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Background Methods Results Conclusions Large‐scale trials evaluating a multicomponent lifestyle intervention aimed at weight loss on kidney function are lacking.This was a post hoc analysis of the “PREvención con DIeta MEDiterránea‐Plus” (PREDIMED‐Plus) randomized controlled trial, including patients with overweight/obesity and metabolic syndrome, measured cystatin C and creatinine. Participants were randomly assigned (1:1) to an intensive weight loss lifestyle intervention (intervention group [IG]) consisting of an energy‐restricted Mediterranean diet (MedDiet), physical activity promotion and behavioral support, or a control group (CG) receiving ad libitum MedDiet recommendations. The primary outcome was between‐group differences in cystatin C–based kidney function (cystatin C–based estimated glomerular filtration rate—eGFRcys—and combined cystatin C–creatinine‐based eGFR—eGFRcr‐cys) change from baseline to 12 and 36 months. Secondary outcomes included between‐group differences in creatinine‐based eGFR (eGFRcr) and urinary albumin‐to‐creatinine ratio (UACR) change and the predictive capacity of these formulas at baseline for new‐onset chronic kidney disease (CKD).A total of 1909 participants (65 ± 5 years, 54% men) were included. Twelve‐month decline in eGFRcys, eGFRcr‐cys, and eGFRcr was greater in the CG compared to the IG, with between‐group differences of −1.77 mL/min/1.73 m2 [95% confidence interval −2.92 to −0.63], −1.37 [−2.22 to −0.53], and −0.91 [−1.74 to −0.71], respectively. At 36 months, the decline in eGFRcr‐cys and eGFRcr was greater in the CG. No between‐group differences in UACR were found. Significant adjusted areas under the curve for baseline eGFRcys and eGFRcr‐cys were observed for incident CKD at 36 months, which were similar to those for eGFRcr and UACR.In older adults with overweight/obesity and metabolic syndrome, the PREDIMED‐Plus intervention may be an optimal approach to preserve kidney function. [ABSTRACT FROM AUTHOR]

Background: The role of metabolic dysfunction-associated steatotic liver disease (MASLD) in sleeve gastrectomy (SG)-related outcomes remains uncertain. In this study, we aimed to assess the influence of preoperative biopsy-proven MASLD and its stages on weight loss after SG. Methods: One hundred sixty-three patients with obesity undergoing SG with concomitant intraoperative liver biopsy were followed up for 1 year. Fifty-eight participants were categorized as no MASLD, thirty-eight as metabolic dysfunction-associated steatotic liver (MASL), and sixty-seven as metabolic dysfunction-associated steatohepatitis (MASH). Percentage total weight loss (%TWL) and percentage excess weight loss (%EWL) 1 year after SG were calculated for the different groups. We also evaluated the association between preoperative MASLD (and its stages) and weight loss, after adjusting for potential confounders. Results: Significant differences among groups were detected in %EWL (p = 0.004, ANOVA test), but not in %TWL (p = 0.079). However, significant differences in %TWL were found when MASH and no MASH (i.e., participants with MASL and participants without MASLD) groups were compared (27.3 ± 9.9 vs. 30.7 ± 9, respectively, p = 0.025). In the linear regression model for predicting %EWL 1 year after SG, the presence of MASH was independently associated with a lower %EWL, after adjusting for age, sex, baseline body mass index (BMI), and baseline glycated hemoglobin (HbA1c) (Beta −7.1; 95% CI −13.6, −0.5; p = 0.035). The presence of MASLD, liver fibrosis, or advanced liver fibrosis (≥F2) was also associated with lower %EWL after SG in crude models, although they did not remain significant after adjusting for these confounders. The presence of MASH was inversely related to %TWL, although the association did not remain significant after adjustment (Beta −2.7; 95% CI −5.7, 0.2; p = 0.069). Conclusions: MASH may be independently associated with lower %EWL 1 year after SG in patients with obesity. [ABSTRACT FROM AUTHOR]

The burden of cardiovascular disease is particularly high among individuals with diabetes, even when LDL cholesterol is normal or within the therapeutic target. Despite this, cholesterol accumulates in their arteries, in part, due to persistent atherogenic dyslipidaemia characterized by elevated triglycerides, remnant cholesterol, smaller LDL particles and reduced HDL cholesterol. The causal link between dyslipidaemia and atherosclerosis in T2DM is complex, and our contention is that a deeper understanding of lipoprotein composition and functionality, the vehicle that delivers cholesterol to the artery, will provide insight for improving our understanding of the hidden cardiovascular risk of diabetes. This narrative review covers three levels of complexity in lipoprotein characterization: 1—the information provided by routine clinical biochemistry, 2—advanced nuclear magnetic resonance (NMR)‐based lipoprotein profiling and 3—the identification of minor components or physical properties of lipoproteins that can help explain arterial accumulation in individuals with normal LDLc levels, which is typically the case in individuals with T2DM. This document highlights the importance of incorporating these three layers of lipoprotein‐related information into population‐based studies on ASCVD in T2DM. Such an attempt should inevitably run in parallel with biotechnological solutions that allow large‐scale determination of these sets of methodologically diverse parameters. [ABSTRACT FROM AUTHOR]

Context Metabolic dysfunction–associated steatotic liver disease (MASLD) is characterized by the intracellular lipid accumulation in hepatocytes. Excess caloric intake and high-fat diets are considered to significantly contribute to MASLD development. Objective To evaluate the hepatic and serum fatty acid (FA) composition in patients with different stages of MASLD, and their relationship with FA dietary intake and MASLD-related risk factors. Methods This was a case–control study in patients with obesity undergoing bariatric surgery at a university hospital between January 2020 and December 2021. Participants were distributed in 3 groups: no MASLD (n = 26), steatotic liver disease (n = 33), and metabolic dysfunction–associated steatohepatitis (n = 32). Hepatic and serum FA levels were determined by gas chromatography-mass spectrometry. Nutritional status was evaluated using validated food frequency questionnaires. The hepatic expression of genes involved in FA metabolism was analyzed by reverse transcription quantitative polymerase chain reaction. Results The hepatic, but not serum, FA profiles were significantly altered in patients with MASLD compared with those without MASLD. No differences were observed in FA intake between the groups. Levels of C16:0, C18:1, and the C18:1/C18:0 ratio were higher, while C18:0 levels and C18:0/C16:0 ratio were lower in patients with MASLD, being significantly different between the 3 groups. Hepatic FA levels and ratios correlated with histopathological diagnosis and other MASLD-related parameters. The expression of genes involved in the FA metabolism was upregulated in patients with MASLD. Conclusion Alterations in hepatic FA levels in MASLD patients were due to enhancement of de novo lipogenesis in the liver. [ABSTRACT FROM AUTHOR]

Summary: The increasing prevalence of metabolic syndrome is associated with major health and socioeconomic consequences. Currently, physical exercise, together with dietary interventions, is the mainstay of the treatment of obesity and related metabolic complications. Although exercise training includes different modalities, with variable intensity, duration, volume, or frequency, which may have a distinct impact on several characteristics related to metabolic syndrome, the potential effects of exercise timing on metabolic health are yet to be fully elucidated. Remarkably, promising results with regard to this topic have been reported in the last few years. Similar to other time‐based interventions, including nutritional therapy or drug administration, time‐of‐day‐based exercise may become a useful approach for the management of metabolic disorders. In this article, we review the role of exercise timing in metabolic health and discuss the potential mechanisms that could drive the metabolic‐related benefits of physical exercise performed in a time‐dependent manner. [ABSTRACT FROM AUTHOR]

A study published in the Journal of Internal Medicine evaluated the impact of switching from subcutaneous semaglutide to oral semaglutide in patients with type 2 diabetes (T2D) due to a shortage of the subcutaneous medication. The study included 43 patients who switched from once-weekly subcutaneous semaglutide to once-daily oral semaglutide. The results showed that there were no significant changes in weight or HbA1c levels after the switch, but treatment satisfaction decreased. The study suggests that oral semaglutide may be a useful alternative in the short term, but patients with previous use of subcutaneous semaglutide may prefer that treatment. [Extracted from the article]

The article discusses the relationship between renal sinus fat (RSF) and type 2 diabetes (T2D), specifically focusing on the impact of the glucagon-like peptide-1 (GLP-1) analogue liraglutide on RSF volume in patients with T2D. The study found that liraglutide reduced RSF volume in South Asian patients with T2D, but no significant changes were observed in Western European patients. The results suggest that ethnicity may play a role in the response to the drug, and further research is needed to understand the variations in response among different ethnic groups. Additionally, larger studies are needed to evaluate the clinical significance of the observed changes in RSF. [Extracted from the article]

Summary: Nonalcoholic fatty liver disease (NAFLD) is increasing in parallel with the rising prevalence of obesity, leading to major health and socioeconomic consequences. To date, the most effective therapeutic approach for NAFLD is weight loss. Accordingly, bariatric surgery (BS), which produces marked reductions in body weight, is associated with significant histopathological improvements in advanced stages of NAFLD, such as nonalcoholic steatohepatitis (NASH) and liver fibrosis. BS is also associated with substantial taxonomical and functional alterations in gut microbiota, which are believed to play a significant role in metabolic improvement after BS. Interestingly, gut microbiota and related metabolites may be implicated in the pathogenesis of NAFLD through diverse mechanisms, including specific microbiome signatures, short chain fatty acid production or the modulation of one‐carbon metabolism. Moreover, emerging evidence highlights the potential association between gut microbiota changes after BS and NASH resolution. In this review, we summarize the current knowledge on the relationship between NAFLD severity and gut microbiota, as well as the role of the gut microbiome and related metabolites in NAFLD improvement after BS. [ABSTRACT FROM AUTHOR]

Objective: To evaluate whether the MiniMed™ 780G advanced hybrid closed-loop (AHCL) system maintains similar glycemic control across two different phases of the menstrual cycle in women with type 1 diabetes (T1D) and to analyze the system's performance in these situations. Methods: Continuous glucose monitoring (CGM) and insulin delivery metrics from 12 participants with T1D using the MiniMed™ 780G AHCL were analyzed throughout 3 prospectively recorded, consecutive menstrual cycles (36 cycles in total). Mixed models were used to compare the different variables between the early follicular phase and late luteal phase. Results: A higher average glucose was found throughout the late luteal phase compared with the early follicular phase (139.5 [133.5, 145.2] vs. 131.5 [126.8, 140.2] mg/dl, respectively, P = 0.002), together with an increase in total daily insulin dose (37.2 ± 11.9 vs. 33.6 ± 12.2 IU, P < 0.001). However, similar values between phases were observed for most of the remaining CGM metrics, including time in range (83.0 [76.0, 87.5] vs. 85.0 [79.8, 89.0] %, P = 0.101). Conclusion: Our results suggest that differences in glycemic control may be found across the menstrual cycle in women with T1D using the MiniMed™ 780G AHCL. Although higher average glucose levels may be expected in the late luteal phase, the deterioration of glycemic control during this phase may be mild with the MiniMed™ 780G AHCL, given the similarities for most of the CGM metrics with respect to the early follicular phase.

Background: The regular practice of physical activity is considered a health promoter and appears to be one of the main contributors to the prevention of chronic diseases. However, the potential effects of exercise on health depending on the time of day at which it is performed have not yet been fully elucidated., Objectives: To evaluate the effect of physical exercise (aerobic or anaerobic) and chronobiology (morning or afternoon) on the glycemic metabolism of healthy subjects., Methods: Healthy subjects participated in aerobic or anaerobic physical exercise sessions, either in the morning or in the afternoon. Blood was drawn from the subjects before, at the end of the exercise and 2 hours after the end of the exercise. Glycemic parameters were analyzed at these time points. A general linear model test was performed after verifying the normal distribution of the raw data (as assessed by the Shapiro-Wilk test) or after a logarithmic/square root transformation, considering aerobic or anaerobic exercise and morning or afternoon exercise as independent variables., Results: Twenty-three subjects (14 women and 9 men) were included in the study. The rate of change in glucose levels was significantly higher at the end of anaerobic exercise compared to aerobic exercise (1.19 ± 0.04 vs. 0.98 ± 0.02, respectively), with a more pronounced decrease in insulin and C-peptide levels following aerobic exercise. In addition, the increase of glucose was higher after the exercise in the morning compared with the afternoon (1.14 ± 0.03 vs. 1.03 ± 0.03, respectively)., Conclusions: The type of exercise and chronobiology influence short-term glucose metabolism.