The current study examines the prevalence of binge eating and its association with adiposity and psychosocial functioning in a large, diverse sample of youth with type 2 diabetes.
In the TODAY study, ...678 (mean age 14.0 years; 64.9% girls) of the 704 youth randomized to the study completed a self-report measure of eating disorder symptoms and were categorized as nonovereaters, overeaters, subclinical binge eaters, or clinical binge eaters.
Youth with clinical (6%) and subclinical (20%) levels of binge eating had significantly higher levels and rates of extreme obesity, global eating disorder and depressive symptoms, and impaired quality of life.
These findings highlight the importance of evaluating youth with type 2 diabetes for the presence of binge eating. Future research is needed to determine the cumulative effects of disordered eating, obesity, and psychosocial distress on adherence to lifestyle change recommendations and longitudinal response to treatment.
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The identification and SAR development of a series of negative allosteric modulators of the GABAA α5 receptor is described. This novel series of compounds was optimised to provide ...analogues with high GABAA α5 binding affinity, high α5 negative allosteric modulatory activity, good functional subtype selectivity and low microsomal turnover, culminating in identification of ONO-8590580.
INTRODUCTION
The prevalence of poor sleep quality and sleep apnea differs by race and ethnicity and may contribute to racial disparities in cognitive aging. We investigated whether sleep quality and ...sleep apnea risk were associated with cognitive function and decline and whether the associations differed by race/ethnicity.
METHODS
Participants from the Kaiser Healthy Aging and Diverse Life Experiences (KHANDLE; N = 1690; mean age: 75.7 years) study, a cohort of Asian, Black, Latino, and White participants, completed a modified Pittsburgh Sleep Quality Index assessing subjective sleep quality, latency, duration, disturbances, sleep medication use, and daytime dysfunction. Sleep apnea risk was measured by questions about snoring, tiredness, and whether apnea was observed. Executive function and verbal episodic memory were assessed at three time points over an average of 2.7 years with the Spanish and English Neuropsychological Assessment Scale. We fit linear mixed‐effect models and stratified analyses by race/ethnicity.
RESULTS
Higher sleep apnea risk was associated with faster declines in verbal episodic memory (β̂$\hat \beta $sleep apnea = −0.02, 95% confidence interval CI, −0.04, −0.001) but not in executive function. Poorer sleep quality was associated with lower levels of and faster decline in executive function but not in verbal episodic memory. Race/ethnicity modified these associations: compared to estimated effects among White participants, poorer global sleep quality (β̂$\hat \beta $sleep*time = −0.02, 95% CI, −0.02, −0.01) was associated with larger effects on decline in executive function among Black participants. Estimated effects of some individual sleep quality components were also modified by race/ethnicity; for example, sleep medication use was associated with faster declines in executive function (β̂$\hat \beta $sleep*time = −0.05, 95% CI, −0.07, −0.03) and verbal episodic memory β̂$\hat \beta $sleep*time = −0.04, 95% CI, −0.07, −0.02) among Black participants compared to White participants.
DISCUSSION
Observational evidence indicates sleep quality is a promising target for addressing racial/ethnic disparities in cognitive aging, especially among Black older adults.
Highlights
Sleep apnea risk was associated with faster declines in verbal episodic memory but not executive function among all participants.
Global sleep quality was associated with lower levels of and faster decline in executive function but not verbal episodic memory among all participants.
Black older adults were particularly susceptible to the estimated adverse cognitive impacts of global sleep quality, particularly the use of sleep medication.
Summary
Background
The Treatment Options for type 2 Diabetes in Adolescents and Youth (TODAY) clinical trial documented that metformin plus rosiglitazone, but not metformin plus lifestyle ...intervention, provided superior durability of glycemic control relative to metformin monotherapy.
Objectives
We examined weight changes among TODAY participants that completed at least 6 months of treatment, evaluated predictors of lifestyle outcome, and examined whether weight changes were related to cardiometabolic outcomes across treatment arms.
Methods
The 595 youth with type 2 diabetes, (85.1% of randomized participants aged 11–17 years) completed assessments of weight‐related and cardiometabolic measures at months 0, 6, 12 and 24. Repeated measures models were used to investigate associations over time.
Results
Lifestyle intervention did not enhance outcome relative to metformin alone and no predictors of response to lifestyle treatment were identified. However, changes in percent overweight across treatment arms were associated with changes in multiple cardiometabolic risk factors, and decreases of ≥ 7% in overweight were associated with significant benefits over 24 months.
Conclusions
Although adjunctive intensive lifestyle intervention did not improve weight‐related outcomes, weight changes in the full TODAY sample were associated with small, but significant improvements in cardiometabolic status, highlighting the importance of optimizing weight management in youth with T2DM.
Presence of Diabetes Risk Factors in a Large U.S. Eighth-Grade Cohort
The STOPP-T2D Prevention Study Group *
From the George Washington University Biostatistics Center, Rockville, Maryland
Address ...correspondence and reprint requests to Kathryn Hirst, PhD, George Washington University Biostatistics Center, 6110
Executive Blvd., Suite 750, Rockville, MD 20852. E-mail: khirst{at}biostat.bsc.gwu.edu
Abstract
OBJECTIVE —The study was conducted in 12 middle schools to determine the prevalence of diabetes, pre-diabetes, and diabetes risk factors
in eighth-grade students who were predominantly minority and evaluate the feasibility of collecting physical and laboratory
data in schools.
RESEARCH DESIGN AND METHODS —Anthropometric measurements and fasting and 2-h post-glucose load blood draws were obtained from ∼1,740 eighth-grade students.
RESULTS —Mean recruitment rate was 50% per school, 49% had BMI ≥85th percentile, 40.5% had fasting glucose ≥100 mg/dl, 0.4% had fasting
glucose ≥126 mg/dl, and 2.0% had 2-h glucose ≥140 mg/dl and 0.1% ≥200 mg/dl. Mean fasting insulin value was 30.1 μU/ml, 36.2%
had fasting insulin ≥30 μU/ml, and 2-h mean insulin was 102.1 μU/ml. Fasting and 2-h glucose and insulin values increased
across BMI percentiles, and fasting glucose was highest in Hispanic and Native American students.
CONCLUSIONS —There was a high prevalence of risk factors for diabetes, including impaired fasting glucose (≥100 mg/dl), hyperinsulinism
suggestive of insulin resistance (fasting insulin ≥30 μU/ml), and BMI ≥85th percentile. These data suggest that middle schools
are appropriate targets for population-based efforts to decrease overweight and diabetes risk.
IFG, impaired fasting glucose
IGT, impaired glucose tolerance
NHANES, National Health and Nutrition Examination Survey
STOPP-T2D, Studies to Treat Or Prevent Pediatric Type 2 Diabetes
Footnotes
*
↵ * A complete listing of STOPP-T2D Prevention Study Group members can be found in the appendix .
A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances.
Accepted October 23, 2005.
Received June 7, 2005.
DIABETES CARE
BACKGROUNDPreterm birth is a leading cause of infant mortality, particularly for those born extremely prematurely (EP; <28 weeks' gestational age GA). Survivors are predisposed to complications such ...as bronchopulmonary dysplasia (BPD), chronic lung disease (CLD), intraventricular hemorrhage (IVH), and retinopathy of prematurity (ROP). AIMSTo examine the epidemiology, complications, and mortality/survival among EP infants. STUDY DESIGNRetrospective analysis of electronic medical records from the Kaiser Permanente Northern California database. SUBJECTSEP infants live-born between 22 and <28 weeks' GA from 1997 to 2016. OUTCOME MEASURESCumulative all-cause mortality/survival were analyzed and stratified by GA (22 to <24, 24 to <26, 26 to <28 weeks), complications (BPD/CLD, IVH, ROP), and birth period (1997 to 2003, 2004 to 2009, 2010 to 2016). Cox proportional hazard models were constructed to assess the mortality risk associated with BPD/CLD or IVH. RESULTS2154 EP infants were identified; of these, 916 deaths were recorded. Mortality was highest during the first 3 months (41.7 % cumulative mortality), and few were reported after 2 years (42.5 % cumulative mortality). Mortality decreased with higher GA and over more recent birth periods. BPD/CLD and IVH grade 3/4 were associated with increased mortality risk versus no complications (adjusted hazard ratios 1.41 and 1.78, respectively). CONCLUSIONSThe risk of mortality is high during the first few months of life for EP infants, and is even higher for those with BPD and IVH. Despite an overall trend toward increased survival for EP infants, strategies targeting survival of EP infants with these complications are needed.
This IJNS special issue celebrates the first ten years of the International Nuclear Security Education Network (INSEN). A partnership between the International Atomic Energy Agency (IAEA) and the ...international academic community, INSEN was established in 2010 to promote nuclear security education. The articles in this issue focus on the shared education and training experiences of INSEN members in this new academic field of nuclear security. This special issue also features sketches of INSEN life provided by a number of its chairs, who share their thoughts and feelings about INSEN’s significance for the organization’s educators and leaders, and who chronicle the transformation of the network.
Summary
Objective
The objective of this study was to examine the effects of an integrated, multi‐component, school‐based intervention programme on cardiovascular disease (CVD) risk factors among a ...multi‐ethnic cohort of middle school students.
Methods
HEALTHY was a cluster randomized, controlled, primary prevention trial. Middle school was the unit of randomization and intervention. Half of the schools were assigned to an intervention programme consisting of changes in the total school food environment and physical education classes, enhanced by educational outreach and behaviour change activities and promoted by a social marketing campaign consisting of reinforcing messages and images. Outcome data reported (anthropometrics, blood pressure and fasting lipid levels) were collected on a cohort of students enrolled at the start of 6th grade (∼11–12 years old) and followed to end of 8th grade (∼13–14 years old).
Results
Forty‐two middle schools were enrolled at seven field centres; 4363 students provided both informed consent and CVD data at baseline and end of study. The sample was 52.7% female, 54.5% Hispanic, 17.6% non‐Hispanic Black, 19.4% non‐Hispanic White and 8.5% other racial/ethnic combinations, and 49.6% were categorized as overweight or obese (body mass index ≥ 85th percentile) at baseline. A significant intervention effect was detected in the prevalence of hypertension in non‐Hispanic Black and White males. The intervention produced no significant changes in lipid levels.
Conclusions
The prevalence of some CVD risk factors is high in minority middle school youth, particularly males. A multi‐component, school‐based programme achieved only modest reductions in these risk factors; however, promising findings occurred in non‐Hispanic Black and White males with hypertension.
Approximately 5% of global preterm births are extremely premature (EP), defined as occurring at less than 28 weeks gestational age. Advances in care have led to an increase in the survival of EP ...infants during the neonatal period. However, EP infants have a higher risk of developing complications such as bronchopulmonary dysplasia (BPD), intraventricular hemorrhage (IVH), and retinopathy of prematurity (ROP). BPD and other respiratory morbidities are particularly prevalent among this population. To understand the healthcare resource utilization (HRU) of EP infants in the United States, the clinical and economic burden of extreme prematurity was examined in this retrospective study of data extracted from electronic medical records in the Kaiser Permanente Northern California (KPNC) health system.
The analysis included data from EP infants live-born between January 1997 and December 2016, and focused on complications and HRU up to 3 years corrected age (CA), covering the period up to December 2018. Stillbirths, infants born at <22 weeks gestational age, and infants with major congenital malformations were excluded. Complications of interest (BPD, IVH, and ROP) and medication use were compared by age group (≤1 year, >1 year and ≤2 years, and >2 years and ≤3 years CA). Analysis of HRU included hospital readmissions, ambulatory visits, and emergency room (ER) visits.
A total of 2154 EP births (0.32% of total live births and 4.0% of preterm births that met the inclusion/exclusion criteria) were analyzed. The prevalence of EP birth showed a declining trend over time. ROP was the most commonly recorded complication during the birth hospitalization (37.1% any stage; 2.9% Stages 3 and 4). BPD was recorded in 34.3% of EP infants. IVH (any grade) was recorded in 22.7% of EP infants (6.4% Grades III and IV). A majority (78.7%) of EP infants were diagnosed with at least one respiratory condition during the first year CA, the most common being pneumonia (68.9%); the prevalence of respiratory conditions decreased over the second and third years CA. During the first 3 years CA, the most common medications prescribed to children born EP were inhaled bronchodilators (approximately 30% of children); at least 15% of children received systemic corticosteroids and inhaled steroids during this period. During the first 3 years CA, at least one hospital readmission was recorded for 16.4% of children born EP; 57.1% of these readmissions were related to respiratory conditions. At least one ER visit was recorded for 33.8% of children born EP, for which 53.1% were due to a respiratory condition. Ambulatory visits were recorded for 54.2% of EP children, for which 82.9% were due to a respiratory condition.
The short- and long-term clinical burden of EP birth was high. The onset of BPD, IVH, and ROP was common during the birth hospitalization for EP infants. Medication use, hospital readmission, and clinic visits (ER and ambulatory) occurred frequently in these children during the first 3 years CA, and were commonly due to respiratory conditions. Strategies prioritizing the reduction of risk and severity of respiratory conditions may alleviate the clinical burden of EP birth over the long term.
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