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Appl Physiol Nutr Metab. 2007 Feb;32(1):46-60.

Nutritional strategies in the prevention and treatment of metabolic syndrome.


Feldeisen SE, Tucker KL.

Source
Jean Mayer US Department of Agriculture Human Nutrition Research Center on Aging at Tufts University, 711 Washington Street, Boston, MA 02111, USA.

Abstract
The metabolic syndrome (MetS) is a clustering of metabolic abnormalities that increase the risk of developing atherosclerotic cardiovascular disease and type 2 diabetes. The exact etiology remains unclear, but it is known to be a complex interaction between genetic, metabolic, and environmental factors. Among environmental factors, dietary habits are of central importance in the prevention and treatment of this condition. However, there is currently no firm consensus on the most appropriate dietary recommendations. General recommendations include decreasing obesity, increasing physical activity, and consuming an anti-atherogenic diet, and have traditionally focused on low total fat intake. A major problem with the focus on low fat is that high-carbohydrate diets can contribute to increasing triglyceride and decreasing high-density lipoprotein (HDL) concentrations. Low-carbohydrate diets have been popular in recent years. However, such diets are typically higher in saturated fat and lower in fruits, vegetables, and whole grains than national dietary recommendations. More recently the quality of carbohydrate has been studied in relation to MetS, including a focus on dietary fiber and glycemic index. Similarly, there has been a move from limiting total fat to a focus on the quality of the fat, with evidence of beneficial effects of replacing some carbohydrate with monounsaturated fat. Other nutrients examined for possible importance include calcium, vitamin D, and magnesium. Together, the evidence suggests that the components of diet currently recommended as "healthy" are likely also protective against MetS, including low saturated and trans fat (rather than low total fat) and balanced carbohydrate intake rich in dietary fiber, as well as high fruit and vegetable intake (rather than low total carbohydrate); and the inclusion of low-fat dairy foods. Accelerating research on gene-diet interactions is likely to contribute interesting information that may lead to further individualized dietary guidance in the future
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Send to: Eur Rev Med Pharmacol Sci. 2011 Feb;15(2):135-47.

Vitamin D, parathyroid hormone levels and insulin sensitivity among obese young adult Saudis.
Al-Sultan AI, Amin TT, Abou-Seif MA, Al Naboli MR.

Source
Department of Internal Medicine, Endocrinology Section, College of Medicine, King Faisal University, Saudi Arabia.

Abstract
OBJECTIVES:

To determine alterations of vitamin D and parathyroid hormone levels and their relationship to insulin resistance among a sample of healthy young adult obese Saudis and to identify factors that might predict these alterations.
METHODS:

Age and gender matched obese young (aged 18-25 years) adult Saudis (N = 76) with body mass index of > or = 30 and their lean controls (N = 84) were recruited after fulfilling exclusion and inclusion criteria from attendees of health facility at King Faisal University, Saudi Arabia. Selected participants were invited to a personal interview to gather information regarding sociodemographics. Fasting blood samples were assessed for the following essays: serum calcium, 25 OH vitamin D, inorganic phosphorus, intact parathyroid hormone (iPTH), serum insulin, fasting glucose, renal and liver function tests.
RESULTS:

Vitamin D levels were significantly higher in lean controls, and showed significant decline in relation to obesity classes, hypovitaminosis D was found in 30% (38.2% obese vs. 22.7% in lean) and deficiency in 17.5% of subjects; (19% vs. obese 15.8%). iPTH was significantly higher in obese subjects. Secondary hyperparathyroidism was found in 48.1% (60.5% obese vs. 36.9% controls). Regression analysis showed that body mass index, serum calcium and creatinine levels were the main predictors for vitamin D level. Vitamin D is positively associated with fasting blood sugar (r = -.133, P = 0.09) and beta cell function index (r = .192, P = 0.08), negatively associated with HOMA-IR (r = -.122, P = .34) but without statistical significance after controlling of possible confounders.

CONCLUSION:

Vitamin D level among young adult Saudi obese is negatively associated by body mass index and classes of obesity. Negative associations between vitamin D, iPTH levels and HOMA-IR exist but without statistical signifcance.
Arch Dis Child. 2011 May;96(5):447-52. Epub 2011 Feb 20.

A cross-sectional study of vitamin D and insulin resistance in children.


Kelly A, Brooks LJ, Dougherty S, Carlow DC, Zemel BS.

Source
Division of Endocrinology/Diabetes, 1130 Northwest Tower, The Children's Hospital of Philadelphia, 34th & Civic Center Boulevard, Philadelphia, PA 19104, USA. kellya@email.chop.edu

Abstract
OBJECTIVE:

Vitamin D deficiency is common and has been associated with several non-bone/calcium related outcomes. The objective was to determine the association between serum 25-hydroxyvitamin D (25-OH-D) and fasting glucose, insulin and insulin sensitivity in obese and non-obese children. PATIENTS/SETTING/DESIGN: Cross-sectional study of 85 children aged 4-18 years recruited from the local Philadelphia community and Sleep Center.
MAIN OUTCOME MEASURES:

Fasting blood glucose, insulin and 25-OH-D were measured. Insulin resistance was calculated using homeostasis model assessment (HOMA). Body mass index standard deviation scores (BMI-Z) and pubertal stage were determined. Multivariable linear regression was used to determine factors associated with decreased 25-OH-D and to determine the association of vitamin D with HOMA.
RESULTS:

Median 25-OH-D was 52 nmol/l (IQR 34-76). 26% of subjects were vitamin D sufficient (25OH-D 75 nmol/l), 27% had intermediate values (50-75 nmol/l) and 47% were insufficient (2550 nmol/l) or frankly deficient (<25 nmol/l). In the multivariable model, older age, higher BMI-Z and African-American race were all negatively associated with 25-OH-D; summer was

positively associated with 25-OH-D. Lower 25-OH-D was associated with higher fasting blood glucose, insulin and HOMA after adjustment for puberty and BMI-Z.
CONCLUSION:

Low 25-OH-D, common in the paediatric population at risk for diabetes (older children, AfricanAmericans, children with increasing BMI-Z) is associated with worse insulin resistance. J Steroid Biochem Mol Biol. 2010 Jul;121(1-2):425-9. Epub 2010 Mar 18.

Vitamin D and diabetes.


Pittas AG, Dawson-Hughes B.

Source
Division of Endocrinology, Diabetes and Metabolism, Tufts Medical Center, Boston, MA 02111, United States. apittas@tuftsmedicalcenter.org

Abstract
On the basis of evidence from animal and human studies, vitamin D has emerged as a potential risk modifier for type 1 and type 2 diabetes (type 1 diabetes and type 2 diabetes). Vitamin D is thought to have both direct (through activation of the vitamin D receptor) and indirect (via regulation of calcium homeostasis) effects on various mechanisms related to the pathophysiology of both types of diabetes, including pancreatic beta-cell dysfunction, impaired insulin action and systemic inflammation. Observational case-control studies have shown that vitamin D supplementation in pregnancy or early childhood is associated with reduced risk of incident type 1 diabetes. There are no trials on the effect of vitamin D (ergocalciferol or cholecalciferol) on type 1 diabetes. An association between vitamin D insufficiency and incident type 2 diabetes has been reported in longitudinal observational studies, but the association is not consistent. Results from small underpowered trials and post-hoc analyses of data from larger trials designed for bone-specific outcomes show no effect of vitamin D supplementation on glycemia in healthy adults but vitamin D may retard the progression to diabetes in adults with glucose intolerance. Because vitamin D is an excellent marker of general health status, the positive results reported in some observational studies might reflect unmeasured and unaccounted confounding. Therefore, the hypothesis that vitamin D may modify diabetes risk needs to be confirmed in trials specifically designed for that purpose. Copyright (c) 2010 Elsevier Ltd. All rights reserved. PMID: 20304061 [PubMed - indexed for MEDLINE] PMCID: PMC2900448

[Available on 2011/7/1]
Diabetologia. 2009 Dec;52(12):2542-50. Epub 2009 Oct 13.

Calcium, vitamin D and dairy intake in relation to type 2 diabetes risk in a Japanese cohort.
Kirii K, Mizoue T, Iso H, Takahashi Y, Kato M, Inoue M, Noda M, Tsugane S; Japan Public Health Centerbased Prospective Study Group.

Collaborators (107) Source


Department of Epidemiology and International Health, Research Institute, International Medical Center of Japan, Tokyo, Japan.

Abstract
AIMS/HYPOTHESIS:

Calcium and vitamin D have been implicated in the development of type 2 diabetes, but epidemiological evidence is limited. We examined prospectively the relation of calcium and vitamin D intake to type 2 diabetes risk in a Japanese cohort.
METHODS:

Participants were 59,796 middle-aged and older men and women, who participated in the Japan Public Health Center-based Prospective Study and had no history of type 2 diabetes or other serious diseases. Dietary intake of calcium and vitamin D were estimated using a validated food frequency questionnaire. Logistic regression was used to assess the association between intake of these nutrients and self-reported newly diagnosed type 2 diabetes.
RESULTS:

During a 5 year follow-up, 1,114 cases of type 2 diabetes were documented. Overall, calcium intake was not associated with a significantly lower risk of type 2 diabetes; the multivariable odds ratio for the highest vs lowest quartiles was 0.93 (95% CI 0.71-1.22) in men and 0.76 (95% CI 0.56-1.03) in women. However, among participants with a higher vitamin D intake, calcium intake was inversely associated with diabetes risk; the odds ratio for the highest vs lowest intake categories was 0.62 (95% CI 0.41-0.94) in men and 0.59 (95% CI 0.38-0.91) in women. Dairy food intake was significantly associated with a lower risk of type 2 diabetes in women only.

CONCLUSIONS/INTERPRETATION: Calcium and vitamin D may not be independently associated with type 2 diabetes risk. Our finding suggesting a joint action of these nutrients against type 2 diabetes warrants further investigation.

Nippon Rinsho. 2009 May;67(5):1003-10.

[Management of osteoporosis in diabetes mellitus].


[Article in Japanese] Okazaki R.

Source
Third Department of Medicine, Teikyo University Chiba Medical Center.

Abstract
Recent metaanalyses have revealed both type 1 and type 2 diabetes mellitus (DM) are associated with an increased risk of hip fracture. In type 1 DM, decreased bone mineral density (BMD) and diabetic vascular complications are associated with an increased risk of fracture. Hence, strict metabolic control with intensive insulin therapy combined with earlier BMD assessment is important to prevent osteoporotic fractures. In type 2 DM, fracture risk is increased despite increased BMD. Presence of diabetic vascular complications, advanced glycation of bone collagen, deranged bone turnover, and possibly certain types of anti-diabetic medications are related to an increased risk of fracture. Comprehensive management, including calcium and vitamin D rich diet, exercise together with tight metabolic control would be important to prevent fractures in type 2 DM. Special care may be necessary in the use of thiazolidinediones toward high fracture risk individuals, such as postmenopausal women. PMID: 19432124 [PubMed - indexed for MEDLINE]

Fertil Steril. 2009 Sep;92(3):1053-8. Epub 2008 Oct 18.

Role of vitamin D treatment in glucose metabolism in polycystic ovary syndrome.


Kotsa K, Yavropoulou MP, Anastasiou O, Yovos JG.

Source
Division of Endocrinology and Metabolism, Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece.

Abstract
OBJECTIVE:

To determine the effect of treatment with vitamin D(3) analogue in the parameters of glucose metabolism in obese women with polycystic ovary syndrome (PCOS).
DESIGN:

Observational study.
SETTING:

Obese women with PCOS in an academic research environment.


PATIENT(S):

Fifteen obese women (mean age 28 +/- 1.3 years, mean body mass index 32.55 +/- 0.43) with documented chronic anovulation and hyperandrogenism were recruited into the study.
INTERVENTION(S):

Alphacalcidol (1-alpha-hydroxyvitamin D(3)) was administered orally 1 microg/day for 3 months. All subjects underwent a frequently sampled IV glucose tolerance test after a 10- to 12hour overnight fast during a spontaneous bleeding episode before and after treatment with alphacalcidol.
MAIN OUTCOME MEASURE(S):

Peripheral insulin resistance and insulin effectiveness were estimated with minimal model.
RESULT(S):

The first phase of insulin secretion was significantly increased after treatment with alphacalcidol. A favorable statistically significant change also was observed in the lipid profile.
CONCLUSION(S):

Treatment with the vitamin D(3) analogue (alphacalcidol) could be of value in the management of PCOS.

PMID: 18930208 [PubMed - indexed for MEDLINE]

ndian J Physiol Pharmacol. 2010 Oct-Dec;54(4):344-54.

Effect of Nigella sativa seeds on the glycemic control of patients with type 2 diabetes mellitus.
Bamosa AO, Kaatabi H, Lebdaa FM, Elq AM, Al-Sultanb A.

Source
Department of Physiology, College of Medicine, King Faisal University, Dammam, Saudi Arabia. aosbamosa@gmail.com

Abstract
Diabetes mellitus is a common chronic disease affecting millions of people world wide. Standard treatment is failing to achieve required correction of blood glucose in many patients. Therefore, there is a need for investigating potential hypoglycemic drugs or herbs to improve glycemic control in diabetic patients. Nigella sativa seeds were used as an adjuvant therapy in patients with diabetes mellitus type 2 added to their anti-diabetic medications. A total of 94 patient were recruited and divided randomly into three dose groups. Capsules containing Nigella sativa were administered orally in a dose of 1, 2 and 3 gm/day for three months. The effect of Nigella sativa on the glycemic control was assessed through measurement of fasting blood glucose (FBG), blood glucose level 2 hours postprandially (2 hPG), and glycosylated hemoglobin (HbA1c). Serum C-peptide and changes in body weight were also measured. Insulin resistance and betacell function were calculated usin the homeostatic model assessment (HOMA2). Nigella sativa at a dose of 2 gm/day caused significant reductions in FBG, 2hPG, and HbA1 without significant change in body weight. Fasting blood glucose was reduced by an average of 45, 62 and 56 mg/dl at 4, 8 and 12 weeks respectively. HbAlC was reduced by 1.52% at the end of the 12 weeks of treatment (P<0.0001). Insulin resistance calculated by HOMA2 was reduced significantly (P<0.01), while B-cell function was increased (P<0.02) at 12 weeks of treatment. The use of Nigella sativa in a dose of 1 gm/day also showed trends in improvement in all the measured parameters but it was not statistically significant from the baseline. However, no further increment in the beneficial response was observed with the 3 gm/day dose. The three doses of Nigella sativa used in the study did not adversely affect either renal functions or hepatic functions of the diabetic patients throughout the study period. In Conclusion: the results of this study indicate that a dose of 2 gm/ day of Nigella sativa might be a beneficial adjuvant to oral hypoglycemic agents in type 2 diabetic patients.

PMID: 21675032 [PubMed - in process]


Eur J Nutr. 2009 Mar;48(2):92-100. Epub 2009 Jan 13.

Effects of high and normal soyprotein breakfasts on satiety and subsequent energy intake, including amino acid and 'satiety' hormone responses.
Veldhorst MA, Nieuwenhuizen AG, Hochstenbach-Waelen A, Westerterp KR, Engelen MP, Brummer RJ, Deutz NE, Westerterp-Plantenga MS.

Source
Dept. of Human Biology Nutrition and Toxicology Research Institute (NUTRIM), Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands. m.veldhorst@hb.unimaas.nl

Abstract
BACKGROUND:

The role of dietary protein in short term satiety is of interest with respect to body weight regulation.
AIM:

To compare the effects of a high versus a normal soyprotein breakfast on satiety and subsequent energy intake (EI), including 'satiety' hormones and plasma amino acid responses.
METHODS:

Twenty-five healthy subjects (mean +/- SEM, BMI: 23.9 +/- 0.3 kg/m(2); age: 22 +/- 1 years) received a subject-specific standardized breakfast: a custard with soy as single protein type with either 10/55/35 (normal-protein) or 25/55/20 (high-protein) En% protein/carbohydrate/fat in a randomized, single-blind design. Appetite profile (Visual Analogue Scale, VAS), plasma glucose, insulin, Glucagon-like Peptide 1, ghrelin, and amino acid concentrations were determined for 4 h, determining the sensitive time point to assess EI. Since at 180 min glucose and insulin concentrations still were significantly different, in a second set of experiments subjects received an ad lib lunch at 180 min after the breakfasts; EI was assessed.

RESULTS:

Overall the 25 En% soy-custard was rated as being more satiating than the 10 En% soy-custard (P < 0.01) and there was a difference at 20 min after breakfast (64 +/- 5 vs. 52 +/- 5 mmVAS, P < 0.05), related to higher postprandial taurine concentrations (P < 0.05). Insulin response was increased more after the 25 En% than after the 10 En% soy-custard (AUC: 7,520 +/- 929 vs. 4,936 +/- 468 mU/l h, P < 0.001). There was no difference in EI (25 En%: 3,212 +/- 280 kJ vs. 10 En%: 3,098 +/- 286 kJ, ns).
CONCLUSION:

A high soyprotein breakfast is more satiating than a normal soyprotein breakfast related to elevated taurine and insulin concentrations.
PMID: 19142569Am J Clin Nutr. 2011 Mar;93(3):525-34. Epub 2011 Jan 12.

Protein choices targeting thermogenesis and metabolism.


Acheson KJ, Blondel-Lubrano A, Oguey-Araymon S, Beaumont M, Emady-Azar S, Ammon-Zufferey C, Monnard I, Pinaud S, Nielsen-Moennoz C, Bovetto L.

Source
Nestl Research Center, Vers-chez-les-Blanc, Lausanne, Switzerland. kevin.acheson@rdls.nestle.com

Abstract
BACKGROUND:

Dietary proteins stimulate thermogenesis and satiety more than does carbohydrate or fat; however, less is known about the differences between protein sources.
OBJECTIVE:

The objective was to determine the differential effects of 3 proteins on energy metabolism, satiety, and glucose control.

DESIGN:

Energy metabolism, satiety, and glucose control were measured in 23 lean, healthy subjects on separate occasions, before and 5.5 h after consumption of 4 isocaloric test meals in a randomized, double-blind, crossover design. Three meals consisting of 50% protein (whey, casein, or soy), 40% carbohydrate, and 10% fat and a fourth meal consisting of 95.5% carbohydrate were compared with a glucose meal that provided the same glucose load as the protein meals.
RESULTS:

The thermic effect was greater after the whey (14.4 0.5%) than after the casein (12.0 0.6%; P = 0.002) and soy (11.6 0.5%; P = 0.0001) meals and was greater after the whey, casein, and soy meals than after the high-carbohydrate meal (6.6 0.5%; P < 0.0001). Cumulative fat oxidation tended to be greater after the whey meal (16.2 1.1 g) than after the soy meal (13.7 1.0 g; P = 0.097) and was greater after the whey and soy meals than after the high-carbohydrate meal (10.9 0.9 g; P < 0.05). The glycemic response to glucose was attenuated 32% by the proteins (P < 0.001) at the expense of a greater insulin response after whey than after glucose (154%; P = 0.02), casein (143%; P = 0.07), and soy (151%; P = 0.03). Subjective appetite sensations indicated that casein and soy were more satiating than whey (P < 0.01), but whey was more "liked" compared with casein and soy (P = 0.025 and P = 0.09, respectively).
CONCLUSION:

The results suggest that different protein sources could be used to modulate metabolism and subsequently energy balance.

[PubMed - indexed for MEDLINE] Nat Prod Res. 2011 Feb;25(3):244-55.

Therapeutic effects of soy isoflavones on amylase activity, insulin deficiency, liverkidney function and metabolic disorders in diabetic rats.
Hamden K, Jaouadi B, Carreau S, Aouidet A, Elfeki A.

Source
Laboratory of Animal Ecophysiology, Faculty of Science, University of Sfax, Sfax 3052, Tunisia. khaled.hamden@yahoo.fr

Abstract
Natural estrogens have demonstrated a wide variety of biological activities, which makes them a good candidate for the treatment of diabetes. In vitro, this study evidenced that isoflavones enhanced insulin secretion and inhibited -amylase activity. In vivo, the findings indicated that soy isoflavones stimulated insulin secretion, increased the hepatic glycogen content and suppressed blood glucose level. The soy isoflavones were also protected hepatic-kidney functions showed by the significant increase in superoxide dismutase, catalase and glutathione peroxidase activities and the decrease in thiobarbituric acid reactive substances, total bilirubin, creatinine and transaminases content. Moreover, soy isoflavones induced a decrease in LDLcholesterol and triglycerides and an increase in HDL-cholesterol in plasma and liver. Overall, the findings of the current study indicate that soy isoflavones exhibit attractive properties and can, therefore, be considered a promising candidate for future application as alternative therapeutic agents, particularly in the development of anti-diabetic and hypolipidaemic drugs. PMID: 21108110 [PubMed - indexed for MEDLINE] Nutrition. 2011 Feb;27(2):244-52. Epub 2010 Jun 11.

Isoflavonoids and peptides from meju, longterm fermented soybeans, increase insulin sensitivity and exert insulinotropic effects in vitro.
Kwon DY, Hong SM, Ahn IS, Kim MJ, Yang HJ, Park S.

Source
Food Functional Research Division, Korean Food Research Institutes, Sungnam-Si, Korea.

Abstract
OBJECTIVE:

Although soybeans have been shown to alleviate metabolic syndromes, fermented soybeans may have even greater effects. We investigated the antidiabetic effects of meju, a soy food that is fermented up to 2 mo, and the mechanism by which it exerts its effects.

METHODS:

Meju was prepared by a traditional fermentation process: soybeans were fermented outdoors for 20 or 60 d. Methanol (M-60) and water (W-60) extracts from meju that had fermented for 60 d contained mostly isoflavonoid aglycones and small peptides, respectively, as opposed to mostly glycosylated isoflavonoids and proteins in the original soybeans.
RESULTS:

Daidzein, M-60, and W-60 had better insulin-sensitizing actions by activating peroxisome proliferator-activated receptor- in 3T3-L1 adipocytes than did unfermented soybeans. In addition, Min6 insulinoma cells treated with genistein, M-60, and W-60 had greater glucosestimulated insulin secretion capacity and greater -cell viability than those treated with unfermented soybeans. This improvement was associated with insulin/insulin-like growth factor1 signaling that was activated by the tyrosine phosphorylation of insulin receptor substrate-2 and serine phosphorylation of Akt, and this in turn increased pancreatic and duodenal homeobox-1 expression. Furthermore, genistein, daidzein, and M-60 stimulated glucagon-like peptide-1 secretion in enteroendocrine NCI-H716 cells, which generated insulinotropic actions.
CONCLUSION:

The compositional changes in isoflavonoids and peptides that occurred during a longer fermentation period, without the use of salt, enhanced the antidiabetic effect of soybeans.

Diabetologia. 2011 Jun 15. [Epub ahead of print]

Additive effects of glycaemia and dyslipidaemia on risk of cardiovascular diseases in type 2 diabetes: an observational study from the Swedish National Diabetes Register.
Gudbjrnsdottir S, Eliasson B, Eeg-Olofsson K, Zethelius B, Cederholm J; on behalf of the National Diabetes Register (NDR).

Source
Department of Medicine, Sahlgrenska University Hospital, Gothenburg University, Gothenburg, Sweden.

Abstract
AIMS/HYPOTHESIS:

The study aimed to assess the relative importance of the control of HbA(1c) and total cholesterol/HDL-cholesterol ratio (TC/HDL) on risk of cardiovascular disease (CVD).
METHODS:

In 22,135 participants with type 2 diabetes (age 30-75 years, 15% with previous CVD) followed for 5 years, baseline and annually updated mean HbA(1c) and TC/HDL were analysed and also categorised in combinations of quartiles. Outcomes were fatal/non-fatal CHD, stroke, CVD and total mortality.
RESULTS:

In all participants, HRs per 1 SD increase in updated mean HbA(1c) or TC/HDL using Cox regression analysis were 1.13 (95% CI 1.07, 1.19) and 1.31 (1.25, 1.37) for CHD, 1.15 (1.06, 1.24) and 1.25 (1.17, 1.34) for stroke, 1.13 (1.08, 1.18) and 1.29 (1.24, 1.34) for CVD (all p < 0.001), and 1.07 (1.02, 1-13; p = 0.01) and 1.18 (1.12, 1.24; p < 0.001) for total mortality, respectively, adjusted for clinical characteristics and traditional risk factors. The p value for the interaction between HbA(1c) and TC/HDL was 0.02 for CHD, 0.6 for stroke and 0.1 for CVD. Adjusted mean 5-year event rates in a Cox model, in combinations of quartiles of updated mean TC/HDL and HbA(1c) (lowest <3.1 mmol/l and 5.0-6.4% [31-46 mmol/mol]; <3.1 mmol/l and 7.8% [62 mmol/mol]; 4.6 mmol/l and 5.0-6.4% 31-46 mmol/mol; and highest 4.6 mmol/l and 7.8% [62 mmol/mol]), were 4.8%, 7.0%, 9.1% and 14.5% for CHD, and 7.1%, 9.9%, 12.8% and 19.4% for CVD, respectively. Adjusted HRs for highest vs lowest combinations were 2.24 (1.58-3.18) for CHD and 2.43 (1.79-3.29) for CVD (p < 0.001).
CONCLUSIONS/INTERPRETATION:

Hyperglycaemia and hyperlipidaemia were less than additive for CHD and additive for other endpoints, with the lowest risk at lowest combination levels and a Open Cardiovasc Med J. 2011;5:24-34. Epub 2011 Feb 24.

Dyslipidaemia of obesity, metabolic syndrome and type 2 diabetes mellitus: the case for residual risk reduction after statin treatment.
Athyros VG, Tziomalos K, Karagiannis A, Mikhailidis DP.

Source
Second Propedeutic Department of Internal Medicine, Aristotle University, Hippocration Hospital, Thessaloniki, Greece.

Abstract
Dyslipidaemia is frequently present in obesity, metabolic syndrome (MetS) and type 2 diabetes mellitus (T2DM). The predominant features of dyslipidaemia in these disorders include increased flux of free fatty acids (FFA), raised triglyceride (TG) and low high density lipoprotein cholesterol (HDL-C) levels, a predominance of small, dense (atherogenic) low density lipoprotein cholesterol (LDL) particles and raised apolipoprotein (apo) B values Posprandial hyperlipidaemia may also be present. Insulin resistance (IR) appears to play an important role in the pathogenesis of dyslipidaemia in obesity, MetS and T2DM. The cornerstone of treatment of this IR-related dyslipidaemia is lifestyle changes and in diabetic patients, tight glycaemic control. In addition to these measures, recent clinical trials showed benefit with statin treatment. Nevertheless, a substantial percentage of patients treated with statins still experience vascular events. This residual vascular risk needs to be addressed. This review summarizes the effects of hypolipidaemic drug combinations (including statins with cholesterol ester protein inhibitors, niacin, fibrates or fish oil, as well as fibrate-ezetimibe combination) on the residual vascular risk in patients with obesity, MetS or T2DM. PMID: 21660248 [PubMed - in process] PMCID: PMC3109607 Free PMC Article

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