The Association of Dietary Choline and Betaine With the Risk of Type 2 Diabetes: The Atherosclerosis Risk in Communities (ARIC) Study.

OBJECTIVE: To examine the association between dietary intake of choline and betaine and the risk of type 2 diabetes. RESEARCH DESIGN AND METHODS: Among 13,440 Atherosclerosis Risk in Communities (ARIC) study participants, the prospective longitudinal association between dietary choline and betaine intake and the risk of type 2 diabetes was assessed using interval-censored Cox proportional hazards and logistic regression models adjusted for baseline potential confounding variables. RESULTS: Among 13,440 participants (55% women, mean age 54 [SD 7.4] years), 1,396 developed incident type 2 diabetes during median follow-up of 9 years from 1987 to 1998. There was no statistically significant association between every 1-SD increase in dietary choline and risk of type 2 diabetes (hazard ratio [HR] 1.01 [95% CI 0.87, 1.16]) nor between dietary betaine intake and the risk of type 2 diabetes (HR 1.01 [0.94, 1.10]). Those in the highest quartile of dietary choline intake did not have a statistically significant higher risk of type 2 diabetes than those in the lowest choline quartile (HR 1.09 [0.84, 1.42]); similarly, dietary betaine intake was not associated with the risk of type 2 diabetes comparing the highest quartile to the lowest (HR 1.06 [0.87, 1.29]). Among women, there was a higher risk of type 2 diabetes, comparing the highest to lowest dietary choline quartile (HR 1.54 [1.06, 2.25]), while in men, the association was null (HR 0.82 [0.57, 1.17]). Nevertheless, there was a nonsignificant interaction between high choline intake and sex on the risk of type 2 diabetes (P = 0.07). The results from logistic regression were similar. CONCLUSIONS: Overall and among male participants, dietary choline or betaine intakes were not associated with the risk of type 2 diabetes. Among female participants, there was a trend for a modestly higher risk of type 2 diabetes among those with the highest as compared with the lowest quartile of dietary choline intake. Our study should inform clinical trials on dietary choline and betaine supplementation in relationship with the risk of type 2 diabetes.

Sevelamer hydrochloride binds phosphate released from phytate in chicks fed 1α-hydroxy cholecalciferol.

OBJECTIVE: Hyperphosphatemia in animal models of human renal disease has been linked to increased risk of death. Phosphate binders (e.g., sevelamer hydrochloride) and plant-based, low phosphate diets are used to reduce dietary phosphate load; however, animal models show that treatment with active forms of vitamin D(3) (e.g., calcitriol, a renal disease therapy) renders plant phytate phosphate available for absorption. Using an established chick model, the effectiveness of sevelamer in preventing the apparent absorption of liberated phytate phosphate during active vitamin D use was investigated in two separate experiments. DESIGN: One-day-old chicks were fed ad libitum a basal diet containing deficient levels of inorganic phosphate (0.13%), but adequate in total phosphate (0.40%, 0.23% as phytate phosphate), with or without the inclusion of sevelamer hydrochloride (a phosphate binder), available inorganic phosphate, or active vitamin D as 1α-(OH) D(3). MAIN OUTCOME MEASURES: Plasma phosphate (mg/dL), total bone ash (%), and weight gain (g). RESULTS: Adding inorganic phosphate (0.36%) or 1α-(OH) D(3) increased plasma phosphate 49% and 48%, respectively (P < .0001), and bone ash 23% and 19%, respectively (P < .001). The addition of 1% sevelamer to the basal diet with added inorganic phosphate or 1α-(OH) D(3) significantly decreased plasma phosphate by 28% and 20%, respectively (P < .01). CONCLUSION: Active vitamin D increased the availability of phytate phosphate for intestinal absorption in an animal model; however, sevelamer effectively reduced the availability of phosphate liberated from phytate. These data imply that sevelamer has phytate phosphate binding efficacy.

Characteristics of coordinated ongoing comprehensive care within a medical home in Maine.

OBJECTIVES: Access to coordinated, ongoing comprehensive care in a medical home (CCMH) is a national health objective and a federal performance measure. The National Survey of Children With Special Health Care Needs (National Survey of CSHCN) provides state level data on this Maternal Child Health Bureau performance measure. In Maine, only 60% of CSHCN received CCMH in 2001. Here we described characteristics of receiving comprehensive care in a medical home for CSHCN, in Maine. METHODS: Data from the National Survey of CSHCN were used for the analysis. We examined associations between receiving CCMH and demographic factors, severity of a condition or problem, and having adequate insurance coverage for services in univariate and multivariate logistic regression models. RESULTS: The distribution of children who received CCMH did not differ across gender, race, age, or poverty level. Children with adequate insurance were more likely to have received this care than those without adequate insurance and those with a more severe condition or problem were less likely to receive CCMH. CONCLUSIONS: We found that receiving CCMH was positively related to adequate insurance, independent of poverty. We also found that CSHCN with more severe conditions have more unmet needs than those with less severe conditions. CSHCN programs, which have a responsibility to assure that CSHCN receive CCMH, must work to maximize insurance coverage. Programs can also work to raise awareness among providers of the complexity of CCMH and the role it plays in maximizing the health of the child and family.

Low maternal alcohol consumption during pregnancy and oral clefts in offspring: the Slone Birth Defects Study.

BACKGROUND: The association between maternal alcohol consumption during pregnancy and oral clefts in offspring remains unclear. We studied this relation in a case-control surveillance study of birth defects. METHODS: From 1983 to 1997, we recruited 5956 study subjects from greater Boston, Philadelphia, Toronto, and parts of Iowa. The cases were liveborn infants with cleft palate alone (CP; n = 205), cleft lip and palate (CLP; n = 383), cleft lip alone (CL; n = 259), or Pierre-Robin sequence (n = 65). The controls (n = 4272) were infants who had no oral clefts but had one or more of the following defects: malformations of the digestive tract, reproductive organs, abdominal wall, and respiratory tract; chromosomal anomalies; inguinal hernia; tumors; and Mendelian inherited disorders. Based on maternal reports of alcohol consumption during the first 4 months of pregnancy, we derived average weekly consumption, average number of drinks per drinking day, and the maximum number of drinks consumed in a given day. The mothers also provided data on potential confounding or modifying variables, such as vitamin supplement use. RESULTS: There was no relation between maternal alcohol consumption during pregnancy and CL or CP. The odds ratios (ORs) for cleft lip with or without palate (CL/P) were 1.0, 1.1, and 0.9 in women who consumed <1.0, 1.0-2.9, and 3.0 + drinks per week, respectively. These findings did not change when we considered possible modifying effects of vitamin supplement use. CONCLUSIONS: Our findings do not support an association between oral clefts and a low level of alcohol consumption.