Fasting plasma glucose as initial screening for diabetes and prediabetes in irish adults: The Diabetes Mellitus and Vascular health initiative (DMVhi).

OBJECTIVE: Type 2 diabetes has a long pre clinical asymptomatic phase. Early detection may delay or arrest disease progression. The Diabetes Mellitus and Vascular health initiative (DMVhi) was initiated as a prospective longitudinal cohort study on the prevalence of undiagnosed Type 2 diabetes and prediabetes, diabetes risk and cardiovascular risk in a cohort of Irish adults aged 45-75 years. RESEARCH DESIGN AND METHODS: Members of the largest Irish private health insurance provider aged 45 to 75 years were invited to participate in the study. EXCLUSION CRITERIA: already diagnosed with diabetes or taking oral hypoglycaemic agents. Participants completed a detailed medical questionnaire, had weight, height, waist and hip circumference and blood pressure measured. Fasting blood samples were taken for fasting plasma glucose (FPG). Those with FPG in the impaired fasting glucose (IFG) range had a 75gm oral glucose tolerance test performed. RESULTS: 122,531 subjects were invited to participate. 29,144 (24%) completed the study. The prevalence of undiagnosed diabetes was 1.8%, of impaired fasting glucose (IFG) was 7.1% and of impaired glucose tolerance (IGT) was 2.9%. Dysglycaemia increased among those aged 45-54, 55-64 and 65-75 years in both males (10.6%, 18.5%, 21.7% respectively) and females (4.3%, 8.6%, 10.9% respectively). Undiagnosed T2D, IFG and IGT were all associated with gender, age, blood pressure, BMI, abdominal obesity, family history of diabetes and triglyceride levels. Using FPG as initial screening may underestimate the prevalence of T2D in the study population. CONCLUSIONS: This study is the largest screening study for diabetes and prediabetes in the Irish population. Follow up of this cohort will provide data on progression to diabetes and on cardiovascular outcomes.

Inverse Relationship Between Physical Activity, Adiposity, and Arterial Stiffness in Healthy Middle-Aged Subjects.

BACKGROUND: Several obesity related factors are reported to exacerbate premature arterial stiffening, including inactivity and metabolic disarray. The aim of the current study was to investigate the relationship between physical activity, arterial stiffness and adiposity using objective methods. To further explore the role of adiposity in this complex process, obesity associated anthropometric and humoral biomarkers were measured. METHODS: Seventy-nine healthy, lifelong nonsmoking subjects were recruited. Habitual physical activity was measured using accelerometry. Arterial stiffness [augmentation index (AIx) and pulse wave velocity (PWV)] was measured using tonometry. Body composition was estimated using bioimpedence. Adipose associated biomarkers, leptin and adiponectin, were also measured. RESULTS: Sedentary time was significantly associated with AIx (r = 0.38, P < .001), PWV (r = 0.33, P < .01), body fat composition (r = 0.40, P < .001) and age (r = 0.30, P < .01). Moderate-to-vigorous physical activity (MVPA) was inversely correlated with AIx (r = -0.28, P < .05), body fat composition (r = -0.30, P < .01), postprandial insulin (r = -0.35, P < .01), and leptin/adiponectin ratio (r = -0.28, P < .05). MVPA, body fat composition, and postprandial insulin remained independent predictors of AIx but not PWV. CONCLUSION: The more time healthy individuals spend being sedentary, the greater their body fat and arterial stiffness. Conversely higher activity levels are associated with reduced body fat and less arterial stiffness.

An association between abnormal bone turnover, systemic inflammation, and osteoporosis in patients with chronic pancreatitis: a case-matched study.

INTRODUCTION: Because of deteriorating exocrine function, malabsorption renders chronic pancreatitis (CP) patients at risk of osteoporosis and fracture. However, the pathogenesis of low bone mineral density (BMD) has not been characterized. We hypothesized that bone turnover is elevated in CP, and we sought to investigate an association between bone metabolism and systemic inflammation. METHODS: Twenty-nine CP patients and twenty-nine matched controls were recruited. Bone-turnover markers procollagen 1 amino-terminal propeptide (P1NP), OC (osteocalcin; bone formation markers), and carboxy-terminal telopeptide of type I collagen (CTX-I; bone resorption marker) were measured along with vitamin D (25-hydroxyvitamin D, 25OHD), parathyroid hormone (PTH), interleukin 6 (IL-6), high-sensitivity (hs) C-reactive protein (CRP), and sex/thyroid hormones. BMD was measured by dual-energy X-ray absorptiometry. Smoking status was noted. RESULTS: Of the CP patients, 31% had osteoporosis and 44.8% osteopenia (controls: 6.9 and 51.7%, respectively; P=0.019). BMD was lower for patients at the lumbar spine (P=0.014) and femoral neck (P=0.029). Patients had elevated bone formation (P1NP (P=0.0068), OC (P=0.033)) and bone resportion (CTX-I (P=0.016)) compared with controls. Patients had lower 25OHD compared with controls (P=0.0126) and higher inflammatory markers (hsCRP, P=0.0013). Sex and thyroid hormone levels were similar. Patients with lowest 25OHD levels had highest P1NP. In a multivariable model, age, PTH, and smoking were predictive of 25OHD. Patients with osteoporosis had higher P1NP, PTH, and IL-6 and lower 25OHD. Using analysis of variance, inflammation (hsCRP) was highest in those with lowest 25OHD and lowest BMD. CONCLUSIONS: For the first time, bone turnover was shown to be abnormal in CP, and importantly, an association between low 25-OHD, smoking, and systematic inflammation was identified. Moreover, those with osteoporosis had the highest systemic inflammation. Together these factors provide an avenue for potential modification of risk factors, which may ultimately reduce bone loss and avert fractures in this group.

Age and cortisol levels modulate judgment of positive and negative facial expressions.

There is some evidence that older adults respond to emotional stimuli differently to young adults, and that they may exhibit better performance on measures of memory and attention when stimuli are positive rather than negative in valence. A relation between cortisol levels and attention/memory for emotional stimuli in young adults has also been reported. The relationship between cortisol levels and the judgment of facial expressions of emotion in aging, however, has yet to be explored. The aim of this study was to investigate performance on a simple emotional face judgment task in young (N=37) and middle-aged (N=37) adults in association with salivary cortisol levels. Middle-aged participants were slower in responding to stimuli than younger participants. Cortisol levels were found to be associated with shorter response latencies to categorise emotional but not neutral faces, and with a greater tendency to judge neutral faces as being emotional. An interaction between age and cortisol levels emerged in response to angry faces; such that higher cortisol levels predicted significantly shorter reaction times to angry faces in young adults, but not in middle-aged adults. Thus, cortisol may be differently related to the processing of emotional facial expressions, particularly of anger, in middle-aged and young individuals. The findings are discussed in relation to the hypothesised changes in emotion regulation with aging.

Why the "widespread agreement" is wrong: contesting the non-harm arguments for the prohibition of full commercial surrogacy.

Entering a commercial surrogacy agreement is an offence in almost all Australian jurisdictions. A 2009 Consultation Paper produced by the Standing Committee of Attorneys-General suggested that there was "widespread agreement" that commercial surrogacy should remain prohibited. The arguments most commonly raised against legalising commercial surrogacy are not harm-based; that is, they do not purport to show that any party involved is tangibly, objectively and non-consensually worse off as a result of the transaction. This would be very difficult to show. Rather, the arguments against commercial surrogacy tend to focus on non-harm considerations, including principally concerns about the commodification of life and exploitation. This article argues that there are no sound non-harm reasons for banning one form of commercial surrogacy namely full commercial surrogacy.

New and old cardiovascular risk factors: C-reactive protein, homocysteine, cysteine and von Willebrand factor increase risk, especially in smokers.

BACKGROUND: The relative importance of new risk factors for heart disease singly or in combination is uncertain. We assessed relationships between C-reactive protein, homocysteine, cysteine, von Willebrand factor, activated factor XII and stable heart disease, as well as interaction with established risk factors. METHODS: A case-control study of 260 cases of stable heart disease from the Irish component of the European Action on Secondary Prevention through Intervention to Reduce Events (EUROASPIRE) II cohort and 260 age, sex-matched controls. C-reactive protein, homocysteine, cysteine, von Willebrand factor, activated factor XII and conventional risk factors were assayed or recorded. Interaction effects between new and conventional factors were assessed using additive and multiplicative models. RESULTS: C-reactive protein, homocysteine, cysteine and von Willebrand factor were significantly higher in cases than controls. Comparing the top fifth with the bottom four-fifths showed independent associations between heart disease and C-reactive protein [odds ratio (OR) 1.79; 95% confidence interval (CI) 1.12-2.86; P = 0.01], cysteine (OR 2.00; 95% CI 1.25-3.20; P = 0.004), von Willebrand factor (OR, 3.0; 95% CI 1.9-4.8; P < 0.0001). For homocysteine, the association was independent comparing the top tenth to the bottom nine-tenths (OR 1.95; 95% CI 1.02-3.41; P = 0.04). Activated factor XII was not associated with risk. The association between C-reactive protein and disease was U-shaped and a graded association existed between homocysteine, cysteine, von Willebrand factor and disease. C-reactive protein, homocysteine, cysteine and von Willebrand factor considerably increased risk associated with other factors, particularly smoking. CONCLUSIONS: Independent associations exist between stable heart disease and C-reactive protein, homocysteine, cysteine and von Willebrand factor. Strong combined effects were observed between these and conventional risk factors, particularly smoking. Smoking cessation may profoundly reduce risk associated with other risk factors. We found no evidence of a relationship between activated factor XII and disease.

Recurrent abdominal pain in children and the endogenous opiates: a brief hypothesis.

The aetiology of recurrent abdominal pain in children (RAP) remains unclear. Some features of this syndrome suggest that an opiate-like mechanism may be involved. The evidence for this is reviewed, and it is hypothesised that RAP may result from a differential gastrointestinal response to stress mediated by the endogenous opiate system.