Search Results (975)

Background/Objectives: Vitamin D plays an important role in glucose metabolism, lipid regulation, and inflammatory processes, and has been implicated in cardiometabolic health. However, its associations with specific metabolic biomarkers remain inconsistent, particularly in older adults. This study aimed to examine whether vitamin D deficiency is differentially associated with multiple metabolic biomarkers in a nationally representative sample of older adults. Methods: This cross-sectional study used data from the 2024 Korea National Health and Nutrition Examination Survey, including 1806 adults aged ≥65 years. Vitamin D deficiency was defined as serum 25-hydroxyvitamin D levels < 20 ng/mL. Metabolic biomarkers included fasting glucose, glycated hemoglobin (HbA1c), triglycerides, C-reactive protein (CRP), high-density lipoprotein cholesterol (HDL-C), waist circumference, and body mass index (BMI). Complex sample linear regression analyses were performed with sequential adjustment for sociodemographic factors, health behaviors, and comorbidities. Results: In unadjusted analyses, vitamin D deficiency was associated with adverse metabolic profiles, including higher fasting glucose, HbA1c, triglycerides, waist circumference, and CRP levels, and lower HDL-C levels. After adjustment for sociodemographic factors, health behaviors, and comorbidities, significant associations remained for HbA1c (β = 0.10, p = 0.034), triglycerides (β = 0.10, p = 0.003), and waist circumference (β = 1.21, p = 0.040). No significant associations were observed for fasting glucose, HDL-C, CRP, or BMI. Conclusions: Vitamin D deficiency was independently associated with poorer long-term glycemic status, hypertriglyceridemia, and central adiposity in older adults, but not with other metabolic markers after adjustment. These findings suggest that the metabolic correlates of vitamin D deficiency may be domain-specific rather than generalized. Longitudinal and interventional studies are needed to clarify causality and underlying mechanisms. Full article

Background/Objectives: This study aimed to compare the diagnostic performance of usual gait speed (UGS), maximal gait speed (MGS), and gait speed reserve (GSR) for identifying sarcopenia in older adults with type 2 diabetes (T2D), and to examine whether combining gait indices improves diagnostic performance. Methods: This cross-sectional study included 117 older adults with T2D hospitalized for glycemic control. UGS and MGS were measured in the central 10-m section of a 16-m course, which included 3-m acceleration and deceleration zones on either side. GSR was calculated as the difference between MGS and UGS. Sarcopenia was diagnosed according to the AWGS 2025 criteria. Multivariable logistic regression was used to examine the associations between each gait index and sarcopenia. Diagnostic performance was evaluated using receiver operating characteristic (ROC) curve analysis, and the usefulness of a combined criterion based on UGS and GSR was also assessed. Results: Sarcopenia was identified in 32 participants (27.4%). UGS, MGS, and GSR were each associated with sarcopenia independently of clinical factors. UGS showed the highest sensitivity (90.6%), suggesting its potential usefulness as a screening measure, whereas GSR showed the highest specificity (83.5%), suggesting its potential usefulness in reducing false positives when identifying sarcopenia. In the ROC analysis of the three gait-related indices, the area under the curve (AUC) for MGS was the highest (0.79), but it was not significantly different from the AUC for UGS. The combined criterion of UGS < 1.07 m/s and GSR < 0.21 m/s improved specificity and yielded a high positive likelihood ratio (PLR = 6.5). Conclusions: UGS, MGS, and GSR each exhibit distinct diagnostic characteristics for sarcopenia. UGS may be useful for screening, whereas GSR may help improve specificity. In particular, combining UGS and GSR may provide complementary diagnostic information for identifying sarcopenia in older adults with T2D. Full article

Background: This study evaluated the independent predictive value of preoperative Systemic Immune–Inflammation Index (SII) for postoperative wound infection (WI) in diabetic patients undergoing isolated Coronary Artery Bypass Grafting (CABG). Methods: A retrospective cohort of 300 diabetic patients (2024–2025) was analyzed. The primary outcome was 30-day postoperative WI. Preoperative SII was calculated from blood counts within 24 h before surgery. Multivariable logistic regression was performed using both a primary model (adjusting for age, BMI, and comorbidities) and an extended model including glycemic control (HbA1c), smoking status, operative duration, and transfusion requirements. Model discrimination was evaluated via Area Under the ROC Curve (AUC). Statistical power and sensitivity analyses were conducted to ensure the robustness of the findings. Results: WI occurred in 7% (n = 21). Preoperative SII was significantly lower in the WI group (958.48 ± 493.49 vs. 1293.56 ± 758.15, p = 0.047). SII remained an independent predictor in the adjusted model (Adjusted OR per 100-unit increase: 0.93; 95% CI: 0.86–1.00; p = 0.048). ROC analysis confirmed an inverse predictive pattern (AUC: 0.374, 95% CI: 0.312–0.436). Comparative analysis showed that SII provided superior additional insight compared to NLR and PLR in this population. Conclusions: Preoperative SII is an independent predictor for WI in diabetic CABG patients. However, given the modest discriminative performance (AUC: 0.374), it should be integrated into a broader clinical risk assessment. Contrary to conventional expectations, lower SII values indicated increased susceptibility, suggesting that immune exhaustion rather than hyperinflammation may drive infectious risk in diabetic patients. Full article

Purpose: The aims of this study were to evaluate the feasibility of time-restricted eating (TRE) in patients with Cushing’s disease (CD) and assess its effects on body weight and metabolic parameters. Methods: Twelve CD patients in remission with obesity were enrolled in a TRE program restricting food intake to 10:00–18:00. Anthropometric data, glycemic and lipid profiles, and circadian cortisol secretion were assessed at baseline and post-intervention. Serum cortisol levels were measured at multiple time points to evaluate diurnal patterns. Results: Nine patients completed the study. Over the 12-week period, participants showed a significant reduction in body weight, with median values decreasing from 93.8 kg [83.1–106.5] to 82.6 kg [76.9–100.3] (p = 0.011). Body mass index (BMI) also declined from 37.6 kg/m² [34.2–39.7] to 34.4 kg/m² [32.6–38.3] (p = 0.012). No statistically significant changes were observed in fasting glucose, HbA1c, or lipid parameters. Notably, 24 h urinary free cortisol levels significantly decreased (p = 0.01), and serum cortisol showed a downward trend at all measured time points, with the most pronounced reductions during mid-day and evening hours. No clinical or biochemical evidence of CD relapse was observed during the 12-month follow-up. Conclusions: Time-restricted eating is a feasible and well-tolerated dietary approach for patients with CD in remission, promoting weight loss and modest improvements in metabolic markers and cortisol rhythmicity. Full article

Background/Objectives: Patients with poor sleep are at high risk of developing type II diabetes mellitus (T2DM). Since T2DM is linked to increased risk of obstructive sleep apnea (OSA), and Metformin is commonly used to treat T2DM, we examined how Metformin affects sleep stages in patients with concurrent T2DM and OSA-related symptoms of snoring and fatigue. Patients with T2DM on Metformin progressively develop increased insulin resistance associated with sleep disturbances and poor glycemic control. We therefore explored sleep pattern changes in patients with OSA symptoms and T2DM on Metformin, with a special focus on whether Metformin affects sleep architecture. Methods: Polysomnogram (PSG) data from patients with T2DM on Metformin was evaluated along with data on age, body-mass index (BMI), and biological sex. Data analysis included mean ± standard deviation, t-test with p < 0.05 taken as significant, and linear regression. Results: Patients with a BMI of less than 30 (non-obese) and taking Metformin exhibited a significantly shorter rapid eye movement sleep stage (REM) duration than patients on alternative therapies (p = 0.036). No such difference in REM was found for patients with a BMI of 30 or greater (obese) taking Metformin. While there was also no significant difference in slow-wave sleep stage (N3) duration with Metformin use, linear regression identified a moderate negative correlation between N3 and age in patients taking non-Metformin therapies (R² = 0.4555). No significant correlations between sleep stage duration and patient sex, smoking status, or BMI greater than 30 were identified. Conclusions: Overall, patients with OSA and T2DM on Metformin had lower mean quantities of N3, and REM sleep compared to those not on Metformin. Non-obese patients with T2DM and OSA being treated with Metformin were observed to have less REM sleep, regardless of sex or smoking history. N3 and REM sleep are needed for the timely secretion of growth hormone and memory consolidation. Since Metformin is correlated with differences in N3 and REM sleep, it may contribute to the development of insulin resistance. Future studies are needed to explore potential causes for this relationship and how it may affect the treatment of T2DM. Full article

Background/Objectives: Sodium–glucose cotransporter-2 (SGLT2) inhibitors have demonstrated cardiovascular benefits beyond glycemic control, yet the specific biological pathways potentially linking SGLT2 inhibitor exposure to cardiovascular outcomes after acute myocardial infarction (AMI) remain incompletely characterized. Two biologically plausible pathways, serum uric acid (SUA) reduction and renal functional preservation, have been proposed, but not directly compared in a unified analytical framework. This study aimed to explore whether associations between SGLT2 inhibitor exposure and recurrent post-AMI outcomes may be more strongly linked to SUA reduction and to renal functional changes, using a hypothesis-generating causal mediation analysis. Methods: This retrospective observational cohort study included 142 consecutive patients hospitalized for AMI who underwent percutaneous coronary intervention (PCI) during the index hospitalization, reflecting standard-of-care management for AMI in this tertiary center. Patients were categorized by SGLT2 inhibitor exposure (n = 57) vs. controls (n = 85). Both diabetic (47.2%) and non-diabetic (52.8%) patients were included. The primary endpoint was change in SUA (ΔUA); the secondary endpoint was myocardial infarction (MI) recurrence. Causal mediation analysis with nonparametric bootstrap simulation tested both mechanistic pathways. Results: SGLT2 inhibitor therapy was associated with significant SUA reduction (ΔUA = −0.99 mg/dL vs. +0.56 mg/dL in controls; p < 0.001), consistent across diabetic and non-diabetic subgroups and independent of AMI recurrence. Each 1 mg/dL decrease in SUA was associated with lower odds of recurrent MI in the initial model (β = −0.25; p = 0.041). However, after incorporation of renal functional change, the uric acid-mediated pathway lost significance (ACME p = 0.462), whereas the renal-mediated pathway remained significant (ACME p = 0.038). Serum creatinine change emerged as the strongest independent predictor of MI recurrence (β = 2.22; p = 0.015). Conclusions: The findings are more consistent with a renal-mediated pathway than with an independent uric acid-mediated pathway in explaining the observed associations between SGLT2 inhibitor exposure and recurrent post-AMI outcomes. These hypothesis-generating results from a retrospective design warrant prospective validation. Full article

Background: Ambient air pollution, particularly particulate matter (PM), has been linked to metabolic disorders, including diabetes. We evaluated associations between long-term exposure to coarse particulate matter (PM₁₀) and fine particulate matter (PM_2.5) and glycated hemoglobin (HbA1c) levels in a Korean population and assessed whether specific subgroups exhibited heightened susceptibility. Methods: We analyzed 6940 participants without diabetes from the Korean Genome and Epidemiology Study (KoGES) Ansan-Ansung cohort. Participants contributed 35,395 observations across a mean follow-up of 5.1 visits (2005–2017). Linear mixed models estimated associations between PM exposure and HbA1c while adjusting for covariates, including body mass index (BMI), time, and region. Subgroup analyses stratified by sex, age, BMI, region, education, smoking status, drinking status, and exercise. Results: Higher long-term PM₁₀ exposure was associated with elevated HbA1c (β = 0.0347 per interquartile range [IQR] increase of 9.48 μg/m³; 95% CI: 0.0220, 0.0473; p < 0.001). PM_2.5 showed a comparable positive association (β = 0.0166 per IQR of 8.67 μg/m³; 95% CI: 0.0010, 0.0321; p = 0.037). Associations were stronger among older adults (≥60 years: β = 0.0789 vs. <60 years: β = 0.0210; p-interaction < 0.001), rural Ansung residents (β = 0.0963 vs. Ansan: β = 0.0398; p-interaction < 0.001), participants with lower educational attainment (≤middle school: β = 0.0637; p-interaction < 0.001), and never smokers (β = 0.0455; p-interaction = 0.035). Conclusions: Among nondiabetic Korean adults, long-term PM₁₀ exposure was associated with higher HbA1c; PM_2.5 demonstrated a similar positive association. Associations were more pronounced among older adults, rural residents, individuals with lower educational attainment, and never smokers. These findings support ambient air pollution as an environmental contributor to subclinical glycemic changes and underscore the need for targeted public health strategies for vulnerable populations. Full article

This study investigated the effects of incorporating colored wheat flours (red, blue, purple, and black) and replacing sucrose with xylitol on the technological, functional, and nutritional properties of cookies. Cookies were produced using 50:50 blends of colored whole wheat flours and refined cookie flour, and their physical, color, textural, phenolic, antioxidant, and in vitro glycemic index (GI) properties were evaluated. It has been determined that the addition of colored wheat flours significantly alters the textural properties. The incorporation of colored wheat flours significantly decreased width and increased thickness compared with the control cookies. The spread ratio of sucrose-containing cookies was higher (5.07 to 5.82) compared to xylitol-containing ones (4.91 to 5.41). Substitution of sucrose with xylitol generally reduced dough hardness. The colored wheat flour cookies had lower lightness values (52.31 to 63.18) compared to control samples (68.38 and 69.07 for sucrose and xylitol), while xylitol-based formulations produced slightly lighter cookies due to their lower browning potential. The cookies containing colored whole wheat flours exhibited higher hardness and brittleness than control cookies, likely due to their higher dietary fiber content, whereas xylitol resulted in softer cookies than sucrose. Cookies prepared with colored wheats showed significantly higher total phenolic content (367.41 and 424.87 mg GAE/100 g) and antioxidant capacity than the control samples (312.42 and 306.28 mg GAE/100 g for sucrose and xylitol), with purple wheat cookies exhibiting the highest values (424.69 and 424.87 mg GAE/100 g for sucrose and xylitol). Furthermore, colored wheat cookies demonstrated lower estimated GI values compared with control cookies (73.74 and 67.12), particularly those produced with blue wheat (66.68 and 60.94). Overall, the results indicate that colored wheat flours combined with alternative sweeteners such as xylitol can be used to develop cookies with improved antioxidant properties and moderated glycemic response while maintaining acceptable technological quality. Full article

Background and Objectives: Human data on obesity and type 2 diabetes mellitus (T2DM) remain limited and inconsistent, particularly with respect to adiposity-related phenotypes and renal involvement. We aimed to assess PNX-14 across body mass index (BMI) categories and to investigate its associations with BMI, insulin resistance indicators, and proteinuria in adults with T2DM. Materials and Methods: In this prospective cross-sectional study, participants were classified into four groups according to World Health Organization body mass index (BMI) thresholds: 18.5–24.9, 25.0–29.9, 30.0–34.9, and ≥35.0 kg/m². Serum PNX-14 was measured using a human ELISA kit. Group comparisons, trend analysis, false discovery rate-adjusted Spearman correlations, HC3-robust multivariable regression, and parsimonious structural equation modeling were performed. Results: PNX-14 differed significantly across BMI categories and increased monotonically with increasing BMI (p < 0.001 for both the overall comparison and the trend). PNX-14 showed a positive correlation with BMI (ρ = 0.491; qFDR < 0.001), whereas no significant relationship was observed with insulin or HOMA-IR after FDR correction (qFDR = 0.795 for insulin and qFDR = 0.793 for HOMA-IR). In the model adjusted for age, sex, and BMI, higher PNX-14 was independently associated with lower proteinuria (β = −0.326, 95% CI −0.584 to −0.067; p < 0.05), whereas BMI was positively associated with proteinuria (β = 0.407, 95% CI 0.132 to 0.682; p < 0.01). Structural equation modeling supported positive BMI→PNX-14 and BMI → proteinuria paths, a negative PNX-14→proteinuria path, and a non-significant PNX-14→HOMA-IR path. Conclusions: In adults with T2DM, PNX-14 appears to be more consistently related to adiposity than to glycemic or insulin resistance indicators. However, when evaluated together with proteinuria, it may offer a testable framework for phenotyping based on renal involvement within the obesity spectrum. Nevertheless, this approach needs to be validated in studies from different centers and with repeated measurements. Full article

Commercially produced gluten-free bread has gained popularity over the past decade. However, it often struggles to match its gluten-containing counterparts in terms of nutritional aspects, appearance, texture, and consumer acceptability. In this study, we aimed to optimize a novel gluten-free formulation based on tapioca starch and red lentil flour using a D-optimal mixture design. According to our findings, the swelling power and oil-holding capacity of the blended flour increased with the proportion of red lentil flour. The volume of bread loaves with 15% red lentil flour and 15% or 30% tapioca starch was close to that of the control bread. The addition of lentil flour tended to reduce the springiness of the experimental bread crumb, while the hardness was lower for the experimental sample with 15% lentil and 30% tapioca starch. The predicted glycemic index of the bread samples ranged from 70 to 87, and the sample containing 30% tapioca and 30% red lentil flour achieved the lowest score. Finally, the optimized gluten-free bread formulation showed lower hardness, pore density, and predicted glycemic index, and higher volume compared to the control bread sample, demonstrating that it is possible to improve gluten-free baked goods without compromises. Full article

Background/Objectives: Erectile dysfunction (ED) affects up to 50% of men with type 2 diabetes mellitus (T2DM), yet the independent effects of oral antihyperglycemic medications on erectile function remain controversial. This study investigated associations between commonly prescribed antihyperglycemic medications and erectile function in Taiwanese men with T2DM. Methods: This cross-sectional study enrolled 242 Taiwanese men aged 18–80 years with T2DM. Erectile function was assessed using the International Index of Erectile Function–5 (IIEF-5). Participants were categorized by 12-month HbA1c patterns into well-controlled, variably controlled, and poorly controlled groups. Multiple linear regression models adjusted for demographics, metabolic parameters, and comorbidities examined medication–IIEF-5 associations. Results: The mean IIEF-5 score was 18.16 ± 5.68. None of the seven oral antihyperglycemic medication classes showed significant independent associations with IIEF-5 scores. However, glycemic control demonstrated a significant association with erectile function (F(2,192) = 3.390, p = 0.036), with well-controlled patients showing higher scores than poorly controlled patients (mean difference = 2.488, p = 0.032). Conclusions: In this cross-sectional study, better glycemic control was associated with improved erectile function in men with T2DM. No significant independent associations were observed between individual oral antihyperglycemic medication classes and erectile function after adjustment for glycemic control and other confounders. These findings suggest that glycemic management, rather than the independent effect of medication class, may be the primary determinant of erectile function in this population; however, causal inferences cannot be drawn from this cross-sectional design. Full article

This study investigated the effects of rice bran extract (RBE) on the quality and digestibility of Chinese steamed buns (CSBs). RBE decreased the starch pasting properties, weakened the starch gel network structure, and reduced the storage modulus (G′) and loss modulus (G″). With the increase in RBE addition in CSBs, lightness difference (ΔL*) decreased, total color difference (ΔE*) increased, and the color of CSBs shifted from light to dark orange-red. Additionally, RBE increased the specific volume and enlarged the pore size of the CSBs. When 15% RBE was added, the CSBs had the lowest hardness and the highest springiness, indicating optimal quality. Notably, the addition of RBE significantly (p < 0.05) reduced the estimated glycemic index (eGI) from 90.916 ± 0.530 to 82.282 ± 0.399 at a 20% concentration, which represents a 9.5% reduction. This study provides a reference for the development of low-glycemic-index (GI) foods. Full article

Objectives: The aim of this study was to analyze the association between cardiovascular risk factors such as glycated hemoglobin (HbA1c), low-density lipoprotein cholesterol (LDL-C), hypertension, overweight, and smoking and longitudinal anatomical and functional changes in diabetic macular edema (DME) during intravitreal therapy. Materials and Methods: This is a retrospective, observational, descriptive study conducted on a sample of 318 patients with DME associated with some degree of diabetic retinopathy (DR). They were treated with aflibercept, ranibizumab, and/or dexamethasone, assessing anatomical and functional outcomes through visual acuity, retinal thickness, and macular volume. Simultaneously, serum HbA1c and LDL-C levels, blood pressure, body mass index (BMI) and tobacco use were measured at baseline, 6, and 12 months to determine their association with treatment response using linear mixed models. Results: Of the variables analyzed in this study, HbA1c and degree of retinopathy were significantly associated with greater retinal thickness over time. Likewise, we found that, compared with aflibercept, dexamethasone intravitreal treatment was associated with greater retinal thickness over time. Concerning visual acuity, we found an inverse relationship with age, tobacco use and degree of retinopathy. Associations between outcomes and the initial intravitreal agent were observed; however, these findings should be interpreted cautiously. Conclusions: This study was consistent with previous research suggesting an association between glycemic control and DME response and progression. It also highlighted the importance of degree of retinopathy and intravitreal treatment in diabetic macular edema progression. Treatment-related findings represent exploratory associations and should not be interpreted as evidence of comparative effectiveness. Full article

Background: Among individuals with type 2 diabetes (T2D), lifestyle improvements can restore glycemic control, yet few studies have examined deprescribing in settings where it was necessitated by improvements in health. This study aimed to (1) identify instances of medication deprescribing among adults with T2D in a primary care setting where patients had access to lifestyle medicine (LM), (2) document lifestyle changes among deprescribed patients, (3) assess changes in body mass index (BMI), glucose, and hemoglobin A1c (HbA1c) following deprescribing, and (4) assess the safety of deprescribing in the context of LM-informed care by identifying adverse events. Methods: A retrospective review of electronic health records (EHR) was conducted among 650 adults with a diagnosis of T2D per ICD-10 code at two primary care practices. To be included in the study, individuals had to be seen at least two times during the study period, from 2014 to 2023. Using a previously developed deprescribing framework, records were reviewed to identify deprescribing events. Among patients who were identified as deprescribed, BMI, glucose, and HbA1c, were extracted from the EHR, and age-, sex-, and time-adjusted differences in least squares means were calculated. Mentions of lifestyle change in provider notes in the EHR were also extracted pre- vs. post-deprescribing. Results: Forty-one deprescribing events were confirmed, totaling 6.3% of the study population. The most common medication changes included metformin dose reduction 34%, metformin discontinuation 19.5%, and insulin dose reduction 19.5%. Among patients with follow-up data, mean BMI decreased by 2.25 kg/m², p = 0.0003. Mean decreases of 25% in glucose and 13% in HbA1c were also observed, p < 0.0003 and p < 0.0013, respectively. Lifestyle modifications were specifically cited in 51% of records among deprescribed patients, most frequently related to diet and exercise. No serious adverse events were identified in patients who were deprescribed. Conclusions: In a primary care setting where patients had access to lifestyle medicine, a subset of adults with T2D experienced meaningful health improvements and were able to reduce glucose-lowering medications without any serious adverse events noted in the EHR. Full article

Enriching bakery products with highly nutritious ingredients, such as microalgae and insect powder, is a promising strategy for developing functional foods. This study aimed to evaluate the effects of spirulina, chlorella, and cricket powder on the quality of sponge cakes. The assessed parameters included color, nutritional value, mineral composition, antioxidant activity, predicted glycemic index (pGI), and sensory properties. The addition of microalgae significantly reduced the L* value and altered the color shade of the sponge cakes, while the insect powder caused milder color changes. The enriched samples contained higher levels of protein (by up to 14%) and minerals, including calcium, magnesium, iron, and zinc. Antioxidant activity was enhanced across all variations, particularly in sponge cakes with insect powder, which showed the highest TPC (47.96 mg GAE), DPPH· (0.107 mM TE), and ABTS·⁺ (0.208 mM TE) levels. Cakes containing spirulina exhibited the highest total flavonoid content (63.95 mg EPI). Additionally, the enriched samples demonstrated a statistically significant reduction in the pGI. Among all the supplemented samples, the sponge cake with cricket powder received the highest consumer acceptance. Overall, enriching sponge cakes with microalgae and cricket powder improved their nutritional value and antioxidant properties, with insect powder offering the best balance between sensory quality and functionality. Full article