Daily Endocrinology Research Analysis

AIMS/HYPOTHESIS: There is no clear consensus regarding accurate risk stratification in early pregnancy for later developing gestational diabetes mellitus (GDM). Therefore, this study aims to evaluate the predictive performance of an OGTT and several biomarkers in the first trimester of pregnancy. Their association with insulin action, beta cell function and requirement for insulin were additionally assessed. METHODS: In this prospective cohort study, we included 657 pregnant women in six Central European centres. Patient history and anthropometric data were obtained, a blinded 75 g OGTT was performed and biochemical markers were assessed at a median gestational age of 13.4 weeks (IQR 12.7-14.1). Another OGTT was performed in later pregnancy to identify women with GDM. A detailed investigation of glucose homeostasis was performed at both visits in a subgroup of women. RESULTS: Eighty-three women (12.6%) developed GDM. Progression to GDM was fairly well predicted by glucose concentrations during the early OGTT in terms of areas under the receiver operating characteristic curves (OGTT glucose at fasting: 0.68; OGTT glucose at 60 min: 0.74; OGTT glucose at 120 min: 0.72). Some biomarkers showed significant but modest predictive accuracy. Early gestational OGTT glucose concentrations were further associated with impaired insulin sensitivity and beta cell dysfunction, as well as the requirement for insulin in later pregnancy. CONCLUSIONS/INTERPRETATION: Although the accurate diagnosis of GDM before 24 weeks remains an ongoing discussion, dynamically assessed glucose concentrations during an early OGTT were closely associated with impaired glucose homeostasis and showed good predictive accuracy for later development of GDM as well as the requirement for insulin. These findings may be used to develop a protocol to distinguish between low- and high-risk mothers. Trial registration ClinicalTrials.gov NCT02035059.

BACKGROUND & AIMS: Dietary emulsifier consumption might promote intestinal inflammation, eventually leading to inflammatory bowel diseases. However, human data are scarce and involve a limited number of emulsifiers. We studied the effects of an emulsifier-free diet (EFD) and specific emulsifier supplementation. METHODS: Sixty healthy participants followed an EFD for 2 weeks. Then, using a randomized placebo-controlled trial design, participants continued an EFD for 4 weeks with the addition of either carboxymethyl cellulose, polysorbate-80, carrageenan, soy lecithin, native rice starch, or no additives administered through brownies. Effects on cardiometabolic markers, gut microbiota, intestinal inflammation, and permeability were explored. RESULTS: After 2 weeks of an EFD, cholesterol levels decreased (P = .00006). Under emulsifier supplementation, alpha diversity remained stable, yet microbial composition was affected by treatment and visit. Compared with placebo, concentrations of all short chain fatty acids were lower in those consuming carboxymethyl cellulose, which was mirrored by other emulsifiers, although not all reached significance. No differences in fecal calprotectin, C-reactive protein, serum lipopolysaccharide-binding protein, cholesterol levels, or other metabolic markers were observed between placebo and emulsifiers at the end of the intervention. Serum inflammatory and cardiometabolic proteins remained unchanged. In individuals consuming carrageenan, transcellular intestinal permeability increased (P = .04) compared with baseline. CONCLUSION: In this double-blind placebo-controlled exploratory trial, emulsifier supplementation lowered short chain fatty acid concentration compared with placebo. Emulsifier supplementation did not impact intestinal or systemic inflammation or metabolic endpoints. Cholesterol levels decreased after 2 weeks of an EFD. These results point towards potential intestinal benefits of limiting dietary emulsifiers in the diet, requiring further investigation. CLINICALTRIALS: gov, Number: NCT06552156.

OBJECTIVE: To study bone turnover markers (BTM) and sex steroids in relation to Trabecular Bone Score (TBS) in men. MATERIAL AND METHODS: Longitudinal, population-based study in 465 healthy men, aged 25-45 years at baseline. Lumbar spine TBS was calculated with TBS iNsight® version 4 (v19.4.1, core module, Medimaps, Pessac, France), which adjusts for soft tissue thickness correction via DXA measurements. Sex hormone binding globulin (SHBG), C-terminal telopeptide and pro collagen type 1 N-terminal propeptide were measured using immunoassays. Total testosterone (T) and estradiol (E2) were determined by liquid chromatography-tandem mass spectrometry, free T and free E2 calculated. Statistical analyses were conducted via linear mixed-effects modelling. RESULTS: At baseline, TBS was positively associated with free testosterone (p=0.01), free estradiol and total estradiol (both p<0.001), but not with total testosterone nor with BTM. Over a follow-up of 12.5 years, TBS declined by 1.43% (p<0.001). Higher baseline BMI and trunk fat were predictive of greater decreases in TBS (p=0.01 and p=0.02). Baseline levels of sex steroids and BTM nor changes therein were associated with changes in TBS. CONCLUSIONS: TBS already decreases in young and middle-aged healthy men, corroborating earlier studies showing early decrease of trabecular bone volume and changes in trabecular microarchitecture. Although we identified some potentially contributing determinants, the underlying mechanisms of changes in TBS and trabecular bone in young men are yet to be fully elucidated.