BACKGROUND: Difficulty in chewing has been shown to be associated with increased mortality, geriatric syndromes, and poor activities of daily living, indicating the need for intervention. Chewing difficulties are related to tooth loss, periodontitis, dry mouth, and a number of oral health conditions. Diabetes mellitus (DM) is one of the major causes of global burden of diseases, and has been associated with poor oral health. Prospective association between oral health status and the development of diabetes has also been reported. However, relationship between glycemic control and self-reported chewing difficulty remains less explored in working-age populations. The objective of this study is to cross-sectionally explore the association between fasting blood glucose (FBG) and self-reported chewing difficulty in adults working in a Japanese worksite. METHODS: Participants from the Aichi Workers' Cohort Study who responded to the 2018 survey were included. Participants were categorized into five FBG groups (<100, 100-109, 110-125, 126-159, and ≥160 mg/dl). Multivariable odds ratios (ORs) and 95% confidence intervals (CIs) for chewing difficulty were estimated using logistic regression adjusted for age, sex, body mass index, smoking and alcohol consumption status, number of teeth, presence of periodontal disease and the number of anti-diabetic medication classes. RESULTS: A total of 164 participants (4.2%) reported difficulty with chewing, the prevalence of which tended to increase with increasing FBG level. FBG ≥160 mg/dl was significantly and strongly associated with difficulty with chewing in the final multivariable model (multivariable OR 3.84 [95% CI 1.13-13.0]). CONCLUSIONS A relationship between higher FBG levels and difficulty with chewing was observed, independent of potential confounding factors. However, prospective or interventional studies are needed to determine causality.
Humans ; Male ; Japan/epidemiology* ; Female ; Mastication/physiology* ; Middle Aged ; Adult ; Blood Glucose/analysis* ; Cross-Sectional Studies ; Fasting/blood* ; Cohort Studies ; Oral Health ; Prevalence

The influence of β-cell function on cardiovascular autonomic neuropathy (CAN), an important diabetes-related complication, is still unclear. In this study, we aimed to investigate the association between residual β-cell function and CAN in patients newly diagnosed with type 2 diabetes. We enrolled 90 newly-diagnosed type 2 diabetic patients and 37 participants with normal glucose tolerance as controls. The patients were divided into a CAN+ group (diabetic patients with CAN, n = 20) and a CAN- group (diabetic patients without CAN, n = 70) according to the standard Ewing battery of tests. Fasting and postprandial plasma glucose, insulin, and C-peptide were measured. Homeostasis model assessment-beta cells (HOMA-B) and HOMA-insulin resistance (IR) were calculated. The prevalence of CAN in this population was 22.2%. Compared with the CAN- group, the CAN+ group had significantly lower fasting plasma insulin (6.60 ± 4.39 vs 10.45 ± 7.82 μ/L, P = 0.029), fasting C-peptide (0.51 ± 0.20 vs 0.82 ± 0.51 nmol/L, P = 0.004), and HOMA-B (21.44 ± 17.06 vs 44.17 ± 38.49, P = 0.002). Fasting C-peptide was correlated with the Valsalva ratio (r = 0.24, P = 0.043) and the 30:15 test (r = 0.26, P = 0.023). Further analysis showed that fasting C-peptide (OR: 0.041, 95% CI 0.003-0.501, P = 0.012) and HOMA-B (OR: 0.965, 95% CI 0.934-0.996, P = 0.028) were independently associated with cardiovascular autonomic nerve function in this population. The patients with fasting C-peptide values < 0.67 nmol/L were more likely to have CAN than those with C-peptide levels ≥0.67 nmol/L (OR: 6.00, 95% CI 1.815-19.830, P = 0.003). A high prevalence of CAN was found in patients with newly-diagnosed type 2 diabetes. Decreased β-cell function was closely associated with CAN in this population.
Adult ; Asian Continental Ancestry Group ; Blood Glucose ; analysis ; Diabetes Mellitus, Type 2 ; complications ; metabolism ; Diabetic Neuropathies ; etiology ; Fasting ; physiology ; Female ; Glucose ; metabolism ; Humans ; Insulin ; metabolism ; Insulin Resistance ; physiology ; Insulin-Secreting Cells ; metabolism ; Male ; Middle Aged

BACKGROUNDThe clinical significance of metabolic syndrome (MS) score, MS, and its individual components with respect to risk prediction of coronary artery disease (CAD) remains unclear. The objective of this study was to investigate whether and to what extent MS score, MS, and its individual components were related to the risk of CAD.

METHODSAmong 1191 participants who underwent coronary angiography for the confirmation of suspected myocardial ischemia, 858 were included in this study according to the inclusion criteria from September 2010 to June 2013. MS was diagnosed with the 2005 National Cholesterol Education Program Adult Treatment Panel III criteria. The severity of coronary atherosclerosis was assessed by Gensini score.

RESULTSThe results showed that the age- and sex-adjusted odds ratios (OR s) for CAD were as follows: MS score, 1.327; MS, 2.013; elevated waist circumference, 1.447; reduced high-density lipoprotein cholesterol, 1.654; and elevated fasting glucose, 1.782; all P < 0.05; whereas for elevated triglycerides, 1.324, and elevated blood pressure, 1.342, both P > 0.05. After multivariate adjustment, results showed that only MS and elevated fasting glucose were significantly associated with CAD (OR, 1.628, 95% confidence interval [CI], 1.151-2.305, P = 0.006 for elevated fasting glucose, and OR, 1.631, 95% CI, 1.208-2.203, P = 0.001 for MS). The study showed that only MS score and elevated fasting glucose were significantly associated with Gensini score (standardized coefficient, 0.101, P = 0.031 for elevated fasting glucose and standardized coefficient, 0.103, P = 0.009 for MS score).

CONCLUSIONSThe present study demonstrated that MS score, MS, and its individual components might have different contributions to CAD prevalence and severity. MS and elevated fasting glucose were independent risk factors for the prevalence of angiographic CAD whereas MS score and elevated fasting glucose were significantly associated with the severity of CAD.

Adult ; Aged ; Aged, 80 and over ; Blood Glucose ; metabolism ; Blood Pressure ; physiology ; Coronary Angiography ; Coronary Artery Disease ; epidemiology ; metabolism ; pathology ; Fasting ; blood ; Female ; Humans ; Lipoproteins, HDL ; blood ; Male ; Metabolic Syndrome ; epidemiology ; metabolism ; pathology ; Middle Aged ; Prevalence ; Risk Factors ; Triglycerides ; blood

OBJECTIVETo investigate the effect of laparoscopic sleeve gastrectomy(LSG) on sex hormone in male patients with severe obesity.

METHODSRetrospective analysis was performed in 31 male patient with severe obese [body mass index(BMI) ≥28 kg/m, obesity group] who underwent LSG in Shanghai Tenth People's Hospital of Tongji University from December 2012 to May 2016. The anthropometric parameters(weight, BMI, waist circumference, hip circumference, waist-hip ratio, body fat percentage), glucose metabolic indices [fasting plasma glucose(FPG), fasting insulin (FINS), glycosylated hemoglobin (HbA1c), homeostasis model assessment-insulin resistance index(HOMA-IR)], and sex hormone parameters [estradiol(E2), total testosterone (TT), follicle-stimulating hormone (FSH) and luteinizing hormone (LH)] were collected preoperatively and 1, 3, 6 months postoperatively. In addition, 31 healthy male volunteers with normal BMI were consecutively recruited in this study as control group. The above-mentioned parameters were also determined in control group. Changes of these variables before and after surgery were analyzed. Pearson method was used to analyze the correlation of TT with anthropometric parameters and glucose metabolic indices before and after surgery.

RESULTSThe average age of patients in obesity and control group was (32.9±9.7) (18 to 56) years and (30.7±8.9) (18 to 49) years. Compared to the control group, obesity group had significantly higher anthropometric parameters and glucose metabolic indices before surgery (all P<0.05). In obesity group, the anthropometric and glucose metabolic indices significantly decreased at 1 to 6 months after surgery compared to those before surgery (all P<0.05). At 1 month after surgery, the anthropometric parameters and glucose metabolic indices in obesity group were significantly higher than those in control group (all P<0.05). At 3, and 6 months after surgery, there were no significant differences in glucose metabolic indices between obesity and control group (all P>0.05), while the anthropometric parameters in obesity group were still significantly higher than those in control group(all P<0.05). The sex hormone parameters in control and obesity group before surgery were as follows: E2: (100.2±23.5) pmol/L and (129.2±81.9) pmol/L; TT: (18.0±4.9) nmol/L and (8.4±4.5) nmol/L; FSH: (4.5±3.1) IU/L and (4.3±2.5) IU/L; LH: (4.4±1.7) IU/L and (5.3±2.6) IU/L. Compared to control group, the TT level of obese patients before surgery significantly decreased(P=0.000), while no significant differences were observed in the levels of E2, FSH, and LH(all P>0.05). The TT levels were significantly increased at 1, 3, 6 months after surgery[(13.1±7.0), (13.6±5.7), (21.0±19.3) nmol/L, respectively, all P<0.05] and the E2 level was significantly decreased at 6 months after surgery [(91.4±44.9) pmol/L, P<0.05], while no significant differences were observed at 1 and 3 months after surgery (all P>0.05). Furthermore, the FSH and LH levels did not exhibit significant change at 1, 3, and 6 months after surgery compared to those before surgery (all P>0.05). At 1 month after surgery, no significant correlations were examined in the change value of TT levels (▹TT) with the changes of BMI(▹BMI), FPG(▹FPG), FINS(▹FINS), HOMA-IR(▹HOMA-IR), and E2(▹E2) (all P>0.05). At 3 months after surgery, ▹TT was negatively correlated with ▹BMI (r=-0.441, P=0.015), ▹FINS (r=-0.375, P=0.041), and ▹HOMA-IR(r=-0.397, P=0.030), but not correlated with ▹FPG and ▹E2 (all P>0.05). At 6 months after surgery, ▹TT was negatively correlated with ▹BMI(r=-0.510, P=0.018) and ▹HOMA-IR (r=-0.435, P=0.049), but not correlated with ▹FPG, ▹FINS and ▹E2 (all P>0.05).

CONCLUSIONSMale severe obese patients are accompanied with abnormal sex hormone levels. LSG has a significant effect on weight loss and blood glucose improvement, and may ameliorate the sex hormone unbalance by improving the insulin resistance in men with severe obesity.

Adult ; Bariatric Surgery ; Blood Glucose ; physiology ; Body Mass Index ; Body Weights and Measures ; China ; Estradiol ; blood ; physiology ; Fasting ; blood ; Follicle Stimulating Hormone ; blood ; physiology ; Follow-Up Studies ; Gastrectomy ; Glycated Hemoglobin A ; physiology ; Humans ; Insulin ; blood ; physiology ; Insulin Resistance ; physiology ; Luteinizing Hormone ; blood ; physiology ; Male ; Obesity, Morbid ; surgery ; Retrospective Studies ; Testosterone ; blood ; physiology ; Treatment Outcome ; Weight Loss ; physiology

INTRODUCTIONMillions of Muslim patients with diabetes mellitus (DM) fast during Ramadan. However, little is known about the metabolic impact of Ramadan fasting. We aimed to study the changes in body composition and metabolic profile in this group of patients.

MATERIALS AND METHODSWe studied 29 Southeast Asian Muslim patients with type 2 diabetes; all underwent pre-Ramadan education. Study variables were weight change, body composition (using multifrequency bioimpedance method, InBody S20®, Biospace, South Korea), blood pressure (BP), glycated haemoglobin (HbA1c), fasting lipid profile, and caloric intake assessment using FoodWorks® nutrient analysis software.

RESULTSTwenty-three subjects fasted ≥15 days; mean ± SD: 57 ± 11 years; 52% were males. HbA1c improved significantly (8.6 ± 2.4% pre-Ramadan vs 8.0 ± 2.3% end-Ramadan, P = 0.017). Despite similar body weight, there was reduction in body fat mass (BFM) (30.9 ± 11 kg vs 29.2 ± 12.2 kg, P = 0.013). Multivariate analysis suggested that the reduction in HbA1c was attributed by reduction in BFM (β = -0.196, P = 0.034). There was no change in visceral adiposity (visceral fat area (VFA)) but stratification by gender showed a reduction amongst females (137.6 ± 24.5 cm2 to 132.5 ± 25.7 cm2, P = 0.017). These changes occurred despite similar total caloric intake (1473.9 ± 565.4 kcal vs 1473.1 ± 460.4 kcal, P = 0.995), and proportion of carbohydrate (55.4 ± 6.3% vs 53.3 ± 7.5%, P = 0.25) and protein intake (17.6 ± 4.1% vs 17.3 ± 5.4%, P = 0.792), before and during Ramadan respectively, but with increased proportion of fat intake (11.9 ± 2.4% vs 13 ± 11.7%, P = 0.04). Seven out of 23 patients had medications adjusted to avert symptomatic hypoglycaemia but none of the patients developed severe hypoglycaemia.

CONCLUSIONRamadan fasting can be practiced safely with prior patient education and medication adjustment. It also confers modest benefits on metabolic profile and body composition, especially among females.

Adult ; Aged ; Biomarkers ; blood ; Blood Glucose ; metabolism ; Body Composition ; Body Mass Index ; Diabetes Mellitus, Type 2 ; blood ; physiopathology ; Energy Intake ; Fasting ; physiology ; Female ; Glycated Hemoglobin A ; metabolism ; Holidays ; Humans ; Islam ; Male ; Middle Aged ; Multivariate Analysis ; Prospective Studies ; Sex Factors ; Singapore ; Weight Gain ; Weight Loss

BACKGROUNDThe conventional approaches to diabetes screening are potentially limited by poor compliance and laboratory demand. This study aimed to evaluate the performance of fasting plasma glucose (FPG) and postprandial urine glucose (PUG) in screening for diabetes in Chinese high-risk population.

METHODSNine hundred and nine subjects with high-risk factors of diabetes underwent oral glucose tolerance test after an overnight fast. FPG, hemoglobin A1c, 2-h plasma glucose (2 h-PG), and 2 h-PUG were evaluated. Diabetes and prediabetes were defined by the American Diabetes Association criteria. The area under the receiver operating characteristic (ROC) curve was used to evaluate the diagnostic accuracy of 2 h-PUG, and the optimal cut-off determined to provide the largest Youden index. Spearman correlation was used for relationship analysis.

RESULTSAmong 909 subjects, 33.4% (304/909) of subjects had prediabetes, and 17.2% (156/909) had diabetes. The 2 h-PUG was positively related to FPG and 2 h-PG (r = 0.428 and 0.551, respectively, both P < 0.001). For estimation of 2 h-PG ≥ 7.8 mmol/L and 2 h-PG ≥ 11.1 mmol/L using 2 h-PUG, the area under the ROC curve were 0.772 (95% confidence interval [CI ]: 0.738-0.806) and 0.885 (95% CI: 0.850-0.921), respectively. The corresponding optimal cut-offs for 2 h-PUG were 5.6 mmol/L and 7.5 mmol/L, respectively. Compared with FPG alone, FPG combined with 2 h-PUG had a higher sensitivity for detecting glucose abnormalities (84.1% vs. 73.7%, P < 0.001) and diabetes (82.7% vs. 48.1%, P < 0.001).

CONCLUSIONFPG combined with 2 h-PUG substantially improves the sensitivity in detecting prediabetes and diabetes relative to FPG alone, and may represent an efficient layperson-oriented diabetes screening method.

Aged ; Asian Continental Ancestry Group ; Blood Glucose ; metabolism ; Diabetes Mellitus ; blood ; diagnosis ; urine ; Fasting ; blood ; Female ; Glucose Tolerance Test ; Humans ; Male ; Mass Screening ; methods ; Middle Aged ; Postprandial Period ; physiology

The relationship between obesity and ketonuria is not well-established. We conducted a retrospective observational study to evaluate whether their body weight reduction response differed by the presence of ketonuria after fasting in the healthy obese. We used the data of 42 subjects, who had medical records of initial urinalysis at routine health check-up and follow-up urinalysis in the out-patient clinic, one week later. All subjects in the initial urinalysis showed no ketonuria. However, according to the follow-up urinalysis after three subsequent meals fasts, the patients were divided into a non-ketonuria group and ketonuria group. We compared the data of conventional low-calorie diet programs for 3 months for both groups. Significantly greater reduction of body weight (-8.6 +/- 3.6 kg vs -1.1 +/- 2.2 kg, P < 0.001), body mass index (-3.16 +/- 1.25 kg/m2 vs -0.43 +/- 0.86 kg/m2, P < 0.001) and waist circumference (-6.92 +/- 1.22 vs -2.32 +/- 1.01, P < 0.001) was observed in the ketonuria group compared to the non-ketonuria group. Fat mass and lean body mass were also more reduced in the ketonuria group. In addition, serum free fatty acid concentration after intervention in the ketonuria group showed significant more increment than in the non-ketonuria group. The presence of ketonuria after fasting may be a predicting factor of further body weight reduction.
Adult ; Diet, Reducing ; Fasting/*physiology ; Female ; Humans ; Ketosis/*complications/*pathology ; Male ; Middle Aged ; Obesity/*complications/diet therapy/pathology/*urine ; Retrospective Studies ; Weight Loss/*physiology

INTRODUCTIONCirculating insulin concentrations provide important information for the evaluation of insulin secretion and insulin resistance. Reference intervals are the most widely applied tool for the interpretation of clinical laboratory results. We carried out an analysis of the data available from the Fangchenggang Area Male Health and Examination Survey in order to derive a reference interval for fasting insulin specific to the Chinese population.

METHODSA total of 1,434 fasting serum insulin results were obtained from healthy nondiabetic adult men aged 20-69 years, after taking into consideration the inclusion and exclusion criteria. Serum insulin was measured using electrochemiluminescence immunoassays. Nonparametric statistical methods were used to calculate and analyse the data.

RESULTSThe reference interval for fasting serum insulin for Chinese adults was in the range 1.57-16.32 μU/mL (median 5.79 μU/mL). Significant correlations were found between fasting serum insulin and glucose and diastolic blood pressure (p < 0.001). Statistically significant differences were observed in insulin concentration with respect to age and body mass index (BMI; p < 0.001). Younger people had a higher fasting serum insulin concentration. Increased fasting serum insulin was also found to be associated with BMI.

CONCLUSIONWe established a reference interval for fasting serum insulin in healthy nondiabetic adult Chinese men that is lower than what was previously suggested. BMI and age (but not smoking, alcohol consumption or physical activity) were found to be important factors associated with fasting serum insulin. Our results will help improve the diagnostic interpretation of investigations for metabolic and cardiovascular disorders in a Chinese population.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Body Mass Index ; China ; Fasting ; blood ; Humans ; Insulin ; blood ; Insulin Resistance ; physiology ; Male ; Middle Aged ; Nomograms ; Reference Values ; Retrospective Studies ; Young Adult

BACKGROUNDInsulin resistance is an underlying feature of both type 2 diabetes and metabolic syndrome. Currently, it is unclear whether nuclear factor (NF)-κB inducing kinase (NIK) plays a role in the development of insulin resistance. The present in vivo study investigated the roles of NIK and IκB kinase α (IKKα) in obesity-induced insulin resistance using animal models.

METHODSNIK expression was evaluated by Western blotting in male Lep(ob) mice and C57BL/6J mice fed a high-fat diet (HFD) (45% fat). After metformin and sulfasalazine treatment, NIK expression was investigated during the improvement of insulin resistance.

RESULTSNIK was increased by about 1-fold in the renal tissues of Lep(ob) mice and C57BL/6J mice fed a HFD for 12 weeks. After 1 and 3 weeks of high-fat feeding, we observed an almost 50% decrease in NIK and IKKα expression in the liver and renal tissues of C57BL/6J mice. NIK expression was significantly lower in the liver and renal tissues of HFD-fed mice that were treated with insulin sensitizers, metformin and sulfasalazine. However, IKKα expression was increased after metformin treatment in both tissues.

CONCLUSIONThese results suggest a possible role of NIK in the liver and renal tissues of insulin-resistant mice.

Animals ; Blotting, Western ; Body Weight ; physiology ; Fasting ; blood ; Glucose Tolerance Test ; I-kappa B Kinase ; metabolism ; Insulin ; blood ; Insulin Resistance ; physiology ; Kidney ; metabolism ; Liver ; metabolism ; Male ; Mice ; Mice, Inbred C57BL ; Mice, Obese ; Protein-Serine-Threonine Kinases ; metabolism

PURPOSE: The aim of this study was to identify the most precise and clinically practicable parameters that predict future oral hypoglycemic agent (OHA) failure in patients with type 2 diabetes, and to determine whether these parameters are valuable in various subgroups. MATERIALS AND METHODS: We took fasting blood samples from 231 patients for laboratory data and standard breakfast tests for evaluation of pancreatic beta-cell function. Hemoglobin A1c (HbA1c) levels were tested, and we collected data related to hypoglycemic medications one year from the start date of the study. RESULTS: Fasting C-peptide, postprandial insulin and C-peptide, the difference between fasting and postprandial insulin, fasting beta-cell responsiveness (M0), postprandial beta-cell responsiveness (M1), and homeostasis model assessment-beta (HOMA-B) levels were significantly higher in those with OHA response than in those with OHA failure. The area under the curve (AUC) of the receiver operating characteristic (ROC) measured with postprandial C-peptide to predict future OHA failure was 0.720, and the predictive power for future OHA failure was the highest of the variable parameters. Fasting and postprandial C-peptide, M0, and M1 levels were the only differences between those with OHA response and those with OHA failure among diabetic subjects with low body mass index, high blood glucose level, or long-standing diabetes. CONCLUSION: In conclusion, postprandial C-peptide was most useful in predicting future OHA failure in type 2 diabetic subjects. However, these parameters measuring beta-cell function are only valuable in diabetic subjects with low body mass index, high blood glucose level, or long-standing diabetes.
Administration, Oral ; Adolescent ; Aged ; Blood Glucose/analysis ; Body Mass Index ; C-Peptide/blood ; Child ; Child, Preschool ; Diabetes Mellitus, Type 2/*blood/drug therapy/*metabolism/physiopathology ; Fasting/blood ; Female ; Humans ; Hypoglycemic Agents/administration & dosage/therapeutic use ; Insulin/blood ; Insulin-Secreting Cells/*metabolism/*physiology ; Male ; Middle Aged ; Postprandial Period