Deletional types of alpha-thalassaemia in central Java

Absence of insulin-induced vasodilation of internal carotid artery in type 2 diabetes

BACKGROUND

Impaired cerebrovascular reserve could contribute to the increased risk of strokes in type 2 diabetes. We have shown a vasodilatory effect of insulin on the internal carotid artery in healthy subjects. As absence of this effect could be responsible for the impairment of cerebral blood flow reserve demonstrated in this population, we have now investigated the effect of insulin on the internal carotid artery of type 2 diabetics.

METHODS

Internal carotid artery diameter was continuously monitored, using a 7.5-MHz transducer linked to an Acuson XP10 ultrasonograph, during the infusion of 125 mL of 10% dextrose with 3 units of regular insulin and 5 mmol of potassium chloride, over 1 h.

RESULTS

The internal carotid artery diameter increased progressively from 5.4 +/- 1 to 6 +/- 1 mm at 60 min in controls (p < 0.05), an increase of 10% over baseline, while there was no dilatation in type 2 diabetes group; 6.6 +/- 1 mm at baseline and at 60 min. The response in type 2 diabetics was significantly impaired compared to controls. Glucose levels were maintained at 114-131 mg/dL in type 2 diabetics and at 73-124 mg/dL in controls. There was no change in MABP or heart rate during the infusion.

CONCLUSIONS

We conclude that insulin-induced dilation of internal carotid artery is absent in type 2 diabetes and that lack of this beneficial effect may contribute to the increased risk and the mortality and morbidity associated with stroke in this population.

The high prevalence of low hemoglobin concentration among Indonesian infants aged 3-5 months is related to maternal anemia

Iron deficiency anemia among young children is a large health problem. However, there is little information about the prevalence of anemia among young infants because it has been assumed that normal, breast-fed infants have adequate iron stores until 4-6 mo of age. We analyzed cross-sectional data from the HKI/GOI Nutrition and Health Surveillance System in rural Java, Indonesia from Sept. 1999 to Feb. 2001 for hemoglobin (Hb) of 3- to 5-mo-old breast-fed infants (n = 990) and related factors. The prevalence of Hb < 90 g/L was 13.4%, < 100 g/L, 37%, and < 110 g/L, 71%. Multiple logistic regression analysis revealed that normal birth weight infants (>2500 g) of anemic mothers (Hb < 120 g/L) had an odds ratio (OR) [95% confidence interval (CI)] of 1.81 [1.34-2.43] to have a low Hb (< 100 g/L) compared with infants of nonanemic mothers with a normal birth weight. Infants of nonanemic mothers but with low birth weight had an OR of 1.15 [0.61-2.16], and those with low birth weight and anemic mothers of 3.68 [1.69-8.02]. Other risk factors included stunting (OR 1.70 [0.97-2.95]), a young mother (<20 y, OR 1.54 [0.95-2.49]), lower maternal education and living in West Java or East Java. Considering that maternal postpartum Hb reflects Hb during pregnancy, that anemia among mothers in this population is due mainly to iron deficiency, and that children born to anemic mothers are at higher risk of a low Hb, we hypothesize that low infant Hb in this population is due to iron deficiency. Intervention studies in iron deficient populations should test this hypothesis.