Miras, A.D. (Alexander D.)

Filtering

20192

Settings

Author search.filters.isAuthorOfPublication.c3b90dfc-1e2a-4a26-a7ca-e5cc941e25d7

Search Results

Now showing 1 - 2 of 2
  • Thumbnail Image
    Discriminatory ability of anthropometric measurements of central fat distribution for prediction of post‑prandial hyperglycaemia in patients with normal fasting glucose: the DICAMANO Study
    (Springer Science and Business Media LLC, 2019) Miras, A.D. (Alexander D.); Ibañez, P. (Patricia); Pérez-Pevida, B. (Belén); Frühbeck, G. (Gema); Margall, M.A. (María Ángeles); Silva, C. (Camilo); Salvador, J. (Javier); Romero, S. (Sonia); Escalada, J. (Javier); Nuñez-Cordoba, J.M. (Jorge M.); Vila, N. (Neus)
    Background and aims: Obesity is associated with impaired glucose tolerance which is a risk factor for cardiovascular risk. However, the oral glucose tolerance test (OGTT) is not usually performed in patients with normal fasting glycae‑ mia, thus ofering false reassurance to patients with overweight or obesity who may have post-prandial hyperglycae‑ mia. As an alternative to resource demanding OGTTs, we aimed to examine the predictive value of anthropometric measures of total and central fat distribution for post-prandial hyperglycaemia in patients with overweight and obesity with normal fasting glycaemia enrolled in the DICAMANO study. Methods: We studied 447 subjects with overweight/obesity with a fasting glucose value ≤5.5 mmol l −1 (99 mg dl−1 ) and BMI≥25 kg/m2 who underwent a 75-g OGTT. Post-prandial hyperglycaemia was defned as a glucose level≥7.8 mmol l −1 (140 mg dl−1 ) 2-h after the OGTT. The anthropometric measurements included body mass index, body adiposity index, waist circumference, neck circumference, waist-to-hip ratio and waist-to-height ratio. Results: The prevalence of post-prandial hyperglycaemia was 26%. Mean 1-h OGTT glucose levels, insulin resistance and beta cell dysfunction was higher in those subjects in the highest tertile for each anthropometric measurement, irrespective of fasting glucose level. Central fat depot anthropometric measurements were strongly and indepen‑ dently associated with an increased risk of post-prandial hyperglycaemia. After multivariable-adjustment for fasting plasma glucose level, smoking, and physical activity level, the odds ratio (95% confdence intervals) for the presence of post-prandial hyperglycaemia for neck circumference, waist circumference and waist-to-height ratio were 3.3 (1.4, 7.7), 2.4 (1.4, 4.4) and 2.5 (1.4, 4.5), respectively. Conclusions: In this large and comprehensively phenotyped cohort, one in four subjects had post-prandial hyper‑ glycaemia despite normal fasting glycaemia. Anthropometric indices of central fat distribution were strongly and independently associated with an increased risk of post-prandial hyperglycaemia. These results support the associa‑ tion between central adiposity and glucose derangements and demonstrate the clinical usefulness of anthropometric measurements as screening tools for the selection of patients who are most likely to beneft from an OGTT.
  • Thumbnail Image
    Mechanisms underlying type 2 diabetes remission after metabolic surgery
    (Frontiers Media SA, 2019) Miras, A.D. (Alexander D.); Pérez-Pevida, B. (Belén); Frühbeck, G. (Gema); Escalada, J. (Javier)
    Type 2 diabetes prevalence is increasing dramatically worldwide. Metabolic surgery is the most effective treatment for selected patients with diabetes and/or obesity. When compared to intensive medical therapy and lifestyle intervention, metabolic surgery has shown superiority in achieving glycemic improvement, reducing number of medications and cardiovascular risk factors, which translates in long-term benefits on cardiovascular morbidity and mortality. The mechanisms underlying diabetes improvement after metabolic surgery have not yet been clearly understood but englobe a complex interaction among improvements in beta cell function and insulin secretion, insulin sensitivity, intestinal gluconeogenesis, changes in glucose utilization, and absorption by the gut and changes in the secretory pattern and morphology of adipose tissue. These are achieved through different mediators which include an enhancement in gut hormones release, especially, glucagon-like peptide 1, changes in bile acids circulation, gut microbiome, and glucose transporters expression. Therefore, this review aims to provide a comprehensive appraisal of what is known so far to better understand the mechanisms through which metabolic surgery improves glycemic control facilitating future research in the field.