Development and validation of a multivariable genotype-informed gestational diabetes prediction algorithm for clinical use in the Mexican population: insights into susceptibility mechanisms.

INTRODUCTION: Gestational diabetes mellitus (GDM) is underdiagnosed in Mexico. Early GDM risk stratification through prediction modeling is expected to improve preventative care. We developed a GDM risk assessment model that integrates both genetic and clinical variables. RESEARCH DESIGN AND METHODS: Data from pregnant Mexican women enrolled in the 'Cuido mi Embarazo' (CME) cohort were used for development (107 cases, 469 controls) and data from the 'Mónica Pretelini Sáenz' Maternal Perinatal Hospital (HMPMPS) cohort were used for external validation (32 cases, 199 controls). A 2-hour oral glucose tolerance test (OGTT) with 75 g glucose performed at 24-28 gestational weeks was used to diagnose GDM. A total of 114 single-nucleotide polymorphisms (SNPs) with reported predictive power were selected for evaluation. Blood samples collected during the OGTT were used for SNP analysis. The CME cohort was randomly divided into training (70% of the cohort) and testing datasets (30% of the cohort). The training dataset was divided into 10 groups, 9 to build the predictive model and 1 for validation. The model was further validated using the testing dataset and the HMPMPS cohort. RESULTS: Nineteen attributes (14 SNPs and 5 clinical variables) were significantly associated with the outcome; 11 SNPs and 4 clinical variables were included in the GDM prediction regression model and applied to the training dataset. The algorithm was highly predictive, with an area under the curve (AUC) of 0.7507, 79% sensitivity, and 71% specificity and adequately powered to discriminate between cases and controls. On further validation, the training dataset and HMPMPS cohort had AUCs of 0.8256 and 0.8001, respectively. CONCLUSIONS: We developed a predictive model using both genetic and clinical factors to identify Mexican women at risk of developing GDM. These findings may contribute to a greater understanding of metabolic functions that underlie elevated GDM risk and support personalized patient recommendations.

Sarcopenia, neuropatía periférica y enfermedad arterial periférica en pacientes con diabetes mellitus sometidos a hemodiálisis / Sarcopenia, peripheral neuropathy, and peripheral arterial disease in patients with diabetes mellitus under hemodialysis

Resumen Introducción: La sarcopenia se caracteriza por pérdida de fuerza y masa muscular. Los pacientes con diabetes mellitus que se encuentran bajo tratamiento en hemodiálisis tienen disminución de actividad física y cambios en su ingestión alimentaria, lo que propicia también la presencia de sarcopenia; por otro lado, la neuropatía periférica y enfermedad arterial periférica aparecen comúnmente como complicaciones crónicas de la diabetes mellitus. Material y métodos: Se realizó un estudio transversal, observacional, en pacientes con diabetes mellitus y hemodiálisis. Para la evaluación de la sarcopenia se midió fuerza muscular, rendimiento físico y cantidad de masa muscular. Se midió fuerza muscular con dinamómetro, mientras que el rendimiento físico se evaluó con el tiempo en segundos de marcha con cronómetro, la cantidad de músculo de obtuvo utilizando una báscula con bioimpedancia. Se consideró sarcopenia severa cuando existía baja fuerza y cantidad muscular además de bajo rendimiento físico. La neuropatía periférica se evaluó explorando la sensibilidad a la presión y el tacto con el monofilamento de Semmes-Weinstein y sensibilidad profunda con un diapasón de 128 Hz. El índice tobillo-brazo fue la medición tomada para la clasificación de enfermedad arterial periférica. Resultados: El análisis final se realizó con 33 pacientes. Con un tiempo en hemodiálisis de 3,57 ± 2,56 años. La prevalencia de sarcopenia severa y sarcopenia fue de 90,8% y la de pre-sarcopenia de 9% del total de los pacientes; por otro lado, se encontró al 78,1% los pacientes con pérdida de la sensibilidad profunda, mientras que el porcentaje de los pacientes con pérdida de la sensibilidad a la presión y al tacto fue de 54,5%. Se encontró correlación entre los parámetros de sarcopenia y el tiempo de evolución de la insuficiencia renal y la edad. Conclusión: La sarcopenia se presenta, en sus diferentes etapas, en prácticamente todos los pacientes con diabetes mellitus sometidos a hemodiálisis; existe relación con la edad del paciente y el tiempo de hemodiálisis.

Abstract Introduction: Sarcopenia is characterized by loss of strength and muscle mass. Patients with diabetes mellitus who are under hemodialysis treatment show decreased physical activity and changes in their food intake, which also leads to the presence of sarcopenia. On the other hand, peripheral neuropathy and peripheral arterial disease commonly appear as chronic complications of diabetes mellitus. Methods: A cross-sectional, observational study was carried out in diabetes mellitus patients on hemodialysis. For the assessment of sarcopenia, muscle strength, physical performance and muscle mass percentage were measured. Muscle strength was calculated with a dynamometer, while physical performance was evaluated in seconds by means of a walk test with a stopwatch; muscle mass percentage was obtained using a scale with bioelectrical impedance. Sarcopenia was considered severe when there was low muscle strength and percentage in addition to low physical performance. Peripheral neuropathy was assessed by exploring touch and pressure sensibility with the Semmes-Weinstein monofilament test and deep sensibility with a 128 Hz tuning fork. The ankle-brachial index was the measurement taken for the peripheral arterial disease classification. Results: The final analysis was performed with 33 patients, whose time on hemodialysis was 3.57 ± 2.56 years. The prevalence of severe sarcopenia and sarcopenia was 90.8% and that of pre-sarcopenia was 9% of all patients. On the other hand, 78.1% were found to be patients with loss of deep sensibility, while the percentage of patients with loss of sensibility to pressure and touch was 54.5%. A correlation was found between the sarcopenia parameters and the time of evolution of renal failure and age. Conclusion: Sarcopenia occurs, in its different stages, in practically all diabetes mellitus patients undergoing hemodialysis; there is a relationship with the patient's age and hemodialysis time.

Association of Irisin Serum Concentration and Muscle Strength in Normal-Weight and Overweight Young Women.

Background: Irisin is a muscle-contraction-induced myokine. In previous studies, it has been related to exercise type, fitness and physical activity; however, evidence is not consistent. Thus, the aim of this study was to research the association between health-related fitness and irisin in young women. Methods: The study was designed as a prospective cross-sectional one. Young, healthy, nonsmoking women were enlisted. The sample comprised 40 overweight (OW) and 40 normal-weight (NW) individuals. The average age was 18.63 ± 0.63 and 18.78 ± 0.73 years, respectively. Components of health-related fitness, metabolic parameters, serum irisin and body composition were analyzed. Results: Statistically significant differences were found in physical tests between NW and OW groups for one-leg standing, hand grip strength, vertical jump, modified push-up, fitness index and maximal oxygen uptake (VO2MAX). There were no differences in concentrations of serum irisin between the groups. We found a positive correlation between irisin and hand grip strength (r = 0.374, p = 0.023). In a multivariate analysis adjusted by body fat, a significant association between irisin and hand grip strength was observed in OW group (ß = 0.380, p = 0.026); as well, a positive association between irisin and one-leg standing test in NW group (ß = 0.311, p = 0.044) was found. Conclusions: According to our findings, hand grip strength could be linked to irisin concentration in overweight young women.

Irisin a Novel Metabolic Biomarker: Present Knowledge and Future Directions.

The rising prevalence of chronic diseases such as type 2 diabetes and cardiovascular diseases owing to fat mass excess has been described. In recent years, muscle function/dysfunction has become relevant in metabolic homeostasis. Irisin was described as an exercise-induced myokine. It is the product of type I membrane protein cleavage encoded by the fibronectin type III domain containing 5 (FNDC5) gene. The main beneficial function attributable to irisin is the change of subcutaneous and visceral adipose tissue into brown adipose tissue, with a consequential increase in thermogenesis. Irisin has also been described as a hormone that may have a key role in glucose homeostasis. The way the association of type 2 diabetes with obesity occurs is not fully understood. In recent years, the possible pathways through which irisin could interact with other organs such as the brain or bone have been described. The present paper intends to review the new findings and possible new directions in irisin research.

[Effect of exercise on the serum concentrations of leptin and adiponectin in adolescents with risk factors of developing diabetes]. / Efecto del ejercicio en la concentración sérica de leptina y adiponectina en adolescentes con factores de riesgo de DM.

BACKGROUND: Type 2 diabetes mellitus (T2DM) is an increasing health issue. Physical activity (PA) in early stages is a preventive measure in the development of degenerative diseases. It has been documented the association between exercise and leptin and adiponectin concentrations. The objective was to evaluate the effect of a physical activity program (PAP) on serum leptin and adiponectin in teenagers with risk factors for developing T2DM. METHODS: Experimental-longitudinal study. Teenagers (men and women), with T2DM risk factors, aged 14 to 16 years, participated in a PAP for three months, five days a week, 45 minutes each day. Before and after the program, all anthropometric variables, incluiding leptin and adiponectin, were evaluated. RESULTS: 22 adolescents participated in the PAP and they were compared with 22 adolescents from the control group (who did not participate in the PAP). There was a reduction in the serum concentration of leptin in the intervention group (baseline 23 ± 13; after the PAP 14 ± 8, p > 0.0001), compared with the control group (baseline 18 ± 13, three months follow-up 20 ± 14, p < 0.520). Also, the adiponectin concentration increased (baseline 10 ± 3, after the PAP 13 ± 4.0, p > 0.014), compared with the control group (baseline 11 ± 3, 13 ± 4.0 after the PAP p > 0.032). CONCLUSIONS: This study support the efficacy of an aerobic exercise intervention on metabolic markers of adolescents with risk factors for developing diabetes.

INTRODUCCIÓN: la diabetes mellitus tipo 2 (DM2) es un problema de salud cada vez más preocupante. El ejercicio en etapas tempranas es una medida preventiva en el desarrollo de enfermedades crónico-degenerativas. Se ha postulado la asociación entre el ejercicio con las concentraciones de leptina y adiponectina. El objetivo fue evaluar el efecto de un programa de actividad física (AF) sobre la concentración sérica de leptina y adiponectina en adolescentes con factores de riesgo para el desarrollo de DM2. Métodos: estudio de tipo experimental-longitudinal. Participaron en un programa de AF durante tres meses adolescentes de 14 a 16 años, con factores de riesgo para el desarrollo de diabetes, cinco días a la semana, durante 45 minutos. Antes y después del programa, se evaluó la respuesta de leptina y adiponectina. RESULTADOS: participaron 22 adolescentes en el programa y se compararon con 22 adolescentes del grupo control. Las cifras de leptina disminuyeron en el grupo de intervención: basal 23 ± 13, después del programa 14 ± 8, p < 0.001; grupo control: basal 18 ± 13, seguimiento a tres meses 20 ± 14, p < 0.520. Asimismo, incrementaron las cifras de adiponectina: basal 10 ± 3, después del programa 13 ± 4.0, p < 0.014; grupo control: basal 11 ± 3, post ejercicio 13 ± 4.0, p < 0.032. CONCLUSIONES: nuestros resultados apoyan la eficacia de una intervención con ejercicio aeróbico sobre las características en un grupo minoritario de adolescentes con factores de riesgo para desarrollar diabetes.

Dietary patterns associated with body mass index (BMI) and lifestyle in Mexican adolescents.

BACKGROUND: The objetive in this study is to determine the relationship between dietary patterns, BMI, type 2 diabetes mellitus family history (T2DMFH) and some lifestyle variables such as smoking and skipping breakfast in a Mexican adolescent population. METHODS: Cross-sectional, observational, analytical study.Subjetcts: 14-16 years old male and female adolescents (n 373). A previously validated food frequency questionnaire (FFQ) was used and dietary patterns were derived using principal component analysis (PCA). Scores for dietary patterns were categorized by tertiles. RESULTS: Three major dietary patterns that explained 47 % of variance were found: westernized, high in protein/fat and prudent pattern. Subjects at the highest tertile of prudent pattern had lower BMI. And was also associated with less T2DMFH and less smoking habit when compared with the lowest tertile. We found a positive correlation between BMI and high scores for westernized and high in protein/fat pattern CONCLUSIONS: Dietary patterns of adolescents are a public health concern because there is a direct association between inadequate diet at this early age and obesity.