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    <recommendedItem id="20100101_19_394"
                     title="Even Normal Glucose in Kids Could Predict Diabetes Later (CME/CE)"
                     score="0.013"
                     href="http://www.medpagetoday.com/Endocrinology/Diabetes/tb/18291?impressionId=1265792641185"
                     
      Increases in fasting plasma glucose during childhood  --  even though levels remain in the normal range  --  can predict adult prediabetes and type 2 diabetes later in life, a retrospective cohort study showed.&lt;br&gt;
&lt;br&gt;Among individuals with a fasting plasma glucose of less than 100 mg/dL as children, increasing levels were associated with greater risks of prediabetes (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.001) and type 2 diabetes (&lt;em&gt;P&lt;/em&gt;=0.03) in adulthood, according to Gerald Berenson, MD, of Tulane University Health Sciences Center in New Orleans, and colleagues.&lt;br&gt;
&lt;br&gt;There appeared to be a threshold  --  85 mg/dL  --  above which the risk of adult problems began to increase, the researchers reported in the February issue of &lt;em&gt;Archives of Pediatrics and Adolescent Medicine&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;&quot;It is not surprising that a higher fasting glucose level in childhood predicts prediabetes and diabetes in adulthood,&quot; Matthew Gillman, MD, of Harvard, wrote in an accompanying editorial.&lt;/p&gt;
&lt;p&gt;More surprising, he said, was the existence of the apparent threshold, although &quot;the authors are appropriately circumspect about recommending lowering glucose cutoff points to diagnose children at risk of developing prediabetes or diabetes.&quot;&lt;/p&gt;
&lt;p&gt;&quot;Even if there is a threshold over which children are at substantially higher risk of later prediabetes, it is unclear exactly how high the risk should be to make changing guidelines a good thing,&quot; he wrote. &quot;After all, the right interventions for individuals with prediabetes are still obscure, so identifying more of them may be more trouble than it&apos;s worth.&quot;&lt;/p&gt;
&lt;p&gt;According to Berenson and colleagues, 19 million U.S. adults have type 2 diabetes. More common is a prediabetic state of impaired fasting glucose, affecting about 54 million.&lt;/p&gt;
&lt;p&gt;Previous studies have suggested that higher plasma glucose levels, even if still in the normal range, might be a predictor of diabetes.&lt;/p&gt;
&lt;p&gt;Berenson&apos;s group wanted to see whether elevated fasting plasma glucose in childhood would predict prediabetes or type 2 diabetes in adulthood.&lt;/p&gt;
&lt;p&gt;To find out, they turned to the Bogalusa Heart Study, which began tracking children from that Louisiana town in 1978. All had a fasting plasma glucose lower than 100 mg/dL.&lt;/p&gt;
&lt;p&gt;The current analysis included those same individuals assessed as adults after a mean follow-up of 21 years  --  1,723 were normoglycemic (99 mg/dL or lower), 79 were prediabetic (100 to 125 mg/dL), and 47 had type 2 diabetes.&lt;/p&gt;
&lt;p&gt;Using a childhood fasting plasma glucose of 86 mg/dL or higher as a predictor for prediabetes yielded a 76.9% sensitivity and 85.2% specificity. For diabetes, sensitivity was 75% and specificity was 76%.&lt;/p&gt;
&lt;p&gt;In a multivariate analysis controlling for anthropometric, hemodynamic, and metabolic variables from childhood to adulthood, as well as baseline fasting plasma glucose level, those individuals who had a childhood level 86 mg/dL or higher had increased risks of both prediabetes (OR 3.40, 95% CI 1.87 to 6.18) and type 2 diabetes (OR 2.06, 95% CI 1.01 to 4.23) as adults.&lt;/p&gt;
&lt;p&gt;The authors acknowledged some limitations of the study, including the lack of data on postchallenge glucose, in vivo insulin action and secretion, and glycosylated hemoglobin in childhood.&lt;/p&gt;
&lt;p&gt;Gillman, the editorialist, also noted that the findings&apos; generalizability to children today is unclear because obesity was much less prevalent when the adults in this study were children.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The study was supported by grants from the National Institute on Aging and the American Heart Association.&lt;/p&gt;&lt;p&gt;The editorial was supported by a grant from the NIH.&lt;/p&gt;&lt;p&gt;Neither the study authors nor the editorialist reported any conflicts of interest.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_291"
                     title="Obese Kids at Risk for Adult CVD (CME/CE)"
                     score="0.005"
                     href="http://www.medpagetoday.com/Endocrinology/MetabolicSyndrome/tb/18153?impressionId=1265792641185"
                     
      Obesity in children as young as 7 years old may put them at higher risk of heart disease and stroke later in life, even if they lack other cardiovascular risk factors such as high blood pressure, a new study found.&lt;br&gt;
&lt;br&gt;Obese children had higher levels of biomarkers for inflammation and prothrombosis than thin children. These included 10 times higher concentrations of high sensitivity C-reactive protein, a marker associated with increased risk of developing heart disease, cardiovascular disease, or other processes involving inflammation (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.01), according to an online report published Jan. 26 in the &lt;em&gt;Journal of Clinical Endocrinology and Metabolism&lt;/em&gt;.&lt;br&gt;
&lt;br&gt;Fibrinogen, interleukin-6 (IL-6) and plasminogen activator inhibitor 1 (PAI-1), other markers associated with inflammation and elevated blood clotting risk, were also elevated in obese children (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.01).&lt;p&gt;&lt;/p&gt;
&lt;p&gt;&quot;These observations reflect the unhealthy status of many youth at risk for adult cardiovascular disease in our catchment area in the southeastern U.S.,&quot; Nelly Mauras, MD, of Nemours Children&apos;s Clinic in Jacksonville, Fla., and colleagues wrote.&lt;/p&gt;
&lt;p&gt;The number of overweight children in the U.S. has tripled in the last 30 years, and more than 17% of children between the ages of 6 and 19 are overweight, according to the authors.&lt;/p&gt;
&lt;p&gt;Overweight children often develop metabolic syndrome, a collection of findings that includes abdominal obesity, elevated triglyceride and decreased HDL concentrations, hypertension, and impaired glucose tolerance. These put the youngsters at risk for early adult cardiovascular disease. Yet the exact definition of metabolic syndrome is a matter of ongoing debate.&lt;/p&gt;
&lt;p&gt;While children are typically considered to be at low risk of tissue damage if they show no signs of carbohydrate intolerance, hypertension, and dyslipidemia, Mauras and colleagues theorized that obese children without other risk factors for metabolic syndrome could still be at risk for later cardiovascular disease.&lt;/p&gt;
&lt;p&gt;To test this, they compared markers for inflammation and prothrombosis in 115 obese children and 88 lean children between the ages of 7 and 18 years. The study was conducted at Wolfson Children&apos;s Hospital, in Jacksonville, Fla.&lt;/p&gt;
&lt;p&gt;&quot;Children with obesity show a marked increase in the concentrations of hsCRP, 351 fibrinogen, IL-6 and PAI-1, reflective of a proinflammatory and prothrombotic state, even before the comorbidities of the Metabolic Syndrome are present, and even before the onset of puberty,&quot; they wrote.&lt;/p&gt;
&lt;p&gt;&quot;These data support the need for more aggressive interventions in very young children with obesity regardless of the absence of associated comorbidities.&quot;&lt;/p&gt;
&lt;p&gt;They also found that elevated levels of hsCRP and fibrinogen correlated with a wider waist circumference (R=0.73 and 0.40, respectively) and the percent of fat mass (r= 0.76 and 0.47) (&lt;em&gt;P&lt;/em&gt;=0.0001). Prepubertal obese children were taller than their lean counterparts (&lt;em&gt;P&lt;/em&gt;=0.005) and had higher systolic blood pressure.&lt;/p&gt;
&lt;p&gt;The authors noted that their study did not address whether the abnormalities they found are reversible with early therapeutic interventions.&lt;/p&gt;
&lt;p&gt;&quot;Weight reduction (or weight maintenance in many growing children) remains the cornerstone of any intervention in childhood obesity,&quot; they wrote.&lt;/p&gt;
&lt;p&gt;&quot;However, further longitudinal studies adding pharmacological interventions, in addition to lifestyle changes, will soon offer much needed insight as to whether a decrease in the proinflammatory and prothrombotic state will improve long-term cardiovascular risk of obese children, even in preadolescence and before the development of the Metabolic Syndrome.&quot;&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The authors reported no sources of funding for the study and no financial conflicts of interest.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20090101_1_267"
                     title="The Year in Diabetes, 2005"
                     score="-0.005"
                     href="