Effects of orthodox religious fasting versus combined energy and time restricted eating on body weight, lipid concentrations and glycaemic profile.

For seven weeks, 37 overweight adults followed a hypocaloric diet based on Orthodox Fasting (OF). A hypocaloric, time restricted eating (TRE) plan (eating between 08:00 to 16:00 h, water fasting from 16:00 to 08:00 h) was followed by 23 Body Mass Index (BMI)-matched participants. Anthropometric, glycaemic and inflammation markers and serum lipids were assessed before and after the diets. Both OF and TRE groups demonstrated reductions in BMI (28.54 ± 5.45 vs 27.20 ± 5.10 kg/m2, p < 0.001 and 26.40 ± 4.11 vs 25.81 ± 3.78 kg/m2 p = 0.001, respectively). Following the intervention, the OF group presented lower concentrations of total and low-density lipoprotein-cholesterol, compared with the pre-fasting values (178.40 ± 34.14 vs 197.17 ± 34.30 mg/dl, p < 0.001 and 105.89 ± 28.08 vs 122.37 ± 29.70 mg/dl, p < 0.001, respectively). Neither group manifested significant differences in glycaemic and inflammatory parameters. Our findings suggest that OF has superior lipid lowering effects than the TRE pattern.

Rising Glucagon-Like Peptide 1 Concentrations After Parathyroidectomy in Patients With Primary Hyperparathyroidism.

BACKGROUND: Although primary hyperparathyroidism has been associated with insulin resistance, potential optimal effects of parathyroidectomy (PTX) on glucose homeostasis remain controversial. Accordingly, the impact of PTX on glucose-stimulated incretin (glucagon-like peptide 1 [GLP-1] and gastric inhibitory peptide) secretion has not been evaluated. The aim of this pilot study was to compare glucose-stimulated incretin secretion (GSIS) in patients with asymptomatic primary hyperparathyroidism with normal glucose homeostasis, before and after PTX. METHODS: Fourteen patients were included in the study. Fasting calcium, parathyroid hormone, glucose, insulin, GLP-1, and gastric inhibitory peptide were measured pre- and post-operatively. Homeostasis Model Assessment 2, QUICKI, and Matsuda indexes were used as markers of insulin sensitivity and resistance before and after PTX. Preoperatively, a 75 g oral glucose tolerance test (OGTT) was performed to evaluate the response of glucose, insulin, and GSIS. OGTT measurements were repeated 6 ± 2 wk post-PTX. RESULTS: Patients had a mean age of 52.93 ± 9.96 y, and female-to-male ratio was 12:2. Pre- and post-operatively, a positive correlation between parathyroid hormone and Homeostasis Model Assessment 2 for ß-cell function was evident (r = 0.74, P = 0.002 and r = 0.55, P = 0.04, respectively). After PTX, a significant increase in GSIS for GLP-1 during OGTT was observed (in 60 min: 63.06 ± 44.78 versus 102.64 ± 40.19 pg/mL, P = 0.02; and in 120 min: 71.20 ± 35.90 versus 102.49 ± 40.02 pg/mL, P = 0.03). CONCLUSIONS: The increase of GLP-1 response following oral glucose load after PTX may reflect an initial recovery phase of glucose homeostasis. Long-term studies are required to elucidate the physiological interplay between the normalization of calciotropic axis and the rising GLP-1 concentrations post-PTX.

Effects of Orthodox religious fasting on human health: a systematic review.

PURPOSE: Different studies have pointed towards a positive effect of religious fasting on human health. Orthodox fasting (OF) regime could be characterized as a periodical vegetarian diet, demonstrating several common characteristics with the typical Mediterranean diet. The present systematic review aimed to synthesize available results regarding the potential impact of OF on human health. METHODS: Key biomedical databases were searched to identify studies examining the effects of OF on humans. Following implementation of specific criteria, ten studies were included in the analysis and their results were systematically reported and critically appraised in this review. RESULTS: According to the available limited results, OF periods are characterized by a restriction in total energy and fat intake, an increase in carbohydrate and fiber consumption, while in terms of protein intake, results are contradictive. The overall effect of OF on lipids profile seems to be optimal, with the reduction of total cholesterol and LDL-C levels, being a consistent finding across studies (up to 17.8 and 31.4%, respectively). However, the effect on HDL-C is still unclear. Conclusions regarding the impact on body weight and glucose homeostasis cannot be drawn, given that relevant data are limited with conflicting results. Any potential negative aspects of OF, mainly attributed to reduced dietary intake of vitamin D and B12 and minerals (mainly calcium), require further investigation. CONCLUSIONS: Given the limitations of available evidence, more studies are required before reaching definite conclusions about the effects of OF on human health.

The effect of vitamin D supplementation on glycemic status of elderly people with prediabetes: a 12-month open-label, randomized-controlled study.

BACKGROUND: Data on the efficacy of vitamin D in improving the glycemic status of elderly people with prediabetes are scarce. This open-label, randomized-controlled trial investigated the effect of vitamin D supplementation on glycemic markers of Greek people with prediabetes aged 60 years or above, over 12 months. RESEARCH DESIGN AND METHODS: Participants were randomized to a weekly vitamin D3 dose of 25,000 IU (n = 45) or nothing (n = 45), on top of lifestyle measures. Anthropometric and glycemic markers were assessed at baseline, 3, 6, and 12 months. RESULTS: Supplemented participants demonstrated a significant increase in 25(OH)D concentrations at 3,      6,      and 12 months     compared to baseline    . In the intervention group, fasting glucose was decreased at 6 months compared to baseline (96.12 ± 5.51 vs 103.40 ± 12.05 mg/dl, p < 0.01) and glycated hemoglobin was significantly lower at 6 and 12 months compared to baseline [5.82 ± 0.21% vs 5.87 ± 0.21%, p = 0.004 and 5.80 ± 0.23% vs 5.87 ± 0.21%, p < 0.001, respectively]. CONCLUSIONS: Vitamin D could be complementary to lifestyle change strategy for the management of prediabetes in the elderly. CLINICAL TRIAL REGISTRATION: ISRCTN51643592.

Characterizing neonatal vitamin D deficiency in the modern era: A maternal-neonatal birth cohort from Southern Europe.

Absence of adequate maternal vitamin D supplementation and decreased maternal ultraviolet exposure during pregnancy are key determinants for the manifestation of neonatal hypovitaminosis D at birth. These parameters may vary, according to country-specific dietary patterns, health policies and sunshine exposure. We aimed to investigate differences in calcium metabolism and anthropometric profiles according to neonatal vitamin D status at birth, in a sunny region of Northern Greece. A secondary aim was to identify maternal parameters as risk factors for developing neonatal vitamin D deficiency at birth. A total of 129 mother-neonate pairs were included in the study and classified into three groups, according to neonatal 25-hydroxy-D [25(OH)D)] concentrations at birth [deficiency (<30 nmol/l), insufficiency (30-50 nmol/l) and sufficiency (>50 nmol/l)]. Neonatal biochemical and anthropometric profiles and maternal demographic, social, dietary and biochemical profiles were comparatively evaluated between the three groups. Univariate and multivariate logistic regression was performed to identify independent associations of maternal factors with neonatal vitamin D status. Vitamin D deficient-neonates manifested higher parathyroid hormone (7.20 ± 2.60 vs 5.50 ± 1.50 pg/ml, p = 0.01) and lower corrected calcium (10.70 ± 0.70 vs 11.30 ± 1.30 mg/dl, p = 0.02) concentrations compared with vitamin d-insufficient neonates. Mothers of vitamin D deficient and insufficient neonates had a lower total of 25(OH)D (31.7 ± 19.2 and 36.5 ± 22.3 vs 53.3 ± 39.0 nmol/l, p < 0.01) and 25(OH)D3 (27.4 ± 17.5 and 33.3 ± 19.9 vs 47.3 ± 36.7 nmol/l, p < 0.01 and p = 0.04, respectively) concentrations respectively, compared with those of vitamin D-sufficient neonates. Maternal use of alcohol during pregnancy was associated with a 5.57-fold higher risk for neonatal vitamin D deficiency at birth (OR 5.57, 95 % CI1.17-26.56, p = 0.03). Newborns with vitamin D deficiency presented a 6.89-fold higher risk of having been given birth by vitamin D deficient mothers (OR 6.89, 95 % CI 3.09-15.38, p < 0.01). In conclusion, neonatal vitamin D deficiency is associated with maternal 25(OH)D concentrations at birth and maternal alcohol use. Further studies are required to replicate these findings in other regions and populations.

Vitamin D receptor Fokl polymorphism is a determinant of both maternal and neonatal vitamin D concentrations at birth.

Maternal vitamin D deficiency is considered to be the key determinant of the development of neonatal vitamin D deficiency at birth and during early infancy. Specific vitamin D receptor (VDR) gene polymorphisms have been associated with adverse pregnancy and offspring outcomes. The aim of this study was to evaluate the effect of maternal and neonatal VDR polymorphisms (ApaI, TaqI, BsmI, FokI, Tru9I) on maternal and neonatal vitamin D status. VDR polymorphisms were genotyped in 70 mother-neonate pairs of Greek origin, and classified according to international thresholds for Vitamin D status. Mean neonatal and maternal 25-hydroxy-vitamin D [25(OH)D] concentrations were 35 ± 20 and 47 ± 26 nmol/l, respectively. Neonatal VDR polymorphisms were not associated with neonatal 25(OH)D concentrations. In contrast, mothers with the Fokl FF polymorphism had a 70 % lower risk of vitamin D deficiency [25(OH)D <30 nmol/l] compared with ff ones, after adjustment for several confounders. They were also in 73 % and 88 % lower risk of giving birth to vitamin D deficient [25(OH)D <30 nmol/l] neonates compared with Ff and ff mothers, respectively. These results suggest a protective role of maternal Fokl FF genotype against both maternal and neonatal vitamin D deficiency. Further studies are needed to clarify the complex gene-gene and gene-environment interactions that determine vitamin D status at birth.

Emerging incretin hormones actions: focus on bone metabolism.

Incretin hormones, namely glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide-1 (GLP-1) are gastro-intestinal hormones released from different enteroendocrine cells after nutrient intake. Incretins exert their actions though binding to and activation of specific GIP and GLP-1 receptors which are present in several target tissues. Incretin receptor activation in the pancreas leads to the incretin effect and other significant non-insulinotropic effects. Extra-pancreatic effects of incretin hormones in several other target tissues, such as their role in the pathophysiology of obesity and their potential relation with cardiovascular function, cognitive function, triglyceride storage in adipose tissue and bone metabolism, have attracted scientific interest. In the current review we intend to summarize existing knowledge on specific effects of GIP and GLP-1 in bone cells and bone metabolism. Starting from the identification of GIP receptor and GLP-1 receptor in animal and human bone cells, continuing with the skeletal effects of incretin deficiency or overexpression in animals, ending to the latest data on incretin and incretin agonists administration in cells, animals and humans, incretins play a significant yet complex role in the pathophysiology of bone metabolism affecting both formation and resorption. Although existing evidence seem strong and concrete, there is still a long way to go until their possible therapeutic or adjuvant use as bone modulating drugs can be considered.

The Relationship between Primary Hyperparathyroidism and Thrombotic Events: Report of Three Cases and a Review of Potential Mechanisms.

We have described three uncommon cases of patients who presented with clinical thrombotic events (stroke, pulmonary embolism and deep venous thrombosis) during the course of a hypercalcemia-induced hypercoagulable state. After thorough investigation, the diagnosis of primary hyperparathyroidism - due to a parathyroid adenoma - was established in all cases. The association between hypercalcemia and venous or arterial thrombosis has been previously described; however, relevant data are still insufficient. The existing evidence in the field was reviewed and the interesting underlying pathophysiologic mechanisms were also discussed. Further studies are required to shed more light on the unusual, still intriguing relationship between calcium and thrombosis.

The combined effect of vitamin D and parathyroid hormone concentrations on glucose homeostasis in older patients with prediabetes: A cross-sectional study.

BACKGROUND: The combined effect of vitamin D and parathyroid hormone on glucose homeostasis has not been adequately investigated. The aim of this study was to examine the role of parathyroid hormone/vitamin D axis on glucose homeostasis in elderly persons with prediabetes. METHODS: Patients with prediabetes ( n = 144) and healthy age-matched controls ( n = 81) were included in this cross-sectional study. Study parameters included anthropometric characteristics, morning fasting glucose (fasting plasma glucose), insulin (fasting plasma insulin), parathyroid hormone, 25-hydroxyvitamin D, homeostasis model assessment of insulin resistance and homeostasis model assessment of ß-cell function. Both groups were stratified into subgroups according to vitamin D status and tertiles of parathyroid hormone. RESULTS: Both groups were comparable in terms of body mass index, 25-hydroxyvitamin D and parathyroid hormone status. In the prediabetes group, fasting plasma glucose differed significantly across parathyroid hormone tertiles, increasing from the first to the third tertile ( p = 0.011). There were higher fasting plasma glucose values in participants with vitamin D deficiency/parathyroid hormone third tertile compared to all other groups ( p = 0.031, 0.027 and 0.039, respectively). CONCLUSION: Parathyroid hormone status is associated with impaired glucose homeostasis; hypovitaminosis D combined with high parathyroid hormone concentrations are associated with glycaemic dysregulation in elderly patients with prediabetes.

The role of telenursing in the management of Diabetes Type 1: A randomized controlled trial.

BACKGROUND: Diabetes Mellitus type 1 (T1DM) is a chronic disease that requires patients' self-monitoring and self-management to achieve glucose targets and prevent complications. Telenursing implicates technology in the interaction of a specialized nurse with patients with chronic diseases in order to provide personalized care and support. OBJECTIVE: To evaluate the effect of telenursing on T1DM patients' compliance with glucose self-monitoring and glycemic control. DESIGN: Randomized controlled study. SETTINGS: Outpatient Department of Diabetes, Endocrinology and Metabolism of a University Hospital in Northern Greece. METHODS: Ninety-four T1DM patients were recruited and randomized in two groups by a random number generator. The intervention group (N = 48) was provided with telenursing services. A specialized nurse made a weekly contact via telephone motivating patients to frequently measure blood glucose and adopt a healthy lifestyle. The control group (N = 46) received standard diabetes advice and care in the clinic. The primary outcome was the effect of the intervention in glucose control and glucose variability. The secondary outcome was the effect on frequency of self-monitoring. SPSS 20.0 was used for data analysis. RESULTS: The two groups did not differ in age, sex, physical activity or initial HbA1c. In the intervention group, blood glucose significantly decreased at the end of the study in all predefined measurements, compared to control group: morning (93.18 ±â€¯13.30 mg/dl vs. 105.17 ±â€¯13.74 mg/dl, p < 0.005), pre-prandial (114.76 ±â€¯9.54 mg/dl vs. 120.84 ±â€¯4.05 mg/dl, p < 0.005), post-prandial (193.35 ±â€¯25.36 mg/dl vs. 207.84 ±â€¯18.80 mg/dl, p < 0.005), and HbA1c decreased significantly over time in the intervention group (8.3 ±â€¯0.6% at the beginning of the study vs. 7.8 ±â€¯1% at the end of the study, p = 0.03). In the intervention group there were also fewer omitted glucose measurements than in the control group. CONCLUSIONS: Patients in the intervention group achieved better glucose control and more frequent self-monitoring than patients in routine care in the clinic. The findings of our study indicate that telenursing can motivate T1DM patients to better control their disease.