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Testosterone does not affect lower urinary tract symptoms while improving markers of prostatitis in men with benign prostatic hyperplasia: a randomized clinical trial.
Rastrelli, G, Cipriani, S, Lotti, F, Cellai, I, Comeglio, P, Filippi, S, Boddi, V, Della Camera, PA, Santi, R, Boni, L, et al
Journal of endocrinological investigation. 2022;45(7):1413-1425
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Benign prostatic hyperplasia (BPH) — also called benign prostate enlargement — is frequent in aging populations, with a 40 – 50% prevalence in men aged 50–60 years and up to 90% in men older than 80 years. The aim of this study was to verify whether testosterone therapy (TTh) in men with BPH, metabolic syndrome (MetS) and low testosterone is able to improve lower urinary tract symptoms (LUTS) and intraprostatic inflammation. This study is a double blind, randomised 24-week clinical trial in men with low testosterone and MetS and a candidate for prostate surgery for BPH. Patients (n=144) were centrally randomised 1:1 to one of the two groups; TTh or placebo. Results show that TTh administered for 24 weeks is a safe option and it improves prostatic inflammatory features thus ameliorating one of the pathogenic components of BPH. However, there were no differences in improvements of the urinary symptoms between both groups (TTh and placebo). Authors conclude that decreased inflammation is not accompanied by a consistent improvement in urinary symptoms, and that their findings show the safety of TTh in subjects with BPH of surgical significance.
Abstract
PURPOSE Benign Prostatic Hyperplasia (BPH) is a result of prostate inflammation, frequently occurring in metabolic syndrome (MetS). Low testosterone is common in MetS. A randomized clinical trial was designed to evaluate if 24 weeks of testosterone therapy (TTh) in BPH men with MetS and low testosterone improve urinary symptoms and prostate inflammation. METHODS One-hundred-twenty men with MetS waitlisted for BPH surgery were enrolled. They were categorized into normal testosterone (TT ≥ 12 nmol/L and cFT ≥ 225 pmol/L; n = 48) and testosterone deficient (TD) (TT < 12 nmol/L and/or cFT < 225 pmol/L; n = 72) then randomized to testosterone gel 2% (5 g/daily) or placebo for 24 weeks. At baseline and follow-up, questionnaires for urinary symptoms and trans-rectal ultrasound were performed. Prostate tissue was collected for molecular and histopathological analyses. RESULTS No differences in the improvement of urinary symptoms were found between TTh and placebo (OR [95% CI] 0.96 [0.39; 2.37]). In TD + TTh, increase in prostate but not adenoma volume was observed (2.64 mL [0.07; 5.20] and 1.82 mL [- 0.46; 0.41], respectively). Ultrasound markers of inflammation were improved. In a subset of 61 men, a hyper-expression of several pro-inflammatory genes was found in TD + placebo when compared with normal testosterone. TTh was able to counteract this effect. For 80 men, the inflammatory infiltrate was higher in TD + placebo than in normal testosterone (0.8 points [0.2; 1.4]) and TD + TTh men (0.9 points [0.2; 1.5]). CONCLUSIONS Twenty-four weeks of TTh in TD men with BPH and MetS improves ultrasound, molecular and histological proxies of prostate inflammation. This does not result in symptom improvement.
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Non-Nutritive Sweeteners and Their Implications on the Development of Metabolic Syndrome.
Liauchonak, I, Qorri, B, Dawoud, F, Riat, Y, Szewczuk, MR
Nutrients. 2019;11(3)
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Artificial sweeteners, such as aspartame, neotame, saccharin, sucralose, and stevia are widely promoted as low-calorie alternatives to sugar and are known as non-nutritive sweeteners (NNS). Generally, they have been considered as a healthy option to replace sugars, but data is emerging that they may influence obesity and metabolic syndrome (METs) and contribute to the development of type II diabetes. These non-nutritive sweeteners can be thousands of times sweeter than sugar and have been widely adopted by the food industry to help reduce calories, and promote weight loss and diabetic products. It is believed that 25% of children and 41% of adults consume low-calorie sweeteners regularly, with the beverage industry relying heavily on them. However, it is now been shown that these sweeteners can cause imbalances to gut bacteria and interact with taste receptors and insulin signalling. These findings mean that artificial sweeteners may trigger the same hormonal response as sugar by releasing insulin and overtime lead to insulin resistance, obesity, and overall metabolic syndrome. Finally, there is evidence that our body develops a learned response to sweeteners which paradoxically leads to weight gain.
Abstract
Individuals widely use non-nutritive sweeteners (NNS) in attempts to lower their overall daily caloric intake, lose weight, and sustain a healthy diet. There are insufficient scientific data that support the safety of consuming NNS. However, recent studies have suggested that NNS consumption can induce gut microbiota dysbiosis and promote glucose intolerance in healthy individuals that may result in the development of type 2 diabetes mellitus (T2DM). This sequence of events may result in changes in the gut microbiota composition through microRNA (miRNA)-mediated changes. The mechanism(s) by which miRNAs alter gene expression of different bacterial species provides a link between the consumption of NNS and the development of metabolic changes. Another potential mechanism that connects NNS to metabolic changes is the molecular crosstalk between the insulin receptor (IR) and G protein-coupled receptors (GPCRs). Here, we aim to highlight the role of NNS in obesity and discuss IR-GPCR crosstalk and miRNA-mediated changes, in the manipulation of the gut microbiota composition and T2DM pathogenesis.
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Sugar-Sweetened Beverage Consumption in Relation to Obesity and Metabolic Syndrome among Korean Adults: A Cross-Sectional Study from the 2012⁻2016 Korean National Health and Nutrition Examination Survey (KNHANES).
Shin, S, Kim, SA, Ha, J, Lim, K
Nutrients. 2018;10(10)
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Obesity and Metabolic Syndrome (MetS) in Korea has increased significantly in the last decade and dietary factors, including the consumption of sugar sweetened drinks, is considered one of the key drivers. Soft drinks, soda coffee, fruit juices, sports drinks and sweetened rice drinks are popular beverages in Asia. Consumption of these is a major source of sugar intake for the Korean population. This study analysed data from over 12,112 participants of the Korean National Health and Nutrition Examination Survey (KNHANES) to see if the consumption of sugar sweetened beverages was causally linked to obesity and MetS. Food questionnaires were used in the original study to assess which foods and drinks the participants consumed during a 1-year period. Within the study group the number of participants with obesity was 34.9% and MetS was 26.7% respectively. They found that the participants who regularly consumed >4 sugar sweetened beverages per week consumed more calories on average than those who did not drink these beverages. In men, it was linked to higher blood pressure and blood glucose levels whilst in women it linked to a higher body mass index (BMI), increased waist circumference, and elevated cholesterol. Overall drinking 1 sugar sweetened beverage per day increased the risks of obesity in women by 59% and MetS by 61% whilst in men it increased the prevalence of obesity by 41% and MetS by 7%. Therefore drinking sugar sweetened beverages increases the risk of both obesity and MetS.
Abstract
It is well known that the consumption of sugar-sweetened beverages (SSBs) increases the risk of developing obesity and metabolic syndrome (MetS). However, there are not many studies investigating the link between SSBs and increased incidences of diseases in the Asian population, and in particular, in Korea. We explored the association of SSB consumption with the risk of developing obesity and MetS among Korean adults (12,112 participants from the 2012⁻2016 Korean National Health and Nutrition Examination Survey). We calculated the total SSB consumption frequency by counting each beverage item, including soda beverages, fruit juices, and sweetened rice drinks. Obesity was defined as a body mass index ≥25 kg/m², and MetS was defined using the National Cholesterol Education Program, Adult Treatment Panel III. A survey logistic regression analyses was conducted to examine the association of SSB consumption with obesity and MetS, adjusting for related confounders such as age, energy intake, household income, education, alcohol drinking, smoking status, and physical activity. The SSB consumption was positively associated with an increased risk of the prevalence for obesity (Odd ratio (OR): 1.60; 95% confidence interval (CI): 1.23⁻2.09; p for trend = 0.0009) and MetS (OR: 1.61; 95% CI: 1.20⁻2.16; p for trend = 0.0003) among women. In men, SSB consumption only contributed to a higher prevalence of obesity (OR: 1.38; 95% CI: 1.11⁻1.72; p for trend = 0.0041). In conclusion, increased consumption of SSBs was closely linked with a higher prevalence of obesity and MetS in the Korean population.
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Effects of weight loss interventions for adults who are obese on mortality, cardiovascular disease, and cancer: systematic review and meta-analysis.
Ma, C, Avenell, A, Bolland, M, Hudson, J, Stewart, F, Robertson, C, Sharma, P, Fraser, C, MacLennan, G
BMJ (Clinical research ed.). 2017;359:j4849
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Obesity is known to increase the risk of many diseases including cardiovascular disease, various cancers and type 2 diabetes. Interestingly, there is evidence suggesting weight loss in obese adults may be harmful, particularly in older people with cardiovascular disease. The aim of this systematic review was to assess the effect of weight loss interventions for adults with obesity on mortality, cardiovascular disease, cancer and body weight. Based on the 30,000 participants identified, current evidence shows that weight loss interventions significantly decrease all cause mortality. There was also evidence to suggest weight loss is associated with developing new cardiovascular events, though fewer trials reported these outcomes so uncertainty remains around these results. Based on the current literature and this review, the authors conclude weight-reducing diets may reduce all cause mortality in adults with obesity and support public health measures to prevent weight gain and facilitate weight loss.
Abstract
Objective To assess whether weight loss interventions for adults with obesity affect all cause, cardiovascular, and cancer mortality, cardiovascular disease, cancer, and body weight.Design Systematic review and meta-analysis of randomised controlled trials (RCTs) using random effects, estimating risk ratios, and mean differences. Heterogeneity investigated using Cochran's Q and I2 statistics. Quality of evidence assessed by GRADE criteria.Data sources Medline, Embase, the Cochrane Central Register of Controlled Trials, and full texts in our trials' registry for data not evident in databases. Authors were contacted for unpublished data.Eligibility criteria for selecting studies RCTs of dietary interventions targeting weight loss, with or without exercise advice or programmes, for adults with obesity and follow-up ≥1 year.Results 54 RCTs with 30 206 participants were identified. All but one trial evaluated low fat, weight reducing diets. For the primary outcome, high quality evidence showed that weight loss interventions decrease all cause mortality (34 trials, 685 events; risk ratio 0.82, 95% confidence interval 0.71 to 0.95), with six fewer deaths per 1000 participants (95% confidence interval two to 10). For other primary outcomes moderate quality evidence showed an effect on cardiovascular mortality (eight trials, 134 events; risk ratio 0.93, 95% confidence interval 0.67 to 1.31), and very low quality evidence showed an effect on cancer mortality (eight trials, 34 events; risk ratio 0.58, 95% confidence interval 0.30 to 1.11). Twenty four trials (15 176 participants) reported high quality evidence on participants developing new cardiovascular events (1043 events; risk ratio 0.93, 95% confidence interval 0.83 to 1.04). Nineteen trials (6330 participants) provided very low quality evidence on participants developing new cancers (103 events; risk ratio 0.92, 95% confidence interval 0.63 to 1.36).Conclusions Weight reducing diets, usually low in fat and saturated fat, with or without exercise advice or programmes, may reduce premature all cause mortality in adults with obesity.Systematic review registration PROSPERO CRD42016033217.
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Effect of probiotics on lipid profiles and blood pressure in patients with type 2 diabetes: A meta-analysis of RCTs.
He, J, Zhang, F, Han, Y
Medicine. 2017;96(51):e9166
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Type 2 diabetes mellitus (T2DM) is the most common metabolic disorder worldwide. Though many clinical studies have explored the effects of probiotics on T2DM they have concluded mixed results. The purpose of this meta-analysis was to evaluate all current randomised controlled trials and determine the effect of probiotics on lipid profiles and blood pressure in patients with T2DM. According to the existing literature, probiotic supplementation for patients with T2DM has a positive effect by lowering total cholesterol and increasing high-density lipoproteins (HDLs). While these beneficial effects on lipid profiles and blood pressure have been found, the authors conclude there is still a need for a multi-centre, longitudinal study to better understand the effects of probiotics on patients with T2DM.
Abstract
BACKGROUND This meta-analysis aimed to systematically evaluate the effects of probiotics on blood lipid and blood pressure among patients with type 2 diabetes mellitus (T2DM) based on the randomized controlled studies. METHODS PubMed, Cochrane, Embase, Wanfang, China National Knowledge Infrastructure, and VIP database were searched by the index words to identify the qualified randomized control trial. The latest research was done in the January 2017. Mean difference (MD) along with 95% confidence interval (CI) was used to analyze the included outcomes. RESULTS Ten trials were included at last with 297 patients in the treatment group and 294 patients in the control group. Probiotics significantly decreased the value of total cholesterol (SMD -0.57, 95% CI -0.92 to 0.21), triglyceride (SMD -0.66, 95% CI -0.93 to 0.39), low-density lipoprotein (SMD -0.40, 95% CI -0.79 to 0.01), systolic blood pressure (WMD -5.04, 95% CI -8.8 to 1.20), diastolic blood pressure (SMD -0.39, 95% CI -0.62 to 0.17), fasting blood glucose (FBG) (SMD 3.54, 95% CI 1.94-5.15) compared with the placebo treatment. Apart from this, probiotics could significantly improve the value of high-density lipoprotein (SMD 0.38, 95% CI 0.03-0.73). CONCLUSION Probiotics may decrease the indexes of lipid profile, blood pressure, and FBG in patients with T2DM; application of probiotics might be a new method for lipid profiles and blood pressure management in T2DM.
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Randomized placebo control study of insulin sensitizers (Metformin and Pioglitazone) in psoriasis patients with metabolic syndrome (Topical Treatment Cohort).
Singh, S, Bhansali, A
BMC dermatology. 2016;16(1):12
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As an immune-mediated chronic inflammatory skin condition, psoriasis is associated with obesity, metabolic syndrome, diabetes, and cardiovascular disease. Medications capable of sensitising insulin, such as Metformin and Pioglitazone, have also shown benefits in improving factors associated with metabolic syndrome and psoriasis. This single-centre, parallel-group, randomised, open-label with blinded endpoint evaluated the effects of Metformin with Pioglitazone and placebo in psoriatic patients. Patients with mild-to-moderate psoriasis were randomised to a topical treatment cohort to take 1000 mg metformin daily or 30 mg pioglitazone or placebo groups for 12 weeks. Each participant received a topical ointment containing 5% coal tar during the treatment period. The Metformin and Pioglitazone groups showed significant improvements in psoriasis and metabolic syndrome parameters, such as fasting plasma glucose, total cholesterol, and triglyceride levels, after 12 weeks of treatment. The treatment with metformin resulted in significant improvements in weight, BMI, waist circumference, FPG, triglycerides, and total cholesterol, while the treatment with pioglitazone resulted in significant improvements in FPG, triglycerides, systolic and diastolic blood pressure, cholesterol levels, and LDL cholesterol levels. There was no significant improvement in inflammatory cytokine levels in any group. For further evaluation of the beneficial effects of insulin-sensitising drugs in patients suffering from psoriasis and metabolic syndrome, more robust studies are needed. The study results can be used by healthcare professionals to better understand how insulin-sensitising drugs may decrease the risk of diabetes, cardiovascular disease, and psoriasis in psoriasis patients with metabolic syndrome.
Abstract
BACKGROUND Increased prevalence of metabolic syndrome (MS) is observed in psoriasis. Metformin has shown improvement in cardiovascular risk factors while pioglitazone demonstrated anti proliferative, anti-inflammatory and anti angiogenic effects. Study objective is to evaluate the efficacy and safety of Insulin sensitizers (metformin and pioglitazone) in psoriasis patients with metabolic syndrome (MS). METHODS Single centre, parallel group, randomized, study of metformin, pioglitazone and placebo in psoriasis patients with MS. RESULTS Statistically significant improvement was observed in Psoriasis Area and Severity Index (PASI), Erythema, Scaling and Induration (ESI) and Physician global assessment (PGA) scores in pioglitazone (p values - PASI = 0.001, ESI = 0.002, PGA = 0.008) and metformin groups (p values - PASI = 0.001, ESI = 0.016, PGA = 0.012) as compared to placebo. There was statistically significant difference in percentage of patients achieving 75 % reduction in PASI and ESI scores in metformin (p value - PASI = 0.001, ESI = 0.001) and pioglitazone groups (p vaue - PASI = 0.001, ESI = 0.001). Significant improvement was observed in fasting plasma glucose (FPG) and triglycerides levels in metformin and pioglitazone arms. Significant improvement was noted in weight, BMI, waist circumference, FPG, triglycerides and total cholesterol after 12 weeks of treatment with metformin while pioglitazone showed improvement in FPG, triglyceride levels, systolic blood pressure (SBP), diastolic blood pressure (DBP), total cholesterol and LDL cholesterol levels. There was no difference in pattern of adverse drug reaction in three groups. CONCLUSION Insulin sensitizers have shown improvement in the parameters of MS as well as disease severity in psoriasis patients. TRIAL REGISTRATION CTRI Registration Number: CTRI/2011/12/002252 . Registered on 19/12/2011.