Parental diabetics children get too

How this happens is explained by Prof. Groham Hitman, Professor of Molecular Medicine and Consultant Diabetologist at Bats and the London Queen Mary’s School of Medicine and Dentistry, University of London.

Writing in the Diabetes Voice Vol. 48 (special issue) on-understanding Diabetes the Genetics!

He says:-

“Type II Diabetes - is more common in some families. It is well-known that the risk of diabetes in children is lowest if neither parent has type II diabetes. The risk increases if one parent has the condition and is highest if both parents have it.” The risk to their children is then over 70 per cent.

The article goes on -

In most people who develop diabetes there is a hereditary (genetic) component. However, in nearly all cases the genetic component alone does not cause the diabetes, but interaction with the environment of a person who is genetically susceptible. This is clearly demonstrated by the epidemic of diabetes worldwide.

The dramatic increase in figures clearly cannot be accounted for by genetic factors. It is most likely to be due to changing lifestyles in urban areas. Westernised life brings with it a more refined diet, reduced exercise, and increased stress.

This offers a clue as to the methods that should be chosen in order to alleviate the burden of the disease. And again, this does not relate to genetics.

However, without the genetic susceptibility these modern lifestyle changes would have no fertile field on which to exert their dangerous influences. The present article concentrates on this genetic susceptibility of diabetes.

It focuses on the single-gene disorders leading to Type II diabetes and the hunt for genes in the more common forms of Type II diabetes. There are also some lessons to be learnt from a type of diabetes seen mainly in ‘tropical countries’ - fibrocalculous pancreatic diabetes (FCPD).

A genetic component: Indirect evidence

Over 2000 years ago, the Hindu Physicians Charuka and Susruta commented on the two causes of ‘honey urine’ - passed from one generation to another in the seed’ (ie genetic) and ‘injudicious diet’ (ie environmental). This is the earliest reference to both the genetic component and the multifactorial nature of the condition.

When both parents have diabetes, the risk to children is over 70%

Type II diabetes is more common in some families. It is well-known that the risk of diabetes in children is lowest if neither parent has Type II diabetes. Risk increases if one parent has the condition and is highest if both parents have diabetes.

Data from India has demonstrated that when both parents have diabetes, the risk to children is over 70%. Risk of Type II diabetes to children appears to increase if the parent with diabetes is the mother, or if the parent developed the condition at early age.

In identical twins, if one twin has Type II diabetes, approximately 28-34% of the co-twins will also have diabetes. In contrast, in twins who are not necessarily genetically identical, only 14-16% will have diabetes. Furthermore, if identical twins are followed up for many years, the risk to the co-twin for abnormalities of glucose tolerance gradually approaches 100%.

More significant data can be taken from populations in which there is evidence of genetic mixing - in particular of a high risk ethnic group with a low risk group. The Pacific island of Nauru offers a good example.

Pure-blooded Nauruans over the age of 60 years have a prevalence of diabetes of 83%. However, despite an identical environment, in those who have evidence of Europid genes, the prevalence of diabetes is 17%.

Thrifty genotype and phenotype hypotheses - are they exclusive?

The ‘thrifty genotype’ hypothesis attempts to explain the advantage to humans of diabetes - predisposing genes. In the past, famine was common. Sadly, this is still the case in some parts of the world.

In order to survive famine, one needs to save energy stores in times of plenty and use them efficiently in times of famine.

It is hypothesised that those individuals with ‘beneficial’ genes would survive famine. However, in the presence of westernisation, the advantage turns to a disadvantage and the result is obesity.

In contrast, the ‘thrifty phenotype’ hypothesis puts the whole emphasis on events before birth which lead to the metabolic programming of the fetus and diabetes in later life.

Indeed, there is overwhelming evidence that small babies (presumably a reflection of nutritional influences in the womb) who subsequently become overweight as adults are those at most risk of a number of adult conditions including diabetes and cardiovascular disease (see the article by Chittaranjan Yajnik in this issue of Diabetes Voice for an exploration of the fetal origins of diabetes).

However, the hypotheses are not mutually exclusive and the truth lies somewhere between the two. Indeed, single-gene defects have been shown to have a profound effect on fetal growth.

Furthermore, a genetic basis for the predisposition of metabolic programming might implicate additional genes besides those involved in insulin action and secretion - namely those involved in fetal development.

Genetic success - maturity onset diabetes of the young (Mody)

Mody is a ‘success story’ of diabetes research, in which genetics has been the means for a fuller understanding of the condition. It also points to future applicability for the more common forms of Type II diabetes.

Mody is clinically defined as onset of Type II diabetes before 25 years in at least two family members of successive generations. ‘Mody’ accounts for approximately 2% of Type II diabetes in the world.

So far six genes have been found to account for 95% of cases of ‘Mody’ of which two (one for the enzyme glucokinase and one for a factor governing gene transcription into proteins - hepatic nuclear factor I (HNF1) account for the majority.

Television - what it does to your child

In good old days family was the most important influence in a child’s life, but research now suggest that television is not far behind. In Sri Lanka television can both educate and entertain us, but it does harm too.

Here are some of the findings of American Academy of Paediatrics on impact of television.

Studies show that TV viewing may lead to more aggressive behaviour, less physical activity, altered body image, and increased use of drugs and alcohol.

But high-quality, nonviolent children’s shows can have a positive effect on learning. However, for younger children it’s a very different story.

The first two years of life are especially important in the growth and development of your child’s brain.

During this time, children need good, positive interaction with other children and adults to develop good language and social skills. Learning to talk and play with others is far more important than watching television.

Until more research is done about the effects of TV on very young children, the American Academy of Paediatrics does not recommend television for children younger than two years of age.

In another study done by Robert Hancox at the University of Otago in New Zealand, he studied nearly 1000 children born in Dunedin, in 1972 and 1973.

The conclusions were, children who watched the least TV - especially between the ages of 5 and 11 - had the highest probability of graduating from university by the age of 26, regardless of IQ or socio-economic status.

While those who watched the most TV, more than 3 hours per day, had the highest chance of dropping out of school without qualifications.

Frederick Zimmerman and Dimitri Christakis at the University of Washington in Seattle, found that children who watched the most TV before the age of 3 performed poorest on reading and mathematics tests at ages 6 and 7.

Concerned parents should think twice before placing their child in front of the TV, as the standards of local TV channels have dropped drastically.

Dr. Himantha Atukorale, Radawana Government Hospital

Neural tube Defected children:

What happens to them in Sri Lanka

Rajpal SALGADO from Panadura writes

Spina Bifida I wonder how many people in Sri Lanka have heard this word. For 45 years of my life I hadn’t. Then I was blessed with a little boy with this Neural Tube Defect, which is a birth of about one in every 1500 births worldwide.

Spina Bifida is a Latin term meaning “split spine”. It is a name given to a group of birth defects which interfere with the development of the central nervous system (the brain, the spinal cord and the nerve tissues).

The central nervous system begins to develop from the ectoderm (the layer of cells from which the brain and spinal cord develop) in the third week following fertilization when the embryo is only 3-5 mm long.

Prior to this the ectoderm resembles a flat group of cells running down the middle of the embryo. This flat sheet begins to change, however, and folds to from a groove.

The edges of the sheet eventually come together to from a tube which later develops into the spinal cord and the brain. This structure is called the neural tube. Once the neural tube closes it sinks into the embryo and is covered by a layer of skin.

The spinal vertebrae (bony covering), then begins to form around the tube. Normally the neural tube closes by the twenty eighth day after fertilization. However, if the tube fails to close properly, a neural tube defect occurs. Spina Bifida is one example of a neural tube defect.

In Spina Bifida, at some point along the spine the posterior part of the vertebrae (the bones of the spine) are not completely joined. Babies are born with the spinal cord and covering (meninges) protruding through the opening.

Within a few days of birth, the site of the lesion on the back is operated on to ensure that it has a good skin covering. This is performed to stop infection and also for cosmetic reasons.

There are several types of Spina Bifida; Occulta, where the posterior part of the vertebrae has not completely joined but the spinal cord and the covering (meninges) usually intact.

Hair growth is common at site of the defect. Meningocele, when the outer part of vertebrae is split. Spinal cord is usually normal but Meninges damaged and displaced through opening appearing as a bulge in the lower back.

Myelomeningolele, when the outer part of vertebrae is split. Both Spinal cord and Meninges damaged and displaced through the opening and usually associated with the condition Hydrocephalus.

Spina Bifida Occulta is the least serious and the most common. One may not discover the defect or know one had the condition unless an X-ray of the back was taken.

The site of the lesion may be normal, or it may have some hairs growing from it; there may be a dimple in the skin, or a birthmark.

Most lead a totally normal life but occasionally problems do arise, however and medical advice is needed. The defect is hidden since the deformity of the spine and any associated abnormalities are covered by the skin.

Spina Bifida Meningocele is the least common form of Spina Bifida. In this type the Meninges (covering the spinal cord) protrude through the opening, causing a lump or sac on the back. The spinal cord is often undamaged and there are usually no long term problems, although once again, problems can arise.

The effect that Spina Bifida Myleomeningocele has on a person’s life depends on many things including the location and size of the lesion and the degree of damage to the spinal cord and nerves.

Spina Bifida most often occurs in the small of the back or lower down, but all three types can appear anywhere along the spine. The most common occurrence of Spina Bifida is in the lumbar and sacral areas.

The lumbar nerves control the muscles in the hip, leg, knee and foot and help to keep the body erect.

The sacral nerves control some of the muscles in the feet, bowel and bladder. Some degree of impairment can be expected in these areas. Problems may include lack of sensation and muscle function in the lower body and legs, an inability to control urination and bowel function, joint abnormalities and deformities of the back.

Are they confined to a bed ridden life until death? Cant hey school due to incontinence problems associated with Spina Bifida? So do they end up as illiterates too? Why not attempt to make life easier of them?

Why not try and give them wheelchairs if necessary? Why not provide public facilities accessible to persons on wheelchairs? Can the poorer sections of society cope with such a member in the family? Pampers, catheters, enemas, medicines cost money; can we not provide them free or at a concession?

Cannot we train these humans to manage their incontinence so that they can go about their social activities in an acceptable manner? Cannot they be given an education to be useful to society and to provide for themselves?

To attempt all of this we need to collect data on such persons. Thus I together with a few persons have formed a Spina Bifida Hydrocephalus Association of Sri Lanka.

The Association is in its formative stages and any person, baby, child or adult afflicted with the condition Spina Bifida and/or Hydrocephalus may send their Name, Contact Address, Telephone Number, Age, Sex, Medical Condition, Current remedies/medications practised, Assistance which would be welcome and recent photograph to SBHA Sri Lanka, P.O. Box 1, Panadura.

Introverts prone to heart problems

NEW DELHI: Are you an introvert? Do you find it difficult to express your feelings? You better step out of your cocoon and start to socialise more. According to a 30-year-study, men and women who bottle up their emotions are 50% more likely to die from a heart disease or stroke.

Researchers from Chicago’s Northwestern University followed 2,000 men over three decades and recorded all possible health changes they underwent. At the beginning of the study, the men, aged 40-55 years, filled in questionnaires designed to gauge their levels of sociability.

By the end of the study, almost 1,000 had died of heart problems and 412 from other causes. Heart deaths included 404 from coronary heart disease such as heart attacks and strokes and 541 from cardiovascular diseases, which include other heart and circulation illnesses.

Scientists then tabulated the accumulated data over the 30-year period keeping in mind other factors like high cholesterol, diet and smoking and found a direct link between shyness and onset of heart disease.

The conclusion was that sociable men have healthier hearts than their more reserved friends. The researchers, who announced their research in the journal ‘Annals of Epidemiology’, however, failed to explain why unsociable men should have more heart problems.

According to them, one reason could be that introverts lead more sheltered lives and so find new situations more stressful. Alternatively, the part of the brain that controls the day-to-day running of the heart may also be involved in setting personality traits.

According to cardiologist K K Aggarwal, humans have three types of emotions - suppressive emotion when one keeps things to themselves, expressive emotion like throwing tantrums and showing anger and neutralising emotion in which a person balances the situation and expresses anger or sadness at the appropriate time.

Times of India

Talk on cancer

The Health Watch recently organised a talk on cancer by Dr. Lim Hong Liang, a visiting oncology (cancer) specialist from the Parkway Cancer Centre, Mount Elizabeth Hospital Singapore. Several who came for the talk were provided the opportunity to personally consult Dr. Liang.

Here one such personal consultation is in progress at the Nations Trust Bank Building Auditorium (Leasing) Colombo 2.

The programme was done in association with Parkway Group Health Care Colombo office and the Banks Training and Development Manager Ronnie George and the Social Welfare Association of the Bank. Picture by Amarasena Ahangama (Lake House Correspondent)