Pearls for Primary Care From ENDO 2015
Pearls for Primary Care From ENDO 2015
The Endocrine Society is the world's oldest and largest organization devoted to research on hormones and the clinical practice of endocrinology. The group's annual meeting, held recently in San Diego, California, covers some esoteric topics, but many more clinical issues that we encounter routinely in primary care. Below is a summary of key "take-away lessons" from the conference that are relevant to primary care practitioners.
Increased calorie consumption generally leads to weight gain and obesity, which then predisposes patients to diabetes. Oxytocin, which has long been used to induce labor in pregnant women, is now being studied as a potential agent to fight obesity.
A Harvard study by Lawson and colleagues showed that intranasal oxytocin reduced food consumption in men by an average of 122 calories in a single meal. This randomized, double-blind, placebo-controlled crossover study used a single dose of 24-IU intranasal oxytocin (Syntocinon®, Novartis) or placebo in 13 normal-weight and 12 overweight or obese men aged 18-45 years.
In addition to reducing calorie consumption, the oxytocin also reduced fat intake by 8.7 g. In addition, insulin sensitivity was improved, and there were no significant adverse events associated with the study drug. However, these results should be interpreted cautiously; this was a single-meal study, and the effect may not be sustained over time if homeostatic mechanisms adapt.
Another study out of Texas by Kim and Leonard looked at the relationship between nut intake and the risk for metabolic syndrome, to determine whether the link seen in adults extends to adolescents as well.The investigators analyzed data from the National Health and Nutrition Examination Survey (NHANES) database from 2003 to 2010. They found that adolescents (age 12-19 years) who ate at least 12.9 grams of nuts per day had a lower body mass index, lower waist circumference, higher high-density lipoprotein cholesterol level, and lower systolic blood pressure—all risk factors for the metabolic syndrome. They saw no differences in triglycerides, diastolic blood pressure, or glucose levels. In addition, risk for the metabolic syndrome decreased with each additional gram of nuts consumed per day, up to but not more than 50 grams per day.
In addition to adding nuts to one's diet, eliminating certain sugars may also help avoid gaining excess weight. A team of investigators from California was interested in seeing whether fructose restriction would have an impact on both hepatic lipogenesis and amounts of fat in the liver. They studied 40 obese Latino and African American children who routinely consumed more than 50 grams of fructose per day, much of it from processed food and sugary drinks. For 10 days, the children's usual meals were replaced with food containing the same relative energy and macronutrient content, but without fructose. In that short time, hepatic fat production decreased by 58.7% and liver fat was lowered by 29.5%. Excess liver fat is a risk factor for developing diabetes.
Finally, efforts to reduce obesity and diabetes also may involve the bacteria in our gut. A group of Chicago researchers presented a study demonstrating that gut flora changes with progressive states of dysglycemia. The investigators measured changes in intestinal bacteria at baseline and at 12 months in 116 African American veterans aged 45-75 years (average age, 60 years). These men were put into one of four groups:
The investigators found that the Bacteroidetes/Firmicutes ratio was 1.9 vs 0.9 in the first and second groups (P = .01) and 1.9 vs 1.1 in the first and third groups (P = .04). This study adds to other research that suggests the intestinal microbiome is a key factor in metabolic syndrome and diabetes, and it suggests that changing the diet could lead to healthier gut bacteria that may reduce the risk for disease.
The Endocrine Society is the world's oldest and largest organization devoted to research on hormones and the clinical practice of endocrinology. The group's annual meeting, held recently in San Diego, California, covers some esoteric topics, but many more clinical issues that we encounter routinely in primary care. Below is a summary of key "take-away lessons" from the conference that are relevant to primary care practitioners.
Diet, Weight Loss, and Diabetes
Increased calorie consumption generally leads to weight gain and obesity, which then predisposes patients to diabetes. Oxytocin, which has long been used to induce labor in pregnant women, is now being studied as a potential agent to fight obesity.
A Harvard study by Lawson and colleagues showed that intranasal oxytocin reduced food consumption in men by an average of 122 calories in a single meal. This randomized, double-blind, placebo-controlled crossover study used a single dose of 24-IU intranasal oxytocin (Syntocinon®, Novartis) or placebo in 13 normal-weight and 12 overweight or obese men aged 18-45 years.
In addition to reducing calorie consumption, the oxytocin also reduced fat intake by 8.7 g. In addition, insulin sensitivity was improved, and there were no significant adverse events associated with the study drug. However, these results should be interpreted cautiously; this was a single-meal study, and the effect may not be sustained over time if homeostatic mechanisms adapt.
Another study out of Texas by Kim and Leonard looked at the relationship between nut intake and the risk for metabolic syndrome, to determine whether the link seen in adults extends to adolescents as well.The investigators analyzed data from the National Health and Nutrition Examination Survey (NHANES) database from 2003 to 2010. They found that adolescents (age 12-19 years) who ate at least 12.9 grams of nuts per day had a lower body mass index, lower waist circumference, higher high-density lipoprotein cholesterol level, and lower systolic blood pressure—all risk factors for the metabolic syndrome. They saw no differences in triglycerides, diastolic blood pressure, or glucose levels. In addition, risk for the metabolic syndrome decreased with each additional gram of nuts consumed per day, up to but not more than 50 grams per day.
In addition to adding nuts to one's diet, eliminating certain sugars may also help avoid gaining excess weight. A team of investigators from California was interested in seeing whether fructose restriction would have an impact on both hepatic lipogenesis and amounts of fat in the liver. They studied 40 obese Latino and African American children who routinely consumed more than 50 grams of fructose per day, much of it from processed food and sugary drinks. For 10 days, the children's usual meals were replaced with food containing the same relative energy and macronutrient content, but without fructose. In that short time, hepatic fat production decreased by 58.7% and liver fat was lowered by 29.5%. Excess liver fat is a risk factor for developing diabetes.
Finally, efforts to reduce obesity and diabetes also may involve the bacteria in our gut. A group of Chicago researchers presented a study demonstrating that gut flora changes with progressive states of dysglycemia. The investigators measured changes in intestinal bacteria at baseline and at 12 months in 116 African American veterans aged 45-75 years (average age, 60 years). These men were put into one of four groups:
Those with stable glucose tolerance;
Those with stable impaired fasting glucose or stable impaired glucose tolerance;
Those with worsened glucose tolerance; or
Those with improved glucose tolerance.
The investigators found that the Bacteroidetes/Firmicutes ratio was 1.9 vs 0.9 in the first and second groups (P = .01) and 1.9 vs 1.1 in the first and third groups (P = .04). This study adds to other research that suggests the intestinal microbiome is a key factor in metabolic syndrome and diabetes, and it suggests that changing the diet could lead to healthier gut bacteria that may reduce the risk for disease.