Search

Objective: Patients undergoing bariatric surgery present long-term metabolic improvements and reduced type 2 diabetes risk, despite long-term weight regain. We hypothesized that part of these protective effects could be linked to altered gene expression in white adipose tissue (WAT).Methods: Transcriptomic profiling by gene microarray was performed in abdominal subcutaneous WAT from women before (n = 50) and two (n = 49) and five (n = 38) years after Roux-en-Y gastric bypass (RYGB) surgery as well as in 28 age-matched nonoperated women.Results: In the obese women, the average body weight decrease was 38 kg 2 years postsurgery followed by an 8 kg weight regain between 2 and 5 years. Most of the long-term changes in WAT gene expression occurred during the first 2 years. However, a subset of genes encoding proteins involved in inflammation displayed a continued decrease between baseline, 2 and 5 years, respectively; that is an expression pattern independent of body weight regain. Expression of 71 of these genes correlated with measurements of adipocyte morphology or serum adipokine levels.Conclusion: The continuous improvement in WAT inflammatory gene expression, despite body weight relapse, may contribute to the sustained effects on adipose morphology after bariatric surgery. [ABSTRACT FROM AUTHOR]

Aim Screening for Type 2 diabetes among people at high risk is recommended by many organizations. The aim of this study was to analyse all-cause mortality and cardiovascular disease ( CVD) outcomes in patients with Type 2 diabetes detected by screening or diagnosed clinically. Methods A diabetes register was established at the primary healthcare centre in Laxå, Sweden beginning in 1972. The register was based on data from clinical records with information on medical treatment and laboratory data, as well as all-cause mortality, CVD, myocardial infarction and stroke events from national registers until 31 December 2013. A total of 740 patients with new-onset Type 2 diabetes were registered between 1972 and 2001. In addition, an opportunistic diabetes-screening programme involving people aged 35-79 years started in 1983 and was repeated onwards in 5-year cycles. Results Baseline characteristics showed a significantly higher CVD risk, mainly depending on more prevalent CVD events in the screened compared with the clinically detected group (propensity score 0.59 vs. 0.46, P < 0.0001). After mean follow-up periods of 12.9 and 13.6 years for screening detected vs. clinically detected patients, respectively, hazard ratios were as follows: all-cause mortality, 0.99 ( P = 0.89); CVD, 1.17 ( P = 0.10); myocardial infarction, 1.08 ( P = 0.49); and stroke, 1.03 ( P = 0.83). Conclusions No reduction in total mortality or CVD outcomes was found in patients with Type 2 diabetes that was detected by screening compared with those diagnosed clinically. [ABSTRACT FROM AUTHOR]

Aims To analyse the effects of hyperglycaemia and hypertension and treatment of diabetes and hypertension on cardiovascular disease incidence in patients with Type 2 diabetes with up to 30 years of follow-up. Methods A total of 740 patients with incident Type 2 diabetes were registered at the Laxå Primary Health Care Centre, Sweden between 1972 and 2001. Annual data on mean fasting blood glucose, systolic, diastolic and mean arterial blood pressure, and type of diabetes and hypertension treatment were obtained from patient records, and information on cardiovascular disease, myocardial infarction and stroke events was obtained from national registers. Results During the follow-up period, cumulative cardiovascular disease incidence increased significantly with male sex (hazard ratio 1.48, 95% CI 1.21-1.82), number of previous cardiovascular disease events (hazard ratio 1.13, 95% CI 1.08-1.18), age, per year ( HR 1.05, 95% CI 1.04-1.07), mean fasting blood glucose, per mmol/l (hazard ratio 1.05, 95% CI 1.00-1.10) BMI (hazard ratio 1.04, 95% CI 1.01-1.06), mean arterial blood pressure, per mmHg (hazard ratio 1.02, 95% CI 1.01-1.03), and decreased significantly with metformin treatment (hazard ratio 0.58, 95% CI 0.38-0.90) and sulfonylurea (hazard ratio 0.73, 95% CI 0.55-0.97). Cumulative myocardial infarction incidence increased significantly with male sex, number of previous myocardial infarction events, mean fasting blood glucose level, BMI, age and mean arterial blood pressure, and decreased with metformin treatment. Cumulative stroke incidence increased with number of previous stroke events, age and mean arterial blood pressure. Conclusions The cumulative incidence of cardiovascular disease and myocardial infarction increased with number of previous events and presence of hyperglycaemia and hypertension and decreased with pharmacological treatment of diabetes. A higher number of previous stroke events increased the cumulative incidence of stroke but no protective effect of pharmacological treatment was observed. [ABSTRACT FROM AUTHOR]

Aims To analyse the effects of hyperglycaemia and blood pressure, diabetes and anti-hypertension treatment on total and various types of cardiovascular disease incidence in patients with Type 2 diabetes followed for 30 years. Methods A total of 740 incident patients with Type 2 diabetes were registered at the Laxå Primary Health Care Centre, Sweden between 1972 and 2001. Information on systolic, diastolic, and mean arterial blood pressure, mean fasting blood glucose, type of diabetes and anti-hypertension treatment was obtained from the patient records, and information on cardiovascular disease, myocardial infarction and stroke events from National Registers. Results During the follow-up period the cumulative incidence of cardiovascular disease increased significantly with male sex ( HR 1.52, 95% CI 1.25-1.85), age ( HR 1.05, 95% CI 1.04-1.07), year of diabetes onset ( HR 1.03, 95% CI 1.01-1.05), BMI, ( HR 1.04, 95% CI 1.02-1.07), mean arterial blood pressure ( HR 1.04, 95% CI 1.02-1.05) and number of previous cardiovascular disease events ( HR 1.15, 95% CI 1.10-1.21), and decreased significantly with sulfonylurea treatment ( HR 0.64, 95% CI 0.49-0.84), insulin ( HR 0.57, 95% CI 0.33-0.98) and calcium channel blocker treatment ( HR, 0.69, 95% CI 0.48-0.99). Cumulative incidence of myocardial infarction increased significantly with male sex, age, BMI, mean arterial blood pressure, number of previous myocardial infarction events and diuretic treatment, and decreased with metformin treatment. Cumulative incidence of stroke increased with age, year of diabetes onset, mean arterial blood pressure, and previous number of stroke events. Conclusions Cumulative cardiovascular disease, myocardial infarction and incidence of stroke increased with number of previous events and presence of hypertension and decreased with pharmacological anti-diabetic treatment and, to a lesser extent, with anti-hypertension treatment. [ABSTRACT FROM AUTHOR]

Background:The endogenous factors contributing to long-term changes in body weight are not known but the regulation of energy metabolism by different beta-adrenoceptors (β1-AR, β2-AR, β3-AR) or alpha-adrenoceptors (α2-AR) may play a role.Methods:In a prospective study, we investigated β-AR and α2-AR subtype function in subcutaneous fat cells of 85 healthy, non-obese women by using a standardized bioassay of lipolysis. Of these 73 were re-investigated on an average 10 years later to compare baseline function of β1-AR, β2-AR, β3-AR and α2-AR with longitudinal weight changes.Results:Weight change over time was normally distributed ranging from−4 kg/m2 to +6 kg/m2 in body mass index. Long-term changes in body weight correlated inversely with β3-AR function at base line (r=0.5, P=0.001). Those with low β3−AR function gained weight, whereas the opposite was observed with those who had a high β3-AR function. Nineteen percent of weight changes could be explained by β3-AR status. No relationship with weight changes was observed as regards the function of α2-AR, β1-AR or β2-AR function.Conclusions:β3-ARs are important for long-term changes in body weight putting energy metabolism in adipose tissue in frontline among endogenous factors that regulate body weight in adulthood.International Journal of Obesity (2009) 33, 662–668; doi:10.1038/ijo.2009.54; published online 14 April 2009 [ABSTRACT FROM AUTHOR]