Autonomic neuropathy in diabetes: early detection and the role in development of microvascular complications
ABSTRACT Diabetic autonomic neuropathy (DAN) is common complication of diabetes mellitus (DM), associated with development of angiopathies and increased mortality. The objective of the study was to determine the frequency of DAN in type 1 DM patients using heart rate variability (HRV) analysis and, besides, to study the relationship between DAN and circadian profile of blood pressure (BP) and vascular diabetic complications. Power spectral analysis of HRV is found to be a useful method for early detection of autonomic neuropathy in diabetes patients. Dysfunction of autonomic nervous system in type 1 DM patients is associated with increased systolic BP and with reduced fall in nocturnal systolic BP. Through the changes in hemodynamics autonomic neuropathy may contribute to development of diabetic vascular complications.
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ABSTRACT: The objective was to determine if having a television (TV) in the bedroom is associated with physical activity (PA), TV/video viewing, and adiposity throughout adolescence. Longitudinal data (September 2002 through June 2005) were analyzed of 379 initially 12-year-old French adolescents participating as controls in the Intervention Centered on Adolescents' Physical activity and Sedentary behavior (ICAPS). Presence of a TV set in the bedroom (TV(bedroom)) and leisure activities were obtained by questionnaire. There was annual assessment of BMI, waist circumference, and body fat by bioimpedance. In boys but not girls, baseline TV(bedroom) was associated with higher TV/video viewing over time [odds ratio (OR) of high TV/video = 1.87; 95% confidence interval, 1.2 to 2.8] and less no-sport club participation (OR = 0.59; 95% confidence interval, 0.35 to 1.0). Both boys and girls with baseline TV(bedroom) had lower reading time (p < 0.0001 in boys; p = 0.04 in girls), while PA did not differ according to TV(bedroom) for boys or for girls. For boys only, baseline TV(bedroom) was associated with higher BMI (mean BMI over time 20.5 +/- 0.5 vs. 19.0 +/- 0.5 kg/m(2); p = 0.001), waist circumference (70.9 +/- 0.9 vs. 67.2 +/- 0.8 cm; p < 0.001), and body fat (15.9 +/- 0.9% vs. 13.5 +/- 0.9%; p < 0.001), without interaction with time. These relationships remained significant after adjustment for socioeconomic status. TV/video viewing explained 26%, 42%, and 36% of the relationships of TV(bedroom) with BMI, waist circumference, and body fat, respectively, while addition of other leisure activities in the models only marginally reduced the effects. These results suggest the importance of keeping TV out of an adolescent's bedroom from an obesity prevention perspective but show gender differences.Obesity 10/2007; 15(10):2495-503. · 3.92 Impact Factor
- BMJ. 01/2000; 320:1240-1243.
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ABSTRACT: The prevalence and magnitude of childhood obesity are increasing dramatically. We examined the effect of varying degrees of obesity on the prevalence of the metabolic syndrome and its relation to insulin resistance and to C-reactive protein and adiponectin levels in a large, multiethnic, multiracial cohort of children and adolescents. We administered a standard glucose-tolerance test to 439 obese, 31 overweight, and 20 nonobese children and adolescents. Baseline measurements included blood pressure and plasma lipid, C-reactive protein, and adiponectin levels. Levels of triglycerides, high-density lipoprotein cholesterol, and blood pressure were adjusted for age and sex. Because the body-mass index varies according to age, we standardized the value for age and sex with the use of conversion to a z score. The prevalence of the metabolic syndrome increased with the severity of obesity and reached 50 percent in severely obese youngsters. Each half-unit increase in the body-mass index, converted to a z score, was associated with an increase in the risk of the metabolic syndrome among overweight and obese subjects (odds ratio, 1.55; 95 percent confidence interval, 1.16 to 2.08), as was each unit of increase in insulin resistance as assessed with the homeostatic model (odds ratio, 1.12; 95 percent confidence interval, 1.07 to 1.18 for each additional unit of insulin resistance). The prevalence of the metabolic syndrome increased significantly with increasing insulin resistance (P for trend, <0.001) after adjustment for race or ethnic group and the degree of obesity. C-reactive protein levels increased and adiponectin levels decreased with increasing obesity. The prevalence of the metabolic syndrome is high among obese children and adolescents, and it increases with worsening obesity. Biomarkers of an increased risk of adverse cardiovascular outcomes are already present in these youngsters.New England Journal of Medicine 01/2004; 350(23):2362-2374. · 51.66 Impact Factor