Multimodal Lifestyle Intervention: Outlines and Outcomes

Multimodal lifestyle intervention is an essential step in obesity management. This chapter will discuss the structure and components of a proper multimodal lifestyle intervention. The setting for suppling this intervention is preferred to be served by a multidisciplinary team in a secondary care setting, but primary healthcare or even online setting is effective. The results of this type of holistic intervention are much more promising than single-discipline outcome. Success rates of intensive multimodal lifestyle intervention are growing to make it as a potential alternative to bariatric surgery in selected morbidly obese cases. However, this intervention has some limitations such as unpredicted outcomes and high dropout rates. Future studies should augment its curing effects and address the underlying mechanisms

Sunlight exposure vs. vitamin D supplementation on bone homeostasis of vitamin D deficient rats

BACKGROUND & AIM OF THE WORK: Vitamin D deficiency is highly prevalent in our locality and worldwide. Two major sources of Vit D replenishment are available; sun exposure and dietary supplementation. This study compared sun exposure with vitamin D3 supplementation on restoring bone homeostasis in a vitamin D deficient (VDD) versus vitamin D sufficient (VDS) rat models. METHODS: Vitamin D deficient-normocalcemic diet was used for 6 weeks to produce a group of VDD rats (n = 21), then were subdividedinto three equal subgroups: direct sunlight exposure subgroup (Sd subgroup), vitamin D3 treated subgroup (Tt subgroup), and a Control subgroup (Ct group). Normal rats (group II) (n = 14) were fed on normal vitamin D-diet for equal period and then subdivided into two equal subgroups: direct sunlight exposure subgroup (Ss subgroup), and a control (C) subgroup. For all of the subgroups, Exposures and supplementations were continued for 10 days, then the plasma 25 hydroxy vitamin D3, parathyroid hormone, calcium, phosphorus levels and alkaline phosphatase activity were estimated and femur bones were used to prepare histopathological sections. RESULTS: The sun-exposed vitamin D deficient group showed a significant reduction of parathyroid hormone more than that in vitamin D supplemented group vs. VDD controls (67.69 ± 13.18 and 78.93 ± 8.31 vs. 86.05 ± 9.67 pg/ml, respectively), while sun-exposed vitamin D sufficient group showed an insignificant change (15.56 ± 2.73 vs. 16.84 ± 3.16 pg/ml). Furthermore, the improvement of osteoid area and the reduction of trabecular separation in the bone sections among vitamin D deficient rats, after sunlight exposure, were better. CONCLUSIONS: Sunlight-exposure have a more positive effect on bone structure and homeostasis than vitamin D supplementation and control. This effect was more with vitamin D deficient than vitamin D sufficient rats

Intake of dietary advanced glycation end products influences inflammatory markers, immune phenotypes, and antiradical capacity of healthy elderly in a little-studied population

Dietary advanced glycation end products (dAGE) have profound negative effects on overall health, and their intake must be assessed. In this cross-sectional study, we investigated dAGE intake of 337 adult participants (180/157:M/F; age range 50–73 years). Data were collected on anthropometrics, body composition, dietary intake, selected blood biochemistry, immunological parameters, and antiradical capacity (50% hemolysis time; HT50). From the dietary data, dAGEs and phytochemical index (PI) were calculated. Mean BMI, % body fat (%BF), and fasting plasma glucose were all within the accepted normal range. Subjects with high dAGE intake had higher %BF, higher energy intake, and lower PI. They tended to have lower CD4/CD8 ratios and higher proportions of B cells and NK cells, but had significantly higher hs-CRP levels and lower HT50 values. Results on HT50 suggested that being >60 years of age enhanced dAGE-associated impairment of defense capacity in both those with low and high HT50 compared with those <60 years of age. Thus, overall dAGE consumption was high, but elderly participants had lower dAGE intake than younger adults. Indicators of nutritional status and immunological parameters of the subjects were found to be associated with dAGE intake, suggesting a potential impact on health

Impact of the Glycemic Control and Duration of Type 2 Diabetes on Vitamin D Level and Cardiovascular Disease Risk

Background and Aims. To investigate the impact of glycemic control and T2D duration on vitamin D status and cardiovascular disease (CVD) risk among Saudi patients. Methods. This case-control study was conducted in King Faisal Specialist Hospital, Saudi Arabia. A total of 25 nondiabetic controls and 92 patients with confirmed T2D, aged 20–60 years, were included. Patients with T2D were divided into the following groups based on disease duration (newly diagnosed: ≈6 months and long duration: ≥5 years) and glycemic control based on their glycated hemoglobin (HbA1C) level with a threshold of ≤0.053 mol/mol: newly diagnosed controlled (NC, n=25), newly diagnosed uncontrolled (NU, n=17), long duration controlled (LC, n=25), and long duration uncontrolled (LU, n=25). Blood levels of fasting blood glucose, HbA1C, lipid profile, and serum 25-hydroxyvitamin D (25(OH)D) were assessed and used to define the CVD risk score. Results. Our study showed that T2D duration was an independent predictor of vitamin D deficiency. The longer disease duration, the lower odds of being vitamin D deficient (odds ratio (OR) = 0.05, 95% CI: 0.01–0.29, p<0.05). No significant association was observed between vitamin D and HbA1C levels. In the NU group, CVD risk scores were directly correlated with serum 25(OH)D (r=0.53, p<0.05). On the contrary, 25(OH)D was moderately inversely correlated with CVD risk score in the LU group (r=−0.45, p<0.05). Conclusion. Duration of diabetes rather than glycemic control is associated with vitamin D deficiency. Glycemic uncontrol may augment vitamin D deficiency-associated CVD risk in both newly diagnosed and old patients with type 2 diabetes

GLIM Criteria for Assessment of Malnutrition in Saudi Patients with Type 2 Diabetes

The Global Leadership Initiative on Malnutrition (GLIM) is a new approach established for the assessment of malnutrition. This study aimed to validate the GLIM for the diagnosis of malnutrition in patients with type 2 diabetes mellitus (T2DM) in Saudi Arabia, using the Subjective Global Assessment (SGA) as a reference. In addition, the association between the GLIM criteria and vascular complications in those patients was examined. A cross-sectional study was conducted on 101 patients with T2DM. The level of agreement between the GLIM and SGA tools was calculated using the kappa coefficient (&kappa;). A receiver operating characteristic curve was used to determine the sensitivity and specificity of the GLIM. In addition, binary logistic regression was performed to investigate the association between each GLIM criterion and T2DM vascular complications. According to both the GLIM and the SGA, malnutrition was found in 15.8% and 17.8% of patients, respectively. The GLIM criteria achieved a very good level of accuracy (AUC = 0.877). The agreement between the tools was substantial (&kappa; = 0.778). The &lsquo;disease/inflammation&rsquo; criterion of the GLIM was significantly associated with macrovascular complications. To conclude, the GLIM criteria for diagnosis of malnutrition presented satisfactory levels of validity, and as such are acceptable for assessing the nutritional status of patients with T2DM

Energy Homeostasis-Associated (Enho) mRNA Expression and Energy Homeostasis in the Acute Stress Versus Chronic Unpredictable Mild Stress Rat Models

The energy homeostasis-associated (Enho) gene, the transcript for the Adropin peptide, is usually linked to energy homeostasis, adiposity, glycemia, and insulin resistance. Studies on Enho expression in stressful conditions are lacking. This work aimed to investigate Enho mRNA expression and energy homeostasis in acute stress (AS) versus chronic unpredictable mild stress (CUMS) rat models. A total of thirty male Wistar rats (180–220 g) were fed a balanced diet with free access to water. Rats were divided into three equal groups (n = 10): (a) the normal control (NC) group; (b) the AS group, where one episode of stress for 2 h was applied; and (c) the CUMS group, in which rats were exposed to a variable program of mild stressors for 4 weeks. Energy homeostasis was analyzed by the PhenoMaster system for the automatic measuring of food intake (FI), respiratory O2 volume (VO2), CO2 volume (VCO2), respiratory quotient (RQ), and total energy expenditure (TEE). Finally, liver, whole brain, and adipose (WAT) tissue samples were collected, total RNA was prepared, and RT-PCR analysis of the Enho gene was performed. The CUMS group showed higher VO2 consumption and VCO2 production, and a higher RQ than the AS group. Furthermore, the TEE and FI were higher in the CUMS group compared to the AS group. Enho gene expression in the liver, brain, and WAT was significantly higher in the CUMS group than in the AS and NC groups. We can conclude that in the chew-fed AS rats, hypophagia was evident, with a shift in the RQ toward fat utilization, with no changes in body weight despite the increase in Enho mRNA expression in all studied tissues. In the CUMS group, the marked rise in Enho mRNA expression may have contributed to weight loss despite increased FI and TEE

Effect of Long-Term Continuous Light Exposure and Western Diet on Adropin Expression, Lipid Metabolism, and Energy Homeostasis in Rats

Long-term continuous light exposure (CL) and western diet (WD) effects on Adropin expression, RORα, and Rev-erb-α nuclear receptors and energy homeostasis were studied in rats. Thirty-two male Wistar rats (250–290 g) were enrolled for 3 months in the following groups (n = 8/group): (a) Normal control group (NC), (b) CL group, (c) WD group, and (d) CL + WD group. Then, indirect calorimetry and food intake (FI) were measured. Finally, Adropin, hormone-sensitive lipase (HSL), adipocyte triglyceride lipase (ATGL), and free fatty acids (FFA) were measured. Additionally, the histopathology and gene expression of Enho, RORα, and Rev-erb-α genes were done. The CL alone elevated the Adropin plasma level and gene expression, increased RORα expression, and decreased the Rev-erb-α nuclear receptor expression mainly in the liver and kidney. Besides, CL increased the total energy expenditure (TEE) and decreased the respiratory quotient. WD alone or in combination with the CL reversed gene expression of Enho, RORα, and Rev-erb-α. Combined CL and WD increased the TEE, reduced the food intake, increased the ATGL, and reduced the Adropin level in addition to widespread degenerative changes in the liver, spleen, and renal tissues. The deleterious effects of CL and WD on energy homeostasis may include Adropin with the involvement of the RORα and Rev-erb-α nuclear receptors

Ameliorative effects of rutin against cisplatin-induced reproductive toxicity in male rats

Abstract Background Cisplatin (CP) or cis-diammine dichloroplatinum (II) is a platinum based standard antineoplastic drug which is used against variety of solid tumors and neoplasms. The present study aimed to evaluate the shielding effects of rutin against CP induced testicular toxicity in rats. Methods 28 male rats were divided into four groups. First group was given saline orally while second group received intra-peritoneal (i.p) injection of cisplatin (7 mg/kg) on day first and received saline for next 13 days. Third group received i.p injection of cisplatin at day one and treated with rutin (75 mg/kg) orally for next 13 days. Fourth group was treated with rutin orally for 13 days. Animals were sacrificed on 14th day and reproductive organs were analyzed for various parameters. Results Cisplatin treatment resulted in a significant decrease in daily sperm production, decrease in head length and % DNA in head, reduction of epithelial cell height, tubular diameter, reduction of the number of spermatogonia, spermatocytes and spermatids, increase in the thiobarbituric acid reactive substances (TBARS) and oxidative stress in testicular tissues, and change of the intra-testicular testosterone concentrations. Rutin co-treatment resulted in reversing cisplatin effect on DNA damage, sperm count, histological and biochemical parameters. Conclusion These results indicated that rutin co-treatment could ameliorate cisplatin-induced reproductive toxicity in male rats