News from the latest research

CELIAC DISEASE Linked to HIP FRACTURES

Patients who suffer from celiac disease and whose small intestine is chronically damaged may have a higher risk of fracturing a hip, according to a paper recently published in theJournal of Clinical Endocrinology and Metabolism.

Researchers, led by Jonas F. Ludvigsson, MD, PhD, of Orebro University, studied tissue samples of 7,146 Swedish participants who had been diagnosed with celiac disease from July 1969 to February 2008 and received follow-up biopsies within five years of diagnosis, examining intestinal tissue from the biopsies to determine the level of damage. Among this population, 43% had persistent villous atrophy (VA) where the intestinal tissue did not heal.

The scientists then analyzed patient records to determine how many had broken bones. Patients were monitored for a median of 10.3 years after being diagnosed with celiac disease. The authors wrote that, “Persistent VA was associated with an increased risk of hip fracture (HR 1.67, 95% CI 1.05–2.66). Hip fracture risk increased, depending on the degree of VA (HR for partial VA compared with those with healing 1.70, 95% CI 0.82–3.49, HR for subtotal/total VA compared with those with healing 2.16, 95% CI 1.06–4.41).”

They concluded that persistent VA is “predictive” of a higher risk of hip fracture, but not fracture overall, meaning that, “thinner subcutaneous tissue and fall or trauma may be mechanisms by which persistent VA confers an increased fracture risk.”

PREGNANT WOMEN Should Be Screened for GESTATIONAL DIABETES

The U.S. Preventive Services Task Force (USPSTF) in January released recommendations calling for pregnant women to be screened for gestational diabetes after 24 weeks gestation. The Endocrine Society responded, agreeing that pregnant women who have not previously been diagnosed with overt or gestational diabetes should be tested at 24 to 28 weeks gestation, but also pointed to its own guidelines, published in the November issue of theJournal of Clinical Endocrinology and Metabolism.

The Society recommends universal diabetes testing for women at the first prenatal visit, as outlined in its Diabetes and Pregnancy Clinical Practice Guideline. The authors, led by task force chair Ian Blumer, MD, of the Charles H. Best Diabetes Centre, wrote, “We recommend universal testing for diabetes with a fasting plasma glucose, HbA1C, or an untimed random plasma glucose at the first prenatal visit (before 13 weeks gestation, or as soon as possible thereafter) for those women not known to already have diabetes.”

“Given that many cases of type 2 diabetes are undiagnosed, it’s important to ascertain early in pregnancy whether women have this condition,” Blumer said. “Untreated diabetes poses serious risks to the mother and the fetus, so it is important to reduce the chance of complications through early diagnosis and treatment.”

The authors noted that universal testing for diabetes in early pregnancy could yield a high rate of false positives, and that women “with positive testing may have anxiety and will suffer the burden of additional testing,” but nevertheless recommend universal testing because the Society places the highest value on preventing fetal complications.

When pregnant women are screened for gestational diabetes at 24 to 28 weeks gestation, the Endocrine Society recommends pregnant women taking a 75-g oral glucose tolerance test, a method that is in line with the consensus panel of the International Association of the Diabetes and Pregnancy Study Groups’ protocol.

FRACKING associated with ENDOCRINE-DISRUPTING ACTIVITY IN WATER

Fracking — the controversial drilling technique to access oil and natural gas deposits — uses more than 700 chemicals in the process, many of which disrupt the body’s hormones, according to a study recently published in the journalEndocrinology.

“With fracking on the rise,” said the article’s lead author Susan C. Nagel, PhD, of the University of Missouri, “populations may face greater health risks from increased endocrine-disrupting chemical [EDC] exposure.”

Researchers hypothesized that surface and ground water samples collected in a drilling-dense region of Garfield County, Colo., and a selected subset of chemicals used in natural gas drilling operations would exhibit estrogen and androgen receptor activities. They collected surface and ground water samples from sites with drilling spills or accidents in Garfield County — an area with more than 10,000 active natural gas wells — and from drillingsparse control sites without spills in Garfield County as well as Boone County, Mo. — an area “devoid of natural gas drilling.” The scientists then solid-phase extracted the samples and measured for estrogen and androgen receptor activities using reporter gene assays in human cell lines.

Nagel and her team found that 11 chemicals exhibited anti-estrogenic activity, one exhibited estrogenic activity, and nine exhibited antiandrogenic activity. Water samples from sites with known natural gas drilling incidents had greater estrogen and androgen receptor activity than drilling-sparse or absent reference sites, leading them to conclude that natural gas drilling operations may result in elevated EDC activity in ground and surface water.

“Fracking has received several exemptions from federal regulations to protect water quality, but spills associated with natural gas drilling can contaminate surface, ground, and drinking water,” Nagel said. “We found more endocrine-disrupting activity in the water close to drilling locations that had experienced spills than at control sites. This could raise the risk of reproductive, metabolic, neurological, and other diseases, especially in children who are exposed to EDCs.”

Shared Spousal RISK OF DIABETES

It’s well understood that biologically related family members with histories of type 2 diabetes share increased risk of developing the disease, but a study recently published in the journalBMC Medicine suggests spouses may also share the risk.

Lead author Kaberi Dasgupta, MD, MSc, FRCPC, of McGill University, and her team wrote, “While heritable factors are important, socio-environmental influences are critical for the expression of genetic risk,” and noted that in addition to “biological” clustering of diabetes, there may also be “social” clustering of the disease. “Spouses are generally genetically unrelated but may share common living environments, resources, social habits, eating patterns, physical activity levels, and other health behaviors,” the researchers wrote.

To evaluate this theory, the scientists studied 75,498 couples using systematic review and meta-analysis of cross-sectional, case-control, andcohort studies examining spousal association for diabetes and/or prediabetes (impaired fasting glucose or impaired glucose tolerance), indexed in Medline, Embase, or Scopus (Jan. 1, 1997 to 28 Feb. 28, 2013).

Their analyses showed spousal diabetes concordance, which was “lowest in a study that relied on women’s reports of diabetes in themselves and their spouses (effect estimate 1.1, 95% CI 1.0 to 1.30) and highest in a study with systematic assessment of glucose tolerance (2.11, 95% CI 1.74 to 5.10).”

The researchers wrote, “The random effects pooled estimate suggests that a spousal history of diabetes is associated with a 26% risk increase for diabetes overall without adjustments for BMI (effect estimate 1.26, 95% CI 1.08 to 1.45) and 18% with BMI adjustment (effect estimate 1.18, 95% CI 0.97 to 1.40).

They concluded, “Recognizing shared risk between spouses may improve diabetes detection and motivate couples to increase collaborative efforts to optimize eating and physical activity habits.”

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