Childhood maltreatment, shame, psychological distress, and binge eating: testing a serial mediational model.

OBJECTIVE: Despite evidence of causal relationships between childhood maltreatment and the development of binge eating disorder (BED), research on mediating mechanisms is lacking. The present study sought to understand the childhood maltreatment-binge eating relationship more fully by examining three types of shame (internal, external, body) and psychological distress as mediators in this relationship. There is evidence that shame and psychological distress are associated with both childhood maltreatment and binge eating pathology. It was hypothesised that shame stemming from childhood maltreatment would contribute to psychological distress, and to binge eating as a dysfunctional emotion regulation strategy, in a serial mediational model. METHOD: Five hundred and thirty adults with self-reported binge eating symptoms completed an online survey, which included measures of childhood maltreatment, internal shame, external shame, body shame, psychological distress, and binge eating and other eating disorder symptoms. RESULTS: Path analyses showed three specific relationships: (1) a relationship between childhood emotional maltreatment and binge eating, which was serially mediated by internal shame and psychological distress; (2) a relationship between childhood sexual abuse and binge eating, which was mediated by body shame; and (3) a relationship between childhood physical maltreatment and binge eating, which was mediated by psychological distress. We also found a feedback loop, whereby binge eating might lead to increased overvaluation of body shape and weight (possibly due to increased weight) and then to an increase in internal shame and body shame. The final model showed excellent fit for the data. DISCUSSION: Findings extend our understanding of the link between childhood maltreatment and BED. Future intervention research should focus on examining the efficacy of interventions for different forms of childhood maltreatment, based on the key mediating factors.

Despite research showing a clear link between past childhood maltreatment (e.g., childhood emotional abuse, sexual abuse, physical abuse, neglect) and developing binge eating disorder as an adult, research cannot currently fully explain why this link exists. In this study, we explored several ways that childhood maltreatment might lead to binge eating. We examined whether different types of childhood maltreatment led to increased levels of shame or psychological distress (e.g., symptoms of depression, anxiety, and stress), and whether increased shame or psychological distress then contributed to the use of binge eating as a strategy to manage these emotions (e.g., through emotional binge eating). The results of our study showed that specific types of childhood maltreatment did lead to increased shame and binge eating. For instance, we found that adults who had experienced childhood emotional abuse tended to experience higher levels of shame about themselves, as well as higher levels of psychological distress and higher levels of binge eating. Findings from this study suggest that specific types of therapy (e.g., compassion-focused therapy for eating disorders for high levels of shame in eating disorders) might be useful for adults who have experienced childhood maltreatment and experience high levels of shame and psychological distress that accompany their binge eating.

The functions of binge eating scale (FBES): Development and preliminary psychometric validation.

OBJECTIVE: Binge eating within binge-eating disorder (BED) is a behaviour widely understood as a response to dietary restraint and emotion dysregulation. However, qualitative literature suggests that a wider range of functions of binge eating exist, with associations between functions of binge eating and adverse childhood experiences highlighted across this research. The present study sought to develop a scale to measure a wide range of functions of binge eating within BED. A secondary aim was to examine the relationship between these functions and adverse childhood experiences (ACEs). METHOD: The researchers developed an initial item pool for the Functions of Binge Eating Scale (FBES) and invited experts within the eating disorder (ED) field (n = 22) to review the items. The refined item pool was administered online to adults with self-reported binge eating symptoms (N = 882), along with related measures to establish scale validity. RESULTS: Exploratory and confirmatory factor analyses produced an eight-factor structure (emotion regulation, hedonic hunger, compensatory eating, numbness/dissociation, emotion expression, self-punishment, control, self-protection). The scale demonstrated good internal reliability and adequate construct and predictive validity. Results also showed that functions theoretically related to childhood maltreatment were predicted by ACEs. DISCUSSION: Findings extend our understanding of the range of functions of binge eating experienced in BED. Additionally, findings indicate that type of adverse childhood experience predicts functions of binge eating. Initial validation of the FBES suggests that functions of binge eating are wider than previously understood. Accordingly, clinicians are encouraged to explore and target more complex processes which might perpetuate binge-eating behaviour.

Occupational violence and aggression in urgent and critical care in rural health service settings: A systematic review of mixed studies.

Rural/remote health services are vulnerable to occupational violence and aggression due to factors such as weapon accessibility, poor network coverage and distance to backup. This systematic review investigated (1) the nature of occupational violence and aggression perpetrated in rural/remote health service urgent care settings and (2) the availability and effectiveness of policies/interventions/recommendations that address occupational violence and aggression in this context. We searched Business Source Complete, CINAHL Complete, Health & Society, APAIS Health, Health Collection, PsycINFO, PubMed, Scopus, SocIndex and Web of Science. Included articles (peer-reviewed, no grey literature and English language) addressed occupational violence and aggression in rural health service urgent care settings. Fifteen articles matched these criteria (total [rural/remote only, where specified] N ~ 2555) and were included in the final analysis. The Mixed Methods Appraisal Tool was applied to assess the risk of bias. A data extraction table and narrative synthesis are presented. The most common occupational violence and aggression type was verbal aggression. The primary perpetrator was patients. Risk factors reflected practitioner age, remoteness, sector, staffing, shift type and area of practice. Precipitating factors were alcohol/drugs, dissatisfaction and mental health conditions. Policy content and limitations and education/training programme effectiveness were not addressed. Community collaboration supported occupational violence and aggression prevention/management. Organisational culture should promote reporting, debriefing and post-incident care for staff well-being. Work environment and job/task design are priorities for safety, but with possible limitations for traumatised clients. Occupational violence and aggression policies/interventions in rural health settings must be systematically evaluated to inform best practices. Co-funded by Swinburne Social Innovation Research Institute Interdisciplinary Seed Funding Scheme and SMART Rural Health Network.

Shame and binge eating pathology: A systematic review.

OBJECTIVE: Shame is broadly implicated in the development and maintenance of eating pathology. However, the relationship between shame and binge eating symptoms specifically is less clear. This review aimed to clarify what types of shame are associated with binge eating symptoms and the antecedents and maintenance factors in these relationships. METHOD: A systematic search for quantitative and qualitative empirical studies was conducted to identify evidence of the relationship between shame and binge eating symptoms. Altogether, 270 articles were identified and screened for eligibility in the review. RESULTS: Results of the relevant empirical studies (n = 31) identified several types of shame associated with binge eating pathology: (i) internal shame, (ii) external shame, (iii) body shame and (iv) binge eating-related shame, as well as several mechanisms and pathways through which shame was associated with binge eating symptoms. DISCUSSION: Drawing from the research findings, this review presents an original, integrated model of the cyclical shame-binge eating relationship. Clinical interventions that might break this cycle are discussed, as well as methodological weaknesses which limit causal inferences and important areas of future research.

Yeast Mannan-Rich Fraction Modulates Endogenous Reactive Oxygen Species Generation and Antibiotic Sensitivity in Resistant E. coli.

Mannan-rich fraction (MRF) isolated from Saccharomyces cerevisiae has been studied for its beneficial impact on animal intestinal health. Herein, we examined how MRF affected the formation of reactive oxygen species (ROS), impacting antibiotic susceptibility in resistant Escherichia coli through the modulation of bacterial metabolism. The role of MRF in effecting proteomic change was examined using a proteomics-based approach. The results showed that MRF, when combined with bactericidal antibiotic treatment, increased ROS production in resistant E. coli by 59.29 ± 4.03% compared to the control (p ≤ 0.05). We further examined the effect of MRF alone and in combination with antibiotic treatment on E. coli growth and explored how MRF potentiates bacterial susceptibility to antibiotics via proteomic changes in key metabolic pathways. Herein we demonstrated that MRF supplementation in the growth media of ampicillin-resistant E. coli had a significant impact on the normal translational control of the central metabolic pathways, including those involved in the glycolysis-TCA cycle (p ≤ 0.05).

Yeast cell wall mannan rich fraction modulates bacterial cellular respiration potentiating antibiotic efficacy.

Now more than ever there is a demand to understand the mechanisms surrounding antibiotic resistance and look for alternative ways to impact phenotypic antibiotic outcome. Cellular energetics can be impacted by many bacteriostatic and bactericidal antibiotics, which affect metabolism and energy output, resulting in a reduction of cell growth or induction of cell death respectively. In this study, we provide evidence that a mannan rich fraction (MRF) from the cell wall of Saccharomyces cerevisiae modulates growth of antibiotic susceptible and resistant Escherichia coli and potentiates bactericidal antibiotic efficiency through modulation of bacterial cellular respiration. The role of MRF in modulating bactericidal impact and cellular metabolic state were assessed in E. coli by monitoring microbial growth and by measuring oxygen consumption rate (OCR) and extracellular acidification rate (ECAR) using the Seahorse XFe96 Analyser, respectively. This work further illustrates the link between bacterial susceptibility to antibiotics (phenotypic resistance) and resistance through modulation of bacterial metabolism. This is the first example of yeast MRF enabling collateral sensitivity to antibiotics in vitro and supports the search for alternative strategies to promote animal health without contributing to the growing issue of antimicrobial resistance.

Simultaneous quantification of humic acid-water and silanized glass-water partition constants for PCBs, PCDDs and OCDF.

Super-hydrophobic organic contaminants (SHOCs) such as polychlorinated biphenyls (PCBs), polychlorinated dibenzo-p-dioxins (PCDDs) and octachlorodibenzofuran (OCDF) can sorb to dissolved hydrophobic materials including humic acids (HAs), enhancing their apparent aqueous solubility and potentially resulting in increased groundwater contamination and offsite transport. To manage risks associated with transport of and contamination by SHOCs, modelling approaches incorporating partitioning data, i.e. dissolved organic carbon-water partition constants (KDOC), are necessary. Measurement of KDOC can however be compromised by SHOC sorption to glassware surfaces leading to an overestimation of experimental values resulting in larger KDOC. A method for simultaneous derivation of KDOC and glass-water partition constants (KGW) is described. It involves a mass balance approach combined with HA as a co-solvent at various concentrations and accounts for SHOC losses to silanized glassware. Measured log KDOC values ranged from 5.28 to 7.64 for tetra- to decachlorinated PCBs, 6.67 to 7.93 for tetra- to octachlorinated PCDDs and 8.20 for OCDF. These data were linear functions of log KOW and consistent with relationships reported for more polar compounds. Log KGW (mm3 mm-2) values (1.62 to 4.06 for PCBs, 2.96 to 3.90 for PCDDs, 3.77 for OCDF) were one order of magnitude greater compared to literature PCB borosilicate glass-water partition constants. Techniques such as those presented in this work present simple, versatile means to provide prediction of the SHOC proportion remaining in aqueous solutions after loss to glassware that was inversely related to container surface area/volume ratio and log KOW in our study.

Harnessing the Power of the Census: Characterizing Wastewater Treatment Plant Catchment Populations for Wastewater-Based Epidemiology.

Wastewater studies that provide per capita estimates of consumption (influent) or release (effluent) via wastewater systems rely heavily on accurate population data. This study evaluated the accuracy of Wastewater Treatment Plant (WWTP) reported populations, as well as hydrochemical parameters, against accurate populations from a population census. 104 catchment maps were received from WWTPs, geolocated in geospatial software and overlaid with the smallest area unit of the Australian census, equating to 14.9 million Australians or 64% of the national population. We characterized each catchment for population counts, as well as by age profile, income profile, and education level. For a subset of sites, population estimates using hydrochemical parameters BOD, COD, and dissolved ammonia were evaluated for accuracy against census populations. Population estimates provided by WWTP personnel were on average 18% higher than census-based populations. Furthermore, hydrochemical-based population estimates had high RSD (>44%) for BOD, COD, and ammonium between sites, suggesting that their applicability for use in population estimation may not be appropriate for every WWTP. Catchment age distributions were evaluated and 46% of catchments had skewed age distributions: 6% were skewed older, and 40% were skewed younger. Through this process WWTP catchment populations can be characterized in a way that will enhance the interpretations of per capita estimates.

Transport potential of super-hydrophobic organic contaminants in anionic-nonionic surfactant mixture micelles.

Surfactant mixtures are commonly used in agricultural and soil remediation applications, necessitating an understanding of their micellization behavior and associated impact on the fate of co-existing chemicals in the subsurface. A polymer-water sorption isotherm approach was shown to present an alternative to traditional methods for quantifying, understanding and predicting surfactant mixture properties. Micelle compositions were measured for anionic-nonionic surfactant mixtures. This is important since micelle composition can alter the apparent aqueous solubility of super-hydrophobic organic contaminants (SHOCs) resulting in surfactant facilitated transport (SFT). A key parameter in predicting SFT for SHOCs is their micelle-water partition constant (KMI). These were determined for polychlorinated dibenzo-p-dioxins (PCDDs) and polychlorinated biphenyls (PCBs) with representative anionic-nonionic surfactant mixtures using a polymer depletion method. These previously unreported constants were intermediate between those for pure anionic and nonionic surfactant solutions, with magnitude depending on micelle composition. Separate linear relationships were found between log KMI and log KOW for PCDDs and PCBs. This work provides new methods and preliminary results relating to binary surfactant mixtures (e.g. critical micelle concentration and micelle composition) and SHOCs (KMI) that are important in the evaluation of the fate and transport of SHOCs in the subsurface environment and provide insight into the environmental mobility of these important contaminants.

LC-HRMS suspect screening to show spatial patterns of New Psychoactive Substances use in Australia.

New Psychoactive Substances (NPS) are an ever-changing class of compounds designed to imitate the effects of current recreational drugs. Such a diverse market is difficult to assess by traditional means, while collected information can become obsolete before it is available. Wastewater-based epidemiology is one technique which can capture information on where and when NPS appear at the community level. The aim of this study was to identify NPS in wastewater samples using a suspect screening approach. Weekend samples were collected from 50 wastewater treatment plants from Australian capital cities and regional areas across all eight States and Territories and screened against a database containing almost 200 NPS. A total of 22 different NPS were found across all regional and metropolitan wastewater treatment plants. Results showed that the most detected compounds were of the cathinone class, with both Alpha-PVP and methcathinone found in every region. In addition, five different synthetic cannabinoids were detected, at least once in half of the regions analysed. Herein, we report the first comprehensive nationwide analysis of NPS and show the utility of liquid chromatography-high resolution mass spectrometry screening for delivering spatial information of the NPS being consumed in communities.

Weight stigmatisation in antiobesity campaigns: The role of images.

ISSUE ADDRESSED: Antiobesity campaigns may inadvertently stigmatise individuals with obesity via the use of images that portray negative obesity stereotypes. This study investigated the impact of images on weight stigma using mock antiobesity campaigns featuring different types of images. METHODS: Participants (N = 240) were randomly assigned to one of four campaign conditions: stereotypical images, counter-stereotypical images, neutral images, or no images. All four conditions used the same nonstigmatising message text. Participants indicated their attitudes towards being in social situations (desired social distance) with the target featured in the images, or individuals with obesity (no images), rated the target or individuals with obesity on various traits, and indicated to what extent the campaign was motivating and stigmatising. RESULTS: Analysis of variance revealed that the stereotypical images were rated as the most stigmatising and were also associated with higher negative and lower positive trait ratings of the target and more desired social distance from the target. Neutral images generally produced the least weight stigma. CONCLUSION: It is important to consider the impact of antiobesity campaign images that depict common obesity stereotypes. Developing, testing and disseminating nonstigmatising campaigns is important to reduce stigma and better engage individuals with antiobesity public health messages. SO WHAT?: Weight stigma has negative consequences for physical and psychological health, which may undermine obesity intervention efforts. Stereotypical images that blame individuals for their weight reinforce obesity stigma and are likely to be in-effective in increasing healthier behaviour and reducing obesity. The development of effective antiobesity campaigns should be a public health priority.

A National Wastewater Monitoring Program for a better understanding of public health: A case study using the Australian Census.

Wastewater contains a large range of biological and chemical markers of human activity and exposures. Through systematic collection and analysis of these markers within wastewater samples it is possible to measure the public health of whole populations. The analysis of effluent and biosolids can also be used to understand the release of chemicals from wastewater treatment plants into the environment. Wastewater analysis and comparison with catchment specific data (e.g. demographics) however remains largely unexplored. This manuscript describes a national wastewater monitoring study that combines influent, effluent and biosolids sampling with the Australian Census. An archiving program allows estimation of per capita exposure to and consumption of chemicals, public health information, as well as per capita release of chemicals into the environment. The paper discusses the study concept, critical steps in setting up a coordinated national approach and key logistical and other considerations with a focus on lessons learnt and future applications. The unique combination of archived samples, analytical data and associated census-derived population data will provide a baseline dataset that has wide and potentially increasing applications across many disciplines that include public health, epidemiology, criminology, toxicology and sociology.

Effect of surfactant application practices on the vertical transport potential of hydrophobic pesticides in agrosystems.

Surfactants have the potential to modify the environmental behavior of hydrophobic pesticides leading to an enhanced or reduced mobility risk. This risk is often overlooked in registration procedures due to a lack of suitable methodologies to quantify the transport potential of pesticides with surfactants. In this study we present a novel methodology designed to study the surfactant facilitated transport of pesticides under controlled equilibrium and dynamic hydrologic conditions. Using this methodology, we investigated the risk of chlorpyrifos enhanced mobility for two common surfactant application practices in agrosystems: pesticide spraying and irrigation with waste water. With the dynamic experiments we showed that a single irrigation event with artificial reclaimed water containing the nonionic surfactant Triton X100 at a concentration of 15 mg/L reduced the leaching of chlorpyrifos by 20% while the presence of the same surfactant in the chlopyrifos spraying formulation reduced the leaching amount by 60%. However, in the first case 90% of the chlropyrifos fraction remaining in soil was retained in the upper 3 cm while in the second cas, 72% was transported to the bottom layers. The presence of Triton X100 in irrigation water or spraying formulation retards the leaching of chlorpyrifos but enhances its downward transport.

Solubility enhancement of dioxins and PCBs by surfactant monomers and micelles quantified with polymer depletion techniques.

Partitioning of super-hydrophobic organic contaminants (SHOCs) to dissolved or colloidal materials such as surfactants can alter their behaviour by enhancing apparent aqueous solubility. Relevant partition constants are, however, challenging to quantify with reasonable accuracy. Partition constants to colloidal surfactants can be measured by introducing a polymer (PDMS) as third phase with known PDMS-water partition constant in combination with the mass balance approach. We quantified partition constants of PCBs and PCDDs (log KOW 5.8-8.3) between water and sodium dodecyl sulphate monomers (KMO) and micelles (KMI). A refined, recently introduced swelling-based polymer loading technique allowed highly precise (4.5-10% RSD) and fast (<24 h) loading of SHOCs into PDMS, and due to the miniaturisation of batch systems equilibrium was reached in <5 days for KMI and <3 weeks for KMO. SHOC losses to experimental surfaces were substantial (8-26%) in monomer solutions, but had a low impact on KMO (0.10-0.16 log units). Log KMO for PCDDs (4.0-5.2) were approximately 2.6 log units lower than respective log KMI, which ranged from 5.2 to 7.0 for PCDDs and 6.6-7.5 for PCBs. The linear relationship between log KMI and log KOW was consistent with more polar and moderately hydrophobic compounds. Apparent solubility increased with increasing hydrophobicity and was highest in micelle solutions. However, this solubility enhancement was also considerable in monomer solutions, up to 200 times for OCDD. Given the pervasive presence of surfactant monomers in typical field scenarios, these data suggest that low surfactant concentrations may be effective long-term facilitators for subsurface transport of SHOCs.

Experimental Solubility Approach to Determine PDMS-Water Partition Constants and PDMS Activity Coefficients.

Freely dissolved aqueous concentration and chemical activity are important determinants of contaminant transport, fate, and toxic potential. Both parameters are commonly quantified using Solid Phase Micro-Extraction (SPME) based on a sorptive polymer such as polydimethylsiloxane (PDMS). This method requires the PDMS-water partition constants, KPDMSw, or activity coefficient to be known. For superhydrophobic contaminants (log KOW >6), application of existing methods to measure these parameters is challenging, and independent measures to validate KPDMSw values would be beneficial. We developed a simple, rapid method to directly measure PDMS solubilities of solid contaminants, SPDMS(S), which together with literature thermodynamic properties was then used to estimate KPDMSw and activity coefficients in PDMS. PDMS solubility for the test compounds (log KOW 7.2-8.3) ranged over 3 orders of magnitude (4.1-5700 µM), and was dependent on compound class. For polychlorinated biphenyls (PCBs) and polychlorinated dibenzo-p-dioxins (PCDDs), solubility-derived KPDMSw increased linearly with hydrophobicity, consistent with trends previously reported for less chlorinated congeners. In contrast, subcooled liquid PDMS solubilities, SPDMS(L), were approximately constant within a compound class. SPDMS(S) and KPDMSw can therefore be predicted for a compound class with reasonable robustness based solely on the class-specific SPDMS(L) and a particular congener's entropy of fusion, melting point, and aqueous solubility.

Isomer-specific investigation of PCDD/F mobility and other fate processes in deep soil cores.

Polychlorinated dibenzo-p-dioxins and dibenzofurans (PCDD/Fs) are highly hydrophobic compounds with low migration potential in soil-water. Nevertheless, they have been occasionally reported in subsurface soils hypothesised as the result of facilitated transport processes with colloids or surfactants, or yet unidentified in-situ formation processes. To date, however, the prevalence of deep soil contamination, involved processes and their kinetics remain poorly understood. This study investigated PCDD/F concentrations and isomer profiles through deep soil cores (to 20 m) from agricultural, industrial and urban sites in Queensland, Australia. Based on isomer profiles, a unique source common to all core soils (regardless of depth) was identified, dominated by octachlorodibenzo-p-dioxin (OCDD). The source was consistent with contamination resulting from pesticide impurities. Elevated PCDD concentrations (µg/kg range) to depths up to ∼4-17 m and a continuous increase of peri-chlorinated (1,4,6,9-substituted) isomers through the cores suggested that vertical transport and lateral dechlorination were key post-depositional processes at these sites. The mobility of PCDDs in the present study is far greater than previously reported in soils in general. High estimated mass transport rates for OCDD in four agricultural cores (3.0-6.2% year(-1)) likely reflect significant levels of facilitating species, including surfactants, and intensive rainfall at these sites. The implications of such extensive subsurface transport of PCDD/Fs for groundwater contamination and load estimates may be significant. If the cores of the present study are assumed representative of the region, a total PCDD/F load in the order of 800 tonnes (1.6 tonnes TEQ) could be present in subsurface Queensland coastal soils.

Historical emissions of octachlorodibenzodioxin in a watershed in Queensland, Australia: estimation from field data and an environmental fate model.

An octachlorodibenzodioxin (OCDD)-dominated contamination is present along the coast of Queensland, Australia. Several findings indicate that this contamination originates from pesticide use, although due to limited information on OCDD levels in the pesticides used, estimating past and current emissions of OCDD solely from pesticide use data is unfeasible. We used all the qualitative and quantitative information available on OCDD in pesticides together with a previously validated chemical fate model for a catchment in the Queensland Wet Tropics to back-calculate the emissions of OCDD from measured soil concentrations. We estimate that under different emission scenarios an average of 2,500 kg of OCDD was emitted within the modelled 1,685 km2 (Tully river) catchment between 1950 and 2010. Because this catchment represents only approximately 0.85% of the whole coast of Queensland under a similar contamination, the total amount of OCDD released in this region is considerably larger. For all emission scenarios, we could show that the OCDD currently present in agricultural soil is a result of historical emissions, and current-day emissions are less important in comparison to past emissions. Overall 18% was lost by degradation and 62% was buried below the agricultural surface soil, as a result of facilitated transport.

The CTGF gene -945 G/C polymorphism is not associated with cardiac or kidney complications in subjects with type 2 diabetes.

BACKGROUND: Connective tissue growth factor (CTGF) has been implicated in the cardiac and kidney complications of type 2 diabetes, and the CTGF -945 G/C polymorphism is associated with susceptibility to systemic sclerosis, a disease characterised by tissue fibrosis. This study investigated the association of the CTGF -945 G/C promoter variant with cardiac complications (left ventricular (LV) hypertrophy (LVH), diastolic and systolic dysfunction) and chronic kidney disease (CKD) in type 2 diabetes. METHODS: The CTGF -945 G/C polymorphism (rs6918698) was examined in 495 Caucasian subjects with type 2 diabetes. Cardiac structure and function were assessed by transthoracic echocardiography. Kidney function was assessed using estimated glomerular filtration rate (eGFR) and albuminuria, and CKD defined as the presence of kidney damage (decreased kidney function (eGFR <60 ml/min/1.73 m2) or albuminuria). RESULTS: The mean age ± SD of the cohort was 62 ± 14 years, with a body mass index (BMI) of 31 ± 6 kg/m2 and median diabetes duration of 11 years [25th, 75th interquartile range; 5, 18]. An abnormal echocardiogram was present in 73% of subjects; of these, 8% had LVH alone, 74% had diastolic dysfunction and 18% had systolic ± diastolic dysfunction. CKD was present in 42% of subjects. There were no significant associations between the CTGF -945 G/C polymorphism and echocardiographic parameters of LV mass or cardiac function, or kidney function both before and after adjustment for covariates of age, gender, BMI, blood pressure and hypertension. CTGF -945 genotypes were not associated with the cardiac complications of LVH, diastolic or systolic dysfunction, nor with CKD. CONCLUSIONS: In Caucasians with type 2 diabetes, genetic variation in the CTGF -945 G/C polymorphism is not associated with cardiac or kidney complications.

Association of ACE2 genetic variants with blood pressure, left ventricular mass, and cardiac function in Caucasians with type 2 diabetes.

BACKGROUND: Cardiovascular disease is common in diabetes, and is associated with activation of the renin-angiotensin system (RAS). Angiotensin-converting enzyme (ACE)2 is a recently described member of the RAS, and this study investigated whether ACE2 polymorphisms are associated with hypertension, left ventricular (LV) mass, and cardiac function in type 2 diabetes. METHODS: Variants in ACE2 (rs1978124, rs2074192, rs4240157, rs4646156, rs4646188) were examined in 503 Caucasian subjects with type 2 diabetes. As ACE2 is located on the X chromosome, analyses were performed separately for men and women. Hypertension was defined by a history of hypertension, and/or antihypertensive medications or blood pressure (BP) >130/80 mm Hg. LV mass and systolic function (ejection fraction) were assessed by transthoracic echocardiography. RESULTS: In men, hypertension was more prevalent with the ACE2 rs2074192 C allele (P = 0.023), rs4240157 G allele (P = 0.016) and rs4646188 T allele (P = 0.006). In men, the rs1978124 A allele was associated with a significantly lower ejection fraction compared to the G allele (62.3 ± 13.3 vs. 67.2 ± 10.9%, P = 0.002). This association remained significant after covariate adjustment for age, body mass index, hypertension, antihypertensive treatment, and BP. In women, the prevalence of hypertension was higher (P = 0.009) with the rs4240157 G allele, and the rs1978124 A allele was associated with significantly higher LV mass (P = 0.008). CONCLUSIONS: In Caucasians with type 2 diabetes, genetic variation in ACE2 is associated with hypertension and reduced systolic function in men, and hypertension and increased LV mass in women.