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Rovani S, Butler V, Samara-Boustani D, Pinto G, Gonzalez-Briceno L, Nguyen Quoc A, Vermillac G, Stoupa A, Besançon A, Beltrand J, Thalassinos C, Flechtner I, Dassa Y, Viaud M, Arrom-Branas MB, Boddaert N, Puget S, Blauwblomme T, Alapetite C, Bolle S, Doz F, Grill J, Dufour C, Bourdeaut F, Abbou S, Guerrini-Rousseau L, Leruste A, Beccaria K, Polak M, Kariyawasam D. Long-term weight gain in children with craniopharyngioma. Eur J Endocrinol 2024; 190:363-373. [PMID: 38662730 DOI: 10.1093/ejendo/lvae044] [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: 09/28/2023] [Revised: 02/07/2024] [Accepted: 03/13/2024] [Indexed: 05/09/2024]
Abstract
OBJECTIVE Adamantinomatous craniopharyngioma mainly affects children. Excessive weight gain is a major long-term complication. The primary objective of this study was to assess long-term weight changes in children treated for craniopharyngioma. The secondary objectives were to identify risk factors for excessive weight gain and to look for associations with hypothalamic damage by the tumour or treatment. DESIGN Single-centre retrospective cohort study. METHOD Children managed for craniopharyngioma at our centre between 1990 and 2019 were included. The body mass index (BMI) standard deviation scores (SDS) at baseline and at last follow-up were compared. Univariate and multivariate analyses were performed in order to identify variables associated with the long-term BMI-SDS variation. RESULTS The 108 patients had a mean follow-up of 10.4 years. The mean BMI-SDS increase over time was 2.11 (P < .001) overall, 1.21 (P < .001) in the group without hypothalamic involvement by the tumour, and 1.95 (P < .001) in the group managed using intended hypothalamus-sparing surgery. The absence of hypothalamic involvement by the tumour or treatment was significantly associated with less weight gain (P = .046 and P < .01, respectively). After adjustment, factors associated with a BMI-SDS change greater than 2 were female sex (P = .023), tumour involving the hypothalamus (P = .04), and higher baseline BMI (P < .001). CONCLUSION Clinically significant weight gain occurred in nearly all children treated for craniopharyngioma, including those whose hypothalamus was spared by the tumour and intentionally by treatment. However, hypothalamus integrity was associated with less weight gain. Despite hypothalamus-sparing strategies, hypothalamic obesity remains a major concern, indicating a need for novel treatment approaches.
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Affiliation(s)
- Sibylle Rovani
- Paediatric Endocrinology, Diabetology, Gynaecology Department, Necker-Enfants Malades University Hospital, AP-HP Centre, Paris 75015, France
| | - Victoria Butler
- Department of Neonatal Medicine of Port Royal, Cochin Hospital, FHU PREMA, AP-HP Centre-Université Paris Cité, Paris 75014, France
| | - Dinane Samara-Boustani
- Paediatric Endocrinology, Diabetology, Gynaecology Department, Necker-Enfants Malades University Hospital, AP-HP Centre, Paris 75015, France
| | - Graziella Pinto
- Paediatric Endocrinology, Diabetology, Gynaecology Department, Necker-Enfants Malades University Hospital, AP-HP Centre, Paris 75015, France
| | - Laura Gonzalez-Briceno
- Paediatric Endocrinology, Diabetology, Gynaecology Department, Necker-Enfants Malades University Hospital, AP-HP Centre, Paris 75015, France
| | - Adrien Nguyen Quoc
- Paediatric Endocrinology, Diabetology, Gynaecology Department, Necker-Enfants Malades University Hospital, AP-HP Centre, Paris 75015, France
- Faculty of Medicine, Université Paris Cité, Paris 75006, France
| | - Gaëlle Vermillac
- Paediatric Endocrinology, Diabetology, Gynaecology Department, Necker-Enfants Malades University Hospital, AP-HP Centre, Paris 75015, France
| | - Athanasia Stoupa
- Paediatric Endocrinology, Diabetology, Gynaecology Department, Necker-Enfants Malades University Hospital, AP-HP Centre, Paris 75015, France
| | - Alix Besançon
- Paediatric Endocrinology, Diabetology, Gynaecology Department, Necker-Enfants Malades University Hospital, AP-HP Centre, Paris 75015, France
| | - Jacques Beltrand
- Paediatric Endocrinology, Diabetology, Gynaecology Department, Necker-Enfants Malades University Hospital, AP-HP Centre, Paris 75015, France
- Faculty of Medicine, Université Paris Cité, Paris 75006, France
- Cochin Institute, INSERM Department U1016, Paris 75014, France
- IMAGINE Institute Affiliate, INSERM Department U1163, Paris 75015, France
| | - Caroline Thalassinos
- Paediatric Endocrinology, Diabetology, Gynaecology Department, Necker-Enfants Malades University Hospital, AP-HP Centre, Paris 75015, France
| | - Isabelle Flechtner
- Paediatric Endocrinology, Diabetology, Gynaecology Department, Necker-Enfants Malades University Hospital, AP-HP Centre, Paris 75015, France
| | - Yamina Dassa
- Paediatric Endocrinology, Diabetology, Gynaecology Department, Necker-Enfants Malades University Hospital, AP-HP Centre, Paris 75015, France
| | - Magali Viaud
- Paediatric Endocrinology, Diabetology, Gynaecology Department, Necker-Enfants Malades University Hospital, AP-HP Centre, Paris 75015, France
| | - Maria Beatriz Arrom-Branas
- Paediatric Endocrinology, Diabetology, Gynaecology Department, Necker-Enfants Malades University Hospital, AP-HP Centre, Paris 75015, France
| | - Nathalie Boddaert
- Faculty of Medicine, Université Paris Cité, Paris 75006, France
- Department of Pediatric Radiology, Hospital Necker Enfants Malades, Université Paris Cité, Paris F-75015, France
| | - Stéphanie Puget
- Department of Neurosurgery, Centre Hospitalier Universitaire de Fort de France, University of Antilles, Fort-de-France 97100, Martinique
| | - Thomas Blauwblomme
- Faculty of Medicine, Université Paris Cité, Paris 75006, France
- Department of Pediatric Neurosurgery, Necker-Enfants Malades University Hospital, AP-HP Centre, Paris 75015, France
| | - Claire Alapetite
- Radiation Oncology Department, Curie Institute, Paris 75005, France
- Department ICPO (Institut Curie-Centre de Protonthérapie d'Orsay), Orsay 94800, France
| | - Stéphanie Bolle
- Department SIREDO Center (Care, Innovation, Research in, Children, Adolescent and Young Adults Oncology), Curie Institute, 75005 Paris, France
- Department of Radiation Oncology, Gustave Roussy Institute, Villejuif 94800, France
| | - François Doz
- Faculty of Medicine, Université Paris Cité, Paris 75006, France
- Radiation Department, Proton Center, Orsay 94800, France
| | - Jacques Grill
- Child and Adolescent Cancer Department, Gustave Roussy Institute, Villejuif 94800, France
| | - Christelle Dufour
- Child and Adolescent Cancer Department, Gustave Roussy Institute, Villejuif 94800, France
| | | | - Samuel Abbou
- Child and Adolescent Cancer Department, Gustave Roussy Institute, Villejuif 94800, France
| | - Léa Guerrini-Rousseau
- Child and Adolescent Cancer Department, Gustave Roussy Institute, Villejuif 94800, France
| | - Amaury Leruste
- Radiation Department, Proton Center, Orsay 94800, France
| | - Kévin Beccaria
- Faculty of Medicine, Université Paris Cité, Paris 75006, France
- Department of Pediatric Neurosurgery, Necker-Enfants Malades University Hospital, AP-HP Centre, Paris 75015, France
| | - Michel Polak
- Paediatric Endocrinology, Diabetology, Gynaecology Department, Necker-Enfants Malades University Hospital, AP-HP Centre, Paris 75015, France
- Faculty of Medicine, Université Paris Cité, Paris 75006, France
- Cochin Institute, INSERM Department U1016, Paris 75014, France
- IMAGINE Institute Affiliate, INSERM Department U1163, Paris 75015, France
| | - Dulanjalee Kariyawasam
- Paediatric Endocrinology, Diabetology, Gynaecology Department, Necker-Enfants Malades University Hospital, AP-HP Centre, Paris 75015, France
- Faculty of Medicine, Université Paris Cité, Paris 75006, France
- Cochin Institute, INSERM Department U1016, Paris 75014, France
- IMAGINE Institute Affiliate, INSERM Department U1163, Paris 75015, France
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2
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Moore BF. Prenatal Exposure to Cannabis: Effects on Childhood Obesity and Cardiometabolic Health. Curr Obes Rep 2024; 13:154-166. [PMID: 38172481 PMCID: PMC10933144 DOI: 10.1007/s13679-023-00544-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/21/2023] [Indexed: 01/05/2024]
Abstract
PURPOSE OF REVIEW To consolidate information on the obesogenic and cardiometabolic effects of prenatal exposure to cannabis. RECENT FINDINGS A PubMed search strategy updated from January 1, 2014, through 14 June 2023, produced a total of 47 epidemiologic studies and 12 animal studies. Prenatal exposure to cannabis is consistently associated with small for gestational age and low birth weight. After birth, these offspring gain weight rapidly and have increased adiposity and higher glucose (fat mass percentage) in childhood. More preclinical and prospective studies are needed to deepen our understanding of whether these associations vary by sex, dose, timing, and composition of cannabis (e.g., ratio of delta-Δ9-tetrahydrocannabinol [Δ9-THC] to cannabidiol [CBD]). Addressing these gaps may help to solidify causality and identify intervention strategies. Based on the available data, clinicians and public health officials should continue to caution against cannabis use during pregnancy to limit its potential obesogenic and adverse cardiometabolic effects on the offspring.
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Affiliation(s)
- Brianna F Moore
- Department of Epidemiology, Colorado School of Public Health, Aurora, CO, USA.
- Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, University of Colorado Anschutz Medical Campus, 1890 N Revere Ct, Aurora, 80045, CO, USA.
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3
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Athar F, Karmani M, Templeman N. Metabolic hormones are integral regulators of female reproductive health and function. Biosci Rep 2024; 44:BSR20231916. [PMID: 38131197 PMCID: PMC10830447 DOI: 10.1042/bsr20231916] [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: 11/03/2023] [Revised: 11/29/2023] [Accepted: 12/21/2023] [Indexed: 12/23/2023] Open
Abstract
The female reproductive system is strongly influenced by nutrition and energy balance. It is well known that food restriction or energy depletion can induce suppression of reproductive processes, while overnutrition is associated with reproductive dysfunction. However, the intricate mechanisms through which nutritional inputs and metabolic health are integrated into the coordination of reproduction are still being defined. In this review, we describe evidence for essential contributions by hormones that are responsive to food intake or fuel stores. Key metabolic hormones-including insulin, the incretins (glucose-dependent insulinotropic polypeptide and glucagon-like peptide-1), growth hormone, ghrelin, leptin, and adiponectin-signal throughout the hypothalamic-pituitary-gonadal axis to support or suppress reproduction. We synthesize current knowledge on how these multifaceted hormones interact with the brain, pituitary, and ovaries to regulate functioning of the female reproductive system, incorporating in vitro and in vivo data from animal models and humans. Metabolic hormones are involved in orchestrating reproductive processes in healthy states, but some also play a significant role in the pathophysiology or treatment strategies of female reproductive disorders. Further understanding of the complex interrelationships between metabolic health and female reproductive function has important implications for improving women's health overall.
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Affiliation(s)
- Faria Athar
- Department of Biology, University of Victoria, Victoria, British Columbia V8P 5C2, Canada
| | - Muskan Karmani
- Department of Biology, University of Victoria, Victoria, British Columbia V8P 5C2, Canada
| | - Nicole M. Templeman
- Department of Biology, University of Victoria, Victoria, British Columbia V8P 5C2, Canada
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Bravo C, Mericq V, Pereira A, Corvalán C, Tobar HE, Miranda JP, Santos JL. Association between plasma leptin/adiponectin ratio and insulin resistance indexes in prepubertal children. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2024; 68:e220353. [PMID: 38289144 PMCID: PMC10948042 DOI: 10.20945/2359-4292-2022-0353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 03/06/2023] [Indexed: 02/01/2024]
Abstract
Objective To assess the association between leptin/adiponectin ratio (LAR) and insulin resistance surrogates in prepubertal children. Materials and methods Study based on data from the Growth and Obesity Chilean Cohort Study (GOCS) involving 968 Chilean prepubertal children. Plasma insulin, leptin, and adiponectin were determined by immunoassays. Several common insulin resistance surrogates were calculated, including the homeostasis model assessment of insulin resistance (HOMA-IR), triglyceride/HDL cholesterol index, triglyceride-glucose (TyG) index, and the TyG index corrected for body mass index (BMI; TyG-BMI) and waist circumference (WC; TyG-WC). Associations among variables were assessed using multiple linear and logistic regression analysis. Results There was a significant direct association between plasma leptin and LAR with BMI z-score but no association between plasma adiponectin and adiposity. After adjustments for sex and age, LAR was significantly associated with all insulin resistance surrogates (which were categorized using the 75th percentile as the cutoff point), with the TyG-WC index emerging as the surrogate with the highest magnitude of association (odds ratio [OR] 2.44, 95% confidence interval [CI] 2.05-2.9). After additional adjustment for BMI z-score, only the association between LAR and TyG-WC remained significant (OR 1.64, 95% CI 1.27-2.12). Conclusion Plasma leptin and LAR were strongly associated with several common insulin resistance surrogates in prepubertal children, most notably with the TyG-WC index. Associations between LAR and insulin resistance indexes were mainly driven by the effect of plasma leptin, which is also directly associated with increased adiposity.
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Affiliation(s)
- Carolina Bravo
- Departamento de Nutrición, Diabetes y Metabolismo, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
- Instituto de Nutrición y Tecnología de Alimentos, Universidad de Chile, Santiago, Chile
| | - Verónica Mericq
- Instituto de Investigaciones MaternoInfantil, Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - Ana Pereira
- Instituto de Nutrición y Tecnología de Alimentos, Universidad de Chile, Santiago, Chile
| | - Camila Corvalán
- Instituto de Nutrición y Tecnología de Alimentos, Universidad de Chile, Santiago, Chile
| | - Hugo E Tobar
- Departamento de Nutrición, Diabetes y Metabolismo, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - José Patricio Miranda
- Departamento de Nutrición, Diabetes y Metabolismo, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - José Luis Santos
- Departamento de Nutrición, Diabetes y Metabolismo, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile,
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5
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González-Domínguez Á, Domínguez-Riscart J, Millán-Martínez M, Lechuga-Sancho AM, González-Domínguez R. Sexually dimorphic metal alterations in childhood obesity are modulated by a complex interplay between inflammation, insulin, and sex hormones. Biofactors 2023; 49:849-860. [PMID: 36945726 DOI: 10.1002/biof.1948] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 03/04/2023] [Indexed: 03/23/2023]
Abstract
Although growing evidence points to a pivotal role of perturbed metal homeostasis in childhood obesity, sexual dimorphisms in this association have rarely been investigated. In this study, we applied multi-elemental analysis to plasma and erythrocyte samples from an observational cohort comprising children with obesity, with and without insulin resistance, and healthy control children. Furthermore, a wide number of variables related to carbohydrate and lipid metabolism, inflammation, and sex hormones were also determined. Children with obesity, regardless of sex and insulin resistance status, showed increased plasma copper-to-zinc ratios. More interestingly, obesity-related erythroid alterations were found to be sex-dependent, with increased contents of iron, zinc, and copper being exclusively detected among female subjects. Our findings suggest that a sexually dimorphic hormonal dysregulation in response to a pathological cascade involving inflammatory processes and hyperinsulinemia could be the main trigger of this female-specific intracellular sequestration of trace elements. Therefore, the present study highlights the relevance of genotypic sex as a susceptibility factor influencing the pathogenic events behind childhood obesity, thereby opening the door to develop sex-personalized approaches in the context of precision medicine.
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Affiliation(s)
- Álvaro González-Domínguez
- Instituto de Investigación e Innovación Biomédica de Cádiz (INiBICA), Hospital Universitario Puerta del Mar, Universidad de Cádiz, Cádiz, Spain
| | - Jesús Domínguez-Riscart
- Instituto de Investigación e Innovación Biomédica de Cádiz (INiBICA), Hospital Universitario Puerta del Mar, Universidad de Cádiz, Cádiz, Spain
- Unidad de Endocrinología Pediátrica y Diabetes, Servicio de Pediatría, Hospital Universitario Puerta del Mar, Cádiz, Spain
| | - María Millán-Martínez
- Associate Unit CSIC-University of Huelva "Atmospheric Pollution", Center for Research in Sustainable Chemistry - CIQSO, University of Huelva, Huelva, Spain
- Department of Chemistry, Faculty of Experimental Sciences, University of Huelva, Huelva, Spain
| | - Alfonso María Lechuga-Sancho
- Instituto de Investigación e Innovación Biomédica de Cádiz (INiBICA), Hospital Universitario Puerta del Mar, Universidad de Cádiz, Cádiz, Spain
- Unidad de Endocrinología Pediátrica y Diabetes, Servicio de Pediatría, Hospital Universitario Puerta del Mar, Cádiz, Spain
- Departamento Materno Infantil y Radiología, Facultad de Medicina, Universidad de Cádiz, Cádiz, Spain
| | - Raúl González-Domínguez
- Instituto de Investigación e Innovación Biomédica de Cádiz (INiBICA), Hospital Universitario Puerta del Mar, Universidad de Cádiz, Cádiz, Spain
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Azab SM, Shanmuganathan M, de Souza RJ, Kroezen Z, Desai D, Williams NC, Morrison KM, Atkinson SA, Teo KK, Azad MB, Simons E, Moraes TJ, Mandhane PJ, Turvey SE, Subbarao P, Britz-McKibbin P, Anand SS. Early sex-dependent differences in metabolic profiles of overweight and adiposity in young children: a cross-sectional analysis. BMC Med 2023; 21:176. [PMID: 37158942 PMCID: PMC10166631 DOI: 10.1186/s12916-023-02886-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 04/29/2023] [Indexed: 05/10/2023] Open
Abstract
BACKGROUND Childhood obesity is a global health concern and can lead to lifetime cardiometabolic disease. New advances in metabolomics can provide biochemical insights into the early development of obesity, so we aimed to characterize serum metabolites associated with overweight and adiposity in early childhood and to stratify associations by sex. METHODS Nontargeted metabolite profiling was conducted in the Canadian CHILD birth cohort (discovery cohort) at age 5 years (n = 900) by multisegment injection-capillary electrophoresis-mass spectrometry. Clinical outcome was defined using novel combined measures of overweight (WHO-standardized body mass index ≥ 85th percentile) and/or adiposity (waist circumference ≥ 90th percentile). Associations between circulating metabolites and child overweight/adiposity (binary and continuous outcomes) were determined by multivariable linear and logistic regression, adjusting for covariates and false discovery rate, and by subsequent sex-stratified analysis. Replication was assessed in an independent replication cohort called FAMILY at age 5 years (n = 456). RESULTS In the discovery cohort, each standard deviation (SD) increment of branched-chain and aromatic amino acids, glutamic acid, threonine, and oxoproline was associated with 20-28% increased odds of overweight/adiposity, whereas each SD increment of the glutamine/glutamic acid ratio was associated with 20% decreased odds. All associations were significant in females but not in males in sex-stratified analyses, except for oxoproline that was not significant in either subgroup. Similar outcomes were confirmed in the replication cohort, where associations of aromatic amino acids, leucine, glutamic acid, and the glutamine/glutamic acid ratio with childhood overweight/adiposity were independently replicated. CONCLUSIONS Our findings show the utility of combining measures of both overweight and adiposity in young children. Childhood overweight/adiposity at age 5 years has a specific serum metabolic phenotype, with the profile being more prominent in females compared to males.
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Affiliation(s)
- Sandi M Azab
- Department of Medicine, McMaster University, Hamilton, ON, Canada
- Department of Pharmacognosy, Alexandria University, Alexandria, Egypt
- Chanchlani Research Centre, McMaster University, Hamilton, Canada
| | - Meera Shanmuganathan
- Department of Chemistry and Chemical Biology, McMaster University, Hamilton, ON, Canada
| | - Russell J de Souza
- Chanchlani Research Centre, McMaster University, Hamilton, Canada
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
- Population Health Research Institute, Hamilton Health Sciences, Hamilton, ON, Canada
| | - Zachary Kroezen
- Department of Chemistry and Chemical Biology, McMaster University, Hamilton, ON, Canada
| | - Dipika Desai
- Department of Medicine, McMaster University, Hamilton, ON, Canada
- Population Health Research Institute, Hamilton Health Sciences, Hamilton, ON, Canada
| | - Natalie C Williams
- Department of Medicine, McMaster University, Hamilton, ON, Canada
- Chanchlani Research Centre, McMaster University, Hamilton, Canada
| | - Katherine M Morrison
- Population Health Research Institute, Hamilton Health Sciences, Hamilton, ON, Canada
- Centre for Metabolism, Obesity and Diabetes Research, McMaster University, Hamilton, ON, Canada
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada
| | | | - Koon K Teo
- Department of Medicine, McMaster University, Hamilton, ON, Canada
- Population Health Research Institute, Hamilton Health Sciences, Hamilton, ON, Canada
| | - Meghan B Azad
- Department of Pediatrics and Child Health, Children's Hospital Research Institute of Manitoba, University of Manitoba, Winnipeg, MB, Canada
| | - Elinor Simons
- Department of Pediatrics and Child Health, Children's Hospital Research Institute of Manitoba, University of Manitoba, Winnipeg, MB, Canada
| | - Theo J Moraes
- Department of Pediatrics, Hospital for Sick Children, Toronto, ON, Canada
| | - Piush J Mandhane
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Stuart E Turvey
- Department of Pediatrics, BC Children's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Padmaja Subbarao
- Department of Medicine, McMaster University, Hamilton, ON, Canada
- Department of Pediatrics, Hospital for Sick Children, Toronto, ON, Canada
| | - Philip Britz-McKibbin
- Department of Chemistry and Chemical Biology, McMaster University, Hamilton, ON, Canada
| | - Sonia S Anand
- Department of Medicine, McMaster University, Hamilton, ON, Canada.
- Chanchlani Research Centre, McMaster University, Hamilton, Canada.
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada.
- Population Health Research Institute, Hamilton Health Sciences, Hamilton, ON, Canada.
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7
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de Vries SAG, Verheugt CL, Mul D, Nieuwdorp M, Sas TCJ. Do sex differences in paediatric type 1 diabetes care exist? A systematic review. Diabetologia 2023; 66:618-630. [PMID: 36700969 PMCID: PMC9947056 DOI: 10.1007/s00125-022-05866-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 11/25/2022] [Indexed: 01/27/2023]
Abstract
AIMS/HYPOTHESIS Sex differences are present in cardiovascular care and in outcomes among adults with type 1 diabetes mellitus, which typically commences in childhood. Whether sex influences care and outcomes in childhood is not known. This systematic review provides an overview of sex differences in children with type 1 diabetes, focusing on patient and disease characteristics, treatment, comorbidities and complications. METHODS Literature in MEDLINE up to 15 June 2021 was searched, using the terms diabetes mellitus, sex characteristics, sex distribution, children and/or adolescents. All primary outcome studies on children with type 1 diabetes that mentioned a sex difference in outcome were included, with the exception of qualitative studies, case reports or case series. Studies not pertaining to the regular clinical care process and on incidence or prevalence only were excluded. Articles reporting sex differences were identified and assessed on quality and risk of bias using Joanna Briggs Institute critical appraisal tools. Narrative synthesis and an adapted Harvest plot were used to summarise evidence by category. RESULTS A total of 8640 articles were identified, rendering 90 studies for review (n=643,217 individuals). Studies were of observational design and comprised cohort, cross-sectional and case-control studies. Most of the included studies showed a higher HbA1c in young female children both at diagnosis (seven studies, n=22,089) and during treatment (20 out of 21 studies, n=144,613), as well as a steeper HbA1c increase over time. Many studies observed a higher BMI (all ages, ten studies, n=89,700; adolescence, seven studies, n=33,153), a higher prevalence of being overweight or obese, and a higher prevalence of dyslipidaemia among the female sex. Hypoglycaemia and partial remission occurred more often in male participants, and ketoacidosis (at diagnosis, eight studies, n=3561) and hospitalisation was more often seen in female participants. Most of the findings showed that female participants used pump therapy more frequently (six studies, n=211,324) and needed higher insulin doses than male participants. Several comorbidities, such as thyroid disease and coeliac disease, appeared to be more common in female participants. All studies reported lower quality of life in female participants (15 studies, n=8722). Because the aim of this study was to identify sex differences, studies with neutral outcomes or minor differences may have been under-targeted. The observational designs of the included studies also limit conclusions on the causality between sex and clinical outcomes. CONCLUSIONS/INTERPRETATION Sex disparities were observed throughout diabetes care in children with type 1 diabetes. Several outcomes appear worse in young female children, especially during adolescence. Focus on the cause and treatment of these differences may provide opportunities for better outcomes. REGISTRATION This systematic review is registered in PROSPERO (CRD42020213640).
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Affiliation(s)
- Silvia A G de Vries
- Department of Vascular Medicine, Amsterdam University Medical Centers, Amsterdam, the Netherlands.
| | - Carianne L Verheugt
- Department of Vascular Medicine, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Dick Mul
- Diabeter, Center for Paediatric and Adult Diabetes Care and Research, Rotterdam, the Netherlands
| | - Max Nieuwdorp
- Department of Vascular Medicine, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Theo C J Sas
- Diabeter, Center for Paediatric and Adult Diabetes Care and Research, Rotterdam, the Netherlands
- Department of Paediatrics, Division of Paediatric Endocrinology, Erasmus University Medical Center, Sophia Children's Hospital, Rotterdam, the Netherlands
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8
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Salas-González MD, Aparicio A, Loria-Kohen V, Ortega RM, López-Sobaler AM. Association of Healthy Eating Index-2015 and Dietary Approaches to Stop Hypertension Patterns with Insulin Resistance in Schoolchildren. Nutrients 2022; 14:4232. [PMID: 36296916 PMCID: PMC9607022 DOI: 10.3390/nu14204232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 10/06/2022] [Accepted: 10/07/2022] [Indexed: 11/29/2022] Open
Abstract
Background: Diet quality patterns are associated with a lower incidence of insulin resistance (IR) in adults. The aim of this study was to investigate the association between two diet quality indices and IR in schoolchildren and to identify the best diet quality index associated with a lower risk of IR. Methods: A total of 854 schoolchildren (8−13 years) were included in a cross-sectional study, who completed a three-day dietary record to assess their diet. Fasting plasma glucose and insulin were also measured, and anthropometric data were collected. Healthy Eating Index-2015 (HEI-2015), Dietary Approaches to Stop Hypertension (DASH), and adjusted DASH (aDASH) were calculated as diet quality indices. The homeostasis model assessment of insulin resistance (HOMA-IR) was used, and IR was defined as HOMA-IR > 3.16. Results: The prevalence of IR was 5.5%, and it was higher in girls. The mean HEI-2015 and DASH scores were 59.3 and 23.4, respectively, and boys scored lower in both indices. In girls, having a HEI-2015 score above the 33rd percentile was associated with a lower risk of IR (odds ratio [95% CI]: 0.43 [0.19−0.96], p = 0.020). Conclusion: Greater adherence to a healthy dietary pattern, as assessed by a higher HEI-2015 score, was associated with a lower risk of IR in schoolchildren, especially in girls.
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Affiliation(s)
- María Dolores Salas-González
- VALORNUT Research Group, Department of Nutrition and Food Science, Faculty of Pharmacy, Complutense University of Madrid, 28040 Madrid, Spain
| | - Aranzazu Aparicio
- VALORNUT Research Group, Department of Nutrition and Food Science, Faculty of Pharmacy, Complutense University of Madrid, IdISSC, 28040 Madrid, Spain
| | - Viviana Loria-Kohen
- VALORNUT Research Group, Department of Nutrition and Food Science, Faculty of Pharmacy, Complutense University of Madrid, 28040 Madrid, Spain
| | - Rosa M. Ortega
- VALORNUT Research Group, Department of Nutrition and Food Science, Faculty of Pharmacy, Complutense University of Madrid, IdISSC, 28040 Madrid, Spain
| | - Ana M. López-Sobaler
- VALORNUT Research Group, Department of Nutrition and Food Science, Faculty of Pharmacy, Complutense University of Madrid, IdISSC, 28040 Madrid, Spain
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9
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Rodriguez BC, Astudillo M, Tosur M, Rafaey A, McKay S, Bacha F, Balasubramanyam A, Redondo MJ. Characteristics of Type 2 Diabetes in Female and Male Youth. Clin Diabetes 2022; 41:239-243. [PMID: 37092145 PMCID: PMC10115763 DOI: 10.2337/cd22-0057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The incidence of type 2 diabetes in children is rising and carries a worse prognosis than in adults. The influence of sex on pediatric type 2 diabetes outcomes has not been well investigated. We studied 715 youth with type 2 diabetes diagnosed at a median age of 13.7 years and compared sex differences in demographic, clinical, and laboratory characteristics within the first year of diagnosis. Females diagnosed with type 2 diabetes were younger and at a higher stage of pubertal development than males, yet presented with lower A1Cs, a lower prevalence of diabetic ketoacidosis, and higher HDL cholesterol levels.
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Affiliation(s)
| | - Marcela Astudillo
- Division of Diabetes and Endocrinology, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX
| | - Mustafa Tosur
- Division of Diabetes and Endocrinology, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX
| | - Ahmad Rafaey
- Division of Diabetes and Endocrinology, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX
| | - Siripoom McKay
- Division of Diabetes and Endocrinology, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX
| | - Fida Bacha
- Division of Diabetes and Endocrinology, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX
- USDA/ARS Children’s Nutrition Research Center, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX
| | - Ashok Balasubramanyam
- Division of Diabetes, Endocrinology and Metabolism, Baylor College of Medicine, Houston, TX
| | - Maria J. Redondo
- Division of Diabetes and Endocrinology, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX
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10
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Flores L, Fragoso I, De León LG, Ortiz-Rodríguez B, Candia-Luján R, Carrasco-Legleu C. Moderating effect of bone maturation on the relationship between body fat and insulin resistance. J Pediatr Endocrinol Metab 2022; 35:577-583. [PMID: 35325514 DOI: 10.1515/jpem-2021-0663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 02/19/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVES The aim of the present study was to analyze the moderating effect of maturation on the relationship between body fat and insulin resistance, in children from 9 to 12 years. METHODS Maturity offset, homeostasis model assessment index of insulin resistance (HOMA-IR), and body fat percentage (BF%) were estimated in 127 children. Skeletal maturation indicator (SMI) was estimated in 105 participants. A moderation analysis based on a linear regression and on Johnson-Neyman technique was performed using a 95% confidence level. RESULTS BF%, insulin levels, and HOMA-IR values were lower in late maturers than on-time maturers (p<0.05). SMI moderated the relationship between BF% and HOMA-IR index in 11.1% of boys and in 32.5% of girls (p<0.05). Also, the highest values of HOMA-IR index were observed at -1 year to achieve the peak height velocity, in girls (p<0.05). CONCLUSIONS Maturation process has a moderation effect on the relationship BF% and insulin resistance, particularly in early maturers; furthermore, it was independently associated with HOMA-IR.
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Affiliation(s)
- Luis Flores
- Facultad de Ciencias de la Cultura Física, Universidad Autónoma de Chihuahua, Chihuahua, México
| | - Isabel Fragoso
- Faculdade de Motricidade Humana, Universidade de Lisboa, Cruz Quebrada, Portugal
| | - Lidia G De León
- Facultad de Ciencias de la Cultura Física, Universidad Autónoma de Chihuahua, Chihuahua, México
| | | | - Ramón Candia-Luján
- Facultad de Ciencias de la Cultura Física, Universidad Autónoma de Chihuahua, Chihuahua, México
| | - Claudia Carrasco-Legleu
- Facultad de Ciencias de la Cultura Física, Universidad Autónoma de Chihuahua, Chihuahua, México
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11
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Peled A, Raz I, Zucker I, Derazne E, Megreli J, Pinhas-Hamiel O, Einan-Lifshitz A, Morad Y, Pras E, Lutski M, Cukierman-Yaffe T, Mosenzon O, Tzur D, Tirosh A, Gerstein HC, Afek A, Twig G. Myopia and Early-Onset Type 2 Diabetes: A Nationwide Cohort Study. J Clin Endocrinol Metab 2022; 107:e663-e671. [PMID: 34505129 DOI: 10.1210/clinem/dgab669] [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: 07/14/2021] [Indexed: 02/08/2023]
Abstract
CONTEXT A correlation between myopia and insulin resistance has been suggested. OBJECTIVE We investigated the association between myopia in adolescence and type 2 diabetes (T2D) incidence in young adulthood. METHODS This population-based, retrospective, cohort study comprised 1 329 705 adolescents (579 543 women, 43.6%) aged 16 to 19 years, who were medically examined before mandatory military service during 1993 to 2012, and whose data were linked to the Israel National Diabetes Registry. Myopia was defined based on right-eye refractive data. Cox proportional models were applied, separately for women and men, to estimate hazard ratios (HRs) for T2D incidence per person-years of follow-up. RESULTS There was an interaction between myopia and sex with T2D (P < .001). For women, T2D incidence rates (per 100 000 person-years) were 16.6, 19.2, and 25.1 for those without myopia, and with mild-to-moderate and high myopia, respectively. These corresponded to HRs of 1.29 (95% CI, 1.14-1.45) and 1.63 (1.21-2.18) for women with mild-to-moderate and high myopia, respectively, compared to those without myopia, after adjustment for age at study entry, birth year, adolescent body mass index, cognitive performance, socioeconomic status, and immigration status. Results persisted in extensive sensitivity and subgroup analyses. When managed as a continuous variable, every 1-diopter lower spherical equivalent yielded a 6.5% higher adjusted HR for T2D incidence (P = .003). There was no significant association among men. CONCLUSION For women, myopia in adolescence was associated with a significantly increased risk for incident T2D in young adulthood, in a severity-dependent manner. This finding may support the role of insulin resistance in myopia pathogenesis.
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Affiliation(s)
- Alon Peled
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Ophthalmology, Assaf-Harofeh Medical Center, Zerifin, Israel
| | - Itamar Raz
- The Diabetes Unit, Department of Internal Medicine, Hadassah Hebrew University Hospital, Jerusalem, Israel
| | - Inbar Zucker
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Ministry of Health, Israel Center for Disease Control, Ramat Gan, Israel
| | - Estela Derazne
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jacob Megreli
- Hebrew University-Hadassah Braun School of Public Health and Community, Jerusalem, Israel
- Israel Defense Forces Medical Corps, Ramat Gan, Israel
| | - Orit Pinhas-Hamiel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Pediatric Endocrine and Diabetes Unit, Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center at Tel Hashomer, Ramat Gan, Israel
| | - Adi Einan-Lifshitz
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Ophthalmology, Assaf-Harofeh Medical Center, Zerifin, Israel
| | - Yair Morad
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Ophthalmology, Assaf-Harofeh Medical Center, Zerifin, Israel
| | - Eran Pras
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Ophthalmology, Assaf-Harofeh Medical Center, Zerifin, Israel
| | - Miri Lutski
- Ministry of Health, Israel Center for Disease Control, Ramat Gan, Israel
| | - Tali Cukierman-Yaffe
- Ministry of Health, Israel Center for Disease Control, Ramat Gan, Israel
- Institute of Endocrinology, Chaim Sheba Medical Center at Tel Hashomer, Ramat Gan, Israel
| | - Ofri Mosenzon
- The Diabetes Unit, Department of Internal Medicine, Hadassah Hebrew University Hospital, Jerusalem, Israel
| | - Dorit Tzur
- Israel Defense Forces Medical Corps, Ramat Gan, Israel
- Department of Military Medicine, Hebrew University, Jerusalem, Israel
| | - Amir Tirosh
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Institute of Endocrinology, Chaim Sheba Medical Center at Tel Hashomer, Ramat Gan, Israel
| | | | - Arnon Afek
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Central Management, Chaim Sheba Medical Center at Tel Hashomer, Ramat Gan, Israel
| | - Gilad Twig
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Israel Defense Forces Medical Corps, Ramat Gan, Israel
- Institute of Endocrinology, Chaim Sheba Medical Center at Tel Hashomer, Ramat Gan, Israel
- Department of Military Medicine, Hebrew University, Jerusalem, Israel
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12
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Gemelli IFB, Silva TR, Farias EDS, Olinto MTA, Spritzer PM. Insulin resistance and associated factors in female adolescents from two capital cities in the north and south of Brazil. Diabetol Metab Syndr 2021; 13:113. [PMID: 34666809 PMCID: PMC8527714 DOI: 10.1186/s13098-021-00730-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Accepted: 10/05/2021] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND It has been described that physiological changes in glucose metabolism, represented by insulin resistance (IR), are predicted during pubertal evolution, and obesity may be associated with its persistence even at the end of puberty. The aim of this study was to investigate the prevalence of IR in female adolescents with possible associated factors and evaluate the relationship of time since menarche (< 2 vs. ≥ 2 years) in the occurrence of IR in two Brazilian capital cities: Porto Velho (RO) and Porto Alegre (RS). METHODS This is a cross-sectional school-based study, using information from the Study of Cardiovascular Risks (ERICA) database for adolescents aged 12-17 years, enrolled in public and private schools, in municipalities with more than 100,000 inhabitants in Brazil, between 2013 and 2014. The present study included 889 adolescents, 382 in Porto Velho (PVh) and 507 in Porto Alegre (PoA). The homeostasis model assessment for insulin resistance (HOMA-IR) ≥ 3.16 and fasting insulin ≥ 15 mU/L was used to determine the outcome variable of IR. Estimates of crude and adjusted prevalence ratios with confidence intervals of 95% were calculated using Poisson regression with robust variance. Sociodemographic, behavioral, reproductive and nutritional characteristics were considered as potential confounding factors in multivariable models based on a conceptual framework of IR determination. RESULTS In the total sample, the prevalence of IR was 22.03% (95% CI 17.84-26.89). After adjusting the models, age 15-17 years and time since menarche ≥ 2 years were found to act as protective factors for IR; in contrast, the highest probability of IR was observed in black adolescents, with increased waist circumference (WC) and overweight/obesity (Ow/Ob). The protective effect of two or more years since menarche (post-menarche) was observed for both higher HOMA-IR and fasting insulin in PVh; in PoA, such protection was maintained only for fasting insulin ≥ 15 mU/L after adjustments in the multivariate models. CONCLUSIONS IR is more prevalent during the peri-menarche period, especially in younger and black adolescents, compared to their white and post-menarche counterparts. The association between Ow/Ob and high WC with the occurrence of IR was independent of age and ethnicity variables.
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Affiliation(s)
| | - Thais Rasia Silva
- Federal University of Rio Grande Do Sul (UFRGS), Porto Alegre, Brazil
- Gynecological Endocrinology Unit, Division of Endocrinology, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
| | | | - Maria Teresa Anselmo Olinto
- Federal University of Rio Grande Do Sul (UFRGS), Porto Alegre, Brazil
- University of Vale Do Rio Dos Sinos, UNISINOS, São Leopoldo, Brazil
| | - Poli Mara Spritzer
- Federal University of Rio Grande Do Sul (UFRGS), Porto Alegre, Brazil.
- Gynecological Endocrinology Unit, Division of Endocrinology, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil.
- Department of Physiology, Laboratory of Molecular Endocrinology, Federal University of Rio Grande Do Sul (UFRGS), Porto Alegre, Brazil.
- Division of Endocrinology, Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos 2350, Porto Alegre, Rio Grande Do Sul, 90035-003, Brazil.
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13
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Nyasordzi J, Conrad J, Goletzke J, Ludwig-Walz H, Herder C, Roden M, Wudy SA, Hua Y, Remer T, Buyken AE. Early life factors and their relevance for markers of cardiometabolic risk in early adulthood. Nutr Metab Cardiovasc Dis 2021; 31:2109-2121. [PMID: 34023180 DOI: 10.1016/j.numecd.2021.03.024] [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: 01/06/2021] [Revised: 03/09/2021] [Accepted: 03/25/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND AND AIMS Early life exposures could be pertinent risk factors of cardiometabolic diseases in adulthood. We assessed the prospective associations of early life factors with markers of cardiometabolic risk among healthy German adults. METHODS AND RESULTS We examined 348 term-born DONALD Study participants with measurement of fasting blood at the age of 18-24 years to assess metabolic indices: fatty liver index (FLI), hepatic steatosis index (HSI), pro-inflammatory score and insulin sensitivity (HOMA2-%S). Early life factors (maternal weight in early pregnancy, maternal early pregnancy BMI, gestational weight gain (GWG), maternal age, birth weight and full breastfeeding (>17 weeks)) were assessed at enrolment of the offspring into the study. Multivariable linear regression models were used to analyze associations between early life factors and markers of cardiometabolic risk in early adulthood with adjustment for potential confounders. A higher early pregnancy BMI was related to notably higher levels of offspring FLI, HSI, pro-inflammatory score and a lower HOMA2-%S (all p < 0.0001). Similarly, a higher gestational weight gain was associated with a higher FLI (p = 0.044), HSI (p = 0.016), pro-inflammatory score (p = 0.032) and a lower HOMA2-%S among females (p = 0.034). Full breastfeeding was associated with a lower adult FLI (p = 0.037). A casual mediation analysis showed that these associations were mediated by offspring adult waist circumference (WC). CONCLUSION This study suggests that early pregnancy BMI, gestational weight gain, and full breastfeeding are relevant for offspring markers of cardiometabolic risk which seems to be mediated by body composition in young adulthood.
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Affiliation(s)
- Juliana Nyasordzi
- Department of Sports and Health, Institute of Nutrition, Consumption and Health, Paderborn University, Germany; University of Health and Allied Sciences, Ho, Volta Region, Ghana.
| | - Johanna Conrad
- Institute of Nutritional and Food Sciences, Nutritional Epidemiology, University of Bonn, Bonn, Germany.
| | - Janina Goletzke
- Department of Sports and Health, Institute of Nutrition, Consumption and Health, Paderborn University, Germany.
| | - Helena Ludwig-Walz
- DONALD Study Dortmund, Department of Nutrition and Food Sciences (IEL), Nutritional Epidemiology, University of Bonn, Dortmund, Germany; Department of Nutritional, Food and Consumer Sciences, Fulda University of Applied Sciences, Germany.
| | - Christian Herder
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany; Pediatric Endocrinology and Diabetology, Laboratory for Translational Hormone Analytics, Peptide Hormone Research Unit, Center of Child and Adolescent Medicine, Justus Liebig University Giessen, Germany; German Center for Diabetes Research (DZD), München-Neuherberg, Germany; Division of Endocrinology and Diabetology, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany.
| | - Michael Roden
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany; Pediatric Endocrinology and Diabetology, Laboratory for Translational Hormone Analytics, Peptide Hormone Research Unit, Center of Child and Adolescent Medicine, Justus Liebig University Giessen, Germany; German Center for Diabetes Research (DZD), München-Neuherberg, Germany; Division of Endocrinology and Diabetology, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany.
| | - Stefan A Wudy
- Pediatric Endocrinology and Diabetology, Laboratory for Translational Hormone Analytics, Peptide Hormone Research Unit, Center of Child and Adolescent Medicine, Justus Liebig University Giessen, Germany.
| | - Yifan Hua
- DONALD Study Dortmund, Department of Nutrition and Food Sciences (IEL), Nutritional Epidemiology, University of Bonn, Dortmund, Germany; Department of Nutritional, Food and Consumer Sciences, Fulda University of Applied Sciences, Germany.
| | - Thomas Remer
- DONALD Study Dortmund, Department of Nutrition and Food Sciences (IEL), Nutritional Epidemiology, University of Bonn, Dortmund, Germany; Department of Nutritional, Food and Consumer Sciences, Fulda University of Applied Sciences, Germany.
| | - Anette E Buyken
- Department of Sports and Health, Institute of Nutrition, Consumption and Health, Paderborn University, Germany.
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14
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Della Corte KA, Penczynski K, Kuhnle G, Perrar I, Herder C, Roden M, Wudy SA, Remer T, Alexy U, Buyken AE. The Prospective Association of Dietary Sugar Intake in Adolescence With Risk Markers of Type 2 Diabetes in Young Adulthood. Front Nutr 2021; 7:615684. [PMID: 33537338 PMCID: PMC7848860 DOI: 10.3389/fnut.2020.615684] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 12/18/2020] [Indexed: 12/14/2022] Open
Abstract
Purpose: To examine the prospective relevance of dietary sugar intake (based on dietary data as well as urinary excretion data) in adolescent years for insulin sensitivity and biomarkers of inflammation in young adulthood. Methods: Overall 254 participants of the DONALD study who had at least two 3-day weighed dietary records for calculating intakes of fructose, glucose, sucrose, total, free, added sugars, total sugars from sugar-sweetened beverages (SSB), juice, and sweets/sugar or at least two complete 24 h urine samples (n = 221) for calculating sugar excretion (urinary fructose and urinary fructose + sucrose) in adolescence (females: 9–15 years, males: 10–16 years) and a fasting blood sample in adulthood (18–36 years), were included in multivariable linear regression analyses assessing their prospective associations with adult homeostasis model assessment insulin sensitivity (HOMA2-%S) and a pro-inflammatory score (based on CRP, IL-6, IL-18, leptin, chemerin, adiponectin). Results: On the dietary intake level, no prospective associations were observed between adolescent fructose, sucrose, glucose, added, free, total sugar, or total sugar from SSB, juice or sweets/sugar intake and adult HOMA2-%S (p > 0.01). On the urinary level, however, higher excreted fructose levels were associated with improved adult HOMA2-%S (p = 0.008) among females only. No associations were observed between dietary or urinary sugars and the adult pro-inflammatory score (p > 0.01). Conclusion: The present study did not provide support that dietary sugar consumed in adolescence is associated with adult insulin sensitivity. The one potential exception was the moderate dietary consumption of fructose, which showed a beneficial association with adult fasting insulin and insulin sensitivity.
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Affiliation(s)
| | - Katharina Penczynski
- Public Health Nutrition, Paderborn University, Paderborn, Germany.,Department of Food Safety, German Federal Institute for Risk Assessment (BfR), Berlin, Germany
| | - Gunter Kuhnle
- Department of Food & Nutritional Sciences, Whiteknights, University of Reading, Reading, United Kingdom
| | - Ines Perrar
- DONALD Study, Nutritional Epidemiology, University of Bonn, Dortmund, Germany
| | - Christian Herder
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University, Düsseldorf, Germany.,German Center for Diabetes Research (DZD), Oberschleissheim, Germany.,Division of Endocrinology and Diabetology, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Michael Roden
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University, Düsseldorf, Germany.,German Center for Diabetes Research (DZD), Oberschleissheim, Germany.,Division of Endocrinology and Diabetology, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Stefan A Wudy
- Pediatric Endocrinology and Diabetology, Laboratory for Translational Hormone Analytics, Center of Child and Adolescent Medicine, Justus Liebig University Giessen, Giessen, Germany
| | - Thomas Remer
- DONALD Study, Nutritional Epidemiology, University of Bonn, Dortmund, Germany
| | - Ute Alexy
- DONALD Study, Nutritional Epidemiology, University of Bonn, Dortmund, Germany
| | - Anette E Buyken
- Public Health Nutrition, Paderborn University, Paderborn, Germany
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15
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Dong Y, Zou Z, Wang H, Dong B, Hu P, Ma Y, Song Y, Ma J. National School-Based Health Lifestyles Intervention in Chinese Children and Adolescents on Obesity and Hypertension. Front Pediatr 2021; 9:615283. [PMID: 34123956 PMCID: PMC8192970 DOI: 10.3389/fped.2021.615283] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 04/15/2021] [Indexed: 12/28/2022] Open
Abstract
Introduction: This study aimed to examine the effectiveness of the national school-based intervention on both obesity and high blood pressure in Chinese children and adolescents aged 6-18 years. Methods: The national school-based cluster non-randomized controlled trial was done in seven provinces from September 2013 to February 2014. A total of 23,175 children and adolescents in the control group and 25,702 in the intervention group were included in this trial with a mean follow-up of 6.7 ± 0.9 months. Mixed-effects regression models were used to evaluate the effect of the interventions on body weight and blood pressure (BP). Results: A significant upward in the body mass index (BMI) levels but downward in systolic BP (SBP), diastolic BP (DBP), BMI Z-scores, SBP Z-scores, and DBP Z-scores were witnessed in the intervention group compared to those in the control group (<0.001). Subgroup analyses presented significant intervention effects in children aged 6-12 years for BMI, SBP, DBP, and their standardized values Z-scores, but no effective results were found in adolescents aged 13-18 years. Stratification analyses based on the dynamic weight changes presented non-differential HBP, SHBP, and DHBP prevalence gaps between the control and intervention groups. Children aged 6-12 years with higher BMI percentiles at baseline presented obvious declines in SBP and DBP standardized values Z-scores. Conclusion: A mean 6-month multi-centered school-based comprehensive obesity intervention in China yields a small to null effect on obesity and hypertension with increasing age; the early age before 12 years may be the key period for interventions, and the younger, the better. Precise and high-intensity interventions targeting the population at different stages of childhood and adolescence are urgently needed to be developed. Clinical Trial Registration: https://www.clinicaltrials.gov/, identifier: NCT02343588.
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Affiliation(s)
- Yanhui Dong
- School of Public Health, Institute of Child and Adolescent Health, Peking University, Beijing, China
| | - Zhiyong Zou
- School of Public Health, Institute of Child and Adolescent Health, Peking University, Beijing, China
| | - Haijun Wang
- Department of Maternal and Child Health, School of Public Health, Peking University, Beijing, China
| | - Bin Dong
- School of Public Health, Institute of Child and Adolescent Health, Peking University, Beijing, China
| | - Peijin Hu
- School of Public Health, Institute of Child and Adolescent Health, Peking University, Beijing, China
| | - Yinghua Ma
- School of Public Health, Institute of Child and Adolescent Health, Peking University, Beijing, China
| | - Yi Song
- School of Public Health, Institute of Child and Adolescent Health, Peking University, Beijing, China
| | - Jun Ma
- School of Public Health, Institute of Child and Adolescent Health, Peking University, Beijing, China
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16
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Coles N, Patel BP, Birken C, Hanley AJ, Retnakaran R, K Hamilton J. Determinants of insulin resistance in children exposed to gestational diabetes in utero. Pediatr Diabetes 2020; 21:1150-1158. [PMID: 32808724 DOI: 10.1111/pedi.13104] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 07/28/2020] [Accepted: 08/12/2020] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND The evolution of increased adiposity and cardiometabolic risk in offspring exposed to maternal gestational diabetes (GDM) is not well understood. OBJECTIVE (a) To evaluate the impact of in utero exposure to GDM and maternal weight status on homeostasis model assessment of insulin resistance (HOMA-IR) in the offspring longitudinally from 1 to 3 years of age and (b) to compare body mass index (BMI) and HOMA-IR in GDM and non-GDM exposed offspring at 1 and 3 years of age. METHODS A prospective cohort of children born to mothers with and without GDM underwent metabolic characterization between birth and 3 years of age. RESULTS In the overall cohort, weight gain between birth and 3 years of age was positively associated with HOMA-IR (β = 0.1491, P = .02), independent of maternal weight status. HOMA-IR was not different between GDM and non-GDM exposed children from 1 to 3 years of age; however, BMI z score was greater in GDM exposed children at 3 years of age. Among non-GDM exposed children, male sex predicted a 35.1% lower HOMA-IR (P = .03). In GDM exposed offspring, a 1 unit increase in maternal insulin sensitivity predicted a 20.8% decrease in HOMA-IR (P = .002). CONCLUSIONS Overall, weight gain in the first 3 years of life was positively associated with HOMA-IR, while insulin sensitivity of mothers with GDM negatively predicted HOMA-IR in the offspring. Our findings indicate the need to target weight trajectories in early life, as well as maternal factors during gestation to improve metabolic outcomes in the offspring, particularly those exposed to GDM.
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Affiliation(s)
- Nicole Coles
- Division of Endocrinology, Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Barkha P Patel
- Division of Endocrinology, Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Catherine Birken
- Department of Nutritional Sciences, University of Toronto, Toronto, Canada.,Division of Paediatric Medicine, The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Anthony J Hanley
- Leadership Sinai Centre for Diabetes, Mount Sinai Hospital, Toronto, Canada.,Division of Endocrinology and Metabolism, University of Toronto, Toronto, Canada.,Department of Nutritional Sciences, University of Toronto, Toronto, Canada
| | - Ravi Retnakaran
- Leadership Sinai Centre for Diabetes, Mount Sinai Hospital, Toronto, Canada.,Division of Endocrinology and Metabolism, University of Toronto, Toronto, Canada.,Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Canada
| | - Jill K Hamilton
- Division of Endocrinology, Hospital for Sick Children, University of Toronto, Toronto, Canada
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17
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Luo HH, Feng XF, Yang XL, Hou RQ, Fang ZZ. Interactive effects of asparagine and aspartate homeostasis with sex and age for the risk of type 2 diabetes risk. Biol Sex Differ 2020; 11:58. [PMID: 33092635 PMCID: PMC7579815 DOI: 10.1186/s13293-020-00328-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Accepted: 09/01/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Asparagine and aspartate homeostasis are linked with type 2 diabetes (T2D). This study aimed to explore whether asparagine and aspartate metabolism interacted with sex and age to increase the risk of T2D. METHODS From 27 May 2015 to 3 August 2016, we consecutively retrieved 1032 T2D patients and 1522 subjects without T2D from a tertiary care hospital in Liaoning, China. Restricted cubic spline nested in the logistic regression was used to draw odds ratio curves of plasma asparagine to aspartate ratio for T2D by sex and age. Cut-off point was selected where curves went apart, indicating possible interaction. Addictive interactions of asparagine to aspartate ratio with sex or age and secondary interaction with copresence of unfavorable sex and age were further estimated using relative excess risk due to interaction (RERI), attributable proportion due to interaction (AP), and synergy index (S). RESULTS Ratio of asparagine to aspartate > 1.5 was associated with elevated risk of T2D (OR 7.99, 95%CI 5.50 to 11.6), which was enhanced by female gender to 13.6, (95%CI 8.10-22.9) and by > 50 years of age to 28.7 (14.6-56.3), with significant additive interactions. There was a significant secondary-interaction of copresence of female sex and > 50 years of age with high asparagine to aspartate ratio for increased T2D risk with the OR being further increased to 34.4 (20.5-57.5). CONCLUSIONS High asparagine to aspartate ratio was associated with markedly increased risk of T2D, which was further amplified by either female gender or > 50 years of age, and especially both.
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Affiliation(s)
- Hui-Huan Luo
- Department of Toxicology and Sanitary Chemistry, School of Public Health, Tianjin Medical University, Tianjin, 300070, China
| | - Xiao-Fei Feng
- Department of Toxicology and Sanitary Chemistry, School of Public Health, Tianjin Medical University, Tianjin, 300070, China
| | - Xi-Lin Yang
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China.,Tianjin Key Laboratory of Environment, Nutrition and Public Health, Tianjin, China
| | - Rui-Qin Hou
- Department of Blood Transfusion, Peking University People's Hospital, Beijing, China.
| | - Zhong-Ze Fang
- Department of Toxicology and Sanitary Chemistry, School of Public Health, Tianjin Medical University, Tianjin, 300070, China. .,Tianjin Key Laboratory of Environment, Nutrition and Public Health, Tianjin, China.
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18
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Schoelwer MJ, Robic JL, Gautier T, Fabris C, Carr K, Clancy-Oliveri M, Brown SA, Anderson SM, DeBoer MD, Cherñavvsky DR, Breton MD. Safety and Efficacy of Initializing the Control-IQ Artificial Pancreas System Based on Total Daily Insulin in Adolescents with Type 1 Diabetes. Diabetes Technol Ther 2020; 22:594-601. [PMID: 32119790 DOI: 10.1089/dia.2019.0471] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Objective: To assess the safety and efficacy of a simplified initialization for the Tandem t:slim X2 Control-IQ hybrid closed-loop system, using parameters based on total daily insulin ("MyTDI") in adolescents with type 1 diabetes under usual activity and during periods of increased exercise. Research Design and Methods: Adolescents with type 1 diabetes 12-18 years of age used Control-IQ for 5 days at home using their usual parameters. Upon arrival at a 60-h ski camp, participants were randomized to either continue Control-IQ using their home settings or to reinitialize Control-IQ with MyTDI parameters. Control-IQ use continued for 5 days following camp. The effect of MyTDI on continuous glucose monitoring outcomes were analyzed using repeated measures analysis of variance (ANOVA): baseline, camp, and at home. Results: Twenty participants were enrolled and completed the study; two participants were excluded from the analysis due to absence from ski camp (1) and illness (1). Time in range was similar between both groups at home and camp. A tendency to higher time <70 mg/dL in the MyTDI group was present but only during camp (median 3.8% vs. 1.4%, P = 0.057). MyTDI users with bolus/TDI ratios >40% tended to show greater time in the euglycemic range improvements between baseline and home than users with ratios <40% (+16.3% vs. -9.0%, P = 0.012). All participants maintained an average of 95% time in closed loop (84.1%-100%). Conclusions: MyTDI is a safe, effective, and easy way to determine insulin parameters for use in the Control-IQ artificial pancreas. Future modifications to account for the influence of carbohydrate intake on MyTDI calculations might further improve time in range.
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Affiliation(s)
- Melissa J Schoelwer
- Center for Diabetes Technology, University of Virginia, Charlottesville, Virginia
- Department of Pediatrics, University of Virginia
| | - Jessica L Robic
- Center for Diabetes Technology, University of Virginia, Charlottesville, Virginia
| | - Thibault Gautier
- Center for Diabetes Technology, University of Virginia, Charlottesville, Virginia
| | - Chiara Fabris
- Center for Diabetes Technology, University of Virginia, Charlottesville, Virginia
| | - Kelly Carr
- Center for Diabetes Technology, University of Virginia, Charlottesville, Virginia
| | - Mary Clancy-Oliveri
- Center for Diabetes Technology, University of Virginia, Charlottesville, Virginia
| | - Sue A Brown
- Center for Diabetes Technology, University of Virginia, Charlottesville, Virginia
- Division of Endocrinology, Department of Medicine, University of Virginia
| | - Stacey M Anderson
- Center for Diabetes Technology, University of Virginia, Charlottesville, Virginia
- Division of Endocrinology, Department of Medicine, University of Virginia
| | - Mark D DeBoer
- Center for Diabetes Technology, University of Virginia, Charlottesville, Virginia
| | - Daniel R Cherñavvsky
- Center for Diabetes Technology, University of Virginia, Charlottesville, Virginia
- Dexcom, Inc., San Diego, California
| | - Marc D Breton
- Center for Diabetes Technology, University of Virginia, Charlottesville, Virginia
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19
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Kelsey MM, Pyle L, Hilkin A, Severn CD, Utzschneider K, Van Pelt RE, Nadeau KJ, Zeitler PS. The Impact of Obesity On Insulin Sensitivity and Secretion During Pubertal Progression: A Longitudinal Study. J Clin Endocrinol Metab 2020; 105:5717690. [PMID: 31996919 PMCID: PMC7236627 DOI: 10.1210/clinem/dgaa043] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 01/27/2020] [Indexed: 11/19/2022]
Abstract
CONTEXT Physiologic changes in glucose metabolism are well-described to occur during puberty. However, there are important gaps in understanding the interaction between obesity and the normal physiologic changes during puberty, as well as how these changes could contribute to the increased risk of comorbidities, such as type 2 diabetes and dyslipidemia, in youth with obesity. OBJECTIVE The objective of this study was to compare longitudinal changes in insulin sensitivity (Si) and secretion during pubertal progression in youth with obesity versus those with normal weight. DESIGN Longitudinal observational study evaluating youth from early puberty (Tanner [T]2-T3) until puberty completion (T5). SETTING Pediatric academic hospital Clinical Translational Research Center. PARTICIPANTS Pubertal youth with normal weight (n = 47; 22 female, 25 male) and obesity (n = 37; 23 female, 14 male). MAIN OUTCOME MEASURES Si, insulin response (acute insulin response to glucose, AIRg) and disposition index (DI) by intravenous glucose tolerance test at baseline (T2-T3), T4, and T5. RESULTS Youth with obesity had significantly lower Si and higher AIRg at each time point (P < 0.001), but DI was similar between the groups. There were no group differences in trajectory of Si, AIRg or DI over time. Leptin, insulin-like growth factor-1, and obesity were most strongly associated with Si and AIRg at all time points. CONCLUSIONS Obesity significantly impacts Si during puberty, even at the earliest stages. However, in general, obese youth have adequate β-cell compensation for the significantly reduced Si of puberty. Future studies are needed to better predict the subset of youth who fail to maintain β-cell compensation during puberty.
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Affiliation(s)
- Megan M Kelsey
- University of Colorado School of Medicine, Department of Pediatrics, Aurora, Colorado
- Correspondence and Reprint Requests: Megan M. Kelsey MD, MS, University of Colorado Anschutz Medical Campus, Department of Pediatrics, 13123 East 16th Avenue, B265, Aurora, CO 80045. E-mail:
| | - Laura Pyle
- University of Colorado School of Medicine, Department of Biostatistics, Aurora, Colorado
| | - Allison Hilkin
- University of Colorado School of Medicine, Department of Pediatrics, Aurora, Colorado
| | - Cameron D Severn
- University of Colorado School of Medicine, Department of Biostatistics, Aurora, Colorado
| | - Kristina Utzschneider
- VA Puget Sound and the University of Washington, Department of Medicine, Seattle, Washington
| | - Rachael E Van Pelt
- University of Colorado School of Medicine, Department of Medicine, Aurora, Colorado
| | - Kristen J Nadeau
- University of Colorado School of Medicine, Department of Pediatrics, Aurora, Colorado
| | - Philip S Zeitler
- University of Colorado School of Medicine, Department of Pediatrics, Aurora, Colorado
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20
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Baghersalimi M, Fathi R, Kazemi S. The effect of eight-week walking program on plasma levels of amino acids in early/mid pubertal obese girls. Med J Islam Repub Iran 2020; 33:128. [PMID: 32280634 PMCID: PMC7137814 DOI: 10.34171/mjiri.33.128] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Indexed: 01/17/2023] Open
Abstract
Background: Altered circulating amino acids levels have been observed in metabolic disorders, like obesity, type-2 diabetes, and other insulin-resistant states. This study aimed to investigate the effect of 8-week walking on plasma amino acids (PAAs) in obese girls. Methods: This clinical trial study (IRCT20180928041160N1) was conducted on 32 early/mid pubertal obese girls which they divided into interval-walking (IWG, n=12), continuous-walking (CWG, n=11) and control (CG, n=9) groups. The walking program (3- sessions/week for 8-weeks) consists of 30-min walking with 70-85%HRmax and 60-75%HRmax, respectively in the IWG (2-min walking and 1-min active rest) and CWG. The concentration of PAAs was measured at baseline and 72-hours after the last session in fasting state, using high-performance liquid chromatography. A repeated measures ANCOVA (group (3) * time (2)) with post hoc Bonferroni was used to analyze the data. Results: More the PAAs were not affected by interval or continuous walking training. A significant increase in lysine (p=0.003, 95%CI 24.08, 108.97) was observed only in the CG, and there was a significant difference between the CG and CWG (p=0.032). Global arginine bioavailability (GABA) significantly decreased in the CG (P<0.001, 95%CI -0.65, -0.21) and the IWG (p=0.004, 95%CI -0.60, -0.21). A significant increase in weight (p=0.043, 95%CI 0.27, 1.46), insulin (p=0.046, 95%CI -0.91, 9.01), and HOMA-IR (p=0.007, 95%CI 0.26, 2.63) were found only in the CG, and both insulin and HOMA-IR tended to decline in the CWG. Conclusion: Except for lysine and GABA, all groups roughly showed similar changes in more amino acids. Continuous-walking could improve the plasma level of lysine and GABA, which along with an improvement of fasting insulin levels and HOMA-IR.
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Affiliation(s)
- Masoumeh Baghersalimi
- Department of Exercise Physiology, Faculty of Sport Sciences, University of Mazandaran, Babolsar, Iran
| | - Rozita Fathi
- Department of Exercise Physiology, Faculty of Sport Sciences, University of Mazandaran, Babolsar, Iran
| | - Sohrab Kazemi
- Cellular and Molecular Biology Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
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21
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22
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Huebschmann AG, Huxley RR, Kohrt WM, Zeitler P, Regensteiner JG, Reusch JEB. Sex differences in the burden of type 2 diabetes and cardiovascular risk across the life course. Diabetologia 2019; 62:1761-1772. [PMID: 31451872 PMCID: PMC7008947 DOI: 10.1007/s00125-019-4939-5] [Citation(s) in RCA: 185] [Impact Index Per Article: 37.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2019] [Accepted: 05/29/2019] [Indexed: 12/11/2022]
Abstract
By 2017 estimates, diabetes mellitus affects 425 million people globally; approximately 90-95% of these have type 2 diabetes. This narrative review highlights two domains of sex differences related to the burden of type 2 diabetes across the life span: sex differences in the prevalence and incidence of type 2 diabetes, and sex differences in the cardiovascular burden conferred by type 2 diabetes. In the presence of type 2 diabetes, the difference in the absolute rates of cardiovascular disease (CVD) between men and women lessens, albeit remaining higher in men. Large-scale observational studies suggest that type 2 diabetes confers 25-50% greater excess risk of incident CVD in women compared with men. Physiological and behavioural mechanisms that may underpin both the observed sex differences in the prevalence of type 2 diabetes and the associated cardiovascular burden are discussed in this review. Gender differences in social behavioural norms and disparities in provider-level treatment patterns are also highlighted, but not described in detail. We conclude by discussing research gaps in this area that are worthy of further investigation.
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Affiliation(s)
- Amy G Huebschmann
- Center for Women's Health Research, University of Colorado School of Medicine, MS C263, 12348 E. Montview Boulevard, Aurora, CO, 80045, USA
- Division of General Internal Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Rachel R Huxley
- College of Science, Health and Engineering, La Trobe University, Melbourne, VIC, Australia
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
| | - Wendy M Kohrt
- Center for Women's Health Research, University of Colorado School of Medicine, MS C263, 12348 E. Montview Boulevard, Aurora, CO, 80045, USA
- Division of Geriatric Medicine, University of Colorado School of Medicine, Aurora, CO, USA
- Department of Medicine, Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, CO, USA
| | - Philip Zeitler
- Division of Pediatric Endocrinology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Judith G Regensteiner
- Center for Women's Health Research, University of Colorado School of Medicine, MS C263, 12348 E. Montview Boulevard, Aurora, CO, 80045, USA
- Division of General Internal Medicine, University of Colorado School of Medicine, Aurora, CO, USA
- Division of Cardiology, University of Colorado School of Medicine (CU-SOM), Aurora, CO, USA
| | - Jane E B Reusch
- Center for Women's Health Research, University of Colorado School of Medicine, MS C263, 12348 E. Montview Boulevard, Aurora, CO, 80045, USA.
- Department of Medicine, Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, CO, USA.
- Division of Endocrinology, Metabolism and Diabetes, University of Colorado School of Medicine, Aurora, CO, USA.
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23
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Aris IM, Rifas-Shiman SL, Li LJ, Kleinman KP, Coull BA, Gold DR, Hivert MF, Kramer MS, Oken E. Patterns of body mass index milestones in early life and cardiometabolic risk in early adolescence. Int J Epidemiol 2019; 48:157-167. [PMID: 30624710 PMCID: PMC6380298 DOI: 10.1093/ije/dyy286] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/18/2018] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Few studies have examined the independent and combined relationships of body mass index (BMI) peak and rebound with adiposity, insulin resistance and metabolic risk later in life. We used data from Project Viva, a well-characterized birth cohort from Boston with repeated measures of BMI, to help fill this gap. METHODS Among 1681 children with BMI data from birth to mid childhood, we fitted individual BMI trajectories using mixed-effects models with natural cubic splines and estimated age, and magnitude of BMI, at peak (in infancy) and rebound (in early childhood). We obtained cardiometabolic measures of the children in early adolescence (median 12.9 years) and analysed their associations with the BMI parameters. RESULTS After adjusting for potential confounders, age and magnitude at infancy BMI peak were associated with greater adolescent adiposity, and earlier adiposity rebound was strongly associated with greater adiposity, insulin resistance and metabolic risk score independently of BMI peak. Children with a normal timing of BMI peak plus early rebound had an adverse cardiometabolic profile, characterized by higher fat mass index {β 2.2 kg/m2 [95% confidence interval (CI) 1.6, 2.9]}, trunk fat mass index [1.1 kg/m2 (0.8, 1.5)], insulin resistance [0.2 units (0.04, 0.4)] and metabolic risk score [0.4 units (0.2, 0.5)] compared with children with a normal BMI peak and a normal rebound pattern. Children without a BMI peak (no decline in BMI after the rise in infancy) also had adverse adolescent metabolic profiles. CONCLUSIONS Early age at BMI rebound is a strong risk factor for cardiometabolic risk, independent of BMI peak. Children with a normal peak-early rebound pattern, or without any BMI decline following infancy, are at greatest risk of adverse cardiometabolic profile in adolescence. Routine monitoring of BMI may help to identify children who are at greatest risk of developing an adverse cardiometabolic profile in later life and who may be targeted for preventive interventions.
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Affiliation(s)
- Izzuddin M Aris
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
- Department of Obstetrics and Gynecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore, Singapore
| | - Sheryl L Rifas-Shiman
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - Ling-Jun Li
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
- Division of Obstetrics and Gynecology, KK Women’s and Children’s Hospital, Singapore, Singapore
- Obstetrics and Gynecology Academic Clinical Programme, Duke-NUS Medical School, Singapore, Singapore
| | - Ken P Kleinman
- Department of Biostatistics and Epidemiology, School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, MA, USA
| | - Brent A Coull
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Diane R Gold
- Channing Division of Network Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
- Department of Environmental Medicine, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Marie-France Hivert
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
- Diabetes Unit, Massachusetts General Hospital, Boston, MA, USA
| | - Michael S Kramer
- Department of Obstetrics and Gynecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Departments of Pediatrics
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University Faculty of Medicine, Montreal, QC, Canada
| | - Emily Oken
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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24
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Nakiriba R, Mayega RW, Piloya T, Nabukeera-Barungi N, Idro R. Prevalence and factors associated with dysglycemia among girls in selected boarding secondary schools in Wakiso District, Uganda. Adolesc Health Med Ther 2018; 9:167-176. [PMID: 30464672 PMCID: PMC6211585 DOI: 10.2147/ahmt.s178746] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND There is limited information on dysglycemia in adolescents in low-income countries. The objective of this study was to determine the prevalence and factors associated with dysglycemia among boarding secondary school adolescent girls in a peri-urban district. METHODS The design was a cross-sectional survey. A total of 688 adolescents from four randomly selected girls-only boarding secondary schools in Wakiso District, Uganda, participated in this study. Fasting plasma glucose, body mass index (BMI), and blood pressure (BP) were measured. A questionnaire was used to assess demographic and lifestyle factors. Suspected dysglycemia was defined using the American Diabetes Association cutoff of fasting glucose ≥5.6 mmol/L. Overweight and hypertension were defined being above two SDs or the 95th percentile of the WHO BMI for age and BP for age reference charts, respectively. Logistic regression was used to determine the factors independently associated with dysglycemia. RESULTS The mean age of the participants was 15.4 years (SD=1.7 years). Probable dysglycemia was found in 44 of 688 (6.4%) participants, ranging from 3.5% in the least affluent school to 9.8% in the most affluent school. No case of type 2 diabetes was found. 11.6% of the participants were found to have probable hypertension. Dysglycemia was higher in adolescents who were overweight (adjusted OR [AOR] 2.3; 95% CI 1.22-4.48), those with hypertension (AOR 4.0; 95% CI 1.86-8.45), and those who frequently stocked biscuits (AOR 3.0; 95% CI 1.21-7.28). Dysglycemia was lower in older adolescents (AOR 0.3; 95% CI 0.10-0.86) and those who took water with meals (AOR 3.0; 95% CI 1.21-7.28). CONCLUSION In these predominantly peri-urban boarding secondary schools, 6.4% of the adolescent girls have probable dysglycemia. As Africa undergoes the epidemiological transition, there is a need for closer surveillance for diabetes and hypertension in peri-urban schools and school health measures against lifestyle diseases.
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Affiliation(s)
- Rhoda Nakiriba
- Department of Paediatrics and Child Health, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Roy William Mayega
- Department of Epidemiology and Biostatistics, School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda,
| | - Thereza Piloya
- Department of Paediatrics and Child Health, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Nicolette Nabukeera-Barungi
- Department of Paediatrics and Child Health, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Richard Idro
- Department of Paediatrics and Child Health, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
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Short KR, Pratt LV, Teague AM. A single exercise session increases insulin sensitivity in normal weight and overweight/obese adolescents. Pediatr Diabetes 2018; 19:10.1111/pedi.12684. [PMID: 29687558 PMCID: PMC6201285 DOI: 10.1111/pedi.12684] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Revised: 03/15/2018] [Accepted: 04/16/2018] [Indexed: 01/30/2023] Open
Abstract
We measured the effect of an aerobic exercise session on postprandial glucose control in adolescents with habitually low-physical activity. The goal was to determine if the acute or residual response of exercise was altered in people who are overweight/obese (OW/Ob). Eleven normal weight, body mass index (NW, BMI = 48 ± 13 percentile) and 12 OW/Ob (BMI = 91 ± 5 percentile) participants completed 3 trials. In the no exercise (No Ex) trial, participants rested quietly before and after consuming a test meal. In the other 2 trials, a 45-minute aerobic exercise session was performed either 17-hour (Prior Day Ex) or 40 minutes (Same Day Ex) before the test meal. On all trials, the OW/Ob group had higher fasting glucose (~6%) and insulin (~66%), and lower insulin sensitivity (~9%) than the NW group. The Same Day Ex and Prior Day Ex trials resulted in reduced area under the curve for glucose (6% on both trials, P < .01) and insulin (15% and 13%, respectively, P < .03), and increased insulin sensitivity (8% and 6%, respectively, P < .01). The magnitudes of those effects did not differ between the NW and OW/Ob groups. Plasma fatty acids declined and carbohydrate oxidation increased after the meal, but did not differ among trials or groups. The results demonstrate that moderate intensity aerobic exercise increases insulin sensitivity in NW and OW/Ob adolescents and that the beneficial effects of exercise last up to 17 hours. The acute impact of exercise on metabolic health in adolescents is not impaired in overweight/obese participants.
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Affiliation(s)
- Kevin R. Short
- Section of Diabetes/Endocrinology, Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73104, United States of America
| | - Lauren V. Pratt
- Section of Diabetes/Endocrinology, Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73104, United States of America
| | - April M. Teague
- Section of Diabetes/Endocrinology, Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73104, United States of America
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Dalla Valle M, Laatikainen T, Potinkara H, Nykänen P, Jääskeläinen J. Girls and Boys Have a Different Cardiometabolic Response to Obesity Treatment. Front Endocrinol (Lausanne) 2018; 9:579. [PMID: 30333791 PMCID: PMC6176006 DOI: 10.3389/fendo.2018.00579] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 09/11/2018] [Indexed: 01/22/2023] Open
Abstract
Background: Childhood obesity exposes individuals to cardiometabolic disturbances. We analyzed how family-based multidisciplinary obesity treatment influenced children's cardiometabolic health. Materials and methods: In this retrospective, two-year, follow-up study of 654 2- to 18-year-old children treated for obesity in three Finnish pediatric clinics in 2005-2012, blood pressure (BP), metabolic parameters, and the influence of sex, puberty and a change in body mass index standard deviation score (BMI SDS) were analyzed. Results: At baseline, at least one cardiovascular risk factor was present in 474 (80%) cases. Boys presented with more significant changes in cardiometabolic parameters than girls during the treatment. Boys' total cholesterol (TC) improved by 12 months (P = 0.009), and their low-density lipoprotein C (LDL-C) and glycosylated hemoglobin ameliorated by 12 months (P = 0.030 and 0.022, respectively) and 24 months (P = 0.043 and 0.025, respectively). Boys' triglycerides, insulin, homeostasis model assessment for insulin resistance (HOMA-IR) and systolic BP deteriorated at 24 months (P < 0.001, 0.004, 0.002, and 0.037, respectively). In all children, the number of acceptable TC, LDL-C, insulin, and HOMA-IR values increased if BMI SDS reduced 0.25 or more by 12 months. Conclusion: Minor cardiometabolic improvements were found during the obesity treatment. These findings indicate the need to assess treatment methods and focus on prevention.
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Affiliation(s)
- Marketta Dalla Valle
- Department of Pediatrics, North Karelia Central Hospital, Joensuu, Finland
- Siun Sote - the Joint Municipal Authority for North Karelia Social and Health Services, Joensuu, Finland
- Department of Pediatrics, University of Eastern Finland, Kuopio, Finland
- *Correspondence: Marketta Dalla Valle
| | - Tiina Laatikainen
- Siun Sote - the Joint Municipal Authority for North Karelia Social and Health Services, Joensuu, Finland
- Health Department, National Institute for Health and Welfare, Helsinki, Finland
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Hanna Potinkara
- School of Medicine, University of Eastern Finland, Kuopio, Finland
| | - Päivi Nykänen
- Department of Pediatrics, Mikkeli Central Hospital, Mikkeli, Finland
| | - Jarmo Jääskeläinen
- Department of Pediatrics, University of Eastern Finland, Kuopio, Finland
- Department of Pediatrics, Kuopio University Hospital, Kuopio, Finland
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