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Yang L, Han S, Miao C, Lou H, Gao G, Lou X, Hao C, Wang X. Associations of multiple sleep dimensions with overall and abdominal obesity among children and adolescents: a population-based cross-sectional study. Int J Obes (Lond) 2023; 47:817-824. [PMID: 37179449 DOI: 10.1038/s41366-023-01324-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Revised: 04/22/2023] [Accepted: 05/02/2023] [Indexed: 05/15/2023]
Abstract
BACKGROUND The relationship of insufficient sleep with the increased risk of obesity has been reported, but less is known about other sleep dimensions in the sleep-obesity associations. OBJECTIVES To assess the associations of multiple sleep dimensions with overall and abdominal obesity among Chinese students. METHODS This was a cross-sectional study involving 10,686 Han students aged 9-18 from Chinese National Survey on Students' Constitution and Health (CNSSCH). We collected sex, age, regions, parental educational levels, physical activity duration and sleep-related information by questionnaire survey, and also conducted anthropometric measurements including height, weight and waist circumference (WC). Unadjusted and adjusted binary logistic regression models were used to estimate the associations of sleep-related dimensions with obesity-related indicators. RESULTS Short sleep duration was associated with higher body mass index (BMI), larger WC and higher waist-to-height ratio (WHtR) in 9-12 and 16-18 age groups, whereas prolonged sleep duration on weekday was associated with higher BMI in 13-15 age group. Non-habitual midday napping and midday napping ≤0.5 h/d (vs 0.5 to 1 h/d) increased the risk of higher BMI in 13-15 age group, and the former was also associated with larger WC in 9-12 age group. Late bedtime was associated with larger WC and higher WHtR in 9-12 age group and with higher BMI and WHtR in 13-15 age group. Students aged 9-12 with social jet lag ≥2 h were found to have greater BMI after adjustment (Odds Ratio: 1.421; 95% confidence interval: 1.066-1.894). CONCLUSIONS Short or overlong sleep duration, late bedtime and great social jet lag were associated with higher prevalence of overall or abdominal obesity, while moderate midday napping can effectively decrease the risk. Those findings may assist in developing preventive strategies to combat obesity epidemic.
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Affiliation(s)
- Liu Yang
- College of Public Health, Zhengzhou University, No.100 Science Avenue, Zhengzhou, 450001, Henan, P. R. China
| | - Shuo Han
- College of Public Health, Zhengzhou University, No.100 Science Avenue, Zhengzhou, 450001, Henan, P. R. China
| | - Chengyuan Miao
- College of Public Health, Zhengzhou University, No.100 Science Avenue, Zhengzhou, 450001, Henan, P. R. China
| | - Hao Lou
- Department of Nosocomial Infection Management, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, P. R. China
| | - Genli Gao
- The Education Department of Henan Province, Zhengzhou, 450018, Henan, P. R. China
| | - Xiaomin Lou
- College of Public Health, Zhengzhou University, No.100 Science Avenue, Zhengzhou, 450001, Henan, P. R. China
| | - Changfu Hao
- College of Public Health, Zhengzhou University, No.100 Science Avenue, Zhengzhou, 450001, Henan, P. R. China
| | - Xian Wang
- College of Public Health, Zhengzhou University, No.100 Science Avenue, Zhengzhou, 450001, Henan, P. R. China.
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Serum lactate dehydrogenase is associated with impaired lung function: NHANES 2011-2012. PLoS One 2023; 18:e0281203. [PMID: 36730242 PMCID: PMC9894433 DOI: 10.1371/journal.pone.0281203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 01/17/2023] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Serum lactate dehydrogenase levels reflect disease status in a variety of organs, but its role in indicating pulmonary function is not yet clear. Therefore, this study explored the correlation between pulmonary function and serum lactate dehydrogenase, and investigated thresholds for changes in pulmonary function indicators in the total population as well as in different strata of the population. METHODS Based on data from the National Health and Nutrition Examination Survey (NHANES) 2011-2012 (n = 3453), univariate and stratified analyses were performed to investigate factors associated with pulmonary function, and multiple regression analysis was used to further investigate the specific relationship with serum lactate dehydrogenase. Smoothed curve fitting, threshold effect and saturation effect analysis were used to explore the threshold level of serum lactate dehydrogenase at the onset of changes in pulmonary function indicators. RESULTS Adjusted smoothed curve fit plots showed a linear relationship between serum lactate dehydrogenase levels and forced vital capacity and forced expiratory volume in one second: for each 1 U/L increase in serum lactate dehydrogenase levels, forced vital capacity decreased by 1.24 mL (95% CI = -2.05, -0.42, P = 0.0030) and forced expiratory volume in one second by 1.11 mL (95% CI = -1.82, -0.39, P = 0.0025). CONCLUSIONS Serum lactate dehydrogenase was negatively and linearly correlated with pulmonary function indices in the total population analyzed. Based on the total population and different population stratifications, this study determined the threshold values of serum lactate dehydrogenase at the onset of decline of pulmonary function in different populations. This provides a new serological monitoring indicator for patients suffering from respiratory diseases and has implications for patients with possible clinical impairment of pulmonary function. However, our cross-sectional study was not able to determine a causal relationship between these two factors, and further research is needed.
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Rand BG, Ehrlich SF, Johnson TM, Churilla JR. Diabetes risk status and meeting the US physical activity recommendations in reproductive-aged women: 2011, 2013, 2015 and 2017 Behavioral Risk Factor Surveillance System. Diabet Med 2022; 39:e14889. [PMID: 35593657 DOI: 10.1111/dme.14889] [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: 01/09/2022] [Accepted: 05/18/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Women at increased risk for type 2 diabetes, due to recognized prediabetes (PD) or previous gestational diabetes (GD), stand to benefit from meeting U.S. physical activity (PA) recommendations. This study examined the association of diabetes risk status with meeting aerobic activity (AA), muscle strengthening activity (MSA) and both recommendations. METHODS Non-pregnant women, 18-44, free of recognized diabetes, who participated in the 2011, 2013, 2015, or 2017 U.S. Behavioral Risk Factor Surveillance System survey (N = 211,114) were categorized as no diabetes (ND; n = 202,766, referent) versus at-risk for diabetes (RD; n = 8348). Logistic regression models generated odds ratios (ORs) and 95% confidence intervals (95% CIs), adjusted for demographics and BMI. Tests for multiplicative interactions were performed for BMI category and race and ethnicity. RESULTS There were lower odds of meeting AA, MSA and both recommendations in the RD group (referent = ND; OR 0.95 [5% CI 0.78, 0.97], 0.83 [95% CI 0.91, 0.98] and 0.87 [95% CI 0.78, 0.97], respectively). Effect modification by BMI category was detected for models assessing MSA (p = 0.10), both (p = 0.07) and neither recommendation (p = 0.005), but not for AA. Among those with a BMI in the healthy and overweight groups, RD had decreased odds of meeting MSA recommendations (referent = ND; 0.69 [95% CI 0.58, 0.81] and 0.78 [95% CI 0.65, 0.93], respectively); among the healthy BMI, RD had 24% decreased odds of meeting both recommendations (referent = ND; 95% CI 0.63, 0.91). There was no difference in meeting PA recommendations among groups in the obese category, but the increased odds of meeting the AA recommendation among the RD group were approaching significance (referent = ND; [95% CI 1.00, 1.29], p = 0.06]. CONCLUSION Reproductive-aged women with previous GD or recognized PD stand to benefit from increasing PA, especially MSA, the least often met recommendation.
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Affiliation(s)
- Bethany G Rand
- Department of Public Health, The University of Tennessee, Knoxville, Tennessee, USA
| | - Samantha F Ehrlich
- Department of Public Health, The University of Tennessee, Knoxville, Tennessee, USA
| | - Tammie M Johnson
- Florida A&M University, Institute of Public Health, Tallahassee, Florida, USA
| | - James R Churilla
- Department of Clinical and Applied Movement Sciences, University of North Florida, Jacksonville, Florida, USA
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Walker SL, Anguzu R, Egede LE, Palatnik A. Contraception utilization in women with pregestational diabetes. EUR J CONTRACEP REPR 2022; 27:317-321. [PMID: 35946609 PMCID: PMC9759819 DOI: 10.1080/13625187.2022.2074392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To compare contraception use between women with and without pregestational diabetes. METHODS Cross-sectional data on women aged 18-44 years from 2011 to 2017 National Survey of Family Growth (NSFG) was analysed. Maternal diabetes was defined as the presence of pre-gestational type 1 or type 2 diabetes. Bivariate and multiple logistic regression analyses were run to evaluate the association between the use of contraception and by contraception type: permanent, long-acting reversible contraception (LARC), other hormonal method, other non-hormonal method, and none, and maternal diabetes status, controlling for relevant covariates. RESULTS Among the total study sample of 28,454, 1344 (4.7%) had pregestational diabetes. Unadjusted analysis showed women with a history of pregestational diabetes were more likely to use permanent contraception following pregnancy (58.0% vs. 38.7%, p < 0.001) or no contraception (27.2% vs. 24.5%, p < 0.001), but less likely to use LARC (3.4% vs. 11.7%, p < 0.001), other hormonal contraception (4.1% vs. 8.9%, p < 0.001), or other non-hormonal contraception (7.2% vs. 16.4%, p < 0.001). In adjusted analyses, permanent (aOR 1.62, 95% CI 0.72-2.26) remained significant, however the differences were no longer statistically significant: LARC (aOR 0.34, 95% CI 0.12-1.00); other hormonal (aOR 0.61, 95% CI 0.27-1.35); other non-hormonal (aOR 0.59, 95% CI 0.25-1.43); and None (aOR 1.11, 95% CI 0.65-1.89). CONCLUSION In this analysis, we found that women with pregestational diabetes were more likely to use permanent contraception methods compared to women without pregestational diabetes; however over a quarter of women with pregestational diabetes did not use contraception between pregnancies.
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Affiliation(s)
- Shannon L. Walker
- Institute for Health and Equity (IHE), Medical College of Wisconsin, Milwaukee, WI, USA
- Center for Advancing Population Science (CAPS), Medical College of Wisconsin, Milwaukee, WI, USA
| | - Ronald Anguzu
- Institute for Health and Equity (IHE), Medical College of Wisconsin, Milwaukee, WI, USA
- Center for Advancing Population Science (CAPS), Medical College of Wisconsin, Milwaukee, WI, USA
| | - Leonard E. Egede
- Center for Advancing Population Science (CAPS), Medical College of Wisconsin, Milwaukee, WI, USA
- Division of General Internal Medicine, Department of Medicine, Froedtert and The Medical College of Wisconsin, Milwaukee, WI, USA
| | - Anna Palatnik
- Center for Advancing Population Science (CAPS), Medical College of Wisconsin, Milwaukee, WI, USA
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Medical College of Wisconsin, Milwaukee, WI, USA
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Liang F, Fu J, Xu Y, Wang Y, Qiu N, Ding K, Zeng J, Moore JB, Li R. Associations of Social Jetlag with Dietary Behavior, Physical Activity and Obesity among Chinese Adolescents. Nutrients 2022; 14:nu14030510. [PMID: 35276869 PMCID: PMC8840712 DOI: 10.3390/nu14030510] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 01/18/2022] [Accepted: 01/21/2022] [Indexed: 01/15/2023] Open
Abstract
This study aimed to investigate the associations between social jetlag (SJL), dietary behavior, physical activity, and weight status in Chinese youth. Data were derived from a cross-sectional survey in Wuhan, China in 2019. Information on SJL, the frequency of food and beverage consumption, physical activity, and BMI category were collected via a self-reported questionnaire. The Kruskal-Wallis test and ANOVA were conducted to determine differences in daily consumption frequency of food and beverage groups, BMI category, and physical activity among SJL groups. Logistic regressions and restricted cubic splines were performed to test the association between SJL and the incidence of overweight or obesity. A final sample of 3567 Chinese adolescents [mean (SD) age, 14.67 (1.72) years; 47.41% (1691) female] were included. Our findings demonstrated that adolescents with SJL may consume more unhealthy foods and fewer beneficial foods, while engaging in less moderate to vigorous physical activity (MVPA) and reporting higher BMIs. In addition, adolescents who experience more than 2 h of SJL had significant greater risk of overweight or obesity. Our findings on SJL of Chinese adolescents confirm the harmful effects of SJL and also provide insights into the etiology of obesity in Chinese adolescents.
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Affiliation(s)
- Fang Liang
- Department of Healthcare Management, School of Public Health, Wuhan University, Wuhan 430071, China; (F.L.); (J.F.); (Y.X.); (Y.W.); (N.Q.); (K.D.); (J.Z.)
| | - Jialin Fu
- Department of Healthcare Management, School of Public Health, Wuhan University, Wuhan 430071, China; (F.L.); (J.F.); (Y.X.); (Y.W.); (N.Q.); (K.D.); (J.Z.)
| | - Yijia Xu
- Department of Healthcare Management, School of Public Health, Wuhan University, Wuhan 430071, China; (F.L.); (J.F.); (Y.X.); (Y.W.); (N.Q.); (K.D.); (J.Z.)
| | - Yechuang Wang
- Department of Healthcare Management, School of Public Health, Wuhan University, Wuhan 430071, China; (F.L.); (J.F.); (Y.X.); (Y.W.); (N.Q.); (K.D.); (J.Z.)
| | - Nan Qiu
- Department of Healthcare Management, School of Public Health, Wuhan University, Wuhan 430071, China; (F.L.); (J.F.); (Y.X.); (Y.W.); (N.Q.); (K.D.); (J.Z.)
| | - Kai Ding
- Department of Healthcare Management, School of Public Health, Wuhan University, Wuhan 430071, China; (F.L.); (J.F.); (Y.X.); (Y.W.); (N.Q.); (K.D.); (J.Z.)
| | - Jing Zeng
- Department of Healthcare Management, School of Public Health, Wuhan University, Wuhan 430071, China; (F.L.); (J.F.); (Y.X.); (Y.W.); (N.Q.); (K.D.); (J.Z.)
| | - Justin B. Moore
- Department of Implementation Science, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC 27101, USA;
| | - Rui Li
- Department of Healthcare Management, School of Public Health, Wuhan University, Wuhan 430071, China; (F.L.); (J.F.); (Y.X.); (Y.W.); (N.Q.); (K.D.); (J.Z.)
- School of Nursing, Wuhan University, Wuhan 430071, China
- Correspondence: ; Tel.: +86-27-6875-9901; Fax: +86-27-6875-8648
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Zheng Y, Wen X, Bian J, Zhao J, Lipkind HS, Hu H. Racial, Ethnic, and Geographic Disparities in Cardiovascular Health Among Women of Childbearing Age in the United States. J Am Heart Assoc 2021; 10:e020138. [PMID: 34431309 PMCID: PMC8649299 DOI: 10.1161/jaha.120.020138] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
Background In the United States, large disparities in cardiovascular health (CVH) exist in the general population, but little is known about the CVH status and its disparities among women of childbearing age (ie, 18–49 years). Methods and Results In this cross‐sectional study, we examined racial, ethnic, and geographic disparities in CVH among all women of childbearing age in the United States, using the 2011 to 2019 Behavioral Risk Factor Surveillance System. Life's Simple 7 (ie, blood pressure, glucose, total cholesterol, smoking, body mass index, physical activity, and diet) was used to examine CVH. Women with 7 ideal CVH metrics were determined to have ideal CVH. Among the 269 564 women of childbearing age, 13 800 (4.84%) had ideal CVH. After adjusting for potential confounders, non‐Hispanic Black women were less likely to have ideal CVH (odds ratio, 0.54; 95% CI, 0.46–0.63) compared with non‐Hispanic White women, and with significantly lower odds of having ideal metrics of blood pressure, blood glucose, body mass index, and physical activity. No significant difference in CVH was found between non‐Hispanic White and Hispanic women. Large geographic disparities with temporal variations were observed, with the age‐ and race‐adjusted ideal CVH prevalence ranging from 4.05% in the District of Columbia (2011) to 5.55% in Maine and Montana (2019). States with low ideal CVH prevalence and average CVH score were mostly clustered in the southern United States. Conclusions Large racial, ethnic, and geographic disparities in CVH exist among women of childbearing age. More efforts are warranted to understand and address these disparities.
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Affiliation(s)
- Yi Zheng
- Department of Epidemiology College of Public Health and Health Professions and College of Medicine University of Florida Gainesville FL
| | - Xiaoxiao Wen
- Department of Epidemiology College of Public Health and Health Professions and College of Medicine University of Florida Gainesville FL
| | - Jiang Bian
- Department of Health Outcomes and Biomedical Informatics College of Medicine University of Florida Gainesville FL
| | - Jinying Zhao
- Department of Epidemiology College of Public Health and Health Professions and College of Medicine University of Florida Gainesville FL
| | - Heather S Lipkind
- Department of Obstetrics, Gynecology, and Reproductive Sciences School of Medicine Yale University New Haven CT
| | - Hui Hu
- Department of Epidemiology College of Public Health and Health Professions and College of Medicine University of Florida Gainesville FL
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Andrisse S, Garcia-Reyes Y, Pyle L, Kelsey MM, Nadeau KJ, Cree-Green M. Racial and Ethnic Differences in Metabolic Disease in Adolescents With Obesity and Polycystic Ovary Syndrome. J Endocr Soc 2021; 5:bvab008. [PMID: 33644620 PMCID: PMC7896356 DOI: 10.1210/jendso/bvab008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Indexed: 01/23/2023] Open
Abstract
Context Polycystic ovary syndrome (PCOS) is common and associated with metabolic syndrome. In the general population, metabolic disease varies by race and ethnicity. Objective This work aimed to examine in depth the interaction of race and ethnicity with PCOS-related metabolic disease in adolescent youth. Methods A secondary analysis was conducted of data from girls (age 12-21 years) with overweight or obesity (> 90 body mass index [BMI] percentile) and PCOS. Measurements included fasting hormone and metabolic measures, a 2-hour oral glucose tolerance test (OGTT), and magnetic resonance imaging for hepatic fat. Groups were categorized by race or ethnicity. Results Participants included 39 non-Hispanic White (NHW, age 15.7 ± 0.2 years; BMI 97.7 ± 0.2 percentile), 50 Hispanic (HW, 15.2 ± 0.3 years; 97.9 ± 0.3 percentile), and 12 non-Hispanic Black (NHB, 16.0 ± 0.6 years; 98.6 ± 0.4 percentile) adolescents. Hepatic markers of insulin resistance were worse in NHW, including lower sex hormone-binding globulin and higher triglycerides over high-density lipoprotein cholesterol (TGs/HDL-C) ratio (P = .002 overall, HW vs NHB [P = .009] vs NHW [P = 0.020]), although homeostasis model assessment of estimated insulin resistance was worst in NHB (P = .010 overall, NHW vs NHB P = .014). Fasting and 2-hour OGTT glucose were not different between groups, although glycated hemoglobin A1c (HbA1c) was lowest in NHW (overall P < .001, NHW 5.2 ± 0.3 vs HW 5.5 ± 0.3 P < .001 vs 5.7 ± 0.4%, P < .001). The frequency of hepatic steatosis (HW 62%, NHW 42%, NHB 25%, P = .032); low HDL-C < 40 mg/dL (HW 82%, NHW 61%, NHB 50%, P < .001) and prediabetes HbA1c 5.7% to 6.4% (NHB 50%, HW 36%, NHW 5%, P < .001) were different between the groups. Conclusion Adolescents with PCOS appear to show similar racial and ethnic variation to the general population in terms of metabolic disease components.
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Affiliation(s)
- Stanley Andrisse
- Howard University College of Medicine, Physiology and Biophysics, Baltimore, Maryland, USA.,Johns Hopkins Medicine, Pediatric Endocrinology, Baltimore, Maryland, USA
| | - Yesenia Garcia-Reyes
- Department of Pediatrics, Division of Pediatric Endocrinology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Laura Pyle
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.,Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, Colorado, USA
| | - Megan M Kelsey
- Department of Pediatrics, Division of Pediatric Endocrinology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.,Center for Women's Health Research, Aurora, Colorado, USA
| | - Kristen J Nadeau
- Department of Pediatrics, Division of Pediatric Endocrinology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.,Center for Women's Health Research, Aurora, Colorado, USA
| | - Melanie Cree-Green
- Department of Pediatrics, Division of Pediatric Endocrinology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.,Center for Women's Health Research, Aurora, Colorado, USA
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Nguyen VK, Kahana A, Heidt J, Polemi K, Kvasnicka J, Jolliet O, Colacino JA. A comprehensive analysis of racial disparities in chemical biomarker concentrations in United States women, 1999-2014. ENVIRONMENT INTERNATIONAL 2020; 137:105496. [PMID: 32113086 PMCID: PMC7137529 DOI: 10.1016/j.envint.2020.105496] [Citation(s) in RCA: 70] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 01/09/2020] [Accepted: 01/14/2020] [Indexed: 05/11/2023]
Abstract
BACKGROUND Stark racial disparities in disease incidence among American women remain a persistent public health challenge. These disparities likely result from complex interactions between genetic, social, lifestyle, and environmental risk factors. The influence of environmental risk factors, such as chemical exposure, however, may be substantial and is poorly understood. OBJECTIVES We quantitatively evaluated chemical-exposure disparities by race/ethnicity, life stage, and time in United States (US) women (n = 38,080) by using biomarker data for 143 chemicals from the National Health and Nutrition Examination Survey (NHANES) 1999-2014. METHODS We applied a series of survey-weighted, generalized linear models using data from the entire NHANES women population along with cycle and age-group stratified subpopulations. The outcome was chemical biomarker concentration, and the main predictor was race/ethnicity with adjustment for age, socioeconomic status, smoking habits, and NHANES cycle. RESULTS Compared to non-Hispanic White women, the highest disparities were observed for non-Hispanic Black, Mexican American, Other Hispanic, and Other Race/Multi-Racial women with higher levels of pesticides and their metabolites, including 2,5-dichlorophenol, o,p'-DDE, beta-hexachlorocyclohexane, and 2,4-dichlorophenol, along with personal care and consumer product compounds, including parabens and monoethyl phthalate, as well as several metals, such as mercury and arsenic. Moreover, for Mexican American, Other Hispanic, and non-Hispanic black women, there were several exposure disparities that persisted across age groups, such as higher 2,4- and 2,5-dichlorophenol concentrations. Exposure levels for methyl and propyl parabens, however, were the highest in non-Hispanic black compared to non-Hispanic white children with average differences exceeding 4-fold. Exposure disparities for methyl and propyl parabens are increasing over time in Other Race/Multi-Racial women while fluctuating for non-Hispanic Black, Mexican American, and Other Hispanic. Cotinine levels are among the highest in Non-Hispanic White women compared to Mexican American and Other Hispanic women with disparities plateauing and increasing, respectively. DISCUSSION We systematically evaluated differences in chemical exposures across women of various race/ethnic groups and across age groups and time. Our findings could help inform chemical prioritization in designing epidemiological and toxicological studies. In addition, they could help guide public health interventions to reduce environmental and health disparities across populations.
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Affiliation(s)
- Vy Kim Nguyen
- Department of Environmental Health Sciences, School of Public Health, University of Michigan, Ann Arbor, MI, USA; Department of Computational Medicine and Bioinformatics, Medical School, University of Michigan, Ann Arbor, MI, USA
| | - Adam Kahana
- Department of Environmental Health Sciences, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Julien Heidt
- Department of Environmental Health Sciences, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Katelyn Polemi
- Department of Environmental Health Sciences, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Jacob Kvasnicka
- Department of Environmental Health Sciences, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Olivier Jolliet
- Department of Environmental Health Sciences, School of Public Health, University of Michigan, Ann Arbor, MI, USA; Center for Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, MI, USA
| | - Justin A Colacino
- Department of Environmental Health Sciences, School of Public Health, University of Michigan, Ann Arbor, MI, USA; Center for Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, MI, USA; Department of Nutritional Sciences, School of Public Health, University of Michigan, Ann Arbor, MI, USA; Rogel Cancer Center, University of Michigan, Ann Arbor, MI, USA.
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Marshall C, Britton L. Delivering family planning and preconception care to women with diabetes: Implementation challenges and promising strategies. HEALTHCARE (AMSTERDAM, NETHERLANDS) 2019; 8:100386. [PMID: 31668425 DOI: 10.1016/j.hjdsi.2019.100386] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 09/27/2019] [Accepted: 10/04/2019] [Indexed: 02/08/2023]
Abstract
Diabetes is increasingly prevalent among women of reproductive age and during pregnancy. The American Diabetes Association, which has called for improvements in the patient-centeredness of care, recommends preconception counseling and care for women of reproductive age with diabetes. However, data suggests this care is not sufficiently delivered. In this article, we describe demographic shifts in the need for preconception care and outline several changes at the clinical encounter as well as the health system- and community-levels that can help improve the delivery of diabetes-specific preconception care.
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Affiliation(s)
- Cassondra Marshall
- School of Public Health, University of California, Berkeley, 2121 Berkeley Way, Berkeley, CA, 94720, USA.
| | - Laura Britton
- School of Nursing, Columbia University, 560 W 168th St, New York City, New York, 10032, USA
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Taylor YJ, Spencer MD, Mahabaleshwarkar R, Ludden T. Racial/ethnic differences in healthcare use among patients with uncontrolled and controlled diabetes. ETHNICITY & HEALTH 2019; 24:245-256. [PMID: 28393538 DOI: 10.1080/13557858.2017.1315372] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Accepted: 03/20/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES To examine racial/ethnic differences in healthcare use among patients classified as having controlled and uncontrolled diabetes. DESIGN Data from the Carolinas HealthCare System electronic data warehouse were used. Glycemic control was defined as glycosylated hemoglobin (HbA1c) < 8% (64 mmol/mol) in 2012 (n = 9996). Patients with HbA1c ≥ 8% (64 mmol/mol) in 2012 were classified as uncontrolled (n = 2576). Race and ethnicity were jointly classified as non-Hispanic Black, non-Hispanic White or Other. Separate mixed effects negative binomial models estimated the independent effect of race/ethnicity on the number of emergency department (ED) visits, hospitalizations and physician office visits in 2013, in each patient group, adjusting for significant confounding variables. RESULTS Rates of diabetes-related ED visits were two to three times higher for non-Hispanic Blacks compared to non-Hispanic Whites (uncontrolled rate ratio [RR]: 3.41 95% CI: 1.41-8.22; controlled RR: 2.95; 95% CI: 1.78-4.91). Similar differences were observed for all-cause ED visits (uncontrolled RR: 1.83, 95% CI: 1.50-2.24; controlled RR: 2.45, 95% CI: 2.17-2.77). Non-Hispanic Blacks with controlled and uncontrolled diabetes also had lower rates of all-cause physician office visits when compared to non-Hispanic Whites (uncontrolled RR: 0.84, 95% CI: 0.77-0.91; controlled RR: 0.81, 95% CI: 0.78-0.84). CONCLUSION Notable racial/ethnic disparities exist in the use of emergency services and physician offices for diabetes care. Strategies such as patient education and care delivery changes that address healthcare access issues in racial/ethnic minorities should be considered to offer better diabetes management and address diabetes disparities.
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Affiliation(s)
- Yhenneko J Taylor
- a Center for Outcomes Research and Evaluation , Carolinas HealthCare System , Charlotte , USA
| | - Melanie D Spencer
- a Center for Outcomes Research and Evaluation , Carolinas HealthCare System , Charlotte , USA
| | - Rohan Mahabaleshwarkar
- a Center for Outcomes Research and Evaluation , Carolinas HealthCare System , Charlotte , USA
| | - Thomas Ludden
- b Department of Family Medicine , Carolinas HealthCare System , Charlotte , USA
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11
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Srugo SA, de Groh M, Jiang Y, Morrison HI, Villeneuve PJ. Evaluating the utility of self-reported questionnaire data to screen for dysglycemia in young adults: Findings from the US National Health and Nutrition Examination Survey. Prev Med 2019; 120:50-59. [PMID: 30639079 DOI: 10.1016/j.ypmed.2019.01.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 12/29/2018] [Accepted: 01/08/2019] [Indexed: 12/25/2022]
Abstract
Dysglycemia, including prediabetes and type 2 diabetes, is dangerous and widespread. Yet, the condition is transiently reversible and sequelae preventable, prompting the use of prediction algorithms to quickly assess dysglycemia status through self-reported data. However, as current algorithms have largely been developed in older populations, their application to younger adults is uncertain considering associations between risk factors and dysglycemia vary by age. We sought to identify sex-specific predictors of current dysglycemia among young adults and evaluate their ability to screen for prediabetes and undiagnosed diabetes. We analyzed 2005-2014 data from the National Health and Nutrition Examination Survey for 3251 participants aged 20-39, who completed an oral glucose tolerance test (OGTT), had not been diagnosed with diabetes, and, for females, were not pregnant. Sex-specific stepwise logistic models were fit with predictors identified from univariate analyses. Risk scores were developed using adjusted odds ratios and model performance was assessed using area under the curve (AUC) measures. The OGTT identified 906 (27.9%) and 78 (2.4%) participants with prediabetes or undiagnosed diabetes, respectively. Predictors of dysglycemia status for males were BMI, age, race, and first-degree family history of diabetes, and, in addition to those, education, delivered baby weight, waist circumference, and vigorous physical activity for females. Our male- and female-specific models demonstrated improved validity to assess dysglycemia presence among young adults relative to the widely-used American Diabetes Association test (AUC = 0.69 vs. 0.61; 0.92 vs. 0.71, respectively). Thus, age-specific scoring algorithms employing questionnaire data show promise and are effective in identifying dysglycemia among young adults.
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Affiliation(s)
- Sebastian A Srugo
- Department of Health Sciences, Carleton University, Ottawa, Ontario, Canada
| | | | - Ying Jiang
- Public Health Agency of Canada, Ottawa, Ontario, Canada
| | | | - Paul J Villeneuve
- Department of Health Sciences, Carleton University, Ottawa, Ontario, Canada.
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12
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Britton LE, Hussey JM, Berry DC, Crandell JL, Brooks JL, Bryant AG. Contraceptive Use Among Women with Prediabetes and Diabetes in a US National Sample. J Midwifery Womens Health 2018; 64:36-45. [PMID: 30548397 DOI: 10.1111/jmwh.12936] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Revised: 10/01/2018] [Accepted: 10/07/2018] [Indexed: 01/04/2023]
Abstract
INTRODUCTION Although elevated blood glucose is associated with adverse maternal and fetal health outcomes, evidence suggests that women with diabetes may not be receiving comprehensive reproductive health care, including family planning and preconception care. Using a population-based sample, we evaluated the relationship between contraceptive use and biomarker-identified diabetes. METHODS This cross-sectional study used data from 5548 women in the nationally representative National Longitudinal Study of Adolescent to Adult Health (Add Health) from 2007 to 2009. Women were aged 24 to 32 years, sexually active with men, and not pregnant. Hemoglobin A1C identified prediabetes and diabetes from blood specimens. The primary outcome was most effective contraception used in the past year: more effective (sterilization, intrauterine device, implant, combined hormonal methods, or injectable), less effective (condoms, diaphragms, spermicides, natural family planning, or withdrawal), or none. Multinomial regression models were adjusted for race and ethnicity, education, insurance, health care access, and body mass index. RESULTS Of the women with diabetes, 37.6% used more effective contraception, 33.6% less effective contraception, and 28.8% none. Women with diabetes had higher odds of using no contraception, rather than more effective contraception, than women with normoglycemia (adjusted odds ratio [aOR], 1.90; 95% CI, 1.25-2.87). Women with diabetes who were undiagnosed had greater odds of using less effective contraception, rather than more effective contraception, compared with those who were diagnosed (aOR 3.39; 95% CI, 1.44-7.96). Contraceptive use did not differ between women with prediabetes and normoglycemia. DISCUSSION Less effective contraceptive methods were commonly used by women with diabetes. Midwives and other women's health care providers can support women with diabetes to reach their pregnancy goals by providing preconception care and family planning.
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Conway BN, Han X, Munro HM, Gross AL, Shu XO, Hargreaves MK, Zheng W, Powers AC, Blot WJ. The obesity epidemic and rising diabetes incidence in a low-income racially diverse southern US cohort. PLoS One 2018; 13:e0190993. [PMID: 29324894 PMCID: PMC5764338 DOI: 10.1371/journal.pone.0190993] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Accepted: 12/22/2017] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Obesity is known to be a major risk factor for diabetes, but the magnitude of risk and variation between blacks and whites are less well documented in populations heavily affected by obesity. Herein we assess rates and risks of incident diabetes in a diverse southern population where obesity is common. METHODS A total of 24,000 black and 14,064 white adults aged 40-79 in the Southern Community Cohort Study with no self-reported diabetes at study enrollment during 2002-2009 was followed for up to 10 (median 4.5) years. Incidence rates, odds ratios (OR) and accompanying 95% confidence intervals (CI) for medication-treated incident diabetes were determined according to body mass index (BMI) and other characteristics, including tobacco and alcohol consumption, healthy eating and physical activity indices, and socioeconomic status (SES). RESULTS Risk of incident diabetes rose monotonically with increasing BMI, but the trends differed between blacks and whites (pinteraction < .0001). Adjusted ORs (CIs) for diabetes among those with BMI≥40 vs 20-25 kg/m2 were 11.9 (8.4-16.8) for whites and 4.0 (3.3-4.8) for blacks. Diabetes incidence was more than twice as high among blacks than whites of normal BMI, but the racial difference became attenuated as BMI rose, with estimated 5-year probabilities of developing diabetes approaching 20% for both blacks and whites with BMI≥40 kg/m2. Diabetes risk was also associated with low SES, significantly (pinteraction≤.02) more so for whites, current cigarette smoking, and lower healthy eating and physical activity indices, although high BMI remained the predominant risk factor among both blacks and whites. From baseline prevalence and 20-year projections of the incidence trends, we estimate that the large majority of surviving cohort participants with BMI≥40 kg/m2 will be diagnosed with diabetes. CONCLUSIONS Even using conservative criteria to ascertain diabetes incidence (i.e., requiring diabetes medication use and ignoring undiagnosed cases), rates of obesity-associated diabetes were exceptionally high in this low-income adult population. The findings indicate that effective strategies to halt the rising prevalence of obesity are needed to avoid substantial increases in diabetes in coming years.
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Affiliation(s)
- Baqiyyah N. Conway
- Department of Epidemiology and Biostatistics, University of Texas Health Science Center, Tyler, Texas, United States of America
| | - Xijing Han
- International Epidemiology Field Station, Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Rockville, Maryland, United States of America
| | - Heather M. Munro
- International Epidemiology Field Station, Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Rockville, Maryland, United States of America
| | - Amy L. Gross
- International Epidemiology Field Station, Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Rockville, Maryland, United States of America
| | - Xiao-Ou Shu
- Division of Epidemiology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, United States of America
| | - Margaret K. Hargreaves
- Department of Internal Medicine, Meharry Medical College, Nashville, Tennessee, United States of America
| | - Wei Zheng
- Division of Epidemiology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, United States of America
| | - Alvin C. Powers
- Division of Diabetes, Endocrinology and Metabolism, Vanderbilt University School of Medicine, Nashville, Tennessee, United States of America
| | - William J. Blot
- International Epidemiology Field Station, Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Rockville, Maryland, United States of America
- Division of Epidemiology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, United States of America
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14
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Albrecht SS, Mayer-Davis E, Popkin BM. Secular and race/ethnic trends in glycemic outcomes by BMI in US adults: The role of waist circumference. Diabetes Metab Res Rev 2017; 33. [PMID: 28198145 DOI: 10.1002/dmrr.2889] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Revised: 12/16/2016] [Accepted: 02/03/2017] [Indexed: 11/08/2022]
Abstract
BACKGROUND For the same body mass index (BMI) level, waist circumference (WC) is higher in more recent years. How this impacts diabetes and prediabetes prevalence in the United States and for different race/ethnic groups is unknown. We examined prevalence differences in diabetes and prediabetes by BMI over time, investigated whether estimates were attenuated after adjusting for waist circumference, and evaluated implications of these patterns on race/ethnic disparities in glycemic outcomes. METHODS Data came from 12 614 participants aged 20 to 74 years from the National Health and Nutrition Examination Surveys (1988-1994 and 2007-2012). We estimated prevalence differences in diabetes and prediabetes by BMI over time in multivariable models. Relevant interactions evaluated race/ethnic differences. RESULTS Among normal, overweight, and class I obese individuals, there were no significant differences in diabetes prevalence over time. However, among individuals with class II/III obesity, diabetes prevalence rose 7.6 percentage points in 2007-2012 vs 1988-1994. This estimate was partly attenuated after adjustment for mean waist circumference but not mean BMI. For prediabetes, prevalence was 10 to 13 percentage points higher over time at lower BMI values, with minimal attenuation after adjustment for WC. All patterns held within race/ethnic groups. Diabetes disparities among blacks and Mexican Americans relative to whites remained in both periods, regardless of BMI, and persisted after adjustment for WC. CONCLUSIONS Diabetes prevalence rose over time among individuals with class II/III obesity and may be partly due to increasing waist circumference. Anthropometric measures did not appear to account for temporal increases in prediabetes, nor did they attenuate race/ethnic disparities in diabetes. Reasons underlying these trends require further investigation.
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Affiliation(s)
- Sandra S Albrecht
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
- Carolina Population Center, University of North Carolina, Chapel Hill, NC, USA
| | - Elizabeth Mayer-Davis
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
- Department of Medicine, School of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Barry M Popkin
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
- Carolina Population Center, University of North Carolina, Chapel Hill, NC, USA
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15
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Rosenberg N, Daviglus ML, DeVon HA, Park CG, Eldeirawi K. Systemic Inflammation and Viral Exposure among Young Mexican American Women: Nativity-Related Differences. Ethn Dis 2017; 27:133-142. [PMID: 28439184 DOI: 10.18865/ed.27.2.133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Factors contributing to elevated inflammation in racial/ethnic minority populations are not well understood. We examined the association of viral exposure with C-reactive protein (CRP) in young Mexican American women. METHODS AND RESULTS Participants (N=1,141) were currently non-pregnant women of Mexican background, aged 18-39 years, from the cross-sectional National Health and Nutrition Examination Survey (NHANES) 1999-2010. Viral exposure was defined as seropositive status for hepatitis B, and herpes simplex types 1 and 2, and classified as seronegative, seropositive for any one agent, and seropositive for 2 or 3 agents. The association of viral exposure with elevated CRP (3.01-10.00 mg/L) varied by country of birth (P=.001). Among Mexico-born women, those seropositive for 2 or 3 agents had 3.79 times (95% CI: 1.28-11.27) and those seropositive for any one agent 2.56 times (95% CI: 1.12-5.86) the odds of elevated CRP compared with seronegative women, after adjustment for age, country of birth, household density, waist circumference, glycated hemoglobin, and total cholesterol. Among US-born women, the corresponding odds were OR: .32, 95% CI: .12-.86 and OR: .71, 95% CI .43-1.17. CONCLUSIONS In Mexico-born Mexican American women, viral exposure is associated with higher odds of elevated CRP.
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Affiliation(s)
- Natalya Rosenberg
- Institute for Minority Health Research, College of Medicine, University of Illinois at Chicago
| | - Martha L Daviglus
- Institute for Minority Health Research, College of Medicine, University of Illinois at Chicago
| | - Holli A DeVon
- College of Nursing, University of Illinois at Chicago
| | - Chang Gi Park
- College of Nursing, University of Illinois at Chicago
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Shearer DM, Thomson WM, Broadbent JM, Mann J, Poulton R. Periodontitis is not associated with metabolic risk during the fourth decade of life. J Clin Periodontol 2017; 44:22-30. [PMID: 27783846 PMCID: PMC6547373 DOI: 10.1111/jcpe.12641] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/22/2016] [Indexed: 12/11/2022]
Abstract
AIM To examine associations between periodontitis and developmental trajectories of glycated haemoglobin (HbA1c) during the third and fourth decades in an initially healthy sample. MATERIALS AND METHODS HbA1c data collected at ages 26, 32 and 38 in the prospective Dunedin Multidisciplinary Health and Development Study were used to assign study members (n = 893) to trajectories applying group-based trajectory modelling (GBTM). The model allowed the statistical linking of baseline demographic, smoking and waist-height ratio covariates to group membership probability; and added a time-varying covariate (periodontitis) to the trajectories themselves to examine whether events that occurred during the course of the trajectory altered its course. RESULTS Three HbA1c trajectory groups were identified: "Low" (n = 98, 11.0%); "Medium" (n = 482, 54.0%); and "High" (n = 313, 35.0%) with mean HbA1c of 29.6, 34.1 and 38.7 mmol/mol, respectively, at age 38. Having periodontitis at 32 and 38 was associated with an upward shift in the trajectories. However, none of the associations were statistically significant. CONCLUSIONS Periodontitis was not found to be associated with dysglycaemia over 12 years from early adulthood into early middle age. This suggests that any influence periodontitis may have on dysglycaemia develops later in life.
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Affiliation(s)
- Dara M Shearer
- Department of Oral Sciences, Faculty of Dentistry, University of Otago, Dunedin, New Zealand
| | - W Murray Thomson
- Department of Oral Sciences, Faculty of Dentistry, University of Otago, Dunedin, New Zealand
| | - Jonathan M Broadbent
- Department of Oral Rehabilitation, Faculty of Dentistry, University of Otago, Dunedin, New Zealand
| | - Jim Mann
- Department of Human Nutrition, University of Otago, Dunedin, New Zealand
- Edgar National Centre for Diabetes and Obesity Research, Dunedin, New Zealand
| | - Richie Poulton
- Dunedin Multidisciplinary Health and Development Research Unit, University of Otago, Dunedin, New Zealand
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Hokke S, Arias N, Armitage JA, Puelles VG, Fong K, Geraci S, Gretz N, Bertram JF, Cullen-McEwen LA. Maternal glucose intolerance reduces offspring nephron endowment and increases glomerular volume in adult offspring. Diabetes Metab Res Rev 2016; 32:816-826. [PMID: 27037899 DOI: 10.1002/dmrr.2805] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Revised: 03/09/2016] [Accepted: 03/25/2016] [Indexed: 12/16/2022]
Abstract
BACKGROUND Animal studies report a nephron deficit in offspring exposed to maternal diabetes, yet are limited to models of severe hyperglycaemia which do not reflect the typical clinical condition and which are associated with foetal growth restriction that may confound nephron endowment. We aimed to assess renal morphology and function in offspring of leptin receptor deficient mice (Leprdb /+) and hypothesized that exposure to impaired maternal glucose tolerance (IGT) would be detrimental to the developing kidney. METHODS Nephron endowment was assessed in offspring of C57BKS/J Leprdb /+ and +/+ mice at embryonic day (E)18 and postnatal day (PN)21 using design-based stereology. Transcutaneous measurement of renal function and total glomerular volume were assessed in 6-month-old offspring. Only +/+ offspring of Leprdb /+ dams were analysed. RESULTS Compared with +/+ dams, Leprdb /+ dams had a 20% and 35% decrease in glucose tolerance prior to pregnancy and at E17.5 respectively. Offspring of IGT Leprdb /+ dams had approximately 15% fewer nephrons at E18.5 and PN21 than offspring of +/+ dams. There was no difference in offspring bodyweight. Despite normal renal function, total glomerular volume was 13% greater in 6-month-old offspring of IGT Leprdb /+ dams than in +/+ offspring. CONCLUSIONS IGT throughout gestation resulted in a nephron deficit that was established early in renal development. Maternal IGT was associated with glomerular hypertrophy in adult offspring, likely a compensatory response to maintain normal renal function. Given the increasing prevalence of IGT, monitoring glucose from early in gestation may be important to prevent altered kidney morphology. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Stacey Hokke
- Development and Stem Cells Program, Monash Biomedicine Discovery Institute, and Department of Anatomy and Developmental Biology, Monash University, Clayton, VIC, Australia
| | - Nicole Arias
- Development and Stem Cells Program, Monash Biomedicine Discovery Institute, and Department of Anatomy and Developmental Biology, Monash University, Clayton, VIC, Australia
| | - James A Armitage
- Development and Stem Cells Program, Monash Biomedicine Discovery Institute, and Department of Anatomy and Developmental Biology, Monash University, Clayton, VIC, Australia
- School of Medicine (Optometry), Deakin University, Waurn Ponds, VIC, Australia
| | - Victor G Puelles
- Development and Stem Cells Program, Monash Biomedicine Discovery Institute, and Department of Anatomy and Developmental Biology, Monash University, Clayton, VIC, Australia
| | - Karen Fong
- Development and Stem Cells Program, Monash Biomedicine Discovery Institute, and Department of Anatomy and Developmental Biology, Monash University, Clayton, VIC, Australia
| | - Stefania Geraci
- Medical Research Center, University of Heidelberg, Mannheim, Germany
| | - Norbert Gretz
- Medical Research Center, University of Heidelberg, Mannheim, Germany
| | - John F Bertram
- Development and Stem Cells Program, Monash Biomedicine Discovery Institute, and Department of Anatomy and Developmental Biology, Monash University, Clayton, VIC, Australia
| | - Luise A Cullen-McEwen
- Development and Stem Cells Program, Monash Biomedicine Discovery Institute, and Department of Anatomy and Developmental Biology, Monash University, Clayton, VIC, Australia.
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Shearer DM, Thomson WM, Broadbent JM, McLean R, Poulton R, Mann J. High-risk glycated hemoglobin trajectories established by mid-20s: findings from a birth cohort study. BMJ Open Diabetes Res Care 2016; 4:e000243. [PMID: 27648291 PMCID: PMC5013337 DOI: 10.1136/bmjdrc-2016-000243] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Accepted: 07/01/2016] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE To describe the natural history of glycemia (as measured by glycated hemoglobin (HbA1c)) over 12 years using group-based trajectory modeling (GBTM), and to examine baseline predictors of trajectory. RESEARCH DESIGN AND METHODS HbA1c data collected at ages 26, 32 and 38 in the long-running, prospective Dunedin Multidisciplinary Health and Development Study were used to assign study members (n=893) to trajectories applying GBTM. A generalization of the model allowed the statistical linking of baseline demographic, smoking and anthropometric characteristics to group membership probability. RESULTS Mean HbA1c increased with age, as did prevalence of prediabetes, diabetes and dysglycemia. The greatest increase occurred between ages 26 and 32. Glycemic health status at age 26 predicted glycemic health status at age 38. 3 HbA1c trajectory groups were identified: 'low' (n=98, 11.0%); 'medium' (n=482, 54.0%); and 'high' (n=313, 35.0%) with mean HbA1c of 29.6, 34.1, and 38.7 mmol/mol, respectively, at age 38. High waist circumference (≥880 mm for women and ≥1020 mm for men), high waist-height ratio (≥0.50), and being a smoker at age 26 predicted membership of the least favorable trajectory over the next 12 years. High body mass index (≥30) at age 26 did not predict of trajectory. CONCLUSIONS Trajectories of HbA1c are established relatively early in adulthood. HbA1c levels, waist circumference, waist-height ratio, and smoking status at age 26 are valid clinical predictors for future dysglycemic risk. The identification of HbA1c trajectories and their predictors introduces the possibility of an individualized approach to prevention at an earlier stage than is currently done.
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Affiliation(s)
- Dara M Shearer
- Faculty of Dentistry, Department of Oral Sciences, University of Otago, Dunedin, New Zealand
| | - W Murray Thomson
- Faculty of Dentistry, Department of Oral Sciences, University of Otago, Dunedin, New Zealand
| | - Jonathan M Broadbent
- Faculty of Dentistry, Department of Oral Rehabilitation, University of Otago, Dunedin, New Zealand
| | - Rachael McLean
- Department of Human Nutrition, University of Otago, Dunedin, New Zealand
- Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
- Edgar National Centre for Diabetes and Obesity Research, Dunedin, New Zealand
| | - Richie Poulton
- Dunedin Multidisciplinary Health and Development Research Unit, University of Otago, Dunedin, New Zealand
| | - Jim Mann
- Department of Human Nutrition, University of Otago, Dunedin, New Zealand
- Edgar National Centre for Diabetes and Obesity Research, Dunedin, New Zealand
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Priest JR, Yang W, Reaven G, Knowles JW, Shaw GM. Maternal Midpregnancy Glucose Levels and Risk of Congenital Heart Disease in Offspring. JAMA Pediatr 2015; 169:1112-6. [PMID: 26457543 PMCID: PMC4996656 DOI: 10.1001/jamapediatrics.2015.2831] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE There is a well-described association between maternal diabetes mellitus and risk of congenital heart disease (CHD) in offspring. Although the clinical diagnoses of type 2 diabetes or gestational diabetes are strong risk factors for CHD, subclinical abnormalities of glucose and insulin metabolism are common within the general population and could also confer risk for CHD. We hypothesize that continuous measures of blood analytes related to maternal diabetes are related to odds of cardiac malformations. OBJECTIVE To explore the potential association of 2 different CHD phenotypes in offspring with maternal midpregnancy measures of glucose and insulin. DESIGN, SETTING, AND PARTICIPANTS Case-control study from a population-based cohort of 277 pregnant women in southern and central California carrying infants with tetralogy of Fallot (TOF) (n = 55), dextrotransposition of the great arteries (dTGA) (n = 42), or healthy infants without CHD (n = 180). Serum samples were collected from 2003 through 2007. The analysis was conducted from March through June 2015. MAIN OUTCOMES AND MEASURES Blood analytes related to maternal glucose metabolism were measured from random nonfasting second-trimester blood samples. We measured serum insulin levels by a validated radioimmunoassay, and we measured glucose levels. Multivariable logistic regression models estimated the association between these levels and case status. RESULTS Serum glucose values were elevated in the maternal samples for offspring with TOF (median, 97.0 mg/dL [to convert to millimoles per liter, multiply by 0.0555]) relative to controls (median, 91.5 mg/dL) (P = .01, Wilcoxon rank sum test), a phenomenon not observed in the maternal samples for offspring with dTGA (median, 90.0 mg/dL) relative to controls (P = .18, Wilcoxon rank sum test). Serum insulin levels were significantly different between controls (median, 18.8 μIU/mL [to convert to picomoles per liter, multiply by 6.945]) and maternal samples for offspring with dTGA (median, 13.1 μIU/mL; P = .048, Wilcoxon rank sum test) but not with TOF (median, 14.3 μIU/mL; P = .35, Wilcoxon rank sum test). Relative to maternal blood glucose levels of infants without cardiac malformations, we observed that maternal blood glucose levels in models including insulin were strongly associated with odds of TOF (adjusted odds ratio = 7.54; 95% CI, 2.30-24.69) but not with dTGA (adjusted odds ratio = 1.16; 95% CI, 0.28-4.79). CONCLUSIONS AND RELEVANCE These results represent a direct correlation of glucose as a continuous variable to odds of specific cardiac malformations. The association between serum glucose and odds of TOF indicates the need for additional epidemiological and mechanistic investigations into the risk conferred by insulin signaling and glucose metabolism during early pregnancy.
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Affiliation(s)
- James R Priest
- Division of Pediatric Cardiology and Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, California USA
- Cardiovascular Institute, Stanford University School of Medicine, Stanford, California, USA
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
| | - Wei Yang
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
| | - Gerald Reaven
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
| | - Joshua W. Knowles
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
| | - Gary M. Shaw
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
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