The Weak Relationship between Vitamin D Compounds and Glucose Homeostasis Measures in Pregnant Women with Obesity : An Exploratory Sub-Analysis of the DALI Study

Altres ajuts: Netherlands Organization for Health Research and Development (ZonMw, 200310013); Polish Ministry of Science (2203/7, PR/2011/2); Odense University Free Research Fund; NIHR Clinical Research Network: Eastern; In Spain (CAIBER 1527-B-226); Spanish Diabetes Society (SED) XI Grant for clinical research projects in diabetes.Studies on the relationship between vitamin D (VitD) and glucose homeostasis usually consider either total VitD or 25OHD3 but not 25OHD2 and epimers. We aimed to evaluate the cross-sectional association of VitD compounds with glucose homeostasis measurements in pregnant women with overweight/obesity participating in the Vitamin D And Lifestyle Intervention for Gestational Diabetes Mellitus Prevention study. Methods: The analysis included 912 women. Inclusion criteria: <20 weeks gestation, body mass index ≥29 kg/m and information on exposure and outcome variables at baseline. Measurements: A 75 g OGTT at <20, 24-28 and 35-37 weeks gestation (except if previous diabetes diagnosis). Exposure variables: 25OHD2, 25OHD3 and C3-epimer. Outcome variables: fasting and post-challenge insulin sensitivity and secretion indices, corresponding disposition indices (DI), plasma glucose at fasting and 1 and 2 h, hyperglycemia in pregnancy (HiP). Statistics: Multivariate regression analyses with adjustment. Results: Baseline VitD sufficiency was 66.3%. Overall, VitD compounds did not show strong associations with any glucose homeostasis measures. 25OHD3 showed direct significant associations with: FPG at <20 and 24-28 weeks (standardized β coefficient (β) 0.124, p = 0.030 and 0.111, p = 0.026 respectively), 2 h plasma glucose at 24-28 weeks (β 0.120, p = 0.018), and insulin sensitivity (1/HOMA-IR, β 0.127, p = 0.027) at 35-37 weeks; it showed an inverse association with fasting DI (QUCKI*HOMA-β) at <20 and 24-28 weeks (β −0.124, p = 0.045 and β −0.148, p = 0.004 respectively). 25OHD2 showed direct associations with post-challenge insulin sensitivity (Matsuda, β 0.149, p = 0.048) at 24-28 weeks) and post-challenge DI (Matsuda*Stumvoll phase 1) at 24-28 and 35-37 weeks (β 0.168, p = 0.030, β 0.239, p = 0.006). No significant association with C3-epimer was observed at any time period. Conclusions: In these women with average baseline VitD in sufficiency range, VitD compounds did not show clear beneficial associations with glucose homeostasis measures

Does the disturbance hypothesis explain the biomass increase in basin-wide Amazon forest plot data?

Positive aboveground biomass trends have been reported from old-growth forests across the Amazon basin and hypothesized to reflect a large-scale response to exterior forcing. The result could, however, be an artefact due to a sampling bias induced by the nature of forest growth dynamics. Here, we characterize statistically the disturbance process in Amazon old-growth forests as recorded in 135 forest plots of the RAINFOR network up to 2006, and other independent research programmes, and explore the consequences of sampling artefacts using a data-based stochastic simulator. Over the observed range of annual aboveground biomass losses, standard statistical tests show that the distribution of biomass losses through mortality follow an exponential or near-identical Weibull probability distribution and not a power law as assumed by others. The simulator was parameterized using both an exponential disturbance probability distribution as well as a mixed exponential–power law distribution to account for potential large-scale blowdown events. In both cases, sampling biases turn out to be too small to explain the gains detected by the extended RAINFOR plot network. This result lends further support to the notion that currently observed biomass gains for intact forests across the Amazon are actually occurring over large scales at the current time, presumably as a response to climate change

Long-term thermal sensitivity of Earth’s tropical forests

The sensitivity of tropical forest carbon to climate is a key uncertainty in predicting global climate change. Although short-term drying and warming are known to affect forests, it is unknown if such effects translate into long-term responses. Here, we analyze 590 permanent plots measured across the tropics to derive the equilibrium climate controls on forest carbon. Maximum temperature is the most important predictor of aboveground biomass (−9.1 megagrams of carbon per hectare per degree Celsius), primarily by reducing woody productivity, and has a greater impact per °C in the hottest forests (>32.2°C). Our results nevertheless reveal greater thermal resilience than observations of short-term variation imply. To realize the long-term climate adaptation potential of tropical forests requires both protecting them and stabilizing Earth’s climate

Clonal chromosomal mosaicism and loss of chromosome Y in elderly men increase vulnerability for SARS-CoV-2

The pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, COVID-19) had an estimated overall case fatality ratio of 1.38% (pre-vaccination), being 53% higher in males and increasing exponentially with age. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, we found 133 cases (1.42%) with detectable clonal mosaicism for chromosome alterations (mCA) and 226 males (5.08%) with acquired loss of chromosome Y (LOY). Individuals with clonal mosaic events (mCA and/or LOY) showed a 54% increase in the risk of COVID-19 lethality. LOY is associated with transcriptomic biomarkers of immune dysfunction, pro-coagulation activity and cardiovascular risk. Interferon-induced genes involved in the initial immune response to SARS-CoV-2 are also down-regulated in LOY. Thus, mCA and LOY underlie at least part of the sex-biased severity and mortality of COVID-19 in aging patients. Given its potential therapeutic and prognostic relevance, evaluation of clonal mosaicism should be implemented as biomarker of COVID-19 severity in elderly people. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, individuals with clonal mosaic events (clonal mosaicism for chromosome alterations and/or loss of chromosome Y) showed an increased risk of COVID-19 lethality

Alcohol use and burden for 195 countries and territories, 1990-2016 : a systematic analysis for the Global Burden of Disease Study 2016

Background Alcohol use is a leading risk factor for death and disability, but its overall association with health remains complex given the possible protective effects of moderate alcohol consumption on some conditions. With our comprehensive approach to health accounting within the Global Burden of Diseases, Injuries, and Risk Factors Study 2016, we generated improved estimates of alcohol use and alcohol-attributable deaths and disability-adjusted life-years (DALYs) for 195 locations from 1990 to 2016, for both sexes and for 5-year age groups between the ages of 15 years and 95 years and older. Methods Using 694 data sources of individual and population-level alcohol consumption, along with 592 prospective and retrospective studies on the risk of alcohol use, we produced estimates of the prevalence of current drinking, abstention, the distribution of alcohol consumption among current drinkers in standard drinks daily (defined as 10 g of pure ethyl alcohol), and alcohol-attributable deaths and DALYs. We made several methodological improvements compared with previous estimates: first, we adjusted alcohol sales estimates to take into account tourist and unrecorded consumption; second, we did a new meta-analysis of relative risks for 23 health outcomes associated with alcohol use; and third, we developed a new method to quantify the level of alcohol consumption that minimises the overall risk to individual health. Findings Globally, alcohol use was the seventh leading risk factor for both deaths and DALYs in 2016, accounting for 2.2% (95% uncertainty interval [UI] 1.5-3.0) of age-standardised female deaths and 6.8% (5.8-8.0) of age-standardised male deaths. Among the population aged 15-49 years, alcohol use was the leading risk factor globally in 2016, with 3.8% (95% UI 3.2-4-3) of female deaths and 12.2% (10.8-13-6) of male deaths attributable to alcohol use. For the population aged 15-49 years, female attributable DALYs were 2.3% (95% UI 2.0-2.6) and male attributable DALYs were 8.9% (7.8-9.9). The three leading causes of attributable deaths in this age group were tuberculosis (1.4% [95% UI 1. 0-1. 7] of total deaths), road injuries (1.2% [0.7-1.9]), and self-harm (1.1% [0.6-1.5]). For populations aged 50 years and older, cancers accounted for a large proportion of total alcohol-attributable deaths in 2016, constituting 27.1% (95% UI 21.2-33.3) of total alcohol-attributable female deaths and 18.9% (15.3-22.6) of male deaths. The level of alcohol consumption that minimised harm across health outcomes was zero (95% UI 0.0-0.8) standard drinks per week. Interpretation Alcohol use is a leading risk factor for global disease burden and causes substantial health loss. We found that the risk of all-cause mortality, and of cancers specifically, rises with increasing levels of consumption, and the level of consumption that minimises health loss is zero. These results suggest that alcohol control policies might need to be revised worldwide, refocusing on efforts to lower overall population-level consumption.Peer reviewe

Taking the pulse of Earth's tropical forests using networks of highly distributed plots

Tropical forests are the most diverse and productive ecosystems on Earth. While better understanding of these forests is critical for our collective future, until quite recently efforts to measure and monitor them have been largely disconnected. Networking is essential to discover the answers to questions that transcend borders and the horizons of funding agencies. Here we show how a global community is responding to the challenges of tropical ecosystem research with diverse teams measuring forests tree-by-tree in thousands of long-term plots. We review the major scientific discoveries of this work and show how this process is changing tropical forest science. Our core approach involves linking long-term grassroots initiatives with standardized protocols and data management to generate robust scaled-up results. By connecting tropical researchers and elevating their status, our Social Research Network model recognises the key role of the data originator in scientific discovery. Conceived in 1999 with RAINFOR (South America), our permanent plot networks have been adapted to Africa (AfriTRON) and Southeast Asia (T-FORCES) and widely emulated worldwide. Now these multiple initiatives are integrated via ForestPlots.net cyber-infrastructure, linking colleagues from 54 countries across 24 plot networks. Collectively these are transforming understanding of tropical forests and their biospheric role. Together we have discovered how, where and why forest carbon and biodiversity are responding to climate change, and how they feedback on it. This long-term pan-tropical collaboration has revealed a large long-term carbon sink and its trends, as well as making clear which drivers are most important, which forest processes are affected, where they are changing, what the lags are, and the likely future responses of tropical forests as the climate continues to change. By leveraging a remarkably old technology, plot networks are sparking a very modern revolution in tropical forest science. In the future, humanity can benefit greatly by nurturing the grassroots communities now collectively capable of generating unique, long-term understanding of Earth's most precious forests.Additional co-authors: Susan Laurance, William Laurance, Francoise Yoko Ishida, Andrew Marshall, Catherine Waite, Hannsjoerg Woell, Jean-Francois Bastin, Marijn Bauters, Hans Beeckman, Pfascal Boeckx, Jan Bogaert, Charles De Canniere, Thales de Haulleville, Jean-Louis Doucet, Olivier Hardy, Wannes Hubau, Elizabeth Kearsley, Hans Verbeeck, Jason Vleminckx, Steven W. Brewer, Alfredo Alarcón, Alejandro Araujo-Murakami, Eric Arets, Luzmila Arroyo, Ezequiel Chavez, Todd Fredericksen, René Guillén Villaroel, Gloria Gutierrez Sibauty, Timothy Killeen, Juan Carlos Licona, John Lleigue, Casimiro Mendoza, Samaria Murakami, Alexander Parada Gutierrez, Guido Pardo, Marielos Peña-Claros, Lourens Poorter, Marisol Toledo, Jeanneth Villalobos Cayo, Laura Jessica Viscarra, Vincent Vos, Jorge Ahumada, Everton Almeida, Jarcilene Almeida, Edmar Almeida de Oliveira, Wesley Alves da Cruz, Atila Alves de Oliveira, Fabrício Alvim Carvalho, Flávio Amorim Obermuller, Ana Andrade, Fernanda Antunes Carvalho, Simone Aparecida Vieira, Ana Carla Aquino, Luiz Aragão, Ana Claudia Araújo, Marco Antonio Assis, Jose Ataliba Mantelli Aboin Gomes, Fabrício Baccaro, Plínio Barbosa de Camargo, Paulo Barni, Jorcely Barroso, Luis Carlos Bernacci, Kauane Bordin, Marcelo Brilhante de Medeiros, Igor Broggio, José Luís Camargo, Domingos Cardoso, Maria Antonia Carniello, Andre Luis Casarin Rochelle, Carolina Castilho, Antonio Alberto Jorge Farias Castro, Wendeson Castro, Sabina Cerruto Ribeiro, Flávia Costa, Rodrigo Costa de Oliveira, Italo Coutinho, John Cunha, Lola da Costa, Lucia da Costa Ferreira, Richarlly da Costa Silva, Marta da Graça Zacarias Simbine, Vitor de Andrade Kamimura, Haroldo Cavalcante de Lima, Lia de Oliveira Melo, Luciano de Queiroz, José Romualdo de Sousa Lima, Mário do Espírito Santo, Tomas Domingues, Nayane Cristina dos Santos Prestes, Steffan Eduardo Silva Carneiro, Fernando Elias, Gabriel Eliseu, Thaise Emilio, Camila Laís Farrapo, Letícia Fernandes, Gustavo Ferreira, Joice Ferreira, Leandro Ferreira, Socorro Ferreira, Marcelo Fragomeni Simon, Maria Aparecida Freitas, Queila S. García, Angelo Gilberto Manzatto, Paulo Graça, Frederico Guilherme, Eduardo Hase, Niro Higuchi, Mariana Iguatemy, Reinaldo Imbrozio Barbosa, Margarita Jaramillo, Carlos Joly, Joice Klipel, Iêda Leão do Amaral, Carolina Levis, Antonio S. Lima, Maurício Lima Dan, Aline Lopes, Herison Madeiros, William E. Magnusson, Rubens Manoel dos Santos, Beatriz Marimon, Ben Hur Marimon Junior, Roberta Marotti Martelletti Grillo, Luiz Martinelli, Simone Matias Reis, Salomão Medeiros, Milton Meira-Junior, Thiago Metzker, Paulo Morandi, Natanael Moreira do Nascimento, Magna Moura, Sandra Cristina Müller, Laszlo Nagy, Henrique Nascimento, Marcelo Nascimento, Adriano Nogueira Lima, Raimunda Oliveira de Araújo, Jhonathan Oliveira Silva, Marcelo Pansonato, Gabriel Pavan Sabino, Karla Maria Pedra de Abreu, Pablo José Francisco Pena Rodrigues, Maria Piedade, Domingos Rodrigues, José Roberto Rodrigues Pinto, Carlos Quesada, Eliana Ramos, Rafael Ramos, Priscyla Rodrigues, Thaiane Rodrigues de Sousa, Rafael Salomão, Flávia Santana, Marcos Scaranello, Rodrigo Scarton Bergamin, Juliana Schietti, Jochen Schöngart, Gustavo Schwartz, Natalino Silva, Marcos Silveira, Cristiana Simão Seixas, Marta Simbine, Ana Claudia Souza, Priscila Souza, Rodolfo Souza, Tereza Sposito, Edson Stefani Junior, Julio Daniel do Vale, Ima Célia Guimarães Vieira, Dora Villela, Marcos Vital, Haron Xaud, Katia Zanini, Charles Eugene Zartman, Nur Khalish Hafizhah Ideris, Faizah binti Hj Metali, Kamariah Abu Salim, Muhd Shahruney Saparudin, Rafizah Mat Serudin, Rahayu Sukmaria Sukri, Serge Begne, George Chuyong, Marie Noel Djuikouo, Christelle Gonmadje, Murielle Simo-Droissart, Bonaventure Sonké, Hermann Taedoumg, Lise Zemagho, Sean Thomas, Fidèle Baya, Gustavo Saiz, Javier Silva Espejo, Dexiang Chen, Alan Hamilton, Yide Li, Tushou Luo, Shukui Niu, Han Xu, Zhang Zhou, Esteban Álvarez-Dávila, Juan Carlos Andrés Escobar, Henry Arellano-Peña, Jaime Cabezas Duarte, Jhon Calderón, Lina Maria Corrales Bravo, Borish Cuadrado, Hermes Cuadros, Alvaro Duque, Luisa Fernanda Duque, Sandra Milena Espinosa, Rebeca Franke-Ante, Hernando García, Alejandro Gómez, Roy González-M., Álvaro Idárraga-Piedrahíta, Eliana Jimenez, Rubén Jurado, Wilmar López Oviedo, René López-Camacho, Omar Aurelio Melo Cruz, Irina Mendoza Polo, Edwin Paky, Karen Pérez, Angel Pijachi, Camila Pizano, Adriana Prieto, Laura Ramos, Zorayda Restrepo Correa, James Richardson, Elkin Rodríguez, Gina M. Rodriguez M., Agustín Rudas, Pablo Stevenson, Markéta Chudomelová, Martin Dancak, Radim Hédl, Stanislav Lhota, Martin Svatek, Jacques Mukinzi, Corneille Ewango, Terese Hart, Emmanuel Kasongo Yakusu, Janvier Lisingo, Jean-Remy Makana, Faustin Mbayu, Benjamin Toirambe, John Tshibamba Mukendi, Lars Kvist, Gustav Nebel, Selene Báez, Carlos Céron, Daniel M. Griffith, Juan Ernesto Guevara Andino, David Neill, Walter Palacios, Maria Cristina Peñuela-Mora, Gonzalo Rivas-Torres, Gorky Villa, Sheleme Demissie, Tadesse Gole, Techane Gonfa, Kalle Ruokolainen, Michel Baisie, Fabrice Bénédet, Wemo Betian, Vincent Bezard, Damien Bonal, Jerôme Chave, Vincent Droissart, Sylvie Gourlet-Fleury, Annette Hladik, Nicolas Labrière, Pétrus Naisso, Maxime Réjou-Méchain, Plinio Sist, Lilian Blanc, Benoit Burban, Géraldine Derroire, Aurélie Dourdain, Clement Stahl, Natacha Nssi Bengone, Eric Chezeaux, Fidèle Evouna Ondo, Vincent Medjibe, Vianet Mihindou, Lee White, Heike Culmsee, Cristabel Durán Rangel, Viviana Horna, Florian Wittmann, Stephen Adu-Bredu, Kofi Affum-Baffoe, Ernest Foli, Michael Balinga, Anand Roopsind, James Singh, Raquel Thomas, Roderick Zagt, Indu K. Murthy, Kuswata Kartawinata, Edi Mirmanto, Hari Priyadi, Ismayadi Samsoedin, Terry Sunderland, Ishak Yassir, Francesco Rovero, Barbara Vinceti, Bruno Hérault, Shin-Ichiro Aiba, Kanehiro Kitayama, Armandu Daniels, Darlington Tuagben, John T. Woods, Muhammad Fitriadi, Alexander Karolus, Kho Lip Khoon, Noreen Majalap, Colin Maycock, Reuben Nilus, Sylvester Tan, Almeida Sitoe, Indiana Coronado G., Lucas Ojo, Rafael de Assis, Axel Dalberg Poulsen, Douglas Sheil, Karen Arévalo Pezo, Hans Buttgenbach Verde, Victor Chama Moscoso, Jimmy Cesar Cordova Oroche, Fernando Cornejo Valverde, Massiel Corrales Medina, Nallaret Davila Cardozo, Jano de Rutte Corzo, Jhon del Aguila Pasquel, Gerardo Flores Llampazo, Luis Freitas, Darcy Galiano Cabrera, Roosevelt García Villacorta, Karina Garcia Cabrera, Diego García Soria, Leticia Gatica Saboya, Julio Miguel Grandez Rios, Gabriel Hidalgo Pizango, Eurídice Honorio Coronado, Isau Huamantupa-Chuquimaco, Walter Huaraca Huasco, Yuri Tomas Huillca Aedo, Jose Luis Marcelo Peña, Abel Monteagudo Mendoza, Vanesa Moreano Rodriguez, Percy Núñez Vargas, Sonia Cesarina Palacios Ramos, Nadir Pallqui Camacho, Antonio Peña Cruz, Freddy Ramirez Arevalo, José Reyna Huaymacari, Carlos Reynel Rodriguez, Marcos Antonio Ríos Paredes, Lily Rodriguez Bayona, Rocio del Pilar Rojas Gonzales, Maria Elena Rojas Peña, Norma Salinas Revilla, Yahn Carlos Soto Shareva, Raul Tupayachi Trujillo, Luis Valenzuela Gamarra, Rodolfo Vasquez Martinez, Jim Vega Arenas, Christian Amani, Suspense Averti Ifo, Yannick Bocko, Patrick Boundja, Romeo Ekoungoulou, Mireille Hockemba, Donatien Nzala, Alusine Fofanah, David Taylor, Guillermo Bañares-de Dios, Luis Cayuela, Íñigo Granzow-de la Cerda, Manuel Macía, Juliana Stropp, Maureen Playfair, Verginia Wortel, Toby Gardner, Robert Muscarella, Hari Priyadi, Ervan Rutishauser, Kuo-Jung Chao, Pantaleo Munishi, Olaf Bánki, Frans Bongers, Rene Boot, Gabriella Fredriksson, Jan Reitsma, Hans ter Steege, Tinde van Andel, Peter van de Meer, Peter van der Hout, Mark van Nieuwstadt, Bert van Ulft, Elmar Veenendaal, Ronald Vernimmen, Pieter Zuidema, Joeri Zwerts, Perpetra Akite, Robert Bitariho, Colin Chapman, Eilu Gerald, Miguel Leal, Patrick Mucunguzi, Miguel Alexiades, Timothy R. Baker, Karina Banda, Lindsay Banin, Jos Barlow, Amy Bennett, Erika Berenguer, Nicholas Berry, Neil M. Bird, George A. Blackburn, Francis Brearley, Roel Brienen, David Burslem, Lidiany Carvalho, Percival Cho, Fernanda Coelho, Murray Collins, David Coomes, Aida Cuni-Sanchez, Greta Dargie, Kyle Dexter, Mat Disney, Freddie Draper, Muying Duan, Adriane Esquivel-Muelbert, Robert Ewers, Belen Fadrique, Sophie Fauset, Ted R. Feldpausch, Filipe França, David Galbraith, Martin Gilpin, Emanuel Gloor, John Grace, Keith Hamer, David Harris, Tommaso Jucker, Michelle Kalamandeen, Bente Klitgaard, Aurora Levesley, Simon L. Lewis, Jeremy Lindsell, Gabriela Lopez-Gonzalez, Jon Lovett, Yadvinder Malhi, Toby Marthews, Emma McIntosh, Karina Melgaço, William Milliken, Edward Mitchard, Peter Moonlight, Sam Moore, Alexandra Morel, Julie Peacock, Kelvin Peh, Colin Pendry, R. Toby Pennington, Luciana de Oliveira Pereira, Carlos Peres, Oliver L. Phillips, Georgia Pickavance, Thomas Pugh, Lan Qie, Terhi Riutta, Katherine Roucoux, Casey Ryan, Tiina Sarkinen, Camila Silva Valeria, Dominick Spracklen, Suzanne Stas, Martin Sullivan, Michael Swaine, Joey Talbot, James Taplin, Geertje van der Heijden, Laura Vedovato, Simon Willcock, Mathew Williams, Luciana Alves, Patricia Alvarez Loayza, Gabriel Arellano, Cheryl Asa, Peter Ashton, Gregory Asner, Terry Brncic, Foster Brown, Robyn Burnham, Connie Clark, James Comiskey, Gabriel Damasco, Stuart Davies, Tony Di Fiore, Terry Erwin, William Farfan-Rios, Jefferson Hall, David Kenfack, Thomas Lovejoy, Roberta Martin, Olga Martha Montiel, John Pipoly, Nigel Pitman, John Poulsen, Richard Primack, Miles Silman, Marc Steininger, Varun Swamy, John Terborgh, Duncan Thomas, Peter Umunay, Maria Uriarte, Emilio Vilanova Torre, Ophelia Wang, Kenneth Young, Gerardo A. Aymard C., Lionel Hernández, Rafael Herrera Fernández, Hirma Ramírez-Angulo, Pedro Salcedo, Elio Sanoja, Julio Serrano, Armando Torres-Lezama, Tinh Cong Le, Trai Trong Le, Hieu Dang Tra

Risk factors for hyperglycemia in pregnancy, and vitamin D as a prevention strategy in the DALI study

La present tesi doctoral se centra en l'estudi dels factors de risc i l'ús de la vitamina D com a estratègia de prevenció de la diabetis mellitus gestacional (DMG) en una població d'alt risc participants en l'estudi DALI (Intervenció d'estil de vida i vitamina D per a la prevenció de DMG) En el primer article, es descriu l'assaig controlat aleatoritzat DALI de vitamina D per a la prevenció de DMG. L'assaig controlat aleatoritzat DALI va avaluar la suplementació de vitamina D amb 1600 UI / dia, (+/- intervenció combinada d'estil de vida), en una població d'alt risc de DMG, des <20 setmanes de gestació fins al part. Els resultats primaris van ser les mesures subrogades de DMG: glucèmia plasmàtica en dejú (GPA), HOMA-IR i augment de pes intragestación. Hi va haver una petita millora en la GPA (-0,14 mmol / l; IC 95%: -0,28, -0,00) a les 35-37 setmanes de gestació, però no es va observar millora en cap resultat primari a les 24-28 setmanes. Una anàlisi post hoc va identificar com a variables independents per a la suficiència de vitamina D: l'ètnia europea (OR 19,84, CI95 5,87-67,08), l'estació de l'any de l'extracció (OR estiu vs. primavera 17,0 , IC 95 1,84-157,5, ns per altres estacions) i la presa de vitamines (OR 11,1, IC 95 3,01-41,2). En el segon article es descriuen els factors de risc d'hiperglucèmia gestacional (HG) en la població DALI, en diferents períodes de la gestació i punts de la sobrecàrrega oral de glucosa (SOG). Realitzem un sub-anàlisi observacional de l'estudi DALI, que va incloure a 971 dones, que es van sotmetre a una SOG a les <20, 24-28 i 35-37 setmanes (criteris IADPSG / WHO2013). Una regressió logística multivariant va seleccionar variables independents (incloent característiques basals maternes i de la gestació actual) per HG. Les característiques clíniques associades de forma independent amb HG van ser: <20 setmanes, intolerància a la glucosa prèvia (odds ratio (OR): 3,11; IC 95%: 1,41-6,85), DMG prèvia (OR: 2 , 22; IC 95%: 1,20-4,11), circumferència cervical (CC) (OR: 1,58; IC 95%: 1,06-2,36 per al tercil superior), freqüència cardíaca en repòs ( FCR, OR: 1,99; IC 95%: 1,31-3,00 per al tercil superior) i centre de reclutament; a les 24-28 setmanes, mortinat previ (OR: 2,92; IC 95%: 1,18-7,22), FCR (OR: 3,32; IC 95%: 1,70-6,49 per al tercil superior) i centre de reclutament; a les 35-37 setmanes, talla materna (OR: 0,41; IC 95%: 0,20-0,87 per al tercil superior). Les característiques clíniques associades de forma independent amb DMG / diabetis franca, diferien segons el punt de temps de la SOG (per exemple, la CC es va associar amb glucosa alterada en dejú a <20 setmanes, mentre que la FCR es va associar amb la glucosa postsobrecarga a <20 setmanes). En conclusió, en dones amb sobrepès / obesitat participants en l'estudi DALI, la suplementació amb vitamina D no va millorar substancialment les mesures subrogades de DMG definides com a resultats primaris (GPA, HOMA-IR, augment de pes intragestación). Les concentracions mitjana de vitamina D a l'inici de l'estudi van ser més altes del que s'esperava i els principals predictors de la suficiència de vitamina D van ser l'ètnia europea i la ingesta de multivitaminas. En aquesta població, els factors de risc d'HG diferien segons el període de la gestació i el punt de la SOG, i podrien ajudar a definir els criteris per a la detecció selectiva o els participants d'assajos de prevenció."La presente tesis doctoral se centra en el estudio de los factores de riesgo y el uso de la vitamina D como estrategia de prevención de la diabetes mellitus gestacional (DMG) en una población de alto riesgo participantes en el estudio DALI (Intervención de estilo de vida y vitamina D para la prevención de DMG) En el primer artículo, se describe el ensayo controlado aleatorizado DALI de vitamina D para la prevención de DMG. El ensayo controlado aleatorizado DALI evaluó la suplementación de vitamina D con 1600 UI/día, (+/- intervención combinada de estilo de vida), en una población de alto riesgo de DMG, desde <20 semanas de gestación hasta el parto. Los resultados primarios fueron las medidas subrogadas de DMG: glucemia plasmática en ayunas (GPA), HOMA-IR y aumento de peso intragestación. Hubo una pequeña mejoría en la GPA (-0,14 mmol/l; IC 95%: -0,28, -0,00) a las 35-37 semanas de gestación, pero no se observó mejora en ningún resultado primario a las 24-28 semanas. Un análisis post hoc identificó como variables independientes para la suficiencia de vitamina D: la etnia europea (OR 19,84, CI95 5,87-67,08), la estación del año de la extracción (OR verano vs. primavera 17,0, IC 95 1,84-157,5, ns para otras estaciones) y la toma de vitaminas (OR 11,1, IC 95 3,01-41,2). En el segundo artículo se describen los factores de riesgo de hiperglucemia gestacional (HG) en la población DALI, en diferentes periodos de la gestación y puntos de la sobrecarga oral de glucosa (SOG). Realizamos un sub-análisis observacional del estudio DALI, que incluyó a 971 mujeres, que se sometieron a una SOG a las <20, 24-28 y 35-37 semanas (criterios IADPSG/WHO2013). Una regresión logística multivariante seleccionó variables independientes (incluyendo características basales maternas y de la gestación actual) para HG. Las características clínicas asociadas de forma independiente con HG fueron: <20 semanas, intolerancia a la glucosa previa (odds ratio (OR): 3,11; IC 95%: 1,41-6,85), DMG previa (OR: 2,22; IC 95%: 1,20-4,11), circunferencia cervical (CC) (OR: 1,58; IC 95%: 1,06-2,36 para el tercil superior), frecuencia cardíaca en reposo (FCR, OR: 1,99; IC 95%: 1,31-3,00 para el tercil superior) y centro de reclutamiento; a las 24-28 semanas, mortinato previo (OR: 2,92; IC 95%: 1,18-7,22), FCR (OR: 3,32; IC 95%: 1,70-6,49 para el tercil superior) y centro de reclutamiento; a las 35-37 semanas, talla materna (OR: 0,41; IC 95%: 0,20-0,87 para el tercil superior). Las características clínicas asociadas de forma independiente con DMG/diabetes franca, diferían según el punto de tiempo de la SOG (por ejemplo, la CC se asoció con glucosa alterada en ayunas a <20 semanas, mientras que la FCR se asoció con la glucosa postsobrecarga a <20 semanas). En conclusión, en mujeres con sobrepeso / obesidad participantes en el estudio DALI, la suplementación con vitamina D no mejoró sustancialmente las medidas subrogadas de DMG definidas como resultados primarios (GPA, HOMA-IR, aumento de peso intragestación). Las concentraciones promedio de vitamina D al inicio del estudio fueron más altas de lo esperado y los principales predictores de la suficiencia de vitamina D fueron la etnia europea y la ingesta de multivitaminas. En esta población, los factores de riesgo de HG diferían según el período de la gestación y el punto de la SOG, y podrían ayudar a definir los criterios para la detección selectiva o los participantes de ensayos de prevención.The present doctoral thesis focuses on the study of risk factors and the use of vitamin D as a prevention strategy for gestational diabetes mellitus (GDM) in a high-risk population (pregnant overweight/obese women) enrolled in the DALI (Vitamin D And Lifestyle Intervention for GDM prevention) study. In the first article, the DALI vitamin D randomized controlled trial for GDM prevention is reported. The DALI vitamin D randomized controlled trial for GDM prevention tested vitamin D supplementation with 1600 IU/day, with or without combined lifestyle intervention in a high-risk population for GDM, starting at <20 weeks' gestation until delivery. The primary study outcomes were the GDM surrogates, fasting plasma glucose (FPG), HOMA-IR and gestational weight gain (GWG). There was a small improvement in FPG (-0.14 mmol/l; 95%CI -0.28, -0.00) at 35-37 weeks' gestation, but no improvement in any primary outcome was observed at 24-28 weeks' gestation, when testing for GDM usually takes place. A post hoc analysis identified as independent variables for vitamin D sufficiency: European ethnicity (OR 19.84, CI95 5.87-67.08), season of measurement (OR summer vs. spring 17.0, CI 95 1.84-157.5, ns for other seasons) and taking vitamins (OR 11.1, CI 95 3.01-41.2). In the second article risk factors for hyperglycemia in pregnancy (HiP) in the DALI population, at different pregnancy periods and oral glucose tolerance test (OGTT) time points are described. We conducted an observational sub-analysis of the DALI study, including 971 women, who underwent an OGTT at <20, 24-28 and 35-37 weeks (IADPSG/WHO2013 criteria). A multivariate logistic regression selected independent variables (including baseline maternal and current pregnancy characteristics) for HiP. Clinical characteristics independently associated with HiP were: at <20 weeks, previous abnormal glucose tolerance (odds ratio (OR): 3.11; 95%CI: 1.41-6.85), previous GDM (OR: 2.22; 95%CI: 1.20-4.11), neck circumference (NC) (OR: 1.58; 95%CI: 1.06-2.36 for the upper tertile), resting heart rate (RHR, OR: 1.99; 95%CI: 1.31-3.00 for the upper tertile) and recruitment site; at 24-28 weeks, previous stillbirth (OR: 2.92; 95%CI: 1.18-7.22), RHR (OR: 3.32; 95%CI: 1.70-6.49 for the upper tertile) and recruitment site; at 35-37 weeks, maternal height (OR: 0.41; 95%CI: 0.20-0.87 for upper tertile). Clinical characteristics independently associated with GDM/overt diabetes differed by OGTT time point (for example, NC was associated with abnormal fasting glucose at <20 weeks, while RHR was associated with post-challenge glucose at <20 weeks and with both, fasting and post-challenge glucose at 24-28 weeks). In conclusion, in overweight/obese women enrolled in the DALI study, vitamin D supplementation did not substantially improve surrogate GDM measurements defined as primary outcomes (FPG, HOMA-IR, GWG) and did not modify secondary outcomes. Average vitamin D concentrations at baseline were higher than expected and major vitamin D sufficiency predictors were European ethnicity and multivitamin intake. In this population, risk factors for HiP differed by pregnancy period and OGTT time point and could assist in defining criteria for selective screening or participants of prevention trials

Prevalência de internação hospitalar e fatores associados: um estudo de base populacional em um centro urbano no Sul do Brasil Prevalence and factors associated with hospital admissions in a population-based study in a southern Brazilian city

Este estudo transversal investiga a utilização de serviços hospitalares e fatores associados em indivíduos com 14 anos ou mais em Canoas, Rio Grande do Sul, Brasil. Foram entrevistados 1.954 indivíduos de 40 setores censitários. A prevalência de internação hospitalar no período de um ano foi de 9,4%. Na análise ajustada para as demais variáveis, as que permaneceram associadas a uma maior chance de hospitalização foram: idade de 60 anos ou mais (RP = 4,14; IC95%: 2,07-8,25), realização de consulta médica nos últimos dois meses (RP = 2,79; IC95%: 2,03-3,83), a ocorrência de dois ou mais eventos estressantes (RP = 1,83; IC95%: 1,19-2,80). A renda individual, de 2,10 salários mínimos ou mais, esteve associada a uma menor chance de hospitalização (RP = 0,60; IC95%: 0,41-0,87). A prevalência de internações encontrada é compatível com outros estudos. A maior prevalência de hospitalização nos grupos de menor nível sócio-econômico pode indicar um menor acesso aos serviços de atenção básica. Outros fatores envolvidos poderiam ser a maior morbidade e severidade da doença entre os grupos mais pobres. Salienta-se a importância de investigar a relação entre eventos estressantes e morbidade.<br>This cross-sectional study investigates the use of health services and associated factors in individuals > 14 years of age in Canoas, Rio Grande do Sul, Brazil. 1,954 persons were interviewed in 40 census tracts. One-year prevalence of hospital admissions was 9.4%. Adjusted data analysis showed that hospitalization was associated with: age > 60 years (RP = 4.14; 95% CI: 2.07-8.25), physician visit in the previous two months (RP = 2.79; 95%CI: 2.03-3.83), and > 2 stressful life events (RP = 1.83; 95%CI: 1.19-2.80). Individual income of > 2.10 times the prevailing minimum wage was associated with decreased likelihood of hospitalization (RP = 0.60; 95% CI: 0.41-0.87). Prevalence of hospital admissions was consistent with other studies. Higher prevalence of hospitalization in lower-income groups may indicate decreased access to primary health care. Other possible factors are higher morbidity and severity of diseases among lower-income groups. Future research should focus on the relationship between morbidity and stressful life events

Drought sensitivity of the Amazon rainforest.

Amazon forests are a key but poorly understood component of the global carbon cycle. If, as anticipated, they dry this century, they might accelerate climate change through carbon losses and changed surface energy balances. We used records from multiple long-term monitoring plots across Amazonia to assess forest responses to the intense 2005 drought, a possible analog of future events. Affected forest lost biomass, reversing a large long-term carbon sink, with the greatest impacts observed where the dry season was unusually intense. Relative to pre-2005 conditions, forest subjected to a 100-millimeter increase in water deficit lost 5.3 megagrams of aboveground biomass of carbon per hectare. The drought had a total biomass carbon impact of 1.2 to 1.6 petagrams (1.2 x 10(15) to 1.6 x 10(15) grams). Amazon forests therefore appear vulnerable to increasing moisture stress, with the potential for large carbon losses to exert feedback on climate change