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Rao H, Jalali JA, Johnston TP, Koulen P. Emerging Roles of Dyslipidemia and Hyperglycemia in Diabetic Retinopathy: Molecular Mechanisms and Clinical Perspectives. Front Endocrinol (Lausanne) 2021; 12:620045. [PMID: 33828528 PMCID: PMC8020813 DOI: 10.3389/fendo.2021.620045] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 01/25/2021] [Indexed: 12/20/2022] Open
Abstract
Diabetic retinopathy (DR) is a significant cause of vision loss and a research subject that is constantly being explored for new mechanisms of damage and potential therapeutic options. There are many mechanisms and pathways that provide numerous options for therapeutic interventions to halt disease progression. The purpose of the present literature review is to explore both basic science research and clinical research for proposed mechanisms of damage in diabetic retinopathy to understand the role of triglyceride and cholesterol dysmetabolism in DR progression. This review delineates mechanisms of damage secondary to triglyceride and cholesterol dysmetabolism vs. mechanisms secondary to diabetes to add clarity to the pathogenesis behind each proposed mechanism. We then analyze mechanisms utilized by both triglyceride and cholesterol dysmetabolism and diabetes to elucidate the synergistic, additive, and common mechanisms of damage in diabetic retinopathy. Gathering this research adds clarity to the role dyslipidemia has in DR and an evaluation of the current peer-reviewed basic science and clinical evidence provides a basis to discern new potential therapeutic targets.
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Affiliation(s)
- Hussain Rao
- Department of Ophthalmology, School of Medicine, Vision Research Center, University of Missouri – Kansas City, Kansas City, MO, United States
| | - Jonathan A. Jalali
- Department of Ophthalmology, School of Medicine, Vision Research Center, University of Missouri – Kansas City, Kansas City, MO, United States
| | - Thomas P. Johnston
- Department of Ophthalmology, School of Medicine, Vision Research Center, University of Missouri – Kansas City, Kansas City, MO, United States
- Division of Pharmacology and Pharmaceutical Sciences, School of Pharmacy, University of Missouri – Kansas City, Kansas City, MO, United States
| | - Peter Koulen
- Department of Ophthalmology, School of Medicine, Vision Research Center, University of Missouri – Kansas City, Kansas City, MO, United States
- Department of Biomedical Sciences, School of Medicine, University of Missouri – Kansas City, Kansas City, MO, United States
- *Correspondence: Peter Koulen,
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Li C, Zhou P, Cai Y, Peng B, Liu Y, Yang T, Li Y, Hu Y, Fu Y, Wang Z, Peng H, Zhang Y, Chen J, Li T, Chen L. Associations between gestational diabetes mellitus and the neurodevelopment of offspring from 1 month to 72 months: study protocol for a cohort study. BMJ Open 2020; 10:e040305. [PMID: 33234643 PMCID: PMC7689080 DOI: 10.1136/bmjopen-2020-040305] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Gestational diabetes mellitus (GDM) is a common gestational disease and an important global public health problem. GDM may affect the short-term and long-term health of offspring, but the associations between GDM and the neurodevelopment of offspring of mothers with GDM (OGDM) are still unclear, and studies based on the Chinese population are lacking. We aim to determine the associations between GDM and the neurodevelopment of OGDM by studying a cohort of OGDM and offspring of non-GDM mothers. METHODS AND ANALYSIS The single-centre prospective cohort study is being conducted in China over 7 years. A total of 490 OGDM (GDM group) and 490 fromof healthy mothers (control group) will be enrolled during the same period. Baseline characteristics, neuropsychological development scores and clinical data at specific time points (at 0, 1, 3, 6, 12, 24, 36, 48, 60 and 72 months old) will be collected from the children in both groups until the age of 6 years. The associations between GDM and the neurodevelopment of OGDM from infancy to preschool age will be analysed using a multiple linear regression model adjusted for confounders. In addition, we will compare longitudinal data to further assess the effects of GDM on neurodevelopmental trajectories. ETHICS AND DISSEMINATION The study has been approved by the Ethics Committee of the Children's Hospital of Chongqing Medical University (Approval Number: (2019) Institutional Review Board (IRB) (STUDY) No. 85). The findings of this study will be disseminated through open access journals, peer-reviewed journals and scientific meetings. TRIAL REGISTRATION NUMBER NCT03997396.
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Affiliation(s)
- Chao Li
- Growth, Development and Mental Health Center of Children and Adolescents, Children's Hospital of Chongqing Medical University; National Clinical Research Center for Child Health and Disorders; Ministry of Education Key Laboratory of Child Development and Disorders; Chongqing Key Laboratory of Child Health and Nutrition, Chongqing, China
- Department of Child Care, The First People's Hospital of Chongqing Liangjiang New Area, Chongqing, China
| | - Ping Zhou
- Growth, Development and Mental Health Center of Children and Adolescents, Children's Hospital of Chongqing Medical University; National Clinical Research Center for Child Health and Disorders; Ministry of Education Key Laboratory of Child Development and Disorders; Chongqing Key Laboratory of Child Health and Nutrition, Chongqing, China
| | - Yixi Cai
- Department of Child Care, The First People's Hospital of Chongqing Liangjiang New Area, Chongqing, China
| | - Bin Peng
- Department of Health Statistics, Chongqing Medical University, Chongqing, China
| | - Yongfang Liu
- Growth, Development and Mental Health Center of Children and Adolescents, Children's Hospital of Chongqing Medical University; National Clinical Research Center for Child Health and Disorders; Ministry of Education Key Laboratory of Child Development and Disorders; Chongqing Key Laboratory of Child Health and Nutrition, Chongqing, China
| | - Ting Yang
- Growth, Development and Mental Health Center of Children and Adolescents, Children's Hospital of Chongqing Medical University; National Clinical Research Center for Child Health and Disorders; Ministry of Education Key Laboratory of Child Development and Disorders; Chongqing Key Laboratory of Child Health and Nutrition, Chongqing, China
| | - Yinying Li
- Department of Child Care, The First People's Hospital of Chongqing Liangjiang New Area, Chongqing, China
| | - Yirong Hu
- Department of Outpatient, The First People's Hospital of Chongqing Liangjiang New Area, Chongqing, China
| | - Yajun Fu
- Department of Obstetrics, The First People's Hospital of Chongqing Liangjiang New Area, Chongqing, China
| | - Zhenming Wang
- Department of Obstetrics, The First People's Hospital of Chongqing Liangjiang New Area, Chongqing, China
| | - Hong Peng
- Department of Child Care, The First People's Hospital of Chongqing Liangjiang New Area, Chongqing, China
| | - Yue Zhang
- Department of Child Care, The First People's Hospital of Chongqing Liangjiang New Area, Chongqing, China
| | - Jie Chen
- Growth, Development and Mental Health Center of Children and Adolescents, Children's Hospital of Chongqing Medical University; National Clinical Research Center for Child Health and Disorders; Ministry of Education Key Laboratory of Child Development and Disorders; Chongqing Key Laboratory of Child Health and Nutrition, Chongqing, China
| | - Tingyu Li
- Growth, Development and Mental Health Center of Children and Adolescents, Children's Hospital of Chongqing Medical University; National Clinical Research Center for Child Health and Disorders; Ministry of Education Key Laboratory of Child Development and Disorders; Chongqing Key Laboratory of Child Health and Nutrition, Chongqing, China
| | - Li Chen
- Growth, Development and Mental Health Center of Children and Adolescents, Children's Hospital of Chongqing Medical University; National Clinical Research Center for Child Health and Disorders; Ministry of Education Key Laboratory of Child Development and Disorders; Chongqing Key Laboratory of Child Health and Nutrition, Chongqing, China
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Buffarini R, Barros AJD, Matijasevich A, Loret de Mola C, Santos IS. Gestational diabetes mellitus, pre-gestational BMI and offspring BMI z-score during infancy and childhood: 2004 Pelotas Birth Cohort. BMJ Open 2019; 9:e024734. [PMID: 31289054 PMCID: PMC6629409 DOI: 10.1136/bmjopen-2018-024734] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE Gestational diabetes mellitus (GDM) affects a significant number of women. Evidence regarding the association between GDM and offspring body mass index (BMI) is unclear due to small samples and lack of adequate confounding control. The objective of this study was to investigate the association between GDM and offspring BMI z-scores from birth to early adolescence and to examine the role of maternal pre-gestational BMI in this relationship. DESIGN Prospective study. SETTING Pelotas 2004 Birth Cohort, Brazil. PARTICIPANTS Cohort participants that were followed-up from birth up to early adolescence (~3500) and their mothers. PRIMARY OUTCOME MEASURES BMI z-scores at birth, 3, 12, 24, 48 months and 6 and 11 years of age, calculated according to the WHO growth charts. RESULTS Unadjusted and adjusted linear regressions were performed and interaction terms between maternal pre-gestational BMI and GDM were included. Prevalence of self-reported GDM was 2.6% (95% CI 2.1% to 3.1%). The offspring BMI z-scores (SD) at birth, 3, 12, 24, 48 months and at 6 and 11 years were 0.10 (1.12), -0.47 (1.10), 0.59 (1.10), 0.59 (1.08), 0.78 (1.32), 0.70 (1.43) and 0.75 (1.41), respectively. Unadjusted regression models showed positive associations between GDM and offspring BMI z-scores at birth, 6 and 11 years. After adjustment, the associations attenuated towards the null. Statistical evidence of effect modification between maternal pre-gestational BMI and GDM was observed at birth (p=0.007), with the association between GDM and offspring BMI z-score being apparent only in those children born to overweight or obese mothers (β=0.72, 95% CI 0.30 to 1.14 and β=0.61, 95% CI 0.20 to 1.01, respectively). CONCLUSIONS We observed that in the association between GDM and offspring BMI z-scores, there is a predominant role for maternal nutritional status before pregnancy and that the association between GDM and newborn's BMI is apparent only among those born to overweight or obese mothers.
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Affiliation(s)
- Romina Buffarini
- Postgraduate Program in Epidemiology, Federal University of Pelotas (UFPel), Pelotas, Rio Grande do Sul, Brazil
| | - Aluisio J D Barros
- Postgraduate Program in Epidemiology, Federal University of Pelotas (UFPel), Pelotas, Rio Grande do Sul, Brazil
| | | | | | - Ina S Santos
- Postgraduate Program in Epidemiology, Federal University of Pelotas (UFPel), Pelotas, Rio Grande do Sul, Brazil
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Abstract
Lipid is an essential macronutrient in parenteral nutrition (PN) support. intravenous (IV) lipid provides essential fatty acids and a concentrated calorie source. Preterm infants are at risk for essential fatty deficiency early in life. Lipid administration is associated with some risks, and there are guidelines for administration to minimize complications. Lipid emulsions in the United States are derived from soybean oil. Outside of the United States, lipid emulsions made from fish oil or combinations of fish, soybean, olive, and medium-chain triglycerides (MCTs) are under investigation for improved tolerance, lower plasma lipid levels, and improved fatty acid profiles, all of which are considered beneficial. Triglyceride levels are an important measurement to assess patient tolerance.
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Beall V, Hall B, Mulholland JT, Gephart SM. Neonatal Extravasation: An Overview and Algorithm for Evidence-based Treatment. ACTA ACUST UNITED AC 2013. [DOI: 10.1053/j.nainr.2013.09.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Al-Rafay SS, Al-Sharkawy SS. Educational outcomes associated with providing a comprehensive guidelines program about nursing care of preterm neonates receiving total parenteral nutrition. Clin Nurs Res 2011; 21:142-58. [PMID: 21828243 DOI: 10.1177/1054773811417314] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Poor understanding or practice of Total Parenteral Nutrition (TPN) causes devastating complications. Therefore, good Neonatal Intensive Care Unit (NICU) nursing care for preterm neonates and close monitoring of complications is essential for successful TPN therapy. The study was conducted in NICU at Ain Shams University Hospital in Cairo, Egypt, using a quasi-experimental research design with prepost intervention assessments. Data was collected using a self-administered questionnaire sheet and an observation checklist (prepost format) and developed a comprehensive guidelines program about nursing care of TPN of preterm neonates. Results revealed that the program had a significant positive impact on nurses' knowledge and practice outcomes.
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Hoff DS, Michaelson AS. Effects of light exposure on total parenteral nutrition and its implications in the neonatal population. J Pediatr Pharmacol Ther 2009; 14:132-43. [PMID: 23055901 DOI: 10.5863/1551-6776-14.3.132] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Total parenteral nutrition (TPN) is a necessary form of nutrition in neonates with functional or anatomical disruption of the digestive tract. However, laboratory and human investigation have shown that exposure of the TPN solution to light causes the formation of peroxides and other degradation products that are quantifiable in experimental TPN solutions, laboratory animals, and neonates. Premature neonates are at a higher risk for the development and progression of peroxide damage due to their relative lack of antioxidant and free radical scavenger reserves. Furthermore, cell damage seen in a number of neonatal disease states is exacerbated by the presence of peroxides that are generated via intrinsic pathologic processes and from exogenous sources such as TPN. Numerous studies show that the formation of TPN photodegradation products can be slowed or prevented by the application of various light protection mechanisms. While it is not yet known if minimizing TPN associated photodegradation byproducts has a significant direct effect on preventing or mitigating the overall clinical course of some neonatal disease states, it is becoming increasingly clear that light protecting TPN can avoid specific metabolic complications in neonatal patients. It is prudent to implement mechanisms that prevent photodegradation of TPN components from the manufacturer source to the point of patient administration.
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Affiliation(s)
- David S Hoff
- Pharmacy Department, Children's Hospitals and Clinics of Minnesota, Minneapolis, Minnesota
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Abstract
Free radical production occurs continuously in all cells as a by-product of cell metabolism. In tandem, the human body has developed endogenous antioxidant systems as well as taken advantage of dietary exogenous antioxidants to process and detoxify free radicals appropriately. However, certain conditions may increase free radical production beyond the body's endogenous and exogenous antioxidant systems. The neonatal period is a vulnerable time for free radical damage and injury, particularly for preterm infants whose antioxidant defense systems have not fully matured. Endogenous and passively acquired exogenous antioxidant defense systems do not accelerate in maturation until late in the third trimester. To explore the complexities of these concepts, this article includes a description, an evolutionary perspective of oxygen, and a basic background on free radical chemistry in biology. In addition, this chemistry is applied to the etiology of many of the most common diseases seen in the neonatal period. Finally, the current research addressing clinical strategies in this area is critically appraised. Implications for practice and directions for further research are presented with an emphasis on strategies that support the prudent use of oxygen therapies.
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Shin JI, Namgung R, Park MS, Lee C. Could lipid infusion be a risk for parenteral nutrition-associated cholestasis in low birth weight neonates? Eur J Pediatr 2008; 167:197-202. [PMID: 17436017 DOI: 10.1007/s00431-007-0454-7] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2006] [Accepted: 02/14/2007] [Indexed: 10/23/2022]
Abstract
To assess whether lipid infusion could be a risk factor for parenteral nutrition-associated cholestasis (PNAC) in low birth weight neonates, 22 newborns with cholestasis (29.8 +/- 1.6 weeks, 1298 +/- 217 g) were compared with 22 without cholestasis (29.5 +/- 1.7 weeks, 1286 +/- 363 g). The mean level of peak direct bilirubin for the cholestasis group was 4.6 mg/dl compared to 1.2 mg/dl for the noncholestasis group. A univariate analysis revealed that PNAC was significantly related to duration of fasting (p = 0.008) and parenteral nutrition (p < 0.0001), days of antibiotics use (p = 0.025), positive C-reactive protein (p = 0.018) or gastric culture (p = 0.018), and feeding intolerance (p < 0.0001). Total amino acid amount (p < 0.0001), total lipid amount (p < 0.0001), and average daily lipid amount (p = 0.002) were significantly higher in the cholestasis group than in the noncholestasis group. Conversely, prenatal administration of dexamethasone was a significant protective factor of PNAC (p = 0.008). Logistic regression analysis revealed that the cumulative amount of lipid infusion was an independent risk factor for PNAC (p = 0.041; OR 1.174; CI 1.007-1.369). We suggest that decreasing the cumulative load of amino acids and intralipids with early trophic feeding, control of infection, and prenatal administration of dexamethasone could possibly attenuate the severity of PNAC.
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Affiliation(s)
- Jae Il Shin
- Department of Pediatrics, Yonsei University College of Medicine, Severance Children's Hospital, 134 Shinchon-Dong, Seodaemun-Ku, C.P.O. Box 8044, 120-752, Seoul, South Korea
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Abstract
This two-part article presents feeding strategies for the NICU population over the first several weeks of life. It focuses primarily on the theory and approach to feeding extremely low birth weight (ELBW) infants, but also addresses some issues pertinent to larger, ill infants. The premise for these recommendations is that avoiding early malnutrition in ELBW and ill infants has both short- and long-term benefits. Many practitioners may consider our approach to be somewhat aggressive. In this strategy, total parenteral nutrition (TPN) is initiated in the first hours after birth and is given together with initially small, and then increasing, enteral feedings beginning on the first or second day of life. The role of the TPN is to provide rapid, maximal nutrition and that of the early enteral feedings is to "prime" the gut and stimulate normal gastrointestinal tract activity.
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Affiliation(s)
- R A Evans
- University of Colorado Health Science Center Denver, USA
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