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Postprandial Period (postprandial + period)
Selected AbstractsGlycaemic variability and complications in patients with diabetes mellitus: evidence from a systematic review of the literatureDIABETES OBESITY & METABOLISM, Issue 4 2010L. Nalysnyk Aim: The objective of this review was to assess the published evidence for an association between glycaemic variability and the development of chronic micro- and macrovascular complications in patients with diabetes mellitus (DM). Methods: A systematic review of English-language literature published from January 1990 through November 2008 was performed. Interventional and observational studies in patients with type 1 or type 2 DM reporting a measure of glycaemic variability and its impact on the development or progression of micro- and macrovascular diabetic complications were assessed. Results: A total of 18 studies ,8 on type 1 DM and 10 on type 2 DM patients,meeting the inclusion criteria were identified. Studies in patients with type 1 DM revealed that glucose variability has little impact on the development of diabetic complications. Only in two of the eight type 1 DM studies did glucose variability have a significant association with microvascular complications, but not with macrovascular complications. Among type 2 DM studies, a significant positive association between glucose variability and the development or progression of diabetic retinopathy, cardiovascular events and mortality was reported in 9 of 10 studies. Only one type 2 DM study reported no association between glucose variability and progression of retinopathy. Conclusions: Based on this overview of the available evidence, there appears to be a signal suggesting that glucose variability, characterized by extreme glucose excursions, could be a predictor of diabetic complications, independent of HbA1c levels, in patients with type 2 DM. Better daily control of blood glucose excursions, especially in the postprandial period, may reduce the risk of these complications. Future prospective trials evaluating and comparing the effect of the control of glycaemic variability on the development of diabetic micro- and macrovascular complications are needed to further strengthen the evidence base. [source] Glucose homeostasis and the gastrointestinal tract: insights into the treatment of diabetesDIABETES OBESITY & METABOLISM, Issue 1 2008D. Maggs The gastrointestinal tract is increasingly viewed as a critical organ in glucose metabolism because of its role in delivering glucose to the circulation and in secreting multiple glucoregulatory hormones that, in concert with insulin and glucagon, regulate glucose homeostasis. Under normal conditions, a complex interplay of these hormones acts to maintain plasma glucose within a narrow range despite large variations in the availability of glucose, particularly during transition from the fasting to fed state. In the fed state, the rate at which nutrients are passed from the stomach to the duodenum, termed gastric emptying rate, is a key determinant of postprandial glucose flux. In patients with diabetes, the regulation of glucose metabolism is disrupted resulting in fasting and postprandial hyperglycaemia. Elucidation of the role of the gastrointestinal tract, gut-derived glucoregulatory peptides and gastric emptying rate offers a new perspective on glucose homeostasis and the respective importance of these factors in the diabetes state. This review will highlight the importance of the gastrointestinal tract in playing a key role in glucose homeostasis, particularly in the postprandial period, and the role of established or new therapies that either leverage or modify gastrointestinal function to improve glycaemic state. [source] The benefits of oestrogens on postprandial lipid metabolism are lost in post-menopausal women with Type 2 diabetesDIABETIC MEDICINE, Issue 7 2006M. G. Masding Abstract Aims, Women with Type 2 diabetes appear to lose the protection against cardiovascular disease (CVD) afforded by oestrogens. We examined the effects of oestrogen hormone replacement therapy (HRT) on postprandial clearance of dietary fat in non-diabetic and diabetic post-menopausal women. Methods, In a cross-sectional study, fasting subjects [HRT+ and HRT, control and diabetic women; Type 2 diabetes (DM) HRT+n = 8, DM HRT,n = 14, control HRT+n = 7, control HRT,n = 11] consumed a meal containing the stable isotope 1,1,1,[13]C-tripalmitin, with blood and breath sampled for 6 and 24 h, respectively, in the postprandial period. Results, In diabetic women, there were no differences between the HRT+ and HRT, groups for any of these parameters. In contrast, in HRT+ compared with HRT, control women, the triglyceride (TG) area under the curve was lower [AUC; HRT+ median (range) 7.7 (4.1, 12.8) mmol/l per 6 h, HRT, 9.7 (3.9, 18.5) mmol/l per 6 h, P < 0.05] and [13]C-palmitic acid in the TG fraction was also lower [HRT+ 23.2 (10.3, 41.3) ng/ml per 6 h, HRT, 47.7 (12.6, 77.2) ng/ml per 6 h, P < 0.05], suggesting the lower postprandial triglyceridaemia associated with HRT in non-diabetic women is because of better chylomicron clearance. Conclusions, The oestrogen-associated advantage in clearance of dietary lipid we observed in non-diabetic post-menopausal women is not seen in post-menopausal diabetic women. This is likely to promote an atherogenic lipoprotein profile and may contribute to the loss of CVD protection seen in diabetic women. [source] Changes of gallbladder and gastric dynamics in patients with acute hepatitis AEUROPEAN JOURNAL OF CLINICAL INVESTIGATION, Issue 7 2001P. Portincasa Transient alterations of gallbladder morphology and dynamics have been reported in patients with during acute hepatitis A. The presence of dyspepsia also suggests involvement of gastric motility. During a 60-day follow-up, we investigated gallbladder and gastric motility in relation to dyspepsia in acute viral hepatitis A patients. Twenty patients were assessed at referral (day 0) and at days 7, 21, 42 and 60 and compared with 20 healthy volunteers. Gallbladder morphology and motility and gastric motility were assessed in the fasting and postprandial period by functional ultrasonography using a liquid test meal. Dyspeptic symptoms were scored. At day 0, fasting gallbladder volume was 5·9 ± 1·3 mL, 32·6 ± 4·6 mL, and 21·5 ± 1·9 mL (mean ±,SE) in patients with gallbladder sludge (n = 7), without sludge (n = 13) and controls, respectively (P < 0·05 in sludge vs. no sludge and controls; P < 0·05 in no sludge vs. controls, anova). Small fasting gallbladder volume in patients with sludge increased and sludge disappeared within 7 days. At day 0, patients with sludge also had increased thickness of fasting gallbladder wall and increased serum transaminase levels compared with patients without sludge and controls. Gallbladder contraction was similar in patients and controls. However, patients had delayed gastric emptying, which positively correlated with dyspepsia score. Gallbladder morphological changes observed in the acute phase of hepatitis A are transient and are associated with hepatocellular damage. Gastric emptying is delayed during the first week of disease and is associated with dyspeptic symptoms. [source] Frequency analyses of gastric pH in control and gastro-oesophageal reflux disease subjects treated with a proton-pump inhibitorALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 11-12 2004J. D. Gardner Summary Background :,We are unaware of any solid theoretical or pathophysiological basis for selecting pH 4 or any other pH value to assess gastric acidity. Aim :,To examine the frequency of different gastric pH values in control and GERD subjects. Methods :,Gastric pH was measured for 24 h in 26 control subjects, 26 gastro-oesophageal reflux disease subjects at baseline and the same 26 gastro-oesophageal reflux disease subjects during treatment with a proton-pump inhibitor. Histograms were constructed using the 21 600 values generated from each recording and bins of 0.25 pH units. Results :,The distribution of gastric pH values in gastro-oesophageal reflux disease subjects was significantly different from that in controls and in some instances the distributions detected significant differences that were not detected by integrated acidity. Proton-pump inhibitor treatment significantly altered the distribution of gastric pH values and the nature of this alteration during the postprandial period was different from that during the nocturnal period. Using time pH,4 can significantly underestimate the magnitude of inhibition of gastric acidity caused by a proton-pump inhibitor. Conclusions :,The distribution of gastric pH values provides a rationale for selecting a particular pH value to assess gastric acidity. In some instances, the distribution of gastric pH values detects significant differences between gastro-oesophageal reflux disease and normal subjects that are not detected by integrated acidity. [source] Circadian patterns of gastric electrical and mechanical activity in dogsNEUROGASTROENTEROLOGY & MOTILITY, Issue 1 2008R. Aviv Abstract, Gastric motor function assessment, in humans and animals, is typically performed for short recording periods. The aim of this article was to monitor gastric electrical and motor activity in the antrum and fundus simultaneously, for long periods, using a new implantable system. Ten dogs were implanted with fundic and antral electrodes for assessment of impedance and electrical activity. Dogs were studied while in cages, for periods of 22,26 h. From late evening and until feeding on the next day, slow wave (SW) rhythm demonstrated a distinct pattern of intermittent pauses (mean duration = 22.8 ±4.1 s) that delineated groups of SW's. Phasic increases in fundic tone were seen mostly in association with SW pauses, and were highly correlated with antral contractions, R2 = 0.652, P < 0.05. The SW rate (events per minute) in the postprandial period, fasting and night time was 4.2 ± 0.2, 5 ± 0.2 and 4.7 ± 0.3, respectively, P < 0.05 postprandial vs other periods. Antral and fundic mechanical activities were highly correlated during fasting, particularly at night. This novel method of prolonged gastric recording provides valuable data on the mechanical and electrical activity of the stomach, not feasible by current methods of recording. During fasting, fundic and antral motor activities are highly correlated and are associated with periodic pauses in electrical activity. [source] 35 Electrogastrography in healthy participants: comparison of children and adultsNEUROGASTROENTEROLOGY & MOTILITY, Issue 6 2006CA FRIESEN The current study examined whether electrogastrogram (EGG) patterns differ between children/adolescents and adults, including whether EGG recordings obtained from healthy children would be considered normal by standards established for adults. Twenty-eight healthy children (54% females; ages 8,17, M = 12.4 years) were evaluated and compared to 15 healthy adults. EGGs were recorded for 30 min in the fasting state and for 1 h following a standard meal. For both pediatric and adult participants, there was a significant increase in both the dominant frequency and the dominant power from the pre- to the post , prandial period (p < 0.001 for each). There was a significant post-prandial increase in the %normal slow waves in pediatric participants only (81.5 vs. 89.0% vs. p < 0.001). Children demonstrated a significantly lower mean fasting %normal slow waves (81.5% vs. 94.2%) and a significantly greater fasting % tachygastria (8.9% vs. 2.3%) than did adults. Other parameters did not differ. Using adult standards, the %normal slow waves were ,70% of recording time in 96% children in the fasting state and in 100% in the postprandial period. A postprandial power increase was seen in 89% of the children. In conclusion, while adults should not be used as controls in pediatric studies of EGG, our data would indicate that American Motility Society (AMS) consensus adult criteria for a normal EGG are appropriate to apply to children and adolescents when utilizing methodology and meal challenge similar to that used to establish the adult norms. [source] Cardiorespiratory measures before and after feeding challenge in term infants are related to birth weightACTA PAEDIATRICA, Issue 7 2009M Cohen Abstract Aim:, This study tested the hypothesis that, within a few hours of delivery, cardiorespiratory measure taken during feeding provides markers of group differences related to birth weight. A secondary hypothesis was that high-frequency heart period variability would be related to underlying differences in autonomic control associated with birth weight. Methods and Subjects:, One hundred four term infants in the lowest, middle, and highest birth weight quintiles were enrolled. Exclusion criteria were evidence of drug abuse, congenital anomalies, Apgar scores less than 7 or admission to the neonatal intensive care unit. Within 96 h of delivery, heart and respiratory rates, blood pressures and heart period variability were measured before, during and after feeding. Results:, Term babies in the lowest quintile of birth weights have lower heart rates prior to feeding but greater increases in heart rate during the early postprandial period. Assessments of high-frequency heart period variability suggest that small term infants have greater parasympathetic tone before feeding and more sustained parasympathetic withdrawal following feeding. Conclusion:, Measurements of cardiorespiratory functions before and after feeding are related to birth weight and may provide markers that can help identify the most vulnerable of infants with small size at birth. [source] 47 Effects of retrograde gastric electrical stimulation on gastric motility and plasma hormones in dogsNEUROGASTROENTEROLOGY & MOTILITY, Issue 6 2006G SONG Aims:, The aim of this study was to investigate the effect of different parameters of RGES with trains of long pulses in turning gastric slow waves into tachygastria, and evaluate the effects of RGES with the efficient trains of pulses on gastric slow waves, gastric emptying of solids and plasma concentrations of satiety-related peptides and glucose. Methods:, Seven female dogs implanted with four pairs of gastric electrodes were studied in two experiments. The first experiment included a series of sessions with different pacing parameters in the fasting state, each lasting 10 min. The second experiment included two randomized sessions (control and RGES). Gastric emptying of solid was measured by scintigraphy for a period of 4 h. Blood samples were collected at 45 and 15 min before, 30, 60 and 120 min after the meal. Plasma leptin, insulin and glucagon were measured using radioimmunoassay method. Plasma glucose was assessed with a commercially available glucometer. RGES was applied via the distal pair of electrodes (2 cm above the pylorus) with trains of pulses. RGES was initiated 30 min before the first blood sample and maintained for a period of 2.5 h. Gastric slow waves and symptomatic response were also recorded in each session. Results:, (1) RGES with pulse trains (12 trains/min) was able to turn regular gastric slow waves into tachygastria. (2) RGES with the efficient parameters (frequency: 40 Hz; pulse width: 2 ms; amplitude: 5 mA; train on-time, 2 s; off-time, 3 s) was capable of delaying gastric emptying of solids (P < 0.05). (3) Compared with the control session without RGES, the total AUC's of plasma insulin with RGES was significantly decreased in the fasting and postprandial periods (p < 0.05). However, the total area under curves (AUC's) of plasma leptin, glucagon, and glucose were not significantly affected by RGES (p > 0.05). (4) This method of GES induced no noticeable symptoms. Conclusion:, RGES with at a tachygastrial frequency decreases gastric emptying of solids and plasma insulin, but has no effects on plasma leptin, glucagons, and glucose. [source] | ||||||||||||||||||||||