High fat diet attenuates hyperglycemia, body composition changes, and bone loss in male streptozotocin-induced type 1 diabetic mice.

There is a growing and alarming prevalence of obesity and the metabolic syndrome in type I diabetic patients (T1DM), particularly in adolescence. In general, low bone mass, higher fracture risk, and increased marrow adipose tissue (MAT) are features of diabetic osteopathy in insulin-deficient subjects. On the other hand, type 2 diabetes (T2DM) is associated with normal or high bone mass, a greater risk of peripheral fractures, and no change in MAT. Therefore, we sought to determine the effect of weight gain on bone turnover in insulin-deficient mice. We evaluated the impact of a 6-week high-fat (HFD) rich in medium chain fatty acids or low-fat diet (LFD) on bone mass and MAT in a streptozotocin (STZ)-induced model using male C57BL/6J mice at 8 weeks of age. Dietary intervention was initiated after diabetes confirmation. At the endpoint, lower non-fasting glucose levels were observed in diabetic mice fed with high fat diet compared to diabetic mice fed the low fat diet (STZ-LFD). Compared to euglycemic controls, the STZ-LFD had marked polydipsia and polyphagia, as well as reduced lean mass, fat mass, and bone parameters. Interestingly, STZ-HFD mice had higher bone mass, namely less cortical bone loss and more trabecular bone than STZ-LFD. Thus, we found that a HFD, rich in medium chain fatty acids, protects against bone loss in a T1DM mouse model. Whether this may also translate to T1DM patients who are overweight or obese in respect to maintenance of bone mass remains to be determined through longitudinal studies.

Energy Metabolism of Bone.

Biological processes utilize energy and therefore must be prioritized based on fuel availability. Bone is no exception to this, and the benefit of remodeling when necessary outweighs the energy costs. Bone remodeling is important for maintaining blood calcium homeostasis, repairing micro cracks and fractures, and modifying bone structure so that it is better suited to withstand loading demands. Osteoclasts, osteoblasts, and osteocytes are the primary cells responsible for bone remodeling, although bone marrow adipocytes and other cells may also play an indirect role. There is a renewed interest in bone cell energetics because of the potential for these processes to be targeted for osteoporosis therapies. In contrast, due to the intimate link between bone and energy homeostasis, pharmaceuticals that treat metabolic disease or have metabolic side effects often have deleterious bone consequences. In this brief review, we will introduce osteoporosis, discuss how bone cells utilize energy to function, evidence for bone regulating whole body energy homeostasis, and some of the unanswered questions and opportunities for further research in the field.

Excessive iodine intake in schoolchildren.

PURPOSE: Inadequate iodine intake may result in iodine deficiency disorders (IDD). Thus, for more than 50 years, policies for the regulation of salt fortification with iodine have existed in Brazil. In 2003, a study on 6-14-year-old schoolchildren from regions of the state of São Paulo showed a median urinary iodine concentration of 360 µg/L. The objective of the present study was to assess the iodine nutrition status among schoolchildren. METHODS: The study was conducted on 828 schoolchildren aged 4-13 years from eight schools in the interior of the state of São Paulo. A casual urine sample was collected from each volunteer for iodine determination by the adapted method of Sandell-Kalthoff. RESULTS: Only 1.9% (n = 16) of the children evaluated had low values of urinary iodine (<100 µg/L), while 24.6% had urinary iodine excretion values between 200 and 300 µg/L, and 67.1% had values above >300 µg/L. CONCLUSIONS: The results show that the iodine nutritional status of the schoolchildren studied is characterized by a high urinary iodine excretion, which might reveal an increase in iodine consumption by this population.

Sustained Morphine Delivery Suppresses Bone Formation and Alters Metabolic and Circulating miRNA Profiles in Male C57BL/6J Mice.

Opioid use is detrimental to bone health, causing both indirect and direct effects on bone turnover. Although the mechanisms of these effects are not entirely clear, recent studies have linked chronic opioid use to alterations in circulating miRNAs. Here, we developed a model of opioid-induced bone loss to understand bone turnover and identify candidate miRNA-mediated regulatory mechanisms. We evaluated the effects of sustained morphine treatment on male and female C57BL/6J mice by treating with vehicle (0.9% saline) or morphine (17 mg/kg) using subcutaneous osmotic minipumps for 25 days. Morphine-treated mice had higher energy expenditure and respiratory quotient, indicating a shift toward carbohydrate metabolism. Micro-computed tomography (µCT) analysis indicated a sex difference in the bone outcome, where male mice treated with morphine had reduced trabecular bone volume fraction (Tb.BV/TV) (15%) and trabecular bone mineral density (BMD) (14%) in the distal femur compared with vehicle. Conversely, bone microarchitecture was not changed in females after morphine treatment. Histomorphometric analysis demonstrated that in males, morphine reduced bone formation rate compared with vehicle, but osteoclast parameters were not different. Furthermore, morphine reduced bone formation marker gene expression in the tibia of males (Bglap and Dmp1). Circulating miRNA profile changes were evident in males, with 14 differentially expressed miRNAs associated with morphine treatment compared with two differentially expressed miRNAs in females. In males, target analysis indicated hypoxia-inducible factor (HIF) signaling pathway was targeted by miR-223-3p and fatty acid metabolism by miR-484, -223-3p, and -328-3p. Consequently, expression of miR-223-3p targets, including Igf1r and Stat3, was lower in morphine-treated bone. In summary, we have established a model where morphine leads to a lower trabecular bone formation in males and identified potential mediating miRNAs. Understanding the sex-specific mechanisms of bone loss from opioids will be important for improving management of the adverse effects of opioids on the skeleton. © 2022 American Society for Bone and Mineral Research (ASBMR).

Beyond the metabolic syndrome: Visceral and marrow adipose tissues impair bone quantity and quality in Cushing's disease.

The present study was designed to evaluate the relationship between bone traits [bone mineral density (BMD) and trabecular bone score (TBS)] and the accumulation of fat in adipose tissues [abdominal subcutaneous (SAT), visceral (VAT), marrow (MAT) and intrahepatic lipids (IHL)], as well as insulin resistance, in subjects with Cushing's disease (CD). The study included control (C = 27), paired (P = 16) and Cushing's disease (CD = 10) groups, which underwent biochemical assessment, dual X-ray absorptiometry, TBS, and magnetic resonance imaging to determine fat deposits. The CD group showed higher serum levels of glucose and insulin, as well as HOMA-IR values, but lower circulatory levels of osteocalcin, in comparison to C and P. The CD group exhibited lower L1-L4 BMD than P (P = 1.059 ± 0.141 vs CD = 0.935 ± 0.093 g/cm2, p < 0.05) (Fig 1A). The lumbar spine BMD from the C group was similar to the other groups. TBS was lower in CD than in P and C (C = 1.512±0.077 vs P = 1.405±0.150 vs CD = 1.135±0.136; p<0.05); there was also significant difference between C and P (p<0.05). MAT, VAT, and IHL were higher in CD than in C and P (p<0.05). Considering all subjects, there was a positive association between TBS with both lumbar spine BMD (R2 = 0.45; p<0.0001) and osteocalcin (R2 = 0.44; p = 0.05). TBS was negatively associated with MAT (R2 = 0.49; p = 0.01), VAT (R2 = 0.55; p<0.05), and HOMA-IR (R2 = 0.44; p<0.01). MAT was positively related with VAT (R2 = 0.44; p<0.01) and IHL (R2 = 0.41; p<0.05). In CD, insulin resistance and adipose tissue dysfunction, including high MAT, are active players in bone deterioration, as confirmed by lower lumbar spine BMD and lower TBS. Thus, our findings point to an additional component of the already well-known complex mechanisms of osteoporosis associated with hypercortisolism.

Reflexões sobre o conhecimento dos usuários no contexto do Programa de Saúde da Família: a lacuna entre o saber técnico e o popular / Reflections on the knowledge of patients from the Family Health Program: the gap between technical and popular knowledge

Tem por objetivo avaliar o conhecimento dos hipertensos e diabéticos cadastrados no Programa de Saúde daFamília do município de Teixeiras-MG, sobre suas patologias, visando ao desenvolvimento de estratégias de empoderamento/ libertação deste grupo populacional, essenciais na viabilizaçãode políticas de promoção da saúde, prevenção e controle destas enfermidades. Estudo transversal, realizado por meio da aplicação de questionários semi-estruturados através de entrevistas a uma amostra de 10,33% dos hipertensos e 15% dos diabéticos. Houve predominância de indivíduos idosos, do sexo feminino, de baixa escolaridade e renda; 40,0% dosdiabéticos e 69,14% dos hipertensos não souberam conceituar as doenças. Em relação ao nível de conhecimento sobre as causas e sintomas, 50% dos diabéticos as desconheciam; dos hipertensos, 37,14% desconheciam as causas e 12,57%, os sintomas. Em relação às complicações decorrentes das doenças, 33,33% dos diabéticos e 33,14% dos hipertensos as desconheciam. Quanto às formas de tratamento, 16,67% dos diabéticos e 10,86% dos hipertensos não souberam informar. Destaca-se a importância da implementação de estratégias de cuidado em saúde a estes grupos populacionais, voltadas à conscientização sanitária e aos fatores condicionantes e complicadores das enfermidades, visando a proporcionar uma educação em saúde mais efetiva, visto que a mudança de hábitos e a conscientização jamais se separam - toda transformação deve estar intimamente associada à tomada deconsciência da situação real vivida pelo sujeito. Para isto é necessário o comprometimento dos profissionais de saúde, visando a uma participação livre e crítica dos usuários, contribuindo para o empoderamento/libertação deste grupo populacional, questões essenciais para a viabilização de políticas de promoção da saúde e prevenção de agravos e controle de enfermidades.

This paper aims to evaluate the knowledge of the diabetic and high blood pressure patients from the Family Health Program in the city of Teixeiras-MG, about their illnesses, aiming to develop their empowering/freedom strategies, essential to promote health, to prevent and control such diseases. It is a cross-sectional study, with semistructured questionnaires, interviewing 10.33% of the high bloodpressure and to 15% of the diabetic patients. Most patients were aged individuals, female, with low educational level and income. A total of 40.0% of the diabetic, and 69.14% of the high blood pressure patients could not define these diseases; 50% of the diabetic could not tell the cause and symptoms of their disease; 37.14% of the high blood pressure patients were unaware of the cause and 12.57% were unaware of their symptoms. In terms of the complications associated to their diseases, 33.14% of the diabetic and 33.33% of the high blood pressure patients were unaware of them. About 16.67% of the diabetic and 10.86% of the high blood pressure patients could not inform how to treat these diseases. It is important to implement health carestrategies for these population groups, aiming awareness of health, its conditioning factors, and factors that complicate the diseases, so as to have a more effective health education process, once the changes in habits and awareness should always together be side by side - every transformation should be closely associated to the awareness of the situation which the subject lives. The latter takes the commitment of the health care staff, aiming a free and critical participation of the users, contributing to the empowering/freedom of this population, essential to the development of health promotion policies, prevention of disorders and diseases control.