High-Protein or Low Glycemic Index Diet-Which Energy-Restricted Diet Is Better to Start a Weight Loss Program?

BACKGROUND: To date, no crossover studies have compared the effects of high-protein (HP) and low glycemic index (LGI) diets applied as starting energy-restricted diets. METHODS: Thirty-five overweight or obese volunteers with sedentary lifestyles aged 41.4 ± 11.0 years, with body mass index (BMI) of 33.6 ± 4.2 kg/m2, without diabetes, completed an 8-week randomized crossover study of an energy-restricted diet (reduction of 30%; approximately 600 kcal/day). The anthropometric parameters, body composition, 24 h blood pressure, and basic metabolic profile were measured at baseline and after completing the two 4-week diets; i.e., the HP (protein at 30% of the daily energy intake) or LGI diet, followed by the opposite diet. All subjects maintained food diaries and attended six counselling sessions with a clinical dietitian. RESULTS: The final weight loss was not significantly different when the HP diet was used first but was associated with a greater loss of fat mass: 4.6 kg (5.8; 3.0 kg) vs. 2.2 (4.5; 0.8); p < 0.025, preserved muscle mass, and reduced LDL-cholesterol. CONCLUSIONS: A short-term HP diet applied as a jump-start diet appeared to be more beneficial than an LGI diet, as indicated by the greater fat mass loss, preservation of muscle mass, and better effects on the lipid profile.

Is Uric Acid a Missing Link between Previous Gestational Diabetes Mellitus and the Development of Type 2 Diabetes at a Later Time of Life?

INTRODUCTION: A high level of uric acid (UA) is a strong, independent risk factor for type 2 diabetes mellitus. The relationship between UA levels and the development of type 2 diabetes in women with previous gestational diabetes mellitus (pGDM) remains unclear. The aim of study was to evaluate the UA levels in pGDM women in relation to their current nutritional status and carbohydrate metabolism. MATERIAL AND METHODS: 199 women with pGDM diagnoses based on oral glucose tolerance tests (OGTTs) 5-12 years previously and a control group of 50 women without pGDM. The assessment included anthropometric parameters, body composition (Tanita SC-330S), current OGTT, insulin resistance index (HOMA-IR), ß-cell function (HOMA-%B), HbA1c, lipids, and uric acid. RESULTS: No differences between groups were found in terms of age, time from the index pregnancy, anthropometric parameters, lipids or creatinine levels. The incidences of overweight and obesity were similar. Carbohydrate abnormalities were more frequent in the pGDM group than the control group (43.2% vs 12.0% p<0.001). The women with pGDM had significantly higher fasting glucose, HbA1c, glucose and insulin levels in the OGTTs, but similar HOMA-IR values. Their UA levels were significantly higher (258±58 vs 230±50 µmol/L, p<0.005) and correlated with BMI and the severity of carbohydrate disorders. The normal weight and normoglycemic pGDM women also demonstrated higher UA levels than a similar control subgroup (232±48 vs 208±48 µmol/L, p<0.05). Multivariate analysis revealed significant correlations of UA level with BMI (ß = 0.38, 95% CI 0.25-0.51, p<0.0001), creatinine level (ß = 0.23, 95% CI 0.11-0.35, p<0.0005), triglycerides (ß = 0.20, 95% CI 0.07-0.33, p<0.005) and family history of diabetes (ß = 0.13, 95% CI 0.01-0.25, p<0.05). In logistic regression analysis, the association between higher UA level (defined as value ≥297 µmol/L) and presence of any carbohydrate metabolism disorder (IFG, IGT or diabetes) was statistically significant (odds ratio 3.62 [95% CI 1.8-7.3], p<0.001). CONCLUSIONS: Higher UA levels may be associated with the development of type 2 diabetes in pGDM women, also in these with normal body weights.

Homocysteine levels in women with a history of gestational diabetes mellitus.

BACKGROUND: Previous gestational diabetes (pGDM) is a risk factor of type 2 diabetes, hypertension and cardiovascular diseases. Homocysteine is one of markers of cardiovascular risk. The aim of this study was to assess the homocysteine levels in women with pGDM and to evaluate its relationship with current carbohydrate metabolism and nourishment status. METHODS: The study group comprised 199 women at 7.8 ± 1.0 years after pGDM and 50 control women in whom pGDM was excluded. The analyzed parameters: BMI, WHR, body composition (Tanita SC-330S analyzer), glucose and insulin levels in oral glucose tolerance test (OGTT), insulin resistance index (HOMA-IR), HbA1c, lipid profile, homocysteine, creatinine and creatinine clearance. The Mann-Whitney test and Chi-squared test were used for comparison of continuous and nominal variables, respectively. Correlations between continuous variables in each group were analyzed using Spearman's rank correlation coefficient (Rs). A logarithmic transformation was applied for variables with non-normal distribution. RESULTS: There were no differences between the pGDM women and controls in terms of age, number of childbirths, time from indexed pregnancy, pre-pregnancy BMI, or current anthropometric parameters. In pGDM women HbA1c and all glucose levels in OGTT were significantly higher, but still within the normal range. No significant differences were found in homocysteine levels, HOMA-IR, blood lipids, creatinine and creatinine clearance. Homocysteine levels did not differ significantly in subgroups categorized according to the current OGTT results or BMI. Carbohydrate metabolism disorders, overweight and obesity were associated with higher creatinine clearance. Positive correlation between homocysteine and creatinine (r = 0.21, p < 0.004), and a negative correlation with creatinine clearance (r = -0.16, p < 0.03) were found. CONCLUSIONS: In women with pGDM, homocysteine is not a marker of glucose tolerance disturbances and cardiovascular risk. Increased glomerular filtration rate, observed in more severe disorders of carbohydrate metabolism and greater BMI, may temporarily protect against an increase of proatherogenic homocysteine.

Adipokines and ß-cell dysfunction in normoglycemic women with previous gestational diabetes mellitus.

INTRODUCTION: An increased risk of developing type 2 diabetes in women with a history of gestational diabetes mellitus(gestational diabetes mellitus - GDM) may be associated with increased insulin resistance and subclinical inflammation. However, approximately half of women with previous GDM (pGDM) do not develop diabetes. These women were the population of focus in the present study. OBJECTIVES: The aim of the study was to assess ß-cell function, insulin resistance, and the levels of pro- and anti inflammatory adipokines in normoglycemic women with pGDM. PATIENTS AND METHODS: A study group included 199 women with pGDM; the mean time after delivery was 7.4 years. A control group included 50 women without pGDM. All patients underwent an oral glucose tolerance test (OGTT) with the assessment of glycemia and insulinemia, ß-cell function (HOMA-%ß), and insulin resistance (HOMA-IR), as well as the levels of soluble tumor necrosis factor α receptor (sTNF-α-R2), interleukin 6 (IL-6), adiponectin, and visfatin. RESULTS: Normal glucose tolerance was found in 113 women with pGDM (56.8%; the NGT-GDM[+] group) and in 44 control subjects (88.0%). In comparison with controls, the NGT-GDM[+] group had significantly higher glycemia in the OGTT and significantly lower HOMA-%ß values, with comparable HOMA-IR and body mass index values. The NGT-GDM(+) group was shown to have significantly higher levels of sTNF-α-R2 and IL-6, with similar adiponectin and visfatin levels. CONCLUSIONS: Normoglycemic women with a history of GDM are characterized by concomitant disturbances in insulin secretion and subclinical inflammation, with normal body weight and insulin sensitivity. It is not known whether these disturbances were present before a GDM-complicated pregnancy or whether they were induced by pregnancy.

[Practical implementation of recommendations concerning diagnostic procedures in gestational diabetes]. / Praktyczna realizacja zalecen dotyczacych diagnostyki cukrzycy ciazowej.

BACKGROUND: Gestational diabetes mellitus (GDM) is associated with health consequences for both, the mother and her offspring. In Poland, the diagnosis of GDM is based on the recommendations of the Polish Gynecological Society (PTG) and is usually made by obstetricians. OBJECTIVE: The aim of the study was to assess practical implementation of PTG standards of GDM screening and diagnosis. MATERIAL AND METHODS: The study group consisted of 351 pregnant women consulted by a diabetologist: 102 patients between 2008-2010 (PTG guidelines of 2005) and 249 patients between 2011-2013 (PTG guidelines of 2011). Data concerning diagnostic procedures performed by obstetricians--time of diagnostic tests, fasting glucose levels, oral glucose tolerance test (OGTT) results, and GDM risk factors--were collected. Adherence to the diagnostic procedures was assessed. RESULTS: Adherence to the diagnostic guidelines for 2008-2010 was 42.2%. The most common errors were incorrect time of OGGT (36.4%) and wrong interpretation of glycaemia (34.1%). Between 2011-2013 incorrect diagnostic testing was detected in 78.3% of the affected women. The most common deviation was lack of OGTT at the beginning of pregnancy in women with GDM risk factors (91.3%). CONCLUSIONS: A considerable number of GDM women underwent incorrect diagnostic procedures. More precise description of GDM risk factors in PTG recommendations seems to be necessary.

Increased concentration of C-reactive protein in obese patients with type 2 diabetes is associated with obesity and presence of diabetes but not with macrovascular and microvascular complications or glycemic control.

The purpose of this study was to assess the concentration of C-reactive protein (CRP) in obese type 2 diabetes mellitus (DM2) patients and its association with macrovascular and microvascular complications. The study group consisted of 80 obese DM2 patients, including 20 macrovascular, 20 microvascular, 20 both macrovascular and microvascular, and 20 with no complications patients. The control group comprised 40 normoglycemic subjects--20 obese and 20 of normal body weight. Highly sensitive CRP and metabolic control parameters were assessed. CRP levels in obese diabetes subgroups and normoglycemic obese were similar and significantly higher than those in nonobese controls. No correlation was found between CRP and diabetes control parameters. There was a strong positive correlation between CRP level and body mass index in all groups. A multivariate analysis showed that DM2 and obesity are independent factors increasing CRP levels. Increased concentration of CRP in obese DM2 patients is related to obesity and diabetes itself. The lack of association between CRP and vascular complications remains unclear.

The common C49620T polymorphism in the sulfonylurea receptor gene SUR1 (ABCC8) in patients with gestational diabetes and subsequent glucose metabolism abnormalities.

AIM: The aim of this study is to investigate the relationship between the common C49620T polymorphism in the sulfonylurea receptor (SUR1) gene and glucose metabolism, ß-cell secretory function and insulin resistance in women with a history of gestational diabetes (GDM). MATERIAL AND METHODS: Study group included 199 women, diagnosed GDM within the last 5-12 years and control group of comparable 50 women in whom GDM was excluded during pregnancy. Blood glucose and insulin levels were measured during oral glucose tolerance test. Indices of insulin resistance (HOMA-IR) and ß-cell function (HOMA %B) were calculated. In all patients, the C49620T polymorphism in intron 15 of the SUR1 gene was determined. RESULTS: The distribution of the studied polymorphism in the two groups did not differ from each other (χ(2) = 0.34, P = 0.8425). No association between the distribution of polymorphisms and coexisting glucose metabolism disorders (χ(2) = 7,13, P = 0, 3043) was found. No association was also observed between the polymorphism and HOMA %B or HOMA-IR. CONCLUSIONS: The polymorphism C49620T in the SUR1 gene is not associated with insulin resistance and/or insulin secretion in women with a history of GDM and does not affect the development of GDM, or the development of glucose intolerance in the studied population.

[Rare causes of hypoglycemia in adults--glycogen storage diseases]. / Rzadkie przyczyny hipoglikemii u doroslych--choroby spichrzeniowe glikogenu.

Metabolic diseases such as glycogen storage diseases, disorders of gluconeogenesis and fatty acid oxidation disorders belong to rare causes of hypoglycemia. Most of them are diagnosed in a childhood, but they can be also revealed in an adulthood. This paper discusses clinical and laboratory signs of glycogen storage diseases leading to hypoglycemia. It also presents cases of patients with such disorders diagnosed in adulthood and described in the literature.

[Rare causes of hypoglycemia in adults--disorders of gluconeogenesis and fatty acid oxidation disorders]. / Rzadkie przyczyny hipoglikemii u doroslych--zaburzenia glukoneogenezy i zaburzenia beta-oksydacji kwasów tluszczowych.

Disorders of gluconeogenesis and fatty acid oxidation disorders belong to rare causes of hypoglycemia. Most of them are diagnosed in a childhood, but they can be revealed also in an adulthood. This paper discusses clinical and laboratory signs of these disorders and presents cases of patients diagnosed in adulthood and described in the literature.

[Multilevel blockade of the renin-angiotensin-aldosterone system in the treatment of diabetic nephropathy]. / Wielopoziomowa blokada ukladu renina-angiotensyna-aldosteron w leczeniu nefropatii cukrzycowej.

Diabetic nephropathy is a leading cause of end-stage renal disease. In this paper the role of renin-angiotensin-aldosterone system (RAA) in the pathogenesis of diabetic nephropathy is discussed and clinical effects of multilevel pharmacological blockade of RAA system by combined treatment with ACE inhibitors, angiotensin receptor blockers (ARB) and aldosterone antagonists is described.