Normal Gestational Weight Gain Protects From Large-for-Gestational-Age Birth Among Women With Obesity and Gestational Diabetes

Background: Pre-pregnancy obesity, excess gestational weight gain (GWG), and gestational diabetes (GDM) increase fetal growth. Our aim was to assess whether normal GWG is associated with lower risk for a large-for-gestational-age (LGA; over the 90th percentile of birth weight for sex and gestational age) infant and lower birth weight standard deviation (SD) score in the presence of GDM and maternal obesity. Methods: This multicenter case-control study is part of the Finnish Gestational Diabetes (FinnGeDi) Study and includes singleton pregnancies of 1,055 women with GDM and 1,032 non-diabetic controls. Women were divided into 12 subgroups according to their GDM status, pre-pregnancy body mass index (BMI; kg/m(2)), and GWG. Non-diabetic women with normal BMI and normal GWG (according to Institute of Medicine recommendations) served as a reference group. Results: The prevalence of LGA birth was 12.2% among women with GDM and 6.2% among non-diabetic women (p < 0.001). Among all women, normal GWG was associated with lower odds of LGA [odds ratio (OR) 0.57, 95% CI: 0.41-0.78]. Among women with both obesity and GDM, the odds for giving birth to a LGA infant was 2.25-fold (95% CI: 1.04-4.85) among those with normal GWG and 7.63-fold (95% CI: 4.25-13.7) among those with excess GWG compared with the reference group. Compared with excess GWG, normal GWG was associated with 0.71 SD (95% CI: 0.47-0.97) lower birth weight SD score among women with GDM and obesity. Newborns of normal weight women with GDM and normal GWG had 0.28 SD (95% CI: 0.05-0.51) lower birth weight SD scores compared with their counterparts with excess GWG. In addition, in the group of normal weight non-diabetic women, normal GWG was associated with 0.46 SD (95% CI: 0.30-0.61) lower birth weight SD scores compared with excess GWG. Conclusion: GDM, obesity, and excess GWG are associated with higher risk for LGA infants. Interventions aiming at normal GWG have the potential to lower LGA rate and birth weight SD scores even when GDM and obesity are present.Peer reviewe

Type 2 Diabetes Risk Alleles Are Associated With Reduced Size at Birth

OBJECTIVE: Low birth weight is associated with an increased risk of type 2 diabetes. The mechanisms underlying this association are unknown and may represent intrauterine programming or two phenotypes of one genotype. The fetal insulin hypothesis proposes that common genetic variants that reduce insulin secretion or action may predispose to type 2 diabetes and also reduce birth weight, since insulin is a key fetal growth factor. We tested whether common genetic variants that predispose to type 2 diabetes also reduce birth weight. RESEARCH DESIGN AND METHODS: We genotyped single-nucleotide polymorphisms (SNPs) at five recently identified type 2 diabetes loci (CDKAL1, CDKN2A/B, HHEX-IDE, IGF2BP2, and SLC30A8) in 7,986 mothers and 19,200 offspring from four studies of white Europeans. We tested the association between maternal or fetal genotype at each locus and birth weight of the offspring. RESULTS: We found that type 2 diabetes risk alleles at the CDKAL1 and HHEX-IDE loci were associated with reduced birth weight when inherited by the fetus (21 g [95% CI 11-31], P = 2 x 10(-5), and 14 g [4-23], P = 0.004, lower birth weight per risk allele, respectively). The 4% of offspring carrying four risk alleles at these two loci were 80 g (95% CI 39-120) lighter at birth than the 8% carrying none (P(trend) = 5 x 10(-7)). There were no associations between birth weight and fetal genotypes at the three other loci or maternal genotypes at any locus. CONCLUSIONS: Our results are in keeping with the fetal insulin hypothesis and provide robust evidence that common disease-associated variants can alter size at birth directly through the fetal genotype

Economic downturn results in tick-borne disease upsurge

<p>Abstract</p> <p>Background</p> <p>The emergence of zoonoses is due both to changes in human activities and to changes in their natural wildlife cycles. One of the most significant vector-borne zoonoses in Europe, tick-borne encephalitis (TBE), doubled in incidence in 1993, largely as a consequence of the socio-economic transition from communism to capitalism and associated environmental changes.</p> <p>Methods</p> <p>To test the effect of the current economic recession, unemployment in 2009 and various socio-economic indices were compared to weather indices (derived from principal component analyses) as predictors for the change in TBE case numbers in 2009 relative to 2004-08, for 14 European countries.</p> <p>Results</p> <p>Greatest increases in TBE incidence occurred in Latvia, Lithuania and Poland (91, 79 and 45%, respectively). The weather was rejected as an explanatory variable. Indicators of high background levels of poverty, e.g. percent of household expenditure on food, were significant predictors. The increase in unemployment in 2009 relative to 2008 together with 'in-work risk of poverty' is the only case in which a multivariate model has a second significant term.</p> <p>Conclusion</p> <p>Background socio-economic conditions determine susceptibility to risk of TBE, while increased unemployment triggered a sudden increase in risk. Mechanisms behind this result may include reduced resistance to infection through stress; reduced uptake of costly vaccination; and more exposure of people to infected ticks in their forest habitat as they make greater use of wild forest foods, especially in those countries, Lithuania and Poland, with major marketing opportunities in such products. Recognition of these risk factors could allow more effective protection through education and a vaccination programme targeted at the economically most vulnerable.</p

Public Acceptance of Nature-based Solutions (NbS): a Framework for Successful NbS and its Application in Three European Case Studies

Nature-based solutions (NbS) are increasingly recognized as sustainable approaches to address socio-environmental challenges. Disaster risk reduction (DRR) has benefited by increasingly moving away from purely ‘grey’ infrastructure measures towards NbS, which can better provide cultural, aesthetic, and recreational co-benefits that are highly valued among European citizens. Public acceptance is of particular importance for NbS since they often rely on collaborative implementation, management, and monitoring, as well as protection against competing land uses. Although public engagement is a common goal of NbS projects and found in the IUCN’s core principles of NbS, outreach efforts are rarely based on a sufficient understanding of the (de)motivating factors tied to public perceptions. As a first step, we conducted a systematic literature review to examine how unique NbS characteristics relate to public acceptance through a comparison with grey measures. We identified influential acceptance factors related to individuals, society, and DRR measures. Based on the review, we introduce the PA-NbS framework as a starting point for the systematic consideration, design, and testing of strategies for increasing public acceptance. The PA-NbS highlights the roles of trust, competing interests, and effectiveness of NbS, as well as public perceptions of risk, nature and place. A lack of consideration of these factors may lead to misaligned public expectations and failed participatory initiatives, while jeopardizing the success of NbS projects. Therefore, as a second step, we conducted citizen surveys within three NbS host communities. Distinct NbS being implemented within the OPERANDUM project aim to reduce risk from (socio-)natural hazards in Scotland (landslides and coastal erosion), Finland (eutrophication and algal blooms) and Greece (river flooding). Associations of factors related to risk, nature, and place perceptions with pro-NbS attitudes and behavior were tested to determine how these may be leveraged to increase acceptance. We find that trust is a consistent factor for defining attitudes towards the NbS across the sites. Attitudes are strongly associated with respondents’ commitment to nature and concern for risk, while some skepticism of NbS effectiveness leads to high public demand for relevant evidence. Risk perception and particularly the potential for future impacts are associated with behavioural acceptance (i.e. willingness to engage), along with responsibility for nature and connectedness to place. Current data collection efforts to demonstrate NbS effectiveness for risk reduction are well-positioned to increase public acceptance in Europe. However, recognizing the differences among segments of the public within each site along with distinct hazard types, proposed NbS, and historical, social, and cultural characteristics across the sites is crucial for designing strategies that increase acceptance. An overview of these dynamics leads to evidence-based recommendations for the case-study sites and for successful NbS in Europe

Parent-of-origin-specific allelic associations among 106 genomic loci for age at menarche.

Age at menarche is a marker of timing of puberty in females. It varies widely between individuals, is a heritable trait and is associated with risks for obesity, type 2 diabetes, cardiovascular disease, breast cancer and all-cause mortality. Studies of rare human disorders of puberty and animal models point to a complex hypothalamic-pituitary-hormonal regulation, but the mechanisms that determine pubertal timing and underlie its links to disease risk remain unclear. Here, using genome-wide and custom-genotyping arrays in up to 182,416 women of European descent from 57 studies, we found robust evidence (P < 5 × 10(-8)) for 123 signals at 106 genomic loci associated with age at menarche. Many loci were associated with other pubertal traits in both sexes, and there was substantial overlap with genes implicated in body mass index and various diseases, including rare disorders of puberty. Menarche signals were enriched in imprinted regions, with three loci (DLK1-WDR25, MKRN3-MAGEL2 and KCNK9) demonstrating parent-of-origin-specific associations concordant with known parental expression patterns. Pathway analyses implicated nuclear hormone receptors, particularly retinoic acid and γ-aminobutyric acid-B2 receptor signalling, among novel mechanisms that regulate pubertal timing in humans. Our findings suggest a genetic architecture involving at least hundreds of common variants in the coordinated timing of the pubertal transition

Causal relationship between obesity and vitamin d status : Bi-directional mendelian randomization analysis of multiple cohorts

Background: Obesity is associated with vitamin D deficiency, and both are areas of active public health concern. We explored the causality and direction of the relationship between body mass index (BMI) and 25-hydroxyvitamin D [25(OH)D] using genetic markers as instrumental variables (IVs) in bi-directional Mendelian randomization (MR) analysis. Methods and Findings: We used information from 21 adult cohorts (up to 42,024 participants) with 12 BMI-related SNPs (combined in an allelic score) to produce an instrument for BMI and four SNPs associated with 25(OH)D (combined in two allelic scores, separately for genes encoding its synthesis or metabolism) as an instrument for vitamin D. Regression estimates for the IVs (allele scores) were generated within-study and pooled by meta-analysis to generate summary effects. Associations between vitamin D scores and BMI were confirmed in the Genetic Investigation of Anthropometric Traits (GIANT) consortium (n = 123,864). Each 1 kg/m2 higher BMI was associated with 1.15% lower 25(OH)D (p = 6.52610227). The BMI allele score was associated both with BMI (p = 6.30610262) and 25(OH)D (20.06% [95% CI 20.10 to 20.02], p = 0.004) in the cohorts that underwent meta-analysis. The two vitamin D allele scores were strongly associated with 25(OH)D (p#8.07610257 for both scores) but not with BMI (synthesis score, p = 0.88; metabolism score, p = 0.08) in the meta-analysis. A 10% higher genetically instrumented BMI was associated with 4.2% lower 25(OH)D concentrations (IV ratio: 24.2 [95% CI 27.1 to 21.3], p = 0.005). No association was seen for genetically instrumented 25(OH)D with BMI, a finding that was confirmed using data from the GIANT consortium (p$0.57 for both vitamin D scores). Conclusions: On the basis of a bi-directional genetic approach that limits confounding, our study suggests that a higher BMI leads to lower 25(OH)D, while any effects of lower 25(OH)D increasing BMI are likely to be small. Population level interventions to reduce BMI are expected to decrease the prevalence of vitamin D deficiency

Public acceptance of nature-based solutions for natural hazard risk reduction: survey findings from three study sites in europe

Climate change is one factor increasing the risk of hydro-meteorological hazards globally. The use of nature-based solutions (NbS), and more specifically ecosystem-based disaster risk reduction measures (Eco-DRR), has become a popular response for risk reduction that also provides highly-valued co-benefits. Public acceptance is of particular importance for NbS since they often rely on local collaborative implementation, management, and monitoring, as well as long-term protection against competing societal interests. Although public engagement is a common goal of NbS projects, it is rarely carried out with a sufficient understanding of the (de)motivating factors tied to public perceptions. Successful collaboration demands consideration of societal attitudes and values in relation to risk, nature, and place. However, existing research does not sufficiently explore these themes together, their interactions, and their implications for the public acceptance of NbS. This may lead to misaligned public expectations and failed participatory initiatives, while jeopardizing the success of NbS projects and their continued funding and uptake. We conducted citizen surveys within local NbS “host” communities to determine the degree of pro-NbS attitudes and behavior, associated variables, and how these may be leveraged to increase acceptance. We compared results across sites, relying primarily on correlations and regression models along with survey comments and expert knowledge. Three distinct rural NbS being implemented within the OPERANDUM project aim to reduce risk from (socio-)natural hazards in Scotland (landslides and coastal erosion; n = 66 respondents), Finland (eutrophication and algal blooms; n = 204) and Greece (river flooding and water scarcity; n = 84). Our research thus centers on rural NbS for risk reduction within a large EU project. Trust in implementers is a consistent factor for defining attitudes towards the NbS across the sites, and attitudes are strongly associated with respondents’ commitment to nature and behavioral acceptance (i.e., willingness to engage). Behaviorial acceptance is most consistently predicted by connectedness to place and the extent of expected future impacts. Skepticism of NbS effectiveness leads to high public demand for relevant evidence. To increase public acceptance, we recommend greater framing of NbS in relation to place-based values as well as demonstration of the effectiveness of NbS for risk reduction. However, distinct hazard types, proposed NbS, and historical characteristics must be considered for developing strategies aimed at increasing acceptance. An understanding of these characteristics and their interactions leads to evidence-based recommendations for our study sites and for successful NbS deployment in Europe and beyond