Metabolic dysfunction-associated fatty liver disease: current therapeutic strategies.

The definition of "Metabolic Associated Fatty Liver Disease - MAFLD" has replaced the previous definition of Nonalcoholic Fatty Liver Disease (NAFLD), because cardiometabolic criteria have been added for the prevention of cardiological risk in these patients. This definition leads to an in-depth study of the bidirectional relationships between hepatic steatosis, Type 2 Diabetes Mellitus (T2DM), Cardiovascular Disease (CVD) and/or their complications. Lifestyle modification, which includes correct nutrition combined with regular physical activity, represents the therapeutic cornerstone of MAFLD. When therapy is required, there is not clear accord on how to proceed in an optimal way with nutraceutical or pharmacological therapy. Numerous studies have attempted to identify nutraceuticals with a significant benefit on metabolic alterations and which contribute to the improvement of hepatic steatosis. Several evidences are supporting the use of silymarin, berberine, curcumin, Nigella sativa, Ascophyllum nodosum, and Fucus vesiculosus, vitamin E, coenzyme Q10 and Omega-3. However, more evidence regarding the long-term efficacy and safety of these compounds are required. There is numerous evidence that highlights the use of therapies such as incretins or the use of Proprotein Convertase Subtilisin/Kexin type 9 (PCSK9) inhibitors or other similar therapies which, by assisting existing therapies for pathologies such as diabetes, hypertension, insulin resistance, have given a breakthrough in prevention and the reduction of cardiometabolic risk. This review gave an overview of the current therapeutic strategies that are expected to aid in the treatment and prevention of MAFLD.

Overview of the use of antiarrhythmic drugs at a tertiary hospital in Oman

Background: Antiarrhythmic drugs are commonly used to treat arrhythmia. However, data on the usage pattern of antiarrhythmic drugs, associated side effects, and the role of clinical pharmacist interventions in the Middle East are scarce. Objective: The purpose of this study was to describe the usage pattern, side effects, and clinical pharmacist interventions of antiarrhythmic drugs at the Sultan Qaboos University Hospital (SQUH), a tertiary care hospital in Oman. Methods: This retrospective observational study included adult patients (≥18 years) who received at least one dose of antiarrhythmic drugs at SQUH between January 2020 and December 2021. Ethical approval was obtained prior to conducting the study. Results: In total, 400 patients were enrolled in this study. Their mean age was 62.5 ± 16.6 years (range:19-96), and 55.3% (221/400) were male. Atrial arrhythmias were the most commonly observed (344/400, 86.0%). Beta-blockers (337/500, 67.4%) were the most prescribed class of drugs. The most commonly prescribed drugs were bisoprolol (263/400, 65.8%), carvedilol (65/400, 16.3%), and amiodarone (59/400, 14.8%). The majority of patients (300/400, 75.0%) received monotherapy, whereas 25% (100/400) received combination therapy. A total of 109 side effects were reported in 45 patients, resulting in an incidence rate of 11.3 %, with cardiovascular side effects accounting for the majority (41/109, 37.6%) of these. Amiodarone had the highest prevalence of adverse effects (33/109, 30.3%). A total of 122 clinical pharmacist interventions were observed in 13.0 % (52/400) of patients. Beta-blockers were associated with more than half of the interventions (61/122, 50.0%). (AU)

The Role of Advanced Glycation End Products on Dyslipidemia.

Disorders of lipoprotein metabolism and glucose homeostasis are common consequences of insulin resistance and usually co-segregate in patients with metabolic syndrome and type 2 diabetes mellitus (DM). Insulin-resistant subjects are characterized by atherogenic dyslipidemia, a specific lipid pattern which includes hypertriglyceridemia, reduced high-density lipoprotein cholesterol level, and increased proportion of small, dense low-density lipoprotein (LDL). Chronic hyperglycemia favors the processes of non-enzymatic glycation, leading to the increased production of advanced glycation end products (AGEs). Apart from direct harmful effects, AGEs are also potent inducers of oxidative stress and inflammation. In addition, increased AGEs' production may induce further qualitative modifications of small, dense LDL particles, converting them to glycated LDLs. These particles are even more atherogenic and may confer an increased cardiovascular risk. In this narrative review, we summarize the available evidence of the pathophysiological role and clinical importance of circulating AGEs and glycated LDLs in patients with dyslipidemia, particularly those with DM and related complications. In addition, we discuss recent advances and the issues that should be improved regarding laboratory assessment of AGEs and glycated LDLs, as well as the possibilities for their therapeutic modulation.

The Achievement of Non-high-density Lipoprotein Cholesterol Target in Patients with Very High Atherosclerotic Cardiovascular Disease Risk Stratified by Triglyceride Levels Despite Statin-controlled Low-density Lipoprotein Cholesterol.

Objectives: We sought to estimate the percentage achievements of non-high-density lipoprotein cholesterol (non-HDL-C) target in patients with very high atheroscleroticcardiovascular diseases (ASCVD) risk stratified by triglyceride (TG) levels despite statin-controlled low-density lipoprotein cholesterol (LDL-C) in the Centralized Pan-Middle East Survey on the under treatment of hypercholesterolemia. Methods: The non-HDL-C target achievement in patients with diabetes mellites (DM) and patients with established ASCVD was defined according to European Society of Cardiology and European Atherosclerosis Society 2019 guidelines for managing dyslipidemia. Patients were stratified to controlled LDL-C defined as < 70 mg/dL (< 1.8 mmol/L) with normal TG < 150 mg/dL (< 1.7 mmol/L) and high TG between 150-400 mg/dL (1.7-4.5 mmol/L). Results: The mean age of our cohort was 58.0±11.0 years, 6.8% (n = 717) were male, 9.7% (104) were smokers, and 48.4% (n = 518) had body mass index of ≥ 30 kg/m2. Those with high TG levels male (76.5% vs. 63.8%; p < 0.001), smokers (16.1% vs. 7.7%; p < 0.001), have metabolic syndrome (77.6% vs. 17.1%; p < 0.001), and low HDL-C levels (79.2% vs. 49.4%; p < 0.001). The majority (93.9%, n = 1008) were on statins (atorvastatin and rosuvastatin) with only 2.2% (n = 24) on the combined statins plus fenofibrate/gemfibrozil. Only 27.4% (n = 294) of patients had non-HDL-C goal attainment. Goal attainment rates in patients with diabetes (3.1% vs. 34,4%; p < 0.001), coronary artery disease (CAD) (2.4% vs. 37.9%; p < 0.001), diabetes plus CAD (0% vs. 40.0%; p < 0.001), and CVD (0% vs. 30.0%; p = 0.048) were significantly lower in those with higher TG levels. Conclusions: A large proportion of statin-controlled LDL-C diabetic patients and patients with established ASCVD with high TGs did not achieve the non-HDL-C target. Our study did not demonstrate an association between ASCVD and high TG levels; and therefore, a follow-up study is highly required to assess long-term ASCVD outcomes in this cohort.

Antihypertensive Drugs and Perinatal Outcomes in Hypertensive Women Attending a Specialized Tertiary Hospital.

Objectives: We sought to identify the most commonly used antihypertensive medications in pregnant women and to determine the impact of these medications on perinatal (maternal and fetal) outcomes. Methods: The medical records of 484 hypertensive pregnant women who attended a tertiary university hospital during the study period were retrospectively evaluated for eligibility. Singleton pregnancies of women on antihypertensive medications and who delivered in the hospital were included in the study. Results: A total of 210 women (mean age of 32.4±5.6 years and mean body mass index of 34.0±8.1 kg/m2) were eligible for inclusion in the study. The most prevalent subtype of hypertension was preeclampsia (41.4%). Low birth weight (LBW), preterm delivery (PTD), intrauterine growth restriction (IUGR), small for gestational age (SGA), respiratory distress syndrome, and neonatal care unit admissions were significantly higher in women with preeclampsia than in the women with other types of hypertension. Labetalol was the most commonly prescribed antihypertensive drug. There were 101 (48.1%) women on combined therapy. LBW, PTD, IUGR, SGA, respiratory distress syndrome, absent end diastolic flow, neonatal care unit admission, preeclampsia, and high dependency unit admissions of mothers were significantly higher in the women who received combined therapy. Conclusions: Labetalol was the most commonly prescribed antihypertensive drug in this cohort, and women on combined antihypertensive medications had significantly higher maternal and fetal complications. A larger prospective study including hypertensive women with or without antihypertensive medications in more than one center is needed to evaluate the effect of these drugs on perinatal outcomes.

COVID-19 and the Clinical Phase of the Medical Doctorate Curriculum in Oman: Challenges and the way forward.

COVID-19 has gripped the world with lightning speed. Since the onset of the pandemic, activity throughout the world came to a grinding halt. However, business had to continue and people have to learn to live with the virus while the pandemic continues to rage. Medical education is no exception and may even deserve special mention, as it prepares frontline workers against the endemics of tomorrow. We discuss here the journey of medical education at the College of Medicine and Health Sciences at Sultan Qaboos University, Muscat, Oman, as the pandemic struck the world and Oman. This work suggests a roadmap for changes, discusses challenges and proposes measures to mitigate the effects of COVID-19 on medical schools.

Awareness of the Dangers of High Salt Intake among the Urban Omani Population.

OBJECTIVES: This study aimed to assess the knowledge, attitudes and practices of the general public in Oman regarding the dangers of high salt intake. METHODS: This cross-sectional questionnaire-based survey was conducted among the urban population in Oman. Individuals aged ≥18 were invited to join the study. RESULTS: A total of 1,214 respondents (mean age 34 ± 10 years) answered the questionnaire. The majority were male (65.8%), employed (69.4%) and some were hypertensive (14.3%). Most (90.9%) were aware that excess salt can cause diseases such as hypertension and that it is either somewhat important (51.2%) or very important (42.9%) to reduce salt in the diet. However, only 42.2% said that they actively try to reduce salt in their diet. CONCLUSION: Although most people in urban areas of Oman appear to be aware of the dangers of high salt intake, only a few are actively trying to reduce it. More educational activities are required to improve awareness.

Clinical and Genetic Characteristics of Familial Hypercholesterolemia at Sultan Qaboos University Hospital in Oman.

OBJECTIVES: We sought to describe the clinical and genetic characteristics of patients with familial hypercholesterolemia (FH) that presented to the lipid clinic at Sultan Qaboos University Hospital, Muscat, Oman. METHODS: Patients who presented with high low-density lipoprotein cholesterol (LDL-C) levels (> 189.0 mg/dL or 4.9 mmol/L) were recruited to the study. FH was diagnosed according to the Dutch Lipid Clinic Network criteria. Analyses were performed using univariate statistics. RESULTS: The study enrolled 450 patients with a mean age of 48.0±12.0 years, 56.0% (n = 252) were males and 11.3% (n = 51) were smokers. At admission, the proportion of 'probable/definite', 'possible', and 'unlikely' FH were 27.6% (n = 124), 70.0% (n = 315), and 2.4% (n = 11), respectively. Overall, 26.0% (n = 117) of patients had hypertension, 22.4% (n = 101) had a history of coronary artery disease, and 17.3% (n = 78) had diabetes mellitus. Those with 'probable/definite' FH were more likely to be prescribed high-intensity statin therapy (75.8% vs. 54.5%; p < 0.001) and statin ezetimibe combination (50.8% vs. 27.3%; p < 0.001) when compared to the 'unlikely' FH cohort. Additionally, those with very high atherosclerotic vascular disease (ASCVD) risk were also associated with high-intensity statin therapy (54.7% vs. 42.7%; p = 0.006) and statin ezetimibe combination (26.4% vs. 17.2%; p = 0.023). Patients with 'probable/definite' FH were less likely to achieve their LDL-C goal attainment compared to those with 'unlikely' FH (13.0% vs. 57.1%; p < 0.001). Furthermore, those with very high ASCVD risk were less likely to achieve their LDL-C goals compared to the high ASCVD risk cohort (9.6% vs. 32.0%; p < 0.001). CONCLUSIONS: FH patients are underdiagnosed, undertreated, and less likely to attain their LDL-C goals in Oman.

Systemic Oxidative Stress Is Increased in Postmenopausal Women and Independently Associates with Homocysteine Levels.

Oxidative stress plays a pivotal role in the pathogenesis of cardiovascular diseases (CVD). Postmenopausal women have an increased risk of developing CVD due to decreased estrogen availability, which is accompanied by increased oxidative stress. Serum free thiols (R-SH) provide a robust and powerful read-out of systemic oxidative stress. In this study, we aimed to establish serum levels of free thiols and explore associations between free thiols and demographic, clinical, and biochemical parameters related to obesity and the risk for developing CVD in both pre- and postmenopausal women. Serum free thiols were measured in a cohort consisting of healthy pre- (n = 223) and postmenopausal (n = 118) Omani women. Postmenopausal women had significantly lower levels of serum free thiols as compared to premenopausal women (762.9 ± 85.3 vs. 780 ± 80.9 µM, age-adjusted p < 0.001). Women's age was positively associated with serum free thiol levels in premenopausal women (ß = 0.36, p = 0.002), whereas an inverse association was observed in postmenopausal women (ß = -0.29, p = 0.002). Homocysteine levels were significantly inversely associated with serum free thiol levels in both pre- (ß = -0.19, p = 0.005) and postmenopausal (ß = -0.20, p = 0.032) women, independent from known cardiovascular risk factors. In this study, we show that postmenopausal women are affected by increased systemic oxidative stress, which independently associates with homocysteine levels.

Evaluation of Hospital Referral Notes for Pulmonary Function Tests at Tertiary Care Teaching Hospital in Oman.

OBJECTIVES: There is substantial increase in referrals for investigations at Sultan Qaboos University Hospital (SQUH). Evaluating the quality of hospital referral notes (RNs) is necessary from diagnostic, patient, and economic perspectives. RNs for pulmonary function tests (PFTs) can be considered as representative of the array of tests performed at SQUH. METHODS: This cross-sectional study evaluated the quality of RNs based on 'completeness' for all consecutive patients referred for PFTs at SQUH over six months. Evaluation included documentation of demographic features, RNs date, priority for investigation, referral reason, pulmonary and relevant medical and smoking history for spirometry RNs, and addition of hemoglobin level for full lung functions (Full-LuFs) tests. The proportion of complete RNs was determined and analyzed separately to study association of spirometry and full-LuFs tests with source and reasons for referral. RESULTS: Only 644 of 683 RNs were available for analysis. Smoking history was stated in only 3.3% of all RNs; hence, it was excluded from the analysis. RNs were complete only in 12.4% of cases for spirometry and 14.4% for full-LuFs tests. RNs for patients who primarily had pulmonary disease were proportionately incomplete than those for patients with other reasons (p < 0.050). There was no significant association between incompleteness of RNs and referral hospital (SQUH vs. non-SQUH) and SQUH inpatient or outpatient status implying that the overall proportion of completeness of RNs from all concerned referral locations was similar and low in both types of RNs. CONCLUSIONS: There is a need to improve the quality of RNs at SQUH. Referring doctors must be made aware of the importance of completeness of RNs to improve test reporting, patient management and satisfaction, and reduce financial burden on hospital exchequer.

Cardio-autonomic functions and sleep indices before and after coronary artery bypass surgery.

BACKGROUND: Earlier studies showed a short-term impairment of cardio-autonomic functions following coronary artery bypass grafting (CABG). There is a lack of consistency in the time of recovery from this impairment. Studies have attributed the post-CABG atrial fibrillation to preexisting obstructive sleep apnea (OSA) without an objective sleep assessment. The aim of this study was to evaluate the effect of CABG on cardio-autonomic and hemodynamic functions and on OSA indices in patients with ischemic heart disease (IHD). METHODS: Cardio-autonomic function using heart rate variability indices, hemodynamic parameters, and sleep studies were performed in 26 patients with stable IHD before, on day-6, and day-30 post-CABG surgery. RESULTS: The high-frequency powers of normalized R-R intervals significantly (P = 0.002) increased from the preoperative value of 46.09 to 66.52 on day-6 and remained unchanged on day-30 postsurgery. In contrary, the low-frequency powers of normalized R-R interval decreased from 53.91 to 33.48 during the same period (P = 0.002) and remained unchanged on day 30 postsurgery. Baroreceptor sensitivity, obstructive and central apnea indices, desaturation index, and lowest O2 saturation were not significantly different between preoperative, day-6, and day-30 postsurgery. CONCLUSION: Our study revealed that recovery of autonomic functions following CABG occurs as early as 30 days of postsurgery. CABG does not seem to have short-term effects on sleep study indices. However, long-term effects need further evaluation.

The Management of Dyslipidaemia in Patients with Type 2 Diabetes Mellitus Receiving Lipid-Lowering Drugs: A Sub-Analysis of the CEPHEUS Findings.

BACKGROUND: Dyslipidaemia is a risk factor for macrovascular complications in patients with type 2 diabetes mellitus (T2DM). Our aim was to assess the use of lipid lowering drugs (LLDs) in patients with T2DM and co-existing dyslipidaemia. METHOD: A multicentre, non-interventional survey conducted in 6 Middle Eastern countries (Bahrain, Oman, Qatar, United Arab Emirates, Kingdom of Saudi Arabia and Kuwait). Patients with T2DM (n = 3338) taking LLD treatment for ≥3 months with no dose change for ≥6 weeks were enrolled. RESULTS: The mean age (SD) of T2DM patients was 56.6 ±10.6 years; the majority (99%) were on statin monotherapy. Only 48% of these patients achieved their low density lipoprotein cholesterol (LDL-C) goal and 67.7% of the patients had a high cardiovascular disease (CVD) risk according to the National Cholesterol Education Program (NCEP) Adult Treatment Panel (ATP) III guidelines. Of those who achieved LDL-C goals (n=1589), approximately one-third were at very high CVD risk and the patients who had received statin monotherapy showed the highest proportion in LDL-C goal attainment, followed by those treated with fibrate monotherapy. In a multivariate logistic regression model, taking drugs daily (odds ratio, OR: 1.64, 95% CI 1.25, 2.15) and older age (OR: 1.09, 95% CI 1.01, 1.18) were significantly associated with better odds of attaining LDL-C target. In contrast, patients with higher levels of ApoA1 (OR: 0.73, 95% CI [0.67,0.79]), Metabolic Syndrome (OR: 0.64, 95% CI [0.53, 0.76]), higher CV risk (OR: 0.33, 95% CI 0.27, 0.41), those who forgot to take their medication (OR: 0.74, 95% CI 0.62,0.88) and those who stopped taking medication when cholesterol became normal (OR: 0.67, 95% CI 0.55,0.82) were significantly associated with lower odds of attaining LDL-C target. CONCLUSION: The results of this study highlight the suboptimal management of dyslipidaemia in T2DM patients at high and very high risk of CVD.

Gender Disparity in Lipid Target Achievements in High and Very High Atherosclerotic Cardiovascular Disease Risk Patients in the Arabian Gulf.

BACKGROUND: Few studies assessed gender disparity in lipid goal attainment in the Arabian Gulf. Hence, we estimated gender gaps in lipid target achievements among patients at high and very high atherosclerotic cardiovascular disease (ASCVD) risk in the Centralized Pan-Middle East Survey on the undertreatment of hypercholesterolemia (CEPHEUS). METHODS: The study (conducted between November 22, 2009 and July 7, 2010) included 4,384 patients (≥18 years) on lipid lowering drugs at high and very ASCVD risk status from outpatient clinics of 177 specialists and primary care physicians in 6 Arabian Gulf countries. RESULTS: The overall mean age was 57±11 years and 40% (n=1763) were women. Women were more likely to have diabetes mellitus (84 vs 71%; p <0.001) and metabolic syndrome (49 vs 35%; p <0.001) compared with males. Women were less likely to achieve their low-density lipoprotein cholesterol (LDLC) (28 vs 32%; p = 0.002), high-density lipoprotein cholesterol (HDL-C) (42 vs 50%; p <0.001), and apolipoprotein B (Apo B) (38 vs 42%; p = 0.015) targets compared with men. In the very high ASCVD risk cohort, women were significantly less likely to achieve their LDL-C (20 vs 30%; p <0.001), non- HDL-C (34 vs 39%; p = 0.001) and Apo B (34 vs 41%; p <0.001) therapeutic targets compared with men. CONCLUSION: Women in the Arabian Gulf were less likely to achieve their lipid targets than men. The difference was more significant in the very high ASCVD risk group.

Habitual Sleep Deprivation is Associated with Type 2 Diabetes: A Case-Control Study.

OBJECTIVES: It is suggested that a minimum of eight hours of sleep per night is needed for metabolism to work normally. The aim of the study was to determine the association of habitual sleep deprivation and type 2 diabetes mellitus (T2DM). METHODS: We conducted a case-control study comparing patients with T2DM with age and sex matched healthy controls. Standard sleep questionnaires (the Berlin and Epworth Sleepiness Scale) and a weekly diary were used by patients to self-report habitual sleep. RESULTS: A total of 172 diabetics and 188 healthy controls were enrolled in the study. There was a significant difference between T2DM and healthy controls in nocturnal sleep duration (p = 0.033). There was a significant association between nocturnal sleep duration of fewer than six hours and T2DM (χ2 = 14.0; p = 0.0001). There was no significant difference in daytime sleepiness and daytime naps between the T2DM and control groups (p = 0.452; p = 0.581, respectively). CONCLUSIONS: A nocturnal sleep duration < 6 hours is associated with T2DM.

Impact of metabolic syndrome on lipid target achievements in the Arabian Gulf: findings from the CEPHEUS study.

BACKGROUND: The aim of this study was to determine the impact of metabolic syndrome (MetS) on lipid target achievements in the Arabian Gulf. METHODS: The centralized pan-middle east survey on the undertreatment of hypercholesterolemia (CEPHEUS) included 4171 high and very high atherosclerotic cardiovascular disease (ASCVD) risk patients from six Arabian Gulf countries. Analyses were performed using univariate statistics. RESULTS: The overall mean age was 57 ± 11 years, 41 % were females and 71 % had MetS. MetS patients were less likely to attain their HDL-C (34 vs. 79 %; P < 0.001), LDL-C (27 vs. 37 %; P < 0.001), non HDL-C (35 vs. 55 %; P < 0.001) and Apo B (35 vs. 54 %; P < 0.001) compared to those without MetS. Within the MetS cohort, those with very high ASCVD risk were less likely to attain their lipid targets compared to those with high ASCVD risk [HDL-C (32 vs. 41 %; P < 0.001), LDL-C (24 vs. 43 %; P < 0.001), non HDL-C (32 vs. 51 %; P < 0.001) and Apo B (33 vs. 40 %; P = 0.001)]. In those with MetS and very high ASCVD risk status, females were less likely to attain their HDL-C (27 vs. 36 %; P < 0.001), LDL-C (19 vs. 27 %; P < 0.001) and Apo B (30 vs. 35 %; P = 0.009) compared to males. CONCLUSIONS: MetS was associated with low lipid therapeutic targets. Women and those with very high ASCVD risk were also less likely to attain their lipid targets in the Arabian Gulf.

Non-high-density lipoprotein cholesterol target achievement in patients on lipid-lowering drugs and stratified by triglyceride levels in the Arabian Gulf.

BACKGROUND: Atherogenic dyslipidemia is highly prevalent in the Arabian Gulf. Non-high-density lipoprotein cholesterol (non-HDL-C) reduction has been proposed as an additional goal to low-density lipoprotein cholesterol (LDL-C) lowering to prevent atherosclerotic cardiovascular disease (ASCVD). Data on non-HDL-C goal attainment in patients with high triglycerides (TGs) on lipid-lowering drugs (LLDs) in the region is scarce. OBJECTIVE: Evaluate non-HDL-C target attainment according to the National Lipid Association in patients on LLDs stratified by TG (<150 [1.69], 150-200 [1.69-2.26], >200 [2.26] mg/dL [mmol/L]) levels in the Arabian Gulf. METHODS: Overall, 4383 patients on LLD treatment from 6 Middle Eastern countries participating in the Centralized Pan-Middle East Survey on the Undertreatment of Hypercholesterolemia study were evaluated. Patients were classified according to TG levels and ASCVD risk. RESULTS: The overall non-HDL-C goal attainment was 41% of the subjects. Non-HDL-C goal was less likely attained in patients with high TGs (12% vs 27% vs 55%; P < .001). Very high ASCVD risk patients with high TGs attained less their non-HDL-C targets compared with those with lower TG levels (8% vs 23% vs 51%; P < .001). Similarly, high ASCVD risk patients with high TGs also failed more in attaining non-HDL-C targets compared with those with lower TGs (26% vs 42% vs 69%; P < .001). In addition, those with high TG also succeeded less in attaining LDL-C and apolipoprotein B goals (P < .001). CONCLUSIONS: A large proportion of very high and high ASCVD patients on LLDs in the Arabian Gulf are not at recommended non-HDL-C targets and hence remain at a substantial residual risk.

Nutraceuticals as Lipid-Lowering Treatment in Pregnancy and Their Effects on the Metabolic Syndrome.

Maternal nutrition and lifestyle before and during pregnancy influence both mother and offspring's health and can be correlated with the metabolic syndrome in later life. Findings from animal and human studies indicate that nutrition during pregnancy has an important role in microbiological, metabolic, physiologic and immunologic development and homeostasis. A low nutritional intake in early pregnancy may represent a risk for adverse effects during pregnancy as well as on birth outcome. It seems that dietary supplementation with probiotics in perinatal period may represent safe and practical approach in dealing with the most common adverse pregnancy outcomes such as obesity and gestational diabetes. The SPRING (Study of Probiotics in the prevention of Gestational diabetes) will give important answers about potential benefits of probiotics in pregnant women who are obese and overweight and otherwise at the high risk for complications during pregnancy. Fish oil supplementation during the last trimester of pregnancy showed no effects on plasma lipids and lipoproteins in offspring, as well as on their adiposity. The effect of hypercholesterolemia during pregnancy on both mothers and child needs to be further investigated as it could have a biological role. The guidelines for the eventual clinical approach currently do not exist. Potential benefits of nutraceuticals on several metabolic parameters have been suggested. Limited evidence does not allow to draw final conclusions on preventive health strategies and dietary patterns that should be promoted during pregnancy. Further prospective and intervention studies are needed to establish it. Healthy lifestyle and dietary advice with appropriate supplements usage should be considered.

Incretins, Pregnancy, and Gestational Diabetes.

The number of pregnant women affected by gestational diabetes mellitus (GDM) is increasing among Caucasians, and East Asians. GDM also increases the risk for later advent of type 2 diabetes mellitus (T2DM), obesity, and cardiovascular disease in both women and their offspring. The underlying mechanism of GDM is not fully elucidated. Incretins such as glucagon-like peptide 1 (GLP-1) and glucose-dependent insulinotropic peptide (GIP), have been suggested to have a role in maternal metabolism and weight as well as fetal growth. These hormones might be implicated in mechanisms that compensate for the increment in glycemia and insulin resistance seen during pregnancy, while other factors, such as heredity, environment and lifestyle, but also different race/ethnic background might also lead to the comorbid health problems. Some studies indicate that pregnancy is associated with a diminished GLP-1 response which is more prominently evident in women with GDM and normalizes after delivery. Postprandial GIP level seems to be unaffected by pregnancy, despite its increased level in GDM. On the other hand, the reduced incretin effect observed in GDM may represent a risk factor for obesity, T2DM and metabolic disorders even in the offspring of these women. Further investigations are needed to establish the exact role of incretins in pregnancy and gestational glucose intolerance.