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Sharma S, Subrahmanyam YV, Ranjani H, Sidra S, Parmar D, Vadivel S, Kannan S, Grallert H, Usharani D, Anjana RM, Balasubramanyam M, Mohan V, Jerzy A, Panchagnula V, Gokulakrishnan K. Circulatory levels of lysophosphatidylcholine species in obese adolescents: Findings from cross-sectional and prospective lipidomics analyses. Nutr Metab Cardiovasc Dis 2024; 34:1807-1816. [PMID: 38503619 DOI: 10.1016/j.numecd.2024.02.009] [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: 11/30/2023] [Revised: 02/15/2024] [Accepted: 02/19/2024] [Indexed: 03/21/2024]
Abstract
BACKGROUND AND AIMS Obesity has reached epidemic proportions, emphasizing the importance of reliable biomarkers for detecting early metabolic alterations and enabling early preventative interventions. However, our understanding of the molecular mechanisms and specific lipid species associated with childhood obesity remains limited. Therefore, the aim of this study was to investigate plasma lipidomic signatures as potential biomarkers for adolescent obesity. METHODS AND RESULTS A total of 103 individuals comprising overweight/obese (n = 46) and normal weight (n = 57) were randomly chosen from the baseline ORANGE (Obesity Reduction and Noncommunicable Disease Awareness through Group Education) cohort, having been followed up for a median of 7.1 years. Plasma lipidomic profiling was performed using the UHPLC-HRMS method. We used three different models adjusted for clinical covariates to analyze the data. Clustering methods were used to define metabotypes, which allowed for the stratification of subjects into subgroups with similar clinical and metabolic profiles. We observed that lysophosphatidylcholine (LPC) species like LPC.16.0, LPC.18.3, LPC.18.1, and LPC.20.3 were significantly (p < 0.05) associated with baseline and follow-up BMI in adolescent obesity. The association of LPC species with BMI remained consistently significant even after adjusting for potential confounders. Moreover, applying metabotyping using hierarchical clustering provided insights into the metabolic heterogeneity within the normal and obese groups, distinguishing metabolically healthy individuals from those with unhealthy metabolic profiles. CONCLUSION The specific LPC levels were found to be altered and increased in childhood obesity, particularly during the follow-up. These findings suggest that LPC species hold promise as potential biomarkers of obesity in adolescents, including healthy and unhealthy metabolic profiles.
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Affiliation(s)
- Sapna Sharma
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, 85764, Neuherberg, Germany
| | - Yalamanchili Venkata Subrahmanyam
- CEPD Division, CSIR-National Chemical Laboratory, Dr. Homi Bhabha Road, Pune, 411008 India; Academy of Scientific and Innovative Research (AcSIR), Ghaziabad 201002, India
| | - Harish Ranjani
- Madras Diabetes Research Foundation, No. 4, Conran Smith Road, Gopalapuram, Chennai, 600086 India; Department of Preventive and Digital Health Research, Madras Diabetes Research Foundation, No. 4, Conran Smith Road, Gopalapuram, Chennai, 600086 India
| | - Sidra Sidra
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, 85764, Neuherberg, Germany
| | - Dharmeshkumar Parmar
- CEPD Division, CSIR-National Chemical Laboratory, Dr. Homi Bhabha Road, Pune, 411008 India; Academy of Scientific and Innovative Research (AcSIR), Ghaziabad 201002, India
| | - Sangeetha Vadivel
- Madras Diabetes Research Foundation, No. 4, Conran Smith Road, Gopalapuram, Chennai, 600086 India
| | - Shanthini Kannan
- Madras Diabetes Research Foundation, No. 4, Conran Smith Road, Gopalapuram, Chennai, 600086 India
| | - Harald Grallert
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, 85764, Neuherberg, Germany
| | - Dandamudi Usharani
- Department of Food Safety and Analytical Quality Control Laboratory, CSIR-Central Food Technological Research Institute (CFTRI), Mysore, Karnataka 570020, India
| | - Ranjit Mohan Anjana
- Madras Diabetes Research Foundation, No. 4, Conran Smith Road, Gopalapuram, Chennai, 600086 India
| | | | - Viswanathan Mohan
- Madras Diabetes Research Foundation, No. 4, Conran Smith Road, Gopalapuram, Chennai, 600086 India
| | - Adamski Jerzy
- Institute of Experimental Genetics, Helmholtz Zentrum München, German Research Center for Environmental Health, Ingolstädter Landstraße 1, 85764 Neuherberg, Germany; Department of Biochemistry, Yong Loo Lin School of Medicine, National University of Singapore, 8 Medical Drive, 117597, Singapore; Institute of Biochemistry, Faculty of Medicine, University of Ljubljana, Vrazov trg 2, 1000 Ljubljana, Slovenia
| | - Venkateswarlu Panchagnula
- CEPD Division, CSIR-National Chemical Laboratory, Dr. Homi Bhabha Road, Pune, 411008 India; Academy of Scientific and Innovative Research (AcSIR), Ghaziabad 201002, India
| | - Kuppan Gokulakrishnan
- Department of Neurochemistry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Hosur Road, Bengaluru, Karnataka 560029, India.
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Rabotin A, Schwarz Y, Pinhas-Hamiel O, Amir O, Derazne E, Tzur D, Chodick G, Afek A, Tsur AM, Twig G. Stuttering in adolescence and the risk for dysglycemia in early adulthood. Diabetes Metab Res Rev 2024; 40:e3828. [PMID: 38859687 DOI: 10.1002/dmrr.3828] [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: 12/20/2023] [Revised: 03/30/2024] [Accepted: 05/27/2024] [Indexed: 06/12/2024]
Abstract
AIMS To investigate the association between stuttering during adolescence and the onset of dysglycemia (prediabetes or type 2 diabetes) in early adulthood among men and women. MATERIALS AND METHODS This cohort study included Maccabi Health Services members assessed for mandatory military service at ages 16-19 during 1990-2019 and followed until 31 December 2020. Stuttering status was recorded in the baseline medical evaluation. Incident cases of dysglycemia were identified systematically using prediabetes and diabetes registries. Cox proportional hazard models were applied for men and women separately, adjusting for sociodemographics and medical status. RESULTS The study cohort comprised 866,304 individuals (55% men; 0.21% with stuttering) followed for a total of 12,696,250 person-years. During the study period, 7.6% (n = 36,603) of men and 9.0% (n = 34,723) of women were diagnosed with dysglycemia. The mean ages at diagnosis were 34 and 32 years for men and women, respectively. Women with stuttering exhibited the highest dysglycemia incidence rate (102.3 per 10,000 person-years) compared with the other groups (61.4, 69.0, and 51.9 per 10,000 person-years for women without stuttering, men with stuttering, and men without stuttering, respectively). For both men and women, those with stuttering showed an increased risk of being diagnosed with dysglycemia compared with those without (adjusted hazard ratios 1.18 [1.01-1.38] and 1.61 [1.15-2.26], respectively). The associations persisted in extensive sub-analyses. CONCLUSIONS Stuttering in adolescence is associated with a higher risk of dysglycemia in early adulthood for men and women. Screening and targeted prevention in this population, especially women, may be beneficial.
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Affiliation(s)
- Alexandra Rabotin
- The Israel Defense Forces Medical Corps, Ramat Gan, Israel
- Faculty of Medical & Health Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Yair Schwarz
- Faculty of Medical & Health Sciences, Tel Aviv University, Tel Aviv, Israel
- Division of Endocrinology, Diabetes and Metabolism, Sheba Medical Center, Ramat Gan, Israel
| | - Orit Pinhas-Hamiel
- Faculty of Medical & Health Sciences, Tel Aviv University, Tel Aviv, Israel
- Pediatric Endocrine and Diabetes Unit, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Ramat Gan, Israel
| | - Ofer Amir
- Department of Communication Disorders, Faculty of Medical & Health Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Estela Derazne
- Faculty of Medical & Health Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Dorit Tzur
- The Israel Defense Forces Medical Corps, Ramat Gan, Israel
| | - Gabriel Chodick
- Faculty of Medical & Health Sciences, Tel Aviv University, Tel Aviv, Israel
- Maccabi Institute for Research and Innovation, Maccabi Healthcare Services, Tel Aviv, Israel
| | - Arnon Afek
- Central Management, Sheba Medical Center, Ramat Gan, Israel
| | - Avishai M Tsur
- The Israel Defense Forces Medical Corps, Ramat Gan, Israel
- Department of Military Medicine, Hebrew University of Jerusalem Faculty of Medicine, Jerusalem, Israel
- Department of Medicine B, Sheba Medical Center, Ramat Gan, Israel
- Department of Preventive Medicine, School of Public Health, Faculty of Medical & Health Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Gilad Twig
- Division of Endocrinology, Diabetes and Metabolism, Sheba Medical Center, Ramat Gan, Israel
- Department of Preventive Medicine, School of Public Health, Faculty of Medical & Health Sciences, Tel Aviv University, Tel Aviv, Israel
- The Gertner Institute for Epidemiology & Health Policy Research, Sheba Medical Center, Ramat Gan, Israel
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La Grasta Sabolic L, Marusic S, Cigrovski Berkovic M. Challenges and pitfalls of youth-onset type 2 diabetes. World J Diabetes 2024; 15:876-885. [PMID: 38766423 PMCID: PMC11099376 DOI: 10.4239/wjd.v15.i5.876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 02/04/2024] [Accepted: 04/01/2024] [Indexed: 05/10/2024] Open
Abstract
The incidence and prevalence of youth-onset type 2 diabetes mellitus (T2DM) are increasing. The rise in frequency and severity of childhood obesity, inclination to sedentary lifestyle, and epigenetic risks related to prenatal hyperglycemia exposure are important drivers of the youth-onset T2DM epidemic and might as well be responsible for the early onset of diabetes complications. Indeed, youth-onset T2DM has a more extreme metabolic phenotype than adult-onset T2DM, with greater insulin resistance and more rapid deterioration of beta cell function. Therefore, intermediate complications such as microalbuminuria develop in late childhood or early adulthood, while end-stage complications develop in mid-life. Due to the lack of efficacy and safety data, several drugs available for the treatment of adults with T2DM have not been approved in youth, reducing the pharmacological treatment options. In this mini review, we will try to address the present challenges and pitfalls related to youth-onset T2DM and summarize the available interventions to mitigate the risk of microvascular and macrovascular complications.
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Affiliation(s)
- Lavinia La Grasta Sabolic
- Department of Pediatric Endocrinology and Diabetology, University Hospital Centre Sestre Milosrdnice, Zagreb 10000, Croatia
- School of Medicine, Catholic University of Croatia, Zagreb 10000, Croatia
| | - Sanda Marusic
- Department for Sport and Exercise Medicine, University of Zagreb Faculty of Kinesiology , Zagreb 10000, Croatia
| | - Maja Cigrovski Berkovic
- Department for Sport and Exercise Medicine, University of Zagreb Faculty of Kinesiology , Zagreb 10000, Croatia
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Krnic N, Sesa V, Mrzljak A, Berkovic MC. Are treatment options used for adult-onset type 2 diabetes mellitus (equally) available and effective for children and adolescents? World J Diabetes 2024; 15:623-628. [PMID: 38680687 PMCID: PMC11045425 DOI: 10.4239/wjd.v15.i4.623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 01/29/2024] [Accepted: 03/06/2024] [Indexed: 04/11/2024] Open
Abstract
Youth-onset type 2 diabetes mellitus (T2DM), influenced by an increase in obesity, is a rising problem worldwide. Pathophysiological mechanisms of this early-onset T2DM include both peripheral and hepatic insulin resistance, along with increased hepatic fasting glucose production accompanied by inadequate first and second-phase insulin secretion. Moreover, the incretin effect is reduced. The initial presentation of type 2 diabetes can be dramatic and symptoms may overlap with those of type 1 diabetes mellitus. Therefore, immediate therapy should address hyperglycemia and associated metabolic derangements irrespective of ultimate diabetes type, while further therapy adjustments are prone to patients' phenotype. New agents with proven glycemic and beyond glycemia benefits, such as Glucagon-like polypeptide 1 receptor agonists and Sodium-glucose cotransporter-2 inhibitors, used in the adult population of T2DM patients, might become increasingly important in the treatment armamentarium. Moreover, metabolic surgery is an option for markedly obese (body mass index > 35 kg/m2) children and adolescents suffering from T2DM who have uncontrolled glycemia and/or serious comorbidities when lifestyle and pharmacologic interventions fail. In this mini-review, we will discuss the potential of treatment options considering new data available from randomized control trials, including individuals with adult-onset type diabetes mellitus.
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Affiliation(s)
- Nevena Krnic
- Clinics for Pediatrics, University Hospital Center Zagreb, Zagreb 10000, Croatia
| | - Vibor Sesa
- Department of Gastroenterology and Hepatology, University Hospital Centre Zagreb, Zagreb 10000, Croatia
| | - Anna Mrzljak
- Department of Gastroenterology and Hepatology, University Hospital Centre Zagreb, Zagreb 10000, Croatia
- University of Zagreb School of Medicine, Zagreb 10000, Croatia
| | - Maja Cigrovski Berkovic
- Department for Sport and Exercise Medicine, University of Zagreb Faculty of Kinesiology, Zagreb 10000, Croatia
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Yang H, Kuang M, Qiu J, He S, Yu C, Sheng G, Zou Y. Relative importance of triglyceride glucose index combined with body mass index in predicting recovery from prediabetic state to normal fasting glucose: a cohort analysis based on a Chinese physical examination population. Lipids Health Dis 2024; 23:71. [PMID: 38459527 PMCID: PMC10921811 DOI: 10.1186/s12944-024-02060-w] [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: 01/17/2024] [Accepted: 02/27/2024] [Indexed: 03/10/2024] Open
Abstract
BACKGROUND Prediabetes is a high-risk state for diabetes, and numerous studies have shown that the body mass index (BMI) and triglyceride-glucose (TyG) index play significant roles in risk prediction for blood glucose metabolism. This study aims to evaluate the relative importance of BMI combination with TyG index (TyG-BMI) in predicting the recovery from prediabetic status to normal blood glucose levels. METHODS A total of 25,397 prediabetic subjects recruited from 32 regions across China. Normal fasting glucose (NFG), prediabetes, and diabetes were defined referring to the American Diabetes Association (ADA) criteria. After normalizing the independent variables, the impact of TyG-BMI on the recovery or progression of prediabetes was analyzed through the Cox regression models. Receiver Operating Characteristic (ROC) curve analysis was utilized to visualize and compare the predictive value of TyG-BMI and its constituent components in prediabetes recovery/progression. RESULTS During the average observation period of 2.96 years, 10,305 individuals (40.58%) remained in the prediabetic state, 11,278 individuals (44.41%) recovered to NFG, and 3,814 individuals (15.02%) progressed to diabetes. The results of multivariate Cox regression analysis demonstrated that TyG-BMI was negatively associated with recovery from prediabetes to NFG and positively associated with progression from prediabetes to diabetes. Further ROC analysis revealed that TyG-BMI had higher impact and predictive value in predicting prediabetes recovering to NFG or progressing to diabetes in comparison to the TyG index and BMI. Specifically, the TyG-BMI threshold for predicting prediabetes recovery was 214.68, while the threshold for predicting prediabetes progression was 220.27. Additionally, there were significant differences in the relationship of TyG-BMI with prediabetes recovering to NFG or progressing to diabetes within age subgroups. In summary, TyG-BMI is more suitable for assessing prediabetes recovery or progression in younger populations (< 45 years old). CONCLUSIONS This study, for the first time, has revealed the significant impact and predictive value of the TyG index in combination with BMI on the recovery from prediabetic status to normal blood glucose levels. From the perspective of prediabetes intervention, maintaining TyG-BMI within the threshold of 214.68 holds crucial significance.
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Affiliation(s)
- Hongyi Yang
- Department of Ultrasound, the Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi Province, China
| | - Maobin Kuang
- Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi Province, China
- Jiangxi Cardiovascular Research Institute, Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, Jiangxi Province, China
- Jiangxi Provincial Geriatric Hospital, Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, Jiangxi Province, China
| | - Jiajun Qiu
- Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi Province, China
- Jiangxi Cardiovascular Research Institute, Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, Jiangxi Province, China
- Jiangxi Provincial Geriatric Hospital, Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, Jiangxi Province, China
| | - Shiming He
- Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi Province, China
- Jiangxi Cardiovascular Research Institute, Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, Jiangxi Province, China
- Jiangxi Provincial Geriatric Hospital, Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, Jiangxi Province, China
| | - Changhui Yu
- Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi Province, China
- Jiangxi Cardiovascular Research Institute, Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, Jiangxi Province, China
- Jiangxi Provincial Geriatric Hospital, Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, Jiangxi Province, China
| | - Guotai Sheng
- Jiangxi Provincial Geriatric Hospital, Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, Jiangxi Province, China.
| | - Yang Zou
- Jiangxi Cardiovascular Research Institute, Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, Jiangxi Province, China.
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Mo Z, Hu H, Han Y, Cao C, Zheng X. Association between high-density lipoprotein cholesterol and reversion to normoglycemia from prediabetes: an analysis based on data from a retrospective cohort study. Sci Rep 2024; 14:35. [PMID: 38168464 PMCID: PMC10762102 DOI: 10.1038/s41598-023-50539-w] [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: 10/30/2023] [Accepted: 12/21/2023] [Indexed: 01/05/2024] Open
Abstract
The available evidence on the connection between high-density lipoprotein cholesterol (HDL-C) levels and the reversion from prediabetes (Pre-DM) to normoglycemia is currently limited. The present research sought to examine the connection between HDL-C levels and the regression from Pre-DM to normoglycemia in a population of Chinese adults. This historical cohort study collected 15,420 Pre-DM patients in China who underwent health screening between 2010 and 2016. The present research used the Cox proportional hazards regression model to investigate the connection between HDL-C levels and reversion from Pre-DM to normoglycemia. The Cox proportional hazards regression model with cubic spline functions and smooth curve fitting was employed to ascertain the nonlinear association between HDL-C and reversion from Pre-DM to normoglycemia. Furthermore, a set of sensitivity analyses and subgroup analyses were employed. Following the adjustment of covariates, the findings revealed a positive connection between HDL-C levels and the likelihood of reversion from Pre-DM to normoglycemia (HR 1.898, 95% CI 1.758-2.048, P < 0.001). Furthermore, there was a non-linear relationship between HDL-C and the reversion from Pre-DM to normoglycemia in both genders, and the inflection point of HDL-C was 1.540 mmol/L in males and 1.620 mmol/L in females. We found a strong positive correlation between HDL-C and the reversion from Pre-DM to normoglycemia on the left of the inflection point (Male: HR 2.783, 95% CI 2.373-3.263; Female: HR 2.217, 95% CI 1.802-2.727). Our sensitivity analysis confirmed the robustness of these findings. Subgroup analyses indicated that patients with SBP < 140 mmHg and ever smoker exhibited a more pronounced correlation between HDL-C levels and the reversion from Pre-DM to normoglycemia. In contrast, a less robust correlation was observed among patients with SBP ≥ 140 mmHg, current and never smokers. This study provides evidence of a positive and nonlinear association between HDL-C levels and the reversion from Pre-DM to normoglycemia in Chinese patients. Implementing intensified intervention measures to control the HDL-C levels of patients with Pre-DM around the inflection point may substantially enhance the likelihood of regression to normoglycemia.
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Affiliation(s)
- Zihe Mo
- Department of Physical Examination, DongGuan Tungwah Hospital, Dongguan, 523000, Guangdong Province, China
| | - Haofei Hu
- Department of Nephrology, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, 518000, Guangdong Province, China
| | - Yong Han
- Department of Emergency, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, No.3002, Sungang West Road, Futian District, Shenzhen, 518000, Guangdong Province, China.
| | - Changchun Cao
- Department of Rehabilitation, Shenzhen Second People's Hospital, Shenzhen Dapeng New District Nan'ao People's Hospital, No. 6, Renmin Road, Dapeng New District, Shenzhen, 518000, Guangdong Province, China.
| | - Xiaodan Zheng
- Department of Neurology, Shenzhen Samii Medical Center, The Fourth People's Hospital of Shenzhen, No. 1 Jinniu West Road, Shijing Street, Pingshan District, Shenzhen, 518000, Guangdong Province, China.
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Ouyang A, Hu K, Chen L. Trends and risk factors of diabetes and prediabetes in US adolescents, 1999-2020. Diabetes Res Clin Pract 2024; 207:111022. [PMID: 37981123 DOI: 10.1016/j.diabres.2023.111022] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 11/13/2023] [Accepted: 11/15/2023] [Indexed: 11/21/2023]
Abstract
AIMS To assess the national trends in prevalence of diabetes and prediabetes and their major risk factors among adolescents in the US. METHODS We analyzed data on 6,936 adolescents aged 12 to 19 years from the National Health and Nutrition Examination Surveys (NHANES) between 1999 and 2020. Diabetes was defined by self-reported physician-diagnosis (diagnosed) and by fasting plasma glucose and HbA1c levels (undiagnosed). Prediabetes was identified by fasting plasma glucose and HbA1c levels. Logistic regression was performed to estimate the associations of major risk factors with diabetes and prediabetes. RESULTS The prevalence of prediabetes in adolescents increased from 11.5% in 1999-2002 to 36.3% in 2015-2020. The prevalence of diabetes increased from 0.82% (0.62% of diagnosed and 0.20% of undiagnosed) in 1999-2002 to 1.14% (0.76% of diagnosed and 0.38% of undiagnosed) in 2015-2020, but the increase was not statistically significant (P value = 0.69). Obesity was significantly associated with higher odds of diabetes and prediabetes while boys and Mexican Americans had a significantly higher risk of prediabetes than their counterparts. CONCLUSIONS The prevalence of prediabetes among adolescents in the US has more than tripled from 1999 to 2020. Obese adolescents are at the greatest risk for diabetes and prediabetes.
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Affiliation(s)
- Anthony Ouyang
- Thomas S. Wootton High School, 2100 Wootton Pkwy, Rockville, MD 20850, USA
| | - Kathy Hu
- Episcopal School of Baton Rouge, 3200 Woodland Ridge Blvd, Baton Rouge, LA 70816, USA
| | - Liwei Chen
- Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles, 650 Charles E Young Dr S, Los Angeles, CA 90095, USA.
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Hu K, Button AM, Tate CM, Kracht CL, Champagne CM, Staiano AE. Adolescent Diet Quality, Cardiometabolic Risk, and Adiposity: A Prospective Cohort. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2023; 55:851-860. [PMID: 37897452 PMCID: PMC10842960 DOI: 10.1016/j.jneb.2023.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 07/27/2023] [Accepted: 10/03/2023] [Indexed: 10/30/2023]
Abstract
OBJECTIVE Examine the prospective association among diet with adolescent cardiometabolic risk (CMR) and anthropometrics. METHODS Secondary analysis of an observational study of adolescents aged 10-16 years. Twenty-four-hour food recalls were used to calculate Healthy Eating Index-2015 (HEI-2015) scores. Anthropometrics were assessed using magnetic resonance imaging, dual-energy x-ray absorptiometry, and height/weight measurements. CMR included mean arterial pressure, homeostatic model assessment for insulin resistance, high-density lipoprotein cholesterol, and triglycerides. Associations between HEI-2015 score at baseline with follow-up adiposity and CMR were examined using regression models. RESULTS A total of 192 adolescents were included. Baseline HEI-2015 scores were inversely associated with follow-up total CMR z-score (P = 0.01), homeostatic model assessment for insulin resistance (P < 0.01), waist circumference z-score (P = 0.02), body mass index percentile (P = 0.01), fat mass (P = 0.04), lean mass (P = 0.02), and visceral adipose tissue mass (P = 0.01). CONCLUSIONS AND IMPLICATIONS Adolescents with lower adherence to dietary guidelines and greater CMR and anthropometry measurements at baseline continued this trajectory across the observation.
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Affiliation(s)
- Kathy Hu
- Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, LA; Episcopal School of Baton Rouge, Baton Rouge, LA
| | - Alyssa M Button
- Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, LA
| | - Claire M Tate
- Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, LA
| | - Chelsea L Kracht
- Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, LA
| | | | - Amanda E Staiano
- Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, LA.
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Patil S, Patil N, Hardikar-Bhat P, Dervankar O, Joglekar C, Bhat R, Nandoskar A, Yadav A, Nilawar A. Prediabetes in rural adolescent girls from DERVAN cohort: data from the KONKAN region of the state of Maharashtra, India (DERVAN-4). Front Public Health 2023; 11:1181401. [PMID: 37601212 PMCID: PMC10435731 DOI: 10.3389/fpubh.2023.1181401] [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: 03/07/2023] [Accepted: 07/11/2023] [Indexed: 08/22/2023] Open
Abstract
Background India is witnessing an epidemic of type 2 diabetes. Overweight/obesity, overnutrition, physical inactivity, and family history are well-known risk factors for diabetes. We investigated the role of undernutrition in the development of diabetes among rural adolescent girls. Methods DERVAN cohort study was set up in the KONKAN region of the western Indian state of Maharashtra. It enrolled 1,520 adolescent girls (16-18 years old at the time of enrollment). We measured glycemic parameters (glucose, insulin, and HbA1C) and body size using anthropometry and body composition using bioimpedance. Prediabetes was diagnosed using the American Diabetic Association (ADA) criteria. We also calculated various HOMA indices for insulin resistance (HOMA-IR), β-cell function (HOMA-β), insulin sensitivity (HOMA-S), and compensatory β-cell response using a homeostasis model. BMI, body fat%, and waist circumferences were treated as exposures and all the glycemic parameters and indices as outcomes. Results The median age of the subjects was 16.6 years. The median weight, height, and BMI were 40.7 kg, 151.7 cm, and 17.5 kg/m2, respectively. Prevalence of underweight was 28.8%, and stunting was observed in 30.4%. Thinness and obesity using BMI were observed in 58.4% and 4.2%, respectively. The median body fat% was 22.5, and excess body fat (>35%) was observed in 5.7%. The prevalence of prediabetes was 39.4%. Fasting insulin concentrations, HOMA-IR, and HOMA-β showed a positive trend across body composition quartiles (p < 0.001). HOMA-S and compensatory β-cell response showed an inverse trend (p < 0.001). Compared with prediabetic girls in the overweight/obese group, girls most undernourished group had lower median insulin concentrations (8.1 μIU/ml vs. 17.1 μIU/ml), lower HOMA-IR (1.1 vs. 2.3), and lower HOMA-β (75.6 vs. 129.2) but higher sensitivity (87.4 vs. 43.7) (p < 0.001) for all. Conclusion We have reported a high prevalence of prediabetes among rural adolescent girls with a very low prevalence of obesity. Prediabetes in obesity is driven by hyperinsulinemia and overworking of the pancreas while poor β-cell function and poor insulin secretion are major drivers in the undernourished group. The high-risk diabetes screening programs are much needed for the undernourished populations. Caution should be exercised for planning the interventions as overfeeding (or overnutrition) is likely to put the populations at risk of development of obesity and insulin resistance.
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Affiliation(s)
- Suvarna Patil
- Department of Medicine, BKL Walawalkar Rural Medical College, Sawarde, Maharashtra, India
| | - Netaji Patil
- Department of Radiology, BKL Walawalkar Hospital and Rural Medical College, Sawarde, Maharashtra, India
| | - Pallavi Hardikar-Bhat
- Regional Centre for Adolescent Health and Nutrition, BKL Walawalkar Rural Medical College, Sawarde, Maharashtra, India
| | - Omkar Dervankar
- Regional Centre for Adolescent Health and Nutrition, BKL Walawalkar Rural Medical College, Sawarde, Maharashtra, India
| | - Charudatta Joglekar
- Regional Centre for Adolescent Health and Nutrition, BKL Walawalkar Rural Medical College, Sawarde, Maharashtra, India
| | - Rohit Bhat
- Regional Centre for Adolescent Health and Nutrition, BKL Walawalkar Rural Medical College, Sawarde, Maharashtra, India
| | - Ajit Nandoskar
- Regional Centre for Adolescent Health and Nutrition, BKL Walawalkar Rural Medical College, Sawarde, Maharashtra, India
| | - Arvind Yadav
- Department of Biochemistry, BKL Walawalkar Rural Medical College, Sawarde, Maharashtra, India
| | - Anup Nilawar
- Department of Biochemistry, BKL Walawalkar Rural Medical College, Sawarde, Maharashtra, India
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Vajravelu ME, Tas E, Arslanian S. Pediatric Obesity: Complications and Current Day Management. Life (Basel) 2023; 13:1591. [PMID: 37511966 PMCID: PMC10381624 DOI: 10.3390/life13071591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 07/12/2023] [Accepted: 07/17/2023] [Indexed: 07/30/2023] Open
Abstract
Obesity affects approximately 1 in 5 youth globally and increases the risk of complications during adolescence and young adulthood, including type 2 diabetes, dyslipidemia, hypertension, non-alcoholic fatty liver disease, obstructive sleep apnea, and polycystic ovary syndrome. Children and adolescents with obesity frequently experience weight stigma and have an impaired quality of life, which may exacerbate weight gain. Pediatric obesity is typically defined using sex-, age-, and population-specific body mass index percentiles. Once identified, pediatric obesity should always be managed with lifestyle modification. However, adolescents with obesity may also benefit from anti-obesity medications (AOM), several of which have been approved for use in adolescents by the US Food and Drug Administration, including liraglutide, phentermine/topiramate, and semaglutide. For children with specific, rare monogenic obesity disorders, setmelanotide is available and may lead to significant weight loss. Metabolic and bariatric surgery may be used for the management of severe obesity in youth; though highly effective, it is limited to specialized centers and has had relatively low pediatric uptake. In this narrative review using pediatric-focused data from original research, reviews, clinical practice guidelines, governmental agencies, and pharmaceutical companies, we review obesity-related metabolic complications in youth and management strategies, including AOM and bariatric surgery.
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Affiliation(s)
- Mary Ellen Vajravelu
- Center for Pediatric Research in Obesity and Metabolism, UPMC Children's Hospital of Pittsburgh, 4401 Penn Ave., Faculty Pavilion 6th Floor, Pittsburgh, PA 15224, USA
- Division of Pediatric Endocrinology, Diabetes, and Metabolism, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
| | - Emir Tas
- Center for Pediatric Research in Obesity and Metabolism, UPMC Children's Hospital of Pittsburgh, 4401 Penn Ave., Faculty Pavilion 6th Floor, Pittsburgh, PA 15224, USA
- Division of Pediatric Endocrinology, Diabetes, and Metabolism, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
| | - Silva Arslanian
- Center for Pediatric Research in Obesity and Metabolism, UPMC Children's Hospital of Pittsburgh, 4401 Penn Ave., Faculty Pavilion 6th Floor, Pittsburgh, PA 15224, USA
- Division of Pediatric Endocrinology, Diabetes, and Metabolism, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
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Perng W, Conway R, Mayer-Davis E, Dabelea D. Youth-Onset Type 2 Diabetes: The Epidemiology of an Awakening Epidemic. Diabetes Care 2023; 46:490-499. [PMID: 36812420 PMCID: PMC10090267 DOI: 10.2337/dci22-0046] [Citation(s) in RCA: 25] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 11/26/2022] [Indexed: 02/24/2023]
Abstract
In this narrative review, we describe the epidemiology (prevalence, incidence, temporal trends, and projections) of type 2 diabetes among children and adolescents (<20 years), focusing on data from the U.S. and reporting global estimates where available. Secondarily, we discuss the clinical course of youth-onset type 2 diabetes, from prediabetes to complications and comorbidities, drawing comparisons with youth type 1 diabetes to highlight the aggressive course of this condition, which, only recently, has become recognized as a pediatric disease by health care providers. Finally, we end with an overview of emerging topics in type 2 diabetes research that have potential to inform strategies for effective preventive action at the community and individual levels.
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Affiliation(s)
- Wei Perng
- Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, University of Colorado Anschutz Medical Campus, Aurora, CO
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Rebecca Conway
- Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, University of Colorado Anschutz Medical Campus, Aurora, CO
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO
| | | | - Dana Dabelea
- Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, University of Colorado Anschutz Medical Campus, Aurora, CO
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO
- Department of Pediatrics, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
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Kohansal K, Ahmadi N, Hadaegh F, Alizadeh Z, Azizi F, Habibi-Moeini AS, Khalili D. Determinants of the progression to type 2 diabetes and regression to normoglycemia in people with pre-diabetes: A population-based cohort study over ten years. Prim Care Diabetes 2022; 16:797-803. [PMID: 36404444 DOI: 10.1016/j.pcd.2022.10.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Revised: 09/08/2022] [Accepted: 10/04/2022] [Indexed: 11/07/2022]
Abstract
AIMS To determine the rates and predictors of the regression to normoglycemia and progression to diabetes among subjects with pre-diabetes. METHODS A 10-year longitudinal population-based study was conducted among 1329 participants with pre-diabetes in the Tehran Lipid and Glucose Study. Pre-diabetes was divided into isolated IFG (iIFG), isolated IGT (iIGT), and combined IFG/IGT. Univariate and stepwise multivariable Cox regression was used to evaluate predictors of glycemic conversions. RESULTS The cumulative incidences of normoglycemia and diabetes were 43.7% (95%CI 40.9-46.4) and 40.1% (37.3-42.7), respectively. Isolated IGT returned to normoglycemia more than iIFG (HR:1.26, 1.05-1.51), but there was no difference in how quickly they progressed to diabetes. Regression to normoglycemia was associated with younger age, female sex, lower BMI, no familial history of diabetes, higher HDL-C, and ex-smoking. Older age, higher BMI, diastolic blood pressure, total cholesterol, lower HDL-C, and familial history for diabetes were associated with progression to diabetes. The influence of BMI on glycemic status conversions diminished with age. At approximately above 60 years old, the hazards of BMI for any conversions faded out. CONCLUSIONS The modifiable predictors of regression to normoglycemia and progression to diabetes are roughly the same. The importance of BMI attenuates in elderly subjects.
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Affiliation(s)
- Karim Kohansal
- Department of Epidemiology and Biostatistics, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Nooshin Ahmadi
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farzad Hadaegh
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Zeinab Alizadeh
- Department of Epidemiology, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Fereidoun Azizi
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ali Siamak Habibi-Moeini
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Davood Khalili
- Department of Epidemiology and Biostatistics, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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13
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Saleh M, Kim JY, March C, Gebara N, Arslanian S. Youth prediabetes and type 2 diabetes: Risk factors and prevalence of dysglycaemia. Pediatr Obes 2022; 17:e12841. [PMID: 34382374 DOI: 10.1111/ijpo.12841] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 07/23/2021] [Accepted: 07/26/2021] [Indexed: 01/14/2023]
Abstract
BACKGROUND The American Diabetes Association recommends risk-based screening for dysglycaemia (prediabetes and type 2 diabetes) in youth with overweight/obesity plus ≥1 risk factor. However, evidence for these recommendations is lacking. OBJECTIVES Examine the association between the number of risk factors and the prevalence of dysglycaemia in youth with overweight/obesity at initial presentation. METHODS In a paediatric obesity registry, youth (>10 and <20 years old, body mass index ≥85th percentile) were categorized into four groups according to number of risk factors (1, 2, 3 and ≥4). Based on oral glucose tolerance test, participants were classified into normal glucose tolerance or dysglycaemia. RESULTS Of 635 youth, 31.5% had prediabetes and 6.1% had type 2 diabetes. The prevalence of dysglycaemia was 23.1% with 1 risk factor and increased to 44.9% with ≥4 risk factors (p = 0.025). Dyslipidaemia, family history of type 2 diabetes and maternal history of gestational diabetes were significantly associated with dysglycaemia. Fasting and 2-h insulin, 2-h glucose increased (all p < 0.0001) and ALT increased (p = 0.001) with increasing risk factors. Insulin sensitivity and β-cell function deteriorated significantly with increasing risk factors. CONCLUSION Screening for dysglycaemia in youth with obesity and any additional risk factor is warranted to target early management.
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Affiliation(s)
- Mohamed Saleh
- Division of Pediatric Endocrinology, Metabolism and Diabetes Mellitus, UPMC-Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Joon Young Kim
- Department of Exercise Science, Syracuse University, Syracuse, New York, USA
| | - Christine March
- Division of Pediatric Endocrinology, Metabolism and Diabetes Mellitus, UPMC-Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Nour Gebara
- Division of Pediatric Endocrinology, Metabolism and Diabetes Mellitus, UPMC-Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Center for Pediatric Research in Obesity and Metabolism, UPMC-Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Silva Arslanian
- Division of Pediatric Endocrinology, Metabolism and Diabetes Mellitus, UPMC-Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Center for Pediatric Research in Obesity and Metabolism, UPMC-Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
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