Original Data

Rev Diabet Stud, 2016, 13(2-3):148-157 DOI 10.1900/RDS.2016.13.148

Whey and Casein Proteins and Medium-Chain Saturated Fatty Acids from Milk Do Not Increase Low-Grade Inflammation in Abdominally Obese Adults

Mette Bohl1, Ann Bjørnshave1,2, Søren Gregersen1, Kjeld Hermansen1

1Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
2The Danish Diabetes Academy, Odense, Denmark
Address correspondence to: Mette Bohl, Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Tage-Hansens Gade 2, DK-8000 Aarhus C, Denmark, e-mail: mette.bohl.larsen@aarhus.rm.dk


BACKGROUND: Low-grade inflammation is involved in the development of diabetes and cardiovascular disease (CVD). Inflammation can be modulated by dietary factors. Dairy products are rich in saturated fatty acids (SFA), which are known to possess pro-inflammatory properties. However, different fatty acid compositions may exert different effects. Other components such as milk proteins may exert anti-inflammatory properties which may compensate for the potential negative effects of SFAs. Generally, the available data suggest a neutral role of dairy product consumption on inflammation. AIM: To investigate the effects of, and potential interaction between, a dietary supplementation with whey protein and milk fat, naturally enriched in medium-chain SFA (MC-SFA), on inflammatory markers in abdominal obese adults. METHODS: The study was a 12-week, randomized, double-blinded, intervention study. Sixty-three adults were equally allocated to one of four groups which received a supplement of either 60 g/day whey or 60 g/day casein plus 63 g/day milk fat either high or low in MC-SFA content. Fifty-two subjects completed the study. Before and after the intervention, changes in plasma interleukin-6 (IL-6), interleukin-1 receptor antagonist (IL-1RA), high-sensitive C-reactive protein (hsCRP), adiponectin, and monocyte chemoattractant protein-1 (MCP-1) were measured. Changes in inflammatory genes in the subcutaneous adipose tissue were also documented. RESULTS: There were no differences in circulating inflammatory markers between protein types or fatty acid compositions in abdominally obese subjects, with the exception of an increase in adiponectin in response to high compared to low MC-SFA consumption in women. We found that combined dairy proteins and MC-SFAs influenced inflammatory gene expression in adipose tissue, while no effect was detected by dairy proteins or MC-SFA per se. CONCLUSION: Whey protein compared with casein and MC-SFA-enriched milk fat did not alter circulating markers of low-grade inflammation in abdominally obese subjects, except for an increase in circulating adiponectin in response to high MC-SFA in abdominally obese women.

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Rev Diabet Stud, 2016, 13(2-3):158-186 DOI 10.1900/RDS.2016.13.158

A Critical Evaluation of Existing Diabetic Foot Screening Guidelines

Cynthia Formosa1,2, Alfred Gatt1,2, Nachiappan Chockalingam1,2

1Faculty of Health Sciences, University of Malta, Tal-Qroqq, Msida, MSD 2080, Malta
2Faculty of Health Sciences, Staffordshire University, UK
Address correspondence to: Cynthia Formosa, e-mail: cynthia.formosa@um.edu.mt


AIM: To evaluate critically the current guidelines for foot screening in patients with diabetes, and to examine their relevance in terms of advancement in clinical practice, improvement in technology, and change in socio-cultural structure. METHODS: A structured literature search was conducted in Pubmed/Medline, CINAHL, Cochrane Register of Controlled Trials, and Google between January 2011 and January 2015 using the keywords '(Diabetes) AND (Foot Screening) AND (Guidelines)'. RESULTS: Ten complete diabetes foot screening guidelines were identified and selected for analysis. Six of them included the full-process guidelines recommended by the International Diabetes Federation. Evaluation of the existing diabetes foot screening guidelines showed substantial variability in terms of different evidence-based methods and grading systems to achieve targets, making it difficult to compare the guidelines. In some of the guidelines, it is unclear how the authors have derived the recommendations, i.e. on which study results they are based, making it difficult for the users to understand them. CONCLUSIONS: Limitations of currently available guidelines and lack of evidence on which the guidelines are based are responsible for the current gaps between guidelines, standard clinical practice, and development of complications. For the development of standard recommendations and everyday clinical practice, it will be necessary to pay more attention to both the limitations of guidelines and the underlying evidence.

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Rev Diabet Stud, 2016, 13(2-3):187-196 DOI 10.1900/RDS.2016.13.187

Low Levels of High-Density Lipoprotein Cholesterol Do Not Predict the Incidence of Type 2 Diabetes in an Iranian High-Risk Population: The Isfahan Diabetes Prevention Study

Mohsen Janghorbani1,2, Masoud Amini1, Ashraf Aminorroaya1

1Isfahan Endocrine and Metabolism Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
2Department of Epidemiology and Biostatistics, School of Public Health, Isfahan University of Medical Sciences, Isfahan, Iran
Address correspondence to: Mohsen Janghorbani, e-mail: janghorbani@hlth.mui.ac.ir


OBJECTIVES: To evaluate the ability of low-level fasting high-density lipoprotein cholesterol (HDLC) to predict the incidence of type 2 diabetes (T2D) in an Iranian high-risk population. METHODS: Seven-year follow-up data (n = 1,775) in non-diabetic first-degree relatives (FDR) of consecutive patients with T2D aged 30-70 years were analyzed. The primary outcome was the diagnosis of T2D based on repeated oral glucose tolerance test (OGTT). We used Cox proportional hazard models to estimate the hazard ratio (HR) for the incidence of T2D across quartiles of HDLC, and plotted a receiver operating characteristic (ROC) curve to assess discrimination. RESULTS: The highest quartile compared with the lowest quartile of HDLC was associated with T2D in age- and gender-adjusted models (HR: 0.83, 95% CI: 0.73-0.95). Further adjustment for fasting plasma glucose and cholesterol attenuated the association for T2D incidence (HR: 0.93, 95% CI: 0.80-1.08). The area under the ROC curve for HDLC was 54.1% (95% CI: 50.2-58.0). CONCLUSIONS: HDLC level was a weak predictor of T2D in an Iranian high-risk population, independent of age and gender.

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Rev Diabet Stud, 2016, 13(2-3):197-206 DOI 10.1900/RDS.2016.13.197

Effect of Exercise Training on Signaling of Interleukin-6 in Skeletal Muscles of Type 2 Diabetic Rats

Pattarawan Pattamaprapanont1, Chatchai Muanprasat1, Sunhapas Soodvilai1, Chutima Srimaroeng2, Varanuj Chatsudthipong1

1Department of Physiology, Faculty of Science, Mahidol University, Rama 6 Rd, Rajathevi, Bangkok, 10400, Thailand
2Department of Physiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand
Address correspondence to: Varanuj Chatsudthipong, e-mail: varanuj.cha@mahidol.ac.th


OBJECTIVES: Diabetes and exercise training have been shown to involve interleukin 6 (IL-6) signaling in muscle. However, the relationship between the actions of these two stimuli on muscle IL-6 and their downstream components is still unknown. Thus, the effect of endurance training on the key components of muscle IL-6 signaling transduction was investigated in a rat model of type 2 diabetes. METHODS: Diabetes was induced by streptozotocin (STZ) in male Wistar rats fed a high-fat diet, with normal rats acting as controls. The animals were left to conduct their normal activities or assigned to endurance training in a treadmill. At the end of 8 weeks, blood biochemical profiles, exercise performance, muscle oxidative capacity, glucose transporter 4 (GLUT4) protein distribution, and expressions of IL-6 and its downstream proteins were determined. RESULTS: Blood biochemical profiles of the diabetic rats were altered compared to normal rats, whereas endurance training improved blood chemistry and exercise performance. It also increased muscle oxidative capacity, and promoted GLUT4 subcellular localization to the membrane in muscles. Furthermore, protein expression of IL-6 receptor (IL-6Rα) was increased in both normal and diabetic rats after endurance training, but no significant changes in IL-6, phosphorylated signal transducer and activator of transcription 3 (p-STAT3), or suppressor of cytokine signaling 3 (SOC3) were observed in muscles of normal and diabetic rats. CONCLUSIONS: IL-6 signaling pathway mediating muscle response to endurance training was conserved in type 2 diabetes. There was no link between training-induced IL-6 downstream targets in skeletal muscles and IL-6-induced type 2 diabetes.

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