1
|
El-Heis S, Barton SJ, Chang HF, Nield H, Cox V, Galani S, Cutfield W, Chan SY, Godfrey KM. Maternal mood, anxiety and mental health functioning after combined myo-inositol, probiotics, micronutrient supplementation from preconception: Findings from the NiPPeR RCT. Psychiatry Res 2024; 334:115813. [PMID: 38402742 DOI: 10.1016/j.psychres.2024.115813] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 11/24/2023] [Accepted: 02/22/2024] [Indexed: 02/27/2024]
Abstract
Observational studies have reported associations between nutrition during pregnancy and mental wellbeing. As secondary outcomes, the NiPPeR double-blind randomized trial in women planning conception investigated whether a myo-inositol, probiotics and enriched micronutrients formulation (intervention) taken preconception and throughout pregnancy could improve mental wellbeing during pregnancy and post-delivery, compared with a standard micronutrient supplement (control). Mood and anxiety symptoms were ascertained (Edinburgh Postnatal Depression Scale (EPDS), State-Trait Anxiety Inventory (STAI-state)) at preconception (baseline), 7, 28 and 34 weeks gestation, 3-weeks and 6-months post-delivery. EPDS>=13 was categorised as low mood; STAI-state>=45 as high anxiety. Change in mental health functioning was assessed as difference between preconception baseline and 6-month post-delivery 12-item Short-Form Health Survey (SF-12v2) mental component scores. Adjusting for site, ethnicity and baseline scores, there were no robust differences in EPDS and STAI-state scores between intervention and control groups across pregnancy (n = 630) and post-delivery (n = 532). Compared to controls, intervention group women averaged a 1.21 (95 %CI 0.04,2.39) higher change in SF-12v2 mental component score from preconception to 6-months post-delivery. Taking a myo-inositol, micronutrient and probiotic supplement during preconception/pregnancy had no effect on mood and anxiety, but there was evidence of a modest improvement in mental health functioning from preconception to 6-months post-delivery.
Collapse
Affiliation(s)
- Sarah El-Heis
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton SO16 6YD, United Kingdom; National Institute for Health Research Southampton Biomedical Research Centre, University of Southampton, Southampton and University Hospital Southampton NHS Foundation Trust, SO16 6YD, United Kingdom.
| | - Sheila J Barton
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton SO16 6YD, United Kingdom; National Institute for Health Research Southampton Biomedical Research Centre, University of Southampton, Southampton and University Hospital Southampton NHS Foundation Trust, SO16 6YD, United Kingdom
| | - Hsin Fang Chang
- Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore, 119228
| | - Heidi Nield
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton SO16 6YD, United Kingdom
| | - Vanessa Cox
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton SO16 6YD, United Kingdom
| | - Sevasti Galani
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton SO16 6YD, United Kingdom
| | - Wayne Cutfield
- Liggins Institute, University of Auckland, Auckland 1142, New Zealand
| | - Shiao-Yng Chan
- Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore, 119228; Agency for Science, Technology and Research, Singapore Institute for Clinical Sciences, 117609, Singapore
| | - Keith M Godfrey
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton SO16 6YD, United Kingdom; National Institute for Health Research Southampton Biomedical Research Centre, University of Southampton, Southampton and University Hospital Southampton NHS Foundation Trust, SO16 6YD, United Kingdom
| |
Collapse
|
2
|
Maessen SE, Nichols M, Cutfield W, Norris SA, Beger C, Ong KK. High but decreasing prevalence of overweight in preschool children: encouragement for further action. BMJ 2023; 383:e075736. [PMID: 37813417 PMCID: PMC10561018 DOI: 10.1136/bmj-2023-075736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/11/2023]
Affiliation(s)
- Sarah E Maessen
- Better Start National Science Challenge, Auckland, New Zealand
- Department of Paediatrics: Child and Youth Health, University of Auckland, New Zealand
| | - Melanie Nichols
- Global Centre for Preventive Health and Nutrition, Institute for Health Transformation, Deakin University, Geelong, Australia
| | - Wayne Cutfield
- Better Start National Science Challenge, Auckland, New Zealand
- Liggins Institute, University of Auckland, New Zealand
| | - Shane A Norris
- SAMRC/Wits Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- School of Human Development and Health, University of Southampton, UK
| | - Christoph Beger
- LIFE Child and CrescNet, Center for Pediatric Research, Leipzig University Hospital for Children and Adolescents, Leipzig University, Leipzig, Germany
| | - Ken K Ong
- MRC Epidemiology Unit, Institute of Metabolic Science, and Department of Paediatrics, University of Cambridge, UK
| |
Collapse
|
3
|
Sharma N, Watkins OC, Chu AHY, Cutfield W, Godfrey KM, Yong HEJ, Chan SY. Myo-inositol: a potential prophylaxis against premature onset of labour and preterm birth. Nutr Res Rev 2023; 36:60-68. [PMID: 34526164 PMCID: PMC7614523 DOI: 10.1017/s0954422421000299] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The incidence of preterm birth (PTB), delivery before 37 completed weeks of gestation, is rising in most countries. Several recent small clinical trials of myo-inositol supplementation in pregnancy, which were primarily aimed at preventing gestational diabetes, have suggested an effect on reducing the incidence of PTB as a secondary outcome, highlighting the potential role of myo-inositol as a preventive agent. However, the underlying molecular mechanisms by which myo-inositol might be able to do so remain unknown; these may occur through directly influencing the onset and progress of labour, or by suppressing stimuli that trigger or promote labour. This paper presents hypotheses outlining the potential role of uteroplacental myo-inositol in human parturition and explains possible underlying molecular mechanisms by which myo-inositol might modulate the uteroplacental environment and inhibit preterm labour onset. We suggest that a physiological decline in uteroplacental inositol levels to a critical threshold with advancing gestation, in concert with an increasingly pro-inflammatory uteroplacental environment, permits spontaneous membrane rupture and labour onset. A higher uteroplacental inositol level, potentially promoted by maternal myo-inositol supplementation, might affect lipid metabolism, eicosanoid production and secretion of pro-inflammatory chemocytokines that overall dampen the pro-labour uteroplacental environment responsible for labour onset and progress, thus reducing the risk of PTB. Understanding how and when inositol may act to reduce PTB risk would facilitate the design of future clinical trials of maternal myo-inositol supplementation and definitively address the efficacy of myo-inositol prophylaxis against PTB.
Collapse
Affiliation(s)
- Neha Sharma
- Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Oliver C Watkins
- Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Anne H Y Chu
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore, Singapore
| | - W Cutfield
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Keith M Godfrey
- MRC Lifecourse Epidemiology Centre and NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Hannah E J Yong
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore, Singapore
| | - Shiao-Yng Chan
- Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore, Singapore
| |
Collapse
|
4
|
Maessen SE, Taylor BJ, Gillon G, Moewaka Barnes H, Firestone R, Taylor RW, Milne B, Hetrick S, Cargo T, McNeil B, Cutfield W. A better start national science challenge: supporting the future wellbeing of our tamariki E tipu, e rea, mō ngā rā o tō ao: grow tender shoot for the days destined for you. J R Soc N Z 2023. [DOI: 10.1080/03036758.2023.2173257] [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: 02/24/2023]
Affiliation(s)
- Sarah E. Maessen
- A Better Start National Science Challenge, Auckland, New Zealand
- Liggins Institute, Auckland, New Zealand
| | - Barry J. Taylor
- A Better Start National Science Challenge, Auckland, New Zealand
- Department of Women’s and Children’s Health, University of Otago, Dunedin, New Zealand
| | - Gail Gillon
- A Better Start National Science Challenge, Auckland, New Zealand
- Child Well-being Research Institute, University of Canterbury, Christchurch, New Zealand
| | - Helen Moewaka Barnes
- A Better Start National Science Challenge, Auckland, New Zealand
- Whariki Research Group, SHORE and Whariki Research Centre, School of Public Health, Massey University, Auckland, New Zealand
| | - Ridvan Firestone
- A Better Start National Science Challenge, Auckland, New Zealand
- Research Centre for Hauora & Health, College of Health, Massey University, Wellington, New Zealand
| | - Rachael W. Taylor
- A Better Start National Science Challenge, Auckland, New Zealand
- Department of Medicine, University of Otago, Dunedin, New Zealand
| | - Barry Milne
- A Better Start National Science Challenge, Auckland, New Zealand
- Centre of Methods and Policy Application in Social Sciences, University of Auckland, Auckland, New Zealand
| | - Sarah Hetrick
- A Better Start National Science Challenge, Auckland, New Zealand
- Department of Psychological Medicine, University of Auckland, Auckland, New Zealand
| | - Tania Cargo
- A Better Start National Science Challenge, Auckland, New Zealand
- Department of Psychological Medicine, University of Auckland, Auckland, New Zealand
| | - Bridgid McNeil
- A Better Start National Science Challenge, Auckland, New Zealand
- Child Well-being Research Institute, University of Canterbury, Christchurch, New Zealand
- School of Teacher Education, University of Canterbury, Christchurch, New Zealand
| | - Wayne Cutfield
- A Better Start National Science Challenge, Auckland, New Zealand
- Liggins Institute, Auckland, New Zealand
| |
Collapse
|
5
|
Maghnie M, Ranke MB, Geffner ME, Vlachopapadopoulou E, Ibáñez L, Carlsson M, Cutfield W, Rooman R, Gomez R, Wajnrajch MP, Linglart A, Stawerska R, Clayton PE, Darendeliler F, Hokken-Koelega ACS, Horikawa R, Tanaka T, Dörr HG, Albertsson-Wikland K, Polak M, Grimberg A. Response to Letter to the Editor from Virú-Loza and Chávez-Nomberto: "Safety and efficacy of pediatric growth hormone therapy: Results from the full KIGS cohort". J Clin Endocrinol Metab 2023; 108:e356-e357. [PMID: 36721915 DOI: 10.1210/clinem/dgad055] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 01/25/2023] [Indexed: 02/02/2023]
Affiliation(s)
- Mohamad Maghnie
- Department of Pediatrics, IRCCS Giannina Gaslini, Genova 16124, Italy
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health - DINOGMI, University of Genova, Genova 16124, Italy
| | - Michael B Ranke
- Department of Pediatric Endocrinology, University Children´s Hospital, Tübingen 72076, Germany
| | - Mitchell E Geffner
- The Saban Research Institute, Children's Hospital Los Angeles, Los Angeles, California 90027, USA
| | - Elpis Vlachopapadopoulou
- Department of Endocrinology, Growth and Development, Aglaia Kyriakou Children's Hospital, Athens 11527, Greece
| | - Lourdes Ibáñez
- Endocrinology, Pediatric Research Institute Sant Joan de Déu, Barcelona 08950, Spain
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III, Madrid 28029, Spain
| | - Martin Carlsson
- Rare Disease, Biopharmaceuticals, Pfizer, New York, NY 10017, USA
| | - Wayne Cutfield
- Liggins Institute, University of Auckland, Auckland 1142, New Zealand
| | | | - Roy Gomez
- European Medical Affairs, Pfizer, Brussels 1070, Belgium
| | - Michael P Wajnrajch
- Rare Disease, Biopharmaceuticals, Pfizer, New York, NY 10017, USA
- Department of Pediatrics, New York University Langone Medical Center, New York, NY 10016, USA
| | - Agnès Linglart
- Department of Pediatric Endocrinology and Diabetology for Children, AP-HP, Bicêtre Paris Saclay, Le Kremlin Bicêtre 94270, France
- APHP, Reference Center for Rare Disorders of the Calcium and Phosphate Metabolism, Filière OSCAR and Plateforme d'Expertise Maladies Rares Paris-Sud, Bicêtre Paris Saclay Hospital, Le Kremlin Bicêtre 94270, France
| | - Renata Stawerska
- Department of Endocrinology and Metabolic Diseases, Polish Mother's Memorial Hospital-Research Institute, Lodz 93-338, Poland
- Department of Pediatric Endocrinology, Medical University of Lodz, Lodz 93-338, Poland
| | - Peter E Clayton
- Developmental Biology and Medicine, Faculty of Biology Medicine and Health, Manchester NIHR Academic Health Science Centre, University of Manchester, Manchester M13 9PL, UK
| | - Feyza Darendeliler
- I ̇ stanbul University, Istanbul Faculty of Medicine, Pediatric Endocrinology Unit, İ stanbul 34452, Turkey
| | - Anita C S Hokken-Koelega
- Pediatrics, Subdivision of Endocrinology, Erasmus University Medical Center, Rotterdam 3015 GD, the Netherlands
| | - Reiko Horikawa
- Division of Endocrinology and Metabolism, National Center for Child Health and Development, Tokyo 157-8535, Japan
| | | | - Helmuth-Günther Dörr
- Division of Pediatric Endocrinology, Department of Pediatrics and Adolescent Medicine, Friedrich-Alexander University of Erlangen Nürnberg, Erlangen 91054, Germany
| | - Kerstin Albertsson-Wikland
- Department of Physiology/Endocrinology, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg 405 30, Sweden
| | - Michel Polak
- Université de Paris Cité; Hôpital Universitaire Necker Enfants Malades, Paris 75015, France
| | - Adda Grimberg
- Division of Pediatric Endocrinology and Diabetes, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania 19104, USA
| |
Collapse
|
6
|
Fangupo L, Daniels L, Taylor R, Glover M, Taungapeau F, Sa'u S, Cutfield W, Taylor B. The care of infants with rapid weight gain: Should we be doing more? J Paediatr Child Health 2022; 58:2143-2149. [PMID: 36259748 PMCID: PMC10092129 DOI: 10.1111/jpc.16247] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 09/27/2022] [Accepted: 10/02/2022] [Indexed: 11/28/2022]
Abstract
Rapid weight gain (RWG) during infancy is a known risk factor for later childhood obesity. It can be measured using a range of definitions across various time periods in the first 2 years of life. In recent years, some early childhood obesity prevention trials have included a focus on preventing RWG during infancy, with modest success. Overall, RWG during infancy remains common, yet little work has examined whether infants with this growth pattern should receive additional care when it is identified in health-care settings. In this viewpoint, we contend that RWG during infancy should be routinely screened for in health-care settings, and when identified, viewed as an opportunity for health-care professionals to instigate non-stigmatising discussions with families about RWG and general healthy practices for their infants. If families wish to engage, we suggest that six topics from early life obesity prevention studies (breastfeeding, formula feeding, complementary feeding, sleep, responsive parenting, and education around growth charts and monitoring) could form the foundations of conversations to help them establish and maintain healthy habits to support their infant's health and well-being and potentially lower the risk of later obesity. However, further work is needed to develop definitive guidelines in this area, and to address other gaps in the literature, such as the current lack of a standardised definition for RWG during infancy and a clear understanding of the time points over which it should be measured.
Collapse
Affiliation(s)
- Louise Fangupo
- Department of Medicine, University of Otago, Dunedin, New Zealand
| | - Lisa Daniels
- Department of Medicine, University of Otago, Dunedin, New Zealand.,Department of Women's and Children's Health, University of Otago, Dunedin, New Zealand
| | - Rachael Taylor
- Department of Medicine, University of Otago, Dunedin, New Zealand.,A Better Start National Science Challenge, University of Auckland, Auckland, New Zealand
| | - Marewa Glover
- Papaharakeke International Ltd, Auckland, New Zealand
| | | | | | - Wayne Cutfield
- A Better Start National Science Challenge, University of Auckland, Auckland, New Zealand.,The Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Barry Taylor
- Department of Women's and Children's Health, University of Otago, Dunedin, New Zealand.,A Better Start National Science Challenge, University of Auckland, Auckland, New Zealand
| |
Collapse
|
7
|
Maghnie M, Ranke MB, Geffner ME, Vlachopapadopoulou E, Ibáñez L, Carlsson M, Cutfield W, Rooman R, Gomez R, Wajnrajch MP, Linglart A, Stawerska R, Clayton PE, Darendeliler F, Hokken-Koelega ACS, Horikawa R, Tanaka T, Dörr HG, Albertsson-Wikland K, Polak M, Grimberg A. Safety and Efficacy of Pediatric Growth Hormone Therapy: Results From the Full KIGS Cohort. J Clin Endocrinol Metab 2022; 107:3287-3301. [PMID: 36102184 PMCID: PMC9693805 DOI: 10.1210/clinem/dgac517] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Indexed: 02/03/2023]
Abstract
CONTEXT The Kabi/Pfizer International Growth Database (KIGS) is a large, international database (1987-2012) of children treated with recombinant human growth hormone (rhGH) in real-world settings. OBJECTIVE This work aimed to evaluate the safety and efficacy of rhGH from the full KIGS cohort. METHODS Data were collected by investigators from children with growth disorders treated with rhGH (Genotropin [somatropin]; Pfizer). Safety was evaluated in all treated patients, and efficacy in those treated for 1 year or more. A subgroup included patients treated for 5 years or more (≥ 2 years prepubertal) who had reached near-adult height (NAH). Main outcomes included adverse events (AEs), serious AEs (SAEs), and height growth. RESULTS The full KIGS cohort (N = 83 803 [58% male]) was treated for idiopathic GH deficiency (IGHD; 46.9%), organic GHD (10.0%), small for gestational age (SGA; 9.5%), Turner syndrome (TS; 9.2%), idiopathic short stature (ISS; 8.2%), and others (16.2%). Median rhGH treatment duration was 2.7 years and observation 3.1 years. SAEs occurred in 3.7% of patients and death in 0.4%. The most common SAEs were recurrence of craniopharyngioma (n = 151), neoplasm (n = 99), and cancer (n = 91); and scoliosis (n = 91). Median first-year delta height-SD score (SDS) (Prader) in prepubertal patients was 0.66 (IGHD), 0.55 (ISS), 0.58 (TS), and 0.71 (SGA). Median gains in NAH-SDS were 1.79 (IGHD), 1.37 (ISS), and 1.34 (SGA) for boys, and 2.07 (IGHD), 1.62 (ISS), 1.07 (TS), and 1.57 (SGA) for girls. CONCLUSION Data from KIGS, the largest and longest running international database of rhGH-treated children, show that rhGH is safe and increases short-term height gain and adult height across GHD and non-GHD conditions.
Collapse
Affiliation(s)
- Mohamad Maghnie
- Department of Pediatrics, IRCCS Giannina Gaslini, Genova 16124, Italy
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health - DINOGMI, University of Genova, Genova 16124, Italy
| | - Michael B Ranke
- Department of Pediatric Endocrinology, University Children´s Hospital, Tübingen 72076, Germany
| | - Mitchell E Geffner
- The Saban Research Institute, Children's Hospital Los Angeles, Los Angeles, California 90027, USA
| | - Elpis Vlachopapadopoulou
- Department of Endocrinology, Growth and Development, Aglaia Kyriakou Children's Hospital, Athens 11527, Greece
| | - Lourdes Ibáñez
- Endocrinology, Pediatric Research Institute Sant Joan de Déu, Barcelona 08950, Spain
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III, Madrid 28029, Spain
| | - Martin Carlsson
- Rare Disease, Biopharmaceuticals, Pfizer, New York, NY 10017, USA
| | - Wayne Cutfield
- Liggins Institute, University of Auckland, Auckland 1142, New Zealand
| | | | - Roy Gomez
- European Medical Affairs, Pfizer, Brussels 1070, Belgium
| | - Michael P Wajnrajch
- Rare Disease, Biopharmaceuticals, Pfizer, New York, NY 10017, USA
- Department of Pediatrics, New York University Langone Medical Center, New York, NY 10016, USA
| | - Agnès Linglart
- Department of Pediatric Endocrinology and Diabetology for Children, AP-HP, Bicêtre Paris Saclay, Le Kremlin Bicêtre 94270, France
- APHP, Reference Center for Rare Disorders of the Calcium and Phosphate Metabolism, Filière OSCAR and Plateforme d’Expertise Maladies Rares Paris-Sud, Bicêtre Paris Saclay Hospital, Le Kremlin Bicêtre 94270, France
| | - Renata Stawerska
- Department of Endocrinology and Metabolic Diseases, Polish Mother’s Memorial Hospital-Research Institute, Lodz 93-338, Poland
- Department of Pediatric Endocrinology, Medical University of Lodz, Lodz 93-338, Poland
| | - Peter E Clayton
- Developmental Biology and Medicine, Faculty of Biology Medicine and Health, Manchester NIHR Academic Health Science Centre, University of Manchester, Manchester M13 9PL, UK
| | - Feyza Darendeliler
- İstanbul University, Istanbul Faculty of Medicine, Pediatric Endocrinology Unit, İstanbul 34452, Turkey
| | - Anita C S Hokken-Koelega
- Pediatrics, Subdivision of Endocrinology, Erasmus University Medical Center, Rotterdam 3015 GD, the Netherlands
| | - Reiko Horikawa
- Division of Endocrinology and Metabolism, National Center for Child Health and Development, Tokyo 157-8535, Japan
| | | | - Helmuth-Günther Dörr
- Division of Pediatric Endocrinology, Department of Pediatrics and Adolescent Medicine, Friedrich-Alexander University of Erlangen-Nürnberg, Erlangen 91054, Germany
| | - Kerstin Albertsson-Wikland
- Department of Physiology/Endocrinology, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg 405 30, Sweden
| | - Michel Polak
- Université de Paris Cité; Hôpital Universitaire Necker Enfants Malades, Paris 75015, France
| | - Adda Grimberg
- Correspondence: Adda Grimberg, MD, Division of Pediatric Endocrinology and Diabetes, Children’s Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104.
| |
Collapse
|
8
|
Ostring G, Prestidge T, Olding R, Mato H, Drake R, Cutfield W. Calcium conundrums in juvenile dermatomyositis: Calcinosis universalis and hypercalcaemia post stem cell transplant. J Paediatr Child Health 2022; 58:1256-1258. [PMID: 34674313 DOI: 10.1111/jpc.15806] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 06/01/2021] [Accepted: 10/06/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Genevieve Ostring
- Paediatric Rheumatology Department, Starship Children's Hospital, Auckland, New Zealand
| | - Timothy Prestidge
- Paediatric Rheumatology Department, Starship Children's Hospital, Auckland, New Zealand
| | - Rosalie Olding
- Paediatric Rheumatology Department, Starship Children's Hospital, Auckland, New Zealand
| | - Haeley Mato
- Paediatric Rheumatology Department, Starship Children's Hospital, Auckland, New Zealand
| | - Ross Drake
- Paediatric Rheumatology Department, Starship Children's Hospital, Auckland, New Zealand
| | - Wayne Cutfield
- Paediatric Rheumatology Department, Starship Children's Hospital, Auckland, New Zealand
| |
Collapse
|
9
|
Styles S, Wheeler B, Boucsein A, Crocket H, de Lange M, Signal D, Wiltshire E, Cunningham V, Lala A, Cutfield W, de Bock M, Serlachius A, Jefferies C. A comparison of FreeStyle Libre 2 to self-monitoring of blood glucose in children with type 1 diabetes and sub-optimal glycaemic control: a 12-week randomised controlled trial protocol. J Diabetes Metab Disord 2021; 20:2093-2101. [PMID: 34900845 PMCID: PMC8630241 DOI: 10.1007/s40200-021-00907-y] [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: 04/01/2021] [Accepted: 09/23/2021] [Indexed: 11/26/2022]
Abstract
Purpose Frequent glucose monitoring is necessary for optimal glycaemic control. Second-generation intermittently scanned glucose monitoring (isCGM) systems inform users of out-of-target glucose levels and may reduce monitoring burden. We aim to compare FreeStyle Libre 2 (Abbott Diabetes Care, Witney, U.K.) to self-monitoring of blood glucose in children with type 1 diabetes and sub-optimal glycaemic control. Methods This open-label randomised controlled trial will enrol 100 children (4–13 years inclusive, diagnosis of type 1 diabetes ≥ 6 months, HbA1c 58–110 mmol/mol [7.5–12.2%]), from 5 New Zealand diabetes centres. Following 2 weeks of blinded sensor wear, children will be randomised 1:1 to control or intervention arms. The intervention (duration 12 weeks) includes second-generation isCGM (FreeStyle Libre 2) and education on using interstitial glucose data to manage diabetes. The control group will continue self-monitoring blood glucose. The primary outcome is the difference in glycaemic control (measured as HbA1c) between groups at 12 weeks. Pre-specified secondary outcomes include change in glucose monitoring frequency, glycaemic control metrics and psychosocial outcomes at 12 weeks as well as isCGM acceptability. Discussion This research will investigate the effectiveness of the second-generation isCGM to promote recommended glycaemic control. The results of this trial may have important implications for including this new technology in the management of children with type 1 diabetes. Trial registration This trial was prospectively registered with the Australian New Zealand Clinical Trials Registry on 19 February 2020 (ACTRN12620000190909p) and the World Health Organization International Clinical Trials Registry Platform (Universal Trial Number U1111-1237-0090).
Collapse
Affiliation(s)
- Sara Styles
- Department of Human Nutrition, University of Otago, Dunedin, New Zealand
| | - Ben Wheeler
- Department of Women's and Children's Health, University of Otago, Dunedin, New Zealand.,Paediatrics, Southern District Health Board, Dunedin, New Zealand.,Department of Paediatrics and Child Health, University of Otago, Wellington, New Zealand
| | - Alisa Boucsein
- Department of Women's and Children's Health, University of Otago, Dunedin, New Zealand
| | - Hamish Crocket
- Health, Sport and Human Performance, School of Health, University of Waikato, Hamilton, New Zealand
| | - Michel de Lange
- Centre for Biostatistics, Te Pokapū Tatauranga Koiora, Division of Health Sciences, Dunedin, New Zealand
| | - Dana Signal
- Paediatric Diabetes and Endocrinology, Starship Children's Health, Auckland, New Zealand.,Liggins Institute, The University of Auckland, Auckland, New Zealand
| | - Esko Wiltshire
- Department of Paediatrics and Child Health, University of Otago, Wellington, Wellington, New Zealand.,Capital & Coast District Health Board, Wellington, New Zealand.,Department of Paediatrics and Child Health, University of Otago, Wellington, New Zealand
| | | | - Anita Lala
- Paediatrics, Bay of Plenty District Health Board, Tauranga, New Zealand
| | - Wayne Cutfield
- Paediatric Diabetes and Endocrinology, Starship Children's Health, Auckland, New Zealand.,Liggins Institute, The University of Auckland, Auckland, New Zealand
| | - Martin de Bock
- Department of Paediatrics, University of Otago, Christchurch, New Zealand.,Canterbury District Health Board, Christchurch, New Zealand
| | - Anna Serlachius
- Psychological Medicine, The University of Auckland, Auckland, New Zealand
| | - Craig Jefferies
- Paediatric Diabetes and Endocrinology, Starship Children's Health, Auckland, New Zealand.,Liggins Institute, The University of Auckland, Auckland, New Zealand
| |
Collapse
|
10
|
Cutfield W, Ayyavoo A. The Auxological and Metabolic Consequences for Children Born Small for Gestational Age. Indian J Pediatr 2021; 88:1235-1240. [PMID: 34405367 DOI: 10.1007/s12098-021-03897-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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] [Received: 05/19/2021] [Accepted: 07/12/2021] [Indexed: 12/15/2022]
Abstract
'Small for gestational age' (SGA) is an auxological and not an etiological definition that characterizes children born small based upon low-birth-weight and/or birth-length criteria [≥ 2 standard deviations (SD) below the mean for gestational age]. Most SGA children exhibit catch-up growth into the normal range within 6 mo of age. Overall SGA children are 4 cm shorter than expected based upon midparental height and being born SGA is a common cause of adult short stature. Recombinant human growth hormone (rhGH) has been shown to improve adult height by 0.9 SDs and is a safe treatment. Surprisingly, a higher rhGH dose (67 μgm/kg/d) did not lead to a greater adult height than a conventional dose (33 μgm/kg/d). At least 85% of SGA children treated through childhood with rhGH achieve a height within the normal adult range. Other long-term consequences for children born SGA include insulin resistance, abdominal adiposity, dyslipidemia, type 2 diabetes mellitus, and metabolic syndrome. Cross-sectional studies have found reduced insulin sensitivity in the neonatal, childhood, and young adult periods. Increased abdominal fat has been shown in preschool SGA children and is more evident in young adults. Increased adiposity markedly accentuates reduction in insulin sensitivity. Many SGA children have suffered from in utero nutritional restriction that leads to long-term growth restriction and adverse metabolic sequelae.
Collapse
Affiliation(s)
- Wayne Cutfield
- Department of Pediatric Endocrinology, Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Ahila Ayyavoo
- Department of Pediatrics, G. Kuppuswamy Naidu Memorial Hospital, Coimbatore, Tamil Nadu, 641037, India.
| |
Collapse
|
11
|
Godfrey KM, Barton SJ, El-Heis S, Kenealy T, Nield H, Baker PN, Chong YS, Cutfield W, Chan SY. Myo-Inositol, Probiotics, and Micronutrient Supplementation From Preconception for Glycemia in Pregnancy: NiPPeR International Multicenter Double-Blind Randomized Controlled Trial. Diabetes Care 2021; 44:1091-1099. [PMID: 33782086 PMCID: PMC8132330 DOI: 10.2337/dc20-2515] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [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: 10/11/2020] [Accepted: 02/10/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Better preconception metabolic and nutritional health are hypothesized to promote gestational normoglycemia and reduce preterm birth, but evidence supporting improved outcomes with nutritional supplementation starting preconception is limited. RESEARCH DESIGN AND METHODS This double-blind randomized controlled trial recruited from the community 1,729 U.K., Singapore, and New Zealand women aged 18-38 years planning conception. We investigated whether a nutritional formulation containing myo-inositol, probiotics, and multiple micronutrients (intervention), compared with a standard micronutrient supplement (control), taken preconception and throughout pregnancy could improve pregnancy outcomes. The primary outcome was combined fasting, 1-h, and 2-h postload glycemia (28 weeks gestation oral glucose tolerance test). RESULTS Between 2015 and 2017, participants were randomized to control (n = 859) or intervention (n = 870); 585 conceived within 1 year and completed the primary outcome (295 intervention, 290 control). In an intention-to-treat analysis adjusting for site, ethnicity, and preconception glycemia with prespecified P < 0.017 for multiplicity, there were no differences in gestational fasting, 1-h, and 2-h glycemia between groups (β [95% CI] loge mmol/L intervention vs. control -0.004 [-0.018 to 0.011], 0.025 [-0.014 to 0.064], 0.040 [0.004-0.077], respectively). Between the intervention and control groups there were no significant differences in gestational diabetes mellitus (24.8% vs. 22.6%, adjusted risk ratio [aRR] 1.22 [0.92-1.62]), birth weight (adjusted β = 0.05 kg [-0.03 to 0.13]), or gestational age at birth (mean 39.3 vs. 39.2 weeks, adjusted β = 0.20 [-0.06 to 0.46]), but there were fewer preterm births (5.8% vs. 9.2%, aRR 0.43 [0.22-0.82]), adjusting for prespecified covariates. CONCLUSIONS Supplementation with myo-inositol, probiotics, and micronutrients preconception and in pregnancy did not lower gestational glycemia but did reduce preterm birth.
Collapse
Affiliation(s)
- Keith M Godfrey
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, U.K. .,NIHR Southampton Biomedical Research Centre, University Hospital Southampton, NHS Foundation Trust, Southampton, U.K
| | - Sheila J Barton
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, U.K
| | - Sarah El-Heis
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, U.K
| | - Timothy Kenealy
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Heidi Nield
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, U.K
| | - Philip N Baker
- College of Life Sciences, Biological Sciences and Psychology, University of Leicester, Leicester, U.K
| | - Yap Seng Chong
- Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore.,Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore
| | - Wayne Cutfield
- Liggins Institute, University of Auckland, Auckland, New Zealand.,A Better Start, New Zealand National Science Challenge, Auckland, New Zealand
| | | | | |
Collapse
|
12
|
Lyons-Reid J, Ward LC, Kenealy T, Cutfield W. Bioelectrical Impedance Analysis-An Easy Tool for Quantifying Body Composition in Infancy? Nutrients 2020; 12:E920. [PMID: 32230758 PMCID: PMC7230643 DOI: 10.3390/nu12040920] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 03/20/2020] [Accepted: 03/25/2020] [Indexed: 12/26/2022] Open
Abstract
There has been increasing interest in understanding body composition in early life and factors that may influence its evolution. While several technologies exist to measure body composition in infancy, the equipment is typically large, and thus not readily portable, is expensive, and requires a qualified operator. Bioelectrical impedance analysis shows promise as an inexpensive, portable, and easy to use tool. Despite the technique being widely used to assess body composition for over 35 years, it has been seldom used in infancy. This may be related to the evolving nature of the fat-free mass compartment during this period. Nonetheless, a number of factors have been identified that may influence bioelectrical impedance measurements, which, when controlled for, may result in more accurate measurements. Despite this, questions remain in infants regarding the optimal size and placement of electrodes, the standardization of normal hydration, and the influence of body position on the distribution of water throughout the body. The technology requires further evaluation before being considered as a suitable tool to assess body composition in infancy.
Collapse
Affiliation(s)
- Jaz Lyons-Reid
- Liggins Institute, The University of Auckland, Auckland 1023, New Zealand;
| | - Leigh C. Ward
- School of Chemistry and Molecular Biosciences, The University of Queensland, St. Lucia, Brisbane, QLD 4072, Australia;
| | - Timothy Kenealy
- Department of Medicine and Department of General Practice and Primary Health Care, The University of Auckland, Auckland 1023, New Zealand;
| | - Wayne Cutfield
- Liggins Insitute and A Better Start – National Science Challenge, The University of Auckland, Auckland 1023, New Zealand
| |
Collapse
|
13
|
Anderson Y, Wynter L, Grant C, Wild C, O'Sullivan N, Cave T, Derraik J, Cutfield W, Hofman P. Two-year outcomes of Whānau Pakari: a novel home-based intervention for child and adolescent obesity. Obes Res Clin Pract 2019. [DOI: 10.1016/j.orcp.2018.11.116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
14
|
Gibb S, Shackleton N, Audas R, Taylor B, Swinburn B, Zhu T, Taylor R, Derraik JG, Cutfield W, Milne B. Child obesity prevalence across communities in New Zealand: 2010–2016. Aust N Z J Public Health 2019; 43:176-181. [DOI: 10.1111/1753-6405.12881] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 12/01/2018] [Accepted: 01/01/2019] [Indexed: 11/28/2022] Open
Affiliation(s)
- Sheree Gibb
- Department of Public HealthUniversity of Otago Wellington New Zealand
- A Better Start National Science Challenge Dunedin New Zealand
| | - Nichola Shackleton
- A Better Start National Science Challenge Dunedin New Zealand
- Centre of Methods and Policy Application in the Social Sciences (COMPASS)University of Auckland New Zealand
| | - Rick Audas
- A Better Start National Science Challenge Dunedin New Zealand
- Department of Women’s and Children’s HealthUniversity of Otago Dunedin New Zealand
| | - Barry Taylor
- A Better Start National Science Challenge Dunedin New Zealand
- Department of Women’s and Children’s HealthUniversity of Otago Dunedin New Zealand
| | - Boyd Swinburn
- Population Nutrition and Global HealthUniversity of Auckland New Zealand
| | - Tong Zhu
- A Better Start National Science Challenge Dunedin New Zealand
- Centre of Methods and Policy Application in the Social Sciences (COMPASS)University of Auckland New Zealand
| | - Rachael Taylor
- A Better Start National Science Challenge Dunedin New Zealand
- Department of MedicineUniversity of Otago Dunedin New Zealand
| | - José G.B. Derraik
- A Better Start National Science Challenge Dunedin New Zealand
- Liggins InstituteUniversity of Auckland New Zealand
| | - Wayne Cutfield
- A Better Start National Science Challenge Dunedin New Zealand
- Liggins InstituteUniversity of Auckland New Zealand
| | - Barry Milne
- A Better Start National Science Challenge Dunedin New Zealand
- Centre of Methods and Policy Application in the Social Sciences (COMPASS)University of Auckland New Zealand
| |
Collapse
|
15
|
Sjardin N, Reed P, Albert B, Mouat F, Carter PJ, Hofman P, Cutfield W, Gunn A, Jefferies C. Increasing incidence of type 2 diabetes in New Zealand children <15 years of age in a regional-based diabetes service, Auckland, New Zealand. J Paediatr Child Health 2018; 54:1005-1010. [PMID: 29689124 DOI: 10.1111/jpc.13924] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [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] [Received: 09/19/2017] [Revised: 03/13/2018] [Accepted: 03/13/2018] [Indexed: 01/23/2023]
Abstract
AIM It is important to understand whether type 2 diabetes mellitus (T2DM) is increasing in childhood for health-care planning and clinical management. The aim of this study is to examine the incidence of T2DM in New Zealand children, aged <15 years from a paediatric diabetes centre, Auckland, New Zealand. METHODS Retrospective analysis of prospectively collected data from a population-based referral cohort from 1995 to 2015. RESULTS Hundred and four children presented with T2DM over the 21-year period. The female:male ratio was 1.8:1, at mean (standard deviation) age 12.9 (1.9) years, body mass index standard deviation score +2.3 (0.5), blood sugar 15.3 (8.5) mmol/L, HbA1c 76 (28) mmol/mol. At diagnosis, 90% had acanthosis nigricans and 48% were symptomatic. In all, 33% were Maori, 46% Pacific Island, 15% Asian/Middle Eastern and 6% European. There was a progressive secular increase of 5% year on year in incidence. The overall annual incidence of T2DM <15 years of age was 1.5/100 000 (1.2-1.9) (95% confidence interval), with higher rates in Pacific Island (5.9/100 000) and Maori (4.1/100 000). CONCLUSIONS The incidence of T2DM in children <15 years of age in New Zealand has increased progressively at 5%/year over the last 21 years. The risk was disproportionately associated with girls and children from high-risk ethnic groups.
Collapse
Affiliation(s)
- Natalia Sjardin
- Department of Paediatrics and Physiology, University of Auckland, Auckland, New Zealand
| | - Peter Reed
- Research Office, Auckland District Health Board, Auckland, New Zealand
| | - Ben Albert
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Fran Mouat
- Auckland District Health Board, Starship Children's Hospital, Auckland, New Zealand
| | - Phillipa J Carter
- Auckland District Health Board, Starship Children's Hospital, Auckland, New Zealand
| | - Paul Hofman
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Wayne Cutfield
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Alistair Gunn
- Faculty of Medical Health Sciences, University of Auckland, Auckland, New Zealand
| | - Craig Jefferies
- Auckland District Health Board, Starship Children's Hospital, Auckland, New Zealand
| |
Collapse
|
16
|
Bonfig W, Lindberg A, Carlsson M, Cutfield W, Dunger D, Camacho-Hübner C, Holl RW. Efficacy of Growth Hormone Treatment in Children with Type 1 Diabetes Mellitus and Growth Hormone Deficiency-An Analysis of KIGS Data. J Pediatr 2018; 198:260-264. [PMID: 29656861 DOI: 10.1016/j.jpeds.2018.02.035] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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] [Received: 07/27/2017] [Revised: 01/23/2018] [Accepted: 02/13/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To analyze first-year treatment growth response and growth hormone (GH) dosage in prepubertal patients with the combination of type 1 diabetes mellitus (T1DM) and growth hormone deficiency (GHD). STUDY DESIGN A total of 69 patients with T1DM and GHD treated with GH have been enrolled in KIGS (Pfizer International Growth Database). Of these, 24 prepubertal patients had developed T1DM before GHD and were included in this analysis. Of 30 570 patients with GHD without T1DM, 15 024 were prepubertal and served as controls. Values are expressed as mean ± SD. RESULTS Patients with T1DM and GHD had similar characteristics compared with the GHD-alone group. Neither age (10.2 ± 3.13 vs 8.42 ± 3.46 years, P = .14), height SDS corrected for midparental height SDS at start of treatment (-1.62 ± 1.38 vs -1.61 ± 1.51, P = .80), nor GH dosage (0.24 ± 0.08 mg/kg/wk vs 0.20 ± 0.04 mg/kg/wk, P = .09) were different between those with and without T1DM. First-year catch-up growth was comparable between the 2 patient groups (first treatment year height velocity 7.54 ± 3.11 cm/year compared with 8.35 ± 2.54 cm/year in control patients, P = .38). Height SDS of children with T1DM and GHD improved from -2.62 ± 1.04 to -1.88 ± 1.11 over 1 year of GH treatment. CONCLUSION Short-term response to GH therapy appeared similar in subjects with T1DM who then developed GHD and in those with GHD alone. Thus, T1DM does not appear to compromise GH response in children with GHD and should not exclude GH treatment in these children. GH treatment was safe in both subgroups of patients.
Collapse
Affiliation(s)
- Walter Bonfig
- Department of Pediatrics, Klinikum Wels-Grieskirchen, Wels, Austria; Department of Pediatrics, Technical University München, Munich, Germany.
| | | | | | - Wayne Cutfield
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - David Dunger
- Department of Pediatrics and the Wellcome Trust-MRC Institute of Metabolic Science, University of Cambridge, Cambridge, United Kingdom
| | | | - Reinhard W Holl
- Institute of Epidemiology and Medical Biometry, University of Ulm, Ulm, Germany; German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany
| |
Collapse
|
17
|
Godfrey KM, Cutfield W, Chan SY, Baker PN, Chong YS. Nutritional Intervention Preconception and During Pregnancy to Maintain Healthy Glucose Metabolism and Offspring Health ("NiPPeR"): study protocol for a randomised controlled trial. Trials 2017; 18:131. [PMID: 28320484 PMCID: PMC5359891 DOI: 10.1186/s13063-017-1875-x] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Accepted: 03/06/2017] [Indexed: 01/04/2023] Open
Abstract
Background Improved maternal nutrition and glycaemic control before and during pregnancy are thought to benefit the health of the mother, with consequent benefits for infant body composition and later obesity risk. Maternal insulin resistance and glycaemia around conception and in early pregnancy may be key determinants of maternal physiology and placental function, affecting fetal nutrient supply and maternal-feto-placental communications throughout gestation, with implications for later postnatal health. Methods/design This double-blind randomised controlled trial will recruit up to 1800 women, aged 18–38 years, who are planning a pregnancy in the United Kingdom (UK), Singapore and New Zealand, with a view to studying 600 pregnancies. The primary outcome is maternal glucose tolerance at 28 weeks’ gestation following an oral glucose tolerance test. Secondary outcomes include metabolic, molecular and health-related outcomes in the mother and offspring, notably infant body composition. Participants will be randomly allocated to receive a twice-daily control nutritional drink, enriched with standard micronutrients, or a twice-daily intervention nutritional drink enriched with additional micronutrients, myo-inositol and probiotics, both demonstrated previously to assist in maintaining healthy glucose metabolism during pregnancy. Myo-inositol is a nutrient that enhances cellular glucose uptake. The additional micronutrients seek to address deficiencies of some B-group vitamins and vitamin D that are both common during pregnancy and that have been associated with maternal dysglycaemia, epigenetic changes and greater offspring adiposity. Women who conceive within a year of starting the nutritional drinks will be followed through pregnancy and studied with their infants at six time points during the first year of life. Blood, urine/stool, hair and cheek swabs will be collected from the mothers for genetic, epigenetic, hormone, nutrient and metabolite measurements, and assessments of the mother’s body composition, anthropometry, health, diet and lifestyle will be made. Infants will also undergo hair, cheek swab, urine and stool sampling for similar biological measurements; infant body composition will be assessed and feeding recorded. Discussion There is an increasing focus on the need to optimise maternal nutrition starting prior to conception. This trial will provide evidence on the potential for nutritional interventions beginning prior to conception to promote healthy maternal and offspring outcomes. Trial registration ClinicalTrials.gov, identifier: NCT02509988, Universal Trial Number U1111-1171-8056. Registered on 16 July 2015. This is an academic-led study by the EpiGen Global Research Consortium. Electronic supplementary material The online version of this article (doi:10.1186/s13063-017-1875-x) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Keith M Godfrey
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton, NHS Foundation Trust, Southampton, UK. .,MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Mailpoint 95, Southampton, SO16 6YD, UK.
| | - Wayne Cutfield
- Liggins Institute, University of Auckland, Auckland, New Zealand.,A Better Start, New Zealand National Science Challenge, Auckland, New Zealand
| | - Shiao-Yng Chan
- Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore, Singapore.,Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore, Singapore
| | - Philip N Baker
- Liggins Institute, University of Auckland, Auckland, New Zealand.,College of Medicine, Biological Sciences and Psychology, University of Leicester, Leicester, UK
| | - Yap-Seng Chong
- Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore, Singapore.,Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore, Singapore
| | | |
Collapse
|
18
|
Hughes IP, Choong C, Rath S, Atkinson H, Cotterill A, Cutfield W, Hofman P, Harris M. Early cessation and non-response are important and possibly related problems in growth hormone therapy: An OZGROW analysis. Growth Horm IGF Res 2016; 29:63-70. [PMID: 27179230 DOI: 10.1016/j.ghir.2016.04.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Revised: 04/15/2016] [Accepted: 04/18/2016] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To investigate growth hormone (GH) treatment and treatment cessation with respect to efficacy and efficiency. To identify factors that best classify or predict cessation type: completed treatment (CT), early cessation (EC), or non-response (NR). DESIGN Observational study (1990-2013) of the Australian GH Program comparing CT, EC, and NR groups with respect to demographic, clinical, and response criteria. All patients treated for GH deficiency (GHD; 909), short stature and slow growth (SSSG; 2144), and Turner Syndrome (TS; 626) were included. Information was retrieved from the OZGROW database. RESULTS 51.9% of patients were EC, 40.7% CT and 7.4% NR.Median treatment durations for NR patients were often longer than patients who completed treatment. EC and NR groups were both associated with poor growth response with males overrepresented.Socioeconomic status differentiated NR (higher) and EC (lower) groups. CONCLUSIONS EC was observed at very high rates and appears, generally, to be a little-recognised but frequent problem in GH therapy.EC and delayed recognition of NR may be interrelated being differentiated by the decision to cease or continue treatment following poor response.Poor treatment compliance is likely a major causal factor in EC.Strategies to address poor response and compliance have been developed, however, given the scale of these problems, it may be that long acting GH formulations or individualized treatment need consideration.
Collapse
Affiliation(s)
- Ian P Hughes
- Mater Research, University of Queensland Institute, OZGROW - APEG, South Brisbane, QLD, Australia.
| | - Catherine Choong
- Princess Margaret Hospital for Children, Endocrinology, Subiaco, WA, Australia; The University of Western Australia, School of Paediatrics and Child Health Crawley, WA, Australia
| | - Shoshana Rath
- The University of Western Australia, School of Paediatrics and Child Health Crawley, WA, Australia
| | - Helen Atkinson
- The University of Western Australia, School of Paediatrics and Child Health Crawley, WA, Australia
| | - Andrew Cotterill
- Lady Cilento Children's Hospital, Endocrinology, South Brisbane, QLD, Australia
| | - Wayne Cutfield
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Paul Hofman
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Mark Harris
- Lady Cilento Children's Hospital, Endocrinology, South Brisbane, QLD, Australia
| |
Collapse
|
19
|
Seneviratne S, Parry G, Jiang Y, Mc Cowan L, Cutfield W, Rodrigues R, Gusso S, Ekeroma A, Craigie S, Hofman P. A randomized controlled trial on the effects of antenatal exercise on birth weight and neonatal body composition. Int J Pediatr Endocrinol 2015. [PMCID: PMC4428637 DOI: 10.1186/1687-9856-2015-s1-o38] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
|
20
|
Chiavaroli V, Hopkins S, Biggs J, Derraik J, Rodrigues RO, Cutfield W, Hofman P. Regular, moderate intensity maternal exercise reduces birth weight but increases the risk of later childhood adiposity. Int J Pediatr Endocrinol 2015. [PMCID: PMC4428197 DOI: 10.1186/1687-9856-2015-s1-o43] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
|
21
|
Theodore RF, Broadbent J, Nagin D, Ambler A, Hogan S, Ramrakha S, Cutfield W, Williams MJA, Harrington H, Moffitt TE, Caspi A, Milne B, Poulton R. Childhood to Early-Midlife Systolic Blood Pressure Trajectories: Early-Life Predictors, Effect Modifiers, and Adult Cardiovascular Outcomes. Hypertension 2015; 66:1108-15. [PMID: 26558818 DOI: 10.1161/hypertensionaha.115.05831] [Citation(s) in RCA: 194] [Impact Index Per Article: 21.6] [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: 07/23/2015] [Accepted: 08/21/2015] [Indexed: 01/01/2023]
Abstract
Previous studies examining blood pressure change over time have modeled an average population trajectory. Recent research among older adults suggests there may be subgroups with different blood pressure trajectories. Identifying subgroups at risk of developing adult hypertension early in life can inform effective risk reduction efforts. We sought to identify different systolic blood pressure trajectories from childhood, their correlated risk factors, and early-midlife cardiovascular outcomes. Blood pressure data at ages 7, 11, 18, 26, 32, and 38 years from a longitudinal, representative birth cohort study (n=975) were used to identify 4 distinct trajectory groups via group-based trajectory modeling: normal (21.8%), high-normal (43.3%), prehypertensive (31.6%), and hypertensive (4.2%). The categories refer to blood pressure beginning at the age of 7 years and most recently measured at the age of 38 years. Family history of high blood pressure (odds ratio [OR], 43.23; 95% confidence interval [CI], 5.27-354.65), male sex (OR, 109.48; 95% CI, 26.82-446.96), being first born (OR, 2.5; 95% CI, 1.00-8.69) and low birth weight (OR, 2.79; 95% CI, 2.49-3.09) were associated with hypertensive group membership (compared with the normal group). Higher body mass index and cigarette smoking resulted in increasing blood pressure across trajectories, particularly for the higher blood pressure groups. Prehypertensive and hypertensive trajectory groups had worse cardiovascular outcomes by early midlife. Harmful blood pressure trajectories are identifiable in childhood, associated with both antecedent and modifiable risk factors over time, and predict adult cardiovascular disease risk. Early detection and subsequent targeted prevention and intervention may reduce the lifecourse burden associated with higher blood pressure.
Collapse
Affiliation(s)
- Reremoana F Theodore
- From the Dunedin Multidisciplinary Health and Development Research Unit, Department of Psychology (R.F.T., S.H., S.R., R.P.), Department of Oral Rehabilitation, Sir John Walsh Research Institute, Faculty of Dentistry (J.B.), Department of Medicine, Dunedin School of Medicine (M.J.A.W.), University of Otago, Dunedin, New Zealand; Heinz School of Public and Policy and Management, Carnegie Mellon University, Pittsburgh, PA (D.N.); Medical Research Council Social, Genetic, and Developmental Psychiatry Research Centre, Institute of Psychiatry, King's College London, London, United Kingdom (A.A., T.E.M., A.C.); Liggins Institute (W.C.) and Centre of Methods and Policy Application in the Social Sciences (B.M.), University of Auckland, Auckland, New Zealand; and Departments of Psychology and Neuroscience (H.L.H., T.E.M., A.C.) and Psychiatry and Behavioral Sciences (H.L.H., T.E.M., A.C.), Duke University, Durham, NC.
| | - Jonathan Broadbent
- From the Dunedin Multidisciplinary Health and Development Research Unit, Department of Psychology (R.F.T., S.H., S.R., R.P.), Department of Oral Rehabilitation, Sir John Walsh Research Institute, Faculty of Dentistry (J.B.), Department of Medicine, Dunedin School of Medicine (M.J.A.W.), University of Otago, Dunedin, New Zealand; Heinz School of Public and Policy and Management, Carnegie Mellon University, Pittsburgh, PA (D.N.); Medical Research Council Social, Genetic, and Developmental Psychiatry Research Centre, Institute of Psychiatry, King's College London, London, United Kingdom (A.A., T.E.M., A.C.); Liggins Institute (W.C.) and Centre of Methods and Policy Application in the Social Sciences (B.M.), University of Auckland, Auckland, New Zealand; and Departments of Psychology and Neuroscience (H.L.H., T.E.M., A.C.) and Psychiatry and Behavioral Sciences (H.L.H., T.E.M., A.C.), Duke University, Durham, NC
| | - Daniel Nagin
- From the Dunedin Multidisciplinary Health and Development Research Unit, Department of Psychology (R.F.T., S.H., S.R., R.P.), Department of Oral Rehabilitation, Sir John Walsh Research Institute, Faculty of Dentistry (J.B.), Department of Medicine, Dunedin School of Medicine (M.J.A.W.), University of Otago, Dunedin, New Zealand; Heinz School of Public and Policy and Management, Carnegie Mellon University, Pittsburgh, PA (D.N.); Medical Research Council Social, Genetic, and Developmental Psychiatry Research Centre, Institute of Psychiatry, King's College London, London, United Kingdom (A.A., T.E.M., A.C.); Liggins Institute (W.C.) and Centre of Methods and Policy Application in the Social Sciences (B.M.), University of Auckland, Auckland, New Zealand; and Departments of Psychology and Neuroscience (H.L.H., T.E.M., A.C.) and Psychiatry and Behavioral Sciences (H.L.H., T.E.M., A.C.), Duke University, Durham, NC
| | - Antony Ambler
- From the Dunedin Multidisciplinary Health and Development Research Unit, Department of Psychology (R.F.T., S.H., S.R., R.P.), Department of Oral Rehabilitation, Sir John Walsh Research Institute, Faculty of Dentistry (J.B.), Department of Medicine, Dunedin School of Medicine (M.J.A.W.), University of Otago, Dunedin, New Zealand; Heinz School of Public and Policy and Management, Carnegie Mellon University, Pittsburgh, PA (D.N.); Medical Research Council Social, Genetic, and Developmental Psychiatry Research Centre, Institute of Psychiatry, King's College London, London, United Kingdom (A.A., T.E.M., A.C.); Liggins Institute (W.C.) and Centre of Methods and Policy Application in the Social Sciences (B.M.), University of Auckland, Auckland, New Zealand; and Departments of Psychology and Neuroscience (H.L.H., T.E.M., A.C.) and Psychiatry and Behavioral Sciences (H.L.H., T.E.M., A.C.), Duke University, Durham, NC
| | - Sean Hogan
- From the Dunedin Multidisciplinary Health and Development Research Unit, Department of Psychology (R.F.T., S.H., S.R., R.P.), Department of Oral Rehabilitation, Sir John Walsh Research Institute, Faculty of Dentistry (J.B.), Department of Medicine, Dunedin School of Medicine (M.J.A.W.), University of Otago, Dunedin, New Zealand; Heinz School of Public and Policy and Management, Carnegie Mellon University, Pittsburgh, PA (D.N.); Medical Research Council Social, Genetic, and Developmental Psychiatry Research Centre, Institute of Psychiatry, King's College London, London, United Kingdom (A.A., T.E.M., A.C.); Liggins Institute (W.C.) and Centre of Methods and Policy Application in the Social Sciences (B.M.), University of Auckland, Auckland, New Zealand; and Departments of Psychology and Neuroscience (H.L.H., T.E.M., A.C.) and Psychiatry and Behavioral Sciences (H.L.H., T.E.M., A.C.), Duke University, Durham, NC
| | - Sandhya Ramrakha
- From the Dunedin Multidisciplinary Health and Development Research Unit, Department of Psychology (R.F.T., S.H., S.R., R.P.), Department of Oral Rehabilitation, Sir John Walsh Research Institute, Faculty of Dentistry (J.B.), Department of Medicine, Dunedin School of Medicine (M.J.A.W.), University of Otago, Dunedin, New Zealand; Heinz School of Public and Policy and Management, Carnegie Mellon University, Pittsburgh, PA (D.N.); Medical Research Council Social, Genetic, and Developmental Psychiatry Research Centre, Institute of Psychiatry, King's College London, London, United Kingdom (A.A., T.E.M., A.C.); Liggins Institute (W.C.) and Centre of Methods and Policy Application in the Social Sciences (B.M.), University of Auckland, Auckland, New Zealand; and Departments of Psychology and Neuroscience (H.L.H., T.E.M., A.C.) and Psychiatry and Behavioral Sciences (H.L.H., T.E.M., A.C.), Duke University, Durham, NC
| | - Wayne Cutfield
- From the Dunedin Multidisciplinary Health and Development Research Unit, Department of Psychology (R.F.T., S.H., S.R., R.P.), Department of Oral Rehabilitation, Sir John Walsh Research Institute, Faculty of Dentistry (J.B.), Department of Medicine, Dunedin School of Medicine (M.J.A.W.), University of Otago, Dunedin, New Zealand; Heinz School of Public and Policy and Management, Carnegie Mellon University, Pittsburgh, PA (D.N.); Medical Research Council Social, Genetic, and Developmental Psychiatry Research Centre, Institute of Psychiatry, King's College London, London, United Kingdom (A.A., T.E.M., A.C.); Liggins Institute (W.C.) and Centre of Methods and Policy Application in the Social Sciences (B.M.), University of Auckland, Auckland, New Zealand; and Departments of Psychology and Neuroscience (H.L.H., T.E.M., A.C.) and Psychiatry and Behavioral Sciences (H.L.H., T.E.M., A.C.), Duke University, Durham, NC
| | - Michael J A Williams
- From the Dunedin Multidisciplinary Health and Development Research Unit, Department of Psychology (R.F.T., S.H., S.R., R.P.), Department of Oral Rehabilitation, Sir John Walsh Research Institute, Faculty of Dentistry (J.B.), Department of Medicine, Dunedin School of Medicine (M.J.A.W.), University of Otago, Dunedin, New Zealand; Heinz School of Public and Policy and Management, Carnegie Mellon University, Pittsburgh, PA (D.N.); Medical Research Council Social, Genetic, and Developmental Psychiatry Research Centre, Institute of Psychiatry, King's College London, London, United Kingdom (A.A., T.E.M., A.C.); Liggins Institute (W.C.) and Centre of Methods and Policy Application in the Social Sciences (B.M.), University of Auckland, Auckland, New Zealand; and Departments of Psychology and Neuroscience (H.L.H., T.E.M., A.C.) and Psychiatry and Behavioral Sciences (H.L.H., T.E.M., A.C.), Duke University, Durham, NC
| | - HonaLee Harrington
- From the Dunedin Multidisciplinary Health and Development Research Unit, Department of Psychology (R.F.T., S.H., S.R., R.P.), Department of Oral Rehabilitation, Sir John Walsh Research Institute, Faculty of Dentistry (J.B.), Department of Medicine, Dunedin School of Medicine (M.J.A.W.), University of Otago, Dunedin, New Zealand; Heinz School of Public and Policy and Management, Carnegie Mellon University, Pittsburgh, PA (D.N.); Medical Research Council Social, Genetic, and Developmental Psychiatry Research Centre, Institute of Psychiatry, King's College London, London, United Kingdom (A.A., T.E.M., A.C.); Liggins Institute (W.C.) and Centre of Methods and Policy Application in the Social Sciences (B.M.), University of Auckland, Auckland, New Zealand; and Departments of Psychology and Neuroscience (H.L.H., T.E.M., A.C.) and Psychiatry and Behavioral Sciences (H.L.H., T.E.M., A.C.), Duke University, Durham, NC
| | - Terrie E Moffitt
- From the Dunedin Multidisciplinary Health and Development Research Unit, Department of Psychology (R.F.T., S.H., S.R., R.P.), Department of Oral Rehabilitation, Sir John Walsh Research Institute, Faculty of Dentistry (J.B.), Department of Medicine, Dunedin School of Medicine (M.J.A.W.), University of Otago, Dunedin, New Zealand; Heinz School of Public and Policy and Management, Carnegie Mellon University, Pittsburgh, PA (D.N.); Medical Research Council Social, Genetic, and Developmental Psychiatry Research Centre, Institute of Psychiatry, King's College London, London, United Kingdom (A.A., T.E.M., A.C.); Liggins Institute (W.C.) and Centre of Methods and Policy Application in the Social Sciences (B.M.), University of Auckland, Auckland, New Zealand; and Departments of Psychology and Neuroscience (H.L.H., T.E.M., A.C.) and Psychiatry and Behavioral Sciences (H.L.H., T.E.M., A.C.), Duke University, Durham, NC
| | - Avshalom Caspi
- From the Dunedin Multidisciplinary Health and Development Research Unit, Department of Psychology (R.F.T., S.H., S.R., R.P.), Department of Oral Rehabilitation, Sir John Walsh Research Institute, Faculty of Dentistry (J.B.), Department of Medicine, Dunedin School of Medicine (M.J.A.W.), University of Otago, Dunedin, New Zealand; Heinz School of Public and Policy and Management, Carnegie Mellon University, Pittsburgh, PA (D.N.); Medical Research Council Social, Genetic, and Developmental Psychiatry Research Centre, Institute of Psychiatry, King's College London, London, United Kingdom (A.A., T.E.M., A.C.); Liggins Institute (W.C.) and Centre of Methods and Policy Application in the Social Sciences (B.M.), University of Auckland, Auckland, New Zealand; and Departments of Psychology and Neuroscience (H.L.H., T.E.M., A.C.) and Psychiatry and Behavioral Sciences (H.L.H., T.E.M., A.C.), Duke University, Durham, NC
| | - Barry Milne
- From the Dunedin Multidisciplinary Health and Development Research Unit, Department of Psychology (R.F.T., S.H., S.R., R.P.), Department of Oral Rehabilitation, Sir John Walsh Research Institute, Faculty of Dentistry (J.B.), Department of Medicine, Dunedin School of Medicine (M.J.A.W.), University of Otago, Dunedin, New Zealand; Heinz School of Public and Policy and Management, Carnegie Mellon University, Pittsburgh, PA (D.N.); Medical Research Council Social, Genetic, and Developmental Psychiatry Research Centre, Institute of Psychiatry, King's College London, London, United Kingdom (A.A., T.E.M., A.C.); Liggins Institute (W.C.) and Centre of Methods and Policy Application in the Social Sciences (B.M.), University of Auckland, Auckland, New Zealand; and Departments of Psychology and Neuroscience (H.L.H., T.E.M., A.C.) and Psychiatry and Behavioral Sciences (H.L.H., T.E.M., A.C.), Duke University, Durham, NC
| | - Richie Poulton
- From the Dunedin Multidisciplinary Health and Development Research Unit, Department of Psychology (R.F.T., S.H., S.R., R.P.), Department of Oral Rehabilitation, Sir John Walsh Research Institute, Faculty of Dentistry (J.B.), Department of Medicine, Dunedin School of Medicine (M.J.A.W.), University of Otago, Dunedin, New Zealand; Heinz School of Public and Policy and Management, Carnegie Mellon University, Pittsburgh, PA (D.N.); Medical Research Council Social, Genetic, and Developmental Psychiatry Research Centre, Institute of Psychiatry, King's College London, London, United Kingdom (A.A., T.E.M., A.C.); Liggins Institute (W.C.) and Centre of Methods and Policy Application in the Social Sciences (B.M.), University of Auckland, Auckland, New Zealand; and Departments of Psychology and Neuroscience (H.L.H., T.E.M., A.C.) and Psychiatry and Behavioral Sciences (H.L.H., T.E.M., A.C.), Duke University, Durham, NC
| |
Collapse
|
22
|
Holdaway IM, Hunt P, Manning P, Cutfield W, Gamble G, Ninow N, Staples-Moon D, Moodie P, Metcalfe S. Three-year experience with access to nationally funded growth hormone (GH) replacement for GH-deficient adults. Clin Endocrinol (Oxf) 2015; 83:85-90. [PMID: 25523467 DOI: 10.1111/cen.12691] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [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] [Received: 10/02/2014] [Revised: 10/23/2014] [Accepted: 12/03/2014] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Treatment of growth hormone (GH)-deficient adults with GH has been shown to improve a range of metabolic abnormalities and enhance quality of life. However, the results of access to nationally funded treatment have not been reported. DESIGN Retrospective case series auditing nationally funded treatment of defined GH-deficient adults in New Zealand, with carefully designed entry and exit criteria overseen by a panel of endocrinologists. PATIENTS Applications for 201 patients were assessed and 191 approved for funded treatment over the initial 3 years since inception. The majority had GH deficiency following treatment of pituitary adenomas or tumours adjacent to the pituitary. RESULTS After an initial 9-month treatment period using serum IGF-I measurements to adjust GH dosing, all patients reported a significant improvement in quality of life (QoL) score on the QoL-AGHDA(®) instrument (baseline (95%CI) 19 (18-21), 9 months 6 (5-7.5)), and mean serum IGF-I SD scores rose from -3 to zero. Mean waist circumference decreased significantly by 2.8 ± 0.6 cm. The mean maintenance GH dose after 9 months of treatment was 0.39 mg/day. After 3 years, 17% of patients had stopped treatment, and all of the remaining patients maintained the improvements seen at 9 months of treatment. CONCLUSION Carefully designed access to nationally funded GH replacement in GH-deficient adults was associated with a significant improvement in quality of life over a 3-year period with mean daily GH doses lower than in the majority of previously reported studies.
Collapse
Affiliation(s)
- I M Holdaway
- Department of Endocrinology, Auckland Hospital and Greenlane Clinical Centre, Auckland, New Zealand
| | - P Hunt
- Department of Endocrinology, Christchurch Hospital, Christchurch, New Zealand
| | - P Manning
- Department of Endocrinology, Dunedin Hospital, Dunedin, New Zealand
| | - W Cutfield
- Liggins Institute, Auckland University School of Medicine, Auckland, New Zealand
| | - G Gamble
- Department of Medicine, University of Auckland School of Medicine, Auckland, New Zealand
| | - N Ninow
- Pharmaceutical Management Agency, Wellington, New Zealand
| | - D Staples-Moon
- Pharmaceutical Management Agency, Wellington, New Zealand
| | - P Moodie
- Pharmaceutical Management Agency, Wellington, New Zealand
| | - S Metcalfe
- Pharmaceutical Management Agency, Wellington, New Zealand
| |
Collapse
|
23
|
|
24
|
Albert B, Vickers M, Gray C, Reynolds C, Derraik J, Cameron-Smith D, Hofman P, Cutfield W. Supplementation with oxidised fish oil in pregnancy markedly increases neonatal mortality in male rat offspring. Int J Pediatr Endocrinol 2015. [PMCID: PMC4428201 DOI: 10.1186/1687-9856-2015-s1-o41] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
|
25
|
Albert B, de Bock M, Derraik J, Biggs J, Brennan C, Hofman P, Cutfield W. First borns and offspring of younger parents have increased metabolic risk. Int J Pediatr Endocrinol 2015. [PMCID: PMC4429093 DOI: 10.1186/1687-9856-2015-s1-p107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
26
|
Hughes I, Cotterill A, Choong C, Hofman P, Cutfield W, Werther G, Craig M, Cowell C, Harris M. How databases inform clinical management – insights from ozgrow. Int J Pediatr Endocrinol 2015. [PMCID: PMC4429015 DOI: 10.1186/1687-9856-2015-s1-o4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
|
27
|
Hughes I, Harris M, Cotterill A, Garnett S, Bannink E, Pennell C, Sly P, Leong GM, Cowell C, Ambler G, Werther G, Hofman P, Cutfield W, Choong CS. Comparison of Centers for Disease Control and Prevention and World Health Organization references/standards for height in contemporary Australian children: analyses of the Raine Study and Australian National Children's Nutrition and Physical Activity cohorts. J Paediatr Child Health 2014; 50:895-901. [PMID: 24953978 DOI: 10.1111/jpc.12672] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [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] [Accepted: 05/13/2014] [Indexed: 11/28/2022]
Abstract
AIM (i) To compare the Centers for Disease Control and Prevention (CDC) reference and World Health Organization (WHO) standard/reference for height, particularly with respect to short stature and eligibility for growth hormone (GH) treatment by applying them to contemporary Australian children; (ii) To examine the implications for identifying short stature and eligibility for GH treatment. METHODS Children from the longitudinal Raine Study were serially measured for height from 1991 to 2005 (2-15-year-old girls (660) and boys (702) from Western Australia). In the cross-sectional Australian National Children's Nutrition and Physical Activity survey (2-16-year-old boys (2415) and girls (2379) from all states), height was measured in 2007. Heights were converted to standard deviation scores (SDSs) based on CDC and WHO. RESULTS Means and standard deviations of height-SDS varied between CDC and WHO definitions and with age and gender within each definition. However, both identified similar frequencies of short stature (<1st centile for GH eligibility), although these were very significantly less than the anticipated 1% (0.1-0.7%) of the Australian cohorts. Mean heights in the Australian cohorts were greater than both the WHO and CDC means. CONCLUSIONS Neither CDC nor WHO height standardisations accurately reflect the contemporary Australian child population. Australian children are taller than the CDC or WHO height means, and significantly less than 1% of Australian children are defined as being short using either CDC or WHO. This study suggests there may be a case for an Australian-specific standard/reference for height.
Collapse
Affiliation(s)
- Ian Hughes
- OZGROW, Mater Research, The University of Queensland, Brisbane, Queensland, Australia
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
28
|
Cutfield W. How safe is growth hormone treatment during childhood? Int J Pediatr Endocrinol 2013. [PMCID: PMC3849829 DOI: 10.1186/1687-9856-2013-s1-o14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
29
|
Savage T, Ayyavoo A, Hofman P, Derraik J, Cutfield W. First born children are taller, insulin resistant and have higher blood pressure. Int J Pediatr Endocrinol 2013. [PMCID: PMC3849935 DOI: 10.1186/1687-9856-2013-s1-o53] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
|
30
|
de Bock M, Derraik J, Brennan C, Thorstensen E, Cutfield W. Olive leaf extract improves insulin sensitivity in overweight middle aged males; a randomized, double-blinded, placebo controlled, crossover trial. Int J Pediatr Endocrinol 2013. [PMCID: PMC3849892 DOI: 10.1186/1687-9856-2013-s1-o34] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
31
|
Albert B, Heather N, Cutfield W, Webster D, Gunn A, Jefferies C, Wouldes T, Roberts C, Tregurtha S, Stewart H, Mathai S, Derraik J, Hofman P. Neurodevelopmental outcomes are normal in congenital hypothyroid children diagnosed early and treated aggressively over the first three years. Int J Pediatr Endocrinol 2013. [PMCID: PMC3849863 DOI: 10.1186/1687-9856-2013-s1-o23] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
|
32
|
de Bock M, Derraik J, Brennan C, Cutfield W. Olive leaf extract improves insulin sensitivity in overweight middle aged males: A randomized, double-blinded, placebo controlled, crossover trial. Obes Res Clin Pract 2012. [DOI: 10.1016/j.orcp.2012.08.166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
33
|
|
34
|
Hofman P, Cutfield W, Derraik J, Mathai S, Dalziel S, Harding J, Jefferies C. Preterm birth is associated with increased adiposity in men and their children. Obes Res Clin Pract 2012. [DOI: 10.1016/j.orcp.2012.08.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
35
|
Abstract
Newborn screening for congenital hypothyroidism has been remarkably effective, although rare cases of false negative screening have been reported in same sex twins, presumptively due to fetal blood exchange. We report a case in which the diagnosis of congenital hypothyroidism due to thyroid ectopia in a monozygotic twin was delayed by 8 months, with a normal newborn screening TSH level of 11 mIU/L blood (normal < 15 mIU/L) at 2 days of life. This is the first such case since the national New Zealand newborn screening programme introduced screening for congenital hypothyroidism in 1981 (30 years ago). Repeating thyroid studies at 14 days of age in same-sex twins has been advocated to avoid delayed diagnosis, but given the low risk, may not be cost effective. It is important to maintain a high index of suspicion in same-sex twin pregnancies of potential congenital hypothyroidism.
Collapse
Affiliation(s)
- Anita Azam
- Starship Children's Hospital, Auckland, New Zealand
| | | | | | | | | | | | | |
Collapse
|
36
|
Hughes IP, Harris M, Choong CS, Ambler G, Cutfield W, Hofman P, Cowell CT, Werther G, Cotterill A, Davies PSW. Growth hormone regimens in Australia: analysis of the first 3 years of treatment for idiopathic growth hormone deficiency and idiopathic short stature. Clin Endocrinol (Oxf) 2012; 77:62-71. [PMID: 21950731 DOI: 10.1111/j.1365-2265.2011.04230.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [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: 11/30/2022]
Abstract
OBJECTIVE To investigate response to growth hormone (GH) in the first, second and third years of treatment for all idiopathic GH-deficient (GHD) and idiopathic short stature (ISS) patients in Australia. CONTEXT Eligibility for subsidized GH treatment in Australia is determined on auxological criteria for the indication of Short Stature and Slow Growth (SSSG), which includes ISS (SSSG-ISS). The biochemical GHD (BGHD, peak GH < 10 mU/l) and SSSG indications are treated similarly: starting dose of 4·5 mg/m(2)/week with provision for incremental dosing. Some ISS patients were specifically diagnosed with familial short stature (SSSG-FSS). DESIGN Responses for each year of treatment for BGHD, SSSG-ISS and SSSG-FSS cohorts were compared in relation to influencing variables and with international benchmarks. The effect of incremental dosing was assessed. PATIENTS Australian BGHD, SSSG-ISS and SSSG-FSS patients who had completed 1, 2, or 3 years of treatment and were currently receiving GH. MEASUREMENTS Growth hormone dose, change in height-standard deviation score (ΔSDS) and growth velocity (GV). RESULTS First-year response was 2-3 times greater than that in subsequent years: ΔSDS(1st year) = 0·92, 0·50 and 0·46 for BGHD, SSSG-ISS and SSSG-FSS, respectively. Responses were similar to international reports and inversely related to age at commencement of GH. First-year GV-for-age for BGHD patients was similar to international standards for idiopathic GHD. However, girls had an inferior response to boys when treatment commenced at <6 years of age. First-year GV-for-age for SSSG-ISS/FSS patients was less than ISS standards. Dose increments attenuated the first- to second-year decline in response to BGHD but marginally improved the responses for SSSG-ISS/FSS. CONCLUSIONS The Australian auxology-based GH programme produces comparable responses to international programmes. A lower starting dose is offset by the initiation of treatment at younger ages. Incremental dosing does not appear optimal. A first-year dose of 6·4-6·9 mg/m(2)/week for GHD and 8·9 mg/m(2)/week for ISS with early commencement of GH treatment may be most efficacious.
Collapse
Affiliation(s)
- Ian P Hughes
- The Children's Nutrition Research Centre, Discipline of Paediatrics and Child Health, School of Medicine, The University of Queensland, Herston, Qld, Australia.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
37
|
Jefferies C, Carter P, Reed PW, Cutfield W, Mouat F, Hofman PL, Gunn AJ. The incidence, clinical features, and treatment of type 2 diabetes in children <15 yr in a population-based cohort from Auckland, New Zealand, 1995–2007. Pediatr Diabetes 2012; 13:294-300. [PMID: 22646236 DOI: 10.1111/j.1399-5448.2012.00851.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [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: 11/30/2022] Open
Abstract
BACKGROUND The incidence of type 2 diabetes mellitus (T2DM) is increasing in adolescents in most western countries. The time-course of glycemic control and impact of early treatment remain poorly understood. OBJECTIVES To determine the change in incidence of T2DM, and the time-course of glycemic control in a regional pediatric cohort with T2DM. METHODS Retrospective analysis of prospectively collected data on 52 patients with T2DM from a population-based treatment referral cohort from 1 January 1995 to 31 December 2007. RESULTS The annual incidence of new cases of T2DM in children <15 yr increased fivefold in the Auckland region of New Zealand from 1995 [0.5/100,000; 95% confidence interval (CI) 0.0–2.2] to 2007 (2.5/100,000; 95% CI 1.0–5.5). The average annual incidence per 100,000 over the entire period was 1.3 (95% CI 1.0–1.8) overall, 0.1 (0.0–0.4) in Europeans, and 3.4 in both Maori (2.0–5.3) and Pacifica (2.2–5.0). Fifty-seven percent of children were symptomatic at presentation. Fifty-eight percent of patients were treated with insulin from diagnosis, most of whom were symptomatic (p = 0.003). Follow-up data were available for 48 patients with a mean of 2.4 yr. Although insulin therapy was associated with a greater fall in HbA1c values in the first 12 months of treatment (to a nadir of 7.1 vs. 8.1%, p < 0.05), there was a rapid deterioration after 12 months, and subsequent mean HbA1c values were >9% in both groups. Therapy did not affect body mass index standard deviation score (BMI SDS). CONCLUSIONS The incidence of T2DM in childhood or adolescence increased markedly over a 13-yr period in the Auckland region. Long-
Collapse
Affiliation(s)
- Craig Jefferies
- Starship Children’s Hospital, Auckland District Health Board, Auckland, New Zealand.
| | | | | | | | | | | | | |
Collapse
|
38
|
Gusso S, Salvador C, Hofman P, Cutfield W, Baldi JC, Taberner A, Nielsen P. Design and testing of an MRI-compatible cycle ergometer for non-invasive cardiac assessments during exercise. Biomed Eng Online 2012; 11:13. [PMID: 22423637 PMCID: PMC3334686 DOI: 10.1186/1475-925x-11-13] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [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: 09/06/2011] [Accepted: 03/18/2012] [Indexed: 12/30/2022] Open
Abstract
Background Magnetic resonance imaging (MRI) is an important tool for cardiac research, and it is frequently used for resting cardiac assessments. However, research into non-pharmacological stress cardiac evaluation is limited. Methods We aimed to design a portable and relatively inexpensive MRI cycle ergometer capable of continuously measuring pedalling workload while patients exercise to maintain target heart rates. Results We constructed and tested an MRI-compatible cycle ergometer for a 1.5 T MRI scanner. Resting and sub-maximal exercise images (at 110 beats per minute) were successfully obtained in 8 healthy adults. Conclusions The MRI-compatible cycle ergometer constructed by our research group enabled cardiac assessments at fixed heart rates, while continuously recording power output by directly measuring pedal force and crank rotation.
Collapse
Affiliation(s)
- Silmara Gusso
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | | | | | | | | | | | | |
Collapse
|
39
|
de Bock M, Gunn AJ, Holt JA, Derraik JGB, Reed P, Cutfield W, Mouat F, Hofman P, Jefferies C. Impact of insulin pumps on glycaemic control in a pump-naïve paediatric regional population. J Paediatr Child Health 2012; 48:247-52. [PMID: 22085335 DOI: 10.1111/j.1440-1754.2011.02245.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [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: 11/27/2022]
Abstract
AIM To examine the clinical impact of insulin-pump therapy for children with type 1 diabetes mellitus (T1DM) in a regional paediatric service, Auckland, New Zealand. METHODS Retrospective analysis of children with T1DM from the Starship paediatric diabetes database who started on insulin-pump therapy from 2002 to 2008 compared with the whole T1DM population and with an equal number of non-pump patients matched by age, sex, ethnicity and duration of diabetes. RESULTS From 621 subjects with 6680 clinic visits, 75 children were treated with insulin-pump therapy for more than 12 months. Transitioning to insulin-pump treatment was associated with an improvement in HbA1c compared with baseline (-0.3%/year, P < 0.001) for up to 3 years. In contrast, despite similar deprivation scores, non-pump controls showed a continuing trend to higher HbA1C values (+0.2%/year, P < 0.01). The risk of severe hypoglycaemia fell after pump start (from 27 (0-223) to 5 (0-0.91) events/100 patient years) with no change in non-pump controls; the rate of diabetic ketoacidosis remained low in both groups. CONCLUSIONS In a pump-naïve regional paediatric population, insulin-pump therapy for T1DM was safe and effective, and associated with sustained improvements in HbA1c and lower risk of hypoglycaemia.
Collapse
Affiliation(s)
- Martin de Bock
- The Liggins Institute Department of Physiology, University of Auckland, Auckland, New Zealand.
| | | | | | | | | | | | | | | | | |
Collapse
|
40
|
Affiliation(s)
- Natasha Heather
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | | |
Collapse
|
41
|
Levy-Marchal C, Arslanian S, Cutfield W, Sinaiko A, Druet C, Marcovecchio ML, Chiarelli F. Insulin resistance in children: consensus, perspective, and future directions. J Clin Endocrinol Metab 2010; 95:5189-98. [PMID: 20829185 PMCID: PMC3206517 DOI: 10.1210/jc.2010-1047] [Citation(s) in RCA: 265] [Impact Index Per Article: 18.9] [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: 05/12/2010] [Accepted: 08/06/2010] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Emerging data indicate that insulin resistance is common among children and adolescents and is related to cardiometabolic risk, therefore requiring consideration early in life. However, there is still confusion on how to define insulin resistance, how to measure it, what its risk factors are, and whether there are effective strategies to prevent and treat it. A consensus conference was organized in order to clarify these points. PARTICIPANTS The consensus was internationally supported by all the major scientific societies in pediatric endocrinology and 37 participants. EVIDENCE An independent and systematic search of the literature was conducted to identify key articles relating to insulin resistance in children. CONSENSUS PROCESS The conference was divided into five themes and working groups: background and definition; methods of measurement and screening; risk factors and consequences; prevention; and treatment. Each group selected key issues, searched the literature, and developed a draft document. During a 3-d meeting, these papers were debated and finalized by each group before presenting them to the full forum for further discussion and agreement. CONCLUSIONS Given the current childhood obesity epidemic, insulin resistance in children is an important issue confronting health care professionals. There are no clear criteria to define insulin resistance in children, and surrogate markers such as fasting insulin are poor measures of insulin sensitivity. Based on current screening criteria and methodology, there is no justification for screening children for insulin resistance. Lifestyle interventions including diet and exercise can improve insulin sensitivity, whereas drugs should be implemented only in selected cases.
Collapse
Affiliation(s)
- Claire Levy-Marchal
- Institut National de la Santé et de la Recherche Médicale, Unité 690, Hôpital Robert Debré, Université Paris Diderot, 75013 Paris, France
| | | | | | | | | | | | | |
Collapse
|
42
|
Gusso S, Baldi JC, Cutfield W, Hofman P. Left Ventricular Function During Submaximal Exercise in Type 1 Diabetic Adolescents: an MRI Study. Med Sci Sports Exerc 2010. [DOI: 10.1249/01.mss.0000385338.07904.45] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
43
|
Whalley GA, Gusso S, Hofman P, Cutfield W, Poppe KK, Doughty RN, Baldi JC. Structural and functional cardiac abnormalities in adolescent girls with poorly controlled type 2 diabetes. Diabetes Care 2009; 32:883-8. [PMID: 19196881 PMCID: PMC2671111 DOI: 10.2337/dc08-2005] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [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 Type 2 diabetes is associated with left ventricular hypertrophy (LVH) and diastolic dysfunction, which may eventually lead to clinical heart failure. We sought to determine the cardiovascular effects of adolescent-onset type 2 diabetes. RESEARCH DESIGN AND METHODS We recruited diabetic girls (8 with type 2 and 11 with type 1 diabetes) from a hospital diabetes service and nondiabetic control subjects (9 lean and 11 overweight) from the schools of the diabetic subjects. Echocardiography and measurements were performed by a single observer, blinded to subject group allocation, and included M-mode left ventricular dimensions, two-dimensional left ventricular mass, Doppler diastolic flows, estimation of left ventricular filling pressure, and systolic longitudinal motion. Left ventricular mass was indexed to height and fat-free body mass. ANOVA was used to compare the groups. RESULTS The groups were similar in age and height, but significant differences in body composition were observed. Subjects with type 2 diabetes had larger left ventricular dimensions and left ventricular mass, which persisted when indexed to height. Diastolic filling was impaired in both diabetic groups, and systolic longitudinal function was lower in the type 2 diabetic group. Half of the group with type 2 diabetes met the published criteria for LVH and left ventricular dilatation; 25% had evidence of elevated left ventricular filling pressure in association with structural abnormalities. CONCLUSIONS This study has demonstrated preclinical abnormalities of cardiac structure and function in adolescent girls with type 2 diabetes, despite the short duration of diabetes and highlights the potential high cardiovascular risk occurring in adolescent type 2 diabetes.
Collapse
Affiliation(s)
- Gillian A Whalley
- Department of Medicine, Faculty of Medicine and Health Sciences, The University of Auckland, Auckland, New Zealand.
| | | | | | | | | | | | | |
Collapse
|
44
|
Gusso S, Hofman P, Lalande S, Cutfield W, Robinson E, Baldi JC. Impaired stroke volume and aerobic capacity in female adolescents with type 1 and type 2 diabetes mellitus. Diabetologia 2008; 51:1317-20. [PMID: 18446317 DOI: 10.1007/s00125-008-1012-1] [Citation(s) in RCA: 75] [Impact Index Per Article: 4.7] [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: 02/11/2008] [Accepted: 03/25/2008] [Indexed: 10/22/2022]
Abstract
AIM/HYPOTHESIS This study was designed to determine whether type 2 diabetic adolescents have reduced aerobic capacity and to investigate the role of cardiac output and arteriovenous oxygen difference (a-vO(2)) in their exercise response. METHODS Female adolescents (age 12-18 years) with type 2 diabetes mellitus (n = 8) and type 1 diabetes mellitus (n = 12) and obese (n = 10) and non-obese (n = 10) non-diabetic controls were recruited for this study. Baseline data included maximal aerobic capacity (cycle ergometer) and body composition. Cardiac output and a-vO(2) were determined at rest and during submaximal exercise. RESULTS Diabetic groups had lower aerobic capacity than non-diabetic groups (p < 0.05). Adolescents with type 2 diabetes had lower aerobic capacity than the type 1 diabetic group. Maximal heart rate was lower in the type 2 diabetic group (p < 0.05). Exercise stroke volume was 30-40% lower at 100 and 120 beats per min in the diabetic than in the non-diabetic groups (p < 0.05). The a-vO(2) value was not different in any condition. CONCLUSIONS AND INTERPRETATION Type 2 diabetic adolescents have reduced aerobic capacity and reduced heart rate response to maximal exercise. Furthermore, type 2 and type 1 diabetic adolescent girls have a blunted exercise stroke volume response compared with non-diabetic controls. Central rather than peripheral mechanisms contribute to the reduced aerobic capacity in diabetic adolescents. Although of short duration, type 2 diabetes in adolescence is already affecting cardiovascular function in adolescents.
Collapse
Affiliation(s)
- S Gusso
- Liggins Institute, University of Auckland, 2-6 Park Ave, Grafton, Private Bag 92019, Auckland, New Zealand.
| | | | | | | | | | | |
Collapse
|
45
|
Affiliation(s)
- Maithé Tauber
- Hôpital des Enfants, Pediatrie-Endocrinologie, Génétique et Gynécologie Medicale, Toulouse, France.
| | | |
Collapse
|
46
|
Abstract
The developmental origins of health and disease can be understood by reference to the fundamentals of developmental plasticity. It is essential to distinguish between those environmental effects acting during development that are disruptive from those that have adaptive value. The latter are likely to underpin programming and the developmental origins of adult disease. It is suggested that greater disease risk is created by a mismatch between the environment predicted during the plastic phase of development and the actual environment experienced in the postplastic phase. This plastic phase extends from conception to after birth at least for some systems. It is not necessary to invoke a particular mechanism in the neonatal or infant period. There is increasing evidence that prematurity can be associated with long-term consequences, and this is to be anticipated from conceptual considerations. Different preventative strategies may be relevant in different populations.
Collapse
Affiliation(s)
- Peter D Gluckman
- Liggins Institute and National Research Centre for Growth and Development, University of Auckland, 2-6 Park Avenue, Grafton, Private Bag 92019, Auckland, New Zealand.
| | | | | | | |
Collapse
|
47
|
|
48
|
Ranke MB, Lindberg A, Chatelain P, Wilton P, Cutfield W, Albertsson-Wikland K, Price DA. Prediction of long-term response to recombinant human growth hormone in Turner syndrome: development and validation of mathematical models. KIGS International Board. Kabi International Growth Study. J Clin Endocrinol Metab 2000; 85:4212-8. [PMID: 11095456 DOI: 10.1210/jcem.85.11.6976] [Citation(s) in RCA: 58] [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: 02/04/2023]
Abstract
It has become common practice to apply GH treatment in short Turner syndrome patients with the objective of promoting growth. The variability in response and the high costs of this treatment demand the individualization and optimization of therapy. Based on 686 prepubertal Turner patients from the Kabi International Growth Study (KIGS; Pharmacia & Upjohn, Inc. International Growth Database), we undertook a multiple regression analysis of height velocity (centimeters per yr) by using various parameters of potential relevance. Derived prediction models for the first 4 yr of GH treatment were validated with 76 additional KIGS patients and 81 patients from Tuebingen, Germany. Among the 6 predictors identified, the most influential variable for first year growth response was the natural log (ln) of the weekly GH dose. The first year growth response was also correlated with age and distance between height and target height (SD score; both negative) and body weight SD, number of GH injections per week, and oxandrolone treatment given additionally (positive). The first year model explains 46% of the variability, with 1 SD of 1.26 cm. For the second to fourth years, 5 predictors were identified: height velocity during previous years, weekly GH dose (ln), weight SD, oxandrolone therapy (all positive), and age (negative). These models explained 32%, 29%, and 30% of the variability, respectively, with SD scores of 1.1, 1.0, and 1.0 cm, respectively. When the models were applied to the other cohorts, no significant difference was noted between observed and predicted responses. Although the parameters used in our models do not entirely explain the variability in the growth response in Turner syndrome, the parameters themselves were clinically relevant to our present understanding and proved to be of high precision. Some of the tested markers, such as karyotype, do not contribute to the growth response. These variables make the models practical and suitable for planning beneficial and cost-effective therapy.
Collapse
Affiliation(s)
- M B Ranke
- Pediatric Endocrinology Section, University Children's Hospital, Tuebingen, Germany
| | | | | | | | | | | | | |
Collapse
|
49
|
Price DA, Wilton P, Jönsson P, Albertsson-Wikland K, Chatelain P, Cutfield W, Ranke MB. Efficacy and safety of growth hormone treatment in children with prior craniopharyngioma: an analysis of the Pharmacia and Upjohn International Growth Database (KIGS) from 1988 to 1996. Horm Res 2000; 49:91-7. [PMID: 9485178 DOI: 10.1159/000023133] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
We studied short- and long-term responses to growth hormone (GH) treatment and adverse medical events (AE) in 488 patients with craniopharyngioma who were entered into the Kabi International Growth Study (KIGS). First-year growth response and responsiveness (n = 394) were similar to those seen in children with idiopathic GH deficiency. The growth response over 5 years (n = 152) was unaffected by the recurrence of tumour and prior tumour management, but was greater in those receiving thyroxine. Mean height standard deviation scores (SDS) at the end of GH treatment (n = 129) was -0.7+/-1.2, and 79% achieved a height over -2 SD of target height, with evidence of further growth potential. Final height SDS correlated positively with height SDS at the start of treatment and with target height SDS, whereas gain in height SDS was inversely correlated with height SDS and bone age at the start of GH treatment. The rate of recurrence of tumour, 0.045/treatment year, was greater in those who had been treated with surgery alone compared to surgery and cranial irradiation. Other AE included headaches, fluid retention and convulsions occurring at rates of 0.025, 0.005 and 0.004/treatment year, respectively. We concluded that GH treatment is safe and effective in children with craniopharyngioma and provide data for counselling of parents about outcome during GH treatment.
Collapse
Affiliation(s)
- D A Price
- Department of Child Health, University of Manchester, UK
| | | | | | | | | | | | | |
Collapse
|
50
|
Ranke MB, Lindberg A, Chatelain P, Wilton P, Cutfield W, Albertsson-Wikland K, Price DA. Predicting the response to recombinant human growth hormone in Turner syndrome: KIGS models. KIGS International Board. Kabi International Growth Study. Acta Paediatr Suppl 1999; 88:122-5. [PMID: 10626562 DOI: 10.1111/j.1651-2227.1999.tb14420.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
A mathematical model for predicting the growth response in patients with Turner syndrome who received growth hormone (GH) therapy was developed by analysing data from KIGS, the Pharmacia & Upjohn International Growth Database. A model for year 1 of GH therapy explained 46% of the variability of the growth response, with GH dose being the most important of the predictors of height velocity. In years 2-4 of therapy, height velocity during the previous year was the most important predictor, suggesting that an individual's initial response to GH may determine the height outcome of treatment. Additional predictors of height velocity in years 1-4 of GH therapy included age (negative), weight SDS and additional treatment with oxandrolone. The predictions in all 4 years were highly accurate, as indicated by the low error SDs. However, relatively low predictive power (R) during years 2-4 of treatment suggests the models are missing other parameters that would explain more of the variability of the growth response. These growth prediction models could help clinicians to design individualized treatment regimens, provide realistic expectations of therapy outcomes, and adjust treatment on the basis of detected differences between observed and predicted height velocities.
Collapse
Affiliation(s)
- M B Ranke
- Paediatric Endocrinology Section, University Children's Hospital, Tübingen, Germany.
| | | | | | | | | | | | | |
Collapse
|