Furthermore, neurotensin-deficient mice exhibited reduced intestinal fat absorption and were protected against diet-induced obesity, liver steatosis, and diabetes, despite having similar feeding ...conditions and energy expenditure compared with their wild-type littermates, which further complicates the issue (7). Furthermore, it should be taken into account that recent studies have revealed that within the gastrointestinal tract, neurotensin, peptide YY (PYY), and glucagon-like peptide-1 (GLP-1) are not only coexpressed but also cosecreted in response to a wide range of stimuli, including bile acids (9). ...neurotensin has been shown to act synergistically with GLP-1 and PYY when administered peripherally. ...it is important to recognize stimulus-dependent neurotensin and its possible lack in pathological conditions.
Background
Laparoscopic Roux-en-Y gastric bypass (LRYGB) is the most common bariatric technique. Laparoscopic sleeve gastrectomy (LSG) is a restrictive procedure; the metabolic and endocrine effects ...of which remain unknown. We compared the effects of both procedures on glucose metabolism and fasting and meal-stimulated gut hormone levels.
Methods
Seven patients were randomised to LRYGB and eight to LSG. All patients were evaluated before and at 3 and 12 months postoperatively. Plasma levels of glucose, insulin, ghrelin, leptin, peptide YY (PYY), GLP-1 and pancreatic polypeptide were measured before and after 10 and 60 min of a standard test meal ingestion.
Results
Age, body mass index and preoperative hormone levels were similar in both groups. A significant reduction of plasma glucose and insulin levels was observed after surgery. Moreover, a normalisation of homeostatic model assessment for insulin resistance value was also seen after both procedures. The fasting and postprandial leptin levels were significantly lower in the LRYGB group. LSG was followed by a significant reduction in fasting ghrelin levels. In the LRYGB group, GLP-1 levels increased significantly after the test meal.
Conclusions
LRYGB and LSG markedly improved glucose homeostasis. Only LSG decreased fasting and postprandial ghrelin levels, whereas GLP-1 and PYY levels increased similarly after both procedures.
Abstract Patients with type 1 diabetes mellitus (T1DM) traditionally had a low body mass index and microangiopathic complications were common, while macroangiopathy and the metabolic syndrome were ...exceptional. The Diabetes Control and Complications Trial, published in 1993, demonstrated that therapy aimed at maintaining HbA1c levels as close to normal as feasible reduced the incidence of microangiopathy. Since then, the use of intensive insulin therapy to optimize metabolic control became generalized. Improved glycemic control resulted in a lower incidence of microangiopathy; however, its side effects included a higher rate of severe hypoglycemia and increased weight gain. Approximately 50% of patients with T1DM are currently obese or overweight, and between 8% and 40% meet the metabolic syndrome criteria. The components of the metabolic syndrome and insulin resistance have been linked to chronic T1DM complications, and cardiovascular disease is now the leading cause of death in these patients. Therefore, new therapeutic strategies are required in T1DM subjects, not only to intensively lower glycemia, but to control all associated metabolic syndrome traits.
Statin treatment and increased diabetes risk. Possible mechanisms Climent, Elisenda; Benaiges, David; Pedro-Botet, Juan
Clinica e investigacion en arteriosclerosis : publicacion oficial de la Sociedad Espanola de Arteriosclerosis,
09/2019, Letnik:
31, Številka:
5
Journal Article
Recenzirano
Statins have been associated with an increased risk of new-onset diabetes mellitus (NODM), as confirmed in previous observational studies and meta-analyses. Controversy exists as to whether this risk ...varies depending on statin type or dose. However, there appears to be unanimity regarding the different associated factors that raise this risk. Furthermore, diverse pathophysiologic mechanisms have been described that could explain the increased risk of diabetes in patients with statin treatment. These fundamentally cause a rise in insulin resistance together with a decrease in insulin secretion. The present review aimed to describe the relationship between statin treatment and the presence of diabetes and provide an update of previous published evidence and the possible mechanisms involved.
Risk of obstetric complications increases linearly with rising maternal glycemia. Testing hemoglobin A1c (HbA1c) is an effective option to detect hyperglycemia, but its association with adverse ...pregnancy outcomes remains unclear. Emerging data sustain that an early HbA1c ≥5.9% could act as a pregnancy risk marker.
To determine, in a multiethnic cohort, whether an early ≥5.9% HbA1c could be useful to identify women without diabetes mellitus at increased pregnancy risk.
A prospective study was conducted at Hospital del Mar, Barcelona, between April 2013 and September 2015.
A total of 1631 pregnant women had an HbA1c measurement added to their first antenatal blood tests and were screened for gestational diabetes mellitus at 24 to 28 weeks' gestation.
Primary outcome was macrosomia. Secondary outcomes were preeclampsia, preterm birth, and cesarean section rate.
A total of 1228 pregnancies were included for outcome analysis. Women with HbA1c ≥5.9% (n = 48) showed a higher rate of macrosomia (16.7% vs 5.9%, P = 0.008) and a tendency toward a higher rate of preeclampsia (9.32% vs 3.9%, P = 0.092). There were no statistically significant differences in other pregnancy outcomes. After adjusting for potential confounders, an HbA1c ≥5.9% was independently associated with a 3-fold increased risk of macrosomia (95% confidence interval, 1.127 to 8.603, P = 0.028) and preeclampsia (95% confidence interval, 1.086 to 11.532, P = 0.036).
In a multiethnic population, an early HbA1c ≥5.9% measurement identifies women at high risk for poorer pregnancy outcomes independently of gestational diabetes mellitus diagnosis later in pregnancy. Further studies are required to establish cutoff points adapted to each ethnic group and to assess whether early detection and treatment are of benefit.
: Controversial results exist on mid-term effects of Roux-en-Y gastric bypass and sleeve gastrectomy on hypertension remission. The aim of the present systematic review was to study 5-year ...hypertension remission after both procedures. One-year hypertension remission and SBP and DBP pressure change at 1 and 5 years after both surgical techniques were also evaluated. We searched MEDLINE, EMBASE and The Cochrane Central Register of Controlled Trials (CENTRAL). Thirty-two articles were included (six randomized controlled trials, 18 cohort and eight case-control studies). The proportion of patients with hypertension remission was greater for those treated with gastric bypass compared with sleeve gastrectomy at 5 years (RR = 1.26, 95% CI = 1.07-1.48) and 1 year (RR = 1.14, 95% CI = 1.06-1.21). Gastric bypass and sleeve gastrectomy did not differ in terms of SBP or DBP change. Patients treated with gastric bypass present a higher hypertension remission rate at 1 and 5 years.
The recognition of atherogenesis as an active process rather than a passive cholesterol storage disease has underlined key inflammatory mechanisms. Hence, innate and adaptive immune responses play an ...important role in the onset and progression of atherosclerosis. More recently, some clinical studies were designed to address the impact of anti-inflammatory intervention strategies in reducing risk of cardiovascular disease beyond the management of classic risk factors. Therefore, we review first the pathophysiological contribution of inflammation to atherosclerosis and the effect of lipid-lowering drugs on inflammatory biomarkers. Next, we address the effect of classic anti-inflammatory drugs, pharmacological therapies targeting specific inflammatory mediators and vaccines in cardiovascular prevention.
El reconocimiento de la aterogénesis como un proceso dinámico en vez de un depósito pasivo de colesterol ha subrayado la existencia de mecanismos inflamatorios claves. Así, la respuesta inmune, tanto innata como adaptativa, desempeña un papel importante en el inicio y la progresión de la aterosclerosis. Más recientemente, algunos estudios clínicos han sido diseñados para abordar el impacto de las estrategias de intervención antiinflamatoria en la reducción del riesgo de enfermedad cardiovascular más allá del control de los factores clásicos de riesgo. Por todo ello, revisamos en primer lugar la contribución fisiopatológica de la inflamación en la aterosclerosis y el efecto del tratamiento farmacológico hipolipidemiante en los marcadores de inflamación. A continuación, abordamos el efecto de los fármacos antiinflamatorios clásicos, de los tratamientos farmacológicos dirigidos a mediadores inflamatorios específicos y de las vacunas en la prevención cardiovascular.
Stroke is the second cause of death after myocardial infarction, and the main cause of acquired disability. Patients with ischaemic stroke have a higher risk of future vascular events, including ...recurrent stroke, myocardial infarction, and death by vascular cause. The initial epidemiological studies demonstrated a weak or non-existent relationship between cholesterolaemia and stroke. Subsequently, statin intervention trials showed a reduction in the risk of recurrence of cerebrovascular events. The Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL), the first clinical trial designed to assess effects of statin therapy in secondary stroke prevention, highlighted the reduction of stroke recurrence with atorvastatin 80 mg/daily in patients with a recent ischaemic established or transient stroke, with a modest increase in the rate of haemorrhagic stroke. Successive studies have also reported the benefits of statin therapy combined with ezetimibe or PCSK9 inhibitors in primary and secondary ischaemic stroke prevention. Since 80% of recurrent cerebrovascular events could be prevented, it is considered of interest to carry out a narrative review of the benefits of lipid-lowering therapy in the secondary prevention of ischaemic cerebrovascular disease.
El accidente cerebrovascular es la segunda causa de mortalidad después del infarto de miocardio y la principal causa de discapacidad adquirida. Los pacientes con ictus isquémico tienen un elevado riesgo de posteriores episodios vasculares, incluyendo ictus recurrente, infarto de miocardio y muerte de causa vascular. Los primeros estudios epidemiológicos mostraron una relación débil o inexistente entre la colesterolemia y el ictus. Posteriormente, los estudios de intervención con estatinas revelaron una reducción del riesgo de recurrencia de episodios cerebrovasculares. El Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL), primer ensayo clínico diseñado para analizar los efectos de la terapia con estatinas en la prevención secundaria del ictus, demostró que el tratamiento con atorvastatina 80 mg/día reducía la recurrencia de ictus en pacientes con un accidente cerebrovascular isquémico reciente establecido o transitorio, con un modesto aumento en la tasa de ictus hemorrágico. Estudios posteriores han recabado los beneficios de la terapia de estatinas, con ezetimiba o inhibidores de PCSK9 tanto en la prevención primaria como secundaria del accidente cerebrovascular isquémico. Dado que el 80% de los episodios cerebrovasculares recurrentes pueden prevenirse hemos considerado de interés realizar una revisión narrativa de los beneficios de la terapia hipolipemiante en la prevención secundaria de la enfermedad cerebrovascular isquémica.
The main objective was to assess if foods fortified with phytosterols (PS), including plant sterols and plant stanols, reduce low-density lipoprotein cholesterol (LDL-C) concentrations. The secondary ...objective was to determine the impact of different factors related to PS administration.
The search was carried out in MEDLINE, EMBASE, Web of Science, Scopus and The Cochrane Central Register of Controlled Trials (CENTRAL) databases up to March 2023. The meta-analysis was registered in the PROSPERO database (CRD42021236952). From a total of 223 studies, 125 were included. On average, PS lowered LDL-C 0.55 mmol/L 95% confidence interval (CI) = 10.82–12.67, and this decrease was significantly maintained for all analysed subgroups. A greater reduction in LDL-C levels was detected in relation to a higher daily PS dosage. The food format “Bread, biscuits, cereals”, conditioned a lower decrease of 0.14 mmol/L (95%CI -8.71 to −2.16) in LDL-C levels, compared to the predominant food format group of “butter, margarine, spreads”. No significant differences were detected with the other subgroups (treatment duration, intake pattern, number of daily intakes and concomitant statin treatment).
The present meta-analysis supported that the use of PS-fortified foods had a beneficial effect on LDL-C lowering. In addition, it was observed that the factors that influence a decline LDL-C levels were PS dose as well as the food format in which they were consumed.
•Use of PS-fortified foods had a beneficial effect on LDL-C reduction, about a 0.55 mmol/L.•The factors that influence LDL-C decreasing levels were the dose of PS and the food format in which they were consumed.
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