tolerance test (OGTT), and calculated measures of insulin resistance (HOMA-IR, and HOMA-%β), and insulinogenic index. Associations were assessed using multivariable linear regression models, which controlled for sociodemographic factors and health behaviors, and which were stratified by dysglycemia status.In those with normoglycemia, avocado intake was associated with a higher insulinogenic index (β = 0.17 ± 0.07, P = 0.02). In those with T2D (treated and untreated), avocado intake was associated with lower hemoglobin A1c (HbA1c; β = −0.36 ± 0.21, P = 0.02), and lower fasting glucose (β = −0.27 ± 0.12, P = 0.02). In the those with untreated T2D, avocado intake was additionally associated with HOMA-%β (β = 0.39 ± 0.19, P = 0.04), higher insulin values 2-h after an oral glucose load (β = 0.62 ± 0.23, P = 0.01), and a higher insulinogenic index (β = 0.42 ± 0.18, P = 0.02). No associations were observed in participants with prediabetes. ConclusionsWe observed an association of avocado intake with better glucose/insulin homeostasis, especially in those with T2D.

Empagliflozin improves insulin sensitivity in patients with recent acute coronary syndrome and newly detected dysglycaemia

BackgroundEmpagliflozin reduces the risk of cardiovascular disease (CVD) in patients with type 2 diabetes (T2DM) and high cardiovascular risk via mechanisms which have not been fully explained. The mechanisms of such benefit have not been fully understood, and whether empagliflozin can be safely administered as first-line treatment in patients with CVD at the initial stages of glycaemic perturbations remains to be established. We investigated the effects of empagliflozin on insulin resistance, insulin sensitivity and β-cell function indexes in patients with a recent acute coronary event and newly detected dysglycaemia, i.e., impaired glucose tolerance (IGT) or T2DM.MethodsForty-two patients (mean age 67.5 years, 19% females) with a recent myocardial infarction (n = 36) or unstable angina (n = 6) and newly detected dysglycaemia were randomized to either empagliflozin 25 mg daily (n = 20) or placebo (n = 22). Patients were investigated with stress-perfusion cardiac magnetic resonance imaging before randomization, 7 months after the start of study drug and 3 months following its cessation. Indexes of insulin resistance, sensitivity and β-cell function were calculated based on glucose and insulin values from 2-hour oral glucose tolerance tests (OGTT) and fasting C-peptide. The differences in glucose, insulin, C-peptide, mannose levels and indexes between the two groups were computed by repeated measures ANOVA including an interaction term between the treatment allocation and the time of visit.ResultsAfter 7 months, empagliflozin significantly decreased glucose and insulin values during the OGTT, whereas C-peptide, mannose and HbA1c did not differ. Empagliflozin significantly improved insulin sensitivity indexes but did not impact insulin resistance and β-cell function. After cessation of the drug, all indexes returned to initial levels. Insulin sensitivity indexes were inversely correlated with left ventricular mass at baseline.ConclusionsEmpagliflozin improved insulin sensitivity indexes in patients with a recent coronary event and drug naïve dysglycaemia. These findings support the safe use of empagliflozin as first-line glucose-lowering treatment in patients at very high cardiovascular risk with newly diagnosed dysglycaemia.Trial registration numberEudraCT number 2015-004571-73.

The Triglycerides-Glucose Index Shows a Stronger Correlation with Serum Adiponectin Levels than Homeostasis Model Assessment of Insulin Resistance and Quantitative Insulin Sensitivity Check Index.

Purpose: To evaluate the association between diverse surrogate markers of insulin resistance and adiponectin concentrations. Methods: Four hundred healthy participants were included. Two different cohorts were formed according to the body mass index (BMI) values. Group 1 (n = 200) consisted of individuals with normal BMI values (18.50-24.99 kg/m2), whereas in Group 2 (n = 200) there were overweight or obese individuals (BMI ≥25.00 kg/m2). Homeostasis model assessment of insulin resistance (HOMA-IR), quantitative insulin sensitivity check index (QUICKI), and triglycerides-glucose index (TyG) were calculated. Serum adiponectin levels were measured by ELISA. A correlation analysis was performed to assess the association between serum adiponectin and HOMA-IR, QUICKI, and TyG. Results: Participants in Group 2 were older (age in years: Group 1, 33.3 ± 6.8 vs. Group 2, 36.4 ± 7.0, P < 0.001). There was no gender difference between groups. Overweight or obese participants had higher BMI, waist circumference, fat mass, fat ratio, fasting plasma glucose, fasting plasma insulin, triglycerides, total cholesterol, and low-density lipoprotein cholesterol values, whereas high-density lipoprotein cholesterol was higher in participants with normal BMI measures. Overweight or obese subjects were more insulin resistant (higher TyG index and HOMA-IR) and less insulin sensitive (lower QUICKI), P < 0.001 for all. Serum adiponectin levels were lower in Group 2 (serum adiponectin in ng/mL: Group 1, 11,880 ± 6838 vs. Group 2, 9115 ± 5766, P < 0.001). The correlation between TyG index and adiponectin was stronger than the correlation between QUICKI and adiponectin, and HOMA-IR and adiponectin (r for TyG and adiponectin -0.408, r for QUICKI and adiponectin 0.394, r for HOMA-IR and adiponectin -0.268, respectively, P < 0.001 for all correlations). Conclusions: TyG has a stronger association with adiponectin than HOMA-IR and QUICKI.

Effects of ultrasound-guided erector spinae plane block in radical prostatectomy surgery on pain and surgical stress response

BackgroundErector spina plane block, as a part of a multimodal approach in perioperative pain management, is effective in many surgical procedures on pain management. The aim of this prospective, randomized, controlled study was to investigate the effects of erector spinae plane block on pain, analgesic consumption, and surgical stress in radical prostatectomy operations.ResultsForty-six patients operated for elective open radical prostatectomy surgery were randomly allocated to Group B (n = 23) and Group K (n = 23). Ultrasound-guided erector spinae plane block was performed bilaterally on patients in Group B, while group K was the control group. Remifentanil and tramadol consumption, rescue analgesic need, pain scores, and nausea-vomiting scores were less in Group B. While there was no difference in glucose, cortisol, insulin, and C-reactive protein values at all times between groups, postoperative 24-h prolactin values were higher in Group B. Shapiro–Wilk test, Student t-test, and Mann–Whitney U-test were used for statistical analysis.ConclusionsUltrasound-guided erector spinae plane block is an effective analgesic method in radical retropubic prostatectomy surgeries providing a reduction in intraoperative and postoperative opioid consumption but has limited effect on the surgical stress response.Trial registrationClinicalTrials NCT05170373, Registered 11/03/2021 — retrospectively registered.

Adherence to 24-h movement guidelines in Spanish schoolchildren and its association with insulin resistance: a cross-sectional study.

Being more active, being less sedentary, and sleeping enough are associated with adequate body weight and adiposity in children. However, few researchers have analyzed these different lifestyle behaviors and the adherence to 24 h movement guidelines with respect to insulin resistance (IR) at school age. Therefore, we aimed to analyse the association between the adherence to 24 h movement guidelines (physical activity, sedentary time, sleep) and IR in Spanish schoolchildren. A cross-sectional study of 839 children (8-13 years, 51.1% girls) were studied. Anthropometric, biochemical, and lifestyle behavioral data were collected. IR was defined as HOMA-IR>3.16. Compliance with the 24 h movement guidelines were defined as ≥60 min/day of moderate and/or vigorous physical activity, < 120 min/day of screen time, and 9-11 h/day of sleep time. Associations between adherence to the 24 h movement guidelines and IR were performed by multivariate logistic regression analyses. The IR in our sample was 5.0%, being higher in girls. Compliance with physical activity or screen time, but not with sleep recommendations, was associated with lower fasting glucose, fasting insulin, and HOMA-IR values. A low adherence to 24 h movement guidelines was associated with a higher risk of IR (odds ratio (95% CI): 2.150 [1.089-4.247]), especially in girls (odds ratio (95% CI): 2.800 [1.180-6.645]). Higher physical activity levels and lower screen times were associated with a lower risk of IR in schoolchildren, underlining the importance of adhering to as many healthy lifestyle recommendations as possible.

Fasting indices of glucose-insulin-metabolism across life span and prediction of glycemic deterioration in children with obesity from new diagnostic cut-offs.

Fasting indices of glucose-insulin-metabolism are an easy and affordable tool to assess insulin resistance. We aimed to establish reference ranges for fasting insulin indices that reflect age-dependent variation over the entire life span and subsequently test their clinical application regarding the prediction of glycemic deterioration in children. We calculated age- and puberty-dependent reference values for HOMA-IR, HOMA2-IR, HOMA-β, McAuley index, fasting insulin, and fasting glucose from 6994 observations of 5512 non-obese healthy subjects aged 5-80 years. Applying those references, we determined the prevalence of insulin resistance among 2538 subjects with obesity. Furthermore, we investigated the intraindividual stability and the predictive values for future dysglycemia of these fasting indices in 516 children and adolescents with obesity up to 19 years of follow-up. We validated the results in three independent cohorts. There was a strong age-dependent variation of all indices throughout the life span, including prolonged recovery of pubertal insulin resistance and a subsequent continuous increase throughout adulthood. Already from age 5 years onwards, >40% of children with obesity presented with elevated parameters of insulin resistance. Applying newly developed reference ranges, insulin resistance among children with obesity doubled the risk for future glycemic deterioration (HOMA-IR HR 1.88 (95% CI 1.1-3.21)), fasting insulin HR 1.89 (95% CI 1.11-3.23). In contrast, fasting glucose alone was not predictive for emerging dysglycemia in children with obesity (HR 1.03 (95% CI 0.62-1.71)). The new insulin-based thresholds were superior to fasting glucose and HbA1c in detecting children eventually manifesting with dysglycemia in prospective analyses. The variation of fasting glucose-insulin-metabolism across the life span necessitates age-specific reference ranges. The improved prediction of future glycemic deterioration by indices based on fasting insulin beyond simple glucose measures alone could help to stratify risk characteristics of children with obesity in order to guide patient-tailored prevention and intervention approaches. German Research Foundation (DFG)-through SFB 1052, project number 209933838, subproject C5; Federal Ministry of Education and Research, Germany; European Union-European Regional Development Fund; Free State of Saxony. The German Diabetes Association, the CarbHealth consortium (01EA1908B). EU-IMI2-Consortium SOPHIA (grant agreement No 875534), German Center for Diabetes Research (DZD), grant number 82DZD14E03.

Association of serum leptin and resistin levels among obese Saudi patients with acute myocardial infarction in Asir region.

In the current scenario, the importance of cardiac biomarkers in diagnosing, assessing, and managing people with cardiovasculardiscomfort is required. This cross-sectional study examined the relationship between serum leptin and resistin levels among obese people with acute myocardial infarction (AMI) with varying body mass index (BMI). The cardio and diabetic biomarkers among the 77 Saudi patients with hypoxia who lived in the Asir region were analyzed in the study. The patients were categorized into three groups, namely, group 1 (control), group 2 (AMI with normal BMI), and group 3 (AMI with varying BMI). Our results showed a positive correlation between serum glucose, HbA1C, triglycerides, Troponin-I (cTnI), creatine kinase MB (CK-MB), leptin, and resistin in patients with AMI. We also observed significantly lower HbA1C, cholesterol, and insulin values in groups 2 and 3. A statistical difference between the groups with and without AMI and between the genders was noticed. BMI with leptin showed a positive connection in group 3 but no association was observed for groups 1 and 2. A stronger relationship between BMI and leptin levels in men in Group 3 than in women was observed. In all three groups, resistin levels did not correlate with BMI. Thus, circulating leptin concentrations do not significant impact AMI compared to participants with and without AMI. However, resistin levels were considerably higher in obese individuals with AMI. Therefore, we suggest that resistin can be used as a pro-inflammatory marker to detect AMI disorder with varying BMI and as a prognostic marker associated with AMI.

Effectiveness of Atenolol on the Basis of Pattern of Side Effects in Hypertensive Patients

Hypertension plays a significant role in changing Insulin parameter. They are taken as valid diagnostic markers in determining side effects of anti-hypertensive drugs. These parameters are grossly affected by the use of beta blockers which are used to control hypertension. Objective: To determine the effects of atenolol, a beta blocker on insulin when taking alone in hypertensive patients. Methods: A total of 80 patients participated in this study of which 43 patients were taking atenolol alone while 37 were taking atenolol in combination with other anti-hypertensive drugs and 20 healthy controls were included of all age groups population to make a comparison and to find variation in values of insulin levels, in patients experiencing hypertension. Medical efficacy was evaluated on the basis of variations in insulin levels upon use of anti-hypertensive medications. ELISA technique was used for conducting insulin levels. Results: We found significant results of insulin values because atenolol cause hyperglycemia Atenolol was non-significant in both groups of patients having low insulin levels due to use of atenolol alone or use of atenolol in combination therapy. Other anti-hypertensive drugs did not affect the insulin levels therefore variation is basically because of atenolol so the main focus of our study was atenolol. Conclusions: Atenolol prove efficacy but it also causes the disturbance in insulin levels therefore we recommend use of any other drug in conjunction with atenolol to avoid insulin variation due to atenolol. Further these results may be employed on large patient population for strengthening our evidences.

Lower adiponectin is associated with higher anthropometry and insulin resistance but not with low cardiorespiratory fitness in adolescents.

The aim of this study was to analyze the relationship between adiposity, cardiometabolic risk and cardiorespiratory fitness (CRF) according to different groups of adiponectin concentration. 255 adolescents of both sexes, aged 11-17years old, participated. Anthropometric and biochemical parameters such as body mass, height, abdominal circumference (AC), waist circumference (WC), fat mass, fat-free mass, total cholesterol (TC), high-density lipoprotein (HDL-c), low-density lipoprotein (LDL-c), triglycerides (TG), glucose, insulin, adiponectin, blood pressure, peak oxygen consumption (VO2peak) were measured. Body mass index (BMI), z-score BMI (BMI-z), triponderal mass index (TMI), waist-to-height ratio (WHtR), homeostasis model to assessment insulin resistance (HOMA-IR), and quantitative insulin sensitivity check index (QUICKI) were calculated. Adiponectin was categorized: low adiponectin concentration (LAC ≤ 5.18µg/mL-1), intermediate (IAC = 5.18 and 7.63µg/mL-1) and high (HAC ≥ 7.63µg/ml-1). LAC showed higher BMI, BMI-z and TMI than the other groups (p < 0.05) and higher AC, WC and WHtR that the HAC (p < 0.05). IAC showed lower values of TC, LDL-c and TG, and the LAC presented the highest values of insulin, HOMA-IR and QUICKI (p < 0.05) to the IAC and HAC. HAC presented the lower VO2peak than the other groups (p < 0.01). BMI, TMI, glucose, insulin, HOMA-IR showed inverse, and QUICKI a direct and weak correlation with adiponectin (p < 0.05). No significant association was found between adiponectin and VO2peak (p > 0.05). The LAC group had higher means in the anthropometric variables and the worst results related to insulin resistance and sensitivity. Thus, adiponectin may play an important role in obesity and reduced concentration may be a factor in the development of obesity-associated morbidities.

Comparison of Anterior Segment Parameters in Obese Children And Healthy Control Group

Objective:: To evaluate anterior segment parameters in obese children&#x0D; Material and methods: 55 obese and 30 control group children subjects participated. All participants and the control group were examined and anthropometric measurements were made. The measurements of fasting blood glucose(FBG), triglyceride(TG), total cholesterol (TC), high-density lipoprotein-cholesterol (HDL-C), low-density lipoprotein-cholesterol (LDL-C), and insulin values were performed. The homeostasis model assessment of insulin resistance (HOMA‑IR) was calculated. Each participant underwent a detailed ophthalmic examination and IOP, CCT, ACD and LT were measured.&#x0D; Results: The gender distribution of the groups was similar (p=0.893). The mean of CCT and LT were significantly higher in the obese group (572.9 ± 14.5 vs. 559.5 ± 10.1 µm, p=0.001; 3.6 ± 0.14 vs. 3.48 ± 0.25 mm, p=0.007) . No significant difference was found between the obese and control groups in terms of other parameters. BMI and WC had a significant negative correlation with LT control groups. The obese group showed a significant positive correlation between IOP and TG (r=0.276, p=0.042), and a significant negative correlation with HDL-C (r=-0.273, p=0.043). In the control group, there was a significant positive correlation between IOP and BMI (r=0.389, p=0.034), WC (r=0.497, p=0.005), HOMA-IR (r=0.384, p=0.036), Insulin (r=0.407, p=0.026), and a significant negative correlation with TC (r=-0.511, p=0.004). A significantly positive correlation between ACD and LDL-C (r=0.371, p=0.043) and a significantly negative correlation between HOMA-IR in the control group were detected (r=-0.682, p=0.000).&#x0D; Conclusion: The obese group had higher CCT and LT than the control groups.

198-LB: Dynamic Behavior of Healthy People with Different Numbers of Autoantibodies

Background and aims: The risk of type 1 diabetes (T1D) can be assessed by the number of islet autoantibodies (Ab), genetic, and metabolic markers to predict the progression to diabetes. Prior OGTT-based work had suggested that β cell dysfunction exists prior to T1D diagnosis. Here, we test whether the frequently sampled glucose, insulin, and C-peptide responses to a mixed meal depend on the number of Ab. Methods: Sixty healthy relatives to T1D with mean±SD age of 23.7±10.7 years, HbA1c of 5.3±0.3%, and BMI of 23.8±5.6 kg/m2 with zero (N=21), one (N=18), and ≥2 (N=21) Ab, were enrolled in an ancillary study from the NIH-funded TrialNet Pathway to Prevention study. At 08:00, the participants consumed a 6ml/kg standardized liquid mixed meal (SLMM). To estimate the SLMM glycemic and hormonal behavior, 14 blood samples were collected from -30 (relative to the SLMM ingestion) to 120 minutes for insulin, C-peptide, and glucose. Glucose-Insulin-C-peptide features were extracted from the post-SLMM period to compare the different Ab groups. Results: Among all glycemia metrics, only two were different across the Ab groups: glucose incremental AUC for the “tail” (60 min- 120 min; during the decline, after glucose reaches its peak) and glucose at 90 min with p-value 0.036, and 0.025 respectively. Regarding the insulin features after the post-SLMM; the insulin AUC for the tail, insulin at 30 min, insulin at 120 min, and the baseline insulin were different across the Ab groups (p=0.043, 0.033, 0.029, and 0.019 respectively), with higher insulin values for those with 1 Ab. As well, the C-peptide features: C-peptide at SLMM time, max C-peptide, and C-peptide at 120 min were different across the different Ab groups (p=0.019, 0.038, and 0.041 respectively), with higher C-peptide values for those with 1 Ab. Conclusion: The study suggests that the progression to T1D may be marked by detectable simultaneous changes in glycemia, insulin, and C-peptide in the very early stages of the disease even before transitioning to the first stage of T1D. Disclosure E. Montaser: None. M. D. Breton: Consultant; Dexcom, Inc., Tandem Diabetes Care, Inc., Roche Diabetes Care, Sanofi, Arecor, Research Support; Dexcom, Inc., Tandem Diabetes Care, Inc., Novo Nordisk. S. A. Brown: Research Support; Dexcom, Inc., Insulet Corporation, Tandem Diabetes Care, Inc. M. D. Deboer: Research Support; Dexcom, Inc., Tandem Diabetes Care, Inc. A. L. Mccall: None. B. Kovatchev: Other Relationship; Dexcom, Inc., Johnson &amp; Johnson Medical Devices Companies, Novo Nordisk, Sanofi, Research Support; Dexcom, Inc., Novo Nordisk, Tandem Diabetes Care, Inc., Speaker's Bureau; Tandem Diabetes Care, Inc. L. Farhy: Research Support; Dexcom, Inc., Novo Nordisk. Funding National Institute of Diabetes and Digestive and Kidney Diseases (DP3DK106907); Commonwealth Research Commercialization Fund (MF20-007-LS); The Leona M. and Harry B. Helmsley Charitable Trust (2204-05134); JDRF (2-SRA-2022-1260-S-B)

223-LB: Associations between Genetic Risk for Insulin Resistance and Measured Insulin Sensitivity Are Impacted by Race and BMI Status

African Americans (AA) are at greater risk for type 2 Diabetes (T2D) compared to European Americans (EA). This greater risk may derive in part from genetic factors. The genetic risk for insulin resistance (IR) has been linked to the failure to expand adipose tissue and is reflected in a genetic risk score (GRS) that is inversely associated with adiposity. In this study, we investigated whether associations between the GRS and measured insulin sensitivity (IS) differ by BMI status and/or race in a sample of 107 EA and AA adults without diabetes. IS was measured with the euglycemic clamp with an insulin dose of 120 µU/m²/min/kg lean body mass. In addition, surrogate indices of IS were calculated using glucose and insulin values obtained from an oral glucose tolerance test. Participants were classified as “high” or “low” BMI using the sample median (25.9 kg/m^2) as the cut-point. GRS were derived from imputed genotypes and weighted for clamp-derived IS. Multiple linear regression models were used to assess interactions between BMI status and GRS on measures of IS. Models were stratified by race and adjusted for percent body fat, sex, and age. In EA, associations of GRS with HOMA-IR and Matsuda differed by BMI status (pint=0.024 and pint=0.007, respectively), where GRS was inversely associated with IS in the high BMI group only (p=0.027 and p=0.010, respectively), suggesting that genetic risk for IR in EA is driven by greater adiposity. Conversely in AA, associations of GRS with IS from the clamp differed by BMI status (pint=0.083), but an inverse association was observed only in the low BMI group (p=0.035), suggesting that in AA, genetic risk for IR is associated with lower adiposity. Our results indicate that obesity status may differentially impact the link between genetic risk for IR and measured IS within and between races. Further, these results suggest that with a larger sample, a distinct phenotype may exist in AA where higher adiposity permits greater IS. Disclosure M. L. Yurchishin: None. L. A. Fowler: None. V. Parcha: None. P. Arora: None. W. Garvey: Advisory Panel; Boehringer-Ingelheim, Novo Nordisk, Eli Lilly and Company, Merck &amp; Co., Inc., Alnylam Pharmaceuticals, Inc., Fractyl Health, Inc. Research Support; Novo Nordisk, Eli Lilly and Company, Epitomee, Pfizer Inc. Advisory Panel; Inogen. Research Support; Neurovalens. B. Gower: Consultant; Abbott.

Effect of Manual Lymphatic Drainage on the Concentrations of Selected Adipokines, Cytokines, C-Reactive Protein and Parameters of Carbohydrate and Lipid Metabolism in Patients with Abnormal Body Mass Index: Focus on Markers of Obesity and Insulin Resistance.

The aim of the study was to assess the impact of manual lymphatic drainage (MLD) on the parameters of carbohydrate metabolism, lipid metabolism and the level of selected adipokines and cytokines in people with abnormal body mass index (BMI). In addition, an attempt was made to assess the optimal cut-off values of serum concentrations of the biochemical parameters studied in identifying the risk of obesity and insulin resistance (IR). The study included 60 subjects who underwent 10 and 30 min long MLD sessions three times a week. The study group included 15 patients with a normal body mass index (group I; n = 15), overweight patients (group II; n = 15) and obese patients (group III; n = 10). The control group was IV; n = 20 subjects not undergoing MLD. Biochemical tests were carried out on all subjects at stage 0' (before MLD therapy) and at stage 1' (one month after MLD therapy). In the control group, the time between the sample collection at stage 0' and stage 1' was the same as in the study group. Our results showed that 10 MLD sessions may have a positive effect on the selected biochemical parameters, including insulin, 2h-PG, leptin and HOMA-IR values in normal weight and overweight patients. In addition, in the study group, the highest AUCROC values in identifying the risk of obesity were found for leptin (AUCROC = 82.79%; cut-off = 17.7 ng/mL; p = 0.00004), insulin (AUCROC = 81.51%; cut-off = 9.5 µIU/mL; p = 0.00009) and C-peptide (AUCROC = 80.68%; cut-off = 2.3 ng/mL; p = 0.0001) concentrations as well as for HOMA-IR values (AUCROC = 79.97%; cut-off = 1.8; p = 0.0002). When considering the risk of IR, we observed the highest diagnostic value for insulin (AUCROC = 93.05%; cut-off = 1.8 ng/mL; p = 0.053), which was followed by C-peptide (AUCROC = 89.35%; cut-off = 17.7 ng/mL; p = 0.000001), leptin (AUCROC = 79.76%; cut-off = 17.6 ng/mL; p = 0.0002) and total cholesterol (AUCROC = 77.31%; cut-off = 198 mg/dL; p = 0.0008). Our results indicate that MLD may have a positive effect on selected biochemical parameters, including insulin, 2h-PG, leptin and HOMA-IR, in normal weight and overweight patients. In addition, we successfully established optimal cut-off values for leptin in the assessment of obesity and insulin in the assessment of insulin resistance in patients with abnormal body mass index. Based on our findings, we hypothesize that MLD, when combined with caloric restriction and physical activity, may serve as an effective preventive intervention against the development of obesity and insulin resistance.

Serum adiponectin profile in obese Bangladeshi children attending an obesity clinic

Background and objective: Childhood obesity plays major role in the pathogenesis of various cardiovascular and metabolic diseases. Serum adiponectin has been found to be associated with several cardiometabolic risk factors. The study investigated the serum adiponectin levels and its relationship with obesity and cardiometabolic risk factors in Bangladeshi obese children. Material and methods: Overweight or obese children, between 6-18 years of age, attending the obesity clinic of the Department of Endocrinology, BSMMU were enrolled. Waist circumference (WC) and blood pressure (BP) were measured and blood samples were taken for estimation of glucose, insulin, lipid profile and adiponectin. Fasting plasma glucose (FPG), serum insulin and lipid profile were estimated by automated analyzer. Insulin resistance (HOMA-IR) was calculated from fasting insulin and fasting plasma glucose values. Serum adiponectin (total) was measured by ELISA method using DRG ELISA kit, Germany. Results:A total of 78 overweight or obese children of 6-18-year of age were enrolled. The mean (±SD) age of the study population was 12.22 ± 2.56 years and the mean BMI was 28.79 ± 4.54 kg/m2. Mean (±SD) serum adiponectin was 36.93 ± 17.85 µg/ml in 78 overweight/obese children. One way ANOVA showed no significant (P= 0.582) difference of adiponectin levels among children with overweight and different grades of obesity. There was no significant correlation between adiponectin and measures of generalized (r=0.035, p=0.763) or central (r=0.098, p=0.392) obesity. Also, no significant correlation was found between serum adiponectin level and any of cardiovascular risk factors of obesity or metabolic health. Conclusion: The study showed high serum adiponectin level in obese Bangladeshi children. Also, no association was found between serum adiponectin levels with grades of obesity and cardiometabolic risk factors among obese children of Bangladesh. IMC J Med Sci. 2023; 17(2):009. DOI: https://doi.org/10.55010/imcjms.17.019 *Correspondence: Palash Chandra Sutradhar, Department of Medicine, Sir Salimullah Medical College Mitford Hospital, Kotwali, Dhaka-1000, Bangladesh. Email: palashdmc@gmail.com

Short-chain fatty acids and insulin sensitivity: a systematic review and meta-analysis.

There is substantial evidence that reduced short-chain fatty acids (SCFAs) in the gut are associated with obesity and type 2 diabetes, although findings from clinical interventions that can increase SCFAs are inconsistent. This systematic review and meta-analysis aimed to assess the effect of SCFA interventions on fasting glucose, fasting insulin, and homeostatic model assessment of insulin resistance (HOMA-IR). Relevant articles published up to July 28, 2022, were extracted from PubMed and Embase using the MeSH (Medical Subject Headings) terms of the defined keywords [(short-chain fatty acids) AND (obesity OR diabetes OR insulin sensitivity)] and their synonyms. Data analyses were performed independently by two researchers who used the Cochrane meta-analysis checklist and the PRISMA guidelines. Clinical studies and trials that measured SCFAs and reported glucose homeostasis parameters were included in the analysis. Standardized mean differences (SMDs) with 95%CIs were calculated using a random-effects model in the data extraction tool Review Manager version 5.4 (RevMan 5.4). The risk-of-bias assessment was performed following the Cochrane checklist for randomized and crossover studies. In total, 6040 nonduplicate studies were identified, 23 of which met the defined criteria, reported fasting insulin, fasting glucose, or HOMA-IR values, and reported change in SCFA concentrations post intervention. Meta-analyses of these studies indicated that fasting insulin concentrations were significantly reduced (overall effect: SMD = -0.15; 95%CI = -0.29 to -0.01, P = 0.04) in treatment groups, relative to placebo groups, at the end of the intervention. Studies with a confirmed increase in SCFAs at the end of intervention also had a significant effect on lowering fasting insulin (P = 0.008). Elevated levels of SCFAs, compared with baseline levels, were associated with beneficial effects on HOMA-IR (P < 0.00001). There was no significant change in fasting glucose concentrations. Increased postintervention levels of SCFAs are associated with lower fasting insulin concentrations, offering a beneficial effect on insulin sensitivity. PROSPERO registration number CRD42021257248.

Metabolic preconditions for the formation andprogression of steatohepatitis of alcoholic,mixed, non-alcoholic aetiology and their comorbidity withobesity and anaemic conditions

Background. The urgency of the problem of comorbidity of alcoholic steatohepatitis (ASH) and non-alcoholic steatohepatitis (NASH) with anaemic conditions and the need for their differentiated correction is determined by the significant frequency of these diseases in the world and Ukraine and the presence of the syndrome of the mutual burden. Anaemia is a marker for the progression of steatohepatitis to liver cirrhosis, in which anaemic conditions is often a manifestation of hypersplenism with the increased destruction of red blood cells in the spleen, as well as frequent complications of liver cirrhosis caused by posthemorrhagic anaemia, which occurs due to bleedings from the oesophageal and gastric varices, portal hypertension and decreased biosynthesis of coagulation factors by the liver. The purpose of the study was to find out metabolic prerequisites for the formation and progression of steatohepatitis of alcoholic, mixed and non-alcoholic aetiology and comorbid anaemic conditions. Materials and methods. One hundred and twenty-five patients with steatohepatitis of alcoholic, non-alcoholic and mixed aetiology were examined for comorbidities of anaemic conditions with lipid metabolism and glycemic regulation disorders. Results. The results of investigations demonstrate hyperlipidemia (by 1.35–1.5 times) in patients with steatohepatitis of mixed aetiology and ASH, although in anaemic conditions, the content of blood total cholesterol and low-density lipoprotein (LDL) cholesterol decreased (p&lt;0.05). Increased blood levels of triglycerides (in the range of 1.6–2.2 times) and decreased blood levels of high-density lipoprotein cholesterol (by 1.45–1.55 times) in all groups of patients with steatohepatitis and comorbidity with anaemic conditions deepened (p&lt;0.05). In NASH with anaemic conditions, there is an increase in the blood LDL cholesterol and total cholesterol levels, with the rise of the atherogenic index by 2.8 times (p&lt;0.05). Рatients with NASH and obesity have high values of glucose, insulin and degree of insulin resistance (by 2.6 times, p&lt;0.05), and with anaemic conditions, insulinemia and degree of insulin resistance are increased (by 2.9 and 3.0 times, respectively; p&lt;0.05). In patients with ASH and steatohepatitis of mixed aetiology associated with alcohol consumption, insulin deficiency is formed (by 1.4 and 1.2 times, p&lt;0.05), which develops in addition to anaemic conditions (blood insulin content is below the lower values by 1.8 and 1.6 times). Conclusions. The consequence of metabolic pathology (hyperlipidemia, hyperglycemia, insulin resistance), which developed under the comorbidity of steatohepatitis with anaemic conditions, was an increase in the degree of hepatocyte steatosis (p&lt;0.05).

Metabolic syndrome in children: risk factors, diagnostic features and treatment

Introduction: The prevalence of metabolic syndrome in children is increasing, in parallel with the increasing trends of obesity rates and his fact requires the early diagnosis of risk factors through the use of non-invasive biomarkers. Aim of the study: Estimation of risk factors contributing to the onset of metabolic syndrome in children, as well as some particularities of diagnosis and treatment. Material and methods: The results are obtained from the research project titled «Evolutionary aspects of the metabolic syndrome in children under treatment with gastrointestinal lipase inhibitors», with code 20.80009.8007.33, within the State Program 2020-2023, carried out in the scientific laboratory of pediatric cardiology of the IMSP Institute of Cardiology, Republic of Moldova. The study included 43 children aged 10-18 years (general research group), diagnosed with metabolic syndrome (MS), estimated according to the IDF 2007 criteria. The gender ratio was: 24 (55.8%) boys and 19 (44.2%) girls. The control group consisted of 50 children (normotensive and normoweight), of similar age (25 children each (50% in each age category) - 26 (52%) boys and 24 (48%) girls), without hereditary and family anamnesis aggravated by cardiovascular pathologies, obesity and type II diabetes. Depending on the treatment received in addition to the non-pharmacological treatment, the children were divided into 3 groups: group I received ACE inhibitors (angiotensin converting enzyme inhibitors), group II - gastrointestinal lipase inhibitors (orlip), group III - ACE inhibitors and gastro lipase inhibitors -intestinal (orlip). Risk factors were assessed according to a specially developed questionnaire. Serum adipokines (leptin, adiponectin) and TNF-α were evaluated by the immunoenzymatic ELISA method, hs-CRP by the latex-immunoturbidimetry method, and serum insulin by the immunochemical method with electrochemiluminescence detection (ECLIA). The study protocol was approved by the Medical Ethics Committee. Results: Most of the children were sedentary, had poor nutrition, as well as a hereditary history aggravated by hypertension and obesity. Also, in the families of these children, more harms were encountered: chronic stress (divorced parents, conflicts with parents, schoolmates, teachers, etc.), as well as exposure to passive smoking. The serum level of leptin (35,4±2,61 vs 7,9±0,23 ng/ml; p&lt;0.001), hs – CRP (3,0±0,44 vs 0,2±0,01 mg/l; p&lt;0.001), TNFα (9,1±0,43 vs 3,1±0,09 pg/ml; p&lt;0.001) was higher, and adiponectin (5,1±0,38 vs 11,0±0,33 μg/ml; p&lt;0.001) lower in children with metabolic syndrome, compared to the control group. Regardless of the medication administered, all drug combination formulas contributed to the decrease in the degree of obesity, blood pressure values, blood fat levels, as well as serum insulin values in the interval of 3 months after the initiation of the medication. Conclusion: The causes of metabolic syndrome in children are multiple and involve interactions between genetic, environmental (sedentary, high-calorie diet), hormonal and metabolic factors that ultimately lead to the appearance of the conditions that characterize this syndrome. Hypoadiponectinemia, hyperleptinemia, and increased serum PCRhs and TNFα values suggested that these adipokines/cytokines contribute to subclinical inflammation in children with MS and may also serve as biomarkers of MS. In combination with a low-calorie diet, regular exercise, and behavioral changes, treatment with gastrointestinal lipase inhibitors may help reduce the degree of obesity and hypertension, respectively.

EVALUATION OF THYROID FUNCTION MARKERS IN TYPE 2 DIABETIC PATIENTS IN RELATION TO INSULIN RESISTANCE

Diabetes mellitus (DM) and thyroid disorders are both caused by endocrine abnormalities, and both have been shown to have a reciprocal influence and frequently coexist. Hence, the current study aims to detect the thyroid functions markers among patients with Type 2 diabetes (T2DM). In this research study, 90 enrolled participants aged 40 to 60 years were taken as samples for the study. There were 66 with T2DM and 24 who were non diabetic healthy individual. All individuals were investigated in terms of age, gender, diabetes duration, glycemic control (HbA1c), fasting blood glucose (FBG), diabetic complications, Body mass index (BMI), waist circumference (WC), and family history of DM. Samples were to assess serum thyroid hormones (TSH, FT3 and FT4), HbA1c, FBG, and insulin levels. The study's findings showed higher glucose incidence, hyperinsulinemia and higher insulin resistance (IR) in diabetic patients. Additionally, it has been noted that T2DM patients have low TSH concentrations and elevated blood concentrations of FT4 and FT3 than controls. Moreover, there was a highly significant correlation between serum FT4 and FT3 with values of FBG, insulin and IR. Also, a significant association between WC with insulin and Homa – Ir was noted. In conclusion, the diabetic patients showed significant relations with thyroid functions status.

LETROZOLE COMPARED WITH CLOMPIHENE CITRATE FOR POLYCYSTIC OVARIAN SYNDROME : A SYSTEMATIC REVIEW

According to the Consensus on the Management of PCOS, polycystic ovary syndrome, is an endocrine condition that produces oligo-anovulation, clinical and biochemical symptoms of hyperandrogenism, and distinctive ovarian morphological characteristics on ultrasonographic examination. PCOS is also associated with a higher risk of endometrial cancer. Both hyperandrogenism and anovulation are difficult conditions to manage. PCOS women often have higher GnRH pulsatility, which in turn causes increased pituitary LH secretion and an elevated LH/FSH ratio. Granulosa cells are responsible for the conversion of androgens to estrogen and the maturation of follicles, while LH is responsible for promoting androgen synthesis in theca cells. Intraovarian androgens produce atresia in later antral stages, although they do boost initial follicle recruitment by increasing preantral and early antral follicle growth. In contrast to CC on its own, letrozole was shown to increase the number of live births, and the overall level of evidence was moderate. There was insufficient evidence that there was a difference in the rate of live births between CC plus metformin and CC alone, and the overall certainty of the evidence was poor due to the risk of bias and imprecision. When contrasted with the use of CC by itself, the potential benefit of CC in combination with metformin was more apparent in women whose baseline blood insulin or HOMA-IR values were higher than average. In comparison to clomiphene citrate, letrozole was related with higher rates of ovulation, pregnancy, and successful delivery of a live baby. Despite the fact that the quality of the data is inconsistent, one study recommends letrozole over clomiphene citrate as an ovulation induction medicine for women who have infertility and PCOS.

Long-term effects of GH therapy in adult patients with Prader-Willi syndrome: a longitudinal study.

Prader-Willi syndrome (PWS) is a complex disorder resulting from the failure of expression of paternal alleles in the PWS region of chromosome 15. The PWS phenotype resembles that observed in the classic non-PWS GH deficiency (GHD), including short stature, excessive fat mass, and reduced muscle mass. To date, a small number of studies on the long-term effects of GH treatment are available in adult subjects with PWS. In this longitudinal study, 12 obese subjects with PWS (GHD/non-GHD 6/6) were treated for a median of 17 years, with a median GH dose of 0.35 mg/day. The median age was 27.1 years. Anthropometric, body composition, hormonal, biochemical, and blood pressure variables were analyzed in all subjects. Waist circumference was significantly lower at the end of the treatment period (p-value=0.0449), while body mass index (BMI) did not differ significantly. Compared to the baseline, a highly significant reduction of Fat Mass % (FM%) was observed (p-value=0.0005). IGF-I SDS values significantly increased during GH therapy (p-value=0.0005). A slight impairment of glucose homeostasis was observed after GH therapy, with an increase in the median fasting glucose levels, while insulin, HOMA-IR, and HbA1c values remained unchanged. Considering GH secretory status, both subjects with and without GHD showed a significant increase in IGF-I SDS and a reduction of FM% after GH therapy (p-value= 0.0313 for all). Our results indicate that long-term GH treatment has beneficial effects on body composition and body fat distribution in adults with PWS associated with obesity. However, the increase in glucose values during GH therapy should be considered, and continuous surveillance of glucose metabolism is mandatory during long-term GH therapy, especially in subjects with obesity.