Impact of agricultural expansion on water footprint in the Amazon under climate change scenarios

Agricultural expansion and intensification are main drivers of land-use change in Brazil. Soybean is the major crop under expansion in the area. Soybean production involves large amounts of water and fertiliser that act as sources of contamination with potentially negative impacts on adjacent water bodies. These impacts might be intensified by projected climate change in tropical areas. A Water Footprint Assessment (WFA) serves as a tool to assess environmental impacts of water and fertiliser use. The aim of this study was to understand potential impacts on environmental sustainability of agricultural intensification close to a protected forest area of the Amazon under climate change. We carried out a WFA to calculate the water footprint (WF) related to soybean production, Glycine max, to understand the sustainability of the WF in the Tapajós river basin, a region in the Brazilian Amazon with large expansion and intensification of soybean. Based on global datasets, environmental hotspots — potentially unsustainable WF areas — were identified and spatially plotted in both baseline scenario (2010) and projection into 2050 through the use of a land-use change scenario that includes climate change effects. Results show green and grey WF values in 2050 increased by 304% and 268%, respectively. More than one-third of the watersheds doubled their grey WF in 2050. Soybean production in 2010 lies within sustainability limits. However, current soybean expansion and intensification trends lead to large impacts in relation to water pollution and water use, affecting protected areas. Areas not impacted in terms of water pollution dropped by 20.6% in 2050 for the whole catchment, while unsustainability increased 8.1%. Management practices such as water consumption regulations to stimulate efficient water use, reduction of crop water use and evapotranspiration, and optimal fertiliser application control could be key factors in achieving sustainability within a river basin

Effect of Diacerein on Metabolic Control and Inflammatory Markers in Patients with Type 2 Diabetes Using Antidiabetic Agents: A Randomized Controlled Trial

Introduction. Studies have shown that T2DM is an inflammatory disease. Thus, the present study was aimed at evaluating whether diacerein could improve the metabolic and inflammatory profile among patients with T2DM under long-term treatment with glucose-lowering agents. Methods. This is a double-blind, parallel, placebo-controlled trial with 72 participants randomly assigned to diacerein 50 mg or placebo for 12 weeks. The primary endpoint was the between-group difference in change in HbA1c. Secondary endpoints included the proportion of patients achieving metabolic control [HbA1c≤7.0% (53 mmol/mol)] and change in inflammatory mediators. Results. Participants in the diacerein group had greater reductions in mean HbA1c level in comparison to placebo (−0.98; 95% CI: −2.02 to 0.05, P=0.06), independently of confounding factors. The difference in HbA1c level was −1.3 (95% CI: −2.3 to −0.4) in favor of diacerein (P=0.007) in those with <14 years of diabetes duration versus 0.05 (−0.7 to 0.8; P=0.9) in those with longer duration. The diacerein group had a 50% increase in the number of participants at the lowest TNF-α level (≤1.46 pg/mL). Conclusions. In patients with long-established T2DM under long-term treatment with glucose-lowering agents, diacerein improves metabolic control as measured by HbA1c level and has a favorable impact on inflammatory profile. Clinical Trial Registry. This trial is registered with Brazilian Clinical Trials Registry (ReBEC) number RBR-29j956

Effect of diacerein on renal function and inflammatory cytokines in participants with type 2 diabetes mellitus and chronic kidney disease: A randomized controlled trial

<div><p>Diacerein seems to improve metabolic control and reduce inflammatory marker levels in individuals with type 2 diabetes mellitus (Type 2 DM), but for participants with chronic kidney disease (CKD) its effect is unknown. This study aimed to evaluate the effect of diacerein <i>vs</i>. placebo on urinary albumin/creatinine ratio (ACR), glomerular filtration rate (GFR), and inflammatory cytokines in type 2 DM participants with CKD. Blood pressure (BP) and metabolic control were secondary outcomes. This randomized, placebo-controlled, parallel trial of adjuvant treatment of type 2 DM with diacerein enrolled seventy-two participants with CKD, aged 30–80 years, with glycated hemoglobin levels from 53–97 mmol/mol (7.0–11.0%), receiving angiotensin-converting enzyme inhibitors or angiotensin receptor blockers and antidiabetic agents. Participants randomized to diacerein or placebo were followed-up up to 90 days. Both groups had a marked reduction in ACR, but there was no effect on glomerular filtration rate. While the diacerein group had reduced TNF-α levels at the 75th percentile with a borderline significance (P = 0.05), there were no changes in the IL levels at the 75^th percentile.</p><p>Diacerein prevented the increase in blood glucose to the level observed in the placebo group (P = 0.04), improving metabolic control by 74%, reducing 24-hour diastolic BP, nighttime systolic and diastolic BP compared to the placebo group. In conclusion, among patients with type 2 DM and CKD, diacerein does not have an effect on ACR or GFR, but slows metabolic control deterioration and is associated with lower nighttime systolic and diastolic blood pressure.</p><p><b>Trial registration:</b> Brazilian Clinical Trials Registry (Registro Brasileiro de Ensaios Clinicos; ReBeC) <a href="http://www.ensaiosclinicos.gov.br/rg/edit/2510/" target="_blank">U1111-1156-0255</a></p></div

Flow diagram of participant selection, randomization, and follow-up.

<p>Flow diagram of participant selection, randomization, and follow-up.</p

Changes in adipokines according to randomization group (mean ± SE).

<p>Changes in adipokines according to randomization group (mean ± SE).</p

Baseline characteristics of participants according treatment group [Mean ± SD or n (%) or median (interquartile range)].

<p>Baseline characteristics of participants according treatment group [Mean ± SD or n (%) or median (interquartile range)].</p

End-of-trial changes in ACR in diacerein and placebo participants stratified by baseline ACR ≥300 or < 300 mg/g.

<p>Interaction of time and group (<i>P</i> = 0.006).</p

Effect of diacerein versus placebo on changes in renal function markers, control of type 2 diabetes, and blood pressure (mean ±SE).

<p>Effect of diacerein versus placebo on changes in renal function markers, control of type 2 diabetes, and blood pressure (mean ±SE).</p

Levels of inflammatory markers in diacerein and placebo groups at baseline and end of trial.

<p>Levels of inflammatory markers in diacerein and placebo groups at baseline and end of trial.</p