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Journal of the American Medical... Jul 2023The study aimed to investigate the prevalence of postprandial hypotension (PPH) in older inpatients, to verify the overall postprandial behavior of blood pressure and...
OBJECTIVES
The study aimed to investigate the prevalence of postprandial hypotension (PPH) in older inpatients, to verify the overall postprandial behavior of blood pressure and attentional performances, and to explore the overall associations between blood pressure (including PPH) and attentional performances. Eventually, we aimed to investigate differences on PPH, blood pressure values and attentional performances based on the subjects' frailty status.
DESIGN
Cross-sectional study.
SETTING AND PARTICIPANTS
A sample of older inpatients at the Geriatric Unit of the University Hospital of Messina (Italy).
METHODS
Basal, preprandial, and postprandial blood pressures (75 minutes after the meal) were measured for each patient; PPH was detected according to its empirical definition. Global cognitive functioning, and sustained and selective attention were assessed; a 46-item Frailty Index was calculated.
RESULTS
The sample consisted of 112 inpatients (54 females), with a mean age of 80.9 years. The prevalence of PPH was 30.4%; in the postprandial window, a reduction in blood pressure between 10 and 20 mm Hg and a reduction of >20 mm Hg were reported by 27.1% and 29.9% of inpatients, respectively. In the postprandial evaluation, sustained and selective attention markedly decreased. No significant associations were found between PPH occurrence and the postprandial dip of attentional performances, and no significant cognitive differences were found between inpatients with and without PPH. On the other hand, reduced postprandial attentional performances were associated especially with preprandial lower systolic and diastolic blood pressure values. Ultimately, no significant differences in PPH occurrence were found between frail and nonfrail inpatients; frail inpatients significantly exhibited also an overall lower cognitive functioning.
CONCLUSIONS AND IMPLICATIONS
In our sample, PPH and impaired postprandial attentional performances were not associated, even though this association deserves further investigation. In hospitalized older adults, the accurate management of blood pressure levels appears relevant, because we evidenced that low blood pressure (especially preprandial) was associated with poor attentional functioning. Although the plausible occurrence of several interfering and confounder factors was observed in an acute care setting, we consider that the screening of attentional functioning among hospitalized older patients could be helpful.
Topics: Female; Humans; Aged; Aged, 80 and over; Inpatients; Cross-Sectional Studies; Frailty; Hypotension; Blood Pressure; Postprandial Period; Attention
PubMed: 37121263
DOI: 10.1016/j.jamda.2023.03.023 -
The Journal of Experimental Biology Aug 2023Transient thermophily in ectothermic animals is a common response during substantial physiological events. For example, ectotherms often elevate body temperature after...
Transient thermophily in ectothermic animals is a common response during substantial physiological events. For example, ectotherms often elevate body temperature after ingesting a meal. In particular, the increase in metabolism during the postprandial response of pythons - known as specific dynamic action - is supported by a concurrent increase in preferred temperature. The objective of this study was to determine whether hydration state influences digestion-related behavioral thermophily. Sixteen (8 male and 8 female) Children's pythons (Antaresia childreni) with surgically implanted temperature data loggers were housed individually and provided with a thermal gradient of 25-45°C. Body temperature was recorded hourly beginning 6 days prior to feeding and for 18 days post-feeding, thus covering pre-feeding, postprandial and post-absorptive stages. Each snake underwent this 24 day trial twice, once when hydrated and once when dehydrated. Our results revealed a significant interaction between temperature preference, digestive stage and hydration state. Under both hydrated and dehydrated conditions, snakes similarly increased their body temperature shortly after consuming a meal, but during the later days of the postprandial stage, snakes selected significantly lower (∼1.5°C) body temperature when they were dehydrated compared with when they were hydrated. Our results demonstrate a significant effect of hydration state on postprandial thermophily, but the impact of this dehydration-induced temperature reduction on digestive physiology (e.g. passage time, energy assimilation) is unknown and warrants further study.
Topics: Animals; Female; Male; Temperature; Boidae; Postprandial Period; Snakes
PubMed: 37455645
DOI: 10.1242/jeb.245925 -
Current Diabetes Reports Jun 2024Postprandial hyperglycemia, or elevated blood glucose after meals, is associated with the development and progression of various diabetes-related complications. Prandial... (Review)
Review
PURPOSE OF REVIEW
Postprandial hyperglycemia, or elevated blood glucose after meals, is associated with the development and progression of various diabetes-related complications. Prandial insulins are designed to replicate the natural insulin release after meals and are highly effective in managing post-meal glucose spikes. Currently, different types of prandial insulins are available such as human regular insulin, rapid-acting analogs, ultra-rapid-acting analogs, and inhaled insulins. Knowledge about diverse landscape of prandial insulin will optimize glycemic management.
RECENT FINDINGS
Human regular insulin, identical to insulin produced by the human pancreas, has a slower onset and extended duration, potentially leading to post-meal hyperglycemia and later hypoglycemia. In contrast, rapid-acting analogs, such as lispro, aspart, and glulisine, are new insulin types with amino acid modifications that enhance their subcutaneous absorption, resulting in a faster onset and shorter action duration. Ultra-rapid analogs, like faster aspart and ultra-rapid lispro, offer even shorter onset of action, providing better meal-time flexibility. The Technosphere insulin offers an inhaled route for prandial insulin delivery. The prandial insulins can be incorporated into basal-bolus, basal plus, or prandial-only regimens or delivered through insulin pumps. Human regular insulin, aspart, lispro, and faster aspart are recommended for management of hyperglycemia during pregnancy. Ongoing research is focused on refining prandial insulin replacement and exploring newer delivery methods. The article provides a comprehensive overview of various prandial insulin options and their clinical applications in the management of diabetes.
Topics: Humans; Hypoglycemic Agents; Insulin; Postprandial Period; Hyperglycemia; Female; Blood Glucose; Diabetes Mellitus; Pregnancy
PubMed: 38568467
DOI: 10.1007/s11892-024-01540-8 -
Neurogastroenterology and Motility Oct 2023Mitochondrial neurogastrointestinal encephalomyopathy (MNGIE) is a rare mitochondrial disease caused by mutations in TYMP, encoding thymidine phosphorylase. Clinically...
BACKGROUND
Mitochondrial neurogastrointestinal encephalomyopathy (MNGIE) is a rare mitochondrial disease caused by mutations in TYMP, encoding thymidine phosphorylase. Clinically it is characterized by severe gastrointestinal dysmotility associated with cachexia and a demyelinating sensorimotor polyneuropathy. Even though digestive manifestations are progressive and invariably lead to death, the features of gastrointestinal motor dysfunction have not been systematically evaluated. The objective of this study was to describe gastrointestinal motor dysfunction in MNGIE using state-of-the art techniques and to evaluate the relationship between motor abnormalities and symptoms.
METHODS
Prospective study evaluating gastrointestinal motor function and digestive symptoms in all patients with MNGIE attended at a national referral center in Spain between January 2018 and July 2022.
KEY RESULTS
In this period, five patients diagnosed of MNGIE (age range 16-46 years, four men) were evaluated. Esophageal motility by high-resolution manometry was abnormal in four patients (two hypoperistalsis, two aperistalsis). Gastric emptying by scintigraphy was mildly delayed in four and indicative of gastroparesis in one. In all patients, small bowel high-resolution manometry exhibited a common, distinctive dysmotility pattern, characterized by repetitive bursts of spasmodic contractions, without traces of normal fasting and postprandial motility patterns. Interestingly, objective motor dysfunctions were detected in the absence of severe digestive symptoms.
CONCLUSIONS AND INFERENCES
MNGIE patients exhibit a characteristic motor dysfunction, particularly of the small bowel, even in patients with mild digestive symptoms and in the absence of morphological signs of intestinal failure. Since symptoms are not predictive of objective findings, early investigation is indicated.
Topics: Male; Humans; Adolescent; Young Adult; Adult; Middle Aged; Prospective Studies; Intestinal Pseudo-Obstruction; Mitochondrial Encephalomyopathies; Mutation; Gastrointestinal Diseases
PubMed: 37448106
DOI: 10.1111/nmo.14643 -
Journal of Applied Physiology... Oct 2023To examine the effects of daily step count on same-day fat oxidation and postprandial metabolic responses to an evening high-fat mixed meal (HFMM). Ten healthy... (Randomized Controlled Trial)
Randomized Controlled Trial
To examine the effects of daily step count on same-day fat oxidation and postprandial metabolic responses to an evening high-fat mixed meal (HFMM). Ten healthy participants (5 females, 30 ± 7 yr) completed four different daily step counts-2,000 (2 K), 5,000 (5 K), 10,000 (10 K), and 15,000 (15 K) steps-on separate days in randomized order. On experimental days, participants ate the same meals and walked all steps on an indoor track at a pace of 100 steps/min in three roughly equal bouts throughout the day. After the final walking bout, participants' resting energy expenditure (REE), respiratory exchange ratio (RER), and fat oxidation rate (FAT) were measured. Blood samples were obtained before (BL) and 30-, 60-, 90-, 120-, and 240-min following consumption of an HFMM (960 kcal; 48% fat) to measure triglycerides (i.e., postprandial lipemia; PPL), nonesterified fatty acids (NEFAs), insulin, and glucose. Two-way ANOVAs indicated condition effects where PPL was significantly higher after 2 K versus 10 K (+23 ± 8 mg/dL, = 0.027), and NEFAs were significantly higher after 15 K versus 2 K (+86 ± 23 µmol/L; = 0.006). No differences were found for insulin, glucose, or REE among conditions (all > 0.124). Similarly, RER ( = 0.054; η = 0.24) and FAT ( = 0.071; η = 0.23) were not significantly different among conditions. In young adults, 10 K steps elicited the greatest decrease in PPL, an established cardiovascular disease risk factor. NEFA levels were highest after the 15 K condition, likely due to alterations in adipose tissue lipolysis or lipoprotein lipase activity with increased activity. This randomized controlled trial demonstrated that walking 10,000, compared with 2,000, steps/day significantly reduced postprandial lipemia (PPL), an independent predictor of cardiovascular disease (CVD) following same-day evening meal consumption. These experimental data support walking 10,000 steps/day to lower CVD risk.
Topics: Female; Young Adult; Humans; Cardiovascular Diseases; Blood Glucose; Triglycerides; Glucose; Hyperlipidemias; Adipose Tissue; Energy Metabolism; Fatty Acids, Nonesterified; Insulins; Postprandial Period; Insulin; Cross-Over Studies
PubMed: 37560764
DOI: 10.1152/japplphysiol.00052.2023 -
Diabetes Care Sep 2023Meals are a consistent challenge to glycemic control in type 1 diabetes (T1D). Our objective was to assess the glycemic impact of meal anticipation within a fully... (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVE
Meals are a consistent challenge to glycemic control in type 1 diabetes (T1D). Our objective was to assess the glycemic impact of meal anticipation within a fully automated insulin delivery (AID) system among adults with T1D.
RESEARCH DESIGN AND METHODS
We report the results of a randomized crossover clinical trial comparing three modalities of AID systems: hybrid closed loop (HCL), full closed loop (FCL), and full closed loop with meal anticipation (FCL+). Modalities were tested during three supervised 24-h admissions, where breakfast, lunch, and dinner were consumed per participant's home schedule, at a fixed time, and with a 1.5-h delay, respectively. Primary outcome was the percent time in range 70-180 mg/dL (TIR) during the breakfast postprandial period for FCL+ versus FCL.
RESULTS
Thirty-five adults with T1D (age 44.5 ± 15.4 years; HbA1c 6.7 ± 0.9%; n = 23 women and n = 12 men) were randomly assigned. TIR for the 5-h period after breakfast was 75 ± 23%, 58 ± 21%, and 63 ± 19% for HCL, FCL, and FCL+, respectively, with no significant difference between FCL+ and FCL. For the 2 h before dinner, time below range (TBR) was similar for FCL and FCL+. For the 5-h period after dinner, TIR was similar for FCL+ and FCL (71 ± 34% vs. 72 ± 29%; P = 1.0), whereas TBR was reduced in FCL+ (median 0% [0-0%] vs. 0% [0-0.8%]; P = 0.03). Overall, 24-h control for HCL, FCL, and FCL+ was 86 ± 10%, 77 ± 11%, and 77 ± 12%, respectively.
CONCLUSIONS
Although postprandial control remained optimal with hybrid AID, both fully AID solutions offered overall TIR >70% with similar or lower exposure to hypoglycemia. Anticipation did not significantly improve postprandial control in AID systems but also did not increase hypoglycemic risk when meals were delayed.
Topics: Male; Humans; Adult; Female; Middle Aged; Insulin; Diabetes Mellitus, Type 1; Blood Glucose; Hypoglycemic Agents; Meals; Insulin, Regular, Human; Insulin Infusion Systems; Cross-Over Studies
PubMed: 37478323
DOI: 10.2337/dc23-0119 -
The American Journal of Clinical... Mar 2024Glucagon-like peptide 1 (GLP-1), a gastrointestinal peptide and central mediator of glucose metabolism, is secreted by L cells in the intestine in response to food... (Review)
Review
Glucagon-like peptide 1 (GLP-1), a gastrointestinal peptide and central mediator of glucose metabolism, is secreted by L cells in the intestine in response to food intake. Postprandial secretion of GLP-1 is triggered by nutrient-sensing via transporters and G-protein-coupled receptors (GPCRs). GLP-1 secretion may be lower in adults with obesity/overweight (OW) or type 2 diabetes mellitus (T2DM) than in those with normal glucose tolerance (NGT), but these findings are inconsistent. Because of the actions of GLP-1 on stimulating insulin secretion and promoting weight loss, GLP-1 and its analogs are used in pharmacologic preparations for the treatment of T2DM. However, physiologically stimulated GLP-1 secretion through the diet might be a preventive or synergistic method for improving glucose metabolism in individuals who are OW, or have impaired glucose tolerance (IGT) or T2DM. This narrative review focuses on fasting and postprandial GLP-1 secretion in individuals with different metabolic conditions and degrees of glucose intolerance. Further, the influence of relevant diet-related factors (e.g., specific diets, meal composition, and size, phytochemical content, and gut microbiome) that could affect fasting and postprandial GLP-1 secretion are discussed. Some studies showed diminished glucose- or meal-stimulated GLP-1 response in participants with T2DM, IGT, or OW compared with those with NGT, whereas other studies have reported an elevated or unchanged GLP-1 response in T2DM or IGT. Meal composition, especially the relationship between macronutrients and interventions targeting the microbiome can impact postprandial GLP-1 secretion, although it is not clear which macronutrients are strong stimulants of GLP-1. Moreover, glucose tolerance, antidiabetic treatment, grade of overweight/obesity, and sex were important factors influencing GLP-1 secretion. The results presented in this review highlight the potential of nutritional and physiologic stimulation of GLP-1 secretion. Further research on fasting and postprandial GLP-1 concentrations and the resulting metabolic consequences under different metabolic conditions is needed.
Topics: Adult; Humans; Glucagon-Like Peptide 1; Diabetes Mellitus, Type 2; Glucose Tolerance Test; Insulin; Blood Glucose; Overweight; Diet; Fasting; Glucose Intolerance; Obesity; Postprandial Period
PubMed: 38218319
DOI: 10.1016/j.ajcnut.2024.01.007 -
Journal of Clinical Medicine Jun 2023The residual risk for arteriosclerotic cardiovascular disease after optimal statin treatment may amount to 50% and is the consequence of both immunological and lipid... (Review)
Review
The residual risk for arteriosclerotic cardiovascular disease after optimal statin treatment may amount to 50% and is the consequence of both immunological and lipid disturbances. Regarding the lipid disturbances, the role of triglyceride-rich lipoproteins (TRLs) and their remnants has come to the forefront in the past decade. Triglycerides (TGs) stand as markers of the remnants of the catabolism of TRLs that tend to contain twice as much cholesterol as compared to LDL. The accumulation of circulating TRLs and their partially lipolyzed derivatives, known as "remnants", is caused mainly by ineffective triglyceride catabolism. These cholesterol-enriched remnant particles are hypothesized to contribute to atherogenesis. The aim of the present narrative review is to briefly summarize the main pathways of TRL metabolism, bringing to the forefront the newly discovered role of apolipoproteins, the key physiological function of lipoprotein lipase and its main regulators, the importance of the fluxes of these particles in the post-prandial period, their catabolic rates and the role of apo CIII and angiopoietin-like proteins in the partition of TRLs during the fast-fed cycle. Finally, we provide a succinct summary of the new and old therapeutic armamentarium and the outcomes of key current trials with a final outlook on the different methodological approaches to measuring TRL remnants, still in search of the gold standard.
PubMed: 37445434
DOI: 10.3390/jcm12134399 -
The American Journal of Clinical... May 2024Metabolite abundance is a dynamic trait that varies in response to environmental stimuli and phenotypic traits, such as food consumption and body mass index (BMI, kg/m).
BACKGROUND
Metabolite abundance is a dynamic trait that varies in response to environmental stimuli and phenotypic traits, such as food consumption and body mass index (BMI, kg/m).
OBJECTIVES
In this study, we used the Netherlands Epidemiology of Obesity (NEO) study data to identify observational and causal associations between BMI and metabolite response to a liquid meal.
METHODS
A liquid meal challenge was performed, and Nightingale Health metabolite profiles were collected in 5744 NEO participants. Observational and one-sample Mendelian randomization (MR) analysis were conducted to estimate the effect of BMI on metabolites (n = 229) in the fasting, postprandial, and response (or change in abundance) states.
RESULTS
We observed 473 associations with BMI (175 fasting, 188 postprandial, and 110 response) in observational analyses. In MR analyses, we observed 20 metabolite traits (5 fasting, 12 postprandial, and 3 response) to be associated with BMI. MR associations included the glucogenic amino acid alanine, which was inversely associated with BMI in the response state (β: -0.081; SE: 0.023; P = 5.91 × 10), suggesting that as alanine increased in postprandial abundance, that increase was attenuated with increasing BMI.
CONCLUSIONS
Overall, this study showed that MR estimates were strongly correlated with observational effect estimates, suggesting that the broad associations seen between BMI and metabolite variation has a causal underpinning. Specific effects in previously unassessed postprandial and response states are detected, and these may likely mark novel life course risk exposures driven by regular nutrition.
Topics: Humans; Mendelian Randomization Analysis; Body Mass Index; Female; Male; Meals; Middle Aged; Postprandial Period; Netherlands; Adult; Obesity; Fasting
PubMed: 38494119
DOI: 10.1016/j.ajcnut.2024.03.009 -
The American Journal of Clinical... Mar 2024Anthocyanin and blueberry intakes positively associated with cognitive function in population-based studies and cognitive benefits in randomized controlled trials of...
Chronic and postprandial effect of blueberries on cognitive function, alertness, and mood in participants with metabolic syndrome - results from a six-month, double-blind, randomized controlled trial.
BACKGROUND
Anthocyanin and blueberry intakes positively associated with cognitive function in population-based studies and cognitive benefits in randomized controlled trials of adults with self-perceived or clinical cognitive dysfunction. To date, adults with metabolic syndrome (MetS) but without cognitive dysfunction are understudied.
OBJECTIVES
Cognitive function, mood, alertness, and sleep quality were assessed as secondary end points in MetS participants, postprandially (>24 h) and following 6-mo blueberry intake.
METHODS
A double-blind, randomized controlled trial was conducted, assessing the primary effect of consuming freeze-dried blueberry powder, compared against an isocaloric placebo, on cardiometabolic health >6 mo and a 24 h postprandial period (at baseline). In this secondary analysis of the main study, data from those completing mood, alertness, cognition, and sleep assessments are presented (i.e., n = 115 in the 6 mo study, n = 33 in the postprandial study), using the following: 1) Bond-Lader self-rated scores, 2) electronic cognitive battery (i.e., testing attention, working memory, episodic memory, speed of memory retrieval, executive function, and picture recognition), and 3) the Leeds Sleep Evaluation Questionnaire. Urinary and serum anthocyanin metabolites were quantified, and apolipoprotein E genotype status was determined.
RESULTS
Postprandial self-rated calmness significantly improved after 1 cup of blueberries (P = 0.01; q = 0.04; with an 11.6% improvement compared with baseline between 0 and 24 h for the 1 cup group), but all other mood, sleep, and cognitive function parameters were unaffected after postprandial and 6-mo blueberries. Across the ½ and 1 cup groups, microbial metabolites of anthocyanins and chlorogenic acid (i.e., hydroxycinnamic acids, benzoic acids, phenylalanine derivatives, and hippuric acids) and catechin were associated with favorable chronic and postprandial memory, attention, executive function, and calmness.
CONCLUSIONS
Although self-rated calmness improved postprandially, and significant cognition-metabolite associations were identified, our data did not support strong cognitive, mood, alertness, or sleep quality improvements in MetS participants after blueberry intervention. This trial was registered at clinicaltrials.gov as NCT02035592.
Topics: Adult; Humans; Anthocyanins; Blueberry Plants; Metabolic Syndrome; Postprandial Period; Cognition; Attention; Randomized Controlled Trials as Topic
PubMed: 38432713
DOI: 10.1016/j.ajcnut.2023.12.006