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Savarirayan R, Hoernschemeyer DG, Ljungberg M, Zarate YA, Bacino CA, Bober MB, Legare JM, Högler W, Quattrin T, Abuzzahab MJ, Hofman PL, White KK, Ma NS, Schnabel D, Sousa SB, Mao M, Smith A, Chakraborty M, Giwa A, Winding B, Volck B, Shu AD, McDonnell C. Once-weekly TransCon CNP (navepegritide) in children with achondroplasia (ACcomplisH): a phase 2, multicentre, randomised, double-blind, placebo-controlled, dose-escalation trial. EClinicalMedicine 2023; 65:102258. [PMID: 37823031 PMCID: PMC10562841 DOI: 10.1016/j.eclinm.2023.102258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 09/19/2023] [Accepted: 09/20/2023] [Indexed: 10/13/2023] Open
Abstract
Background TransCon CNP (navepegritide) is an investigational prodrug of C-type natriuretic peptide (CNP) designed to allow for continuous CNP exposure with once-weekly dosing. This 52-week phase 2 (ACcomplisH) trial assessed the safety and efficacy of TransCon CNP in children with achondroplasia. Methods ACcomplisH is a global, randomised, double-blind, placebo-controlled, dose-escalation trial. Study participants were recruited between June 10, 2020, and September 24, 2021. Eligible participants were prepubertal, aged 2-10 years, with genetically confirmed achondroplasia, and randomised 3:1 to once-weekly subcutaneous injections of TransCon CNP (6, 20, 50, or 100 μg CNP/kg/week) or placebo for 52 weeks. Primary objectives were safety and annualised growth velocity (AGV). ACcomplisH is registered with ClinicalTrials.gov (NCT04085523) and Eudra (CT 2019-002754-22). Findings Forty-two participants received TransCon CNP at doses of 6 μg (n = 10; 7 female), 20 μg (n = 11; 3 female), 50 μg (n = 10; 3 female), or 100 μg (n = 11; 6 female) CNP/kg/week, with 15 receiving placebo (5 female). Treatment-emergent adverse events (TEAEs) were mild or moderate with no grade 3/4 events reported. There were 2 serious TEAEs that were assessed as not related to TransCon CNP. Eleven injection site reactions occurred in 8 participants receiving TransCon CNP and no symptomatic hypotension occurred. TransCon CNP demonstrated a dose-dependent improvement in AGV. At 52 weeks, TransCon CNP 100 μg CNP/kg/week significantly improved AGV vs placebo (least squares mean [95% CI] 5.42 [4.74-6.11] vs 4.35 [3.75-4.94] cm/year; p = 0.0218), and improved achondroplasia-specific height SDS from baseline (least squares mean [95% CI] 0.22 [0.02-0·41] vs -0·08 [-0.25 to 0.10]; p = 0.0283). All participants completed the randomised period and continued in the ongoing open-label extension period receiving TransCon CNP 100 μg CNP/kg/week. Interpretation This phase 2 trial suggests that TransCon CNP is effective, safe, with low injection site reaction frequency, and may provide a novel, once-weekly treatment option for children with achondroplasia. These results support TransCon CNP at 100 μg CNP/kg/week in the ongoing pivotal trial. Funding Ascendis Pharma, A/S.
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Affiliation(s)
- Ravi Savarirayan
- Murdoch Children's Research Institute, Parkville, Australia
- Royal Children's Hospital, Parkville, Australia
- University of Melbourne, Parkville, Australia
| | | | - Merete Ljungberg
- Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Yuri A. Zarate
- University of Arkansas for Medical Sciences, Little Rock, AR, USA
- University of Kentucky, Lexington, KY, USA
| | | | | | - Janet M. Legare
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | | | | | | | - Paul L. Hofman
- The Liggins Institute, University of Auckland, Auckland, New Zealand
| | | | - Nina S. Ma
- Children's Hospital Colorado, Aurora, CO, USA
| | - Dirk Schnabel
- Center for Chronically Sick Children, Charité – University Medicine Berlin, Berlin, Germany
| | | | - Meng Mao
- Ascendis Pharma Inc., Palo Alto, CA, USA
| | | | | | | | | | | | | | - Ciara McDonnell
- Children's Health Ireland at Temple Street, Dublin, Ireland
- University of Dublin, Trinity College, Dublin, Ireland
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Button AM, Paluch RA, Schechtman KB, Wilfley DE, Geller N, Quattrin T, Cook SR, Eneli IU, Epstein LH. Parents, but not their children, demonstrate greater delay discounting with resource scarcity. BMC Public Health 2023; 23:1983. [PMID: 37828503 PMCID: PMC10568819 DOI: 10.1186/s12889-023-16832-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 09/25/2023] [Indexed: 10/14/2023] Open
Abstract
BACKGROUND Individuals with obesity tend to discount the future (delay discounting), focusing on immediate gratification. Delay discounting is reliably related to indicators of economic scarcity (i.e., insufficient resources), including lower income and decreased educational attainment in adults. It is unclear whether the impact of these factors experienced by parents also influence child delay discounting between the ages of 8 and 12-years in families with obesity. METHODS The relationship between indices of family income and delay discounting was studied in 452 families with parents and 6-12-year-old children with obesity. Differences in the relationships between parent economic, educational and Medicaid status, and parent and child delay discounting were tested. RESULTS Results showed lower parent income (p = 0.019) and Medicaid status (p = 0.021) were differentially related to greater parent but not child delay discounting among systematic responders. CONCLUSIONS These data suggest differences in how indicators of scarcity influence delay discounting for parents and children, indicating that adults with scarce resources may be shaped to focus on immediate needs instead of long-term goals. It is possible that parents can reduce the impact of economic scarcity on their children during preadolescent years. These findings suggest a need for policy change to alleviate the burden of scarce conditions and intervention to modify delay discounting rate and to improve health-related choices and to address weight disparities.
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Affiliation(s)
- Alyssa M Button
- Division of Population and Public Health Science, Pennington Biomedical Research Center, Baton Rouge, LA, USA
| | - Rocco A Paluch
- Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, 3435 Main Street, Building #26, Buffalo, NY, 14214, USA
| | - Kenneth B Schechtman
- Department of Psychiatry, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | - Denise E Wilfley
- Department of Psychiatry, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | - Nancy Geller
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Teresa Quattrin
- Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, 3435 Main Street, Building #26, Buffalo, NY, 14214, USA
| | - Stephen R Cook
- Department of Pediatrics, University of Rochester Medical Center, Rochester, NY, USA
| | - Ihouma U Eneli
- Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH, USA
| | - Leonard H Epstein
- Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, 3435 Main Street, Building #26, Buffalo, NY, 14214, USA.
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Thanos PK, Hanna C, Mihalkovic A, Hoffman A, Posner A, Butsch J, Blum K, Georger L, Mastrandrea LD, Quattrin T. Genetic Correlates as a Predictor of Bariatric Surgery Outcomes after 1 Year. Biomedicines 2023; 11:2644. [PMID: 37893019 PMCID: PMC10603884 DOI: 10.3390/biomedicines11102644] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 08/30/2023] [Accepted: 09/19/2023] [Indexed: 10/29/2023] Open
Abstract
This study analyzed genetic risk assessments in patients undergoing bariatric surgery to serve as a predictive factor for weight loss parameters 1 year after the operation. Thirty (30) patients were assessed for Genetic Addiction Risk Severity (GARS), which analyzes neurogenetic polymorphisms involved in addiction and reward deficiency. Genetic and psychosocial data collected before the operation were correlated with weight loss data, including changes in weight, body mass index (BMI), and percent of expected weight loss (%EWL). Results examined correlations between individual gene risk alleles, 1-year body weight data, and psychosocial trait scores. Spearman's correlations revealed that the OPRM1 (rs1799971) gene polymorphism had significant negative correlation with 1-year weight (rs = -0.4477, p < 0.01) and BMI (rs = -0.4477, p < 0.05). In addition, the DRD2 risk allele (rs1800497) was correlated negatively with BMI at 1 year (rs = -0.4927, p < 0.05), indicating that one risk allele copy was associated with lower BMI. However, this allele was positively correlated with both ∆Weight (rs = 0.4077, p < 0.05) and %EWL (rs = 0.5521, p < 0.05) at 1 year post-surgery. Moreover, the overall GARS score was correlated with %EWL (rs = 0.4236, p < 0.05), ∆Weight (rs = 0.3971, p < 0.05) and ∆BMI (rs = 0.3778, p < 0.05). Lastly, Food Cravings Questionnaire (FCQ) scores were negatively correlated with %EWL (rs = -0.4320, p < 0.05) and ∆Weight at 1 year post-surgery (rs = -0.4294, p < 0.05). This suggests that individuals with a higher genetic addiction risk are more responsive to weight loss treatment, especially in the case of the DRD2 polymorphism. These results should translate clinically to improve positivity and attitude related to weight management by those individuals born with the risk alleles (rs1800497; rs1799971).
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Affiliation(s)
- Panayotis K. Thanos
- Behavioral Neuropharmacology and Neuroimaging Laboratory on Addictions, Department of Pharmacology and Toxicology, Clinical Research Institute on Addictions, Jacobs School of Medicine and Biosciences, University at Buffalo, Buffalo, NY 14203, USA; (C.H.)
| | - Colin Hanna
- Behavioral Neuropharmacology and Neuroimaging Laboratory on Addictions, Department of Pharmacology and Toxicology, Clinical Research Institute on Addictions, Jacobs School of Medicine and Biosciences, University at Buffalo, Buffalo, NY 14203, USA; (C.H.)
| | - Abrianna Mihalkovic
- Behavioral Neuropharmacology and Neuroimaging Laboratory on Addictions, Department of Pharmacology and Toxicology, Clinical Research Institute on Addictions, Jacobs School of Medicine and Biosciences, University at Buffalo, Buffalo, NY 14203, USA; (C.H.)
- Department of Psychology, University at Buffalo, Buffalo, NY 14203, USA
| | - Aaron Hoffman
- Department of Surgery, Methodist Hospital Medical Center, Dallas, TX 75208, USA
| | - Alan Posner
- Department of Surgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY 14203, USA
| | - John Butsch
- Department of Surgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY 14203, USA
| | - Kenneth Blum
- Division of Nutrigenomics, SpliceGen, Therapeutics, Inc., Austin, TX 78701, USA;
- Department of Psychiatry, Wright State University Boonshoft School of Medicine and Dayton VA Medical Center, Dayton, OH 45435, USA
- Division of Addiction Research & Education, Center for Exercise Sports & Global Mental Health, Western University Health Sciences, Pomona, CA 91766, USA
- The Kenneth Blum Behavioral & Neurogenetic Institute, LLC., Austin, TX 78701, USA
- Institute of Psychology, ELTE Eötvös Loránd University, 1075 Budapest, Hungary
- Centre for Genomics and Applied Gene Technology, Institute of Integrative Omics and Applied Biotechnology (IIOAB), Nonakuri, Purba Medinipur 721172, West Bengal, India
- Department of Molecular Biology, Adelson School of Medicine, Ariel University, Ariel 40700, Israel
| | - Lesley Georger
- Department of Natural Sciences and Mathematics, D’Youville University, Buffalo, NY 14201, USA;
| | - Lucy D. Mastrandrea
- UBMD Pediatrics, JR Oishei Children’s Hospital, University at Buffalo, Buffalo, NY 14203, USA (T.Q.)
| | - Teresa Quattrin
- UBMD Pediatrics, JR Oishei Children’s Hospital, University at Buffalo, Buffalo, NY 14203, USA (T.Q.)
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Ramel M, Wilfley DE, Tabak R, Lew D, Moursi NA, Kilanowski C, Cook SR, Eneli IU, Quattrin T, Schechtman KB, Epstein LH. Relationships examined: Parent and child readiness to change and sociodemographic characteristics in family based weight loss treatment. Pediatr Obes 2023; 18:e13062. [PMID: 37282798 DOI: 10.1111/ijpo.13062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 04/20/2023] [Accepted: 05/08/2023] [Indexed: 06/08/2023]
Abstract
BACKGROUND Family based treatment is an effective, multipronged approach to address obesity as it plagues families. OBJECTIVE To investigate the relationships among sociodemographic characteristics (e.g., education and income), body mass index (BMI) and race/ethnicity with readiness to change for parents enrolled in the Primary care pediatrics, Learning, Activity and Nutrition (PLAN) study. METHODS Multivariate linear regressions tested two hypotheses: (1) White parents will have higher levels of baseline readiness to change, when compared to Black parents; (2) parents with higher income and education will have higher levels of readiness to change at baseline. RESULTS A positive relationship exists between baseline parent BMI and readiness to change (Pearson correlation, 0.09, p < 0.05); statistically significant relationships exist between parent education level (-0.14, p < 0.05), income (0.04, p < 0.05) and readiness to change. Additionally, a statistically significant relationship exists, with both White (β, -0.10, p < 0.05), and Other, non-Hispanic (-0.10, p < 0.05) parents exhibiting lower readiness to change than Black, non-Hispanic parents. Child data did not indicate significant relationships between race/ethnicity and readiness to change. CONCLUSIONS Results demonstrate that investigators should consider sociodemographic characteristic factors and different levels of readiness to change in participants enrolling in obesity interventions.
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Affiliation(s)
- Melissa Ramel
- Department of Family and Consumer Sciences, Fontbonne University, St. Louis, Missouri, USA
| | - Denise E Wilfley
- Department of Psychiatry, Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA
| | - Rachel Tabak
- Brown School, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Daphne Lew
- Department of Biostatistics, Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA
| | - Nasreen A Moursi
- Department of Psychiatry, Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA
| | - Colleen Kilanowski
- Department of Pediatrics, Jacobs School of Medicine, and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
| | - Steven R Cook
- Department of Pediatrics, University of Rochester Medical Center, Rochester, New York, USA
| | - Ihouma U Eneli
- Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Teresa Quattrin
- Department of Pediatrics, Jacobs School of Medicine, and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
| | - Kenneth B Schechtman
- Department of Biostatistics, Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA
| | - Leonard H Epstein
- Department of Pediatrics, Jacobs School of Medicine, and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
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5
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Thanos PK, Hanna C, Mihalkovic A, Hoffman AB, Posner AR, Busch J, Smith C, Badgaiyan RD, Blum K, Baron D, Mastrandrea LD, Quattrin T. The First Exploratory Personalized Medicine Approach to Improve Bariatric Surgery Outcomes Utilizing Psychosocial and Genetic Risk Assessments: Encouraging Clinical Research. J Pers Med 2023; 13:1164. [PMID: 37511777 PMCID: PMC10381606 DOI: 10.3390/jpm13071164] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 07/06/2023] [Accepted: 07/10/2023] [Indexed: 07/30/2023] Open
Abstract
It is predicted that by 2030, globally, an estimated 2.16 billion adults will be overweight, and 1.12 billion will be obese. This study examined genetic data regarding Reward Deficiency Syndrome (RDS) to evaluate their usefulness in counselling patients undergoing bariatric surgery and gathered preliminary data on the potential use in predicting short term (6-month) weight loss outcomes. Methods: Patients undergoing bariatric surgery (n = 34) were examined for Genetic Addiction Risk Severity (GARS) [measures the presence of risk alleles associated with RDS]; as well as their psychosocial traits (questionnaires). BMI changes and sociodemographic data were abstracted from Electronic Health Records. Results: Subjects showed ∆BMI (M = 10.0 ± 1.05 kg/m2) and a mean % excess weight loss (56 ± 13.8%). In addition, 76% of subjects had GARS scores above seven. The homozygote risk alleles for MAO (rs768062321) and DRD1 (rs4532) showed a 38% and 47% prevalence among the subjects. Of the 11 risk alleles identified by GARS, the DRD4 risk allele (rs1800955), was significantly correlated with change in weight and BMI six months post-surgery. We identified correlations with individual risk alleles and psychosocial trait scores. The COMT risk allele (rs4680) showed a negative correlation with EEI scores (r = -0.4983, p < 0.05) and PSQI scores (r = -0.5482, p < 0.05). The GABRB3 risk allele (rs764926719) correlated positively with EEI (r = 0.6161, p < 0.01) and FCQ scores (r = 0.6373, p < 0.01). The OPRM1 risk allele showed a positive correlation with the DERS score (r = 0.5228, p < 0.05). We also identified correlations between DERS and BMI change (r = 0.61; p < 0.01). Conclusions: These data support the potential benefit of a personalized medicinal approach inclusive of genetic testing and psychosocial trait questionnaires when counselling patients with obesity considering bariatric surgery. Future research will explore epigenetic factors that contribute to outcomes of bariatric surgery.
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Affiliation(s)
- Panayotis K. Thanos
- Behavioral Neuropharmacology and Neuroimaging Laboratory on Addictions (BNNLA), Clinical Research Institute on Addictions, Department of Pharmacology and Toxicology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY 14203, USA; (C.H.); (A.M.)
- Department of Psychology, University at Buffalo, Buffalo, NY 14203, USA
| | - Colin Hanna
- Behavioral Neuropharmacology and Neuroimaging Laboratory on Addictions (BNNLA), Clinical Research Institute on Addictions, Department of Pharmacology and Toxicology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY 14203, USA; (C.H.); (A.M.)
| | - Abrianna Mihalkovic
- Behavioral Neuropharmacology and Neuroimaging Laboratory on Addictions (BNNLA), Clinical Research Institute on Addictions, Department of Pharmacology and Toxicology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY 14203, USA; (C.H.); (A.M.)
- Department of Psychology, University at Buffalo, Buffalo, NY 14203, USA
| | - Aaron B. Hoffman
- Department of Surgery, Methodist Hospital Medical Center, Dallas, TX 75001, USA; (A.B.H.); (L.D.M.)
| | - Alan R. Posner
- Department of Surgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY 14203, USA; (A.R.P.); (J.B.)
| | - John Busch
- Department of Surgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY 14203, USA; (A.R.P.); (J.B.)
| | - Caroline Smith
- UBMD Pediatrics, JR Oishei Children’s Hospital, University at Buffalo, Buffalo, NY 14203, USA;
| | - Rajendra D. Badgaiyan
- Department of Psychiatry, South Texas Veteran Health Care System, Audie L. Murphy Memorial VA Hospital, Long School of Medicine, University of Texas Health Science Center, San Antonio, TX 78229, USA;
| | - Kenneth Blum
- Division of Nutrigenomics, SpliceGen, Therapeutics, Inc., Austin, TX 78701, USA;
- Department of Psychiatry, Wright State University Boonshoft School of Medicine, Dayton, OH 45435, USA;
- Division of Addiction Research & Education, Center for Exercise Sports & Global Mental Health, Western University Health Sciences, Pomona, CA 91766, USA
- The Kenneth Blum Behavioral & Neurogenetic Institute, LLC., Austin, TX 78701, USA
- Institute of Psychology, ELTE Eötvös Loránd University, 23-27, 1075 Budapest, Hungary
- Centre for Genomics and Applied Gene Technology, Institute of Integrative Omics and Applied Biotechnology (IIOAB), Nonakuri, Purba Medinipur 721172, West Bengal, India
- Department of Molecular Biology, Adelson School of Medicine, Ariel University, Ariel 40700, Israel
| | - David Baron
- Department of Psychiatry, Wright State University Boonshoft School of Medicine, Dayton, OH 45435, USA;
| | - Lucy D. Mastrandrea
- Department of Surgery, Methodist Hospital Medical Center, Dallas, TX 75001, USA; (A.B.H.); (L.D.M.)
| | - Teresa Quattrin
- Department of Surgery, Methodist Hospital Medical Center, Dallas, TX 75001, USA; (A.B.H.); (L.D.M.)
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Abstract
Type 1 diabetes is a chronic disease caused by autoimmune destruction of pancreatic β cells. Individuals with type 1 diabetes are reliant on insulin for survival. Despite enhanced knowledge related to the pathophysiology of the disease, including interactions between genetic, immune, and environmental contributions, and major strides in treatment and management, disease burden remains high. Studies aimed at blocking the immune attack on β cells in people at risk or individuals with very early onset type 1 diabetes show promise in preserving endogenous insulin production. This Seminar will review the field of type 1 diabetes, highlighting recent progress within the past 5 years, challenges to clinical care, and future directions in research, including strategies to prevent, manage, and cure the disease.
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Affiliation(s)
- Teresa Quattrin
- Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA; Diabetes Center, John R Oishei Children's Hospital, Buffalo, NY, USA.
| | - Lucy D Mastrandrea
- Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA; Diabetes Center, John R Oishei Children's Hospital, Buffalo, NY, USA
| | - Lucy S K Walker
- Institute of Immunity and Transplantation, Division of Infection and Immunity, University College London, London, UK
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Epstein LH, Wilfley DE, Kilanowski C, Quattrin T, Cook SR, Eneli IU, Geller N, Lew D, Wallendorf M, Dore P, Paluch RA, Schechtman KB. Family-Based Behavioral Treatment for Childhood Obesity Implemented in Pediatric Primary Care: A Randomized Clinical Trial. JAMA 2023; 329:1947-1956. [PMID: 37314275 PMCID: PMC10265310 DOI: 10.1001/jama.2023.8061] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 04/25/2023] [Indexed: 06/15/2023]
Abstract
Importance Intensive behavioral interventions for childhood overweight and obesity are recommended by national guidelines, but are currently offered primarily in specialty clinics. Evidence is lacking on their effectiveness in pediatric primary care settings. Objective To evaluate the effects of family-based treatment for overweight or obesity implemented in pediatric primary care on children and their parents and siblings. Design, Setting, and Participants This randomized clinical trial in 4 US settings enrolled 452 children aged 6 to 12 years with overweight or obesity, their parents, and 106 siblings. Participants were assigned to undergo family-based treatment or usual care and were followed up for 24 months. The trial was conducted from November 2017 through August 2021. Interventions Family-based treatment used a variety of behavioral techniques to develop healthy eating, physical activity, and parenting behaviors within families. The treatment goal was 26 sessions over a 24-month period with a coach trained in behavior change methods; the number of sessions was individualized based on family progress. Main Outcomes and Measures The primary outcome was the child's change from baseline to 24 months in the percentage above the median body mass index (BMI) in the general US population normalized for age and sex. Secondary outcomes were the changes in this measure for siblings and in BMI for parents. Results Among 452 enrolled child-parent dyads, 226 were randomized to undergo family-based treatment and 226 to undergo usual care (child mean [SD] age, 9.8 [1.9] years; 53% female; mean percentage above median BMI, 59.4% [n = 27.0]; 153 [27.2%] were Black and 258 [57.1%] were White); 106 siblings were included. At 24 months, children receiving family-based treatment had better weight outcomes than those receiving usual care based on the difference in change in percentage above median BMI (-6.21% [95% CI, -10.14% to -2.29%]). Longitudinal growth models found that children, parents, and siblings undergoing family-based treatment all had outcomes superior to usual care that were evident at 6 months and maintained through 24 months (0- to 24-month changes in percentage above median BMI for family-based treatment and usual care were 0.00% [95% CI, -2.20% to 2.20%] vs 6.48% [95% CI, 4.35%-8.61%] for children; -1.05% [95% CI, -3.79% to 1.69%] vs 2.92% [95% CI, 0.58%-5.26%] for parents; and 0.03% [95% CI, -3.03% to 3.10%] vs 5.35% [95% CI, 2.70%-8.00%] for siblings). Conclusions and Relevance Family-based treatment for childhood overweight and obesity was successfully implemented in pediatric primary care settings and led to improved weight outcomes over 24 months for children and parents. Siblings who were not directly treated also had improved weight outcomes, suggesting that this treatment may offer a novel approach for families with multiple children. Trial Registration ClinicalTrials.gov Identifier: NCT02873715.
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Affiliation(s)
- Leonard H Epstein
- Department of Pediatrics, Jacobs School of Medicine, and Biomedical Sciences, University at Buffalo, Buffalo, New York
| | - Denise E Wilfley
- Department of Psychiatry, Washington University in St Louis School of Medicine, St Louis, Missouri
| | - Colleen Kilanowski
- Department of Pediatrics, Jacobs School of Medicine, and Biomedical Sciences, University at Buffalo, Buffalo, New York
| | - Teresa Quattrin
- Department of Pediatrics, Jacobs School of Medicine, and Biomedical Sciences, University at Buffalo, Buffalo, New York
| | - Steven R Cook
- Department of Pediatrics, University of Rochester Medical Center, Rochester, New York
| | - Ihuoma U Eneli
- Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio
| | - Nancy Geller
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Daphne Lew
- Division of Biostatistics, Washington University in St Louis School of Medicine, St Louis, Missouri
| | - Michael Wallendorf
- Division of Biostatistics, Washington University in St Louis School of Medicine, St Louis, Missouri
| | - Peter Dore
- Division of Biostatistics, Washington University in St Louis School of Medicine, St Louis, Missouri
| | - Rocco A Paluch
- Department of Pediatrics, Jacobs School of Medicine, and Biomedical Sciences, University at Buffalo, Buffalo, New York
| | - Kenneth B Schechtman
- Division of Biostatistics, Washington University in St Louis School of Medicine, St Louis, Missouri
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8
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Majumdar I, Talal AH, Harmon CM, Tabaczynsk E, Cercone K, Wrotniak BH, Mastrandrea LD, Quattrin T. Role of Dual-Contingency Management in Family-Based Obesity Therapy and the Effects of Weight Loss on Liver Transient Elastography Parameters in Youth: A Pilot Study. Cureus 2023; 15:e36629. [PMID: 37155438 PMCID: PMC10122838 DOI: 10.7759/cureus.36629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/23/2023] [Indexed: 05/10/2023] Open
Abstract
The pilot study evaluated contingency management (CM) for family-based obesity therapy (FBT). The secondary outcome assessed the association of the hepatic transient electrography (TE) parameters, including the controlled attenuation parameter (CAP) and liver stiffness (LSM), and changes in liver function blood tests and BMI changes in youth involved in intensive FBT. It included youth-parent dyads from an urban pediatric center randomized to weekly behavioral therapy (BT, n= 4) who received fixed financial compensation for attendance, or BT+CM (n= 5) who received an escalating monetary reward for weight loss. At week 30, all youth and parents had weight-loss trends without significant differences between groups. While the TE measures and blood tests were normal in the youth at baseline and week 30, the CAP changes correlated with BMI changes (R2= 0.86, P< 0.001) and LSM changes with alanine aminotransferase changes (R2= 0.79, P=0.005). In conclusion, BT+CM did not significantly add to the BMI improvement seen with BT alone in youth and their parents. However, in youth with obesity and normal liver blood tests, TE may be useful for monitoring changes in fatty liver disease.
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Affiliation(s)
- Indrajit Majumdar
- Pediatric Endocrinology, Mount Sinai Medical Center, New York, USA
- Pediatric Endocrinology, Valley Medical Group, Paramus, USA
| | - Andrew H Talal
- Medicine, Division of Gastroenterology, Hepatology and Nutrition, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, Buffalo, USA
| | - Carrol M Harmon
- Surgery, Pediatric Surgery, John R Oishei Children's Hospital/Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, Buffalo, USA
| | - Emily Tabaczynsk
- Pediatrics, Roswell Park Comprehensive Cancer Center, Buffalo, USA
| | - Kristen Cercone
- Psychiatry, John R. Oishei Children's Hospital/Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, Buffalo, USA
| | - Brian H Wrotniak
- Pediatrics, John R. Oishei Children's Hospital/UBMD Pediatrics, Buffalo, USA
| | - Lucy D Mastrandrea
- Pediatrics, Division of Pediatric Endocrinology and Diabetes, John R. Oishei Children's Hospital/Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, Buffalo, USA
| | - Teresa Quattrin
- Pediatrics, Division of Pediatric Endocrinology and Diabetes, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, Buffalo, USA
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9
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Rigby MR, Hayes B, Li Y, Vercruysse F, Hedrick JA, Quattrin T. Two-Year Follow-up From the T1GER Study: Continued Off-Therapy Metabolic Improvements in Children and Young Adults With New-Onset T1D Treated With Golimumab and Characterization of Responders. Diabetes Care 2023; 46:561-569. [PMID: 36576974 PMCID: PMC10020023 DOI: 10.2337/dc22-0908] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 12/06/2022] [Indexed: 12/29/2022]
Abstract
OBJECTIVE The T1GER (A Study of SIMPONI to Arrest β-Cell Loss in Type 1 Diabetes) study showed many metabolic benefits of the tumor necrosis factor-α blocker golimumab in children and young adults with type 1 diabetes (T1D). Off-therapy effects are reported. RESEARCH DESIGNS AND METHODS T1GER was a phase 2, placebo-controlled, randomized trial in which golimumab or placebo was administered for 52 weeks to participants 6-21 years old diagnosed with T1D within 100 days of randomization. Assessments occurred during the 52-week on-therapy and 52-week off-therapy periods. RESULTS After treatment was stopped, C-peptide area under the curve (AUC) remained greater in the treatment versus control group. At weeks 78 and 104, the golimumab group had lower reductions in the 4-h C-peptide AUC baseline than the placebo group, where specifically the golimumab group had reductions of 0.31 and 0.41 nmol/L, and the placebo group had reductions of 0.64 and 0.74 nmol/L. There were also trends in less insulin use, higher peak C-peptide levels and those in partial remission, and higher peak C-peptide levels in the golimumab group. Golimumab responders, defined as having an increase or minimal loss of C-peptide AUC and/or being in partial remission at week 52, showed even greater improvements in most metabolic parameters on and off therapy and had less hypoglycemia during the off-therapy period versus placebo. Adverse events, including infections, were similar between the groups during all time periods of the study. CONCLUSIONS In children and young adults with new-onset T1D, golimumab preserved endogenous β-cell function and resulted in other favorable metabolic parameters on and off therapy. A subpopulation had disease stabilization while on therapy, with improved metabolic parameters off therapy.
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Affiliation(s)
- Mark R. Rigby
- Janssen Pharmaceuticals Inc. Research and Development, Springhouse, PA
| | - Beverly Hayes
- Janssen Pharmaceuticals Inc. Research and Development, Springhouse, PA
| | - Yinglei Li
- Janssen Pharmaceuticals Inc. Research and Development, Springhouse, PA
| | - Frank Vercruysse
- Janssen Pharmaceuticals Inc. Research and Development, Beerse, Belgium
| | - Joseph A. Hedrick
- Janssen Pharmaceuticals Inc. Research and Development, Springhouse, PA
| | - Teresa Quattrin
- The Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY
- Diabetes Center, John R. Oishei Children’s Hospital, Buffalo, NY
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10
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Hamilton J, Nguyen C, McAvoy M, Roeder N, Richardson B, Quattrin T, Hajnal A, Thanos PK. Calorie restriction, but not Roux-en-Y gastric bypass surgery, increases [ 3 H] PK11195 binding in a rat model of obesity. Synapse 2023; 77:e22258. [PMID: 36352528 DOI: 10.1002/syn.22258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 10/05/2022] [Accepted: 10/09/2022] [Indexed: 11/11/2022]
Abstract
Roux-en-Y gastric bypass surgery (RYGB) remains an effective weight-loss method used to treat obesity. While it is successful in combating obesity, there are many lingering questions related to the changes in the brain following RYGB surgery, one of them being its effects on neuroinflammation. While it is known that chronic high-fat diet (HFD) contributes to obesity and neuroinflammation, it remains to be understood whether bariatric surgery can ameliorate diet-induced inflammatory responses. To examine this, rats were assigned to either a normal diet (ND) or a HFD for 8 weeks. Rats fed a HFD were split into the following groups: sham surgery with ad libitum access to HFD (sham-HF); sham surgery with calorie-restricted HFD (sham-FR); RYGB surgery with ad libitum access to HFD (RYGB). Following sham or RYGB surgeries, rats were maintained on their diets for 9 weeks before being euthanized. [3 H] PK11195 autoradiography was then performed on fresh-frozen brain tissue in order to measure activated microglia. Sham-FR rats showed increased [3 H] PK11195 binding in the amygdala (63%), perirhinal (60%), and ectorhinal cortex (53%) compared with the ND rats. Obese rats who had the RYGB surgery did not show this increased inflammatory effect. Since the sham-FR and RYGB rats were fed the same amount of HFD, the surgery itself seems responsible for this attenuation in [3 H] PK11195 binding. We speculate that calorie restriction following obese conditions may be seen as a stressor and contribute to inflammation in the brain. Further research is needed to verify this mechanism.
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Affiliation(s)
- John Hamilton
- Behavioral Neuropharmacology and Neuroimaging Laboratory on Addictions (BNNLA), Clinical Research Institute on Addictions, Department of Pharmacology and Toxicology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
| | - Cynthia Nguyen
- Behavioral Neuropharmacology and Neuroimaging Laboratory on Addictions (BNNLA), Clinical Research Institute on Addictions, Department of Pharmacology and Toxicology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
| | - Margaret McAvoy
- Behavioral Neuropharmacology and Neuroimaging Laboratory on Addictions (BNNLA), Clinical Research Institute on Addictions, Department of Pharmacology and Toxicology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
| | - Nicole Roeder
- Behavioral Neuropharmacology and Neuroimaging Laboratory on Addictions (BNNLA), Clinical Research Institute on Addictions, Department of Pharmacology and Toxicology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA.,Department of Psychology, University at Buffalo, Buffalo, New York, USA
| | - Brittany Richardson
- Behavioral Neuropharmacology and Neuroimaging Laboratory on Addictions (BNNLA), Clinical Research Institute on Addictions, Department of Pharmacology and Toxicology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA.,Department of Psychology, University at Buffalo, Buffalo, New York, USA
| | - Teresa Quattrin
- Department of Pediatrics, University at Buffalo, UBMD Pediatrics, JR Oishei Children's Hospital, Buffalo, New York, USA
| | - Andras Hajnal
- Department of Neural and Behavioral Sciences, The Pennsylvania State University College of Medicine, Hershey, Pennsylvania, USA
| | - Panayotis K Thanos
- Behavioral Neuropharmacology and Neuroimaging Laboratory on Addictions (BNNLA), Clinical Research Institute on Addictions, Department of Pharmacology and Toxicology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA.,Department of Psychology, University at Buffalo, Buffalo, New York, USA
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11
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Lew D, Davison G, Kilanowski C, Eneli IU, Cook SR, Quattrin T, Schechtman K, Epstein L, Wilfley D. Abstract P254: Mental Well-Being of Caregivers With Overweight and Obesity is Associated With Cognitive Stimulation Provided to Children in the Home. Circulation 2023. [DOI: 10.1161/circ.147.suppl_1.p254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/15/2023]
Abstract
Introduction:
Parents with poor mental health are less likely to engage in cognitively enriching parenting behaviors, such as reading and playing with their children. This, in turn, is associated with increased risk of obesity in the child and poor treatment outcomes for children enrolled in behavioral weight management. Parents and caregivers with obesity also have worse mental health and lower life satisfaction than their non-obese counterparts. Among parents with overweight and obesity who have a child with overweight/obesity, the relationship between parent mental health and cognitive enrichment provided in the home is unknown.
Hypothesis:
We hypothesize that higher depressive symptoms and lower subjective well-being scores among parents will be associated with less cognitive enrichment provided to children. Further, we hypothesize that these relationships will be moderated by the sex of the parent.
Methods:
This study was a secondary analysis of baseline data from 452 parent-child dyads with overweight/obesity enrolled in a family-based behavioral treatment study for obesity. Depression symptoms and subjective well-being were assessed using the Patient Health Questionnaire-9 scale and the MacArthur Scale of Subjective Social Status, respectively. Cognitive stimulation was measured with the Cognitive Stimulation subscale of the Environmental Enrichment scale. Univariable relationships were assessed using Pearson correlations. Multivariable linear regression models were used to control for study site, parent characteristics (age, BMI, sex, race/ethnicity, education), child characteristics (age, and sex), and family characteristics (health insurance status and household income).
Results:
Higher depression symptom score was correlated with lower cognitive stimulation (ρ = -0.165, p < 0.001), whereas higher subjective well-being was associated with higher cognitive stimulation (ρ = 0.377, p < 0.001). These relationships were maintained even after controlling for covariates in the multivariable models, with each one-unit increase in depression symptoms associated with a 0.16 unit decrease in cognitive stimulation (95% CI -0.27 to -0.06, p = 0.003) and each one-unit increase in subjective well-being associated with a 0.04 unit increase in cognitive stimulation (95% CI 0.01, 0.07, p = 0.01). Parent sex did not moderate these effects.
Conclusions:
Mental well-being of parents and caregivers with overweight/obesity is associated with the degree of cognitive enrichment provided to the child in the home, though the effect sizes after controlling for covariates were modest. Thus, interventions targeting parental wellbeing offer a potential avenue to improve their child’s cognitive wellbeing and response to obesity treatment.
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Affiliation(s)
- Daphne Lew
- Washington Univ Sch of Medicine, St. Louis, MO
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12
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Mastrandrea LD, Quattrin T. Preventing type 1 diabetes development and preserving beta-cell function. Curr Opin Endocrinol Diabetes Obes 2022; 29:386-391. [PMID: 35799459 DOI: 10.1097/med.0000000000000746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
PURPOSE OF REVIEW Type 1 diabetes (T1D) is the most common chronic disease of childhood presenting a significant burden, both in terms of day-to-day medical management and lifelong care. Studies aligned with diverse strategies to prevent or modify the course of T1D are reviewed. RECENT FINDINGS The diagnosis of T1D precedes the classic clinical presentation when insulin dependence develops. With an increased understanding of the pathophysiology of the autoimmune process leading to T1D, treatment strategies to prevent the development of autoimmunity and/or modify the immune response have been trialed in persons at risk for developing the disease. Interventions prior to insulin dependence or very early after clinical diagnosis show some promise both in preventing disease onset and prolonging beta-cell insulin production. SUMMARY Significant progress has been made in the treatment of T1D. However, suboptimal glycemic control remains a challenge impacting overall health and quality of life for patients with this chronic disease. Although physicians and basic sciences investigators continue to pursue the prevention of the autoimmune process, the advent of disease-modifying agents is a promising strategy. Further studies are needed to ensure that insulin preservation can be achieved longer term.
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Affiliation(s)
- Lucy D Mastrandrea
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo
- Diabetes Center, John R. Oishei Children's Hospital, Buffalo, New York, USA
| | - Teresa Quattrin
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo
- Diabetes Center, John R. Oishei Children's Hospital, Buffalo, New York, USA
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13
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Neuman J, Roeder N, Richardson B, Quattrin T, Hamilton J, Thanos PK. High Fat Diet Increases [ 3H] Flunitrazepam Binding in the Mouse Brain that is Dependent on the Expression of the Dopamine D2 Gene. Neurochem Res 2022; 47:3003-3011. [PMID: 35708880 DOI: 10.1007/s11064-022-03644-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 05/16/2022] [Accepted: 05/22/2022] [Indexed: 11/24/2022]
Abstract
Dopamine is an important neuromodulator in the brain that binds to dopamine D1-like receptors (D1, D5) as well as dopamine D2-like receptors (D2, D3, D4). The D2 receptor is known to play an integral role in a variety of physiological processes including addictive behaviors, locomotion, motivation, feeding behavior, and more. It was recently reported that dopamine is a direct-acting modulator of mammalian GABA(A) receptors. To this end, we wanted to examine how the expression of the dopamine D2 gene impacts the expression of GABA(A) receptors in the brain under different dietary conditions. Adult female Drd2 wild-type (WT), heterozygous (HT), and knockout (KO) mice were given either normal or high-fat diet for a period of 30 weeks. Following this, their brains were collected for [3H] Flunitrazepam binding in order to assess GABA(A) receptor expression. A high fat diet significantly increased [3H] Flunitrazepam binding in the regions of the somatosensory cortex, striatum, and various other cortical areas within WT mice. In contrast, no effect of diet was observed in HT or KO mice. As such, HT and KO mice displayed reduced [3H] Flunitrazepam binding in these areas relative to WT mice under high-fat dietary conditions. The effect of a high-fat diet on [3H] Flunitrazepam binding is consistent with recent evidence showing increases in GABA neurotransmitter levels following a high-fat diet. We demonstrate for the first time that the expression of the D2 gene plays a prominent role in the ability of a high-fat diet to impact GABA(A) receptors in the mouse brain.
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Affiliation(s)
- Josh Neuman
- Behavioral Neuropharmacology and Neuroimaging Laboratory on Addictions, Clinical Research Institute on Addictions, Department of Pharmacology and Toxicology, Jacobs School of Medicine and Biosciences, State University of New York at Buffalo, Buffalo, NY, USA
| | - Nicole Roeder
- Behavioral Neuropharmacology and Neuroimaging Laboratory on Addictions, Clinical Research Institute on Addictions, Department of Pharmacology and Toxicology, Jacobs School of Medicine and Biosciences, State University of New York at Buffalo, Buffalo, NY, USA
| | - Brittany Richardson
- Behavioral Neuropharmacology and Neuroimaging Laboratory on Addictions, Clinical Research Institute on Addictions, Department of Pharmacology and Toxicology, Jacobs School of Medicine and Biosciences, State University of New York at Buffalo, Buffalo, NY, USA
| | - Teresa Quattrin
- University at Buffalo, UBMD Pediatrics, JR Oishei Children's Hospital, Buffalo, NY, USA
| | - John Hamilton
- Behavioral Neuropharmacology and Neuroimaging Laboratory on Addictions, Clinical Research Institute on Addictions, Department of Pharmacology and Toxicology, Jacobs School of Medicine and Biosciences, State University of New York at Buffalo, Buffalo, NY, USA
| | - Panayotis K Thanos
- Behavioral Neuropharmacology and Neuroimaging Laboratory on Addictions, Clinical Research Institute on Addictions, Department of Pharmacology and Toxicology, Jacobs School of Medicine and Biosciences, State University of New York at Buffalo, Buffalo, NY, USA.
- Department of Psychology, State University at Buffalo, Buffalo, NY, USA.
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14
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Epstein LH, Schechtman KB, Kilanowski C, Ramel M, Moursi NA, Quattrin T, Cook SR, Eneli IU, Pratt C, Geller N, Campo R, Lew D, Wilfley DE. Implementing family-based behavioral treatment in the pediatric primary care setting: Design of the PLAN study. Contemp Clin Trials 2021; 109:106497. [PMID: 34389519 PMCID: PMC9664376 DOI: 10.1016/j.cct.2021.106497] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 05/20/2021] [Accepted: 06/27/2021] [Indexed: 12/11/2022]
Abstract
Family-based behavioral treatment (FBT) is an evidence-based treatment for pediatric obesity. FBT has primarily been implemented in specialty clinics, with highly trained interventionists. The goal of this study is to assess effectiveness of FBT implemented in pediatric primary care settings using newly trained interventionists who might implement FBT in pediatric practices. The goal is to randomize 528 families with a child with overweight/obesity (≥85th BMI percentile) and parent with overweight/obesity (BMI ≥ 25) across four sites (Buffalo and Rochester, New York; Columbus, Ohio; St. Louis, Missouri) to FBT or usual care and obtain assessments at 6-month intervals over 24 months of treatment. FBT is implemented using a mastery model, which provides quantity of treatment tailored to family progress and following the United States Preventive Services Task Force recommendations for effective dose and duration of treatment. The primary outcome of the trial is change in relative weight for children, and secondarily, for parents and siblings who are overweight/obese. Between group differences in the tendency to prefer small immediate rewards over larger, delayed rewards (delay discounting) and how this is related to treatment outcome is also evaluated. Challenges in translation of group-based interventions to individualized treatments in primary care settings, and in study implementation that arose due to the COVID-19 pandemic are discussed. It is hypothesized that the FBT intervention will be associated with better changes in relative weight for children, parents, and siblings than usual care. The results of this study can inform future dissemination and implementation of FBT into primary care settings.
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Affiliation(s)
- Leonard H Epstein
- Department of Pediatrics, Jacobs School of Medicine, and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA.
| | - Kenneth B Schechtman
- Department of Biostatistics, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | - Colleen Kilanowski
- Department of Pediatrics, Jacobs School of Medicine, and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
| | - Melissa Ramel
- Department of Psychiatry, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | - Nasreen A Moursi
- Department of Psychiatry, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | - Teresa Quattrin
- Department of Pediatrics, Jacobs School of Medicine, and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
| | - Steven R Cook
- Department of Pediatrics, University of Rochester Medical Center, Rochester, NY, USA
| | - Ihouma U Eneli
- Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH, USA
| | - Charlotte Pratt
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Nancy Geller
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Rebecca Campo
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Daphne Lew
- Department of Biostatistics, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | - Denise E Wilfley
- Department of Psychiatry, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
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15
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Shelat T, Mastrandrea LD, Majumdar I, Quattrin T. Perceptions of Diabetes Self-Efficacy and Glycemic Control in Youth With Type 1 Diabetes. Diabetes Spectr 2021; 34:313-320. [PMID: 34511859 PMCID: PMC8387614 DOI: 10.2337/ds20-0035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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16
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Epstein LH, Paluch RA, Stein JS, Quattrin T, Mastrandrea LD, Bree KA, Sze YY, Greenawald MH, Biondolillo M, Bickel WK. Delay Discounting, Glycemic Regulation and Health Behaviors in Adults with Prediabetes. Behav Med 2021; 47:194-204. [PMID: 32275202 PMCID: PMC8462992 DOI: 10.1080/08964289.2020.1712581] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
The majority of people with prediabetes transition to type 2 diabetes. Research has suggested that persons with type 2 diabetes are likely to discount the future and focus on immediate rewards. This study was designed to assess whether this process of delay discounting (DD) is associated with glycemic regulation, medication adherence and eating and exercise behaviors in adults with prediabetes. Participants included 81 adults with prediabetes who were also prescribed hypertension or dyslipidemia drugs, which is common for people with prediabetes. Participants completed adjusting amount DD $100 and $1000 tasks, as well assessments of glycemic control (Hemoglobin (Hb) A1c), medication adherence, diet quality, and objectively measured physical activity. Relationships between DD and these variables were assessed. Results showed higher rates of DD were related to higher HbA1c; as well as poorer medication adherence, lower diet quality and lower physical activity. Hierarchical regression showed that the association between minority status, a known risk factor for type 2 diabetes, was moderated by DD, as minorities with higher DD had greater HbA1c values. Delay discounting may represent a novel target to prevent progression from prediabetes to type 2 diabetes.
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Affiliation(s)
| | - Rocco A. Paluch
- University at Buffalo Jacobs School of Medicine and Biomedical Sciences
| | | | - Teresa Quattrin
- University at Buffalo Jacobs School of Medicine and Biomedical Sciences
| | | | - Kyle A. Bree
- University at Buffalo Jacobs School of Medicine and Biomedical Sciences
| | - Yan Yan Sze
- University at Buffalo Jacobs School of Medicine and Biomedical Sciences
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17
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Quattrin T, Haller MJ, Steck AK, Felner EI, Li Y, Xia Y, Leu JH, Zoka R, Hedrick JA, Rigby MR, Vercruysse F. Golimumab and Beta-Cell Function in Youth with New-Onset Type 1 Diabetes. N Engl J Med 2020; 383:2007-2017. [PMID: 33207093 DOI: 10.1056/nejmoa2006136] [Citation(s) in RCA: 114] [Impact Index Per Article: 28.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Type 1 diabetes is an autoimmune disease characterized by progressive loss of pancreatic beta cells. Golimumab is a human monoclonal antibody specific for tumor necrosis factor α that has already been approved for the treatment of several autoimmune conditions in adults and children. Whether golimumab could preserve beta-cell function in youth with newly diagnosed overt (stage 3) type 1 diabetes is unknown. METHODS In this phase 2, multicenter, placebo-controlled, double-blind, parallel-group trial, we randomly assigned, in a 2:1 ratio, children and young adults (age range, 6 to 21 years) with newly diagnosed overt type 1 diabetes to receive subcutaneous golimumab or placebo for 52 weeks. The primary end point was endogenous insulin production, as assessed according to the area under the concentration-time curve for C-peptide level in response to a 4-hour mixed-meal tolerance test (4-hour C-peptide AUC) at week 52. Secondary and additional end points included insulin use, the glycated hemoglobin level, the number of hypoglycemic events, the ratio of fasting proinsulin to C-peptide over time, and response profile. RESULTS A total of 84 participants underwent randomization - 56 were assigned to the golimumab group and 28 to the placebo group. The mean (±SD) 4-hour C-peptide AUC at week 52 differed significantly between the golimumab group and the placebo group (0.64±0.42 pmol per milliliter vs. 0.43±0.39 pmol per milliliter, P<0.001). A treat-to-target approach led to good glycemic control in both groups, and there was no significant difference between the groups in glycated hemoglobin level. Insulin use was lower with golimumab than with placebo. A partial-remission response (defined as an insulin dose-adjusted glycated hemoglobin level score [calculated as the glycated hemoglobin level plus 4 times the insulin dose] of ≤9) was observed in 43% of participants in the golimumab group and in 7% of those in the placebo group (difference, 36 percentage points; 95% CI, 22 to 55). The mean number of hypoglycemic events did not differ between the trial groups. Hypoglycemic events that were recorded as adverse events at the discretion of investigators were reported in 13 participants (23%) in the golimumab group and in 2 (7%) of those in the placebo group. Antibodies to golimumab were detected in 30 participants who received the drug; 29 had antibody titers lower than 1:1000, of whom 12 had positive results for neutralizing antibodies. CONCLUSIONS Among children and young adults with newly diagnosed overt type 1 diabetes, golimumab resulted in better endogenous insulin production and less exogenous insulin use than placebo. (Funded by Janssen Research and Development; T1GER ClinicalTrials.gov number, NCT02846545.).
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Affiliation(s)
- Teresa Quattrin
- From the Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, and Diabetes Center, John R. Oishei Children's Hospital, Buffalo, NY (T.Q.); the Department of Pediatrics, University of Florida, Gainesville (M.J.H.); the Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Aurora (A.K.S.); the Division of Pediatric Endocrinology, Emory University School of Medicine, Atlanta (E.I.F.); Janssen Research and Development, Spring House (Y.L., Y.X., J.H.L.) and Horsham (R.Z., J.A.H., M.R.R.) - both in Pennsylvania; and Janssen Research and Development, Beerse, Belgium (F.V.)
| | - Michael J Haller
- From the Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, and Diabetes Center, John R. Oishei Children's Hospital, Buffalo, NY (T.Q.); the Department of Pediatrics, University of Florida, Gainesville (M.J.H.); the Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Aurora (A.K.S.); the Division of Pediatric Endocrinology, Emory University School of Medicine, Atlanta (E.I.F.); Janssen Research and Development, Spring House (Y.L., Y.X., J.H.L.) and Horsham (R.Z., J.A.H., M.R.R.) - both in Pennsylvania; and Janssen Research and Development, Beerse, Belgium (F.V.)
| | - Andrea K Steck
- From the Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, and Diabetes Center, John R. Oishei Children's Hospital, Buffalo, NY (T.Q.); the Department of Pediatrics, University of Florida, Gainesville (M.J.H.); the Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Aurora (A.K.S.); the Division of Pediatric Endocrinology, Emory University School of Medicine, Atlanta (E.I.F.); Janssen Research and Development, Spring House (Y.L., Y.X., J.H.L.) and Horsham (R.Z., J.A.H., M.R.R.) - both in Pennsylvania; and Janssen Research and Development, Beerse, Belgium (F.V.)
| | - Eric I Felner
- From the Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, and Diabetes Center, John R. Oishei Children's Hospital, Buffalo, NY (T.Q.); the Department of Pediatrics, University of Florida, Gainesville (M.J.H.); the Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Aurora (A.K.S.); the Division of Pediatric Endocrinology, Emory University School of Medicine, Atlanta (E.I.F.); Janssen Research and Development, Spring House (Y.L., Y.X., J.H.L.) and Horsham (R.Z., J.A.H., M.R.R.) - both in Pennsylvania; and Janssen Research and Development, Beerse, Belgium (F.V.)
| | - Yinglei Li
- From the Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, and Diabetes Center, John R. Oishei Children's Hospital, Buffalo, NY (T.Q.); the Department of Pediatrics, University of Florida, Gainesville (M.J.H.); the Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Aurora (A.K.S.); the Division of Pediatric Endocrinology, Emory University School of Medicine, Atlanta (E.I.F.); Janssen Research and Development, Spring House (Y.L., Y.X., J.H.L.) and Horsham (R.Z., J.A.H., M.R.R.) - both in Pennsylvania; and Janssen Research and Development, Beerse, Belgium (F.V.)
| | - Yichuan Xia
- From the Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, and Diabetes Center, John R. Oishei Children's Hospital, Buffalo, NY (T.Q.); the Department of Pediatrics, University of Florida, Gainesville (M.J.H.); the Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Aurora (A.K.S.); the Division of Pediatric Endocrinology, Emory University School of Medicine, Atlanta (E.I.F.); Janssen Research and Development, Spring House (Y.L., Y.X., J.H.L.) and Horsham (R.Z., J.A.H., M.R.R.) - both in Pennsylvania; and Janssen Research and Development, Beerse, Belgium (F.V.)
| | - Jocelyn H Leu
- From the Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, and Diabetes Center, John R. Oishei Children's Hospital, Buffalo, NY (T.Q.); the Department of Pediatrics, University of Florida, Gainesville (M.J.H.); the Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Aurora (A.K.S.); the Division of Pediatric Endocrinology, Emory University School of Medicine, Atlanta (E.I.F.); Janssen Research and Development, Spring House (Y.L., Y.X., J.H.L.) and Horsham (R.Z., J.A.H., M.R.R.) - both in Pennsylvania; and Janssen Research and Development, Beerse, Belgium (F.V.)
| | - Ramineh Zoka
- From the Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, and Diabetes Center, John R. Oishei Children's Hospital, Buffalo, NY (T.Q.); the Department of Pediatrics, University of Florida, Gainesville (M.J.H.); the Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Aurora (A.K.S.); the Division of Pediatric Endocrinology, Emory University School of Medicine, Atlanta (E.I.F.); Janssen Research and Development, Spring House (Y.L., Y.X., J.H.L.) and Horsham (R.Z., J.A.H., M.R.R.) - both in Pennsylvania; and Janssen Research and Development, Beerse, Belgium (F.V.)
| | - Joseph A Hedrick
- From the Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, and Diabetes Center, John R. Oishei Children's Hospital, Buffalo, NY (T.Q.); the Department of Pediatrics, University of Florida, Gainesville (M.J.H.); the Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Aurora (A.K.S.); the Division of Pediatric Endocrinology, Emory University School of Medicine, Atlanta (E.I.F.); Janssen Research and Development, Spring House (Y.L., Y.X., J.H.L.) and Horsham (R.Z., J.A.H., M.R.R.) - both in Pennsylvania; and Janssen Research and Development, Beerse, Belgium (F.V.)
| | - Mark R Rigby
- From the Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, and Diabetes Center, John R. Oishei Children's Hospital, Buffalo, NY (T.Q.); the Department of Pediatrics, University of Florida, Gainesville (M.J.H.); the Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Aurora (A.K.S.); the Division of Pediatric Endocrinology, Emory University School of Medicine, Atlanta (E.I.F.); Janssen Research and Development, Spring House (Y.L., Y.X., J.H.L.) and Horsham (R.Z., J.A.H., M.R.R.) - both in Pennsylvania; and Janssen Research and Development, Beerse, Belgium (F.V.)
| | - Frank Vercruysse
- From the Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, and Diabetes Center, John R. Oishei Children's Hospital, Buffalo, NY (T.Q.); the Department of Pediatrics, University of Florida, Gainesville (M.J.H.); the Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Aurora (A.K.S.); the Division of Pediatric Endocrinology, Emory University School of Medicine, Atlanta (E.I.F.); Janssen Research and Development, Spring House (Y.L., Y.X., J.H.L.) and Horsham (R.Z., J.A.H., M.R.R.) - both in Pennsylvania; and Janssen Research and Development, Beerse, Belgium (F.V.)
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White NH, Quattrin T, Aubin LBS, Duggan WT, England RD, Fryburg JS. Efficacy and Safety of Inhaled Human Insulin (Exu hera ®) Compared to Subcutaneous Insulin in Children Ages 6 to 11 Years with Type 1 Diabetes Mellitus: Results of a 3-Month, Randomized, Parallel Trial. J Pediatr Endocrinol Metab 2020; 21:555-568. [PMID: 33600687 DOI: 10.1515/jpem-2008-210610] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AIM To compare the efficacy and safety of Exubera® (EXU) with subcutaneous (SC) insulin in children, ages 6-11 years, with type 1 diabetes mellitus. DESIGN AND METHODS 121 children were randomized to receive EXU or SC insulin, plus intermediate/ long-acting insulin for 12 weeks. Change in HbA1c was the primary efficacy endpoint. RESULTS Decreases from baseline HbA1c were comparable between treatment groups ( difference between adjusted mean decrease from baseline [EXU - SC insulin], -0.23 [95% CI, -0.49, 0.03]). Differences between groups on pulmonary function tests were small and not significant. Mild to moderate cough occurred in 24.6% of EXU versus 6.8% of SC insulin patients. The risk for hypoglycemia was comparable between EXU and SC insulin (relative risk 0.88 [95% CI, 0.71, 1.11]). Increased insulin antibodies with EXU were not associated with clinical findings. CONCLUSION The efficacy and safety profiles shown in this study are the foundation for further investigation of EXU in this population.
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Affiliation(s)
- Neil H White
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO,Washington, USA
| | - Teresa Quattrin
- Diabetes Center, Children's Hospital of Buffalo, State University of New York at Buffalo,NY, USA
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19
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Stein JS, Craft WH, Paluch RA, Gatchalian KM, Greenawald MH, Quattrin T, Mastrandrea LD, Epstein LH, Bickel WK. Bleak present, bright future: II. Combined effects of episodic future thinking and scarcity on delay discounting in adults at risk for type 2 diabetes. J Behav Med 2020; 44:222-230. [PMID: 32989616 DOI: 10.1007/s10865-020-00178-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 09/02/2020] [Indexed: 12/17/2022]
Abstract
The present study sought to determine if episodic future thinking (EFT) can decrease delay discounting (DD) and demand for fast food under simulations of economic scarcity in adults at risk for diabetes (i.e., overweight/obese and with hemoglobin A1c values in, or approaching, the prediabetic range). Across two sessions, participants completed assessments of DD and food demand at baseline and while prompted to: (1) engage in either EFT or control episodic recent thinking, and (2) while reading a brief narrative describing either economic scarcity or neutral income conditions. Results showed that EFT significantly reduced DD, whereas the economic scarcity narrative significantly increased DD; no significant interaction between EFT and scarcity was observed. No significant effect of either EFT or scarcity was observed on food demand. We conclude that EFT decreases DD even when challenged by simulated economic scarcity in adults at risk for diabetes. The absence of a significant interaction between EFT and scarcity suggests that these variables operate independently to influence DD in opposing directions. Effects of EFT and economic scarcity on food demand require further study. The present study was registered on clinicaltrials.gov (NCT03664726).
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Affiliation(s)
- Jeffrey S Stein
- Center for Transformative Research on Health Behaviors, Fralin Biomedical Research Institute at VTC, 1 Riverside Circle, Roanoke, VA, 24016, USA.
| | - William H Craft
- Center for Transformative Research on Health Behaviors, Fralin Biomedical Research Institute at VTC, 1 Riverside Circle, Roanoke, VA, 24016, USA
| | - Rocco A Paluch
- School of Medicine and Biomedical Sciences, University at Buffalo Jacobs, Buffalo, NY, USA
| | - Kirstin M Gatchalian
- Center for Transformative Research on Health Behaviors, Fralin Biomedical Research Institute at VTC, 1 Riverside Circle, Roanoke, VA, 24016, USA
| | - Mark H Greenawald
- Department of Family and Community Medicine, Carilion Clinic, Roanoke, VA, USA
| | - Teresa Quattrin
- School of Medicine and Biomedical Sciences, University at Buffalo Jacobs, Buffalo, NY, USA
| | - Lucy D Mastrandrea
- School of Medicine and Biomedical Sciences, University at Buffalo Jacobs, Buffalo, NY, USA
| | - Leonard H Epstein
- School of Medicine and Biomedical Sciences, University at Buffalo Jacobs, Buffalo, NY, USA
| | - Warren K Bickel
- Center for Transformative Research on Health Behaviors, Fralin Biomedical Research Institute at VTC, 1 Riverside Circle, Roanoke, VA, 24016, USA
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20
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Affiliation(s)
- Leonard H Epstein
- Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York
| | - Teresa Quattrin
- Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York
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21
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Carias E, Hamilton J, Robison LS, Delis F, Eiden R, Quattrin T, Hadjiargyrou M, Komatsu D, Thanos PK. Chronic oral methylphenidate treatment increases microglial activation in rats. J Neural Transm (Vienna) 2018; 125:1867-1875. [PMID: 30238340 DOI: 10.1007/s00702-018-1931-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Accepted: 09/17/2018] [Indexed: 12/18/2022]
Abstract
Methylphenidate (MP) is a widely prescribed psychostimulant used to treat attention deficit hyperactivity disorder. Previously, we established a drinking paradigm to deliver MP to rats at doses that result in pharmacokinetic profiles similar to treated patients. In the present study, adolescent male rats were assigned to one of three groups: control (water), low-dose MP (LD; 4/10 mg/kg), and high dose MP (HD; 30/60 mg/kg). Following 3 months of treatment, half of the rats in each group were euthanized, and the remaining rats received only water throughout a 1-month-long abstinence phase. In vitro autoradiography using [3H] PK 11195 was performed to measure microglial activation. HD MP rats showed increased [3H] PK 11195 binding compared to control rats in several cerebral cortical areas: primary somatosensory cortex including jaw (68.6%), upper lip (80.1%), barrel field (88.9%), and trunk (78%) regions, forelimb sensorimotor area (87.3%), secondary somatosensory cortex (72.5%), motor cortices 1 (73.2%) and 2 (69.3%), insular cortex (59.9%); as well as subcortical regions including the thalamus (62.9%), globus pallidus (79.4%) and substantia nigra (22.7%). Additionally, HD MP rats showed greater binding compared to LD MP rats in the hippocampus (60.6%), thalamus (59.6%), substantia nigra (38.5%), and motor 2 cortex (55.3%). Following abstinence, HD MP rats showed no significant differences compared to water controls; however, LD MP rats showed increased binding in pre-limbic cortex (78.1%) and ventromedial caudate putamen (113.8%). These findings indicate that chronic MP results in widespread microglial activation immediately after treatment and following the cessation of treatment in some brain regions.
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Affiliation(s)
- Emily Carias
- Behavioral Neuropharmacology and Neuroimaging Laboratory on Addictions (BNNLA), Research Institute on Addictions, Department of Pharmacology and Toxicology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, 1021 Main St., Buffalo, NY, USA
| | - John Hamilton
- Behavioral Neuropharmacology and Neuroimaging Laboratory on Addictions (BNNLA), Research Institute on Addictions, Department of Pharmacology and Toxicology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, 1021 Main St., Buffalo, NY, USA
| | - Lisa S Robison
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, 47 New Scotland Ave., Albany, NY, USA
| | - Foteini Delis
- Department of Pharmacology, Medical School, University of Ioannina, 45110, Ioannina, Greece
| | - Rina Eiden
- Department of Psychology, University at Buffalo, 1021 Main St., Buffalo, NY, USA
| | - Teresa Quattrin
- Women and Children's Hospital of Buffalo, Department of Pediatrics, School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
| | - Michael Hadjiargyrou
- Department of Life Sciences, New York Institute of Technology, Northern Blvd., Old Westbury, NY, USA
| | - David Komatsu
- Department of Orthopedics, Stony Brook University, 100 Nicolls Rd., Stony Brook, NY, USA
| | - Panayotis K Thanos
- Behavioral Neuropharmacology and Neuroimaging Laboratory on Addictions (BNNLA), Research Institute on Addictions, Department of Pharmacology and Toxicology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, 1021 Main St., Buffalo, NY, USA.
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Redondo MJ, Geyer S, Steck AK, Sharp S, Wentworth JM, Weedon MN, Antinozzi P, Sosenko J, Atkinson M, Pugliese A, Oram RA, Antinozzi P, Atkinson M, Battaglia M, Becker D, Bingley P, Bosi E, Buckner J, Colman P, Gottlieb P, Herold K, Insel R, Kay T, Knip M, Marks J, Moran A, Palmer J, Peakman M, Philipson L, Pugliese A, Raskin P, Rodriguez H, Roep B, Russell W, Schatz D, Wherrett D, Wilson D, Winter W, Ziegler A, Benoist C, Blum J, Chase P, Clare-Salzler M, Clynes R, Eisenbarth G, Fathman C, Grave G, Hering B, Kaufman F, Leschek E, Mahon J, Nanto-Salonen K, Nepom G, Orban T, Parkman R, Pescovitz M, Peyman J, Roncarolo M, Simell O, Sherwin R, Siegelman M, Steck A, Thomas J, Trucco M, Wagner J, Greenbaum ,CJ, Bourcier K, Insel R, Krischer JP, Leschek E, Rafkin L, Spain L, Cowie C, Foulkes M, Krause-Steinrauf H, Lachin JM, Malozowski S, Peyman J, Ridge J, Savage P, Skyler JS, Zafonte SJ, Kenyon NS, Santiago I, Sosenko JM, Bundy B, Abbondondolo M, Adams T, Amado D, Asif I, Boonstra M, Bundy B, Burroughs C, Cuthbertson D, Deemer M, Eberhard C, Fiske S, Ford J, Garmeson J, Guillette H, Browning G, Coughenour T, Sulk M, Tsalikan E, Tansey M, Cabbage J, Dixit N, Pasha S, King M, Adcock K, Geyer S, Atterberry H, Fox L, Englert K, Mauras N, Permuy J, Sikes K, Berhe T, Guendling B, McLennan L, Paganessi L, Hays B, Murphy C, Draznin M, Kamboj M, Sheppard S, Lewis V, Coates L, Moore W, Babar G, Bedard J, Brenson-Hughes D, Henderson C, Cernich J, Clements M, Duprau R, Goodman S, Hester L, Huerta-Saenz L, Karmazin A, Letjen T, Raman S, Morin D, Henry M, Bestermann W, Morawski E, White J, Brockmyer A, Bays R, Campbell S, Stapleton A, Stone N, Donoho A, Everett H, Heyman K, Hensley H, Johnson M, Marshall C, Skirvin N, Taylor P, Williams R, Ray L, Wolverton C, Nickels D, Dothard C, Hsiao B, Speiser P, Pellizzari M, Bokor L, Izuora K, Abdelnour S, Cummings P, Paynor S, Leahy M, Riedl M, Shockley S, Karges C, Saad R, Briones T, Casella S, Herz C, Walsh K, Greening J, Hay F, Hunt S, Sikotra N, Simons L, Keaton N, Karounos D, Oremus R, Dye L, Myers L, Ballard D, Miers W, Sparks R, Thraikill K, Edwards K, Fowlkes J, Kinderman A, Kemp S, Morales A, Holland L, Johnson L, Paul P, Ghatak A, Phelen K, Leyland H, Henderson T, Brenner D, Law P, Oppenheimer E, Mamkin I, Moniz C, Clarson C, Lovell M, Peters A, Ruelas V, Borut D, Burt D, Jordan M, Leinbach A, Castilla S, Flores P, Ruiz M, Hanson L, Green-Blair J, Sheridan R, Wintergerst K, Pierce G, Omoruyi A, Foster M, Linton C, Kingery S, Lunsford A, Cervantes I, Parker T, Price P, Urben J, Doughty I, Haydock H, Parker V, Bergman P, Liu S, Duncum S, Rodda C, Thomas A, Ferry R, McCommon D, Cockroft J, Perelman A, Calendo R, Barrera C, Arce-Nunez E, Lloyd J, Martinez Y, De la Portilla M, Cardenas I, Garrido L, Villar M, Lorini R, Calandra E, D’Annuzio G, Perri K, Minuto N, Malloy J, Rebora C, Callegari R, Ali O, Kramer J, Auble B, Cabrera S, Donohoue P, Fiallo-Scharer R, Hessner M, Wolfgram P, Maddox K, Kansra A, Bettin N, McCuller R, Miller A, Accacha S, Corrigan J, Fiore E, Levine R, Mahoney T, Polychronakos C, Martin J, Gagne V, Starkman H, Fox M, Chin D, Melchionne F, Silverman L, Marshall I, Cerracchio L, Cruz J, Viswanathan A, Miller J, Wilson J, Chalew S, Valley S, Layburn S, Lala A, Clesi P, Genet M, Uwaifo G, Charron A, Allerton T, Milliot E, Cefalu W, Melendez-Ramirez L, Richards R, Alleyn C, Gustafson E, Lizanna M, Wahlen J, Aleiwe S, Hansen M, Wahlen H, Moore M, Levy C, Bonaccorso A, Rapaport R, Tomer Y, Chia D, Goldis M, Iazzetti L, Klein M, Levister C, Waldman L, Muller S, Wallach E, Regelmann M, Antal Z, Aranda M, Reynholds C, Leech N, Wake D, Owens C, Burns M, Wotherspoon J, Nguyen T, Murray A, Short K, Curry G, Kelsey S, Lawson J, Porter J, Stevens S, Thomson E, Winship S, Wynn L, O’Donnell R, Wiltshire E, Krebs J, Cresswell P, Faherty H, Ross C, Vinik A, Barlow P, Bourcier M, Nevoret M, Couper J, Oduah V, Beresford S, Thalagne N, Roper H, Gibbons J, Hill J, Balleaut S, Brennan C, Ellis-Gage J, Fear L, Gray T, Pilger J, Jones L, McNerney C, Pointer L, Price N, Few K, Tomlinson D, Denvir L, Drew J, Randell T, Mansell P, Roberts A, Bell S, Butler S, Hooton Y, Navarra H, Roper A, Babington G, Crate L, Cripps H, Ledlie A, Moulds C, Sadler K, Norton R, Petrova B, Silkstone O, Smith C, Ghai K, Murray M, Viswanathan V, Henegan M, Kawadry O, Olson J, Stavros T, Patterson L, Ahmad T, Flores B, Domek D, Domek S, Copeland K, George M, Less J, Davis T, Short M, Tamura R, Dwarakanathan A, O’Donnell P, Boerner B, Larson L, Phillips M, Rendell M, Larson K, Smith C, Zebrowski K, Kuechenmeister L, Wood K, Thevarayapillai M, Daniels M, Speer H, Forghani N, Quintana R, Reh C, Bhangoo A, Desrosiers P, Ireland L, Misla T, Xu P, Torres C, Wells S, Villar J, Yu M, Berry D, Cook D, Soder J, Powell A, Ng M, Morrison M, Young K, Haslam Z, Lawson M, Bradley B, Courtney J, Richardson C, Watson C, Keely E, DeCurtis D, Vaccarcello-Cruz M, Torres Z, Alies P, Sandberg K, Hsiang H, Joy B, McCormick D, Powell A, Jones H, Bell J, Hargadon S, Hudson S, Kummer M, Badias F, Sauder S, Sutton E, Gensel K, Aguirre-Castaneda R, Benavides Lopez V, Hemp D, Allen S, Stear J, Davis E, Jones T, Baker A, Roberts A, Dart J, Paramalingam N, Levitt Katz L, Chaudhary N, Murphy K, Willi S, Schwartzman B, Kapadia C, Larson D, Bassi M, McClellan D, Shaibai G, Kelley L, Villa G, Kelley C, Diamond R, Kabbani M, Dajani T, Hoekstra F, Magorno M, Beam C, Holst J, Chauhan V, Wilson N, Bononi P, Sperl M, Millward A, Eaton M, Dean L, Olshan J, Renna H, Boulware D, Milliard C, Snyder D, Beaman S, Burch K, Chester J, Ahmann A, Wollam B, DeFrang D, Fitch R, Jahnke K, Bounmananh L, Hanavan K, Klopfenstein B, Nicol L, Bergstrom R, Noland T, Brodksy J, Bacon L, Quintos J, Topor L, Bialo S, Bream S, Bancroft B, Soto A, Lagarde W, Lockemer H, Vanderploeg T, Ibrahim M, Huie M, Sanchez V, Edelen R, Marchiando R, Freeman D, Palmer J, Repas T, Wasson M, Auker P, Culbertson J, Kieffer T, Voorhees D, Borgwardt T, DeRaad L, Eckert K, Gough J, Isaacson E, Kuhn H, Carroll A, Schubert M, Francis G, Hagan S, Le T, Penn M, Wickham E, Leyva C, Ginem J, Rivera K, Padilla J, Rodriguez I, Jospe N, Czyzyk J, Johnson B, Nadgir U, Marlen N, Prakasam G, Rieger C, Granger M, Glaser N, Heiser E, Harris B, Foster C, Slater H, Wheeler K, Donaldson D, Murray M, Hale D, Tragus R, Holloway M, Word D, Lynch J, Pankratz L, Rogers W, Newfield R, Holland S, Hashiguchi M, Gottschalk M, Philis-Tsimikas A, Rosal R, Kieffer M, Franklin S, Guardado S, Bohannon N, Garcia M, Aguinaldo T, Phan J, Barraza V, Cohen D, Pinsker J, Khan U, Lane P, Wiley J, Jovanovic L, Misra P, Wright M, Cohen D, Huang K, Skiles M, Maxcy S, Pihoker C, Cochrane K, Nallamshetty L, Fosse J, Kearns S, Klingsheim M, Wright N, Viles L, Smith H, Heller S, Cunningham M, Daniels A, Zeiden L, Parrimon Y, Field J, Walker R, Griffin K, Bartholow L, Erickson C, Howard J, Krabbenhoft B, Sandman C, Vanveldhuizen A, Wurlger J, Paulus K, Zimmerman A, Hanisch K, Davis-Keppen L, Cotterill A, Kirby J, Harris M, Schmidt A, Kishiyama C, Flores C, Milton J, Ramiro J, Martin W, Whysham C, Yerka A, Freels T, Hassing J, Webster J, Green R, Carter P, Galloway J, Hoelzer D, Ritzie AQL, Roberts S, Said S, Sullivan P, Allen H, Reiter E, Feinberg E, Johnson C, Newhook L, Hagerty D, White N, Sharma A, Levandoski L, Kyllo J, Johnson M, Benoit C, Iyer P, Diamond F, Hosono H, Jackman S, Barette L, Jones P, Shor A, Sills I, Bzdick S, Bulger J, Weinstock R, Douek I, Andrews R, Modgill G, Gyorffy G, Robin L, Vaidya N, Song X, Crouch S, O’Brien K, Thompson C, Thorne N, Blumer J, Kalic J, Klepek L, Paulett J, Rosolowski B, Horner J, Terry A, Watkins M, Casey J, Carpenter K, Burns C, Horton J, Pritchard C, Soetaert D, Wynne A, Kaiserman K, Halvorson M, Weinberger J, Chin C, Molina O, Patel C, Senguttuvan R, Wheeler M, Furet O, Steuhm C, Jelley D, Goudeau S, Chalmers L, Wootten M, Greer D, Panagiotopoulos C, Metzger D, Nguyen D, Horowitz M, Christiansen M, Glades E, Morimoto C, Macarewich M, Norman R, Harding P, Patin K, Vargas C, Barbanica A, Yu A, Vaidyanathan P, Osborne W, Mehra R, Kaster S, Neace S, Horner J, McDonough S, Reeves G, Cordrey C, Marrs L, Miller T, Dowshen S, Doyle D, Walker S, Catte D, Dean H, Drury-Brown M, McGee PF, Hackman B, Lee M, Malkani S, Cullen K, Johnson K, Hampton P, McCarrell M, Curtis C, Paul E, Zambrano Y, Hess KO, Phoebus D, Quinlan S, Raiden E, Batts E, Buddy C, Kirpatrick K, Ramey M, Shultz A, Webb C, Romesco M, Fradkin J, Blumberg E, Beck G, Brillon D, Gubitosi-Klug R, Laffel L, Veatch R, Wallace D, Braun J, Lernmark A, Lo B, Mitchell H, Naji A, Nerup J, Orchard T, Steffes M, Tsiatis A, Zinman B, Loechelt B, Baden L, Green M, Weinberg A, Marcovina S, Palmer JP, Weinberg A, Yu L, Babu S, Winter W, Eisenbarth GS, Bingley P, Clynes R, DiMeglio L, Eisenbarth G, Hays B, Marks J, Matheson D, Rodriguez H, Wilson D, Redondo MJ, Gomez D, Zheng X, Pena S, Pietropaolo M, Batts E, Brown T, Buckner J, Dove A, Hammond M, Hefty D, Klein J, Kuhns K, Letlau M, Lord S, McCulloch-Olson M, Miller L, Nepom G, Odegard J, Ramey M, Sachter E, St. Marie M, Stickney K, VanBuecken D, Vellek B, Webber C, Allen L, Bollyk J, Hilderman N, Ismail H, Lamola S, Sanda S, Vendettuoli H, Tridgell D, Monzavi R, Bock M, Fisher L, Halvorson M, Jeandron D, Kim M, Wood J, Geffner M, Kaufman F, Parkman R, Salazar C, Goland R, Clynes R, Cook S, Freeby M, Gallagher MP, Gandica R, Greenberg E, Kurland A, Pollak S, Wolk A, Chan M, Koplimae L, Levine E, Smith K, Trast J, DiMeglio L, Blum J, Evans-Molina C, Hufferd R, Jagielo B, Kruse C, Patrick V, Rigby M, Spall M, Swinney K, Terrell J, Christner L, Ford L, Lynch S, Menendez M, Merrill P, Pescovitz M, Rodriguez H, Alleyn C, Baidal D, Fay S, Gaglia J, Resnick B, Szubowicz S, Weir G, Benjamin R, Conboy D, deManbey A, Jackson R, Jalahej H, Orban T, Ricker A, Wolfsdorf J, Zhang HH, Wilson D, Aye T, Baker B, Barahona K, Buckingham B, Esrey K, Esrey T, Fathman G, Snyder R, Aneja B, Chatav M, Espinoza O, Frank E, Liu J, Perry J, Pyle R, Rigby A, Riley K, Soto A, Gitelman S, Adi S, Anderson M, Berhel A, Breen K, Fraser K, Gerard-Gonzalez A, Jossan P, Lustig R, Moassesfar S, Mugg A, Ng D, Prahalod P, Rangel-Lugo M, Sanda S, Tarkoff J, Torok C, Wesch R, Aslan I, Buchanan J, Cordier J, Hamilton C, Hawkins L, Ho T, Jain A, Ko K, Lee T, Phelps S, Rosenthal S, Sahakitrungruang T, Stehl L, Taylor L, Wertz M, Wong J, Philipson L, Briars R, Devine N, Littlejohn E, Grant T, Gottlieb P, Klingensmith G, Steck A, Alkanani A, Bautista K, Bedoy R, Blau A, Burke B, Cory L, Dang M, Fitzgerald-Miller L, Fouts A, Gage V, Garg S, Gesauldo P, Gutin R, Hayes C, Hoffman M, Ketchum K, Logsden-Sackett N, Maahs D, Messer L, Meyers L, Michels A, Peacock S, Rewers M, Rodriguez P, Sepulbeda F, Sippl R, Steck A, Taki I, Tran BK, Tran T, Wadwa RP, Zeitler P, Barker J, Barry S, Birks L, Bomsburger L, Bookert T, Briggs L, Burdick P, Cabrera R, Chase P, Cobry E, Conley A, Cook G, Daniels J, DiDomenico D, Eckert J, Ehler A, Eisenbarth G, Fain P, Fiallo-Scharer R, Frank N, Goettle H, Haarhues M, Harris S, Horton L, Hutton J, Jeffrrey J, Jenison R, Jones K, Kastelic W, King MA, Lehr D, Lungaro J, Mason K, Maurer H, Nguyen L, Proto A, Realsen J, Schmitt K, Schwartz M, Skovgaard S, Smith J, Vanderwel B, Voelmle M, Wagner R, Wallace A, Walravens P, Weiner L, Westerhoff B, Westfall E, Widmer K, Wright H, Schatz D, Abraham A, Atkinson M, Cintron M, Clare-Salzler M, Ferguson J, Haller M, Hosford J, Mancini D, Rohrs H, Silverstein J, Thomas J, Winter W, Cole G, Cook R, Coy R, Hicks E, Lewis N, Marks J, Pugliese A, Blaschke C, Matheson D, Sanders-Branca N, Sosenko J, Arazo L, Arce R, Cisneros M, Sabbag S, Moran A, Gibson C, Fife B, Hering B, Kwong C, Leschyshyn J, Nathan B, Pappenfus B, Street A, Boes MA, Eck SP, Finney L, Fischer TA, Martin A, Muzamhindo CJ, Rhodes M, Smith J, Wagner J, Wood B, Becker D, Delallo K, Diaz A, Elnyczky B, Libman I, Pasek B, Riley K, Trucco M, Copemen B, Gwynn D, Toledo F, Rodriguez H, Bollepalli S, Diamond F, Eyth E, Henson D, Lenz A, Shulman D, Raskin P, Adhikari S, Dickson B, Dunnigan E, Lingvay I, Pruneda L, Ramos-Roman M, Raskin P, Rhee C, Richard J, Siegelman M, Sturges D, Sumpter K, White P, Alford M, Arthur J, Aviles-Santa ML, Cordova E, Davis R, Fernandez S, Fordan S, Hardin T, Jacobs A, Kaloyanova P, Lukacova-Zib I, Mirfakhraee S, Mohan A, Noto H, Smith O, Torres N, Wherrett D, Balmer D, Eisel L, Kovalakovska R, Mehan M, Sultan F, Ahenkorah B, Cevallos J, Razack N, Ricci MJ, Rhode A, Srikandarajah M, Steger R, Russell WE, Black M, Brendle F, Brown A, Moore D, Pittel E, Robertson A, Shannon A, Thomas JW, Herold K, Feldman L, Sherwin R, Tamborlane W, Weinzimer S, Toppari J, Kallio T, Kärkkäinen M, Mäntymäki E, Niininen T, Nurmi B, Rajala P, Romo M, Suomenrinne S, Näntö-Salonen K, Simell O, Simell T, Bosi E, Battaglia M, Bianconi E, Bonfanti R, Grogan P, Laurenzi A, Martinenghi S, Meschi F, Pastore M, Falqui L, Muscato MT, Viscardi M, Castleden H, Farthing N, Loud S, Matthews C, McGhee J, Morgan A, Pollitt J, Elliot-Jones R, Wheaton C, Knip M, Siljander H, Suomalainen H, Colman P, Healy F, Mesfin S, Redl L, Wentworth J, Willis J, Farley M, Harrison L, Perry C, Williams F, Mayo A, Paxton J, Thompson V, Volin L, Fenton C, Carr L, Lemon E, Swank M, Luidens M, Salgam M, Sharma V, Schade D, King C, Carano R, Heiden J, Means N, Holman L, Thomas I, Madrigal D, Muth T, Martin C, Plunkett C, Ramm C, Auchus R, Lane W, Avots E, Buford M, Hale C, Hoyle J, Lane B, Muir A, Shuler S, Raviele N, Ivie E, Jenkins M, Lindsley K, Hansen I, Fadoju D, Felner E, Bode B, Hosey R, Sax J, Jefferies C, Mannering S, Prentis R, She J, Stachura M, Hopkins D, Williams J, Steed L, Asatapova E, Nunez S, Knight S, Dixon P, Ching J, Donner T, Longnecker S, Abel K, Arcara K, Blackman S, Clark L, Cooke D, Plotnick L, Levin P, Bromberger L, Klein K, Sadurska K, Allen C, Michaud D, Snodgrass H, Burghen G, Chatha S, Clark C, Silverberg J, Wittmer C, Gardner J, LeBoeuf C, Bell P, McGlore O, Tennet H, Alba N, Carroll M, Baert L, Beaton H, Cordell E, Haynes A, Reed C, Lichter K, McCarthy P, McCarthy S, Monchamp T, Roach J, Manies S, Gunville F, Marosok L, Nelson T, Ackerman K, Rudolph J, Stewart M, McCormick K, May S, Falls T, Barrett T, Dale K, Makusha L, McTernana C, Penny-Thomas K, Sullivan K, Narendran P, Robbie J, Smith D, Christensen R, Koehler B, Royal C, Arthur T, Houser H, Renaldi J, Watsen S, Wu P, Lyons L, House B, Yu J, Holt H, Nation M, Vickers C, Watling R, Heptulla R, Trast J, Agarwal C, Newell D, Katikaneni R, Gardner C, Del Rio A, Logan A, Collier H, Rishton C, Whalley G, Ali A, Ramtoola S, Quattrin T, Mastrandea L, House A, Ecker M, Huang C, Gougeon C, Ho J, Pacuad D, Dunger D, May J, O’Brien C, Acerini C, Salgin B, Thankamony A, Williams R, Buse J, Fuller G, Duclos M, Tricome J, Brown H, Pittard D, Bowlby D, Blue A, Headley T, Bendre S, Lewis K, Sutphin K, Soloranzo C, Puskaric J, Madison H, Rincon M, Carlucci M, Shridharani R, Rusk B, Tessman E, Huffman D, Abrams H, Biederman B, Jones M, Leathers V, Brickman W, Petrie P, Zimmerman D, Howard J, Miller L, Alemzadeh R, Mihailescu D, Melgozza-Walker R, Abdulla N, Boucher-Berry C, Ize-Ludlow D, Levy R, Swenson Brousell C, Scott R, Heenan H, Lunt H, Kendall D, Willis J, Darlow B, Crimmins N, Edler D, Weis T, Schultz C, Rogers D, Latham D, Mawhorter C, Switzer C, Spencer W, Konstantnopoulus P, Broder S, Klein J, Bachrach B, Gardner M, Eichelberger D, Knight L, Szadek L, Welnick G, Thompson B, Hoffman R, Revell A, Cherko J, Carter K, Gilson E, Haines J, Arthur G, Bowen B, Zipf W, Graves P, Lozano R, Seiple D, Spicer K, Chang A, Fregosi J, Harbinson J, Paulson C, Stalters S, Wright P, Zlock D, Freeth A, Victory J, Maheshwari H, Maheshwari A, Holmstrom T, Bueno J, Arguello R, Ahern J, Noreika L, Watson V, Hourse S, Breyer P, Kissel C, Nicholson Y, Pfeifer M, Almazan S, Bajaj J, Quinn M, Funk K, McCance J, Moreno E, Veintimilla R, Wells A, Cook J, Trunnel S, Transue D, Surhigh J, Bezzaire D, Moltz K, Zacharski E, Henske J, Desai S, Frizelis K, Khan F, Sjoberg R, Allen K, Manning P, Hendry G, Taylor B, Jones S, Couch R, Danchak R, Lieberman D, Strader W, Bencomo M, Bailey T, Bedolla L, Roldan C, Moudiotis C, Vaidya B, Anning C, Bunce S, Estcourt S, Folland E, Gordon E, Harrill C, Ireland J, Piper J, Scaife L, Sutton K, Wilkins S, Costelloe M, Palmer J, Casas L, Miller C, Burgard M, Erickson C, Hallanger-Johnson J, Clark P, Taylor W, Galgani J, Banerjee S, Banda C, McEowen D, Kinman R, Lafferty A, Gillett S, Nolan C, Pathak M, Sondrol L, Hjelle T, Hafner S, Kotrba J, Hendrickson R, Cemeroglu A, Symington T, Daniel M, Appiagyei-Dankah Y, Postellon D, Racine M, Kleis L, Barnes K, Godwin S, McCullough H, Shaheen K, Buck G, Noel L, Warren M, Weber S, Parker S, Gillespie I, Nelson B, Frost C, Amrhein J, Moreland E, Hayes A, Peggram J, Aisenberg J, Riordan M, Zasa J, Cummings E, Scott K, Pinto T, Mokashi A, McAssey K, Helden E, Hammond P, Dinning L, Rahman S, Ray S, Dimicri C, Guppy S, Nielsen H, Vogel C, Ariza C, Morales L, Chang Y, Gabbay R, Ambrocio L, Manley L, Nemery R, Charlton W, Smith P, Kerr L, Steindel-Kopp B, Alamaguer M, Tabisola-Nuesca E, Pendersen A, Larson N, Cooper-Olviver H, Chan D, Fitz-Patrick D, Carreira T, Park Y, Ruhaak R, Liljenquist D. A Type 1 Diabetes Genetic Risk Score Predicts Progression of Islet Autoimmunity and Development of Type 1 Diabetes in Individuals at Risk. Diabetes Care 2018; 41:1887-1894. [PMID: 30002199 PMCID: PMC6105323 DOI: 10.2337/dc18-0087] [Citation(s) in RCA: 86] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 06/06/2018] [Indexed: 02/03/2023]
Abstract
OBJECTIVE We tested the ability of a type 1 diabetes (T1D) genetic risk score (GRS) to predict progression of islet autoimmunity and T1D in at-risk individuals. RESEARCH DESIGN AND METHODS We studied the 1,244 TrialNet Pathway to Prevention study participants (T1D patients' relatives without diabetes and with one or more positive autoantibodies) who were genotyped with Illumina ImmunoChip (median [range] age at initial autoantibody determination 11.1 years [1.2-51.8], 48% male, 80.5% non-Hispanic white, median follow-up 5.4 years). Of 291 participants with a single positive autoantibody at screening, 157 converted to multiple autoantibody positivity and 55 developed diabetes. Of 953 participants with multiple positive autoantibodies at screening, 419 developed diabetes. We calculated the T1D GRS from 30 T1D-associated single nucleotide polymorphisms. We used multivariable Cox regression models, time-dependent receiver operating characteristic curves, and area under the curve (AUC) measures to evaluate prognostic utility of T1D GRS, age, sex, Diabetes Prevention Trial-Type 1 (DPT-1) Risk Score, positive autoantibody number or type, HLA DR3/DR4-DQ8 status, and race/ethnicity. We used recursive partitioning analyses to identify cut points in continuous variables. RESULTS Higher T1D GRS significantly increased the rate of progression to T1D adjusting for DPT-1 Risk Score, age, number of positive autoantibodies, sex, and ethnicity (hazard ratio [HR] 1.29 for a 0.05 increase, 95% CI 1.06-1.6; P = 0.011). Progression to T1D was best predicted by a combined model with GRS, number of positive autoantibodies, DPT-1 Risk Score, and age (7-year time-integrated AUC = 0.79, 5-year AUC = 0.73). Higher GRS was significantly associated with increased progression rate from single to multiple positive autoantibodies after adjusting for age, autoantibody type, ethnicity, and sex (HR 2.27 for GRS >0.295, 95% CI 1.47-3.51; P = 0.0002). CONCLUSIONS The T1D GRS independently predicts progression to T1D and improves prediction along T1D stages in autoantibody-positive relatives.
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Affiliation(s)
- Maria J. Redondo
- Texas Children’s Hospital, Baylor College of Medicine, Houston, TX
| | | | - Andrea K. Steck
- Barbara Davis Center for Childhood Diabetes, University of Colorado School of Medicine, Aurora, CO
| | - Seth Sharp
- Institute of Biomedical and Clinical Science, University of Exeter, Exeter, U.K
| | - John M. Wentworth
- Walter and Eliza Hall Institute of Medical Research and Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Michael N. Weedon
- Institute of Biomedical and Clinical Science, University of Exeter, Exeter, U.K
| | | | | | | | | | - Richard A. Oram
- Institute of Biomedical and Clinical Science, University of Exeter, Exeter, U.K
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Abstract
BACKGROUND AND OBJECTIVES We translated family-based behavioral treatment (FBT) to treat children with overweight and obesity and their parents in the patient-centered medical home. We reported greater reductions in child and parent weight at 6 and 24 months compared with an attention-controlled information control (IC) group. This article reports the cost-effectiveness of long-term weight change for FBT compared with IC. METHODS Ninety-six children 2 to 5 years of age with overweight or obesity and with parents who had a BMI ≥25 were randomly assigned to FBT or IC, and both received diet and activity education (12-month treatment and 12-month follow-up). Weight loss and cost-effectiveness were assessed at 24 months. Intention-to-treat, completers, and sensitivity analyses were performed. RESULTS The average societal cost per family was $1629 for the FBT and $886 for the IC groups at 24 months. At 24 months, child percent over BMI (%OBMI) change decreased by 2.0 U in the FBT group versus an increase of 4.4 U in the IC group. Parents lost 6.0 vs 0.2 kg at 24 months in the FBT and IC groups, respectively. The incremental cost-effectiveness ratios (ICERs) for children and parents' %OBMI were $116.1 and $83.5 per U of %OBMI, respectively. Parental ICERs were also calculated for body weight and BMI and were $128.1 per 1, and $353.8/ per kilogram, respectively. ICER values for child %OBMI were similar in the intention-to-treat group ($116.1/1 U decrease) compared with completers ($114.3). CONCLUSIONS For families consisting of children and parents with overweight, FBT presents a more cost-effective alternative than an IC group.
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Affiliation(s)
- Teresa Quattrin
- Department of Pediatrics, Women and Children's Hospital of Buffalo, Buffalo, New York;
| | - Ying Cao
- Department of Epidemiology and Environmental Health, University at Buffalo, Buffalo, New York; and
| | - Rocco A. Paluch
- Department of Pediatrics, Women and Children’s Hospital of Buffalo, Buffalo, New York
| | - James N. Roemmich
- USDA/ARS Grand Forks Human Nutrition Research Center, Grand Forks, North Dakota
| | - Michelle A. Ecker
- Department of Pediatrics, Women and Children’s Hospital of Buffalo, Buffalo, New York
| | - Leonard H. Epstein
- Department of Pediatrics, Women and Children’s Hospital of Buffalo, Buffalo, New York
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Affiliation(s)
- Teresa Quattrin
- Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York
| | - Denise E Wilfley
- Department of Psychiatry, Washington University School of Medicine, St Louis, Missouri
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DuBose SN, Hermann JM, Tamborlane WV, Beck RW, Dost A, DiMeglio LA, Schwab KO, Holl RW, Hofer SE, Maahs DM, Lipman T, Calvano T, Kucheruk O, Minnock P, Nguyen C, Klingensmith G, Banion C, Barker J, Cain C, Chase P, Hoops S, Kelsy M, Klingensmith G, Maahs D, Mowry C, Nadeau K, Raymond J, Rewers M, Rewers A, Slover R, Steck A, Wadwa P, Walravens P, Zeitler P, Haro H, Manseau K, Weinstock R, Izquierdo R, Sheikh U, Conboy P, Bulger J, Bzdick S, Goland R, Gandica R, Weiner L, Cook S, Greenberg E, Kohm K, Pollack S, Lee J, Gregg B, Tan M, Burgh K, Eason A, Garg S, Michels A, Myers L, DiMeglio L, Hannon T, Orr D, Cruz C, Woerner S, Wolfsdorf J, Quinn M, Tawa O, Ahmann A, Castle J, Joarder F, Bogan C, Cady N, Cox J, Pitts A, Fitch R, White B, Wollam B, Bode B, Lindmark K, Hosey R, Bethin K, Quattrin T, Ecker M, Wood J, Chao L, Cheung C, Fisher L, Jeandron D, Kaufman F, Kim M, Miyazaki B, Monzavi R, Patel P, Pitukcheewanont P, Sandstrom A, Cohen M, Ichihara B, Lipton M, Cemeroglu A, Appiagyei-Dankah Y, Daniel M, Postellon D, Racine M, Wood M, Kleis L, Hirsch I, DeSantis A, Dugdale D, Failor RA, Gilliam L, Greenbaum C, Janci M, Odegard P, Trence D, Wisse B, Batts E, Dove A, Hefty D, Khakpour D, Klein J, Kuhns K, McCulloch-Olson M, Peterson C, Ramey M, Marie MS, Thomson P, Webber C, Liljenquist D, Sulik M, Vance C, Coughenour T, Brown C, Halford J, Prudent A, Rigby S, Robison B, Starkman H, Berry T, Cerame B, Chin D, Ebner-Lyon L, Guevarra F, Sabanosh K, Silverman L, Wagner C, Fox M, Buckingham B, Shah A, Caswell K, Harris B, Bergenstal R, Criego A, Damberg G, Matfin G, Powers M, Tridgell D, Burt C, Olson B, Thomas L, Mehta S, Katz M, Laffel L, Hathway J, Phillips R, Cengiz E, Tamborlane W, Cappiello D, Steffen A, Zgorski M, Peters A, Ruelas V, Benjamin R, Adkins D, Cuffee J, Spruill A, Bergenstal R, Criego A, Damberg G, Matfin G, Powers M, Tridgell D, Burt C, Olson B, Thomas L, Aleppo-Kacmarek G, Derby T, Massaro E, Webb K, Burt Solorzano C, DeBoer M, Madison H, McGill J, Buechler L, Clifton MJ, Hurst S, Kissel S, Recklein C, Tsalikian E, Tansey M, Cabbage J, Coffey J, Salamati S, Clements M, Raman S, Turpin A, Bedard J, Cohoon C, Elrod A, Fridlington A, Hester L, Kruger D, Schatz D, Clare-Salzler M, Cusi K, Digman C, Fudge B, Haller M, Meehan C, Rohrs H, Silverstein J, Wagh S, Cintron M, Sheehan E, Thomas J, Daniels M, Clark S, Flannery T, Forghani N, Naidu A, Reh C, Scoggin P, Trinh L, Ayala N, Quintana R, Speer H, Zipf W, Seiple D, Kittelsrud J, Gupta A, Peterson V, Stoker A, Gottschalk M, Hashiguchi M, Smith K, Rodriguez H, Bobik C, Henson D, Simmons J, Potter A, Black M, Brendle F, Gubitosi-Klug R, Kaminski B, Bergant S, Campbell W, Tasi C, Copeland K, Beck J, Less J, Schanuel J, Tolbert J, Adi S, Gerard-Gonzalez A, Gitelman S, Chettout N, Torok C, Pihoker C, Yi-Frazier J, Kearns S, Libman I, Bills V, Diaz A, Duke J, Nathan B, Moran A, Bellin M, Beasley S, Kogler A, Leschyshyn J, Schmid K, Street A, Nelson B, Frost C, Reifeis E, Haymond M, Bacha F, Caldas-Vasquez M, Klinepeter S, Redondo M, Berlanga R, Falk T, Garnes E, Gonzalez J, Martinez C, Pontifes M, Yulatic R, Arnold K, Evans T, Sellers S, Raman V, Foster C, Murray M, Raman V, Brown T, Slater H, Wheeler K, Harlan D, Lee M, Lock JP, Hartigan C, Hubacz L, Buse J, Calikoglu A, Largay J, Young L, Brown H, Duncan V, Duclos M, Tricome J, Brandenburg V, Blehm J, Hallanger-Johnson J, Hanson D, Miller C, Weiss J, Hoffman R, Chaudhari M, Repaske D, Gilson E, Haines J, Rudolph J, McClave C, Biersdorf D, Tello A, Blehm J, Amundson D, Ward R, Rickels M, Dalton-Bakes C, Markman E, Peleckis A, Rosenfeld N, Dolan L, Corathers S, Kichler J, Baugh H, Standiford D, Hassing J, Jones J, Willis S, Willis S, Wysham C, Davis L, Blackman S, Abel KL, Clark L, Jonas A, Kagan E, Sosenko J, Blashke C, Matheson D, Edelen R, Repas T, Baldwin D, Borgwardt T, Conroy C, DeGrote K, Marchiando R, Wasson M, Fox L, Mauras N, Damaso L, Englert K, Hamaty M, Kennedy L, Schweiger M, Konstantinopoulos P, Mawhorter C, Orasko A, Rose D, Deeb L, Rohrbacher K, Schroeder L, Roark A, Ali O, Kramer J, Whitson-Jones D, Potter A, Black M, Brendle F, Gassner H, Kollipara S, Bills V, Duke J, Harwood K, Prasad V, Brault J. Obesity in Youth with Type 1 Diabetes in Germany, Austria, and the United States. J Pediatr 2015; 167:627-32.e1-4. [PMID: 26164381 DOI: 10.1016/j.jpeds.2015.05.046] [Citation(s) in RCA: 122] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Revised: 04/28/2015] [Accepted: 05/22/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To examine the current extent of the obesity problem in 2 large pediatric clinical registries in the US and Europe and to examine the hypotheses that increased body mass index (BMI) z-scores (BMIz) are associated with greater hemoglobin A1c (HbA1c) and increased frequency of severe hypoglycemia in youth with type 1 diabetes (T1D). STUDY DESIGN International (World Health Organization) and national (Centers for Disease Control and Prevention/German Health Interview and Examination Survey for Children and Adolescents) BMI references were used to calculate BMIz in participants (age 2-<18 years and ≥ 1 year duration of T1D) enrolled in the T1D Exchange (n = 11,435) and the Diabetes Prospective Follow-up (n = 21,501). Associations between BMIz and HbA1c and severe hypoglycemia were assessed. RESULTS Participants in both registries had median BMI values that were greater than international and their respective national reference values. BMIz was significantly greater in the T1D Exchange vs the Diabetes Prospective Follow-up (P < .001). After stratification by age-group, no differences in BMI between registries existed for children 2-5 years, but differences were confirmed for 6- to 9-, 10- to 13-, and 14- to 17-year age groups (all P < .001). Greater BMIz were significantly related to greater HbA1c levels and more frequent occurrence of severe hypoglycemia across the registries, although these associations may not be clinically relevant. CONCLUSIONS Excessive weight is a common problem in children with T1D in Germany and Austria and, especially, in the US. Our data suggest that obesity contributes to the challenges in achieving optimal glycemic control in children and adolescents with T1D.
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Affiliation(s)
| | - Julia M Hermann
- Institute for Epidemiology and Medical Biometry, ZIBMT, University of Ulm, Ulm, Germany
| | | | - Roy W Beck
- Jaeb Center for Health Research, Tampa, FL
| | - Axel Dost
- Department of Pediatrics, University Children's Hospital Jena, Jena, Germany
| | | | | | - Reinhard W Holl
- Institute for Epidemiology and Medical Biometry, ZIBMT, University of Ulm, Ulm, Germany
| | - Sabine E Hofer
- Department of Pediatrics, Medical University of Innsbruck, Innsbruck, Austria
| | - David M Maahs
- Barbara Davis Center for Childhood Diabetes, Aurora, CO
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Majumdar I, Bethin K, Quattrin T. Weight trajectory of youth with new-onset type 1 diabetes comparing standard and enhanced dietary education. Endocrine 2015; 49:155-62. [PMID: 25358449 DOI: 10.1007/s12020-014-0469-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2014] [Accepted: 10/24/2014] [Indexed: 12/01/2022]
Abstract
Youth with type 1 diabetes (T1DM) gain weight after insulin therapy initiation. We aimed to study the effects of Enhanced Dietary Counseling (EDC) compared to Standard of Care Dietary Counseling (SDC) on BMI trajectory in youth with new-onset T1DM. Youth with new-onset T1DM (n = 47; 8.9 + 4.2 years) were randomized 6 weeks post-diagnosis to either SDC per American Diabetes Association guidelines (n = 25) or EDC (n = 22: SDC plus monthly nutritional education and 3-day food records (FRs) at 6 and 24 weeks). Weights and heights were measured at diagnosis, 6 weeks, 3, 6, and 12 months post-diagnosis; pre-diagnosis BMI was obtained from pediatricians' records. BMI Z score was used to track BMI change. Knowledge of recommended daily energy intake (DEI) and daily carbohydrate intake was assessed at follow-up visits. Changes in BMI Z scores were similar in SDC versus EDC subjects from pre-diagnosis to 12 months post-diagnosis. BMI Z score at 12 months exceeded pre-diagnosis level in 58.5 % subjects (54.5 % EDC vs. 63.1 % SDC, p = 0.75). From 6 weeks to 6 months, percentage of subjects correctly recalling recommended DEI increased in EDC along with percentage of subjects meeting recommended daily fruit servings intake from 25 % (6 weeks) to 64 % (6 months), p = 0.047). EDC did not prevent BMI Z score increases in youth with new-onset T1DM, and BMI Z score exceeded pre-diagnosis levels in >50 % 12 months post-diagnosis. A family-based approach and/or additional intervention may be needed to prevent excessive weight gain.
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Affiliation(s)
- Indrajit Majumdar
- Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics, School of Medicine and Biomedical Sciences, University at Buffalo & Women and Children's Hospital of Buffalo, 219 Bryant Street, Buffalo, NY, 14222, USA,
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Abstract
OBJECTIVE To test in the primary care setting the short- and long-term efficacy of a behavioral intervention that simultaneously targeted an overweight child and parent versus an information control (IC) targeting weight control only in the child. METHODS Two- to 5-year-old children who had BMI ≥85th percentile and an overweight parent (BMI >25 kg/m2) were randomized to Intervention or IC, both receiving diet and activity education over 12 months (13 sessions) followed by 12-month follow-up (3 sessions). Parents in the Intervention group were also targeted for weight control and received behavioral intervention. Pediatricians in 4 practices enrolled their patients with the assistance of embedded recruiters (Practice Enhancement Assistants) who assisted with treatment too. RESULTS A total of 96 of the 105 children randomized (Intervention n = 46; IC n = 50) started the program and had data at baseline. Children in the Intervention experienced greater reductions in percent over BMI (group × months; P = .002) and z-BMI (group × months; P < 0.001) compared with IC throughout treatment and follow-up. Greater BMI reduction was observed over time for parents in the Intervention compared with IC (P < .001) throughout treatment and follow-up. Child weight changes were correlated with parent weight changes at 12 and 24 months (r = 0.38 and 0.26; P < .001 and P = .03). CONCLUSIONS Concurrently targeting preschool-aged overweight and obese youth and their parents in primary care with behavioral intervention results in greater decreases in child percent over BMI, z-BMI, and parent BMI compared with IC. The difference between Intervention and IC persists after 12 months of follow-up.
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Affiliation(s)
- Teresa Quattrin
- Department of Pediatrics, University at Buffalo, Women and Children's Hospital, Buffalo, New York;
| | - James N. Roemmich
- Department of Pediatrics, University at Buffalo, Women and Children's Hospital, Buffalo, New York;,USDA/ARS Grand Forks Human Nutrition Research Center, Grand Forks, North Dakota; and
| | - Rocco Paluch
- Department of Pediatrics, University at Buffalo, Women and Children's Hospital, Buffalo, New York
| | - Jihnhee Yu
- Department of Biostatistics, University at Buffalo, Buffalo, New York
| | - Leonard H. Epstein
- Department of Pediatrics, University at Buffalo, Women and Children's Hospital, Buffalo, New York
| | - Michelle A. Ecker
- Department of Pediatrics, University at Buffalo, Women and Children's Hospital, Buffalo, New York
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Danilovich N, Mastrandrea LD, Cataldi L, Quattrin T. Methylphenidate decreases fat and carbohydrate intake in obese teenagers. Obesity (Silver Spring) 2014; 22:781-5. [PMID: 23839907 DOI: 10.1002/oby.20574] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2012] [Accepted: 06/25/2013] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Dopamine is a neurotransmitter that mediates the reward value of food. Methylphenidate (MPH) selectively binds and inhibits the dopamine transporter, thus increasing brain dopamine levels shortly after oral administration. This investigation studied whether a single dose of MPH decreases energy intake (EI) in obese teenagers compared to placebo (P). METHODS This study used a single-blind, placebo-controlled, within subject design. Teenagers with body mass index (BMI) ≥95th percentile underwent two identical meal tests (P or MPH) after a 10 h fast in random order. Food was weighed before and after the meals, and EI was calculated as energy content/gram of consumed foods. Total and macronutrient EI (mean ± SD) were analyzed by Mann-Whitney U and Wilcoxon tests. RESULTS Twenty-two subjects (15 females, 7 males) completed the study. Participants were 13.4 ± 2.2 years old and had BMI 34.9 ± 10.7 kg/m². EI from fat (167 vs. 203 kcal, P = 0.03) and carbohydrates (311 vs. 389 kcal, P = 0.04) was decreased for MPH compared to P meals, with a trend in decreased total EI (545 vs. 663 kcal, P = 0.06). CONCLUSION A single dose of MPH decreases EI from fat and carbohydrates in obese adolescents. This effect underscores the importance of central dopamine signaling on eating behavior.
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Affiliation(s)
- N Danilovich
- Women and Children's Hospital of Buffalo, Department of Pediatrics, School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
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29
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Mogri M, Dhindsa S, Quattrin T, Ghanim H, Dandona P. Testosterone concentrations in young pubertal and post-pubertal obese males. Clin Endocrinol (Oxf) 2013; 78:593-9. [PMID: 22970699 PMCID: PMC3524388 DOI: 10.1111/cen.12018] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2012] [Revised: 06/26/2012] [Accepted: 08/13/2012] [Indexed: 01/22/2023]
Abstract
OBJECTIVE Obesity in adult males is associated with hypogonadotropic hypogonadism. We evaluated the effect of obesity on plasma testosterone concentrations in pubertal and post-pubertal young males. DESIGN AND METHODS Morning fasting blood samples were obtained from 25 obese [body mass index (BMI) ≥95th percentile] and 25 lean (BMI <85th percentile) males between the ages 14-20 years with Tanner staging ≥4. Total (TT) and free testosterone (FT) and estradiol concentrations were measured by liquid chromatography tandem mass spectrometry and equilibrium dialysis. Free testosterone was also calculated using SHBG and albumin. C-reactive protein (CRP), insulin and glucose concentrations were measured and homoeostasis model of insulin resistance (HOMA-IR) was calculated. RESULTS After controlling for age and Tanner staging, obese males had a significantly lower total testosterone (10·5 vs 21·44 nmol/l), free testosterone (0·22 vs 0·39 nmol/l) and calculated free testosterone (0·26 vs 0·44 nmol/l) concentrations as compared to lean males (P < 0·001 for all). Obese males had higher CRP concentrations (2·8 vs 0·8 mg/l; P < 0·001), and HOMA-IR (3·8 vs 1·1; P < 0·001) than lean males. Free testosterone concentrations were positively related to age and negatively to BMI, HOMA-IR and CRP concentrations. Total and free estradiol concentrations were significantly lower in males with subnormal testosterone concentrations. CONCLUSION Testosterone concentrations of young obese pubertal and post-pubertal males are 40-50% lower than those with normal BMI. Obesity in young males is associated with low testosterone concentrations, which are not secondary to an increase in estradiol concentrations. Our results need to be confirmed in a larger number of subjects.
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Affiliation(s)
- Muniza Mogri
- Division of Pediatric Endocrinology, Department of Pediatrics, State University of New York at Buffalo, Buffalo, NY 14209
| | - Sandeep Dhindsa
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, State University of New York at Buffalo, Buffalo, NY 14209
| | - Teresa Quattrin
- Division of Pediatric Endocrinology, Department of Pediatrics, State University of New York at Buffalo, Buffalo, NY 14209
| | - Husam Ghanim
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, State University of New York at Buffalo, Buffalo, NY 14209
| | - Paresh Dandona
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, State University of New York at Buffalo, Buffalo, NY 14209
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Abstract
OBJECTIVE To test the efficacy of an innovative family-based intervention for overweight preschool-aged children and overweight parents conducted in the primary care setting. METHODS Children with BMI ≥ 85th percentile and an overweight parent were randomized to intervention or information control (IC). Trained staff delivered dietary and physical/sedentary activities education to parents over 6 months (10 group meetings and 8 calls). Parents in the intervention received also behavioral modification. An intention-to-treat analysis was performed by using mixed analysis of variance models to test changes in child percent over BMI (%OBMI) and z-BMI and to explore potential moderators of group differences in treatment response. RESULTS Ninety-six of 105 randomized families started the program: 46 children (31 girls/15 boys) in the intervention and 50 (33 girls/17 boys) in the IC, with 33 and 39 mothers and 13 and 11 fathers in intervention and IC, respectively. Baseline characteristics did not differ between groups. Children in the intervention group had greater %OBMI and z-BMI decreases at 3 and 6 months compared with those assigned to IC (P < .0021). A greater BMI reduction over time was also observed in parents in the intervention compared with parents assigned to IC (P < .0001). Child %OBMI and parent BMI changes were correlated (r = .31; P = .003). Children with greater baseline %OBMI were more likely to have a greater %OBMI decrease over time (P = .02). CONCLUSIONS Concurrently targeting preschool-aged overweight youth and their overweight parents for behavioral weight control in a primary care setting reduced child %OBMI and parent BMI, with parent and child weight changes correlating.
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Affiliation(s)
| | | | - Rocco Paluch
- Pediatrics and,Women and Children’s Hospital, Buffalo, New York
| | - Jihnhee Yu
- Biostatistics, University at Buffalo, Buffalo, New York; and
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Rafalson L, Eysaman J, Quattrin T. Screening obese students for acanthosis nigricans and other diabetes risk factors in the urban school-based health center. Clin Pediatr (Phila) 2011; 50:747-52. [PMID: 21727074 DOI: 10.1177/0009922811404698] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To determine the prevalence of acanthosis nigricans (AN) and other diabetes risk factors in urban school health clinics. METHODS During the period 2006-2009 nurse practitioners (NPs) screened students who had a BMI ≥ 95th percentile and 1 additional diabetes risk factor. Blood glucose (BG) was measured by finger stick. NPs were trained on how to ascertain the presence of AN on the neck area. RESULTS NPs screened 854 students (mean age 11.4 years, 60.5% female, and 73.3% black). AN and elevated BG were found among 26% and 6.4% of students, respectively. Females and minorities were respectively 50% and 4 times more likely to have AN. Youth with AN were twice as likely to have elevated glucose. CONCLUSION AN can be easily identified by trained health care professionals even in busy school-based clinic settings. Checking for AN and appropriate education and counseling should become a routine part of electronic documentation in overweight youth.
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Affiliation(s)
- Lisa Rafalson
- State University of New York, University at Buffalo, Buffalo, NY, USA.
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Daniel M, Mastrandrea LD, Salis RJ, Erbe R, Quattrin T. Does the dopamine transporter protein allele predict growth hormone testing results or response to growth hormone therapy? Endocrine 2010; 37:361-4. [PMID: 20960275 DOI: 10.1007/s12020-010-9313-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2009] [Accepted: 02/18/2010] [Indexed: 10/19/2022]
Abstract
Animal studies have shown dopamine transporter protein (DAT1) knock out mice are growth retarded and hyperactive. DAT1 has been researched in several human psychiatric studies with varying results regarding phenotype and DAT1 alleles. However, the relationship between DAT1 and short stature in humans has not been explored. Buccal swabs were collected from patients receiving growth hormone (GH) therapy and were genotyped for variable number tandem repeat (VNTR) by polymerase chain reaction. Forty subjects were included; twenty-three patients had the 10/10 DAT1 genotype and thirteen had the 9/10 genotype. Fifteen of the patients with the 10/10 genotype tested GH deficient. Seven patients with the 9/10 genotype tested GH sufficient. The linear growth rate during the first year of GH therapy was equivalent in both genotypes. In conclusion, polymorphisms in the DAT1 40 base pair (bp) VNTR genotype do not predict GH deficiency or response to GH therapy in short children.
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Affiliation(s)
- Maala Daniel
- Department of Pediatrics, School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
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Greenfield S, Mazur T, Michal G, Quattrin T. 529 MANAGEMENT OF CHILDREN WITH AMBIGUOUS GENITALIA USING A “DISORDERS OF SEX DEVELOPMENT (DSD) TEAM”. J Urol 2010. [DOI: 10.1016/j.juro.2010.02.728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Mastrandrea L, Yu J, Behrens T, Buchlis J, Albini C, Fourtner S, Quattrin T. Etanercept treatment in children with new-onset type 1 diabetes: pilot randomized, placebo-controlled, double-blind study. Diabetes Care 2009; 32:1244-9. [PMID: 19366957 PMCID: PMC2699714 DOI: 10.2337/dc09-0054] [Citation(s) in RCA: 172] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To gather preliminary data on the feasibility and efficacy of etanercept therapy to prolong endogenous insulin production in pediatric patients with newly diagnosed type 1 diabetes. RESEARCH DESIGN AND METHODS This was a 24-week double-blind, randomized, placebo-controlled study conducted at the Diabetes Center, Women and Children's Hospital of Buffalo. Eighteen subjects (11 male and 7 female, aged 7.8-18.2 years) were randomly assigned to receive either placebo or etanercept. Inclusion criteria included age 3-18 years, GAD-65 and/or islet cell antibody positivity, A1C >6%, three insulin injections per day, white blood cell count 3,000-10,000, platelets >100,000, and normal liver and renal function. Intention-to-treat analysis was used. RESULTS A1C at week 24 was lower in the etanercept group (5.91 +/- 0.5%) compared with that in the placebo group (6.98 +/- 1.2%; P < 0.05) with a higher percent decrease from baseline than in the placebo group (etanercept 0.41 +/- 0.1 vs. placebo 0.18 +/- 0.21; P < 0.01). The percent change in C-peptide area under the curve from baseline to week 24 showed a 39% increase in the etanercept group and a 20% decrease in the placebo group (P < 0.05). From baseline to week 24 insulin dose decreased 18% in the etanercept group compared with a 23% increase in the placebo group (P < 0.05). Seventeen patients completed the study, and none withdrew because of adverse events. CONCLUSIONS In this small pilot study, treatment of pediatric patients newly diagnosed with type 1 diabetes with etanercept resulted in lower A1C and increased endogenous insulin production, suggesting preservation of beta-cell function. A larger study is needed to further explore safety and efficacy.
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Affiliation(s)
- Lucy Mastrandrea
- Department of Pediatrics, School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
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Mastrandrea LD, Wactawski-Wende J, Donahue RP, Hovey KM, Clark A, Quattrin T. Young women with type 1 diabetes have lower bone mineral density that persists over time. Diabetes Care 2008; 31:1729-35. [PMID: 18591404 PMCID: PMC2518333 DOI: 10.2337/dc07-2426] [Citation(s) in RCA: 87] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Individuals with type 1 diabetes have decreased bone mineral density (BMD), yet the natural history and pathogenesis of osteopenia are unclear. We have previously shown that women with type 1 diabetes (aged 13-35 years) have lower BMD than community age-matched nondiabetic control subjects. We here report 2-year follow-up BMD data in this cohort to determine the natural history of BMD in young women with and without diabetes. RESEARCH DESIGN AND METHODS BMD was measured by dual-energy X-ray absorptiometry at baseline and 2 years later in 63 women with type 1 diabetes and in 85 age-matched community control subjects. A1C, IGF-1, IGF binding protein-3, serum osteocalcin, and urine N-teleopeptide were measured at follow-up. RESULTS After adjusting for age, BMI, and oral contraceptive use, BMD at year 2 continued to be lower in women >or=20 years of age with type 1 diabetes compared with control subjects at the total hip, femoral neck, and whole body. Lower BMD values were observed in cases <20 years of age compared with control subjects; however, the differences were not statistically significant. Lower BMD did not correlate with diabetes control, growth factors, or metabolic bone markers. CONCLUSIONS This study confirms our previous findings that young women with type 1 diabetes have lower BMD than control subjects and that these differences persist over time, particularly in women >or=20 years of age. Persistence of low BMD as well as failure to accrue bone density after age 20 years may contribute to the increased incidence of osteoporotic hip fractures seen in postmenopausal women with type 1 diabetes.
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Affiliation(s)
- Lucy D Mastrandrea
- Department of Pediatrics, University at Buffalo, School of Medicine and Biomedical Sciences, Buffalo, New York, USA.
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White NH, Quattrin T, St Aubin LB, Duggan WT, England RD, Fryburg JS. Efficacy and safety of inhaled human insulin (Exubera) compared to subcutaneous insulin in children ages 6 to 11 years with type 1 diabetes mellitus: results of a 3-month, randomized, parallel trial. J Pediatr Endocrinol Metab 2008; 21:555-68. [PMID: 18717242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/08/2023]
Abstract
AIM To compare the efficacy and safety of Exubera (EXU) with subcutaneous (SC) insulin in children, ages 6-11 years, with type 1 diabetes mellitus. DESIGN AND METHODS 121 children were randomized to receive EXU or SC insulin, plus intermediate/long-acting insulin for 12 weeks. Change in HbA1c was the primary efficacy endpoint. RESULTS Decreases from baseline HbA1c were comparable between treatment groups (difference between adjusted mean decrease from baseline [EXU-SC insulin], -0.23 [95% CI, -0.49, 0.03]). Differences between groups on pulmonary function tests were small and not significant. Mild to moderate cough occurred in 24.6% of EXU versus 6.8% of SC insulin patients. The risk for hypoglycemia was comparable between EXU and SC insulin (relative risk 0.88 [95% CI, 0.71, 1.11]). Increased insulin antibodies with EXU were not associated with clinical findings. CONCLUSION The efficacy and safety profiles shown in this study are the foundation for further investigation of EXU in this population.
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Affiliation(s)
- Neil H White
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO 63110, USA.
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Cappelleri JC, Gerber RA, Quattrin T, Deutschmann R, Luo X, Arbuckle R, Abetz L. Development and validation of the WEll-being and Satisfaction of CAREgivers of Children with Diabetes Questionnaire (WE-CARE). Health Qual Life Outcomes 2008; 6:3. [PMID: 18205937 PMCID: PMC2262877 DOI: 10.1186/1477-7525-6-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2007] [Accepted: 01/18/2008] [Indexed: 11/23/2022] Open
Abstract
Background This study was designed to develop a diabetes-specific questionnaire on parents' quality of life and satisfaction with their child's diabetes treatment, the WEll-being and Satisfaction of CAREgivers of Children with Diabetes Questionnaire, and to conduct psychometric validation of the WE-CARE. Methods Parents of 116 children aged 6 to 11 years were enrolled in the United States. Children had type 1 diabetes mellitus for > 1 year, had been treated with subcutaneous insulin for ≥ 2 months, and had a recent glycosylated hemoglobin (HbA1C) measurement. Recruiting clinicians provided clinical information on the children. Over a two-week period, parents completed WE-CARE (initial 68 items) and two other questionnaires (the 36-item Short Form of the Medical Outcomes Study and the 50-item Child Health Questionnaire-Parent Form) twice. Results A literature review and one-on-one interview with caregivers and pediatricians led to the development of a draft questionnaire consisting of 68 items. Factor analysis suggested retention of 37 of the 68 initial items grouped into four multi-item scales (Psychosocial Well-being, Ease of Insulin Use, Treatment Satisfaction, and Acceptance of Insulin Administration as well as a Total Score). The four multi-item domains of WE-CARE were found to be psychometrically robust – they had negligible floor and ceiling effects, excellent internal consistency and test-retest reliability, high item-discriminant validity and good concurrent, divergent, known-group and clinical validity. Moderate interscale correlations among the four WE-CARE domains indicated that the concepts they measure were related but distinct. Conclusion These data suggest that WE-CARE provides a reliable and valid measure of parents' well-being and treatment satisfaction related to their child's diabetes. While these results show promise, additional validation of WE-CARE is warranted.
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Sutu E, Crespo CJ, Shine B, Doshi A, Quattrin T. Detecting overweight children in primary care: do national data reflect the typical urban practice? J Fam Pract 2006; 55:976-80. [PMID: 17090358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Primary care physicians can easily identify overweight in children aged < 2 years using body-mass index. There is no consensus on the appropriate way of identifying overweight before age 2 years. However, the primary care physician should be alert if the body-mass index of a child < 2 years of age is significantly higher then those published (as a guideline) in this paper. Overweight is occurring early. Thus it is essential that primary care physicians focus on identifying overweight as early as preschool age. Primary care physicians have to pay particular attention to identifying overweight in non-Hispanic black children aged 2 to 11 years, who may have a higher prevalence of being at risk for overweight compared with 1999-2002 national data. Children seen for a sick-child visit may be at higher risk for overweight; thus, we recommend that height and weight measurements be obtained during these visits.
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Affiliation(s)
- Elena Sutu
- Division of Endocrinology/Diabetes, Women and Children's Hospital of Buffalo, 219 Bryant Street, Buffalo, NY 14222, USA
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Abstract
Diabetes affects over 18.2 million individuals in the United States alone. Current therapy to treat type 1 diabetes relies on subcutaneous insulin administration either by injection or continuous infusion. In addition, patients with type 2 diabetes who fail lifestyle intervention and oral therapy require subcutaneous insulin. Optimal injection protocols to achieve tight metabolic control often prove burdensome to patients. Thus, development of pulmonary insulin delivery to supplement and/or replace subcutaneous insulin injections may be an effective alternative, allowing patients to achieve intensive diabetes management. This review will discuss the devices in development for the delivery of inhaled insulin. In addition, the efficacy of inhaled insulin in both type 1 and type 2 diabetic populations will be discussed. Finally, the available safety data with respect to the unique pulmonary effects of inhaled insulin will be covered.
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Affiliation(s)
- Lucy D Mastrandrea
- Division of Endocrinology-Diabetes, Department of Pediatrics, School of Medicine and Biomedical Sciences, State University of New York at Buffalo, The Women's and Children's Hospital, 219 Bryant Street, Buffalo, New York 14222, USA
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Abstract
There are promising data in the field of inhaled insulin. This article describes the current devices being developed for insulin delivery via inhalation. Encouraging advanced clinical data are available in Type 1 diabetes, where inhaled insulin is used in conjunction with basal insulin. Moreover, patients with Type 2 diabetes who have failed oral therapy show improved control when inhaled insulin therapy is initiated. Safety data show that cough is the most common side effect. Pulmonary function tests have shown some changes in carbon monoxide diffusion in the lung. Further studies are needed to clarify the significance of this finding. Inhaled insulin appears to be a non-invasive, well-tolerated and -liked modality of treatment, with potential in both Type 1 and 2 diabetes.
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Affiliation(s)
- Teresa Quattrin
- State University of New York at Buffalo, Division of Endocrinology, The Women and Children's Hospital of Buffalo, Kaleida Health, 219 Bryant St., Buffalo, NY 14222, USA.
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Fuhrman B, Barba M, Schünemann HJ, Hurd T, Quattrin T, Cartagena R, Carruba G, Muti P. Basal growth hormone concentrations in blood and the risk for prostate cancer: a case-control study. Prostate 2005; 64:109-15. [PMID: 15666390 DOI: 10.1002/pros.20203] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To assess the relationship between basal serum growth hormone (GH) levels and prostate cancer risk. METHODS We conducted a population-based case-control study; cases included 68 men, aged 45-85 years, diagnosed with incident, primary, histologically confirmed, and clinically apparent (stage B and higher) prostate cancer. Controls included 240 men, frequency matched on age and residential area. Age, race, BMI, waist circumference, history of enlarged prostate, education, and current smoking status, were all considered as possible confounders. RESULTS We found a statistically significant trend of decreasing prostate cancer risk across increasing GH quintiles, in both crude (OR: 0.31, 95% CI: 0.12-0.83, P for trend 0.01) and adjusted models (OR: 0.35, 95% CI: 0.12-1.05, P for trend 0.03), in the highest compared to the lowest quintile, respectively. CONCLUSIONS Lower basal levels of GH in serum are associated with increased prostate cancer risk. The inverse association may be explained by the negative feedback loop generated by IGF-1 produced by the tumor on GH secretion.
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Affiliation(s)
- Barbara Fuhrman
- Department of Social and Preventive Medicine, University at Buffalo, State University of New York, Buffalo, NY 14214, USA
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Abstract
OBJECTIVE The objective of this study was to characterize a population of obese children who were referred to a pediatric endocrinology clinic and to analyze the outcome of the referral. METHODS Children who were referred for obesity and seen at least twice between January 1984 and July 2003 were included in this retrospective study. Demographic, clinical, and, when available, laboratory (fasting glucose and insulin, random cholesterol, and liver function tests) and bone age data were abstracted from the medical record at the first and last endocrine evaluations. Self-reported parental height, weight, and family history of diabetes were also entered in the database. Records from the pediatrician were used to identify the age of onset of obesity. RESULTS The database included 587 children (mean age at referral: 9.5 years) with a preponderance of non-Hispanic white children (75.6%) and female gender (57.6%). Growth records in 251 children indicated that 80.6% of the children had become obese before the age of 6 years and were referred 4.3 +/- 2.9 years after having become obese. At follow-up, 38% of the children exhibited a decreased percentage of overweight compared with the baseline visit, but only 5 children had an age- and gender-specific BMI below the 95th percentile. Cholesterol and fasting insulin were elevated in 174 of 311 and 72 of 94 children, respectively. Bone age radiographic records for 157 patients showed significant advancement in 46%. Half of the mothers and 57.7% of fathers were obese, and type 2 diabetes was self-reported in 11.4% parents. CONCLUSIONS In the majority of this predominantly non-Hispanic white referred sample of obese children, overweight started in the preschool years. The referral to the endocrinologist, occurring after a prolonged interval from the obesity onset, was ineffective in treating obesity. Hyperinsulinemia and hypercholesterolemia are often present also at a young age. These obesity comorbidities in association with high prevalence of parental obesity and type 2 diabetes expose these youths to high risk for developing type 2 diabetes and coronary heart disease. Our data underscore the need for early family-based behavioral-lifestyle intervention programs to be made available to pediatricians, enabling them to target the "at risk for overweight" preschool children and their likely overweight parents.
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Affiliation(s)
- Teresa Quattrin
- Division of Endocrinology/Diabetes, Women's and Children's Hospital of Buffalo, 219 Bryant St, Buffalo, NY 14222, USA.
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Roemmich JN, Liu EY, Rogol AD, Epstein LH, Quattrin T. Diminished Insulin Resistance with Weight Loss in Severely Overweight Youth. Metab Syndr Relat Disord 2004; 2:160-8. [DOI: 10.1089/met.2004.2.160] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- James N. Roemmich
- Department of Pediatrics, University at Buffalo, Buffalo, New York
- Department of Exercise and Nutrition Sciences, University at Buffalo, Buffalo, New York
| | - Emily Y. Liu
- Department of Pediatrics, University at Buffalo, Buffalo, New York
| | - Alan D. Rogol
- Pediatrics, University of Virginia, Charlottesville, Virginia
| | - Leonard H. Epstein
- Department of Pediatrics, University at Buffalo, Buffalo, New York
- Department of Exercise and Nutrition Sciences, University at Buffalo, Buffalo, New York
- Department of Social and Preventive Medicine, University at Buffalo, Buffalo, New York
| | - Teresa Quattrin
- Department of Pediatrics, University at Buffalo, Buffalo, New York
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Abstract
OBJECTIVE Type 1 diabetes has been associated with decreased bone mineral density (BMD). However, the natural history and etiopathogenesis of osteoporosis in type 1 diabetes are not clear. The aims of this study were to assess BMD in a cohort of young women with type 1 diabetes compared with nondiabetic control subjects and to evaluate the possible association of BMD with diabetes duration, HbA(1c), and biomarkers of bone metabolism. RESEARCH DESIGN AND METHODS BMD was measured by dual-energy X-ray absortiometry scan in 39 teenage (age 13-19 years) and 33 post-teenage females (age 20-37 years) with type 1 diabetes and 91 female age-matched control subjects. Serum osteocalcin, IGF-I, IGF binding protein-3 (IGFBP-3), HbA(1c), and urine N-telopeptides were measured. RESULTS After adjustment for age and BMI, BMD values were significantly lower at the femoral neck and lateral spine in women with type 1 diabetes older than age 20 years compared with control subjects but not in the case subjects younger than age 20 years, nor at the anterio-posterior spine, wrist, or whole body. No association was found between BMD and diabetes duration or glycemic control. IGF-I, IGFBP-3, osteocalcin, and N-telopeptides were similar in diabetic subjects and control subjects. CONCLUSIONS This study indicates that women with type 1 diabetes exhibit BMD differences early in life with significant differences already present in the post-teenage years. Lower hip BMD in these young women may explain, in part, the higher incidence of hip fracture experienced in postmenopausal women with type 1 diabetes.
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Affiliation(s)
- Emily Y Liu
- The Women and Children's Hospital of Buffalo, Division of Endocrinology/Diabetes, Buffalo, New York 14222, USA
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Muti P, Quattrin T, Grant BJB, Krogh V, Micheli A, Schünemann HJ, Ram M, Freudenheim JL, Sieri S, Trevisan M, Berrino F. Fasting glucose is a risk factor for breast cancer: a prospective study. Cancer Epidemiol Biomarkers Prev 2002; 11:1361-8. [PMID: 12433712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2023] Open
Abstract
There is some evidence that glucose and other factors related to glucose metabolism, such as insulin and insulin-like growth-factors (IGFs) may contribute to breast cancer development. The present study analyzed the hypothesis that serum glucose, insulin levels, and IGF-I pattern are associated with breast cancer using a nested case-control study. Between 1987 and 1992, 10,786 women ages 35-69 were recruited in a prospective study in Italy. Women with history of cancer and on hormone therapy were excluded at baseline. At recruitment, blood samples were collected after a 12-h fast between 7:30 and 9:00 a.m. from all of the study participants. After 5.5 years, 144 breast cancer cases were identified among the participants of the cohort. Four matched controls were chosen for each breast cancer case from members of the cohort who did not develop breast cancer during the follow-up period. In premenopausal women, glucose was associated with breast cancer risk: the age, body mass index, and reproductive variable adjusted relative risk (RR) for the highest quartile of serum glucose versus the lowest was 2.8 [95% confidence interval (CI), 1.2-6.5], and P for trend was 0.02. Insulin showed a weaker association with breast cancer, the adjusted RR of the highest quartile versus the lowest was 1.7 (95% CI, 0.7-4.1), and P for trend was 0.14, whereas the adjusted RR of the highest quartile of IGF-I was 3.1 (95% CI, 1.1-8.6), and P for trend was 0.01. Increased levels of insulin-like growth factor binding protein-3 (IGFBP)-3 were related to breast cancer risk: the adjusted RR for the highest quartile was 2.1 (95% CI, 0.95-4.75), and P for trend was 0.02. In postmenopausal women, the associations of glucose, insulin, and IGF-1 pattern were associated with breast cancer risk in heavier subjects characterized by a body mass index higher than 26. These results indicate that chronic alteration of glucose metabolism is related to breast cancer development.
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Affiliation(s)
- Paola Muti
- Department of Social and Preventive Medicine, University at Buffalo, State University of New York, Buffalo 14214, USA
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Muti P, Gaddi P, Quattrin T. Correspondence re: Chokkalingam A. et al., Insulin-like growth factors and prostate cancer: a population-based case-control study in China. Cancer Epidemiol. Biomark. Prev., 10: 421-427, 2001. Cancer Epidemiol Biomarkers Prev 2002; 11:323. [PMID: 11895887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023] Open
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Quattrin T, Thrailkill K, Baker L, Kuntze J, Compton P, Martha P. Improvement of HbA1c without increased hypoglycemia in adolescents and young adults with type 1 diabetes mellitus treated with recombinant human insulin-like growth factor-I and insulin. rhIGF-I in IDDM Study Group. J Pediatr Endocrinol Metab 2001; 14:267-77. [PMID: 11308044 DOI: 10.1515/jpem.2001.14.3.267] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE A 12-week trial with insulin and rhIGF-I compared to insulin and placebo was conducted in patients with type 1 diabetes mellitus aged 11-66 years. We present the efficacy and safety data pertinent to the younger subset of participants (11-21 years). STUDY DESIGN The patients were randomized to receive s.c. insulin and either placebo or rhIGF-I at one of the following doses (microg/kg): 40 a.m./40 p.m., 80 a.m./40 p.m. or 80 a.m./60 p.m.). RESULTS The average decrease of HbA1c from baseline was higher (-1.3 +/- 0.2%) in the rhIGF-I treated group compared to the placebo group (-0.6 +/- 0.3%; p <0.05). This was associated with a significant decrease in daily insulin dose (U) of both Regular (rhIGF-I: -7 +/- 1; placebo: -1 +/- 1; p <0.01) and NPH (rhIGF-I: -4 +/- 2; placebo: +5 +/- 3; p <0.05). The incidence of hypoglycemia and weight gain were not increased. Edema, jaw pain and tachycardia were associated with rhIGF-I treatment, particularly at doses higher than 40 microg/kg b.i.d. Dose-related early worsening of retinopathy was observed in 11/55 patients in the rhIGF-I group, with resolution in the majority of them in the follow-up photographs. CONCLUSIONS These findings suggest a possible role for rhIGF-I co-therapy in adolescents and young adults with type 1 diabetes mellitus.
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Affiliation(s)
- T Quattrin
- Department of Pediatrics, Children's Hospital of Buffalo, State University of New York at Buffalo, 14222, USA.
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Maclaren N, Lan M, Coutant R, Schatz D, Silverstein J, Muir A, Clare-Salzer M, She JX, Malone J, Crockett S, Schwartz S, Quattrin T, DeSilva M, Vander Vegt P, Notkins A, Krischer J. Only multiple autoantibodies to islet cells (ICA), insulin, GAD65, IA-2 and IA-2beta predict immune-mediated (Type 1) diabetes in relatives. J Autoimmun 1999; 12:279-87. [PMID: 10330299 DOI: 10.1006/jaut.1999.0281] [Citation(s) in RCA: 74] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
We report here our prospective study of 15,224 non-diabetic, first-degree relatives of probands with immune-mediated (type 1) diabetes (IMD), of which 135 were found to eventually develop diabetes. We determined islet cell, insulin, GAD65, insulinoma-associated antigen-2 and 2beta autoantibodies (ICA, IAA, GAD65A, IA-2A and IA-2betaA), on the first available serum samples. The latter three autoantibodies were however assayed on subsets of the relatives with and without ICA, IAA and/or GAD65A, plus most of the relatives who developed diabetes. Of the relatives who progressed to diabetes, 94% had at least one of these autoantibodies on the first screening, while ICA proved to be the most sensitive single marker (sensitivity 74%). Risk of diabetes was however negligible when ICA was found in the absence of the others (5-year risk=5.3%), but increased dramatically whenever two or more autoantibodies were present (5-year risk=28.2% and 66.2%, respectively). The most predictive combination of markers was ICA plus IA-2A and/or IA-2beta A. Loss of first phase insulin release to IVGTT also occurred only in those ICA-positive relatives who had one or more of the other autoantibodies. The data suggests that significant beta-cell damage is seen only when the underlying autoimmunity has spread to multiple antigenic islet cell determinants. Combinations of the autoantibodies occurred most often in relatives with the highest risk HLA-DR/DQ phenotypes. These data document that only relatives positive for at least two or more of these five autoantibodies are at significant risk of diabetes themselves. Intervention trials for the prevention of type 1 diabetes could be designed based on testing for these autoantibodies alone, without the need for HLA typing and IVGTT testing.
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Affiliation(s)
- N Maclaren
- Departments of Pediatrics and Biometry and Genetics, Louisiana State University Medical School at the Research Institute for Children, New Orleans, LA, USA
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Thrailkill KM, Quattrin T, Baker L, Kuntze JE, Compton PG, Martha PM. Cotherapy with recombinant human insulin-like growth factor I and insulin improves glycemic control in type 1 diabetes. RhIGF-I in IDDM Study Group. Diabetes Care 1999; 22:585-92. [PMID: 10189536 DOI: 10.2337/diacare.22.4.585] [Citation(s) in RCA: 61] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To study the effects of 12 weeks of cotherapy with recombinant human IGF-I (rhIGF-I) and insulin on glycemic control in patients with type 1 diabetes. RESEARCH DESIGN AND METHODS The study population consisted of 223 patients who ranged in age from 11-66 years and were randomized in a double-blind study to receive 12 weeks of treatment with twice-daily subcutaneous injections of placebo (n = 54), or rhIGF-I at a dose (A.M/P.M) of 40/40 micrograms/kg (n = 56), 80/40 micrograms/kg (n = 57), or 80/60 micrograms/kg (n = 56), while continuing to receive standard insulin therapy. Patients were instructed to test blood glucose levels four times daily and adjust insulin doses to optimize blood glucose control. HbAlc, insulin requirements, body weight, and parameters of the IGF-IGF-binding protein axis were assessed before and during treatment. RESULTS All groups were comparable at baseline with respect to mean age, gender distribution, duration of diabetes, HbAlc, and BMI. Cotherapy with rhIGF-I/insulin produced a mean decrease in HbAlc of 1.2%, compared with a 0.7% decrease in HbAlc for patients receiving intensified insulin therapy alone (P < or = 0.01). Subjects receiving rhIGF-I/insulin cotherapy also decreased their daily insulin usage by 11-19%, compared with a 7% increase in insulin usage reported by the placebo group. Moreover, the incidence of hypoglycemia was similar in subjects treated with rhIGF-I/Insulin cotherapy compared with those treated with insulin alone, despite the better glycemic control of the former group. The 40/40 dose of rhIGF-I was well tolerated. Higher doses of rhIGF-I did not further improve efficacy yet were associated with unacceptable levels of adverse events, including edema, jaw pain, and early worsening of retinopathy. CONCLUSIONS These results demonstrate that rhIGF/insulin cotherapy improves glycemic control in patients with type 1 diabetes better than optimized insulin management alone; longer-term trials would be required to determine an acceptable benefit-risk profile.
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Affiliation(s)
- K M Thrailkill
- Department of Pediatrics, University of Kentucky, Lexington, USA.
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