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31	Retrospektive Analyse des Therapieverlaufs und kardiovaskulären Risikoprofils bei Patienten mit Rheumatoider Arthritis unter immunsuppressiver Therapie / Retrospective analysis of the course of therapy and cardiovascular risk profile in patients with rheumatoid arthritis under immunosuppressive therapy Gebauer, Katrin 12 June 2018 (has links) No description available. 610 Rheumatoide Arthritis Kardiovaskuläres Risiko rheumatoid arthritis cardiovascular risk DAS28 DMARD biologic myocardial infarction stroke Framingham score PROCAM score Medizin (PPN619874732) Rheumatologie (PPN619875887)
32	Avaliação do risco cardiovascular em pacientes com lipodistrofia secundária a terapia antirretroviral: critérios de framingham, índice tornozelo-braço e medida da espessura da camada medio-intimal da carótida KOURY JUNIOR, Adib 16 December 2011 (has links) Submitted by Cássio da Cruz Nogueira (cassionogueirakk@gmail.com) on 2017-10-16T16:31:41Z No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Dissertacao_AvaliacaoRiscoCardiovascular.pdf: 2466410 bytes, checksum: 59ef7e378a65080149c8f7f68305854c (MD5) / Approved for entry into archive by Irvana Coutinho (irvana@ufpa.br) on 2017-10-18T16:18:41Z (GMT) No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Dissertacao_AvaliacaoRiscoCardiovascular.pdf: 2466410 bytes, checksum: 59ef7e378a65080149c8f7f68305854c (MD5) / Made available in DSpace on 2017-10-18T16:18:41Z (GMT). No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Dissertacao_AvaliacaoRiscoCardiovascular.pdf: 2466410 bytes, checksum: 59ef7e378a65080149c8f7f68305854c (MD5) Previous issue date: 2011-12-16 / O uso da terapia antirretroviral reduziu significativamente a mortalidade e a morbidade nos pacientes infectados pelo HIV. Entretanto, este tratamento pode causar alterações metabólicas como dislipidemia, intolerância à glicose, resistência insulínica e lipodistrofia. As consequências clínicas e laboratoriais que acompanham estas alterações podem aumentar o risco para desenvolvimento de doenças cardiovasculares. Este estudo teve o intuito de investigar os aspectos epidemiológicos, clínicos e laboratoriais dos pacientes com lipodistrofia associados ao aumento do risco cardiovascular com ênfase à medida da camada média-intimal e índice tronozelobraço. Para tanto foi conduzido um estudo Transversal analítico com 62 paciente com lipodistrofia em uso de Terapia antirretroviral ativa (TARV) com idades variando de 29 a 68 anos acompanhados no ambulatório de lipodistrofia do Hospital Universitário João de Barros Barreto. Os pacientes foram submetidos a anamnese com exame clínico, coleta de sangue para exames laboratoriais com dosagem de glicemia, colesterol total e suas frações, triglicerídeos e PCR ultra-sensível, medida do índice de pressão tornozelo-braço (ITB) e medida da espessura da camada médio-intimal da carótida (CMI) através de ultra-sonografia modo B. Os pacientes foram classificados quanto ao risco cardiovascular através dos critérios do escore de Framingham. As variáveis foram analisadas pelo estudo de medidas de tendência central e as hipóteses foram avaliadas pelos testes qui-quadrado e e/ou exato de Fisher. A prevalência de alteração do ITB na amostra estudada foi de 21% e os pacientes com aumento da CMI foi de 48,4%. De acordo com o escore de Framingham, 53,2% dos pacientes apresentaram risco baixo para evento cardiovascular em 10 anos, 16,1% risco moderado e 30,7% risco alto. Paciente com aumento da CMI apresentaram maior risco cardiovascular através do escore de Framingham O sexo masculino, idade, aumento da circunferência abdominal apresentaram uma associação significante com o aumento da espessura da camada médio-intimal da carótida. / The use of combination antiretroviral therapy has significantly reduced mortality and morbidity in patients infected by HIV virus. However, this treatment may cause metabolic alterations such as dyslipidemia, glucose intolerance, insulin resistance and lipodystrophy. The clinical and laboratorial consequences that follow these alterations may raise the risk for cardiovascular diseases. This research aimed to investigate the epidemiological, clinical and laboratorial aspects of patients with lipodystrophy associated to raise cardiovascular risk, ankle-brachial index (ABI) and measurement of the carotid intima-media thickness (cIMT). For so, it was performed a Transversal analytical study with 62 patients with lipodystrophy using highly active antiretroviral therapy (HAART) with ages varying from 29 to 68, followed up in the outpatient unit of lipodystrophy of João de Barros Barreto University Hospital. The patients were submitted to anamnesis with clinical examination, blood collection for laboratorial tests with glycemia dosage, total cholesterol and its fractions, triglycerides and ultrasensitive PCR, measurement of the ankle-brachial index and measurement of the carotid intima-media thickness through mode B ultrasonography. The patients were classified according to their cardiovascular risks through the criteria of the Framingham Score. The variables were analyzed by the study of the measurements of central trend and the hypotheses were analyzed by the chi-square Test and/or the Fisher exact Test. The prevalence of alteration of the ABI in the studied sample was 21% and of the patients with a increase of the cIMT was 48.4%. According to the Framingham score, 53.2% of the patients presented low risk to a cardiovascular event in a 10 year range, 16.1% of moderate risk and 30.7% of high risk. A patient with a increase of the cIMT presented a larger cardiovascular risk through the Framingham score. Male, age, increase of the abdominal circumference have presented a significant association with the carotid intima-media thickness cIMT. Doenças cardiovasculares Epidemiologia Terapia antirretroviral Artéria carótida - Doenças Lipodistrofia Escore de Framingham HIV/AIDS
33	Integración de la Bioinformática en la Investigación Genómica Cardiovascular: Aplicaciones en el Framingham Heart Study Coltell Simón, Oscar 08 October 2004 (has links) El objetivo principal de esta tesis es la aplicación integrada de enfoques metodológicos de las disciplinas Ingeniería del Software y Auditoría de Sistemas de Información a la Bioinformática, en función de la identificación y caracterización de las aportaciones de esta disciplina a los trabajos de investigación en el área de la Epidemiología Genómica de las Enfermedades Cardiovasculares. Dado que el ámbito de aplicación así definido es demasiado amplio, se ha establecido un tema específico, el cálculo del riesgo cardiovascular a escala individual, sobre el cual giran los trabajos de investigación y se describen las aportaciones concretas de esta tesis.El ámbito de la Epidemiología Genómica de las Enfermedades Cardiovasculares está caracterizado por el Framingham Heart Study (Massachusetts, EE.UU., 1948 ) y los factores de riesgo cardiovascular son de tipo genético y ambiental. Dado que la lista actual de factores genéticos implicados en las enfermedades cardiovasculares contiene casi 3.000 genes, de la misma se han elegido un reducido subconjunto de los cuales se tiene información sobre sus polimorfismos y fenotipos patológicos: CETP, APOE, APOA1, LIPC, SR-BI y PLIN. Este último gen también se ha estudiado comparativamente en población general de la Comunidad Valenciana. Se ha desarrollado un estudio completo de cada uno de los genes relacionados. Los resultados obtenidos permiten descubrir unas interesantes interacciones genambiente, gensexo, gendieta, gendiabetes 2 y genobesidad, asociados a los polimorfismos de los genes estudiados y que se identifican en cada estudio. En resumen, se ofrecen datos concretos de asociaciones reales observadas entre variaciones genéticas y fenotipos cardiovasculares, así como de interacciones genambiente.En el ámbito de la Bioinformática, se ha desarrollado un modelo para el cálculo del riesgo cardiovascular a escala individual y un modelo para la aplicación de la Auditoría Bioinformática en el análisis y control de las funciones bioinformáticas. También se han desarrollado soluciones específicas para la resolución de problemas planteados en el protocolo científico del laboratorio genómico.En conclusión, la Bioinformática, entendida como una disciplina científico-técnica, es indispensable como instrumento de integración en la investigación genómica cardiovascular en los distintos niveles de adquisición, tratamiento, análisis, almacenamiento y salvaguarda de datos. Sin embargo, debido a su reciente desarrollo, tropieza todavía con las dificultades derivadas de la ausencia de un cuerpo teórico común y consistente, que permita dar respuesta rápida a las grandes demandas de proceso de información ómica que se están detectando en la actualidad. Estudio Framingham interacciones gen*ambiente Auditoría Bioinformática Bioinformática Llenguatges i Sistemes Informàtics 004 575 577 61
34	Évaluation économique de l'ajustement des antihypertenseurs par le pharmacien en milieu communautaire Houde, François-Xavier 07 1900 (has links) OBJECTIF : L’hypertension est une maladie chronique pour laquelle seulement 68 % des patients étaient contrôlés en 2013. Les pharmaciens de la province de Québec ont récemment obtenu l’autorité législative pour ajuster la dose des antihypertenseurs lorsqu’une cible thérapeutique est entendue avec le médecin. Cette étude économique vise à estimer le ratio coût- utilité incrémental (RCUI) de ce nouveau modèle de soin au Québec. MÉTHODE : Un modèle de Markov a été développé pour extrapoler l’impact de cette pratique pharmaceutique sur les accidents vasculaires cérébraux (AVC), sur les infarctus du myocarde aigus et sur la mortalité. Les équations du modèle de risque de Framingham ont été utilisées pour estimer l’impact du contrôle de la pression artérielle sur la survenue d’AVC et d’infarctus. L’efficacité de l’intervention a été estimée à partir des résultats de l’essai clinique RxAction, conduit en Alberta. L’efficacité de l’intervention pharmaceutique est exprimée via la proportion de patients contrôlés. La perspective du payeur public a été utilisée et seulement les coûts directs des soins de santé ont été intégrés. L’issue principale observée par le modèle est le gain en années de vie ajustées par la qualité (AVAQ). Les AVAQ et les coûts ont été actualisés à un taux annuel de 1,5 %. Le modèle a simulé une cohorte de 1000 patients âgés de 65 ans, sur un horizon temporel de 20 ans en utilisant des cycles d’un an. RÉSULTATS: Le modèle a généré 0,051 AVAQs de plus par patient dans le groupe d’intervention pour une dépense supplémentaire de 268 $ par patient. Le RCUI est de 5 223 $/AVAQ gagnée. Si le seuil de volonté à payer du tiers public se tient à 50 000 $/AVAQ, cette intervention serait dite coût-efficace. Les résultats de cette simulation étaient surtout sensibles à l’efficacité de l’intervention pharmaceutique ainsi qu’à l’utilité attribuée à l’hypertension. CONCLUSION: Permettre aux pharmaciens d’ajuster la dose des traitements antihypertenseurs à l’intérieur du modèle de rémunération actuel apparaît coût-efficace. L’obtention de données d’efficacité issue d’une étude clinique conduite au Québec nous permettrait d’augmenter la validité externe de cette modélisation économique. / OBJECTIVE: Hypertension is a chronic disease for which only 68% of treated patients were controlled in Canada in 2013. Pharmacists in the province of Québec recently received legislative authority to adjust the dosage of antihypertensive drugs if there is an agreement with the prescriber of the therapeutic target. This research aims to estimate the incremental cost- utility ratio (ICUR) of this new model of care in Québec. METHODS: A Markov model was developed to extrapolate the impact of this pharmacy practice on strokes, myocardial infarctions and mortality. Framingham Risk Equations were used to derive the impact of blood pressure control on strokes and myocardial infarctions. The efficacy of the intervention was derived from the RxAction clinical trial, conducted in Alberta. Efficacy was expressed as the proportion of patients with controlled blood pressure. The model used the payer perspective and direct costs only. The main clinical outcome was expressed as the number of quality-adjusted life years (QALYs) gained. Both QALYS and costs were discounted at a 1.5% annual rate. A cohort of 1000 patients entered the model at 65 years old. The model used a 20 years time horizon, with a 1-year cycle length. RESULTS: The model yielded 0.051 QALYs per patient in the intervention group for an incremental expense of $268 per patient. The ICUR was 5,223 $/QALY. At a willingness-to- pay threshold of $50,000/QALY, the intervention is cost-effective. The results were sensitive to the comparative efficacy of the pharmacist intervention against usual care and to the utility of hypertension. CONCLUSION: Providing pharmacists the ability to adjust the dosage of antihypertensive drugs within the actual fee-for-service rational appears to be cost-effective. Obtaining data on the efficacy of this pharmacy practice from a trial conducted in Québec would provide better data to inform this economic evaluation. Hypertension Pharmacien Ajustement Antihypertenseurs Coût-utilité Pharmacist Adjustment Antihypertensive Cost-utility Pharmacoéconomie Modèle de Markov Framingham Markov model Pharmacoeconomics Health economics Économie de la santé
35	Co-morbidities as quantitative traits Raska, Paola January 2010 (has links) No description available. Biomedical Research Biostatistics Genetics correlations co-morbidities framingham data obesity coronary heart disease diabetes physiological ceiling physiological resilience chromosome substitution strains A/J C57BL/6J gene by environment interactions gene by gene interactions
36	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
37	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
38	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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