Scholarship & Creativity

Updated 11:00 AM March 6, 2006

Scholarship & Creativity

Obese children twice as likely to have diabetes

Obese children are twice as likely to have diabetes than children of normal weight, according to a study from the U-M Health System.

The study, published in the February issue of Diabetes Care, is the most recent national effort to estimate the prevalence of children with diabetes. It found that more than 229,000 children—approximately 3.2 cases for every 1,000 American children under the age of 18—currently have diabetes. And one-third of those children are obese.

The study was conducted by researchers with the Child Health Evaluation Research (CHEAR) Unit in the Division of General Pediatrics at C.S.Mott Children's Hospital.

As children's waistlines have continued to grow so has concern that obesity will lead to even more children developing diabetes before they've graduated from high school. And caring for the combination of diabetes and obesity may place more strain on the health care system, says study lead author Dr. Joyce Lee with the Division of Pediatric Endocrinology and CHEAR.

"Among school-aged children, obese children have a greater than twofold chance of having diabetes, compared with children of normal weight," Lee says. "The large number of children with diabetes in the U.S., and the potential for increasing numbers of children developing diabetes with the obesity epidemic, has serious implications for how these children will receive appropriate health care now and as they grow into adulthood."

The study found that children ages 6-11 and 12-17 who were obese were more than twice as likely to have diabetes than children of the same age who were of normal weight.

While one form of diabetes, type 2, usually is associated with obesity, data used for the study did not distinguish between the two types. Still, results point to a greater need for public health strategies to curb childhood obesity and reduce the number of children with diabetes, Lee says.

In addition to Lee, Melissa McPheeters and James Gurney with the CHEAR team; and Dr. William Herman, with the Department of Internal Medicine at the Medical School and the Department of Epidemiology at the School of Public Health, co-authored the study.—Krista Hopson, UMHS Public Relations

Stressed women have higherincidence of early miscarriage

Women who exhibit signs of stress are three times more likely to miscarry during the first three weeks of the pregnancy, a recent study of a small population of women found.

Pablo Nepomnaschy and a group of U-M researchers measured levels of the stress-induced hormone cortisol in urine samples taken three times weekly for a year from 61women in a rural Guatemalan community. Nepomnaschy conducted the fieldwork while he was a doctoral student in the Anthropology Department and School of Natural Resources and Environment (SNRE). He now is a postdoctoral fellow at the Epidemiology Branch of the National Institute of Environmental Health Sciences.

According to previous scientific reports anywhere from 31 percent to 89 percent of all conceptions result in miscarriage. Most studies begin when women notice they are pregnant, about six weeks after conception. Most miscarriages, however, are known to happen during the first three weeks of pregnancy.

In the Guatemalan study, 22 pregnancies occurred in a total of 16 women, and each woman's cortisol levels were measured against their own baseline levels. Researchers found that 90 percent of women, whose ages ranged from 18-34, with elevated levels of the stress-induced hormone miscarried during the first three weeks of pregnancy, compared to 33 percent of those with normal levels.

The body may recognize the elevated cortisol levels as an alarm that conditions are unfavorable for pregnancy, Nepomnaschy says. "The body's response is to stop any extra activity and go back to its most basic functions."

Nepomnaschy and colleagues speculate that stress may be more likely to lead to loss during the earliest stages of pregnancy when the embryo is just beginning to develop. It's unclear if cortisol directly is involved with the miscarriages or if it signals some other mechanism in the body that causes the miscarriage.

Co-authors on the Guatemalan study include Kathleen Welch, Center for Statistical Consultation and Research; Daniel McConnell, Department of Epidemiology and the Reproductive Sciences Program (RSP); Bobbi Low, SNRE; Beverly Strassmann, Department of Anthropology and the Research Center for Group Dynamics; and Barry England, Department of Pathology and RSP.—Laura Bailey, News Service

Kidney cancer patients may be overtreated

A less aggressive type of surgery designed to spare healthy organ tissue is used infrequently to treat early-stage kidney cancer, according to researchers at the Comprehensive Cancer Center (CCC).

A majority of patients with small kidney tumors have their entire organ removed as treatment, even though they may be eligible for a type of surgery that removes only the cancer and spares the rest of the normal kidney. This surgery, called partial nephrectomy, has been associated with improved quality of life and better preservation of long-term kidney function.

Results of a study in the March issue of the Journal of Urology found that only 9.6 percent of patients were treated with partial nephrectomy, while 90 percent had their entire kidney removed. The smaller the tumor the more likely patients were to receive partial nephrectomy, although even among this group partial nephrectomy was used infrequently.

One possible explanation for the larger number of total kidney removals, the researchers suggest, is that total nephrectomy is more likely than partial nephrectomy to be performed with minimally invasive laparoscopic surgery. Partial nephrectomy can be done laparoscopically but is technically difficult and is not offered at all hospitals.

"Many surgeons are able to take the whole kidney out laparoscopically but are less experienced performing partial nephrectomy laparoscopically," says study author Dr. David Miller, clinical lecturer in urology at the Medical School. "Such technical considerations may have swayed how doctors presented treatment options to patients and how patients decided what surgery to have."

Dr. Brent Hollenbeck, assistant professor of urology at the Medical School, says doctors need to make all surgical options available to patients so they can make the decision that's best for them.

In addition to Miller and Hollenbeck, study authors were Dr. John Hollingsworth, urology resident; Dr. Khaled Hafez, assistant professor of urology; and Stephanie Daignault, a CCC biostatistician.—Nicole Fawcett, Comprehensive Cancer Center

Family and neighborhood impact school outcomes

Many education improvement policies focus on test scores and academic issues, but student attitudes and beliefs about education, behavior at school, family influences and neighborhood factors can determine if students will have positive school outcomes, a U-M study indicates.

"Unless you promote students' and families' positive beliefs about school and create a supportive environment at home and in the neighborhood, some students will not respond to efforts to improve their grades or standardized test scores," says Michael Woolley, assistant professor in the schools of Social Work and Education, who co-authored the study with Andrew Grogan-Kaylor, assistant professor of social work.

In the study, the researchers analyzed four family factors: student satisfaction with parenting; family support; social integration of family members; and home academic culture, which involves parents emphasizing the importance of school.

Students who reported a strong home academic culture earned higher grades, but home academic culture did not influence a student's behavior, beliefs or attitudes about school. Students who reported higher levels of family satisfaction with parenting, family social integration and home academic culture reported more positive beliefs and attitudes about attending school and success in school.

Better grades also were related to students' perceptions of how safe they feel in their neighborhoods and the crime rate. The nature of the neighborhood peer culture, satisfaction with the quality of the neighborhood, transience and economic resources also were neighborhood factors related to various aspects of school outcomes from avoiding problem behavior to getting good grades.

For school behavior and academic performance race/ethnicity was not significant once other factors, such as neighborhood were accounted for, Grogan-Kaylor says.

"The implication is that policy and practice efforts to reduce the achievement gap experienced by African American and Latino students should not simply focus on academic issues such as curriculum planning and high-stakes testing," the researchers wrote.—Jared Wadley, News Service

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