bluuebunny/crossref_metadata_2025_split huggingface dataset:
Features of the Metabolic Syndrome Are Associated With Objectively Measured Physical Activity and Fitness in Danish Children
Authors: Brage Søren , Wedderkopp Niels , Ekelund Ulf , Franks Paul W. , Wareham Nicholas J. , Andersen Lars Bo , Froberg Karsten 
Published: March 2007

OBJECTIVE—Features of the metabolic syndrome are becoming increasingly evident in children. Decreased physical activity is likely to be an important etiological factor, as shown previously for subjective measures of physical activity in selected groups. The purpose of this study was to examine the relationship between the metabolic syndrome and objectively measured physical activity and whether fitness modified this relationship.
RESEARCH DESIGN AND METHODS—A total of 589 Danish children (310 girls, 279 boys, mean [±SD] age 9.6 ± 0.44 years, mean weight 33.6 ± 6.4 kg, mean height 1.39 ± 0.06 m) were randomly selected. Physical activity was measured with the uni-axial Computer Science & Applications accelerometer (MTI actigraph) worn at the hip for at least 3 days (≥10 h/day) and fitness with a maximal bike test. As outcomes, we measured sitting systolic and diastolic blood pressure, degree of adiposity (sum of four skinfolds), and, finally, insulin, glucose, triglicerides, and HDL cholesterol in fasting blood samples. The outcome variables were statistically normalized and expressed as the number of SDs from the mean. (i.e., Z scores). A metabolic syndrome risk score was computed as the mean of these Z scores. Multiple linear regression was used to test the association between physical activity and metabolic risk, adjusted primarily for age, sex, sexual maturation, ethnicity, parental smoking, socioeconomic factors, and the Computer Science & Applications unit, as well as for fitness. Robust SEs were computed by clustering on school.
RESULTS—All children were in the nondiabetic range of fasting glucose. Metabolic risk was inversely related to physical activity (P = 0.008). The relationship was weakened after adjustment for fitness, but there was a significantly positive interaction between physical activity and fitness.
CONCLUSIONS—Physical activity is inversely associated with metabolic risk, independently of potential confounders. The interaction between physical activity and fitness suggests that the potential beneficial effect of activity may be greatest in children with lower cardiorespiratory fitness.
Contribution of Insulin-Stimulated Glucose Uptake and Basal Hepatic Insulin Sensitivity to Surrogate Measures of Insulin Sensitivity
Authors: Tripathy Devjit , Almgren Peter , Tuomi Tiinamaija , Groop Leif 
Published: March 2007

OBJECTIVE—The goal of this study was to evaluate the performance of surrogate measures of insulin sensitivity and insulin secretion.
RESEARCH DESIGN AND METHODS—The homeostasis model assessment (HOMA) of insulin resistance (IR) and the insulin sensitivity index (Si) from oral glucose tolerance test (OGTT) were compared with the M value from a hyperinsulinemic-euglycemic clamp in 467 subjects with various degrees of glucose tolerance. Endogenous glucose production (EGP) and hepatic insulin sensitivity were determined in a subset (n = 143). Insulin secretion was estimated as the HOMA β-cell index and as the insulinogenic index from the first 30 min of the OGTT (I/G30) and compared with the first-phase insulin response (FPIR) to an intravenous glucose tolerance test (n = 218).
RESULTS—The M value correlated with the HOMA-IR (r = −0.591, P &lt; 0.0001) and the Si (r = 0.533, P &lt; 0.0001) indexes in the total study group. HOMA-IR correlated with basal EGP in the total study group (r = 0.378, P &lt; 0.0005) and in subjects with diabetes (r = 0.330, P = 0.01). However, neither HOMA-IR nor Si correlated significantly with the M value in subjects with impaired fasting glucose (IFG) (r = −0.108, P = 0.5; r = 0.01, P = 0.9) or IFG/impaired glucose tolerance (IGT) (r = −0.167, P = 0.4; r = 0.09, P = 0.6). The HOMA-IR correlated with hepatic insulin sensitivity in the whole study group (r = −0.395, P &lt; 0.005) as well as in the IFG/IGT subgroup (r = −0.634, P = 0.002) and in the diabetic subgroup (r = −0.348, P = 0.008). In subjects with IFG/IGT, hepatic insulin sensitivity was the most important determinant of HOMA-IR, explaining 40% of its variation. The HOMA β-cell index showed a weak correlation with FPIR in the whole study group (r = 0.294, P = 0.001) but not in the subgroups. In contrast, the I/G30 correlated with FPIR in the whole study group (r = 0.472, P &lt; 0.0005) and in the IFG/IGT subgroup (r = 0.493, P &lt; 0.005).
CONCLUSIONS—HOMA-IR is dependent upon both peripheral and hepatic insulin sensitivity, the contribution of which differs between subjects with normal and elevated fasting glucose concentrations. These discrepancies develop as a consequence of a nonparallel deterioration of the variables included in the equations with worsening of glucose tolerance.
Lower Toenail Chromium in Men With Diabetes and Cardiovascular Disease Compared With Healthy Men
Authors: Rajpathak Swapnil , Rimm Eric B. , Li Tricia , Morris J. Steven , Stampfer Meir J. , Willett Walter C. , Hu Frank B. 
Published: March 2007

OBJECTIVE—Chromium may improve insulin sensitivity, which can modify the risk of diabetes and cardiovascular disease (CVD). Therefore, we evaluated the association between toenail chromium and CVD in diabetic men.
RESEARCH DESIGN AND METHODS—We performed cross-sectional and nested case-control analyses among men aged 40–75 years within the Health Professionals Follow-up Study. The cross-sectional analysis compared men with diabetes only (n = 688), diabetes with prevalent CVD (n = 198), and healthy control subjects (n = 361). The nested case-control study included 202 men with baseline diabetes who developed incident CVD and 361 matched control subjects.
RESULTS—Mean toenail chromium (μg/g) was 0.71 in healthy control subjects, 0.61 in diabetes-only subjects, and 0.52 in diabetic subjects with prevalent CVD (P for trend = 0.003). In the cross-sectional analysis, the multivariate odds ratio (OR) between extreme quartiles was 0.74 (95% CI 0.49–1.11; P for trend = 0.18), comparing diabetes only with healthy control subjects. A similar comparison between diabetic subjects with prevalent CVD and healthy control subjects yielded an OR of 0.45 (0.24–0.84; P for trend = 0.003). In the nested case-control study, comparing diabetic men with incident CVD with healthy control subjects, the multivariate OR was 0.65 (0.36–1.17; P for trend = 0.16) between extreme quartiles. When we combined prevalent and incident CVD cases among diabetic men and compared them with healthy control subjects, the OR was 0.62 (0.39–1.01; P for trend = 0.02) between extreme quartiles.
CONCLUSIONS—Our results suggest that diabetic men with CVD have lower toenail chromium than healthy control subjects. However, this study could not distinguish between the effects of chromium on diabetes and those on CVD. Long-term clinical trials are needed to determine whether chromium supplementation is beneficial for preventing CVD among diabetic patients.
Metabolic Syndrome in Normal-Weight Americans
Authors: St-Onge Marie-Pierre , Janssen Ian , Heymsfield Steven B. 
Published: March 2007

OBJECTIVE—To determine the prevalence rates and likelihood of the metabolic syndrome and its individual components in normal-weight and slightly overweight individuals (BMI 18.5–26.9 kg/m2).
RESEARCH DESIGN AND METHODS—There were a total of 7,602 adult participants of the Third National Health and Nutrition Examination Survey, a nationally representative cross-sectional survey. Prevalence and odds ratios (ORs) of the metabolic syndrome, defined according to National Cholesterol Education Program Adult Treatment Panel III criteria, were computed according to 2.0- to 2.5-unit increments in BMI.
RESULTS—Depending on ethnicity and sex, the prevalence of the metabolic syndrome increased in a graded fashion from 0.9–3.0% at BMI 18.5–20.9 kg/m2 to 9.6–22.5% at BMI 25.0–26.9 kg/m2. Compared with men with BMI 18.5–20.9 kg/m2, the odds for the metabolic syndrome were 4.13 (95% CI 1.57–10.87) for men with BMI 21–22.9 kg/m2, 5.35 (2.41–11.86) for men with BMI 23–24.9 kg/m2, and 9.08 (4.23–19.52) for men with BMI 25–26.9 kg/m2 after controlling for age, ethnicity, education, income, physical activity, smoking status, and alcohol and total fat, saturated fat, carbohydrate, and fiber intakes. The corresponding ORs in women were 4.34 (2.08–9.07), 7.77 (3.95–15.26), and 17.34 (9.29–32.38).
CONCLUSIONS—Individuals in the upper normal-weight and slightly overweight BMI range have a relatively high prevalence and are at increased risk of having the metabolic syndrome. Therefore, screening in individuals with normal or slightly elevated BMI is important in the prevention of diabetes and cardiovascular disease.
Development of Evidence-Based Clinical Practice Guidelines for Diabetes
Authors: Pogach Leonard M. , Brietzke Stephen A. , Cowan, Jr. Claude L. , Conlin Paul , Walder Debby J. , Sawin Clark T. ,   for the VA/DoD Diabetes Guideline Development Group*
Published: March 2007

OBJECTIVE—To describe the Veterans Affairs (VA)/Department of Defense (DoD) Clinical Practice Guidelines for diabetes and contrast selected recommendations with those of the American Diabetes Association (ADA).
RESEARCH DESIGN AND METHODS—We summarize the general structure of the VA/DoD Guidelines and describe the rationale for recommendations issued in 2003 for glycemic control, management of hypertension, and retinopathy screening. We compare the synthesis of evidence and resulting recommendations for these content areas with the 2004 American Diabetes Association Clinical Practice Recommendations.
RESULTS—The VA/DoD Guidelines and the ADA Clinical Practice Recommendations reported similar strength of evidence findings by content area, but clinical recommendations varied. The VA/DoD Guidelines and practice recommendations emphasize the use of data on absolute risk reduction from available published randomized clinical trials rather than relative risk reduction from observational analyses. The VA/DoD Guidelines employ an algorithm-based methodology to guide clinicians through a risk-stratified approach to managing individual patients rather than promoting a single standard for most or all patients without explicit consideration of competing comorbidities.
CONCLUSIONS—The VA/DoD Guidelines are intended to guide diabetes care by providing Internet-ready, evidence-based annotations in algorithmic form to help clinicians set and revise individual treatment goals for their patients.
Plasma Concentration of IGF-I Is Independently Associated With Insulin Sensitivity in Subjects With Different Degrees of Glucose Tolerance
Authors: Sesti Giorgio , Sciacqua Angela , Cardellini Marina , Marini Maria Adelaide , Maio Raffaele , Vatrano Marco , Succurro Elena , Lauro Renato , Federici Massimo , Perticone Francesco 
Published: March 2007

OBJECTIVE—We studied the relationships between plasma IGF-I concentrations and insulin sensitivity in subjects with various degrees of glucose tolerance.
RESEARCH DESIGN AND METHODS—A total of 357 nondiabetic subjects, 54 subjects with impaired glucose tolerance and 98 newly diagnosed type 2 diabetic subjects, were consecutively recruited, and anthropometric and biochemical characteristics were collected.
RESULTS—IGF-I concentrations were negatively correlated with age, BMI, waist-to-hip ratio, triglyceride levels, and systolic and diastolic blood pressure. IGF-I concentrations were positively correlated with HDL cholesterol and homeostasis model assessment of insulin sensitivity (HOMA-S). The correlations remained significant after adjusting for sex, age, and BMI. Correlations for HOMA-S with these metabolic and anthropometric variables were of a similar degree and direction to those for IGF-I concentrations. Stepwise linear regression analysis in a model, which included well-known modulators of insulin sensitivity such as sex, age, BMI, glucose tolerance status, family history of diabetes, waist-to-hip ratio, systolic and diastolic blood pressure, HDL cholesterol, and triglyceride levels, revealed that IGF-I concentrations were independently associated with insulin sensitivity accounting for 10.8% of its variation (P &lt; 0.0001). IGF-I concentrations were significantly lower in subjects with World Health Organization (WHO)-defined metabolic syndrome compared with subjects without metabolic syndrome (P &lt; 0.0001). Logistic regression analysis showed that each unit increase in log-transformed IGF-I concentrations was associated with a 90.5% reduction in the risk of WHO-defined metabolic syndrome.
CONCLUSIONS—These data indicate that IGF-I has the characteristics to be a marker for the insulin resistance syndrome. This suggests that low IGF-I levels may be a useful marker for identifying subjects at risk for cardiovascular disease.
Metabolic Syndrome Among HIV-Infected Patients
Authors: Jericó Carlos , Knobel Hernando , Montero Milagro , Ordoñez-Llanos Jordi , Guelar Ana , Gimeno Juan L. , Saballs Pere , López-Colomés Jose L. , Pedro-Botet Juan 
Published: March 2007

OBJECTIVE—To assess the prevalence in HIV-infected patients of the metabolic syndrome as defined by the National Cholesterol Education Program, i.e., three or more of the following components: abdominal obesity, hypertriglyceridemia, low HDL cholesterol, high blood pressure, and high fasting glucose.
RESEARCH DESIGN AND METHODS—In this cross-sectional study, 710 HIV-infected patients managed at the outpatient clinic of a tertiary hospital during 2003 completed the study protocol consisting of a medical examination and laboratory analysis after a 12-h overnight fast.
RESULTS—Metabolic syndrome prevalence was 17% and increased from 5.1% among HIV-infected patients under age 30 years to 27.0% for those aged 50–59 years. Age (per 10-year increment) (odds ratio [OR] 1.41 [95% CI 1.12–1.77]), BMI (1.27 [1.19–1.36]), past and present protease inhibitor exposure (2.96 [1.03–3.55] and 4.18 [1.4–12.5], respectively) were independently associated with the metabolic syndrome on logistic regression analysis. Furthermore, only stavudine (d4T) (1.74 [1.01–2.98]) and lopinavir/ritonavir (2.46 [1.28–4.71]) were associated with the metabolic syndrome after adjustment for age and BMI.
CONCLUSIONS—The prevalence of metabolic syndrome among these HIV-infected patients is similar to that previously reported in uninfected individuals. Of specific concern is the association of protease inhibitor exposure with the metabolic syndrome and, more specifically, with exposure to stavudine and lopinavir/ritonavir when individual antiretroviral drugs were analyzed.
Periodontal Disease and Mortality in Type 2 Diabetes
Authors: Saremi Aramesh , Nelson Robert G. , Tulloch-Reid Marshall , Hanson Robert L. , Sievers Maurice L. , Taylor George W. , Shlossman Marc , Bennett Peter H. , Genco Robert , Knowler William C. 
Published: March 2007

OBJECTIVE—Periodontal disease may contribute to the increased mortality associated with diabetes.
RESEARCH DESIGN AND METHODS—In a prospective longitudinal study of 628 subjects aged ≥35 years, we examined the effect of periodontal disease on overall and cardiovascular disease mortality in Pima Indians with type 2 diabetes. Periodontal abnormality was classified as no or mild, moderate, and severe, based on panoramic radiographs and clinical dental examinations.
RESULTS—During a median follow-up of 11 years (range 0.3–16), 204 subjects died. The age- and sex-adjusted death rates for all natural causes expressed as the number of deaths per 1,000 person-years of follow-up were 3.7 (95% CI 0.7–6.6) for no or mild periodontal disease, 19.6 (10.7–28.5) for moderate periodontal disease, and 28.4 (22.3–34.6) for severe periodontal disease. Periodontal disease predicted deaths from ischemic heart disease (IHD) (P trend = 0.04) and diabetic nephropathy (P trend &lt; 0.01). Death rates from other causes were not associated with periodontal disease. After adjustment for age, sex, duration of diabetes, HbA1c, macroalbuminuria, BMI, serum cholesterol concentration, hypertension, electrocardiographic abnormalities, and current smoking in a proportional hazards model, subjects with severe periodontal disease had 3.2 times the risk (95% CI 1.1–9.3) of cardiorenal mortality (IHD and diabetic nephropathy combined) compared with the reference group (no or mild periodontal disease and moderate periodontal disease combined).
CONCLUSIONS— Periodontal disease is a strong predictor of mortality from IHD and diabetic nephropathy in Pima Indians with type 2 diabetes. The effect of periodontal disease is in addition to the effects of traditional risk factors for these diseases.
The Influence of Insulin Use on Glycemic Control
Authors: Cramer Joyce A. , Pugh Mary Jo 
Published: March 2007

OBJECTIVE—The purposes of this study were to determine the relationship between insulin self-management and glycemic control and to identify patient characteristics associated with better control.
RESEARCH DESIGN AND METHODS—A Department of Veterans Affairs regional database was used to identify patients with diabetes on chronic insulin therapy (n = 6,222) with dose defined as number of units and doses. The rate of insulin use during a 2-year period was calculated using pharmacy data. Regression analyses were used 1) to predict compliance with prescribed insulin regimens using demographic variables, HbA1c levels, and a measure of diabetes management intensity and 2) to predict HbA1c levels using demographic variables and rates of insulin use.
RESULTS—Insulin use was 77.44 ± 17% of prescribed amounts, including wastage; HbA1c levels were 7.98 ± 1.66%. Concomitant oral hypoglycemic agent use (84.89 ± 16%) was higher than insulin use (P &lt; 0.0001) but correlated with insulin use (r = 0.189, P &lt; 0.0001). Ordinary least-squares regression showed that race, HbA1c levels, and intensity of diabetes management were significant predictors of insulin use. Age, race, and insulin use were significant predictors of HbA1c levels.
CONCLUSIONS—Adults prescribed a specific insulin regimen averaged using 77% of prescribed doses, demonstrating good intention to follow the prescription. However, HbA1c higher than the recommended level suggested that the rate of insulin use, the prescribed regimen, or both were inadequate to achieve good glycemic control in patients with long-term insulin use.
The Relationship of Disordered Eating Habits and Attitudes to Clinical Outcomes in Young Adult Females With Type 1 Diabetes
Authors: Peveler Robert C. , Bryden Kathryn S. , Neil H. Andrew W. , Fairburn Christopher G. , Mayou Richard A. , Dunger David B. , Turner Hannah M. 
Published: March 2007

OBJECTIVE—To describe the clinical outcomes of adolescent and young adult female subjects with type 1 diabetes in relation to the disturbance of eating habits and attitudes over 8–12 years.
RESEARCH DESIGN AND METHODS—Patients were recruited from the registers of pediatric and young adult diabetes clinics (including nonattenders) and interviewed in the community. A total of 87 patients were assessed at baseline (aged 11–25 years), and 63 (72%) were reinterviewed after 8–12 years (aged 20–38 years). Eating habits and attitudes were assessed by a semistructured research diagnostic interview (Eating Disorder Examination).
RESULTS—Clinical eating disorders ascertained from the interview and/or case note review at baseline or follow-up were found in 13 subjects (14.9% [95% CI 8.2–24.2]), and an additional 7 subjects had evidence of bingeing or purging, bringing the total affected to 26%. Insulin misuse for weight control was reported by 31 (35.6% [25.7–46.6]) subjects. Overall outcome was poor; serious microvascular complications were common and mortality was high. There were significant relationships between disordered eating habits, insulin misuse, and microvascular complications.
CONCLUSIONS—Although the cross-sectional prevalence of clinical eating disorders in young women with diabetes is modest, the cumulative incidence of eating problems continues to increase after young adulthood, and this is strongly associated with poor physical health outcomes. The combination of an eating disorder and diabetes puts patients at high risk of mortality and morbidity. Better methods of detection and management are needed.
Glycemic Characteristics in Continuously Monitored Patients With Type 1 and Type 2 Diabetes
Authors: Bode Bruce W. , Schwartz Sherwyn , Stubbs Harrison A. , Block Jon E. 
Published: March 2007

OBJECTIVE—The purpose of this study was to generate normative values for periods of euglycemia as well as for daily patterns of glycemic excursions in patients with type 1 and type 2 diabetes monitored continuously for a maximum period of 21 days and blinded to glucose levels.
RESEARCH DESIGN AND METHODS—This was a multicenter, prospective observational study in which 101 consecutive patients with type 1 (n = 60) or type 2 (n = 41) diabetes underwent blinded continuous glucose monitoring. Serial glucose measurements were divided into periods of euglycemia (70–180 mg/dl), hyperglycemia (&gt;180 mg/dl), and hypoglycemia (&lt;70 mg/dl). The proportions of time patients were hypoglycemic, euglycemic, and hyperglycemic and the total areas under the curves (AUCs) were determined.
RESULTS—During the observation period the 101 subjects contributed an average 287 ± 132 h of continuous glucose values. Subjects remained in the euglycemic range for ∼63% of the total day, were hypoglycemic 8%, and were hyperglycemic 29%. Hypoglycemia was more prevalent nocturnally (11 vs. 7%) and hyperglycemia diurnally (31 vs. 25%). Compared with subjects with type 2 diabetes, type 1 diabetic subjects had more frequent hypoglycemic episodes per day (2.1 vs. 1.0; P &lt; 0.001) that were of longer duration (1.1 vs. 0.7 h; P &lt; 0.0001), reflecting a greater number of hours per day in the hypoglycemic range (2.3 vs. 1.0 h; P &lt; 0.0001). The mean hypoglycemic AUC values were &gt;150% higher for type 1 compared with type 2 diabetic subjects (41 vs. 16, respectively; P &lt; 0.0001).
CONCLUSIONS—These normative data will assist in study and sample size planning for future investigations of continuous glucose monitoring and allow for qualitative comparisons with trials of therapeutic interventions aimed at reducing the occurrence of glycemic excursions.