Search Results (240)

Background: Dilated cardiomyopathy (DCM) is a major contributor to heart failure-related morbidity and mortality. While type 2 diabetes mellitus (T2DM), obesity, and thyroid dysfunction are individually linked to cardiovascular disease, their combined effects on DCM remain poorly understood. Objective: To evaluate the independent and synergistic associations of diabetes (stratified by treatment), thyroid dysfunction, and obesity with the prevalence of DCM and 30-day hospital readmission. We further examined the utility of a composite Metabolic Burden Score for risk stratification. Methods: In this retrospective cohort study, electronic health record data from 1079 adult patients at a tertiary care center were analyzed. Multivariable logistic regression, including ridge regularization, was used to identify predictors of DCM. Endocrine phenotypes were stratified by diabetes and thyroid status. A Metabolic Burden Score (range: 0–3) based on diabetes, obesity, and thyroid dysfunction was developed and correlated with clinical outcomes. Results: DCM was diagnosed in 46% of the cohort. Non-insulin-treated diabetes (OR: 6.93; 95% CI: 3.78–12.73), hypothyroidism (OR: 1.78; 95% CI: 1.02–3.11), and male sex (OR: 2.33; 95% CI: 1.36–4.00) were independently associated with increased DCM risk. Obesity was not independently predictive but contributed to DCM prevalence when assessed within the Metabolic Burden Score. DCM prevalence increased across burden strata, reaching 50% in the high-risk group. Notably, the moderate-risk group had the highest 30-day readmission rate (42.8%). Conclusions: Non-insulin-treated diabetes and hypothyroidism are key metabolic drivers of DCM. A simple composite burden score offers a clinically useful tool for stratifying risk of DCM and early readmission. These findings support integrated endocrine–cardiac screening strategies to improve early identification and prevention of structural heart disease. Full article

Objective: The aim of this study was to retrospectively evaluate the results of administering subcutaneous neutral protamine Hagedorn (NPH) insulin every 8 h (NPH-8) versus every 12 h (NPH-12) in critically ill, hyperglycemic trauma patients who required continuous enteral nutrition (EN). Methods: Both groups of patients were given concurrent sliding scale regular human insulin (SSI) with NPH therapy. The evaluation of glycemic control continued for 7 days. Results: A total of 15 patients were given NPH every 8 h (NPH-8), and 19 were given NPH every 12 h (NPH-12). Carbohydrate intake was similar between groups (115 ± 35 vs. 108 ± 37 g/d; p = 0.584). There was no significant difference in average blood glucose (BG) concentration (168 ± 18 vs. 166 ± 17 mg/dL; p = 0.803) or time within a BG target range of 70 to 149 mg/dL (7.5 ± 4.7 vs. 8.1 ± 5.0 h/d; p = 0.678) or 70 to 179 mg/dL (14.5 ± 5.0 vs. 16 ± 5.6 h/d; p = 0.419) or the incidence of Level 1 hypoglycemia (2 patients in each group; p = 1.00) or Level 2 hypoglycemia (1 patient vs. 0 patients, p = 0.441) between the NPH-8 and NPH-12 groups, respectively. However, the NPH-8 group required twice as much total (NPH + SSI) insulin (115 ± 52 vs. 58 ± 33 units/d; p = 0.004). Conclusions: These preliminary data suggest no significant difference between the administration of NPH-8 and NPH-12 based on glycemic control metrics in critically ill hyperglycemic trauma patients given EN. However, these results may be confounded by a selection bias as to who received NPH-8 vs. NPH-12. Further research is required. Full article

Background: Pelemir (Cephalaria syriaca) is a bitter-tasting ancestral legume with a high polyphenol content and emerging potential as a functional food ingredient. This study investigated the acute metabolic effects of pelemir-enriched bread in adults. Methods: In this two-phase non-randomized trial, 60 participants in three groups (n = 20 per group: healthy controls [HCs], individuals with obesity [OB], and individuals with type 2 diabetes [T2D]) consumed regular or pelemir-enriched bread on two separate test days. Postprandial glucose, insulin, C-peptide, GLP-1, PYY, ghrelin, leptin, triglyceride, and IL-6 were measured over 120 min. Subjective appetite ratings were evaluated using visual analog scales (VASs). The incremental area under the curve (iAUC) values were compared using Wilcoxon tests and linear mixed-effects models. Results: Pelemir-enriched bread significantly increased iAUCs for insulin (p = 0.014), C-peptide (p = 0.046), and GLP-1 (p = 0.039) compared to regular bread. There was no significant change in iAUC for glucose. Group-stratified analyses showed a higher postprandial iAUC of glucose, insulin, and C-peptide in the OB group compared to the HC group. VAS-based appetite ratings did not show significant changes in hunger, fullness, or desire to eat, but a borderline significant reduction was observed in prospective food consumption after pelemir-enriched bread (p = 0.050). Conclusions: Acute consumption of pelemir-enriched bread may modulate postprandial insulin and incretin responses. Its modest impact on subjective appetite regulation supports further investigation of pelemir as a functional food rich in polyphenols, especially in populations with metabolic dysfunction. Full article

Milk and dairy are rich in insulin-like growth factor 1 (IGF-1), a protein secreted through the action of growth hormone (GH) and implicated in growth and metabolism. Objective: This study aimed to investigate the roles of milk intake and body composition and identify the presence of the single nucleotide variant (SNV) rs6214 in the insulin-like growth factor 1 gene (IGF1) and its effects on the serum IGF-1 and GH levels and body composition. Methods: We analyzed 110 volunteers with and without a history of milk intake. Through a case–control study with one hundred ten healthy volunteers, serum IGF-1 and GH levels were measured using the ELISA technique, the body composition was determined with bio-electrical impedance equipment, genotyping of the rs6214 SNV was carried out using real-time PCR, and a dietary questionnaire was administered to assess milk intake, with or without consumption. Results: The results showed that the highest levels of IGF-1 were found in people who regularly consumed milk, along with a lower body mass index (BMI) and percentage of fat. A lower BMI and fat percentage were associated with higher levels of IGF-1, lean mass, and SNV presence. Lower levels of BMI and percentages of subcutaneous and visceral fat were found in regular milk consumers. Conclusions: Our study suggests that dairy intake and the IGF1 gene rs6214 SNV are associated with higher levels of IGF-1, high levels of lean mass, a low BMI, a low % fat, and low visceral fat. Full article

Regular physical activity induces a dynamic crosstalk between skeletal muscle and adipose tissue, modulating the key molecular pathways that underlie metabolic flexibility, mitochondrial function, and inflammation. This review highlights the role of myokines and adipokines—particularly IL-6, irisin, leptin, and adiponectin—in orchestrating muscle–adipose tissue communication during exercise. Exercise stimulates AMPK, PGC-1α, and SIRT1 signaling, promoting mitochondrial biogenesis, fatty acid oxidation, and autophagy, while also regulating muscle hypertrophy through the PI3K/Akt/mTOR and Wnt/β-catenin pathways. Simultaneously, adipose-derived factors like leptin and adiponectin modulate skeletal muscle metabolism via JAK/STAT3 and AdipoR1-mediated AMPK activation. Additionally, emerging exercise mimetics such as the mitochondrial-derived peptide MOTS-c and myostatin inhibitors are highlighted for their roles in increasing muscle mass, the browning of white adipose tissue, and improving systemic metabolic function. The review also addresses the role of anti-inflammatory compounds, including omega-3 polyunsaturated fatty acids and low-dose aspirin, in mitigating NF-κB and IL-6 signaling to protect mitochondrial health. The resulting metabolic flexibility, defined as the ability to efficiently switch between lipid and glucose oxidation, is enhanced through repeated exercise, counteracting age- and disease-related mitochondrial and functional decline. Together, these adaptations demonstrate the importance of inter-tissue signaling in maintaining energy homeostasis and preventing sarcopenia, obesity, and insulin resistance. Finally, here we propose a stratified treatment algorithm based on common age-related comorbidities, offering a framework for precision-based interventions that may offer a promising strategy to preserve metabolic plasticity and delay the age-associated decline in cardiometabolic health. Full article

Background/Objectives: Polycystic Ovary Syndrome (PCOS), as a multifactorial chronic disease, can cause heterogeneous metabolic, physical, and psychological disorders as well as infertility in both obese and non-obese patients. Therefore, this review aimed to present differences in pathophysiology, clinical presentation, and therapy in obese and non-obese patients with PCOS. Methods: A non-systematic review was conducted by searching papers published in English from 2010 to 2024 in MEDLINE. Results: Obesity in PCOS significantly contributes to IR and worsens metabolic dysfunction. Lifestyle modifications, including a balanced diet and regular exercise, are the first line of treatment. Pharmacological therapies, such as metformin, GLP-1 receptor agonists, myoinositol, and resveratrol, are used to improve insulin sensitivity, regulate the hormonal milieu, and reduce hyperandrogenism. Metformin is widely used to improve glucose metabolism and reduce androgen levels, while myoinositol is effective in promoting ovarian function. GLP-1 receptor agonists and resveratrol improve metabolic and reproductive outcomes. For patients with severe obesity, bariatric surgery offers substantial improvements in body composition, metabolic function, and fertility. Combination therapies, such as metformin and GLP-1 receptor agonists, provide comprehensive treatment for both reproductive and metabolic aspects of PCOS. Conclusions: The first-line treatment for PCOS is a lifestyle-modifying strategy. PCOS patients with insulin resistance and obesity would mostly benefit from combination therapy with metformin and GLP-1 receptor agonists. Full article

Obesity, type 2 diabetes mellitus (T2DM) and steatohepatitis associated with metabolic dysfunction (MASLD) are on the rise and pose serious health challenges worldwide. In recent years, researchers have gained a better understanding of the important role of the gut microbiota in the development and progression of these diseases. Intestinal dysbiosis can contribute to the occurrence of increased intestinal permeability, inflammation and reduced numbers of commensal bacteria. In obesity, these changes contribute to chronic low-grade inflammation and deregulated metabolism. In MASLD, gut microbiota dysbiosis can promote liver fibrosis and impair bile acid metabolism, while in T2DM, they are associated with impaired glycemic control and insulin resistance. Regular physical activity has a positive effect on the composition of the gut microbiota, increasing its diversity, modulating its metabolic functions, strengthening the intestinal barrier and reducing inflammation. These findings suggest that exercise and microbiota-targeted interventions may play an important role in the prevention and treatment of metabolic diseases. Full article

Metabolic syndrome (MetS) is defined as a group of metabolic defects that include hypertension, insulin resistance, visceral obesity, fatty liver disease, and atherosclerotic cardiovascular disease (CVD). The first step in controlling the progression of MetS is lifestyle changes, including dietary modification. Regular consumption of fruits, vegetables, whole grains and other plant foods negatively correlates with the risk of developing chronic diseases. Green leafy vegetables (GLVs) are a key element of healthy eating habits and an important source of vitamins C and E, carotenoids—mainly β-carotene and lutein—and minerals. This review discusses and summarizes the current knowledge on the health benefits of consuming GLVs in the prevention and treatment of MetS to provide a compendium for other researchers investigating new natural products. Full article

Benign prostatic hyperplasia (BPH) is a multifactorial condition that is highly prevalent and affects aging males. It frequently results in lower urinary tract symptoms (LUTS) and a reduced quality of life. While hormonal dysregulation and chronic inflammation have long been implicated in BPH pathogenesis, recent evidence highlights the role of physical activity in modulating prostate health. In this narrative review, evidence from quantitative studies examining the effect of exercise on BPH risk and symptom severity was first synthesized. Collectively, these studies suggest that regular physical activity is associated with a lower incidence and reduced progression of BPH. The potential mechanisms through which exercise may exert protective effects on the prostate were then explored. These include modulation of sympathetic nervous system activity, alterations in hormonal profiles (e.g., testosterone and insulin), suppression of chronic inflammation and oxidative stress, and the promotion of autophagy within prostatic tissue. Central to these mechanisms is the role of myokines—signaling molecules secreted by skeletal muscle during exercise. Key myokines, such as irisin, interleukin-6 (IL-6), brain-derived neurotrophic factor (BDNF), and myostatin, are reviewed in the context of prostate health. These molecules regulate inflammatory pathways, metabolic processes, and tissue remodeling. For instance, exercise-induced reductions in myostatin are linked to improved insulin sensitivity and decreased fat accumulation, while elevated irisin and BDNF levels may exert anti-inflammatory and metabolic benefits relevant to BPH pathophysiology. Although direct causal evidence linking myokines to BPH is still emerging, their biological plausibility and observed systemic effects suggest a promising avenue for non-pharmacological intervention. Future research should focus on identifying the specific myokines involved, elucidating their molecular mechanisms within the prostate, and evaluating their therapeutic potential in clinical trials. Full article

Background/Objectives: We evaluated the efficacy of a good lifestyle intervention on the severity of metabolic dysfunction-associated steatotic liver disease (MASLD) in children with Down syndrome (DS). Methods: This retrospective longitudinal study included 31 children with Down syndrome (DS) who were affected by MASLD and attended nutritional counseling based on a nutritional approach (e.g., Mediterranean diet and antioxidant supplements), as well as physical exercise. Clinical parameters, markers of low-grade systemic inflammation, and hepatic steatosis, as assessed by ultrasound, were evaluated at baseline (T0) and after 6 months (T1). Results: Several anthropometric and biochemical parameters, including body mass index, waist circumference, diastolic and systolic blood pressure, aspartate aminotransferase, basal insulin, insulin resistance, pro-inflammatory interleukin-1β, and anti-inflammatory interleukin-10, showed significant improvement after 6 months of a nutritional approach. This study also found a regression of at least one grade of hepatic steatosis in a significant portion of patients, especially in those who received antioxidant supplements. Conclusions: Our study further supports the hypothesis that a healthy lifestyle intervention, based on adherence to the Mediterranean diet, natural supplements with antioxidant properties, and regular physical activity, can be considered a safe therapeutic approach for reducing the risk and severity of MASLD in children with DS. Full article

Type 1 diabetes is classified into three clinical subtypes: fulminant type 1 diabetes, acute-onset type 1 diabetes, and slowly progressive type 1 diabetes, also known as latent autoimmune diabetes in adults. Among these, the fulminant and slowly progressive forms may develop in association with pregnancy and are herein collectively referred to as “pregnancy-associated type 1 diabetes”. Fulminant type 1 diabetes can manifest suddenly during pregnancy, often accompanied by ketoacidosis, posing a significant risk to both the mother and the fetus. Early diagnosis and treatment are, therefore, critical. In pregnant women with no prior history of diabetes who present with marked hyperglycemia (≥288 mg/dL) but relatively low HbA1c levels (<8.7%), fulminant type 1 diabetes should be suspected, and insulin therapy should be initiated immediately. Conversely, women diagnosed with gestational diabetes who test positive for anti-islet autoantibodies are at high risk of developing slowly progressive type 1 diabetes postpartum. For these patients, regular monitoring of blood glucose levels, HbA1c, and endogenous insulin secretion is essential for early detection and management. Full article

A five-month-old female mixed-breed dog presented with a two-week history of polyuria, polydipsia, and vomiting. Clinical examination revealed poor body condition, growth retardation, pale oral mucous membranes, weak pulse, and prolonged capillary refill time. Laboratory findings included neutrophilic leukocytosis with a regenerative left shift, fasting hyperglycemia, elevated fructosamine, glycated hemoglobin, and β-hydroxybutyrate concentrations, while the acid–base balance remained normal. Canine-specific pancreatic lipase and trypsin-like immunoreactivity concentrations ruled out an underlying pancreatitis or exocrine pancreatic insufficiency, respectively. Urinalysis showed glycosuria and ketonuria. Supportive care included antibiotics and regular insulin administration. Abdominal ultrasonography identified a pancreatic cavity with a thick wall and mixed echogenic fluid. Ultrasound-guided drainage was performed without complications. Cytology confirmed a pancreatic abscess with pyogranulomatous inflammation, though the culture results were negative. The dog was discharged with intermediate-acting lente insulin. Follow-up ultrasonographic evaluations at 7, 14, and 21 days and 5 months post-drainage showed no recurrence. The diabetes remained well-controlled one year post-discharge. This case report describes the successful management of a dog with juvenile diabetes mellitus complicated by a pancreatic abscess, highlighting the effectiveness of percutaneous ultrasound-guided drainage combined with medical therapy. Full article

Polycystic ovary syndrome (PCOS) is a common metabolic–endocrine disorder affecting women of reproductive age, and insulin resistance (IR) is a key pathophysiological feature. Current medical education and clinical practice emphasize glucose-centric approaches in PCOS management, and IR testing is often overlooked due to limited emphasis in current clinical guidelines or the lack of standardized protocols. Additionally, the glucose-focused paradigm has been the standard of care for decades. However, this approach has led to delayed diagnosis of progressive metabolic and reproductive consequences, leaving many patients underdiagnosed and undertreated. Therefore, we propose a paradigm shift towards an insulin-centric model for PCOS management. This new approach aims to diagnose IR at an earlier stage, enabling the timely implementation of effective lifestyle and treatment strategies. By focusing on IR, clinicians can potentially limit the progression of PCOS-related reproductive and metabolic diseases. The insulin-centric model is a novel approach that involves comprehensive IR screening, dynamic insulin testing, personalized lifestyle and insulin-sensitizing interventions, and regular monitoring of insulin and glycemic parameters. This model could improve patient outcomes by facilitating early diagnosis of metabolic dysfunction and reducing the incidence of subsequent chronic disease. Furthermore, this model has broader implications, potentially transforming treatment approaches for various chronic diseases beyond PCOS. Full article

Background/Objectives: Hormonal fluctuations during the menstrual cycle can affect glycemic control in women with type 1 diabetes (T1D), especially during the luteal phase, when increased insulin resistance may lead to prolonged hyperglycemia. Advanced Hybrid Closed-Loop (AHCL) systems could help manage these hormone-driven fluctuations. This study aimed to assess glycemic control across menstrual phases and explore the role of AHCL systems in counteracting the related glucose variability. Methods: A retrospective study was conducted including women with T1D and regular menstrual cycles (study group) and women on estroprogestin therapy (control group). Each group was subdivided by insulin delivery method (AHCL vs. non-AHCL). Glycemic metrics and insulin requirements were compared between the follicular and luteal phases, and between groups. Results: The study included 94 women (62 in the study group, 32 in the control group). In the study group, glycemic control worsened during the luteal phase, with increased average glucose, glycemic variability, and time above range > 250 mg/dL (+0.93%, p = 0.03) and reduced time in range 70–180 mg/dL. These changes were more pronounced among AHCL users, who also showed a significant increase in bolus insulin. No phase-related differences were observed in the control group or among non-AHCL users. Significantly higher insulin needs during the follicular phase were found in the study group compared with the controls. Conclusions: This study confirmed a worsening in glycemic control in women affected by T1D during the luteal phase of the menstrual cycle, suggesting a need for more tailored management. The clear efficacy of AHCL systems in counteracting hormone-related glycemic fluctuations has not been proved, highlighting the need for further research in larger, more homogeneous cohorts. Full article

Overfeeding, currently defined as providing excessive energy and nutrients beyond metabolic requirements, is a common yet often overlooked issue in the intensive care unit (ICU) setting. Understanding the factors contributing to overfeeding and implementing strategies to prevent it is essential for optimizing patient care in the ICU. Several factors contribute to overfeeding in the ICU, including inaccurate estimation of energy requirements, formulaic feeding protocols, and failure to adjust nutritional support based on individual patient needs. Prolonged overfeeding can lead to insulin resistance and hepatic dysfunction, exacerbating glycemic control, increasing the risk of infectious complications, and worsening clinical outcomes. Clinically, overfeeding has been linked to delayed weaning from mechanical ventilation, prolonged ICU stay, and increased mortality rates. Regular review and adjustment of feeding protocols, incorporating advances in enteral and parenteral nutrition strategies, are essential for improving patient outcomes. Clinicians must be proficient in interpreting metabolic data, understanding the principles of energy balance, and implementing appropriate feeding algorithms. Interdisciplinary collaboration among critical care teams, including dieticians, physicians, and nurses, is crucial for ensuring consistent and effective nutritional management. Overfeeding remains a significant concern in the ICU after discharge as well, implying further complications for patient safety and integrity. By understanding the causes, consequences, and strategies for the prevention of overfeeding, healthcare providers can optimize nutrition therapy and mitigate the risk of metabolic complications. Through ongoing education, interdisciplinary collaboration, and evidence-based practice, the ICU community can strive to deliver personalized and precise nutritional support to critically ill patients. Full article