• Title/Summary/Keyword: Blood Metabolism

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Effects of Vitamin E on the Changes of Mineral Contents in Chronic Cadmium-Poisoned Rats

  • Kim, Mi-Ji;Rhee, Soon-Jae
    • Nutritional Sciences
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    • v.6 no.4
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    • pp.223-228
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    • 2003
  • This study was carried out to investigate the effects of vitamin E on the cadmium contents of bone and on the calcium and phosphorous contents of the blood, urine and feces. Male Sprague-Dawley rats weighing 100$\pm$10g were randomly assigned to one normal group and three cadmium poisoned groups. The cadmium poisoned groups consisted of a vitamin E free diet (Cd-0E) group; a 40 mg vitamin E /kg diet (Cd-40E) group; and a 400 mg/kg diet (Cd-400E) group. Experimental animals were maintained on their respective diets for 20 weeks and were simultaneously administered 50 ppm $Cd^{2+}$ dissolved in the drinking water. At the end of the trial, the average hematocrit value in the Cd-0E group was 28.13% lower than in the normal group. However, the average hematocrit value in the Cd-400E group was significantly higher than in the Cd-0E and Cd-40E groups. WBC levels in the cadmium-poisoned groups were lower than in the normal group, but Cd-400E group levels were significantly higher than in the Cd-0E and Cd-40E groups. The contents of calcium of tibia has no significant difference between normal group and cadmium exposed group at $10^{th}$ week After 20 weeks, the calcium contents of the tibia in the Cd-0E and Cd-40E groups were lower than in the normal group by 25.5% and 22.1 %, respectively, although the calcium contents of the tibia in the Cd-400E group were higher than in the normal group. After 10 weeks, the calcium contents of the femur in the Cd-0E and Cd-40E groups were 19.25% and 15.45% lower than in the normal group, respectively, but the calcium contents of the femur in the Cd-400E group were at the same levels as in the normal group. The levels of calcium in the femur after 20 weeks were similar to the 10-week levels. Calcium levels of the urine in the Cd-0E and Cd-40E groups were 3.92 fold and 2.92 fold higher, respectively, than in the normal group, but levels in the Cd-400E group were significantly lower than in either the Cd-0E group or the Cd-40E group. Calcium levels of the feces in cadmium-poisoned groups were significantly higher than in the normal group, although levels in the Cd-400E group were significantly lower than in the Cd-0E and Cd-40E groups. Phosphorous levels of the blood in the Cd-0E group were 17% lower than in the normal group, although levels in the Cd-400E group were significantly higher than in the Cd-0E group. Phosphorous levels of the urine in the Cd-0E and Cd-40E groups were significantly higher than in the normal group, while Cd-400E group levels were found to be at the same level as in the normal group. Cadmium contents of the tibia in the Cd-40E and Cd-400E groups were 13% and 17% lower, respectively, than in the Cd-0E group. Regarding cadmium levels in the femur, only the Cd-400E group achieved lower levels (10% lower) than the Cd-0E group. In conclusion, vitamin E supplementation resulted in a suppression of the release of calcium from bone, and a reduction in the excretion of calcium via the urine and feces, thus having a normalizing effect on calcium metabolism in rats with chronic cadmium poisoning.

In Vivo Image and Biodistribution of $^{123}I$-15-(p-iodophenyl)-3-R, S-methylpentadecanoic acid (BMIPP) in Liposarcoma Bearing Nude Mice (지방육종형성 동물모델에서 $^{123}I$-15-(p-iodophenyl)-3-R, S-methylpentadecanoic acid (BMIPP)의 생체분포와 생체영상)

  • Lee, Tae-Sup;Suh, Yong-Sup;Choi, Chang-Woon;Woo, Kwang-Sun;Chung, Wee-Sup;Lim, Soo-Jung;Lim, Sang-Moo;Awh, Ok-Doo
    • The Korean Journal of Nuclear Medicine
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    • v.35 no.5
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    • pp.324-333
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    • 2001
  • Purpose: $^{123}I$-labeled fatty acids have been used in the evaluation of regional myocardial energy metabolism. This study aimed to evaluate the usefulness of $^{123}I$-BMIPP as a liposarcoma-imaging agent. Materials and Methods: We compared in vitro uptakes between liposarcoma(SW872) and glioma(9L) cell lines, and examined biodistribution and in vivo images of $^{123}I$-BMIPP in liposarcoma-bearing nude mice. Cold-BMIPP was labeled with $^{123}I\;using\;Cu^{2+}$ as catalyst. After purification by Sep-pak, radiochemical purity was determined by TLC. We compared cellular uptake between glioma and liposarcoma after incubation of 5, 10, 15, 30, 60, 120, and 180 mins with culture medium containing $^{123}I$-BMIPP. The difference in biodistribution was determined between non-feeding (water only) group for 18 hr and feeding group in normal mice (n=6/group) at 0.5, 2, and 24 hr. In liposarcoma-hearing nude mice model, liposarcoma, SW872, ceil lines were injected subcutaneously into the felt thigh of nude mice. The biodistribution of $^{123}I$-BMIPP was evaluated at 0.5, 2, and 24 hr (n:5 / group) and in vivo Image of $^{123}I$-BMIPP was obtained with gamma camera at 2 and 24 hr in liposarcoma-hearing nude mice. Results: Radiolabeling yield and radiochemical purity were 95% and above 99%, respectively. SW872 cell line showed more increased uptake than 9L with 1.5 times at 180 mins. The clearance of $^{123}I$-BMIPP in various tissues was more delayed in the non-feeding group than in the feeding group, especially at delayed time (24 hr) in normal mice, and the major excreting organ was the gastrointestinal tract. In liposarcoma-bearing nude mice, tumor/blood ratio of $^{123}I$-BMIPP was 0.94, 0.75, and 1.38 and tumor/muscle ratio was 0.66, 1.53, and 1.11 at 0.5, 2, and 24hr, respectively. $^{123}I$-BMIPP was selectively localized in liposarcoma at 24 hr image. Conclusions: These results suggest that $^{123}I$-BMIPP can be used as a liposarcoma-imaging agent.

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Effect of Buan Mulberry on Metabolic Improvement in Streptozotocin-Induced Diabetic Rats (Streptozotocin으로 유발된 당뇨쥐의 신진대사 증진에 대한 부안 오디의 효과)

  • Lee, Ju-Taek;Ryu, Jae-Sung;Kwak, Dong-Hoon;Park, Yun-Jum;Kang, Seong-Sun;Kim, Pyoung-Jun;Hwang, Kyung-A;Choo, Young-Kug
    • Journal of Life Science
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    • v.20 no.12
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    • pp.1750-1757
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    • 2010
  • This study was designed to evaluate the anti-diabetic effects of Buan mulberries by using an insulin-dependent diabetes mellitus animal model. Several studies have shown that mulberries have metabolism-improving, antioxidant, and lipid-lowering properties in rats with streptozotocin (STZ)-induced diabetes. In this study, Sprague-Dawley male rats were randomly assigned to 1 normal control group and 5 STZ-induced diabetes groups: rats that had STZ-induced diabetes and did not receive any agents (diabetic group; negative control), rats that had STZ-induced diabetes and received insulin (insulin group; positive control), rats that had STZ-induced diabetes and received 0.5% mulberry extract (0.5% mulberry group), rats that had STZ-induced diabetes and received 1.0% mulberry extract (1.0% mulberry group), and rats that had STZ-induced diabetes and received 2.0% mulberry extract (2.0% mulberry group). Mulberry extracts were administered to the diabetic animals for 4 weeks. The rats that received mulberry extracts showed lower body weights and insulin levels, as well as higher kidney weights, blood glucose levels, urine quantities, and water intake in comparison with the normal controls. Further, the insulin concentrations in the mulberry-fed animals were higher than those in the diabetic group, and the kidney weights, blood glucose levels, urine quantities, and water intake in the mulberry-fed animals were lower than the corresponding values in the diabetic controls. These results suggest that mulberry may be an effective functional food to prevent diabetes-related complications.

Comparison of Gangjihwan and Combination of Gangjihwan and Gamisochehwan in the Improvement Effects of Nonalcoholic Fatty Liver Disease in a High Fat Diet-Fed NAFLD Mouse Model (고지방식이 비만마우스 모델에서 강지환(降脂丸)과 강지환(降脂丸)+가미소체환(加味消滯丸)의 비알콜성 지방간질환 개선효과 비교)

  • Jang, Du Hyon;Jung, Yang Sam;Kim, Jong Hoon;Kim, Byeong Chul;Seok, Hoa Jun;Yoo, Jae Sang;Ku, Ja Ryong;Yoon, Ki Hyeon;Jo, Ju Heum;Lee, Hye Rim;Roh, Jong Seong;Yun, Ho Young;Yoon, Michung;Shin, Soon Shik
    • Herbal Formula Science
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    • v.22 no.1
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    • pp.167-176
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    • 2014
  • Objectives : This study investigated the improvement effects of Gangjihwan (DF) and combination of Gangjihwan and Gamisochehwan (GSH) on nonalcoholic fatty liver disease in a high fat diet-induced obese mouse model. Methods : Eight-week-old C57BL/6N mice were divided into five groups: a normal lean group given a standard diet, an obese control group given a high fat diet, and atorvastatin, DF, and DF+GSH groups given a high fat diet with atorvastatin (10 mg/kg), DF (40 mg/kg), and DF+GSH (80 mg/kg), respectively. After 8 weeks of treatment, body weight gain, blood lipid markers, ALT concentrations, liver weight and histology were examined. Results : 1. Body weight gain was significantly decreased in DF, DF+GSH and atorvastatin groups compared with control. The extent of decreases was eminent in DF+GSH group. 2. Circulating concentrations of total cholesterol, HDL-cholesterol and LDL-cholesterol were decreased in DF, DF+GSH and atorvastatin groups compared with control. The decreases were significant in DF+GSH and atorvastatin groups. 3. Liver weights were decreased in DF, DF+GSH and atorvastatin groups compared with control. In particular, liver weight was significantly reduced only in DF+GSH group. 4. Hepatic lipid accumulation was significantly decreased in DF, DF+GSH and atorvastatin groups compared with control, and the magnitude of which was more effective in DF+GSH group than in DF-only group. 5. Circulating ALT concentrations were decreased in DF, DF+GSH and atorvastatin compared with control, but ALS levels were significantly reduced only in DF+GSH group. Conclusions : In conclusion, these results suggest that DF decreases body weight gain, improves blood lipid metabolism, and reduces liver weight and hepatic lipid accumulation, contributing to the improvement of nonalcoholic fatty liver disease. In addition, these effects were more effective in DF+GSH combination group than in DF-only group.

Comparison of Pakistani and Chinese Ephedra Herba-Containing Gangjihwan in the Improvement Effects of Nonalcoholic Fatty Liver Disease in a High Fat Diet-Fed NAFLD Mouse Model (고지방식이 비만마우스 모델에서 파키스탄산 및 중국산 마황으로 조성된 강지환(降脂丸)의 비알콜성 지방간질환 개선효과 비교)

  • Jo, Ju Heum;Jang, Du Hyon;Jung, Yang Sam;Kim, Jong Hoon;Kim, Byeong Chul;Seok, Hoa Jun;Yoo, Jae Sang;Ku, Ja Ryong;Yoon, Ki Hyeon;Roh, Jong Seong;Ahn, Ye Ji;Lee, Won Kyung;Yoon, Michung;Shin, Soon Shik
    • Herbal Formula Science
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    • v.22 no.1
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    • pp.113-122
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    • 2014
  • Objectives : This study investigated the improvement effects of Pakistani (DF-a) and Chinese Ephedra herba-containing Gangjihwan (DF-b) on nonalcoholic fatty liver disease in a high fat diet-induced obese mouse model. Methods : Eight-week-old C57BL/6N mice were divided into five groups: a normal lean group given a standard diet, an obese control group given a high fat diet, and atorvastatin, DF-a, and DF-b groups given a high fat diet with atorvastatin (10 mg/kg), DF-a (80 mg/kg), and DF-b (80 mg/kg), respectively. After 8 weeks of treatment, body weight gain, blood lipid markers, ALT concentrations, liver weight and histology were examined. Results : 1. Body weight gain was significantly decreased in DF-a, DF-b, and atorvastatin groups compared with control. The extent of decreases was eminent in DF-a group. 2. Circulating concentrations of total cholesterol and LDL-cholesterol were significantly decreased in DF-a, DF-b, and atorvastatin groups compared with control. The decreases were most effective in atorvastatin group. 3. Liver weights were decreased in DF-a, DF-b, and atorvastatin groups compared with control. In particular, liver weight was significantly reduced in DF-b group. 4. Hepatic lipid accumulation was significantly decreased in DF-a, DF-b, and atorvastatin groups compared with control, and the magnitude of which was most effective in DF-b group. 5. Circulating ALT concentrations were decreased in DF-a, DF-b, and atorvastatin groups compared with control, but ALS levels were significantly reduced only in DF-b group. Conclusions : In conclusion, these results suggest that DF-a and DF-b decrease body weight gain, improve blood lipid metabolism, and reduce liver weight and hepatic lipid accumulation, contributing to the improvement of nonalcoholic fatty liver disease. In addition, these effects were similar between Pakistani and Chinese Ephedra herba-containing Gangjihwan.

Effect of heat stress on growth performance and physiological changes of pigs in commercial farm (고온스트레스가 일반 양돈농가의 돼지 생산성 및 생리 변화에 미치는 영향)

  • Oh, Seo Young;Jeong, Yong Dae;Kim, Doo Wan;Min, Ye Jin;Yu, Dong Jo;Kim, Ki Hyun;Kim, Young Hwa
    • Journal of the Korea Academia-Industrial cooperation Society
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    • v.18 no.7
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    • pp.130-139
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    • 2017
  • This study investigated the effect of heat stress on the performance and blood characteristics in commercial pig farms. A total of 180 growing pigs and 180 finishing pigs were assigned to two treatments consisting of thermal-neutral period(TNP) and high-temperature period(HTP) with three replications in floor pen, respectively. Feeding trials in the TNP and HTP were individually performed in autumn and summer seasons, respectively. Temperature-humidity index(THI) was calculated by temperature and humidity. Performance and physiological responses were identified per growth stages and feeding trial. Average temperature and THI were $16.8^{\circ}C$ and 61.4 at the TNP, and $25^{\circ}C$ and 74.3 at the HTP, respectively. Growing pigs in HTP exhibited lower BW, ADG and ADFI than in TNP(p<0.01). Similarly, finishing pigs showed lower growth parameters in HTP than in TNP(p<0.01). Lymphocytes and neutrophils of growing pigs were lower in HTP than in TNP(p<0.05). The serum T-PRO and NEFA in finishing pigs were higher in HTP than in TNP(p<0.05). In HTP, finishing pigs had higher cortisol levels than in TNP. Therefore, HTP can negatively influence growth performance and nutritional metabolism in pigs. Our results may provide useful information for developing feeding programs and diets to control heat stress for swine farms.

Effects of Allium Vegetable Intake on Levels of Plasma Glucose, Lipid and Minerals in Streptozotocin Induced Diabetic Rats (Allium속 식용식물의 섭취가 Streptozotocin 유발 당뇨 흰쥐의 혈당, 지질 및 무기질 수준에 미치는 영향)

  • Ahn, Young-Mi;Lim, Sook-Ja;Han, Hye-Kyoung;Choi, Sung-Sook
    • Journal of Nutrition and Health
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    • v.39 no.5
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    • pp.433-443
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    • 2006
  • The effects of Allium vegetables on blood glucose levels and lipid metabolism in streptozotocin (S12) induced diabetic rats were investigated. Diabetes mellitus was induced by S1'2 injection (45 mg/kg 5.w.) into the tail vein. Sprague-Dawley rats weighing $220\;{\pm}\;10\;g$ were randomly assigned to 7 groups: normal, S1'2-control and five Allium groups (Allium cepa, Allium fistulosum, Allium sativum, Allium tuberosum and Allium victorialisL Normal and S12control groups were fed an AIN-93 diet and five Allium groups were fed a modified diet containing. 10% Allium powder each for 4 weeks. Body weight, diet intake, food efficiency ratio (FER) and organ weights- were monitored. Activities of aspartate aminotransferase (AST) & alanine aminotransferase (ALT) were observed: Plasma lev~ls of glucose, free fatty acid, triglyceride and HDL-cholesterol were analyzed. Levels of glycogen, cholesterol and triglyceride in liver were determined. Levels of malondialdehyde (MDA) in liver, lung, kidney, and pancreas were assayed. The hepatic contents of chromium (Cr) , iron (Fe), zinc (Zn) and manganese (Mu) were measured. The Allium sativum group had weight gain and suppressed a hypertrophy of the kidney significantly. The activity of ALT was significantly lowered in the diabetic groups except Allium sativum group compared to STZ-control group. The Allium sativum and Allium tuberosum groups showed the hypoglycemic effects at 4 weeks. There were no significant differences between the control and all the other diabetic groups in the plasma levels of cholesterol, HDL-cholesterol, triglycerides and free fatty acids. Most of the Allium groups except Allium fistulosum were observed significantly lowered level of MDA in the lung compared to STZ-control group. The diabetic rats fed the Allium cepa and Allium sativum have shown significantly lowered hepatic Zn contents. The results suggested that the intake of the Allium vegetables may be effective in the antihyperglycemia by lowering blood glucose levels.

The Effects of Aminophylline on the Superoxide Anion Generation of Neutrophils from Established Human Sepsis Caused by Acute Pneumonia (급성 폐렴에 의한 패혈증 환자에서 Aminophylline이 혈중 호중구의 과산화물 음이온 유리에 미치는 영향)

  • Kim, Yong-Hoon;Park, Jun-Young;Cha, Mi-Kyong;Lee, Sang-Moo;Kim, Hyeon-Tae;Uh, Soo-Taek;Chung, Yeon-Tae;Park, Choon-Sik
    • Tuberculosis and Respiratory Diseases
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    • v.40 no.1
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    • pp.16-22
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    • 1993
  • Background: The Microbicidal and cytotoxic activities of neutrophils are to a large extent dependent on a burst of oxidative metabolism which generates superoxide anion, hydrogen peroxide, and other reactive products of oxygen. The respiratory burst of PMN is initiated by intracellular calcium mobilization that follows immune or particular stimulation and is very sensitive to modulation by c-AMP or adenosine. Despite its antagonism against adenosine, earlier study has demonstrated potent theophylline inhibition of the PMN respiratory burst at variable ranges of blood concentrations of theophylline in the healthy normal volunteers and in the septic animals pretreated or early post-treated with aminophylline (AMPH) or pentoxifylline. However it is unclear whether theophylline inhibits the superoxide generation or not in the established human sepsis caused by acute pneumonia, as taking into consideration of the fact that full activation of neutrophils have occurred within minutes after the septic insult in the animal experiments. Methods: We measured the $O_2$ generation of peripheral arterial neutrophils obtained from 11 human septic subjects caused by acute pneumonia before and 1 hour after completion of continuous AMPH infusion. Patients were identified and studied within 48 hour of admission. All subjects were administered an intravenous loading and maintenance dose of AMPH. The generation of $O_2$ was measured at a discrete time point (60 min) by the reduction of ferricytochrome c.PMA (10 ${\mu}g/ml$) was used as a stimulating agent. PMNs were isolated at a concentration of $2{\times}10^6$ cells/ml. The arterial oxygen tension, blood pressure and heart rates were also checked to evaluate the systemic effects of AMPH in the acute pneumonia. Results: The mean serum concentration of AMPH at 60 minutes was $8.8{\pm}0.6{\mu}g/ml$. Sixty minutes after AMPH infusion the generatition of $O_2$ was decreased from $0.076{\pm}0.034$ to $0.013{\pm}0.004$(OD) (p<0.05) and from $0.177{\pm}0.044$ to $0.095{\pm}0.042$(OD) (p<0.01) in the resting and stimulated PMNs respectively. $PaO_2$ was not changed after AMPH infusion. Conclusion: AMPH may compromise host defense by significant inhibition of neutrophil release of superoxide anion and it had no effect on improving $PaO_2$ in the acute pneumonia.

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Establishment of Reference Value of Insulin Using the Statistical Analysis (통계적 분석을 통한 Insulin의 정상 참고치 설정)

  • Kim, Whe-Jung;Yoon, Pil-Young;Shin, Young-Goon;Yoo, Seon-Hee;Cho, Shee-Man
    • The Korean Journal of Nuclear Medicine Technology
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    • v.14 no.1
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    • pp.143-146
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    • 2010
  • Purpose: Insulin is involved in carbohydrate metabolism and also it's very important because it increases storage of glycogen, synthesis of fatty acids, absorption of amino acid, synthesis of protein. Insulin is clinically useful when we evaluate fasting patients in hypoglycemia, classify and predict diabetes, assess the activity of ${\beta}$-cell, research insulin resistance. We are going to increase usability of insulin assay by establishing normal reference value according to statistical analysis. Material & Method: We selected 6,648 patients who visited asan health medical center from May to August in 2008. We set exclusion criteria as family of diabetes, diabetes medication, the past history of blood glucose rise, more than 100 mg/dL in normal fasting blood glucose, outside the scope of BMI 18.5~22.9 $kg/m^2$, and more than HbA1c 6.5%. We determine whether the subgroup is portioned as sex and age or not and establish normal reference value by conducting statistical analysis as Bayesian's method and Hoffman's method. Result: Portioning of subgroup as sex and age is not needed. By statistical analysis of Bayesian method, results 1.5-11.0 uIU/mL. By statistical analysis of Hoffman method, results 1.8~12.8 uIU/mL. Conclusion: We established 1.8~12.8 uIU/mL as Insulin normal reference value by Hoffman method. This is a similar value with reporting reference value 1.7~11.8 uIU/mL in kit. This will enhance the usability of insulin assay by establishing normal reference value.

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A cross-sectional study on prevalence rate and contributing factors of fatty liver diagnosed by ultrasonography (초음파로 진단된 지방간의 유병율 조사 및 그 유발인자에 대한 연구)

  • Ahn, Jae-Eog;Ham, Jung-Oh;Hwang, Kyu-Yoon;Kim, Joo-Ja;Lee, Byung-Kook;Nam, Tack-Sung;Kim, Joung-Soon;Kim, Hun
    • Journal of Preventive Medicine and Public Health
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    • v.24 no.2 s.34
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    • pp.195-210
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    • 1991
  • Fatty liver is caused by derangement of fat metabolism and can be reversed by removal of contributing factors. The contributing factors of fatty liver is known to be overweight, chronic alcoholism, diabetes mellitus, malnutrition, and drug abuse such as tetracycline. This study was carried out on 1335 persons who visited 'Soon Chun Hyang Human Dock Center' from March to June 1990. In analysis of the data, prevalence of fatty liver diagnosed by ultrasonogram by age and sex, laboratory finding between fatty liver group and normal group, and odds ratio of known contributing factors, were compared. The results obtained are as following ; 1) The prevalence rate of fatty liver diagnosed by ultrasonogram is 29.6% in male and 11.5% in female. 2) Age groups with high prevalences are $40{\sim}50's$ in male (32.0%) and 50's in female (24.5%). 3) The fatty liver shows significant association with style (p<0.05), whereas not with hepatitis B-virus surface antigen (p>0.05). 4) All laboratory values except alkaline phosphatase and bilirubin are elevated significantly in accordance with the degree of fatty liver (p<0.01). 5) Fatty liver diagnosed by ultrasonogram showed so strong associations with body index, triglycerides and gamma-glutamyl transferase for males, and body index and fasting blood sugar for females that these factors may be used as supplementary data in establishing diagnosis of fatty liver. 6) Odds ratio of contributing factors are as follows ; If the odds ratio of below 29 year of age is 1.0 then that of $30{\sim}39$ is 1.74 (p=0.33), $40{\sim}49$ is 2.47 (p=0.10), $50{\sim}59$ is 2.86 (p=0.0570), over 60 is 1.81 (p=0.34). If the odds ratio of female is 1.0 then that of male is 5.67 (p<0.01). If the odds ratio of body index below zero is 1.0 then that of $0{\sim}9$ is 5.08 (p<0.01), $10{\sim}19$ is 12.37 (p<0.01), $20{\sim}29$ is 29.19 (p<0.01), 30 above is 154.02 (p<0.01). If the odds ratio of below 99 mg/dl FBS is 1.0 then that of $100{\sim}120$ is 106 (p=0.76), over 120 is 1.91 (p=0.02). If the odds ratio of below $29{\mu}/1{\gamma}-GT$ is 1.0 then that of $30{\sim}s59$ is 2.11 (p<0.01), $60{\sim}90$ is 1.87 (p<0.05), 90 above is 1.69 (p=0.15). If the odds ratio of below 149 mg/dl TG is 1.0 then $150{\sim}199$ is 1.49 (p=0.05), $200{\sim}250$ is 1.09 (P=0.77), 250 above is 2.53 (p<0.01). In summary, early diagnosis of fatty liver could be made by ultrasonogram supplemented with body index and nm triglyceride. The fatty liver could be preventive by avoiding contributing factors such as obesity, alcohol intake, high blood sugar appropriately.

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