Patrick J Manning

University of Otago , Taieri, Otago Region, New Zealand

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Publications (37)159.38 Total impact

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    ABSTRACT: The aim of this study was to investigate whether small doses of intense exercise before each main meal ('exercise snacks') would result in better blood glucose control than a single bout of prolonged, continuous, moderate-intensity exercise in individuals with insulin resistance. Nine individuals completed three exercise interventions in randomised order. Measures were recorded across 3 days with exercise performed on the middle day, as either: (1) traditional continuous exercise (CONT), comprising 30 min moderate-intensity (60% of maximal heart rate [HRmax]) incline walking before dinner; (2) exercise snacking (ES), consisting of 6 × 1 min intense (90% HRmax) incline walking intervals 30 min before each meal; or (3) composite exercise snacking (CES), encompassing 6 × 1 min intervals alternating between walking and resistance-based exercise, 30 min before meals. Meal timing and composition were controlled within participants for exercise interventions. ES attenuated mean 3 h postprandial glucose concentration following breakfast (by 1.4 ± 1.5 mmol/l, p = 0.02) but not lunch (0.4 ± 1.0 mmol/l, p = 0.22), and was more effective than CONT following dinner (0.7 ± 1.5 mmol/l below CONT; p = 0.04). ES also reduced 24 h mean glucose concentration by 0.7 ± 0.6 mmol/l (p = 0.01) and this reduction persisted for the subsequent 24 h (lower by 0.6 ± 0.4 mmol/l vs CONT, relative to their baselines; p = 0.01). CES was just as effective as ES (p > 0.05 for all glycaemic variables) at improving glycaemic control. Dosing exercise as brief, intense 'exercise snacks' before main meals is a time-efficient and effective approach to improve glycaemic control in individuals with insulin resistance.
    Diabetologia 05/2014; 57(7). · 6.88 Impact Factor
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    Diabetes care 12/2013; 36(12):e223. · 7.74 Impact Factor
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    ABSTRACT: Milk consumption decreases inflammatory stress in overweight and obese subjects. Casein is the major protein in milk and enhances the secretion of insulin that has anti-inflammatory activity. The aim of the present study was to compare the acute effect of meals rich in casein and carbohydrate and a combination of both nutrients on postprandial plasma concentrations of IL-6, a marker of inflammation, in obese women. A total of twenty-five obese women aged 38–68 years consumed isoenergetic meals rich in potato (POT) or casein (CA) or a combination of both these meals (POT + CA), in random order in a cross-over trial. After an overnight fast, blood samples were collected before and at 1 and 4 h after the meals and circulating concentrations of IL-6, glucose, insulin and NEFA were measured. Plasma IL-6 concentrations increased significantly (P < 0·001) during 4 h after the meals. The AUC of postprandial IL-6 concentrations was not significantly (P = 0·77) different among the meals. Postprandial serum insulin concentration AUC was significantly higher during the POT + CA meal compared with the POT meal (P = 0·001) and the CA meal (P < 0·05), which in turn was significantly higher than the POT meal (P < 0·05). These data show that while ingestion of CA alone or combined with POT acutely increases circulating insulin concentrations, it does not appreciably alter the postprandial increase in plasma IL-6 concentrations in obese women.
    Journal of Nutritional Science. 09/2013; 2.
    This article is viewable in ResearchGate's enriched format
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    ABSTRACT: Animal studies have shown that diets rich in thermally oxidized fat increase glucose and decrease insulin and triglyceride (TG) concentrations in the blood. We hypothesized that ingestion of a potato meal rich in thermally oxidized sunflower oil (TOSO) would decrease postprandial concentrations of insulin, incretins, and TG and increase plasma glucose concentrations. Twenty healthy subjects aged 22 to 70 years consumed meals rich in TOSO or unheated sunflower oil and containing paracetamol (1.5 g) in a randomized, crossover trial. Blood samples were taken at baseline and 10, 20, 30, 60, 90, and 120 minutes after the meals and glucose, insulin, TG, nonesterified fatty acids, glucagon-like polypeptide-1, glucose-independent polypeptide, and paracetamol (as a marker of gastric emptying) were measured in plasma or serum. The incremental areas under the curve of glucose, insulin, nonesterified fatty acid, incretins, and paracetamol levels were not significantly different between the meals. Plasma TG incremental area under the curve was 44% lower after the TOSO meal at a marginal level of significance (P = .06) in the total study population and was significantly (P = .04) and 61% lower in those of median age and younger (n = 11). These data suggest that ingestion of TOSO may acutely decrease plasma TG mainly in younger individuals and does not acutely affect glucose and insulin metabolism or gastric emptying in healthy subjects.
    Nutrition research 09/2013; 33(9):711-8. · 2.59 Impact Factor
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    ABSTRACT: Plasma interleukin-6 (IL-6) concentrations decrease acutely 1 h after ingestion of a glucose load or mixed meals and this may be mediated by an anti-inflammatory effect of insulin. The aim of the present study was to compare the effect of higher versus lower insulin levels on plasma IL-6 concentrations following oral compared with intravenous glucose administration in overweight/obese subjects. Fifteen subjects (12 women and 3 men) with BMI >28 kg/m(2) were given an oral glucose load (75g) followed a week later by an intravenous infusion of glucose aimed at matching plasma glucose concentrations during the oral glucose load. A week later, they drank a volume of water equivalent to the volume consumed with the oral glucose load. Plasma glucose, insulin, nonesterified fatty acids, and IL-6 concentrations and blood hematocrit were measured at 30 minute intervals for 2 h following each intervention. Plasma IL-6 decreased (13-20%) significantly (P = 0.009) at 30 min to 90 min following the oral glucose load and did not change significantly following the other two interventions. The incremental area under the curve for plasma IL-6 concentrations following oral intake of glucose was significantly lower compared with concentrations following intravenous glucose (P = 0.005) and water control (P = 0.02). Circulating insulin concentrations were significantly (P<0.001) and 2.8 fold higher following oral compared with intravenous glucose administration. These data show that plasma IL-6 concentrations did not decrease during isoglycemic, intravenous glucose administration suggesting that the markedly higher circulating insulin levels and/or gut-related factors may mediate the acute decrease in plasma IL-6 after oral glucose intake in overweight/obese subjects. Australian New Zealand Clinical Trials Registry ACTRN12612000491864.
    PLoS ONE 06/2013; 8(6):e66395. · 3.53 Impact Factor
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    ABSTRACT: The metabolic syndrome is associated with abnormal glucose and lipid metabolism, insulin resistance, increased oxidative stress and pro-inflammatory activity that increase the risk of type 2 diabetes and cardiovascular disease. The aim of this study was to investigate the effect of treatment with the antioxidant α-lipoic acid (ALA) with or without vitamin E supplementation, on markers of insulin resistance and systemic inflammation and plasma nonesterified fatty acid (NEFA) concentrations in individuals with the metabolic syndrome. In a randomized, double-blind, placebo-controlled trial, subjects with the metabolic syndrome received ALA (600 mg/day, n = 34), vitamin E (100 IU/day, n = 36), both ALA and vitamin E (n = 41), or matching placebo (n = 40) for 1 year. Fasting circulating concentrations of glucose and insulin were measure every 3 months and NEFA, markers of inflammation, adiponectin and vitamin E were measured at 6 monthly intervals. Plasma NEFA concentrations decreased [-10 (-18, 0)%] at a marginal level of significance (p = 0.05) in those who received ALA alone compared with placebo and decreased [-8 (-14, -1)% (95% CI)] significantly (P = 0.02) in participants who were randomised to ALA with and without vitamin E compared with those who did not receive ALA. Fasting glucose, insulin, homeostatic model assessment of insulin resistance, adiponectin, and markers of inflammation did not change significantly during the study. These data suggest that prolonged treatment with ALA may modestly reduce plasma NEFA concentrations but does not alter insulin or glucose levels in individuals with the metabolic syndrome.
    Nutrition, metabolism, and cardiovascular diseases: NMCD 03/2012; · 3.52 Impact Factor
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    ABSTRACT: Paraoxonase 1 (PON 1) has antioxidant and cardioprotective properties and is abnormally low in type 2 diabetic serum. This study aimed to determine the effect of type 2 diabetes and meals rich in saturated fat and oleic acid on PON1 activity in chylomicrons and very low density lipoproteins (VLDL). PON1 arylesterase activity was measured in chylomicrons and VLDL that were isolated in serum from 20 patients with type 2 diabetes and 20 age- and gender-matched, overweight controls 3 h after meals rich in cream or olive oil in a randomized, cross-over study. Chylomicron-PON1 activity (45%, P = 0.02), ratio chylomicron-PON1/chylomicron-triacylglycerides (TAG) (42%, P = 0.03) and chylomicron-protein content (46%, P < 0.001) were significantly lower in patients with type 2 diabetes compared with controls after the olive oil meal with comparable findings after the meal rich in cream. After ingestion of olive oil, chylomicron-PON1 activity was significantly higher in controls (P = 0.01) and marginally higher (P = 0.06) in diabetic patients and chylomicron-TAG were significantly (P < 0. 05) higher in both groups of subjects, compared with values after ingestion of cream. VLDL-PON1 increased (two-fold) significantly (P < 0.003) during both meals. Chylomicron-PON1 activity was correlated significantly with chylomicron-protein (P < 0.001, n = 40) and with postprandial serum PON1 activity (P ≤ 0.001, n = 40). Our data suggest that type 2 diabetes is associated with abnormally low chylomicron-PON1 activity after fatty meals and this may be linked to lower chylomicron-protein content and serum PON1 activity. Switching from saturated fat to olive oil in the meal increases PON1 activity in the chylomicron fraction largely due to increased numbers of chylomicron particles.
    Lipids 12/2011; 47(3):259-67. · 2.56 Impact Factor
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    ABSTRACT: Due to altered red blood cell survival and erythropoietin therapy glycated haemoglobin (HbA1c) may not accurately reflect long-term glycaemic control in patients with diabetes and chronic kidney disease (CKD). Glycated albumin (GA) and fructosamine are alternative markers of glycaemia. The aim of this study was to investigate the accuracy of HbA1c, GA and fructosamine as indicators of glycaemic control using continuous glucose monitoring. HbA1c, GA and fructosamine concentrations were measured in 25 subjects with diabetic nephropathy (CKD stages 4 and 5 (estimated glomerular filtration rate <30 mL/min per 1.73 m(2) )) matched with 25 subjects with diabetes and no evidence of nephropathy. Simultaneous real-time glucose concentrations were monitored by continuous glucose monitoring over 48 h. GA correlated significantly to mean glucose concentrations in patients with and without CKD (r = 0.54 vs 0.49, P < 0.05). A similar relationship was observed with fructosamine relative to glucose. A poor correlation between HbA1c and glucose was observed with CKD (r = 0.38, P = ns) but was significant in the non-CKD group (r = 0.66, P < 0.001). The GA/HbA1c ratio was significantly higher in diabetic patients with CKD compared with controls (2.5 ± 0.4 vs 2.2 ± 0.4, P < 0.05). HbA1c values were significantly lower in CKD patients, relative to non-CKD patients at comparable mean glucose concentrations. HbA1c significantly underestimates glycaemic control in patients with diabetes and CKD stages 4 and 5. In severe CKD, GA more accurately reflects glycaemic control compared with fructosamine and HbA1c and should be the preferred marker of glycaemic control.
    Nephrology 08/2011; 17(2):182-8. · 1.86 Impact Factor
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    ABSTRACT: A retrospective audit to assess the impact of a combined diabetes-renal consultant clinic over 10 years, on slowing the progression of diabetic nephropathy, using recognised markers of renal disease progression, including creatinine clearance and proteinuria. 44 high-risk patients with diabetic nephropathy defined as having significant proteinuria (an elevated albumin creatinine ratio greater than 30 mg/mmol), and hypertension, a progressive rise in plasma creatinine or other evidence of diabetic microvascular disease or macrovascular disease, were identified. Sufficient follow up was defined as at least two data sets over a 12-month period prior to referral to the combined clinic, and at least 18 months of combined clinic follow up thereafter. In this high risk group, GFR was falling at an average of 7.97 m/min/year (95% CI 9.83-6.10 ml/min/year) at the time of referral and following clinic intervention this was significantly reduced to 3.17 ml/min/year (95% CI 4.47-1.87 ml/min/year) over the duration of follow up. Blood pressure, glycaemic control and lipid status remained stable and close to current recommended guidelines. A combined diabetes-renal consultant clinic is an effective intervention to improve the outcome of high-risk diabetics with progressive diabetic nephropathy.
    Diabetes research and clinical practice 03/2011; 92(3):356-60. · 2.74 Impact Factor
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    ABSTRACT: A pilot study to investigate the anti-inflammatory effect of insulin in patients on maintenance haemodialysis. Elevated concentrations of pro-inflammatory and oxidative mediators are thought to contribute to the increased cardiovascular risk in haemodialysis. Insulin has been demonstrated to have anti-inflammatory properties and a continuous low-dose insulin infusion in critically ill patients is associated with improved outcomes. The anti-inflammatory effects of insulin in haemodialysis have not been investigated. In a single-blind cross-over study, 11 stable, non-diabetic, haemodialysis patients received a continuous insulin infusion (Actrapid 2 IU/h) during a dialysis of 4 h or a conventional dialysis in random order. Normoglycaemia was maintained by a modified glucose dialysate and glucose infusion. Blood samples were collected at baseline, 1, 4, 6 and 24 h. C-reactive protein (CRP), tumour necrosis factor-α, interleukin-6, neopterin, vascular cell adhesion molecule 1, protein thiols, dityrosine and peroxides were measured. Insulin produced a significant reduction in median CRP over the immediate dialysis phase (confidence interval) by 6% (2-9% (95% CI), P=0.006) and an even greater decline at 24 h (19% (8-28%, 95% CI), P=0.001) compared with values of the conventional dialysis. No significant changes were observed in the other markers. Median glucose levels were comparable during both dialysis sessions. During haemodialysis, insulin may have a modest anti-inflammatory effect as evident by a reduction in CRP that appears to have a persistent effect over the next 24 h post dialysis. More studies are required to examine longer-term benefits as well as the potential role in more high-risk individuals.
    Nephrology 01/2011; 16(1):68-75. · 1.86 Impact Factor
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    ABSTRACT: The suggestion that body mass index (BMI) cutoffs to define obesity should differ in persons of Polynesian descent compared with Europeans is based principally on the observation that persons of Polynesian descent have a relatively higher proportion of lean body mass for a given BMI. The objectives were to determine whether the relation between BMI, waist circumference, and metabolic comorbidity differs in the 2 major ethnic groups in New Zealand and to ascertain whether ethnicity-specific BMI and waist circumference cutoffs for obesity are justified for Māori (indigenous New Zealanders). Subjects included a convenience sample of 1539 men and women aged 17-82 y (47% Māori, 53% white) with measures of BMI, waist circumference, blood pressure, fasting insulin, glucose, and lipids. The sensitivity and specificity of BMI (in kg/m(2); 30 and 32), waist circumference (80 and 88 cm in women, 94 and 102 cm in men), and waist-to-height ratio (WHtR; > or =0.6) in relation to insulin sensitivity, insulin resistance, and the metabolic syndrome were determined. Receiver operating characteristic curves and areas under the curve (AUCs) were also calculated. No ethnic or sex differences between AUCs were observed for BMI, waist circumference, or WHtR, which showed that these anthropometric measures perform similarly in Māori and European men and women and correctly discriminate between those with and without insulin resistance or the metabolic syndrome 79-87% of the time. Any increase in specificity from a higher BMI cutoff of 32 in Māori was offset by appreciable reductions in sensitivity. These findings argue against having different BMI or waist circumference cutoffs for people of Polynesian descent.
    American Journal of Clinical Nutrition 08/2010; 92(2):390-7. · 6.50 Impact Factor
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    ABSTRACT: Ingestion of 75 g glucose during an oral glucose tolerance test (OGTT) increases systemic inflammation and oxidative stress in healthy subjects and patients with type 2 diabetes mellitus, but the effect in overweight/obese nondiabetic individuals is uncertain. The aim of the present study was to determine the effect of an OGTT on plasma concentrations of inflammatory cytokines and peroxides in 33 subjects with body mass index >27 kg/m(2). After an overnight fast, blood samples were taken from participants immediately before and at 30, 60, 90, and 120 minutes after ingestion of 75 g glucose. Plasma glucose, insulin, free fatty acid, interleukin (IL)-6, tumor necrosis factor alpha, and peroxides were measured during the tests. Plasma IL-6 concentrations decreased (13%) significantly (P < .001) at 30 and 60 minutes, whereas plasma peroxide concentrations decreased slightly (3%, P = .003) at 30 minutes during the tests. The 30-minute decrease in plasma IL-6 was correlated significantly and inversely with the concomitant increase in plasma insulin (r = -0.410, P = .02) and with the ratio of insulin to glucose at 30 minutes during the OGTT (r = -0.366, P = .04). These data suggest that plasma concentrations of IL-6 are acutely decreased possibly because of the predominance of the anti-inflammatory effect of hyperinsulinemia over the proinflammatory effect of hyperglycemia after ingestion of a large quantity of glucose in obese individuals.
    Metabolism: clinical and experimental 11/2008; 57(10):1345-9. · 3.61 Impact Factor
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    ABSTRACT: The aim of this study was to compare the acute effect of (i) meals rich in saturated fat, oleic acid, and alpha-linolenic acid and (ii) meals rich in starch and fiber on markers of inflammation and oxidative stress in obese and lean women. In a crossover study, 15 abdominally obese women (age, 54 +/- 9 years; BMI, 37.3 +/- 5.5 kg/m2) and 14 lean women (age, 53 +/- 10 years; BMI, 22.9 +/- 1.9 kg/m2) consumed meals rich in cream (CR), olive oil (OL), canola oil (CAN), potato (POT), and All-Bran (BRAN) in random order. Blood samples were collected before and up to 6 h after the meals and plasma interleukin-6 (IL-6), IL-8, tumor necrosis factor-alpha (TNF-alpha), lipid peroxides (LPOs), free-fatty acids (FFAs), insulin, glucose, and cortisol were measured. Plasma IL-6 decreased significantly 1 h after the meals then increased significantly above baseline at 4h and 6h in obese women and at 6h in lean women. The incremental area under the curve (iAUC) for IL-6 was significantly (P = 0.02) higher in obese compared with lean women and was significantly lower following the high fiber BRAN meal compared with a POT meal (P = 0.003). Waist circumference (R = 0.491, P = 0.007) and cortisol AUC (R = -0.415, P = 0.03) were significant determinants of the magnitude of 6h changes in plasma IL-6 after the meals. These findings suggest that the postprandial response of plasma IL-6 concentrations may be influenced by the type of carbohydrate in the meal, central adiposity, and circulating cortisol concentrations in women.
    Obesity 10/2008; 16(9):2046-52. · 4.39 Impact Factor
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    ABSTRACT: The purpose of this study was to examine the chronic effect of rosiglitazone on oxidative stress, inflammatory markers and hepatic risk factors for type 2 diabetes in overweight individuals. In addition we examined the effect of rosiglitazone on post-glucose challenge levels of glucose and insulin. Forty overweight individuals (BMI>27kg/m(2)) were randomized in a double blind fashion to receive 6 months treatment with either rosiglitazone 4mg/day or placebo. Primary endpoints were markers of oxidative stress (plasma peroxides), inflammatory markers (IL-6, TNF-alpha and CRP) and postprandial glucose metabolism (glucose and insulin). Secondary endpoints were changes in insulin resistance as measured by HOMA, first and second phase insulin secretion, adiponectin and effects on lipid and hepatic parameters. Plasma peroxides (-15%) decreased significantly during 6 months in the group that received rosiglitazone compared with placebo. Fasting plasma insulin concentrations decreased by 24% and HOMA increased by 35% in those receiving rosiglitazone. Plasma IL-6 (-25%), CRP (-55%) and GGT (-25%) concentrations declined significantly in the rosiglitazone group. Rosiglitazone increased plasma adiponectin by 81%. Treatment with rosiglitazone also resulted in significantly reduced first phase (-33%) and second phase (-20%) insulin release. In overweight non-diabetic people rosiglitazone reduces oxidative stress and improves insulin sensitivity. Rosiglitazone also improves first and second phase insulin secretion and reduces markers of inflammation and GGT.
    Diabetes research and clinical practice 07/2008; 81(2):209-15. · 2.74 Impact Factor
  • Diabetes Research and Clinical Practice 02/2008; 79. · 2.54 Impact Factor
  • Diabetes Research and Clinical Practice 02/2008; 79. · 2.54 Impact Factor
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    ABSTRACT: Regular endurance exercise stimulates muscle metabolic capacity, but effects of very prolonged endurance exercise are largely unknown. This study examined muscle substrate availability and utilization during prolonged endurance exercise, and associated metabolic genes. Data were obtained from 11 competitors of a 4- to 5-day, almost continuous ultraendurance race (seven males, four females; age: 36 +/- 11 years; cycling Vo(2peak): males 57.4 +/- 5.9, females 48.1 +/- 4.0 mL kg(-1) min(-1)). Before and after the race muscle biopsies were obtained from vastus lateralis, respiratory gases were sampled during cycling at 25 and 50% peak aerobic power output, venous samples were obtained, and fat mass was estimated by bioimpedance under standardized conditions. After the race fat mass was decreased by 1.6 +/- 0.4 kg (11%; P < 0.01). Respiratory exchange ratio at the 25 and 50% workloads decreased (P < 0.01) from 0.83 +/- 0.06 and 0.93 +/- 0.03 before, to 0.71 +/- 0.01 and 0.85 +/- 0.02, respectively, after the race. Plasma fatty acids were 3.5 times higher (from 298 +/- 74 to 1407 +/- 118 micromol L(-1); P < 0.01). Muscle glycogen content fell 50% (from 554 +/- 28 to 270 +/- 25 nmol kg(-1) d.w.; n = 7, P < 0.01), whereas the decline in muscle triacylglycerol (from 32 +/- 5 to 22 +/- 3 mmol kg(-1) d.w.; P = 0.14) was not statistically significant. After the race, muscle mRNA content of lipoprotein lipase and glycogen synthase increased (P < 0.05) 3.9- and 1.7-fold, respectively, while forkhead homolog in rhabdomyosarcoma, pyruvate dehydrogenase kinase 4 and vascular endothelial growth factor mRNA tended (P < 0.10) to be higher, whereas muscle peroxisome proliferator-activated receptor gamma co-activator-1beta mRNA tended to be lower (P = 0.06). Very prolonged exercise markedly increases plasma fatty acid availability and fat utilization during exercise. Exercise-induced regulation of genes encoding proteins involved in fatty acid recruitment and oxidation may contribute to these changes.
    Acta Physiologica 10/2007; 191(1):77-86. · 4.25 Impact Factor
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    ABSTRACT: Isoprostanes are a marker of oxidant stress and atherosclerotic risk, and plasma concentrations are elevated in obesity. Adiponectin is a regulator of insulin sensitivity, and low circulating levels are associated with oxidant stress and obesity. The aim of this study was to determine the effect of vitamin E supplementation on plasma concentrations of 8-isoprostane and adiponectin in overweight/obese subjects. The study was a 6-month, randomized, double-blind, placebo-controlled trial in 80 overweight subjects (60 women and 20 men, BMI >27 kg/m(2)). Exclusion criteria were serious illness, smoking, or taking antioxidant supplements. Participants were randomized to receive 800 IU/d natural vitamin E (n = 39) or placebo (n = 41) for 3 months with an increase in the dose to 1200 IU/d for a further 3 months. Plasma 8-isoprostane and adiponectin concentrations were measured at baseline and 3 and 6 months. During 6 months of supplementation with vitamin E, plasma vitamin E concentration increased significantly (p < 0.001) by 76%, and plasma 8-isoprostane concentrations decreased significantly (-11%, p = 0.03), whereas plasma adiponectin concentrations did not change significantly. These findings suggest that supplementation with high-dose vitamin E decreases systemic oxidative stress and 8-isoprostane concentrations in overweight/obese individuals. A decrease in plasma 8-isoprostane has the potential to reduce risk of cardiovascular disease in obesity.
    Obesity 03/2007; 15(2):386-91. · 4.39 Impact Factor
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    ABSTRACT: Objective: Isoprostanes are a marker of oxidant stress and atherosclerotic risk, and plasma concentrations are elevated in obesity. Adiponectin is a regulator of insulin sensitivity, and low circulating levels are associated with oxidant stress and obesity. The aim of this study was to determine the effect of vitamin E supplementation on plasma concentrations of 8-isoprostane and adiponectin in overweight/obese subjects.
    Obesity 01/2007; 15(2):386-391. · 4.39 Impact Factor
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    ABSTRACT: To assess changes in diabetes care between 1998 and 2003 using data from the Otago Diabetes Register. A regional diabetes register was established in 1998 to monitor diabetes care in the Otago region, New Zealand. Cross-sectional data relating to process and outcome measures were collected annually from participating general practices, 93% of general practitioners in the region. Generalised estimating equations with robust standard errors were used to test for trends in clinical measures across the study period. Process measures improved dramatically over the 6-year period. The proportion of patients prescribed ACE inhibitors and other antihypertensives increased markedly (32.3-52.4% and 13.2-27.1%, respectively) and both mean systolic and diastolic blood pressure decreased significantly (140.6-137.0 mmHg, p < 0.001 and 78.6-77.0 mmHg, p < 0.001, respectively). The proportion prescribed lipid lowering medication more than trebled (12.4-40.0%), while mean lipid levels improved significantly (total cholesterol: 5.94-5.21 mmol/l, p < 0.001, HDL-cholesterol: 1.23-1.28 mmol/l, p < 0.001 and triglycerides: 2.17-1.94 mmol/l, p < 0.001). Mean weight increased significantly, as did HbA1c in all treatment groups except type 2 diabetic patients treated with combined insulin and oral hypoglycaemic agents. At a population level appreciable improvements in blood pressure and lipid control were observed, but not glycaemic control, probably due to insufficient attention to necessary lifestyle changes.
    Diabetes Research and Clinical Practice 04/2006; 71(3):345-52. · 2.54 Impact Factor