Glycoprotein Acetyls Associate With Intraglomerular Hemodynamic Dysfunction, Albuminuria, Central Adiposity, and Insulin Resistance in Youth With Type 1 Diabetes

OBJECTIVES

Glycoprotein acetyls (GlycA's) are biomarkers of systemic inflammation and cardiovascular disease, yet little is known about their role in type 1 diabetes (T1D). In this study we examined the associations among GlycA's, central adiposity, insulin resistance, and early kidney injury in youth with T1D.

METHODS

Glomerular filtration rate and renal plasma flow by iohexol and p-aminohippurate clearance, urine albumin-to-creatinine ratio (UACR), central adiposity by dual-energy x-ray absorptiometry, and estimated insulin sensitivity were assessed in 50 youth with T1D (16±3.0 years of age, 50% female, glycated hemoglobin 8.7±1.3%, T1D duration 5.7±2.6 years). Concentrations of GlycA were quantified by targeted nuclear magnetic resonance spectroscopy. Correlation and multivariable linear regression analyses were performed.

RESULTS

GlycA's were higher in girls vs boys (1.05±0.26 vs 0.84±0.15 mmol/L, p=0.001) and in participants living with overweight/obesity vs normal weight (1.12±0.23 vs 0.87±0.20 mmol/L, p=0.0004). GlycA's correlated positively with estimated intraglomerular pressure (r=0.52, p=0.001), UACR (r=0.53, p<0.0001), and trunk mass (r=0.45, p=0.001), and inversely with estimated insulin sensitivity (r=-0.36, p=0.01). All relationships remained significant after adjustment for age, sex, and glycated hemoglobin.

CONCLUSIONS

As biomarker of inflammation, GlycA's were higher in girls and those with overweight or obese body habitus in T1D. GlycA's associated with parameters of early kidney dysfunction, central adiposity, and insulin resistance.

The quality of physical activity guidelines, but not the specificity of their recommendations, has improved over time: a systematic review and critical appraisal

While numerous guidelines for the prescription of physical activity are released each year, the quality and practicability of these guidelines is unknown. We assessed the quality of 95 guidance documents published since 2000 that included recommendations about physical activity for the promotion of general health and prevention of cardiometabolic disease. We used 3 tools: Appraisal of Guidelines for Research and Evaluation (AGREE II), the National Academy of Medicine's (NAM) Standards for Trustworthy Clinical Practice Guidelines, and the Frequency, Intensity, Time, and Type (FITT) score. Average AGREE II domain scores ranged from 38%-84%, and the portion of criteria fulfilled per NAM domain ranged from 7%-39%. The average FITT score for all recommendations was 2.48 out of 4. While guidelines improved according to both AGREE II and the NAM standards over time, their practicability as assessed by FITT score did not improve. Guidelines produced by governmental agencies or other nonprofit organizations, using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach, or fulfilling a higher number of NAM criteria tended to be of higher quality. Organizations producing physical activity guidelines can improve their quality by establishing and reporting processes for public representation, external review, and conflict of interest (COI) management. Future recommendations about physical activity should be more specific and include strategies to improve implementation. Registration no.: PROSPERO CRD42019126364. Novelty: Most physical activity recommendations are not sufficiently specific to be practically implemented. The overall quality of guidelines has improved over time, but the specificity of recommendations has not. Improved public representation, external review, and COI disclosure and management processes would improve guideline quality.

Timing and pattern of postexercise protein ingestion affects whole-body protein balance in healthy children: a randomized trial

The dose and timing of postexercise protein ingestion can influence whole-body protein balance (WBPB) in adults, although comparable data from children are scarce. This study investigated how protein intake (both amount and distribution) postexercise can affect WBPB in physically active children. Thirty-five children (26 males; 9-13 years old) underwent a 5-day adaptation diet, maintaining a protein intake of 0.95 g·kg^-1·day^-1. Participants consumed [¹⁵N]glycine (2 mg·kg^-1) before performing 3 × 20 min of variable-intensity cycling, and whole-body protein kinetics were assessed over 6 and 24 h of recovery. Fifteen grams of protein was distributed across 2 isoenergetic carbohydrate-containing beverages (15 and 240 min postexercise) containing reciprocal amounts of protein (i.e., 0 + 15 g, 5 + 10 g, 10 + 5 g, and 15 + 0 g for Groups A-D, respectively). Over the 6 h that included the exercise bout and consumption of the first beverage at 15 min postexercise, WBPB (i.e., synthesis - breakdown) demonstrated a linear increase of 0.647 g·kg^-1·day^-1 per 1 g protein intake (P < 0.001). Over 24 h, robust regression revealed that WBPB was best modeled by a parabola (P < 0.05), suggesting that a maximum in WBPB was achieved between groups B and C. In conclusion, despite a dose response early in recovery, a periodized protein intake with multiple smaller doses after physical activity may be more beneficial than a single bolus dose in promoting daily WBPB in healthy active children.

Prenatal, Obstetric and Perinatal Factors Associated With the Development of Childhood-Onset Type 2 Diabetes

OBJECTIVE

To explore associations among prenatal, obstetric and perinatal factors and the development of childhood-onset type 2 diabetes.

METHODS

This retrospective, case-control study utilized administrative data housed at the Manitoba Centre for Health Policy. De-identified health records were examined from a sample of 270 children (aged 10 to 17 years at time of diagnosis) with type 2 diabetes and 1341 children without type 2 diabetes matched for age, sex and geographic location. Patients and control subjects were linked to their de-identified biological mothers' health records. Prenatal, obstetric and perinatal factors were investigated. Univariate and multivariable conditional regression analyses were conducted to identify key factors associated with the development of type 2 diabetes in children.

RESULTS

The mean age at diagnosis was 13.1 years, and 61% of patients were girls. The majority (71.1%) of children with type 2 diabetes resided in rural areas. Exposure to maternal pregestational diabetes increased the odds of childhood-onset type 2 diabetes nearly 6-fold, and exposure to gestational diabetes carried a 4-fold increased risk. Breastfeeding was found to be protective, decreasing the risk of childhood-onset type 2 diabetes (odds ratio = 0.52, 95% confidence interval = 0.36-0.74). Low maternal income was significantly associated with development of childhood-onset type 2 diabetes (odds ratio = 6.67, 95% confidence interval = 3.01-14.79).

CONCLUSIONS

Health and social policies and programs are needed to provide financial, educational and clinical resources that target women whose pregnancies are affected by poverty, type 2 diabetes or gestational diabetes. Breastfeeding should be encouraged to aid in the prevention of childhood-onset type 2 diabetes.

Obesity and Insulin Resistance Screening Tools in American Adolescents: National Health and Nutrition Examination Survey (NHANES) 1999 to 2010

OBJECTIVE

To identify which feasible obesity and insulin resistance (IR) screening tools are most strongly associated in adolescents by using a nationally representative sample.

METHODS

Adolescents aged 12.0 to 18.9 years who were participating in the National Health and Nutrition Examination Survey (NHANES) (n=3584) and who were measured for height, weight, waist circumference (WC), triceps and subscapular skinfold thickness, glycated hemoglobin, fasting glucose (FG) and fasting insulin (FI) level were included. Adolescents were split by gender and grouped by body mass index (BMI) percentile. Age- and gender-specific classifications were constructed for each obesity screening tool measure to account for growth and maturation. General linear models were used to establish groups objectively for analysis based on when IR began to increase. Additional general linear models were used to identify when IR significantly increased for each IR measure as obesity group increased and to identify the variance accounted for among each obesity-IR screening tool relationship.

RESULTS

As the obesity group increased, homeostasis model assessment-insulin resistance (HOMA-IR) and FI significantly increased, while FG increased only (above the referent) in groups with BMI percentiles ≥95.0, and glycated hemoglobin level did not vary across obesity groups. The most strongly associated screening tools were WC and FI in boys (R(2)=0.253) and girls (R(2)=0.257). FI had the strongest association with all of the obesity measures. BMI associations were slightly weaker than WC in each in relation to IR.

CONCLUSIONS

Our findings show that WC and FI are the most strongly associated obesity and IR screening tool measures in adolescents. These feasible screening tools should be utilized in screening practices for at-risk adolescents.

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OBJECTIVE

The province of Quebec has initiated a vast reform of youth mental health services. This article aims at evaluating the first year of the implementation of first-line services in Lanaudière's two local service networks.

METHODOLOGY

A formative and participatory qualitative evaluation was carried out. Data collection was led by 32 key individuals who were engaged in the implementation of these services or who were involved in the decision-making process. Five semi-directed group interviews were carried out with the committees and teams concerned. The information collected is the object of a descriptive, qualitative content analysis.

RESULTS

The implementation of first-line services in youth mental health in the Lanaudière region has caused partners to mobilize. This fact was identified by the group as a positive element of the establishment of these services. The decision to go ahead with the implementation of these services in spite of a lack of child and adolescent psychiatrists has strengthened these individuals' determination. On the other hand, the implementation of these services has been impeded by the lack of human resources, insufficient doctors, and difficulties with the integration of first-line services and child and adolescent psychiatry.

CONCLUSION

Despite certain difficulties and differences between the local service networks in the implementation of first-line services in youth mental health, the establishment of these services seems to have caused an evolution in the institutional and clinical culture in Lanaudière.