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<recommendedContent xmlns="http://api.mspoke.com">
    <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=1265776656054"
                     
      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=1265776656054"
                     
      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="20100101_19_235"
                     title="Congenital Anomalies Linked to Mom&apos;s Diabetes (CME/CE)"
                     score="0"
                     href="http://www.medpagetoday.com/OBGYN/Pregnancy/tb/18065?impressionId=1265776656054"
                     
      &lt;p&gt;Pregestational maternal diabetes was associated with an increased risk of a major congenital anomaly, but obesity itself was not, a cross-sectional study found.&lt;/p&gt;
&lt;p&gt;In a multivariable logistic model, the major contributor to a rising rate of congenital anomalies was maternal pregestational diabetes (OR 3.8, 95% CI 2.1 to 6.6), according to Joseph R. Biggio, Jr., MD, and colleagues from the University of Alabama at Birmingham.&lt;/p&gt;
&lt;p&gt;&quot;Because hyperglycemia is a major contributor to developmental malformations, interventions to address obesity and identify women at risk for diabetes and hyperglycemia should be considered in efforts to reduce the occurrence of congenital anomalies,&quot; they wrote in the February issue of &lt;em&gt;Obstetrics &amp;amp; Gynecology.&lt;/em&gt;&lt;/p&gt;
&lt;p&gt;Maternal obesity has been linked with numerous problems, including preeclampsia, gestational diabetes, fetal and neonatal death, and birth trauma, but scientists have disagreed over whether it also contributes to the risk of fetal malformations, the researchers noted.&lt;/p&gt;
&lt;p&gt;To help settle the issue, Biggio and colleagues used a perinatal database in their university health system that included all women with singletons delivered between 1991 and 2004.&lt;/p&gt;
&lt;p&gt;They divided the cohort into three time periods  --  1991 to 1994, 1995 to 1999, and 2000 to 2004, with a total of 41,902 pregnancies.&lt;/p&gt;
&lt;p&gt;For their primary analysis, they defined maternal obesity as a first prenatal visit weight greater than 200 lb, because during the earlier epochs many women did not have body mass index (BMI) calculated. For their secondary analyses they used BMI greater than 29 kg/m&lt;sup&gt;2&lt;/sup&gt; as the criterion for obesity.&lt;/p&gt;
&lt;p&gt;In each epoch, there were increases in mean maternal weight, mean BMI, the proportion of women weighing more than 200 lb, the proportion with a BMI greater than 29 kg/m&lt;sup&gt;2&lt;/sup&gt;, and the prevalence of pregestational diabetes (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.001 for all).&lt;/p&gt;
&lt;p&gt;Univariable analysis determined that the rate of major anomalies, particularly involving the cardiac and pulmonary systems, also increased during each time period.&lt;/p&gt;
&lt;p&gt;But there was no independent association between congenital anomalies and maternal obesity using either definition, during any of the three time periods or during the study overall.&lt;/p&gt;
&lt;p&gt;Although no direct association was seen between congenital malformations and maternal obesity, the investigators reported that the proportion of anomalies that could be attributed to obesity increased from 0% to 23% during the overall study period.&lt;/p&gt;
&lt;p&gt;The proportion of anomalies that could be attributed to diabetes ranged from 58% to 76%.&lt;/p&gt;
&lt;p&gt;Moreover, for obese women with diabetes the proportion of anomalies attributed to diabetes increased sharply, from 48% in the first epoch to 74% in the third epoch.&lt;/p&gt;
&lt;p&gt;In contrast, for the obstetric population as a whole, the population-attributable risk of congenital malformation related to obesity rose from near zero in the first epoch to 6.1% in the third epoch, while that related to diabetes increased from 3.3% to 9.2%, the investigators reported.&lt;/p&gt;
&lt;p&gt;During the course of the study there was a nearly 15-lb increase in maternal weight and a 30% increase in the proportion of women whose BMI exceeded 29 kg/m&lt;sup&gt;2&lt;/sup&gt;.&lt;/p&gt;
&lt;p&gt;There also was a nearly twofold increase in the rate of major anomalies  --  and a 250% increase in the prevalence of diabetes.&lt;/p&gt;
&lt;p&gt;The authors observed that there has been much interest in the effects of maternal obesity on birth defects.&lt;/p&gt;
&lt;p&gt;Although the pathophysiologic basis for this possible association have not been identified, hypotheses have included increased serum insulin, lower levels of folic acid, chronic hypoxia, and increased inflammatory mediators.&lt;/p&gt;
&lt;p&gt;&quot;Our study provides evidence that the defects may not be due solely to the maternal obesity per se but may be due to undiagnosed diabetes,&quot; the investigators wrote.&lt;/p&gt;
&lt;p&gt;From a public health standpoint, the study findings suggest that efforts to reduce the prevalence of congenital anomalies should be focused less on obesity and aimed more closely at correcting hyperglycemia.&lt;/p&gt;
&lt;p&gt;&quot;If euglycemia could be achieved before pregnancy, or at least embryogenesis and organogenesis, the majority of these anomalies could potentially be avoided,&quot; they observed.&lt;/p&gt;
&lt;p&gt;They also suggested that even women of normal weight, but with other diabetes risk factors, could benefit from closer attention to glycemic control.&lt;/p&gt;
&lt;p&gt;A weakness of the study was the fact that detailed data on glycemic control was not available in the perinatal database, &quot;and therefore we cannot comment on the association between glycemic control and anomaly rates,&quot; the investigators wrote.&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 in part by the National Institute of Child Health and Human Development.&lt;/p&gt;&lt;p&gt;The authors did not report any potential conflicts of interest.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20090101_19_3891"
                     title="Gestational Glucose Intolerance Linked to Metabolic Syndrome (CME/CE)"
                     score="-0.005"
                     href="http://www.medpagetoday.com/OBGYN/Pregnancy/tb/17240?impressionId=1265776656054"
                     
      &lt;p&gt;Even mild impairment in glucose tolerance during pregnancy is associated with a greater risk of postpartum metabolic syndrome, researchers found.&lt;/p&gt;
&lt;p&gt;Women who had either gestational glucose intolerance or gestational diabetes were about twice as likely to have metabolic syndrome three months after giving birth than those with normal glucose tolerance, according to Ravi Retnakaran, MD, of Mount Sinai Hospital in Toronto, and colleagues.&lt;/p&gt;
&lt;p&gt;The findings were reported online in the &lt;em&gt;Journal of Clinical Endocrinology &amp;amp; Metabolism&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;The study raises &quot;the important possibility that [these women] represent a patient population at particularly high risk for the future development of metabolic and vascular disease,&quot; Retnakaran said in a statement.&lt;/p&gt;
&lt;p&gt;Screening for gestational diabetes may allow for the detection of otherwise unrecognized latent metabolic syndrome and enable the early modification of cardiovascular risk factors, the researchers said.&lt;/p&gt;
&lt;p&gt;Further study with long-term follow-up is necessary, they said, to determine whether this would have an effect on rates of disease.&lt;/p&gt;
&lt;p&gt;Previous studies have found an association between gestational dysglycemia and increased risks of type 2 diabetes and cardiovascular disease, both of which have also been linked to metabolic syndrome, the researchers said.&lt;/p&gt;
&lt;p&gt;To explore whether impaired glucose tolerance during pregnancy had a relationship with postpartum metabolic syndrome, Retnakaran and colleagues followed 487 women who had a three-hour 100 g oral glucose tolerance test during their second trimester.&lt;/p&gt;
&lt;p&gt;The researchers defined metabolic syndrome according to two different sets of criteria  --  those from the International Diabetes Federation (IDF) and those from the American Heart Association/National Heart, Lung, and Blood Institute (AHA/NHLBI).&lt;/p&gt;
&lt;p&gt;Both sets of criteria required the presence of at least three of the following factors  --  abdominal obesity, dysglycemia, hypertriglyceridemia, hypertension, and low HDL cholesterol.&lt;/p&gt;
&lt;p&gt;The difference between the two sets of criteria lies in how they treat abdominal obesity. IDF requires that it be one of the three factors and defines it as a waist circumference of at least 80 cm, more inclusive than the 88-cm threshold from the AHA/NHLBI.&lt;/p&gt;
&lt;p&gt;In general, rates of dysglycemia, hypertension, hypertriglyceridemia, and low HDL at three months postpartum increased with greater levels of glucose intolerance during pregnancy (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.05 for all).&lt;/p&gt;
&lt;p&gt;Accordingly, the prevalence of metabolic syndrome at three months rose as well.&lt;/p&gt;
&lt;p&gt;Using IDF criteria, 10% of women with normal glucose tolerance, 17.6% of those with impaired glucose tolerance, and 20% of those with gestational diabetes had the syndrome (&lt;em&gt;P&lt;/em&gt;=0.016).&lt;/p&gt;
&lt;p&gt;Using the AHA/NHLBI criteria, rates were 8.98%, 15.4%, and 16.8%, respectively (&lt;em&gt;P&lt;/em&gt;=0.046).&lt;/p&gt;
&lt;p&gt;Logistic regression showed that both impaired glucose tolerance (OR 2.16, 95% CI 1.05 to 4.42) and gestational diabetes (OR 2.05, 95% CI 1.07 to 3.94) were independent predictors of metabolic syndrome at three months&lt;strong&gt; &lt;/strong&gt;postpartum.&lt;/p&gt;
&lt;p&gt;The differences observed between groups were not driven by the rate of abdominal obesity, which did not vary significantly.&lt;/p&gt;
&lt;p&gt;The higher rate of metabolic syndrome among women with some degree of impaired glucose tolerance resulted mostly from elevated rates of hypertriglyceridemia and low HDL, the researchers said.&lt;/p&gt;
&lt;p&gt;They acknowledged that the study was limited by the lack of a prepregnancy assessment of cardiovascular risk factors.&lt;/p&gt;
&lt;p&gt;Also, they said, the study could not provide an estimate for the population prevalence of metabolic syndrome because the researchers disproportionately selected women with impaired glucose tolerance&lt;strong&gt; &lt;/strong&gt;for inclusion in the study.&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 funded by operating grants from the Canadian Institutes of Health Research, the Canadian Diabetes Association, and the Heart and Stroke Foundation of Ontario.&lt;/p&gt;&lt;p&gt;The authors made no financial disclosures.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20090101_1_459"
                     title="Breastfeeding Lowers Mom&apos;s Diabetes Risk"
                     score="-0.005"
                     href="