Exploring the impact of type II diabetes mellitus on voice quality.

PURPOSE: This cross-sectional study aimed to investigate the potential of voice analysis as a prescreening tool for type II diabetes mellitus (T2DM) by examining the differences in voice recordings between non-diabetic and T2DM participants. METHODS: 60 participants diagnosed as non-diabetic (n = 30) or T2DM (n = 30) were recruited on the basis of specific inclusion and exclusion criteria in Iran between February 2020 and September 2023. Participants were matched according to their year of birth and then placed into six age categories. Using the WhatsApp application, participants recorded the translated versions of speech elicitation tasks. Seven acoustic features [fundamental frequency, jitter, shimmer, harmonic-to-noise ratio (HNR), cepstral peak prominence (CPP), voice onset time (VOT), and formant (F1-F2)] were extracted from each recording and analyzed using Praat software. Data was analyzed with Kolmogorov-Smirnov, two-way ANOVA, post hoc Tukey, binary logistic regression, and student t tests. RESULTS: The comparison between groups showed significant differences in fundamental frequency, jitter, shimmer, CPP, and HNR (p < 0.05), while there were no significant differences in formant and VOT (p > 0.05). Binary logistic regression showed that shimmer was the most significant predictor of the disease group. There was also a significant difference between diabetes status and age, in the case of CPP. CONCLUSIONS: Participants with type II diabetes exhibited significant vocal variations compared to non-diabetic controls.

Effects of brushing duration on the efficacy of dental plaque removal: An in vitro study.

INTRODUCTION: This study was performed to evaluate the effects of varying brushing times on the dental plaque-removal efficacy of a power toothbrush to determine the optimal length of time required to brush the teeth. METHODS: A typodont with 32 teeth was divided into four quadrants and further divided into four zones each (two teeth per zone). Using a robotic arm, toothbrushing was performed over eight different brushing times (0, 60, 120, 180, 240, 300, 360, and 420 s) to remove the artificial plaque applied on the labial surface of the teeth in occlusion. Photographs were taken every 60 s from each zone of the typodont. The images obtained were processed using ImageJ software to measure the percentage of remaining plaque. Data were analysed with factorial ANOVA, least squares regression analysis, and post hoc Tukey tests. RESULTS: Plaque removal significantly increased with brushing time across the brushing intervals studied (p < 0.05). Efficient plaque removal was achieved after 240 s of brushing. There was no significant difference in plaque accumulations between the maxillary and mandibular arch (p = 0.19) and the right and left areas after each time interval (p = 0.49). CONCLUSION: Brushing duration is negatively correlated with the remaining plaque for a given toothbrush. Two minutes of brushing is not sufficient for significant plaque removal. Considering the limitations of this in vitro study, clinical studies are needed in order to change brushing recommendations to 240 s.

Effect of low frequency ultrasound waves on the morphology and viability of cultured human gingival fibroblasts.

Objectives: The aim of this study was to investigate the effect of the vibration amplitude of mechanical ultrasound waves (27 kHz) on the viability and morphology of human gingival fibroblasts (hGFs) when cultured on a biomaterial substrate. Method: hGFs were seeded on tissue culture plates (TCPs) and an Ti6Al4V titanium alloy surface in two groups for three days and seven days of cell culture. The cells were subjected to three vibration amplitudes for 20 min each day. Scanning electron microscope (SEM) images were used to characterize cell morphology. Results: Experiments showed that hGF cells became detached from their plates at a vibration amplitude comparable to an intensity of 260 mW/cm2. In addition, hGfs that received a vibrational amplitude comparable to an intensity of 50 mW/cm2 underwent significant proliferation proliferated significantly; however, cells receiving higher amplitudes suffered from adverse effects. Conclusions: SEM images of hGFs on titanium disks at vibration amplitude comparable to an intensity 50 mW/cm2 showed a remarkable hexagonal architecture, which we refer to as a honeycomb pattern. On day 6 the observed hGFs on TCPs, proliferated at a higher rate and new cells attached uniformly on the existing layer of cells. These data indicate the effect of cellular tissue as a substrate on the growth of new hGFs under low-intensity ultrasound.

Diabetes negatively affects tooth enamel and dentine microhardness: An in-vivo study.

OBJECTIVE: This study was performed to evaluate the effect of type 1 diabetes mellitus (T1DM) on the microhardness of tooth enamel and dentine in mice. DESIGN: Seventy male C57BL/6 J mice were used in this study. Thirty-five mice were rendered diabetic by administration of streptozotocin (STZ), and the remaining animals received citrate buffer (normal/non-diabetic). In each group, specimens were divided into 7 subgroups of 5 mice based on the time points 0, 1, 4, 8, 12, 20, and 28 weeks. The microhardness value (MHV) of the second molars' enamel and root dentine were tested with a Vickers microhardness tester. Five specimens from each subgroup were evaluated for dentinal tubular density by scanning electron microscope (SEM) and color dot map analysis to determine the color intensity of strontium (Sr) and magnesium (Mg) by using ImageJ software. RESULTS: The MHV of enamel was significantly reduced in STZ specimens in time points of 12 weeks (STZ: 274.39 ± 15.42, normal: 291.22 ± 15.28), 20 weeks (STZ: 247.28 ± 19.65, normal: 290.68 ± 11.52), and 28 weeks (STZ: 232.87 ± 15.07, normal: 282.76 ± 10.36) (P < 0.05). When comparing the MHV of dentine in subgroups of the normal group, after 20 weeks (169.1 ± 7.5) and 28 weeks (168.6 ± 7.81), the MHV increased significantly (P < 0.05). However, in the STZ group, a significant reduction of MHV was noticed between 28 weeks (131.69 ± 6.2) specimens with other subgroups (P < 0.05). CONCLUSIONS: T1DM negatively affected enamel and dentine microhardness, and enamel was influenced much more negatively and rapidly compared with dentine in diabetic groups.

Long-term exposure to PM2.5 and cardiovascular disease incidence and mortality in an Eastern Mediterranean country: findings based on a 15-year cohort study.

BACKGROUND: Evidence concerning the impact of long-term exposure to fine Particulate Matter ≤2.5 µm (PM2.5) on Cardio-Vascular Diseases (CVDs) for those people subject to ambient air pollution in developing countries remains relatively scant. This study assessed the relationship of 15-year PM2.5 exposure with cardiovascular incidence and mortality rate in Isfahan province, Iran. METHODS: The cohort comprised 3081 participants over 35 years old who were free of CVDs. They were selected through multi-stage cluster sampling in Isfahan, Iran. PM2.5 exposure was determined separately for each individual via satellite-based spatiotemporal estimates according to their residential addresses. In this context, CVD is defined as either fatal and non-fatal Acute Myocardial Infarctions (AMI) or stroke and sudden cardiac death. The incidence risk for CVD and the ensuing mortality was calculated based on the average PM2.5 exposure within a study period of 15 years using the Cox proportional hazards frailty model upon adjusting individual risk factors. The mean annual rate of PM2.5 and the follow-up data of each residential area were combined. RESULTS: Mean three-year PM2·5 exposure for the cohort was measured at 45.28 µg/m3, ranging from 20.01 to 69.80 µg/m3. The median time period for conducting necessary follow-ups was 12.3 years for the whole population. Notably, 105 cardiovascular and 241 all-cause deaths occurred among 393,786 person-months (27 and 61 per 100,000 person-months, respectively). In well-adjusted models, 10 µg/m3 increase in PM2.5 corresponded to a 3% increase in the incidence rate of CVDs [0.95 CI = 1.016, 1.036] (in case of p = 0.000001 per 10 µg/m3 increase in PM2.5, the Hazard Ratio (HR) for AMI and Ischemic Heart Disease (IHD) was 1.031 [0.95 CI = 1.005, 1.057] and 1.028 [0.95 CI = 1.017, 1.039]), respectively. No consistent association was observed between PM2.5 concentration and fatal CVD (fatal AMI, fatal stroke, SCD (Sudden Cardiac Death)) and all-cause mortality. CONCLUSIONS: Results from analyses suggest that the effect of PM2.5 on cardiovascular disease occurrence was stronger in the case of older people, smokers, and those with high blood pressure and diabetes. The final results revealed that long-term exposure to ambient PM2.5 with high concentrations positively correlated with IHD incidence and its major subtypes, except for mortality. The outcome accentuates the need for better air quality in many countries.

Using a saddle-assistive device equipped with mechanical orthosis for walking of the person with incomplete spinal cord injury.

The majority of the people with incomplete spinal cord injury lose their walking ability, due to the weakness of their muscle motors in providing torque. As a result, developing assistive devices to improve their conditionis of great importance. In this study, a combined application of the saddle-assistive device (S-AD) and mechanical medial linkage or thosis was evaluated to improve the walking ability in patients with spinal cord injury in the gait laboratory. This mobile assistive device is called the saddle-assistive device equipped with medial linkage or thosis (S-ADEM). In this device, a mechanical orthosis was used in a wheeled walker as previously done in the literature. Initially, for evaluation of the proposed assistive device, the experimental results related to the forces and torques exerted on the feet and upper limbs of a person with the incomplete Spinal Cord Injury (SCI) during walking usingthe standard walker were compared with an those obtained from using the S-ADEM on an able-bodied subject. It was found that using this combination of assistive devices decreases the vertical force and torque on the foot at the time of walking by 53% and 48%, respectively compared to a standard walker. Moreover, the hand-reaction force on the upper limb was negligible instanding and walking positions usingthe introduced device. The findings of this study revealed that the walking ability of the patients with incomplete SCI was improved using the proposed device, which is due to the bodyweight support and the motion technology used in it.

Improving sit-to-stand transition by the saddle-assistive device in the spinal cord injury: A case study.

Physical problems caused by fractures, aging, stroke, and accidents can reduce foot power; these, in the long term, can dwindle the muscles of the waist, thighs, and legs. These conditions provide the basis for the invalidism of the harmed people. In this study, a saddle-walker was designed and evaluated to help people suffering from spinal cord injury and patients with lower limb weakness. This S-AD works based on body weight support against the previously report designs. This saddle-walker consisted of a non-powered four-wheel walker helping to walk and a powered mechanism for the sit-to-stand (STS) transfer. A set of experiments were done on the STS in the use of the standard walker and the saddle-assistive device(S-AD). A comparison of the results showed that this device could reduce the vertical ground reaction force (GRF) of the legs up to 70%. Using this device could help a wide range of patients with lower limb weakness and SCI patients in changing from sitting to standing.

Lack of Telemedicine Training in Academic Medicine: Are We Preparing the Next Generation?

Background: Telemedicine focuses on providing medical care to patients in remote locations using telecommunication technologies. It has been shown to be cost-effective, improve health outcomes, and enhance patient satisfaction. This study examines the extent to which medical students and resident physicians are exposed to telemedicine during training. Materials and Methods: The authors accessed the American College of Graduate Medical Education (ACGME) Residency Milestones from specialties and subspecialties mentioned in the 2018 Milestones National Report and searched for key terms, including "Technology," "Telemedicine," "Telehealth," "EMR," "Electronic Medical Record," "EHR," "Electronic Health Record," "Electronics," and "Social Media." The authors also accessed the 2018 American Association of Medical Colleges (AAMC) "Curriculum Inventory and Reports" to retrieve data from surveys of medical schools that included telemedicine in required courses and electives for medical students from 2013 to 2018. Results: From the 104 ACGME specialty milestones, only one specialty (Child and Adolescent Psychiatry) mentioned telehealth in its ACGME Milestone document. According to the AAMC data the number of medical schools surveyed increased every academic year from 140 in 2013/2014 to 147 in 2017/2018, telemedicine education in medical school increased significantly from 41% in 2013/2014 to 60% in 2017/2018 (p = 0.0006). However, the growth in telemedicine education plateaued from 56% in 2015/2016 to 60% in 2017/2018 (p = 0.47). Conclusion: Familiarizing medical students with telemedicine is essential; the next generation of health care providers should be equipped with knowledge of telemedicine as a valuable skill to serve populations that do not have direct access to quality medical care. Methods of implementing telemedicine education into more medical schools and residency programs merits further study.

Improving the surface energy of titanium implants by the creation of hierarchical textures on the surface via three-dimensional elliptical vibration turning for enhanced osseointegration.

An increase in bone-implant contact and an increase in surface hydrophilicity are the two important factors involved in improving osseointegration. Therefore, three-dimensional elliptical vibration turning method is applied to increase the hydrophilicity of titanium surface by the generation of hierarchical nano- and micro-textures. That being the case, face turning process at different cutting conditions is carried out in this research. Surface roughness and the contact angle of water drops with machined surfaces were selected to be measured for the analysis of surface hydrophilicity. The results show that an additional surface area can be achieved by the generation of micro- or nano-textures, resulting in a lower contact angle. Furthermore, intermittent movement of cutting tool in vibration cutting causes the process to be more stable, achieving the desired range of surface roughness.

3D FEM simulation of tool wear in ultrasonic assisted rotary turning.

In this study, a model is developed to predict tool wear and heat distribution on tool faces in conventional, rotary, and ultrasonic assisted rotary tuning methods. To model the flank wear rate, a modified Usui wear rate model which includes tool clearance angle, is proposed. As well as the simulation, a series of experiments is conducted to validate the model, by comparison of the predicted and measured flank wear rates, which are shown to be in good agreement. According to the results of the simulation, localized heat in the tool-chip contact zone during conventional turning is distributed in the circumference of the tool cutting edge in rotary turning. Due to the existence of disengagement periods in ultrasonic-assisted rotary turning, the total time for thermal conduction in the contact zone decreases, resulting in a significant reduction in tool wear.

Experimental and numerical study of ultrasonically-assisted drilling.

In this study, 3D finite element simulation of ultrasonically-assisted drilling is carried out to analyze the effect of ultrasonic vibrations on common difficulties existed in conventional drilling. Influence of harmonic movement of drill bit on the formation of built-up edge is experimentally evaluated and also discussed by investigation of heat generation on the tool faces in simulation. At the end, it was revealed that intermittent movement of drill bit in vibration method causes the total time of heat transfer between workpiece and drill bit to be reduced resulting lower built-up edge formation compared to conventional drilling. Moreover, linear motion of cutting tool in the feed direction results in the increase of chip strain and consequently damage value which causes to generation of broken chips.

Are the metabolic changes of pregnancy reversible in the first year postpartum?

AIMS/HYPOTHESIS: Maternal metabolic alterations are essential to achieve healthy pregnancy outcomes, but increasing maternal parity may be associated with long-term metabolic dysfunction risk. As existing data are limited by study design, our aim was to employ robust metabolic measures to determine whether or not physiological pregnancy alterations in maternal metabolic function persist at 1 year postpartum. METHODS: We evaluated 21 healthy women, of whom 11 had an interval pregnancy (IP) and assessment at preconception, during pregnancy and 1 year postpartum, and 10 had no IP and assessment at baseline and a 1 year interval. Assessment measures included body composition, insulin sensitivity and response, and basal metabolic rate. For each measure, IP vs no IP and time intervals within each group were compared using nonparametric analyses, reporting median (IQR). RESULTS: IP and no IP women were similar at enrolment, and no IP women had similar metabolic profiles at enrolment and the 1 year interval. IP women exhibited expected metabolic changes during pregnancy compared with preconception. In IP women, preconception and postpartum measures, including fat mass (20.7 [13.7-37.4] kg vs 18.4 [13.8-41.3] kg; p = 0.2), total insulin response (AUC 11,459 [9,230-13,696] pmol/ml × min vs 11,522 [5,882-17,404] pmol/ml × min; p = 0.9), insulin sensitivity (0.12 [0.06-0.13] mg [kg fat-free mass (FFM)](-1) min(-1) vs 0.11 [0.10-0.15] mg [kg FFM](-1) min(-1); p = 0.1) and basal metabolic rate (0.092 [0.092-0.105] kJ min(-1) FFM vs 0.096 [0.088-0.096] kJ min(-1) FFM; p = 0.5), were similar. CONCLUSIONS/INTERPRETATION: Our findings suggest pregnancy might not irreversibly alter maternal metabolic profile, measured at preconception through to 1 year postpartum. This result might be explained by a return to pre-pregnancy weight.

Does the dawn phenomenon have clinical relevance in normal pregnancy?

OBJECTIVE: The dawn phenomenon is a transient rise in blood glucose between 4 and 6 am that is attributed to the pulsatile release of pituitary growth hormone (GH). In pregnancy, GH is suppressed by placental GH. Hence, we hypothesize that there is no evidence for the dawn phenomenon in late pregnancy in healthy women. STUDY DESIGN: Twenty glucose-tolerant women with singleton gestations between 28 weeks and 36 weeks 6 days' gestation were recruited. The women were admitted overnight to the Clinical Research Unit and had continuous glucose monitoring. Insulin and GH were measured at 2-hour intervals from 8 pm to 8 am. GH was grouped into times 1A (8-10 pm), 2A (12-2 am), and 3A (4-8 am) for changes over time. Further analysis was performed with time 1B (8 pm to 2 am) and 2B (4-8 am). Insulin was measured between 4 and 8 am. RESULTS: Plasma glucose decreased over time (P < .001). There were no significant changes in GH among times 1A, 2A, and 3A (P = .45) or times 1B and 2B (P = .12). Insulin concentrations increased after meals, but there were no changes from 4 am (8.5 ± 1.4 µU/mL) through 8 am (8.6 ± 1.1 µU/mL; P = .98). CONCLUSION: Glucose and insulin concentrations show no increase from 4-8 am; although there is variability in GH, there is no evidence for the dawn phenomenon in late pregnancy in healthy women.

Exercise in pregnancy: effect on fitness and obstetric outcomes-a randomized trial.

OBJECTIVE: A prospective randomized controlled trial was designed to assess the benefits and possible risks of aerobic exercise during pregnancy, using a fitness regimen based on the 2002 American College of Obstetricians and Gynecologists guidelines for exercise during pregnancy. METHODS: Inactive women were randomized at 12-14 wk gestation to a group that remained sedentary or to a group that performed moderate aerobic exercise 45-60 min, 4 d·wk, through 36 wk gestation. Thirty-one subjects in each group completed the study. RESULTS: Compared with women who remained sedentary, active women improved aerobic fitness (P < 0.05) and muscular strength (P < 0.01), delivered comparable size infants with significantly fewer cesarean deliveries (P < 0.01), and recovered faster postpartum (P < 0.05), at least related to the lower incidence of cesarean section. Active women developed no gestational hypertension (P = 0.16 compared with controls) and reported no injuries related to the exercise regimen. In the active group, there was one premature birth at 33 wk by a woman with a history of premature delivery of twins at 34 wk. There were no differences between groups in the incidence of gestational diabetes, musculoskeletal pains during pregnancy, flexibility on sit-and-reach test, mean length of pregnancy, neonatal Apgar scores, placenta weights, overall length of labor, weight gain during pregnancy, or weight retention postpartum. CONCLUSION: Previously sedentary women who began exercising at 12-14 wk improved fitness and delivery outcomes.

Five-year outcome of surgical treatment of migraine headaches.

BACKGROUND: This study was designed to assess the long-term efficacy of surgical deactivation of migraine headache trigger sites. METHODS: One hundred twenty-five volunteers were randomly assigned to the treatment (n = 100) or control group (n = 25) after examination by the team neurologist to ensure a diagnosis of migraine headache. Patients were asked to complete the Medical Outcomes Study 36-Item Short Form Health Survey, Migraine-Specific Quality of Life, and Migraine Disability Assessment questionnaires before treatment and at 12- and 60-month postoperative follow-up. The treatment group received botulinum toxin to confirm the trigger sites; controls received saline injections. Treated patients underwent surgical deactivation of trigger site(s). Results were analyzed at 1 year (previously published) and 5 years postoperatively (the subject of this report). RESULTS: Eighty-nine of 100 patients in the treatment group underwent surgery, and 79 were followed for 5 years. Ten patients underwent deactivation of additional (different) trigger sites during the follow-up period and were not included in the data analysis. The final outcome with or without inclusion of these 10 patients was not statistically different. Sixty-one (88 percent) of 69 patients have experienced a positive response to the surgery after 5 years. Twenty (29 percent) reported complete elimination of migraine headache, 41 (59 percent) noticed a significant decrease, and eight (12 percent) experienced no significant change. When compared with the baseline values, all measured variables at 60 months improved significantly (p < 0.0001). CONCLUSION: Based on the 5-year follow-up data, there is strong evidence that surgical manipulation of one or more migraine trigger sites can successfully eliminate or reduce the frequency, duration, and intensity of migraine headache in a lasting manner.

Birth weight and body composition of neonates born to Caucasian compared with African-American mothers.

OBJECTIVE: To estimate whether neonates of African-American women have lower birth weights because of either decreased lean body mass or fat mass. METHODS: A secondary analysis of a cohort of 104 African-American and 274 Caucasian term, singleton, healthy pregnancies. Women with existing or gestational diabetes were excluded. Neonatal body composition was estimated using anthropometric measurements. RESULTS: There were significant differences in maternal age (29.5 compared with 25.8, P<.001), prepregnancy body mass index (26.2 compared with 30.9 kg/m, P<.001), and weight gain during pregnancy (15.2 compared with 13.4 kg, P=.03) in Caucasian compared with African-American women, respectively. After adjusting for these factors, African-American women's neonates had significantly lower birth weights (3.20 compared with 3.36 kg, P=.003), less lean body mass (2.80 compared with 2.94 kg, P=.002), but no difference in fat mass (392 compared with 417 g, P=.078). CONCLUSION: Decreased birth weight in African-American neonates is due to lower lean body mass and not a difference in adiposity.

Hormonal and metabolic factors associated with variations in insulin sensitivity in human pregnancy.

OBJECTIVE: The objective of this study was to determine maternal hormonal and metabolic factors associated with insulin sensitivity in human pregnancy. RESEARCH DESIGN AND METHODS: This was a prospective observational cross-sectional study of 180 normal pregnant women, using samples collected at the time of a blinded oral glucose tolerance test (OGTT) between 24 and 32 weeks' gestation as an ancillary to the Hyperglycemia and Adverse Pregnancy Outcome (HAPO) study. The study was conducted at two public university teaching hospitals, Cleveland, Ohio, and Brisbane, Australia. Fasting maternal serum cholesterol, triglycerides, free fatty acids, insulin, leptin, tumor necrosis factor-alpha, placental growth hormone (PGH), insulin-like growth factors (IGFs) 1 and 2, and insulin-like growth factor binding proteins (IGFBPs) 1 and 3 were assayed. Correlation and multiple regression analyses were used to determine factors associated with maternal insulin sensitivity (IS) estimated using both OGTT-derived (IS(OGTT)) and fasting (using the homeostasis model assessment [HOMA]; IS(HOMA)) insulin and glucose concentrations. RESULTS: Insulin sensitivity correlated (r = x and y for IS(OGTT) and IS(HOMA,) respectively) with fasting maternal serum leptin (-0.44 and -0.52), IGFBP1 (0.42 and 0.39), and triglycerides (-0.31 and -0.27). These factors were significantly associated with insulin sensitivity in multiple regression analyses (adjusted R(2) 0.44 for IS(OGTT) and IS(HOMA)). These variables explained more than 40% of the variance in estimates of insulin sensitivity. CONCLUSIONS: Maternal hormonal and metabolic factors related to the placenta, adipose tissue, and the growth hormone axis are associated with the variation in insulin sensitivity seen during normal human pregnancy.

Estimates of insulin sensitivity using glucose and C-Peptide from the hyperglycemia and adverse pregnancy outcome glucose tolerance test.

OBJECTIVE To determine if glucose and C-peptide values obtained as part of the Hyperglycemia and Adverse Pregnancy Outcome (HAPO) study could be used to estimate insulin sensitivity during late pregnancy. RESEARCH DESIGN AND METHODS A total of 78 women enrolled in the HAPO study were recruited for this ancillary study. Venous plasma samples were drawn after an 8- to 10-h fast (time 0) and at 30, 60, 90, and 120 min after a 75-g glucose challenge, which was performed at 24-32 weeks' gestation. Samples were analyzed for plasma glucose, insulin, and C-peptide. Insulin sensitivity was estimated using the established Matsuda and DeFronzo insulin sensitivity index for oral glucose tolerance tests (IS(OGTT)). Insulin sensitivity was also calculated from two other commonly used indexes of insulin sensitivity (that for homeostasis model assessment [IS(HOMA)] and that for quantitative insulin sensitivity check index [IS(QUICKI)]). A new insulin sensitivity index was calculated using the glucose and C-peptide concentrations at 0 and 60 min to derive IS(HOMA C-pep), IS(QUICKI C-pep), and IS(OGTT C-pep). These indexes were then correlated with insulin sensitivity estimated from the IS(OGTT). RESULTS The strongest correlation with the IS(OGTT) was obtained for IS(OGTT C-pep) (r = 0.792, P < 0.001). Further, the correlations of IS(HOMA) (C-pep) and IS(QUICKI C-pep) with IS(OGTT) were also significant (r = 0.676, P < 0.001 and r = 0.707, P < 0.001, respectively). CONCLUSIONS These data suggest that calculated IS(OGTT C-pep) is an excellent predictor of insulin sensitivity in pregnancy and can be used to estimate insulin sensitivity in over 25,000 women participating in the HAPO study.

Perinatal risk factors for childhood obesity and metabolic dysregulation.

BACKGROUND: Childhood obesity has increased significantly in recent decades. OBJECTIVE: The objective was to examine the perinatal risk factors related to childhood obesity. DESIGN: In a prospective study, 89 women with normal glucose tolerance (NGT) or gestational diabetes mellitus (GDM) and their offspring were evaluated at birth and at 8.8 +/- 1.8 y. At birth, obstetrical data, parental anthropometric measures, and neonatal body composition were assessed; at follow-up, diet and activity were assessed and laboratory studies were conducted. Weight was classified by using weight for age and sex, and body composition was measured by using dual-energy X-ray absorptiometry. In childhood, data were analyzed as tertiles and prediction models were developed by using logistic and stepwise regression. RESULTS: No significant differences in Centers for Disease Control and Prevention weight percentiles, body composition, and most metabolic measures were observed between children of mothers with NGT and GDM at follow-up. Children in the upper tertile for weight had greater energy intake (P = 0.02), skinfold thickness (P = 0.0001), and leptin concentrations (P < 0.0001) than did those in tertiles 1 and 2. Children in the upper tertile for percentage body fat had greater waist circumference (P = 0.0001), insulin resistance (P = 0.002), and triglyceride (P = 0.009) and leptin (P = 0.0001) concentrations than did children in tertiles 1 and 2. The correlation between body fat at birth and follow-up was r = 0.29 (P = 0.02). The strongest perinatal predictor for a child in the upper tertile for weight was maternal pregravid body mass index (BMI; kg/m(2)) >30 (odds ratio: 3.75; 95% CI: 1.39, 10.10; P = 0.009) and for percentage body fat was maternal pregravid BMI >30 (odds ratio: 5.45; 95% CI: 1.62, 18.41; P = 0.006). CONCLUSION: Maternal pregravid BMI, independent of maternal glucose status or birth weight, was the strongest predictor of childhood obesity.