Metabolic syndrome can precede the development of type 2 diabetes and cardiovascular disease and includes phenotypes such as obesity, systemic inflammation, insulin resistance, and hyperlipidemia. A recent epidemiological study indicated that blueberry intake reduced cardiovascular mortality in humans, but the possible genetic mechanisms of this effect are unknown. Blueberries are a rich source of anthocyanins, and anthocyanins can alter the activity of peroxisome proliferator-activated receptors (PPARs), which affect energy substrate metabolism. The effect of blueberry intake was assessed in obesity-prone rats. Zucker Fatty and Zucker Lean rats were fed a higher-fat diet (45% of kcal) or a lower-fat diet (10% of kcal) containing 2% (wt/wt) freeze-dried whole highbush blueberry powder or added sugars to match macronutrient and calorie content. In Zucker Fatty rats fed a high-fat diet, the addition of blueberry reduced triglycerides, fasting insulin, homeostasis model index of insulin resistance, and glucose area under the curve. Blueberry intake also reduced abdominal fat mass, increased adipose and skeletal muscle PPAR activity, and affected PPAR transcripts involved in fat oxidation and glucose uptake/oxidation. In Zucker Fatty rats fed a low-fat diet, the addition of blueberry also significantly reduced liver weight, body weight, and total fat mass. Finally, Zucker Lean rats fed blueberry had higher body weight and reduced triglycerides, but all other measures were unaffected. In conclusion, whole blueberry intake reduced phenotypes of metabolic syndrome in obesity-prone rats and affected PPAR gene transcripts in adipose and muscle tissue involved in fat and glucose metabolism.

Obesity, systemic inflammation, and hyperlipidemia are among the components of metabolic syndrome, a spectrum of phenotypes that can precede the development of type 2 diabetes and cardiovascular disease. Animal studies show that intake of anthocyanin-rich extracts can affect these phenotypes. Anthocyanins can alter the activity of tissue peroxisome proliferator-activated receptors (PPARs), which affect energy substrate metabolism and inflammation. However, it is unknown if physiologically relevant, anthocyanin-containing whole foods confer similar effects to concentrated, anthocyanin extracts. The effect of anthocyanin-rich tart cherries was tested in the Zucker fatty rat model of obesity and metabolic syndrome. For 90 days, rats were pair-fed a higher fat diet supplemented with either 1% (wt/wt) freeze-dried, whole tart cherry powder or with a calorie- and macronutrient-matched control diet. Tart cherry intake was associated with reduced hyperlipidemia, percentage fat mass, abdominal fat (retroperitoneal) weight, retroperitoneal interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-alpha) expression, and plasma IL-6 and TNF-alpha. Tart cherry diet also increased retroperitoneal fat PPAR-alpha and PPAR-gamma mRNA (P = .12), decreased IL-6 and TNF-alpha mRNA, and decreased nuclear factor kappaB activity. In conclusion, in at-risk obese rats fed a high fat diet, physiologically relevant tart cherry consumption reduced several phenotypes of metabolic syndrome and reduced both systemic and local inflammation. Tart cherries may reduce the degree or trajectory of metabolic syndrome, thereby reducing risk for the development of type 2 diabetes and heart disease.

Just as we depend on medical science and research to treat patients, we should connect our teaching methods to educational theory and research. In particular, the foundations of adult education philosophy and adult learning theories can be deliberately applied to further strengthen the clinical learning experience of physician assistants (PAs). We propose that PA educators should be aware of how their personal philosophy of education affects their teaching practice. In addition, educators should apply learning theories to both classroom process and content. We provide an overview of 5 categories of learning philosophy (liberal, progressive, behavioral, humanist, and radical) and 6 learning theories (experiential learning, reflective practice, situated learning, communities of practice, transformative learning, and critical consciousness) of adult education. Concrete examples of how to apply adult education theory to meet specific learning objectives for PA students are described. Understanding how to apply learning theory and identify and shape one's educational philosophy provides theoretical and empirical support for what we often deem an intuitive process.

Several studies suggest that anthocyanin intake could modify risk factors for metabolic syndrome. Blueberries are a rich, whole‐food source of anthocyanins. We tested the effect of a semi‐purified diet with added whole blueberry powder (2% w:w) or a carbohydrate‐matched control diet on factors of metabolic syndrome in the obesity‐prone Zucker Fatty rat, fed either a low fat (10% fat) diet or a high fat (45% fat) diet. After 90 days, both the low fat blueberry (LFB) and high fat blueberry (HFB) groups had reduced abdominal fat compared to controls, and the LFB group had reduced body weight and % fat mass. Both LFB and HFB groups had significantly reduced triglycerides, total cholesterol, fasting insulin, and fasting glucose. LFB and HFB also had improved glucose clearance, as measured by a glucose tolerance test. Given the improved glucose control, we then measured mRNA transcripts in skeletal muscle and retroperitoneal fat related to glucose and lipid uptake and metabolism by PCR Array. The results suggest that regular intake of blueberry reduced several key risk factors for cardiovascular disease and metabolic syndrome. Furthermore, these benefits were augmented when fed a low fat diet. Finally, blueberry diet conferred tissue changes in several genes related to lipid and glucose metabolism, which could support the in vivo results of greater insulin sensitivity and reduced fat accumulation.