Glucose metabolism in gestational diabetes and their relationship with fat mass / muscle mass index.

Introduction: During pregnancy, women experience metabolic changes that may induce insulin resistance, which can be traced to the blood glucose levels A number of factors may intervene in the metabolism of glucose in pregnant women; one of them is body composition. This factor is useful for studying metabolic diseases, for which the identification of the fat mass/muscle mass index (FMMMI) considered an especially relevant factor. Owing to their nature, techniques such as bioimpedance have been sparsely used for analysis during pregnancy. Aim: This study aimed to identify the relationship between fat mass / muscle mass index and glucose metabolism in pregnant women. Methods: This descriptive cross-sectional study included 231 women between the ages of 18 and 35 years and 24-28 weeks of gestation, who attended a state hospital for regular check-ups and exhibited risk factors for the development of gestational diabetes (GD) according to the Current Practice Guidelines in Primary Care. The participants underwent a physical examination, anthropometric measurements bio impedance were obtained, and oral glucose tolerance curves were constructed. FMMMI was calculated. Results: The prevalence of gestational diabetes was observed to be 13.4%. Women with a GD diagnosis had a significantly higher FMMMI than in those with no GD (0.746 ± 0.168 vs 0.567 ± 0.167;p < 0.005). The assessment of the FMMMI tertiles revealed that GD prevalence was higher in tertile 3 than in tertiles 1 and 2 (tertile 1: 2.6%; tertile 2: 9.1%; tertile 3: 24%). Conclusion: FMMMI is associated with glucose tolerance test response in pregnant women and a higher prevalence of GD.

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.

Correlation of the Homeostasis Model Assessment Index and Adiponectin, Leptin and Insulin Levels to Body Mass Index-Associated Gene Polymorphisms in Adolescents.

OBJECTIVES: This study aimed to describe correlations between glucose, insulin and adipokine levels and the homeostasis model assessment (HOMA) index with regards to the presence/absence of fat mass and obesity-associated (FTO) rs9939609 and peroxisome proliferator-activated receptor (PPAR)-y rs1801282 single nucleotide polymorphisms (SNPs) as indicators of body mass index in adolescents. METHODS: This cross-sectional study was conducted between September and December 2016 in Toluca, Mexico. A total of 71 students between 14-18 years old were included. Various anthropometric and laboratory measurements were collected, including lipid profile, glucose, insulin and adipokine levels and HOMA index. The degree of association between variables was evaluated with regards to the presence/absence of the SNPs. RESULTS: Leptin levels were significantly higher among female students (P = 0.001), although adiponectin levels did not differ significantly (P = 0.060). There were significant positive correlations between insulin levels and HOMA index with FTO (r = 0.391; P = 0.007 and r = 0.413; P = 0.005, respectively) and PPARγ (r = 0.529; P = 0.007 and r = 0.537; P = 0.007, respectively) SNPs. Leptin showed a significant positive correlation in the presence of PPARγ (r = 0.483; P = 0.007) or in the absence of both SNPs (r = 0.627; P = 0.039). However, adiponectin was significantly negatively correlated in the presence of FTO, either alone (r = -0.333; P = 0.024) or in combination with PPARγ (r = -0.616; P = 0.043). CONCLUSION: The presence of FTO and/or PPARγ SNPs might be related to a genetic predisposition to metabolic syndrome.

[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.

Thyroid function is associated with insulin resistance markers in healthy adolescents with risk factors to develop diabetes.

INTRODUCTION: The prevalence of obesity and Type 2 diabetes mellitus (T2DM) among children and adolescents is rising. Thyroid function has been associated with insulin resistance. There is scarce information about how thyroid function could be related with cardiovascular risk or glucose homeostasis in adolescent. AIM: To analyze how thyroid function is associated with insulin resistance and another cardiovascular risk factors in healthy adolescents with risk factors to develop diabetes. METHODS: A prospective cross-sectional analysis was carried out on euthyroid, adolescents. considered at high risk to develop Type 2 diabetes. Fasting blood samples were obtained. Thyroid function test and another cardiometabolic parameters were assessed. A 75 grams oral glucose tolerance test was performed to calculate insulin resistance. RESULTS: One hundred adolescents were evaluated. The mean age was 15.9 ± 0.8 years, There is a negative correlation between Fasting insulin, post glucose load insulin and HOMA IR. There were no correlation with Matsuda index. We could not found any correlation with TSH values. CONCLUSIONS: We found a correlation between fasting insulin, HOMA IR and serum thyroid hormones, we did not find any relation with serum TSH. In euthyroid adolescents with risk factors to develop diabetes.

Correlación entre la resistencia a la insulina y T3 en adolescentes con factores de riesgo para el desarrollo de diabetes / Correlation between insulin resistance and T3 in adolescents with risk factors for developing diabetes

Objetivo. Establecer la correlación entre las concentraciones séricas de triyodotironina y la resistencia a la insulina a través del índice HOMA en un grupo de hombres adolescentes con factores de riesgo para el desarrollo de diabetes. Materiales y métodos: estudio descriptivo de corte transversal. Participaron adolescentes con algún factor de riesgo para diabetes. Se determinó la presencia de síndrome metabólico empleando los criterios de ATPIII modificada por Cook. Se determinaron T3, T4, TSH e insulina basal. Se calculó el índice HOMA para resistencia a la insulina. Resultados. Se estudiaron 36 hombres con una edad promedio de 15.97±0.9 años. En la población total existió correlación positiva entre T3 y HOMA-IR (r=0.380 p=0.022), cuando se analizó en el grupo de SM la correlación se incrementó entre T3 y HOMA-IR (r=0.647 p=0.031). Determinando que existe correlación positiva entre los índices de resistencia a la insulina y las concentraciones de hormona tiroidea.

Objetive. Establish the correlation between serum triiodothyronine concentrations and insulin resistance by HOMA index in a group of adolescent men with risk factors for developing diabetes. Material and Methods. It´s a descriptive cross-sectional study. Participating adolescents with some risk factor for diabetes. The presence of metabolic syndrome using the modified ATPIII criteria determined by Cook. T3, T4, TSH and basal insulin were determined. HOMA index was calculated for insulin resistance. Results. 36 men with an average age of 15.97 ± 0.9 years were studied. There was positive correlation between T3 and total population HOMA-IR (r = 0.380 p = 0.022), when analyzed in the group of SM correlation increased between T3 and HOMA-IR (r = 0.647 p = 0.031). Metabolic syndrome in adolescents with a positive correlation between indices of insulin resistance and thyroid hormone concentrations.

Association of inflammatory and oxidative stress biomarkers in subjects with cardiovascular risk.

Cardiovascular disease is originated in the vascular endothelium, which controls the homeostasis and the filtration and diffusion of molecules from blood to the tissues. The classical cardiovascular risk factors (CRFs) act directly on the endothelium through an increase in the production of reactive oxygen species, promoting an endothelial activation mediated by the expression of adhesion and proinflammatory molecules, which lead to endothelial dysfunction, the progression of the atherosclerotic plaque, and the onset of cardiovascular disease. The objective of this study was to analyze the association of superoxide dismutase, catalase, gluthatione peroxidase, and lipoperoxidation with fibrinogen, interleukin (IL)-6, tumor necrosis factor-α, and vascular cell adhesion molecule (VCAM)-1 in subjects with cardiovascular risk (CVR) and CRF. This was a cross-sectional study of 114 individuals; oxidative stress (superoxide dismutase, catalase, gluthatione peroxidase, and lipoperoxidation) and inflammatory (fibrinogen, IL-6, tumor necrosis factor-α, and VCAM-1) biomarkers were measured; a CVR score (Framingham) and its CRF were taken into consideration to classify the participants. Twenty-nine subjects out of a total of 114 had high CVR. Smokers and subjects with diabetes (43 subjects) were excluded from the low CVR group. Significant decreases in lipoperoxidation, IL-6, and VCAM-1 and an increase in SOD were found in the high CVR group (P ≤ 0.05). Individual analysis of each CRF in the 114 subjects revealed a different pattern in the biomarkers' statistical differences. Concluding that the biomarkers show statistical differences in each CRF, especially IL-6, VCAM-1, and SOD; therefore, these are highly recommended to be used as biomarkers of the oxidative stress and inflammatory status in CVR.

Effects of a physical activity program on markers of endothelial dysfunction, oxidative stress, and metabolic status in adolescents with metabolic syndrome.

The metabolic syndrome (MetS) is a precursor of diabetes. Physical activity (PA) improves endothelial dysfunction and may benefit patients with MetS. Aims. To evaluate the effect of a physical activity (PA) program on markers of endothelial dysfunction and oxidative stress in adolescents with (MetS). Methods. We carried out a cohort study of 38 adolescents with and without MetS (18 females and 20 males). All participants completed a 3-month PA program. All variables of the MetS as well as markers of endothelial dysfunction and oxidative stress tests were evaluated. Results. Females with and without MetS showed significant differences for almost all components of the MetS, whereas males were significantly different in half of the components. After the PA program, components of the MetS were not different from baseline values except for HDL-C levels. Some baseline endothelial dysfunction markers were significantly different among adolescents with and without MetS; however, after the PA program, most of these markers significantly improved in subjects with and without MetS. Conclusion. PA improves the markers of endothelial dysfunction in adolescents with MetS although other changes in the components of the MetS were not observed. Perhaps the benefits of PA on all components of MetS would appear after a PA program with a longer duration.

Dificultades en la clasificación del síndrome metabólico: El ejemplode los adolescentes en México / Difficulties in the classification of metabolic syndrome: The example of adolescents in Mexico

OBJETIVO. Determinar la diferencia entre las definiciones del National Cholesterol Education Program Adult Treatment Panel (ATPIII) y de la International Diabetes Federation (IDF) para síndrome metabólico (SM) en adolescentes mexicanos. MATERIAL Y MÉTODOS. Estudio transversal en 575 adolescentes de 14 a 16 años. Se utilizaron pruebas t de Student, ji cuadrada y correlación de Spearman. RESULTADOS. La prevalencia de SM fue mayor por ATPIII (18.6 por ciento) versus IDF (8.2 por ciento) (p<0.001), con 41.1 por ciento de concordancia. CONCLUSIONES. Existe una diferencia estadística de la prevalencia del SM en adolescentes mexicanos entre las dos definiciones.

OBJECTIVE. Determine the difference between the National Cholesterol Education Program Adult Treatment Panel (ATPIII) definition of the diagnosis of metabolic syndrome (MS) in Mexican adolescents and that by the International Diabetes Federation (IDF). MATERIAL AND METHODS. We conducted a cross-sectional study of 575 adolescents aged 14 to 16 years using the student's t test, chi square and Spearman correlation. RESULTS. The prevalence of MS was higher by ATPIII (18.6 percent) than by IDF (8.2 percent) (p <0.001) and there was a concordance of 41.1 percent. CONCLUSIONS. There is a statistical difference in the prevalence of MS depending on the definition.

[Difficulties in the classification of metabolic syndrome. The example of adolescents in Mexico]. / Dificultades en la clasificación del síndrome metabólico. El ejemplode los adolescentes en México.

OBJECTIVE: Determine the difference between the National Cholesterol Education Program Adult Treatment Panel (ATPIII) definition of the diagnosis of metabolic syndrome (MS) in Mexican adolescents and that by the International Diabetes Federation (IDF). MATERIAL AND METHODS: We conducted a cross-sectional study of 575 adolescents aged 14 to 16 years using the student's t test, chi square and Spearman correlation. RESULTS: The prevalence of MS was higher by ATPIII (18.6%) than by IDF (8.2%) (p <0.001) and there was a concordance of 41.1%. CONCLUSIONS: There is a statistical difference in the prevalence of MS depending on the definition.