Electroacupuncture efficacy in diabetic polyneuropathy: Study protocol for a double-blinded randomized controlled multicenter clinical trial.

BACKGROUND: Diabetic peripheral neuropathy (DPN) is the most common complication of type 2 diabetes mellitus (T2DM); its diagnosis and treatment are based on symptomatic improvement. However, as pharmacological therapy causes multiple adverse effects, the implementation of acupunctural techniques, such as electroacupuncture (EA) has been suggested as an alternative treatment. Nonetheless, there is a lack of scientific evidence, and its mechanisms are still unclear. We present the design and methodology of a new clinical randomized trial, that investigates the effectiveness of EA for the treatment of DPN. METHODS: This study is a four-armed, randomized, controlled, multicenter clinical trial (20-week intervention period, plus 12 weeks of follow-up after concluding intervention). A total of 48 T2DM patients with clinical signs and symptoms of DPN; and electrophysiological signs in the Nerve Conduction Study (NCS); will be treated by acupuncture specialists in outpatient units in Mexico City. Patients will be randomized in a 1:1 ratio to one of the following four groups: (a) short fibre DPN with EA, (b) short fibre DPN with sham EA, (c) axonal DPN with EA and (d) axonal DPN with sham EA treatment. The intervention will consist of 32 sessions, 20 min each, per patient over two cycles of intervention of 8 weeks each and a mid-term rest period of 4 weeks. The primary outcome will be NCS parameters, and secondary outcomes will include DPN-related symptoms and pain by Michigan Neuropathy Screening Instrument (MNSI), Michigan Diabetic Neuropathy Score (MDNS), Dolour Neuropatique Score (DN-4), Semmes-Westein monofilament, Numerical Rating Scale (NRS) for pain assessment, and the 36-item Short Form Health Survey (SF-36). To measure quality of life and improve oxidative stress, the inflammatory response; and genetic expression; will be analysed at the beginning and at the end of treatment. DISCUSSION: This study will be conducted to compare the efficacy of EA versus sham EA combined with conventional diabetic and neuropathic treatments if needed. EA may improve NCS, neuropathic pain and symptoms, oxidative stress, inflammatory response, and genetic expression, and it could be considered a potential coadjutant treatment for the management of DPN with a possible remyelinating effect. TRIAL REGISTRATION: ClinicalTrials.gov. NCT05521737 Registered on 30 August 2022. International Clinical Trials Registry Platform (ICTRP) ISRCTN97391213 Registered on 26 September 2022 [2b].

ADIPOQ and ADIPOR2 gene polymorphisms: association with overweight/obesity in Mexican children / Polimorfismos de los genes ADIPOQ y ADIPOR2 y su asociación con sobrepeso/obesidad en niños mexicanos

Background: ENSANUT 2012 showed a combined prevalence of overweight and obesity of 34.4% in Mexican children. Single nucleotide polymorphisms (SNPs) of the ADIPOQ and ADIPOR2 genes have been reported in many populations, but their association with obesity has not been confirmed in other studies. Our aim was to determine the association of SNPs from ADIPOQ and ADIPOR2 genes with obesity in Mexican children. Methods: A total of 2,634 children from 6 to 12 years old were enrolled in the study from four IMSS Units in Mexico City. We selected 1,469 unrelated children (745 normal weight and 724 overweight/obese). Phenotype characterization included anthropometric measurements, blood pressure, biochemical parameters, insulin concentrations and presence of acanthosis nigricans (AN). Analysis of the SNPs rs182052, rs266729, rs2241766, rs822393 of ADIPOQ and rs11061971 of ADIPOR2 was carried out in the DNA samples. Results: The study showed significant differences (p <0.05) between groups in waist circumference, blood pressure, presence of AN, insulin concentrations, HOMA-IR, fasting glucose and lipid parameters, being higher in obese children. No associations in ADIPOQ variants with the presence of overweight/obesity were found. The presence of the variant rs11061971 of ADIPOR2 in children had a significant association with protection of overweight/obesity (OR 0.79, 95% CI 0.68-0.93, p = 0.003). Also, the log-additive model confirmed the association by codominant and dominant models (p <0.05). Conclusions: The presence of rs11061971 of ADIPOR2 variant confers protection against obesity and could be used as a marker in Mexican children.

Introducción: ENSANUT 2012 mostró una prevalencia combinada de sobrepeso y obesidad en el 34.4% en niños mexicanos. Se han reportado polimorfismos de un solo nucleótido (SNP) de los genes ADIPOQ y ADIPOR2 en varias poblaciones, pero su asociación con la obesidad ha sido controversial. El objetivo de este trabajo fue determinar la asociación de SNP de ADIPOQ y ADIPOR2 con obesidad en una muestra de niños mexicanos. Métodos: Un total de 2,634 niños de 6-12 años se inscribieron en el estudio en cuatro unidades del Instituto Mexicano del Seguro Social en la Ciudad de México. Se seleccionaron 1,469 niños no emparentados (745 peso normal y 724 sobrepeso/obesidad). Se les tomaron medidas antropométricas, presión arterial, parámetros bioquímicos, insulina y presencia de acantosis nigricans (AN). El análisis de los SNP (rs182052, rs266729, rs2241766, rs822393 de ADIPOQ y rs11061971 de ADIPOR2) se realizó en muestras de ADN. Resultados: Se observaron diferencias significativas (p < 0.05) entre los grupos en la circunferencia de cintura, presión arterial, AN, insulina, HOMA-IR, glucosa en ayunas y parámetros lipídicos siendo elevados en los niños obesos. No se encontró asociación en variantes ADIPOQ con la presencia de sobrepeso/obesidad. La presencia de rs11061971 de ADIPOR2 tuvo una asociación significativa con la protección de sobrepeso/obesidad (OR de 0.79; IC95% 0.68 a 0.93, p = 0.003). El modelo Log-aditivo confirmó la asociación de los modelos codominante y dominante (p < 0.05). Conclusiones: La presencia de la variante rs11061971 de ADIPOR2 confiere protección contra la obesidad, y podría utilizarse como marcador en niños mexicanos.

ADIPOQ and ADIPOR2 gene polymorphisms: association with overweight/obesity in Mexican children.

BACKGROUND: ENSANUT 2012 showed a combined prevalence of overweight and obesity of 34.4% in Mexican children. Single nucleotide polymorphisms (SNPs) of the ADIPOQ and ADIPOR2 genes have been reported in many populations, but their association with obesity has not been confirmed in other studies. Our aim was to determine the association of SNPs from ADIPOQ and ADIPOR2 genes with obesity in Mexican children. METHODS: A total of 2,634 children from 6 to 12 years old were enrolled in the study from four IMSS Units in Mexico City. We selected 1,469 unrelated children (745 normal weight and 724 overweight/obese). Phenotype characterization included anthropometric measurements, blood pressure, biochemical parameters, insulin concentrations and presence of acanthosis nigricans (AN). Analysis of the SNPs rs182052, rs266729, rs2241766, rs822393 of ADIPOQ and rs11061971 of ADIPOR2 was carried out in the DNA samples. RESULTS: The study showed significant differences (p <0.05) between groups in waist circumference, blood pressure, presence of AN, insulin concentrations, HOMA-IR, fasting glucose and lipid parameters, being higher in obese children. No associations in ADIPOQ variants with the presence of overweight/obesity were found. The presence of the variant rs11061971 of ADIPOR2 in children had a significant association with protection of overweight/obesity (OR 0.79, 95% CI 0.68-0.93, p = 0.003). Also, the log-additive model confirmed the association by codominant and dominant models (p <0.05). CONCLUSIONS: The presence of rs11061971 of ADIPOR2 variant confers protection against obesity and could be used as a marker in Mexican children.

[Genetics of pediatric obesity]. / Genética de la obesidad infantil.

Obesity is a major health problem around the globe. The statistics of overweight and obesity at early ages have reached alarming levels and placed our country in the first place in regard to childhood obesity. In the development of obesity two major factors take part, one genetic and the other one environmental. From the perspective of environmental changes both overweight and obesity result from the imbalance in the energy balance: people ingest more energy than they expend. Despite people live in the same obesogenic environment not all of them develop obesity; it requires genetic factors for this to happen. This review focuses on the description of the main methodologies to find genetic markers, as well as the main loci in candidate genes, whose single nucleotide polymorphisms (SNPs) are associated with obesity and its comorbidities in children, highlighting the association of these genes in the Mexican population. Knowledge of the genetic markers associated with obesity will help to understand the molecular and physiological mechanisms, the genetic background and changes in body mass index in the Mexican population. This information is useful for the planning of new hypotheses in the search for new biomarkers that can be used in a predictive and preventive way, as well as for the development of new therapeutic strategies.

La obesidad es uno de los principales problemas de salud a nivel mundial. Las cifras de sobrepeso y obesidad a edades tempranas han alcanzado niveles alarmantes y ubican a nuestro país en el primer lugar de obesidad infantil. En el desarrollo de la obesidad participan dos grandes factores, uno genético y otro ambiental. Desde la perspectiva de las alteraciones ambientales, tanto el sobrepeso como la obesidad resultan del desequilibrio en el balance energético: las personas ingieren mayor cantidad de energía de la que gastan. A pesar de que las personas vivan en el mismo ambiente obesógeno, no todos desarrollan obesidad; para que esto ocurra, se requiere de los factores genéticos. Esta revisión se enfoca en la descripción de las principales metodologías para la búsqueda de marcadores genéticos, así como los principales loci en genes candidatos, cuyos polimorfismos de un solo nucííleótido (SNP, por sus siglas en inglés) se encuentran asociados con la obesidad y sus comorbilidades en la población infantil, de lo cual resalta la asociación de estos genes en la población mexicana. El conocimiento de los marcadores genéticos asociados a la obesidad ayudará a comprender los mecanismos moleculares y fisiológicos, el fondo genético y las modificaciones en el índice de masa corporal en la población mexicana. Esta información es de gran utilidad para el planteamiento de nuevas hipótesis en la búsqueda de nuevos biomarcadores que puedan ser utilizados de una manera predictiva y preventiva, así como para el desarrollo de nuevas estrategias terapéuticas.