Global ETD Search

11	Asociación entre el control glicémico y microalbuminuria en pacientes diabéticos tipo 2 en una clínica privada de Lima, Perú Guerreros Espino, Camila Nicole, Collazos Huamán, Lucero Del Carmen 08 January 2021 (has links) Objetivo: Valorar la asociación entre el control glicémico y la presencia de microalbuminuria en pacientes con diabetes mellitus tipo 2. Métodos: Se realizó un estudio transversal analítico en pacientes con diabetes mellitus tipo 2 de una clínica privada en Lima, Perú. Se incluyeron pacientes adultos mayores de 18 años que pertenecían a un programa de seguimiento durante el 2018 en una clínica privada. El mal control glicémico fue definido con una hemoglobina glicosilada mayor o igual a 7%. La presencia de microalbuminuria fue definida considerando valores de albúmina mayores a 20 mg/L en la primera orina de la mañana. Se realizó un modelo de regresión lineal generalizado de la familia de Poisson con varianza robusta. Calculamos la razón de prevalencias cruda y ajustada con un intervalo de confianza de 95%. Resultados: Se analizaron los datos de 907 participantes, la mediana de edad fue de 58 años (RIC 49 a 66) y 62,8% de los participantes fueron hombres. La prevalencia de mal control glicémico fue de 39,8%, y la prevalencia de microalbuminuria fue de 32,7%. La prevalencia de microalbuminuria en el grupo de mal control glicémico y en el de buen control glicémico fue de 44,1% y 25,3% respectivamente. En el análisis de regresión ajustada, se encontró una asociación estadísticamente significativa entre el mal control glicémico y microalbuminuria. (RPa=1.48; IC 95%: 1.19-1.85). Conclusión: Se encontraron altos niveles de hemoglobina glicosilada y microalbuminuria en la población estudiada. Los adultos con diabetes mellitus tipo 2 con mal control glicémico tuvieron una mayor prevalencia de microalbuminuria en la primera orina del día. / Background and Aims: Microalbuminuria is the first sign for diabetic nephropathy in people with type 2 diabetes mellitus (T2DM). Few studies associate poor glycemic control and higher microalbuminuria prevalence in Latin American populations. We aimed to evaluate the association between glycemic control and microalbuminuria in adults with T2DM. Methods: We conducted a cross-sectional analytical study in adults with T2DM from a private clinic in Lima, Peru. We included adults over 18 years old who belonged to the clinical follow-up program in 2018. We defined poor glycemic control based on the serum value of glycosylated haemoglobin (HbA1C) ≥7%. We defined microalbuminuria considering albumin values > 20 mg/L in the first-morning urine. We carried out generalized linear regression models from the Poisson family with robust variance. We calculated the crude and adjusted prevalence ratio (PR) with their 95% confidence interval (CI). Results: We analyzed 907 participants, the median age was 58 years (IQR 49 to 66), and 62.8% were males. The prevalence of poor glycemic control was 39.8%, and the prevalence of microalbuminuria was 32.7%. The prevalence of microalbuminuria in the group with poor glycemic control and adequate glycemic control was 44.1% and 25.3%, respectively. In the adjusted regression analysis, we found a statistically significant association between poor glycemic control and microalbuminuria (aPR=1.48; 95% CI: 1.19-1.85). Conclusion: Our study population had high levels of glycosylated haemoglobin and microalbuminuria. T2DM adults with poor glycemic control had more likelihood of microalbuminuria in the first-morning urine. / Tesis Hemoglobina glicosilada Albuminuria Diabetes mellitus Glucemia Glycosylated hemoglobin Blood glucose
12	Social Determinants of Cardiovascular Health among Sexual Minority Adults Sharma, Yashika January 2023 (has links) Cardiovascular disease (e.g., myocardial infarction, stroke, coronary artery disease) is the leading cause of death and disability worldwide. There is a growing body of literature that indicates sexual minority (e.g., gay, lesbian, bisexual, queer) adults are at a higher risk of cardiovascular disease than their heterosexual counterparts. The aim of this dissertation was to identify factors that contribute to the cardiovascular health (CVH) disparities that have been observed among sexual minority individuals. Guided by an adaptation of the minority stress model of CVH among sexual minority individuals, this dissertation includes three studies. In the first study (i.e., Chapter 2), we conducted a scoping review of the literature that investigated social determinants of cardiovascular health among sexual minority adults. Although findings were mixed, several social determinants of health were found to influence the CVH of sexual minority adults. For instance, sexual minority adults who lived in environments that were more supportive of sexual and gender minority people had lower odds of being overweight or obese. In the second study (i.e., Chapter 3), we used data from a racially and ethnically diverse sample of sexual minority women to examine the associations of family-related factors (i.e., sexual identity disclosure and family social support) with self-reported incident hypertension. Additionally, we examined whether these associations were moderated by race/ethnicity and sexual identity, or mediated by depressive symptoms. We found that higher levels of family social support were associated with lower levels of depressive symptoms among sexual minority women. However, family-related factors were not associated with self-reported incident hypertension. Further, race/ethnicity and sexual identity did not moderate the associations between family-related factors and reported incident hypertension. In the third study (i.e., Chapter 4), we used data from a nationally representative sample of adults to investigate sexual identity differences in ideal CVH (as defined by the American Heart Association’s Life Simple 7) and whether these associations were mediated by depressive symptoms. Compared to exclusively heterosexual women, mostly heterosexual and lesbian women were less likely to meet ideal criteria for tobacco use. In contrast, lesbian women were more likely to meet ideal criteria for glycosylated hemoglobin than exclusively heterosexual women. Among men, relative to exclusively heterosexual men, mostly heterosexual men were less likely to meet ideal criteria for tobacco use. Gay and bisexual men were less likely to meet ideal criteria for physical activity, whereas gay men were more likely to meet ideal criteria for body mass index compared to exclusively heterosexual men. Bisexual men were less likely to meet ideal criteria for blood pressure relative to exclusively heterosexual men. Depressive symptoms were found to partially mediate the association between sexual identity and physical activity only among mostly heterosexual women. Overall, these dissertation findings highlight CVH disparities among sexual minority adults. Clinicians should be educated about the CVH disparities that have been documented among sexual minority adults to provide personalized and culturally competent care. Results also indicate there is a need to develop behavioral interventions tailored specifically to the needs of sexual minority adults to improve their CVH outcomes and reduce CVH-related disparities. Nursing Sexual minorities--Health and hygiene Lesbians--Health and hygiene Obesity--Health aspects Hypertension Glycosylated hemoglobin
13	Diabetes Mellitus tipo 1: controle glicêmico e fatores de risco cardiovasculares em adultos / Type 1 Diabetes Mellitus: glycemic control and cardiovascular risk factors in adults GONÇALVES, Alessandra Rocha 29 June 2012 (has links) Made available in DSpace on 2014-07-29T15:23:45Z (GMT). No. of bitstreams: 1 dissertacao setembro alessandra.pdf: 495425 bytes, checksum: 575e13fa35e5d2b8ee0bc6d97a6bdeae (MD5) Previous issue date: 2012-06-29 / Objective: To evaluate the nutritional status, the glycemic control and the prevalence of cardiovascular risk factors in patients with type 1 diabetes mellitus (T1DM), attended at the nutrition and endocrinology outpatient clinic of the Goiânia Geral Hospital (GGH). Methodology: a cross-sectional study conducted from March to August/2011, with the following inclusion criteria: consolidated diagnosis of the disease for at least six months, age ranging from 19 to 60 years. Fifty-two patients were selected and interviewed, and 44 came to the clinic for collection of biological material. Personal, socioeconomic and biochemical data were collected. Fasting glucose (FG), glycated hemoglobin (HbA1c), lipid profile and microalbuminuria (MA) were determined. MA and HbA1c were determined by immunoturbidimetry and FG and lipid profile by the enzymatic colorimetric method using a Labmax Plenno apparatus. After collecting the material, physical assessment was performed by three trained interviewers who collected measurements of weight, height, waist circumference and blood pressure measurement, following recommendations from the literature. The following risk factors were evaluated: hypertension, dyslipidemia, general obesity (BMI- body mass index), abdominal obesity (WC- waist circumference), glycated hemoglobin, microalbuminuria, family history of type 2 diabetes, and smoking. The cutoffs recommended by the American Diabetes Association (ADA) were adopted. Statistical analysis was performed using the Statistical Package for the Social Sciences SPSS 18.0. Results: The average age of patients was 30.6 ± 7.4 years, the time of diagnosis was 9.9 ± 7.1 years and median education was 12 years. The HbA1c was inadequate in 90.9% of the patients and 38.6% of the patients were found to be overweight (n=17). Most cases of inadequacy of BMI, WC and total cholesterol (TC) involved females. The prevalence of hypertension was 38.6% (n=17) and the prevalence of dyslipidemia was 63.6% (n=28). The prevalence of inappropriate LDL, HDL, cholesterol and triglyceride levels was 39.5%, 25%, 22.7%, and 22.7%, respectively. The prevalence of MA was 72%. Conclusion: most patients presented unsatisfactory glucose control. The prevalence of overweight and hypertension, of altered lipid profile, and microalbuminuria was high. / Objetivo: Avaliar o estado nutricional, o controle glicêmico e a prevalência dos fatores de risco cardiovasculares em pacientes adultos com diabetes mellitus tipo 1 (DM1), atendidos no ambulatório de nutrição e endocrinologia do Hospital Geral de Goiânia (HGG). Metodologia: Estudo transversal, realizado entre março e agosto/2011, cujos critérios de inclusão foram: diagnóstico consolidado da doença há pelo menos seis meses, idade maior ou igual a dezenove anos e menor que sessenta anos. Foram selecionados e entrevistados 52 pacientes, dos quais 44 compareceram para coleta de material biológico. Coletou-se dados clínicos, socioeconômicos e bioquímicos. Foram realizados exames de glicemia de jejum (GJ), hemoglobina glicada (HbA1c), perfil lipídico e microalbuminúria (MA). O método utilizado para dosar HbA1c E MA foi a Imunoturbidimetria, realizada no aparelho Labmax Plenno. Os exames de glicemia de jejum e lipidograma também foram realizados no mesmo equipamento, pelo método enzimático-colorimétrico (oxidase/ peroxidase). Após a coleta de material, foi realizada avaliação física por três entrevistadores treinados que coletaram medidas de peso, altura, circunferência da cintura e aferição da pressão arterial, seguindo recomendações da literatura. Foram avaliados os seguintes fatores de risco cardiovasculares: hipertensão arterial, dislipidemia, obesidade geral (IMC- Índice de massa corporal), obesidade abdominal (CC- circunferência da cintura), hemoglobina glicada, microalbuminúria, história familiar de diabetes tipo 2 e tabagismo. Foram adotados os pontos de corte recomendados pela American Diabetes Association (ADA). A análise estatística foi realizada no programa Statistical Package for the Social Sciences- SPSS 18.0. Resultados: A idade média dos pacientes foi de 30,6±7,4 anos, o tempo de diagnóstico foi de 9,9 ±7,1 anos e a mediana da escolaridade foi de 12 anos. A HbA1c estava inadequada em 90,9% dos pacientes. O excesso de peso foi observado em 38,6% dos pacientes (n=17). A maior prevalência de inadequação do IMC, CC e colesterol total (CT) foi associada ao sexo feminino. A prevalência de hipertensão arterial foi de 38,6% (n=17) e de dislipidemia foi de 63,6% (n=28) dos pacientes. As prevalências de inadequação do LDL, HDL, colesterol e triglicerídeos foram de 38,6%, 25%, 22,7%, 22,7%, respectivamente. A prevalência de MA foi de 72%. Conclusão: A maioria dos pacientes apresentou controle glicêmico insatisfatório. Foi alta a prevalência de excesso de peso e de inadequação da pressão arterial, do perfil lipídico, e microalbuminúria. adulto diabetes mellitus diabetes mellitus tipo 1 doenças cardiovasculares fatores de risco hemoglobina A glicada adult diabetes mellitus type 1 diabetes mellitus cardiovascular diseases risk factors glycosylated hemoglobin A CNPQ::CIENCIAS DA SAUDE::NUTRICAO
14	Estudo comparativo entre duas insulinas humanas recombinantes NPH no tratamento do diabetes mellitus tipo 2 / Comparative study between two recombinant human insulins NPH in the treatment of type 2 diabetes mellitus Rassi, Nelson 13 September 2014 (has links) Submitted by Cláudia Bueno (claudiamoura18@gmail.com) on 2015-10-15T19:58:50Z No. of bitstreams: 2 Tese - NELSON RASSI - 2014.pdf: 2531801 bytes, checksum: 4a281a91c2ca563e8fead55207f00d61 (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) / Approved for entry into archive by Cláudia Bueno (claudiamoura18@gmail.com) on 2015-10-15T20:31:04Z (GMT) No. of bitstreams: 2 Tese - NELSON RASSI - 2014.pdf: 2531801 bytes, checksum: 4a281a91c2ca563e8fead55207f00d61 (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) / Made available in DSpace on 2015-10-15T20:31:04Z (GMT). No. of bitstreams: 2 Tese - NELSON RASSI - 2014.pdf: 2531801 bytes, checksum: 4a281a91c2ca563e8fead55207f00d61 (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) Previous issue date: 2014-09-13 / Background: The number of patients with Type 2 Diabetes Mellitus (T2DM) in Brazil has, in recent decades, increased substantially and insulin therapy is often necessary in a large portion of this population in order to achieve appropriate glycemic control. Objective: To evaluate glycemic control achieved with recombinant human insulin NPH - Gansulin and compares it with human NPH insulin - Humulin N® in patients with Type 2 Diabetes Mellitus. Subjects and methods: A prospective, double-blind, randomized, parallel, single center with 37 individuals with type 2 diabetes using insulin NPH insulin. For statistical analyzes were used: the multiple comparison test of Tukey-Kramer test, Wilcoxon paired comparison test and Chi- Square. It was regarded level of significance value lower than 5% (p<0.05). Results: Insulins NPH and Humulin Gansulin showed similar reductions in HbA1c at the end of the study compared to baseline. Initial HbA1c 7.91% in the Humulin group was reduced to 6.56% (p<0.001) at the end of the study whereas in the Gansulin the glycated hemoglobin was reduced from 8.18% to 6.65% (p<0.001). At the end of the study there was no significant difference between the glycated hemoglobin levels (p=0.2410), fasting blood glucose (p=0.9257) and glucose at bedtime (p=0.3906) between the two types of insulin. Regarding the number of hypoglycemic events, there was no significant difference between the two insulins and no severe hypoglycemic episodes were recorded. Conclusion: The NPH Gansulin (Insuneo N®) presented glycemic control similar to that presented by human insulin Humulin N® in patients with DM2. It was considered level of significance value less than 5%. / Fundamento: O número de pacientes com Diabetes Mellitus Tipo 2 (DM2) no Brasil tem, nas últimas décadas, aumentado substancialmente e a terapia insulínica é necessária em uma grande parcela desta população com a finalidade de adquirir controle glicêmico adequado. Objetivo: Avaliar o controle glicêmico obtido com a insulina humana recombinante NPH – Gansulin e compará-la com o da insulina humana NPH – Humulin N® em pacientes com Diabetes Mellitus Tipo 2 (DM2). Sujeitos e métodos: Estudo prospectivo, duplo cego, randomizado, paralelo e monocêntrico com 37 indivíduos portadores de diabetes tipo 2, em uso de insulina NPH. Para as análises estatísticas foram utilizados: o teste de comparações múltiplas de Tukey-Kramer, o teste de comparação pareada de Wilcoxon e o teste Chi-Square. Foi considerado como nível de significância o valor inferior a 5% (p<0,05). Resultados: As insulinas NPH Humulin e Gansulin apresentaram reduções semelhantes da HbA1c ao final do estudo, quando comparadas aos valores iniciais. A HbA1c inicial de 7,91% do grupo Humulin foi reduzida para 6,56% (p<0,001), enquanto que na do Gansulin, a redução foi de 8,18% para 6,65% (p<0,001). Ao final do estudo não houve diferença significativa entre os valores de hemoglobina glicada (p=0,2410), glicemia jejum (p=0,9257) e glicemia ao deitar (p=0,3906) entre os dois tipos de insulina. Em relação ao número de eventos hipoglicêmicos, não se observou diferença significativa entre as duas insulinas e não foram registrados episódios hipoglicêmicos graves. Conclusão: A insulina NPH Gansulin apresentou controle glicêmico semelhante ao apresentado pela insulina humana Humulin N® em pacientes com DM2. Diabetes mellitus tipo 2 Estudo comparativo Insulina NPH Hemoglobina glicada Saúde pública Comparative study NPH insulin Type 2 diabetes mellitus Glycosylated hemoglobin A Public health
15	Development and Characterization of an Iridium-Modified Electrochemical Biosensor for Potential Diabetic Patient Management Fang, Lei January 2009 (has links) No description available. Biochemistry Biomedical Research Chemical Engineering Engineering Iridium-modified Electrochemical biosensor Think film printing Diabetic patient management Ketone body 3-hydroxybutyrate(3HB) Nicotinamide adenine dinucleotide(NAD+) Glycosylated hemoglobin (HbA1c) Fructosyl valine Diffusion-reaction model
16	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
17	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
18	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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