Belinda Elisha

Menopause and sarcopenia : A potential role for sex hormones.

Menopause is associated with a decline in estrogen levels, which could lead to an increase in visceral adiposity as well as a decrease in bone density, muscle mass and muscle strength. This decline in muscle mass, known as sarcopenia, is frequently observed in postmenopausal women. Potential causes of sarcopenia include age-related changes in the hormonal status, low levels of physical activity, reduced protein intake and increased oxidative stress. However, the role of sex hormones, specifically estrogens, on the onset of sarcopenia is controversial. Preventing sarcopenia and preserving muscle strength are highly relevant in order to prevent functional impairment and physical disability. To date, resistance training has been shown to be effective in attenuating age-related muscle loss and strength. However, results on the effect of hormonal supplementation to treat or prevent sarcopenia are contradictory. Further research is needed to identify other potential mechanisms of sarcopenia as well as effective interventions for the prevention and treatment of sarcopenia. Therefore, the purpose of this review will be to examine the role of sex hormonal status in the development of sarcopenia. We will also overview the physical as well as metabolic consequences of sarcopenia and the efficiency of different interventions for the prevention and treatment of sarcopenia.

Body Composition and Epicardial Fat in Type 2 Diabetes Patients Following Insulin Detemir Versus Insulin Glargine Initiation.

The aim of the study was to compare body composition and epicardial fat thickness changes in insulin-naïve inadequately controlled patients with type 2 diabetes following basal insulin initiation with detemir vs. glargine. Six-month, open-label, interventional randomized pilot study was conducted. Dual-energy X-ray absorptiometry and echocardiography were used to estimate the body composition and epicardial fat thickness respectively. Thirty-six patients in the detemir group and 20 in the glargine group completed the study. Study groups baseline characteristics were comparable. At 6 months, for similar glycemic control, those on detemir significantly gained less total weight (0.6±2.5 vs. 4.2±4.1 kg, p=0.004), total fat mass (0.9±2.2 vs. 2.9±2.4 kg, p=0.02), and truncal fat mass (0.8±1.5 vs. 2.1±1.7 kg, p=0.02), with a loss in truncal lean mass (- 0.8±1.9 kg vs. 0.3±1.7 kg; p=0.02). EFT significantly decreased from baseline in both group (detemir - 1.7±0.52-mm, glargine - 1.1±1.6-mm; p<0.05, without significant difference inter-groups). Within the detemir group, epicardial fat thickness change correlated with truncal fat and total fat mass changes (r=0.65, p=0.06 and r=0.60, p=0.07). In conclusion, detemir resulted in less fat mass gain, a trend for a more pronounced epicardial fat thickness reduction when compared with glargine.

Diagnosis of cystic fibrosis-related glucose abnormalities: Can we shorten the standard oral glucose tolerance test?

Adult patients with cystic fibrosis (APCF) are at high risk of developing impaired glucose tolerance (IGT) and CF-related diabetes (CFRD) and thus an annual screening with a 2-h oral glucose tolerance test (OGTT) is recommended. This population would greatly benefit from a simplified and harmless alternative to the standard OGTT. Thus, we aimed to compare the diagnostic values of HbA1c and glycemias at interval time points during the 2-h OGTT for IGT and CFRD detection in APCF. To do so, we conducted a cross-sectional analysis of 194 APCF with normal fasting plasma glucose values (≤ 7.0 mmol · L(-1)) who underwent a 2-h OGTT. Receivers operating characteristic area under the curves (ROC-AUC) were analyzed to assess the diagnostic value of HbA1c and intermediate OGTT glycemias using 2-h OGTT glycemia as reference. For both IGT and CFRD diagnoses, ROC-AUC values obtained from glycemia at 90 min were significantly higher than HbA1c and remaining intermediate glycemias (p < 0.001). The best 90-min OGTT cut-off values for these diagnoses were >9.3 mmol · L(-1) (IGT) and ≥ 11.5 mmol · L(-1) (CFRD). A 90-min OGTT glycemia might be a simplified alternative to 2-h OGTT glycemia for earlier glucose tolerance abnormalities diagnosis in APCF. This finding should be confirmed in other APCF cohorts and its predictive value should be established prospectively.

Weight cycling and depressive symptoms in diabetes: a community-based study of adults with type 2 diabetes mellitus in Quebec.

OBJECTIVE The problems of obesity and depression in type 2 diabetes mellitus are well documented, yet the role of weight cycling in relation to these 2 chronic conditions has not been examined. The study objective was to determine whether weight cycling predicts the development of depressive symptoms in the course of 1 year. METHODS A cohort study of 1100 adults with type 2 diabetes participating in the Diabetes Health and Well-Being Study (telephone survey using the random-digit-dialling method) had complete data at the 1-year follow up on depressive symptoms (Patient Health Questionnaire 9) and weight cycling frequency (going on a diet and losing >10 kg). RESULTS At baseline, 56.5% of subjects reported weight cycling on at least 1 occasion in their lifetime; it was found to be associated with baseline body mass index, depression, sex and age (p<0.05). Regression analyses indicated that severe weight cycling (≥4 times) was not associated with the development of major depressive symptoms; however, it was associated with maintaining major depressive symptoms (p=0.038) but significance disappeared after adjusting for body mass index, physical activity, smoking and sociodemographic characteristics. Development and maintenance of major depressive symptoms were associated with physical inactivity (p<0.05); maintenance of major depressive symptoms was also associated with higher body mass index values (p<0.05). CONCLUSIONS Weight cycling is a widespread phenomenon in diabetes. It was associated with depression, but severe cycling was not an independent predictor of the development and maintenance of major depressive symptoms. Clinicians should consider physical inactivity when evaluating and addressing depression in patients with type 2 diabetes.

From French to Mediterranean Diet: Importance of the Omega-6/Omega-3 Fatty Acids Ratio

aDepartment of Nutrition, Université de Montréal, bInstitut de Recherches Cliniques de Montréal (IRCM), cMontreal Diabetes Research Center (MDRC), and iMontreal University Hospital Research Center (CRCHUM), Montreal, Que., Canada; dUniversité de Lyon, eUnité 870 et fUnité Mixte de Recherche S938, Centre de Recherche SaintAntoine, Institut National de la Santé et de la Recherche Médicale, Lyon, gAPHP, Hôpital Tenon, Service de Biochimie et Hormonologie, Paris, et hInstitut de la Recherche Agronomique (INRA) 1235, INSERM 870, INSALyon, Régulations Métaboliques Nutrition et Diabète, Université Lyon, Oullins, France

Relative contribution of muscle and liver insulin resistance to dysglycemia in postmenopausal overweight and obese women: A MONET group study

OBJECTIVES The relative contribution of muscle and liver insulin resistance (IR) in the development of dysglycemia and metabolic abnormalities is difficult to establish. The present study aimed to investigate the relative contribution of muscle IR vs. liver IR to dysglycemia in non-diabetic overweight or obese postmenopausal women and to determine differences in body composition and cardiometabolic indicators associated with hepatic or muscle IR. MATERIAL AND METHODS Secondary analysis of 156 non-diabetic overweight or obese postmenopausal women. Glucose tolerance was measured using an oral glucose tolerance test. Whole-body insulin sensitivity (IS) was determined as glucose disposal rate during a euglycemic-hyperinsulinemic clamp. Muscle and liver IR have been calculated using Abdul-Ghani et al. OGTT-derived formulas. Participants body compositions as well as cardiometabolic risk indicators were also determined. RESULTS Overall, 57 (36.5%) of patients had dysglycemia, among them 25 (16.0%); 21 (13.5%); 11 (7.1%) had impaired fasting glycemia, impaired glucose tolerance and combined glucose intolerance respectively. Fifty-three (34.0%) participants were classified as combined IS while on the opposite 51 participants (32.7%) were classified as combined IR and 26 (16.7%) participants had either muscle IR or liver IR. For similar body mass index and total fat mass, participants with liver IR were more likely to have lower whole-body IS, dysglycemia and higher visceral fat, liver fat index, triglycerides and alanine aminotransferase than participants with muscle IR. CONCLUSION In the present study, the presence of liver IR is associated with a higher prevalence of dysglycemia, ectopic fat accumulation and metabolic abnormalities than muscle IR.

P151 Contribution relative de l’insulino-sensibilité musculaire et hépatique aux variations du statut glycémique chez des femmes ménopausées obèses ou en surpoids

Introduction La contribution du muscle et du foie dans le developpement de la dysglycemie est difficile a etablir. Le but de cette etude a ete d’explorer la contribution relative de l’insulinoresistance (IR) musculaire comparee a l’IR hepatique en relation avec les anomalies du profil glycemique chez des femmes menopausees en surpoids ou obeses. Patients et methodes: 156 femmes menopausees en surpoids ou obeses ont ete incluses. La tolerance au glucose a ete determinee par un test d’hyperglycemie provoquee par voie orale (HGPO). Les IR musculaire et hepatique ont ete determinees en utilisant des indices derives de l’HGPO proposes par Abdul-Ghani et al en 2007. Patients et methodes Cent cinquante-six femmes menopausees en surpoids ou obeses ont ete incluses. La tolerance au glucose a ete determinee par un test d’hyperglycemie provoquee par voie orale (HGPO). Les IR musculaire et hepa-tique ont ete determinees en utilisant des indices derives de l’HGPO proposes par Abdul-Ghani et al en 2007. Resultats Vingt-cinq (16,0 %) participantes avaient une hyperglycemie a jeun (IFG), 21 (13,5 %) une intolerance au glucose (IGT) et 11 (7,1 %) une combinai-son des deux (CGI). Par ailleurs, 53 (34,0 %) participantes avaient une IR combinee hepatique et musculaire, 26 (16,7 %) avaient une IR musculaire isolee et la meme proportion une IR hepatique simple. Les participantes avec une IR hepatique isolee ou combinee a une IR musculaire etaient les plus susceptibles a avoir une dysglycemie (41,2 % et 69,2 % respectivement). Chez les participantes presentant une dysglycemie, 50 % avec une IR hepatique avaient une IFG alors que 80 % avec une IR musculaire avaient une IGT. Enfin, les participantes qui avaient une IR combinee etaient plus susceptibles d’avoir une CGI. Conclusion Nous confirmons dans la population etudiee que l’IFG est associee a une IR hepatique et l’IGT a une IR musculaire. De plus, nous montrons que les sujets qui presentent une IR hepatique isolee ou combinee a une IR musculaire sont plus susceptibles d’avoir un profil dysglycemique que ceux qui ne presentent qu’une IR musculaire isolee. Declaration d’interet Les auteurs declarent ne pas avoir d’interet direct ou indirect (financier ou en nature) avec un organisme prive, industriel ou commercial en relation avec le sujet presente.