Global ETD Search

1	Facteurs pronostiques et thérapeutiques après traitement chirurgical de l'adénocarcinome du pancréas céphalique / Pronostics and therapeutics factors after surgery for pancreatic ductal adenocarcinoma Lubrano, Jean 18 December 2017 (has links) Le 17 novembre 2016 a eu lieu la 3ème journée mondiale de lutte contre le cancer du pancréas.Cette prise en considération tardive rend compte de la dualité entre une incidence faible et un pronostic redoutable. Sa réputation de cancer rapidement mortel est attestée par un ratio incidence/mortalité proche de 1. Au 10ème rang en termes de localisations de cancers, il se hisse au 4ème rang en termes de mortalité par cancer et devrait devenir, en 2020, la 2ème cause de décès par cancer devant le cancer du côlon et juste après le cancer du poumon. Le taux de survie à 5 ans, tous stades confondus, est de 5% aux USA et en Europe.L’adénocarcinome canalaire pancréatique représente la tumeur la plus fréquente (80% des tumeurs pancréatiques exocrines). Sa localisation dans la glande pancréatique est céphalique dans 2/3 des cas.A ce jour, le traitement chirurgical reste le seul traitement potentiellement curatif. Celui-ci ne s’adresse qu’à une faible proportion de patients. En effet, seul 20% des patients présentant un adénocarcinome pancréatique céphalique sont effectivement résécables permettant d’obtenir un taux de survie globale à 5 ans d'environ 10 à 20% si la résection est suivie de chimiothérapie adjuvante ou non. Ces résultats modestes sont en outre à pondérer par la morbi-mortalité des résections pancréatiques céphaliques. Dans la série de l’Association Française de Chirurgie, reprenant les résections pancréatiques céphaliques réalisées en France entre 2004 et 2010, la mortalité était de 3,8% et la morbidité de 54%. Parmi les complications post-opératoires, la fistule pancréatique représente la principale complication en termes de mortalité (15 à 25%), génératrice de coût important dans les soins et d’une augmentation significative de la durée de séjour. La fistule pancréatique demeure la pierre angulaire de l’amélioration du pronostic des patients.L’objectif de ce travail sur l’adénocarcinome canalaire pancréatique céphalique traité chirurgicalement était d’analyser certains facteurs influençant la morbi-mortalité au trois temps de sa prise en charge :- Avant l’intervention, avec l’étude d’un facteur pronostic préopératoire, sur une cohorte de patients, pouvant influencer la survenue d’une fistule pancréatique et la mortalité- Pendant l’intervention, avec la réalisation d’une méta-analyse sur le type de reconstruction pancréatique et son influence sur la survenue d’une fistule pancréatique- Après l’intervention, avec l’étude de l’influence de la survenue d’une complication sévère sur la survie et la survie sans récidive.Au cours de cette thèse nous avons vu, que la réduction du taux de fistule pancréatique, par le seul biais de techniques peropératoires semble difficilement réalisable au regard de la multiplicité des techniques et de la difficulté à réaliser des études randomisées contrôlées méthodologiquement satisfaisantes. En revanche, la recherche des facteurs liés aux patients, prédisposant à la survenue d’une fistule pancréatique semble l’approche à privilégier. Ceci est d’autant plus primordial dès lors que nous avons mis en évidence un lien entre la survenue d’une complication sévère et la survie ou la récidive chez les patients réséqués. Ce travail souligne l’importance d’être capable d’identifier, dès la consultation, les patients à haut risque de complications sévères et de fistule post-opératoire d’une part, pour sélectionner les bons candidats à la chirurgie et d’autre part, pour être capable de leur apporter une information franche et loyale indispensable éthiquement au consentement éclairé. / The third World Day on pancreatic cancer took place the 17th November 2016. This late consideration is due to the duality between his relative scarcity and a dreadful prognosis.Its aggressiveness is underlined by a mortality rate equal to its incidence. Ranked 10th on cancer-related localization and 4th on cancer-related mortality, he will become the second cause of cancer-related deaths in 2020 just behind pulmonary cancer and before colorectal cancer. 5-yr survival rate is 5% irrespective of the stage.Pancreatic ductal adenocarcinoma is the most frequent form (80% of exocrine pancreatic tumors). He is localized in cephalic pancreas in 2/3 of cases.Although pancreatic resection provides the only chance of long-term survival, no more than 20% of patients will be eligible for surgery in curative intent leading to a 5-yr survival rate of 10 to 20%. Pancreaticoduodenectomy for pancreatic head, neck and uncinated process is still a challenging procedure. In the study of the French Surgery Association, mortality and morbidity rate were respectively 3.8% and 54%. Postoperative pancreatic fistula is considered as the Achilles’ heel of pancreaticoduodenectomy and is associated with increased post-operative mortality. Postoperative pancreatic fistula generates significant costs and prolonged hospital stay. Thus postoperative pancreatic fistula is the corner stone of patient’s prognosis improvement.The aim of this study on operated pancreatic ductal adenocarcinoma was to analyze several factors influencing morbidity and mortality.- Before surgery, by testing the impact of body surface area in a cohort of patients.- During surgery, by conducting a meta-analysis on reconstruction methods for pancreatic anastomosis.- After surgery, by evaluating the influence of severe complications on survival and recurrence.We show that the use of various surgical refinements, such as type of pancreatic anastomoses, are equivocal to decrease postoperative pancreatic fistula rate and that performing randomized controlled trials will be difficult. In contrast, the search for patient’s factors leading to postoperative pancreatic fistula seems to be the promising approach. This is of major concern as we demonstrated the causal link between the occurrence of severe postoperative complications and survival or recurrence. This work highlights the need for surgeons to distinguish during preoperative consultation high-risk patients in order to select the best candidates suitable for surgery as well as to give them a full and frank information ethically necessary for free and informed consent. Duodénopancréatectomie céphalique Surface corporelle Pancréatico-jéjunale Pancreaticoduodenectomy Pancreatic ductal adenocarcinoma Pancreatic fistula Body surface area Pancreaticojejunostomy Pancreaticogastrostomy Survival Recurrence
2	Anthropométrie, alimentation et risque du cancer différencié de la thyroïde dans les îles du Pacifique / Anthropometry, diet and risk of differentiated thyroid cancer in the Pacific Islands Cléro, Enora 15 March 2012 (has links) La Polynésie française et la Nouvelle-Calédonie, îles du Pacifique, ont l’un des taux de cancer de la thyroïde les plus élevés au monde. A l’exception des rayonnements ionisants, aucun autre facteur de risque n’est clairement établi pour ce cancer. Deux études cas-témoins sur le cancer de la thyroïde ont été réalisées en Polynésie française et Nouvelle-Calédonie afin d’étudier les facteurs de risque qui sont encore peu connus. L'objectif de ce travail de thèse est d’étudier le rôle des facteurs anthropométriques et de l’alimentation sur le risque de cancer de la thyroïde dans les îles du Pacifique.En Polynésie française, 229 cas de cancer de la thyroïde diagnostiqués entre 1979 et 2004 et 371 témoins appariés sur l’âge et le sexe ont été inclus. En Nouvelle-Calédonie, 331 cas de cancer de la thyroïde diagnostiqués entre 1993 et 1999 et 412 témoins appariés également sur l’âge et le sexe ont été inclus.Dans l’analyse poolée des deux études cas-témoins, un peu plus de la moitié des Polynésiens et Néo-calédoniens étaient en surpoids ou obèses. Une augmentation du risque de cancer thyroïdien a été mise en évidence avec une taille, un poids, un indice de masse corporelle, et une surface corporelle élevés. Parmi ces facteurs anthropométriques, la surface corporelle joue un rôle dominant dans le risque de cancer de la thyroïde, en particulier à l’âge de 18 ans.Ensuite, nous nous sommes intéressés à l’alimentation des Polynésiens uniquement. Nous avons identifié deux régimes (ou patterns) alimentaires : l’un occidental et l’autre polynésien traditionnel. Le régime « occidental » n’était pas associé à un risque de cancer thyroïdien, alors que le régime « polynésien traditionnel » était faiblement associé à une diminution du risque. Par ailleurs, les résultats ont montré que les Polynésiens avaient une alimentation carencée en iode. Une consommation élevée de poissons et fruits de mer, ainsi qu’un apport alimentaire en iode élevé étaient associés à une diminution du risque de cancer de la thyroïde. Enfin, une consommation élevée de manioc, aliment goitrigène, diminuait le risque de cancer thyroïdien. / French Polynesia and New Caledonia, Pacific Islands, have one of the world’s highest thyroid cancer incidence rates. Except ionizing radiation, no other risk factor is clearly established for this cancer. Two case-control studies on thyroid cancer were conducted in French Polynesia and New Caledonia to investigate the risk factors not still understood. The objective of this thesis is to study the role of anthropometric and dietary factors in the risk of thyroid cancer in the Pacific Islands.In French Polynesia, 229 cases of thyroid cancer diagnosed between 1979 and 2004 and 371 controls matched on age and sex were included. In New Caledonia, 331 cases of thyroid cancer diagnosed between 1993 and 1999 and 412 controls matched also on age and sex were included.In the pooled analysis of the two case-control studies, half of Polynesians and Melanesians were overweighed or obese. An increased risk of thyroid cancer was shown with a high height, weight, body mass index, and body surface area. Among anthropometric factors, BSA plays a dominant role in thyroid cancer risk, in particular at 18 years old.Then, we are interested in the diet only of Polynesians. We have identified two dietary patterns: Western and traditional Polynesian. The pattern “Western" was not associated with a risk of thyroid cancer, while the pattern "traditional Polynesian" was weakly associated with a decreased risk. Moreover, results showed that Polynesians had a diet deficient in iodine. A higher consumption of fish and shellfish, and a higher dietary iodine intake are significantly associated with a decreased risk of thyroid cancer. Lastly, high cassava consumption decreased the thyroid cancer risk. Cancer de la thyroïde Îles du Pacifique Surface corporelle Régime alimentaire Iode Poissons et fruits de mer Aliments goitrigènes Manioc Thyroid cancer Pacific Islands Body surface area Dietary pattern Iodine Fish and shellfish Goitrogenic food Cassava
3	BIRTHWEIGHT AND SUSCEPTIBILITY TO CHRONIC DISEASE Issa Al Salmi Unknown Date (has links) The thesis examines the relationship of birthweight to risk factors and markers, such as proteinuria and glomerular filtration rate, for chronic disease in postnatal life. It made use of the Australian Diabetes, Obesity and Lifestyle Study (AusDiab). The AusDiab study is a cross sectional study where baseline data on 11,247 participants were collected in 1999-2000. Participants were recruited from a stratified sample of Australians aged ≥ 25 years, residing in 42 randomly selected urban and non-urban areas (Census Collector Districts) of the six states of Australia and the Northern Territory. The AusDiab study collected an enormous amount of clinical and laboratory data. During the 2004-05 follow-up AusDiab survey, questions about birthweight were included. Participants were asked to state their birthweight, the likely accuracy of the stated birthweight and the source of their stated birthweight. Four hundred and twelve chronic kidney disease (CKD) patients were approached, and 339 agreed to participate in the study. The patients completed the same questionnaire. Medical records were reviewed to check the diagnoses, causes of kidney trouble and SCr levels. Two control subjects, matched for gender and age, were selected for each CKD patient from participants in the AusDiab study who reported their birthweight. Among 7,157 AusDiab participants who responded to the questionnaire, 4,502 reported their birthweights, with a mean (standard deviation) of 3.4 (0.7) kg. The benefit and disadvantages of these data are discussed in chapter three. The data were analysed for the relationship between birthweight and adult body size and composition, disorders of glucose regulation, blood pressure, lipid abnormalities, cardiovascular diseases and glomerular filtration rate. Low birthweight was associated with smaller body build and lower lean mass and total body water in both females and males. In addition low birthweight was associated with central obesity and higher body fat percentage in females, even after taking into account current physical activity and socioeconomic status. Fasting plasma glucose, post load glucose and glycosylated haemoglobin were strongly and inversely correlated with birthweight. In those with low birthweight (< 2.5 kg), the risks for having impaired fasting glucose, impaired glucose tolerance, diabetes and all abnormalities combined were increased by 1.75, 2.22, 2.76 and 2.28 for females and by 1.40, 1.32, 1.98 and 1.49 for males compared to those with normal birthweight (≥ 2.5 kg), respectively. Low birthweight individuals were at higher risk for having high blood pressure ≥ 140/90 mmHg and ≥ 130/85 mmHg compared to those with normal birthweight. People with low birthweight showed a trend towards increased risk for high cholesterol (≥ 5.5 mmol/l) compared to those of normal birthweight. Females with low birthweight had increased risk for high low density lipoprotein cholesterol (≥ 3.5 mmol/l) and triglyceride levels (≥ 1.7 mmol/l) when compared to those with normal birthweight. Males with low birthweight exhibited increased risk for low levels of high density lipoprotein cholesterol (<0.9 mmol/l) than those with normal birthweight. Females with low birthweight were at least 1.39, 1.40, 2.30 and 1.47 times more likely to have angina, coronary artery disease, stroke and overall cardiovascular diseases respectively, compared to those ≥ 2.5 kg. Similarly, males with low birthweight were 1.76, 1.48, 3.34 and 1.70 times more likely to have angina, coronary artery disease, stroke and overall cardiovascular diseases compared to those ≥ 2.5 kg, respectively. The estimated glomerular filtration rate was strongly and positively associated with birthweight, with a predicted increase of 2.6 ml/min (CI 2.1, 3.2) and 3.8 (3.0, 4.5) for each kg of birthweight for females and males, respectively. The odd ratio (95% confidence interval) for low glomerular filtration rate (<61.0 ml/min for female and < 87.4 male) in people of low birthweight compared with those of normal birthweight was 2.04 (1.45, 2.88) for female and 3.4 (2.11, 5.36) for male. One hundred and eighty-nineCKD patients reported their birthweight; 106 were male. Their age was 60.3(15) years. Their birthweight was 3.27 (0.62) kg, vs 3.46 (0.6) kg for their AusDiab controls, p<0.001 and the proportions with birthweight<2.5 kg were 12.17% and 4.44%, p<0.001. Among CKD patients, 22.8%, 21.7%, 18% and 37.6% were in CKD stages 2, 3, 4 and 5 respectively. Birthweights by CKD stage and their AusDiab controls were as follows: 3.38 (0.52) vs 3.49 (0.52), p=0.251 for CKD2; 3.28 (0.54) vs 3.44 (0.54), p=0.121 for CKD3; 3.19 (0.72) vs 3.43 (0.56), p= 0.112 for CKD4 and 3.09 (0.65) vs 3.47 (0.67), p<0.001 for CKD5. The results demonstrate that in an affluent Western country with a good adult health profile, low birthweight people were predisposed to higher rates of glycaemic dysregulation, high blood pressure, dyslipidaemia, cardiovascular diseases and lower glomerular filtration rate in adult life. In all instances it would be prudent to adopt policies of intensified whole of life surveillance of lower birthweight people, anticipating this risk. The general public awareness of the effect of low birthweight on development of chronic diseases in later life is of vital importance. The general public, in addition to the awareness of people in medical practice of the role of low birthweight, will lead to a better management of this group of our population that is increasingly surviving into adulthood. birth weight birthweight birth weight and renal volume BIRTH WEIGHT QUESTIONNAIRE chronic disease Barker Hypothesis Foetal development DOHaD gestational age Anthropometric Characteristics body composition Height weight body mass index Waist Circumference hip circumference Waist-hip Ratio obesity Central Obesity Fatness Lean Body Mass Lean Mass Fat Mass body fat mass Body Fat Percentage body fatness Body Surface Area diabetes Fasting Glucose fasting insulin level glucose tolerance Impaired Fasting Glucose Impaired Glucose Tolerance Glycosylated Hemoglobin HbA1c IFG glucose control glycaemic control Metabolic Syndrome Syndrome X blood pressure Systolic Blood-pressure Diastolic Blood-pressure Systolic Hypertension high blood pressure Hypertension Dyslipidaemia Dyslipidemia Total Cholesterol Triglyceride Low Density Lipoprotein Cholesterol Ldl Cholesterol High Density Lipoprotein Hdl Cholesterol Fibrinogen angina Angina-pectoris Stroke coronary artery disease cardiovascular disease Framingham Framingham Heart Study Framingham Score coronary heart disease Glomerular Filtration glomerular filtration rate Glomerular Hyperfiltration Glomerular Injury Glomerular Number Nephrogenesis Nephron Endowment Nephron Number NKF-K/DQQI Classification Chronic Kidney Disease (ckd) Chronic Kidney Failure Kidney Failure CKD STAGES end-stage renal disease (ESRD) end-stage renal failure Cockcroft-gault MDRD formula Serum Creatinine Urinary Creatinine albuminuria Albuminuria:creatinine Ratio Kidney Development Kidney dysfunction low birth weight low birth weight Pre-term Birth AusDiab Study case control longitudinal observational study
4	BIRTHWEIGHT AND SUSCEPTIBILITY TO CHRONIC DISEASE Issa Al Salmi Unknown Date (has links) The thesis examines the relationship of birthweight to risk factors and markers, such as proteinuria and glomerular filtration rate, for chronic disease in postnatal life. It made use of the Australian Diabetes, Obesity and Lifestyle Study (AusDiab). The AusDiab study is a cross sectional study where baseline data on 11,247 participants were collected in 1999-2000. Participants were recruited from a stratified sample of Australians aged ≥ 25 years, residing in 42 randomly selected urban and non-urban areas (Census Collector Districts) of the six states of Australia and the Northern Territory. The AusDiab study collected an enormous amount of clinical and laboratory data. During the 2004-05 follow-up AusDiab survey, questions about birthweight were included. Participants were asked to state their birthweight, the likely accuracy of the stated birthweight and the source of their stated birthweight. Four hundred and twelve chronic kidney disease (CKD) patients were approached, and 339 agreed to participate in the study. The patients completed the same questionnaire. Medical records were reviewed to check the diagnoses, causes of kidney trouble and SCr levels. Two control subjects, matched for gender and age, were selected for each CKD patient from participants in the AusDiab study who reported their birthweight. Among 7,157 AusDiab participants who responded to the questionnaire, 4,502 reported their birthweights, with a mean (standard deviation) of 3.4 (0.7) kg. The benefit and disadvantages of these data are discussed in chapter three. The data were analysed for the relationship between birthweight and adult body size and composition, disorders of glucose regulation, blood pressure, lipid abnormalities, cardiovascular diseases and glomerular filtration rate. Low birthweight was associated with smaller body build and lower lean mass and total body water in both females and males. In addition low birthweight was associated with central obesity and higher body fat percentage in females, even after taking into account current physical activity and socioeconomic status. Fasting plasma glucose, post load glucose and glycosylated haemoglobin were strongly and inversely correlated with birthweight. In those with low birthweight (< 2.5 kg), the risks for having impaired fasting glucose, impaired glucose tolerance, diabetes and all abnormalities combined were increased by 1.75, 2.22, 2.76 and 2.28 for females and by 1.40, 1.32, 1.98 and 1.49 for males compared to those with normal birthweight (≥ 2.5 kg), respectively. Low birthweight individuals were at higher risk for having high blood pressure ≥ 140/90 mmHg and ≥ 130/85 mmHg compared to those with normal birthweight. People with low birthweight showed a trend towards increased risk for high cholesterol (≥ 5.5 mmol/l) compared to those of normal birthweight. Females with low birthweight had increased risk for high low density lipoprotein cholesterol (≥ 3.5 mmol/l) and triglyceride levels (≥ 1.7 mmol/l) when compared to those with normal birthweight. Males with low birthweight exhibited increased risk for low levels of high density lipoprotein cholesterol (<0.9 mmol/l) than those with normal birthweight. Females with low birthweight were at least 1.39, 1.40, 2.30 and 1.47 times more likely to have angina, coronary artery disease, stroke and overall cardiovascular diseases respectively, compared to those ≥ 2.5 kg. Similarly, males with low birthweight were 1.76, 1.48, 3.34 and 1.70 times more likely to have angina, coronary artery disease, stroke and overall cardiovascular diseases compared to those ≥ 2.5 kg, respectively. The estimated glomerular filtration rate was strongly and positively associated with birthweight, with a predicted increase of 2.6 ml/min (CI 2.1, 3.2) and 3.8 (3.0, 4.5) for each kg of birthweight for females and males, respectively. The odd ratio (95% confidence interval) for low glomerular filtration rate (<61.0 ml/min for female and < 87.4 male) in people of low birthweight compared with those of normal birthweight was 2.04 (1.45, 2.88) for female and 3.4 (2.11, 5.36) for male. One hundred and eighty-nineCKD patients reported their birthweight; 106 were male. Their age was 60.3(15) years. Their birthweight was 3.27 (0.62) kg, vs 3.46 (0.6) kg for their AusDiab controls, p<0.001 and the proportions with birthweight<2.5 kg were 12.17% and 4.44%, p<0.001. Among CKD patients, 22.8%, 21.7%, 18% and 37.6% were in CKD stages 2, 3, 4 and 5 respectively. Birthweights by CKD stage and their AusDiab controls were as follows: 3.38 (0.52) vs 3.49 (0.52), p=0.251 for CKD2; 3.28 (0.54) vs 3.44 (0.54), p=0.121 for CKD3; 3.19 (0.72) vs 3.43 (0.56), p= 0.112 for CKD4 and 3.09 (0.65) vs 3.47 (0.67), p<0.001 for CKD5. The results demonstrate that in an affluent Western country with a good adult health profile, low birthweight people were predisposed to higher rates of glycaemic dysregulation, high blood pressure, dyslipidaemia, cardiovascular diseases and lower glomerular filtration rate in adult life. In all instances it would be prudent to adopt policies of intensified whole of life surveillance of lower birthweight people, anticipating this risk. The general public awareness of the effect of low birthweight on development of chronic diseases in later life is of vital importance. The general public, in addition to the awareness of people in medical practice of the role of low birthweight, will lead to a better management of this group of our population that is increasingly surviving into adulthood. birth weight birthweight birth weight and renal volume BIRTH WEIGHT QUESTIONNAIRE chronic disease Barker Hypothesis Foetal development DOHaD gestational age Anthropometric Characteristics body composition Height weight body mass index Waist Circumference hip circumference Waist-hip Ratio obesity Central Obesity Fatness Lean Body Mass Lean Mass Fat Mass body fat mass Body Fat Percentage body fatness Body Surface Area diabetes Fasting Glucose fasting insulin level glucose tolerance Impaired Fasting Glucose Impaired Glucose Tolerance Glycosylated Hemoglobin HbA1c IFG glucose control glycaemic control Metabolic Syndrome Syndrome X blood pressure Systolic Blood-pressure Diastolic Blood-pressure Systolic Hypertension high blood pressure Hypertension Dyslipidaemia Dyslipidemia Total Cholesterol Triglyceride Low Density Lipoprotein Cholesterol Ldl Cholesterol High Density Lipoprotein Hdl Cholesterol Fibrinogen angina Angina-pectoris Stroke coronary artery disease cardiovascular disease Framingham Framingham Heart Study Framingham Score coronary heart disease Glomerular Filtration glomerular filtration rate Glomerular Hyperfiltration Glomerular Injury Glomerular Number Nephrogenesis Nephron Endowment Nephron Number NKF-K/DQQI Classification Chronic Kidney Disease (ckd) Chronic Kidney Failure Kidney Failure CKD STAGES end-stage renal disease (ESRD) end-stage renal failure Cockcroft-gault MDRD formula Serum Creatinine Urinary Creatinine albuminuria Albuminuria:creatinine Ratio Kidney Development Kidney dysfunction low birth weight low birth weight Pre-term Birth AusDiab Study case control longitudinal observational study
5	BIRTHWEIGHT AND SUSCEPTIBILITY TO CHRONIC DISEASE Issa Al Salmi Unknown Date (has links) The thesis examines the relationship of birthweight to risk factors and markers, such as proteinuria and glomerular filtration rate, for chronic disease in postnatal life. It made use of the Australian Diabetes, Obesity and Lifestyle Study (AusDiab). The AusDiab study is a cross sectional study where baseline data on 11,247 participants were collected in 1999-2000. Participants were recruited from a stratified sample of Australians aged ≥ 25 years, residing in 42 randomly selected urban and non-urban areas (Census Collector Districts) of the six states of Australia and the Northern Territory. The AusDiab study collected an enormous amount of clinical and laboratory data. During the 2004-05 follow-up AusDiab survey, questions about birthweight were included. Participants were asked to state their birthweight, the likely accuracy of the stated birthweight and the source of their stated birthweight. Four hundred and twelve chronic kidney disease (CKD) patients were approached, and 339 agreed to participate in the study. The patients completed the same questionnaire. Medical records were reviewed to check the diagnoses, causes of kidney trouble and SCr levels. Two control subjects, matched for gender and age, were selected for each CKD patient from participants in the AusDiab study who reported their birthweight. Among 7,157 AusDiab participants who responded to the questionnaire, 4,502 reported their birthweights, with a mean (standard deviation) of 3.4 (0.7) kg. The benefit and disadvantages of these data are discussed in chapter three. The data were analysed for the relationship between birthweight and adult body size and composition, disorders of glucose regulation, blood pressure, lipid abnormalities, cardiovascular diseases and glomerular filtration rate. Low birthweight was associated with smaller body build and lower lean mass and total body water in both females and males. In addition low birthweight was associated with central obesity and higher body fat percentage in females, even after taking into account current physical activity and socioeconomic status. Fasting plasma glucose, post load glucose and glycosylated haemoglobin were strongly and inversely correlated with birthweight. In those with low birthweight (< 2.5 kg), the risks for having impaired fasting glucose, impaired glucose tolerance, diabetes and all abnormalities combined were increased by 1.75, 2.22, 2.76 and 2.28 for females and by 1.40, 1.32, 1.98 and 1.49 for males compared to those with normal birthweight (≥ 2.5 kg), respectively. Low birthweight individuals were at higher risk for having high blood pressure ≥ 140/90 mmHg and ≥ 130/85 mmHg compared to those with normal birthweight. People with low birthweight showed a trend towards increased risk for high cholesterol (≥ 5.5 mmol/l) compared to those of normal birthweight. Females with low birthweight had increased risk for high low density lipoprotein cholesterol (≥ 3.5 mmol/l) and triglyceride levels (≥ 1.7 mmol/l) when compared to those with normal birthweight. Males with low birthweight exhibited increased risk for low levels of high density lipoprotein cholesterol (<0.9 mmol/l) than those with normal birthweight. Females with low birthweight were at least 1.39, 1.40, 2.30 and 1.47 times more likely to have angina, coronary artery disease, stroke and overall cardiovascular diseases respectively, compared to those ≥ 2.5 kg. Similarly, males with low birthweight were 1.76, 1.48, 3.34 and 1.70 times more likely to have angina, coronary artery disease, stroke and overall cardiovascular diseases compared to those ≥ 2.5 kg, respectively. The estimated glomerular filtration rate was strongly and positively associated with birthweight, with a predicted increase of 2.6 ml/min (CI 2.1, 3.2) and 3.8 (3.0, 4.5) for each kg of birthweight for females and males, respectively. The odd ratio (95% confidence interval) for low glomerular filtration rate (<61.0 ml/min for female and < 87.4 male) in people of low birthweight compared with those of normal birthweight was 2.04 (1.45, 2.88) for female and 3.4 (2.11, 5.36) for male. One hundred and eighty-nineCKD patients reported their birthweight; 106 were male. Their age was 60.3(15) years. Their birthweight was 3.27 (0.62) kg, vs 3.46 (0.6) kg for their AusDiab controls, p<0.001 and the proportions with birthweight<2.5 kg were 12.17% and 4.44%, p<0.001. Among CKD patients, 22.8%, 21.7%, 18% and 37.6% were in CKD stages 2, 3, 4 and 5 respectively. Birthweights by CKD stage and their AusDiab controls were as follows: 3.38 (0.52) vs 3.49 (0.52), p=0.251 for CKD2; 3.28 (0.54) vs 3.44 (0.54), p=0.121 for CKD3; 3.19 (0.72) vs 3.43 (0.56), p= 0.112 for CKD4 and 3.09 (0.65) vs 3.47 (0.67), p<0.001 for CKD5. The results demonstrate that in an affluent Western country with a good adult health profile, low birthweight people were predisposed to higher rates of glycaemic dysregulation, high blood pressure, dyslipidaemia, cardiovascular diseases and lower glomerular filtration rate in adult life. In all instances it would be prudent to adopt policies of intensified whole of life surveillance of lower birthweight people, anticipating this risk. The general public awareness of the effect of low birthweight on development of chronic diseases in later life is of vital importance. The general public, in addition to the awareness of people in medical practice of the role of low birthweight, will lead to a better management of this group of our population that is increasingly surviving into adulthood. birth weight birthweight birth weight and renal volume BIRTH WEIGHT QUESTIONNAIRE chronic disease Barker Hypothesis Foetal development DOHaD gestational age Anthropometric Characteristics body composition Height weight body mass index Waist Circumference hip circumference Waist-hip Ratio obesity Central Obesity Fatness Lean Body Mass Lean Mass Fat Mass body fat mass Body Fat Percentage body fatness Body Surface Area diabetes Fasting Glucose fasting insulin level glucose tolerance Impaired Fasting Glucose Impaired Glucose Tolerance Glycosylated Hemoglobin HbA1c IFG glucose control glycaemic control Metabolic Syndrome Syndrome X blood pressure Systolic Blood-pressure Diastolic Blood-pressure Systolic Hypertension high blood pressure Hypertension Dyslipidaemia Dyslipidemia Total Cholesterol Triglyceride Low Density Lipoprotein Cholesterol Ldl Cholesterol High Density Lipoprotein Hdl Cholesterol Fibrinogen angina Angina-pectoris Stroke coronary artery disease cardiovascular disease Framingham Framingham Heart Study Framingham Score coronary heart disease Glomerular Filtration glomerular filtration rate Glomerular Hyperfiltration Glomerular Injury Glomerular Number Nephrogenesis Nephron Endowment Nephron Number NKF-K/DQQI Classification Chronic Kidney Disease (ckd) Chronic Kidney Failure Kidney Failure CKD STAGES end-stage renal disease (ESRD) end-stage renal failure Cockcroft-gault MDRD formula Serum Creatinine Urinary Creatinine albuminuria Albuminuria:creatinine Ratio Kidney Development Kidney dysfunction low birth weight low birth weight Pre-term Birth AusDiab Study case control longitudinal observational study

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