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    ABSTRACT: Elucidating the optimal macronutrient composition for dietary management of gestational diabetes mellitus has enormous potential to improve perinatal outcomes. Diet therapy may result in significant cost savings if effective in deterring the need for expensive medical management within this growing population. In only 6 randomized controlled trials in 250 women, data suggest that a diet higher in complex carbohydrate and fiber, low in simple sugar, and lower in saturated fat may be effective in blunting postprandial hyperglycemia, preventing worsened insulin resistance and excess fetal growth. The use of diet in gestational diabetes mellitus remains an area in grave need for high-quality randomized controlled trials.
    Clinical obstetrics and gynecology 09/2013; · 2.06 Impact Factor
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    ABSTRACT: Objective: To evaluate the generation of rheumatoid arthritis (RA)-related autoantibodies in the lung. Methods: Simultaneous collection of sera and induced sputa was performed in Healthy Controls (N=21), At-Risk subjects without inflammatory arthritis but at risk for RA due to family history or seropositivity for ACPAs (N=49), and Early RA subjects (N=14). Samples were tested for anti-CCP2, CCP3, CCP3.1, rheumatoid factor isotypes immunoglobulin (Ig) M/G/A, and total IgM/G/A. Results: ≥1 autoantibody was positive in sputa of 39% of At-Risk Seronegative, 65% of At-Risk Seropositive, and 86% of Early RA subjects. In At-Risk Seronegative subjects, the rate of CCP3.1 positivity and median number of positive autoantibodies were elevated in sputa vs. sera. In Early RA, the rates of positivity of multiple autoantibodies and median number of positive autoantibodies were higher in sera vs. sputa. Results in At-Risk Seropositive subjects were intermediate between these groups. In At-Risk subjects with sputa autoantibody positivity, the ratios of autoantibody to total Ig were higher in sputa than sera suggesting these autoantibodies are generated or sequestered in the lung. Conclusion: RA-related autoantibodies are detectable in sputa in subjects At-Risk for RA, and with Early RA. In a subset of At-Risk subjects, the presence of sputa autoantibodies in absence of seropositivity, and increased autoantibody to total Ig ratios in sputa, suggest that the lung may be a site of autoantibody generation in the early development of RA. These findings suggest an important role of the lung in the pathogenesis of RA. © 2013 American College of Rheumatology.
    Arthritis & Rheumatology 07/2013; · 7.48 Impact Factor
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    ABSTRACT: Coronary heart disease is the leading cause of mortality among people with type 1 diabetes. Diet is an important lifestyle factor that relates to risk of CHD. The aim of this study was to examine how diet and adherence to dietary guidelines differ between adults with and without type 1 diabetes, and their correlation with CHD risk factors and coronary artery calcium (CAC). The study involved 571 people with type 1 diabetes and 696 controls, aged 19 to 56 years, who were asymptomatic for CHD. CAC was measured by electron-beam computed tomography. Compared with the controls, adults with type 1 diabetes reported a diet higher in fat, saturated fat and protein but lower in carbohydrates. Fewer than half of those with type 1 diabetes met dietary guidelines for fat and carbohydrate intake, and only 16% restricted saturated fat to less than 10% of daily energy intake. Adults with type 1 diabetes were significantly less likely to meet dietary guidelines than controls. Fat and saturated fat intakes were positively correlated, but carbohydrate intake was negatively correlated with CHD risk factors and HbA(1c). A high-fat diet and higher intake of protein were associated with greater odds of CAC, while higher carbohydrate intake was associated with reduced odds of CAC. Adults with type 1 diabetes reported consuming higher than recommended levels of fat and saturated fat. High fat intake was associated with increased CHD risk factors, worse glycaemic control and CAC. An atherogenic diet may contribute to the risk of CHD in adults with type 1 diabetes.
    Diabetologia 03/2009; 52(5):801-9. · 6.49 Impact Factor

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