16 research outputs found
Ethnic inequity in diabetes outcomes-inaction in the face of need
No full textEvaluation of a longstanding primary care audit and diabetes care support service (DCSS) programme was reported in a paper published in Lancet Global Health on 15 October 2020. The paper showed 24 years of health outcome inequity among people with type 2 diabetes in South, East and West Auckland.1 Mortality decreased and hospital admissions increased across European, Māori and Pacific ethnic groups over the period. However, Māori and Pacific had consistently higher hospitalisation rates than European patients. After adjusting for sex, age, socio-economic status, smoking, obesity, birth-cohort and period effects, Māori but not Pacific patients had higher all-cause mortality (adjusted incidence rates ratio (IRR): 1.96 [95% confidence interval 1.8–2.14), cardiovascular mortality (1.93 [1.63–2.29]), and cancer mortality (1.64 [1.40–1.93]) compared with European patients. The excess mortality for Māori occurred at a young age affecting people in their most productive years. Most of this excess mortality can be attributed to diabetes and its complications
Diabetic Dead-in-Bed Syndrome: A Possible Link to a Cardiac Ion Channelopathy
No full textSudden unexpected nocturnal death among patients with diabetes occurs approximately ten times more commonly than in the general population. Malignant ventricular arrhythmia due to Brugada syndrome has been postulated as a cause, since a glucose-insulin bolus can unmask the Brugada electrocardiographic signature in genetically predisposed individuals. In this report we present a 16-year-old male with insulin-dependent diabetes who died suddenly at night. His diabetes had been well controlled, without significant hypoglycaemia. At autopsy, he had a full stomach and a glucose level of 7 mmol/L in vitreous humor, excluding hypoglycaemia. Genetic analysis of autopsy DNA revealed a missense mutation, c.370A>G (p.Ile124Val), in the GPD1L gene. A parent carried the same mutation and has QT prolongation. Mutations in this gene have been linked to Brugada syndrome and sudden infant death. The patient may have died from a ventricular arrhythmia, secondary to occult Brugada syndrome, triggered by a full stomach and insulin. The data suggest that molecular autopsies are warranted to investigate other cases of the diabetic dead-in-bed syndrome
Use of 50/50 Premixed Insulin Analogs in Type 2 Diabetes: Systematic Review and Clinical Recommendations
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Double-blind RCT of fish oil supplementation in pregnancy and lactation to improve the metabolic health in children of mothers with overweight or obesity during pregnancy: study protocol
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BMJ.Introduction
Maternal obesity during pregnancy is associated with adverse changes in body composition and metabolism in the offspring. We hypothesise that supplementation during pregnancy of overweight and obese women may help prevent the development of greater adiposity and metabolic dysfunction in children. Previous clinical trials investigating fish oil supplementation in pregnancy on metabolic outcomes and body composition of the children have not focused on the pregnancies of overweight or obese women.
Methods and analysis
A double-blind randomised controlled trial of fish oil (providing 3 g/day of n-3 polyunsaturated fatty acids) versus an equal volume of olive oil (control) taken daily from recruitment until birth, and in breastfeeding mothers, further continued for 3 months post partum. Eligible women will have a singleton pregnancy at 12–20 weeks’ gestation and be aged 18–40 years with body mass index ≥25 kg/m2 at baseline. We aim to recruit a minimum of 128 participants to be randomised 1:1. Clinical assessments will be performed at baseline and 30 weeks of pregnancy, including anthropometric measurements, fasting metabolic markers, measures of anxiety, physical activity, quality of life and dietary intake. Subsequent assessments will be performed when the infant is 2 weeks, 3 months and 12 months of age for anthropometry, body composition (dual-energy X-ray absorptiometry (DXA)) and blood sampling. The primary outcome of the study is a between-group difference in infant percentage body fatness, assessed by DXA, at 2 weeks of age. Secondary outcomes will include differences in anthropometric measures at each time point, percentage body fat at 3 and 12 months and homeostatic model assessment of insulin resistance at 3 months. Statistical analysis will be carried out on the principle of intention to treat.
Ethics and dissemination
This trial was approved by the Northern A Health and Disabilities Ethics Committee, New Zealand Ministry of Health (17/NTA/154). Results will be published in a peer-reviewed journal.
Trial registration number
ACTRN12617001078347p; Pre-results
Associations of Prenatal and Childhood Antibiotic Exposure With Obesity at Age 4 Years
No full textImportance Although antibiotics are associated with obesity in animal models, the evidence in humans is conflicting. Objective To assess whether antibiotic exposure during pregnancy and/or early childhood is associated with the development of childhood obesity, focusing particularly on siblings and twins. Design, Setting, and Participants This cross-sectional national study included 284 & x202f;211 participants (132 & x202f;852 mothers and 151 & x202f;359 children) in New Zealand. Data analyses were performed for 150 & x202f;699 children for whom data were available, 30 & x202f;696 siblings, and 4188 twins using covariate-adjusted analyses, and for 6249 siblings and 522 twins with discordant outcomes using fixed-effects analyses. Data analysis was performed November 2017 to March 2019. Exposure Exposure to antibiotics during pregnancy and/or early childhood. Main Outcomes and Measures The main outcome is odds of obesity at age 4 years. Anthropometric data from children born between July 2008 and June 2011 were obtained from the B4 School Check, a national health screening program that records the height and weight of 4-year-old children in New Zealand. These data were linked to antibiotics (pharmaceutical records) dispensed to women before conception and during all 3 trimesters of pregnancy and to their children from birth until age 2 years. Results The overall study population consisted of 132 & x202f;852 mothers and 151 & x202f;359 children (77 & x202f;610 [51.3%] boys) who were aged 4 to 5 years when their anthropometrical measurements were assessed. Antibiotic exposure was common, with at least 1 course dispensed to 35.7% of mothers during pregnancy and 82.3% of children during the first 2 years of life. Results from covariate-adjusted analyses showed that both prenatal and early childhood exposures to antibiotics were independently associated with obesity at age 4 years, in a dose-dependent manner. Every additional course of antibiotics dispensed to the mothers yielded an adjusted odds ratio (aOR) of obesity in their children (siblings) of 1.02 (95% CI, 0.99-1.06), which was similar to the odds across pregnancy for the whole population (aOR, 1.06; 95% CI, 1.04-1.07). For the child's exposure, the aOR for the association between antibiotic exposure and obesity was 1.04 (95% CI, 1.03-1.05) among siblings and 1.05 (95% CI, 1.02-1.09) among twins. However, fixed-effects analyses of siblings and twins showed no associations between antibiotic exposure and obesity, with aORs of 0.95 (95% CI, 0.90-1.00) for maternal exposure, 1.02 (95% CI, 0.99-1.04) for child's exposure, and 0.91 (95% CI, 0.81-1.02) for twins' exposure. Conclusions and Relevance Although covariate-adjusted analyses demonstrated an association between antibiotic exposure and odds of obesity, further analyses of siblings and twins with discordant outcomes showed no associations. Thus, these discordant results likely reflect unmeasured confounding factors. Question Is antibiotic exposure during pregnancy and/or during early childhood associated with the development of childhood obesity? Findings This cross-sectional national study of 284 & x202f;211 participants (132 & x202f;852 mothers and 151 & x202f;359 children) in New Zealand found that both prenatal and early childhood exposures to antibiotics were independently associated with obesity at age 4 years in a dose-dependent manner. However, fixed-effects analyses of siblings and twins with discordant outcomes showed no associations between antibiotic exposure and obesity. Meaning Although judicious use of antibiotics is necessary, antibiotics are unlikely to be a major contributor to childhood obesity. This cross-sectional study of mothers and their children in New Zealand assesses whether exposure to antibiotics during pregnancy and/or early childhood is associated with the development of childhood obesity.</p
Strain engraftment competition and functional augmentation in a multi-donor fecal microbiota transplantation trial for obesity
No full text© The Author(s). 2021Background
Donor selection is an important factor influencing the engraftment and efficacy of fecal microbiota transplantation (FMT) for complex conditions associated with microbial dysbiosis. However, the degree, variation, and stability of strain engraftment have not yet been assessed in the context of multiple donors.
Methods
We conducted a double-blinded randomized control trial of FMT in 87 adolescents with obesity. Participants were randomized to receive multi-donor FMT (capsules containing the fecal microbiota of four sex-matched lean donors) or placebo (saline capsules). Following a bowel cleanse, participants ingested a total of 28 capsules over two consecutive days. Capsules from individual donors and participant stool samples collected at baseline, 6, 12, and 26 weeks post-treatment were analyzed by shotgun metagenomic sequencing allowing us to track bacterial strain engraftment and its functional implications on recipients’ gut microbiomes.
Results
Multi-donor FMT sustainably altered the structure and the function of the gut microbiome. In what was effectively a microbiome competition experiment, we discovered that two donor microbiomes (one female, one male) dominated strain engraftment and were characterized by high microbial diversity and a high Prevotella to Bacteroides (P/B) ratio. Engrafted strains led to enterotype-level shifts in community composition and provided genes that altered the metabolic potential of the community. Despite our attempts to standardize FMT dose and origin, FMT recipients varied widely in their engraftment of donor strains.
Conclusion
Our study provides evidence for the existence of FMT super-donors whose microbiomes are highly effective at engrafting in the recipient gut. Dominant engrafting male and female donor microbiomes harbored diverse microbial species and genes and were characterized by a high P/B ratio. Yet, the high variability of strain engraftment among FMT recipients suggests the host environment also plays a critical role in mediating FMT receptivity.
Trial registration
The Gut Bugs trial was registered with the Australian New Zealand Clinical Trials Registry (ACTRN12615001351505).
Trial protocol
The trial protocol is available at https://bmjopen.bmj.com/content/9/4/e026174
JD/MBA Students’ Conference to Explore the Intersection of Law, Business and Mining
No full textJD/MBA Students’ Conference to Explore the Intersection of Law, Business and Mining
Labour Minister Lisa Raitt and Sherritt International Chairman Ian Delaney to deliver addresses
TORONTO, February 5, 2013 – About 30 executives, lawyers, scholars, financiers and regulators will grapple with the Canadian mining industry’s most pressing issues this Friday at a conference organized by students enrolled in the JD/MBA program at Osgoode Hall Law School and Schulich School of Business at York University.
Ian W. Delaney, Chairman of Sherritt International, will be the keynote speaker at the conference, titled Industrious Elements: At the Intersection of Law, Business and Mining. Former natural resources minister, Osgoode alum, and current federal labour minister Lisa Raitt will deliver an opening address, followed by remarks by Stikeman Elliott Managing Partner Jay Kellerman, who heads the firm\u27s global mining group.
The 16th annual conference organized by the JD/MBA Students’ Association will be held Friday, February 8, 2013 at the Courtyard Marriott at 475 Yonge Street in Toronto.
“The JD/MBA Students’ Association has brought together an impressive roster of experts and topical issues in one of Canada’s most challenging and important industries,” said Edward J. Waitzer, Director of the Jay and Barbara Hennick Centre for Business and Law and the Jarislowsky Dimma Mooney Chair in Corporate Governance at Osgoode and Schulich.
“Of course, the Schulich School of Business has recently launched Canada’s first MBA specialization in Global Mining Management and the resources sector is at the leading edge of rapidly evolving social and legal norms, so it’s no wonder that many of our students are intrigued by and well-versed in the complex issues facing this industry,” said Waitzer.
The leading sponsors of the conference are Fogler Rubinoff LLP; Davies Ward Phillips Vineberg LLP; Norton Rose Canada LLP; and Fraser Milner Casgrain LLP. The conference is supported by the Hennick Centre for Business and Law at Osgoode and Schulich.
During the conference, the Hennick Award of Excellence will be presented to Sherena Hussain, JD/MBA’12, an articling student with McCarthy Tètrault LLP who is actively involved in her community as a board member for various non-profit organizations. The Hennick Medal is awarded to the JD/MBA student with the highest cumulative Grade Point Average (GPA) over the course of the program.
“Sherena Hussain represents all of the qualities we hope for in our JD/MBA graduates: she has achieved outstanding academic excellence, developed compelling analytical skills and business acumen, and possesses exemplary character traits,” said Peter Macdonald, Co-Director, JD/MBA Program, Schulich School of Business. We are honoured to celebrate Sherena’s many accomplishments with the presentation of the Hennick Award of Excellence.
Members of the media are welcome to attend the speeches and panel discussions but are asked to email [email protected] to register their attendance in advance.
Conference panel topics and panelists include:
From the Ground Up: Fundamentals of Mining Finance: Richard Ross, Executive-in-Residence, Schulich School of Business (moderator); Egizio Bianchini, Vice-Chair & Global Co-Head, Global Metals & Mining, BMO Capital Markets; Jay Kellerman, Managing Partner, Stikeman Elliott LLP; and Nick Ransley, Managing Director, Americas, Cutfield Freeman & Co.
Regulatory Retooling: Environmental Compliance Post-Budget 2012: Patricia Hania, PhD Candidate, Osgoode Hall Law School (moderator); Sarah Powell, Partner, Davies Ward Phillips & Vineberg LLP; Michael Fortier, Partner, Torys LLP; and Anjala Puvananathan, Regional Director (Ontario), Canadian Environmental Assessment Agency.
Heigh-Ho! Off to Work in Mining Law Practice: Peter Macdonald, Co-Director, JD/MBA Program, Schulich School of Business (moderator); Ali J. Naushahi, Partner, Fraser Milner Casgrain LLP; Melanie Shishler, Partner, Davies Ward Phillips & Vineberg LLP; Trent Mell, Executive VP, Aurico Gold; and Mark Bennett, Cassels Brock & Blackwell LLP.
International Issues in Mining: Janne Duncan, Partner, Norton Rose Canada LLP (moderator); Carlos Espinosa, Head, Business Development, Toronto Stock Exchange; Andrew Foley, Partner, Paul, Weiss, Rifkind, Wharton & Garrison LLP; Rick Moscone, Partner, Fogler Rubinoff LLP; and Jim McArdle, Senior Vice President, Legal Services & Secretary, Export Development Canada.
Aboriginal Partnership: Models for Success: Wesley Cragg, Professor Emeritus, Business Ethics, Schulich School of Business (moderator); Bernie Hughes, Director, Aboriginal Relations, Ministry of Northern Development and Mines; Ormonde Benson, Partner, Miller Thomson LLP; and Michael Fox, President, Fox High Impact Consulting.
After the Mine: Creating Stable Communities: Patricia Dillon, Executive-in-Residence, Schulich School of Business (moderator); Janet Fishlock, Senior Community Development Specialist, rePlan; Aaron Steeghs, Manager, Corporate Social Responsibility, IAMGOLD Corporation; and David Clarry, Vice President, Corporate Social Responsibility, Hudbay.
More information about the conference may be found at www.jdmbaconference.com.
For more information, please contact:
Beth Marlin Media and Public Relations Schulich School of Business, York University
Email: [email protected]
Tel: 416-736-2100, ext. 22750
Cell: 905-717-6278
Douglas Judson, Conference Co-chair, JD/MBA ’15 candidate Email: [email protected] Tel: 613-720-3845
Geoff Malyk, Conference Co-chair, JD/MBA ’13 candidate Email: [email protected] Tel: 416-731-638
Evaluation of Preconception Dietary Patterns in Women Enrolled in a Multisite Study
No full text(c) The Author(s) 2022.BACKGROUND: Diet indices are widely used in nutritional research across communities but do not "capture" the full extent of diet variability across multiple countries. Empirically derived dietary patterns can provide additional information because they reflect combinations of foods potentially associated with health outcomes. Limited studies have evaluated preconception dietary patterns in heterogeneous populations.
OBJECTIVES: In the multisite Nutritional Intervention Preconception and During Pregnancy to Maintain Healthy Glucose Metabolism and Offspring Health (NiPPeR) study, the secondary aims included: 1) derive pooled and site-specific preconception dietary patterns, and 2) evaluate these patterns using anthropometric measures and metabolic biomarkers.
METHODS: Women planning pregnancy (n = 1720) in the United Kingdom, Singapore, and New Zealand completed interviewer-administered harmonized FFQs and lifestyle questionnaires at recruitment. Across-cohort ("pooled") and site-specific dietary patterns were derived, and associations between dietary pattern scores and BMI, waist-to-hip ratio, plasma lipids, and glycemia assessed using multivariable linear regression, expressing results as SD change in outcome per SD change in dietary pattern score.
RESULTS: The pooled analysis identified 3 dietary patterns: "Vegetables/Fruits/Nuts" ("Healthy"), "Fried potatoes/Processed meat/Sweetened beverages" ("Less Healthy"), and "Fish/Poultry/Noodles/Rice" ("Mixed"). The "Healthy" and "Less Healthy" pooled pattern scores were highly correlated with their corresponding site-specific dietary pattern scores ("Healthy": ρ = 0.87-0.93; "Less Healthy": ρ = 0.65-0.88). Women with higher scores for the "Healthy" pooled pattern had a lower waist-to-hip ratio (standardized β: -0.10; 95% CI: -0.18, -0.01); those with higher scores for the "Less Healthy" pooled pattern had a higher BMI (standardized β: 0.17; 95% CI: 0.09, 0.24), higher LDL cholesterol (standardized β: 0.10; 95% CI: 0.01, 0.19), and less optimal glucose profiles. However, we noted higher adherence to the "Healthy" pooled pattern with higher BMI.
CONCLUSIONS: The "Healthy" and "Less Healthy" pooled patterns were comparable to the corresponding site-specific patterns. Although the associations between these patterns and objective anthropometric/metabolic measures were largely in the expected directions, future studies are required to confirm these findings.
This trial is registered at clinicaltrials.gov (NCT02509988).fals
