Tag: Diabetes Mellitus

Exercise shown to curb appetite in diabetes and prediabetes patients
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In a recent study published in the journal Nutrients, researchers evaluated the effects of exercise on appetite in people with type 2 diabetes mellitus (T2DM) or prediabetes.

The global prevalence of T2DM and prediabetes has been steadily growing, with about 537 million people living with diabetes in 2021, compared to 108 million in 1980. Obesity and overweight are major risk factors for diabetes, and weight reduction reduces the risk of diabetes. Therefore, a normal body weight is essential for diabetes prevention and treatment.

Lifestyle interventions and greater physical activity are preferred options for T2DM treatment and prevention. The impact of exercise on energy balance, appetite, and body weight has been studied less in T2DM or prediabetes patients. Thus, a better understanding of the effects of exercise on appetite and its regulation in prediabetes or T2DM patients may improve existing exercise recommendations.

Study: The Influence of Acute and Chronic Exercise on Appetite and Appetite Regulation in Patients with Prediabetes or Type 2 Diabetes Mellitus—A Systematic Review. Image Credit: Benedek Alpar / Shutterstock

About the study

The present study evaluated how acute and chronic exercise affects appetite and its regulation in T2DM or prediabetes patients. Studies were eligible if they incorporated a bout of acute physical activity or physical training intervention, reported appetite sensation ratings, and compared exercise and non-exercise groups, different exercise regimes, or participants with and without T2DM or prediabetes following the same intervention.

The Cochrane Central Register of Controlled Trials (CINAHL), PubMed, and Web of Science databases were searched for studies. References from included studies were also explored to identify additional studies. Following deduplication, titles/abstracts were screened, and full texts were reviewed.

The following data were extracted: sample size, participants’ age, sex, body mass index (BMI), exercise details, dietary regimens, study duration, medications, appetite ratings, adverse events, and appetite ratings. The risk of bias was assessed using the physiotherapy evidence database scale. The team performed a narrative synthesis of the results.

Findings

Of over 4,000 records identified in database searches, seven studies were included. They were published between 2013 and 23 and included 211 participants. Of these, 183 participants were diagnosed with T2DM and 28 with prediabetes. Two studies examined the effects of chronic exercise on appetite, four evaluated acute exercise, and one investigated both. The quality of evidence for chronic and acute interventions was rated as good.

For assessments of satiety, nausea, hunger, and prospective food consumption, the directions of effects were relatively congruent in acute intervention studies. No study showed a simultaneous increase in satiety and hunger; thus, individual rating scales could be translated into a general trend of appetite. After acute endurance exercise, there was either appetite suppression or no effect for up to 180 minutes following the session.

Two studies measured appetite ratings a day after exercise, and one observed an increase in appetite. Further, two studies investigated resistance exercise; one reported an acute increase in appetite with resistance exercise, whereas the other reported suppressive effects at some time points. In addition, the former study reexamined the acute effects after 12 weeks of training; the results remained unchanged, with no chronic changes in appetite ratings.

Besides, there were no significant changes in appetite hormone levels in the two studies, albeit the feeling of fullness increased at some time points. Likewise, appetite ratings declined, or there was no change following chronic exercise. In a chronic intervention study with 108 participants, satiety increased while hunger decreased in the aerobic endurance and resistance training plus aerobic endurance exercise groups.

In the endurance training group, pre-meal satiety increased; in the combined training group, pre- and post-meal satiety increased after six months. Notably, chronic effects on appetite ratings were inconsistent with changes in appetite hormones. Two acute intervention studies compared participants with and without T2DM.

In one study, there were no differences in appetite ratings between T2DM and non-T2DM groups following exercise. In the other, there were differences in desire to eat and fullness between T2DM and non-T2DM subjects. Further, postprandial fullness declined a day after exercise only in T2DM subjects. No study explicitly reported adverse events.

Conclusions

The study observed that the effects on appetite varied in people with T2DM or prediabetes following acute exercise, whereas appetite ratings declined or were unchanged after chronic exercise. In acute intervention studies, the most consistent finding was increased perceived fullness in T2DM patients after exercise. Overall, the findings provide more evidence for the appetite-reducing effect of (chronic) exercise in prediabetes or T2DM subjects.
Journal reference:

Konitz C, Schwensfeier L, Predel HG, Brinkmann C. The Influence of Acute and Chronic Exercise on Appetite and Appetite Regulation in Patients with Prediabetes or Type 2 Diabetes Mellitus—A Systematic Review. Nutrients, 2024, DOI: 10.3390/nu16081126, https://www.mdpi.com/2072-6643/16/8/1126
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April 15, 2024
Maternal diabetes linked to a slight increase in ADHD risk in children
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In a recent study published in the journal Nature Medicine, researchers evaluated associations between maternal diabetes mellitus (MDM) and the risk of attention-deficit/hyperactivity disorder (ADHD) in the offspring.

Sixteen percent of pregnant individuals experience hyperglycemia worldwide. The prevalence of MDM has increased globally, which is associated with the advancing maternal age, the growing obesity epidemic, and improved MDM diagnostic approaches. Animal studies have shown the adverse effects of hyperglycemia in pregnancy on intrauterine oxidative stress, inflammatory response, and epigenetic mechanisms, which might lead to poor neurodevelopment in the offspring.

ADHD is a neurodevelopmental disorder characterized by impulsivity, hyperactivity, and inattentiveness. Globally, 2% to 7% of children are affected by ADHD. Besides, ADHD can have a substantial burden on families of affected individuals and society. Evidence suggests that gestational diabetes mellitus (GDM) and pre-GDM (PGDM) are associated with ADHD. A meta-analysis revealed that the offspring of diabetic mothers had a 40% increased risk of ADHD.

Study: Maternal diabetes and risk of attention-deficit/hyperactivity disorder in offspring in a multinational cohort of 3.6 million mother–child pairs. Image Credit: Pixel-Shot / Shutterstock

About the study

In the present study, researchers assessed the association between MDM and ADHD risk in the offspring. This population-based cohort study used healthcare data from New Zealand, Hong Kong, Taiwan, and Nordic countries (Iceland, Sweden, Norway, and Finland). The study included children from live births within site-specific periods. Mother-child pairs were linked using exact deterministic linkage.

Children without complete birth information, six years of follow-up, and valid linkage were excluded. Follow-up commenced at birth and continued until outcome occurrence, death, or end of study period. The primary exposure was MDM, including PGDM and GDM. MDM was stratified into (unmedicated and medicated) GDM and (types 1 and 2) PGDM.

ADHD was defined using site-specific diagnosis and medication codes. The primary analyses compared ADHD status in children born to mothers with any type of diabetes with those born to non-diabetic mothers. Sibling-matched analyses compared the ADHD status in children of the same mother but with discordant GDM status.

In secondary analyses, ADHD status was compared between children born to mothers with different subtypes of diabetes. The researchers computed hazard ratios of average treatment effect and 95% confidence intervals to examine associations between MDM status and ADHD using Cox proportional hazard regression models.

Covariates included demographic factors, socioeconomic status, birth year, multifetal pregnancies, body mass index (BMI), use of psychotropic medication, alcohol and smoking status, neurologic and psychiatric conditions, and other chronic conditions. Several sensitivity analyses were also performed to evaluate the robustness and validity of the findings.

Findings

The study included more than 3.6 million mother-child pairs. About 6.6%, 8%, 4.1%, and 13.7% of children had mothers with diabetes in the Nordic countries, Hong Kong, New Zealand, and Taiwan, respectively. ADHD risk was higher among children whose mothers had any type of diabetes than in those born to non-diabetic mothers. ADHD risk was higher in children born to mothers with PGDM, type 1 PGDM, type 2 PGDM, or GDM compared to those born to non-diabetic mothers.

Sibling-matched analyses did not find differential risks of ADHD. ADHD risk was similar among children whose mothers were diagnosed with GDM at different trimesters in Hong Kong. However, ADHD risk was the highest in children whose mothers had GDM diagnosis in the first trimester in New Zealand and Taiwan. Further, children whose mothers had GDM might have a lower ADHD risk than those born to mothers with PGDM.

ADHD risks did not differ between children born to mothers with type 1 and type 2 PGDM. Children whose mothers had GDM and received anti-diabetic medications had a similar risk of ADHD compared to those born to mothers with GDM who were unmedicated. Sensitivity analyses produced similar results as primary analyses.

Conclusions

In sum, the findings revealed that MDM, PGDM, and GDM were associated with a small/moderate risk of ADHD in the offspring. ADHD risks did not differ between siblings with discordant GDM status in pregnancy, suggesting potential confounding by unmeasured, shared familial or genetic factors. Moreover, ADHD risk estimates were smaller compared to a previous meta-analysis. Future studies should reevaluate the specific roles of hyperglycemia and genetic factors in the relationship between MDM and ADHD.
Journal reference:

Chan AYL, Gao L, Hsieh MHC, et al. Maternal diabetes and risk of attention-deficit/hyperactivity disorder in offspring in a multinational cohort of 3.6 million mother–child pairs. Nat Med, 2024, DOI: 10.1038/s41591-024-02917-8, https://www.nature.com/articles/s41591-024-02917-8
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April 10, 2024
A game-changer in preventing heart failure and sudden cardiac deaths

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In a trial-level meta-analysis published in the journal Circulation, researchers assessed the effects of sodium-glucose co-transporter 2 (SGLT2) inhibitors (SGLT2i) on major adverse cardiovascular events (MACE) across three patient populations: diabetes at high risk for atherosclerotic cardiovascular disease (ASCVD), heart failure (HF), or chronic kidney disease (CKD). They found that SGLT2i reduced the rate of MACE by 9% with a consistent effect across all patient populations and key subgroups, primarily driven by a reduction in cardiovascular (CV) death, particularly HF and sudden cardiac death.

Study: Sodium Glucose Co-transporter 2 Inhibitors and Major Adverse Cardiovascular Outcomes: A SMART-C Collaborative Meta-Analysis. Image Credit: Lightspring / Shutterstock

Background

SGLT2i have been extensively studied in large, randomized, placebo-controlled trials involving diverse populations of patients, including those with type 2 diabetes mellitus (T2DM) and ASCVD, HF, and CKD. While SGLT2i was primarily developed for diabetes, the trials have consistently shown these drugs to reduce HF and kidney-related issues, regardless of diabetes status. However, their impact on MACE remains unclear, with variations observed among trial results. Prior meta-analyses failed to assess the effects on MACE components definitively. Uncertainty persists, particularly in subgroups without ASCVD or diabetes and those with advanced chronic kidney disease stages. Therefore, using data from all significant placebo-controlled trials, researchers in the present study performed a collaborative meta-analysis to explore SGLT2i’s effects on MACE risk and its components and death subtypes across relevant patient subgroups.

About the study

The researchers conducted a collaborative trial-level meta-analysis within the SGLT2i Meta-Analysis Cardio-Renal Trialists Consortium (SMART-C). A systematic literature search was conducted, and the included studies were phase 3 placebo-controlled, double-blind, randomized trials with ≥ 1,000 participants in every arm and median follow-up of six months and above. Combination SGLT1/2 inhibitors studies were excluded.

The study included 11 randomized trials comparing SGLT2i to placebo, with 78,607 participants in total. Among them, 54.2%, 26.4%, and 19.5% of individuals participated in trials focused on diabetes at high ASCVD risk, established HF, or CKD, respectively. The mean age of participants was between 62 and 72 years. While 34.4% of them were females, 74.5% of them were white. At baseline, about 79.7% of the patients had diabetes, 36% had HF, and 37.2% had eGFR (short for estimated glomerular filtration rate) less than 60 mL/min/1.73 m². Established ASCVD was present in 58.9%, and 28.5% had prior MI.

The median follow-up duration ranged between 2.4 – 4.2 years, 1.3 – 2.2 years, and 2.0 – 2.6 years for trials focused on diabetes at high ASCVD risk, HF, and CKD, respectively. The primary outcome was the composite of 3-point MACE, including cardiovascular death, myocardial infarction (MI), and all types of stroke. The analysis also assessed the individual components of MI and stroke, including fatal and non-fatal events. Additionally, all-cause mortality (ACM) and death subtypes such as fatal MI, fatal stroke, HF death, sudden cardiac death, as well as other CV and non-CV deaths were examined. The analysis treated each outcome as a time-to-event event, and the effect estimates from each trial were derived from intention-to-treat analysis.

Trial effect estimates were meta-analyzed within primary patient groups using fixed-effects models and then combined as random effects for overall estimates. Sensitivity analysis was conducted using fixed effects. Heterogeneity was assessed using the Cochrane Q statistic and Higgins and Thompson’s I2.

Results and discussion

About 10.1% of participants experienced MACE, with 5.3% experiencing CV death, 3.6% experiencing MI, and 2.8% experiencing a stroke. SGLT2i was found to reduce the rate of MACE by 9% overall, with consistent effects across trial populations. The most evident effect was observed on CV death, with reductions in HF death and sudden cardiac death driving the reduction in CV death. There was no significant effect on MI or stroke overall. SGLT2i were also found to reduce ACM, with the most significant effects observed in CKD trials.

Patients with established ASCVD were found to have higher MACE incidence rates across all trial types. SGLT2i consistently reduced the risk of MACE and CV death regardless of established ASCVD status at baseline. Similarly, the effects remained consistent across subgroups stratified by diabetes status, prior HF, kidney function, and baseline eGFR. Stratification by albuminuria suggested a potential benefit primarily among those with ≥30 mg/g albuminuria. Across all the Kidney Disease Improving Global Outcomes (KDIGO) risk groups, the benefits for MACE and CV death were found to be consistent.

The study is limited by fewer trials in each drug in each disease state and variations in eligibility criteria, follow-up duration, and subgroup definitions across studies. These restrictions restrict robust comparisons within the SGLT2i class and lower the generalizability of findings to broader patient populations.

Conclusion

In conclusion, SGLT2i consistently lowers the risk of MACE across diverse patient populations, regardless of baseline ASCVD, diabetes, or kidney function. This benefit predominantly comes from reduced cardiovascular death, notably HF and sudden cardiac death, with no significant impact on MI or stroke overall. These findings suggest the potential utility of SGLT2i across the spectrum of cardiovascular-kidney-metabolic disease, aiding in therapeutic decision-making.

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April 9, 2024
Burdock roots outshine dandelion in antidiabetic potential study
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In a recent study published in the journal Plants, researchers from Latvia analyzed and compared the chemical compounds in the roots of dandelion (Taraxacum officinale) and burdock (Arctium lappa) for their potential antidiabetic properties. They found that while burdock exhibited higher values for total phenolic content (TPC), tannin content, and α-amylase activity compared to dandelion, dandelion had higher total polysaccharide (TP) content. In vivo studies are warranted to confirm these findings and the antidiabetic potential of these plants.

Study: Antidiabetic Properties of the Root Extracts of Dandelion (Taraxacum officinale) and Burdock (Arctium lappa). Image Credit: KatMoys / Shutterstock

Background

Type 2 diabetes mellitus (T2DM) accounts for a majority of diabetes cases globally and is associated with various risk factors, including genetic predisposition, poor diet, and lack of physical activity, leading to insulin resistance and hyperglycemia-associated complications. Given the drawbacks and expenses of conventional hypoglycemic drugs, there is a growing interest in herbal medicine for diabetes management. Preclinical studies highlight the potential of edible plants for blood sugar control and offer promising alternatives with apparent efficacy and low toxicity.

Dandelion and burdock, traditional medicinal plants belonging to the Asteraceae family, are rich in diverse phytochemicals with potential health benefits. They contain phenolic acids, coumarins, and polysaccharides, exhibiting various biological activities, suggesting their potential role in managing complex conditions like T2DM. The present study aimed to investigate the potential antidiabetic properties of chemical compounds in dandelion and burdock roots by assessing their effects on blood sugar levels and antioxidant capabilities.

About the study

Dandelion and burdock roots were collected from two distinct rural regions in Latvia and processed according to standardized methods. While dandelion roots were sourced from “Vecpiebalga” and “Kaļķis,” burdock roots were collected near “Viļani” and “Būdiņas.” The roots were washed, dried, and ground into a powder for extraction. Ethyl alcohol extracts (AE) and lyophilizate extracts (LE) were prepared from the powdered roots, and both extraction methods were analyzed comparatively. Analysis of the extracts included determination of inulin content, TPC, tannin level, and TP.

Preparation of ethyl alcohol and lyophilizate extracts.

Additionally, antioxidant activities were assessed using the DPPH (short for 2,2-diphenyl-1-picrylhydrazyl) assay, and hypoglycemic properties were assessed based on α-amylase activity. Trolox was used as a standard solution for constructing the standard curve in the antioxidant activity analysis. Half maximal inhibitory concentration (IC50) was determined for Trolox and compared with that of dandelion and burdock. Similarly, in the hypoglycemic activity analysis, acarbose was used as the standard solution.

Liquid chromatography-mass spectrometry (LC-MS) was employed for qualitative analysis of the chemical components. Statistical analysis involved means and standard errors, analysis of variance, and the Mann–Whitney U test.

Results and discussion

The results of specific color-change-based chemical tests revealed the presence of inulin and the absence of starch in burdock and dandelion roots. Significant differences were observed in TPC between alcohol-based and lyophilizate extraction methods, with burdock showing higher TPC, particularly in LE. Dandelion roots showed negligible tannin content, while burdock roots exhibited low but detectable levels, with LE showing slightly higher values. However, no significant difference was found in terms of TPC and tannin obtained from samples of the two different Latvian rural regions in the study.

Further, dandelion root extract showed higher values of TP compared to burdock root extract. No statistically significant differences were found in the TP between the two plants. Comparatively, LE exhibited significantly higher antioxidant activity compared to AE. Burdock LE outperformed Trolox, while dandelion AE showed the least favorable outcome.

None of the plant extracts matched the IC50 of acarbose, with LE of burdock showing the most favorable outcomes and the AE of dandelion demonstrating the least favorable results. LE consistently showed significantly higher values compared to AE within the same plant samples.

Diverse chemical compounds were found in root extracts, including amino acids, phenolic acids, and alkaloids, among others. Specific compounds like chlorogenic acid, phenylalanine, and valine were found in all the extracts, while others like caffeic acid and oleanolic acid were exclusive to burdock, and salicylic acid glucoside and protocatechuic acid were unique to dandelion. Burdock showed a wider array of unique compounds than dandelion, indicating its richer chemical profile.

In the future, exploring additional compounds present in the roots and replicating tests with various solvents could provide further insights. Animal and human studies would be crucial to confirm these findings and explore the potential clinical applications of these compounds.

Conclusion

In conclusion, the present study found burdock root to be better than dandelion regarding its chemical composition and potential therapeutic activity. However, more research is needed to confirm the effectiveness of the two plants individually and in combination with other drugs for managing diabetes and other chronic ailments.
Journal reference:

Antidiabetic Properties of the Root Extracts of Dandelion (Taraxacum officinale) and Burdock (Arctium lappa). Zolotova D. et al., Plants, 13(7):1021 (2024), DOI: 10.3390/plants13071021, https://www.mdpi.com/2223-7747/13/7/1021
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April 8, 2024
Exploring the role of iodine in obesity, diabetes, and other metabolic conditions

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In a recent study published in Frontiers in Nutrition, researchers reviewed recent data on the metabolic implications of iodine consumption and elucidated the underlying mechanisms.

Study: The correlation between iodine and metabolism: a review. Image Credit: Evan Lorne/Shutterstock.com

Background

Iodine is an essential nutrient that aids in producing thyroid hormones and is associated with metabolic illnesses such as diabetes, obesity, dyslipidemia, and hypertension.

However, the processes underlying these relationships are unknown. Iodine exerts immunomodulator, antioxidant, and differentiator effects in several tissues and organs, and alters the levels of thyroxine (T4) and tri-iodothyronine (T3), the primary regulators of energy metabolism.

Metabolic syndrome (MetS), which includes hypertension, abdominal obesity, hyperlipidemia, and hyperglycemia, is common globally and can lead to cardiovascular disease, malignancies, and death. Oxidative stress, chronic inflammatory diseases, and dietary changes are all risk factors for MetS.

The nutritional status of iodine may partly explain the incidence of metabolic syndrome. Further study on the relationship between iodine and metabolism will contribute to a better understanding of its role and promote an adequate and reliable iodine feeding standard.

About the study

In the present study, researchers explored the impact of iodine levels on metabolic health.

Research on the effects of iodine on metabolism

The recommended dietary allowance (RDA) of iodine ranges between 150 and 299 μg/day, with a moderately increased consumption potentially lowering the risk of prostate and breast cancer.

Cross-sectional research indicates a U-shaped association between urinary iodine concentration (UIC) and metabolic syndrome prevalence, with a low point of 300 to 499 μg/L.

In Korean postmenopausal women, consuming seaweeds and iodine showed inverse correlations with MetS incidence; however, excess seaweed intake demonstrated adverse effects among male MetS patients with TT and TG genotypes of the lipoprotein lipase gene (LPL). However, a study of school-aged children discovered associations between high UIC and MetS.

Research in China indicated central adiposity decreased when UIC levels reached ≥300 μg/L. A randomized clinical trial found that individuals who received iodine-reduced kelp tablets had a significantly lower body fat percentage.

A 28-day placebo-controlled trial discovered that fucoxanthin seaweed supplementation reduced waist circumference, fat mass, visceral fat, weight, and BMI among obese residents of Japan. However, among reproductive-age Colombian women, mUIC was shown to be positively linked with obesity.

The TIDE study demonstrated a U-shape curve for the relationship between urinary iodine concentration and diabetes prevalence, with higher UIC levels increasing the likelihood of acquiring diabetes mellitus type 2 (T2DM). Patients with diabetes mellitus have lower UIC levels than healthy individuals.

Increased iodine content in the placenta lowers gestational diabetes in pregnant women. The study also discovered a U-shaped curve in the correlation between UIC and hypertension prevalence, with individuals in iodine-excess (IE) and iodine-sufficient (IS) locations having higher blood pressure readings. Iodine deficiency is a risk factor for preeclampsia and pregnancy-related hypertension.

Research has demonstrated an inverse relationship between UIC, hyperuricemia, and gout prevalence. Longitudinal data revealed higher death rates among patients with ID (UIC <100 μg/L).

Iodine consumption can raise blood cholesterol levels in hens and cause hepatic steatosis in BaLB/c mice. In mice, higher iodine consumption enhanced lipid metabolism without affecting thyroid hormone levels or body weight.

Mechanisms underlying the metabolic effects of iodine

Iodine exerts antioxidative, antimicrobial, immunomodulatory, and molecular regulatory effects. Iodine alters the proportion of pathogenic and beneficial bacteria to restore the gut microbiome and reduce insulin resistance, obesity, and metabolic syndrome parameters.

Iodine also reduces inflammation by lowering oxidative and endoplasmic reticulum stress caused by free radicals such as reactive oxygen species (ROS).

Iodine acts on the Kelch-like ECH-associated protein 1-NF-E2-related factor 2 (KEAP1-NRF2) pathway to enhance the activities of antioxidant enzymes such as superoxide dismutase (SOD), catalase (Cat), and glutathione peroxidase (GSH-Px).

In addition, iodine alters inducible nitric oxide synthase (iNOS) and cyclooxygenase-2 (COX2) levels, regulating mitogen-activated protein kinase (MAPK) and nuclear factor kappa B (NF-κB) pathways to reduce chronic inflammation and improve metabolic health.

The mineral acts on type 2 deiodinase (D2) receptors that convert T4 to biologically active T3 to improve weight management and adaptive thermogenesis.

Iodine also interacts with peroxisome proliferator-activated receptor-γ (PPARγ) receptors to enhance adipocyte differentiation, fatty acid uptake, and glucose metabolism by improving insulin sensitivity.

Conclusions

Overall, the review findings indicate that iodine impacts obesity, lipid metabolism, and glucose metabolism. Iodine’s antioxidant, immunomodulatory, gut-restoring, and antimicrobial effects explain the mineral’s effects.

Iodine regulates the oxidative state related to variations in insulin sensitivity or metabolism. However, iodine shortages and persistent iodine excesses may increase the risk of thyroid diseases.

Thus, it is critical to maintain iodine levels in an appropriate range at a population level. Future prospective studies and mechanism research must develop an evidence-backed and safe iodine nutrition standard.

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March 21, 2024
Shared eating habits of couples impact pregnancy weight gain, study suggests
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In a recent article published in the journal Nutrients, researchers assessed how gestational weight gain (GWG) is associated with the eating behaviors of pregnant people and their non-pregnant partners through a cohort study in the United States.

Their results indicate that poor cognitive restraint was associated with higher GWG, suggesting that restrained eating by couples could reduce GWG and, therefore, the risk of infant macrosomia, cesarean section, pre-eclampsia, and gestational diabetes mellitus (GDM).

Study: Healthful Eating Behaviors among Couples Contribute to Lower Gestational Weight Gain. Image Credit: El Nariz / Shutterstock

Background

Excess GWG is associated with increased risks of infant macrosomia, pre-eclampsia, cesarean section, and GDM. It is also associated with pre-gravid body mass index (BMI), and diet-centric interventions during pregnancy are effective in reducing GWG.

Though pregnancy is often associated with eating and snacking more, less is known about what eating behaviors may contribute to excess GWG. The influence of the eating habits of the non-pregnant partner has also not been studied.

About the study

In this study, researchers theorized that the non-pregnant partner can influence household food consumption and encourage healthy eating attitudes and food habits during pregnancy.

They hypothesized that the couple’s behaviors would be most strongly linked with GWG, followed by the pregnant person’s behaviors alone. They expected to see the weakest association between the non-pregnant person’s behaviors and GWG.

Pregnant people included in the study had a BMI between 18.5 and 35, were over 21 years old, had only one other child, and were either planning their pregnancy or had a gestational age of under 10 weeks.

People receiving fertility treatments, with existing medical conditions, taking medications such as insulin, which could influence fetal growth, drinking alcohol, or smoking during pregnancy were excluded.

Demographic factors such as marital status, age, ethnicity and race, individual income, and educational attainment were included. The pregnant person’s weight and GWG were measured during the first and third trimesters, while the partner’s weight was measured once. Weight and height were used to calculate the BMI, while GWG was classified as normal, overweight, or obese.

An eating inventory was used to assess eating behaviors and attitudes, such as perceived hunger, dietary disinhibition, and cognitive restraint. A higher score for each of these components indicated poorer eating behavior. A couple’s score was calculated as the average of the two individual scores.

The perceived hunger component scored between 0 and 14, assesses how susceptible an individual is to feelings of hunger, while dietary disinhibition (0-18) evaluates the tendency to overeat palatable foods. The cognitive restraint component (0-21) examines an individual’s ability to restrict their food intake for weight maintenance.

During data analysis, adjusted general linear models were used to examine statistical associations and odds ratios were calculated.

Findings

The study included 218 pregnant persons (average age 30.3) and 157 non-pregnant partners (average age 31.4). The average BMI for pregnant persons was 26.1, while the partners had an average BMI of 28.5. Non-pregnant partners were more likely to be obese, earn more than USD 40,000, and be at least college graduates.

For the entire cohort, the mean GWG was 11.8 kg, and nearly half showed excess GWG. Only one in three pregnant people with normal weight experienced excess GWG compared to 63% of overweight people and 52.2% of obese people.

Nearly 57%, 86%, and 89% of pregnant participants received low scores on the cognitive restraint, dietary disinhibition, and perceived hunger components, respectively. People with normal weight were more likely to receive low scores. Non-pregnant partners received, on average, lower scores than their partners, indicating healthier eating habits.

Results from the unadjusted models showed that higher scores for each of the components were associated with higher GWG. The association remained significant for the cognitive restraint score after adjusting for BMI during early pregnancy and demographic factors.

There were no significant associations between the non-pregnant partner’s scores and GWG. However, there was a significant positive association between a couple’s score for cognitive restraint and GWG. Specifically, if cognitive restraint increased by one unit, GWG increased, on average, by 0.23 kg; this finding persisted after adjusting for BMI and demographic factors.

Conclusions

Findings from this study indicate that cohesive partnerships can foster better eating behaviors and lead to optimal GWG. The implication is that involving both partners in dietary interventions could lead to better outcomes than if the pregnant person alone is targeted.

One limitation of this study is that it did not assess dietary or energy intake, which could be predicted by eating behavior. Sleep and physical activity, which may both contribute to GWG, were also not accounted for in this analysis.
Journal reference:

Healthful eating behaviors among couples contribute to lower gestational weight gain. Sparks, J.R., Redman, L.M., Drews, K.L., Sims, C.R., Krukowski, R.A., Andres, A. Nutrients (2024). DOI: 10.3390/nu16060822, https://www.mdpi.com/2072-6643/16/6/822
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March 15, 2024
Mediterranean diet’s aromatic herbs lower blood sugar
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In a recent study published in the journal Nutrients, researchers from Spain investigated the influence of aromatic herbs and spices in the Mediterranean diet (MedDiet) on the glycemic profiles of patients with type 2 diabetes mellitus (T2DM). They found that black cumin, cinnamon, ginger, curcumin, and saffron significantly lowered fasting blood glucose levels. Further, they found that black cumin and ginger significantly improved glycated hemoglobin (HbA1c) levels in T2DM patients, while cinnamon and ginger significantly lowered insulin concentration.

Review: Changes in food preferences and ingestive behaviors after glucagon-like peptide-1 analog treatment: techniques and opportunities. Image Credit: aboikis / Shutterstock

Background

T2DM is a critical healthcare concern, affecting 460 million people globally. Its prevalence has surged in the past four decades, contributing to three or more comorbidities in 60% of patients ten years after diagnosis and causing 6.7 million annual deaths. Various risk factors, including genetics, metabolism, and the environment, influence the disease. While non-modifiable factors like ethnicity and family history play a role, addressing the modifiable risk factors such as lack of physical activity, obesity, and an unhealthy diet can potentially prevent T2DM. Dietary guidance is essential for improving patients’ lifespan and quality of life.

MedDiet emphasizes high consumption of extra-virgin olive oil, low-glycemic-index carbohydrates, and moderate fish, poultry, and dairy intake. Additionally, it limits the intake of red meat and alcohol. Evidence suggests that MedDiet can positively impact metabolic syndrome and T2DM, as demonstrated by lowered diabetes risk and improved glycemic profiles. The diet incorporates various aromatic herbs and spices, such as black cumin, clove, parsley, saffron, thyme, ginger, black pepper, rosemary, turmeric, basil, oregano, and cinnamon, known for potential health benefits, including antitumor, antioxidative, anti-inflammatory, and cholesterol-lowering properties. Therefore, researchers in the present study aimed to examine the effect of all these aromatic spices and herbs on the glycemic profiles of T2DM subjects.

About the study

For the present systematic review and meta-analysis, databases including Web of Science, PubMed, and Scopus to identify peer-reviewed articles and interventional studies. Case studies, commentaries, letters, conference papers, narrative reviews, and studies not conducted in humans or those involving children were excluded. The systematic review included 77 studies, while the meta-analysis included 45 studies (3050 participants).

The studies involved varying dosages of the spices and herbs and assessed their effect on glycemic profiles. The primary outcomes included fasting glucose, insulin, and HbA1c alterations, while secondary outcomes included variations in body weight and body mass index (BMI). Statistical analysis involved the determination of changes in means and standard deviation and the use of Cochrane Q and Higgins I² tests. The risk of publication bias was assessed using Egger plots. The quality of the included trials was assessed using the methodology described by Kmet et al.

Results and discussion

Cinnamon supplementation significantly reduced fasting glucose in six out of eleven studies. The meta-analysis indicated a reduction of 18.67 mg/dL compared to placebo, but the difference was not statistically significant in considering predictive value. Curcumin supplementation in seven studies showed a significant reduction in fasting glucose (p < 0.001) compared to placebo, with a significant difference including predictive value. Ginger supplementation in ten studies demonstrated a reduction in fasting glucose (17.12 mg/dL, p = 0.0004) compared to placebo, with no significant difference, including predictive value. Black cumin supplementation in eight studies resulted in a significant reduction in fasting glucose (p = 0.0001) compared to placebo, with no significant difference in considering predictive value. Using saffron supplementation resulted in substantially lowering glucose, an effect more pronounced when combined with physical activity. Overall, black cumin demonstrated the most substantial reduction in fasting glucose, followed by cinnamon and ginger.

Further, only ginger and black cumin exhibited a significant improvement in HbA1c, and cinnamon and ginger significantly decreased insulin levels. Among the analyzed aromatic herbs and spices in the MedDiet, ginger stood out as the sole contributor to significant decreases in all three examined outcomes: HbA1c, fasting glucose, and insulin level.

The quality of studies selected for the review (mean score 0.54) was lower than the quality of studies selected for the meta-analysis (mean score 0.68). Despite the large scale of the study, the findings are limited by the lack of consideration of body weight and lifestyle changes affecting fasting glucose levels, alongside challenges posed by varying study quality, inadequate statistical analyses, and the absence of standardized herb dosage information.

Conclusion

In conclusion, the present study could identify the potential therapeutic benefits of various aromatic herbs and spices in MedDiet for diabetes management. Further research is needed to determine optimal dosages and assess the impact of active components of the herbs and spices, facilitating their application in targeted interventions for glycemic control in T2DM patients.
Journal reference:

Effect of Aromatic Herbs and Spices Present in the Mediterranean Diet on the Glycemic Profile in Type 2 Diabetes Subjects: A Systematic Review and Meta-Analysis. Garza MC et al., Nutrients, 16(6):756 (2024), DOI: 10.3390/nu16060756, https://www.mdpi.com/2072-6643/16/6/756
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March 11, 2024
Pregnant women with autoimmune conditions at a greater risk of developing adverse pregnancy outcomes, study suggests

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In a recent review published in BMC Medicine, researchers analyzed systematic reviews conducted on the association between autoimmune diseases and pregnancy outcomes.

Study: Autoimmune diseases and adverse pregnancy outcomes: an umbrella review. Image Credit: Africa Studio/Shutterstock.com

Background

Autoimmune diseases, particularly in women, have been associated with poor pregnancy outcomes as a result of environmental variables such as lifestyle changes, dietary changes, and exposure to certain infections and medicines. The unfavorable pregnancy outcomes associated with certain autoimmune disorders might improve, worsen, or remain constant during pregnancy.

Autoimmune diseases can complicate pregnancy by enabling antibodies generated by the mother to infiltrate the fetal system, affecting the development of the fetal heart. Clinical management of autoimmune pregnancies necessitates multidisciplinary care and an appreciation of the risk of adverse pregnancy outcomes.

About the review

In the present review, researchers analyzed the impact of autoimmune disease prevalence on pregnancy outcomes, using systematic reviews to identify the strength and precision of these associations.

The team searched the Cochrane Medline and Embase databases from inception through December 15, 2023, without language restrictions for systematic reviews evaluating the association between autoimmune disorders and pregnancy outcomes. They excluded systematic reviews, including those involving women conceiving through assisted reproduction therapy and those evaluating the relationship between drugs for autoimmune diseases and pregnancy outcomes. They also excluded literature reviews, scoping reviews, conference abstracts, and protocols.

The researchers used the Joanna Briggs Institute (JBI) framework, following the Preferred Reporting Items for Overviews of Reviews (PRIOR) checklist. Two researchers independently performed data screening and extraction and appraised the identified records using the Assessment of Multiple Systematic Reviews Version 2 (AMSTAR 2) tool, consulting a third researcher to resolve discrepancies.

The team evaluated systematic review quality using the Newcastle-Ottawa scale (NOS). They synthesized data quantitatively to estimate relative risks (RRs) and odds ratios (ORs) and performed random effect modeling for meta-analysis to obtain pooled effect estimates.

Autoimmune disorders included celiac disease, inflammatory bowel disease (IBD), including ulcerative colitis and Crohn’s disease, psoriatic disorders (psoriasis and psoriatic arthritis), Sjögren’s syndrome, rheumatoid arthritis, systemic sclerosis, systemic lupus erythematosus (SLE), thyroid autoimmunity (Hashimoto’s thyroiditis and Grave’s disease), vitiligo, and type 1 diabetes mellitus (T1DM).

Results

Initially, the team identified 2,743 records, of which 2,351 underwent title-abstract screening and 92 underwent full-text screening after duplicate removal. As a result, they analyzed 32 records, including 709 primary studies, most of which were of moderate-high quality. They found a significant ectopic pregnancy risk among IBD patients (OR, 1.3), with similar risks for ulcerative colitis and Crohn’s disease.

The team found increased miscarriage risk among females with systemic lupus erythematosus (OR, 4.9) and Sjögren’s syndrome (RR, 8.9), with the risk being higher (OR, 2.8) in the case of thyroid autoimmune conditions. Miscarriage risk was also significantly higher among women with celiac disease, rheumatoid arthritis, systemic sclerosis, and psoriasis, with OR values of 1.4, 1.3, 1.6, and 1.1, respectively. Female celiac disease patients had a significantly higher risk of recurrent gestational losses (OR, 5.8), exacerbated in thyroid autoimmunity presence (OR, 1.9).

Gestational hypertension odds were higher among females with T1DM, psoriasis, and psoriatic arthritis, with OR values of 2.7, 1.3, and 1.5, respectively, enhanced by thyroid autoimmunity (OR, 1.3). The team found higher pre-eclampsia prevalence among females with type 1 diabetes mellitus (OR, 4.2), systemic lupus erythematosus (OR, 3.2), and systemic sclerosis or scleroderma (OR, 2.2). Women with IBD were at an increased risk of gestational diabetes (OR, 3.0). Cesarean section delivery was associated with T1DM (OR, 4.0) and SLE (OR, 2.1). Women with thyroid autoimmune disorders had higher odds of postpartum depression (OR, 2.0).

Women with systemic sclerosis and celiac disease were at a higher risk of intrauterine growth restriction (IUGR), with OR values of 3.2 and 1.7, respectively. The OR values for small for gestational age (SGA) babies were 2.5 for SLE, 1.5 for rheumatoid arthritis, and 0.7 for T1DM patients. The OR values for stillbirth among women with SLE, T1DM, rheumatoid arthritis, celiac disease, and IBD were 17, 4.0, 2.0, 2.0, and 1.6, respectively.

The team noted a higher risk for preterm birth among women with T1DM (OR, 4.4), systemic lupus erythematosus (OR, 2.8), systemic sclerosis (OR, 2.4), Sjögren’s syndrome (RR, 2.3), inflammatory bowel disease (OR, 1.8), rheumatoid arthritis (OR, 1.6), psoriatic arthritis (OR, 1.5), celiac disease (OR, 1.3), and psoriasis (OR, 1.2). They reported low-birth-weight babies among women with SLE (OR, 6.0) and systemic sclerosis (OR, 3.8). Neonatal mortality was associated with SLE (OR, 8.3), T1DM (OR, 2.3), and Sjögren’s syndrome (OR, 1.8).

Conclusion

Overall, the review findings showed that women with autoimmune disorders are at a high risk of unfavorable pregnancy outcomes. However, further research is required to develop more evidence-based, standardized recommendations and assist physicians and women in making educated decisions about treating these diseases before and throughout pregnancy.

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March 8, 2024
Is there a higher risk of depression among specific populations of patients with rheumatoid arthritis?

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In a recent study published in JAMA Network Open, researchers assessed the risk of depression following the diagnosis of rheumatoid arthritis (RA).

Study: Rheumatoid Arthritis and Risk of Depression in South Korea. Image Credit: Africa Studio/Shutterstock.com

RA, a prevalent autoimmune disease, is characterized by systemic inflammation. The chronic nature of the disease necessitates lifelong treatment, often leading to comorbidities, including depression. Depression is highly prevalent among RA patients compared to the general population and has been associated with increased disease activity, pain exacerbation, elevated risk of myocardial infarction, less frequent remission, poor health-related quality of life, and higher health care utilization. Therefore, depression management and prevention are essential to improving the health and quality of life of RA patients.

About the study

In the present study, researchers examined associations of RA with subsequent depression risk in South Korea. They included subjects diagnosed with RA during 2010-17. Seropositive RA (SPRA) was defined using the International Classification of Diseases, Tenth Revision (ICD-10) codes and enrolment in the Rare and Intractable Diseases (RID) program.

RID program enrollment for SPRA required a positive test result for anticyclic citrullinated peptide antibodies or rheumatoid factors and a physician report indicating the fulfillment of RA classification criteria. Seronegative RA (SNRA) was defined using ICD-10 codes and prescription of disease-modifying anti-rheumatic drugs (DMARDs) for ≥ 270 days.

The team excluded subjects if they were aged under 20, had prior depression, missing data, or developed depression within a year post-index date. RA patients were matched to individuals without RA (controls) by sex, age, and index date. The study endpoint was a new diagnosis of depression. Participants were followed up from one year post-RA diagnosis until the diagnosis of depression, death, or December 31, 2019.

The Kaplan-Meier method was used to estimate the cumulative incidence of depression. Differences between groups were evaluated using log-rank tests. Cox regression analyses estimated adjusted hazard ratios and 95% confidence intervals for the risk of depression. The association between depression risk and the type of DMARDs used was also evaluated.

Analyses were adjusted for sex, age, smoking/alcohol status, income, body mass index, physical activity, diabetes, chronic kidney disease, hyperlipidemia, and hypertension. Besides, stratified analyses were conducted by sex, age, comorbidities, and health behaviors. Restricted mean survival time (RMST) differences were analyzed between groups by sex and age.

Findings

Overall, 230,922 participants aged 54.6, on average, were included for analysis. There were 38,487 RA patients and 192,435 controls; most participants were female (71%). Among RA patients, 11,645 were seronegative, and 26,842 were seropositive. RA patients were more likely to be non-drinkers and less likely to be obese. SPRA patients were more likely to be female, older, non-drinkers, and less likely to be obese than SNRA patients.

The median follow-up duration was 4.1 years, during which 6,422 RA patients and 20,641 had newly developed depression. RA patients had a higher risk of depression than controls. Moreover, SPRA and SNRA groups had elevated depression risk compared to controls. Among RA patients with depression, 402 were prescribed biological or targeted synthetic DMARDs, and 6,020 were prescribed only conventional synthetic DMARDs.

Notably, the incidence of depression among RA patients was consistently lower among recipients of targeted synthetic or biological DMARDs than non-recipients. Stratified analyses yielded findings consistent with the primary analysis. RMST differences were variable across age groups, with a higher difference in the ≥ 60-year age group.

Conclusions

In sum, the researchers observed a 1.66-fold increased depression risk among RA patients relative to those without RA. There was no significant difference in depression risk by the serologic status of RA, with both SNRA and SPRA groups exhibiting an increased risk. RA patients receiving targeted synthetic or biological DMARDs had lower risks than those who did not. Nevertheless, the study has a few limitations. Notably, disease activity was inaccessible, resulting in limited evaluation of RA severity.

Moreover, information on depression levels at the index date was not available. Besides, because participation was limited to those undergoing health screening, participants might have been healthier or engaged more in healthy behaviors than the general population.

Taken together, the findings suggest an increased depression risk among RA patients, irrespective of RA serologic status, age, sex, and behavioral factors, warranting consistent screening of RA patients and comprehensive healthcare to address their physical and mental well-being.

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March 8, 2024
Are your snacks deadly? New study reveals how ultra-processed foods lead to chronic disease outcomes

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In a recent study published in BMJ, researchers reviewed existing meta-analytic evidence on the association between ultra-processed food exposure and chronic disease outcomes.

Study: Ultra-processed food exposure and adverse health outcomes: umbrella review of epidemiological meta-analyses. Image Credit: FabrikaSimf/Shutterstock.com

Background

Ultra-processed foods, such as packaged snacks, quick noodles, and ready-made meals, are industrial compositions that include chemically manipulated ingredients and additives.

They are consumed extensively in low- and middle-income nations and are related to behavioral processes, eating surroundings, and marketing pressures.

These foods have low nutritional profiles, with higher levels of calories, salt, sugar, and saturated fat but lower levels of dietary fiber, micronutrients, and vitamins, which may synergistically influence chronic inflammatory disorders.

Several meta-analyses have examined the link between ultra-processed foods and adverse health outcomes; however, comprehensive evaluations of current evidence still need to be included.

Further research could improve our understanding of these relationships and provide valuable insights to improve public health policies and practices. It is especially noteworthy given the ongoing global debate on the necessity of public health policies to combat ultra-processed food exposure in general populations.

About the study

In the present umbrella review, researchers examined current data from meta-analyses of observational epidemiological studies investigating the link between ultra-processed food intake and the likelihood of unfavorable health consequences.

The team searched the Embase, PsycINFO, the Cochrane Database of Systematic Reviews, and the MEDLINE databases and their reference lists between 2009 and June 2023 without language restrictions.

Eligible studies included systematic review and meta-analytical research of cross-sectional, cohort, and case-control studies using the Nova food classification to determine ultra-processed food exposure among humans of all ages, regardless of health status, to compare dose-response and non-dose-response associations of dietary ultra-processed food intake and adverse health endpoints.

The team applied pre-determined evidence classifications to assess evidence credibility, graded as class I (convincing), class II (highly suggestive data), class III (representative), class IV (weak), or class V (no evidence).

They used the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach to assess evidence quality. Two researchers performed data screening and resolved disagreements by consensus.

The team included the latest meta-analysis study in case of multiple pooled analyses for the same adverse health outcome, analyzing meta-analyzed effect estimates of non-dose-response and dose-response exposure to ultra-processed foods.

They obtained missing or unclear information from meta-analysis studies by reviewing original research articles or directly requesting it from the corresponding authors. If discrepancies existed, the team prioritized extracting data from the original research article.

They performed random effects modeling to analyze the effect estimates for each endpoint, used I2 values to assess study heterogeneity, and used Egger’s regression asymmetry tests to evaluate the influence of small studies.

Results

The team identified 45 distinct pooled data analyses, including 32 non-dose-response relationships and 13 of the non-dose-response type (n=9,888,373). They found high and moderate heterogeneity in eight and 13 unique pooled analyses.

There were direct associations between ultra-processed food exposure and 32 health characteristics related to cancer, mortality, and respiratory, mental, gastrointestinal, and cardiometabolic disease outcomes.

Class I evidence indicated direct relationships between higher ultra-processed food consumption and increased risks of new-onset heart disease-associated deaths [risk ratio (RR), 1.5; GRADE evidence, very-low quality evidence], diabetes mellitus type 2 (dose-response RR, 1.1; moderate-quality evidence), anxiety [odds ratio (OR), 1.5; low-quality evidence], and mental disorders (OR, 1.5; low-quality evidence).

Class II data indicated increased ultra-processed food exposure directly related to elevated risks of any-cause mortality (RR, 1.2; low-quality evidence), cardiovascular disease-associated deaths [hazard ratio (HR), 1.7; low], diabetes mellitus type 2 (OR, 1.4; very-low quality evidence), and depression (HR, 1.2; low-quality evidence), with increased risks of adverse sleep-associated outcomes (OR, 1.4; low-quality evidence), obesity (OR, 1.6; low-quality evidence), and wheezing (RR, 1.4; low-quality evidence).

Among the other 34 pooled records, 21 and 13 had class III to IV and V evidence, respectively. The team rated 22, 19, and four pooled analyses as low, very low, and moderate quality, respectively.

Conclusions

Overall, the study findings showed higher ultra-processed-type food exposure associated with an increased risk of chronic disease outcomes, particularly cardiometabolic diseases, mental disorders, and death.

The study results provide a basis for developing and assessing the efficacy of public health initiatives to limit ultra-processed food exposure for enhanced well-being. The findings could also assist crucial mechanistic research.

Ultra-processed diets are related to ill health and early death due to lower nutritional profiles, the displacement of non-processed foods, and structural changes in consumables.

They are associated with chronic diseases via inflammatory pathways, and industrial processing methods, components, byproducts, additives, hazardous compounds, and packaging pollutants may alter them.

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March 1, 2024