Relationship between Energy Balance and Circulating Levels of Hepcidin and Ferritin in the Fasted and Postprandial States

Markers of iron metabolism are altered in new-onset diabetes, but their relationship with metabolic signals involved in the maintenance of energy balance is poorly understood. The primary aim was to explore the associations between markers of iron metabolism (hepcidin and ferritin) and markers of energy balance (leptin, ghrelin, and the leptin/ghrelin ratio) in both the fasted and postprandial states. These associations were also studied in the sub-groups stratified by diabetes status. This was a cross-sectional study of individuals without disorders of iron metabolism who were investigated after an overnight fast and, in addition, some of these individuals underwent a mixed meal test to determine postprandial responses of metabolic signals. The associations between hepcidin, ferritin, and leptin, ghrelin, leptin/ghrelin ratio were studied using several multiple linear regression models. A total of 76 individuals in the fasted state and 34 individuals in the postprandial state were included. In the overall cohort, hepcidin was significantly inversely associated with leptin (in the most adjusted model, the β coefficient ± SE was −883.45 ± 400.94; p = 0.031) and the leptin/ghrelin ratio (in the most adjusted model, the β coefficient ± SE was −148.26 ± 61.20; p = 0.018) in the fasted state. The same associations were not statistically significant in the postprandial state. In individuals with new-onset prediabetes or diabetes (but not in those with normoglycaemia or longstanding prediabetes or diabetes), hepcidin was significantly inversely associated with leptin (in the most adjusted model, the β coefficient ± SE was −806.09 ± 395.44; p = 0.050) and the leptin/ghrelin ratio (in the most adjusted model, the β coefficient ± SE was −129.40 ± 59.14; p = 0.037). Leptin appears to be a mediator in the link between iron metabolism and new-onset diabetes mellitus. These findings add to the growing understanding of mechanisms underlying the derangements of glucose metabolism.

Transorgan Short-Chain Fatty Acid Fluxes in the Fasted and Postprandial State in the Pig

The short-chain fatty acids (SCFAs) acetate, propionate, butyrate, isovalerate, and valerate are end products of intestinal bacterial fermentation and important mediators in the interplay between the intestine and peripheral organs. To unravel the transorgan fluxes and mass balance comparisons of SCFAs, we measured their net fluxes across several organs in a translational pig model. In multi-catheterized conscious pigs (n=12, 25.6 (95% CI [24.2, 26.9]) kg, 8-12 weeks old), SCFA fluxes across portal drained viscera (PDV), liver, kidneys, and hindquarter (muscle compartment) were measured after an overnight fast and in the postprandial state, 4 h after administration of a fiber-free, mixed meal. PDV was the main releasing compartment of acetate, propionate, butyrate, isovalerate, and valerate during fasting and in the postprandial state (all P=0.001). Splanchnic acetate release was high due to the absence of hepatic clearance. All other SCFAs were extensively taken up by the liver (all P<0.05). Even though only 7% [4, 10] (propionate), 42% [23, 60] (butyrate), 26% [12, 39] (isovalerate), and 3% [0.4, 5] (valerate) of PDV release were excreted from the splanchnic area in the fasted state, splanchnic release of all SCFAs was significant (all P≤0.01). Splanchnic propionate, butyrate, isovalerate and valerate release remained low but significant in the postprandial state (all P<0.01). We identified muscle and kidneys as main peripheral SCFA metabolizing organs, taking up the majority of all splanchnically released SCFAs in the fasted state and in the postprandial state. We conclude that the PDV is the main SCFA releasing and the liver the main SCFA metabolizing organ. Splanchnically released SCFAs appear to be important energy substrates to peripheral organs not only in the fasted but also in the postprandial state.

A Study of Fasting and Postprandial Lipid Profile among Patients with and without Diabetes Mellitus in a Tertiary Care Hospital - Kottayam, Kerala

BACKGROUND Type 2 diabetes mellitus (DM) is characterized by insulin resistance which is associated with glucose intolerance, hypertension, dyslipidaemia, a procoagulant state, and an increase in the microvascular and the macrovascular disease. The high cardiovascular mortality which is associated with type 2 DM is due to a prolonged, exaggerated, postprandial state. The abnormal lipid profile in the postprandial state is more significant than the abnormal lipid profile in the fasting state in causing atherosclerotic complications in type 2 diabetes. Very few studies are available on the estimation of the postprandial lipid profile in type 2 diabetes patients. The purpose of this study was to compare fasting and postprandial lipid levels among patients with and without diabetes mellitus and find out the correlation between duration of detection of diabetes mellitus and postprandial lipid levels among patients with diabetes mellitus. METHODS This is a cross sectional analytical study of a study population of 200 subjects including in patients and out patients of wards and diabetic clinic of Government Medical College, Kottayam from April 2017 to March 2018. Data was coded and entered in Microsoft Excel and IBM Statistical Package for Social Sciences (SPSS version 22) for statistical analysis. RESULTS Diabetic patients had impaired fasting and postprandial lipid profiles. Impairment in postprandial lipid profile when compared to non-diabetics was statistically significant. Duration of detection of diabetes and postprandial lipid levels showed weak positive correlation. CONCLUSIONS The postprandial lipid profile in diabetes mellitus patients is significantly deranged compared to fasting state and is an important factor in assessing their cardiovascular risk. Hence, there is a need to stress on postprandial lipid profile estimation in diabetic patients. KEYWORDS Fasting Lipid Profile, Postprandial Lipid Profile, Type 2 Diabetics, Nondiabetics

Effects of Acute Fructose Loading on Markers of Inflammation—A Pilot Study

Inflammation plays a role in development of diabetic complications. The postprandial state has been linked to chronic low grade inflammation. We therefore aimed to investigate the acute effects of fructose loading, with and without a pizza, on metabolic and inflammatory markers in patients with type 2 diabetes (T2D) (n = 7) and in healthy subjects (HS) (n = 6), age 47–76 years. Drinks consumed were blueberry drink (18 g fructose), Coca-Cola (17.5 g fructose), and fructose drink (35 g fructose). The levels of glucose, insulin, insulin-like growth factor binding protein-1 (IGFBP-1) and inflammatory markers: Interleukin-6 (IL-6), Monocyte chemoattractant protein-1 (MCP-1), Interleukin-18 (IL-18), Intercellular Adhesion Molecule 1 (ICAM-1), vascular cell adhesion molecule 1 (VCAM-1), and bacterial lipopolysaccharides (LPS) were analyzed in blood. The postprandial responses were assessed using Wilcoxon’s matched-pairs test, Friedman’s ANOVA and Mann–Whitney U test. There was no difference in baseline levels of inflammatory markers between the groups. In T2D, MCP-1 decreased following blueberry drink and Coca-Cola (p = 0.02), Coca-Cola + pizza and fructose + pizza (p = 0.03). In HS, IL-6 increased following blueberry + pizza and fructose + pizza (p = 0.03), there was a decrease in MCP-1 following blueberry drink and Coca-Cola (p = 0.03), and in ICAM-1 following blueberry + pizza (p = 0.03). These results may indicate a role for MCP-1 as a link between postprandial state and diabetes complications, however further mechanistic studies on larger population of patients with T2D are needed for confirmation of these results.

Main Organs Involved in Glucose Metabolism

Sugar, or technically known as glucose, is the main source of energy of all cells in the human body. The glucose homeostasis cycle is the mechanism to maintain blood glucose levels in a healthy threshold. When this natural mechanism is broken, many metabolic disorders appear such as diabetes mellitus, and some substances of interest, like glucose, are out of control. In the mechanism to maintain blood glucose, several organs are involved but the role of most of them has been disregarded in the literature. In this chapter, the main organs involved in such a mechanism and their role in glucose metabolism are described. Specifically, the stomach and small intestine, organs of the gastrointestinal system, are the first to play an important role in the regulatory system, because it is where carbohydrates are digested and absorbed as glucose into the bloodstream. Then glucose as a simple substance goes to the liver to be stored as glycogen. Glucose storage occurs due to the delivery of hormones from the pancreas, which produces, stores, and releases insulin and glucagon, two antagonistic hormones with an important role in glucose metabolism. The kidneys assist the liver in insulin clearance in the postprandial state and gluconeogenesis in the post absorptive state. Physiological aspects and the detailed role of every organ involved in glucose metabolism are described in this chapter.

Study to find out the significance of postprandial dyslipidemia in diabetic patients

: Diabetes Mellitus (DM) is a group of metabolic diseases, which is characterized by chronic hyperglycaemia, which results from the defects in the insulin action, insulin secretion or both. The most prevalent form of the disease, type 2 Diabetes Mellitus is often asymptomatic in the early stages and it may remain undiagnosed for many years.The insulin resistance in the liver leads to failure of the hyperinsulinaemia to suppress the gluconeogenesis, which increases fasting glucose levels and decreases. glycogen storage by the liver in the postprandial phase. Increased glucose production in the liver occurs early in the course of diabetes, and it is likely in skeletal muscles after the onset of the insulin secretory abnormalities and the insulin resistance. Due to the insulin resistance in the adipose tissue and obesity, the free fatty acid (FFA) flux from the adipocytes is increased, which in turn leads to an increase in lipid [very low-density lipoprotein (VLDL) and triglycerides] synthesis in the hepatocytes. This is responsible for the dyslipidaemia which is found in type2 diabetes mellitus [elevated triglycerides, reduced HDL, and increased low-density lipoprotein (LDL) particlesIndividuals with type 2 diabetes mellitus are at increased risk of developing microvascular and macrovascular complications.: To find out the significance of postprandial dyslipidemia in diabetic patients.: This is a cross-sectional study, wherein written informed consent was taken after giving detailed information to the participants regarding the study. Patients who were in the age group of 35-65 years, admitted in the Department of Medicine, RRMCH from November 2017 for next 18 months with Diabetes Mellitus who met a predefined inclusion and exclusion criteria were studied. The study was initiated after obtaining clearance from the institution's ethical committee.: There was a significant elevation of mean values of total serum cholesterol, LDL and TG of cases and controls in the postprandial state compared to their fasting state, statistical significance was found (P&#60;0.05).Mean values of total serum cholesterol, LDL and TG of cases in fasting state were significantly more compared to controls in fasting state, statistical significance was found (P&#60;0.05).Mean values of total serum cholesterol, LDL and TG of cases in the postprandial state were significantly more compared to controls in the postprandial state, statistical significance was found (P&#60;0.05).Mean values of both FBS and PPBS in cases were higher compared to controls (P&#60;0.05). Mean values of PPBS in cases and controls were significantly more compared to their respective FBS values (P&#60;0.05).The mean HbA1c values in cases were higher(7.142) compared to controls (5.554).: Prevalence of diabetes was highest in the age group 56-65 years in our hospital.As the duration of diabetes increases, there is an increased prevalence of dyslipidemia in the cases.Past history of HTN, IHD, PVD and CVA were found significantly more in subjects with fasting and postprandial dyslipidemia (cases) compared to those without(controls).Patients on irregular treatment (63%) were more in the study group(cases) compared to controls. So it could be said that patient not on regular treatment are more prone to have dyslipidemia. (fasting as well as postprandial). There was a significant increase in total serum cholesterol, LDL and TG in postprandial states of cases compared to that in controls, so it could be said that diabetic patients with fasting dyslipidemia are more prone to have dyslipidemia in the postprandial state.

Study of fasting and post prandial lipid abnormalities in type 2 diabetes mellitus in comparison to controls

In the modern world, the growing incidence of type 2 diabetes mellitus (T2DM) is a critical problem. In type 2 DM, abnormal lipid profile in the postprandial state has more significance than abnormal lipid profile in fasting state in causing atherosclerotic complications. The high cardiovascular morbidity and mortality in type2 DM are due to prolonged postprandial hyperglycemia and triglyceridemia. Postprandial hypertriglyceridemia results in a proatherogenic environment which leads to atherosclerosis and macrovascular complications in type 2 diabetes mellitus. It is believed that atherosclerosis is a postprandial phenomenon with respect to lipids, as we are in the postprandial state for most of the day.It is not clearly known whether diabetic patients with macrovascular disease have greater abnormalities of postprandial TG metabolism than those without.Hence this study is being carried out to find out the characteristics of post prandial lipid levels in patients with type 2 diabetes mellitus and itsimpact on macrovascular complications.: To study fasting & postprandial lipid abnormality in type 2 DM patients in comparison to controls.: This is a cross-sectional study, wherein written informed consent was taken after giving detailed information to the participants regarding the study. Patients who were in the age group of 35-65 years, admitted in the Department of Medicine, RRMCH from November 2017 for next 18 months with Diabetes Mellitus who met a predefined inclusion and exclusion criteria were studied. The study was initiated after obtaining clearance from the institution's ethical committee.: There was a significant elevation of mean values of total serum cholesterol, LDL and TG of cases and controls in the postprandial state compared to their fasting state, statistical significance was found (P&#60;0.05). Peripheral vascular disease in our study was found in 25 patients i.e.25% of the study group. In cases, it was found in 20 patients and in controls, it was found in 5 patients i.e. 40% and 10% respectively. The occurrence of PVD was more in cases compared to controls with statistical significance(p&#60;0.05). Stroke in our study is found in 7 patients i.e. 7% of the study group. In cases, it was found in 6 patients and in controls, it was found in 1 patient i.e. 12% and 2% respectively. The occurrence of CVA was more in cases compared to controls with statistical significance(p&#60;0.05). Ischemic strokes were more common than haemorrhagic strokes.: Patients on irregular treatment (63%) were more in the study group(cases) compared to controls. So it could be said that patient not on regular treatment are more prone to have dyslipidemia. (fasting as well as postprandial). There was a significant increase in total serum cholesterol, LDL and TG in postprandial states of cases compared to that in controls, so it could be said that diabetic patients with fasting dyslipidemia are more prone to have dyslipidemia in the postprandial state. This study concluded that all macrovascular complications (IHD, CVA, PVD) were found more in the case compared to controls with statistical significance. So it could be said that there is an increase in the occurrence of macrovascular complications with an increase in postprandial dyslipidemia.