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Xu ZR, Du HW, Cui LW, Zheng RX, Li GM, Wei HY, Lu FY, Chen LL, Wu CS, Zhang SX, Zhang SL, Liu F, Zhang MY, Pei Z, Sun CJ, Wu J, Luo FH. Association of β-cell function and insulin resistance with pediatric type 2 diabetes among Chinese children. World J Diabetes 2021; 12:1292-1303. [PMID: 34512894 PMCID: PMC8394231 DOI: 10.4239/wjd.v12.i8.1292] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 06/15/2021] [Accepted: 07/13/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND In addition to insulin resistance, impaired insulin secretion has recently been identified as a crucial factor in the pathogenesis of type 2 diabetes mellitus (T2DM). Scarce clinical data exist for pediatric T2DM.
AIM To investigate the association of β-cell function and insulin resistance with pediatric T2DM in the first Chinese multicenter study.
METHODS This multicenter cross-sectional study included 161 newly diagnosed T2DM children and adolescents between January 2017 and October 2019. Children with normal glycemic levels (n = 1935) were included as healthy control subjects. The homeostasis models (HOMAs) were used to assess the β-cell function (HOMA2-%B) and insulin resistance (HOMA2-IR) levels. The HOMA index was standardized by sex and age. We performed logistic regression analysis to obtain odds ratios (ORs) for T2DM risk using the standardized HOMA index, adjusted for confounding factors including sex, Tanner stage, T2DM family history, body mass index z-score, and lipid profile.
RESULTS The male-female ratio of newly diagnosed T2DM patients was 1.37:1 (OR = 2.20, P = 0.011), and the mean ages of onset for boys and girls were 12.5 ± 1.9 years and 12.3 ± 1.7 years, respectively. The prevalence of related comorbidities including obesity, elevated blood pressure, and dyslipidemia was 58.2%, 53.2%, and 80.0%, respectively. The T2DM group had lower HOMA2-%B levels (P < 0.001) and higher HOMA2-IR levels (P < 0.001) than the control group. Both the decrease in HOMA2-%B z-score (OR = 8.40, 95%CI: 6.40–11.02, P < 0.001) and the increase in HOMA2-IR z-score (OR = 1.79, 95%CI: 1.60–2.02, P < 0.001) were associated with a higher risk of T2DM, and the decrease in HOMA2-%B z-score always had higher ORs than the increase in HOMA2-IR z-score after adjusting for confounding factors.
CONCLUSION Besides insulin resistance, β-cell function impairment is also strongly associated with Chinese pediatric T2DM. Gender difference in susceptibility and high comorbidities warrant specific T2DM screening and prevention strategies in Chinese children.
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Affiliation(s)
- Zhen-Ran Xu
- Department of Pediatric Endocrinology and Inherited Metabolic Diseases, National Children’s Medical Center, Children’s Hospital of Fudan University, Shanghai 201102, China
| | - Hong-Wei Du
- Department of Pediatric Endocrinology and Inherited Metabolic Diseases, The First Bethune Hospital of Jilin University, Changchun 130021, Jilin Province, China
| | - Lan-Wei Cui
- Department of Pediatrics, The First Affiliated Hospital of Harbin Medical University, Harbin 150001, Heilongjiang Province, China
| | - Rong-Xiu Zheng
- Department of Pediatrics, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Gui-Mei Li
- Department of Pediatric Endocrinology and Inherited Metabolic Diseases, Shandong Provincial Hospital Affiliated to Shandong University, Jinan 250021, Shandong Province, China
| | - Hai-Yan Wei
- Department of Endocrinology, Henan Children's Hospital, Zhengzhou 450052, Henan Province, China
| | - Fei-Yu Lu
- Department of Pediatric Endocrinology and Inherited Metabolic Diseases, The First Bethune Hospital of Jilin University, Changchun 130021, Jilin Province, China
| | - Li-Li Chen
- Department of Pediatrics, The First Affiliated Hospital of Harbin Medical University, Harbin 150001, Heilongjiang Province, China
| | - Chu-Shan Wu
- Department of Pediatrics, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Shu-Xin Zhang
- Department of Pediatrics, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Shu-Le Zhang
- Department of Pediatric Endocrinology and Inherited Metabolic Diseases, Shandong Provincial Hospital Affiliated to Shandong University, Jinan 250021, Shandong Province, China
| | - Fang Liu
- Department of Endocrinology, Henan Children's Hospital, Zhengzhou 450052, Henan Province, China
| | - Miao-Ying Zhang
- Department of Pediatric Endocrinology and Inherited Metabolic Diseases, National Children’s Medical Center, Children’s Hospital of Fudan University, Shanghai 201102, China
| | - Zhou Pei
- Department of Pediatric Endocrinology and Inherited Metabolic Diseases, National Children’s Medical Center, Children’s Hospital of Fudan University, Shanghai 201102, China
| | - Cheng-Jun Sun
- Department of Pediatric Endocrinology and Inherited Metabolic Diseases, National Children’s Medical Center, Children’s Hospital of Fudan University, Shanghai 201102, China
| | - Jing Wu
- Department of Pediatric Endocrinology and Inherited Metabolic Diseases, National Children’s Medical Center, Children’s Hospital of Fudan University, Shanghai 201102, China
| | - Fei-Hong Luo
- Department of Pediatric Endocrinology and Inherited Metabolic Diseases, National Children’s Medical Center, Children’s Hospital of Fudan University, Shanghai 201102, China
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Bhawra J, Cooke MJ, Guo Y, Wilk P. The association of household food security, household characteristics and school environment with obesity status among off-reserve First Nations and Métis children and youth in Canada: results from the 2012 Aboriginal Peoples Survey. HEALTH PROMOTION AND CHRONIC DISEASE PREVENTION IN CANADA-RESEARCH POLICY AND PRACTICE 2017; 37:77-86. [PMID: 28273035 DOI: 10.24095/hpcdp.37.3.03] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Indigenous children are twice as likely to be classified as obese and three times as likely to experience household food insecurity when compared with non- Indigenous Canadian children. The purpose of this study was to explore the relationship between food insecurity and weight status among Métis and off-reserve First Nations children and youth across Canada. METHODS We obtained data on children and youth aged 6 to 17 years (n = 6900) from the 2012 Aboriginal Peoples Survey. We tested bivariate relationships using Pearson chi-square tests and used nested binary logistic regressions to examine the food insecurity-weight status relationship, after controlling for geography, household and school characteristics and cultural factors. RESULTS Approximately 22% of Métis and First Nations children and youth were overweight, and 15% were classified as obese. Over 80% of the sample was reported as food secure, 9% experienced low food security and 7% were severely food insecure. Off-reserve Indigenous children and youth from households with very low food security were at higher risk of overweight or obese status; however, this excess risk was not independent of household socioeconomic status, and was reduced by controlling for household income, adjusted for household size. Negative school environment was also a significant predictor of obesity risk, independent of demographic, household and geographic factors. CONCLUSION Both food insecurity and obesity were prevalent among the Indigenous groups studied, and our results suggest that a large proportion of children and youth who are food insecure are also overweight or obese. This study reinforces the importance of including social determinants of health, such as income, school environment and geography, in programs or policies targeting child obesity.
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Affiliation(s)
- Jasmin Bhawra
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | - Martin J Cooke
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada.,Department of Sociology and Legal Studies, University of Waterloo, Waterloo, Ontario, Canada
| | - Yanling Guo
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | - Piotr Wilk
- Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
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Mohieldein AH, Hasan M, Al-Harbi KK, Alodailah SS, Azahrani RM, Al-Mushawwah SA. Dyslipidemia and reduced total antioxidant status in young adult Saudis with prediabetes. Diabetes Metab Syndr 2015; 9:287-291. [PMID: 25470641 DOI: 10.1016/j.dsx.2014.04.017] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
AIMS Lifestyle related noncommunicable health conditions are having an increasingly negative impact on the health. This study aimed to assess the lipid profile, total antioxidant capacity, and the lifestyle predictors of conversion to prediabetes in young Saudis with prediabetes. MATERIALS AND METHODS One hundred and twenty-one young Saudis with fasting plasma glucose (<125 mg/dl) enrolled in this study who further categorized into normal glucose tolerance "NGT" group (n=86) and prediabetes group (IFG; n=08/IGT; n=27) based on American Association criteria. Venous blood samples were collected at fasting and 2h postprandial from participants. Chemistry parameters and total antioxidant status (TAS) were assayed by standard procedures. Questionnaires were applied to collect information including demographic characteristics, physical activity, and family history to diabetes. Statistical analysis was performed using SPSS version 17. RESULTS Compared to NGT subjects, the prediabetics characterized by marked obesity (p=.027), visceral obesity (p=.002), dyslipidemia, significantly increased HbA1c (p=.003), reduced TAS (p<.001), more sedentary lifestyle (p=.010). Positive correlations were documented between FPG, 2-h plasma glucose and HbA1c, BMI, WC, TC, LDL cholesterol, TG while negative correlations with HDL cholesterol, TAS. CONCLUSION The current study reported that prediabetes condition (in young adult Saudis) was associated with dyslipidemia, reduced total antioxidant status, obesity, central obesity, and physical inactivity compared to those with normoglycemia. Lifestyle modifications (through weight loss, regular physical activity, and healthy diet) should be encouraged especially among young Saudis to prevent the progression to type 2 diabetes and its complications from prediabetes state.
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Affiliation(s)
- Abdelmarouf H Mohieldein
- Department of Medical Laboratories, College of Applied Medical Sciences, Qassim University, Al-Qassim, Saudi Arabia.
| | - Marghoob Hasan
- Department of Medical Laboratories, College of Applied Medical Sciences, Qassim University, Al-Qassim, Saudi Arabia
| | - Khalid K Al-Harbi
- Department of Medical Laboratories, College of Applied Medical Sciences, Qassim University, Al-Qassim, Saudi Arabia
| | - Sattam S Alodailah
- Department of Medical Laboratories, College of Applied Medical Sciences, Qassim University, Al-Qassim, Saudi Arabia
| | - Rajab M Azahrani
- Department of Medical Laboratories, College of Applied Medical Sciences, Qassim University, Al-Qassim, Saudi Arabia
| | - Sami A Al-Mushawwah
- Department of Medical Laboratories, College of Applied Medical Sciences, Qassim University, Al-Qassim, Saudi Arabia
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Naughton MJ, Yi-Frazier JP, Morgan TM, Seid M, Lawrence JM, Klingensmith GJ, Waitzfelder B, Standiford DA, Loots B. Longitudinal associations between sex, diabetes self-care, and health-related quality of life among youth with type 1 or type 2 diabetes mellitus. J Pediatr 2014; 164:1376-83.e1. [PMID: 24582483 PMCID: PMC4500167 DOI: 10.1016/j.jpeds.2014.01.027] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2013] [Revised: 11/22/2013] [Accepted: 01/14/2014] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To examine the longitudinal associations between sex, diabetes self-care, and the health-related quality of life (HRQL) of children and adolescents with type 1 or type 2 diabetes. STUDY DESIGN The sample included 910 participants with type 1 and 241 participants with type 2, ages 10-22 years at baseline, from the SEARCH for Diabetes in Youth Study, a longitudinal observational study. The primary outcome measure was the Pediatric Quality of Life Inventory. Repeated measures, mixed-model regression analysis was conducted with the use of data from baseline and at least one follow-up assessment, spanning approximately 4 years. RESULTS HRQL was greater among those with type 1 versus type 2 diabetes. Among participants with type 1, greater (better) Pediatric Quality of Life Inventory total scores over time were related to greater parent education (P = .0007), lower glycated hemoglobin values (P < .0001), and greater physical activity during the past 7 days (P = .0001). There was a significant interaction between sex and age (P < .0001); girls' HRQL remained stable or decreased over time, whereas males' HRQL increased. For participants with type 2 diabetes, there was no significant interaction by age and sex, but lower total HRQL was related to being female (P = .011) and greater body mass index z-scores (P = .014). CONCLUSIONS HRQL in this cohort varied by diabetes type. The interaction between sex and age for type 1 participants, coupled with poorer HRQL among female than male participants with type 2 diabetes, suggests the impacts of diabetes on HRQL differ by sex and should be considered in clinical management. Encouraging physical activity and weight control continue to be important in improving HRQL.
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Affiliation(s)
- Michelle J. Naughton
- Wake Forest Medical School, Division of Public Health Sciences, Department of Social Sciences and Health Policy, Winston-Salem, NC
| | - Joyce P. Yi-Frazier
- University of Washington School of Medicine, Department of Pediatrics, Seattle, WA, USA
| | | | - Michael Seid
- Cincinnati Children’s Hospital Medical Center, Department of Pediatrics, Cincinnati, OH
| | - Jean M. Lawrence
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA
| | | | - Beth Waitzfelder
- Kaiser Permanente Center for Health Research Hawaii, Honolulu, HI
| | - Debra A. Standiford
- Cincinnati Children’s Hospital Medical Center, Division of Endocrinology, Cincinnati, OH
| | - Beth Loots
- Seattle Children’s Research Institute, Endocrinology, Seattle, WA
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Hall WJ, Zeveloff A, Steckler A, Schneider M, Thompson D, Pham T, Volpe SL, Hindes K, Sleigh A, McMurray RG. Process evaluation results from the HEALTHY physical education intervention. HEALTH EDUCATION RESEARCH 2012; 27:307-18. [PMID: 22156231 PMCID: PMC3303206 DOI: 10.1093/her/cyr107] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2011] [Accepted: 11/07/2011] [Indexed: 05/31/2023]
Abstract
Process evaluation is an assessment of the implementation of an intervention. A process evaluation component was embedded in the HEALTHY study, a primary prevention trial for Type 2 diabetes implemented over 3 years in 21 middle schools across the United States. The HEALTHY physical education (PE) intervention aimed at maximizing student engagement in moderate-to-vigorous physical activity through delivery of structured lesson plans by PE teachers. Process evaluation data collected via class observations and interventionist interviews assessed fidelity, dose delivered, implementor participation, dose received and barriers. Process evaluation results indicate a high level of fidelity in implementing HEALTHY PE activities and offering 225 min of PE every 10 school days. Concerning dose delivered, students were active for approximately 33 min of class, representing an average of 61% of the class time. Results also indicate that PE teachers were generally engaged in implementing the HEALTHY PE curriculum. Data on dose received showed that students were highly engaged with the PE intervention; however, student misbehavior was the most common barrier observed during classes. Other barriers included teacher disengagement, large classes, limited gym space and poor classroom management. Findings suggest that the PE intervention was generally implemented and received as intended despite several barriers.
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Affiliation(s)
- William J Hall
- School of Nursing.chool of Social Work, University of North Carolina, Chapel Hill, NC 27599, USA.
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Vaidyanathan J, Choe S, Sahajwalla CG. Type 2 diabetes in pediatrics and adults: thoughts from a clinical pharmacology perspective. J Pharm Sci 2012; 101:1659-71. [PMID: 22383396 DOI: 10.1002/jps.23085] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2011] [Revised: 01/30/2012] [Accepted: 01/31/2012] [Indexed: 12/23/2022]
Abstract
Type 2 diabetes results when insulin secretion is unable to keep the plasma glucose levels as per acceptable range. This leads to chronic hyperglycemia and its associated microvascular complications such as renal impairment (diabetic nephropathy), retinal abnormalities (diabetic retinopathy), and autonomic, sensory, and motor neuropathies (diabetic neuropathy) and macrovascular disease. Historically, type 2 diabetes is well known as an adult-onset disease; however, lately, the incidence of the disease is reported to be increasing in children. Despite the wealth of information concerning type 2 diabetes in adults, data unique to the pediatric age group regarding the pathophysiology and therapy for type 2 diabetes are limited. For treatment in pediatric type 2 diabetes, metformin and insulin are the only antidiabetic agents approved currently. There are data of use of other oral antidiabetic drugs including glimepiride, rosiglitazone, and glyburide (in combination with metformin) in pediatric patients; however, formal clinical trials to establish the safety and efficacy have not been conducted. This review will compare the clinical pharmacology aspects of the oral type 2 diabetic drugs in pediatric and adult populations in order to determine any differences between the two patient groups.
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Affiliation(s)
- Jayabharathi Vaidyanathan
- Office of Clinical Pharmacology, Office of Translational Sciences, Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, Maryland 20993, USA
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Lee JM, Gebremariam A, Wu EL, LaRose J, Gurney JG. Evaluation of nonfasting tests to screen for childhood and adolescent dysglycemia. Diabetes Care 2011; 34:2597-602. [PMID: 21953800 PMCID: PMC3220868 DOI: 10.2337/dc11-0827] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [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 performance of nonfasting tests to screen children for dysglycemia (prediabetes or diabetes). RESEARCH DESIGN AND METHODS This was a cross-sectional study of 254 overweight or obese (BMI ≥85th percentile) children aged 10-17 years. Subjects came for two visits to a clinical research unit. For visit one, they arrived fasting and a 2-h glucose tolerance test and HbA(1c) and fructosamine testing were performed. For visit two, they arrived nonfasting and had a random plasma glucose, a 1-h 50-g nonfasting glucose challenge test (1-h GCT), and urine dipstick performed. The primary end point was dysglycemia (fasting plasma glucose ≥100 mg/dL or a 2-h postglucose ≥140 mg/dL). Test performance was assessed using receiver operating characteristic (ROC) curves and calculations of area under the ROC curve. RESULTS Approximately one-half of children were female, 59% were white, and 30% were black. There were 99 (39%) cases of prediabetes and 3 (1.2%) cases of diabetes. Urine dipstick, HbA(1c) (area under the curve [AUC] 0.54 [95% CI 0.47-0.61]), and fructosamine (AUC 0.55 [0.47-0.63]) displayed poor discrimination for identifying children with dysglycemia. Both random glucose (AUC 0.66 [0.60-0.73]) and 1-h GCT (AUC 0.68 [0.61-0.74]) had better levels of test discrimination than HbA(1c) or fructosamine. CONCLUSIONS HbA(1c) had poor discrimination, which could lead to missed cases of dysglycemia in children. Random glucose or 1-h GCT may potentially be incorporated into clinical practice as initial screening tests for prediabetes or diabetes and for determining which children should undergo further definitive testing.
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Affiliation(s)
- Joyce M Lee
- Division of Pediatric Endocrinology, Department of Pediatrics, University of Michigan, Ann Arbor, Michigan, USA.
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Lee LL, Kuo YC, Fanaw D, Perng SJ, Juang IF. The effect of an intervention combining self-efficacy theory and pedometers on promoting physical activity among adolescents. J Clin Nurs 2011; 21:914-22. [PMID: 22082301 DOI: 10.1111/j.1365-2702.2011.03881.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
AIM To study the effect of an intervention combining self-efficacy theory and pedometers on promoting physical activity among adolescents. BACKGROUND The beneficial effects of regular physical activity on health in youths are well-documented. However, adolescence is found to be the age of greatest decline in physical activity participation. Physical activity participation among girls was generally less frequent and less intense than boys. Therefore, there is a strong need for effective interventions that can help promote physical activity in this population. DESIGN An experimental design. METHODS Two classes of female junior college students (mean age = 16) were randomly sampled from a total of four classes and, of those, one each was randomly assigned to either the intervention (n = 46) or the control group (n = 48). Self-efficacy was used as a core theoretical foundation of the intervention design, and pedometers were provided to the students in the intervention group. Distances between each domestic scenic spot were illustrated graphically in a walking log for students to mark the extent of their walking or running. Students in the control group participated in a usual physical education programme. The primary outcome was a change in the number of aerobic steps. The secondary outcomes were changes in cardiopulmonary endurance and exercise self-efficacy. RESULTS At 12-week follow-up, the mean change in aerobic steps was 371 steps and 108 steps in the intervention and control group, respectively. The difference in mean change between the two groups was 467 steps. Effects of the intervention on changes of cardiopulmonary endurance and perceived exercise self-efficacy scores were not found. CONCLUSIONS Among adolescent girls, a 12-week intervention designed on the theoretical foundation of self-efficacy theory and provision of pedometers was found to have an effect on increasing their physical activity. The intervention, using graphs of domestic scenic spots to represent the distance of walking or running as monitored by pedometers, might enhance motivation regarding physical activity. RELEVANCE TO CLINICAL PRACTICE It is important for health professionals, including school health nurses, involved in the care of adolescent health, to design and provide a physical activity intervention combining self-efficacy theory and provision of pedometer to promote physical activity.
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Affiliation(s)
- Ling-Ling Lee
- Department of Nursing, Tzu Chi College of Technology, Hualien, Taiwan.
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Vasconcelos HCAD, Araújo MFMD, Damasceno MMC, Almeida PCD, Freitas RWJFD. Fatores de risco para diabetes mellitus tipo 2 entre adolescentes. Rev Esc Enferm USP 2010; 44:881-7. [DOI: 10.1590/s0080-62342010000400004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
O estudo teve como objetivo identificar fatores de risco para diabetes tipo 2 (DM 2) em uma população de adolescentes de escolas particulares de Fortaleza, Brasil. Foram avaliados 794 alunos, de 12 a 17 anos, em doze escolas, nos meses de maio, junho, agosto e setembro de 2007. Aplicou-se um formulário abordando aspectos sociodemográficos, IMC, pressão arterial, glicemia capilar e sedentarismo. Aproximadamente 24% dos participantes tinham o IMC elevado, 65% eram sedentários e 51% tinham antecedentes familiares de DM 2. Naqueles com maior renda, 73,5% tinham antecedentes familiares de DM 2 (p=0,04). Por volta de 39% dos adolescentes apresentavam pelo menos dois fatores de risco para DM 2. A maior parte dos fatores de risco para DM 2, identificados neste estudo, são modificáveis, portanto passíveis de intervenções preventivas no contexto escolar.
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Ickes MJ, Sharma M. Establishing validity and reliability of an instrument using the theory of planned behavior to predict middle school student obesity-related actions. INTERNATIONAL QUARTERLY OF COMMUNITY HEALTH EDUCATION 2010; 31:291-307. [PMID: 21988873 DOI: 10.2190/iq.31.3.g] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND Childhood obesity is of concern to many health professionals, parents, teachers, and school administrators because of the negative impact on the child's physical, psychological, and behavioral health. Lack of structured monitoring and evaluation has hindered the development of an evidence base to disseminate best practices in childhood obesity prevention. PURPOSE The purpose of this study was to develop a valid and reliable instrument which affirmed the constructs of the Theory of Planned Behavior in relation to nutrition and physical activity behaviors related to childhood obesity. METHODS A convenience sample of 242 students participated in the validation of the 129-item instrument, which was administered during class time, and read to students to increase response rate. RESULTS Confirmatory factor analysis established instrument validity, with one factor present for each behavior, and factor loadings greater than 0.32. Reliability and test-retest coefficients achieved apriori criteria of 0.70. DISCUSSION Truly learning how to gauge nutrition and physical activity levels in children and adolescents has proved to be difficult, yet it is imperative to understand the relationship of the proposed potentially modifiable behaviors and childhood obesity.
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Taymoori P, Niknami S, Berry T, Lubans D, Ghofranipour F, Kazemnejad A. A school-based randomized controlled trial to improve physical activity among Iranian high school girls. Int J Behav Nutr Phys Act 2008; 5:18. [PMID: 18387174 PMCID: PMC2386503 DOI: 10.1186/1479-5868-5-18] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2007] [Accepted: 04/03/2008] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Physical activity (PA) rates decline precipitously during the high school years and are consistently lower among adolescent girls than adolescent boys. Due to cultural barriers, this problem might be exacerbated in female Iranian adolescents. However, little intervention research has been conducted to try to increase PA participation rates with this population. Because PA interventions in schools have the potential to reach many children and adolescents, this study reports on PA intervention research conducted in all-female Iranian high schools. METHODS A randomized controlled trial was conducted to examine the effects of two six-month tailored interventions on potential determinants of PA and PA behavior. Students (N = 161) were randomly allocated to one of three conditions: an intervention based on Pender's Health Promotion model (HP), an intervention based on an integration of the health promotion model and selected constructs from the Transtheoretical model (THP), and a control group (CON). Measures were administered prior to the intervention, at post-intervention and at a six-month follow-up. RESULTS Repeated measure ANOVAs showed a significant interaction between group and time for perceived benefits, self efficacy, interpersonal norms, social support, behavioral processes, and PA behavior, indicating that both intervention groups significantly improved across the 24-week intervention, whereas the control group did not. Participants in the THP group showed greater use of counter conditioning and stimulus control at post-intervention and at follow-up. While there were no significant differences in PA between the HP and CON groups at follow-up, a significant difference was still found between the THP and the CON group. CONCLUSION This study provides the first evidence of the effectiveness of a PA intervention based on Pender's HP model combined with selected aspects of the TTM on potential determinants to increase PA among Iranian high school girls.
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Affiliation(s)
- Parvaneh Taymoori
- Department of Public Health, School of Health, Kurdistan Medical University, Sanandaj, Iran
| | - Shamsaddin Niknami
- Department of Health Education, School of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Tanya Berry
- Faculty of Physical Education and Recreation, University of Alberta, Edmonton, Canada
| | - David Lubans
- School of Education, Faculty of Education and Arts, University of Newcastle, Newcastle, UK
| | | | - Anoshirvan Kazemnejad
- Department of Biostatistics, School of Medical Sciences, Tarbiat Modares University,Tehran, Iran
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Affiliation(s)
- Ram Weiss
- Department of Human Nutrition and Metabolism, Hebrew University School of Medicine, Jerusalem, Israel.
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Adams MH, Lammon CAB. The presence of family history and the development of type 2 diabetes mellitus risk factors in rural children. J Sch Nurs 2007; 23:259-66. [PMID: 17894523 DOI: 10.1177/10598405070230050401] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Type 2 diabetes mellitus is reaching epidemic proportions among children and adolescents. School health fairs offer an opportunity to identify children with risk factors for the development of type 2 diabetes mellitus. This study identified selected risk factors (i.e., high-risk racial/ethnic group, obesity, elevated blood pressure, elevated casual blood glucose, elevated total cholesterol, and the presence of acanthosis nigricans) for development of type 2 diabetes mellitus in rural children with or without a family history of diabetes during annual school health fairs. Of the children screened, 40% (673) presented with two or more of the identified risk factors for type 2 diabetes mellitus. The presence of multiple risk factors in participants reporting a positive family history of diabetes mellitus versus those with no family history was not statistically significant. Based on the study results, factors other than family history may be more predictive for the development of type 2 diabetes mellitus in rural school children.
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Edwards JU, Magel R. Use of the youth risk behavior survey to monitor trends for nutrition and physical activity in a Midwest city school district. THE JOURNAL OF SCHOOL HEALTH 2007; 77:351-8. [PMID: 17680893 DOI: 10.1111/j.1746-1561.2007.00219.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
BACKGROUND The Youth Risk Behavior Survey (YRBS) was used by a city school district (approximately 11,000 students) in the upper Midwest to monitor trends for nutrition and physical activity (PA) behaviors both within and between years and to compare with national 2003 data. METHODS Independent random samples were obtained in 1999 (387 middle school [MS] and 931 high school [HS]), in 2001 (322 MS and 367 HS), and in 2003 (658 MS and 1026 HS). A two-sample test of proportions was used. RESULTS Within each survey year, a higher proportion of MS compared to HS reported positive behaviors with some exceptions: (1) an increased proportion of HS having daily physical education (PE) and (2) a reduced proportion of HS reporting media time. Within 2003, a lower proportion of district females compared to males (MS and HS) reported participation in many measured behaviors. District trends overtime indicated a reduced proportion: (1) drinking milk (MS and HS), (2) eating breakfast (HS), and (3) watching television (MS). Trends overtime indicated an increased proportion: (1) using computers for fun (MS and HS), (2) participating in moderate PA (MS), and (3) daily PE (HS). District HS compared to national (2003) indicated a higher proportion: (1) drinking milk, (2) getting moderate PA, and (3) taking daily PE. District HS compared to national indicated a lower proportion: (1) at risk of overweight, (2) overweight, and (3) watching television. CONCLUSIONS Analysis of district YRBS trends provides both a database for informed decisions by the school district and an assessment model for other districts.
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Affiliation(s)
- Jane U Edwards
- Department of Health, Nutrition and Exercise Sciences, North Dakota State University, 351G E Morrow Lebedef Bldg, Fargo, ND 58105, USA.
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Abstract
The incidence of type 1 and type 2 diabetes mellitus in the pediatric population has increased over the past decade. The practitioner is often faced with the challenge of differentiating between type 1 and type 2 diabetes at the time of initial diagnosis because of the overlap of clinical and laboratory characteristics between these two entities. Adipokines are proteins secreted by the adipose tissue. Leptin and adiponectin are two adipokines that have been extensively studied in vitro, in animal studies, and in human subjects with type 1 and type 2 diabetes. Leptin and adiponectin play a significant role in the regulation of lipid and carbohydrate metabolism. Adiponectin increases insulin sensitivity in both the liver and skeletal muscle. Leptin decreases appetite, increases energy expenditure, suppresses insulin synthesis and secretion and increases insulin sensitivity. Changes in the secretion or sensitivity to leptin and adiponectin may contribute to the development of type 1 and type 2 diabetes. Adiponectin is higher in adult and pediatric patients with type 1 diabetes compared to those with type 2 diabetes. Data regarding leptin levels are contradictory. Most studies report decreased serum leptin at the time of diagnosis in type 1 diabetes compared to type 2 diabetes subjects and non-diabetic controls. This paper will review basic research and clinical evidence supporting the role of adiponectin and leptin in the development of type 1 and type 2 diabetes and discuss their potential use as tools in the differential diagnosis of pediatric diabetes.
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Abstract
During the past few decades, there has been an explosion of behavioral science research on family management of pediatric diabetes. This article distills the major conclusions from that literature, emphasizing how primary care providers can apply these findings in clinical practice.
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Affiliation(s)
- Tim Wysocki
- Nemours Children's Clinic, Division of Psychology and Psychiatry, 807 Children's Way, Jacksonville, FL 32207, USA.
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Sapru A, Gitelman SE, Bhatia S, Dubin RF, Newman TB, Flori H. Prevalence and characteristics of type 2 diabetes mellitus in 9-18 year-old children with diabetic ketoacidosis. J Pediatr Endocrinol Metab 2005; 18:865-72. [PMID: 16279364 DOI: 10.1515/jpem.2005.18.9.865] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To estimate the prevalence of type 2 diabetes mellitus (DM2) in 9-18 year-old children with diabetic ketoacidosis (DKA) and to describe the presenting biochemical characteristics and response to standardized DKA treatment. METHODS Data were collected from a consecutive sample of 9-18 year-old children presenting with DKA. DKA was defined as hyperglycemia and ketosis with an initial pH <7.3, or bicarbonate <15 mmol/l. Patients were classified as having DM2 if they had negative autoantibody status and normal or elevated fasting C-peptide. RESULTS The prevalence of DM2 in patients with DKA was 13.0% (6.1-23.3%). There was no significant difference in the presenting pH (7.14 vs 7.15), but blood glucose was higher (735 vs 587 mg/dl) in patients with DM2, than in patients with type 1 DM (DM1). The duration of insulin infusion until resolution of acidosis (17.3 vs 13.2 h) and intensive care unit stay (2.4 vs 1.6 days) were longer in patients with DM2. Seven of the nine patients with DM2 did not require insulin at 1-year follow-up. CONCLUSIONS Children with DM2 can present with DKA and constitute a significant percentage in the above 9-year age group. The need for insulin must be carefully re-evaluated as DKA resolves in these patients. Adolescents with DM2 and their families need to be educated about DKA.
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Affiliation(s)
- Anil Sapru
- Pediatric Critical Care Medicine, University of California, San Francisco, CA 94143, USA.
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Pate RR, Ward DS, Saunders RP, Felton G, Dishman RK, Dowda M. Promotion of physical activity among high-school girls: a randomized controlled trial. Am J Public Health 2005; 95:1582-7. [PMID: 16118370 PMCID: PMC1449401 DOI: 10.2105/ajph.2004.045807] [Citation(s) in RCA: 208] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/17/2004] [Indexed: 12/20/2022]
Abstract
OBJECTIVES Many adolescent girls fail to meet national guidelines for physical activity, and the prevalence of obesity is increasing among this group. Our study examined the effects of a comprehensive school-based intervention on physical activity among high-school girls. METHODS A group-randomized controlled field trial was conducted at 24 high schools. A school-based sample of 2744 girls (48.7% African American, 46.7% White) participated in a measurement protocol when they were in eighth and then ninth grade. A comprehensive physical activity intervention was designed to change the instructional program and the school environment to increase support for physical activity among girls. RESULTS At follow-up, 45% of girls in the intervention schools and 36% of girls in the control schools reported vigorous physical activity during an average of 1 or more 30-minute time blocks per day over a 3-day period. CONCLUSIONS A comprehensive school-based intervention can increase regular participation in vigorous physical activity among high-school girls.
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Affiliation(s)
- Russell R Pate
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, 730 Devine St, Columbia, SC 29208, USA.
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Mbou FM, Forler J, Ventose N, Dupuis E, Elana G. Approche épidémiologique du diabète pédiatrique en Martinique. Arch Pediatr 2005; 12:470-1. [PMID: 15808440 DOI: 10.1016/j.arcped.2005.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2004] [Accepted: 01/13/2005] [Indexed: 10/25/2022]
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Sperling MA. The expanding horizons of pediatric diabetes. Pediatr Diabetes 2004; 5:1-2. [PMID: 15043682 DOI: 10.1111/j.1399-543x.2004.00042.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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