Nutrition security is increasingly recognized as a critical but underexamined driver of health. Identifying barriers to nutrition security is essential for developing effective interventions. To examine associations among barriers to healthy eating, their prevalence by sociodemographics, and their associations with health conditions. In this cross-sectional study, a population-based survey was conducted between February and April 2023 among English-speaking US adults aged 18 years or older recruited and surveyed through the Qualtrics panel service, with oversampling among people with annual household incomes less than $50 000. Data were analyzed from March 18 to November 9, 2025. Nutrition security status and barriers to nutrition security, assessed through the Nutrition Security Screener. Primary outcomes were health conditions: type 2 diabetes, obesity, heart disease, high blood pressure, high cholesterol, stroke, and cancer. Independent variables were nutrition security barriers. Covariates included age, gender, race, ethnicity, educational attainment, annual household income, and food security status. Multivariable regressions with health condition outcomes were stratified by nutrition security status. Of 3009 survey respondents, 3000 provided information on barriers to nutrition security and were included in analyses (1518 [50.6%] were female; 1983 [66.1%] were between ages 18 and 49 years). A mean (SD) of 7.8 (3.0) barriers were reported among participants with nutrition insecurity compared with 4.4 (3.2) among those who had nutrition security. Most barriers were only modestly intercorrelated (mean [SD] r = 0.45 [0.13]), with the highest correlation (r = 0.86) between insufficient time to shop and to cook. Barriers clustered into 2 factors that explained 61.4% of the variance. Black adults had higher odds of transportation barriers (adjusted odds ratio [AOR], 1.56 [95% CI, 1.17-2.08]) than White adults, whereas Hispanic/Latinx adults had higher odds of nutrition assistance barriers (AOR, 1.65 [95% CI, 1.26-2.17]) than those who were non-Hispanic/Latinx. A higher number of barriers (per unit increase [range, 0-13]) was associated with higher prevalence of diabetes (AOR, 1.10 [95% CI, 1.04-1.16]), heart disease (AOR, 1.16 [95% CI, 1.07-1.24]), and obesity (AOR, 1.09 [95% CI, 1.04-1.14]) among adults with nutrition security and of heart disease (AOR, 1.12 [95% CI, 1.03-1.22]) and stroke (AOR, 1.12 [95% CI, 1.02-1.25]) among those with nutrition insecurity. In this study among US adults, barriers to nutrition security were interrelated, varied across demographics, and were associated with disease conditions. These findings provide new insights into how barriers to healthy eating can be assessed, informing more targeted clinical, public health, and policy initiatives.
Renal, metabolic, nutritional, and endocrine disorders significantly affect Filipinos due to the resulting mortality, cardiovascular outcomes, and negative impact on quality of life. Screening for these disorders may lead to earlier detection and management of the disease, with subsequent improvement of clinical outcomes if early therapeutic options are available. This must be balanced with potential harms resulting from mislabeling and the adverse effects of treatment. The objective of this clinical practice guideline (CPG) is to provide recommendations to optimize patient care on screening for renal, metabolic, nutritional, and endocrine disorders among asymptomatic, apparently healthy Filipinos. We followed the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to CPG development recommended in the Department of Health Manual. The process included 1) generation of critical questions and critical outcomes, 2) retrieval of current evidence, 3) synthesis and assessment of the evidence base for these critical questions, 4) formulation of draft recommendations, 5) convening of a multisectoral stakeholder panel that evaluated the evidence base and considered feasibility, values, and preferences in formulating recommendations, and 6) planning for dissemination, implementation, impact evaluation, and updating. We performed a systematic synthesis of evidence to address screening for high climacteric syndrome, hypocalcemia or hypercalcemia, prediabetes, chronic kidney disease, hyperuricemia, malnutrition, nutritional anemia, among asymptomatic, apparently healthy adult Filipinos, and sexual maturity among asymptomatic, apparently healthy adolescent Filipinos. After the presentation of the evidence synthesis and deliberation of the consensus panelists, this CPG provides 18 recommendation statements for the eight conditions. These statement recommendations serve as guides for the primary care physicians in their screening for the identified renal, metabolic, nutritional, and endocrine disorders. The CPG recommends AGAINST screening for high climacteric syndrome among asymptomatic, apparently healthy women aged 45-55 years using hormonal tests. Moreover, the guideline DOES NOT recommend the use of serum calcium, electrocardiogram, or bone mineral density in screening for hypocalcemia or hypercalcemia; estimated glomerular filtration rate, urine albumin concentration, urine albumin-creatinine ratio, and kidney ultrasonography in screening for chronic kidney disease; mid-upper arm circumference in screening for malnutrition; and, serum uric acid in screening for hyperuricemia for apparently healthy, asymptomatic adults. Routine assessment for sexual maturity among asymptomatic adolescents is also NOT recommended. However, the guideline recommends using fasting plasma glucose and hemoglobin A1C in screening for prediabetes and type 2 diabetes mellitus; waist circumference, waist-hip ratio, and body mass index in screening for malnutrition; and hemoglobin and red blood cell parameters in screening for nutritional anemia. The CPG for the Periodic Health Examination, a joint project of the Department of Health and the National Institutes of Health, addressed selected renal, metabolic, nutritional, and endocrine conditions and provided recommendations for their screening. The statements are made to guide the primary care physicians in the screening of identified renal, metabolic, nutritional, and endocrine disorders. These recommendations will be updated after three years or until new evidence arises.
This study aimed to characterize the temporal prognostic roles of composite inflammation-nutrition indices in mortality risk stratification among adults with diabetes. We conducted a retrospective cohort study in a large population-based sample of adults with diabetes derived from a nationally representative health survey conducted between 1999 and 2018. Seven composite inflammation-nutrition indices were evaluated, including nutritional indices (PNI, GNRI), albumin-based ratios (MAR, NAR, RAR), and integrated scores (ALI and HALP). Associations with all-cause and cardiovascular mortality were assessed using Kaplan-Meier analysis and multivariable Cox regression. Nonlinear relationships were explored using restricted cubic splines, and time-dependent discriminative performance was evaluated across different follow-up periods. Kaplan-Meier analysis showed that higher levels of MAR, NAR, and RAR were significantly associated with increased all-cause mortality, whereas higher ALI, PNI, GNRI, and HALP scores were associated with reduced mortality risk. Multivariable Cox regression analysis indicated that, except for GNRI and HALP, all other indicators were independent predictors of cardiovascular mortality risk; Most evaluated indicators showed significant prognostic value for all-cause mortality, whereas the association for HALP was attenuated and no longer statistically significant after FDR correction. Marked temporal heterogeneity in prognostic performance was observed. RAR demonstrated stronger discrimination for short-term (1-year) mortality, whereas ALI provided more stable prognostic stratification across mid- to long-term follow-up. The overall prognostic importance of ALI was further supported by the Random Survival Forest model, in which ALI consistently ranked among the most influential predictors. This study highlights the complementary, time-dependent prognostic roles of inflammation-nutrition indices in diabetes, underscoring their potential utility for integrated and temporally informed risk assessment.
The aim of the study was to investigate the relationship between infertility history, the risk of type 2 diabetes and HbA1c levels. Among the participants in the Nurses' Health Study II (n=116,429), those who reported infertility (>12 months of trying to conceive), both overall and by infertility diagnosis, were compared with gravid women with no history of infertility. We used Cox proportional hazard models to estimate the HR and 95% CI of type 2 diabetes and adjusted for a priori potential confounding variables. Person-time was stratified a priori by age (≤50 and >50 years); in secondary analyses, we restricted the sample to those with a BMI of <25 kg/m2 at 18 years of age. We used linear regression models to assess the prospective association between the history of infertility and log-transformed blood HbA1c concentrations measured on average at age 44, among a subset of participants with this measure (n=2399). The association between a history of infertility and the risk of type 2 diabetes differed before and after the age of 50 (p value, test for interaction: 0.0004). Up to 50 years of age, infertility history was associated with a 32% greater risk of type 2 diabetes (95% CI 1.22, 1.43); for specific infertility diagnoses, ovulatory disorders were associated with a 67% greater risk (95% CI 1.48, 1.89), whereas tubal blockage (HR 1.29 [95% CI 1.01, 1.64]), male factor infertility (HR 1.30 [95% CI 1.08, 1.57]) and 'cause not found' (HR 1.26 [95% CI 1.05, 1.51]) were all associated with a ~30% greater risk of type 2 diabetes. After the age of 50, the association between overall infertility and type 2 diabetes attenuated (HR 1.12 [95% CI 1.06, 1.19]), as did associations between ovulatory disorders and type 2 diabetes (HR 1.18 [95% CI 1.05, 1.32]). The association between tubal blockage and the risk of type 2 diabetes remained similar after the age of 50 (HR 1.26 [95% CI 1.05, 1.51]). The overall association between infertility and the risk of type 2 diabetes remained elevated among women with a BMI of <25 kg/m2 at the age of 18 (≤50 years, HR 1.32 [95% CI 1.20, 1.44]; >50 years, HR 1.11 [95% CI 1.04, 1.19]). Women with a history of infertility also had slightly higher mean HbA1c levels than women without a history of infertility (relative difference: 0.7% [95% CI 0.04, 1.32]), reflecting a minimal absolute difference in HbA1c. Women with a history of infertility had a greater risk of developing type 2 diabetes, particularly prior to the age of 51 years. Specific reasons for infertility were associated with an elevated type 2 diabetes risk, including ovulatory disorders and tubal factors. These associations were independent of BMI.
The global rise in type 2 diabetes (T2D) and obesity, driven by high-sugar snacks, underscores the need for low-calorie, fiber-enriched alternatives that attenuate postprandial glycemia while maintaining cultural appeal in date-consuming regions. This study nutritionally characterized low-calorie date-based snacks (LCDBSs) formulated with Sagai/Sukkari date paste (1:1), nuts, and oat or psyllium fibers at 5%, 7.5%, or 10% (OF1-3, PF1-3). The formulated snacks were organolyptically and nutritionally evaluated as well as postprandial glycemic responses in 20 healthy adults (fasting glucose < 100 mg/dL, BMI average 23.39 kg m- 2) and 20 T2D patients (HbA1c 6.5-9.0%, fasting glucose 126-171 mg/dL) via standardized 100 g portions of sensorily preferred 7.5% variants (OF2, PF2) versus control (CF), measuring capillary glucose at 0, 30, 60, 90, and 120 min was examined. Proximate composition revealed dose-dependent increases in dietary fiber (12.61-17.55% vs. 7.86% in CF), reductions in available carbohydrates (48.24-52.06% vs. 55.16% in CF), and energy (349.72-368.31 kcal 100 g-1 vs. 384.98 kcal 100 g-1 in CF). Bar incorporated psyllium boosting minerals like K (1203.89 mg 100 g-1 in PF3), Mg (181.06 mg 100 g-1 in PF1), and Fe (3.94 mg 100 g in PF3). Regarding sugar profile, fructose (4.78-6.25% vs. 8.27% in CF), and glucose (4.68-6.09% vs. 8.20% in CF). Across formulations, the snacks retained high phenolic contents and antioxidant activity (TPC 475-598 mg GAE 100 g-1; DPPH-RSA 616-773 μmol TE 100 g-1), exhibited nutritionally balanced amino-acid profiles (essential amino acids 383-441 and non?essential amino acids 509-566 mg 100 g-1; EAA: NEAA ratio 0.68-0.87), and maintained a favorable fatty-acid pattern dominated by oleic and linoleic acids (MUFA 36.82-37.7%, PUFA 23.89-26.36%, with SFA 36.24-39.09%). Both OF2 and PF2 significantly blunted glucose excursions compared with control (p < 0.05), with PF2 superior (lower peaks at 60-120 min in both groups), confirming a low glycemic potential. These findings position psyllium/oat-enriched LCDBSs as viable, culturally relevant options for glycemic control, weight management, and T2D dietary interventions.
The longitudinal associations between dietary isoflavones and subtype intakes with the incidence of type 2 diabetes mellitus (T2DM) remains poorly understood. This prospective cohort study aimed to investigate the associations between dietary isoflavones and subtypes, including genistein, daidzein, and glycitein, with the risk of new-onset T2DM in Chinese adults. A total of 14,652 adults from the Chinese Health and Nutrition Survey (1997-2015) were enrolled. Intakes of isoflavones and subtypes were assessed through three consecutive 24-h dietary recalls and food weighing method. Statistical analysis was performed using a Cox proportional hazards regression model. A total of 1,051 new T2DM cases were diagnosed during a mean of 10 years of follow-up. In the fully adjusted models, dietary intakes of isoflavones (p-trend = 0.0116), daidzein (p-trend = 0.0056), glycitein (p-trend = 0.0133) and genistein (p-trend = 0.0032) were inversely associated with T2DM risk, respectively. This inverse association remained robust in sensitivity analyses. Region modified the associations between dietary glycitein intakes and risk of T2DM. RCS analysis demonstrated low T2DM risk with the intake range of 10.65-24.58 mg isoflavones, 3.80-8.29 mg daidzein, 0.70-2.02 mg glycitein and 4.97-11.31 mg genistein, respectively (p-nonlinear<0.0001). The study provided new evidence for the reference intake of dietary isoflavones and subtypes targeted for the T2DM prevention in Chinese population.
Malnutrition and immune dysregulation are common in patients with osteoporosis but are often overlooked and may contribute to poor outcomes. The Controlling Nutritional Status (CONUT) score is a simple instrument reflecting both nutritional and immune status, but its prognostic value in osteoporosis remains unclear. This retrospective, observational study included data of adults aged ≥ 50 years with osteoporosis extracted from five two-year cycles of the National Health and Nutrition Examination Survey (NHANES; 2005-2006, 2007-2008, 2009-2010, 2013-2014, and 2017-2018). Osteoporosis was defined as femoral neck T-score < - 2.5. CONUT scores were calculated from participants' serum albumin, total cholesterol, and total lymphocyte count, and high CONUT was defined as ≥ 2. All-cause and cardiovascular disease (CVD)-related mortality through December 31, 2019, was ascertained via the National Death Index. Weighted Cox regression models were used to estimate hazard ratios (HRs) for mortality outcomes. Among 871 participants representing 5.86 million US adults with osteoporosis, 40.7% had high CONUT scores. During a median follow-up of 9.8 years, high CONUT scores were associated with increased all-cause mortality (53.2% vs. 30.9%, p < 0.001) and CVD mortality (17.6% vs. 8.2%, p < 0.001). In multivariable analysis, after adjustments for possible confounders, high CONUT scores were independently associated with higher all-cause (HR 1.64; 95% CI 1.25-2.14) and CVD mortality (HR 1.91; 95% CI 1.15-3.19). Associations with all-cause mortality were consistent across sex, diabetes, and CKD subgroups and associations with CVD mortality were most pronounced among females and patients with diabetes. The CONUT scores may help identify high-risk individuals, particularly those with greater comorbidity burden, who may benefit from closer monitoring and more comprehensive nutritional assessment.
sepsis is a life-threatening syndrome marked by systemic inflammation, nutritional imbalance, and high prevalence of vitamin D deficiency. However, the mechanistic interconnections between serum vitamin D levels, nutritional status, and inflammatory activity in sepsis remain poorly characterized. to investigate the associations among these factors in septic patients and identify an optimal serum 25-hydroxyvitamin D cutoff value for clinical assessment of sepsis. a cross-sectional study enrolled 97 septic patients in the Intensive Care Unit (ICU) (October 2023-October 2024) and 95 age/sex-matched healthy controls. Serum 25-hydroxyvitamin D [25-(OH)D] levels, nutritional indicators, inflammatory markers, and biochemical parameters were measured and compared between groups; correlation and reveiver operating characteristic (ROC) curve analyses were performed. septic patients had significantly lower 25(OH)D levels, poorer nutritional status, and higher inflammatory markers than controls. The optimal 25(OH)D cutoff for predicting sepsis was 22.55 ng/ml. Serum 25(OH)D concentrations correlated positively with nutritional parameters and negatively with inflammatory indices in septic patients. serum vitamin D is a valid indicator for sepsis progression. The interrelated associations between vitamin D levels, nutritional status, and inflammation highlight vitamin D's role in modulating sepsis severity and prognosis, supporting its integration into sepsis clinical management and risk stratification.
Few studies have investigated the association between diabetes mellitus and risk of anal cancer and the results to date have been inconsistent. We analysed the relation between a history of diabetes and diabetic retinopathy and risk of anal cancer in a nationwide cohort in Taiwan. Data from a retrospective cohort study of 5.9 million Taiwanese men and women aged 18-90 years were used for the analysis. Multivariable proportional hazards regression models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for the association between diabetes diagnosis and diabetic retinopathy and risk of anal cancer. During a mean of 7.8 years follow-up, 2315 anal cancer cases occurred. The HRs (95% CIs) of anal cancer among persons with compared to those without a history of diabetes mellitus was 1.04 (0.95-1.13), and for persons with diabetic retinopathy vs. no diabetic retinopathy was 1.52 (1.20-1.92) and proliferative diabetic retinopathy vs. no proliferative diabetic retinopathy was 1.78 (1.27-2.50), respectively. This large-scale cohort study provides evidence of no clear association between diabetes mellitus and anal cancer risk overall, however, there was indication of increased risk among persons with diabetic retinopathy and proliferative diabetic retinopathy. Additional large-scale cohort studies with more comprehensive risk factor data are needed to further clarify these findings.
Erectile dysfunction (ED) is a common but under-discussed complication among men living with diabetes (MLWD), particularly in African contexts where sexual health is culturally sensitive. Despite major psychosocial and relational consequences, ED is often inadequately addressed within routine diabetes care. This study explored perceptions, impacts, and management practices related to sexual weakness among MLWD, alongside healthcare providers' experiences managing the condition in Ghana. We conducted an exploratory qualitative study across five public healthcare facilities in four regions of Ghana. In-depth interviews were conducted with 26 MLWD and 14 healthcare providers involved in diabetes care. Participants were purposively recruited, and data were analysed using thematic analysis supported by ATLAS.ti. Participants attributed sexual weakness to multiple causes, including diabetes-related complications, medication effects, and spiritual factors. Divergent explanatory models between patients and providers shaped management decisions and care-seeking. Many men reported using herbal remedies, aphrodisiacs, energy drinks, and spiritual interventions, often delaying biomedical care. Sexual weakness was associated with distress, reduced confidence, and relationship strain, and disclosure was selective, shaped by stigma, secrecy, and trust. Providers expressed concern about misconceptions, unregulated treatment use, and structural constraints within overcrowded diabetes clinics that limited meaningful engagement on sexual health.
Proliferative glomerulonephritis with monoclonal immunoglobulin deposits (PGNMID) is a rare glomerular disease characterized by edema, proteinuria, and renal insufficiency. No established treatment protocol is currently available. We report a case of PGNMID with monoclonal IgG1-κ deposits in a patient with a 19-year history of type 1 diabetes. A 30-year-old woman presented with a 1-week history of nausea, vomiting, and generalized edema. She had a 19-year history of type 1 diabetes mellitus with poor glycemic control. Three months before admission, she had been hospitalized for fever and was diagnosed with a urinary tract infection, during which her renal function was normal. After discharge, she continued to experience recurrent episodes of fever. One week before admission, she gradually developed generalized edema accompanied by decreased urine output. On admission, she was found to have nephrotic-range proteinuria, hypoalbuminemia, anemia, acute renal failure, and acute heart failure. After antimicrobial therapy, renal replacement therapy, and nutritional support, the patient underwent renal biopsy. Immunofluorescence showed diffuse, global, granular, and lumpy deposits of IgG, C3, and κ light chain along the glomerular capillary loops and in the mesangial regions, with strong IgG1 positivity. Electron microscopy revealed proliferation of glomerular capillary endothelial cells, accompanied by segmental mesangial matrix interposition into the basement membrane, resulting in a double-contour appearance. Segmental hump-like subepithelial electron-dense deposits were also observed. No abnormal monoclonal bands were detected by serum or urine immunofixation electrophoresis, and the serum and urine free light chain κ/λ ratios were within the normal range. Bone marrow aspiration revealed 0.5% plasma cells. The final diagnosis was proliferative glomerulonephritis with monoclonal IgG1-κ deposits (IgG1κ-PGNMID). The patient was treated with prednisone, cyclophosphamide, and renal replacement therapy, with a good initial response. She was temporarily weaned from renal replacement therapy in the short term, but subsequently required long-term maintenance dialysis. In patients with a long-standing history of diabetes, the presence of a preceding infection, hypocomplementemia, nephrotic-range proteinuria, and rapidly progressive renal dysfunction should prompt suspicion for non-diabetic kidney disease. In such cases, renal biopsy, together with serum and urine immunofixation electrophoresis, free light chain assays, complement testing, and rheumatologic autoantibody screening, is essential for the diagnosis and differential diagnosis of PGNMID and related disorders. For patients with confirmed PGNMID who lack clear evidence of monoclonality or decline targeted therapy, prednisone combined with cyclophosphamide may represent an effective alternative treatment option.
Frailty is increasingly recognized as an important clinical issue in patients with chronic diseases. However, evidence on the prevalence of frailty and its associated factors in patients with type 2 diabetes mellitus (T2DM) complicated by coronary heart disease (CHD) remains limited. This study aimed to investigate the prevalence of frailty and identify factors associated with frailty in patients with T2DM and CHD. A cross-sectional study was conducted among patients with T2DM and CHD recruited from the Departments of Endocrinology and Cardiology of a tertiary hospital in Shanghai, China, between September and December 2025. Frailty was assessed using the Tilburg Frailty Indicator (TFI). Data on demographic, clinical, lifestyle, and psychosocial characteristics were collected using a general information questionnaire and medical records. Univariate analyses were performed to compare differences between frail and non-frail participants, and binary logistic regression analysis was conducted to identify factors associated with frailty. Among 217 participants, 43.8% were frail. Significant between-group differences were observed in age, blood glucose, glycated hemoglobin, BNP, D-dimer, NLR, SIIRI, grip strength, NYHA functional class, anxiety, nutritional risk, history of PCI, number of comorbidities, and sleep duration (all P < 0.05). Binary logistic regression analysis showed that blood glucose, BNP, anxiety, sleep duration, nutritional risk, history of PCI, and age were independently associated with frailty in patients with T2DM and CHD (all P < 0.05). Frailty was common among patients with T2DM and CHD. Metabolic and cardiovascular factors, psychological and behavioral factors, and nutritional vulnerability were all associated with frailty, underscoring its multidimensional nature in this comorbid population. Early frailty screening and multidomain assessment may be important for improving the management of patients with T2DM and CHD.
metabolic syndrome is a clustering of key cardiovascular risk factors, including abdominal obesity, dyslipidemia, hyperglycemia, and hypertension. Individuals with a combination of metabolic syndrome and type 2 diabetes mellitus (T2DM) have a greater risk of developing microvascular and macrovascular complications, cardiovascular disease, and premature death. This study sought to estimate the prevalence of metabolic syndrome among patients with T2DM in Buea Health District and evaluate its correlation with glycemic control. a hospital based cross-sectional study was carried out in the Buea Health District from February to May 2024. One hundred and thirty-nine patients with T2DM were recruited by a systematic sampling. Sociodemographic, lifestyle, and clinical data were collected. Evaluation of anthropometric variables, fasting plasma glucose, triglycerides, high-density lipoprotein cholesterol, blood pressure, and glycated hemoglobin was performed. Data were analyzed using the Statistical Package for Social Sciences. The level of significance was set at p < 0.05. a total of 139 patients with T2DM were recruited in this study with a mean (SD) age of 59.5 ± 10.95 years. The prevalence of metabolic syndrome was 64.00% and 56.80% using the International Diabetes Federation and National Cholesterol Education Program Adult Treatment Panel criteria, respectively. The prevalence was significantly higher in women (56.81%). Central obesity, hyperglycemia, and hypertension were the most common components of metabolic syndrome, and they were more prevalent in female patients. Patients with T2DM who were females, older, who consumed alcohol, did not practice self-glucose monitoring, and had poor glycemic control were more likely to have metabolic syndrome (p < 0.05). this study observed a high prevalence of metabolic syndrome among patients with T2DM in Buea, Cameroon. Lifestyle changes and good glycemic control are recommended for the prevention of metabolic syndrome in patients with type 2 diabetes mellitus.
Dietary patterns that support gut microbiota may influence interconnected cardiometabolic pathways. We investigated the association between adherence to a gut microbiota-supportive dietary pattern, assessed by the Dietary Index for Gut Microbiota (DI-GM), and multisystem cardiometabolic dysregulation in adults with type 2 diabetes (T2D). In this cross-sectional study, 385 adults with T2D from diabetes clinics in Zanjan, Iran were included. Dietary intake was assessed using a validated 168-item food frequency questionnaire, and DI-GM scores (0-14) were derived from 14 microbiota-related components. A composite cardiometabolic dysregulation score was calculated from standardized markers of glycemic control, lipid profile, inflammation, liver enzymes, and blood pressure. Multivariable linear regression was used to estimate associations across DI-GM quartiles and per 1-SD increase, adjusting for demographic, lifestyle, and clinical factors. Dose-response relationships were assessed using restricted cubic splines. Higher DI-GM adherence was inversely associated with cardiometabolic dysregulation. In fully adjusted models, participants in the highest quartile had significantly lower dysregulation scores than those in the lowest (β = -0.31; 95% CI: -0.42, - 0.20; P-trend < 0.001). Each 1-SD increase in DI-GM was associated with a - 0.17 reduction (95% CI: -0.24, - 0.10). Associations were linear with no evidence of non-linearity and remained robust after further adjustments. In adults with T2D, higher adherence to a microbiota-oriented dietary pattern, assessed using the DI-GM, was associated with lower multisystem cardiometabolic dysregulation. Given the cross-sectional design, these findings should be interpreted as observational associations and do not establish temporality or causality. Longitudinal and prospective studies, preferably with direct gut microbiome assessment, are needed to confirm these findings and clarify whether DI-GM adherence is temporally or causally related to cardiometabolic dysregulation.
To examine sex differences in type 2 diabetes mellitus (T2DM) prevalence between individuals with normal-weight obesity (NWO) and individuals with obesity among middle-aged Korean adults using nationally representative data. This cross-sectional study used Korea National Health and Nutrition Examination Survey data from 2019 to 2021. NWO was defined as a body mass index (BMI) of 18.5-24.9 kg/m2 with body fat ≥26% in men and ≥ 36% in women. Propensity score matching (1:1) between NWO and individuals with obesity was conducted separately by sex to balance demographic, socioeconomic, lifestyle, and clinical characteristics. Conditional logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs). A total of 684 participants were included after matching. Among men, T2DM prevalence was lower in the NWO group than in the obesity group (20.00% vs. 31.03%), with lower odds of T2DM (adjusted OR = 0.54; 95% CI 0.29, 0.93). Among women, no significant differences were observed between NWO and obesity groups (11.70% vs. 13.20%, p > 0.05). NWO showed sex-specific differences in association with T2DM prevalence; causal relationships cannot be inferred. Body composition assessment beyond BMI may identify metabolic risks, particularly in Asian populations.
This work examines potential links between lean tissue composition and prior occurrences of gestational diabetes mellitus (GDM) within a nationally representative cohort. This cross-sectional study included 1807 participants from the National Health and Nutrition Examination Survey (NHANES) (2011-2018). GDM history was self-reported. Body composition was assessed using dual-energy X-ray absorptiometry (DXA). Weighted multivariable logistic regression, adjusted for covariates, was used to assess the relationships between body composition distribution and GDM history. Nonlinear associations were evaluated using cubic spline functions, with subgroup and sensitivity analyses to assess robustness. The adjusted model revealed that a history of GDM was associated with higher android-to-gynoid lean mass ratio (AGLR), android lean mass index (ALMI), and android-to-gynoid fat ratio (AGFR). Multivariable restricted cubic spline (RCS) analysis showed a significant linear association between AGLR, AGFR, and GDM history (nonlinearity p > 0.05), while ALMI demonstrated a nonlinear relationship (nonlinearity p < 0.05). These associations were significantly influenced by economic status and blood pressure levels (p < 0.05). Sensitivity analysis excluding participants whose last live birth occurred > 10 years ago yielded results consistent with the primary analysis. Higher AGLR, ALMI, and AGFR are associated with increased odds of a history of GDM, with AGLR showing the strongest correlation. These findings underscore the importance of incorporating GDM history and regional lean mass distribution into risk assessment.
Evidence from randomised controlled trials shows that vitamin C (VC) supplementation may improve cardiometabolic health outcomes in people with type 2 diabetes (T2D). Plasma proteomics may help to further enhance our understanding of VC's therapeutic effects and biological mechanisms in T2D. Therefore, our aim was to explore the effects of VC supplementation on the plasma proteome in people with T2D. A double-blind, placebo-controlled, crossover trial was undertaken in people with T2D, who were administered 1000 mg/day VC or placebo for 4 months. Plasma proteins in 26 participants (22 male, 4 female, age 62.6 ± 6.5 years, HbA1c 60 ± 11 mmol/mol [7.6 ± 0.7%]) were quantified by liquid chromatography/mass spectrometry with data-independent acquisition. Differential protein expression was assessed for VC post-supplementation vs. control [pooling of all non-active conditions]. Twelve proteins were significantly downregulated and three were upregulated following VC supplementation (|log2-fold change [FC]| ≥ 0.5; false discovery rate<0.05). These included proteins with functions in innate immunity, carbohydrate digestion, unfolded protein binding, and muscle contraction. Protein candidates that had the greatest magnitude decrease (|log2-FC| > 1) with VC supplementation were alpha-amylase 1 (AMY1), heat shock protein 75 kDa (TRAP1), myosin-1 (MYH1), and serum amyloid protein A1 (SAA1). Pathway enrichment revealed underrepresentation of unfolded protein binding, ATP binding, attenuation phase, and the innate immune system following VC supplementation. TRAP1, alpha-actin-1, Heat shock 70 kDa protein-1, and CD166 antigen were associated with previously reported improved blood-pressure outcomes following VC supplementation. VC supplementation significantly altered abundance of numerous proteins in plasma, with functions relating to the innate immune system, dietary carbohydrate digestion, and protein folding chaperone activity. We identified novel proteins responsive to VC supplementation and protein-clinical improvement correlations in people with T2D that require further exploration to understand their biological significance.
This study aimed to systematically clarify the changes in the concentrations of human milk oligosaccharides (HMOs) in mothers with gestational diabetes mellitus (GDM) and the differences from healthy mothers. A total of 156 human milk samples were collected from 50 mothers (26 healthy mothers and 24 GDM mothers) in Danyang City at different lactation stages (0-7 days, 8-14 days, 1 month, and 3 months postpartum). By using the method of UPLC-MS/MS to analyse the concentration of HMOs, comparing the changes and the differences of HMO concentrations between healthy mothers and GDM mothers. Intergroup comparisons of the concentrations of total HMO and 32 individual HMOs were performed at 0-7 days, 8-14 days, 1 month, and 3 months postpartum. After adjusting for covariates (age, BMI, gestational days, mid-trimester blood glucose, and gestational weight gain) by using the generalized estimating equation (GEE), it was found that GDM was significantly correlated with specific HMOs, with the specific results showing that 7 HMOs, including 2'-fucosyllactose (2'-FL), lacto-N-difucohexaose I (LNDFH-I) and 3'-Sialyl-N-acetyllactosamine (3'-SLN), differed significantly in relation to GDM (P all < 0.05). Time was closely associated with the total HMOs concentration and other individual HMOs. The total HMOs concentration at 1 month and 3 months postpartum was significantly lower than that in colostrum (p < 0.05); Specific HMOs exhibited distinct temporal variation patterns: for example, three kinds of HMOs including 2'-FL showed a downward trend starting from 8-14 days postpartum; the concentrations of eight kinds of HMOs such as lacto-N-fucopentaose II (LNFP-II) and Lacto-N-triose II (LNT-2) decreased significantly at 1 month and 3 months postpartum; HMOs such as 6-sialyllactose (6'-SL) and lacto-N-tetraose (LNT) showed a significant reduction only at 3 months postpartum. Analysis of the interaction between GDM and time indicated that the magnitude of the decrease in the concentrations of 3 HMOs including Disialyllacto-N-tetraose (DSLNT) and N-Acetyllactosamine (LacNAC) in the GDM group at 8-14 days postpartum was significantly greater than that in the healthy mother group. The total concentration of HMOs in GDM mothers was lower than that in healthy mothers at all time points and showed a downward trend. Meanwhile, the study found that GDM is associated with the concentrations of individual HMOs, and the HMO concentrations in GDM mothers differ from that in healthy mothers at different lactation stages, with all being lower than those in healthy mothers.
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High insulin prices are a major barrier to diabetes management in the U.S. Since 2019, several states have implemented legislation to mitigate high out-of-pocket (OOP) costs for commercially insured individuals by setting caps on monthly OOP payments for insulin. In this study, we examine the reach of these policies. We identified insulin OOP cap legislation enacted through 2026 for each state and Washington, DC. Using public data on diabetes prevalence and health insurance coverage, we identified the population eligible and exposed to OOP caps legislation: adults aged 18-64 years with diabetes, using insulin, enrolled in state-regulated commercial plans, and residing in states that enacted OOP caps legislation. We then estimated the number of commercially insured individuals using insulin still left unprotected due to 1) enrolled in federally regulated plans, regardless of state of residence; or 2) enrolled in state-regulated plans but living in states without OOP cap legislation. By 2026, 29 states and Washington, DC, had enacted OOP caps on insulin, covering an estimated 0.99 million individuals with diabetes, using insulin, and enrolled in state-regulated commercial plans. Despite these gains, policy reach remains uneven: 0.67 million adults with diabetes using insulin and insured by state-regulated plans live in states without an insulin OOP cap, and 2.2 million more are insured by federally regulated commercial plans that fall outside of state jurisdiction. State OOP caps have the potential to reduce OOP insulin costs for many commercial plan enrollees but have limited reach. Legislative efforts to contain costs at the federal level are therefore needed to decrease the financial burden of insulin therapy.