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Liu X, Gilbert RG. Normal and abnormal glycogen structure - A review. Carbohydr Polym 2024; 338:122195. [PMID: 38763710 DOI: 10.1016/j.carbpol.2024.122195] [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: 02/09/2024] [Revised: 04/18/2024] [Accepted: 04/20/2024] [Indexed: 05/21/2024]
Abstract
Glycogen, a complex branched glucose polymer, is found in animals and bacteria, where it serves as an energy storage molecule. It has linear (1 → 4)-α glycosidic bonds between anhydroglucose monomer units, with branch points connected by (1 → 6)-α bonds. Individual glycogen molecules are referred to as β particles. In organs like the liver and heart, these β particles can bind into larger aggregate α particles, which exhibit a rosette-like morphology. The mechanisms and bonding underlying the aggregation process are not fully understood. For example, mammalian liver glycogen has been observed to be molecularly fragile under certain conditions, such as glycogen from diabetic livers fragmenting when exposed to dimethyl sulfoxide (DMSO), while glycogen from healthy livers is much less fragile; this indicates some difference, as yet unknown, in the bonding between β particles in healthy and diabetic glycogen. This fragility may have implications for blood sugar regulation, especially in pathological conditions such as diabetes.
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Affiliation(s)
- Xin Liu
- Jiangsu Key Laboratory of Crop Genomics and Molecular Breeding/Zhongshan Biological Breeding Laboratory, and Jiangsu Key Laboratory of Crop Genetics and Physiology, College of Agriculture, Yangzhou University, Yangzhou 225009, China; Centre for Nutrition & Food Sciences, Queensland Alliance for Agriculture & Food Innovations (QAAFI), The University of Queensland, QLD 4072, Australia
| | - Robert G Gilbert
- Jiangsu Key Laboratory of Crop Genomics and Molecular Breeding/Zhongshan Biological Breeding Laboratory, and Jiangsu Key Laboratory of Crop Genetics and Physiology, College of Agriculture, Yangzhou University, Yangzhou 225009, China; Centre for Nutrition & Food Sciences, Queensland Alliance for Agriculture & Food Innovations (QAAFI), The University of Queensland, QLD 4072, Australia.
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Codazzi V, Frontino G, Galimberti L, Giustina A, Petrelli A. Mechanisms and risk factors of metabolic syndrome in children and adolescents. Endocrine 2024; 84:16-28. [PMID: 38133765 PMCID: PMC10987369 DOI: 10.1007/s12020-023-03642-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 11/30/2023] [Indexed: 12/23/2023]
Abstract
Metabolic syndrome (MetS) is a complex disorder characterized by abdominal obesity, elevated blood pressure, hyperlipidemia, and elevated fasting blood glucose levels. The diagnostic criteria for MetS in adults are well-established, but there is currently no consensus on the definition in children and adolescents. The etiology of MetS is believed to involve a complex interplay between genetic predisposition and environmental factors. While genetic predisposition explains only a small part of MetS pathogenesis, modifiable environmental risk factors play a significant role. Factors such as maternal weight during pregnancy, children's lifestyle, sedentariness, high-fat diet, fructose and branched-chain amino acid consumption, vitamin D deficiency, and sleep disturbances contribute to the development of MetS. Early identification and treatment of MetS in children and adolescents is crucial to prevent the development of chronic diseases later in life. In this review we discuss the latest research on factors contributing to the pathogenesis of MetS in children, focusing on non-modifiable and modifiable risk factors, including genetics, dysbiosis and chronic low-grade inflammation.
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Pan K, Jukic AM, Mishra GD, Mumford SL, Wise LA, Schisterman EF, Ley SH, Charlton BM, Chavarro JE, Hart JE, Sidney S, Xiong X, Barbosa-Leiker C, Schliep K, Shaffer JG, Bazzano LA, Harville EW. The association between preconception cannabis use and gestational diabetes mellitus: The Preconception Period Analysis of Risks and Exposures Influencing health and Development (PrePARED) consortium. Paediatr Perinat Epidemiol 2024; 38:69-85. [PMID: 37751914 PMCID: PMC11000150 DOI: 10.1111/ppe.13008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 09/11/2023] [Accepted: 09/12/2023] [Indexed: 09/28/2023]
Abstract
BACKGROUND The metabolic changes that ultimately lead to gestational diabetes mellitus (GDM) likely begin before pregnancy. Cannabis use might increase the risk of GDM by increasing appetite or promoting fat deposition and adipogenesis. OBJECTIVES We aimed to assess the association between preconception cannabis use and GDM incidence. METHODS We analysed individual-level data from eight prospective cohort studies. We identified the first, or index, pregnancy (lasting ≥20 weeks of gestation with GDM status) after cannabis use. In analyses of pooled individual-level data, we used logistic regression to estimate study-type-specific odds ratios (OR) and 95% confidence intervals (CI), adjusting for potential confounders using random effect meta-analysis to combine study-type-specific ORs and 95% CIs. Stratified analyses assessed potential effect modification by preconception tobacco use and pre-pregnancy body mass index (BMI). RESULTS Of 17,880 participants with an index pregnancy, 1198 (6.7%) were diagnosed with GDM. Before the index pregnancy, 12.5% of participants used cannabis in the past year. Overall, there was no association between preconception cannabis use in the past year and GDM (OR 0.97, 95% CI 0.79, 1.18). Among participants who never used tobacco, however, those who used cannabis more than weekly had a higher risk of developing GDM than those who did not use cannabis in the past year (OR 2.65, 95% CI 1.15, 6.09). This association was not present among former or current tobacco users. Results were similar across all preconception BMI groups. CONCLUSIONS In this pooled analysis of preconception cohort studies, preconception cannabis use was associated with a higher risk of developing GDM among individuals who never used tobacco but not among individuals who formerly or currently used tobacco. Future studies with more detailed measurements are needed to investigate the influence of preconception cannabis use on pregnancy complications.
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Affiliation(s)
- Ke Pan
- Department of Epidemiology, Tulane School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Anne Marie Jukic
- Epidemiology Branch, National Institute of Environmental Health Sciences, Durham, NC, USA
| | - Gita D. Mishra
- School of Public Health, University of Queensland, Herston, QLD, Australia
| | - Sunni L. Mumford
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Lauren A. Wise
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Enrique F. Schisterman
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Sylvia H. Ley
- Department of Epidemiology, Tulane School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Brittany M. Charlton
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
| | - Jorge E. Chavarro
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
- Departments of Nutrition and Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Jaime E. Hart
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Stephen Sidney
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Xu Xiong
- Department of Epidemiology, Tulane School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | | | - Karen Schliep
- Division of Public Health, Department of Family and Preventive Medicine, School of Medicine, University of Utah, Salt Lake City, UT, USA
| | - Jeffrey G. Shaffer
- Department of Biostatistics and Data Science, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Lydia A. Bazzano
- Department of Epidemiology, Tulane School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Emily W. Harville
- Department of Epidemiology, Tulane School of Public Health and Tropical Medicine, New Orleans, LA, USA
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Wang Y, Sun P, Zhao Z, Yan Y, Yue W, Yang K, Liu R, Huang H, Wang Y, Chen Y, Li N, Feng H, Li J, Liu Y, Chen Y, Shen B, Zhao L, Yin C. Identify gestational diabetes mellitus by deep learning model from cell-free DNA at the early gestation stage. Brief Bioinform 2023; 25:bbad492. [PMID: 38168840 PMCID: PMC10782912 DOI: 10.1093/bib/bbad492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 10/26/2023] [Accepted: 11/30/2023] [Indexed: 01/05/2024] Open
Abstract
Gestational diabetes mellitus (GDM) is a common complication of pregnancy, which has significant adverse effects on both the mother and fetus. The incidence of GDM is increasing globally, and early diagnosis is critical for timely treatment and reducing the risk of poor pregnancy outcomes. GDM is usually diagnosed and detected after 24 weeks of gestation, while complications due to GDM can occur much earlier. Copy number variations (CNVs) can be a possible biomarker for GDM diagnosis and screening in the early gestation stage. In this study, we proposed a machine-learning method to screen GDM in the early stage of gestation using cell-free DNA (cfDNA) sequencing data from maternal plasma. Five thousand and eighty-five patients from north regions of Mainland China, including 1942 GDM, were recruited. A non-overlapping sliding window method was applied for CNV coverage screening on low-coverage (~0.2×) sequencing data. The CNV coverage was fed to a convolutional neural network with attention architecture for the binary classification. The model achieved a classification accuracy of 88.14%, precision of 84.07%, recall of 93.04%, F1-score of 88.33% and AUC of 96.49%. The model identified 2190 genes associated with GDM, including DEFA1, DEFA3 and DEFB1. The enriched gene ontology (GO) terms and KEGG pathways showed that many identified genes are associated with diabetes-related pathways. Our study demonstrates the feasibility of using cfDNA sequencing data and machine-learning methods for early diagnosis of GDM, which may aid in early intervention and prevention of adverse pregnancy outcomes.
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Affiliation(s)
- Yipeng Wang
- Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, Beijing 100026, P. R. China
| | - Pei Sun
- BGI-Beijing Clinical Laboratories, BGI-Shenzhen, Beijing 101300, P. R. China
| | - Zicheng Zhao
- Shenzhen Byoryn Technology Co., Ltd., Shenzhen 518118, P. R. China
- Shanxi Keda Research Institute, Taiyuan 030000, P. R. China
| | - Yousheng Yan
- Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, Beijing 100026, P. R. China
| | - Wentao Yue
- Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, Beijing 100026, P. R. China
| | - Kai Yang
- Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, Beijing 100026, P. R. China
| | - Ruixia Liu
- Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, Beijing 100026, P. R. China
| | - Hui Huang
- BGI Genomics, BGI-Shenzhen, Shenzhen 518083, P. R. China
| | - Yinan Wang
- Department of Obstetrics and Gynecology, Peking University Shenzhen Hospital, Shenzhen 518055, P. R. China
| | - Yin Chen
- Shenzhen Byoryn Technology Co., Ltd., Shenzhen 518118, P. R. China
| | - Nan Li
- BGI Genomics, BGI-Shenzhen, Shenzhen 518083, P. R. China
| | - Hailong Feng
- BGI-Beijing Clinical Laboratories, BGI-Shenzhen, Beijing 101300, P. R. China
| | - Jing Li
- Shenzhen Byoryn Technology Co., Ltd., Shenzhen 518118, P. R. China
| | - Yifan Liu
- Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, Beijing 100026, P. R. China
| | - Yujiao Chen
- Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, Beijing 100026, P. R. China
| | - Bairong Shen
- Institutes for Systems Genetics, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Sichuan University, Sichuan, 610041, P. R. China
| | - Lijian Zhao
- BGI Genomics, BGI-Shenzhen, Shenzhen 518083, P. R. China
| | - Chenghong Yin
- Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, Beijing 100026, P. R. China
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Sohn P, McLaughlin MR, Krishnan P, Wu W, Slak Rupnik M, Takasu A, Senda T, Lee CC, Kono T, Evans-Molina C. Stromal Interaction Molecule 1 Maintains β-Cell Identity and Function in Female Mice Through Preservation of G-Protein-Coupled Estrogen Receptor 1 Signaling. Diabetes 2023; 72:1433-1445. [PMID: 37478155 PMCID: PMC10545557 DOI: 10.2337/db22-0988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 07/07/2023] [Indexed: 07/23/2023]
Abstract
Altered endoplasmic reticulum (ER) Ca2+ signaling has been linked with β-cell dysfunction and diabetes development. Store-operated Ca2+ entry replenishes ER Ca2+ through reversible gating of plasma membrane Ca2+ channels by the ER Ca2+ sensor, stromal interaction molecule 1 (STIM1). For characterization of the in vivo impact of STIM1 loss, mice with β-cell-specific STIM1 deletion (STIM1Δβ mice) were generated and challenged with high-fat diet. Interestingly, β-cell dysfunction was observed in female, but not male, mice. Female STIM1Δβ mice displayed reductions in β-cell mass, a concomitant increase in α-cell mass, and reduced expression of markers of β-cell maturity, including MafA and UCN3. Consistent with these findings, STIM1 expression was inversely correlated with HbA1c levels in islets from female, but not male, human organ donors. Mechanistic assays demonstrated that the sexually dimorphic phenotype observed in STIM1Δβ mice was due, in part, to loss of signaling through the noncanonical 17-β estradiol receptor (GPER1), as GPER1 knockdown and inhibition led to a similar loss of expression of β-cell maturity genes in INS-1 cells. Together, these data suggest that STIM1 orchestrates pancreatic β-cell function and identity through GPER1-mediated estradiol signaling. ARTICLE HIGHLIGHTS Store-operated Ca2+ entry replenishes endoplasmic reticulum (ER) Ca2+ through reversible gating of plasma membrane Ca2+ channels by the ER Ca2+ sensor, stromal interaction molecule 1 (STIM1). β-Cell-specific deletion of STIM1 results in a sexually dimorphic phenotype, with β-cell dysfunction and loss of identity in female but not male mice. Expression of the noncanonical 17-β estradiol receptor (GPER1) is decreased in islets of female STIM1Δβ mice, and modulation of GPER1 levels leads to alterations in expression of β-cell maturity genes in INS-1 cells.
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Affiliation(s)
- Paul Sohn
- Department of Anatomy, Cell Biology, and Physiology, Indiana University School of Medicine, Indianapolis, IN
- Center for Diabetes and Metabolic Diseases, Indiana University School of Medicine, Indianapolis, IN
- Herman B Wells Center for Pediatric Research, Indiana University School of Medicine, Indianapolis, IN
| | - Madeline R. McLaughlin
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN
| | - Preethi Krishnan
- Center for Diabetes and Metabolic Diseases, Indiana University School of Medicine, Indianapolis, IN
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN
- Department of Chemical and Biological Engineering, University of British Columbia, Vancouver, Canada
| | - Wenting Wu
- Center for Diabetes and Metabolic Diseases, Indiana University School of Medicine, Indianapolis, IN
- Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, IN
| | - Marjan Slak Rupnik
- Center for Physiology and Pharmacology, Medical University of Vienna, Vienna, Austria
- Institute of Physiology, Faculty of Medicine, University of Maribor, Maribor, Slovenia
| | - Akira Takasu
- Structural Biology Research Center, Institute of Materials Structure Science, High Energy Accelerator Research Organization, Ibaraki, Japan
| | - Toshiya Senda
- Structural Biology Research Center, Institute of Materials Structure Science, High Energy Accelerator Research Organization, Ibaraki, Japan
| | - Chih-Chun Lee
- Center for Diabetes and Metabolic Diseases, Indiana University School of Medicine, Indianapolis, IN
- Herman B Wells Center for Pediatric Research, Indiana University School of Medicine, Indianapolis, IN
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN
| | - Tatsuyoshi Kono
- Center for Diabetes and Metabolic Diseases, Indiana University School of Medicine, Indianapolis, IN
- Herman B Wells Center for Pediatric Research, Indiana University School of Medicine, Indianapolis, IN
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN
- Richard L. Roudebush Veterans' Administration Medical Center, Indianapolis, IN
| | - Carmella Evans-Molina
- Department of Anatomy, Cell Biology, and Physiology, Indiana University School of Medicine, Indianapolis, IN
- Center for Diabetes and Metabolic Diseases, Indiana University School of Medicine, Indianapolis, IN
- Herman B Wells Center for Pediatric Research, Indiana University School of Medicine, Indianapolis, IN
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN
- Richard L. Roudebush Veterans' Administration Medical Center, Indianapolis, IN
- Department of Biochemistry and Molecular Biology, Indiana University School of Medicine, Indianapolis, IN
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN
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Hummelen R, Sodhi S, Poirier J, Gordon J, Asokan S, Matsumoto CL, Kelly L. Progression From Gestational Diabetes Mellitus to Type 2 Diabetes Mellitus Among First Nations Women in Northwest Ontario: A Retrospective Cohort Study. Can J Diabetes 2023; 47:566-570. [PMID: 37196981 DOI: 10.1016/j.jcjd.2023.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 03/07/2023] [Accepted: 05/09/2023] [Indexed: 05/19/2023]
Abstract
OBJECTIVE Our aim in this study was to identify the incidence of type 2 diabetes mellitus among First Nations women in northwest Ontario with a history of gestational diabetes mellitus (GDM). METHODS This work was a retrospective cohort study of women diagnosed with GDM using a 50-gram oral glucose challenge test or a 75-gram oral glucose tolerance test from January 1, 2010, to December 31, 2017, at the Sioux Lookout Meno Ya Win Health Centre. Outcomes were assessed based on glycated hemoglobin (A1C) measurements performed between January 1, 2010, and December 31, 2019. RESULTS The cumulative incidence of T2DM among women with a history of GDM was 18% (42 of 237) at 2 years and 39% (76 of 194) at 6 years. Women with GDM who developed T2DM were of similar age and parity and had equivalent C-section rates (26%) compared to those who did not develop T2DM. They had higher birth weights (3,866 grams vs 3,600 grams, p=0.006) and rates of treatment with insulin (24% vs 5%, p<0.001) and metformin (16% vs 5%, p=0.005). CONCLUSIONS GDM confers a significant risk for the development of T2DM in First Nations women. Broad community-based resources, food security, and social programming are required.
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Affiliation(s)
- Ruben Hummelen
- Division of Clinical Sciences, Northern Ontario School of Medicine, Sioux Lookout, Ontario, Canada
| | - Sumeet Sodhi
- Department of Family and Community Medicine, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Jenna Poirier
- Sioux Lookout Northern Ontario School of Medicine Local Education Group, Sioux Lookout, Ontario, Canada
| | - Janet Gordon
- Sioux Lookout First Nations Health Authority, Sioux Lookout, Ontario, Canada
| | - Shanthive Asokan
- Sioux Lookout Meno Ya Win Health Centre, Sioux Lookout, Ontario, Canada
| | - Cai-Lei Matsumoto
- Sioux Lookout Northern Ontario School of Medicine Local Education Group, Sioux Lookout, Ontario, Canada
| | - Len Kelly
- Sioux Lookout Meno Ya Win Health Centre, Sioux Lookout, Ontario, Canada.
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Thabrew KAS, Sooriyarachchi MR, Jayakody DNK. Determinants of under-five mortality in Sri Lanka: A multilevel analysis of 2016 Sri Lankan DHS data. PLoS One 2023; 18:e0291246. [PMID: 37682906 PMCID: PMC10490942 DOI: 10.1371/journal.pone.0291246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 07/14/2023] [Indexed: 09/10/2023] Open
Abstract
Under-five mortality (U5M) is considered a major public health issue directly impacts a country's development. This study analyzed the prognostic factors of U5M in Sri Lanka using data from the 2016 Demographic and Health Survey (DHS) of 8123 children. The study employed both a binary logistic regression model (BLRM) and a binary logistic random intercept multilevel model (BLRIMM) and compared the accuracy of each model's prediction percentage. The results showed that the BLRIMM had a higher correct prediction percentage (98.67%) compared to the BLRM (98.31%). The study found that children who were not breastfed (Odds Ratio (OR) = 116.74, 95% Confidence Interval (CI) = 62.97-216.41), were part of multiple births (OR = 3.73, 95% CI = 1.21-11.51), did not have a normal delivery (OR = 1.86, 95% CI = 1.11-3.12), were born to mothers who had experienced previous miscarriages or child loss (OR = 2.27, 95% CI = 1.26-4.11), and were born to mothers with a higher Body Mass Index (BMI) (OR = 1.05, 95% CI = 1.003-1.10) had higher odds of U5M. The odds of U5M were found to be lower among Buddhists (OR = 0.06, 95% CI = 0.01-0.50), Hindus (OR = 0.05, 95% CI = 0.01-0.46), and Roman Catholics (OR = 0.032, 95% CI = 0.003-0.307) compared to the "Other Religions" category in the dataset. The estimated covariance parameter of the random intercept (0.8231, p-value = 0.0405) indicated significant unobserved cluster-level variation in U5M. The study's results emphasize the importance of addressing religion related differences of U5M and improving maternal education regarding healthy lifestyle, proper food intake, the significance of breastfeeding, safe delivery methods, safety measures during pregnancy and childbirth in cases of multiple births, and proper child care after birth.
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Affiliation(s)
| | | | - Dushantha Nalin K. Jayakody
- School of Engineering, Sri Lanka Technological Campus, Padukka, Sri Lanka
- TECHLAB—Centro de Investigação em Tecnologias, Universidade Autónoma de Lisboa, Lisbon, Portugal
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Yu B, Zhang B, Han X, Long W, Zhou W, Yuan X. Platelet counts affect the association between hyperhomocysteinemia and pregnancy complications. BMC Public Health 2023; 23:1058. [PMID: 37268909 PMCID: PMC10236586 DOI: 10.1186/s12889-023-16027-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 05/31/2023] [Indexed: 06/04/2023] Open
Abstract
BACKGROUND The joint effect of platelet and other modifiers on the risk of pregnancy complications is unknown. This study investigated whether platelet count (PC) and total homocysteine (tHcy) level have a synergistic effect on the incidence of pregnancy complications in a Chinese population. METHODS Total 11,553 consecutive pregnant women who received whole blood cell and biochemical tests at the time of admission for labor in Changzhou Maternal and Child Health Care Hospital were analyzed. The primary outcome was the prevalence of pregnancy complications: gestational diabetes mellitus (GDM), intrahepatic cholestasis of pregnancy (ICP), pre-eclampsia (PE), and pregnancy induced hypertension (PIH). RESULTS The prevalence of GDM, ICP, PE, and PIH was 8.4%, 6.2%, 3.4%, and 2.1%, respectively. The highest rate of ICP (28.6%) was observed in women with high tHcy (> 15 μmol/L) and low PC (quartile 1); and the lowest rate of GDM (0.6%) was found in women with high tHcy and high PC (quartiles 2 to 4). In low PC group, the prevalence of ICP in women with high tHcy was significantly higher than that in women with low tHcy (≤ 15 μmol/L) (28.6% vs. 8.4%), representing an absolute risk increment of 20.2% and a relative risk increment of 3.3-fold (OR: 3.34; 95% CI: 1.55, 7.17; P = 0.002), whereas no joint effect was observed among high PC group. CONCLUSIONS Among Chinese pregnant women, one subgroup (high tHcy and low PC) has the highest risk of ICP and another (high tHcy and high PC) has the lowest risk of GDM; tHcy and platelet could be used as indicators to identify the women with high risk of ICP or low risk of GDM.
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Affiliation(s)
- Bin Yu
- Department of Medical Genetics, Changzhou Maternal and Child Health Care Hospital, Changzhou Medical Center, Nanjing Medical University, 16th Ding Xiang Road, Changzhou, 213023 Jiangsu China
| | - Bin Zhang
- Department of Medical Genetics, Changzhou Maternal and Child Health Care Hospital, Changzhou Medical Center, Nanjing Medical University, 16th Ding Xiang Road, Changzhou, 213023 Jiangsu China
| | - Xiaoya Han
- Department of Medical Genetics, Changzhou Maternal and Child Health Care Hospital, Changzhou Medical Center, Nanjing Medical University, 16th Ding Xiang Road, Changzhou, 213023 Jiangsu China
| | - Wei Long
- Department of Medical Genetics, Changzhou Maternal and Child Health Care Hospital, Changzhou Medical Center, Nanjing Medical University, 16th Ding Xiang Road, Changzhou, 213023 Jiangsu China
| | - Wenbo Zhou
- Department of Medical Genetics, Changzhou Maternal and Child Health Care Hospital, Changzhou Medical Center, Nanjing Medical University, 16th Ding Xiang Road, Changzhou, 213023 Jiangsu China
| | - Xiaosong Yuan
- Department of Medical Genetics, Changzhou Maternal and Child Health Care Hospital, Changzhou Medical Center, Nanjing Medical University, 16th Ding Xiang Road, Changzhou, 213023 Jiangsu China
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9
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Pavela G, Yi N, Mestre L, Xun P, Allison DB. Birth weight moderates the association between obesity and mortality rate. Ann Epidemiol 2023; 82:26-32. [PMID: 37015307 PMCID: PMC10463462 DOI: 10.1016/j.annepidem.2023.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 02/14/2023] [Accepted: 03/29/2023] [Indexed: 04/06/2023]
Abstract
PURPOSE The strength of the association between obesity and mortality rate (MR) varies by body mass index (BMI) and sociodemographic groups. We test the hypothesis that the association between obesity and MR varies, in part, due to the moderating effect of parental BMI and birth weight. METHODS Data come from the 1958 National Child Development Study, an ongoing longitudinal dataset initiated in 1958 with baseline measures of birth weight from 18,059 infants born in Great Britain over 1 week. We tested whether the association between BMI and MR was moderated by parental BMI and birth weight using generalized additive proportional hazards models. RESULTS The association between adult BMI and MR was moderated by birth weight and maternal BMI, such that the association between BMI and MR was weaker among individuals with a higher birth weight (P = .0148) and stronger among individuals born to mothers with a higher BMI (P = .032). At any given level of BMI approximately greater than 25, individuals with low birth weight or born to mothers with a higher BMI, had a higher MR. Paternal BMI did not significantly modify the relationship between BMI and MR (P = .5168). CONCLUSIONS Results suggest that the relationship between obesity and MR is modified by birth weight and maternal BMI.
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Affiliation(s)
- Gregory Pavela
- School of Public Health, University of Alabama at Birmingham, Birmingham.
| | - Nengjun Yi
- School of Public Health, University of Alabama at Birmingham, Birmingham
| | - Luis Mestre
- School of Public Health, Indiana University Bloomington, Bloomington
| | | | - David B Allison
- School of Public Health, Indiana University Bloomington, Bloomington
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10
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Montaniel KRC, Bucher M, Phillips EA, Li C, Sullivan EL, Kievit P, Rugonyi S, Nathanielsz PW, Maloyan A. Dipeptidyl peptidase IV inhibition delays developmental programming of obesity and metabolic disease in male offspring of obese mothers. J Dev Orig Health Dis 2022; 13:727-740. [PMID: 35068408 PMCID: PMC9308839 DOI: 10.1017/s2040174422000010] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Maternal obesity programs the offspring to metabolic diseases later in life; however, the mechanisms of programming are yet unclear, and no strategies exist for addressing its detrimental transgenerational effects. Obesity has been linked to dipeptidyl peptidase IV (DPPIV), an adipokine, and treatment of obese individuals with DPPIV inhibitors has been reported to prevent weight gain and improve metabolism. We hypothesized that DPPIV plays a role in maternal obesity-mediated programming. We measured plasma DPPIV activity in human maternal and cord blood samples from normal-weight and obese mothers at term. We found that maternal obesity increases maternal and cord blood plasma DPPIV activity but only in male offspring. Using two non-human primate models of maternal obesity, we confirmed the activation of DPPIV in the offspring of obese mothers. We then created a mouse model of maternal high-fat diet (HFD)-induced obesity, and found an early-life increase in plasma DPPIV activity in male offspring. Activation of DPPIV preceded the progression of obesity, glucose intolerance and insulin resistance in male offspring of HFD-fed mothers. We then administered sitagliptin, DPPIV inhibitor, to regular diet (RD)- and HFD-fed mothers, starting a week prior to breeding and continuing throughout pregnancy and lactation. We found that sitagliptin treatment of HFD-fed mothers delayed the progression of obesity and metabolic diseases in male offspring and had no effects on females. Our findings reveal that maternal obesity dysregulates plasma DPPIV activity in males and provide evidence that maternal inhibition of DPPIV has potential for addressing the transgenerational effects of maternal obesity.
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Affiliation(s)
- Kim Ramil C. Montaniel
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, OR, 97232, USA
- Physiology and Pharmacology Graduate Program, Oregon Health & Science University, Portland, OR, 97232, USA
| | - Matthew Bucher
- Department of Obstetrics & Gynecology, Oregon Health & Science University, Portland, OR, 97232, USA
| | - Elysse A. Phillips
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, OR, 97232, USA
| | - Cun Li
- Texas Biomedical Research Institute and Southwest National Primate Research Center, San Antonio, TX, 78227, USA
- Department of Animal Sciences, University of Wyoming, Laramie, WY, 82071, USA
| | - Elinor L. Sullivan
- Oregon National Primate Research Center, Oregon Health & Science University, Beaverton, OR, 97006, USA
- Department of Psychiatry, Oregon Health & Science University, Beaverton, OR, 97006, USA
- Department of Behavioral Neuroscience, Oregon Health & Science University, Portland, OR, 97232, USA
| | - Paul Kievit
- Oregon National Primate Research Center, Oregon Health & Science University, Beaverton, OR, 97006, USA
| | - Sandra Rugonyi
- Department of Biomedical Engineering, Oregon Health & Science University, Portland, OR, 97232, USA
| | - Peter W. Nathanielsz
- Texas Biomedical Research Institute and Southwest National Primate Research Center, San Antonio, TX, 78227, USA
- Department of Animal Sciences, University of Wyoming, Laramie, WY, 82071, USA
| | - Alina Maloyan
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, OR, 97232, USA
- Physiology and Pharmacology Graduate Program, Oregon Health & Science University, Portland, OR, 97232, USA
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11
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Toorie AM, Vassoler FM, Qu F, Slonim D, Schonhoff CM, Byrnes EM. Intergenerational effects of preconception opioids on glucose homeostasis and hepatic transcription in adult male rats. Sci Rep 2022; 12:1599. [PMID: 35102183 PMCID: PMC8803846 DOI: 10.1038/s41598-022-05528-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 01/10/2022] [Indexed: 12/13/2022] Open
Abstract
Adolescence represents a period of significant neurodevelopment during which adverse experiences can lead to prolonged effects on disease vulnerability, including effects that can impact future offspring. Adolescence is a common period for the initiation of drug use, including the use of opioids. Beyond effects on central reward, opioids also impact glucose metabolism, which can impact the risk of diabetes. Moreover, recent animal models suggest that the effects of adolescent opioids can effect glucose metabolism in future offspring. Indeed, we demonstrated that the adult male offspring of females exposed to morphine for 10 days during adolescence (referred to as MORF1 males) are predisposed to the adverse effects of an obesogenic diet. As adults, MORF1 males fed a high fat moderate sucrose diet (FSD) for just 6 weeks had increased fasting glucose and insulin levels when compared to age-matched offspring of females exposed to saline during adolescence (SALF1 males). Clinically, a similar profile of impaired fasting glucose has been associated with hepatic insulin resistance and an increased risk of non-alcoholic fatty liver disease. Thus, in the current study, we used RNA sequencing to determine whether adult MORF1 males demonstrate significant alterations in the hepatic transcriptome suggestive of alterations in metabolism. Age-matched SALF1 and MORF1 males were fed either FSD or control diet (CD) for 8 weeks. Similar to our previous observations, FSD-maintained MORF1 males gained more weight and displayed both fasting hyperglycemia and hyperinsulinemia when compared to FSD-maintained SALF1 males, with no significant effect on glucagon. No differences in bodyweight or fasting-induce glucose were observed in control diet (CD)-maintained F1 males, although there was a trend for CD MORF1 males to display elevated levels of fasting insulin. Unexpectedly, transcriptional analyses revealed profound differences in the hepatic transcriptome of CD-maintained MORF1 and SALF1 (1686 differentially expressed genes) with no significant differences between FSD-maintained MORF1 and SALF1 males. As changes in the hepatic transcriptome were not revealed under 8 weeks FSD conditions, we extended the feeding paradigm and conducted a glucose tolerance test to determine whether impaired fasting glucose observed in FSD MORF1 males was due to peripheral insulin resistance. Impaired glucose tolerance was observed in both CD and FSD MORF1 males, and to a more limited extent in FSD SALF1 males. These findings implicate intergenerational effects of adolescent morphine exposure on the risk of developing insulin resistance and associated comorbidities, even in the absence of an obesogenic diet.
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Affiliation(s)
- Anika M Toorie
- Department of Biomedical Sciences, Cummings School of Veterinary Medicine, Tufts University, 200 Westboro Road, Peabody Pavilion, North Grafton, MA, USA
| | - Fair M Vassoler
- Department of Biomedical Sciences, Cummings School of Veterinary Medicine, Tufts University, 200 Westboro Road, Peabody Pavilion, North Grafton, MA, USA
| | - Fangfang Qu
- Department of Computer Sciences, School of Arts and Sciences, Tufts University, Medford, MA, USA
| | - Donna Slonim
- Department of Computer Sciences, School of Arts and Sciences, Tufts University, Medford, MA, USA
| | - Christopher M Schonhoff
- Department of Biomedical Sciences, Cummings School of Veterinary Medicine, Tufts University, 200 Westboro Road, Peabody Pavilion, North Grafton, MA, USA
| | - Elizabeth M Byrnes
- Department of Biomedical Sciences, Cummings School of Veterinary Medicine, Tufts University, 200 Westboro Road, Peabody Pavilion, North Grafton, MA, USA.
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12
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Gut microbiota mediates the alleviative effect of polar lipids-enriched milk fat globule membrane on obesity-induced glucose metabolism disorders in peripheral tissues in rat dams. Int J Obes (Lond) 2022; 46:793-801. [PMID: 35091670 DOI: 10.1038/s41366-021-01029-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 10/25/2021] [Accepted: 11/17/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Obesity during pregnancy and lactation not only increases the incidence of metabolic disorders and gestational diabetes in mothers, but also programs adiposity and related metabolic diseases in offspring. The aim of this study was to investigate the effects of milk polar lipids on gut microbiota and glucose metabolism in high-fat diet (HFD)-fed rat dams. METHODS Sprague Dawley (SD) female rats were fed a HFD for 8 weeks to induce obesity, followed by HFD with or without oral administration of polar lipids-enriched milk fat globule membrane (MFGM-PL) at 400 mg/kg BW during pregnancy and lactation. At the end of lactation, fresh fecal samples of dams were collected, the gut microbiota was assessed, and the insulin-signaling protein expression in peripheral tissues (adipose tissue, liver and skeletal muscle) were measured. RESULTS MFGM-PL supplementation attenuated body weight gain, ameliorated serum lipid profiles and improved insulin sensitivity in obese dams at the end of lactation. 16 S rDNA sequencing revealed that MFGM-PL increased the community richness and diversity of gut microbiota. The composition of gut microbiota was also changed after MFGM-PL supplementation as shown by an increase in the ratio of Bacteroidetes/Firmicutes and the relative abundance of Akkermansia, as well as a decrease in the relative abundance of Ruminococcaceae. The functional prediction of microbial communities by PICRUSt analysis showed that there were 7 KEGG pathways related to carbohydrate metabolism changed after MFGM-PL supplementation to HFD dams, including glycolysis/gluconeogenesis and insulin signaling pathway. Furthermore, MFGM-PL improved insulin signaling in the peripheral tissues including liver, adipose tissue and skeletal muscle. CONCLUSIONS MFGM-PL supplementation during pregnancy and lactation improves the glucose metabolism disorders in HFD-induced obese dams, which may be linked to the regulation of gut microbiota induced by MFGM-PL.
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13
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Alharbi KK, Alsaikhan AS, Alshammary AF, Al-Hakeem MM, Ali Khan I. Screening of mitochondrial mutations in Saudi women diagnosed with gestational diabetes mellitus: A non-replicative case-control study. Saudi J Biol Sci 2022; 29:360-365. [PMID: 35002430 PMCID: PMC8716902 DOI: 10.1016/j.sjbs.2021.08.102] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 08/29/2021] [Accepted: 08/30/2021] [Indexed: 12/15/2022] Open
Abstract
Introduction Among metabolic disorders, gestational diabetes mellitus (GDM) is specified as hyperglycemia caused by glucose or carbohydrate intolerance defects. GDM is distinguished by oxidative stress, and has been connected to mitochondrial dysfunction. Previous studies have documented the relation between A12026G, A8344G and A3243G mutations in ND4, tRNALeu(UUR), and tRNALys genes in different modes of diabetes. Aim The purpose of this study was to investigate into the relationship between GDM women and common mitochondrial mutations including A12026, A8344G, and A3243G in Saudi women. Methods In this case-control study, we have opted 96 GDM and 102 non-GDM pregnant women and DNA was extracted using EDTA blood and based on specific primers, Polymerase Chain Reaction was followed and then Restriction Fragment Length Polymorphism (RFLP) analysis was performed. Restriction enzymes was cross-checked with Lambda DNA and 10% of the purified PCR products were performed the Sanger sequencing analysis to reconfirm the RFLP analysis of the studied results. Results None of the heterozygous and homozygous mutations were not observed in our study. All the subjects were turned to be homozygous normal genotypes. Conclusion This study confirms that A12026, A8344G, and A3243G mutations have no role in the Saudi women with GDM.
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Affiliation(s)
- Khalid Khalaf Alharbi
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, King Saud University, Riyadh 11433, Saudi Arabia
| | - Abdullah Sulaiman Alsaikhan
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, King Saud University, Riyadh 11433, Saudi Arabia
| | - Amal F Alshammary
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, King Saud University, Riyadh 11433, Saudi Arabia
| | - Malak Mohammed Al-Hakeem
- Department of Obstetrics and Gynecology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Imran Ali Khan
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, King Saud University, Riyadh 11433, Saudi Arabia
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14
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Serbis A, Giapros V, Kotanidou EP, Galli-Tsinopoulou A, Siomou E. Diagnosis, treatment and prevention of type 2 diabetes mellitus in children and adolescents. World J Diabetes 2021; 12:344-365. [PMID: 33889284 PMCID: PMC8040084 DOI: 10.4239/wjd.v12.i4.344] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 01/31/2021] [Accepted: 03/25/2021] [Indexed: 02/06/2023] Open
Abstract
During the last two decades, there have been several reports of an increasing incidence of type 2 diabetes mellitus (T2DM) in children and adolescents, especially among those belonging to minority ethnic groups. This trend, which parallels the increases in prevalence and degree of pediatric obesity, has caused great concern, even though T2DM remains a relatively rare disease in children. Youth T2DM differs not only from type 1 diabetes in children, from which it is sometimes difficult to differentiate, but also from T2DM in adults, since it appears to be an aggressive disease with rapidly progressive β-cell decline, high treatment failure rate, and accelerated development of complications. Despite the recent research, many aspects of youth T2DM still remain unknown, regarding both its pathophysiology and risk factor contribution, and its optimal management and prevention. Current management approaches include lifestyle changes, such as improved diet and increased physical activity, together with pharmacological interventions, including metformin, insulin, and the recently approved glucagon-like peptide-1 analog liraglutide. What is more important for everyone to realize though, from patients, families and physicians to schools, health services and policy-makers alike, is that T2DM is a largely preventable disease that will be addressed effectively only if its major contributor (i.e., pediatric obesity) is confronted and prevented at every possible stage of life, from conception until adulthood. Therefore, relevant comprehensive, coordinated, and innovative strategies are urgently needed.
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Affiliation(s)
- Anastasios Serbis
- Department of Pediatrics, University Hospital of Ioannina, Ioannina 45500, Greece
| | - Vasileios Giapros
- Department of Child Health, University of Ioannina, Ioannina 45500, Greece
| | - Eleni P Kotanidou
- Department of Pediatrics, Medical School, Aristotle University Thessaloniki, Thessaloniki 54636, Greece
| | | | - Ekaterini Siomou
- Department of Pediatrics, University Hospital of Ioannina, Ioannina 45500, Greece
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15
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Muhammad HFL, Pramono A, Rahman MN. The safety and efficacy of supervised exercise on pregnant women with overweight/obesity: A systematic review and meta-analysis of randomized controlled trials. Clin Obes 2021; 11:e12428. [PMID: 33167074 DOI: 10.1111/cob.12428] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 10/13/2020] [Accepted: 10/25/2020] [Indexed: 11/26/2022]
Abstract
Behavioural modification through physical activity and dietary counselling has been shown to have beneficial effects on pregnant women with overweight/obesity. Whether exercise alone with supervision (ie, supervised exercise) may also benefit for pregnant women with overweight/obesity is still unknown. This systematic review and meta-analysis aimed to determine the safety and efficacy of supervised exercise on pregnant women with overweight/obesity. PubMed, Cochrane library, Embase (Ovid), CINAHL (EBSCO), and Web of Science were used to search publications using a combination of main keywords "obesity", "exercise", "pregnant women", and "randomised controlled trial". From a total of 740 publications, 11 randomized controlled trials were included. All studies reported no adverse effects of supervised exercise on pregnant women with overweight/obesity. Of interest, this meta-analysis showed gestational weight gain (GWG) was lower in the supervised exercise group as compared to control (Mean difference 0.88 kg, 95%CI -1.73 to -0.03, P = .04). There was a significant effect of supervised exercise on post-prandial blood glucose (MD: -0.24, 95%CI -0.47 to -0.01, P = .04) and insulin resistance (HOMA-IR) (MD: -0.18, 95%CI -0.30 to -0.05, P = .005). There were no differences in risk of gestational diabetes mellitus, pre-eclampsia/gestational hypertension, and newborn outcomes (eg, infants birth weight, preterm birth incident, and gestational age) (all P > .05). This meta-analysis might suggest beneficial effects of supervised exercise on pregnant women with overweight/obesity to prevent excessive GWG, attenuates insulin resistance, and the post-prandial blood glucose level.
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Affiliation(s)
| | - Adriyan Pramono
- Department of Nutrition Science, Faculty of Medicine, Universitas Diponegoro, Central Java, Semarang, Indonesia
| | - Muhammad Nurhadi Rahman
- Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Gadjah Mada, Yogyakarta, Indonesia
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16
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Dennis CL, Marini F, Dick JA, Atkinson S, Barrett J, Bell R, Berard A, Berger H, Brown HK, Constantin E, Da Costa D, Feller A, Guttmann A, Janus M, Joseph KS, Jüni P, Kimmins S, Letourneau N, Li P, Lye S, Maguire JL, Matthews SG, Millar D, Misita D, Murphy K, Nuyt AM, O'Connor DL, Parekh RS, Paterson A, Puts M, Ray J, Roumeliotis P, Scherer S, Sellen D, Semenic S, Shah PS, Smith GN, Stremler R, Szatmari P, Telnner D, Thorpe K, Tremblay MS, Vigod S, Walker M, Birken C. Protocol for a randomised trial evaluating a preconception-early childhood telephone-based intervention with tailored e-health resources for women and their partners to optimise growth and development among children in Canada: a Healthy Life Trajectory Initiative (HeLTI Canada). BMJ Open 2021; 11:e046311. [PMID: 33568380 PMCID: PMC7878148 DOI: 10.1136/bmjopen-2020-046311] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
INTRODUCTION The 'Developmental Origins of Health and Disease' hypothesis suggests that a healthy trajectory of growth and development in pregnancy and early childhood is necessary for optimal health, development and lifetime well-being. The purpose of this paper is to present the protocol for a randomised controlled trial evaluating a preconception-early childhood telephone-based intervention with tailored e-health resources for women and their partners to optimise growth and development among children in Canada: a Healthy Life Trajectory Initiative (HeLTI Canada). The primary objective of HeLTI Canada is to determine whether a 4-phase 'preconception to early childhood' lifecourse intervention can reduce the rate of child overweight and obesity. Secondary objectives include improved child: (1) growth trajectories; (2) cardiometabolic risk factors; (3) health behaviours, including nutrition, physical activity, sedentary behaviour and sleep; and (4) development and school readiness at age 5 years. METHOD AND ANALYSIS A randomised controlled multicentre trial will be conducted in two of Canada's highly populous provinces-Alberta and Ontario-with 786 nulliparous (15%) and 4444 primiparous (85%) women, their partners and, when possible, the first 'sibling child.' The intervention is telephone-based collaborative care delivered by experienced public health nurses trained in healthy conversation skills that includes detailed risk assessments, individualised structured management plans, scheduled follow-up calls, and access to a web-based app with individualised, evidence-based resources. An 'index child' conceived after randomisation will be followed until age 5 years and assessed for the primary and secondary outcomes. Pregnancy, infancy (age 2 years) and parental outcomes across time will also be assessed. ETHICS AND DISSEMINATION The study has received approval from Clinical Trials Ontario (CTO 1776). The findings will be published in peer-reviewed journals and disseminated to policymakers at local, national and international agencies. Findings will also be shared with study participants and their communities. TRIAL REGISTRATION NUMBER ISRCTN13308752; Pre-results.
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Affiliation(s)
- Cindy-Lee Dennis
- Lawrence S. Bloomburg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
- St Michael's Hospital, Toronto, Ontario, Canada
| | | | - Jennifer Abbass Dick
- Faculty of Health Sciences, University of Ontario Institute of Technology, Oshawa, Ontario, Canada
| | - Stephanie Atkinson
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Jon Barrett
- Department of Obstetrics and Gynecology, University of Toronto, Toronto, Ontario, Canada
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Rhonda Bell
- Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, Alberta, Canada
| | - Anick Berard
- Faculty of Pharmacy, University of Montreal, Montreal, Québec, Canada
- Saint Justine Hospital, Montreal, Québec, Canada
| | - Howard Berger
- St Michael's Hospital, Toronto, Ontario, Canada
- Department of Obstetrics and Gynecology, University of Toronto, Toronto, Ontario, Canada
| | - Hillary K Brown
- Department of Health & Society (Scarborough Campus), University of Toronto, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Evelyn Constantin
- Department of Pediatrics, McGill University, Montreal, Québec, Canada
- McGill University Health Centre, Montreal, Ontario, Canada
| | - Deborah Da Costa
- McGill University Health Centre, Montreal, Ontario, Canada
- School of Physical and Occupational Therapy, McGill University, Montreal, Québec, Canada
| | - Andrea Feller
- Niagara Region Public Health, Thorold, Ontario, Canada
| | - Astrid Guttmann
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
- The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Magdalena Janus
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - K S Joseph
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Peter Jüni
- St Michael's Hospital, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Sarah Kimmins
- Department of Animal Science, McGill University, Montreal, Québec, Canada
| | | | - Patricia Li
- Department of Pediatrics, McGill University, Montreal, Québec, Canada
| | - Stephen Lye
- Lunenfeld-Tanenbaum Research Institute, Toronto, Ontario, Canada
| | - Jonathon L Maguire
- St Michael's Hospital, Toronto, Ontario, Canada
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Stephen G Matthews
- Lunenfeld-Tanenbaum Research Institute, Toronto, Ontario, Canada
- Department of Physiology, University of Toronto, Toronto, Ontario, Canada
| | - David Millar
- Monarch Maternal and Newborn Health Centre, Ottawa, Ontario, Canada
| | - Dragana Misita
- Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, Alberta, Canada
| | - Kellie Murphy
- Department of Obstetrics and Gynecology, University of Toronto, Toronto, Ontario, Canada
- Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Anne Monique Nuyt
- Saint Justine Hospital, Montreal, Québec, Canada
- Department of Pediatrics, McGill University, Montreal, Québec, Canada
| | - Deborah L O'Connor
- The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Rulan Savita Parekh
- The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Andrew Paterson
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Martine Puts
- Lawrence S. Bloomburg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Joel Ray
- St Michael's Hospital, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | | | - Stephen Scherer
- The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Molecular Genetics, University of Toronto, Toronto, Ontario, Canada
| | - Daniel Sellen
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Sonia Semenic
- McGill University Health Centre, Montreal, Ontario, Canada
- Ingram School of Nursing, McGill University, Montreal, Québec, Canada
| | - Prakesh S Shah
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
- Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Graeme N Smith
- Department of Obstetrics and Gynecology, Queen's University, Kingston, Ontario, Canada
| | - Robyn Stremler
- Lawrence S. Bloomburg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
- The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Peter Szatmari
- The Hospital for Sick Children, Toronto, Ontario, Canada
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Deanna Telnner
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Kevin Thorpe
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Mark S Tremblay
- Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
- Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada
| | - Simone Vigod
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Women's College Hospital, Toronto, Ontario, Canada
| | - Mark Walker
- Department of Obstetrics and Gynecology, University of Ottawa, Ottawa, Ontario, Canada
- The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Catherine Birken
- The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
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17
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Facchinetti F, Cavalli P, Copp AJ, D’Anna R, Kandaraki E, Greene NDE, Unfer V. An update on the use of inositols in preventing gestational diabetes mellitus (GDM) and neural tube defects (NTDs). Expert Opin Drug Metab Toxicol 2020; 16:1187-1198. [PMID: 32966143 PMCID: PMC7614183 DOI: 10.1080/17425255.2020.1828344] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Obstetric history and maternal body composition and lifestyle may be associated with serious complications both for the mother, such as gestational diabetes mellitus (GDM), and for the fetus, including congenital malformations such as neural tube defects (NTDs). AREAS COVERED In view of the recent knowledge, changes in nutritional and physical activity habits ameliorate glycemic control during pregnancy and in turn improve maternal and neonatal health outcomes. Recently, a series of small clinical and experimental studies indicated that supplemenation with inositols, a family of insulin sensitizers, was associated with beneficial impact for both GDM and NTDs. EXPERT OPINION Herein, we discuss the most significant scientific evidence supporting myo-inositol administration as a prophylaxis for the above-mentioned conditions.
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Affiliation(s)
- Fabio Facchinetti
- Unit of Obstetrics and Gynecology, Mother-Infant Department, University of Modena and Reggio Emilia, Modena, Italy
| | | | - Andrew J. Copp
- Newlife Birth Defects Research Centre and Developmental Biology & Cancer Research and Teaching Department, Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Rosario D’Anna
- Department of Human Pathology, University of Messina, Messina, Italy
| | - Eleni Kandaraki
- Department of Endocrinology & Diabetes, HYGEIA Hospital, Marousi, Athens, Greece
| | - Nicholas D. E. Greene
- Newlife Birth Defects Research Centre and Developmental Biology & Cancer Research and Teaching Department, Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Vittorio Unfer
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
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18
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Hashim M, Radwan H, Hasan H, Obaid RS, Al Ghazal H, Al Hilali M, Rayess R, Chehayber N, Mohamed HJJ, Naja F. Gestational weight gain and gestational diabetes among Emirati and Arab women in the United Arab Emirates: results from the MISC cohort. BMC Pregnancy Childbirth 2019; 19:463. [PMID: 31795984 PMCID: PMC6892062 DOI: 10.1186/s12884-019-2621-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 11/22/2019] [Indexed: 02/06/2023] Open
Abstract
Background Nutritional status of women during pregnancy has been considered an important prognostic indicator of pregnancy outcomes. Objectives To investigate the pattern of gestational weight gain (GWG) and gestational diabetes mellitus (GDM) and their risk factors among a cohort of Emirati and Arab women residing in the United Arab Emirates (UAE). A secondary objective was to investigate pre-pregnancy body mass index (BMI) and its socio-demographic correlates among study participants. Methods Data of 256 pregnant women participating in the cohort study, the Mother-Infant Study Cohort (MISC) were used in this study. Healthy pregnant mothers with no history of chronic diseases were interviewed during their third trimester in different hospitals in UAE. Data were collected using interviewer-administered multi-component questionnaires addressing maternal sociodemographic and lifestyle characteristics. Maternal weight, weight gain, and GDM were recorded from the hospital medical records. Results Among the study participants, 71.1% had inadequate GWG: 31.6% insufficient and 39.5% excessive GWG. 19.1% reported having GDM and more than half of the participants (59.4%) had a pre-pregnancy BMI ≥ 25 kg/m2. The findings of the multiple multinomial logistic regression showed that multiparous women had decreased odds of excessive gain as compared to primiparous [odds ratio (OR): 0.17; 95% CI: 0.05–0.54]. Furthermore, women with a pre-pregnancy BMI ≥ 25 kg/m2 had increased odds of excessive gain (OR: 2.23; 95%CI: 1.00–5.10) as compared to those with pre-pregnancy BMI < 25 kg/m2. Similarly, women who had a pre-pregnancy BMI ≥ 25 kg/m2 were at higher risk of having GDM (OR: 2.37; 95%CI: 1.10–5.12). As for the associations of women’s characteristics with pre-pregnancy BMI, age and regular breakfast consumption level were significant predictors of higher pre-pregnancy BMI. Conclusions This study revealed alarming prevalence rates of inadequate, mainly excessive, GWG and GDM among the MISC participants. Pre-pregnancy BMI was found a risk factor for both of these conditions (GWG and GDM). In addition, age and regular breakfast consumption were significant determinants of pre-pregnancy BMI. Healthcare providers are encouraged to counsel pregnant women to maintain normal body weight before and throughout pregnancy by advocating healthy eating and increased physical activity in order to reduce the risk of excessive weight gain and its associated complications.
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Affiliation(s)
- Mona Hashim
- Department of Clinical Nutrition and Dietetics, College of Health Sciences, Research Institute of Medical and Health Sciences (RIMHS), University of Sharjah, Sharjah, United Arab Emirates
| | - Hadia Radwan
- Department of Clinical Nutrition and Dietetics, College of Health Sciences, Research Institute of Medical and Health Sciences (RIMHS), University of Sharjah, Sharjah, United Arab Emirates
| | - Hayder Hasan
- Department of Clinical Nutrition and Dietetics, College of Health Sciences, Research Institute of Medical and Health Sciences (RIMHS), University of Sharjah, Sharjah, United Arab Emirates
| | - Reyad Shaker Obaid
- Department of Clinical Nutrition and Dietetics, College of Health Sciences, Research Institute of Medical and Health Sciences (RIMHS), University of Sharjah, Sharjah, United Arab Emirates
| | - Hessa Al Ghazal
- Family Health Promotion Center, Sharjah, United Arab Emirates
| | - Marwa Al Hilali
- Al Qassimi Hospital, Ministry of Health and Prevention, Sharjah, United Arab Emirates
| | - Rana Rayess
- Department of Clinical Nutrition and Dietetics, College of Health Sciences, Research Institute of Medical and Health Sciences (RIMHS), University of Sharjah, Sharjah, United Arab Emirates
| | - Noor Chehayber
- Department of Clinical Nutrition and Dietetics, College of Health Sciences, Research Institute of Medical and Health Sciences (RIMHS), University of Sharjah, Sharjah, United Arab Emirates
| | | | - Farah Naja
- Department of Nutrition and Food Sciences, American University of Beirut, Beirut, Lebanon.
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Sauder KA, Bekelman TA, Harrall KK, Glueck DH, Dabelea D. Gestational diabetes exposure and adiposity outcomes in childhood and adolescence: An analysis of effect modification by breastfeeding, diet quality, and physical activity in the EPOCH study. Pediatr Obes 2019; 14:e12562. [PMID: 31274243 PMCID: PMC6844624 DOI: 10.1111/ijpo.12562] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 06/11/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND Intrauterine exposure to gestational diabetes (GDM) is associated with increased adiposity; however, not all offspring exposed to GDM exhibit excess adiposity. OBJECTIVES Examine whether optimal diet and activity behaviours in infancy, childhood, and adolescence modify the association between GDM exposure and adiposity. METHODS In 564 offspring (84 exposed to GDM), we assessed breastfeeding (maternal recall), dietary intake (food frequency questionnaire), physical activity (3-day recall), and adiposity (BMI, waist-to-height ratio, visceral and subcutaneous adipose tissue, and subscapular-to-triceps skinfold ratio) at 10.4 (SD, 1.5) and 16.7 (SD, 1.2) years. Optimal behaviours were defined as >6 breastmilk months, Healthy Eating Index score >60, and daily vigorous activity >1 hour. Linear mixed models assessed the association between GDM exposure and adiposity among those with optimal versus suboptimal health behaviours, adjusting for sex, race/ethnicity, age, and pubertal status. RESULTS GDM exposure was associated with increased skinfold ratio, visceral and subcutaneous adipose tissue among those with <6 breastmilk months (all Ps < .05), but only associated with increased skinfold ratio among those with >6 breastmilk months (P = .01). GDM exposure was associated with increases in all adiposity measures among those with Healthy Eating Index scores <60 (P < .01), but not those with scores >60 (P > .10). GDM exposure was associated with increased BMI and subcutaneous adipose tissue among those with >1 hour of vigorous activity (P < .05) but not among those with <1 hour of vigorous activity (P > .30). CONCLUSIONS The association of GDM exposure with excess adiposity is attenuated in offspring with more optimal diet and activity behaviours in infancy, childhood, and adolescence.
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Affiliation(s)
- Katherine A Sauder
- Department of Pediatrics, School of Medicine, University of Colorado, Aurora, CO, USA
- Department of Epidemiology, Colorado School of Public Health, University of Colorado, Aurora, CO, USA
- Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, University of Colorado, Aurora, CO, USA
| | - Traci A Bekelman
- Department of Pediatrics, School of Medicine, University of Colorado, Aurora, CO, USA
- Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, University of Colorado, Aurora, CO, USA
| | - Kylie K Harrall
- Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, University of Colorado, Aurora, CO, USA
| | - Deborah H Glueck
- Department of Pediatrics, School of Medicine, University of Colorado, Aurora, CO, USA
- Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, University of Colorado, Aurora, CO, USA
| | - Dana Dabelea
- Department of Pediatrics, School of Medicine, University of Colorado, Aurora, CO, USA
- Department of Epidemiology, Colorado School of Public Health, University of Colorado, Aurora, CO, USA
- Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, University of Colorado, Aurora, CO, USA
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Waring ME, Libby BA, Moore Simas TA, Bracken ML, Bibeau JL, Herrera V, Wang J, Pagoto SL. Delivering a Post-Partum Weight Loss Intervention via Facebook or In-Person Groups: Protocol for a Randomized Feasibility Pilot Trial. JMIR Res Protoc 2019; 8:e15530. [PMID: 31778116 PMCID: PMC6908979 DOI: 10.2196/15530] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 09/25/2019] [Accepted: 09/26/2019] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Postpartum weight retention contributes to long-term weight gain and obesity for many women. Lifestyle interventions with numerous visits are logistically challenging for many postpartum women. Delivering a lifestyle intervention via social media may overcome logistic challenges to participation in in-person weight loss programs. OBJECTIVE The objective of this study is to conduct a randomized feasibility pilot trial of a 6-month postpartum weight loss intervention delivered via Facebook or in-person groups with 72 postpartum women with overweight or obesity. METHODS Women with overweight or obesity who are 8 weeks to 12 months postpartum (N=72) will be recruited from the Hartford, Connecticut community. Eligible participants must also own an iPhone or Android smartphone and be an active Facebook user. Participants will receive a 6-month postpartum weight loss intervention based on the Diabetes Prevention Program lifestyle intervention and adapted for postpartum women. Participants will be randomized to receive the intervention via a private Facebook group or in-person group meetings. Assessments will occur at baseline, weekly during the intervention, at 6 months (at the end of the intervention), and at 12 months. Primary feasibility outcomes are recruitment, sustained participation, contamination, retention, and feasibility of assessment procedures including measurement of costs to deliver and receive the intervention. We will describe 6- and 12-month weight loss as an exploratory outcome. RESULTS Recruitment began in September 2018. The first wave of the intervention began in February 2019, and the second wave of the intervention is expected to begin in fall 2019. We anticipate completing follow-up assessments in fall 2020, and results will be analyzed at that time. CONCLUSIONS Results will inform the design of a large randomized controlled trial to assess whether delivering a postpartum weight loss intervention via Facebook is noninferior for weight loss and more cost-effective than delivering the intervention via traditional in-person groups. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/15530.
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Affiliation(s)
- Molly E Waring
- Department of Allied Health Sciences, UConn Center for mHealth and Social Media, University of Connecticut, Storrs, CT, United States
| | - Brooke A Libby
- Department of Allied Health Sciences, UConn Center for mHealth and Social Media, University of Connecticut, Storrs, CT, United States
| | - Tiffany A Moore Simas
- Department of Obstetrics and Gynecology, University of Massachusetts Medical School/UMass Memorial Health Care, Worcester, MA, United States
- Department of Pediatrics, University of Massachusetts Medical School/UMass Memorial Health Care, Worcester, MA, United States
- Department of Psychiatry, University of Massachusetts Medical School/UMass Memorial Health Care, Worcester, MA, United States
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, United States
| | - Madison L Bracken
- Department of Allied Health Sciences, UConn Center for mHealth and Social Media, University of Connecticut, Storrs, CT, United States
- Department of Psychological and Brain Sciences, University of Massachusetts, Amherst, MA, United States
| | - Jessica L Bibeau
- Department of Allied Health Sciences, UConn Center for mHealth and Social Media, University of Connecticut, Storrs, CT, United States
| | - Valeria Herrera
- Department of Allied Health Sciences, UConn Center for mHealth and Social Media, University of Connecticut, Storrs, CT, United States
| | - Justin Wang
- Social Sciences Department, Community College of Rhode Island, Warwick, RI, United States
| | - Sherry L Pagoto
- Department of Allied Health Sciences, UConn Center for mHealth and Social Media, University of Connecticut, Storrs, CT, United States
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21
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Early second-trimester plasma cell free DNA levels with subsequent risk of pregnancy complications. Clin Biochem 2019; 71:46-51. [DOI: 10.1016/j.clinbiochem.2019.07.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 06/20/2019] [Accepted: 07/01/2019] [Indexed: 12/12/2022]
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Yaya S, Ghose B. Trend in overweight and obesity among women of reproductive age in Uganda: 1995-2016. Obes Sci Pract 2019; 5:312-323. [PMID: 31452916 PMCID: PMC6700515 DOI: 10.1002/osp4.351] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 05/06/2019] [Accepted: 05/07/2019] [Indexed: 12/28/2022] Open
Abstract
Countries in Sub-Saharan Africa (SSA) are experiencing rising burdens of overweight/obesity and associated non-communicable diseases. As in other developing regions, this epidemiological transition in African countries is believed to be resulting from changes in dietary, sociodemographic structure and lifestyle factors. To date, not much is known about the prevalence and sociodemographic patterns of overweight/obesity in Uganda, especially among women of reproductive age. Therefore, this study aimed to address this research gap by using nationally representative data on women of this age group in Uganda. METHODS This study involved analysis of cross-sectional data on 19,395 women aged between 15 and 49 years from Uganda Demographic and Health Survey for the years 1995-2016. Overweight/obesity was measured using body mass index as per World Health Organization guidelines, and logistic regression methods were used to identify the sociodemographic predictors. RESULTS There has a been significant rise in the prevalence of overweight (9.77% in 1995 vs. 16.21% in 2016) and obesity (1.99% in 1995 vs. 6.21% in 2016) since the first survey in 1995, with the most noticeable increase occurring in the central region that accounted for a combined prevalence of 17.22% in 1995 compared with 37. 21% in 2016. Multivariate analysis showed an increased likelihood of having overweight/obesity among women who live in the urban areas, have primary and above primary education, from non-poor households and users of radio and TV. CONCLUSION During the last two decades, there has been a slow but steady rise in the prevalence of overweight and obesity among women of reproductive age in Uganda. The present findings highlight the need for an enhanced attention on growing overweight/obesity within the broader goal improving maternal and child health in the country.
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Affiliation(s)
- S. Yaya
- Faculté de MédecineUniversité de ParakouParakouBenin
| | - B. Ghose
- Institute of Nutrition and Food ScienceUniversity of DhakaDhakaBangladesh
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23
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Intergenerational Interventions for People Living with HIV and Their Families: A Systematic Review. AIDS Behav 2019; 23:21-36. [PMID: 30030740 DOI: 10.1007/s10461-018-2223-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
A variety of interventions have been tested targeting people living with HIV (PLH) and their relationships with their children. The purpose of this study was to synthesize evidence on the goals, types, scope, and outcomes of such intergenerational interventions for PLH. Randomized trials targeting PLH alone or together with their children, published in English, with an intergenerational intervention component were included in this review. Thirteen studies met eligibility criteria. The types and goals of interventions varied greatly but often involved educational sessions with groups of PLH, skill-building sessions, or parental disclosure of HIV status among mothers living with HIV; six studies targeted problem behaviors, resilience, and self-esteem among their children. Two studies addressed general family coping with HIV. Seven studies reported positive outcomes as a result of an intergenerational intervention, with the greatest improvements being observed in those participants with the most stress. Most studies failed to report specific intervention methodology. Due to gaps in the literature noted, future intergenerational interventions targeting PLH should include more diverse groups of PLH. Studies should also explore the impact of intergenerational-based interventions on the mental health of PLH and their families.
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Santos MJ, Fernandes V. Gestational diabetes mellitus: different management strategies should be adopted for different subsets of patients diagnosed by oral glucose tolerance test. Endocrine 2018; 62:602-610. [PMID: 30088142 DOI: 10.1007/s12020-018-1704-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 07/26/2018] [Indexed: 01/31/2023]
Abstract
PURPOSE To compare women diagnosed with gestational diabetes mellitus (GDM) according to the International Association of the Diabetes and Pregnancy Study Groups (IADPSG) diagnostic criteria based on the number of OGTT diagnostic criteria, which OGTT parameters are altered and the glycemic deviation from proposed diagnostic cutoffs. METHODS Cross-sectional, multicentric study of women diagnosed with GDM between 24-28 weeks of pregnancy according to the IADPSG criteria, in Portugal, between 2012-2014. Primary outcomes: large for gestational age (LGA) and maternal glucose metabolism status after delivery. Secondary outcome: small for gestational age (SGA). RESULTS Three-thousand three-hundred fourteen patients were included; 67% had 1 OGTT altered value; 3.6% had LGA and 13% had SGA newborns; 7% had prediabetes/diabetes after delivery. Three diagnostic criteria in OGTT (OR 3.02; p < 0.001), a diagnostic value at 0 min (OR 2.09; p = 0.002) and 60 min (OR 1.70; p = 0.022) and glucose deviation at 0 min (OR 1.02; p = 0.014) were predictors of LGA. Having 2 (OR 1.94; p < 0.001) or 3 (OR 3.93; p < 0.001) diagnostic criteria in OGTT, a diagnostic value at 0 min (OR 1.76; p = 0.002), at 60 min (OR 1.57; p = 0.007) and at 120 min (OR 3.11; p < 0.001), the glucose deviation at 0 (OR 1.02; p = 0.017) and 120 min (OR 1.02; p < 0.001) were predictors of prediabetes/diabetes after delivery. Insufficient weight gain in pregnancy (OR 1.49; p < 0.001) and lower maternal BMI (OR 0.97; p = 0.024) were associated with SGA. CONCLUSION IADPSG diagnostic criteria include a heterogeneous group of women, for whom different management strategies should be adopted to obtain ideal pregnancy outcomes.
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Affiliation(s)
- Maria Joana Santos
- Endocrinology Department, Hospital de Braga, Sete Fontes-São Victor, 4710-243, Braga, Portugal.
- Harvard Medical School's Portugal Clinical Scholars Research Training Program, Lisboa, Portugal.
| | - Vera Fernandes
- Endocrinology Department, Hospital de Braga, Sete Fontes-São Victor, 4710-243, Braga, Portugal
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Amaefule CE, Drymoussi Z, Dodds J, Sweeney L, Pizzo E, Daru J, Robson J, Poston L, Khalil A, Myers J, Harden A, Hitman GA, Khan K, Zamora J, Huda MSB, Thangaratinam S. Effectiveness and acceptability of myo-inositol nutritional supplement in the prevention of gestational diabetes (EMmY): a protocol for a randomised, placebo-controlled, double-blind pilot trial. BMJ Open 2018; 8:e022831. [PMID: 30249632 PMCID: PMC6157508 DOI: 10.1136/bmjopen-2018-022831] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 07/04/2018] [Accepted: 07/31/2018] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION Gestational diabetes increases maternal and offspring complications in pregnancy and cardiovascular complications in the long term. The nutritional supplement myo-inositol may prevent gestational diabetes; however, further evaluation is required, especially in multiethnic high-risk mothers. Our pilot trial on myo-inositol to prevent gestational diabetes will evaluate trial processes, assess acceptability to mothers and obtain preliminary estimates of effect and cost data prior to a large full-scale trial. METHODS AND ANALYSIS EMmY is a multicentre, placebo-controlled, double-blind, pilot, randomised trial, with qualitative evaluation. We will recruit pregnant women at 12-15+6 weeks' gestation, with gestational diabetes risk factors, from five maternity units in England between 2018 and 2019. We will randomise 200 women to take either 2 g of myo-inositol powder (intervention) or placebo, twice daily until delivery. We will assess rates of recruitment, randomisation, adherence to intervention and follow-up. Gestational diabetes will be diagnosed at 24-28 weeks as per the National Institute for Health and Care Excellence (NICE) criteria (fasting plasma glucose: ≥5.6 mmol/L and 2-hour plasma glucose: ≥7.8 mmol/L). We will assess the effects of myo-inositol on glycaemic indices at 28 weeks and on other maternal, fetal and neonatal outcomes at postnatal discharge. Qualitative evaluation will explore the acceptability of the trial and the intervention among women and healthcare professionals. Cost data and health-related quality of life measures will be captured. We will summarise feasibility outcomes using standard methods for proportions and other descriptive statistics, and where appropriate, report point estimates of effect sizes (eg, mean differences and relative risks) and associated 95% CIs. ETHICS AND DISSEMINATION Ethical approval was obtained through the London Queen Square Research Ethics Committee (17/LO/1741). Study findings will be submitted for publication in peer-reviewed journals. Newsletters will be made available to participants, healthcare professionals and members of Katie's Team (a patient and public advisory group) to disseminate. TRIAL REGISTRATION NUMBER ISRCTN48872100. PROTOCOL VERSION AND DATE Version 4.0, 15 January 2018.
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Affiliation(s)
- Chiamaka Esther Amaefule
- Barts Research Centre for Women's Health (BARC), Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Zoe Drymoussi
- Barts Research Centre for Women's Health (BARC), Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Julie Dodds
- Barts Research Centre for Women's Health (BARC), Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Lorna Sweeney
- Institute for Health and Human Development, University of East London, London, London, UK
| | - Elena Pizzo
- Collaborations for Leadership in Applied Health Research and Care (CLAHRC) for North Thames London, Department of Applied Health Research, University College London, London, UK
| | - Jahnavi Daru
- Barts Research Centre for Women's Health (BARC), Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - John Robson
- Clinical Effectiveness Group, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Lucilla Poston
- Women's Health Unit, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Asma Khalil
- Department of Obstetrics and Gynaecology, St George's Hospital, London, UK
| | - Jenny Myers
- Maternal & Fetal Health Research Centre, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Angela Harden
- Institute for Health and Human Development, University of East London, London, London, UK
| | - Graham A Hitman
- Barts Research Centre for Women's Health (BARC), Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Khalid Khan
- Barts Research Centre for Women's Health (BARC), Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Javier Zamora
- Barts Research Centre for Women's Health (BARC), Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
- Clinical Biostatistics Unit (IRYCIS) and CIBER Epidemiology and Public Health, Madrid, Spain
| | - Mohammed S B Huda
- Department of Diabetes & Metabolism, Barts Health NHS Trust, Royal London Hospital, London, UK
| | - Shakila Thangaratinam
- Barts Research Centre for Women's Health (BARC), Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
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Kubo A, Deardorff J, Laurent CA, Ferrara A, Greenspan LC, Quesenberry CP, Kushi LH. Associations Between Maternal Obesity and Pregnancy Hyperglycemia and Timing of Puberty Onset in Adolescent Girls: A Population-Based Study. Am J Epidemiol 2018; 187:1362-1369. [PMID: 29554198 PMCID: PMC6030998 DOI: 10.1093/aje/kwy040] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Revised: 02/23/2018] [Accepted: 02/26/2018] [Indexed: 12/16/2022] Open
Abstract
Early puberty is associated with adverse health outcomes. We investigated whether in utero exposure to maternal obesity is associated with daughters' pubertal timing using 15,267 racially/ethnically diverse Kaiser Permanente Northern California members aged 6-11 years with pediatrician-assessed Tanner staging (2003-2017). We calculated maternal body mass index (BMI; weight (kg)/height (m)2) during pregnancy from the electronic health record data. Using a proportional hazards model with interval censoring, we examined the associations between maternal obesity and girls' pubertal timing, as well as effect modification by race/ethnicity and mediation by prepubertal BMI. Maternal obesity (BMI ≥30) and overweight (BMI 25-29.9) were associated with earlier onset of breast development in girls (hazard ratio (HR) = 1.39 (95% confidence interval (CI): 1.30, 1.49) and HR = 1.21 (95% CI: 1.13, 1.29), respectively), after adjustment for girl's race/ethnicity, maternal age, education, parity, and smoking during pregnancy. There was interaction by race/ethnicity for associations between maternal obesity and girls' pubic hair onset: Associations were strongest among Asian and non-Hispanic white girls (HR = 1.53 (95% CI: 1.24, 1.90) and HR = 1.34 (95% CI: 1.18, 1.52), respectively) and absent for African-American girls. Adjustment for girl's prepubertal BMI only slightly attenuated associations. Our results suggest the importance of maternal metabolic factors during pregnancy in the timing of girls' puberty and potential differences in the associations by race/ethnicity.
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Affiliation(s)
- Ai Kubo
- Kaiser Permanente Division of Research, Oakland, California
| | - Julianna Deardorff
- Division of Maternal and Child Health, School of Public Health, University of California, Berkeley, Berkeley, California
| | | | | | - Louise C Greenspan
- Kaiser Permanente San Francisco Medical Center, San Francisco, California
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Barnes RA, Ross GP, Jalaludin BB, Flack JR. Initial group dietary education compared to individual education in gestational diabetes mellitus management: Do outcomes differ? Diabetes Res Clin Pract 2018; 140:88-96. [PMID: 29605560 DOI: 10.1016/j.diabres.2018.03.039] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Revised: 03/14/2018] [Accepted: 03/22/2018] [Indexed: 11/27/2022]
Abstract
AIMS To assess the effectiveness of Initial Group versus Initial Individual GDM dietary education in terms of insulin requirements and pregnancy outcomes. METHODS A retrospective audit of clinical data was conducted where English speaking women who received initial education in a group setting (01-2-2012 to 01-2-2014) (Group), were compared to women who received initial individual education with a dietitian (1-2-2010 to 31-1-2012) (Individual), all followed by one individual dietitian appointment. The same dietary information was provided in both settings. Data collected included: attendance rates, insulin requirements, maternal weight gain, and rates of adverse birth outcomes. Data were compared by t-test or Chi-squared test. Multivariable logistic regression analysis was conducted to determine independent predictors of insulin therapy. RESULTS Of 743 women; (362 Group and 381 Individual), Group women had a lower HbA1c at GDM diagnosis 5.3 ± 0.6% versus 5.5 ± 0.5% (34 ± 6.6 mmol/mol versus 37 ± 5.5 mmol/mol p < 0.0001). There were no other differences in baseline characteristics. More Group women required insulin (42.0% versus 34.6%, p = 0.048). Group education was found to be an independent predictor of insulin therapy (OR = 1.9 [1.29, 2.75] p < 0.001). CONCLUSIONS Despite adjusting for all known potential confounders, unlike Individual education, Group education remained a significant predictor of insulin therapy (but resulted in similar therapeutic and pregnancy outcomes to Individual education).
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Affiliation(s)
- Robyn A Barnes
- Department of Diabetes and Endocrinology, Bankstown-Lidcombe Hospital, 68 Eldridge Rd, Bankstown, NSW 2200, Australia; School of Health Sciences, Faculty of Health and Medicine, The University of Newcastle, University Drive, Callaghan, NSW 2308, Australia.
| | - Glynis P Ross
- Department of Diabetes and Endocrinology, Bankstown-Lidcombe Hospital, 68 Eldridge Rd, Bankstown, NSW 2200, Australia; Faculty of Medicine, University of Sydney, Sydney, NSW, Australia.
| | - Bin B Jalaludin
- Healthy People and Places Unit, South Western Sydney Local Health District, Liverpool, Australia; Ingham Institute for Medical Research, University of New South Wales, Liverpool, NSW 2170, Australia.
| | - Jeff R Flack
- Department of Diabetes and Endocrinology, Bankstown-Lidcombe Hospital, 68 Eldridge Rd, Bankstown, NSW 2200, Australia; Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia; School of Medicine, Western Sydney University, Sydney, NSW, Australia.
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Waring ME, Schneider KL, Appelhans BM, Simas TAM, Xiao RS, Whited MC, Busch AM, Evans MM, Pagoto SL. Interest in a Twitter-delivered weight loss program among women of childbearing age. Transl Behav Med 2017; 6:277-84. [PMID: 27356998 DOI: 10.1007/s13142-015-0382-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Weight management through the childbearing years is important, yet few women have access to efficacious weight loss programs. Online social network-delivered programs may increase reach and thus impact. The aim of this study was to gauge interest in a Twitter-based weight loss intervention among women of childbearing age and the feasibility of recruitment via Twitter. We recruited English-speaking women aged 18-45 years (N = 63) from Twitter to complete an anonymous online survey including open-ended questions about program advantages and concerns. Forty percent of participants were obese and 83 % were trying to lose weight. Eighty-one percent were interested in a Twitter-delivered weight loss program. Interest was high in all subgroups (62-100 %). Participants (59 %) cited program advantages, including convenience, support/accountability, and privacy. Concerns (59 %) included questions about privacy, support/accountability, engagement, efficacy, and technology barriers. Research is needed to develop and evaluate social media-delivered interventions, and to develop methods for recruiting participants directly from Twitter.
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Affiliation(s)
- Molly E Waring
- Division of Epidemiology of Chronic Diseases and Vulnerable Populations, Department of Quantitative Health Sciences, University of Massachusetts Medical School, 368 Plantation Street, AS8-1077, Worcester, MA, 01605, USA. .,Department of Obstetrics & Gynecology, University of Massachusetts Medical School, Worcester, MA, USA.
| | - Kristin L Schneider
- Department of Psychology, Rosalind Franklin University of Medicine & Science, North Chicago, IL, USA
| | - Bradley M Appelhans
- Department of Preventive Medicine, Rush University Medical Center, Chicago, IL, USA
| | - Tiffany A Moore Simas
- Department of Obstetrics & Gynecology, University of Massachusetts Medical School, Worcester, MA, USA.,Department of Pediatrics, University of Massachusetts Medical School, Worcester, MA, USA
| | - Rui S Xiao
- Division of Epidemiology of Chronic Diseases and Vulnerable Populations, Department of Quantitative Health Sciences, University of Massachusetts Medical School, 368 Plantation Street, AS8-1077, Worcester, MA, 01605, USA
| | - Matthew C Whited
- Department of Psychology, East Carolina University, Greenville, NC, USA
| | - Andrew M Busch
- Department of Psychiatry & Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA.,Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI, USA
| | - Martinus M Evans
- Division of Behavioral and Preventive Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA
| | - Sherry L Pagoto
- Division of Behavioral and Preventive Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA
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Dong Y, Betancourt A, Belfort M, Yallampalli C. Targeting Adrenomedullin to Improve Lipid Homeostasis in Diabetic Pregnancies. J Clin Endocrinol Metab 2017; 102:3425-3436. [PMID: 28666334 PMCID: PMC5587055 DOI: 10.1210/jc.2017-00920] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Accepted: 06/23/2017] [Indexed: 12/29/2022]
Abstract
Context Gestational diabetes mellitus (GDM) is associated with disturbances in maternal lipid metabolism. Hypertriacylglycerolemia in GDM is associated with an increased risk of large for gestational age neonates, but the pathogenesis of disrupted lipid homeostasis remains unclear. Objectives To determine the role of adrenomedullin (AM), a multifunctional peptide, in lipid metabolism in GDM. Design Omental adipose biopsies were collected in term pregnancy from women with normal glucose tolerance (NGT, n = 10) and GDM (n = 10). Results AM and its receptor components, calcitonin receptor-like receptor, receptor activity-modifying protein 2, and receptor activity-modifying protein 3, were higher in adipose tissues from GDM compared with NGT pregnancies, and these expressions in normal adipose tissues were enhanced by glucose and tumor necrosis factor-αin vitro. AM dose- and time-dependently stimulated lipolysis in human adipocytes, and this effect was reversed by AM antagonist AM22-52. Furthermore, AM inhibited phosphorylation of insulin receptor-β and insulin receptor substrate-1 and enhanced the protein expression of leptin and resistin in adipose tissue from NGT women. The increased messenger RNA expression of leptin and resistin in adipose tissue from GDM was reduced by AM22-52 treatment. Conclusions GDM pregnancies are associated with increased AM and its receptor expression in adipose tissues. AM stimulates lipolysis and leptin and resistin expression, and these effects can be reversed by AM antagonist. To our knowledge, manipulation of AM and its receptors in adipocytes might represent an approach in reducing the risk of GDM and fetal overgrowth.
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Affiliation(s)
- Yuanlin Dong
- Department of Obstetrics and Gynecology, Baylor College of Medicine/Texas Children’s Hospital, Houston, Texas 77030
| | - Ancizar Betancourt
- Department of Obstetrics and Gynecology, Baylor College of Medicine/Texas Children’s Hospital, Houston, Texas 77030
| | - Michael Belfort
- Department of Obstetrics and Gynecology, Baylor College of Medicine/Texas Children’s Hospital, Houston, Texas 77030
| | - Chandrasekhar Yallampalli
- Department of Obstetrics and Gynecology, Baylor College of Medicine/Texas Children’s Hospital, Houston, Texas 77030
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Shahi A, Dabiri F, Kamjoo A, Yabandeh AP, Khademi Z, Davaridolatabadi N. Association between body mass index (BMI) and duration of pregnancy in women referred to Shariati Hospital in Bandar Abbas. Electron Physician 2017; 9:3611-3615. [PMID: 28243414 PMCID: PMC5308502 DOI: 10.19082/3611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Accepted: 08/02/2016] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Prolonged pregnancy is associated with increased risk of pregnancy complications. The role of body mass index (BMI) is not completely identified in the risk of occurrence of prolonged pregnancy. The aim of this study was to determine the association between BMI and duration of pregnancy in woman referred to the Shariati Maternity Hospital in Bandar Abbas (Hormozgan Province, Iran). METHODS This cross-sectional study was carried out on 1100 pregnant women referred to the Shariati Hospital in Bandar Abbas in 2015. Gestational age determined by last menstrual period (LMP) or first-trimester ultra-sonography. The women were divided into two groups of less than 40 weeks of gestation and more than 40 weeks of gestation. The women were divided based on their BMI at the first trimester of pregnancy into four groups, including less than normal, normal, overweight, and excess weight. Data were analyzed using ANOVA, Mann-Whitney test, and chi-square test by SPSS version 16.0. RESULTS The average age of mothers studied was 23 ± 4.30 years. Average of gestational age was 39 ± 1.85 weeks. Among the study participants 1020 (92.7%) had term pregnancies, 53 (4.8%) had preterm pregnancies, and 27 (2.5%) had post-term pregnancies. Also among the study participants, 40% had a BMI less than 19.8 kg/m2, 45.9% had BMI between 19.8 and 26 kg/m2, and 9.8% had BMI between 26.1 and 29 kg/m2, and 4.3% had BMI less than 29 kg/m2. Mean BMI was 20.95 ± 4.02 for women with gestational age of equal to or less than 40 weeks and 23.34 ± 4.52 for women with gestational age of more than 40 weeks. Duration of pregnancy was significantly higher in women with higher BMI at the first trimester (p<0.00006). CONCLUSION High BMI of a mother in the first trimester of pregnancy is associated with prolonged pregnancy and may increase the risk of post-term pregnancy. Women are recommended to reach an ideal weight before pregnancy to decrease the risk of the pregnancy complications.
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Affiliation(s)
- Arefeh Shahi
- M.Sc. of Midwifery, Faculty Member, Department of Midwifery, Faculty of Nursing, Midwifery and Paramedicine, Mother & child Welfare Research Center and Midwifery, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Fatemeh Dabiri
- M.Sc. of Midwifery, Faculty Member, Department of Midwifery, Faculty of Nursing, Midwifery and Paramedicine, Mother & child Welfare Research Center and Midwifery, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Azita Kamjoo
- M.Sc. of Midwifery, Faculty Member, Department of Midwifery, Faculty of Nursing, Midwifery and Paramedicine, Mother & child Welfare Research Center and Midwifery, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Asieh Pormehr Yabandeh
- M.Sc. of Midwifery, Faculty Member, Department of Midwifery, Faculty of Nursing, Midwifery and Paramedicine, Mother & child Welfare Research Center and Midwifery, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Zahra Khademi
- M.Sc. of Nursing, Faculty Member, Department of Nursing, Faculty of Nursing, Midwifery and Paramedicine, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Nasrin Davaridolatabadi
- Ph.D. of Health Information Management, Assistant Professor, Department of Health Information Technology, Faculty of Paramedicine, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
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Mirmiran P, Ghorbani Z, Hosseini-Esfahani F. A Narrative Review of Obesity and Its Associated Complications in Iranian Women. WOMEN’S HEALTH BULLETIN 2017. [DOI: 10.17795/whb-40546] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
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32
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Jayabalan N, Nair S, Nuzhat Z, Rice GE, Zuñiga FA, Sobrevia L, Leiva A, Sanhueza C, Gutiérrez JA, Lappas M, Freeman DJ, Salomon C. Cross Talk between Adipose Tissue and Placenta in Obese and Gestational Diabetes Mellitus Pregnancies via Exosomes. Front Endocrinol (Lausanne) 2017; 8:239. [PMID: 29021781 PMCID: PMC5623931 DOI: 10.3389/fendo.2017.00239] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 08/30/2017] [Indexed: 12/16/2022] Open
Abstract
Obesity is an important public health issue worldwide, where it is commonly associated with the development of metabolic disorders, especially insulin resistance (IR). Maternal obesity is associated with an increased risk of pregnancy complications, especially gestational diabetes mellitus (GDM). Metabolism is a vital process for energy production and the maintenance of essential cellular functions. Excess energy storage is predominantly regulated by the adipose tissue. Primarily made up of adipocytes, adipose tissue acts as the body's major energy reservoir. The role of adipose tissue, however, is not restricted to a "bag of fat." The adipose tissue is an endocrine organ, secreting various adipokines, enzymes, growth factors, and hormones that take part in glucose and lipid metabolism. In obesity, the greater portion of the adipose tissue comprises fat, and there is increased pro-inflammatory cytokine secretion, macrophage infiltration, and reduced insulin sensitivity. Obesity contributes to systemic IR and its associated metabolic complications. Similar to adipose tissue, the placenta is also an endocrine organ. During pregnancy, the placenta secretes various molecules to maintain pregnancy physiology. In addition, the placenta plays an important role in metabolism and exchange of nutrients between mother and fetus. Inflammation at the placenta may contribute to the severity of maternal IR and her likelihood of developing GDM and may also mediate the adverse consequences of obesity and GDM on the fetus. Interestingly, studies on maternal insulin sensitivity and secretion of placental hormones have not shown a positive correlation between these phenomena. Recently, a great interest in the field of extracellular vesicles (EVs) has been observed in the literature. EVs are produced by a wide range of cells and are present in all biological fluids. EVs are involved in cell-to-cell communication. Recent evidence points to an association between adipose tissue-derived EVs and metabolic syndrome in obesity. In this review, we will discuss the changes in human placenta and adipose tissue in GDM and obesity and summarize the findings regarding the role of adipose tissue and placenta-derived EVs, with an emphasis on exosomes in obesity, and the contribution of obesity to the development of GDM.
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Affiliation(s)
- Nanthini Jayabalan
- Exosome Biology Laboratory, Centre for Clinical Diagnostics, University of Queensland Centre for Clinical Research, Royal Brisbane and Women’s Hospital, The University of Queensland, Brisbane, QLD, Australia
| | - Soumyalekshmi Nair
- Exosome Biology Laboratory, Centre for Clinical Diagnostics, University of Queensland Centre for Clinical Research, Royal Brisbane and Women’s Hospital, The University of Queensland, Brisbane, QLD, Australia
| | - Zarin Nuzhat
- Exosome Biology Laboratory, Centre for Clinical Diagnostics, University of Queensland Centre for Clinical Research, Royal Brisbane and Women’s Hospital, The University of Queensland, Brisbane, QLD, Australia
| | - Gregory E. Rice
- Exosome Biology Laboratory, Centre for Clinical Diagnostics, University of Queensland Centre for Clinical Research, Royal Brisbane and Women’s Hospital, The University of Queensland, Brisbane, QLD, Australia
- Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Ochsner Clinic Foundation, New Orleans, LA, United States
| | - Felipe A. Zuñiga
- Faculty of Pharmacy, Department of Clinical Biochemistry and Immunology, University of Concepción, Concepción, Chile
| | - Luis Sobrevia
- Cellular and Molecular Physiology Laboratory (CMPL), Division of Obstetrics and Gynaecology, Faculty of Medicine, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
- University of Queensland Centre for Clinical Research, Royal Brisbane and Women’s Hospital, The University of Queensland, Brisbane, QLD, Australia
- Faculty of Pharmacy, Department of Physiology, Universidad de Sevilla, Seville, Spain
| | - Andrea Leiva
- Cellular and Molecular Physiology Laboratory (CMPL), Division of Obstetrics and Gynaecology, Faculty of Medicine, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Carlos Sanhueza
- Cellular and Molecular Physiology Laboratory (CMPL), Division of Obstetrics and Gynaecology, Faculty of Medicine, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Jaime Agustín Gutiérrez
- Cellular Signaling and Differentiation Laboratory (CSDL), Medical Technology School, Health Sciences Faculty, Universidad San Sebastian, Santiago, Chile
- Cellular and Molecular Physiology Laboratory (CMPL), Division of Obstetrics and Gynaecology, Faculty of Medicine, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Martha Lappas
- Obstetrics, Nutrition and Endocrinology Group, Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, VIC, Australia
- Mercy Perinatal Research Centre, Mercy Hospital for Women, Heidelberg, VIC, Australia
| | - Dilys Jane Freeman
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Carlos Salomon
- Exosome Biology Laboratory, Centre for Clinical Diagnostics, University of Queensland Centre for Clinical Research, Royal Brisbane and Women’s Hospital, The University of Queensland, Brisbane, QLD, Australia
- Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Ochsner Clinic Foundation, New Orleans, LA, United States
- Faculty of Pharmacy, Department of Clinical Biochemistry and Immunology, University of Concepción, Concepción, Chile
- Mater Research Institute-University of Queensland, Translational Research Institute, Woolloongabba, QLD, Australia
- *Correspondence: Carlos Salomon,
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Kubo A, Ferrara A, Laurent CA, Windham GC, Greenspan LC, Deardorff J, Hiatt RA, Quesenberry CP, Kushi LH. Associations Between Maternal Pregravid Obesity and Gestational Diabetes and the Timing of Pubarche in Daughters. Am J Epidemiol 2016; 184:7-14. [PMID: 27268032 DOI: 10.1093/aje/kww006] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Accepted: 01/06/2016] [Indexed: 12/24/2022] Open
Abstract
We investigated whether in utero exposure to maternal pregravid obesity and/or gestational diabetes mellitus (GDM) was associated with early puberty in girls. We used data from a longitudinal study of 421 mother-daughter pairs enrolled in an integrated health services organization, Kaiser Permanente Northern California (2005-2012). Girls aged 6-8 years were followed annually through ages 12-14 years. Onset of puberty was assessed using study clinic-based Tanner staging. We examined associations of self-reported pregravid obesity and maternal GDM with timing of the daughter's transition to pubertal maturation stage 2 or above for development of breasts and pubic hair, using accelerated failure time regression models with interval censoring to estimate time ratios and hazard ratios and corresponding 95% confidence intervals. Maternal obesity (pregravid body mass index (BMI; weight (kg)/height (m)(2)) ≥30) was associated with a daughter's earlier transition to breast and pubic hair stage 2+ in comparison with girls whose mothers had pregravid BMI <25. These associations were attenuated and not statistically significant after adjustment for covariates. Girls whose mothers had both pregravid BMI ≥25 and GDM were at higher risk of an earlier transition to pubic hair stage 2+ than those whose mothers had neither condition (adjusted time ratio = 0.89, 95% confidence interval: 0.83, 0.96; hazard ratio = 2.97, 95% confidence interval: 1.52, 5.83). These findings suggest that exposure to maternal obesity and hyperglycemia places girls at higher risk of earlier pubarche.
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Abstract
To prevent the intergenerational transfer of obesity and end the current epidemic, interventions are needed across the early life stages, from preconception to prenatal to infancy through the age of 2 years. The foundation for obesity is laid in early life by actions and interactions passed from parent to child that have long-lasting biologic and behavioral consequences. The purpose of this paper is to examine the best evidence about (a) factors in parents and offspring that promote obesity during the early life stages, (b) the social determinants and dimensions of obesity in early life, (c) promising and effective interventions for preventing obesity in early life, and (d) opportunities for future research into strategies to disrupt the intergenerational cycle of obesity that begins early in life. The pathway for halting the intergenerational obesity epidemic requires the discovery and development of evidence-based interventions that can act across multiple dimensions of influence on early life.
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Affiliation(s)
- Debra Haire-Joshu
- Public Health and Medicine, Brown School, Washington University in St. Louis, St. Louis, Missouri 63130;
| | - Rachel Tabak
- Prevention Research Center, Brown School, Washington University in St. Louis, St. Louis, Missouri 63130;
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Ensenauer R, Brandlhuber L, Burgmann M, Sobotzki C, Zwafink C, Anzill S, Holdt L, Teupser D, Hasbargen U, Netz H, Roscher AA, von Kries R. Obese Nondiabetic Pregnancies and High Maternal Glycated Hemoglobin at Delivery as an Indicator of Offspring and Maternal Postpartum Risks: The Prospective PEACHES Mother-Child Cohort. Clin Chem 2015; 61:1381-90. [PMID: 26265704 DOI: 10.1373/clinchem.2015.242206] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Accepted: 07/16/2015] [Indexed: 01/09/2023]
Abstract
BACKGROUND We investigated whether obese pregnant women negative for gestational diabetes (GDM) still experience dysglycemia, as indicated by high glycated hemoglobin (Hb A1c) at delivery, and whether this impacts offspring and long-term maternal outcomes. METHODS Data of 462 mother-child pairs of our prospective Programming of Enhanced Adiposity Risk in Childhood - Early Screening (PEACHES) cohort study were analyzed. Of 885 obese and normal-weight pregnancies prospectively enrolled after GDM testing according to the International Association of Diabetes and Pregnancy Study Groups criteria, 462 GDM-negative mothers and their offspring were investigated. We assessed associations of maternal Hb A1c at delivery with large-for-gestational-age (LGA) birth weights, cord-blood C-peptide, and biomarkers of glucose metabolism and inflammation in obese mothers followed for 2.9 years (median) postpartum (n = 42). RESULTS Cumulative distribution analysis in GDM-negative normal-weight women (n = 155) revealed that 12% had Hb A1c ≥5.7% at delivery (high Hb A1c). Among obese GDM-negative women (n = 307), 31.9% (95% CI, 26.7%-37.4%) equaled or exceeded this cutoff. In obese GDM-negative women with Hb A1c ≥5.7% (n = 98) vs <5.7% (n = 209) at delivery, newborns were more likely to be born LGA [adjusted odds ratio 3.56 (95% CI, 1.64-8.02)], and mean cordblood serum C-peptide was increased by 0.09 ng/mL (95% CI, 0.01-0.17 ng/mL). In the mothers at follow-up, mean postpartum Hb A1c, fasting glucose, high-sensitivity C-reactive protein, and fibrinogen concentrations were higher by 0.3% (95% CI, 0.1%-0.5%), 6.0 mg/dL (95% CI, 2.4-9.5 mg/dL), 6.8 mg/L (95% CI, 1.4-12.3 mg/L), and 74.9 mg/dL (95% CI, 13.6-136.2 mg/dL), respectively. CONCLUSIONS Increased Hb A1c in obese GDM-negative women at delivery indicates gestational dysglycemia, potentially conferring offspring and long-term maternal health risks. These findings should raise awareness as to careful monitoring of obese pregnancies. Measurement of Hb A1c at delivery could help select women who may need closer postpartum health checks.
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Affiliation(s)
- Regina Ensenauer
- Research Center, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-Universität München, Munich, Germany; Experimental Pediatrics, Department of General Pediatrics, Neonatology and Pediatric Cardiology, University Children's Hospital, Heinrich Heine University Düsseldorf, Düsseldorf, Germany;
| | - Lena Brandlhuber
- Research Center, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-Universität München, Munich, Germany; Department of Pediatric Cardiology and Intensive Care, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Maximiliane Burgmann
- Department of Obstetrics and Gynecology, Campus Grosshadern, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Christina Sobotzki
- Institute for Social Pediatrics and Adolescent Medicine, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Carina Zwafink
- Research Center, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Sabine Anzill
- Research Center, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Lesca Holdt
- Institute of Laboratory Medicine, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Daniel Teupser
- Institute of Laboratory Medicine, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Uwe Hasbargen
- Department of Obstetrics and Gynecology, Campus Grosshadern, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Heinrich Netz
- Department of Pediatric Cardiology and Intensive Care, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Adelbert A Roscher
- Research Center, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Rüdiger von Kries
- Institute for Social Pediatrics and Adolescent Medicine, Ludwig-Maximilians-Universität München, Munich, Germany
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Racusin DA, Antony K, Showalter L, Sharma S, Haymond M, Aagaard KM. Candy twists as an alternative to the glucola beverage in gestational diabetes mellitus screening. Am J Obstet Gynecol 2015; 212:522.e1-5. [PMID: 25446695 DOI: 10.1016/j.ajog.2014.11.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2014] [Revised: 07/24/2014] [Accepted: 07/24/2014] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Screening for gestational diabetes mellitus commonly uses an oral glucose challenge test with a 50-g glucola beverage and subsequent venous puncture. However, up to 30% of pregnant women report significant side-effects, and the beverage is costly. We hypothesized that equivalent glucose loads could be achieved from a popular candy twist (Twizzlers; The Hershey Company, Hershey, PA) and tested it as cost-effective, tolerable alternative with a test of equivalency. STUDY DESIGN The glucose equivalent of the 50-g glucola was calculated as 10 candy twists. We initially used a triple crossover design in nonpregnant patients whereby each subject served as her own control; this ensured the safety and equivalency of this load before using it among pregnant subjects. We then recruited pregnant women with an abnormal screening at 1 hour (glucose challenge test) in a double crossover design study. Subjects consumed 10 candy twists with a 1-hour venous blood glucose assessment. All subjects subsequently completed the confirmatory 3-hour glucose tolerance test. Sensitivity, specificity, positive predictive values, negative predictive values, false-referral rates, and detection rates were calculated. RESULTS At ≥130 mg/dL, the sensitivity (100%) was the same for candy twists and glucola. However, the false-referral rate (82% vs 90%), positive predictive value (18% vs 10%), and detection rate (18% vs 10%) were improved for candy twists when compared with the 50-g glucola beverage. CONCLUSION Our results indicate that strawberry-flavored candy twists are potentially an equally effective screening test, compared with the gold standard glucola beverage but lead to fewer false-positive screens and therefore could be a cost-effective alternative.
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Affiliation(s)
- Diana A Racusin
- Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital, Houston, TX
| | - Kathleen Antony
- Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital, Houston, TX
| | - Lori Showalter
- Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital, Houston, TX
| | - Susan Sharma
- Divisions of Endocrinology and Nutrition, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, TX
| | - Morey Haymond
- Divisions of Endocrinology and Nutrition, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, TX
| | - Kjersti M Aagaard
- Division of Maternal-Fetal Medicine, Baylor College of Medicine and Texas Children's Hospital, Houston, TX; Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital, Houston, TX.
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Harville EW, Juonala M, Viikari JSA, Raitakari OT. Preconception metabolic indicators predict gestational diabetes and offspring birthweight. Gynecol Endocrinol 2014; 30:840-4. [PMID: 25007009 DOI: 10.3109/09513590.2014.937336] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Pregnancy conditions such as gestational diabetes (GDM) and macrosomia lead to an increased risk of diabetes and cardiovascular disease in the offspring, perpetuating a cycle of poor health. We hypothesized that (1) pre-pregnancy indicators of metabolism would be associated with GDM and birthweight; and (2) the lipid accumulation product (LAP; incorporating waist circumference and triglycerides) and visceral adiposity index (VAI; incorporating waist circumference, triglycerides, and HDL-c) would be better predictors of GDM and birthweight than other indicators. Data from the Cardiovascular Risk in Young Finns Study were linked to the Finnish birth registry for 349 women. BMI, triglycerides, waist circumference, insulin, HOMA-IR, LAP, and VAI at the visit prior to the pregnancy were examined as predictors of GDM and large-for-gestational-age (LGA) using logistic regression with adjustment for age, parity, and smoking. Waist circumference was the strongest predictor of GDM (adjusted odds ratio [aOR] 1.66, 95% confidence interval 1.16-2.38) and LGA (aOR 1.41, 1.00-1.99). For GDM, all markers had similar discrimination; for LGA, the area under the receiver operating curve for waist circumference was significantly higher than for BMI (p < 0.01). This analysis suggests that pregnancy and even offspring health is affected by risk factors outside the immediate time period of pregnancy.
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Affiliation(s)
- Emily W Harville
- Tulane School of Public Health and Tropical Medicine , New Orleans , LA
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Magee TR, Ross MG, Wedekind L, Desai M, Kjos S, Belkacemi L. Gestational diabetes mellitus alters apoptotic and inflammatory gene expression of trophobasts from human term placenta. J Diabetes Complications 2014; 28:448-59. [PMID: 24768206 PMCID: PMC4166519 DOI: 10.1016/j.jdiacomp.2014.03.010] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2013] [Revised: 03/13/2014] [Accepted: 03/16/2014] [Indexed: 12/13/2022]
Abstract
AIM Increased placental growth secondary to reduced apoptosis may contribute to the development of macrosomia in GDM pregnancies. We hypothesize that reduced apoptosis in GDM placentas is caused by dysregulation of apoptosis related genes from death receptors or mitochondrial pathway or both to enhance placental growth in GDM pregnancies. METHODS Newborn and placental weights from women with no pregnancy complications (controls; N=5), or with GDM (N=5) were recorded. Placental villi from both groups were either fixed for TUNEL assay, or snap frozen for gene expression analysis by apoptosis PCR microarrays and qPCR. RESULTS Maternal, placental and newborn weights were significantly higher in the GDM group vs. Controls. Apoptotic index of placentas from the GDM group was markedly lower than the Controls. At a significant threshold of 1.5, seven genes (BCL10, BIRC6, BIRC7, CASP5, CASP8P2, CFLAR, and FAS) were down regulated, and 13 genes (BCL2, BCL2L1, BCL2L11, CASP4, DAPK1, IκBκE, MCL1, NFκBIZ, NOD1, PEA15, TNF, TNFRSF25, and XIAP) were unregulated in the GDM placentas. qPCR confirmed the consistency of the PCR microarray. Using Western blotting we found significantly decreased placental pro-apoptotic FAS receptor and FAS ligand (FASL), and increased mitochondrial anti-apoptotic BCL2 post GDM insult. Notably, caspase-3, which plays a central role in the execution-phase of apoptosis, and its substrate poly (ADP-ribose) polymerase (PARP) were significantly down regulated in GDM placentas, as compared to non-diabetic Control placentas. CONCLUSION Maternal GDM results in heavier placentas with aberrant placental apoptotic and inflammatory gene expression that may account, at least partially, for macrosomia in newborns.
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Affiliation(s)
- Thomas R Magee
- Department of Obstetrics and Gynecology, Perinatal Research Laboratories, David Geffen School of Medicine at University of California in Los Angeles, Los Angeles, CA, USA; Los Angeles Biomedical Research Institute at Harbor-UCLA, Torrance, CA, USA; Department of Health and Life Sciences at Charles R. Drew University of Medicine and Science, Los Angeles, CA, USA
| | - Michael G Ross
- Department of Obstetrics and Gynecology, Perinatal Research Laboratories, David Geffen School of Medicine at University of California in Los Angeles, Los Angeles, CA, USA; Los Angeles Biomedical Research Institute at Harbor-UCLA, Torrance, CA, USA
| | - Lauren Wedekind
- Los Angeles Biomedical Research Institute at Harbor-UCLA, Torrance, CA, USA
| | - Mina Desai
- Department of Obstetrics and Gynecology, Perinatal Research Laboratories, David Geffen School of Medicine at University of California in Los Angeles, Los Angeles, CA, USA; Los Angeles Biomedical Research Institute at Harbor-UCLA, Torrance, CA, USA
| | - Siri Kjos
- Department of Obstetrics and Gynecology, Perinatal Research Laboratories, David Geffen School of Medicine at University of California in Los Angeles, Los Angeles, CA, USA
| | - Louiza Belkacemi
- Department of Obstetrics and Gynecology, Perinatal Research Laboratories, David Geffen School of Medicine at University of California in Los Angeles, Los Angeles, CA, USA; Los Angeles Biomedical Research Institute at Harbor-UCLA, Torrance, CA, USA.
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Macaulay S, Dunger DB, Norris SA. Gestational diabetes mellitus in Africa: a systematic review. PLoS One 2014; 9:e97871. [PMID: 24892280 PMCID: PMC4043667 DOI: 10.1371/journal.pone.0097871] [Citation(s) in RCA: 98] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Accepted: 04/25/2014] [Indexed: 12/15/2022] Open
Abstract
Background Gestational diabetes mellitus (GDM) is any degree of impaired glucose tolerance first recognised during pregnancy. Most women with GDM revert to normal glucose metabolism after delivery of their babies; however, they are at risk of developing type 2 diabetes later in life as are their offspring. Determining a country’s GDM prevalence can assist with policy guidelines regarding GDM screening and management, and can highlight areas requiring research. This systematic review assesses GDM prevalence in Africa. Methods and Findings Three electronic databases were searched without language restrictions; PubMed, Scopus and the Cochrane Library. Thirty-one search terms were searched. Eligible articles defined GDM, stated what GDM screening approaches were employed and reported GDM prevalence. The reporting quality and risk of bias within each study was assessed. The PRISMA guidelines for systematic reviews were followed. The literature search identified 466 unique records. Sixty full text articles were reviewed of which 14 were included in the systematic review. One abstract, for which the full text article could not be obtained, was also included. Information regarding GDM classification, screening methods and prevalence was obtained for six African countries; Ethiopia (n = 1), Morocco (n = 1), Mozambique (n = 1), Nigeria (n = 6), South Africa (n = 4) and Tanzania (n = 1). Prevalence figures ranged from 0% (Tanzania) to 13.9% (Nigeria) with some studies focussing on women with GDM risk factors. Most studies utilised the two hour 75 g oral glucose tolerance test and applied the World Health Organization’s diagnostic criteria. Conclusions Six countries, equating to 11% of the African continent, were represented in this systematic review. This indicates how little is known about GDM in Africa and highlights the need for further research. Considering the increasing public health burden of obesity and type 2 diabetes, it is essential that the extent of GDM is understood in Africa to allow for effective intervention programmes.
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Affiliation(s)
- Shelley Macaulay
- Medical Research Council/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, University of the Witwatersrand, Johannesburg, South Africa
- * E-mail:
| | - David B. Dunger
- Medical Research Council/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, University of the Witwatersrand, Johannesburg, South Africa
- Department of Paediatrics, University of Cambridge, Cambridge, United Kingdom
| | - Shane A. Norris
- Medical Research Council/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, University of the Witwatersrand, Johannesburg, South Africa
- Department of Paediatrics, University of Cambridge, Cambridge, United Kingdom
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Bloor ID, Symonds ME. Sexual dimorphism in white and brown adipose tissue with obesity and inflammation. Horm Behav 2014; 66:95-103. [PMID: 24589990 DOI: 10.1016/j.yhbeh.2014.02.007] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2013] [Revised: 02/18/2014] [Accepted: 02/20/2014] [Indexed: 12/24/2022]
Abstract
This article is part of a Special Issue "Energy Balance". Obesity and its associated comorbidities remain at epidemic levels globally and show no signs of abatement in either adult or child populations. White adipose tissue has long been established as an endocrine signalling organ possessing both metabolic and immune functions. This role can become dysregulated following excess adiposity caused by adipocyte hypertrophy and hyperplasia. In contrast, brown adipose tissue (BAT) is only present in comparatively small amounts in the body but can significantly impact on heat production, and thus could prevent excess white adiposity. Obesity and associated risk factors for adverse metabolic health are not only linked with enlarged fat mass but also are dependent on its anatomical deposition. In addition, numerous studies have revealed a disparity in white adipose tissue deposition prior to and during the development of obesity between the sexes. Females therefore tend to develop a greater abundance of femoral and gluteal subcutaneous fat whereas males exhibit more central adiposity. In females, lower body subcutaneous adipose tissue depots appear to possess a greater capacity for lipid storage, enhanced lipolytic flux and hyperplastic tissue remodelling compared to visceral adipocytes. These differences are acknowledged to contribute to the poorer metabolic and inflammatory profiles observed in males. Importantly, the converse outcomes between sexes disappear after the menopause, suggesting a role for sex hormones within the onset of metabolic complications with obesity. This review further considers how BAT impacts upon on the relationship between excess adiposity, gender, inflammation and endocrine signalling and could thus ultimately be a target to prevent obesity.
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Affiliation(s)
- Ian D Bloor
- Early Life Research Unit, Division of Child Health, Obstetrics and Gynaecology, School of Medicine, The University of Nottingham, Queen's Medical Centre, Nottingham, NG7 2UH, UK
| | - Michael E Symonds
- Early Life Research Unit, Division of Child Health, Obstetrics and Gynaecology, School of Medicine, The University of Nottingham, Queen's Medical Centre, Nottingham, NG7 2UH, UK.
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Herring SJ, Nelson DB, Pien GW, Homko C, Goetzl LM, Davey A, Foster GD. Objectively measured sleep duration and hyperglycemia in pregnancy. Sleep Med 2013; 15:51-5. [PMID: 24239498 DOI: 10.1016/j.sleep.2013.07.018] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2013] [Revised: 07/12/2013] [Accepted: 07/16/2013] [Indexed: 12/25/2022]
Abstract
OBJECTIVE Our primary purpose was to assess the impact of objectively measured nighttime sleep duration on gestational glucose tolerance. We additionally examined associations of objectively measured daytime sleep duration and nap frequency on maternal glycemic control. METHODS Sixty-three urban, low-income, pregnant women wore wrist actigraphs for an average of 6 full days in mid-pregnancy prior to screening for hyperglycemia using the 1-h oral glucose tolerance test (OGTT). Correlations of nighttime and daytime sleep durations with 1-h OGTT values were analyzed. Multivariable logistic regression was used to evaluate independent associations between sleep parameters and hyperglycemia, defined as 1-h OGTT values ≥130 mg/dL. RESULTS Mean nighttime sleep duration was 6.9±0.9 h which was inversely correlated with 1-h OGTT values (r=-0.28, P=.03). Shorter nighttime sleep was associated with hyperglycemia, even after controlling for age and body mass index (adjusted odds ratio [OR], 0.2 [95% confidence interval {CI}, 0.1-0.8]). There were no associations of daytime sleep duration and nap frequency with 1-h OGTT values or hyperglycemia. CONCLUSIONS Using objective measures of maternal sleep time, we found that women with shorter nighttime sleep durations had an increased risk for gestational hyperglycemia. Larger prospective studies are needed to confirm our negative daytime sleep findings.
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Affiliation(s)
- Sharon J Herring
- Center for Obesity Research and Education, Department of Medicine, Temple University, Philadelphia, PA, United States; Department of Public Health, Temple University, Philadelphia, PA, United States; Department of Obstetrics, Gynecology, and Reproductive Sciences, Temple University, Philadelphia, PA, United States.
| | - Deborah B Nelson
- Department of Public Health, Temple University, Philadelphia, PA, United States; Department of Obstetrics, Gynecology, and Reproductive Sciences, Temple University, Philadelphia, PA, United States
| | - Grace W Pien
- Division of Pulmonary Medicine, Department of Medicine, Johns Hopkins University, Baltimore, MD, United States
| | - Carol Homko
- Center for Obesity Research and Education, Department of Medicine, Temple University, Philadelphia, PA, United States; Department of Obstetrics, Gynecology, and Reproductive Sciences, Temple University, Philadelphia, PA, United States
| | - Laura M Goetzl
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Temple University, Philadelphia, PA, United States
| | - Adam Davey
- Department of Public Health, Temple University, Philadelphia, PA, United States
| | - Gary D Foster
- Center for Obesity Research and Education, Department of Medicine, Temple University, Philadelphia, PA, United States; Department of Public Health, Temple University, Philadelphia, PA, United States
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Levkovitz R, Zaretsky U, Jaffa A, Hod M, Elad D. In vitro simulation of placental transport: Part II. Glucose transfer across the placental barrier model. Placenta 2013; 34:708-15. [DOI: 10.1016/j.placenta.2013.05.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2013] [Revised: 05/07/2013] [Accepted: 05/14/2013] [Indexed: 01/28/2023]
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Dowling D, McAuliffe FM. The molecular mechanisms of offspring effects from obese pregnancy. Obes Facts 2013; 6:134-45. [PMID: 23571656 PMCID: PMC5644678 DOI: 10.1159/000350706] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2012] [Accepted: 06/29/2012] [Indexed: 11/19/2022] Open
Abstract
The incidence of obesity, increased weight gain and the popularity of high-fat / high-sugar diets are seriously impacting upon the global population. Billions of individuals are affected, and although diet and lifestyle are of paramount importance to the development of adult obesity, compelling evidence is emerging which suggests that maternal obesity and related disorders may be passed on to the next generation by non-genetic means. The processes acting within the uteri of obese mothers may permanently predispose offspring to a diverse plethora of diseases ranging from obesity and diabetes to psychiatric disorders. This review aims to summarise some of the molecular mechanisms and active processes currently known about maternal obesity and its effect on foetal and neonatal physiology and metabolism. Complex and multifactorial networks of molecules are intertwined and culminate in a pathologically synergistic manner to cause disruption and disorganisation of foetal physiology. This altered phenotype may potentiate the cycle of intergenerational transmission of obesity and related disorders.
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Affiliation(s)
| | - Fionnuala M. McAuliffe
- *Prof. Dr. Fionnuala M. McAuliffe, UCD Obstetrics & Gynaecology, School of Medicine and Medical Science, University College Dublin, National Maternity Hospital, Dublin 2 (Ireland),
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Abstract
Intergenerational effects on linear growth are well documented. Several generations are necessary in animal models to 'wash out' effects of undernutrition, consistent with the unfolding of the secular trend in height in Europe and North America. Birthweight is correlated across generations and short maternal stature, which reflects intrauterine and infant growth failure, is associated with low birthweight, child stunting, delivery complications and increased child mortality, even after adjusting for socio-economic status. A nutrition intervention in Guatemala reduced childhood stunting; it also improved growth of the next generation, but only in the offspring of girls. Possible mechanisms explaining intergenerational effects on linear growth are not mutually exclusive and include, among others, shared genetic characteristics, epigenetic effects, programming of metabolic changes, and the mechanics of a reduced space for the fetus to grow. There are also socio-cultural factors at play that are important such as the intergenerational transmission of poverty and the fear of birthing a large baby, which leads to 'eating down' during pregnancy. It is not clear whether there is an upper limit for impact on intrauterine and infant linear growth that programmes in developing countries could achieve that is set by early childhood malnutrition in the mother. Substantial improvements in linear growth can be achieved through adoption and migration, and in a few selected countries, following rapid economic and social development. It would seem, despite clear documentation of intergenerational effects, that nearly normal lengths can be achieved in children born to mothers who were malnourished in childhood when profound improvements in health, nutrition and the environment take place before conception. To achieve similar levels of impact through public health programmes alone in poor countries is highly unlikely. The reality in poor countries limits the scope, quality and coverage of programmes that can be implemented and modest impact should be expected instead. The Lancet series on Maternal and Child Undernutrition estimated that implementation to scale of proven interventions in high burden countries would reduce stunting by one-third; this is perhaps a realistic upper bound for impact for high quality programmes, unless accompanied by sweeping improvements in social services and marked reductions in poverty. Finally, because so much can be achieved in a single generation, intergenerational influences are unlikely to be an important explanation for lack of programme impact aimed at the window of the first 1000 days. Failure to prevent linear growth failure in developing countries has serious consequences for short- and long-term health as well as for the formation of human capital. The nutrition transition has created a double burden by adding obesity and related chronic diseases to the public health agenda of countries still struggling with the 'old' problems of maternal and child undernutrition. The challenge ahead is to increase efforts to prevent linear growth failure while keeping child overweight at bay.
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Affiliation(s)
- Reynaldo Martorell
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA.
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Nielsen GL, Dethlefsen C, Lundbye-Christensen S, Pedersen JF, Mølsted-Pedersen L, Gillman MW. Adiposity in 277 young adult male offspring of women with diabetes compared with controls: a Danish population-based cohort study. Acta Obstet Gynecol Scand 2012; 91:838-43. [PMID: 22486385 DOI: 10.1111/j.1600-0412.2012.01413.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To examine the associations of maternal diabetes, overall and stratified according to treatment of diabetes, with weight-related outcomes at the time of military conscription, at age 18-20 years. DESIGN AND SETTING Cohort study of 277 Danish male offspring of mothers with recognized pre-gestational or gestational diabetes. As population-based controls we selected 870 men matched from the Civil Registration Office. METHODS Data on weight-related outcomes were retrieved from the Danish military conscription registry. MAIN OUTCOME MEASURES Military rejection due to adiposity and body mass index (BMI) at conscription. RESULTS Army rejection rate due to adiposity was 5.8% (n= 16) among 277 diabetes mellitus-exposed men compared with 3.1% (n= 27) in 870 controls (risk difference 2.7 (95% confidence interval (CI) -0.3-5.7)) and mean BMI at conscription was 1.4 kg/m(2) (95%CI 0.8-2.0) higher among those diabetes mellitus-exposed men. In analyses adjusted for birthweight and gestational age, compared with controls, the BMI was 0.6 kg/m(2) (95%CI -0.3-1.5) higher in sons of mothers with pre-gestational and 2.7 kg/m(2) (95% (CI): 0.9-4.5) higher with gestational diabetes. The greatest BMI difference was in offspring of mothers with gestational diabetes in whom insulin was initiated during pregnancy. We found no difference in conscript height. CONCLUSIONS Compared with controls, male offspring of women with diabetes had a higher rejection rate due to adiposity and higher adult BMI. Subgroup analyses showed that the association was most pronounced in sons of mothers with gestational diabetes, whereas pre-gestational diabetes was only weakly associated with higher offspring BMI.
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Willows ND, Hanley AJG, Delormier T. A socioecological framework to understand weight-related issues in Aboriginal children in Canada. Appl Physiol Nutr Metab 2012; 37:1-13. [PMID: 22269027 DOI: 10.1139/h11-128] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Obesity prevention efforts in Aboriginal (First Nations, Métis, or Inuit) communities in Canada should focus predominantly on children given their demographic significance and the accelerated time course of occurrence of type 2 diabetes mellitus in the Aboriginal population. A socioecological model to address childhood obesity in Aboriginal populations would focus on the numerous environments at different times in childhood that influence weight status, including prenatal, sociocultural, family, and community environments. Importantly, for Aboriginal children, obesity interventions need to also be situated within the context of a history of colonization and inequities in the social determinants of health. This review therefore advocates for the inclusion of a historical perspective and a life-course approach to obesity prevention in Aboriginal children in addition to developing interventions around the socioecological framework. We emphasize that childhood obesity prevention efforts should focus on promoting maternal health behaviours before and during pregnancy, and on breastfeeding and good infant and child nutrition in the postpartum and early childhood development periods. Ameliorating food insecurity by focusing on improving the sociodemographic risk factors for it, such as increasing income and educational attainment, are essential. More research is required to understand and measure obesogenic Aboriginal environments, to examine how altering specific environments modifies the foods that children eat and the activities that they do, and to examine how restoring and rebuilding cultural continuity in Aboriginal communities modifies the many determinants of obesity. This research needs to be done with the full participation of Aboriginal communities as partners in the research.
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Affiliation(s)
- Noreen D Willows
- Department of Agricultural, Food, and Nutritional Science, University of Alberta, Edmonton, AB T6G 2P5, Canada.
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Patel S, Fraser A, Davey Smith G, Lindsay RS, Sattar N, Nelson SM, Lawlor DA. Associations of gestational diabetes, existing diabetes, and glycosuria with offspring obesity and cardiometabolic outcomes. Diabetes Care 2012; 35:63-71. [PMID: 22124718 PMCID: PMC3241309 DOI: 10.2337/dc11-1633] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To assess associations of gestational diabetes, existing diabetes, and glycosuria with adiposity and cardiometabolic risk factors in offspring at adolescence. RESEARCH DESIGN AND METHODS Multivariable regression analyses were conducted in a prospective pregnancy cohort (n = 2,563-4,198 for different outcomes). Obstetric data were abstracted from clinical records. Offspring outcomes were assessed at mean age 15.5 years. Compared with those lost to follow-up, participants included in the analysis were of higher socioeconomic position. Outcomes included BMI, waist circumference, fat mass determined by dual-energy X-ray absorptiometry scan, systolic and diastolic blood pressure (sBP and dBP, respectively), fasting glucose, insulin, lipids, and C-reactive protein (CRP). RESULTS Maternal existing diabetes, gestational diabetes, and glycosuria were associated with higher offspring BMI and fat mass (z scores); however, this effect was attenuated in the confounder-adjusted model, and the CIs included the null value. Existing diabetes and gestational diabetes were associated with higher offspring fasting glucose levels (0.24 mmol/L [95% CI 0.03-0.45] and 0.20 mmol/L [0.02-0.39], respectively). Glycosuria was associated with higher fasting insulin (adjusted ratio of geometric means 1.12 [1.01-1.25]), but there were no clear associations of existing or gestational diabetes with offspring fasting insulin. There was little evidence of an association of maternal diabetes or glycosuria with offspring dBP, sBP, lipids, or CRP. CONCLUSIONS Maternal pregnancy glycosuria, gestational diabetes, and existing diabetes show some associations with higher offspring fasting glucose and insulin assessed in adolescence but are not clearly associated with a wider range of cardiometabolic risk factors.
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Affiliation(s)
- Sumaiya Patel
- MRC (Medical Research Council) Centre for Causal Analyses in Translational Epidemiology, School of Social and Community Medicine, University of Bristol, Bristol, UK.
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Lappas M, Hiden U, Desoye G, Froehlich J, Hauguel-de Mouzon S, Jawerbaum A. The role of oxidative stress in the pathophysiology of gestational diabetes mellitus. Antioxid Redox Signal 2011; 15:3061-100. [PMID: 21675877 DOI: 10.1089/ars.2010.3765] [Citation(s) in RCA: 250] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Normal human pregnancy is considered a state of enhanced oxidative stress. In pregnancy, it plays important roles in embryo development, implantation, placental development and function, fetal development, and labor. However, pathologic pregnancies, including gestational diabetes mellitus (GDM), are associated with a heightened level of oxidative stress, owing to both overproduction of free radicals and/or a defect in the antioxidant defenses. This has important implications on the mother, placental function, and fetal well-being. Animal models of diabetes have confirmed the important role of oxidative stress in the etiology of congenital malformations; the relative immaturity of the antioxidant system facilitates the exposure of embryos and fetuses to the damaging effects of oxidative stress. Of note, there are only a few clinical studies evaluating the potential beneficial effects of antioxidants in GDM. Thus, whether or not increased antioxidant intake can reduce the complications of GDM in both mother and fetus needs to be explored. This review provides an overview and updated data on our current understanding of the complications associated with oxidative changes in GDM.
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Affiliation(s)
- Martha Lappas
- Department of Obstetrics and Gynaecology, University of Melbourne, Mercy Hospital for Women, Heidelberg, Victoria, Australia.
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