Vol 2-2 Mini Review

Leptin Gene and Receptor Mutations and its Association with Obesity and Overweight: A Mini Review

Lorena V. Rincones Rojas, Amenaida C. Ferrer Marcano, Juan S. Mojica Muñoz, Angelica M. García, Luis G. Celis*

Faculty of Medicine – Universidad de la Sabana, Bogotá, Colombia

Overweight and obesity are considered a global epidemic in the twenty first century, it is a multifactorial disease due, in part, to a genetic component. The most common genetic alteration is one that affects the neuroregulatory pathway of Leptin, a fundamental hormone for appetite regulation. Mutations that affect the LEP gene are present in the different exons of this gene and have been described for many years. Although obesity due to a genetic mutation is not the most common cause, its diagnosis is of paramount importance since it can affect the quality of life and life expectancy of the patients suffering from this condition.

The purpose of this mini review is to present up-to-date evidence regarding Leptin gene mutations, possible treatment strategies such as Leptin Replacement Therapy (LRT), leptin sensitizers and anti-inflammatory drugs, and discuss the importance of stablishing health policies worldwide to achieve a timely and successful approach to this disease.

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Vol 2-2 Mini Review

Reducing Risks from COVID-19: Cost-Effective Ways of Strengthening Individual's and the Population Immunity with Vitamin D

Sunil J. Wimalawansa

Professor of Medicine, Endocrinology & Nutrition, Cardiometabolic and Endocrine Institute, NJ, USA

In addition to being involved in the regulation of calcium and phosphate metabolism and the musculoskeletal functions, vitamin D has immune modulatory effects through several independent pathways. Its active hormone, calcitriol [1,25(OH)2D] effect both innate and adaptive immune systems essential for optimal immune functions. Vitamin D deficiency exacerbates immune-related disorders, including type 1 diabetes, multiple sclerosis, rheumatoid arthritis, psoriasis, respiratory infections, including COVID-19. In those with COVID-19, complications and the number of deaths is higher in those who are older than 70 years, persons with a darker skin colour and/or ethnic minorities living in colder climatic regions, institutionalized persons, and with pre-existing chronic diseases. These groups of people have exceedingly high prevalence of severe vitamin D deficiency and thereof weaker immune systems. Collectively, these increases the vulnerability to microbial infections, particularly respiratory viruses, and for developing severe complications and deaths. Vitamin D related immune protective effects includes, the generation of anti-microbial peptides cathelicidin and defensins and antibodies against invading pathogens; the initiation of immune defences via natural killer cells, macrophages, and epithelial cells; the enhanced expression of angiotensin-converting enzyme 2 (ACE-2) and diminish expression of inflammatory cytokines; and reduce replication and enhance elimination of viruses from the body. The severity of complications and deaths associated with COVID-19 markedly increases in the presence of severe hypovitaminosis D: serum 25(OH)D concentration of less than 10 ng/mL. Excess complications and deaths from COVID-19 can be cost-effectively prevented with rapidly boosting the immunity using upfront loading, high doses of vitamin D; this will create an equivalent of internal “body armour”-defence system, that protects against COVID-19.

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Vol 2-2 Commentary

A commentary on: Vitamin D deficiency in non-autoimmune hypothyroidism; a case-control study

Salma Ahi

Research Center for Noncommunicable Diseases, Jahrom University of Medical Sciences, Jahrom, Iran

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Vol 3-1 Research Article

HbA1c Evidence for a Prediabetes Diagnosis Delays Onset of Type 2 Diabetes

Maurice C. Johnson, Jr.1, Howard A. Fishbein1*, Rebecca Jeffries Birch1, Qilu Yu2, Russ Mardon1, Wilson Pace3, Natalie Ritchie4, Jennifer K. Carroll5, Daniella Meeker6

1Westat, Rockville, MD, USA

2National Center for Complementary and Integrative Health (NCCIH), National Institutes of Health (NIH), Bethesda, MD, USA

3DARTNet, Aurora, CO, USA

4University of Colorado/Denver Health and Hospitals Authority, USA

5University of Colorado, USA

6University of Southern California, USA 

Objective: This study examined the influential role of making a prediabetes diagnosis resulting in the subsequent delay in onset of type 2 diabetes.

Research Design and Methods: Using electronic medical records, a multivariable logistic regression model examined demographic and clinical risk factors associated with a prediabetes diagnosis among patients with HbA1c evidence of prediabetes. A multivariable non-proportional Cox regression examined development to type 2 diabetes (maximum 7 year follow-up).

Results: Analysis includes 40,970 patients with incident prediabetes (76.8% undiagnosed). Logistic regression showed higher baseline HbA1c levels significantly influenced assigning a prediabetes diagnosis: compared to patients with HbA1c level 5.7-5.9% (low), OR 1.66 (99% CI 1.54-1.78) for HbA1c level 6.0-6.2% (medium) and OR 1.62 (CI 1.43-1.83) for HbA1c level 6.3-6.4% (high). Cox model results, which included an interaction between HbA1c and prediabetes diagnosis, found HbA1c the most significant predictor. Patients with diagnosed prediabetes progressed to type 2 diabetes slower than those undiagnosed. Comparing diagnosed patients to undiagnosed within the same HbA1c level, HRs ranged from 0.47 (CI 0.37-0.61) in the high HbA1c level to 0.83 (CI 0.67-1.02) in the low HbA1c level.

Conclusions: From the LEADR cohort (1) HbA1c levels were the principle factor associated with risk for prediabetes diagnosis. Modeling development to diabetes, baseline HbA1c was the significant predictor of risk. Findings suggest assignment of a prediabetes diagnosis is associated with slower development of diabetes and this protective benefit of being diagnosed increases with a higher baseline HbA1c. Prediabetes diagnosis is useful for delaying onset of type 2 diabetes.

DOI: 10.29245/2767-5157/2021/1.1114 View / Download Pdf
Vol 3-1 Mini Review Article

Abnormal Glucose Tolerance in Prediabetes Patients with Acute Myocardial Infarction: Implications for Therapy

Nitchakarn Laichuthai1, Ralph A. DeFronzo2*

1Hormonal and Metabolic Disorders Research Unit and Excellence Center in Diabetes, Hormone, and Metabolism, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, and Division of Endocrinology and Metabolism, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand

2Diabetes Division, UT Health San Antonio and Texas Diabetes Institute, San Antonio, Texas, USA

Newly discovered abnormal glucose tolerance is common in patients who present with acute myocardial infarction (MI). These individuals are at very high risk for recurrent major adverse cardiovascular events (MACE), cardiovascular (CV) mortality, and all-cause mortality compared to normal-glucose-tolerant individuals who present with acute MI. Early and aggressive intervention with lifestyle and pharmacologic treatment are essential for the prevention of prediabetes progression to diabetes and recurrent cardiovascular events in this high risk population. Management, both with regard to prevention of recurrent cardiovascular events and development of diabetes, has been poorly addressed in current cardiology and diabetes guidelines. In this article, we review current evidence regarding the use of glucagon-like peptide 1 receptor agonists (GLP-1 RAs), sodium glucose cotransporter 2 inhibitors (SGLT2i), and pioglitazone to prevent recurrent cardiovascular events and propose areas of research to be explored in the future.

DOI: 10.29245/2767-5157/2021/1.1115 View / Download Pdf