Identifying adolescents with high fasting glucose: the importance of adding grandparents' data when assessing family history of diabetes

OBJECTIVE

To evaluate the role of adding grandparents' data to parental information to the assessment of a family history of diabetes, in order to identify adolescents with high fasting glucose.

METHOD

In 2003 we evaluated 1276 population-based 13-year-olds, from Porto, Portugal. The history of diabetes in parents and grandparents was collected using self-reported questionnaires and a clinical evaluation was performed, including a fasting blood sample. The 75th percentile of fasting plasma glucose (FPG=91 mg/dl) was used to create two groups of participants (high vs. low fasting glucose).

RESULTS

No association was found between family history of diabetes (with or without grandparental data) and a high FPG. The sensitivity to identify individuals with high FPG increased from 7.8% to 47.9% when grandparental history was combined with parental data. The positive predictive value was slightly increased (25.2% vs. 27.8%) but the specificity dropped (91.8% vs. 56.4%).

CONCLUSION

Combining parental with grandparental history increased the number of adolescents with a positive family history of diabetes and also increased the sensitivity to identify adolescents with high FPG. So, even if it determines a decrease in specificity, grandparental data is relevant when screening for high fasting glucose in adolescents.

A diversity profile from the staphylococcal community on atopic dermatitis skin: a molecular approach

AIMS

The aim of this study was to determine the biodiversity of the skin staphylococcal community from patients with atopic dermatitis (AD) and superantigen (SAg) detection from Staphylococcus aureus isolates.

METHODS AND RESULTS

In this study, we developed a novel multiplex PCR that allows the identification and discrimination of bacteria belonging to the Staphylococcus genus both Staph. aureus and coagulase-negative Staphylococcus - Staph. capitis, Staph. epidermidis, Staph. haemolyticus and Staph. hominis isolated from the skin of patients with AD. In addition, a multiplex PCR assay that allows the rapid screening of the 19 genes that encode staphylococcal enterotoxins (SEs), SE-like toxins and toxic shock syndrome toxin-1 was also performed and applied in Staph. aureus isolates. The microflora of the skin of patients with AD was dominated by Staph. aureus (69 isolates, 35·6%) followed by Staph. epidermidis (59 isolates, 30·4%) species. The SElM and SElN genes were the most frequently detected in our study (15 isolates, 71·4%), followed by SEG and SElO (14 isolates, 66·7%).

CONCLUSIONS

Our molecular-based approach successfully identified the staphylococcal microflora that was relatively specific to patients with AD. Considering skin colonization and expression of virulence factors, the Staph. aureus may play a relevant role in AD pathophysiology.

SIGNIFICANCE AND IMPACT OF THE STUDY

This ability to classify disease-related microbial species provides new insights into the relevance of those microbes in human disorders.

The influence of early feeding practices on fruit and vegetable intake among preschool children in 4 European birth cohorts

BACKGROUND

Fruit and vegetable intake in children remains below recommendations in many countries. The long-term effects of early parental feeding practices on fruit and vegetable intake are not clearly established.

OBJECTIVE

The purpose of the current study was to examine whether early feeding practices influence later fruit and vegetable intake in preschool children.

DESIGN

The study used data from 4 European cohorts: the British Avon Longitudinal Study of Parents and Children (ALSPAC), the French Etude des Déterminants pre et postnatals de la santé et du développement de l'Enfant study, the Portuguese Generation XXI Birth Cohort, and the Greek EuroPrevall study. Fruit and vegetable intake was assessed in each cohort by food-frequency questionnaire. Associations between early feeding practices, such as breastfeeding and timing of complementary feeding, and fruit and/or vegetable intake in 2-4-y-old children were tested by using logistic regressions, separately in each cohort, after adjustment for infant's age and sex and maternal age, educational level, smoking during pregnancy, and maternal fruit and vegetable intake.

RESULTS

Large differences in early feeding practices were highlighted across the 4 European cohorts with longer breastfeeding duration in the Generation XXI Birth Cohort and earlier introduction to complementary foods in ALSPAC. Longer breastfeeding duration was consistently related to higher fruit and vegetable intake in young children, whereas the associations with age of introduction to fruit and vegetable intake were weaker and less consistent across the cohorts. Mothers' fruit and vegetable intake (available in 3 of the cohorts) did not substantially attenuate the relation with breastfeeding duration.

CONCLUSION

The concordant positive association between breastfeeding duration and fruit and vegetable intake in different cultural contexts favors an independent specific effect.

Systematic review of saturated fatty acids on inflammation and circulating levels of adipokines

Diet is one factor that plays a part in coronary heart disease risk through multiple biological mechanisms including subclinical inflammation. In this review, we aimed to systematically assess and summarize evidence regarding the association of saturated fatty acids (SFAs) with inflammatory markers and adipokines. An electronic search of the literature was conducted up to September 2010 using Medline, Scopus, Web of Science, and Science Direct (updated from September 2010 to August 2011 through Medline). Original studies that were written in Portuguese, English, Spanish, or French, and addressed the effects of SFA (not dietary sources or SFA-rich diets) on inflammatory markers or adipokines in adult populations were considered eligible. Data from 15 studies providing adjusted estimates were extracted. The publication year varied from 1995 to 2010 and the sample size from 54 to 4900. Most studies were cross sectional, with 3 studies using a prospective design. Twelve studies assessed total SFA, and 3 studies considered their subtypes, which were measured through dietary assessments (11 studies) or in blood samples (4 studies). Significant positive associations were observed between SFA and soluble intercellular adhesion molecule-1 and interleukin-6, whereas no significant associations were observed with E-selectin, tumor necrosis factor α, granulocyte-macrophage colony-stimulating factor, fibrinogen, and adiponectin. For high-sensitivity C-reactive protein, 2 studies showed significant positive associations, whereas 3 studies reported no significant associations. One study reported a significant inverse association of SFA with leptin, although the other 3 found no significant associations. Based on this systematic review, a potential positive association of SFA with high-sensitivity C-reactive protein but not with adipokines is suggested, which should be confirmed by future research.

Caffeine intake reduces sleep duration in adolescents

In our study, we hypothesized that higher caffeine intake would be associated with lower sleep duration among 13-year-old adolescents. In addition, we aimed to identify food sources of caffeine intake in this sample. Eligible participants were adolescents who were born in 1990 and attended school in Porto, Portugal, in 2003/2004. Self-administered questionnaires were used, and diet was evaluated using a food frequency questionnaire. From the 2160 eligible participants, only 1522 with valid information regarding their diet were included in this study. In our sample, the median intake of caffeine was 23.1 mg/d, with soft drinks being the major source. Ice tea presented the highest median (25th-75th percentiles) contribution (33.1% [14.0-52.1]), followed by cola (21.1% [6.4-37.6]). Regarding cocoa products, chocolate bars presented a median contribution of 5.1% (1.0-14.0), and snacks containing chocolate had a contribution of 3.0% (0.5-7.2). Coffee and tea presented a negligible contribution. Adolescents who reported less sleep duration and those who spent more time watching TV during the weekend had a significantly higher caffeine intake. Overall, boys had higher intakes of caffeine from soft drinks, and private school attendees, those who had parents with more education, who reported less television viewing time and had lower body mass index presented higher intakes of caffeine from chocolate. Considering sleeping more than 9.5 hours as a reference class, for each increase of 10 mg/d in caffeine intake, we found that the odds ratio of sleeping 8.5 hours or less was 1.12 (95% confidence interval, 1.06-1.19). Our results support the hypothesis that caffeine intake was inversely associated with sleep duration in adolescents.

Determinants of inadequate fruit and vegetable consumption amongst Portuguese adults

BACKGROUND

A low consumption of fruit and vegetables (F&V) represents a high burden on health. The present study evaluates sociodemographic, lifestyle and anthropometric determinants of an inadequate consumption of F&V (<5 servings per day).

METHODS

Participants were randomly selected within the adult Porto population (n = 2485). Those with normal cognitive function and information on key variables were analysed (n = 2362). Diet was assessed by a validated food frequency questionnaire. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated by logistic regression, after sex stratification and controlling for age, education, marital status, smoking, regular physical exercise and total energy intake.

RESULTS

Older women and men had 37% and 67%, respectively, lower odds of inadequate F&V consumption (≥65 versus <40 years: OR = 0.63, 95% CI = 0.42-0.94; OR = 0.33, 95% CI = 0.20-0.56). More educated subjects (>12 versus <5 years) and those engaged in regular physical exercise had approximately 50% lower probability of F&V inadequacy compared to nonpractitioners, and this was similar in both sexes. On the other hand, female and male current smokers had 1.86- and 2.05-fold higher probabilities of having inadequate F&V consumption. Individuals consuming excessive alcohol (women: ≥15 g day(-1) ; men: ≥30 g day(-1) ) presented a two- and four-fold higher probability of having inadequate F&V consumption compared to nondrinkers (OR = 1.95, 95% CI = 1.38-2.77 in women; OR = 4.40, 95% CI = 2.70-7.18 in men).

CONCLUSIONS

In both sexes, an inadequate consumption of F&V was more frequently found in younger, less educated and less physically active subjects with smoking and drinking habits. Strategies aiming to increase F&V consumption should consider these target groups that present a clustering of unhealthy lifestyles.

Short-time variation in serum uric acid concentrations in post-myocardial infarction patients

BACKGROUND

Studies on SUA temporal profile in relation to acute myocardial infarction (AMI) are controversial. The aim of this study was to evaluate the SUA level variations following myocardial infarction.

METHODS

We studied 222 patients more than 18 years old diagnosed with AMI. SUA was measured at baseline and on day 2 to 4 and day 5 to 8 after AMI. Within and between person variability of SUA following an AMI was estimated using intraclass correlation coefficients (ICC). The change in SUA between each assessment point was analyzed by repeated measures one-way analysis of variance. To evaluated.SUA variation post-myocardial infarction and its predictors we used generalized linear mixed-effects models.

RESULTS

The mean plasma concentration of SUA was lower at baseline (58.5 +/- 18.9 mg/L). The ICC across the three time points was 0.75 (95% CI 0.70 - 0.80). SUA levels increased 1.33 mg/L per day after AMI (2.3 mg/L/day in women and 1.0 mg/L/day in men). Normouricemic patients had a 1.6 fold increase risk to change to hyperuricemic status per day after AMI (OR = 1.60, 95% CI: 1.27 - 2.00).

CONCLUSIONS

Serum uric acid concentration is relatively stable over an eight-day post-myocardial infarction period. However, even a small increase of SUA per day after AMI is associated with a high probability of changing the classification of hyperuricemic status.

A cross sectional assessment of allergic rhinitis and asthma control at an immunoallergology outpatient hospital setting using CARAT10 questionnaire

INTRODUCTION

The most recent guidelines on asthma and rhinitis management recommend the optimal control of both diseases as the primary goal of treatment. CARAT10 is a recently developed and validated Portuguese questionnaire, which permits the simultaneous assessment of allergic rhinitis and asthma (ARA) control. There is no published data about the use of this tool.

AIMS

To assess ARA control using CARAT10 in an Immunoallergology hospital setting;

METHODS

Patients with diagnosis of allergic rhinitis with or without asthma (positive aeroallergens prick-tests and/or positive specific IgE) were sequentially enrolled and asked to fill in CARAT10 questionnaire at their first appointment.

RESULTS

Two hundred patients were included, mostly female (n=142) with an average age of 33.6±12.3 years. ARA was present in 86 patients while 114 had isolated allergic rhinitis. In ARA group, 86% scored CARATtotal ≤ 24, meaning poor control. Subscores revealed that 83% had poorly controlled rhinitis (CARATr ≤ 8) and 74% had poorly controlled asthma (CARATa < 16). There were no age or gender related differences in ARA control. In allergic rhinitis group (n=114), 89% were poorly controlled.

CONCLUSIONS

Only 14% of patients presenting rhinitis and asthma had both diseases controlled.

Characterization of heavy-metal contamination in surface sediments of the Minho river estuary by way of factor analysis

Surface sediments were collected in August 2009 from 49 sites along the Minho estuary (between Tui and Caminha) and analyzed for grain size, organic carbon (Corg) and total nitrogen (Ntot) contents, and major (silicon [Si], aluminum [Al], iron [Fe], calcium [Ca], magnesium [Mg], sodium [Na], potassium [K], titanium [Ti], and mangesese [Mn]) and trace element (arsenic [As], chromium [Cr], copper [Cu], mercury [Hg], lithium [Li], lead [Pb], rubidium [Rb], tin [Sn], and zinc [Zn]) concentrations. Factor analysis was used to decrease 22 selected variables into 4 factors accounting for 85.9 % of the total variance explained, suggesting distinct elemental sources or sediment components affecting their spatial distributions. Although factors 1 (detrital component; elements strongly associated with fine- [Na, Mg, Ti, Li, Cr, Cu, Fe, Al, Zn, Ca, and As] and coarse-grained sediments [Si, K, Rb; mean grain-size [MGS]) and 3 (Fe-Mn oxyhydroxide sediment component; Fe, Mn, As, fine fraction) are interpreted as reflecting predominance of natural contributions, factors 2 (urban and industrial contamination: sediment components [Pb, Hg, organic carbon [Corg], total nitrogen [Ntot] and 4 (components associated with contamination by nautical activities; the association of tin [Sn] and calcium [Ca]) seem to indicate anthropogenic contributions). Nevertheless, the influence of elemental contributions derived from tungsten (W)-Sn mineralizations and those resulting from mining activities can also contribute to the obtained geochemical associations and should be considered. Spatial distribution of dominant factor scores shows the dominance of factors 2 and 4 between Tui and Vila Nova de Cerveira, whereas samples dominated by factors 3 and 1 are found between Ilha da Boega and Seixas and in the Caminha areas, respectively. Despite the dominance of factor score 1 in the Caminha area, the distribution pattern of dominant factor scores shows samples dominated by other factor scores that can be explained by dredging activities in this river sector that restore ancient sedimentary characteristics or expose contaminated sediments. Through the identification of sample locations dominated by factors associated with contamination, it will be possible to select them as priority areas where new environmental (e.g., toxicity tests, organic Sn compounds, tracers of sewage contamination) studies should be implemented in the future.

E-cadherin and β-catenin expression during urothelial carcinogenesis induced by N-butyl-N-(4-hydroxybutyl) nitrosamine in mice

BACKGROUND

E-cadherin and β-catenin are adhesion molecules that promote integrity and stability of the urothelium. A decrease in their expression is associated with more aggressive tumour phenotypes with the ability to invade and metastasize.

MATERIAL AND METHODS

45 ICR male mice were used, of which 25 received N-butyl-N-(4-hydroxybutyl)nitrosamine (0.05%) in drinking water for a period of 12 weeks. Immunohistochemical expression was evaluated in all urinary bladder preparations for E-cadherin and for β-catenin.

RESULTS

Preneoplastic lesions showed staining patterns similar to normal urothelium. In simple and nodular hyperplasia, membrane staining was dominant (66.7-78.6 and 50-100%, respectively). In dysplasia a cytoplasmic pattern was prevalent (86.7-100%). Neoplastic lesions exhibit an abnormal staining pattern (100%) with heterogeneous staining (cytoplasmic, nuclear and membrane staining). A strong correlation was observed between both adhesion molecule staining patterns (r = 0.83; p = 0.039).

CONCLUSIONS

In mice, as in humans, E-cadherin and β-catenin are valuable tools to investigate cellular adhesion status of urothelium and can be considered as indicators of tumour aggressiveness and evolution.

Phosphorylated EGFR at tyrosine 1173 correlates with poor prognosis in oral squamous cell carcinomas

OBJECTIVES

To evaluate the expression of epidermal growth factor receptor (EGFR) and phosphorylated EGFR (pEGFR), in oral squamous cell carcinomas (OSCC). We examined their utility as prognostic markers by relating to clinicopathological characteristics and the clinical outcome.

MATERIALS AND METHODS

We analysed 74 primary OSCC and examined immunohistochemical expression of EGFR and pEGFR (phosphorylated at tyrosine 1173) using tissue microarray technology. Their role in survival was assessed by Kaplan-Meier method and Cox regression models.

RESULTS

Epidermal growth factor receptor expression was observed in all cases, and pEGFR expression was observed in 41.1% of the cases. We found a significant correlation between EGFR and pEGFR expression (P = 0.003). In the multivariable analysis for cause-specific survival, we found an independent prognostic value for pEGFR expression (HR 7.94, 95% CI 2.03-31.06, P = 0.003) and for clinical stage (HR 2.88, 95% CI 1.10-7.53, P = 0.031). For recurrence-free survival, clinical stage (HR 6.59, 95% CI 1.36-31.90, P = 0.019) and tumour grade (HR 3.35, 95% CI 1.07-10.44, P = 0.037) presented independent prognostic value.

CONCLUSION

Epidermal growth factor receptor is highly expressed in OSCC and is phosphorylated in more than one-third of the cases. The independent value of pEGFR expression in cause-specific survival of OSCC suggests that this marker may serve as reliable biological marker to identify high-risk subgroups and to guide therapy.

Use of poly(DL-lactide-ε-caprolactone) membranes and mesenchymal stem cells from the Wharton's jelly of the umbilical cord for promoting nerve regeneration in axonotmesis: in vitro and in vivo analysis

Cellular systems implanted into an injured nerve may produce growth factors or extracellular matrix molecules, modulate the inflammatory process and eventually improve nerve regeneration. In the present study, we evaluated the therapeutic value of human umbilical cord matrix MSCs (HMSCs) on rat sciatic nerve after axonotmesis injury associated to Vivosorb® membrane. During HMSCs expansion and differentiation in neuroglial-like cells, the culture medium was collected at 48, 72 and 96 h for nuclear magnetic resonance (NMR) analysis in order to evaluate the metabolic profile. To correlate the HMSCs ability to differentiate and survival capacity in the presence of the Vivosorb® membrane, the [Ca(2+)]i of undifferentiated HMSCs or neuroglial-differentiated HMSCs was determined by the epifluorescence technique using the Fura-2AM probe. The Vivosorb® membrane proved to be adequate and used as scaffold associated with undifferentiated HMSCs or neuroglial-differentiated HMSCs. In vivo testing was carried out in adult rats where a sciatic nerve axonotmesis injury was treated with undifferentiated HMSCs or neuroglial differentiated HMSCs with or without the Vivosorb® membrane. Motor and sensory functional recovery was evaluated throughout a healing period of 12 weeks using sciatic functional index (SFI), extensor postural thrust (EPT), and withdrawal reflex latency (WRL). Stereological analysis was carried out on regenerated nerve fibers. In vitro investigation showed the formation of typical neuroglial cells after differentiation, which were positively stained for the typical specific neuroglial markers such as the GFAP, the GAP-43 and NeuN. NMR showed clear evidence that HMSCs expansion is glycolysis-dependent but their differentiation requires the switch of the metabolic profile to oxidative metabolism. In vivo studies showed enhanced recovery of motor and sensory function in animals treated with transplanted undifferentiated and differentiated HMSCs that was accompanied by an increase in myelin sheath. Taken together, HMSC from the umbilical cord Wharton jelly might be useful for improving the clinical outcome after peripheral nerve lesion.

Body image and depressive symptoms in 13-year-old adolescents

AIMS

To evaluate the prevalence of body dissatisfaction and the association with depressive symptoms in 13-year-old adolescents, according to gender, and also to analyse the possible modifying effect of body mass index on this association.

METHODS

We evaluated 1868 adolescents as part of a population-based study in an urban community in Porto, Portugal. Using the Figure Rating Scale, participants choose their perceived and their desired figures; body dissatisfaction was measured by the difference between these values. The Beck Disorder Inventory II was used to measure depressive symptoms. Weight and height were measured by trained interviewers. To quantify the association between depressive symptoms and body dissatisfaction, regression parameters and 95% confidence intervals (CIs) were obtained by linear regression and bootstrapping.

RESULTS

Among females, 15.8% desired a bigger figure and 41.4% desired a thinner figure. Among males, this occurred for 34.1% and 33.5%, respectively. After adjustment, we found that body dissatisfaction was associated with increased depressive symptoms, in both genders, especially in those participants who wish to be thinner and in those presenting higher discrepancy between figures (B = 6.5, 95% CI 4.1;9.3 for females, B = 3.3, 95% CI 1.3;6.8 for males). The association between body dissatisfaction and depressive symptoms was stronger among non-overweight (for participants who wish to be thinner: B = 5.18 95% CI 3.56; 6.95 vs. B = 3.49, 95% CI 1.70; 5.29 among females and B = 2.47, 95% CI 0.73; 4.76 vs. B = 1.60, 95% CI 0.34; 2.88 among males).

CONCLUSIONS

The direct association between the wish to be thinner and depressive symptoms was stronger among the non-overweight youth.

Association between dietary patterns and metabolic syndrome in a sample of Portuguese adults

BACKGROUND

There is scarce evidence regarding the association between diet and metabolic syndrome (MetS) in Portuguese population. We aim to evaluate the association between a posteriori dietary patterns (DPs) and MetS and its features.

METHODS

Using random digit dialing, a sample of 2167 adults was selected between 1999 and 2003, in Porto. During a face-to-face interview, a questionnaire was applied, anthropometric measures were taken, blood pressure measured and a fasting blood sample collected. Diet was assessed using a validated food frequency questionnaire, and four DPs were identified in each sex by multivariate finite mixture models.

RESULTS

After adjustment for age and daily energy intake, comparing to the "healthy" DP, women with the "low fruit and vegetables" DP had a higher odds of high waist circumference (OR = 1.88 95% CI 1.17-3.01) and low HDL-cholesterol (OR = 1.78 95% IC 1.12-2.82) and women in the "red meat and alcohol" DP had higher odds of high waist circumference (OR = 1.45 95% CI 1.01-2.07) and of MetS (OR = 1.57 95% CI 1.07-2.29); men with the "fish" DP had a higher odds of high triglycerides (OR = 1.57 95% CI 1.05-2.35). After further adjustments (education, physical activity, smoking, alcohol drinking, BMI, and menopausal status) no significant associations remained.

CONCLUSIONS

Four distinct DPs were identified in a community sample of Portuguese adults and there was no association with the prevalence of MetS.