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Background: Thyroxine (T4) and triiodothyronine are the main thyroid hormones that play an essential role in cellular metabolism, growth, and tissue development, and subclinical hypothyroidism (SCH) is often defined by a thyroid-stimulating hormone (TSH) level above the upper limit of the reference range (usually around 4.0 or 4.5 mIU/L, usually TSH level in between 4 and 10 mIU/mL) along with a normal free T4 (fT4) level. Previous studies undertaken in various parts of the world have shown food intake can influence the TSH level at different percentages and these studies speculated that if we measure TSH level 2 h after breakfast (9:00 am) compared with the fasting blood samples that is generally collected in the morning (7:00 am), the TSH level is significantly reduced by about 30%, and this significant difference created reasonable doubt in the diagnosis of SCH. Aims and Objectives: The study aimed to evaluate the difference in serum TSH, fT4, leptin, cortisol, insulin, adiponectin, and glucagon-like peptide-1 (GLP-1) between fasting and post-prandial blood samples in known subclinical hypothyroid patients. Materials and Methods: This descriptive, cross-sectional, non-interventional study was done on 50 diagnosed subclinical hypothyroid patients after screening them through the inclusion–exclusion criteria. The estimations were done by chemiluminescence immunoassay or enzyme-linked immunosorbent assay method, statistical analysis was done using Statistical Packages for the Social Sciences. Results: After analysis of blood samples, it showed that the serum TSH decreased progressively after food intake for almost 2 h, the level of decrease is statistically significant (from 7.38 ± 1.22 mIU/mL to 5.9 ± 1.03 mIU/mL) (P < 0.001). Serum fT4 level remained almost unchanged after food intake. Conclusion: As per previous and our study a possible explanation of this post-prandial fall of TSH can be that food consumption causes an alteration in circulating glucose levels, insulin, leptin, gastric inhibitory polypeptide (cholecystokinin and GLP-1), and cortisol. Growth hormone (GH) and somatostatin levels also suppress TSH secretion from the pituitary. As both over- and under-treatment with eltroxin can be detrimental for subclinical hypothyroid children and pregnant women, so further studies with larger sample sizes and somatostatin and GH estimation should be done to authenticate the findings of this study.
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Background: Diabetes mellitus (DM) is associated with decreased performance on cognitive domains. Diabetic patients have poor memory and attention. Cognitive dysfunction has emerged as significant morbidity of DM nowadays. Cognitive function can be screened rapidly by Montreal cognitive assessment test (MoCA). Aims and Objectives: The objective of this study was to study the effect of blood glucose levels and diabetic duration on MoCA score in diabetic patients. Materials and Methods: DM patients of both type 1(30) and type 2(30) from NCD clinic were selected as cases. Thirty persons with good health from master health checkup were selected as controls. Cognitive function was assessed in all the participants with MoCA after getting informed consent. Fasting and postprandial blood sugars were assessed with 2 mL of venous blood. Results: The mean MoCA score has decreased among diabetic cases than controls. Among cases, T1DM has decreased mean MoCA score than T2DM. Fasting blood sugar (FBS), post prandial blood sugar (PPBS), and diabetic duration were found to be correlated negatively with the score obtained in MoCA in controls and T1DM cases. In T2DM cases, FBS and PPBS were found to be correlated negatively with the score obtained in MoCA, but weak positive correlation was found between duration and MoCA score. Conclusion: Our study concludes an association between FBS, PPBS, and duration of diabetes with MoCA score in diabetic patients of both types. Strict glycemic control and regular screening for cognitive dysfunction can prevent dementia.
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Background: Metabolic syndrome has always been linked with obesity and a sedentary lifestyle due to induction of metabolic derangements. Orexin A and B are recently discovered hypothalamic neuropeptides. Orexin A regulates appetite, food intake, and energy expenditure. Aims and Objectives: Metabolic fuel detectors regulate energy balance at peripheral and central levels. The aim of this study is to assess association of serum orexin levels with metabolic risk markers in women of reproductive age group (RAG). Materials and Methods: The study was conducted in the campus of King George Medical University (KGMU), Uttar Pradesh, Lucknow, INDIA. One hundred and fifty apparently healthy women of RAG, that is, 20–40 years of age were randomly selected. Fasting serum orexin and serum insulin levels were measured using enzyme-linked immunosorbent assay and weight, body mass index (BMI), fasting blood glucose, lipid profile, and blood pressure were estimated in women. Results: The results show that serum orexin levels have significant positive correlation with fasting blood glucose, weight, BMI, and waist circumference along with a weak negative correlation with serum insulin level. Conclusion: In the present study, serum orexin levels significantly correlate with weight, BMI, fasting blood glucose, and weak negative correlation with serum insulin levels. Serum orexin levels did not correlate with the lipid profile of women of RAG.
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Background: Prolonged preoperative fasting may worsen postoperative outcomes. Cardiac surgery has higher perioperative risk, and longer fasting periods may be not well-tolerated. We analysed the postoperative metabolic and hemodynamic variables in patients undergoing elective coronary artery bypass grafting (CABG) according to their morning or afternoon schedule. Methods: Single-centre retrospective study at University teaching hospital (1-year data collection from electronic medical records). Using a mixed-effects linear regression model adjusted for several covariates, we compared metabolic (lactatemia, pH, and base deficit [BD]) and haemodynamic values (patients on vasoactive support, and vasoactive inotropic score [VIS]) at 7 prespecified time-points (admission to intensive care, and 1st, 3rd, 6th, 12th, 18th, and 24th postoperative hours). Results: 339 patients ( n = 176 morning, n = 163 afternoon) were included. Arterial lactatemia and BD were similar (overall P = 0.11 and P = 0.84, respectively), while pH was significantly lower in the morning group (overall P < 0.05; mean difference ?0.01). Postoperative urine output, fluid balance, mean arterial pressure, and central venous pressure were similar ( P = 0.59, P = 0.96, P = 0.58 and P = 0.53, respectively). A subgroup analysis of patients with diabetes ( n = 54 morning, n = 45 afternoon) confirmed the same findings. The VIS values and the proportion of patients on vasoactive support was higher in the morning cases at the 18th ( P = 0.002 and p=0.04, respectively) and 24th postoperative hours ( P = 0.003 and P = 0.04, respectively). Mean intensive care length of stay was 1.94 ± 1.36 days versus 2.48 ± 2.72 days for the afternoon and morning cases, respectively ( P = 0.02). Conclusions: Patients undergoing elective CABG showed similar or better metabolic and hemodynamic profiles when scheduled for afternoon surgery.
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Background: Increase in insulin resistance predisposes to cardiovascular disease. Studies from various parts of world show increase prevalence of IR in rheumatoid arthritis (RA) but there is little data from India. Aims and Objectives: To evaluate the prevalence of IR in RA and after 6 months of treatment with disease-modifying antirheumatic drugs. Materials and Methods: This hospital-based longitudinal observational study was done between July 2018 and June 2019 in the Division of Rheumatology, Department of General Medicine, S.S. Hospital, BHU, in treatment-naive RA patients with age ?18 years. Exclusion criteria were known diabetes, preexisting dyslipidemias, or any other chronic illness. Detailed history and examination were done. Fasting glucose and fasting insulin were done to calculate the homeostatic model for assessment of IR (HOMA IR). Results: The most common age group in our study was 31–40 years (38%). The mean age of onset of disease was 39.5 years. Female-to-male ratio was 5.25:1. The mean duration of illness was 3 years with baseline mean disease activity score (DAS) 28 score 6.2698 ± 1.07437. Baseline mean cholesterol level, triglyceride, high-density lipoprotein, low-density lipoprotein, and very low-density lipoprotein were 169.40 ± 33.802 mg/dL, 164.42 ± 91.585 mg/dL, 47.66 ± 11.825 mg/dL, 99.88 ± 27.059 mg/dL, and 34.42 ± 19.186 mg/dL, respectively. Baseline fasting blood glucose levels, fasting insulin levels, and HOMA IR were 99.40 ± 20.761 mg/dL, 11.84770 ± 4.351550 m IU/L,and 2.905 ± 1.2272, respectively. After treatment of 6 months, lipid profile, fasting insulin, and HOMA IR improved significantly. However, there was no significant correlation found between IR and disease activity before and after treatment. Conclusion: The patients of RA are at higher risk of IR and dyslipidemia and early diagnosis with the initiation of treatment for RA can reverse the IR in RA patients.
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Background: Vitamin D deficiency has recently been shown to play a role in insulin resistance and derangement of insulin secretion, which in turn may affect type 2 diabetes adversely. Aims and Objectives: The objective of this study was to investigate the association between vitamin D deficiency and insulin resistance in type 2 diabetic patients. Materials and Methods: A cross-sectional observational study was conducted on 100 type 2 diabetic patients aged 30–75 years, with both genders (60 male and 40 female). To analyze, the relationship between vitamin D and glycemic parameters, a Pearson correlation was performed. Results: In this present study, we found a negative significant correlation between vitamin D and fasting insulin r = ?0.33 (P < 0.001) it was also true for homeostatic model assessment-insulin resistance and fasting plasma glucose r = ?0.42, r = ?0.43 (P < 0.001), respectively. Furthermore, vitamin D was positively correlated QUICKI model in type 2 diabetes mellitus (T2DM). Conclusion: From the findings, we can conclude that vitamin D deficiency has an important role in insulin resistance hence, vitamin D supplementation could improve glycemic control in T2DM.
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Background: The aim of this study is to assess the influence of acute fasting on synaptic properties in the ventral tegmental area (VTA) with regards to the sex-dependent differences by use of male and female mice. The study aimed to unravel the intricate interplay between fasting, synaptic plasticity, and behavioural changes to enhance our understanding of the underlying mechanisms. Methods: This study carried out at a tertiary care centre, employed a 16-hour overnight fasting protocol in female rodents and male rodents to examine the effects on physiological parameters, feeding behaviour, and neuronal attributes in the VTA. Various assays, including measurements of blood glucose, ketones, corticosterone (CORT) levels, locomotor activity, and electrophysiological recordings of synaptic currents, were conducted to assess the physiological and synaptic responses to acute fasting. Results: The study found that acute fasting induced significant metabolic changes, including body mass decrease by about 10%. Altered food-seeking behaviour was evident, with male mice exhibiting a pronounced increase. Moreover, neuronal attributes in the midbrain or VTA showed gender-dependent responses: males displayed substantial 20% increase in the frequency of mEPSC onto the dopaminergic neurons in the midbrain post fasting, while females exhibited a 13% elevation in CORT levels, accompanied by a transient period of depression at stimulatory synapses onto dopaminergic neurons which was mediated by endocannabinoids. Notably, no significant changes were observed at restraining synapses in rodents of both genders. These findings highlight the nuanced influence of short-term fasting/starvation on the VTA's synaptic plasticity, emphasizing sex-specific responses and providing valuable insights into potential mechanisms influencing gender differences in neuropsychiatric conditions. Conclusions: The study reveals that acute fasting induces sex-specific synaptic changes in the VTA, shedding light on the intricate relationship between metabolism, food-seeking behaviour, and neural plasticity. These findings emphasize the importance of considering gender-specific responses in studies exploring the neurobiological effects of fasting and their relevance to mental health.
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Recent data from the 2019 Global Health Metrics report indicates a troubling trend: more than five million deaths annually can be traced back to health issues related to being overweight or obese. This comprehensive review, scrutinizes the role of intermittent fasting (IF) in improving metabolic functions and aiding in weight loss among the adult demographic. This review, built on the solid foundations of the Cochrane and PRISMA protocols, thoroughly examines a plethora of research concerning IF as a viable approach to combat adult obesity and overweight conditions. Our extensive research canvassed several academic and scientific databases such as PubMed, Embase, PsycINFO, Web of sciences, Scopus and the Cochrane Library, up until the latter part of February 2023, with no barriers on language. We identified 3241 studies, which after deduplication procedures, narrowed down to 3065. Through meticulous evaluation, we shortlisted 386 studies. Ultimately, our synthesis includes 10 research papers with contributions from India (6 studies), as well as individual studies from Pakistan, Saudi Arabia, the USA, and China, collectively observing 845 adults. Our synthesis of the selected research posits that IF provides enduring and beneficial outcomes for adults suffering from obesity and excess weight. The intervention showcases a marked improvement in managing blood glucose, lipid concentrations, insulin sensitivity, and overall cardiovascular functioning. It is also observed that integrating IF with consistent physical activity serves as an effective dual strategy for not only weight control but also for fostering an enhanced state of general health.
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RESUMEN Introducción: Las pautas internacionales sobre la práctica del ayuno previo a procedimientos invasivos generalmente ocasionan ayunos más prolongados que en los casos de pacientes internados en las Unidades de Cuidados Intensivos (UCI). Este hecho representa un alto riesgo de desnutrición y, consecuentemente, un pronóstico más negativo. El objetivo de la presente investigación fue analizar el grado de asociación entre el tiempo de ayuno previo a la traqueostomía de pacientes bajo asistencia ventilatoria mecánica (AVM) y la aparición subsecuente de neumonía. Métodos: Fue un estudio de cohorte retrospectivo que incluyó a pacientes ingresados en nuestra UCI desde el 01/10/2018 hasta el 31/08/2022, quienes habían sido sometidos a una traqueostomía. Se definieron dos cohortes caracterizadas por ayuno inferior o igual a tres horas y superior a tres horas. Se utilizó la prueba exacta de Fisher y la prueba U de Mann-Whitney para el análisis bivariado. Un valor de p < 0.05 se consideró significativo. Resultados: Se hospitalizaron 141 pacientes con traqueostomía, 9 fueron excluidos, quedando 132 pacientes. La cohorte con ayuno ≤ 3 horas estuvo compuesta por 15 pacientes y la de ayuno > 3 horas estuvo compuesta por 117; esta última presentó un ayuno promedio de 2.5 horas (RIC 2-3) y 13 días de AVM previos al procedimiento (RIC 12-18), mientras que la otra cohorte presentó un ayuno promedio de 6 horas (RIC 5-8) y 12 días de AVM previos al procedimiento (RIC 10-14.5). Al analizar la asociación entre el tipo de ayuno y la aparición de neumonía, se obtuvo un OR de 0.958 (IC del 95%: 0.32-2.87) y valor de p de 0.743. Conclusiones: No se encontraron diferencias significativas respecto al tiempo de ayuno y la aparición de neumonía, tal como se refleja en la literatura internacional.
ABSTRACT Introduction: International guidelines on aid prior to invasive procedures usually generate longer aid than in intensive care (IT) patients. This fact represents a high risk of malnutrition and, consequently, a worse prognosis. The objective of the present investigation was to analyze the degree of association between the fasting time prior to tracheostomy of patients under mechanical ventilatory assistance (MVA) and the appearance of pneumonia. Methods: Retrospective cohort study that included patients admitted to our IT from 10/01/2018 to 08/31/2022 and with a tracheostomy performed. Two cohorts were defined characterized by fasting ≤3 hours vs. >3 hours. Fisher's exact test and Mann-Whitney test were used for bivariate analysis. A p value <0.05 was shown to be significant. Results: 141 patients were hospitalized with a tracheostomy, 9 were excluded, leaving 132 patients. The cohort with fasting ≤3 hours was made up of 15 patients and the one with fasting >3 hours was made up of 117, the latter presented an average fast of 2.5 hours (IR 2-3), days of AVM prior to the procedure of 13 days (IR 12-18), while the other cohort presented an average fast of 6 hours (IR 5-8), days of AVM prior to the procedure of 12 days (IR 10-14.5). When analyzing the association between the type of fasting and the appearance of pneumonia, an OR of 0.958 (95% CI: 0.32-2.87) was obtained, p value of 0.743. Conclusions: No significant differences were found regarding fasting time and the appearance of pneumonia as referred to in the international literature.
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Las enfermedades de Alzheimer y esclerosis múltiple son neurodegenerativas, con tratamientos complejos y de costos elevados, orientados a disminuir la progresión de la sintomatología. Sin embargo, a causa de la falta de terapias adecuadas y de los posibles efectos adversos ocasionados por tratamientos de primera línea, es necesario implementar mejores abordajes terapéuticos complementarios que no produzcan mayores efectos secundarios y mejoren la sintomatología de dichas patologías. La restricción calórica y el ayuno intermitente han demostrado ser estrategias novedosas y beneficiosas en enfermedades neurodegenerativas, a través de mecanismos inmunitarios, metabólicos y fisiológicos. Con el objetivo de determinar el uso del ayuno intermitente y la restricción calórica como tratamiento coadyuvante en esclerosis múltiple y enfermedad de Alzheimer, se realizó una revisión narrativa de artículos originales en revistas científicas, en idiomas inglés y español, de 2018 a 2022. El uso de la restricción calórica y ayuno intermitente han generado cambios positivos produciendo disminución de estados proinflamatorios, estrés oxidativo y envejecimiento. Se consideran abordajes que modulan la progresión de la enfermedad y mejoran la función cognitiva por vías de señalización de monofosfato de adenosina cinasa, factor de crecimiento similar a la insulina y la enzima sirtuina, generando un efecto neuroprotector.
Alzheimer's disease and multiple sclerosis are neurodegenerative disorders with expensive and complex treatments aimed at reducing the progression of symptoms. However, due to the lack of adequate therapies and the possible adverse effects caused by first-line treatments, it's necessary to implement better complementary therapeutic approaches that do not produce major side effects and improve symptoms. Caloric restriction and intermittent fasting have been shown to be novel and beneficial strategies in neurodegenerative diseases, through immune, metabolic, and physiological mechanisms. To determine the use of intermittent fasting and caloric restriction as a new treatment in multiple sclerosis and Alzheimer's disease, a narrative review of original articles in both national and international scientific journals, in English and Spanish languages with no greater obsolescence than five years. The use of caloric restriction and intermittent fasting have generated positive changes, producing a decrease in pro-inflammatory states, oxidative stress, and aging. Approaches that modulate disease progression and improve cognitive function of adenosine monophosphate kinase, insulin-like growth factor, and sirtuin enzyme pathways are considered, generating a neuroprotective effect.
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@#Introduction: Ramadan fasting affects dietary propensity and mental health. As part of their courses, medical students encounter stressors such as examinations, college assignments, and others that can impact their mental health and contribute to conditions such as anxiety. Limited research has been conducted to date on the impact of Ramadan fasting on anxiety scores among college students. This study aimed to explore the impact of Ramadan fasting on anxiety using DASS-42 scoring system. Methods: A prospective cohort analytic study was conducted with a cross-sectional approach and a one-group pretest-posttest design. A total of 242 medical students were sampled and selected by consecutive sampling. The DASS-42 questionnaire was used to evaluate the respondents’ anxiety scores. Results: We found 99 respondents were experiencing anxiety while 143 were normal. The findings revealed that the anxiety scores fell during the pre- to post-Ramadan period for all respondents (p = 0.003), the respondents who had anxiety (p = 0,000), and the normal respondents (p = 0.001). Conclusion: The current study reports that Ramadan fasting was proven to reduce the anxiety scores of all students including those who experienced anxiety and normal subjects.
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Background Long-term exposure to ambient fine particulate matter (PM2.5) may increase the risk of diabetes, and a healthy diet can effectively control fasting blood glucose levels. However, it is unclear whether dietary factors have a moderating effect on the risk of diabetes associated with atmospheric PM2.5 exposure. Objective To investigate the association between long-term exposure to PM2.5 and diabetes in rural areas of Ningxia, and potential interaction of long-term exposure to atmospheric PM2.5 and diet on diabetes. Methods The study subjects were selected from the baseline survey data of the China Northwest Cohort-Ningxia (CNC-NX) , a natural population cohort. A total of 13917 subjects were included, excluding participants with missing covariate information. We utilized the annual average ambient PM2.5 concentration from 2014 to 2018 as the long-term exposure level. Logistic regression and multiple linear regression were employed to analyze the associations of long-term atmospheric PM2.5 exposure with diabetes and fasting blood glucose levels. Stratification by frequency of vegetable consumption, frequency of fruit consumption, and salty taste was used to examine moderating effects on the diabetes risk associated with atmospheric PM2.5 exposure. Results The mean age of the 13917 subjects was (56.8±10.0) years, and the prevalence of diabetes was 9.8%. Between 2014 and 2018, the average annual concentration of PM2.5 was (38.10±4.67) μg·m−3. The risk (OR) of diabetes was 1.018 (95%CI: 1.005, 1.032) and the fasting blood glucose was increased by 0.011 (95%CI: 0.004, 0.017) mmol·L−1 for each 1 μg·m−3 increase in PM2.5 concentration. Compared to those who consumed vegetables < 1 time per week, individuals who consume vegetables 1-3 times per week and ≥4 times per week had a reduced risk of developing diabetes by 27.1% (OR=0.729, 95%CI: 0.594, 0.893) and 16.8% (OR=0.832, 95%CI: 0.715, 0.971) respectively. Similarly, when compared to those who consumed fruits <1 time per week, individuals who consumed fruits 1-3 times per week and ≥4 times per week exhibited a reduced risk of diabetes by 16.4% (OR=0.836, 95%CI: 0.702, 0.998) and 18.2% (OR=0.818, 95%CI: 0.700, 0.959) respectively. Fasting blood glucose decreased by 0.202 (95%CI: -0.304, -0.101) mmol·L−1 in participants who ate vegetables 1-3 times per week. The effect of salty taste on diabetes and fasting blood glucose was not significant. The results of stratified analysis by dietary factors and PM2.5 concentration showed that the risks of diabetes were increased in the low PM2.5 pollution-low vegetable intake frequency group and the high PM2.5 pollution-low vegetable intake frequency group compared with the low PM2.5 pollution-high vegetable intake frequency group, with OR values of 3.987 (95%CI: 2.943, 5.371) and 1.433 (95%CI: 1.143, 1.796) respectively. The risk of diabetes was 50.1% higher in participants with high PM2.5 pollution and low fruit intake frequency than in participants with low PM2.5 pollution and high fruit intake frequency (OR=1.501, 95%CI: 1.171, 1.926). No interaction was found between salty taste and PM2.5 on diabetes. Conclusion Long-term exposure to ambient PM2.5 is associated with an increased fasting blood glucose and an elevated risk of diabetes in rural Ningxia population. Increasing the frequency of weekly consumption of vegetables or fruits may have a certain protective effect against diabetes occurrence, as well as a moderating effect on diabetes and fasting blood glucose levels associated with long-term exposure to atmospheric PM2.5.
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OBJECTIVE:To systematically evaluate the effects of high-intensity interval training(HIIT)and moderate-intensity continuous training(MICT)on body composition and glucose metabolism-related indexes in overweight or obese patients with type 2 diabetes and to compare the improvement effect of the two exercise modalities,thereby providing a reference basis for the development of exercise prescription for overweight or obese patients with type 2 diabetes. METHODS:The Cochrane Library,PubMed,EMbase,Web of Science,CNKI,CBM,WanFang,and ClinicalTrials.gov were searched for randomized controlled trials comparing the effects of HIIT and MICT interventions on body composition and glucose metabolism-related indicators in overweight or obese patients with type 2 diabetes.The search was conducted from database inception to June 2022.Meta-analysis of outcome indicators was performed using RevMan 5.4. RESULTS:(1)A total of 13 randomized controlled trials with 371 subjects were included,and the overall quality of the included studies was relatively high.(2)There was no significant difference in the improvement of body composition between HIIT and MICT[body mass:weighted mean difference(WMD)=2.44,95%confidence interval(CI):-3.01-7.89,P＞0.05;body mass index:WMD=0.28,95%CI:-1.21-1.77,P＞0.05;waist circumference:WMD=2.16,95%CI:-2.04-6.35,P＞0.05;body fat percentage:WMD=0.47,95%CI:-2.11-3.05,P＞0.05).(3)The results of subgroup analysis showed that there was a significant difference in body mass and body mass index between the"training cycle≥12 weeks"subgroup and the"training frequency≤3 times/week"subgroup(training cycle≥12 weeks subgroup:WMD=4.25,95%CI:0.90-7.59,P=0.01;WMD=2.71,95%CI:1.92-3.51,P＜0.000 01;training frequency≤3 times/week subgroup:WMD=5.14,95%CI:1.7-8.57,P=0.003;WMD=1.67,95%CI:0.66-2.67,P=0.001).(4)The results of sensitivity analysis showed that there was a significant difference in body fat percentage between the HIIT and MICT groups(WMD=2.17,95%CI:1.20-3.14,P＜0.000 1),while there was no significant difference in the improvement of glucose metabolism between the HIIT and MICT groups(fasting blood glucose:WMD=0.31,95%CI:-0.17-0.79,P＞0.05;glycosylated hemoglobin:WMD=0.01,95%CI:-0.19-0.20,P＞0.05;insulin resistance index:WMD=-0.14,95%CI:-0.71-0.42,P＞0.05).(5)The results of subgroup analysis showed that fasting blood glucose was significantly different in the subgroup of"training frequency≤3 times/week"(WMD=0.92,95%CI:0.25-1.60,P=0.007)and glycosylated hemoglobin was significantly different in the"training frequency＞3 times/week"subgroup(WMD=-0.2,95%CI:-0.3 to-0.1,P＜0.000 1). CONCLUSION:Overall,there is no significant difference between HIIT and MICT in improving body composition such as body mass,body mass index,waist circumference,body fat percentage as well as improving glucose metabolic indexes such as fasting blood glucose,glycated hemoglobin and insulin resistance index in overweight or obese patients with type 2 diabetes.When the training period is≥12 weeks and the training frequency is≤3 times/week,MICT has a better effect on the improvement of body mass as well as body mass index.
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Objective To explore the relationship between inflammatory indexes,fasting plasma glucose(FPG),blood lipid in early pregnancy(6 to 13W+6D)and gestational diabetes mellitus(GDM).Methods Ninety-eight pregnant women in early pregnancy who underwent prenatal examinations at the First Affiliated Hospital of Xinxiang Medical University from No-vember 2020 to October 2021 were selected as the research subjects.These pregnant women were divided into the GDM group(n=35)and normal glucose tolerance(NGT)group(n=63)according to the oral glucose tolerance test results in the second trimester of pregnancy(24-28W).All subjects kept fasting for at least 8 hours at 6 to 13W+6D of pregnancy,and the blood was collected from the median cubital vein on the morning of the second day,the white blood cell(WBC)count,neutrophil count(NC),lymphocyte count(LC),monocyte count(MC),FPG,and serum total cholesterol(TC),triglyceride(TG),high-density lipoprotein cholesterol(HDL-C)and low-density lipoprotein cholesterol(LDL-C)levels were measured.The differences in various indicators of pregnant women between the GDM group and NGT group were compared.The joint predictive factors for GDM was obtained by multivariable logistic regression model,and the independent risk factors of GDM were analyzed,and the efficiency of each risk factor in predicting the occurrence of GDM was evaluated by the receiver operating characteristic(ROC)curve.Results The FPG,WBC,LC,TC,TG and LDL-C levels of pregnant women in the GDM group were significantly higher than those in the NGT group in early pregnancy(P＜0.05);there was no significant difference in the NC,MC and HDL-C levels of pregnant women between the two groups(P＞0.05).Logistic regression model analysis results showed that the increase of FPG,WBC,TC and TG were independent risk factors affecting the occurrence of GDM(P＜0.05).Taking FPG=4.80 mmol·L-1,WBC=9.35 × 109 L-1,TC=4.05 mmol·L-1 and TG=1.61 mmol·L-1 as cut-off values,the area under the curve(AUC)of above indexes in predicting GDM were 0.779,0.721,0.685 and 0.762,respectively;the sensitivity was 0.886,0.514,0.857 and 0.543,respectively;the specificity was 0.587,0.857,0.524 and 0.873,respectively.The AUC of the combined prediction of FPG,WBC,TC and TG for GDM was 0.876,with a sensitivity of 0.857 and a specificity of 0.810.The AUC of the combined prediction of FPG,WBC,TC and TG for GDM was significantly higher than that of FPG,WBC,TC and TG in early pregnancy alone for GDM.Conclusion Elevated levels of FPG,WBC,TC and TG in early pregnancy(6 to 13W+6D)are independent risk factors for GDM,and they can be used as clinical indicators for the early prediction of GDM.The combination of the four indicators has better predictive value for GDM.
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Objective To investigate the impact of the interaction of fasting blood glucose(FBG)and serum uric acid(SUA)on diabetic retinopathy(DR).Methods A total of 306 diabetes mellitus(DM)patients diagnosed and re-ceived comprehensive ophthalmic examination in the First Affiliated Hospital of Gannan Medical University from January 2019 to January 2021 were selected.According to the presence or absence of DR,these patients were divided into the DR group(178 patients)and the non-DR(NDR)group(128 patients).The general clinical data of patients in the two groups were compared.The least absolute shrinkage and selection operator(LASSO)regression method and multivariate Logistic regression analysis were used to screen the independent influencing factors of DR in DM patients,and the odds ratio of risk factors was calculated.The sensitivity analysis of the results was performed using the E-value method.The interaction of FBG and SUA on DR in DM patients was analyzed by an additive interaction model.The Nomogram model to predict DR in DM patients was constructed and verified internally.The receiver operating characteristic curve(ROC)was used to evalu-ate the effects of FBG,SUA and both FBG and SUA on DR in DM patients.Results Compared with the NDR group,the course of DM in the DR group was significantly longer,the proportion of patients with history of oral medication was signif-icantly lower,the proportion of patients with history of insulin therapy was significantly higher,and the levels of total cho-lesterol,triglyceride,low-density lipoprotein cholesterol,high-density lipoprotein cholesterol,blood urea nitrogen,serum creatinine,SUA and FBG were significantly higher(all P＜0.05).The history of insulin therapy,course of DM≥9.66 years,TG≥2.07 mmol·L-1,SUA ≥ 297.73 μmol·L-1 and FBG ≥8.92 mmol·L-1 were the risk factors for DR in DM pa-tients,while the history of oral medication was the protective factor for DR in DM patients.The Nomogram model based on the above independent risk factors was accurate in predicting the occurrence of DR in DM patients.SUA and FBG had inter-active effects on DR in DM patients.The value of SUA-FBG interaction in the diagnosis of DR was greater than that of both alone.Conclusion SUA≥ 297.73 μmol·L-1 and FBG ≥8.92 mmol·L-1 are the risk factors for DR in DM patients.The value of interaction of FBG and SUA in the diagnosis of DM accompanied by DR is greater than that of both alone.
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Objective:To retrospectively analyze a pediatric case of X-linked hypophosphatemic rickets treated with Burosumab and improve clinicians′ awareness of the safety and effectiveness of the drug.Methods:Clinical data of the child were collected. Whole-exon genetic testing after parental consent confirmed X-linked hypophosphatemic rickets. During 18 months of Burosumab treatment, fasting blood phosphorus, alkaline phosphate, calcium, and calcium phosphate product were monitored every 11-14 days. Parathyroid hormone and 25 hydroxyvitamin D were checked every 2-6 weeks, while knee spacing, liver and kidney function, urinary calcium creatinine ratio, electrocardiogram were assessed every 3 months. Radiological imaging was performed every 6 months, with continuous follow-up of the child.Results:Whole-exon sequencing results showed a c. 1080_1081insCAATGTTA(p.T361Qfs*3) spontaneous heterozygous frameshift mutation in the PHEX gene in the child, which has not been reported previously. After the patient was treated with Burosumab for 18 months, the biochemical indexes were significantly improved, and the rickets score was reduced, without gingival abscess or other adverse events.Conclusion:The variant c. 1080_1081insCAATGTTA(p.T361Qfs*3) in the PHEX gene was identified as the cause of the patient′s condition. Burosumab, as a targeted therapeutic agent for X-linked hypophosphatemic rickets, showed significant treatment efficacy.
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Objective:To analyze the changes of fasting plasma glucose(FPG)level before and after menopause.Methods:Kailuan health checkup cohort was used to extract data of women aged≥18 years who participated in the first physical examination of Kailuan physical examination cohort and had menopausal age at the end of the seventh physical examination. A total of 3 749 women with 22 057 physical examination records were included in the analysis. Natural logarithmic transformation was applied to FPG, and a segmented linear mixed-effects model was used to analyze the changes in ln-transformed FPG before and after menopause. Additionally, an interaction analysis was performed to assess the multiplicative effect of baseline age and baseline body mass index(BMI)on ln-transformed FPG concerning pre- and post-menopausal periods.Results:The average age of the first physical examination for women in this study was (45.63±4.52)years, the median menopausal age was 51(50~53)years, and the median number of physical examinations was 6(5~7)times. The results of the piecewise linear mixed effect model showed that lnFPG increased from 1 year before menopause, with an average annual increase of 0.021 mmol/L, and continued to increase from menopause to 5 years after menopause, with an average annual increase of 0.007 mmol/L. LnFPG tended to be stable after 5 years of menopause. Baseline age could affect the changes of lnFPG before and after menopause, and there was a negative multiplicative interaction between baseline age ≥45 years and the time period from 6 years to 1 year before menopause( P=0.032). Women with baseline age ≥45 years had a higher average annual increase in lnFPG from 1 year before menopause to 5 years after menopause than women with baseline age <45 years( P<0.05). On lnFPG, there was a positive multiplicative interaction between baseline BMI and time segments around menopause. Compared to women with BMI <24.0 kg/m 2, obese women displayed more annual increase in lnFPG from 6 years to 1 year before menopause as well as from menopause to 5 years after menopause( P<0.05). Conclusions:Menopause has an adverse impact on FPG, with the most significant changes occurring within the period of one year before menopause and up to five years after menopause. Age and BMI significantly influence the changes in FPG before and after menopause.
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Background@#Insulinoma is one of the causes of recurrent hypoglycemia, one of the chief complaints for emergency department admission. The gold standard in diagnosing insulinoma is a 72-hour fasting test which is inconvenient and inefficient as it requires hospitalization. Research has found that measurement of insulin and C-peptide during OGTT may help diagnose insulinoma. We aimed to assess the diagnostic value of OGTT in diagnosing insulinoma.@*Methodology@#The literature search was conducted on 19 August 2022 using several databases (MEDLINE, Scopus, Embase, and ScienceDirect). All studies that measured OGTT as diagnostic tools in diagnosing insulinoma and 72-hour fasting test as reference standard were included. The quality assessment of the selected studies was based on the Centre of Evidence-Based Medicine University of Oxford and the Quality Assessment of Diagnostic Accuracy-2 tool (QUADAS-2). Analysis of the included studies was performed qualitatively. This study was registered on PROSPERO (CRD42022360205).@*Results@#A total of two case-control studies (106 patients) were included, which were at risk of bias and low concern of applicability. Both studies demonstrated that the combination of insulin and C-peptide levels measured during OGTT had high specificity, sensitivity, positive predictive value, and negative predictive value in diagnosing insulinoma compared to the reference standard. A logistic regression model of 8.305 – (0.441 × insulin 2-h/0-h) – (1.679 × C-peptide 1-h/0-h) > 0.351 has the highest diagnostic value in one study (AUC 0.97, Sensitivity 86.5%, Specificity 95.2%, PPV 94.1, NPV 88.9).@*Conclusion@#The measurement of 0-h and 2-h insulin and C-peptide levels during 2-h OGTT was found in two small case-control studies with a total of 106 patients to have good sensitivity and specificity. However, due to these limitations, future research is still needed to validate the potential use of OGTT for the diagnosis of insulinoma.
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Insulinoma , Glucose Tolerance TestABSTRACT
ABSTRACT FGF21 is a hormone produced primarily by the liver with several metabolic functions, such as induction of heat production, control of glucose homeostasis, and regulation of blood lipid levels. Due to these actions, several laboratories have developed FGF21 analogs to treat patients with metabolic disorders such as obesity and diabetes. Here, we performed a systematic review and meta-analysis of randomized controlled trials that used FGF21 analogs and analyzed metabolic outcomes. Our search yielded 236 articles, and we included eight randomized clinical trials in the meta-analysis. The use of FGF21 analogs exhibited no effect on fasting blood glucose, glycated hemoglobin, HOMA index, blood free fatty acids or systolic blood pressure. However, the treatment significantly reduced fasting insulinemia, body weight and total cholesterolemia. None of the included studies were at high risk of bias. The quality of the evidence ranged from moderate to very low, especially due to imprecision and indirection issues. These results indicate that FGF21 analogs can potentially treat metabolic syndrome. However, more clinical trials are needed to increase the quality of evidence and confirm the effects seen thus far.