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Dinh NTT, de Graaff B, Campbell JA, Jose MD, Burgess J, Saunder T, Kitsos A, Wells C, Palmer AJ. Creating an interactive map visualising the geographic variations of the burden of diabetes to inform policymaking: An example from a cohort study in Tasmania, Australia. Aust N Z J Public Health 2024; 48:100109. [PMID: 38429224 DOI: 10.1016/j.anzjph.2023.100109] [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: 05/16/2023] [Revised: 08/16/2023] [Accepted: 11/07/2023] [Indexed: 03/03/2024] Open
Abstract
OBJECTIVES To visualise the geographic variations of diabetes burden and identify areas where targeted interventions are needed. METHODS Using diagnostic criteria supported by hospital codes, 51,324 people with diabetes were identified from a population-based dataset during 2004-2017 in Tasmania, Australia. An interactive map visualising geographic distribution of diabetes prevalence, mortality rates, and healthcare costs in people with diabetes was generated. The cluster and outlier analysis was performed based on statistical area level 2 (SA2) to identify areas with high (hot spot) and low (cold spot) diabetes burden. RESULTS There were geographic variations in diabetes burden across Tasmania, with highest age-adjusted prevalence (6.1%), excess cost ($2627), and annual costs per person ($5982) in the West and Northwest. Among 98 SA2 areas, 16 hot spots and 25 cold spots for annual costs, and 10 hot spots and 10 cold spots for diabetes prevalence were identified (p<0.05). 15/16 (94%) and 6/10 (60%) hot spots identified were in the West and Northwest. CONCLUSIONS We have developed a method to graphically display important diabetes outcomes for different geographical areas. IMPLICATIONS FOR PUBLIC HEALTH The method presented in our study could be applied to any other diseases, regions, and countries where appropriate data are available to identify areas where interventions are needed to improve diabetes outcomes.
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Affiliation(s)
- Ngan T T Dinh
- Menzies Institute for Medical Research, University of Tasmania, Tasmania, Australia; Thai Nguyen University of Medicine and Pharmacy, Thai Nguyen University, Thai Nguyen, Vietnam. https://twitter.com/@NganDin46229988
| | - Barbara de Graaff
- Menzies Institute for Medical Research, University of Tasmania, Tasmania, Australia
| | - Julie A Campbell
- Menzies Institute for Medical Research, University of Tasmania, Tasmania, Australia
| | - Matthew D Jose
- School of Medicine, University of Tasmania, Tasmania, Australia; Australia and New Zealand Dialysis and Transplant Registry (ANZDATA), South Australia, Australia
| | - John Burgess
- School of Medicine, University of Tasmania, Tasmania, Australia; Department of Endocrinology, Royal Hobart Hospital, Tasmania, Australia
| | - Timothy Saunder
- School of Medicine, University of Tasmania, Tasmania, Australia
| | - Alex Kitsos
- School of Medicine, University of Tasmania, Tasmania, Australia
| | | | - Andrew J Palmer
- Menzies Institute for Medical Research, University of Tasmania, Tasmania, Australia.
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2
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Willis J, Cunningham-Tisdall C, Griffin C, Scott R, Darlow BA, Owens N, Ferguson J, Mackenzie K, Williman J, de Bock M. Type 1 diabetes diagnosed before age 15 years in Canterbury, New Zealand: A 50 year record of increasing incidence. Pediatr Diabetes 2022; 23:301-309. [PMID: 34954856 DOI: 10.1111/pedi.13305] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 11/05/2021] [Accepted: 12/12/2021] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To describe the epidemiology of pediatric type 1 diabetes over 50 years in Canterbury, New Zealand. Further, to explore variation in case presentation according to age, gender, ethnicity, urban/rural character, socio-economic deprivation and immunogenetic features. RESEARCH DESIGN AND METHODS Prospective ascertainment of cases commenced in 1982, and incident cases presenting 1970-1982 were ascertained retrospectively from clinical records. Eligibility criteria included diagnosis of type 1 diabetes by a physician and commencement of insulin therapy at diagnosis and age less than 15 years. Data collection included name, hospital number, date of birth, date of diagnosis, and date of initiation of insulin treatment. Full address at diagnosis was assigned an urban-rural classification, and a deprivation score. HLA-DQ susceptibility alleles and diabetes associated autoantibodies were determined. RESULTS The incidence of type 1 diabetes increased more than 5-fold (3.9% per annum) over 50 years for the entire cohort. The mean for 5-year periods, starting from 1970, increased from 5.3 to 29.0 cases per 100,000 person years. Incidence was greatest in the 10-14 year age group. The cohort is predominantly European (89.4%), but there has been an increase in cases identifying as New Zealand Māori in the last three decades. Weak evidence was found for reduced incidence of type 1 diabetes in rural regions (adjusted IRR = 0.70, 95%CI 0.52 to 0.91, p = 0.011). CONCLUSIONS The incidence of type 1 diabetes in children aged less than 15 years continues to increase with time. Incidence was significantly affected by age, ethnicity, and urban/rural characterization of address at diagnosis.
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Affiliation(s)
- Jinny Willis
- Department of Medicine, University of Otago, Christchurch, New Zealand.,New Zealand Nurses Organisation, Christchurch, New Zealand
| | | | - Caroline Griffin
- Department of Paediatrics, University of Otago, Christchurch, New Zealand
| | - Russell Scott
- Department of Medicine, University of Otago, Christchurch, New Zealand
| | - Brian A Darlow
- Department of Paediatrics, University of Otago, Christchurch, New Zealand
| | - Neil Owens
- Paediatric Diabetes Services, Canterbury District Health Board, Christchurch, New Zealand
| | - Janet Ferguson
- Paediatric Diabetes Services, Canterbury District Health Board, Christchurch, New Zealand
| | - Karen Mackenzie
- Paediatric Diabetes Services, Canterbury District Health Board, Christchurch, New Zealand
| | - Jonathan Williman
- Department of Paediatrics, University of Otago, Christchurch, New Zealand
| | - Martin de Bock
- Department of Paediatrics, University of Otago, Christchurch, New Zealand.,Paediatric Diabetes Services, Canterbury District Health Board, Christchurch, New Zealand
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3
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Carnegie ER, Inglis G, Taylor A, Bak-Klimek A, Okoye O. Is Population Density Associated with Non-Communicable Disease in Western Developed Countries? A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19052638. [PMID: 35270337 PMCID: PMC8910328 DOI: 10.3390/ijerph19052638] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 02/19/2022] [Accepted: 02/22/2022] [Indexed: 02/04/2023]
Abstract
Over the last three decades, researchers have investigated population density and health outcomes at differing scale. There has not been a systematic review conducted in order to synthesise this evidence. Following the Preferred Reporting Items for Systematic Reviews (PRISMA) guidelines, we systematically reviewed quantitative evidence published since 1990 on population density and non-communicable disease (NCD) within Westernised countries. Fifty-four studies met the inclusion criteria and were evaluated utilising a quality assessment tool for ecological studies. High population density appears to be associated with higher mortality rates of a range of cancers, cardiovascular disease and COPD, and a higher incidence of a range of cancers, asthma and club foot. In contrast, diabetes incidence was found to be associated with low population density. High and low population density are therefore risk markers for a range of NCDs, indicating that there are unidentified factors and mechanisms underlying aetiology. On closer examination, our synthesis revealed important and complex relationships between population density, the built environment, the nature of greenspace and man-made exposures. In light of increasing rates of morbidity and mortality, future research is required to investigate these associations in order to establish causative agents for each NCD.
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Affiliation(s)
- Elaine Ruth Carnegie
- School of Health and Social Care, Edinburgh Napier University, Sighthill Court, Edinburgh EH114BN, UK; (A.T.); (A.B.-K.); (O.O.)
- Correspondence:
| | - Greig Inglis
- School of Education and Social Sciences, Paisley Campus, University of the West of Scotland, Paisley PA12BE, UK;
| | - Annie Taylor
- School of Health and Social Care, Edinburgh Napier University, Sighthill Court, Edinburgh EH114BN, UK; (A.T.); (A.B.-K.); (O.O.)
| | - Anna Bak-Klimek
- School of Health and Social Care, Edinburgh Napier University, Sighthill Court, Edinburgh EH114BN, UK; (A.T.); (A.B.-K.); (O.O.)
| | - Ogochukwu Okoye
- School of Health and Social Care, Edinburgh Napier University, Sighthill Court, Edinburgh EH114BN, UK; (A.T.); (A.B.-K.); (O.O.)
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4
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Miller KM, Hart PH, Lucas RM, Davis EA, de Klerk NH. Higher ultraviolet radiation during early life is associated with lower risk of childhood type 1 diabetes among boys. Sci Rep 2021; 11:18597. [PMID: 34545118 PMCID: PMC8452739 DOI: 10.1038/s41598-021-97469-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 08/19/2021] [Indexed: 02/08/2023] Open
Abstract
Population-level ecological studies show type 1 diabetes incidence is inversely correlated with ambient ultraviolet radiation (UVR) levels. We conducted a nested case-control study using administrative datasets to test this association at the individual level. Cases (n = 1819) were children born in Western Australia (WA) from 1980-2014, diagnosed with type 1 diabetes at ≤ 16 years. Controls (n = 27,259) were randomly selected from all live births in WA, matched to cases by sex and date of birth. Total ambient erythemal ultraviolet radiation (UVR) doses for each trimester of pregnancy and first year of life were estimated for each individual, using daily NASA satellite data that were date- and geographically-specific. Conditional logistic regression tested the association between UVR dose and case-control status. Type 1 diabetes risk was 42% lower in boys of mothers with third-trimester UVR dose in the highest (compared to the lowest) quartile (p = 0.04). Higher UVR in the first year of life was associated with lower type 1 diabetes risk among boys (p = 0.01). UVR dose was not associated with type 1 diabetes risk in girls. Higher UVR in late pregnancy and early life appear to interact with sex-specific factors to lower type 1 diabetes risk among boys in Western Australia.
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Affiliation(s)
- Kate M. Miller
- grid.414659.b0000 0000 8828 1230Telethon Kids Institute, Nedlands, 6009 Australia
| | - Prue H. Hart
- grid.414659.b0000 0000 8828 1230Telethon Kids Institute, Nedlands, 6009 Australia
| | - Robyn M. Lucas
- grid.1001.00000 0001 2180 7477National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, Australian Capital Territory, 0200 Australia
| | - Elizabeth A. Davis
- grid.410667.20000 0004 0625 8600Perth Children’s Hospital, Nedlands, 6009 Australia
| | - Nicholas H. de Klerk
- grid.1012.20000 0004 1936 7910University of Western Australia, Crawley, 6009 Australia
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5
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French J, Simpson-Yap S, van der Mei I, Ng J, Angus P, Gow PJ. Identification of a Latitude Gradient in the Prevalence of Primary Biliary Cholangitis. Clin Transl Gastroenterol 2021; 12:e00357. [PMID: 34003806 PMCID: PMC8345914 DOI: 10.14309/ctg.0000000000000357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Accepted: 04/05/2021] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION The prevalence of primary biliary cholangitis (PBC) reported in different countries varies significantly and seems to have a latitudinal gradient with the highest prevalence reported in higher latitudes, as has been observed with other autoimmune diseases. This study aimed to determine whether there is a latitudinal gradient of PBC prevalence in Australia using 2 methods of case ascertainment. METHODS We investigated the latitudinal variation of PBC prevalence across the states and territories of Australia (latitudinal range 18.0°-42.7°S) using pathology-based (private pathology antimitochondrial antibody results and PBC-specific prescription databases (prescriptions for ursodeoxycholic acid, the only publicly subsidized treatment for this disease). RESULTS PBC prevalence was significantly positively associated with latitude, and the postcodes in the highest quintile of latitude (encompassing the south coastal areas of the Australian mainland and Tasmania; latitude range -37.75° to -42.72°) had a prevalence estimate that was 1.78 times higher using the pathology-based prevalence estimation than those in the lowest quintile (encompassing tropical and southern Queensland; latitude range -18.02° to -27.59°). Comparing prevalence estimates between states/territories, the result was 2.53 and 2.21 times higher in Tasmania compared with Queensland when using the pathology-based and prescription-based methods, respectively. DISCUSSION Using 2 different case-ascertainment methods, we have demonstrated that prevalence estimates of PBC vary significantly with latitude in Australia. Further studies are needed to determine whether factors such as variations in ultraviolet radiation exposure and/or vitamin D levels are responsible for this observation and to investigate the latitudinal prevalence of PBC in other populations.
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Affiliation(s)
- Janine French
- Department of Gastroenterology, Austin Hospital, Heidelberg, Australia
| | - Steve Simpson-Yap
- Department of Biostatistics and Epidemiology, Melbourne School of Population and Global Health, University of Melbourne, Carlton, Australia
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Ingrid van der Mei
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Justin Ng
- Department of Gastroenterology, Austin Hospital, Heidelberg, Australia
| | - Peter Angus
- Department of Gastroenterology, Austin Hospital, Heidelberg, Australia
| | - Paul J. Gow
- Department of Gastroenterology, Austin Hospital, Heidelberg, Australia
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McCullough ML, Wan N, Pezzolesi MG, Collins TW, Grineski SE, Wei YD, Lazaro-Guevara J, Frodsham SG, Vanderslice JA, Holmen JR, Srinivas TR, Clements SA. Type 1 Diabetes incidence among youth in Utah: A geographical analysis. Soc Sci Med 2021; 278:113952. [PMID: 33933801 DOI: 10.1016/j.socscimed.2021.113952] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 03/23/2021] [Accepted: 04/15/2021] [Indexed: 12/15/2022]
Abstract
Type 1 Diabetes (T1D) poses an increasing threat to public health, as incidence rates continue to rise globally. However, the etiology of T1D is still poorly understood, especially from the perspective of geography. The objective of this research is to examine the incidence of T1D among youth and to identify high-risk clusters and their association with socio-demographic and geographic variables. The study area was the entire state of Utah and included youth with T1D from birth to 19 years of age from 1998 to 2015 (n = 4161). Spatial clustering was measured both globally and locally using the Moran's I statistic and spatial scan statistic. Ordinary least squares (OLS) regression was used to measure the association of high-risk clusters with certain risk factors at the Census Block Group (CBG) level. The mean age at diagnosis was 9.3 years old. The mean incidence rate was 25.67 per 100,000 person-years (95% CI, 24.57-26.75). The incidence rate increased by 14%, from 23.94 per100,000 person-years in 1998 to 27.98 per 100,000 person-years in 2015, with an annual increase of 0.80%. The results of the spatial scan statistic found 42 high-risk clusters throughout the state. OLS regression analysis found a significant association with median household income, population density, and latitude. This study provides evidence that incidence rates of T1D are increasing annually in the state of Utah and that significant geographic high-risk clusters are associated with socio-demographic and geographic factors.
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Affiliation(s)
| | - Neng Wan
- Department of Geography, University of Utah, Salt Lake City, UT, USA
| | - Marcus G Pezzolesi
- Diabetes and Metabolism Research Center, University of Utah School of Medicine, Salt Lake City, UT, USA; Division of Nephrology and Hypertension, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA; Department of Human Genetics, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Timothy W Collins
- Department of Geography, University of Utah, Salt Lake City, UT, USA
| | | | - Yehua Dennis Wei
- Department of Geography, University of Utah, Salt Lake City, UT, USA
| | - Jose Lazaro-Guevara
- Division of Nephrology and Hypertension, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA; Department of Human Genetics, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Scott G Frodsham
- Division of Nephrology and Hypertension, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - James A Vanderslice
- Division of Public Health, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - John R Holmen
- Medical Informatics Department, Intermountain Healthcare, Salt Lake City, UT, USA
| | - Titte R Srinivas
- Division of Nephrology and Hypertension, Case Western Reserve University/University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Scott A Clements
- Department of Pediatrics, University of Utah, Salt Lake City, UT, USA
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7
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Castillo-Reinado K, Maier W, Holle R, Stahl-Pehe A, Baechle C, Kuss O, Hermann J, Holl RW, Rosenbauer J. Associations of area deprivation and urban/rural traits with the incidence of type 1 diabetes: analysis at the municipality level in North Rhine-Westphalia, Germany. Diabet Med 2020; 37:2089-2097. [PMID: 31999840 DOI: 10.1111/dme.14258] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/28/2020] [Indexed: 12/25/2022]
Abstract
AIM To analyse the associations of area deprivation and urban/rural traits with the incidence of type 1 diabetes in the German federal state of North Rhine-Westphalia. METHODS Data of incident type 1 diabetes cases in children and adolescents aged <20 years between 2007 and 2014 were extracted from a population-based diabetes register. Population data, indicators of area deprivation and urban/rural traits at the municipality level (396 entities) were obtained from official statistics. Area deprivation was assessed in five groups based on quintiles of an index of multiple deprivation and its seven deprivation domains. Poisson regression accounting for spatial dependence was applied to investigate associations of area deprivation and urban/rural traits with type 1 diabetes incidence. RESULTS Between 2007 and 2014, 6143 incident cases were reported (99% completeness); the crude incidence was 22.3 cases per 100 000 person-years. The incidence decreased with increasing employment and environmental deprivation (relative risk of the most vs. the least deprived municipalities: 0.905 [95% CI: 0.813, 1.007] and 0.839 [0.752, 0.937], respectively) but was not associated with the composite deprivation index. The incidence was higher in more peripheral, rural, smaller and less densely populated municipalities, and the strongest association was estimated for the location trait (relative risk of peripheral/very peripheral compared with very central location: 1.231 [1.044, 1.452]). CONCLUSIONS The results suggest that the type 1 diabetes risk is higher in more remote, more rural, less densely populated and less deprived areas. Urban/rural traits were stronger predictors of type 1 diabetes risk than area deprivation indicators.
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Affiliation(s)
- K Castillo-Reinado
- German Diabetes Centre, Leibniz Institute for Diabetes Research at Heinrich Heine University Düsseldorf, Institute for Biometrics and Epidemiology, Düsseldorf, Germany
- German Centre for Diabetes Research (DZD), Neuherberg, Germany
| | - W Maier
- German Centre for Diabetes Research (DZD), Neuherberg, Germany
- Helmholtz Zentrum München, Institute of Health Economics and Health Care Management, German Research Centre for Environmental Health, Neuherberg, Germany
| | - R Holle
- German Centre for Diabetes Research (DZD), Neuherberg, Germany
- Helmholtz Zentrum München, Institute of Health Economics and Health Care Management, German Research Centre for Environmental Health, Neuherberg, Germany
| | - A Stahl-Pehe
- German Diabetes Centre, Leibniz Institute for Diabetes Research at Heinrich Heine University Düsseldorf, Institute for Biometrics and Epidemiology, Düsseldorf, Germany
- German Centre for Diabetes Research (DZD), Neuherberg, Germany
| | - C Baechle
- German Diabetes Centre, Leibniz Institute for Diabetes Research at Heinrich Heine University Düsseldorf, Institute for Biometrics and Epidemiology, Düsseldorf, Germany
- German Centre for Diabetes Research (DZD), Neuherberg, Germany
| | - O Kuss
- German Diabetes Centre, Leibniz Institute for Diabetes Research at Heinrich Heine University Düsseldorf, Institute for Biometrics and Epidemiology, Düsseldorf, Germany
- German Centre for Diabetes Research (DZD), Neuherberg, Germany
- Institute of Medical Statistics, Düsseldorf University Hospital and Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - J Hermann
- German Centre for Diabetes Research (DZD), Neuherberg, Germany
- University of Ulm, Institute of Epidemiology and Medical Biometry, ZIBMT, Ulm, Germany
| | - R W Holl
- German Centre for Diabetes Research (DZD), Neuherberg, Germany
- University of Ulm, Institute of Epidemiology and Medical Biometry, ZIBMT, Ulm, Germany
| | - J Rosenbauer
- German Diabetes Centre, Leibniz Institute for Diabetes Research at Heinrich Heine University Düsseldorf, Institute for Biometrics and Epidemiology, Düsseldorf, Germany
- German Centre for Diabetes Research (DZD), Neuherberg, Germany
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Carakushansky M, Patel P, Ben Khallouq BA, Gurnurkar S. Prevalence of Vitamin D Deficiency in Children with Type 1 Diabetes Mellitus. Cureus 2020; 12:e7836. [PMID: 32467811 PMCID: PMC7250523 DOI: 10.7759/cureus.7836] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background In the recent years, controversy has emerged regarding the relationship between vitamin D deficiency and the potential effects it could have on glycemic control in patients with type 1 diabetes mellitus (T1D). This study investigates the prevalence of vitamin D insufficiency/deficiency in pediatric patients with T1D from a single, large volume practice. Methods This was a retrospective chart review that collected clinical/demographic data as well as serum 25(OH) D levels from medical records of 395 children between the ages of 3 and 18 years with T1D followed at Nemours Children’s Hospital. This data was compared to the National Health and Nutrition Examination Survey (NHANES) database. A Pearson’s Chi-square test was used between group associations. All statistical tests were two-sided and p < 0.05 was used for statistical significance. Results Of the 395 children included in these analyses, 4% were vitamin D deficient and 60% were vitamin D insufficient. There were no significant associations of vitamin D deficiency based on sex and age. Vitamin D deficiency was more common among White children when compared to Hispanic children and African American children (42% vs 29%; p < 0.001). Of those that were vitamin D insufficient (n = 235), most were Hispanic (51%), 36% White and 13% African American. There was a significant association between vitamin D deficiency and body mass index (BMI) (p = 0.035). In the summer, children were less likely to be vitamin D deficient (3% vs 6% in winter) and less likely to be vitamin D insufficient (55% vs 71% in winter) (p = 0.007). Conclusions Vitamin D insufficiency is highly prevalent among pediatric type 1 diabetics of Central Florida and statistically significant correlation was found between vitamin D status and ethnicity, BMI as well as seasonal variation.
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Affiliation(s)
| | - Priya Patel
- Internal Medicine, University of Mississippi Medical Center, Jackson, USA
| | | | - Shilpa Gurnurkar
- Pediatric Endocrinology, Nemours Children's Hospital, Orlando, USA
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Gupta MK, Vadde R. Genetic Basis of Adaptation and Maladaptation via Balancing Selection. ZOOLOGY 2019; 136:125693. [PMID: 31513936 DOI: 10.1016/j.zool.2019.125693] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 07/03/2019] [Indexed: 10/26/2022]
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Abstract
INTRODUCTION Vitamin D deficiency is common, world-wide, but vitamin D repletion throughout life, and into older age, has accepted health benefits for bone. Many mechanisms through which vitamin D also benefits soft tissues are understood, and clinical evidence of such benefits is now accumulating, especially following re-analyses of trial data, which are revealing previously missed health benefits with correction of deficiency. AREAS COVERED The sources of vitamin D, its activation, mechanistic effects; problems of trials of supplementation for reducing health risks, the benefits shown for mortality, cardiovascular disease, infection and cancer; the global problem of vitamin D deficiency; age-related reductions in vitamin D efficacy, and currently recommended intakes. EXPERT COMMENTARY High prevalence of vitamin D deficiency and insufficiency worldwide have proven ill-effects on health. Governmental efforts to improve population repletion by recommending minimal daily intakes does benefit some but is not effective at the population-level. However, food fortification with vitamin D3, already implemented in some countries, can solve this highly avoidable problem cost-effectively and is probably the best way to abolish vitamin D inadequacy, allowing public health benefits to emerge over time, thereby allowing future research on vitamin D to be directed at emerging issues on vitamin D.
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11
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Holmes EA, Rodney Harris RM, Lucas RM. Low Sun Exposure and Vitamin D Deficiency as Risk Factors for Inflammatory Bowel Disease, With a Focus on Childhood Onset. Photochem Photobiol 2018; 95:105-118. [PMID: 30155900 DOI: 10.1111/php.13007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 08/19/2018] [Indexed: 12/12/2022]
Abstract
The incidence and prevalence of inflammatory bowel disease (IBD) are increasing worldwide. Some ecological studies show increasing incidence with increasing latitude. Ambient ultraviolet radiation varies inversely with latitude, and sun exposure of the skin is a major source of vitamin D. Vitamin D deficiency is common in patients with IBD. Sun exposure and vitamin D have immune effects that could plausibly reduce, or be protective for, IBD. One quarter of new IBD cases are diagnosed in childhood or adolescence, but most research is for adult-onset IBD. Here, we review the evidence for low sun exposure and/or vitamin D deficiency as risk factors for IBD, focusing where possible on pediatric IBD, where effects of environmental exposures may be clearer. The literature provides some evidence of a latitude gradient of IBD incidence, and evidence for seasonal patterns of timing of birth or disease onset is inconsistent. High prevalence of vitamin D deficiency occurs in people with IBD, but cannot be interpreted as being a causal risk factor. Evidence of vitamin D supplementation affecting disease activity is limited. Further research on predisease sun exposure and well-designed supplementation studies are required to elucidate whether these potentially modifiable exposures are indeed risk factors for IBD.
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Affiliation(s)
- E Ann Holmes
- National Centre for Epidemiology and Population Health, Research School of Population Health, The Australian National University, Canberra, ACT, Australia
| | - Rachael M Rodney Harris
- National Centre for Epidemiology and Population Health, Research School of Population Health, The Australian National University, Canberra, ACT, Australia
| | - Robyn M Lucas
- National Centre for Epidemiology and Population Health, Research School of Population Health, The Australian National University, Canberra, ACT, Australia.,Centre for Ophthalmology and Visual Science, University of Western Australia, Perth, WA, Australia
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12
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Shaygannejad V, Maljaei MB, Bank SS, Mirmosayyeb O, Maracy MR, Askari G. Association between Sun Exposure, Vitamin D Intake, Serum Vitamin D Level, and Immunoglobulin G Level in Patients with Neuromyelitis Optica Spectrum Disorder. Int J Prev Med 2018; 9:68. [PMID: 30167098 PMCID: PMC6106131 DOI: 10.4103/ijpvm.ijpvm_45_16] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Accepted: 04/05/2017] [Indexed: 11/10/2022] Open
Abstract
Background: Neuromyelitis optica spectrum disorder (NMOSD) is a central nervous system inflammatory disorder in which immunoglobulin G (IgG) autoantibodies possibly play a pathogenic role against the aquaporin-4 water channel protein. Vitamin D may modulate B-cell function and decrease the IgG synthesis and may play a role in NMOSD as a crucial factor. The aim of this study was to investigate the relation between Vitamin D intakes from food, Vitamin D intake from sunlight exposure, blood Vitamin D levels, and IgG-neuromyelitis optica (NMO) level in serum of patients with NMOSD and NMO. Method: In this cross-sectional study, food Frequency Questionnaires (FFQ) and Sun Exposure Questionnaire (SEQ) were completed to evaluate of vitamin D intakes from food and sun light exposure. Moreover, serum levels of 25(OH) vitamin D3 and IgG-NMO were assessed in patients with NMOSD and NMO. Results: We assessed IgG-NMO levels in 29 patients with NMOSD that nine patients (n = 31%) were positive and for the rest it was negative. Sunlight exposure scale (P = 0.01) and 25(OH) D3 (P = 0.04) in IgG-NMO-negative patients were significantly more than patients with positive IgG-NMO. Age, gender, and latitude were not confounder variables. A positive significant correlation was observed between the sun exposure scale and serum levels of 25(OH) D3 in all participants (r = 0.747, P ≤ 0.001). Conclusions: Physiological variation in Vitamin D may apply a significant effect on IgG-NMO synthesis in patients with NMO. Vitamin D may have significant role in pathogenesis of NMOSD and NMO.
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Affiliation(s)
- Vahid Shaygannejad
- Isfahan Neuroscience Research Center, Department of Neurology, Alzahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad Bagher Maljaei
- Isfahan Neuroscience Research Center, Department of Neurology, Alzahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran.,Food Security Research Center and Department of Community Nutrition, School of Nutrition and Food Sciences, Isfahan University of Medical Sciences, Isfahan, Iran.,Department of Nutrition, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Sahar Saraf Bank
- Food Security Research Center and Department of Community Nutrition, School of Nutrition and Food Sciences, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Omid Mirmosayyeb
- Isfahan Neuroscience Research Center, Department of Neurology, Alzahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran.,Student Research Committee, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad Reza Maracy
- Department of Epidemiology and Biostatics, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Gholamreza Askari
- Food Security Research Center and Department of Community Nutrition, School of Nutrition and Food Sciences, Isfahan University of Medical Sciences, Isfahan, Iran
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13
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Geographical variation of diabetic emergencies attended by prehospital Emergency Medical Services is associated with measures of ethnicity and socioeconomic status. Sci Rep 2018; 8:5122. [PMID: 29572530 PMCID: PMC5865134 DOI: 10.1038/s41598-018-23457-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 03/13/2018] [Indexed: 12/05/2022] Open
Abstract
Geographical variation of diabetic emergencies attended by prehospital emergency medical services (EMS) and the relationship between area-level social and demographic factors and risk of a diabetic emergency were examined. All cases of hypoglycaemia and hyperglycaemia attended by Ambulance Victoria between 1/01/2009 and 31/12/2015 were tabulated by Local Government Area (LGA). Conditional autoregressive models were used to create smoothed maps of age and gender standardised incidence ratio (SIR) of prehospital EMS attendance for a diabetic emergency. Spatial regression models were used to examine the relationship between risk of a diabetic emergency and area-level factors. The areas with the greatest risk of prehospital EMS attendance for a diabetic emergency were disperse. Area-level factors associated with risk of a prehospital EMS-attended diabetic emergency were socioeconomic status (SIR 0.70 95% CrI [0.51, 0.96]), proportion of overseas-born residents (SIR 2.02 95% CrI [1.37, 2.91]) and motor vehicle access (SIR 1.47 95% CrI [1.08, 1.99]). Recognition of areas of increased risk of prehospital EMS-attended diabetic emergencies may be used to assist prehospital EMS resource planning to meet increased need. In addition, identification of associated factors can be used to target preventative interventions tailored to individual regions to reduce demand.
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14
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Miller KM, Hart PH, de Klerk NH, Davis EA, Lucas RM. Are low sun exposure and/or vitamin D risk factors for type 1 diabetes? Photochem Photobiol Sci 2017; 16:381-398. [DOI: 10.1039/c6pp00294c] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Ultraviolet radiation and vitamin D, with their known immunosuppressive effects, have the potential to delay or inhibit type 1 diabetes.
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Affiliation(s)
| | | | | | | | - R. M. Lucas
- National Centre for Epidemiology and Population Health
- The Australian National University
- Canberra 2600
- Australia
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15
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Grant WB. The role of geographical ecological studies in identifying diseases linked to UVB exposure and/or vitamin D. DERMATO-ENDOCRINOLOGY 2016; 8:e1137400. [PMID: 27195055 PMCID: PMC4862381 DOI: 10.1080/19381980.2015.1137400] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Accepted: 12/28/2015] [Indexed: 02/06/2023]
Abstract
Using a variety of approaches, researchers have studied the health effects of solar ultraviolet (UV) radiation exposure and vitamin D. This review compares the contributions from geographical ecological studies with those of observational studies and clinical trials. Health outcomes discussed were based on the author's knowledge and include anaphylaxis/food allergy, atopic dermatitis and eczema, attention deficit hyperactivity disorder, autism, back pain, cancer, dental caries, diabetes mellitus type 1, hypertension, inflammatory bowel disease, lupus, mononucleosis, multiple sclerosis, Parkinson disease, pneumonia, rheumatoid arthritis, and sepsis. Important interactions have taken place between study types; sometimes ecological studies were the first to report an inverse correlation between solar UVB doses and health outcomes such as for cancer, leading to both observational studies and clinical trials. In other cases, ecological studies added to the knowledge base. Many ecological studies include other important risk-modifying factors, thereby minimizing the chance of reporting the wrong link. Laboratory studies of mechanisms generally support the role of vitamin D in the outcomes discussed. Indications exist that for some outcomes, UVB effects may be independent of vitamin D. This paper discusses the concept of the ecological fallacy, noting that it applies to all epidemiological studies.
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Affiliation(s)
- William B. Grant
- Sunlight, Nutrition, and Health Research Center, San Francisco, CA, USA
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16
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The Role of Vitamin D in Diabetes and Cardiovascular Disease: An Updated Review of the Literature. DISEASE MARKERS 2015; 2015:580474. [PMID: 26576069 PMCID: PMC4630385 DOI: 10.1155/2015/580474] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/21/2015] [Revised: 09/22/2015] [Accepted: 09/29/2015] [Indexed: 02/06/2023]
Abstract
The dietary reference values for Vitamin D were set primarily considering its role in bone health, but with the discovery of Vitamin D receptors throughout body tissues, new links with other health conditions are now studied, such as for diabetes and cardiovascular diseases (CVD). This paper shall analyze and examine all new research studies carried out, especially in 2013–2015 regarding diabetes mellitus (DM) and cardiovascular diseases (CVD). Vast research has been carried out to establish strong relationship between Vitamin D serum levels, supplementation, diabetes, and CVD. However, the results from researches identified in this paper are disputable. Benefits of Vitamin D adequate levels were recognized from gestational period until later in disease development such as diabetes and/or CVD, but since not all studies are in agreement further investigation is suggested. Researches conducting large randomized controlled trials, exploring range of supplement doses, with variable baseline serum Vitamin D levels, and inclusion of array of associated parameters, are still required to conduct large-scale analysis and draw conclusion as a risk factor. Until then it is possible to conclude that maintenance of serum Vitamin D levels holds advantageous aspects in diabetic and cardiovascular conditions, and people should strive to attain them.
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17
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Abstract
Vitamin D deficiency has been linked to an increased risk of a wide range of adverse health outcomes. The active form of vitamin D has an important role in calcium metabolism and in bone mineralisation, but the evidence for other health outcomes is mixed, with the strongest effects seen in the weakest epidemiological study designs. There are plausible pathways whereby vitamin D deficiency can impair immune function, resulting in both overactivity and increased risk of autoimmune disease, as well as immune suppression with poorer resistance to infection. Vitamin D status may influence the bacterial flora that constitute the microbiome and affect immune function through this route. Exposure of the skin to ultraviolet radiation causes the production of a range of chemicals, including vitamin D, and new research is exploring possible vitamin D-independent immunomodulatory pathways.
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Affiliation(s)
- Robyn M. Lucas
- Telethon Kids Institute, University of Western Australia100 Roberts Road, Subiaco, PerthAustralia 6008
- National Centre for Epidemiology and Population Health, The Australian National UniversityCanberraAustralia 0200
| | - Shelley Gorman
- Telethon Kids Institute, University of Western Australia100 Roberts Road, Subiaco, PerthAustralia 6008
| | - Sian Geldenhuys
- Telethon Kids Institute, University of Western Australia100 Roberts Road, Subiaco, PerthAustralia 6008
| | - Prue H. Hart
- Telethon Kids Institute, University of Western Australia100 Roberts Road, Subiaco, PerthAustralia 6008
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