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Optimizing Cardiovascular Outcome in Type 2 Diabetes Mellitus with Better Control of Diabetes Mellitus with Empigliflozin and Hypertension with Renin Angiotensin System Inhibitors and Manidipine Preferably of the Dihydropyridones
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Aim: Obesity is increasing globally by leaps and bounds and thus the incidence of type 2 diabetes mellitus (T2DM) along with it so much so that the term diabesity had to be coined. Earlier we had reviewed how to treat the both together and the role of empagliflozin to improve cardiovascular outcome trials (CVOT). Similarly T2DM and hypertension are pathophysiologically-related diseases which co-exist with a broader complex of metabolic diseases which co-exist possessing similar set of risk factors. Hence it is important to consider which antihypertensives are suitable that possess a positive effect on metabolic factors in cases of T2DM who require an antihypertensive.
Method: A systematic review was carried out using the PubMed search engine with the MeSH terms: “T2DM”; “essential hypertension; “cardiovascular (CV)”; “Complications of diabetes mellitus (DM) and antihypertensive”; “Antihypertensive preferred in T2DM subjects”; “Renin-angiotensin–aldosterone system inhibitors”; “Angiotensin converting enzyme inhibitors (ACEi)”; “Angiotensin receptor blockers (ARBs)”; “Dihydropyridine calcium channel blocker”; “β2 blockers”; “Diuretics”.
Discussion: Most diabetes mellitus (DM) subjects need a minimum of two antihypertensive drugs, combining a renin-angiotensinaldosterone system (RAS) inhibitor with a dihydropyridine calcium channel blocker seems to be the most indicated approach. But not all dihydropyridine calcium channel blockers have equivalent effects on metabolic parameters. Hence manidipine that causes positive effect on insulin resistance (IR) seems to be an effective option. We have reviewed how manidipine is superior to amlodipine with regards to improving IR, not seen with amlodipine, along with not causing excessive sympathetic nervous system (SNS) activation, pulse pressure and ankle edema or to much lesser extent than amlodipine. Therefore, manidipine needs to be the first addition to RAS inhibitors in case of DM’s having hypertension of the dihydropyridines calcium channel blockers. Further good blood pressure (BP) control been correlated with good CVs outcomes.
Conclusion: A RAS inhibitor is the first line of choice of drugs in a subject with T2DM who needs to be treated with empagliflozin for better CVOT outcome, and when a 2nd drug has to be added it is manidipine that is preferred over amlodipine. Plant products are proving to be having a lot of beneficial effects in DM, obesity and hypertension. Thus need for developing agents from plants will prove to be more cost effective in these chronic diseases where compliance is difficult to achieve with the use of common antiDM drugs and antihypertensives with the cost factor along with their side effects.
Keywords
Type 2 diabetes mellitus (T2DM); Diabesity; Antihypertensives; Renin-angiotensin-aldosterone system (RAS) inhibitor; Dihydropyridines calcium channel blockers; Plant products.
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Cross-Sectional Associations between Physical Activity and Internet Addiction among Undergraduate Students in Taiwan
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Purpose
Internet addiction is a major health concern among undergraduate students; however, few studies have addressed modifiable behavioural factors associated with internet addiction in the context of Taiwan. This study aimed to investigate associations between physical activity and the risk of internet addiction among undergraduate students in Taiwan.
Methods
In 2017, we recruited 320 undergraduate students from Northern Taiwan to participate in a cross-sectional questionnaire-based survey. Physical activity was measured by the Taiwanese short-form version of the International Physical Activity Questionnaire, which evaluates an individual’s weekly levels of vigorous-intensity aerobic physical activity (VPA) and moderate-intensity aerobic physical activity (MPA). Internet addiction was measured by the Chen Internet Addiction Scale (CIAS).
Results
For the 320 surveyed students, the average CIAS score was 53.3, and 18.13% of participants were at risk for internet addiction (defined as CIAS score >64). The results of the multiple regression analysis indicated that a routine of at least 150 min of MPA per week was negatively associated with risk for internet addiction (β=−4.39, 95% CI=[-8.10, -0.66]). No significant associations were observed between internet addiction and 75 min of VPA or 150 min of total physical activity per week. Among the 5 dimensions of the CIAS scale, MPA was negatively associated with tolerance symptoms, time-management problems, and interpersonal and health-related problems when a routine of 150 min per week was adopted.
Conclusion
A routine of 150 min of MPA per week was associated with a lower risk for internet addiction. Intervention efforts aimed at reducing undergraduate students’ problematic internet use should promote recommended levels of MPA. We also recommend longitudinal research on the effects of engaging in physical activity on the risk of internet addition.
Keywords
Physical activity; Internet addiction; Undergraduate students.
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The Association of Dietary Fatty Acids and Gut Microbiota Alterations in the Development of Neuropsychiatric Diseases: A Systematic Review
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Aim
Having reviewed earlier the role of probiotics in obesity and other associated metabolic disorders like non-alcoholic fatty liver disease (NAFLD), engineering probiotics for cholera and other neuronal diseases like Alzheimer’s, Parkinson disease with incidence of obesity and diabetes mellitus (DM) so much on the rise, Here the aim of this systematic review is to highlight the influence of dietary patterns, like fatty acids, other lipids on role of maternal stress and the neuropsychiatric disease (NPD) formation along with influence of probiotics in reverting them.
Method
A systematic review was carried out using the PubMed, Web of Science, Medline, Embase, Cochrane reviews, and Google Scholar, Search engine with the MeSH Terms; “Impaired lipid metabolism”; “Oxidative stress”; “inflammation”; “Gut Microbiota (GM)”; “NPD”; “Schizophrenia (SCZ)”; “Autism Spectrum Disorder (ASD)”; “Bipolar disorders (BD)”; “Gamma amino butyric acid (GABA)”; “5-hydroxy tryptamine (5HT)”; “Brain derived neutrotrophicfactor (BDNF)”; “Polyunsaturated fatty acids (PUFA)”; “Saturated (SFA)”; “Depression”; “Resolvins”; “Protectins”; “Short chain fatty acids (SCFA)”; “Probiotics”; “Fecal Transplantation” from 1990 till June 2020.
Results
We found a total of 900 articles under various subheadings of GM and NPD and probiotics with NPD and SCZ, ASD. One hundred ninety-two (192) articles got selected for this comprehensive review. No meta-analysis was conducted.
Conclusion
We observed a marked correlation among dietary habits, like utilization of Western diet (WD) with marked escalation of intake of high fat, high sugar rich diet escalated n6 PUFAS over n3 PUFAS and influence on GM that is not helpful in digestion of the nondigestible fibers in form of starch along with generation of butyrate aiding in certain beneficial effects and on formation of various neurochemicals like escalation of BDNF while increased GABA, reduced 5HT formation alteration of tryptophan metabolism is seen in these WD food and we have tried to detail the role of SCFA formation, generation of resolvins and how they work in the formation of various NPD besides maternal diet during pregnancy and how it determines infants microglial priming and later determinants of early stress.
Keywords
Dietary fat; Western diet; Microbiota to brain communication (MBC); Polyunsaturated fatty acids (PUFA); Gut microbiota (GM); Schizophrenia (SCF); Autism spectrum disorder (ASD).
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The Effect of L-Carnitine, Green Tea Extract and Lotus Leaf Extract on the Body Fat Percentage in High Energy Diet-Induced Obese Rats
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Background
Obesity has become a public health issue of global concern. Obesity is often associated with the occurrence of many diseases, and will also increase mortality; it not only affects personal health, but also increases healthcare costs, thus reducing social productivity and causing negative social and economic impacts. Therefore, ameliorating obesity is an issue worth attention and effort. The development of a natural and safe anti-obesity combination is worthy of further research. It is known that L-carnitine, green tea and lotus leaves have anti-obesity potential, but there is no research and discussion on this novel combination to improve body fat.
Objective
This study explored how the dietary supplement formula containing L-carnitine, green tea extract and lotus leaf extract (CGL) lowered the body fat accumulation in rats induced by high-energy diet.
Design
The test used 60-week-old male Sprague Dawley® white rats, which were first divided into the control group (12 rats were given normal feed) and the experimental group (48 rats were given high energy diet; HE). The HE group was further divided into H2O and CGL groups (296, 593 and 1186 mg/kg, to be designated as CGL-L, CGL-M, CGL-H respectively). The rats were first fed with feed for five-weeks, and then fed with different doses of CGL by gavage starting from the sixth-week. After nine-weeks of feeding, the rats were sacrificed to obtain their body weight, feed intake, body fat, serum biochemical indices and liver lipid measurements.
Results
The results show that the final body weight of HE+CGL-L (578.8±41.6 g) was significantly lower than that of HE+H2O (634.9±42.2 g), and the body fat amount of HE+CGL-L (36.6±9.8 g) was significantly lower than that of HE+H2O (49.4±13.8 g). Feed efficiency and calorie efficiency of HE+CGL-L were also significantly lower than that of HE+H2O (p<0.001). HE+CGL-M and HE+CGL-H were also able to significantly reduce the final body weight, body fat amount and serum-free fatty acid concentration (p<0.05).
Conclusion
CGL can significantly reduce the final body weight, body fat amount, body fat ratio, feed efficiency and calorie efficiency. CGL has the potential as a new dietary supplement for weight loss. However, the significance of these results on humans taking the supplement for prolonged periods of time is unknown and should be a focus for future investigations.
Keywords
Obesity; L-Carnitine; Green tea extract; Lotus leaf extract; Weight loss.
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Why are Patients Reluctant to View Exercise as a Treatment Plan?
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Previous Issue
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A Couple’s Personalized-Care Intervention for Weight-Loss and Diabetes based on DNA and Gut Biome Profiles: A Case Study
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Introduction
The global prevalence of obesity has reached epidemic proportions. Given the negative strain that obesity and associated chronic diseases, such as type 2 diabetes, put on the healthcare system and the economy, disease management has begun evolving to help individuals change their behaviors. Obesity is often difficult to treat and even harder to maintain. Past studies have failed to show weight loss maintenance over long periods after interventions. To overcome the complexity of obesity, a multifaceted precision care treatment approach should be adopted.
Aim
The aim of this case study was to assess the health benefits and weight loss journey of a cohabiting Caucasian heterosexual married couple using the Digbi Health personalized obesity management program. A personalized integrative nutrition plan is created based on one’s genetic and gut microbiome obesity risk profile and incorporates daily digital tracking and lifestyle coaching. Never before has a program offered personalized data including genetic, gut microbiome and lifestyle coaching to help people understand the best plan to lose weight and keep it off long term.
Method
The male subject achieved a total change in weight loss of 15.94%, as well as a reduction in A1C and blood pressure levels and the female subject achieved a 13.65% change in weight loss over a period of four months. The couple have still been able to maintain their weight loss goals four months after completing the program, stating their individual and personalized approach gave them the tools long-term to maintain.
Conclusion
A supportive environment for cohabiting couples following a personalized weight loss program based on their genetic and gut microbiome profile may help with weight loss and long-term maintenance.
Keywords
Diabetes; Gut microbiome; Obesity; Diet; Physical exercise; Overweight; Body mass index (BMI); Couples; Hypertension.
Why are Patients Reluctant to View Exercise as a Treatment Plan?
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Associate Editors
Zhenhua Liu, PhD
Assistant Professor Department of Nutrition School of Public Health and Health Sciences University of Massachusetts, Amherst USA
Effiong E. Otukonyong, PhD, MSc, B.MedSc
Assistant Professor Department of Health Sciences College of Public Health East Tennessee State University P. O. Box 70673 Johnson City, TN 37614, USA
Monem Jemni, PhD
Chair ISAFA www.isafa.info Qatar Olympics Committee Professorial Chair in Sport Science College of Arts and Sciences Qatar University Al Tarfa, Doha 2713 Qatar
Naheed Aryaeian, PhD
Associate Professor Department of Nutrition School of Public health Iran University of Medical Sciences Tehran, Iran