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Punia R, Mor S, Khatri M, Kumar D, Das PP, Jindal DK, Kumar A, Selvaraj P, Kumar R, Mohil R, Jakhar K. Facile synthesis and in silico studies of benzothiazole-linked hydroxypyrazolones targeting α-amylase and α-glucosidase. Future Med Chem 2024; 16:999-1027. [PMID: 38910576 PMCID: PMC11221549 DOI: 10.4155/fmc-2023-0384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 03/19/2024] [Indexed: 06/25/2024] Open
Abstract
Aim: The objective of the present investigation was to design and synthesize new heterocyclic hybrids comprising benzothiazole and indenopyrazolone pharmacophoric units in a single molecular framework targeting α-amylase and α-glucosidase enzymatic inhibition. Materials & methods: 20 new benzothiazole-appended indenopyrazoles, 3a-t, were synthesized in good yields under environment-friendly conditions via cycloaddition reaction, and assessed for antidiabetic activity against α-amylase and α-glucosidase, using acarbose as the standard reference. Results: Among all the hydroxypyrazolones, 3p and 3r showed the best inhibition against α-amylase and α-glucosidase, which finds support from molecular docking and dynamic studies. Conclusion: Compounds 3p and 3r have been identified as promising antidiabetic agents against α-amylase and α-glucosidase and could be considered valuable leads for further optimization of antidiabetic agents.
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Affiliation(s)
- Ravinder Punia
- Department of Chemistry, Guru Jambheshwar University of Science & Technology, Hisar, Haryana, 125001, India
| | - Satbir Mor
- Department of Chemistry, Guru Jambheshwar University of Science & Technology, Hisar, Haryana, 125001, India
| | - Mohini Khatri
- Department of Chemistry, Guru Jambheshwar University of Science & Technology, Hisar, Haryana, 125001, India
| | - Deepak Kumar
- Department of Pharmaceutical Chemistry, School of Pharmaceutical Sciences, Shoolini University, Solan, 173229, India
| | - Priyanku Pradip Das
- Department of Pharmaceutical Chemistry, School of Pharmaceutical Sciences, Shoolini University, Solan, 173229, India
| | - Deepak Kumar Jindal
- Department of Pharmaceutical Sciences, Guru Jambheshwar University of Science & Technology, Hisar, 125001, India
| | - Ashwani Kumar
- Department of Pharmaceutical Sciences, Guru Jambheshwar University of Science & Technology, Hisar, 125001, India
| | - Prem Selvaraj
- Department of Pharmaceutical Engineering & Technology, Indian Institute of Technology (B.H.U.), Varanasi, 221005, Uttar Pradesh, India
| | - Rajnish Kumar
- Department of Pharmaceutical Engineering & Technology, Indian Institute of Technology (B.H.U.), Varanasi, 221005, Uttar Pradesh, India
| | - Rajni Mohil
- Department of Chemistry, Government College, Nalwa, Hisar, 125001, Haryana, India
| | - Komal Jakhar
- Department of Chemistry, Maharshi Dayanand University, Rohtak, Haryana, 124001, India
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Rasheed L, Rehman W, Rahim F, Ali Z, Alanazi AS, Hussain R, Khan I, Alanazi MM, Naseer M, Abdellattif MH, Hussain R, Khan S, Taha M, Ali Shah SA. Molecular Modeling and Synthesis of Indoline-2,3-dione-Based Benzene Sulfonamide Derivatives and Their Inhibitory Activity against α-Glucosidase and α-Amylase Enzymes. ACS OMEGA 2023; 8:15660-15672. [PMID: 37151487 PMCID: PMC10157847 DOI: 10.1021/acsomega.3c01130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 04/07/2023] [Indexed: 05/09/2023]
Abstract
Diabetes is also known as a critical and noisy disease. Hyperglycemia, that is, increased blood glucose level is a common effect of uncontrolled diabetes, and over a period of time can cause serious effects on health such as blood vessel damage and nervous system damage. However, many attempts have been made to find suitable and beneficial solutions to overcome diabetes. Considering this fact, we synthesized a novel series of indoline-2,3-dione-based benzene sulfonamide derivatives and evaluated them against α-glucosidase and α-amylase enzymes. Out of the synthesized sixteen compounds (1-16), only three compounds showed better results; the IC50 value was in the range of 12.70 ± 0.20 to 0.90 ± 0.10 μM for α-glucosidase against acarbose 11.50 ± 0.30 μM and 14.90 ± 0.20 to 1.10 ± 0.10 μM for α-amylase against acarbose 12.20 ± 0.30 μM. Among the series, only three compounds showed better inhibitory potential such as analogues 11 (0.90 ± 0.10 μM for α-glucosidase and 1.10 ± 0.10 μM for α-amylase), 1 (1.10 ± 0.10 μM for α-glucosidase and 1.30 ± 0.10 μM for α-amylase), and 6 (1.20 ± 0.10 μM for α-glucosidase and 1.60 ± 0.10 μM for α-amylase). Molecular modeling was performed to determine the binding affinity of active interacting residues against these enzymes, and it was found that benzenesulfonohydrazide derivatives can be indexed as suitable inhibitors for diabetes mellitus.
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Affiliation(s)
- Liaqat Rasheed
- Department
of Chemistry, Hazara University, Mansehra 21120, Pakistan
| | - Wajid Rehman
- Department
of Chemistry, Hazara University, Mansehra 21120, Pakistan
- . Phone: 0092-333-5779831
| | - Fazal Rahim
- Department
of Chemistry, Hazara University, Mansehra 21120, Pakistan
| | - Zahid Ali
- Department
of Chemistry, Hazara University, Mansehra 21120, Pakistan
| | - Ashwag S. Alanazi
- Department
of Pharmaceutical Sciences, College of Pharmacy, Princess Nourah Bint Abdulrahman University, P.O. Box 84428, Riyadh 11671, Saudi Arabia
| | - Rafaqat Hussain
- Department
of Chemistry, Hazara University, Mansehra 21120, Pakistan
| | - Imran Khan
- Department
of Chemistry, Hazara University, Mansehra 21120, Pakistan
| | - Mohammed M. Alanazi
- Department
of Pharmaceutical Chemistry, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia
| | - Muhammad Naseer
- Department
of Chemistry, Hazara University, Mansehra 21120, Pakistan
| | - Magda H. Abdellattif
- Department
of Chemistry, College of Sciences, Taif
University, P.O. Box 11099, Taif 21944, Saudi Arabia
| | - Riaz Hussain
- Division
of Science and Technology, University of
Education Lahore, Lahore 54770, Pakistan
| | - Shoaib Khan
- Department
of Chemistry, Hazara University, Mansehra 21120, Pakistan
| | - Muhammad Taha
- Department
of Clinical Pharmacy, Institute for Research and Medical Consultations
(IRMC), Imam Abdulrahman Bin Faisal University, P.O. Box 1982, Dammam 31441, Saudi Arabia
| | - Syed Adnan Ali Shah
- Atta-ur-Rahman
Institute for Natural Product Discovery (AuRIns), Universiti Teknologi MARA Cawangan Selangor Kampus Puncak Alam, Bandar Puncak Alam, Selangor 42300, Malaysia
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Unnikrishnan PS, Animish A, Madhumitha G, Suthindhiran K, Jayasri MA. Bioactivity Guided Study for the Isolation and Identification of Antidiabetic Compounds from Edible Seaweed- Ulva reticulata. Molecules 2022; 27:molecules27248827. [PMID: 36557959 PMCID: PMC9783910 DOI: 10.3390/molecules27248827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 12/01/2022] [Accepted: 12/06/2022] [Indexed: 12/15/2022] Open
Abstract
Managing diabetes is challenging due to the complex physiology of the disease and the numerous complications associated with it. As part of the ongoing search for antidiabetic chemicals, marine algae have been demonstrated to be an excellent source due to their medicinal properties. In this study, Ulva reticulata extracts were investigated for their anti-diabetic effect by examining its inhibitory effects on α-amylase, α-glucosidase, and DPP-IV and antioxidant (DPPH) potential in vitro and its purified fraction using animal models. Among the various solvents used, the Methanolic extract of Ulva reticulata (MEUR) displayed the highest antidiabetic activity in both in vitro and in vivo; it showed no cytotoxicity and hence was subjected to bioassay-guided chromatographic separation. Among the seven isolated fractions (F1 to F7), the F4 (chloroform) fraction exhibited substantial total phenolic content (65.19 μg mL-1) and total flavonoid content (20.33 μg mL-1), which showed the promising inhibition against α-amylase (71.67%) and α-glucosidase (38.01%). Active fraction (F4) was further purified using column chromatography, subjected to thin-layer chromatography (TLC), and characterized by spectroscopy techniques. Upon structural elucidation, five distinct compounds, namely, Nonane, Hexadecanoic acid, 1-dodecanol, Cyclodecane methyl, and phenol, phenol, 3,5-bis(1,1-dimethylethyl) were identified. The antidiabetic mechanism of active fraction (F4) was further investigated using various in vitro and in vivo models. The results displayed that in in vitro both 1 and 24 h in vitro cultures, the active fraction (F4) at a concentration of 100 μg mL-1 demonstrated maximum glucose-induced insulin secretion at 4 mM (0.357 and 0.582 μg mL-1) and 20 mM (0.848 and 1.032 μg mL-1). The active fraction (F4) reduces blood glucose levels in normoglycaemic animals and produces effects similar to that of standard acarbose. Active fraction (F4) also demonstrated outstanding hypoglycaemic activity in hyperglycemic animals at a dose of 10 mg/kg B.wt. In the STZ-induced diabetic rat model, the active fraction (F4) showed a (61%) reduction in blood glucose level when compared to the standard drug glibenclamide (68%). The results indicate that the marine algae Ulva reticulata is a promising candidate for managing diabetes by inhibiting carbohydrate metabolizing enzymes and promoting insulin secretion.
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Affiliation(s)
| | - Andhere Animish
- Marine Biotechnology and Bioproducts Laboratory, Vellore Institute of Technology, School of Biosciences and Technology, Vellore 632014, India
| | - Gunabalan Madhumitha
- Chemistry of Heterocycles and Natural Products Research Laboratory, Vellore Institute of Technology, School of Advanced Sciences, Vellore 632014, India
| | - Krishnamurthy Suthindhiran
- Marine Biotechnology and Bioproducts Laboratory, Vellore Institute of Technology, School of Biosciences and Technology, Vellore 632014, India
| | - Mangalam Achuthananthan Jayasri
- Marine Biotechnology and Bioproducts Laboratory, Vellore Institute of Technology, School of Biosciences and Technology, Vellore 632014, India
- Correspondence:
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Nivetha N, Martiz RM, Patil SM, Ramu R, Sreenivasa S, Velmathi S. Benzodioxole grafted spirooxindole pyrrolidinyl derivatives: synthesis, characterization, molecular docking and anti-diabetic activity. RSC Adv 2022; 12:24192-24207. [PMID: 36128541 PMCID: PMC9404121 DOI: 10.1039/d2ra04452h] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 08/11/2022] [Indexed: 11/21/2022] Open
Abstract
A highly stereoselective, three-component method has been developed to synthesize pyrrolidine and pyrrolizidine containing spirooxindole derivatives. The interaction between the dipolarophile α,β-unsaturated carbonyl compounds and the dipole azomethine ylide formed in situ by the reaction of 1,2-dicarbonyl compounds and secondary amino acids is referred to as the 1,3-dipolar cycloaddition reaction. The reaction conditions were optimized to achieve excellent stereo- and regioselectivity. Shorter reaction time, simple work-up and excellent yields are the salient features of the present approach. Various spectroscopic methods and single crystal X-ray diffraction examinations of one example of compound 6i validated the stereochemistry of the expected products. The anti-diabetic activity of the newly synthesized spirooxindole derivatives was tested against the α-glucosidase and α-amylase enzymes. Compound 6i was found to exhibit potent inhibition activity against α-glucosidase and α-amylase enzymes which is further evidenced by molecular docking studies. A highly stereoselective, three-component method has been developed for the synthesis of pyrrolidine and pyrrolizidine containing spirooxindole derivatives that exhibits excellent anti-diabetic activity.![]()
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Affiliation(s)
- Narayanasamy Nivetha
- Organic and Polymer Synthesis Laboratory, Department of Chemistry, National Institute of Technology, Tiruchirappalli, 620 015, Tamil Nadu, India
| | - Reshma Mary Martiz
- Department of Biotechnology and Bioinformatics, School of Life Sciences, JSS Academy of Higher Education and Research, Mysuru, 570 015, Karnataka, India
| | - Shashank M. Patil
- Department of Biotechnology and Bioinformatics, School of Life Sciences, JSS Academy of Higher Education and Research, Mysuru, 570 015, Karnataka, India
| | - Ramith Ramu
- Department of Biotechnology and Bioinformatics, School of Life Sciences, JSS Academy of Higher Education and Research, Mysuru, 570 015, Karnataka, India
| | - Swamy Sreenivasa
- Department of Chemistry, University College of Science, Tumkur University, Tumkur, 572 103, Karnataka, India
| | - Sivan Velmathi
- Organic and Polymer Synthesis Laboratory, Department of Chemistry, National Institute of Technology, Tiruchirappalli, 620 015, Tamil Nadu, India
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Wang X. Retrospection of Analytical Data Collected through Smart Devices for Diseases and Disability Caused by Physical Inactivity. JOURNAL OF HEALTHCARE ENGINEERING 2021; 2021:4731281. [PMID: 34804451 PMCID: PMC8601795 DOI: 10.1155/2021/4731281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 10/23/2021] [Accepted: 10/26/2021] [Indexed: 11/17/2022]
Abstract
The basic meaning of inactive lifestyle is doing sedentary activities. This includes playing video games, watching TV, operating computers, and sitting in a particular place for a long time. It may be sitting on the train or in bus, car, or office. This has many adverse effects on our bodies. This paper emphasizes the importance of physical activity, and a case study is presented to support the hypothesis that physical activity can certainly help improve human health. The diseases caused by inactive life are discussed in our paper. In this paper, a case study is described in which 200 individuals have participated in an activity called "Activity is Life," with the goal of improving the sedentary lifestyle and getting rid of physical ailments. The usage of analytical tools is made to analyse the data collected from the empirical research study, and IoT-based smart devices are used to capture the runtime data. The physicians and nurses have odd working hours, they have to go through many stress-induced situations, and most of them are suffering from life-threatening diseases such as depression, hypertension, cancer, and cardiovascular diseases. The main reason is inactivity in their lifestyles. To carry out an experimental study and to see the impact of regular activities on the health of doctors and nurses, a program was designed where 200 participants have participated. It is found that the activity-based 30-day program yielded great health benefits, including reduction in stress level, improvement in sleep quality index, and improvement in blood pressure values.
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Affiliation(s)
- Xiaoyu Wang
- Sports Department, Jilin Technology College of Electronic Information, Jilin 132000, China
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Altowyan MS, Barakat A, Al-Majid AM, Al-Ghulikah H. Spiroindolone Analogues as Potential Hypoglycemic with Dual Inhibitory Activity on α-Amylase and α-Glucosidase. Molecules 2019; 24:E2342. [PMID: 31242688 PMCID: PMC6630796 DOI: 10.3390/molecules24122342] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 06/17/2019] [Accepted: 06/21/2019] [Indexed: 11/16/2022] Open
Abstract
Inhibition of α-amylase and α-glucosidase by specified synthetic compounds during the digestion of starch helps control post-prandial hyperglycemia and could represent a potential therapy for type II diabetes mellitus. A new series of spiroheterocyclic compounds bearing oxindole/benzofuran/pyrrolidine/thiazolidine motifs were synthesized via a 1,3-dipolar cyclo-addition reaction approach. The specific compounds were obtained by reactions of chalcones having a benzo[b]furan scaffold (compounds 2a-f), with a substituted isatin (compounds 3a-c) and heterocyclic amino acids (compounds 4a,b). The target spiroindolone analogues 5a-r were evaluated for their potential inhibitory activities against the enzymes α-amylase and α-glucosidase. Preliminary results indicated that some of the target compounds exhibit promising α-amylase and α-glucosidase inhibitory activity. Among the tested spiroindolone analogues, the cycloadduct 5r was found to be the most active (IC50 = 22.61 ± 0.54 μM and 14.05 ± 1.03 μM) as α-amylase and α-glucosidase inhibitors, with selectivity indexes of 0.62 and 1.60, respectively. Docking studies were carried out to confirm the binding interaction between the enzyme active site and the spiroindolone analogues.
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Affiliation(s)
- Mezna Saleh Altowyan
- Department of Chemistry, College of Science, Princess Nourah Bint Abdulrahman University, P.O. Box 84428, Riyadh 1167, Saudi Arabia; (M.S.A.); (H.A.A.-G.)
| | - Assem Barakat
- Department of Chemistry, College of Science, King Saud University, P.O. Box 2455, Riyadh 11451, Saudi Arabia;
- Department of Chemistry, Faculty of Science, Alexandria University, P.O. Box 426, Ibrahimia, Alexandria 21321, Egypt
| | - Abdullah Mohammed Al-Majid
- Department of Chemistry, College of Science, King Saud University, P.O. Box 2455, Riyadh 11451, Saudi Arabia;
| | - H.A. Al-Ghulikah
- Department of Chemistry, College of Science, Princess Nourah Bint Abdulrahman University, P.O. Box 84428, Riyadh 1167, Saudi Arabia; (M.S.A.); (H.A.A.-G.)
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Elhag W, El Ansari W, Abdulrazzaq S, Abdullah A, Elsherif M, Elgenaied I. Evolution of 29 Anthropometric, Nutritional, and Cardiometabolic Parameters Among Morbidly Obese Adolescents 2 Years Post Sleeve Gastrectomy. Obes Surg 2018; 28:474-482. [PMID: 28822064 PMCID: PMC5778185 DOI: 10.1007/s11695-017-2868-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Background Laparoscopic sleeve gastrectomy (LSG) is a popular treatment for adolescent morbid obesity. Research on LSG outcomes among adolescents assessed a narrow range of anthropometric, nutritional, or cardiometabolic parameters, leading to an incomplete picture of these changes. We examined a wide variety of anthropometric, nutritional, and cardiometabolic parameters among adolescents before and after LSG. Methods We retrospectively reviewed medical charts of all obese adolescents who underwent LSG at Hamad Medical Corporation, Qatar, between January 2011 and June 2015 (N = 102). We assessed preoperative levels and postoperative changes in 4 anthropometric, 15 nutritional, and 10 cardiometabolic parameters. Results The study sample comprised 79 patients with complete information (36 males, mean age 15.99 ± 1.1 years). At a mean of 24.2 months post-LSG, we observed (1) significantly reduced mean weight and body mass index by 51.82 ± 28.1 kg and 17 ± 6.24 kg/m2, respectively; (2) the highest prevalence of post-LSG deficiencies pertained to vitamin D, albumin, and ferritin (89.3, 38, and 33.3%, respectively); (3) low hemoglobin levels (29.3%) only in females; (4) trace elements were not deficient; (4) significant reductions in percentage of adolescents with elevated low-density lipoprotein (from 66.1 to 38.9%), alanine aminotransferase (from 45.3 to 10.9%), and aspartate aminotransferase (from 24.1 to 8.6%) levels; (5) 100% remission of prediabetes cases; and (6) 80% remission of type 2 diabetes cases. Conclusions LSG achieved significant weight loss and improvement of cardiometabolic risk factors among adolescents. However, the slight worsening of preexisting nutritional deficiencies warrants careful preoperative surveillance and appropriate postoperative nutritional supplementation.
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Affiliation(s)
- Wahiba Elhag
- Department of Bariatric Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, State of Qatar
| | - Walid El Ansari
- Department of Surgery, Hamad General Hospital, Hamad Medical Corporation, PO Box 3050, Doha, State of Qatar. .,College of Medicine, Qatar University, Doha, State of Qatar. .,School of Health and Education, University of Skövde, Skövde, Sweden.
| | - Sama Abdulrazzaq
- Department of Bariatric Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, State of Qatar
| | - Ali Abdullah
- Department of Internal Medicine, Hamad General Hospital, Hamad Medical Corporation, Doha, State of Qatar
| | - Mohamed Elsherif
- Department of Bariatric Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, State of Qatar
| | - Israa Elgenaied
- Department of Bariatric Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, State of Qatar
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Taha M, Shah SAA, Imran S, Afifi M, Chigurupati S, Selvaraj M, Rahim F, Ullah H, Zaman K, Vijayabalan S. Synthesis and in vitro study of benzofuran hydrazone derivatives as novel alpha-amylase inhibitor. Bioorg Chem 2017; 75:78-85. [PMID: 28918064 DOI: 10.1016/j.bioorg.2017.09.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Revised: 08/22/2017] [Accepted: 09/05/2017] [Indexed: 01/08/2023]
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Dickey W, Arday DR, Kelly J, Carnahan CD. Outpatient evaluation, recognition, and initial management of pediatric overweight and obesity in U.S. military medical treatment facilities. J Am Assoc Nurse Pract 2016; 29:85-93. [PMID: 27582288 DOI: 10.1002/2327-6924.12398] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Revised: 05/17/2016] [Accepted: 06/28/2016] [Indexed: 11/09/2022]
Abstract
BACKGROUND AND PURPOSE As childhood obesity is a concern in many communities, this study investigated outpatient evaluation and initial management of overweight and obese pediatric patients in U.S. military medical treatment facilities (MTFs). METHODS Samples of 579 overweight and 341 obese patients (as determined by body mass index [BMI]) aged 3-17 years were drawn from MTFs. All available FY2011 outpatient records were searched for documentation of BMI assessment, overweight/obesity diagnosis, and counseling. Administrative data for these patients were merged to assess coded diagnostic and counseling rates and receipt of recommended laboratory screenings. CONCLUSIONS Generic BMI documentation was high, but BMI percentile assessments were found among fewer than half the patients. Diagnostic recording or recognition totaled 10.9% of overweight and 32.0% of obese. Counseling rates were higher, with 46.4% and 61.0% of overweight and obese patients, respectively, receiving weight related counseling. Among patients 10 years of age or older, rates of recommended lab screenings for diabetes, liver abnormality, and dyslipidemia were not greater than 33%. BMI percentile recording was strongly associated with diagnostic recording, and diagnostic recording was strongly associated with counseling. IMPLICATIONS FOR PRACTICE Improvements to electronic health records or implementation of local procedures to facilitate better diagnostic recording would likely improve adherence to clinical practice guidelines.
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Affiliation(s)
- Wayne Dickey
- Lockheed Martin, Information Systems and Government Support, Military Health, Fairfax, Virginia
| | - David R Arday
- Lockheed Martin, Information Systems and Government Support, Military Health, Fairfax, Virginia
| | - Joseph Kelly
- Lockheed Martin, Information Systems and Government Support, Military Health, Fairfax, Virginia
| | - Col David Carnahan
- Enterprise Intelligence Branch, Health Informatics Division, Defense Health Agency, San Antonio, Texas
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Effects of Brown Seaweed (Sargassum polycystum) Extracts on Kidney, Liver, and Pancreas of Type 2 Diabetic Rat Model. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2014; 2014:379407. [PMID: 24516503 PMCID: PMC3910465 DOI: 10.1155/2014/379407] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/13/2013] [Accepted: 12/23/2013] [Indexed: 02/07/2023]
Abstract
The edible seaweed Sargassum polycystum (SP) is traditionally used against several human diseases. This investigation evaluated the effects of two dietary doses of SP ethanolic and aqueous extracts on the pancreatic, hepatic, and renal morphology of type 2 diabetic rats (T2DM). T2DM was induced by feeding rats on high calorie diet followed by a low dose streptozotocin. Changes in the diabetic rat organs in SP treated groups with different doses of extracts were compared with normal rats, diabetic control rats, and metformin treated rats. After 22 days of treatment, the pathological lesions of the livers and kidneys in the diabetic rats were quantitatively and qualitatively alleviated (P < 0.05) by both the SP extracts at 150 mg/kg body weight and by metformin. All the treated diabetic groups revealed marked improvement in the histopathology of the pancreas compared with the control diabetic group. Oral administration of 300 mg/kg body weight of aqueous and ethanolic extracts of SP and metformin revealed pancreas protective or restorative effects. The seaweed extracts at 150 mg/kg body weight reduced the liver and kidney damages in the diabetic rats and may exert tissue repair or restoration of the pancreatic islets in experimentally induced diabetes to produce the beneficial homeostatic effects.
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Cheng L, Meng XB, Lu S, Wang TT, Liu Y, Sun GB, Sun XB. Evaluation of hypoglycemic efficacy of tangningtongluo formula, a traditional Chinese Miao medicine, in two rodent animal models. J Diabetes Res 2014; 2014:745419. [PMID: 25431772 PMCID: PMC4238278 DOI: 10.1155/2014/745419] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Revised: 09/04/2014] [Accepted: 10/30/2014] [Indexed: 11/18/2022] Open
Abstract
Traditional Chinese medicines largely lack adequate and scientifically rigorous evidence regarding efficacy and functional mechanisms. The present study was aimed to confirm the hypoglycemic effect of Tangningtongluo (TNTL) formula, a traditional Chinese Miao medicine, in two animal models: high-fat diet and streptozotocin- (STZ-) induced diabetic rats and C57BL/KsJ-db/db diabetic mice. After 4 weeks, TNTL intervention in STZ-induced diabetic rats yielded in significant improvement on the glucose tolerance test. Moreover, the islet histopathology showed that oral TNTL reduced the severity of islet necrosis in pancreases tissue. Compared with diabetic controls, a 12-week TNTL treatment regimen (dosages = 0.9, 1.8, and 3.6 g/kg) in db/db mice significantly decreased fasting glucose and HbA1c. Additionally, oral glucose tolerance in TNTL-treated mice improved significantly, compared with diabetic mice receiving metformin. Finally, tissue histopathology and biochemical index evaluations revealed significant improvement in TNTL-treated mice. Taken together, our results show that TNTL exerted a strong hypoglycemic effect in two diabetic rodent animal models, preserving β-cells in the pancreas islet and reducing the risk of diabetic retinopathy and nephropathy.
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Affiliation(s)
- Long Cheng
- Key Laboratory of Bioactive Substances and Resources Utilization of Chinese Herbal Medicine, Institute of Medicinal Plant Development, Chinese Academy of Medical Sciences and Peking Union Medical College, Ministry of Education, No. 151, Malianwa North Road, Haidian District, Beijing 100193, China
| | - Xiang-bao Meng
- Key Laboratory of Bioactive Substances and Resources Utilization of Chinese Herbal Medicine, Institute of Medicinal Plant Development, Chinese Academy of Medical Sciences and Peking Union Medical College, Ministry of Education, No. 151, Malianwa North Road, Haidian District, Beijing 100193, China
| | - Shan Lu
- Heilongjiang University of Chinese Medicine, Harbin, Heilongjiang 150040, China
| | - Ting-ting Wang
- Pharmaceutical College, Harbin University of Commerce, Harbin, Heilongjiang 150076, China
| | - Yue Liu
- Xiyuan Hospital, China Academy of Traditional Chinese Medicine, Beijing 100091, China
| | - Gui-bo Sun
- Key Laboratory of Bioactive Substances and Resources Utilization of Chinese Herbal Medicine, Institute of Medicinal Plant Development, Chinese Academy of Medical Sciences and Peking Union Medical College, Ministry of Education, No. 151, Malianwa North Road, Haidian District, Beijing 100193, China
- *Gui-bo Sun: and
| | - Xiao-bo Sun
- Key Laboratory of Bioactive Substances and Resources Utilization of Chinese Herbal Medicine, Institute of Medicinal Plant Development, Chinese Academy of Medical Sciences and Peking Union Medical College, Ministry of Education, No. 151, Malianwa North Road, Haidian District, Beijing 100193, China
- *Xiao-bo Sun:
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Booth FW, Roberts CK, Laye MJ. Lack of exercise is a major cause of chronic diseases. Compr Physiol 2013; 2:1143-211. [PMID: 23798298 DOI: 10.1002/cphy.c110025] [Citation(s) in RCA: 1225] [Impact Index Per Article: 111.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Chronic diseases are major killers in the modern era. Physical inactivity is a primary cause of most chronic diseases. The initial third of the article considers: activity and prevention definitions; historical evidence showing physical inactivity is detrimental to health and normal organ functional capacities; cause versus treatment; physical activity and inactivity mechanisms differ; gene-environment interaction (including aerobic training adaptations, personalized medicine, and co-twin physical activity); and specificity of adaptations to type of training. Next, physical activity/exercise is examined as primary prevention against 35 chronic conditions [accelerated biological aging/premature death, low cardiorespiratory fitness (VO2max), sarcopenia, metabolic syndrome, obesity, insulin resistance, prediabetes, type 2 diabetes, nonalcoholic fatty liver disease, coronary heart disease, peripheral artery disease, hypertension, stroke, congestive heart failure, endothelial dysfunction, arterial dyslipidemia, hemostasis, deep vein thrombosis, cognitive dysfunction, depression and anxiety, osteoporosis, osteoarthritis, balance, bone fracture/falls, rheumatoid arthritis, colon cancer, breast cancer, endometrial cancer, gestational diabetes, pre-eclampsia, polycystic ovary syndrome, erectile dysfunction, pain, diverticulitis, constipation, and gallbladder diseases]. The article ends with consideration of deterioration of risk factors in longer-term sedentary groups; clinical consequences of inactive childhood/adolescence; and public policy. In summary, the body rapidly maladapts to insufficient physical activity, and if continued, results in substantial decreases in both total and quality years of life. Taken together, conclusive evidence exists that physical inactivity is one important cause of most chronic diseases. In addition, physical activity primarily prevents, or delays, chronic diseases, implying that chronic disease need not be an inevitable outcome during life.
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Affiliation(s)
- Frank W Booth
- Departments of Biomedical Sciences, Medical Pharmacology and Physiology, and Nutrition and Exercise Physiology, Dalton Cardiovascular Institute, University of Missouri, Columbia, Missouri, USA.
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Home Food Environment, Dietary Intake, and Weight among Overweight and Obese Children in Southern Appalachia. South Med J 2013; 106:550-7. [DOI: 10.1097/smj.0000000000000008] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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14
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Kim J, Di Vizio D, Kim TK, Kim J, Kim M, Pelton K, Clinton SK, Hai T, Hwang D, Solomon KR, Freeman MR. The response of the prostate to circulating cholesterol: activating transcription factor 3 (ATF3) as a prominent node in a cholesterol-sensing network. PLoS One 2012; 7:e39448. [PMID: 22768301 PMCID: PMC3388073 DOI: 10.1371/journal.pone.0039448] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2011] [Accepted: 05/21/2012] [Indexed: 12/20/2022] Open
Abstract
Elevated circulating cholesterol is a systemic risk factor for cardiovascular disease and metabolic syndrome, however the manner in which the normal prostate responds to variations in cholesterol levels is poorly understood. In this study we addressed the molecular and cellular effects of elevated and suppressed levels of circulating cholesterol on the normal prostate. Integrated bioinformatic analysis was performed using DNA microarray data from two experimental formats: (1) ventral prostate from male mice with chronically elevated circulating cholesterol and (2) human prostate cells exposed acutely to cholesterol depletion. A cholesterol-sensitive gene expression network was constructed from these data and the transcription factor ATF3 was identified as a prominent node in the network. Validation experiments confirmed that elevated cholesterol reduced ATF3 expression and enhanced proliferation of prostate cells, while cholesterol depletion increased ATF3 levels and inhibited proliferation. Cholesterol reduction in vivo alleviated dense lymphomononuclear infiltrates in the periprostatic adipose tissue, which were closely associated with nerve tracts and blood vessels. These findings open new perspectives on the role of cholesterol in prostate health, and provide a novel role for ATF3, and associated proteins within a large signaling network, as a cholesterol-sensing mechanism.
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Affiliation(s)
- Jayoung Kim
- Division of Cancer Biology and Therapeutics, Departments of Surgery and Biomedical Sciences, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA.
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15
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Type 2 diabetic patients and their offspring show altered parameters of iron status, oxidative stress and genes related to mitochondrial activity. Biometals 2012; 25:725-35. [DOI: 10.1007/s10534-012-9540-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2011] [Accepted: 03/13/2012] [Indexed: 10/28/2022]
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El Mouzan MI, Al Herbish AS, Al Salloum AA, Al Omar AA, Qurachi MM. Regional variation in prevalence of overweight and obesity in Saudi children and adolescents. Saudi J Gastroenterol 2012; 18:129-32. [PMID: 22421719 PMCID: PMC3326974 DOI: 10.4103/1319-3767.93818] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2011] [Accepted: 11/20/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND/AIMS There are limited data on regional variation of overweight and obesity in the Kingdom of Saudi Arabia. Therefore, the aim of this report is to explore the magnitude of these variation in order to focus preventive programs to regional needs. SETTING AND DESIGN Community-based multistage random sample of representative cohort from each region. PATIENTS AND METHODS the study sample was cross-sectional, representative of healthy children and adolescents from 2 to 17 years of age. Body mass index (BMI) was calculated according to the formula (weight/height²). The 2000 center for disease control reference was used for the calculation of prevalence of overweight and obesity defined as the proportion of children and adolescents whose BMI for age was above 85 th and 95 th percentiles respectively, for Northern, Southwestern and Central regions of the Kingdom. Chi-square test was used to assess the difference in prevalence between regions and a P value of <0.05 was considered significant. RESULTS The sample size was 3525, 3413 and 4174 from 2-17 years of age in the Central, Southwestern and Northern regions respectively. The overall prevalence of overweight was 21%, 13.4% and 20.1%, that of obesity was 9.3%, 6% and 9.1% in the Central, Southwestern and Northern regions respectively indicating a significantly-lower prevalence in the Southwestern compared to other regions (P<0.0001). CONCLUSIONS This report revealed significant regional variations important to consider in planning preventive and therapeutic programs tailored to the needs of each region.
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Golub N, Geba D, Mousa SA, Williams G, Block RC. Greasing the wheels of managing overweight and obesity with omega-3 fatty acids. Med Hypotheses 2011; 77:1114-20. [PMID: 21981905 PMCID: PMC3210336 DOI: 10.1016/j.mehy.2011.09.016] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2011] [Accepted: 09/08/2011] [Indexed: 01/22/2023]
Abstract
The epidemic of overweight and obesity around the world and in the US is a major public health challenge, with 1.5 billion overweight and obese adults worldwide, and 68% of US adults and 31% of US children and adolescents overweight or obese. Obesity leads to serious health consequences, including an increased risk of type 2 diabetes mellitus and heart disease. Current preventive and medical treatments include lifestyle modification, medication, and bariatric surgery in extreme cases; however, they are either not very efficacious or are very expensive. Obesity is a complex condition involving the dysregulation of several organ systems and molecular pathways, including adipose tissue, the pancreas, the gastrointestinal tract, and the CNS. The role of the CNS in obesity is receiving more attention as obesity rates rise and treatments continue to fail. While the role of the hypothalamus in regulation of appetite and food intake has long been recognized, the roles of the CNS reward systems are beginning to be examined as the role of environmental influences on energy balance are explored. Omega-3 polyunsaturated fatty acids are essential nutrients that play a beneficial role in several disease processes due to their anti-inflammatory effects, modulation of lipids, and effects on the CNS. Omega-3 fatty acids, specifically EPA and DHA, have shown promising preliminary results in animal and human studies in the prevention and treatment of obesity. Given their effects on many of the pathways involved in obesity, and specifically in the endocannabinoid and mesocorticolimbic pathways, we hypothesize that EPA and DHA supplementation in populations can reduce the reward associated with food, thereby reduce appetite and food intake, and ultimately contribute to the prevention or reduction of obesity. If these fatty acids do harbor such potential, their supplementation in many parts of the world may hold great promise in reducing the global burden of obesity.
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Affiliation(s)
- N Golub
- The University of Rochester School of Medicine and Dentistry, Rochester, NY 14642, USA
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18
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Dalton WT, Schetzina KE, Holt N, Fulton-Robinson H, Ho AL, Tudiver F, McBee MT, Wu T. Parent-Led Activity and Nutrition (PLAN) for healthy living: design and methods. Contemp Clin Trials 2011; 32:882-92. [PMID: 21777701 PMCID: PMC3335199 DOI: 10.1016/j.cct.2011.07.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2010] [Revised: 06/03/2011] [Accepted: 07/04/2011] [Indexed: 11/22/2022]
Abstract
Child obesity has become an important public health concern, especially in rural areas. Primary care providers are well positioned to intervene with children and their parents, but encounter many barriers to addressing child overweight and obesity. This paper describes the design and methods of a cluster-randomized controlled trial to evaluate a parent-mediated approach utilizing physician's brief motivational interviewing and parent group sessions to treat child (ages 5-11 years) overweight and obesity in the primary care setting in Southern Appalachia. Specific aims of this pilot project will be 1) to establish a primary care based and parent-mediated childhood overweight intervention program in the primary care setting, 2) to explore the efficacy of this intervention in promoting healthier weight status and health behaviors of children, and 3) to examine the acceptability and feasibility of the approach among parents and primary care providers. If proven to be effective, this approach may be an exportable model to other primary care practices.
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Affiliation(s)
- William T. Dalton
- Department of Psychology, East Tennessee State University, Johnson City, TN, USA
| | - Karen E. Schetzina
- Department of Pediatrics, James H. Quillen College of Medicine, East Tennessee State University, Johnson City, TN, USA
| | - Nicole Holt
- Department of Biostatistics and Epidemiology, East Tennessee State University, Johnson City, TN, USA
| | - Hazel Fulton-Robinson
- Department of Pediatrics, James H. Quillen College of Medicine, East Tennessee State University, Johnson City, TN, USA
| | - Ai-Leng Ho
- Department of Pediatrics, James H. Quillen College of Medicine, East Tennessee State University, Johnson City, TN, USA
| | - Fred Tudiver
- Department of Family Medicine, James H. Quillen College of Medicine, East Tennessee State University, Johnson City, TN, USA
| | - Mathew T. McBee
- Frank Porter Graham Child Development Institute, University of North Carolina Chapel Hill, Chapel Hill, NC, USA
| | - Tiejian Wu
- Department of Biostatistics and Epidemiology, East Tennessee State University, Johnson City, TN, USA
- Department of Family Medicine, James H. Quillen College of Medicine, East Tennessee State University, Johnson City, TN, USA
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Blakytny R, Spraul M, Jude EB. Review: The diabetic bone: a cellular and molecular perspective. INT J LOW EXTR WOUND 2011; 10:16-32. [PMID: 21444607 DOI: 10.1177/1534734611400256] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
With the increasing worldwide prevalence of diabetes the resulting complications, their consequences and treatment will lead to a greater social and financial burden on society. One of the many organs to be affected is bone. Loss of bone is observed in type 1 diabetes, in extreme cases mirroring osteoporosis, thus a greater risk of fracture. In the case of type 2 diabetes, both a loss and an increase of bone has been observed, although in both cases the quality of the bone overall was poorer, again leading to a greater risk of fracture. Once a fracture has occurred, healing is delayed in diabetes, including nonunion. The reasons leading to such changes in the state of the bone and fracture healing in diabetes is under investigation, including at the cellular and the molecular levels. In comparison with our knowledge of events in normal bone homeostasis and fracture healing, that for diabetes is much more limited, particularly in patients. However, progress is being made, especially with the use of animal models for both diabetes types. Identifying the molecular and cellular changes in the bone in diabetes and understanding how they arise will allow for targeted intervention to improve diabetic bone, thus helping to counter conditions such as Charcot foot as well as preventing fracture and accelerating healing when a fracture does occur.
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20
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Freeman MR, Solomon KR. Cholesterol and benign prostate disease. Differentiation 2011; 82:244-52. [PMID: 21862201 DOI: 10.1016/j.diff.2011.04.005] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2011] [Revised: 04/13/2011] [Accepted: 04/21/2011] [Indexed: 12/17/2022]
Abstract
The origins of benign prostatic diseases, such as benign prostatic hyperplasia (BPH) and chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS), are poorly understood. Patients suffering from benign prostatic symptoms report a substantially reduced quality of life, and the relationship between benign prostate conditions and prostate cancer is uncertain. Epidemiologic data for BPH and CP/CPPS are limited, however an apparent association between BPH symptoms and cardiovascular disease (CVD) has been consistently reported. The prostate synthesizes and stores large amounts of cholesterol and prostate tissues may be particularly sensitive to perturbations in cholesterol metabolism. Hypercholesterolemia, a major risk factor for CVD, is also a risk factor for BPH. Animal model and clinical trial findings suggest that agents that inhibit cholesterol absorption from the intestine, such as the class of compounds known as polyene macrolides, can reduce prostate gland size and improve lower urinary tract symptoms (LUTS). Observational studies indicate that cholesterol-lowering drugs reduce the risk of aggressive prostate cancer, while prostate cancer cell growth and survival pathways depend in part on cholesterol-sensitive biochemical mechanisms. Here we review the evidence that cholesterol metabolism plays a role in the incidence of benign prostate disease and we highlight possible therapeutic approaches based on this concept.
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Affiliation(s)
- Michael R Freeman
- The Urological Diseases Research Center, Children's Hospital Boston, Enders Research Laboratories, 300 Longwood Ave., Boston, MA 02115, USA.
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21
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Kumar R, Sharma B, Tomar NR, Roy P, Gupta AK, Kumar A. In Vivo Evalution of Hypoglycemic Activity of Aloe spp. and Identification of Its Mode of Action on GLUT-4 Gene Expression In Vitro. Appl Biochem Biotechnol 2011; 164:1246-56. [DOI: 10.1007/s12010-011-9210-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2010] [Accepted: 03/01/2011] [Indexed: 12/20/2022]
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Primary care practice addressing child overweight and obesity: a survey of primary care physicians at four clinics in southern Appalachia. South Med J 2011; 104:14-9. [PMID: 21119559 DOI: 10.1097/smj.0b013e3181fc968a] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The prevalence of childhood overweight and obesity in southern Appalachia is among the highest in the United States (US). Primary care providers are in a unique position to address the problem; however, little is known about attitudes and practices in these settings. METHODS A 61-item healthcare provider questionnaire assessing current practices, attitudes, perceived barriers, and skill levels in managing childhood overweight and obesity was distributed to physicians in four primary care clinics. Questionnaires were obtained from 36 physicians. RESULTS Physicians' practices to address childhood overweight and obesity were limited, despite the fact that most physicians shared the attitude that childhood overweight and obesity need attention. While 71% of physicians reported talking about eating and physical activity habits with parents of overweight or obese children, only 19% reported giving these parents the tools they needed to make changes. Approximately 42% determined the parents' readiness to make small changes for their overweight or obese children. Physicians' self-perceived skill level in managing childhood overweight and obesity was found to be a key factor for childhood overweight- and obesity- related practices. CONCLUSION Primary care physicians in southern Appalachia currently play a limited role in the prevention or intervention of childhood overweight and obesity. Training physicians to improve their skills in managing childhood overweight and obesity may lead to an improvement in practice.
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El Mouzan MI, Foster PJ, Al Herbish AS, Al Salloum AA, Al Omer AA, Qurachi MM, Kecojevic T. Prevalence of overweight and obesity in Saudi children and adolescents. Ann Saudi Med 2010; 30:203-8. [PMID: 20427936 PMCID: PMC2886870 DOI: 10.4103/0256-4947.62833] [Citation(s) in RCA: 119] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND AND OBJECTIVE There is limited information on overweight and obesity in Saudi children and adolescents. The objective of this study was to establish the national prevalence of overweight and obesity in Saudi children and adolescents. METHODS The 2005 Saudi reference data set was used to calculate the body mass index (BMI) for children aged 5 to 18 years. Using the 2007 WHO reference, the prevalence of overweight, obesity and severe obesity were defined as the proportion of children with a BMI standard deviation score more than +1, +2 and +3, respectively. The 2000 CDC reference was also used for comparison. RESULTS There were 19 317 healthy children and adolescents from 5 to 18 years of age, 50.8% of whom were boys. The overall prevalence of overweight, obesity and severe obesity in all age groups was 23.1%, 9.3% and 2%, respectively. A significantly lower prevalence of overweight (23.8 vs 20.4; P<.001) and obesity (9.5 vs 5.7; P<.001) was found when the CDC reference was used. CONCLUSIONS This report establishes baseline national prevalence rates for overweight, obesity and severe obesity in Saudi children and adolescents, indicating intermediate levels between developing and industrialized countries. Measures should be implemented to prevent further increases in the numbers of overweight school-age children and adolescents and the associated health hazards.
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24
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Wu T, Dixon WE, Dalton WT, Tudiver F, Liu X. Joint Effects of Child Temperament and Maternal Sensitivity on the Development of Childhood Obesity. Matern Child Health J 2010; 15:469-77. [DOI: 10.1007/s10995-010-0601-z] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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25
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Meneghini L, Liebl A, Abrahamson MJ. Insulin detemir: A historical perspective on a modern basal insulin analogue. Prim Care Diabetes 2010; 4 Suppl 1:S31-S42. [PMID: 20394890 DOI: 10.1016/s1751-9918(10)60007-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Insulin detemir provides prolonged, reproducible blood glucose reduction through a mechanism unique among basal insulins. It was originally studied clinically in predominantly basal + bolus regimens and found to be associated with a low risk of hypoglycaemia compared to insulin NPH, and reduced weight gain compared to other basal insulins. Insulin detemir has been increasingly studied in basal-only insulin regimens in type 2 diabetes, in which an understanding of how to optimize its use has been built incrementally. Glycaemic control and limitation of weight gain tend to be maximized by once-daily (evening) dosing, earlier initiation and careful titration to appropriate fasting glucose targets.
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Affiliation(s)
- Luigi Meneghini
- University of Miami Miller School of Medicine, Florida 33136, USA
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26
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Garg M, Thamotharan M, Pan G, Lee PWN, Devaskar SU. Early exposure of the pregestational intrauterine and postnatal growth-restricted female offspring to a peroxisome proliferator-activated receptor-{gamma} agonist. Am J Physiol Endocrinol Metab 2010; 298:E489-98. [PMID: 20009032 PMCID: PMC2838528 DOI: 10.1152/ajpendo.00361.2009] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2009] [Accepted: 12/08/2009] [Indexed: 01/08/2023]
Abstract
Prenatal nutrient restriction with intrauterine growth restriction (IUGR) alters basal and glucose-stimulated insulin response and hepatic metabolic adaptation. The effect of early intervention with insulin-sensitizing peroxisome proliferator-activated receptor gamma agonists was examined in the metabolically maladapted F(1) pregestational IUGR offspring with a propensity toward pregnancy-induced gestational diabetes. The effect of rosiglitazone maleate [RG; 11 micromol/day from postnatal day (PN) 21 to PN60] vs. placebo (PL) on metabolic adaptations in 2-mo-old F(1) female rats subjected to prenatal (IUGR), postnatal (PNGR), or pre- and postnatal (IUGR + PNGR) nutrient restriction was investigated compared with control (CON). RG vs. PL had no effect on body weight or plasma glucose concentrations but increased subcutaneous white and brown adipose tissue and plasma cholesterol concentrations in all three experimental groups. Glucose tolerance tests with a 1:1 mixture of [2-(2)H(2)]- and [6,6-(2)H(2)]glucose in RG IUGR vs. PL IUGR revealed glucose tolerance with a lower glucose-stimulated insulin release (GSIR) and suppressed endogenous hepatic glucose production (HGP) with no difference in glucose clearance (GC) and recycling (GR). RG PNGR, although similar to PL CON, was hyperglycemic vs. PL PNGR with reduced GR but no difference in the existent low GSIR, HGP, and GC. RG IUGR + PNGR overall was no different from the PL counterpart. Insulin tolerance tests revealed perturbed recovery to baseline from the exaggerated hypoglycemia in RG vs. the PL groups with the only exception being RG PNGR where further worsening of hypoglycemia over PL PNGR was minimal with full recovery to baseline. These observations support that early intervention with RG suppressed HGP in IUGR vs. PL IUGR, without increasing GSIR similar to that seen in CON. Although RG reversed PNGR to the PL CON metabolic state, no such insulin-sensitizing effect was realized in IUGR + PNGR.
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Affiliation(s)
- Meena Garg
- Neonatal Research Center, Department of Pediatrics, David Geffen School of Medicine University of California Los Angeles, USA
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27
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Kim K, Kim H, Kwon J, Lee S, Kong H, Im SA, Lee YH, Lee YR, Oh ST, Jo TH, Park YI, Lee CK, Kim K. Hypoglycemic and hypolipidemic effects of processed Aloe vera gel in a mouse model of non-insulin-dependent diabetes mellitus. PHYTOMEDICINE : INTERNATIONAL JOURNAL OF PHYTOTHERAPY AND PHYTOPHARMACOLOGY 2009; 16:856-863. [PMID: 19303272 DOI: 10.1016/j.phymed.2009.02.014] [Citation(s) in RCA: 78] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2008] [Revised: 11/28/2008] [Accepted: 02/10/2009] [Indexed: 05/27/2023]
Abstract
The effects of processed Aloe vera gel (PAG) on the course of established diet-induced non-insulin-dependent diabetes mellitus (NIDDM) were studied in C57BL/6J mice. NIDDM was induced in C57BL/6J mice by feeding them a high-fat diet. Mice exhibiting diet-induced obesity (DIO) with blood glucose levels above 180mg/dl were selected to examine the antidiabetic effects of PAG. Oral administration of PAG for 8 weeks reduced circulating blood glucose concentrations to a normal level in these DIO mice. In addition, the administration of PAG significantly decreased plasma insulin. The antidiabetic effects of PAG were also confirmed by intraperitoneal glucose tolerance testing. PAG appeared to lower blood glucose levels by decreasing insulin resistance. The administration of PAG also lowered triacylglyceride levels in liver and plasma. Histological examinations of periepididymal fat pad showed that PAG reduced the average size of adipocytes. These results demonstrate that the oral administration of PAG prevents the progression of NIDDM-related symptoms in high-fat diet-fed mice, and suggest that PAG could be useful for treating NIDDM.
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Affiliation(s)
- Kwanghee Kim
- Department of Pharmacy, SahmYook University, Seoul, South Korea
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Pinto Pereira LM, Hinds A, Ali I, Gooding R, Ragbir M, Samaroo K, Nayak SB. Do current standards of primary care of diabetes meet with guideline recommendations in Trinidad, West Indies? Prim Care Diabetes 2009; 3:91-96. [PMID: 19394285 DOI: 10.1016/j.pcd.2009.03.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2008] [Revised: 02/13/2009] [Accepted: 03/22/2009] [Indexed: 11/21/2022]
Abstract
AIMS Primary care management of diabetes was examined using the Caribbean Health Research Council (CHRC) guidelines. METHODS We retrospectively examined a cross-section of 646 type 2 people with diabetics over 12 months with 1st visit between 1997 and 2005. RESULTS There were more women (65.8%) than men (34.2%) with age range between 29 and 89 years. Blood pressure and weight were evaluated in >95% of patients at each centre. Waist circumference and BMI were not measured at any time and HbA(1)c was infrequently measured (1.6-7%) over the 12 months. Information on family history (87.5%), smoking and alcohol (78.1%), exercise (21.4%), socioeconomic status (19.4%) and education (0.3%), and fasting blood sugar (97.2%), lipid profile (51.8%) and serum creatinine (37.9%) were assessed at the 1st visit. At follow-up patients were advised on treatment compliance (47.2%), diet (34.2%), exercise (18.5%) and rarely on home monitoring of blood glucose (0.3%). Peripheral sensations, pedal pulses (6%), visual acuity (3.3%), fundoscopy (12.1%) and ECG (3.9%) were scarcely examined at the annual visit. CONCLUSIONS Current management of diabetes in primary care in Trinidad falls short of Caribbean guideline recommendations. The CHRC and Ministry of Health should jointly educate caregivers of diabetes to implement the guidelines, with annual audits to identify shortfalls in management.
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Affiliation(s)
- Lexley M Pinto Pereira
- Faculty of Medical Sciences, The University of the West Indies, St Augustine, Trinidad and Tobago.
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29
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Garg M, Thamotharan M, Oak SA, Pan G, Maclaren DC, Lee PWN, Devaskar SU. Early exercise regimen improves insulin sensitivity in the intrauterine growth-restricted adult female rat offspring. Am J Physiol Endocrinol Metab 2009; 296:E272-81. [PMID: 19001551 PMCID: PMC2645014 DOI: 10.1152/ajpendo.90473.2008] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
We examined the effect of early exercise training (Ex) on glucose kinetics, basal, and insulin-stimulated skeletal muscle (SKM) plasma membrane (PM) GLUT4 in pre- and/or postnatal nutrient-restricted adult rat offspring compared with sedentary (Sed) state. Pregestational control female (Ex CON vs. Sed CON) and offspring exposed to prenatal (Ex IUGR vs. Sed IUGR), postnatal (Ex PNGR vs. Sed PNGR), or pre- and postnatal (Ex IUGR + PNGR vs. Sed IUGR + PNGR) nutrient restriction were studied. The combined effect of exercise and pre/postnatal nutrition in the Ex IUGR demonstrated positive effects on basal and glucose-stimulated plasma insulin response (GSIR) with suppression of endogenous hepatic glucose production (HGP) compared with sedentary state. Ex PNGR was hyperglycemic after glucose challenge with no change in glucose-stimulated insulin production or HGP compared with sedentary state. Ex IUGR + PNGR remained glucose tolerant with unchanged glucose-stimulated insulin production but increased endogenous HGP compared with sedentary state. Basal SKM PM-associated GLUT4 was unchanged by exercise in all four groups. Whereas Ex PNGR and Ex IUGR + PNGR insulin responsiveness was similar to that of Ex CON, Ex IUGR remained nonresponsive to insulin. Early introduction of regular Ex in the pregestational female offspring had a positive effect on hepatic adaptation to GSIR and HGP in IUGR and IUGR + PNGR, with no effect in PNGR. Change in insulin responsiveness of SKM GLUT4 translocation was observed in exercised IUGR + PNGR and PNGR but not in exercised IUGR.
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Affiliation(s)
- Meena Garg
- Division of Neonatology and Developmental Biology, Neonatal Research Center, Department of Pediatrics, David Geffen School of Medicine, UCLA, Los Angeles, CA 90095-1752, USA
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Morinder G, Larsson UE, Norgren S, Marcus C. Insulin sensitivity, VO2max and body composition in severely obese Swedish children and adolescents. Acta Paediatr 2009; 98:132-8. [PMID: 18808398 DOI: 10.1111/j.1651-2227.2008.01030.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM The aim of this study was to identify relationships between insulin sensitivity (SI), cardiorespiratory fitness and body composition in severely obese Swedish children and adolescents. METHODS Two hundred and twenty-eight obese children (119 girls, 8-16 years, body mass index (BMI) 23.2-57.0 kg/m(2)) performed a frequently sampled intravenous glucose tolerance test (FSIVGTT), a submaximal bicycle ergometry test and a dual-energy X-ray absorptiometry (DEXA). RESULTS Mean SI (SD) was 0.38 (0.32) (x10(-5)/min/pM). SI correlated positively with relative body mass (BM) VO(2)max (r = 0.42) (p < 0.001), relative fat-free mass (FFM) VO(2)max (r = 0.36) (p < 0.001) and negatively with body mass index standard deviation score (BMI SDS) (r =-0.22) (p = 0.001). SI did not correlate with percent body fat (r =-0.01) and absolute VO(2)max (r = 0.01). In multiple regression analyses with SI as dependent variable, VO(2)max and body composition, together with gender, age and Tanner stage, explained 20-26% of the variance. CONCLUSION Relative (BM) VO(2)max and relative (FFM) VO(2)max were stronger predictors of SI than percent body fat in severely obese children and adolescents. The study confirms that cardiorespiratory fitness is of importance for the metabolic syndrome in the studied population. Efforts to improve SI should include physical activity targeting cardiorespiratory fitness also in severely obese children and adolescents.
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Affiliation(s)
- Gunilla Morinder
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Huddinge, Sweden.
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Mayer-Davis EJ. Type 2 diabetes in youth: epidemiology and current research toward prevention and treatment. ACTA ACUST UNITED AC 2008; 108:S45-51. [PMID: 18358256 DOI: 10.1016/j.jada.2008.01.018] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2007] [Accepted: 11/26/2007] [Indexed: 12/21/2022]
Abstract
Type 2 diabetes mellitus has emerged as a diagnosis among adolescents in the United States, particularly among minority groups and concurrent with the well-documented epidemic of overweight and obesity. Opportunities for prevention of type 2 diabetes and approaches to optimized treatment regimens for adolescents with the disease have drawn largely from studies conducted in adult populations. Recognizing that much work remains to be done, this review summarizes key findings from recent research and highlights recent findings from large, ongoing studies of youth that address the prevalence and incidence of type 2 diabetes in young people, the prevalence of complications among this group, and the current knowledge base that informs opportunities for prevention and treatment of type 2 diabetes in adolescents.
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Huang Y, McCullagh P, Black N, Harper R. Feature selection and classification model construction on type 2 diabetic patients’ data. Artif Intell Med 2007; 41:251-62. [PMID: 17707617 DOI: 10.1016/j.artmed.2007.07.002] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2006] [Revised: 06/19/2007] [Accepted: 07/06/2007] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Diabetes affects between 2% and 4% of the global population (up to 10% in the over 65 age group), and its avoidance and effective treatment are undoubtedly crucial public health and health economics issues in the 21st century. The aim of this research was to identify significant factors influencing diabetes control, by applying feature selection to a working patient management system to assist with ranking, classification and knowledge discovery. The classification models can be used to determine individuals in the population with poor diabetes control status based on physiological and examination factors. METHODS The diabetic patients' information was collected by Ulster Community and Hospitals Trust (UCHT) from year 2000 to 2004 as part of clinical management. In order to discover key predictors and latent knowledge, data mining techniques were applied. To improve computational efficiency, a feature selection technique, feature selection via supervised model construction (FSSMC), an optimisation of ReliefF, was used to rank the important attributes affecting diabetic control. After selecting suitable features, three complementary classification techniques (Naïve Bayes, IB1 and C4.5) were applied to the data to predict how well the patients' condition was controlled. RESULTS FSSMC identified patients' 'age', 'diagnosis duration', the need for 'insulin treatment', 'random blood glucose' measurement and 'diet treatment' as the most important factors influencing blood glucose control. Using the reduced features, a best predictive accuracy of 95% and sensitivity of 98% was achieved. The influence of factors, such as 'type of care' delivered, the use of 'home monitoring', and the importance of 'smoking' on outcome can contribute to domain knowledge in diabetes control. CONCLUSION In the care of patients with diabetes, the more important factors identified: patients' 'age', 'diagnosis duration' and 'family history', are beyond the control of physicians. Treatment methods such as 'insulin', 'diet' and 'tablets' (a variety of oral medicines) may be controlled. However lifestyle indicators such as 'body mass index' and 'smoking status' are also important and may be controlled by the patient. This further underlines the need for public health education to aid awareness and prevention. More subtle data interactions need to be better understood and data mining can contribute to the clinical evidence base. The research confirms and to a lesser extent challenges current thinking. Whilst fully appreciating the requirement for clinical verification and interpretation, this work supports the use of data mining as an exploratory tool, particularly as the domain is suffering from a data explosion due to enhanced monitoring and the (potential) storage of this data in the electronic health record. FSSMC has proved a useful feature estimator for large data sets, where processing efficiency is an important factor.
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MESH Headings
- Administration, Oral
- Adult
- Aged
- Aged, 80 and over
- Algorithms
- Blood Glucose/drug effects
- Blood Glucose/metabolism
- Body Mass Index
- Decision Support Systems, Clinical
- Diabetes Mellitus, Type 2/blood
- Diabetes Mellitus, Type 2/diet therapy
- Diabetes Mellitus, Type 2/drug therapy
- Diabetes Mellitus, Type 2/therapy
- Female
- Health Knowledge, Attitudes, Practice
- Humans
- Hypoglycemic Agents/administration & dosage
- Hypoglycemic Agents/therapeutic use
- Information Storage and Retrieval
- Injections
- Life Style
- Male
- Medical Records Systems, Computerized
- Middle Aged
- Models, Biological
- Obesity/complications
- Obesity/physiopathology
- Patient Education as Topic
- Patient Selection
- Reproducibility of Results
- Risk Factors
- Smoking/adverse effects
- Treatment Outcome
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Affiliation(s)
- Yue Huang
- Department of Computing, Faculty of Engineering, Imperial College London, South Kensington, London SW7 2AZ, UK.
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Bibliography. Current world literature. Diabetes and the endocrine pancreas. Curr Opin Endocrinol Diabetes Obes 2007; 14:170-96. [PMID: 17940437 DOI: 10.1097/med.0b013e3280d5f7e9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Moffat T, Galloway T. Adverse environments: Investigating local variation in child growth. Am J Hum Biol 2007; 19:676-83. [PMID: 17636529 DOI: 10.1002/ajhb.20664] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Epigenetic and life history approaches to child growth are centered on the relationship between the organism and its environment. However, defining and operationalizing the concept of environment is challenging, in light of the multiple variables that influence growth. Moreover, the concept of adaptation as it applies to child growth is seldom considered in the developed country context. This paper presents a study of children living in three neighborhoods in the City of Hamilton, Ontario, Canada. Two of the communities are considered adverse environments on the basis of low socioeconomic status, and their inner city, industrial location. In contrast to children living in the higher socioeconomic status area, children in these adverse environments display negative growth indicators, i.e., somewhat constrained linear growth in one and risk for overweight and obesity in both. Although both these inner city neighborhoods constitute adverse environments, they differ in ways that have a significant impact on children's growth. We argue for a definition of "adverse environment" that is broadly based, incorporating a range of physical, social, and temporal factors that are highly localized and sensitive to community-level influences on growth and health. As well, we consider whether higher prevalence of overweight and obesity is adaptive in any way to these adverse environments and conclude that they are more likely to be deleterious than adaptive in either the long or short term.
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Affiliation(s)
- Tina Moffat
- Department of Anthropology, McMaster University, Hamilton, Ontario, Canada L8S 4L9.
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Nader PR, O'Brien M, Houts R, Bradley R, Belsky J, Crosnoe R, Friedman S, Mei Z, Susman EJ. Identifying risk for obesity in early childhood. Pediatrics 2006; 118:e594-601. [PMID: 16950951 DOI: 10.1542/peds.2005-2801] [Citation(s) in RCA: 646] [Impact Index Per Article: 35.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Our aim with this study was to assist clinicians by estimating the predictive value of earlier levels of BMI status on later risk of overweight and obesity during the middle childhood and early adolescent years. METHODS We present growth data from the National Institute of Child Health and Human Development Study of Early Child Care and Youth Development, a longitudinal sample of 1042 healthy US children in 10 locations. Born in 1991, their growth reflects the secular trend of increasing overweight/obesity in the population. Height and weight of participating children in the study were measured at 7 time points. We examined odds ratios for overweight and obesity at age 12 years comparing the frequency with which children did versus did not reach specific BMI percentiles in the preschool- and elementary-age periods. To explore the question of whether and when earlier BMI was predictive of weight status at age 12 years, we used logistic regression to obtain the predicted probabilities of being overweight or obese (BMI > or = 85%) at 12 years old on the basis of earlier BMI. RESULTS Persistence of obesity is apparent for both the preschool and elementary school period. Children who were ever overweight (> 85th percentile), that is, > or = 1 time at ages 24, 36, or 54 months during the preschool period were > 5 times as likely to be overweight at age 12 years than those who were below the 85th percentile for BMI at all 3 of the preschool ages. During the elementary school period, ages 7, 9, and 11 years, the more times a child was overweight, the greater the odds of being overweight at age 12 years relative to a child who was never overweight. Sixty percent of children who were overweight at any time during the preschool period and 80% of children who were overweight at any time during the elementary period were overweight at age 12 years. Follow-up calculations showed that 2 in 5 children whose BMIs were > or = 50th percentile by age 3 years were overweight at age 12 years. No children who were < 50th percentile for BMI at all points during elementary school were overweight at age 12 years. Children who have higher range BMIs earlier, but not at the 85th percentile, are also more likely to be overweight at age 12 years. Even at time points before and including age 9 years, children whose BMIs are between the 75th and 85th percentile have an approximately 40% to 50% chance of being overweight at age 12 years. Children at 54 months old whose BMIs are between the 50th and 75th percentile are 4 times more likely to be overweight at age 12 years than their contemporaries who are < 50th percentile, and those whose BMIs are between the 75th and 85th percentile are > 6 times more likely to be overweight at age 12 years than those < 50th percentile. CONCLUSIONS The data from this study indicate that children with BMIs > 85th percentile, as well as with BMIs in the high reference range are more likely than children whose BMI is < 50th percentile to continue to gain weight and reach overweight status by adolescence. Pediatricians can be confident in counseling parents to begin to address the at-risk child's eating and activity patterns rather than delaying in hopes that overweight and the patterns that support it will resolve themselves in due course. Identifying children at risk for adolescent obesity provides physicians with an opportunity for earlier intervention with the goal of limiting the progression of abnormal weight gain that results in the development of obesity-related morbidity.
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Affiliation(s)
- Philip R Nader
- Division of Community Pediatrics, University of California, San Diego, California, USA.
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Abstract
Perspective on the paper by Reinehr et al (see page 473)
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Affiliation(s)
- T J Wilkin
- University Medicine, Level 7, Derriford Hospital, Plymouth PL6 8DH, UK.
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