Objective: We aimed to compare the levels of plasma zonulin, a non-invasive biomarker of increased intestinal permeability, between pregnant subjects, with and without gestational diabetes mellitus (GDM), at 24–28 gestational weeks. The eighty-five consecutive pregnant subjects that presented to our hospital’s obstetrics outpatient clinic and were diagnosed with GDM, for the first time by an oral glucose tolerance test (OGTT), formed the GDM group; 90 consecutive subjects that were not diagnosed with GDM by OGTT, formed the control group. The diagnosis of GDM was made by an OGTT performed between the 24th and 28th weeks of gestation, and in compliance with the American Diabetes Association (ADA) criteria. Plasma zonulin levels were measured by the enzyme-linked immunosorbent assay (ELISA) methods. The Plasma zonulin level was significantly higher in the GDM group than the control group (p < 0.001). A correlation analysis showed that plasma zonulin level was positively correlated to body mass index (BMI), creatinine, fasting plasma glucose, baseline, first hour, and two hours glucose levels and the OGTT, hemoglobin A1C (HbA1_C), homeostatic model assessment for insulin resistance (HOMA-IR), and alanine aminotransferase (ALT) levels. Our findings suggest that zonulin may be a non-invasive biomarker involved in the pathogenesis of GDM. Further large-scale studies are needed on this subject.

In this study, it was aimed to investigate the relationship between the epicardial adipose tissue thickness (EATT) and serum IL-17A level insulin resistance in metabolic syndrome patients. This study enrolled a total of 160 subjects, of whom 80 were consecutive patients who applied to our outpatient clinic and were diagnosed with metabolic syndrome, and the other 80 were consecutive patients who were part of the control group with similar age and demographics in whom the metabolic syndrome was excluded. The metabolic syndrome diagnosis was made according to International Diabetes Federation (IDF)-2005 criteria. EATT was measured with transthoracic echocardiography (TTE) in the subjects. IL-17A serum levels were determined using the ELISA method. Fasting blood glucose, HDL, triglyceride, and fasting insulin levels were significantly higher in the metabolic syndrome group compared to the control group. In addition, the metabolic syndrome group had significantly higher high-sensitivity C-reactive protein (hs-CRP) and Homeostatic Model Assessment Insulin Resistance (HOMA-IR) levels than the control group. Similarly, serum IL-17A levels were significantly elevated in the metabolic syndrome group compared to the control group statistically (p < 0.001). As well, EATT was higher in the metabolic syndrome than the control group. Conclusion: By virtue of their proinflammatory properties, EATT and IL-17 may play an important role in the pathogenesis of the metabolic syndrome.

In organ or non-organ-specific autoimmune disorders, human ovary is usually the target of the autoimmune attack. We aimed to demonstrate the correlation between ovarian reserve and DM1, based on the view that women with type-1 diabetes mellitus (DM1) will have lower AMH levels secondary to poor glycemic control and autoimmune attacks. Ovarian functions of 42 patients diagnosed with DM1 who use insulin and 65 healthy volunteers were analyzed. Basal hormone and AMH levels were measured during the follicular phase. Fasting and postprandial blood glucose concentrations, HbA1c and C-peptide levels were evaluated. The mean antral follicle count (AFC) was significantly lower in DM1 patients than in healthy controls (p = .001). The AMH levels were lower in women with DM1 than in the controls (p = .001). The HbA1c values of DM1 patients, who formed the study group, was significantly higher than the control group. Ovarian reserve that is evaluated with serum AMH level is affected by poor glycemic control in type 1 diabetes. Due to the time of the autoimmune damage in the ovaries and the observable effects of this damage, more comprehensive and longer-term studies are needed to be conducted for the follow-up of reproductive abnormalities.

By ESRA DEMİR, BURAK ÖNAL, HANİŞE ÖZKAN, et al., Published on 01/01/22

Objective: We aimed to investigate the effects of a low-FODMAP (fermentable oligosaccharides, disaccharides, monosaccharides, and polyols) diet on symptom severity, quality of life, and fecal zonulin levels in patients with irritable bowel syndrome (IBS). Methods: Twenty-four patients with IBS were prospectively randomized to either a low-FODMAP diet (LFD) or a traditional diet (TD) for 4 weeks. IBS Symptom Severity Scale (IBS-SSS), IBS Quality of Life (IBS-QOL), and fecal zonulin levels were assessed at baseline and week 4 in both groups. In the LFD group, FODMAP-containing foods were gradually reintroduced after week 4, and all assessments were repeated at week 16. Changes in laboratory parameters, fecal zonulin levels, IBS-SSS, and IBS-QOL scores were evaluated. Results: Fecal zonulin levels did not differ significantly between groups at baseline or week 4, and no significant within-group changes were observed over time (all p > 0.05). IBS-SSS scores improved significantly at week 4 in both groups compared with the baseline (p < 0.05), with no significant difference in the magnitude of improvement between groups (p > 0.05). In the LFD group, IBS-SSS scores increased at week 16 compared with week 4 (p < 0.05). Similarly, IBS-QOL scores improved significantly at week 4 in both groups (p < 0.05), without significant between-group differences (p > 0.05). In the LFD group, IBS-QOL scores returned to baseline levels by week 16. Conclusions: Both the LFD and TD were associated with significant short-term improvements in IBS symptom severity and quality of life. However, the LFD did not demonstrate superiority over the TD. Furthermore, no statistically significant changes in fecal zonulin levels were observed in either group, although these findings should be interpreted cautiously. In the LFD group, some improvements observed at week 4 were attenuated following FODMAP reintroduction at week 16; however, these findings represent exploratory within-group observations and should not be interpreted as evidence of long-term treatment efficacy or sustained benefit following FODMAP reintroduction.

Background/Objectives: Comparative real-world evidence on early body-weight changes during semaglutide and tirzepatide treatment remains limited, particularly in populations with unequal and irregularly timed follow-up. To compare longitudinal percentage changes in body weight between adults initiating semaglutide and those initiating tirzepatide and to describe changes in anthropometric measures, weight-loss responses, and exploratory metabolic outcomes. Methods: This retrospective, single-center, real-world longitudinal cohort study included adults aged ≥18 years initiating semaglutide or tirzepatide for weight management, with a body mass index (BMI) ≥30 kg/m² or ≥27 kg/m² with a weight-related comorbidity. Patients with type 2 diabetes and concomitant obesity were eligible. Participants were naïve to incretin-based therapy; pregnancy, previous bariatric surgery, and active malignancy were exclusion criteria. Anthropometric and laboratory data were extracted from clinical records. Percentage body-weight change over days 1–230 was analyzed using a linear mixed-effects model incorporating exact follow-up time and adjusting for age, sex, baseline BMI, and diabetes status. Scheduled-visit and sensitivity analyses were also performed. Results: The cohort included 184 patients: 94 (51.1%) receiving semaglutide and 90 (48.9%) receiving tirzepatide. Overall, mean age was 41.7 ± 12.0 years, baseline weight was 97.0 ± 17.9 kg, and 139 patients (75.5%) were female. The longitudinal analysis included 345 measurements from 148 patients (80.4%). The treatment-by-time interaction was significant (p = 0.002). Adjusted weight changes with semaglutide versus tirzepatide were −3.39% versus −4.44% at month 1 (p = 0.116), −8.38% versus −11.52% at month 3 (p < 0.001), and −14.40% versus −15.06% at month 6 (p = 0.699). Sensitivity analyses yielded consistent findings. Only four tirzepatide-treated patients had measurements within the month 6 visit window; therefore, the month 6 estimate for this group relied primarily on the model and requires cautious interpretation. Conclusions: Both semaglutide and tirzepatide were associated with early reductions in body weight. Tirzepatide was associated with larger model-adjusted weight loss at month 3 (between-group difference, −3.14 percentage points; 95% CI, −4.55 to −1.74; p < 0.001), whereas no statistically significant between-group difference was observed at month 1 (p = 0.116). Only four tirzepatide-treated patients had measurements within the month 6 visit window, limiting the reliability of this comparison. Longer-term comparisons require cohorts with more balanced follow-up and more observations at later time points.