Associations between concentrations of vitamin D and concentrations of insulin, glucose, and HbA1c among adolescents in the United States

OBJECTIVE

Our objective was to examine the associations between concentrations of vitamin D and concentrations of insulin, glucose, and HbA_1c in a nationally representative sample of adolescents in the U.S.

RESEARCH DESIGN AND METHODS

We used data for 1,941 adolescents, aged 12–17 years, who participated in the National Health and Nutrition Examination Survey between 2001 and 2006.

RESULTS

Adjusted concentrations of insulin were ~24% lower among male subjects with a concentration of vitamin D ≥75 nmol/L than among male subjects with a concentration of vitamin D <50 nmol/L (P = 0.003). Concentrations of vitamin D were inversely associated with concentrations of glucose only among Mexican American male subjects (P = 0.007). No significant associations between concentrations of vitamin D and HbA_1c were detected.

CONCLUSIONS

Our results support an inverse association between concentrations of vitamin D and insulin primarily in adolescent male subjects.In recent years, the relationships between vitamin D and factors involved in glucose homeostasis have received a great deal of attention. Few studies have been conducted using pediatric samples (1–3). Because the prevalence of deficient or insufficient vitamin D status is high among children and adolescents in the U.S. and is possibly increasing (4,5), any deleterious effect of suboptimal vitamin D status on glucose homeostasis is of interest, especially in light of concerns about increases in diabetes among youth in the U.S. (6). Most previous studies have used small, selected samples of adolescents. To provide additional insights into the associations between circulating concentrations of vitamin D and concentrations of insulin and glucose, we examined data from a large, representative sample of adolescents that included African Americans and Mexican Americans in the U.S.     

Adverse childhood experiences and smoking status in five states

Objective

Our objective was to examine the associations between adverse childhood experiences (ACEs) and smoking behavior among a random sample of adults living in five U.S. states.

Methods

We used data from 25,809 participants of the 2009 Behavioral Risk Factor Surveillance System to assess the relationship of each of the 8 adverse childhood experiences and the adverse childhood experience score to smoking status.

Results and conclusions

Some 59.4% of men and women reported at least one adverse childhood experience. Each of the eight adverse childhood experiences measures was significantly associated with smoking status after adjustment for demographic variables. The prevalence ratios for current and ever smoking increased in a positive graded fashion as the adverse childhood experience score increased. Among adults who reported no adverse childhood experiences, 13.0% were currently smoking and 38.3% had ever smoked. Compared to participants with an adverse childhood experience score of 0, those with an adverse childhood experience score of 5 or more were more likely to be a current smoker (adjusted prevalence ratio (aPR): 2.22, 95% confidence interval [CI]: 1.92-2.57) and to have ever smoked (aPR: 1.80, 95% CI: 1.67-1.93). Further research is warranted to determine whether the prevention of and interventions for adverse childhood experiences might reduce the burden of smoking-related illness in the general population.     

Racial and ethnic approaches to community health: reducing health disparities by addressing social determinants of health

Poor people and people of color are more likely to live shorter and sicker lives and are less likely to survive a host of chronic illnesses. Policies and organizational practices that improve the environments in which people live, work, learn, and play can reduce these disparities. Using the World Health Organization's "Call to Action" principles as a discussion framework, we highlight the Centers for Disease Control and Prevention's Racial and Ethnic Approaches to Community Health programs that have developed and applied such strategies to address chronic illnesses. Several, in turn, foster health equity.     

Relationship between body mass index and perceived insufficient sleep among U.S. adults: an analysis of 2008 BRFSS data

Background  

Over the past 50 years, the average sleep duration for adults in the United States has decreased while the prevalence of obesity and associated outcomes has increased. The objective of this study was to determine whether perceived insufficient sleep was associated with body mass index (BMI) in a national sample.     

Visceral leishmaniasis: consequences to women in a Bangladeshi community

Visceral leishmaniasis (VL) or kala-azar (KA) affects the rural poor, causing significant morbidity and mortality. We examined the epidemiological and social impact of KA in an affected village in Bangladesh. A population-based survey of the village residents showed a case fatality rate of 14.7% among females and 5.3% among males. Before initiation of the study, female patients were ill longer than males before they received treatment. Future work needs to focus on understanding the implications of KA on women and to develop sustainable strategies for appropriate and timely access to treatment.     

Respiratory disease in pregnancy

Breathlessness in the absence of an underlying pathology is common in pregnancy, but serious causes should be excluded depending on symptoms. The use of chest X-rays should not be avoided in pregnancy.Asthma affects about 7% of women of child-bearing age. Treatment is the same as for the non-pregnant population and most drugs are safe in pregnancy. It is important to educate women to continue inhaled corticosteroid preventer therapy to reduce the risk of attacks. Respiratory infections are associated with a higher morbidity in pregnancy and should be treated aggressively.Women with a chronic respiratory disease should receive pre-pregnancy counselling and education, and during pregnancy managed in a multidisciplinary setting with the respiratory team. Most chronic pulmonary diseases do not alter fertility, and in the majority of cases large reserves in respiratory function allow a good pregnancy outcome for fetus and mother. In contrast, the presence of pulmonary hypertension and cor pulmonale is associated with a high risk of death in pregnancy.