Type 2 Diabetes Clinical Trial
Official title:
Effect of Moderate Alcohol Consumption on Cephalic Phase Reflex and Gene Expression of Adipose Tissue in Postmenopausal Women
Moderate alcohol consumption has consistently been associated with lowered risk of
developing type two diabetes mellitus compared to abstainers and heavy drinkers. However,
the underlying mechanism for the lower risk of type two diabetes is not clear.
Hypothesis: moderate alcohol consumption for four weeks changes gene expression pathways of
inflammatory status, insulin sensitivity and lipid and carbohydrate metabolism in adipose
tissue in both lean and obese postmenopausal women.
Hypothesis: Oral sensory stimulation by means of alcohol in the oral cavity will induce a
cephalic phase reflex as indicated by increased autonomic & endocrine responses in
postmenopausal women.
Moderate alcohol consumption has consistently been associated with lowered risk of
developing type two diabetes mellitus compared to abstainers and heavy drinkers. However,
the physiological mechanism for this is not known.
Two potential mechanisms will be investigated in this study to explain the findings from
observational studies: One concerning more acute changes upon alcohol consumption (cephalic
phase reflex) which could explain the observed improvement in postprandial glycemia after
alcohol consumption; the other has to do with metabolic changes after more prolonged
moderate alcohol consumption in gene expression of adipose tissue which might lead to
improved insulin sensitivity. Both mechanisms will be discussed below.
Cephalic phase reflex Mere exposure to smell, sight, taste and textural attributes of foods
elicits myriad digestive, endocrinologic, thermogenic, cardiovascular and renal responses.
These responses are rapid (generally occurring in minutes of sensory stimulation), small
(relative to the magnitude achieved when food is actually being metabolized) and transient
(retuning to baseline levels within minutes). They are termed pre-absorptive or cephalic
phase reflexes/responses (CPR) and refer to a set of food intake-associated autonomic and
endocrine responses to the stimulation of sensory systems mainly located in the
oropharyngeal cavity. Their function may be essential adaptive, preparing the digestive
system for the reception, digestion and absorption of ingested nutrients.
The release of cephalic phase hormones occurs through activation of vagal efferent fibers in
response to food-related sensory stimuli. Pancreatic polypeptide (PP) is a hormone almost
exclusively under vagal control increases. Thus, the cephalic phase PP response is a
sensitive indicator of vagal activation to food stimuli. PP levels rise up to 100% above
baseline when individuals taste, chew and expectorate food while the magnitude of cephalic
phase insulin release is relatively small (25% above baseline). The cephalic phase is by
some considered as a reflex rather then a response as it is dependent on neural rather than
nutrient-induced stimulation.
The physiological significance of the cephalic phase hormonal responses is demonstrated by
experimental manipulations which inhibit or bypass cephalic phase insulin release. Under
these circumstances, hyperglycemia and hyperinsulinemia are evident.
Alcohol consumption lowers postprandial glucose concentrations and improves insulin
secretion. Furthermore, alcohol consumption increases postprandial diet-induced
thermogenesis, heart rate and causes diuresis presumably resulting from inhibition of
vasopressin. Since in the postprandial state, almost all cephalic phase responses are
affected by alcohol, it seems plausible that the human body might exhibit a CPR upon oral
sensory stimulation by alcohol-containing beverages. This study therefore investigates for
the first time if and to what extent alcohol triggers CPR which may account for the improved
postprandial glycemia seen after alcohol consumption.
Gene expression in adipose tissue Application of transcriptomics technology, via gene
expression profiling, with the use of microarrays is a powerful but expensive tool for
identifying molecular pathways responsible for metabolic regulation. Gene expression
profiling in human intervention studies, allows for genome wide screening of the effects of
specific diets or nutrients and results in biomarker profiles. Recently, it has been used to
detect new important signaling pathways involved in glucose and lipid metabolism.
Adipose tissue has important metabolic and endocrine functions. Changes in these functions
are associated with an increased low-grade inflammatory state and with chronic diseases such
as obesity and diabetes. Furthermore, changes in gene expression profiles of subcutaneous
adipose tissue can be observed after nutritional interventions.
An important hormone almost exclusively and abundantly secreted by adipose tissue is
adiponectin. Circulating adiponectin levels in lean persons are far above any other hormone.
It is believed that these high levels of adiponectin protect lean persons while its decrease
in obesity is associated with a low grade inflammation and the development of insulin
resistance and diabetes. Research by our group has shown that moderate alcohol consumption
increases both plasma levels and mRNA adiponectin levels. This suggests that moderate
alcohol consumption, directly or indirectly, exerts effects on adipose tissue gene
expression. Since adiponectin is associated with inflammatory status, lipid metabolism and
insulin sensitivity, changes in gene expression of these pathways are expected after alcohol
consumption to be reflected in adipose gene expression.
Beneficial effects of moderate alcohol consumption might be more apparent in lean then in
overweight persons. Compared to overweight men, lean men have stronger increases in
adiponectin and in the 'good' HDL cholesterol after moderate alcohol consumption.
Furthermore, liver enzymes of obese subjects are elevated after moderate alcohol consumption
indicating a less favorable response to moderate alcohol consumption among overweight
persons. Since the current rise in the obesity pandemic, different responses between lean
and obese subjects after alcohol consumption are of great importance.
Thus, investigating alcohol-induced changes in gene expression of adipose tissue in both
lean and overweight subjects could not only be highly valuable for the identification of new
biomarkers but could also be of pivotal importance to identify specific physiological
mechanisms leading to improved insulin sensitivity and reduced inflammatory status. This
eventually could help in the general understanding of the development of diet-related
chronic disorders such as obesity and type two diabetes.
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Allocation: Randomized, Intervention Model: Crossover Assignment, Masking: Open Label, Primary Purpose: Basic Science
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