[Is alcohol a risk factor for diabetes or does hyperglycemia predict "alcoholic death"? Analysis of causes of death in the Prospective Parisian Study].
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Adult↗
Biomedical subjects
B Balkau
Publications and source records attributed to B Balkau.
Re: "A prospective population-based study of alcohol use and non-insulin-dependent diabetes mellitus".
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Alcohol Drinking↗
A multicenter, controlled trial of ursodiol for the treatment of primary biliary cirrhosis. UDCA-PBC Study Group.
BACKGROUND: In primary biliary cirrhosis the hepatic lesions may result, at least in part, from the intracellular accumulation of potentially toxic endogenous bile acids. Preliminary work suggests that the administration of ursodiol (also called ursodeoxycholic acid), a hydrophilic bile acid without hepatotoxicity, leads to improvement in the condition of patients with primary biliary cirrhosis. METHODS: We conducted a two-year, multicenter, double-blind trial to compare the efficacy of ursodiol with that of placebo. Patients with biopsy-proved primary biliary cirrhosis were randomly assigned to receive either ursodiol (13 to 15 mg per kilogram of body weight per day) (n = 73) or placebo (n = 73). Treatment failure was defined as a doubling of bilirubin levels to more than 70 mumol per liter or the occurrence of a severe complication (ascites or variceal bleeding) or an adverse reaction. RESULTS: Treatment failed in 6 patients in the ursodiol group, as compared with 13 in the placebo group (P less than 0.01 by Cox regression model). A single patient in each group withdrew because of minor adverse effects. After two years of treatment, the proportion of patients with clinically overt disease decreased only in the ursodiol group (P less than 0.02). The patients treated with ursodiol had significant improvements in serum levels of bilirubin, alkaline phosphatase, alanine aminotransferase, aspartate aminotransferase, gamma-glutamyltransferase, cholesterol, and IgM (all P less than 0.001); the antimitochondrial-antibody titer (P less than 0.01); and the Mayo risk score (P less than 0.001). Follow-up analysis of 95 liver-biopsy specimens showed a significant improvement in the mean histologic score (P less than 0.002) and in all the characteristic histologic features except fibrosis only in the group given ursodiol. CONCLUSIONS: Ursodiol is a safe and effective treatment for primary biliary cirrhosis.
Alkaline Phosphatase↗
Repeatability of the oral glucose tolerance test for the diagnosis of impaired glucose tolerance and diabetes mellitus.
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Administration, Oral↗
The high risk of death by alcohol related diseases in subjects diagnosed as diabetic and impaired glucose tolerant: the Paris Prospective Study after 15 years of follow-up.
The 15 year mortality rates and causes of death are reported for the Paris Prospective Study cohort of 7180 working men, aged between 44 and 55 years who attended the first follow-up examination. All subjects were classified as normoglycaemic, impaired glucose tolerant or diabetic according to the WHO criteria, following an oral glucose tolerance test. The relative risks of death in comparison to the normoglycaemic group were 1.6 for impaired glucose tolerant and 2.3 for diabetic subjects; for death due to coronary heart disease: 1.7 and 2.3 respectively; for death due to alcohol and cirrhosis: 7.0 and 13.3 respectively. It appears that in this cohort a proportion of subjects screened as diabetic have impaired liver function and disturbed carbohydrate metabolism, due to excessive alcohol consumption. Alcohol should be investigated as a possible risk factor for diabetes, particularly in epidemiological studies where diabetes is diagnosed by the oral glucose tolerance test and the population has a high consumption of alcohol.
Adult↗
The frequency of alcoholisation among young people injured in accidents in France.
In a nation-wide epidemiological survey carried out in France in 1982-1983, blood alcohol concentration was systematically measured in 1423 young casualties (aged 15-24 years) on their arrival in the emergency room. Traffic accidents accounted for almost half of the admissions, and they were the most severe, with over 10% requiring hospitalisation with vital risk. A quarter of the admissions was female; on average, their blood alcohol concentration was low and not statistically related to age. Conversely, among young male casualties, 1 out of 5 had a blood alcohol concentration of at least 0.50 g/l (11 mmol/l) and 1 out of 15 was classified as a chronic heavy drinker. It is of note that alcohol was implicated in 43% of the car/truck accidents of the young men and that blood alcohol concentration as well as the proportion of chronic drinkers were strongly related to age. Alcohol consumption may begin as early as 15 years; in the young men 15-24 years, only 7% were chronic drinkers whereas in men over 24, 37% were chronic drinkers. On this basis, it is appropriate to focus education about alcohol consumption on adolescents, particularly men.
Accidents↗
Liver tumors in cirrhosis: experimental study with SPIO-enhanced MR imaging.
The influence of cirrhosis on superparamagnetic iron oxide (SPIO)-enhanced magnetic resonance (MR) imaging of the liver was studied in 31 rats. Experimental models included carbon tetrachloride-induced cirrhosis and liver engrafting of rhabdomyosarcoma S4T cells. Hepatic uptake of SPIO measured with relaxometry decreased dramatically with histologic grade, while splenic uptake increased; the same results were achieved by calculating K values. Imaging of 13 tumorous cirrhotic rats confirmed these results by showing a muted decrease in liver signal intensity on spin-echo images after injection of SPIO. Nevertheless, all intrahepatic tumors could be visualized, as confirmed by postmortem examination. On gradient-echo images, postinjection contrast between the tumor and the liver was not affected by cirrhosis. Thus, despite strong impairment of hepatic uptake in cirrhosis, the diagnostic efficacy of MR imaging with SPIO did not seem to be significantly affected.
Animals↗
Oral contraceptives, insulin resistance and ischemic vascular disease.
From a large prospective study on diabetes risks, 1112 professionally active, non-menopausal, non-pregnant, healthy women were cross-sectionally analysed according to their use of oral contraception. After adjustment for age, weight and diabetes risk factors, those taking the pill, compared to those who did not, had significantly higher fasting serum insulin, triglycerides and 2-h 75 g OGTT blood glucose levels. The insulin-resistance markers which have recently been cited as ischemic vascular disease risk factors should be carefully monitored in pill users.
Adult↗
Adherence measured by microtiter assay as a virulence marker for Staphylococcus epidermidis infections.
Staphylococcus epidermidis strains isolated from clinical sources showed a wide range of abilities to adhere to glass and plastic materials. The degree of adherence depended on a number of factors, most notably, the composition of the growth medium. Adherence was enhanced by the addition of glucose or oleic acid to the growth medium and inhibited by serum. We have demonstrated a statistically significant association between the quantitative assessment of adherence to polystyrene tissue culture plates and clinical relevance. No such association was found when adherence was assessed by the qualitative adherence assay. Possible new approaches for assessing the clinical relevance of coagulase-negative staphylococcal isolates are discussed.
Bacterial Adhesion↗
Species identification, antibiotic sensitivity and slime production of coagulase-negative staphylococci isolated from clinical specimens.
Two hundred and seventy-five consecutive clinical isolates of coagulase-negative staphylococci, including strains associated with disease, contaminants and skin colonizers, were speciated, tested for slime production and for their sensitivity to a range of antibiotics. Staphylococcus epidermidis was the most commonly identified species, comprising 63% of all isolates. Slime production was detected in half the strains of Staph. epidermidis, Staph. haemolyticus and Staph. saprophyticus but was rare in other species. Most Staph. haemolyticus strains and approximately half of the Staph. epidermidis strains were resistant to five or more antibiotics. A significant association was found between slime production and multiple antibiotic resistance. For catheter-associated strains, clinical relevance was predictable by species i.e. Staph. epidermidis. Multi-resistant slime-positive Staph. haemolyticus strains, although infrequently associated with disease, were common skin colonizers, presumably acquired from the hospital environment. We describe a practical and inexpensive scheme for the speciation of human coagulase-negative staphylococcal isolates.
Coagulase↗
Factors associated with the development of diabetes in the Micronesian population of Nauru.
A longitudinal study of 266 adult residents of the Pacific Island of Nauru (1975-1976 and 1982) has shown an annual incidence of noninsulin-dependent diabetes of 1.6 per cent per annum. Factors associated with the subsequent development of glucose intolerance were determined by means of regression techniques. The two-hour, post-load plasma glucose concentration was the factor most consistently associated with subsequent glucose intolerance. Other predictors were found to vary in their importance between the sexes. In males, the fasting plasma triglyceride concentration and blood pressure showed a weaker association, and body mass index was of marginal significance. In contrast, in females, two-hour plasma insulin concentration, plasma uric acid concentration, body mass index, and fasting plasma glucose concentration showed a significant association. These findings are discussed in light of the results of similar studies in other populations.
Adult↗
The natural history of impaired glucose tolerance in the Micronesian population of Nauru: a six-year follow-up study.
A longitudinal study of 266 randomly selected non-diabetic Nauruans (215 normal subjects, 51 with impaired glucose tolerance) has permitted the natural history of impaired glucose tolerance to be studied in this Micronesian population. Nauruans are known to suffer from a very high prevalence of abnormal glucose tolerance. The subjects were first examined in 1975-1976, and a follow-up examination was performed in 1982. Of the subjects with impaired glucose tolerance, 26% developed diabetes during the study period (4% per annum) compared with 7% of normal subjects (1% per annum). After controlling for the effects of both age and obesity, the risk of subsequent diabetes for subjects with impaired glucose tolerance remained significantly higher than for normal subjects (odds ratio 3.6, 95% confidence interval 1.4-9.1). Of those with impaired glucose tolerance on initial examination, 39% were normoglycaemic at follow-up. In subjects with impaired glucose tolerance, of nine factors examined only plasma glucose concentration at the time of the initial examination was consistent in predicting progression to diabetes, when the data were examined by both univariate and multivariate methods. Both 2-h and fasting plasma glucose values were useful predictors. Thus, Nauruans with impaired glucose tolerance have a higher risk of subsequent diabetes than their normoglycaemic counterparts, after controlling for age and obesity. Nevertheless, the prognosis of impaired glucose tolerance is unpredictable as a substantial proportion of such subjects return to normality.(ABSTRACT TRUNCATED AT 250 WORDS)
Adolescent↗
Risk factors for diabetes in three Pacific populations.
The association between the prevalence of diabetes and three suspected risk factors--overweight, physical inactivity, and urbanization--has been studied in 5519 subjects from three Pacific populations: Melanesians and migrant Asian Indians in Fiji in 1980, and Micronesians in the Republic of Kiribati (formerly the Gilbert Islands) in 1981. Associations were found to be inconsistent between populations, and between the sexes within populations. In some cases, overweight was strongly associated with prevalence; in others, the principal variable associated with diabetes appeared to be physical inactivity. More than one factor was associated with increased risk in Micronesians, and some evidence of interaction between factors also emerged. Although longitudinal studies will be required for the complete elucidation of risk factors for diabetes, these findings suggest that risk factors may be heterogeneous in their effect upon different populations, and that an assessment of risk variables operating in a given target community may be of value in the initial phase of a diabetes prevention or control program.
Adult↗
The high prevalence of diabetes mellitus, impaired glucose tolerance and diabetic retinopathy in Nauru--the 1982 survey.
A population survey in 1982 has confirmed that Nauruan adults suffer from an extremely high prevalence of Type 2 (noninsulin-dependent) diabetes mellitus. The crude population prevalence of Type 2 diabetes was 24%. Abnormal glucose tolerance (impaired glucose tolerance and diabetes) was present in over 40% of the adult population and exceeded 80% in both sexes after the age of 55 yr. Diabetic retinopathy was present in 24% of diabetic patients, confirming that this Micronesian population is susceptible to the microvascular consequences of hyperglycaemia. Subjects with impaired glucose tolerance had a prevalence of retinopathy three times that of normal subjects, though the difference did not reach statistical significance. Prevalence of retinopathy was substantially higher in diabetic patients than either normal subjects or those with impaired glucose tolerance.
Adult↗
Bimodality in glucose tolerance distributions in the urban Polynesian population of Western Samoa.
The frequency distribution of log plasma glucose concentrations in certain populations show two distinct subgroups--a non-diabetic group and a hyperglycaemic group--when suitable methods of distributional analysis are used. These two groups show up as a double peak (bimodality) in the best-fit frequency distributions of log plasma glucose, and the separation or cut-off point where the two curves intersect, gives an indication of the plasma glucose level at which diabetes could be diagnosed. Venous plasma glucose concentrations 2 hr after a 75 g oral glucose load were determined in the urban Polynesian population of Western Samoa, in subjects aged 20 yr and over. Bimodality was evident in subjects over 35 yr of age in both sexes, but for the younger age groups the frequency distribution of log plasma glucose follows the usual unimodal Gaussian curve. The data show that among these Polynesians, as with Pimas and Nauruans, the frequency distribution of log plasma glucose concentrations can be used to separate the population into normal and hyperglycaemic groups.
Adult↗
Diabetic retinopathy in Nauruans.
An epidemiologic survey of the whole adult Micronesian population of Nauru in the Central Pacific conducted in 1982 has confirmed that Nauruans, along with Pima Indians, suffer the highest rate of abnormal glucose tolerance yet recorded. To establish the morbid effects of hyperglycemia in this population, all responders to the diabetes survey were concurrently examined for diabetic retinopathy. In diabetic subjects, the crude prevalence of retinopathy was 24%. Specific rates were determined at various levels of the following characteristics: age, two-hour post-load plasma glucose, body mass index, duration of diabetes, and systolic blood pressure. Prevalence was found to rise with increasing two-hour plasma glucose and duration, to fall with increasing body mass index, and to have a quadratic relationship with age and systolic blood pressure. The multiple logistic regression model was used to determine whether the selected characteristics were significant in increasing the risk of retinopathy. Body mass index and systolic blood pressure did not contribute significantly to this risk after controlling for age. Increasing two-hour plasma glucose significantly increased the risk of retinopathy, and duration of disease was the strongest predictor variable. This study shows that the consequences of hyperglycemia in this Micronesian population are comparable to those already documented in European and American Indian communities.
Adult↗
Plasma glucose distributions in two pacific populations: the bimodality phenomenon.
The frequency distribution of plasma glucose concentrations in certain populations show two distinct sub-groups, viz. the non-diabetic group and a hyperglycaemic group. The two groups show up as a double peak (bimodality) in the best-fit frequency distributions of log plasma glucose, and the separation or cut-off point where the two curves intersect, gives an indication of the plasma glucose level at which diabetes could be diagnosed. Venous plasma glucose concentrations two hours after a 75 gm oral glucose load were determined in the Micronesian population of Nauru and the urban Polynesian population of Western Samoa, in subjects aged 20 years and over. Both communities exhibit bimodal frequency distributions of plasma glucose in the upper age groups in both sexes. In the younger age groups the frequency distribution of plasma glucose typically follows the usual unimodal Gaussian curve. However, the high prevalence Nauruans show the bimodal form in all groups except the youngest males. The data show that among these two communities, as with the Pimas, the frequency distribution of plasma glucose concentrations can be used to separate the population into normal and hyperglycaemic groups.
Adult↗
Characteristics associated with diabetic retinopathy in Nauruans.
A recent epidemiological survey of the whole adult Micronesian population of Nauru has confirmed that Nauruans, along with Pima Indians, suffer the highest rate of abnormal glucose tolerance yet recorded. To establish the morbid effects of hyperglycaemia in this population, all responders to the diabetes survey were concurrently examined for diabetic retinopathy. In diabetic subjects, the crude prevalence of retinopathy was 24%. Specific rates were determined at various levels of the following characteristics: age, 2 hour post-load plasma glucose, body mass index, duration of diabetes and systolic blood pressure. Prevalence was found to rise with increasing 2 hour plasma glucose and duration, to fall with increasing body mass index and to have a quadratic relationship with age and systolic blood pressure. The multiple logistic regression model was used to determine whether the selected characteristics were significant in increasing the risk of retinopathy. Body mass index and systolic blood pressure did not contribute significantly to this risk after controlling for age. Increasing 2 hour plasma glucose significantly increased the risk of retinopathy, and duration of disease was the strongest predictor variable. This study shows that the consequences of hyperglycaemia in this Micronesian population are comparable to those already documented in European and American Indian communities.
Adult↗