A third of parents suspect food allergy in their children. Questionnaire-based studies usually overestimate the occurrence of food allergies. The aim of the present study was to validate a study questionnaire by comparing children's use of special diets as reported by parents with patient records at the hospital.
A population-based cohort with genetic susceptibility to type 1 diabetes (15% of those screened) was recruited in the Tampere area between 1997 and 2001, and followed for development of food allergy for 3 years. Food allergies and other special diets were queried at the age of 3 years with a structured questionnaire. The hospital records of the children, whose parents had reported an elimination diet of the child, were studied to validate the parental reports of food allergies. The hospital database was also checked for the respective diagnosis codes to estimate underreporting.
Altogether, 1122 parents returned the questionnaire at the study center visit when the child was 3 years old. Food allergy was reported by 15.0% of the parents. In 10.6% of the children food allergy had been diagnosed or confirmed at the hospital. Hospital-confirmed food allergy was unreported in 0.9% of the cases. The measure of agreement between reported and hospital-confirmed food allergies, using crosstabulation with Cohen's Kappa, was within 0.71-0.88 for cow's milk allergy, 0.74-0.82 for cereal allergy and 0.66-0.86 for any reported food allergy.
We found that the validity of the questionnaire obtaining information on food allergies of infants and young children was good to excellent based on a comparison between parental reports and information obtained from patient records.
While patients with type 1 diabetes (T1D) are known to suffer from early cardiovascular disease (CVD), we examined associations between arterial stiffness and diabetic complications in a large patient group with T1D.
This study included 807 subjects (622 T1D and 185 healthy volunteers (age 40.6 ± 0.7 versus 41.6 ± 1.2 years; P = NS)). Arterial stiffness was measured by pulse wave analysis from each participant. Furthermore, information on diabetic retinopathy, nephropathy, and CVD was collected. The renal status was verified from at least two out of three urine collections.
Patients with T1D without signs of diabetic nephropathy had stiffer arteries measured as the augmentation index (AIx) than age-matched control subjects (17.3% ± 0.6% versus 10.0% ± 1.2%; P
Left ventricular diastolic function was assessed by pulsed Doppler echocardiography in 21 subjects (mean age 48 yr) with insulin-dependent diabetes mellitus (IDDM) and without evidence of ischemic heart disease and in 21 healthy control subjects of similar age and sex distribution. The peak mitral valve flow velocities during the early rapid filling phase (E) and during late atrial filling (A) were measured, and the ratio of these peak flow velocities (E:A) was calculated. E was similar in both groups, but A was higher (P less than .01) in the diabetic group. Thus, E:A was lower (1.19 +/- 0.24 vs. 1.65 +/- 0.67; P less than .01) in the diabetic subjects than in the control subjects. On subgroup analysis, 6 patients with cardiac autonomic neuropathy had lower E:A than the patients with no such disorder (0.99 +/- 0.15 vs. 1.29 +/- 0.25; P less than .05). E:A was not related to the duration of diabetes, presence of retinopathy, HbA1, or blood glucose levels. In conclusion, the atrial contribution to left ventricular filling seems to be augmented in diabetic subjects. This finding indirectly supports the view that left ventricular compliance is already reduced in asymptomatic diabetic subjects.
Brain stem auditory evoked response (BAER), visual evoked response (VER) and nerve conduction velocities (NCV) were studied in 18 insulin-dependent diabetic children between the ages of 3.5 and 16 years (mean 9.0 +/- 3.2 years). The results were compared with those of age-matched controls. The VER latencies of the diabetic children in the right eye and left eye were significantly prolonged when compared with the control group. NCV of n. peroneus and the latency of sensorial n. medianus were significantly impaired when compared with the control group. Although the latencies of waves III, IV and V of the right ear and the interpeak latencies of I-III, I-V, III-V of both ears were prolonged, the comparison with the control group was not significant. The beta 2 microglobulin levels of the diabetic patients were significantly higher than those of the control group. There was a positive correlation between the beta 2 microglobulin and the BAER interpeak latencies of wave III-V in both ears (r: 0.51 p
AIMS: To characterize autonomic nervous system function by means of the heart rate and blood pressure responses to various stimuli in relation to pubertal maturation in patients with Type 1 diabetes mellitus (DM). METHODS: One hundred out of 138 eligible patients at the Out-patient Diabetes Clinic and 100 healthy control subjects were examined in terms of cardiovascular parameters at rest, during deep breathing and when standing. Heart rate variability was analysed with time domain,frequency domain and fractal dimension parameters. Tanner pubertal staging was performed before the examinations. RESULTS: The time domain parameters of heart rate variability at rest or during standing did not significantly differ between the patients and controls in total or at pubertal stages. In the spectral analysis of heart rate variability the very low frequency band was decreased in the patients during standing (P = 0.023).The increase in the very low frequency (P = 0.013)and low frequency (P = 0.031) spectral powers upon changing from a supine position to standing was attenuated in the patients in total, while no significant differences were observed within the Tanner pubertal stages between patients and controls.Heart rate variability during deep breathing was decreased in the patients with distal polyneuropathy (P = 0.006). CONCLUSIONS: Although cardiovascular integrity is in the main well preserved in adolescent patients with Type 1 DM, these patients are prone to attenuated autonomic nervous system reactivity.
Death of a close family member such as a parent or a sibling can cause prolonged stress and changes in the family structure that may have extensive social and health effects on a young child. The aim of this paper is to examine the rate of type 1 diabetes following bereavement due to death of a first-degree family member in early life.
We used data from the Danish Civil Registration System (CRS) to identify singleton births in Denmark born 1 January 1980 through 31 December 2005, n?=?1?740?245 and their next of kin. We categorised children as exposed to bereavement if they lost a mother, father or sibling from age 5 years onwards, the remaining children were considered unexposed. Children were followed until first diagnosis of diabetes, death, emigration, or 31 December 2010. We estimated incidence rate ratios (IRRs) from birth using log-linear Poisson regression models with person-years as an offset variable. Exposed children were followed up for an average of 9.1 years [standard deviation (SD) 6.7] and unexposed children were followed up for an average of 12.3 years (SD 7.3).
In our sample 94?943 children were exposed to bereavement, and 6110 cases of type 1 diabetes were identified. Bereavement was associated with an increased rate of type 1 diabetes when exposure onset began after 11 years of age (adjusted IRR 1.28, 95% confidence interval 1.08, 1.51).
We found some evidence to indicate an increase in the rate of type 1 diabetes among children exposed to bereavement when exposure occurred after 11 years of age.
The natural history of lung function in diabetes is unknown due to the lack of longitudinal observations. The decline of forced expiratory volume in one second (FEV1) and forced vital capacity (FVC) was studied over 15 yrs in the 17,506 adult participants of The Copenhagen City Heart Study, which included 266 individuals with diabetes. Multiple linear regression and a mixed-effects model were used, taking into account correlation between repeated measurements and adjusting for relevant confounders. In both sexes, FEV1 and FVC were consistently lower in diabetic individuals, compared with healthy individuals, with an average reduction of approximately 8% of the predicted value. Longitudinal analyses showed that the decline of FEV1 and FVC in diabetic individuals was similar to that observed in nondiabetic subjects. It was concluded that although diabetic subjects have, on average, a lower forced expiratory volume in one second and forced vital capacity than individuals without diabetes, this deficit seems not to be progressive in the long term. These observations may be of importance with regard to diabetes treatment with inhaled pulmonary insulin, which is likely to become available within a few years.
OBJECTIVE: Conflicting evidence of a decline in incidence of microvascular complications in type 1 diabetes during the last decades has been reported. To assess recent trends in the cumulative incidence of diabetic microangiopathy in type 1 diabetes, we analyzed data from long-term prospective observational studies lasting >/=20 years. RESEARCH DESIGN AND METHODS: A total of 600 Caucasian patients with onset of type 1 diabetes between 1965 and 1984 were followed until death or until the year 2000. Patients were divided into four groups based on the year of diabetes onset: group A, 1965-1969 (n = 113); group B, 1970-1974 (n = 130); group C, 1975-1979 (n = 113); and group D, 1979-1984 (n = 244). Group A, B, and C are prevalence cohorts identified in 1984; group D is an inception cohort. RESULTS: In patients followed for >/=20 years, the cumulative incidence (95% CI) of diabetic nephropathy after 20 years of diabetes (urinary albumin excretion >300 mg/24 h) was reduced in patients with more recent diabetes onset (groups A-D): 31.1% (22.5-39.7) vs. 28.4% (19.8-37.0) vs. 18.9% (10.9-26.9) vs. 13.7% (6.2-21.2) (P = 0.015). Similarly, the cumulative incidence of proliferative retinopathy was as follows: 31.2% (22.2-39.8) vs. 30.3% (22.2-38.4) vs. 19.3% (11.2-27.4) vs. 12.5% (5.2-19.8) (P
Limited evidence exists on the determinants of quality of life (QoL) specific to adults with type 1 diabetes (T1D). Further, it appears no study has compared the determinants of QoL between T1D and type 2 diabetes (T2D) groups. The objectives of this study were to examine: (1) determinants of QoL in adults with T1D; and, (2) differences in QoL determinants between T1D and T2D groups.
The Alberta Longitudinal Exercise and Diabetes Research Advancement (ALEXANDRA) study, a longitudinal study of adults with diabetes in Alberta, Canada. Adults (18 years and older) with T1D (N = 490) and T2D (N = 1,147) provided information on demographics (gender, marital status, education, and annual income), personality (activity trait), medical factors (diabetes duration, insulin use, number of comorbidities, and body mass index), lifestyle behaviors (smoking habits, physical activity, and diet), health-related quality of life (HRQL) and life satisfaction. Multiple regression models identified determinants of HRQL and life satisfaction in adults with T1D. These determinants were compared with determinants for T2D adults reported in a previous study from this population data set. Factors significantly associated with HRQL and life satisfaction in either T1D or T2D groups were further tested for interaction with diabetes type.
In adults with T1D, higher activity trait (personality) score (ß = 0.28, p
Cites: Neuro Endocrinol Lett. 2008 Dec;29(6):1045-5319112404