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McDonough C, Li YC, Vangeepuram N, Liu B, Pandey G. A comprehensive youth diabetes epidemiological dataset and web portal: Resource Development and Case Studies. JMIR Public Health Surveill 2024. [PMID: 38666756 DOI: 10.2196/53330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2024] Open
Abstract
BACKGROUND The prevalence of Type 2 diabetes (DM) and prediabetes (preDM) has been increasing among youth in recent decades in the United States, prompting an urgent need for understanding and identifying their associated risk factors. Such efforts, however, have been hindered by the lack of easily accessible youth preDM/DM data. OBJECTIVE We aimed to first build a high quality, comprehensive epidemiological dataset focused on youth preDM/DM. Subsequently, we aimed to make this data accessible by creating a user-friendly web portal to share it and corresponding codes. Through this, we hope to address this significant gap and facilitate youth preDM/DM research. METHODS Building on data from the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2018, we cleaned and harmonized hundreds of variables relevant to preDM/DM (fasting plasma glucose level ≥100 mg/dL and/or HbA1C ≥5.7%) for youth aged 12-19 years (n=15,149). We identified individual factors associated with preDM/DM risk using bivariate statistical analyses and predicted preDM/DM status using our Ensemble Integration (EI) framework for multi-domain machine learning. We then developed a user-friendly web portal named Prediabetes/diabetes in youth ONline Dashboard (POND) to share the data and codes. RESULTS We extracted 95 variables potentially relevant to preDM/DM risk organized into 4 domains (sociodemographic, health status, diet, and other lifestyle behaviors). The bivariate analyses identified 27 significant correlates of preDM/DM (P ≤0.0005, Bonferroni adjusted), including race/ethnicity, health insurance, BMI, added sugar intake, and screen time. Sixteen of these factors were also identified based on the EI methodology (Fisher's P of overlap=7.06x10^-6). In addition to those, the EI approach identified 11 additional predictive variables, including some known (e.g., meat and fruit intake and family income) and less recognized factors (e.g., number of rooms in homes). The factors identified in both analyses spanned over all 4 of the domains mentioned. These data and results, as well as other exploratory tools, can be accessed on POND (https://rstudio-connect.hpc.mssm.edu/POND/). CONCLUSIONS Using NHANES data, we built one of the largest public epidemiological datasets for studying youth preDM/DM and identified potential risk factors using complementary analytical approaches. Our results align with the multifactorial nature of preDM/DM with correlates across several domains. Also, our data-sharing platform, POND, facilitates a wide range of applications to inform future youth preDM/DM studies. CLINICALTRIAL
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Affiliation(s)
- Catherine McDonough
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Pl, New York, US
| | - Yan Chak Li
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Pl,, New York, US
| | - Nita Vangeepuram
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, US
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, US
| | - Bian Liu
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, US
| | - Gaurav Pandey
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Pl, New York, US
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Yeung CHC, Lu J, Soltero EG, Bauer C, Xiao Q. U.S. Adolescent Rest-Activity patterns: insights from functional principal component analysis (NHANES 2011-2014). Int J Behav Nutr Phys Act 2023; 20:125. [PMID: 37833691 PMCID: PMC10571346 DOI: 10.1186/s12966-023-01520-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 09/26/2023] [Indexed: 10/15/2023] Open
Abstract
BACKGROUND Suboptimal rest-activity patterns in adolescence are associated with worse health outcomes in adulthood. Understanding sociodemographic factors associated with rest-activity rhythms may help identify subgroups who may benefit from interventions. This study aimed to investigate the association of rest-activity rhythm with demographic and socioeconomic characteristics in adolescents. METHODS Using cross-sectional data from the nationally representative National Health and Nutrition Examination Survey (NHANES) 2011-2014 adolescents (N = 1814), this study derived rest-activity profiles from 7-day 24-hour accelerometer data using functional principal component analysis. Multiple linear regression was used to assess the association between participant characteristics and rest-activity profiles. Weekday and weekend specific analyses were performed in addition to the overall analysis. RESULTS Four rest-activity rhythm profiles were identified, which explained a total of 82.7% of variance in the study sample, including (1) High amplitude profile; (2) Early activity window profile; (3) Early activity peak profile; and (4) Prolonged activity/reduced rest window profile. The rest-activity profiles were associated with subgroups of age, sex, race/ethnicity, and household income. On average, older age was associated with a lower value for the high amplitude and early activity window profiles, but a higher value for the early activity peak and prolonged activity/reduced rest window profiles. Compared to boys, girls had a higher value for the prolonged activity/reduced rest window profiles. When compared to Non-Hispanic White adolescents, Asian showed a lower value for the high amplitude profile, Mexican American group showed a higher value for the early activity window profile, and the Non-Hispanic Black group showed a higher value for the prolonged activity/reduced rest window profiles. Adolescents reported the lowest household income had the lowest average value for the early activity window profile. CONCLUSIONS This study characterized main rest-activity profiles among the US adolescents, and demonstrated that demographic and socioeconomic status factors may shape rest-activity behaviors in this population.
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Affiliation(s)
- Chris Ho Ching Yeung
- Department of Epidemiology, Human Genetics and Environmental Sciences, School of Public Health, University of Texas Health Science Center at Houston, 1200 Pressler St., Houston, TX, USA
| | - Jiachen Lu
- Department of Biostatistics and Data Science, School of Public Health, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, USA
- Center for Spatial‑Temporal Modeling for Applications in Population Sciences, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Erica G Soltero
- United States Department of Agriculture/Agricultural Research Services Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, TX, 77030, USA
| | - Cici Bauer
- Department of Biostatistics and Data Science, School of Public Health, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, USA.
- Center for Spatial‑Temporal Modeling for Applications in Population Sciences, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, USA.
| | - Qian Xiao
- Department of Epidemiology, Human Genetics and Environmental Sciences, School of Public Health, University of Texas Health Science Center at Houston, 1200 Pressler St., Houston, TX, USA.
- Center for Spatial‑Temporal Modeling for Applications in Population Sciences, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, USA.
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McDonough C, Li YC, Vangeepuram N, Liu B, Pandey G. Facilitating youth diabetes studies with the most comprehensive epidemiological dataset available through a public web portal. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.08.02.23293517. [PMID: 37577465 PMCID: PMC10418570 DOI: 10.1101/2023.08.02.23293517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/15/2023]
Abstract
The prevalence of type 2 diabetes mellitus (DM) and prediabetes (preDM) is rapidly increasing among youth, posing significant health and economic consequences. To address this growing concern, we created the most comprehensive youth-focused diabetes dataset to date derived from National Health and Nutrition Examination Survey (NHANES) data from 1999 to 2018. The dataset, consisting of 15,149 youth aged 12 to 19 years, encompasses preDM/DM relevant variables from sociodemographic, health status, diet, and other lifestyle behavior domains. An interactive web portal, POND (Prediabetes/diabetes in youth ONline Dashboard), was developed to provide public access to the dataset, allowing users to explore variables potentially associated with youth preDM/DM. Leveraging statistical and machine learning methods, we conducted two case studies, revealing established and lesser-known variables linked to youth preDM/DM. This dataset and portal can facilitate future studies to inform prevention and management strategies for youth prediabetes and diabetes.
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Affiliation(s)
- Catherine McDonough
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Yan Chak Li
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Nita Vangeepuram
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Bian Liu
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Gaurav Pandey
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Perng W, Conway R, Mayer-Davis E, Dabelea D. Youth-Onset Type 2 Diabetes: The Epidemiology of an Awakening Epidemic. Diabetes Care 2023; 46:490-499. [PMID: 36812420 PMCID: PMC10090267 DOI: 10.2337/dci22-0046] [Citation(s) in RCA: 25] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 11/26/2022] [Indexed: 02/24/2023]
Abstract
In this narrative review, we describe the epidemiology (prevalence, incidence, temporal trends, and projections) of type 2 diabetes among children and adolescents (<20 years), focusing on data from the U.S. and reporting global estimates where available. Secondarily, we discuss the clinical course of youth-onset type 2 diabetes, from prediabetes to complications and comorbidities, drawing comparisons with youth type 1 diabetes to highlight the aggressive course of this condition, which, only recently, has become recognized as a pediatric disease by health care providers. Finally, we end with an overview of emerging topics in type 2 diabetes research that have potential to inform strategies for effective preventive action at the community and individual levels.
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Affiliation(s)
- Wei Perng
- Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, University of Colorado Anschutz Medical Campus, Aurora, CO
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Rebecca Conway
- Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, University of Colorado Anschutz Medical Campus, Aurora, CO
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO
| | | | - Dana Dabelea
- Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, University of Colorado Anschutz Medical Campus, Aurora, CO
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO
- Department of Pediatrics, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
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Hernández-Montoya D, Cedillo-Escobar EE, Esparza-Aguilar M, Muñoz-Torres AV. Undiagnosed prediabetes in Mexican adolescents under poverty in contexts affected by collective violence: A clinical comparison among health services users and hidden population. Front Nutr 2022; 9:1007781. [DOI: 10.3389/fnut.2022.1007781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Accepted: 09/20/2022] [Indexed: 11/22/2022] Open
Abstract
IntroductionThe epidemiological pattern of prediabetes in adolescents is understudied. In Mexico, adolescents are exposed to social adversity conditions, including poverty and violence. Therefore, understanding their clinical profiles and how the social determinants of health impose barriers to access to health services is important to address detection, in those who, by their vulnerability, remain a hidden population.AimThis study aimed to describe undiagnosed prediabetes in Mexican adolescents under poverty in violent contexts and to compare the clinical features among health services users and hidden population.MethodsThis cross-sectional study included 371 adolescents from difficult access locations in violent contexts. Poverty, lack of health services access, and perceived vulnerability were determined in all samples. Endocrine markers (BMI, HOMA-IR, HbA1c, and cortisol) were measured in those with high violence perception.ResultsA total of 61.7% of the adolescents had a suburban grid and urban cluster residence, and 77.7–85.7% of them belonged to locations where 35–50% of their population lived below the poverty line. In total, 40–75% had a lack of 10–20% access to health services, and 18.8% had a high perceived vulnerability due to collective violence and were screened. Overall, 61.9% of respondents were newly diagnosed with prediabetes and showed the worst HbA1c (p = 0.001) compared to the health services subsample, which showed the highest BMI (p = 0.031) and insulin resistance (p = 0.025).ConclusionThere is a prediabetes hidden population living in violent contexts under poverty. These social determinants promote poor outcomes in perceived vulnerability and endocrine response and represent barriers to access to health services.
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Jackson E, Karlson CW, Herring W, Okhomina VI, Lim CS, Morrow A, Daggett C, Arnold L, McNaull M. Prevalence of raised body mass index in paediatric sickle cell disease. J Paediatr Child Health 2022; 58:1829-1835. [PMID: 35822947 DOI: 10.1111/jpc.16118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 05/16/2022] [Accepted: 06/26/2022] [Indexed: 11/30/2022]
Abstract
AIM Children with sickle cell disease (SCD) have historically weighed less than their healthy peers. More recently, a retrospective chart review from six institutions in New England reported nearly one-quarter of children and adolescents with SCD had raised body mass index (BMI). This study aimed to examine rates of children with SCD with raised BMI in Mississippi compared to state and national norms and assess the correlation between haemoglobin and BMI. METHODS A retrospective chart review of paediatric patients with SCD at the University of Mississippi Medical Center (UMMC) was conducted using data from the most recent clinic visit. Mississippi and national weight status estimates for youth 10-17 years were obtained from the 2016-2017 National Survey of Children's Health. RESULTS For youth 10-17 years with SCD (n = 345), 21.4.% of children with SS/Sβ° and 36.1% with SC/Sβ+ had raised BMI compared to Mississippi and national rates, 39.2 and 31%, respectively. The prevalence of children with raised BMI with SC/Sβ+ did not differ from state and national rates, while children with SS/Sβ° were half as likely as their Mississippi peers to have raised BMI. Haemoglobin levels were different among children with SCD who had low BMI (8.80 g/dL), average BMI (9.2 g/dL) and raised BMI (10.5 g/dL) (P < 0.001). CONCLUSIONS Children with SCD evaluated at UMMC have similar rates of raised BMI compared to state and national norms. Children with raised BMI have higher mean haemoglobin levels compared to children with SCD with low or average BMI. IMPLICATIONS AND CONTRIBUTION Historically, patients with SCD have been underweight and normal weight. Our paediatric and adolescent patients with SCD now have prevalence rates of raised BMI that approach state and national rates. Further work must be done to determine whether this reflects healthier children with SCD or raises concerns about life-style-related comorbidities.
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Affiliation(s)
- Erin Jackson
- Division of Pediatric Hematology Oncology, University of Mississippi Medical Center, Jackson, Mississippi, United States
| | - Cynthia W Karlson
- Division of Pediatric Hematology Oncology, University of Mississippi Medical Center, Jackson, Mississippi, United States.,Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, Mississippi, United States
| | - Whitney Herring
- Mississippi Center for Advanced Medicine, Jackson, Mississippi, United States
| | - Victoria I Okhomina
- Department of Data Science, University of Mississippi Medical center, Jackson, Mississippi, United States
| | - Crystal S Lim
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, Mississippi, United States
| | - Anne Morrow
- Department of Psychology, Florida International University, Miami, Florida, United States.,College of Psychology, Nova Southeastern University, Fort Lauderdale, Florida, United States
| | - Caroline Daggett
- School of Medicine, University of Mississippi Medical Center, Jackson, Mississippi, United States
| | - Laura Arnold
- Division of Pediatric Hematology Oncology, University of Mississippi Medical Center, Jackson, Mississippi, United States
| | - Melissa McNaull
- Division of Pediatric Hematology Oncology, University of Mississippi Medical Center, Jackson, Mississippi, United States
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Tskhvedadze N, Janjgava S, Tananashvili D, Giorgadze E. The Impact of Obesity Assessed by Different Criteria on the Metabolic Parameters in Children and Adolescents in Georgia. Glob Pediatr Health 2022; 9:2333794X221097569. [PMID: 35592792 PMCID: PMC9112292 DOI: 10.1177/2333794x221097569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Accepted: 04/12/2022] [Indexed: 11/23/2022] Open
Abstract
The aim of our study was comparative analysis of anthropometric characteristics
in children and adolescents significantly correlated with the parameters of
metabolic syndrome. The study group is consisted of 113 children and adolescents
(study group) with excessive body weight and obesity (group 1—BMI percentile;
group 2—waist circumference; group 3—waist to height ratio). The control group
consisted of 113 children and adolescents without. Comparative analysis of
obtained data have been carried out by multiple regression analysis. BMI
percentile is more an indicator of a generalized obesity; WC and WHR percentiles
better describe visceral obesity and metabolic disorders—insulin resistance,
hypertension and dyslipidemia. However, the WHR Percentile may be a more useful
tool. To assess obesity in children and adolescents, it is necessary to evaluate
together BMI, WC, and WHR percentiles. It can be also concluded that these
findings indicate the need to continue research in this direction.
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Affiliation(s)
- Nino Tskhvedadze
- Tbilisi State University, Tbilisi, Georgia.,National Institute of Endocrinology, Tbilisi, Georgia
| | | | | | - Elene Giorgadze
- Tbilisi State University, Tbilisi, Georgia.,National Institute of Endocrinology, Tbilisi, Georgia
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Stevens P, Hunter J, Molodysky E. The role of hyperinsulinaemia in screening for prediabetes in the adolescent population: A systematic literature review. Diabetes Metab Syndr 2022; 16:102445. [PMID: 35305511 DOI: 10.1016/j.dsx.2022.102445] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 02/22/2022] [Accepted: 02/24/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND/AIMS Present screening methods for Type 2 diabetes (T2DM) fall short of detecting prediabetes. This paper summarises the literature on the utility of insulin measurements (hyperinsulinemia) in detecting prediabetes in adolescents. METHODS A systematic literature review was conducted using EMBASE and Medline. Relevant data on hyperinsulinemia in the adolescent population is narrated. RESULTS The database search identified 174 potential articles; 106 underwent a full-paper review, and 36 were included. CONCLUSION Elevated fasting insulin is a marker of impaired insulin resistance and pending beta-cell dysfunction in at-risk adolescents and can be an early indicator of prediabetes.
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Song K, Park G, Lee HS, Lee M, Lee HI, Ahn J, Lee E, Choi HS, Suh J, Kwon A, Kim HS, Chae HW. Trends in Prediabetes and Non-Alcoholic Fatty Liver Disease Associated with Abdominal Obesity among Korean Children and Adolescents: Based on the Korea National Health and Nutrition Examination Survey between 2009 and 2018. Biomedicines 2022; 10:biomedicines10030584. [PMID: 35327390 PMCID: PMC8945340 DOI: 10.3390/biomedicines10030584] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 02/24/2022] [Accepted: 02/28/2022] [Indexed: 02/04/2023] Open
Abstract
Investigations on the trends of prediabetes and non-alcoholic fatty liver disease (NAFLD) among children are scarce. We aimed to analyze the trends of prediabetes and NAFLD, as well as their association, among Korean children and adolescents from 2009 to 2018. This study investigated the prevalence of prediabetes, NAFLD, and abdominal obesity among 6327 children and adolescents aged 10–18 years according to age, sex, and body mass index (BMI) using a nationally representative survey. The prevalence of prediabetes, NAFLD, and abdominal obesity increased from 5.14%, 8.17%, and 5.97% respectively, in 2009 to 10.46%, 12.05%, and 10.51% respectively, in 2018. In age-specific analyses, an adverse trend in NAFLD was significant only in participants aged 16–18 years while the prevalence of prediabetes worsened significantly in all age groups. In BMI-specific analyses, the prevalence of prediabetes and NAFLD increased significantly only in participants with normal BMI. In logistic regression analysis, the odds ratio of prediabetes for NAFLD was 1.85 and those of abdominal obesity for prediabetes and NAFLD was 1.85 and 9.34, respectively. Our results demonstrated that the prevalence of prediabetes and NAFLD was increasing in association with abdominal obesity in Korean children and adolescents.
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Affiliation(s)
- Kyungchul Song
- Department of Pediatrics, Severance Children’s Hospital, Endocrine Research Institute, Yonsei University College of Medicine, Seoul 03722, Korea; (K.S.); (M.L.); (H.I.L.); (J.A.); (E.L.); (H.S.C.); (J.S.); (A.K.); (H.-S.K.)
| | - Goeun Park
- Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul 03722, Korea; (G.P.); (H.S.L.)
| | - Hye Sun Lee
- Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul 03722, Korea; (G.P.); (H.S.L.)
| | - Myeongseob Lee
- Department of Pediatrics, Severance Children’s Hospital, Endocrine Research Institute, Yonsei University College of Medicine, Seoul 03722, Korea; (K.S.); (M.L.); (H.I.L.); (J.A.); (E.L.); (H.S.C.); (J.S.); (A.K.); (H.-S.K.)
| | - Hae In Lee
- Department of Pediatrics, Severance Children’s Hospital, Endocrine Research Institute, Yonsei University College of Medicine, Seoul 03722, Korea; (K.S.); (M.L.); (H.I.L.); (J.A.); (E.L.); (H.S.C.); (J.S.); (A.K.); (H.-S.K.)
| | - Jungmin Ahn
- Department of Pediatrics, Severance Children’s Hospital, Endocrine Research Institute, Yonsei University College of Medicine, Seoul 03722, Korea; (K.S.); (M.L.); (H.I.L.); (J.A.); (E.L.); (H.S.C.); (J.S.); (A.K.); (H.-S.K.)
- Department of Pediatrics, Jeju National University College of Medicine and Graduate School of Medicine, Jeju 63241, Korea
| | - Eunbyoul Lee
- Department of Pediatrics, Severance Children’s Hospital, Endocrine Research Institute, Yonsei University College of Medicine, Seoul 03722, Korea; (K.S.); (M.L.); (H.I.L.); (J.A.); (E.L.); (H.S.C.); (J.S.); (A.K.); (H.-S.K.)
- Department of Pediatrics, International St. Mary’s Hospital, Catholic Kwandong University, Incheon 22711, Korea
| | - Han Saem Choi
- Department of Pediatrics, Severance Children’s Hospital, Endocrine Research Institute, Yonsei University College of Medicine, Seoul 03722, Korea; (K.S.); (M.L.); (H.I.L.); (J.A.); (E.L.); (H.S.C.); (J.S.); (A.K.); (H.-S.K.)
| | - Junghwan Suh
- Department of Pediatrics, Severance Children’s Hospital, Endocrine Research Institute, Yonsei University College of Medicine, Seoul 03722, Korea; (K.S.); (M.L.); (H.I.L.); (J.A.); (E.L.); (H.S.C.); (J.S.); (A.K.); (H.-S.K.)
| | - Ahreum Kwon
- Department of Pediatrics, Severance Children’s Hospital, Endocrine Research Institute, Yonsei University College of Medicine, Seoul 03722, Korea; (K.S.); (M.L.); (H.I.L.); (J.A.); (E.L.); (H.S.C.); (J.S.); (A.K.); (H.-S.K.)
| | - Ho-Seong Kim
- Department of Pediatrics, Severance Children’s Hospital, Endocrine Research Institute, Yonsei University College of Medicine, Seoul 03722, Korea; (K.S.); (M.L.); (H.I.L.); (J.A.); (E.L.); (H.S.C.); (J.S.); (A.K.); (H.-S.K.)
| | - Hyun Wook Chae
- Department of Pediatrics, Severance Children’s Hospital, Endocrine Research Institute, Yonsei University College of Medicine, Seoul 03722, Korea; (K.S.); (M.L.); (H.I.L.); (J.A.); (E.L.); (H.S.C.); (J.S.); (A.K.); (H.-S.K.)
- Correspondence: ; Tel.: +82-2-2019-3350; Fax: +82-2-393-9118
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Chae J, Seo MY, Kim SH, Park MJ. Trends and Risk Factors of Metabolic Syndrome among Korean Adolescents, 2007 to 2018. Diabetes Metab J 2021; 45:880-889. [PMID: 34225415 PMCID: PMC8640158 DOI: 10.4093/dmj.2020.0185] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 11/04/2020] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND There is a lack of recent research on the changes in risk factors for metabolic syndrome (MetS) in the Asian pediatric population. We aimed to determine the 12-year trends in the prevalence of MetS and relevant lifestyle factors such as smoking, exercise, and calorie intake among Korean adolescents. METHODS We investigated trends in MetS and lifestyle factors among 6,308 adolescents aged 12 to 18 years from the Korea National Health and Nutrition Examination Survey, 2007 to 2018. RESULTS The prevalence of MetS was stable from 2007 to 2018 (1.7% to 2.2%). There were significant increases in the prevalence of central obesity (from 8.1% to 11.2%, P=0.012) and hyperglycemia (from 5.3% to 10.4%, P<0.001) and decreases in hypo-high-density lipoprotein (HDL)-cholesterolemia (from 22.4% to 14.8%, P<0.001). Total calorie intake and calorie intake from fat significantly increased (P<0.001), whereas calorie intake from carbohydrates significantly decreased (P<0.001) during the study period. The proportions of tobacco smokers and regular walkers significantly decreased from 2007 to 2018. After controlling for all covariates, total calorie intake was positively correlated with waist circumference (P<0.05). HDL-cholesterol was negatively associated with carbohydrate consumption (P<0.01) and positively associated with fat consumption (P<0.001). Regular walking and regular strength training were associated with lower waist circumference (P<0.05). Smoking was associated with lower fasting glucose levels (P<0.01). CONCLUSION Although the prevalence rate of MetS is stable among Korean adolescents, the prevalence of central obesity and hyperglycemia has increased greatly in the recent decade. Public education on proper dietary intake and lifestyle modification is required.
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Affiliation(s)
- Jiun Chae
- Department of Pediatrics, Inje University Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Moon Young Seo
- Department of Pediatrics, Inje University Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Shin-Hye Kim
- Department of Pediatrics, Inje University Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
- Shin-Hye Kim https://orcid.org/0000-0003-0413-122X Department of Pediatrics, Inje University Sanggye Paik Hospital, Inje University College of Medicine, 1342 Dongil-ro, Nowon-gu, Seoul 01757, Korea E-mail:
| | - Mi Jung Park
- Department of Pediatrics, Inje University Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
- Corresponding authors: Mi Jung Park https://orcid.org/0000-0002-7202-500X Department of Pediatrics, Inje University Sanggye Paik Hospital, Inje University College of Medicine, 1342 Dongil-ro, Nowon-gu, Seoul 01757, Korea E-mail:
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Denton JJ, Fernandez JR. The role of family history of diabetes as a predictor of insulin activity in a sample of diverse, normal weight children. ENDOCRINE AND METABOLIC SCIENCE 2021. [DOI: 10.1016/j.endmts.2021.100090] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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12
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Predicting youth diabetes risk using NHANES data and machine learning. Sci Rep 2021; 11:11212. [PMID: 34045491 PMCID: PMC8160335 DOI: 10.1038/s41598-021-90406-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 04/30/2021] [Indexed: 01/21/2023] Open
Abstract
Prediabetes and diabetes mellitus (preDM/DM) have become alarmingly prevalent among youth in recent years. However, simple questionnaire-based screening tools to reliably assess diabetes risk are only available for adults, not youth. As a first step in developing such a tool, we used a large-scale dataset from the National Health and Nutritional Examination Survey (NHANES) to examine the performance of a published pediatric clinical screening guideline in identifying youth with preDM/DM based on American Diabetes Association diagnostic biomarkers. We assessed the agreement between the clinical guideline and biomarker criteria using established evaluation measures (sensitivity, specificity, positive/negative predictive value, F-measure for the positive/negative preDM/DM classes, and Kappa). We also compared the performance of the guideline to those of machine learning (ML) based preDM/DM classifiers derived from the NHANES dataset. Approximately 29% of the 2858 youth in our study population had preDM/DM based on biomarker criteria. The clinical guideline had a sensitivity of 43.1% and specificity of 67.6%, positive/negative predictive values of 35.2%/74.5%, positive/negative F-measures of 38.8%/70.9%, and Kappa of 0.1 (95%CI: 0.06–0.14). The performance of the guideline varied across demographic subgroups. Some ML-based classifiers performed comparably to or better than the screening guideline, especially in identifying preDM/DM youth (p = 5.23 × 10−5).We demonstrated that a recommended pediatric clinical screening guideline did not perform well in identifying preDM/DM status among youth. Additional work is needed to develop a simple yet accurate screener for youth diabetes risk, potentially by using advanced ML methods and a wider range of clinical and behavioral health data.
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13
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Clustering of cardio-metabolic risk factors and pre-diabetes among U.S. adolescents. Sci Rep 2021; 11:5015. [PMID: 33658537 PMCID: PMC7930049 DOI: 10.1038/s41598-021-84128-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 02/01/2021] [Indexed: 11/08/2022] Open
Abstract
Few studies have assessed the association between clustering of cardio-metabolic risk factors (CMRFs) and pre-diabetes in children or adolescents. We aimed to examine the association between clustering of CMRFs and pre-diabetes among U.S. adolescents. Data were available for 5,633 U.S. adolescents aged 12-19 years from the National Health and Nutrition Examination Surveys 1999-2014. Pre-diabetes was defined as impaired fasting glucose (IFG) (fasting plasma glucose 100-125 mg/dL), impaired glucose tolerance (IGT) (2-h plasma glucose 140-199 mg/dL) or elevated hemoglobin A1c (HbA1c) (HbA1c 5.7-6.4%). The individual CMRFs considered in the present study were as follows: waist-to-height ratio, blood pressure, triglycerides, and high-density lipoprotein cholesterol. CMRFs were defined based on the modified National Cholesterol Education Program (NCEP) criteria or the modified International Diabetes Federation (IDF) criteria. Logistic regression analysis was used to examine the association between clustering of CMRFs and pre-diabetes with adjustment for potential covariates. Among 5633 adolescents, 11.4% had IFG, 4.7% had IGT, 4.5% had elevated HbA1c and 16.1% had pre-diabetes. Compared with adolescents with no CMRFs, the odds ratios (ORs) with 95% confidence intervals (CIs) for pre-diabetes across the clustering of CMRFs (i.e., 1, 2, 3, and 4) were 1.32 (1.03-1.68), 2.07 (1.55-2.76), 2.52 (1.69-3.76), and 5.41 (3.14-9.32), respectively, based on the modified NCEP criteria. The corresponding ORs with 95% CIs were 1.16 (0.89-1.51), 1.78 (1.35-2.36), 3.07 (1.89-4.98) and 12.20 (3.93-37.89), respectively, based on the modified IDF criteria. The present study suggests that the clustering of CMRFs is associated with increased pre-diabetes among U.S. adolescents. It might be necessary for effective strategies and measures targeting adolescents with clustering of CMRFs, including those with less than 3 risk factors.
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14
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Esquivel Zuniga R, DeBoer MD. Prediabetes in Adolescents: Prevalence, Management and Diabetes Prevention Strategies. Diabetes Metab Syndr Obes 2021; 14:4609-4619. [PMID: 34858039 PMCID: PMC8629936 DOI: 10.2147/dmso.s284401] [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] [Received: 09/11/2021] [Accepted: 11/03/2021] [Indexed: 12/16/2022] Open
Abstract
The ongoing obesity epidemic in children and adolescents has greatly increased the prevalence of related comorbidities. Prediabetes is defined based on levels of fasting glucose, oral glucose tolerance tests or hemoglobin A1c, that are intermediate between normal levels and thresholds that define type 2 diabetes mellitus (T2DM). As such, prediabetes represents a sign of early pathophysiology preceding T2DM development. Recent analyses of data from US adolescents estimate prediabetes to be present in 4-23% of adolescents, depending on criteria used, with other studies finding an 8% risk of progression from prediabetes to T2DM over a 3-year period. These data support the importance of intervention to avoid long-term sequelae, focusing on reducing degree of obesity and insulin resistance. Lifestyle modification, with increases in physical activity and dietary improvements, remains the first-line approach. Other interventions are based on additional long-term risks and range from metformin treatment for more moderate cases of prediabetes to bariatric surgery for adolescents with severe obesity and comorbidities. As data accumulate regarding sequelae of T2DM in adolescents, there remains a critical need for prevention of obesity and T2DM throughout childhood, and prediabetes should be a trigger for improving this risk profile.
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Affiliation(s)
- Rebeca Esquivel Zuniga
- Division of Pediatric Endocrinology, Department of Pediatrics, University of Virginia, Charlottesville, VA, USA
| | - Mark D DeBoer
- Division of Pediatric Endocrinology, Department of Pediatrics, University of Virginia, Charlottesville, VA, USA
- Correspondence: Mark D DeBoer Division of Pediatric Endocrinology, University of Virginia, PO Box 800386, Charlottesville, VA, 22903, USATel +1 434-924-5956Fax +1 434-924-9181 Email
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15
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Abstract
The prevalence of diabetes in reproductive age women has been reported to be as high as 6.8%, with pregestational diabetes affecting 2% of all pregnancies. As cases of diabetes in children and adolescents rise, more patients will be entering reproductive age and pregnancy with diagnoses of obesity, prediabetes, type 2 diabetes. Early interventions of diet modification and exercise to maintain healthy weights can delay or even prevent these complications. It is critical for health care providers to emphasize the importance of preconception counseling in this high-risk patient population to reduce the morbidities associated with obesity and diabetes in pregnancy.
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16
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Leong KSW, Jayasinghe TN, Wilson BC, Derraik JGB, Albert BB, Chiavaroli V, Svirskis DM, Beck KL, Conlon CA, Jiang Y, Schierding W, Vatanen T, Holland DJ, O'Sullivan JM, Cutfield WS. High prevalence of undiagnosed comorbidities among adolescents with obesity. Sci Rep 2020; 10:20101. [PMID: 33208826 PMCID: PMC7674474 DOI: 10.1038/s41598-020-76921-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 10/07/2020] [Indexed: 12/24/2022] Open
Abstract
Metabolic diseases are increasing among adolescents with obesity. Although the reported prevalence of metabolic syndrome is approximately 30% worldwide, its prevalence is largely unknown among New Zealand adolescents. Therefore, we assessed the health of adolescents with obesity (BMI ≥ 30 kg/m2) enrolled in a randomised clinical trial (Gut Bugs Trial), to identify the prevalence of undiagnosed comorbidities. Assessments included anthropometry, 24-h ambulatory blood pressure monitoring, and insulin sensitivity. We report on baseline data (pre-randomisation) on 87 participants (14–18 years; 59% females), with mean BMI 36.9 ± 5.3 kg/m2 (BMI SDS 3.33 ± 0.79). Approximately 40% of participants had undiagnosed metabolic syndrome, which was twice as common among males. Half (53%) had pre-diabetes and 92% a reduction in insulin sensitivity. Moreover, 31% had pre-hypertension/hypertension, 69% dyslipidaemia, and 25% abnormal liver function. Participants with class III obesity had a greater risk of metabolic syndrome than those with classes I/II [relative risk 1.99 (95% CI 1.19, 3.34)]. Risks for pre-hypertension/hypertension and inflammation were also greater among those with class III obesity. We identified a high prevalence of undiagnosed comorbidities among adolescents with obesity in New Zealand. As adolescent obesity tracks into adulthood, early interventions are needed to prevent progression to overt cardiometabolic diseases.
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Affiliation(s)
- Karen S W Leong
- Liggins Institute, University of Auckland, Auckland, New Zealand.,A Better Start-National Science Challenge, Auckland, New Zealand
| | | | - Brooke C Wilson
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - José G B Derraik
- Liggins Institute, University of Auckland, Auckland, New Zealand.,A Better Start-National Science Challenge, Auckland, New Zealand.,Department of Endocrinology, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Benjamin B Albert
- Liggins Institute, University of Auckland, Auckland, New Zealand.,A Better Start-National Science Challenge, Auckland, New Zealand
| | - Valentina Chiavaroli
- Liggins Institute, University of Auckland, Auckland, New Zealand.,Neonatal Intensive Care Unit, Pescara Public Hospital, Pescara, Italy
| | - Darren M Svirskis
- School of Pharmacy, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Kathryn L Beck
- School of Sport, Exercise and Nutrition, College of Health, Massey University, Auckland, New Zealand
| | - Cathryn A Conlon
- School of Sport, Exercise and Nutrition, College of Health, Massey University, Auckland, New Zealand
| | - Yannan Jiang
- Department of Statistics, University of Auckland, Auckland, New Zealand
| | | | - Tommi Vatanen
- Liggins Institute, University of Auckland, Auckland, New Zealand.,Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - David J Holland
- Department of Infectious Diseases, Counties Manukau District Health Board, Auckland, New Zealand
| | - Justin M O'Sullivan
- Liggins Institute, University of Auckland, Auckland, New Zealand. .,A Better Start-National Science Challenge, Auckland, New Zealand.
| | - Wayne S Cutfield
- Liggins Institute, University of Auckland, Auckland, New Zealand. .,A Better Start-National Science Challenge, Auckland, New Zealand. .,Department of Endocrinology, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China.
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17
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Luzi L, Radaelli MG. Influenza and obesity: its odd relationship and the lessons for COVID-19 pandemic. Acta Diabetol 2020; 57:759-764. [PMID: 32249357 PMCID: PMC7130453 DOI: 10.1007/s00592-020-01522-8] [Citation(s) in RCA: 219] [Impact Index Per Article: 54.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 03/18/2020] [Indexed: 02/06/2023]
Abstract
AIMS Analyze the relationship between obesity and influenza. METHODS Basal hormone milieu, defective response of both innate and adaptive immune system and sedentariness are major determinants in the severity of influenza viral infection in obese patients. Being overweight not only increases the risk of infection and of complications for the single obese person, but a large prevalence of obese individuals within the population might increase the chance of appearance of more virulent viral strain, prolongs the virus shedding throughout the total population and eventually might increase overall mortality rate of an influenza pandemic. RESULTS Waiting for the development of a vaccination against COVID-19, isolation of positive cases and social distancing are the primary interventions. Nonetheless, evidence from previous influenza pandemics suggests the following interventions aimed at improving immune response: (1) lose weight with a mild caloric restriction; (2) include AMPK activators and PPAR gamma activators in the drug treatment for obesity associated with diabetes; and (3) practice mild-to-moderate physical exercise. CONCLUSIONS Due to prolonged viral shedding, quarantine in obese subjects should likely be longer than normal weight individuals.
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Affiliation(s)
- Livio Luzi
- Department of Endocrinology, Nutrition and Metabolic Diseases, IRCCS MultiMedica, Milan, Italy.
- Department of Biomedical Sciences and Health, Università degli Studi di Milano, Milan, Italy.
| | - Maria Grazia Radaelli
- Department of Endocrinology, Nutrition and Metabolic Diseases, IRCCS MultiMedica, Milan, Italy
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18
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Meamar R, Amini M, Aminorroaya A, Nasri M, Abyar M, Feizi A. Severity of the metabolic syndrome as a predictor of prediabetes and type 2 diabetes in first degree relatives of type 2 diabetic patients: A 15-year prospective cohort study. World J Diabetes 2020; 11:202-212. [PMID: 32477456 PMCID: PMC7243485 DOI: 10.4239/wjd.v11.i5.202] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 03/16/2020] [Accepted: 03/24/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Type 2 diabetes mellitus (T2DM) has high morbidity and mortality worldwide, therefore there is of paramount importance to identify the risk factors in the populations at risk early in the course of illness. A strong correlation between severity of metabolic syndrome (MetS) and HbA1c, fasting insulin and insulin resistance has been reported. Accordingly, the MetS severity score (or MestS Z-score) can potentially be used to predict the risk of T2DM progression over time.
AIM To evaluate the association the of MestS Z-score in first degree relatives (FDRs) of T2DM with the risk of prediabetes and type 2 diabetes in future.
METHODS A prospective open cohort study was conducted between 2003-2018. At baseline, the sample comprised of 1766 FDRs of patients with T2DM who had a normal glucose tolerance test. Relative risk (RR) and 95% confidence interval were calculated based on logistic regression. The receiver-operator characteristic analysis and area under the curve based on MetS Z-score were used to evaluate the risk of prediabetes and diabetes among the FDR population.
RESULTS Baseline MetS Z-scores were associated with the its latest values (P < 0.0001). Compared with individuals who were T2DM free at the end of follow up, those who developed T2DM had higher MetS Z-score at baseline (P < 0.001). In multivariable logistic regression analyses for every unit elevation in MetS Z-score at the baseline, the RR for developing future T2DM and prediabetes was (RR = 1.94, RR = 3.84), (RR = 1.5, RR = 2.17) in total population and female group, respectively (P < 0.05). The associations remained significant after adjusting the potential confounding variables. A cut off value of 0.97 and 0.94 was defined in the receiver-operator characteristic curve based on the MetS Z-score for differentiating female patients with diabetes and prediabetes from the normal population, respectively.
CONCLUSION The MetS Z-score was associated with an increased risk of future T2DM. Appropriate interventions at earlier stages for preventing and attenuating MetS effects may be considered as an effective strategy for FDR as at-risk population.
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Affiliation(s)
- Rokhsareh Meamar
- Isfahan Endocrine and Metabolism Research Center, Isfahan Clinical Toxicology Research Center, Isfahan University of Medical Sciences, Isfahan 81746-73461, Iran
| | - Masoud Amini
- Isfahan Endocrine and Metabolism Research Center, Isfahan University of Medical Sciences, Isfahan 81746-73461, Iran
| | - Ashraf Aminorroaya
- Isfahan Endocrine and Metabolism Research Center, Isfahan University of Medical Sciences, Isfahan 81746-73461, Iran
| | - Maryam Nasri
- Grovemead Health Center, London NW4-3EB, United Kingdom
| | - Majid Abyar
- Isfahan Endocrine and Metabolism Research Center, Isfahan University of Medical Sciences, Isfahan 81746-73461, Iran
| | - Awat Feizi
- Isfahan Endocrine and Metabolism Research Center, Isfahan University of Medical Sciences, Isfahan 81746-73461, Iran
- Department of Biostatistics and Epidemiology, School of Health, Isfahan University of Medical Sciences, Isfahan 81746-73461, Iran
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19
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Ekblom-Bak E, Halldin M, Vikström M, Stenling A, Gigante B, de Faire U, Leander K, Hellénius ML. Physical activity attenuates cardiovascular risk and mortality in men and women with and without the metabolic syndrome - a 20-year follow-up of a population-based cohort of 60-year-olds. Eur J Prev Cardiol 2020; 28:1376-1385. [PMID: 34647588 DOI: 10.1177/2047487320916596] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 03/11/2020] [Indexed: 12/17/2022]
Abstract
AIMS The purpose of this study was to analyse the association of leisure-time physical activity of different intensities at baseline, and cardiovascular disease incidence, cardiovascular disease mortality and all-cause mortality in a population-based sample of 60-year-old men and women with and without established metabolic syndrome, for more than 20 years of follow-up. A secondary aim was to study which cardiometabolic factors may mediate the association between physical activity and long-term outcomes. METHODS A total of 3693 participants (53% women) underwent physical examination and laboratory tests, completed an extensive questionnaire at baseline 1997-1999 and were followed until their death or until 31 December 2017. First-time cardiovascular disease events and death from any cause were ascertained through regular examinations of national registers. RESULTS Metabolic syndrome prevalence was 23.0%. In metabolic syndrome participants, light physical activity attenuated cardiovascular disease incidence (hazard ratio = 0.71; 95% confidence interval 0.50-1.00) compared to sedentary (reference) after multi-adjustment. Moderate/high physical activity was inversely associated with both cardiovascular disease and all-cause mortality, but became non-significant after multi-adjustment. Sedentary non-metabolic syndrome participants had lower cardiovascular disease incidence (0.47; 0.31-0.72) but not significantly different cardiovascular disease (0.61; 0.31-1.19) and all-cause mortality (0.92; 0.64-1.34) compared to sedentary metabolic syndrome participants. Both light and moderate/high physical activity were inversely associated with cardiovascular disease and all-cause mortality in non-metabolic syndrome participants (p<0.05). There were significant variations in several central cardiometabolic risk factors with physical activity level in non-metabolic syndrome participants. Fibrinogen mediated the protective effects of physical activity in non-metabolic syndrome participants. CONCLUSION Physical activity of different intensities attenuated cardiovascular risk and mortality in 60-year old men and women with metabolic syndrome during a 20-year follow-up.
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Affiliation(s)
- Elin Ekblom-Bak
- Åstrand Laboratory of Work Physiology, The Swedish School of Sport and Health Sciences, Sweden
| | | | - Max Vikström
- Department of Cardiovascular Epidemiology, Karolinska Institutet, Sweden
| | | | - Bruna Gigante
- Department of Medicine, Karolinska Institutet, Sweden
| | - Ulf de Faire
- Department of Cardiovascular Epidemiology, Karolinska Institutet, Sweden.,Department of Medicine, Karolinska Institutet, Sweden
| | - Karin Leander
- Department of Cardiovascular Epidemiology, Karolinska Institutet, Sweden
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20
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Koutny F, Weghuber D, Bollow E, Greber‐Platzer S, Hartmann K, Körner A, Reinehr T, Roebl M, Simic‐Schleicher G, Wabitsch M, Widhalm K, Wiegand S, Holl RW. Prevalence of prediabetes and type 2 diabetes in children with obesity and increased transaminases in European German-speaking countries. Analysis of the APV initiative. Pediatr Obes 2020; 15:e12601. [PMID: 31810110 PMCID: PMC7079233 DOI: 10.1111/ijpo.12601] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2019] [Revised: 10/10/2019] [Accepted: 10/11/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Non-alcoholic fatty liver disease (NAFLD), prediabetes and type 2 diabetes mellitus are known to be closely linked with obesity as early as during childhood. OBJECTIVES The study aimed to determine the prevalence of prediabetes and T2DM in children with obesity with or without increased transaminases. METHODS Data from the observational multicentre (n = 51), cross-sectional Adipositas Patienten Verlaufsbeobachtung registry were analyzed. Mild increase (mild group) was defined by alanine transaminase (ALT) >24 to ≤50 U/L and moderate to severe increase (advanced group) by ALT > 50 U/L. Prediabetes and T2DM were defined according to recent IDF/ISPAD guidelines. RESULTS The prevalence of prediabetes and T2DM was 11.9% (95% CI: 11.0-12.8) and 1.4% (95% CI: 1.1-1.7) among all participants (n = 4932; male = 2481; mean age 12.9 ± 2.7 years; BMI-SDS 2.1 ± 0.5; Tanner stage 3.2 ± 1.5). The prevalence of impaired glucose metabolism (prediabetes and T2DM) was 13.8% (95% CI: 12.1-15.4) in the mild, 21.9% (95% CI: 18.8-25.1) in the advanced group, 10.7% (95% CI: 9.4-11.9) in the control group. Mild and advanced groups had greater odds ratios for prediabetes [1.42; 95% CI: 1.17-1.72, 2.26-fold; (1.78-2.86), respectively], the advanced group also for T2DM [2.39 (1.36-4.21)] compared to controls. While an increase in transaminases predominantly affected boys, girls within the advanced group had a higher T2DM prevalence than males (5.4 vs. male 2.1%). CONCLUSIONS Children with obesity and increased liver transaminases as surrogates of NAFLD should be screened for T2DM.
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Affiliation(s)
- Florian Koutny
- Department of PediatricsParacelsus Private Medical SchoolSalzburgAustria,Obesity Research UnitParacelsus Private Medical SchoolSalzburgAustria
| | - Daniel Weghuber
- Department of PediatricsParacelsus Private Medical SchoolSalzburgAustria,Obesity Research UnitParacelsus Private Medical SchoolSalzburgAustria
| | - E. Bollow
- Institute of Epidemiology and Medical BiometryUniversity of Ulm, German Center for Diabetes ResearchUlmGermany
| | - S. Greber‐Platzer
- Department of Pediatrics and Adolescent MedicineMedical University of ViennaViennaAustria
| | - K. Hartmann
- Medical Centre of Childhood and AdolescenceFrankfurtGermany
| | - A. Körner
- Center for Pediatric Research, Department of Women and Child HealthUniversity Hospital for Children & Adolescents, University of LeipzigLeipzigGermany
| | - T. Reinehr
- Department of Pediatric Endocrinology, Diabetes and Nutrition Medicine, Vestische Hospital for Children and Adolescents DattelnUniversity of Witten/HerdeckeDattelnGermany
| | - M. Roebl
- Department of Pediatrics and Pediatric NeurologyUniversity Medical Center GöttingenGöttingenGermany
| | | | - M. Wabitsch
- Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics and Adolescent MedicineUniversity Medical Center UlmUlmGermany
| | - K. Widhalm
- Division of Nutrition and Metabolism, Department of PediatricsMedical University of ViennaViennaAustria
| | - S. Wiegand
- Department of Pediatric Endocrinology and Diabetes, Center for social‐pediatric careCharité Universitätsmedizin BerlinBerlinGermany
| | - R. W. Holl
- Institute of Epidemiology and Medical BiometryUniversity of Ulm, German Center for Diabetes ResearchUlmGermany
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21
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Spurr S, Bally J, Bullin C, Allan D, McNair E. The prevalence of undiagnosed Prediabetes/type 2 diabetes, prehypertension/hypertension and obesity among ethnic groups of adolescents in Western Canada. BMC Pediatr 2020; 20:31. [PMID: 31973728 PMCID: PMC6979336 DOI: 10.1186/s12887-020-1924-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Accepted: 01/14/2020] [Indexed: 12/14/2022] Open
Abstract
Background An increased incidence of type 2 diabetes in youth is occurring worldwide. While diverse ethnic groups are disproportionately affected by type 2 diabetes, studies that explore ethnic differences and undiagnosed prediabetes/type 2 diabetes in adolescents are scarce. This paper compares the prevalence of undiagnosed prediabetes and type 2 diabetes and the associated risk factors among various ethnic groups of adolescents living in Western Canada. Methods The data for this study were derived from two previous studies in which 396 adolescents, aged 14 to 19 years and living in a western Canadian province, were screened for undiagnosed prediabetes, diabetes, and any associated risk factors. Risk was determined by demographics, family history, anthropometric measurements (body mass index, BMI), blood pressure (BP), and HbA1c. Descriptive and inferential statistics (SPSS) were used to establish both risk and prevalence for prediabetes and type 2 diabetes. Chi-square analyses were done to determine if the risk factors occurred at higher frequencies in certain ethnicities. Results Based on BP, BMI, and HbA1c measurements, several statistically significant differences were identified in relation to ethnicity. Many of the adolescents had increased HbA1c levels, with 27.3% considered high risk and 2.3% in the prediabetes range; these high risk and prediabetes groups were heavily represented by Filipino (46%), Indigenous (22%), and European (10%) adolescents. Notable prevalence of prehypertension (17.7%) and hypertension (21.7%) were reported in European (59%) followed by Filipino (50%) and Indigenous (26%) adolescents. Higher numbers of adolescents in the European and Filipino ancestry groups had two or more risk factors (BP, BMI, & HbA1c) for developing type 2 diabetes in relation to the adolescents from the Indigenous group. Conclusions Ethnic adolescent groups demonstrate a notable prevalence of undiagnosed prediabetes and type 2 diabetes. Specifically, a significant number of Filipino adolescents had both increased HbA1c and blood pressure that has gone undetected. Earlier onset of type 2 diabetes is congruent with an increased risk of developing diabetes-associated complications and, ultimately, diabetes-related morbidity and mortality at a younger age. Future studies should explore how genetic and/or environmental factors among ethnic groups may contribute to early onset hypertension and prediabetes/type 2 diabetes.
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Affiliation(s)
- Shelley Spurr
- Faculty of Nursing, College of Nursing, University of Saskatchewan, 104 Clinic Place, Saskatoon, Saskatchewan, S7N 2Z4, Canada.
| | - Jill Bally
- Faculty of Nursing, College of Nursing, University of Saskatchewan, 104 Clinic Place, Saskatoon, Saskatchewan, S7N 2Z4, Canada
| | - Carol Bullin
- Faculty of Nursing, College of Nursing, University of Saskatchewan, 104 Clinic Place, Saskatoon, Saskatchewan, S7N 2Z4, Canada
| | - Diane Allan
- Faculty of Nursing, College of Nursing, University of Saskatchewan, 104 Clinic Place, Saskatoon, Saskatchewan, S7N 2Z4, Canada.,Strategic Analyst, College of Nursing, University of Saskatchewan, Saskatoon, Saskatchewan, S7N 5E5, Canada
| | - Erick McNair
- Faculty of Medicine, College of Medicine, University of Saskatchewan, Health Sciences Building, Saskatoon, Saskatchewan, S7N 5E5, Canada
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22
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Zimorovat A, Mohammadi M, Ramezani-Jolfaie N, Salehi-Abargouei A. The healthy Nordic diet for blood glucose control: a systematic review and meta-analysis of randomized controlled clinical trials. Acta Diabetol 2020; 57:1-12. [PMID: 31172295 DOI: 10.1007/s00592-019-01369-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Accepted: 05/14/2019] [Indexed: 12/14/2022]
Abstract
AIMS Investigations on the possible effect of the Nordic diet (ND) on the glycemic control and the risk of diabetes have led to inconsistent results. The present study tried to determine the effect of the ND on the markers of blood glucose control using a systematic review and meta-analysis of randomized controlled clinical trials (RCTs). METHODS Predefined keywords were used to search PubMed, ISI Web of Science, Scopus and Google Scholar up to April 2019. The random effects model was used to compute the overall estimates. RESULTS In total, six RCTs with 618 participants (6-26 weeks of follow-up period) were included in the present study. The meta-analysis revealed that the ND might not have a considerable effect on fasting blood glucose levels [weighted mean difference (WMD) = -0.05 mmol/l, 95% CI - 0.13, 0.01, P = 0.112]. In contrast, the analyses showed that the ND significantly reduces serum insulin concentrations (WMD = -1.12 mU/l, 95% CI - 1.84, - 0.39, P = 0.002) and the homeostasis model assessment for insulin resistance (HOMA-IR) (WMD = - 0.34, 95% CI - 0.53, - 0.14, P = 0.001) compared to control diets. The effect on serum insulin levels was sensitive to one of the included studies. This dietary pattern did not significantly affect 2-h post-prandial blood glucose and Matsuda index. CONCLUSIONS Adherence to the ND might improve serum insulin and HOMA-IR levels; however, this effect was not confirmed for other markers of blood glucose control. Future well-designed and long-term clinical trials are highly recommended.
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Affiliation(s)
- Alireza Zimorovat
- Nutrition and Food Security Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
- Department of Nutrition, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Mohammad Mohammadi
- Nutrition and Food Security Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
- Department of Nutrition, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Nahid Ramezani-Jolfaie
- Nutrition and Food Security Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
- Department of Nutrition, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Amin Salehi-Abargouei
- Nutrition and Food Security Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
- Department of Nutrition, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
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Spurr S, Bally J, Hill P, Gray K, Newman P, Hutton A. Exploring the Prevalence of Undiagnosed Prediabetes, Type 2 Diabetes Mellitus, and Risk Factors in Adolescents: A Systematic Review. J Pediatr Nurs 2020; 50:94-104. [PMID: 31786470 DOI: 10.1016/j.pedn.2019.09.025] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 09/26/2019] [Accepted: 09/28/2019] [Indexed: 11/16/2022]
Abstract
PROBLEM The prevalence of prediabetes and type 2 diabetes (T2D) is increasing in adolescents worldwide. Most studies have focused on the clinical features, treatment, and complications for adolescents and so the need to generate insight into the risk factors and prevalence of undiagnosed prediabetes and T2D in adolescents across the globe remains. ELIGIBILITY CRITERIA Relevant articles that were published from 2007 up to and including January 2017 were identified through electronic searches of CINAHL, Cochrane, Medline, PsycInfo, PubMed, Scopus, Web of Science, and Sociological Abstracts (Proquest). Four independent researchers examined the articles for eligibility. SAMPLE Sixteen studies were included that investigated the risk and prevalence of undiagnosed prediabetes and T2D in adolescents aged 12-19. RESULTS The most commonly measured risk factors included obesity/overweight, family history, and ethnicity. Other studies measured risk factors associated with insulin resistance, including hypertension, acanthosis nigricans, and dyslipidemia. Prevalence of undiagnosed prediabetes and T2D varied among regions globally with rates ranging from 3.3 to 14.3% and 0.1 to 2.2%, respectively. CONCLUSIONS Undiagnosed prediabetes and T2D and the associated risk factors are prevalent in many regions in countries worldwide, significantly impacting adolescents and their families. IMPLICATIONS Future research is required to inform interventions aimed at preventative measures for early screening and detection of prediabetes and T2D in adolescents, as well as the development of multi-disciplinary teams that include pediatric nurses and the specialized care they provide.
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Affiliation(s)
- Shelley Spurr
- University of Saskatchewan, College of Nursing, Saskatoon, Saskatchewan Canada.
| | - Jill Bally
- University of Saskatchewan, College of Nursing, Saskatoon, Saskatchewan Canada.
| | - Pauline Hill
- School of Nursing and Midwifery, University of Flinders, Australia.
| | - Katherine Gray
- School of Nursing and Midwifery, University of Newcastle, Australia
| | | | - Alison Hutton
- School of Nursing and Midwifery, University of Newcastle, Australia.
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Eidkhani V, Parizadeh D, Hasheminia M, Azizi F, Hadaegh F. Impaired fasting glucose prevalence surge among Iranian adolescents in a decade: The Tehran Lipid and Glucose Study. Pediatr Diabetes 2019; 20:1064-1071. [PMID: 31478584 DOI: 10.1111/pedi.12916] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 08/14/2019] [Accepted: 08/18/2019] [Indexed: 12/30/2022] Open
Abstract
PURPOSE Impaired fasting glucose (IFG) is associated with incident diabetes, cardiovascular risk, and markers of atherosclerosis in early adulthood. We aimed to explore the 10-year change in IFG prevalence among adolescent participants of the Tehran Lipid and Glucose Study, a population-based study from Iran. METHODS For our study, we used data on fasting plasma glucose (FPG), anthropometric, and demographic information of 11 to 19-year-old adolescents in study periods I (1999-2005; 1415 boys, 1583 girls) and II (2011-2014; 477 boys, 469 girls). Sex-adjusted and sex-stratified multivariable logistic regression models were used to assess the relationship of the study period (reference: study period I) with IFG. RESULTS The prevalence of IFG, general obesity, and central obesity increased from 7%, 13.3%, and 18.8% in study period I to 16.6%, 24%, and 37.4% in study period II; while a favorable trend was seen for blood pressure, triglycerides, and high-density lipoprotein cholesterol. In the fully adjusted model, being older (age group 15-19 vs 11-14 years) and female sex were associated with lower risk. Being overweight and obese increased the risk by risk ratios (confidence interval) of 1.57 (1.17-2.11) and 1.63 (1.15-2.30), respectively. Central adiposity did not remain as an independent risk factor. Nevertheless, study period persisted as a significant factor despite all adjustments [2.20 (1.81-2.68)]. Results in the sex-stratified models were generally the same. CONCLUSION Our results demonstrated that the over 2-fold rise in IFG prevalence among adolescents was not solely dependent on general and central obesity.
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Affiliation(s)
- Vahid Eidkhani
- Students Research Committee, Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Donna Parizadeh
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mitra Hasheminia
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fereidoun Azizi
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farzad Hadaegh
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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25
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Assessing and Managing the Metabolic Syndrome in Children and Adolescents. Nutrients 2019; 11:nu11081788. [PMID: 31382417 PMCID: PMC6723651 DOI: 10.3390/nu11081788] [Citation(s) in RCA: 97] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Revised: 07/10/2019] [Accepted: 07/30/2019] [Indexed: 02/06/2023] Open
Abstract
The metabolic syndrome (MetS) is a group of cardiovascular risk factors that are associated with insulin resistance and are driven by underlying factors, including visceral obesity, systemic inflammation, and cellular dysfunction. These risks increasingly begin in childhood and adolescence and are associated with a high likelihood of future chronic disease in adulthood. Efforts should be made at both recognition of this metabolic risk, screening for potential associated Type 2 diabetes, and targeting affected individuals for appropriate treatment with an emphasis on lifestyle modification. Effective interventions have been linked to reductions in MetS-and in adults, reductions in the severity of MetS have been linked to reduced diabetes and cardiovascular disease.
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26
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Chiavaroli V, Gibbins JD, Cutfield WS, Derraik JGB. Childhood obesity in New Zealand. World J Pediatr 2019; 15:322-331. [PMID: 31079339 DOI: 10.1007/s12519-019-00261-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 04/15/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Paediatric obesity has reached epidemic proportions globally, resulting in significant adverse effects on health and wellbeing. Early life events, including those that happen before, during, and after pregnancy can predispose children to later obesity. The purpose of this review is to examine the magnitude of obesity among New Zealand children and adolescents, and to determine their underlying risk factors and associated comorbidities. DATA SOURCES PubMed, Web of Science, and Google Scholar searches were performed using the key terms "obesity", "overweight", "children", "adolescents", and "New Zealand". RESULTS Obesity is a major public health concern in New Zealand, with more than 33% of children and adolescents aged 2-14 years being overweight or obese. Obesity disproportionately affects Māori (New Zealand's indigenous population) and Pacific children and adolescents, as well as those of lower socioeconomic status. New Zealand's obesity epidemic is associated with numerous health issues, including cardiometabolic, gastrointestinal, and psychological problems, which also disproportionately affect Māori and Pacific children and adolescents. Notably, a number of factors may be useful to identify those at increased risk (such as demographic and anthropometric characteristics) and inform possible interventions. CONCLUSIONS The prevalence of overweight and obese children and adolescents in New Zealand is markedly high, with a greater impact on particular ethnicities and those of lower socioeconomic status. Alleviating the current burden of pediatric obesity should be a key priority for New Zealand, for the benefit of both current and subsequent generations. Future strategies should focus on obesity prevention, particularly starting at a young age and targeting those at greatest risk.
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Affiliation(s)
| | - John D Gibbins
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Wayne S Cutfield
- Liggins Institute, University of Auckland, Auckland, New Zealand. .,A Better Start - National Science Challenge, University of Auckland, Auckland, New Zealand. .,Endocrinology Department, Children's Hospital of Zhejiang University School of Medicine, Hangzhou, China.
| | - José G B Derraik
- Liggins Institute, University of Auckland, Auckland, New Zealand. .,A Better Start - National Science Challenge, University of Auckland, Auckland, New Zealand. .,Endocrinology Department, Children's Hospital of Zhejiang University School of Medicine, Hangzhou, China. .,Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
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27
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Chung ST, Onuzuruike AU, Magge SN. Cardiometabolic risk in obese children. Ann N Y Acad Sci 2019; 1411:166-183. [PMID: 29377201 DOI: 10.1111/nyas.13602] [Citation(s) in RCA: 99] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2017] [Revised: 12/29/2017] [Accepted: 12/31/2017] [Indexed: 02/06/2023]
Abstract
Obesity in childhood remains a significant and prevalent public health concern. Excess adiposity in youth is a marker of increased cardiometabolic risk (CMR) in adolescents and adults. Several longitudinal studies confirm the strong association of pediatric obesity with the persistence of adult obesity and the future development of cardiovascular disease, diabetes, and increased risk of death. The economic and social impact of childhood obesity is further exacerbated by the early onset of the chronic disease burden in young adults during their peak productivity years. Furthermore, rising prevalence rates of severe obesity in youth from disadvantaged and/or minority backgrounds have prompted the creation of additional classification schemes for severe obesity to improve CMR stratification. Current guidelines focus on primary obesity prevention efforts, as well as screening for clustering of multiple CMR factors to target interventions. This review summarizes the scope of the pediatric obesity epidemic, the new severe obesity classification scheme, and examines the association of excess adiposity with cardiovascular and metabolic risk. We will also discuss potential questions for future investigation.
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Affiliation(s)
- Stephanie T Chung
- Section on Ethnicity and Health, National Institute of Diabetes, Digestive and Kidney Diseases, NIH, Bethesda, Maryland.,Division of Pediatric Endocrinology and Diabetes, Children's National Health System, George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Anthony U Onuzuruike
- Section on Ethnicity and Health, National Institute of Diabetes, Digestive and Kidney Diseases, NIH, Bethesda, Maryland
| | - Sheela N Magge
- Division of Pediatric Endocrinology and Diabetes, Children's National Health System, George Washington University School of Medicine and Health Sciences, Washington, DC
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Spurr S, Bally J, Allan D, Bullin C, McNair E. Prediabetes: An emerging public health concern in adolescents. Endocrinol Diabetes Metab 2019; 2:e00060. [PMID: 31008368 PMCID: PMC6458462 DOI: 10.1002/edm2.60] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 01/15/2019] [Accepted: 01/20/2019] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVES To identify the presence of risk factors for type 2 diabetes (ethnicity, body mass index, blood glucose tolerance and blood pressure) and to determine the prevalence of prediabetes and type 2 diabetes in Canadian adolescents attending two multicultural urban high schools. METHODS A total of 266 multicultural urban high school students who live in a mid-sized Western Canadian city, aged 14-21, were screened for risk factors of prediabetes and type 2 diabetes in March-April 2018. Data with respect to demographics, family history of diabetes, anthropometrics, blood pressure and haemoglobin A1c (HbA1c) were collected. Data analysis was done using descriptive and inferential statistics in addition to chi-square analyses. RESULTS Based on body mass index, 38% of the adolescents were classified as either overweight or obese. Overweight rates for females (69.8%) were double than males (30.2%); however, males (52.2%) were more likely to obese than the females (47.8%). Based on HbA1c levels, 29.3% were at high risk to develop either diabetes or prediabetes and 2.6% were classified in the prediabetes range. Prehypertension/hypertension rates of 47% in the sample increased to 51% in those adolescents with elevated HbA1c; the majority of these prehypertensive/hypertensive participants were male. CONCLUSION High rates of overweight/obesity and prehypertension/hypertension were found in the adolescents studied and indicated the presence of prediabetes and an increased risk to develop type 2 diabetes and associated complications. Obesity and hypertension are major risk factors for developing type 2 diabetes, resulting in earlier exposure to metabolic consequences and, ultimately, long-term complications. Thus, timely research is needed to identify age-appropriate strategies that address risks and to develop recommendations for routine screening of adolescents for prediabetes.
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Affiliation(s)
- Shelley Spurr
- Faculty of Nursing, College of NursingUniversity of SaskatchewanSaskatoonSaskatchewanCanada
| | - Jill Bally
- Faculty of Nursing, College of NursingUniversity of SaskatchewanSaskatoonSaskatchewanCanada
| | - Diane Allan
- Faculty of Nursing, College of NursingUniversity of SaskatchewanSaskatoonSaskatchewanCanada
| | - Carol Bullin
- Faculty of Nursing, College of NursingUniversity of SaskatchewanSaskatoonSaskatchewanCanada
| | - Erick McNair
- Faculty of Medicine, College of MedicineUniversity of SaskatchewanSaskatoonSaskatchewanCanada
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29
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Umapathi KK, Thavamani A, Al-Kindi S. Prediabetes in children and adolescents in the United States: prevalence estimates and comorbidities - a population analysis. J Pediatr Endocrinol Metab 2019; 32:187-189. [PMID: 30681973 DOI: 10.1515/jpem-2018-0374] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2018] [Accepted: 12/19/2018] [Indexed: 11/15/2022]
Affiliation(s)
- Krishna Kishore Umapathi
- Department of Pediatrics, Metro Health Medical Center, Case Western Reserve University School of Medicine, 2500, Metro Health Drive, Cleveland, OH 44129, USA
| | - Aravind Thavamani
- Metro Health Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Sadeer Al-Kindi
- Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA
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30
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Lee AM, Scharf RJ, DeBoer MD. Food insecurity is associated with prediabetes and dietary differences in U.S. adults aged 20-39. Prev Med 2018; 116:180-185. [PMID: 30267733 DOI: 10.1016/j.ypmed.2018.09.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Revised: 09/06/2018] [Accepted: 09/22/2018] [Indexed: 12/25/2022]
Abstract
Food insecurity has been linked with lifestyle and metabolic health differences in varying populations. We sought to assess how food insecurity may have been associated with prediabetes and dietary differences in a relatively young subset of U.S. adults. We examined data from the United States National Health and Nutrition Examination Survey (2003-2014) participants aged 20-39 with complete data regarding food insecurity and metabolic laboratory assessment. We also assessed macronutrient intake and Supplemental Nutrition Assistance Program (SNAP) usage. All logistic regression models controlled for age, sex, and household income. Among 3684 included participants, food insecurity had 19.12% (95% confidence interval [95%CI]: 16.16, 22.08) prevalence. Food-insecure participants had prediabetes/diabetes prevalence of 37.36% (95%CI: 30.47, 44.25) and higher odds of having prediabetes/diabetes (adjusted odds ratio [aOR] = 1.36, 95%CI: 1.00, 1.85). Food-insecure adults has significantly different macronutrient intake: higher carbohydrates (p = 0.02), less protein (p = 0.01), and less total fat (p = 0.04) consumption. Food-insecure adults who used SNAP (compared to food-insecure adults who did not use SNAP) had higher odds of having metabolic syndrome (ATP-III MetS) (aOR = 2.56, 95%CI: 1.27, 5.22). We found that food insecurity was relatively prevalent in this subset of younger U.S. adults. We showed that food-insecure participants had increased prevalence and odds of prediabetes. These associations were also correlated with dietary differences.
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Affiliation(s)
- Arthur M Lee
- Department of Pediatrics, University of Virginia School of Medicine, United States of America
| | - Rebecca J Scharf
- Department of Pediatrics, University of Virginia School of Medicine, United States of America
| | - Mark D DeBoer
- Department of Pediatrics, University of Virginia School of Medicine, United States of America.
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31
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Wang LX, Gurka MJ, Deboer MD. Metabolic syndrome severity and lifestyle factors among adolescents. Minerva Pediatr 2018; 70:467-475. [PMID: 29968453 DOI: 10.23736/s0026-4946.18.05290-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The continued rise of pediatric obesity globally has raised concerns for related sequalae. One marker of risk is the metabolic syndrome, a cluster of cardiovascular risk factors that is associated with future cardiovascular disease and type 2 diabetes. MetS has at its core visceral adipocytes exhibiting dysfunction as a result of excess fat content. MetS in children and adolescents is linked to unhealthy lifestyle practices such as sedentary lifestyles and excess consumption calories. As such, the optimal means of addressing MetS is targeting a decrease in adiposity through lifestyle modification, a decrease in MetS following increases in physical activity and improvements in the quality and content of food intake. Efforts remain needed in increasing motivation to these changes and maintaining adherence to avoid long-term sequelae.
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Affiliation(s)
- Linda X Wang
- Department of Pediatrics, University of Virginia, Charlottesville, VA, USA
| | - Matthew J Gurka
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Mark D Deboer
- Department of Pediatrics, University of Virginia, Charlottesville, VA, USA -
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32
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Wang LX, Filipp SL, Urbina EM, Gurka MJ, DeBoer MD. Longitudinal Associations of Metabolic Syndrome Severity Between Childhood and Young Adulthood: The Bogalusa Heart Study. Metab Syndr Relat Disord 2018; 16:208-214. [PMID: 29584578 PMCID: PMC5984565 DOI: 10.1089/met.2017.0160] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Childhood metabolic syndrome (MetS) is associated with insulin resistance and increased risk for later development of type 2 diabetes (T2DM) and cardiovascular disease (CVD). In using MetS severity z-scores, our objective was to assess longitudinal associations in MetS severity, fasting insulin levels as a sign of insulin resistance and risk for T2DM, and uric acid levels as a biomarker of oxidative stress leading to CVD. METHODS We used linear regression to analyze longitudinal data from 285 white and black participants from the Bogalusa Heart Study evaluated at baseline at ages 5-19 and as young adults after a mean of 12.0 years follow-up. We assessed correlations between childhood MetS severity and young-adult MetS severity, fasting insulin, and uric acid levels, both overall and by sex- and racial subgroups. RESULTS Overall, childhood MetS z-scores were positively associated with young-adult MetS z-scores (r = 0.52), insulin (r = 0.34), and uric acid (r = 0.28) (all P < 0.001). These associations were consistent across all sex- and racial subgroups, except for young adult uric acid in white males in which childhood MetS-z was not associated (r = 0.15, P = 0.243). There was a strong cross-sectional association of young-adult MetS z-scores with insulin (r = 0.70) and uric acid (r = 0.57) (both P < 0.001), which was consistent for all sex- and racial subgroups. CONCLUSIONS These positive longitudinal correlations between childhood MetS z-scores and markers of later insulin resistance and oxidative stress suggest long-term durability of risk for CVD and T2DM. This suggests potential for MetS severity to serve as an indicator to monitor for future risk of T2DM and CVD.
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Affiliation(s)
- Linda X. Wang
- Department of Pediatrics, University of Virginia, Charlottesville, Virginia
| | - Stephanie L. Filipp
- Department of Health Outcomes and Policy, College of Medicine, University of Florida, Gainesville, Florida
| | - Elaine M. Urbina
- Department of Cardiology, Cincinnati Children's Hospital, Cincinnati, Ohio
| | - Matthew J. Gurka
- Department of Health Outcomes and Policy, College of Medicine, University of Florida, Gainesville, Florida
| | - Mark D. DeBoer
- Department of Pediatrics, University of Virginia, Charlottesville, Virginia
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Geographical variation in the prevalence of obesity, metabolic syndrome, and diabetes among US adults. Nutr Diabetes 2018; 8:14. [PMID: 29549249 PMCID: PMC5856741 DOI: 10.1038/s41387-018-0024-2] [Citation(s) in RCA: 74] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Revised: 12/06/2017] [Accepted: 12/28/2017] [Indexed: 01/28/2023] Open
Abstract
Cardiovascular disease (CVD) and type 2 diabetes remain significant public health concerns. Targeting of prevention efforts by geographical location has been suggested by the Institute of Medicine to coincide with the presence of area-based risk. The metabolic syndrome (MetS) is a stronger risk factor than is obesity for the prediction of future CVD and diabetes, yet its prevalence has not previously been described geographically. Our objective is to determine geographical variation in the prevalence of obesity, MetS, and diabetes among US adults. We assessed the prevalence of obesity, MetS, and diabetes by US census division, and the prevalence of obesity, MetS, and diabetes for each sex and racial/ethnic group by US region among 9826 US non-Hispanic white, non-Hispanic black, and Hispanic adults aged 20–65 years participating in the National Health and Nutrition Examination Survey 1999–2014. We also compared a sex- and race/ethnicity-specific MetS severity score by geographical area. The prevalence of obesity, MetS, and diabetes varied by US census division and region, with overall similarity by geographical area in the prevalence of each of these conditions. The prevalence of MetS was particularly high (≥35%) in the West North Central, West South Central, and East South Central and low (30%) in the Pacific, New England, and Mid-Atlantic divisions. Some of the geographical variation appeared due to differences among non-Hispanic white females, who had a high prevalence of MetS (>32%) in the Midwest and South and a low prevalence of MetS (24%) in the West and Northeast. Geographical differences in MetS imply variation in the risk for future CVD and diabetes, with more elevated risk in the center of the United States. As MetS is a stronger risk factor for prediction of CVD and T2DM than is obesity, these differences are potentially important for prompting public health efforts toward surveillance and prevention in high-risk areas.
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Abstract
PURPOSE OF REVIEW Although childhood obesity has leveled off in the last decade, 'severe obesity' continues to be on the rise. Various genetic, environmental and hormonal factors contribute to obesity. This article reviews the most current understanding of obesity's multifactorial origin and recent recommendations for its management in childhood and adolescence. RECENT FINDINGS Epigenetics plays a key role in transmitting obesity risk to offspring. Single-nucleotide polymorphisms at genetic loci for adipokines and their receptors are associated with obesity. Gut microbiota is an important regulator of weight status, and Bifidobacterium species improves metabolic status. The incidence of comorbidities including prediabetes and type 2 diabetes has increased. Novel biomarkers such as alpha-hydroxybutyrate and branched-chain amino acids correlate with insulin sensitivity and predict glycemic control in adolescents. Lifestyle modifications and pharmacotherapy can produce small BMI changes. Bariatric surgery induces substantial weight loss and remission of comorbidities. SUMMARY Alterations in genetics, epigenetics and microbiota influence childhood obesity. Lifestyle modification remains the mainstay of management and pharmacotherapy with Food and Drug Administration approved medications is recommended only for patients resistant to lifestyle changes and for comorbidities. Bariatric surgery produces sustained weight loss and cardiovascular benefits and is an effective option for adolescents with severe obesity.
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Affiliation(s)
- Charumathi Baskaran
- Pediatric Endocrinology, Massachusetts General Hospital for Children, Boston, Massachusetts, USA
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35
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Roth CL, Elfers C, Hampe CS. Assessment of disturbed glucose metabolism and surrogate measures of insulin sensitivity in obese children and adolescents. Nutr Diabetes 2017; 7:301. [PMID: 29242622 PMCID: PMC5865547 DOI: 10.1038/s41387-017-0004-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Revised: 08/01/2017] [Accepted: 08/28/2017] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND With the rising prevalence of obesity and type 2 diabetes (T2D) in obese children, it is becoming imperative to detect disturbed glucose metabolism as early as possible in order to prevent T2D development. SUBJECTS/METHODS Cross-sectional study of 92 obese children (median age 11.7 years, 51% female) and 7 lean children (median age 11.4 years, 57% female) who underwent an oral glucose tolerance test (OGTT) in a tertiary pediatric care center. Glucose tolerance was assessed and different indices for β-cell function, insulin sensitivity and insulin secretion were calculated. RESULTS Nineteen obese children were identified with prediabetes (PD, 12 impaired glucose tolerance, 4 increased fasting glucose and 3 combined). Compared with the 73 obese children with normal glucose tolerance (nGT), subjects with PD had higher insulin resistance, but lower insulin sensitivity and β-cell function, although their glycated hemoglobin (HbA1c) levels were comparable. The Whole Body Insulin Sensitivity Index (WBISI) and β-cell function by Insulin Secretion-Sensitivity Index-2 (ISSI-2) strongly correlated with the OGTT glucose area under the curve 0-120 min (r = 0.392, p < 0.0002; r = 0.547, p < 0.0001, respectively). When testing the relation between early insulin response during OGTT by insulinogenic index and insulin sensitivity assessed by WBISI, a hyperbolic relationship between insulin secretion and insulin sensitivity was found. The calculated disposition index was lower in subjects with PD vs. nGT (median 459 vs. 792, p = 0.004). We identified the OGTT 30-min/120-min insulin ratio as a simple marker, which is significantly lower in obese children with vs. without PD (median 0.87 vs. 1.29, p = 0.021) and which has a better sensitivity and specificity for detecting PD than HbA1c among obese children. CONCLUSIONS Children with identified PD had changes of several markers for β-cell function, insulin sensitivity and resistance before changes in HbA1c occurred. The lower disposition index indicates that these children have already inadequate β-cell compensation for the degree of insulin resistance.
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Affiliation(s)
- Christian L Roth
- Center for Integrative Brain Research, Seattle Children's Hospital and Research Institute, Endocrine Division, Seattle, WA, 98101, USA.
| | - Clinton Elfers
- Center for Integrative Brain Research, Seattle Children's Hospital and Research Institute, Endocrine Division, Seattle, WA, 98101, USA
| | - Christiane S Hampe
- Division of Metabolism, Endocrinology and Nutrition, Department of Medicine, University of Washington, Seattle, WA, 98109, USA
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