A new, alternative risk score for sarcopenia in Chinese patients with type 2 diabetes mellitus.

OBJECTIVE: To develop a new, alternative sarcopenia risk score to screen for sarcopenia in type 2 diabetes patients in China and to demonstrate its validity. RESEARCH DESIGN AND METHODS: The data for this study came from a multicenter, cross-sectional study that had been designed to estimate the prevalence of sarcopenia among adults with type 2 diabetes and had been conducted in several hospitals in Beijing, China. A total of 1125 participants were randomly divided into two groups: an exploratory population and a validation population. A multivariable logistic regression model using the backward stepwise likelihood ratio method to estimate the probability of sarcopenia was fitted with candidate variables in the exploratory population. A new, alternative sarcopenia risk score was developed based on the multivariable model. The internal and external validations were performed in the exploratory and validation populations. The study was registered at Chinese Clinical Trial Registry (ChiCTR-EOC-15006901). RESULTS: The new, alternative sarcopenia risk score included five variables: age, gender, BMI, total energy intake per day, and the proportion of calories supplied by protein. The score ranged from - 2 to 19. The area under the receiver operating characteristic (ROC) curve of the risk score for the prediction of sarcopenia in type 2 diabetes patients was 0.806 (95% CI 0.741-0.872) and 0.836 (95% CI 0.781-0.892) in the exploratory and validation populations, respectively. At the optimal cutoff value of 12, the sensitivity and specificity of the score for the prediction of sarcopenia were 70.9% and 81.0% in the exploratory population and 53.7% and 88.8% in the validation population, respectively. The Hosmer-Lemeshow goodness-of-fit test showed a good calibration with the risk score in external validation (χ2 = 4.459, P = 0.813). CONCLUSIONS: The new, alternative sarcopenia risk score appears to be an effective screening tool for identification of sarcopenia in Chinese patients with type 2 diabetes in clinical practice. Clinical trial registration Chinese Clinical Trial Registry, ChiCTR-EOC-15006901.

Metabolic and Nutritional Characteristics in Middle-Aged and Elderly Sarcopenia Patients with Type 2 Diabetes.

Sarcopenia is considered to be a new complication of type 2 diabetes (T2DM) leading to increased risk of adverse outcome. We performed a survey to evaluate glucose metabolism and nutritional status in sarcopenia patients with T2DM. Diabetic participants aged ≥50 years were grouped into a probable sarcopenia group with low muscle strength (n = 405) and a nonsarcopenia group with normal muscle strength (n = 720) according to the revised recommendations from EWGSOP2 (2018). Compared to the controls, the probable sarcopenia participants were older and had lower waist-to-hip ratio and BMI, longer diabetes duration, higher fasting plasma glucose level and glycosylated hemoglobin (HbA1c), decreased estimated glomerular filtration rate and lower bone mineral content, lower fatless upper arm circumference, lower appendicular skeletal muscle mass index (ASMI), and muscle quality in both genders. Multivariable logistic regression analysis showed increased age, male, low BMI, and increased HbA1c, combined with diabetic nephropathy and decreased serum albumin levels, were risk factors associated with low muscle strength in diabetes patients. In conclusion, diabetic patients with sarcopenia had worse glucose metabolism and nutritional status, decreased renal function and reduced muscle quality ,and muscle mass with a greater likelihood of osteoporosis, who need an overall health management to improve outcomes. This clinical trial registration is registered with the Chinese Clinical Trial Registry, ChiCTR-EOC-15006901.

Resveratrol attenuated estrogen-deficient-induced cardiac dysfunction: role of AMPK, SIRT1, and mitochondrial function.

Large epidemiological studies suggest that there are important differences in the incidence and severity of a wide variety of cardiac diseases, between premenopausal and menopausal women. Recently, it has been demonstrated that resveratrol may has similar function as estrogen. However, whether resveratrol replacement could mimic estrogen to protect heart in ovariectomized mice remains completely unknown. Firstly, the present study has used OVX/CAL model to investigate the effect of RSV on ischemic heart. Echocardiography analysis revealed that RSV administration significantly improved cardiac contractile function in estrogen-deficient mice. RSV also significantly reduced CK and LDH release, and heart infarct size in OVX/CAL group. Secondly, mitochondrial functions, including MRC activities, MDA level, and mitochondrial swelling, were evaluated in OVX mice. It was found that supplementation with RSV could restore mitochondrial function dampened by OVX. Thirdly, these protective functions mediated by RSV were mainly attributed to the enhancement of SIRT1/AMPK activity. In summary, the results support a potential role of resveratrol in the protection of cardiac functions under estrogen depletion status.

Micronutrients decrease incidence of common infections in type 2 diabetic outpatients.

A randomized, double-blind, placebo-controlled trial was carried out to investigate the effects of micronutrients supplementation on immunity and the incidence of common infections in type 2 diabetic outpatients. A total of 196 type 2 diabetic outpatients were randomized to receive tablets of micronutrients (n=97) or placebo (n=99) for 6 months. Individualized dietary energy intake and daily physical activity were recommended. Anthropometric measurements, blood biochemical variables and the incidence of common infections were measured at baseline and at 6 months. Data on diet, exercise and infection (upper respiratory tract infection, skin infection, urinary and genital tract infections, other infections) were recorded 1 month before the study and every month during the study. Blood concentrations of total protein, iron (Fe), folic acid and hemoglobin increased and unsaturated iron-binding capacity(UIBC) levels were decreased in the micronutrients supplementation group compared to the placebo group at 6 months. Moreover, at 6 months, compared to the placebo group, the blood concentrations of IgE, CD4+, CD4+/CD8+, WBC, lymphocyte counts, basophilic leukocyte increased and CD8+ count decreased in the supplementation group, and the levels of IgA, IgM, IgG and complements C3 and C4 did not differ. The incidence of upper respiratory infection, whitlow, dermapostasis, vaginitis, urinary tract infection, gingivitis and dental ulcer were lower and body temperature and duration of fever greatly improved in the supplementation than the placebo group. These data indicated that supplementation of micronutrients might increase immune function and reduce the incidence of common infections in type 2 diabetic outpatients.

[Effects of 9,10-dihydroxysteatic acid on glucose metabolism in KKAy mice].

OBJECTIVE: To study the effect of 9,10-dihydroxystearic acid (DHSA) on glucose tolerance and insulin sensitivity in KKAy diabetic mice. METHODS: 48 male KKAy mice were randomly divided into four groups and were fed with high fat diet containing 4% DHSA, 2% DHSA, 4% Olive oil and 4% Corn oil, respectively. Glucose tolerance and insulin sensitivity were measured after 5 and 6 weeks respectively. Effects of DHSA on activating PPAR-alpha and PPAR-gamma in CV-1 cells were also carried out. RESULTS: In glucose tolerance test, the blood glucose at 0.5 h and 1 h and the area under glucose curve in the group fed with 4% DHSA diet were significantly lower than those of other groups. In insulin sensitivity test, the blood glucose level at 0.5 h and 1 h after injection of insulin was lower in the 4% DHSA diet group, indicating the insulin sensitivity of this group was obviously higher than other groups (P < 0.05). The body weight of the mice fed with 4% DHSA diet was much lower than those mice fed with 4% Corn diet (P < 0.05). 5 - 20 micromol/L DHSA did not activate PPAR-gamma in CV-1 cells but 50 - 100 micromol/L DHSA activated PPARgamma in a dose-dependent way although the activating effect of DHSA on PPARgamma was significantly lower than that of rosiglitazone. DHSA did not activate PPAR-alpha in CV-1 cells. CONCLUSION: DHSA may improve glucose tolerance and insulin sensitivity in KKAy mice and the effect might be related to the activation of PPAR-gamma by DHSA.

Medium- and long-chain triacylglycerols reduce body fat and blood triacylglycerols in hypertriacylglycerolemic, overweight but not obese, Chinese individuals.

In contrast to the consumption of long-chain triacylglycerols (LCT), consumption of medium- and long-chain triacylglycerols (MLCT) reduces the body fat and blood triacylglycerols (TAG) level in hypertriacylglycerolemic Chinese individuals. These responses may be affected by BMI because of obesity-induced insulin resistance. We aimed to compare the effects of consuming MLCT or LCT on reducing body fat and blood TAG level in hypertriacylglycerolemic Chinese subjects with different ranges of BMI. Employing a double-blind, randomized and controlled protocol, 101 hypertriacylglycerolemic subjects (including 67 men and 34 women) were randomly allocated to ingest 25-30 g/day MLCT or LCT oil as the only cooking oil for 8 consecutive weeks. Anthropometric measurements of body weight, BMI, body fat, WC, HC, blood biochemical variables, and subcutaneous fat area and visceral fat area in the abdomen were measured at week 0 and 8. As compared to subjects with BMI 24-28 kg/m(2) in the LCT group, corresponding subjects in the MLCT group showed significantly greater decrease in body weight, BMI, body fat, WC, ratio of WC to HC, total fat area and subcutaneous fat area in the abdomen, as well as blood TAG and LDL-C levels at week 8. Based upon our results, consumption of MLCT oil may reduce body weight, body fat, and blood TAG and LDL-C levels in overweight hypertriacylglycerolemic Chinese subjects but may not induce these changes in normal or obese hypertriacylglycerolemic subjects.

A good response to oil with medium- and long-chain fatty acids in body fat and blood lipid profiles of male hypertriglyceridemic subjects.

A double blind clinical trial was carried out to clarify the effects of oil with medium- and long-chain triglyceride (MLCT) on body fat and blood lipid profiles in hypertriglyceridemic subjects. One-hundred-and-twelve subjects were enrolled and divided into two groups; those that consumed MLCT oil and those that consumed long-chain triglyceride (LCT) oil for 8 weeks. All subjects were requested to consume 25-30 g of the oils daily and maintain a fixed level of energy intake and exercise. Anthropometric and blood biochemical parameters were measured when the study was initiated and completed. The LCT group consisted of 50 subjects (34 men and 16 women), while the MLCT group consisted of 51 subjects (33 men and 18 women) who completed the study. Larger decreases in body weight, body mass index, waist circumference, body fat, total fat area and subcutaneous fat area in the abdomen and serum triglycerides, low-density lipoprotein cholesterol, apolipoprotein B, C2, C3 and E were observed in male subjects in the MLCT group than those in the LCT group. However, no significant differences in these parameters between the female subjects in the two groups were observed. Data from this study indicate that consumption of medium-and long-chain triglycerides can reduce body weight and body fat and improve blood lipid profiles in male hypertriglyceridemic subjects.

[Medium- and long-chain fatty acid triacylglycerol reduce body fat and serum triglyceride in overweight and hypertriglyceridemic subjects].

OBJECTIVE: To investigate effects of medium- and long-chain fatty acid triacylglycerols (MLCT) on body fat and serum lipid in overweight and hypertriglyceridemic subjects. METHODS: A double-blind, controlled clinical trial was carried out, in which 112 subjects with hypertriglyceridemia were enrolled and divided into two groups, there were 56 subjects in each group. One group was randomized to consume long-chain fatty acid triacylglycerol (LCT), and the other to MLCT. All volunteers were asked to consume 25 - 30 g test oil daily for consecutive 8 weeks. Anthropometric measurements of body weight, body fat weight, waist circumference(WC), hip circumference(HC), WHR (ratio of WC/HC), total fat weight, subcutaneous fat area, visceral fat area, and serum biochemical variables of glucose, total cholesterols(TC), triglycerides(TG), high density lipoprotein cholesterol (HDL-C) and low density lipoprotein cholesterol (LDL-C)were measured at the initial and final time of the study. RESULTS: 11 subjects were excluded from the study because of various reasons. Of the 101 included cases, there were 50 (male subject 34, 68.0%) and 51 (male subject 33, 64.7%) subjects left in LCT and MLCT group respectively. The proportion of men in MLCT (64.7%, 33/51) was not significantly different (chi(2) = 0.1227, P > 0.05) compared to those in LCT (68.0%, 34/50). The average age of MLCT was (54.2 +/- 12.5) which was not significantly different (t = 0.39, P > 0.05) compared to those in LCT (53.2 +/- 13.0); Body mass index (BMI) of MLCT was (25.9 +/- 3.3) kg/m(2), which was not significantly different (t = 0.08, P > 0.05) compared to those of LCT (25.9 +/- 2.4) kg/m(2). After consumption of test oil for 8 weeks, extent of decrease in BMI, percent of body fat, subcutaneous fat, serum TG and serum LDL-C in overweight subjects of MLCT were (-0.73 +/- 0.61) kg/m(2), (-1.53 +/- 1.32)%, (-16.29 +/- 19.25) cm(2), (-0.57 +/- 0.86) mmol/L and (-0.05 +/- 0.64) mmol/L respectively, those in overweight subjects of LCT were (-0.19 +/- 0.61) kg/m(2), (-0.58 +/- 1.02)%, (4.69 +/- 19.06) cm(2), (0.65 +/- 1.10) mmol/L and (0.38 +/- 0.58) mmol/L respectively, all of them were significantly different (the value of t were -2.70, -2.43, -3.20, -3.81 and -2.09 respectively, all of P value were less than 0.05). CONCLUSION: Consumption of MLCT can reduce body fat weight and serum triacylglycerol and LDL-C in overweight hypertriglyceridemic subjects under an appropriate dietary regime.