Volume 10 Issue 11, November 2014

Of late, clinical trial data, meta-analyses and observational studies have caused concern that the use of calcium supplements might increase the risk of myocardial infarction and stroke. A new meta-analysis suggests that there is no problem with calcium supplements, but as the analysis includes controversial data omitted from previous analyses, the debate will continue.

The prevalence of the metabolic syndrome has increased in tandem with that of obesity. The metabolic syndrome is associated with structural and functional cerebral damage. A new study confirms the association between the metabolic syndrome and reduced brain volume in the absence of diabetes mellitus. Here, we highlight how vascular dysfunction potentially contributes to this brain damage.

A large-scale study with 5.24 million participants has found statistically significant associations between increased BMI and 17 of 22 frequent cancers. The strongest associations were observed for cancers of the endometrium, kidney, gallbladder and uterus. Questions remain as to whether several of the weaker associations reported in this study reflect genuinely causal relationships.

The recently published HPS2–THRIVE study has shown that the addition of extended release niacin to statin therapy in patients with well-controlled levels of LDL cholesterol does not reduce the risk of cardiovascular events and might even increase harm. Consequently, the use of niacin to increase levels of HDL cholesterol is not recommended.

The evidence base for the efficacy of insulin pump therapy in type 2 diabetes mellitus (T2DM) has been inconsistent to date. However, a recent large-scale randomized controlled trial comparing pump treatment with multiple daily insulin injections in patients with poorly controlled T2DM has shown substantial improvement in glycaemic control with pump therapy.

Mitochondria have a fundamental role in regulating metabolic pathways and in maintaining energy balance. In this Review, Carole Nasrallah and Tamas Horvath discuss the contribution of mitochondrial function, in particular mitochondrial dynamics, to central metabolism from the hypothalamic perspective and describe how mitochondrial dysfunction can lead to the development of metabolic diseases.

Although important risk factors for coronary heart disease (CHD) are well known, advances in research might facilitate improved risk stratification of patients. This Review discusses the latest developments in metabolic biomarkers of cardiovascular disease, including lipoproteins, homocysteine, calcium metabolism and glycaemic markers. It also discusses whether these biomarkers' associations with CHD are sufficient to improve current risk-stratification metrics.

Determination, differentiation and development of the gonads are important processes in early mammalian development. This article is focused on the genetic networks underlying these processes, whose disruption in humans can lead to disorders of sex development. The authors discuss the pathways controlling sex-specific gonadal development, from the bipotential gonad to the fully differentiated ovary or testis.

Gynaecomastia is a common condition that is generally benign. However, the condition can cause localised pain and might be the result of a serious underlying illness or medication. In this Review, the latest advances in the pathophysiology, evaluation and management of gynaecomastia are discussed.