Genetic and Metabolic Markers for the Development of Diabetes after Gestational Diabetes Mellitus

The aims of this work were to determine the prevalence of postpartum diabetes among women with gestational diabetes mellitus (GDM) in a prospective study 5 years postpartum; to characterize these women according to insulin secretion, insulin sensitivity, autoimmunity and genetics; and to identify possible markers and predictors for the development of manifest diabetes. The subjects were recruited through a regional screening programme in which oral glucose tolerance tests (OGTTs) are routinely offered to all pregnant women. The prevalence of MODY mutations among women with GDM and a family history of diabetes was found to be 5%. Arabian women were more insulin resistant than Scandinavian women with the same BMI, and showed impaired beta cell compensation for their degree of insulin resistance. GDM might share some genetic features with type 1 diabetes in Scandinavian women. The prevalence of manifest diabetes 5 years after GDM was 30% in our population. Antenatal levels of fasting glucose and HbA1c were identified as biochemical predictors of diabetes following GDM. These are easy to measure, and are relatively cheap, and could help identify women at particularly high risk of developing diabetes postpartum. Counselling regarding future risk of diabetes could then be initiated during pregnancy in high-risk individuals. The rs8050136 variant in the FTO (fat mass and obesity associated) gene was associated with an increased risk of developing postpartum diabetes, probably due to its effect on increasing obesity . Thus, genetic testing may provide a means of identifying pregnant women at high risk of developing postpartum diabetes

Maten märks: förutsättningar för konsumentmakt

Många människor anser sig numera ha större makt i rollen som konsumenter än som medborgare som röstar i partival. Som konsumenter kan vi idag ta ställning till en rad olika anspråk som görs på produkter och tjänster. Hur ser vi konsumenter på livsmedel som genom olika märken påstås ha unika egenskaper i produktionsledet: för miljön, för konsumentens hälsa, för arbetsförhållanden för fabriks- och jordbruksarbetarna, för djurens väl och ve, eller för det egna produktionslandets välstånd? Förekommer motsättningar och konkurrens mellan olika miljö- och varumärken? Vilka aktörer har makt att vara med och bestämma om vad som ska räknas som miljövänligt, socialt rättvis eller djurvänlig produktion? Går det – om det är önskvärt – att göra den gröna och etiska konsumtionens informationsredskap mer “demokratiska”? Finns det viktiga egenskaper hos varor och produktion som måste falla utanför konsumentmakten? Dessa frågor, som alla behandlas i boken, knyter an till frågan om vilka förutsättningar konsumenter egentligen har att fatta fria och politiska beslut som även går bortom var och ens egennytta. I den allmänna samhällsdebatten ses konsumenters makt av allt fler aktörer som en central förutsättning för att miljöproblem och andra samhällsproblem ska kunna lösas. Därmed blir en ökad kunskap om konsumentmaktens förutsättningar extra betydelsefull. Boken riktar sig till studenter, forskare, myndigheter och till alla andra med intresse för samhällsvetenskap och humaniora med inrikning på konsument- och livsmedelsfrågor, samt andra livsmedelsrelaterade vetenskaper. Mikael Klintman är docent och universitetslektor vid Forskningspolitiska institutet, Lunds universitet. Magnus Boström är docent, lektor och forskare vid institutionen för livsvetenskaper, Södertörns Högskola. Lena Ekelund är fil dr i nationalekonomi och docent i trägårdsvetenskap med ekonomisk inriktning vid Sveriges lantbruksuniversitet i Alnarp. Anna-Lisa Lindén är professor vid sociologiska institutionen, Lunds universitet

Genetic prediction of postpartum diabetes in women with gestational diabetes mellitus

Aims: To examine whether genetic variants that predispose individuals to type 2 diabetes (T2D) could predict the development of diabetes after gestational diabetes mellitus (GDM). Methods: 13 SNPs (FTO rs8050136, CDKAL1 rs7754840 and rs7756992, CDKN2A/2B rs10811661, HHEX rs1111875, IGF2BP2 rs1470579 and rs4402960, SLC30A8 rs13266634, TCF7L2 rs7903146, PPARG rs1801282, GCK rs1799884, HNF1A rs1169288, and KCNJ11 rs5219) were genotyped in 793 women with GDM after a median follow-up of 57 months. Results: After adjustment for age and ethnicity, the TCF7L2 rs7903146 and the FTO rs8050136 variants significantly predicted postpartum diabetes; hazard ratio (95% confidence interval 1.29 (1.01-1.66) and 1.36 (1.06-1.74), respectively (additive model) versus 1.45 (1.01-2.08) and 1.56 (1.06-2.29) (dominant model)). Adjusting for BMI attenuated the effect of the FTO variant, suggesting that the effect was mediated through its effect on BMI. Combining all risk alleles to a weighted risk score was significantly associated with the risk of postpartum diabetes (hazard ratio 1.11, 95% confidence interval 1.05-1.18, p = 0.00016 after adjustment for age and ethnicity). Conclusions: The TCF7L2 rs7903146 and FTO rs8050136 polymorphisms, and particularly a weighted risk score of T2D risk alleles, predict diabetes after GDM. Further studies in other populations are needed to confirm our results. (C) 2012 Elsevier Ireland Ltd. All rights reserved

Evaluation of Effects of Continuous Glucose Monitoring on Physical Activity Habits and Blood Lipid Levels in Persons With Type 1 Diabetes Managed With MDI: An Analysis Based on the GOLD Randomized Trial (GOLD 8)

Background: People with type 1 diabetes generally view it easier to exercise when having continuous information of the glucose levels. We evaluated whether patients with type 1 diabetes managed with multiple daily insulin injections (MDI) exercised more after initiating continuous glucose monitoring (CGM) and whether the improved glycemic control and well-being associated with CGM translates into improved blood lipids and markers of inflammation. Method: The GOLD trial was a randomized cross-over trial over 16 months where patients used either CGM or capillary self-monitoring of blood glucose (SMBG) over six months, with a four-month wash-out period between the two treatment periods. We compared grade of physical activity, blood lipids, apolipoproteins, and high-sensitivity C-reactive protein (hsCRP) levels during CGM and SMBG. Results: There were 116 patients with information of physical activity estimated by the International Physical Activity Questionnaire (IPAQ) during both CGM and SMBG. No changes were found during CGM or SMBG, IPAQ scores 3305 versus 3878 (P =.16). In 136 participants with information of blood lipid levels with no change in lipid-lowering medication during the two treatment periods, HbA1c differed by 4.2 mmol/mol (NGSP 0.39%) between SMBG and CGM treatment (P <.001). No significant changes existed in low-density lipoprotein, high-density lipoprotein, triglycerides, total cholesterol, apolipoprotein A1, apolipoprotein B1, or hsCRP, during CGM and SMBG. Conclusion: Although many patients experience it easier to perform physical activity when monitoring glucose levels with CGM, it does not influence the amount of physical activity in persons with type 1 diabetes. Blood lipids, apolipoprotein, and hsCRP levels were similar during CGM and SMBG

Filaggrin Genotype Determines Functional and Molecular Alterations in Skin of Patients with Atopic Dermatitis and Ichthyosis Vulgaris

BACKGROUND: Several common genetic and environmental disease mechanisms are important for the pathophysiology behind atopic dermatitis (AD). Filaggrin (FLG) loss-of-function is of great significance for barrier impairment in AD and ichthyosis vulgaris (IV), which is commonly associated with AD. The molecular background is, however, complex and various clusters of genes are altered, including inflammatory and epidermal-differentiation genes. OBJECTIVE: The objective was to study whether the functional and molecular alterations in AD and IV skin depend directly on FLG loss-of-function, and whether FLG genotype determines the type of downstream molecular pathway affected. METHODS AND FINDINGS: Patients with AD/IV (n = 43) and controls (n = 15) were recruited from two Swedish outpatient clinics and a Swedish AD family material with known FLG genotype. They were clinically examined and their medical history recorded using a standardized questionnaire. Blood samples and punch biopsies were taken and trans-epidermal water loss (TEWL) and skin pH was assessed with standard techniques. In addition to FLG genotyping, the STS gene was analyzed to exclude X-linked recessive ichthyosis (XLI). Microarrays and quantitative real-time PCR were used to compare differences in gene expression depending on FLG genotype. Several different signalling pathways were altered depending on FLG genotype in patients suffering from AD or AD/IV. Disease severity, TEWL and pH follow FLG deficiency in the skin; and the number of altered genes and pathways are correlated to FLG mRNA expression. CONCLUSIONS: We emphasize further the role of FLG in skin-barrier integrity and the complex compensatory activation of signalling pathways. This involves inflammation, epidermal differentiation, lipid metabolism, cell signalling and adhesion in response to FLG-dependent skin-barrier dysfunction

Paternal and maternal influences on differences in birth weight between Europeans and Indians born in the UK.

BACKGROUND: Ethnic groups differ significantly in adult physique and birth weight. We aimed to improve understanding of maternal versus paternal contributions to ethnic differences in birth weight, by comparing the offspring of same-ethnic versus mixed-ethnic unions amongst Europeans and South Asian Indians in the UK. METHODOLOGY AND PRINCIPAL FINDINGS: We used data from the UK Office for National Statistics Longitudinal Study (LS) and the Chelsea and Westminster Hospital (CWH), London. In the combined sample at all gestational ages, average birth weight of offspring with two European parents was significantly greater than that of offspring with two Indian parents [Δ = 344 (95% CI 329, 360) g]. Compared to offspring of European mothers, the offspring of Indian mothers had lower birth weight, whether the father was European [Δ = -152 (95% CI -92, -212) g] or Indian [Δ = -254 (95% -315, -192) g]. After adjustment for various confounding factors, average birth weight of offspring with European father and Indian mother was greater than that of offspring with two Indian parents [LS: Δ = 249 (95% CI 143, 354) g; CWH: Δ = 236 (95% CI 62, 411) g]. Average birth weight of offspring with Indian father and European mother was significantly less than that of offspring with two European parents [LS: Δ = -117 (95% CI -207, -26) g; CWH: Δ = -83 (-206, 40) g]. CONCLUSIONS/SIGNIFICANCE: Birth weight of offspring with mixed-ethnic parentage was intermediate between that of offspring with two European or two Indian parents, demonstrating a paternal as well as a maternal contribution to ethnic differences in fetal growth. This can be interpreted as demonstrating paternal modulation of maternal investment in offspring. We suggest long-term nutritional experience over generations may drive such ethnic differences through parental co-adaptation