含乳杆菌的益生菌制剂干预2型糖尿病疗效及安全性的Meta分析

目的 系统评价益生菌类制剂治疗2型糖尿病的疗效及安全性，尤其是包含乳杆菌的益生菌制剂的疗效。方法 运用计算机检索Embase、Cochrane、Pubmed数据库，搜索益生菌干预2型糖尿病的临床随机对照试验。应用Review manager 5.4.1软件进行Meta分析，最终纳入16项研究，包含1 015名患者。结果 试验组的干预方式在改善患者空腹血糖[SMD=–0.37,95%CI（–0.52，–0.23）,P<0.01]、改善胰岛素抵抗[SMD=–0.39,95%CI（–0.55，–0.24）,P<0.01]、提高高密度脂蛋白[SMD=0.22,95%CI(0.07,0.38),P<0.01]、降低甘油三酯[SMD=–0.18,95%CI（–0.33，–0.03）,P=0.02]水平方面优于对照组，而在患者体质量指数[MD=0.27,95%CI（–0.45,1.00）,P=0.46]、胆固醇[SMD=0.01,95%CI（–0.13,0.15）,P=0.94]、高敏C-反应蛋白[SMD=–0.15,95%CI（–0.33,0.02）,P=0.09]、收缩压[MD...     

益生菌对结直肠癌术后 患者炎症因子影响的Meta分析

目的系统评价益生菌对结直肠癌术后患者炎症因子的影响。方法通过计算机检索PubMed、Embase、Cochrane、中国学术期刊全文数据库(CNKI)、万方数据库和维普数据库,评价纳入的临床随机对照研究,应用ReMan 5.3软件进行Meta分析。结果最终纳入8个临床随机对照试验,共597例患者。Meta分析结果显示:与对照组相比,使用益生菌进行术前肠道准备,可以降低结直肠癌术后患者血清IL-6[SMD=-1.67,95%CI(-2.65,-0.68),P0.001]、TNF-α[SMD=-1.39,95%CI(-2.05,-0.73),P0.001]及CRP水平[SMD=-2.12,95%CI(-2.67,-1.56),P0.001]。结论使用益生菌进行术前肠道准备,可减轻结直肠癌术后患者炎症反应,但受纳入研究质量的限制,上述结论有待更多高质量研究验证。     

益生菌制剂对脑卒中患者肠道菌群及肠道功能影响的Meta分析

目的探讨益生菌制剂对脑卒中患者肠道菌群及肠道功能的影响。方法通过检索PubMed、EMbase、Cochrane Library、CNKI、维普和万方数据库,收集各数据库从建库至2020年3月发表的所有关于脑卒中患者应用益生菌制剂的随机对照试验,由2名研究者独立筛选文献,按照系统评价的要求对文献质量进行评估,使用RevMan 5.3和Stata 14.0统计软件进行Meta分析。结果共纳入19篇文献(1 528例患者),Meta分析结果显示,2组患者肠道中肠球菌的数量差异没有统计学意义[SMD=-0.74,95%CI(-1.64,0.17),P=0.110],而益生菌组患者肠道中大肠埃希菌的数量低于对照组[SMD=-1.27,95%CI(-1.81,-0.73),P0.001];益生菌组患者肠道中乳杆菌和双歧杆菌数量高于对照组[SMD=1.50,95%CI(0.96,2.03),P0.001;SMD=1.66,95%CI(1.16,2.15),P0.001]。益生菌组患者血清中二胺氧化酶(DAO)和D-乳酸水平低于对照组[SMD=-1.76,95%CI(-2.39,-1.13),P0.001;SMD=-2.21,95%CI(-2.92,-1.51),P0.001];益生菌组患者粪便中分泌型免疫球蛋白A(sIgA)的量高于对照组[SMD=1.76,95%CI(0.84,2.68),P0.001]。结论在肠内营养的基础上添加益生菌制剂对脑卒中患者进行营养治疗,能够有效调节患者肠道菌群,改善患者的肠道功能。     

布拉酵母菌辅助治疗腹泻型肠易激综合征疗效的Meta分析

目的系统评价布拉酵母菌辅助治疗腹泻型肠易激综合征(IBS-D)的有效性。方法计算机检索The Cochrane Library、PubMed、EMbase、中国生物医学文献数据库、中国知网、维普中文期刊数据库和万方数据库,时限为建库至2020年2月。由2位研究人员按纳入、排除标准筛选文献,提取数据,评价纳入文献的方法学质量。研究主要结果为总症状改善人数,次要结果为症状总积分及腹痛、腹胀、腹泻情况。采用RevMan 5.3统计学软件进行Meta分析。结果共纳入13篇RCT文献(n=1 320),Meta分析结果显示,使用布拉酵母菌辅助治疗IBS-D可提高患者治疗效果[RR=1.24,95%CI(1.18,1.31),P0.01],降低总症状积分[SMD=-0.98,95%CI(-1.21,-0.74),P0.01],改善患者腹痛[SMD=-0.79,95%CI(-1.02,-0.57),P0.01]、腹泻[SMD=-0.80,95%CI(-1.02,-0.58),P0.01]和腹胀[SMD=-0.97,95%CI(-1.02,-0.57),P0.01]状况。结论布拉酵母菌可以辅助治疗IBS-D,改善患者症状,但仍需更多高质量研究验证。     

益生菌联合肠内营养对比单用肠内营养在改善胃癌手术患者预后效果的Meta分析

目的对益生菌联合肠内营养对比单用肠内营养在改善胃癌手术患者预后效果进行Meta分析,以得出综合评价结论。方法利用PubMed、Cochrane、Embase、CNKI、维普和万方数据库进行文献检索,搜集有关益生菌联合肠内营养对比单用肠内营养改善胃癌手术患者预后效果的随机对照试验,由2名研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后,应用RevMan 5.3分析软件进行Meta分析。结果最终纳入8个临床随机对照试验,共552例患者。Meta分析显示,与仅用肠内营养相比,益生菌联合肠内营养能更有效地降低胃癌患者术后血清内毒素水平[MD=-15.94,95%CI(-27.40,-4.49),P=0.006]、血清TNF-α水平[MD=-9.25,95%CI(-14.51,-3.99),P0.001]、术后腹泻发生率[OR=0.41,95%CI(0.20,0.83),P=0.010];缩短术后住院天数[MD=-1.62,95%CI(-2.78,-0.46),P=0.006];提高淋巴细胞[MD=0.24,95%CI(0.07,0.42),P=0.007],粪便双歧杆菌[MD=1.94,95%CI(0.71,3.17),P=0.002]和乳杆菌[MD=2.21,95%CI(0.69,3.74),P=0.004]计数水平。益生菌还有增加胃癌患者术后血清IgG[MD=2.37,95%CI(-0.32,5.06),P=0.080]和IgM[MD=0.73,95%CI(-0.35,1.82),P=0.190]水平的趋势,但差异无统计学意义。结论当前证据表明,益生菌联合肠内营养治疗胃癌术后临床疗效确切,远优于仅用肠内营养,可以增强胃癌患者术后的机体免疫力、降低感染和腹泻的发生率、减轻全身炎性反应、维持肠道微生态的平衡,促进患者康复。受纳入研究数量和质量限制,上述结论尚待更多高质量研究予以验证。     

益生菌制剂治疗2型糖尿病 临床疗效的Meta分析

目的系统评价益生菌制剂对2型糖尿病(T2DM)患者空腹血糖、脂质代谢以及应激反应的影响。方法计算机检索PubMed、Embase、The Cochrane Library、中国知网、维普期刊数据库和万方数据库。筛选关于糖尿病患者添加益生菌制剂相关性研究的中英文随机对照试验(RCT),进行纳入文献的资料提取和质量评价,采用RevMan 5.3软件进行Meta分析。对比益生菌组与对照组患者空腹血糖(FPG)、糖化血红蛋白(HbA1c)、甘油三酯(TG)、胆固醇(TC)和C反应蛋白(CRP)指标。结果共纳入17项符合标准的RCTs,Meta分析结果显示:与对照组患者相比,益生菌制剂可显著降低T2DM患者FPG (SMD=-0.43,95%CI:-0.57～-0.28,P0.00001)、HbA1c (SMD=-0.47,95%CI:-0.82～-0.12,P=0.009)和TG (SMD=-0.31,95%CI:-0.51～-0.11,P=0.002)水平;TC (SMD=-0.63,95%CI:-1.46～0.20,P=0.13)、CRP (SMD=-0.59,95%CI:-1.41～0.22,P=0.15)在两组患者之间差异无统计学意义。结论益生菌制剂可改善T2DM患者血糖、血脂状况。     

益生菌治疗类风湿关节炎的meta分析和试验序贯分析

目的 系统评价益生菌治疗类风湿关节炎的临床疗效。方法 检索中国生物医学数据库、中国知网、万方、维普、Embase、PubMed、the Cochrane Library、Web of Science数据库，时间均从建库至2021年7月，对公开发表的益生菌治疗类风湿关节炎的随机对照试验进行meta分析和试验序贯分析。结果 共纳入6项研究，总样本量242例。Meta分析显示，益生菌治疗类风湿关节炎能显著降低CRP[MD=-2.26,95%CI=(-4.30,-0.23),P=0.03]和TNF-α[MD=-1.78,95%CI=(-2.73,0.83),P<0.01]水平，提高IL-10[MD=3.80, 95%CI=(0.40, 7.19), P=0.03]水平，而ESR、 IL-1β、 IL-6、 MDA、 TAC、 DAS28、 TJC、SJC、HAQ和ACR20等水平均与安慰剂相当。敏感性分析显示结果较为稳健，试验序贯分析显示CRP的获益具有结论性，Egger检验显示不存在发表偏倚（P=0.17）。结论 益生菌能够有效降低CRP和TNF-α水平，提高IL-10水平，具有治疗类...     

益生菌对妊娠期糖尿病患者血糖控制和血脂谱影响的Meta分析

目的评价益生菌对妊娠期糖尿病(GDM)患者血糖控制和血脂谱的影响。方法在7个数据库(Web of Science、Embase、Pubmed、中国知网、中国生物医学文献数据库、万方数据库、维普数据库)中搜索从建库至今所有关于益生菌和GDM患者的文献,按纳入排除标准共纳入6篇随机对照试验(RCT)。主要结果是空腹血糖(FBG)、空腹血清胰岛素(FSI)和胰岛素抵抗指数(IRI),次要结果是妊娠体重增加和血脂谱的变化。结果共涉及454例GDM患者,实验组228例,对照组226例。与对照组相比,补充益生菌能降低GDM妇女的胰岛素水平[MD=-2.42,95%CI(-4.48,-0.36),P=0.020]和IRI[MD=-0.56,95%CI(-0.96,-0.17),P=0.005]。而对FBG[MD=-2.19,95%CI(-5.18,0.79),P=0.150]、孕期体重增加[MD=-0.28,95%CI(-0.82,0.26),P=0.300]、血脂无影响。结论与对照组相比,补充益生菌可降低空腹血清胰岛素和IRI,但对FBG、孕期体重增加和血脂无显著影响。     

益生菌治疗中国儿童手足口病疗效Meta分析

目的系统评价补充益生菌对中国儿童手足口病的疗效。方法电脑检索资料库,包括知网、万方、维普、PubMed、Medline、The Cochrane Library。检索时间为建库至2020年3月,搜集有关益生菌辅助治疗儿童手足口病疗效的随机对照试验,由两位研究者独立筛选文献,提取数据并进行质量评价。运用RevMan 5.3软件作数据分析。结果共纳入12项临床研究,计943例患儿。Meta分析结果显示,补充益生菌可缩短患儿皮疹消退时间[MD=-1.20 d, 95%CI(-1.63～-0.77),P0.001]、体温恢复正常时间[MD=-0.67 d, 95%CI(-0.78～-0.56),P0.001]、食欲好转时间[MD=-1.08 d, 95%CI(-1.22～-0.93),P0.001],并提高3 d治疗有效率[OR=7.36,95%CI(4.09～13.23),P0.001]。两组患儿在副反应发生率方面,差异无统计学意义(P0.05)。结论现有证据表明,益生菌作为手足口病的辅助治疗方法,可减轻患儿临床症状,缩短病程且不增加副反应发生率。     

益生菌对非酒精性脂肪肝治疗疗效的Meta分析

目的系统评价益生菌对非酒精性脂肪肝(non-alcoholic fatty liver disease,NAFLD)的治疗疗效。方法通过计算机检索PubMed、Cochrane、中国知网(CNKI)、万方、维普数据库(VIP)检索2008年5月-2018年5月益生菌治疗非酒精性脂肪肝相关文献,纳入11篇病例对照研究,采用NOS量表(Newcastle-Ottawa Scale)进行文献质量评价,提取身体质量指数(body mass index,BMI)、血清学指标、炎性指标及影像学分级等参数,应用RevMan 5.3软件进行Meta分析、亚组分析,Stata 12.0软件进行敏感性分析及发表偏倚检测。结果纳入的11篇病例对照研究符合标准,病例总数为650,Meta分析结果显示:益生菌组较对照组,可明显降低血清学指标ALT (WMD=-12.49,95%CI:-16.67～-8.31,P0.00001)、AST (WMD=-11.39,95%CI:-16.51～-6.26,P0.0001)、TC (WMD=-0.34,95%CI:-0.54～-0.13,P=0.001)水平,增加脂肪肝消退数(RR=4.20,95%CI:2.02～8.72,P=0.001),对于身体质量指数(WMD=-0.81,95%CI:-2.22～0.60,P=0.26)、胰岛素抵抗指数(WMD=-0.06,95%CI:-0.82～0.70,P=0.88)、炎症指标TNF (SMD=-1.00,95%CI:-2.11～0.11,P=0.08)差异则无统计学意义。对身体质量指数进行亚组分析显示,三种以上复合益生菌可明显降低身体质量指数水平(WMD=-2.30,95%CI:-2.43～-2.17,P0.00001)。结论益生菌制剂可改善非酒精性脂肪肝的肝功能及影像学表现,降低血脂水平,但并未明显降低身体质量指数、胰岛素抵抗及炎性指标TNF水平。发现三种以上复合益生菌对于降低BMI有一定作用。     

Retinol-binding protein 4 in young men with low versus normal birth weight: physiological response to short-term overfeeding

Retinol-binding protein 4 (RBP4) is a plasma protein which is elevated in obesity and type 2 diabetes. We aimed to investigate whether RBP4 represents a mechanism underlying the associations between low birth weight (LBW), high-fat diet, and insulin resistance. Forty-six young, lean men with low (n = 20) or normal (n = 26) birth weight underwent a 5-day high-fat high-calorie (HFHC) dietary intervention. In vivo glucose metabolism was assessed by euglycemic-hyperinsulinemic clamp, glucose tracer and intravenous glucose tolerance test techniques. Body composition was measured by a dual-energy x-ray absorptiometry scan, and plasma RBP4 by an enzyme-linked immunosorbent assay. RBP4 was not associated with birth weight, but with BMI (β = 0.9 μg/ml (0.08; 1.8) (95% confidence interval), P = 0.03) and plasma levels of low-density lipoprotein cholesterol (β = 5.3 μg/ml (1.9; 8.7), P = 0.03) and triglycerides (β = 15.4 μg/ml (9.5; 21.3), P < 0.001). Under baseline diet conditions, RBP4 was associated with decreased disposition index (D(i)) (β = -2.4% (-4.5%; -0.2%), P = 0.04) and increased basal hepatic glucose production rate (HGP) (β = 0.02 mg kg(-1) min(-1) (0.002; 0.04), P = 0.03), but not associated with peripheral glucose disposal rate or hepatic insulin resistance index. RBP4 levels were not influenced by overfeeding or related to peripheral and hepatic insulin resistance provoked by the dietary intervention. In conclusion, plasma RBP4 in young men associates with components of the metabolic syndrome, but is not determined by birth weight and seems not to be involved in short-term high-fat diet-induced insulin resistance.     

Long-term efficacy of antipsychotic drugs in initially acutely ill adults with schizophrenia: systematic review and network meta-analysis

Most acute phase antipsychotic drug trials in schizophrenia last only a few weeks, but patients must usually take these drugs much longer. We examined the long-term efficacy of antipsychotic drugs in acutely ill patients using network meta-analysis. We searched the Cochrane Schizophrenia Group register up to March 6, 2022 for randomized, blinded trials of at least 6-month duration on all second-generation and 18 first-generation antipsychotics. The primary outcome was change in overall symptoms of schizophrenia; secondary outcomes were all-cause discontinuation; change in positive, negative and depressive symptoms; quality of life, social functioning, weight gain, antiparkinson medication use, akathisia, serum prolactin level, QTc prolongation, and sedation. Confidence in the results was assessed by the CINeMA (Confidence in Network Meta-Analysis) framework. We included 45 studies with 11,238 participants. In terms of overall symptoms, olanzapine was on average more efficacious than ziprasidone (standardized mean difference, SMD=0.37, 95% CI: 0.26-0.49), asenapine (SMD=0.33, 95% CI: 0.21-0.45), iloperidone (SMD=0.32, 95% CI: 0.15-0.49), paliperidone (SMD=0.28, 95% CI: 0.11-0.44), haloperidol (SMD=0.27, 95% CI: 0.14-0.39), quetiapine (SMD=0.25, 95% CI: 0.12-0.38), aripiprazole (SMD=0.16, 95% CI: 0.04-0.28) and risperidone (SMD=0.12, 95% CI: 0.03-0.21). The 95% CIs for olanzapine versus aripiprazole and risperidone included the possibility of trivial effects. The differences between olanzapine and lurasidone, amisulpride, perphenazine, clozapine and zotepine were either small or uncertain. These results were robust in sensitivity analyses and in line with other efficacy outcomes and all-cause discontinuation. Concerning weight gain, the impact of olanzapine was higher than all other antipsychotics, with a mean difference ranging from –4.58 kg (95% CI: –5.33 to –3.83) compared to ziprasidone to –2.30 kg (95% CI: –3.35 to –1.25) compared to amisulpride. Our data suggest that olanzapine is more efficacious than a number of other antipsychotic drugs in the longer term, but its efficacy must be weighed against its side effect profile.     

Effect of traditional Chinese medicine on gut microbiota in adults with type 2 diabetes: A systematic review and meta-analysis

BackgroundDespite advances in research on type 2 diabetes mellitus (T2DM) with the development of science and technology, the pathogenesis and treatment response of T2DM remain unclear. Recent studies have revealed a significant role of the microbiomein the development of T2DM, and studies have found that the gut microbiota may explain the therapeutic effect of traditional Chinese medicine (TCM), a primary branch of alternative and complementary medicine, in the treatment of T2DM. The aim of this study was to systematically review all randomized controlled trials (RCTs) on TCM for gut microbiota to assess the effectiveness and safety of TCM in T2DM patients.MethodsAll RCTs investigating the effects of TCM interventions on modulating gut microbiota and improving glucose metabolism in the treatment of T2DM adults were included. Meta-analyses were conducted when sufficient data were available, other results were reported narratively. The study protocol was pre-specified, documented, and published in PROSPERO (registration no. CRD42020188043).ResultsFive studies met the eligibility criteria ofthe systematic review. All five studies reported the effects of TCM interventions on the gut microbiota modulation and blood glucose control. There were statistically significant improvements in HbA1c (mean difference [MD]: -0.69%; [95% CI −0.24, −0.14]; p = 0.01, I² = 86%), fasting blood glucose (MD: −0.87 mmol/l; [95% CI -1.26, -0.49]; p < 0.00001, I² = 75%) and 2-h postprandial blood glucose(MD: -0.83mmol/l; [95% CI: -1.01, -0.65]; p < 0.00001, I² = 0%). In addition, there were also statistically significant improvements in homeostasis model assessment of insulin resistance (HOMA-IR) (standardized mean difference [SMD]: −0.99, [95% CI −1.25 to -0.73]; p < 0.00001, I² = 0%) and homeostasis model assessment of β-cell function (HOMA-β) (SMD: 0.54, [95% CI 0.21 to 0.87]; p = 0.001, I² = 0%).There was a significant change in the relative abundance of bacteria in the genera Bacteroides (standardized mean difference [SMD] 0.87%; [95% CI 0.58, 1.16], however, the change in Enterococcus abundance was not statistically significant (SMD: -1.71%; [95% CI: -3.64, 0.23]; p = 0.08) when comparing TCM supplementaltreatment with comparator groups. Other changes in the gut microbiota, including changes in the relative abundances of some probiotics and opportunistic pathogens at various taxon levels, and changes in diversity matrices (α and β), were significant by narrative analysis. However, insufficient evidences were found to support that TCM intervention had an effect on inflammation.ConclusionTCM had the effect of modulating gut microbiota and improving glucose metabolisms in T2DM patients. Although the results of the included studies are encouraging, further well-conducted studies on TCM interventions targeting the gut microbiota are needed.     

New "pre-diabetes" category and the metabolic syndrome in Japanese.

BACKGROUND: Recently, impaired fasting glucose (IFG) was redefined as fasting plasma glucose of 100-125 mg/dl, and individuals with IFG and/or impaired glucose tolerance (IGT) were referred to as having "pre-diabetes". However, there is a lack of data using the new definition of IFG and "pre-diabetes". OBJECTIVE: The aim of this study was to examine associations of the metabolic syndrome components with the new "pre-diabetes" category in relatively lean Japanese. METHODS: Six hundred and sixty-one Japanese study participants underwent a 75 g oral glucose tolerance test. They were classified into three groups-normal (n=225), pre-diabetes (n=308), and diabetes (n=128). The metabolic syndrome was defined according to the National Cholesterol Education Program Adult Treatment Panel III, as modified for waist circumference criteria by the Regional Office for the Western Pacific Region of WHO. RESULTS: Prevalence of the metabolic syndrome in each group was 10.7%, 27.9%, and 53.9%, respectively. Of the metabolic syndrome components, the OR for prevalent pre-diabetes was 2.00 (95% CI, 1.73-2.31, p<0.001) for fasting glucose, 1.93 (95% CI, 1.54-2.42, p<0.001) for waist circumference, and 1.36 (95% CI, 1.10-1.68, p=0.005) for triglycerides. Similar associations were found in prevalent diabetes. Insulin resistance assessed using Stumvoll's index was significantly associated with both pre-diabetes and diabetes. CONCLUSION: Pre-diabetes and the metabolic syndrome frequently coexist in relatively lean Japanese. This association seems to link with abdominal adiposity and insulin resistance.     

The Effect of Tai Chi Training on Cardiorespiratory Fitness in Healthy Adults: A Systematic Review and Meta-Analysis

BackgroundTai Chi may be efficient for healthy adults to improve the cardiorespiratory fitness, but there is no systematic evaluation for its effectiveness.ObjectiveTo systematically assess the effectiveness of Tai Chi on cardiorespiratory fitness in healthy adults.MethodsSeven electronic databases were searched from their inception to October 2013. The controlled trails including randomized controlled trial (RCT), non-randomized controlled trial (NRCT), self-controlled trial (SCT), and cohort study (CS) testing Tai Chi exercise against non-intervention control conditions in healthy adults that assessed any type cardiorespiratory fitness outcome measures were considered. Two reviewers independently performed the selection of the studies according to predefined criteria. The risk of bias was assessed using Cochrane criteria. RevMan 5.2 software was applied for data analysis.ResultsTwenty studies (2 RCTs, 8 NRCTs, 3 SCTs, and 7 CSs) with 1868 participants were included, but most of them belonged to low methodological quality. The results of systematic review showed that Tai Chi exercise had positive effect on majority outcomes of cardio function (Blood pressure: n = 536, SPB SMD = -0.93, 95% CI -1.30 to -0.56, P < 0.00001; DBP SMD = -0.54, 95% CI -0.90 to -0.18, P < 0.00001; heart rate at quiet condition: n = 986, SMD = -0.72, 95% CI -1.27 to -0.18, P = 0.010; stroke volume: n = 583, SMD = 0.44, 95% CI 0.28 to 0.61, P < 0.00001; cardio output: n = 583, MD = 0.32 L/min, 95% CI 0.08 to 0.56, P = 0.009), lung capacity (FVC at quiet condition: n = 1272, MD = 359.16 mL, 95% CI 19.57 to 698.75, P = 0.04 for less than one year intervention, and MD = 442.46 mL, 95% CI 271.24 to 613.68, P<0.0001 for more than one year intervention; V·O₂peak: n = 246, SMD = 1.33, 95% CI 0.97 to 1.70, P < 0.00001), and cardiorespiratory endurance (O₂ pulse at quiet condition: n = 146, SMD = 1.04; 95% CI 0.69 to 1.39; P < 0.00001; stair test index at quiet condition: n = 679, SMD = 1.34, 95% CI 0.27 to 2.40, p = 0.01). No adverse events were reported.ConclusionsThe results are encouraging and suggest that Tai Chi may be effective in improving cardiorespiratory fitness in healthy adults. However, concerning the low methodological quality in the included studies, more larger-scale well-designed trails are needed till the specific and accurate conclusions can be perorated.     

Activation of dopamine D2 receptors simultaneously ameliorates various metabolic features of obese women

The metabolic syndrome comprises a cluster of metabolic anomalies including insulin resistance, abdominal obesity, dyslipidemia, and hypertension. Previous studies suggest that impaired dopamine D2 receptor (D2R) signaling is involved in its pathogenesis. We studied the acute effects of bromocriptine (a D2R agonist) on energy metabolism in obese women; body weight and caloric intake remained constant. Eighteen healthy, obese women (BMI 33.2 +/- 0.6 kg/m(2), mean age 37.5 +/- 1.7, range 22-51 yr) were studied twice in the follicular phase of their menstrual cycle in a prospective, single-blind, crossover design. Subjects received both placebo (P; always first occasion) and bromocriptine (B; always second occasion) on separate occasions for 8 days. At each occasion blood glucose and insulin were assessed every 10 min for 24 h, and circadian plasma free fatty acid (FFA) and triglyceride (TG) levels were measured hourly. Fuel oxidation was determined by indirect calorimetry. Body weight and composition were not affected by the drug. Mean 24-h blood glucose (P < 0.01) and insulin (P < 0.01) were significantly reduced by bromocriptine, whereas mean 24 h FFA levels were increased (P < 0.01), suggesting that lipolysis was stimulated. Bromocriptine increased oxygen consumption (P = 0.03) and resting energy expenditure (by 50 kcal/day, P = 0.03). Systolic blood pressure was significantly reduced by bromocriptine. Thus these results imply that short-term bromocriptine treatment ameliorates various components of the metabolic syndrome while it shifts energy balance away from lipogenesis in obese humans.     

Association Of Peripheral 5-Hydroxyindole-3-Acetic Acid,A Serotonin Derivative,with Metabolic Syndrome and Low-Grade Inflammation

Objective: The constellation of metabolic abnormalities seen in metabolic syndrome (MetS) has been linked to atherosclerosis and adverse cardiovascular outcomes due to heightened inflammation. Accumulating evidence suggests that peripheral 5-hydroxyindole-3-acetic acid (5-HIAA), the derivative end-product of serotonin (5-HT), might be involved in the pathogenesis of obesity, and abnormal lipid and glucose metabolism. We examined the association between serum 5-HIAA concentrations and MetS and also highly sensitive C-reactive protein (hsCRP).Methods: We assessed 180 healthy adults (110 males and 70 females) in a cross-sectional setting. Anthropometric indices and blood pressure were measured, as were laboratory parameters including fasting 5-HIAA concentrations. The associations between 5-HIAA and individual components of MetS, as well as MetS as a single entity, were investigated with bivariate correlation and logistic regression analyses.Results: Eighty-nine individuals (49.4%) were diagnosed with MetS. Significant correlations were found between 5-HIAA concentrations and age (r = 0.184), waist circumference (r = 0.415), high-density lipoprotein (HDL) cholesterol (r = -0.148), systolic blood pressure (r = 0.374), diastolic blood pressure (r = 0.355), homeostasis model assessment of insulin resistance (r = 0.201), and hsCRP (r = 0.453) were found (P<.05 in all tests). In logistic regression, 5-HIAA was significantly associated with 4 MetS components including central obesity, raised triglycerides, raised blood pressure, and raised fasting plasma glucose (FPG) (P<.05). Moreover, 5-HIAA was a predictor of MetS as a single entity, and the relationship persisted after adjusting for hsCRP (odds ratio [OR] = 4.41, 95% confidence interval [CI]: 2.58-7.67, P<.001).Conclusion: Elevated concentrations of 5-HIAA are seen in individuals with MetS. Increased 5-HIAA is also associated with hsCRP, a marker of chronic lowgrade inflammation underlying MetS.Abbreviations: BMI = body mass index CI = confidence interval FI = fasting insulin FPG = fasting plasma glucose HbA1c = glycated hemoglobin HDL = high-density lipoprotein 5-HIAA = 5-hydroxyindole-3-acetic acid 5-HT = 5-hydroxytryptamine HOMA-IR = homeostatic model assessment of insulin resistance hsCRP = highly sensitive C-reactive protein LDL = low-density lipoprotein MetS = metabolic syndrome OR = odds ratio     

A polymorphism at the IL6ST (gp130) locus is associated with traits of the metabolic syndrome

The interleukin 6 signal transducer (IL6ST, also known as gp130) is a ubiquitously expressed intermediate of the interleukin-6 signaling pathway. We investigated whether genetic variability at the IL6ST locus is involved in the modulation of metabolic traits and the etiology of the metabolic syndrome (MS). Four haplotype-tagging single nucleotide polymorphisms were typed in two populations of non-diabetic subjects, one from Northern Italy (Padua (PD), n = 630), the other from Southern Italy (San Giovanni Rotondo (SGR), n = 553). In the PD population, a nominally significant association was observed between fasting glucose and rs715180 (P = 0.02), rs3729960 (P = 0.02), and rs10940495 (P = 0.05), between homeostasis model assessment index (HOMA(IR)) and rs715180 (P = 0.04), and between triglycerides and rs3729960 (P = 0.03). In the SGR population, high-density lipoprotein (HDL) levels were associated with rs715180 (P = 0.01), systolic blood pressure and waist circumference with rs3729960 (P = 0.005 and 0.02, respectively). The frequency of rs715180 minor allele carriers progressively decreased from individuals with no MS components to those with three or more components (P for trend = 0.006 in the two populations combined). Compared to major allele homozygotes, minor allele carriers had 40% lower odds of having at least one MS component (Odds ratio = 0.6, 95% confidence interval 0.4-0.8, P = 0.005). These findings point to IL6ST variants as possible determinants of impaired glucose metabolism and other abnormalities of MS.     

Effectiveness of Wearable Activity Monitors on Metabolic Outcomes in Patients With Type 2 Diabetes: A Systematic Review and Meta-Analysis

ObjectiveWearable activity monitors are promising tools for improving metabolic outcomes in patients with type 2 diabetes mellitus (T2DM); however, no uniform conclusive evidence is available. This study aimed to evaluate the effects of the intervention using wearable activity monitors on blood glucose, blood pressure, blood lipid, weight, waist circumference, and body mass index (BMI) in individuals with T2DM.MethodsTwo independent reviewers searched 4 online databases (PubMed, Cochrane Library, Web of Science, and Embase) to identify relevant studies published from January 2000 to October 2022. The primary outcome indicator was hemoglobin A1c (HbA1c), and the secondary outcome indicators included physical activity (steps per day), fasting blood glucose, triglyceride, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, total cholesterol, systolic blood pressure, diastolic blood pressure, BMI, waist circumference, and weight.ResultsA total of 25 studies were included. The HbA1c level (standardized mean difference [SMD], −0.14; 95% confidence interval [CI], −0.27 to −0.02; P = .02; I² = 48%), BMI (SMD, −0.16; 95% CI, −0.26 to −0.05; P = .002; I² = 0), waist circumference (SMD, −0.21; 95% CI, −0.34 to −0.09; P < .001; I² = 0), and steps/day (SMD, 0.55; 95% CI, 0.36-0.94; P < .001; I² = 77%) significantly improved.ConclusionWearable activity monitor–based interventions could facilitate the improvement of the HbA1c level, BMI, and waist circumference and increase in physical activity in individuals with T2DM. Wearable technology appeared to be an effective tool for the self-management of T2DM; however, there is insufficient evidence about its long-term effect.     

Waist circumference, not the metabolic syndrome, predicts glucose deterioration in type 2 diabetes

We sought to assess the relationship between the metabolic syndrome, abdominal obesity, and glucose deterioration amongst patients with type 2 diabetes. Our prospective cohort consisted of 164 adult patients with established diabetes who have a history of poor glycemic control, have just completed an intensive intervention aimed at improved control, and have demonstrated reduced HbA1c prior to enrollment. Waist circumference and presence of metabolic syndrome were assessed at baseline, and patients were followed up (median 24 months) for assessment of the study outcome, namely, time-to-hyperglycemic relapse, predefined as HbA1c >8% and >1% rise over baseline. Kaplan-Meier estimates of relapse-free glucose maintenance and multivariable Cox regression models were used for quantifying the independent effects of the metabolic syndrome and waist circumference on risk of glucose deterioration. The mean baseline waist circumference was 42.9 5.5 inches. Prevalence of the metabolic syndrome was 80%. During follow-up, 39 patients (24%) experienced hyperglycemic relapse. The metabolic syndrome was not associated with time-to-relapse (P = 0.15). The waist circumference component by itself, however, was associated with increased likelihood of hyperglycemic relapse with an unadjusted hazard ratio of 3.4 (95% confidence interval (CI) 1.2-9.7) and a hazard ratio of 3.2 (95% CI 1.1-9.1) after adjusting for age, gender, insulin use, weight change, and physical activity level. The National Cholesterol Education Program Adult Treatment Panel III (NCEP ATPIII) metabolic syndrome had limited ability to predict glucose deterioration in this type 2 diabetes cohort. Waist circumference by itself, however, is a strong predictor of future glucose control, and may be a parsimonious tool for risk stratification. BMI may also be a useful predictive tool.