Detrimental Long-term Consequences Research Articles

Test–Retest Reliability and Minimal Detectable Change in Chester Step Test and 1-Minute Sit-to-Stand Test in Long COVID Patients

The COVID-19 is a multiorgan disease that appeared in December 2019 in the Chinese province of Wuhan. It produces various clinical manifestations, although it mainly affects the respiratory system. Given these potentially detrimental long-term consequences of COVID-19, an appropriate assessment must be carried out to plan early rehabilitation interventions. To assess the persistent symptoms it produces, as well as exercise tolerance for a given exertion, stress testing is a feasible and cost-effective option. Therefore, the objective of this study was to provide test-retest reliability for the Chester Step Test and 1 minute Sit to Stand tests and to establish the minimum detectable change in Long-COVID patients. Method: This observational, descriptive, cross-sectional study was conducted following the STROBE guidelines. A total of 42 patients carried out, twice per partici-pant, the Chester Step and 1-Minute Sit-to-Stand (1min-STST) tests on two different days, with a five-day time lag between the initial measurement and the second measurement. Results: The Test-retest reliability for the Chester Step was excellent within session ICC (95% CI) 0.96 (0.93 to 0.98), being even better for the 1-STST, ICC (95% CI) 0.98 (0.96 to 0.99). Establishing a change of at least 16.96 steps (MDC90) or 20.15 steps (MDC95) and 1.89 stands (MDC90) or 2.71 stands (MDC95), respectively. Conclusions: The Chester Step and 1min-STST tests are reproducible and reliable tools to measure exercise tolerance in long COVID patients. The minimum detectable changes observed in the values recorded by the participants can be very useful for the evaluation of the effectiveness of interventions applied to these patients.

Sociodemographic and clinical characteristics related with hyperprolactinaemia in psychiatric clinical population

Background Hyperprolactinaemia (HyperPRL) induced by psychotropic drugs is a high-prevalence consequence which has repercussions in psychical and mental health in the psychiatric population, so this research had the objective to expand which sociodemographic and clinical features are associated with prolactin (PRL) elevation in patients treated with antidepressant and/or antipsychotic drugs. Methods An observational, cross-sectional, comparative and retrolective study was conducted on 300 patients who received clinical attention in a third level of psychiatric care unit in Mexico during 2017. These patients have been reported to show PRL levels greater than 25 ng/mL among women and greater than 20 ng/mL among men. In the same way, sociodemographic and clinical variables were collected, as well as psychiatric diagnosis and type of psychopharmacological treatment used by the patients. Results HyperPRL was more frequent in women (80.7%) than men (19.3%). The mean levels of PRL were 68.94 ± 62.28 ng/mL with higher levels in women (71.9 ± 67.3, p=.02). Regarding the treatment, 78.3%, 71.3% and 49.7% consumed antipsychotics, antidepressants, and both drugs, respectively. The relationship between hyperPRL (>100 n/mL) and typical antipsychotics was dose-dependent (33.23 ± 13.24 mg, p=.01). In the multivariate regression models according to the type of treatment, as well as the demographic and clinical features, hyperPRL was associated independently with the use of antipsychotic treatment, pituitary adenoma and hypertension (R 2=0.05). Conclusions HyperPRL is a complex clinical syndrome frequent in the psychiatric population with detrimental long-term consequences, as well as its relationship with the use of psychotropic drugs as in the case of antipsychotics. Effective actions should be implemented in the prevention, approach and treatment of this condition paying special attention to the accompanying medical comorbidities.

Kinder Ready Clinics: A Collaborative Model for Creating Equitable and Engaged Early Learning Environments for Low-income Families.

Disparities in children's school readiness (SR) in the U.S. are well-documented and have detrimental long-term consequences. Clinic-based early education interventions are limited. This report summarizes collaborative efforts of pediatricians and community stakeholders to develop and implement clinic-based interventions to promote early learning and SR among low-income children.

ADGRL3, FGF1 and DRD4: Linkage and Association with Working Memory and Perceptual Organization Candidate Endophenotypes in ADHD.

Attention deficit hyperactivity disorder (ADHD) is a highly heritable neurobehavioral disorder that affects children worldwide, with detrimental long-term consequences in affected individuals. ADHD-affected patients display visual–motor and visuospatial abilities and skills that depart from those exhibited by non-affected individuals and struggle with perceptual organization, which might partially explain impulsive responses. Endophenotypes (quantifiable or dimensional constructs that are closely related to the root cause of the disease) might provide a more powerful and objective framework for dissecting the underlying neurobiology of ADHD than that of categories offered by the syndromic classification. In here, we explore the potential presence of the linkage and association of single-nucleotide polymorphisms (SNPs), harbored in genes implicated in the etiology of ADHD (ADGRL3, DRD4, and FGF1), with cognitive endophenotypes related to working memory and perceptual organization in 113 nuclear families. These families were ascertained from a geographical area of the Caribbean coast, in the north of Colombia, where the community is characterized by its ethnic diversity and differential gene pool. We found a significant association and linkage of markers ADGRL3-rs1565902, DRD4-rs916457 and FGF1-rs2282794 to neuropsychological tasks outlining working memory and perceptual organization such as performance in the digits forward and backward, arithmetic, similarities, the completion of figures and the assembly of objects. Our results provide strong support to understand ADHD as a combination of working memory and perceptual organization deficits and highlight the importance of the genetic background shaping the neurobiology, clinical complexity, and physiopathology of ADHD. Further, this study supplements new information regarding an ethnically diverse community with a vast African American contribution, where ADHD studies are scarce.

The Need for a Mental Health Technology Revolution in the COVID-19 Pandemic.

The current coronavirus 2019 (COVID-19) pandemic not only poses a large threat to the physical health of our population, if we fail to act now, it will also have detrimental long-term consequences for mental health. Though social distancing is a crucial intervention to slow down the destructive effects of the pandemic, it can lead to isolation, decreased physical activity, and increased rumination, which might particularly hurt those with pre-existing mental illness. Further, the stream of disheartening COVID-19 news provides fodder for increased worry and distress, which can be detrimental for people with anxiety disorders. Early cross-sectional surveys in the United States, Canada, and Europe show an increase in symptoms of depression and anxiety for the general population, associated with COVID-19 concerns (1). Thus, this crisis is exacerbating existing mental health conditions and creating conditions for the development of new ones. Further, if lessons from other outbreaks such as Ebola (2) and SARS (Severe Acute Respiratory Syndrome) (3) are any indication, even after an outbreak is controlled, there will likely be a substantial increase in need for psychological support. Crucially, this public health crisis will magnify and deepen existing shortcomings of mental health care systems. The US was already facing a mental health crisis before the pandemic: less than half of those with mental illness receive the care that they need (4). Underserved populations, such as low-income or ethnic minority populations, are disproportionately affected; they show the lowest utilization of mental health services (5). Early data suggest that underserved populations pay a larger health toll from COVID-19: they show higher mortality rates (6, 7). They are more likely to work in essential jobs putting them at greater risk of contracting COVID-19, and suffer greater economic consequences. All these factors lead to increased stress and anxiety. We will therefore be faced with an even greater relative shortage of trained professionals and means to mental health care during and after this pandemic. We argue that what we need during a public health crisis like this is a digital mental health revolution: scaling up the delivery of confidential mental health services to patients across a wide range of platforms, from telemental health to mobile interventions such as apps and text messaging. Here, we provide an overview of technological tools which could help to decrease the mental health burden of COVID-19, provide recommendations on how they could be used and scaled-up, and discuss considerations and limitations of mental health technology applications. Telehealth There is a crucial role for the use of teleconferencing software for therapy sessions during the COVID-19 pandemic. Most studies of teleconferencing services showed that effectiveness is comparable to in-person services across disorders including depression, posttraumatic stress disorder, and anxiety disorders (8). China has had some success with this approach. Researchers recently wrote in a Lancet Commentary that during the worst of the outbreak in January, China successfully provided online psychological counseling and self-help was widely rolled out by mental health professionals in medical institutions, universities, and academic societies (9). In the US, the pandemic has also catalyzed a rapid adoption of telehealth (10). Medicare now allows for billing for telehealth. Further, the Health Insurance Portability and Accountability Act (HIPAA) has been revisited to permit more medical providers to use HIPAA compliant platforms to communicate with patients. This removes a major barrier to wider adoption of telemedicine and could also provide an outstanding opportunity for patients who previously did not feel comfortable seeking mental health care to now approach these services. However, it is important to attend to disparities in technology access and digital literacy. Before the pandemic, only one in ten patients in the US used telehealth, and 75% said that they were unaware of telehealth options or how to access it (11). Recent data from primary care clinics showed that, though video care consults went up by 80% in late March and early April, minority groups represented a smaller portions of these visits (12). This is partly explained because of a lack of Internet availability, which varies due to limited data plans and lack of Wi-Fi, and inability to use smartphone features such as downloading apps (13). At the moment, some US telecom providers are offering free Internet services (14). However, longer-term strategies need to be developed to prevent further widening of the digital divide (15), including providing affordable, high speed Internet access, improving usability of telehealth programs, and providing appropriate guidance/training for patients using these services.

One-year follow-up of The Incredible Years Parents and Babies Program: A pilot randomized controlled trial.

Background:The foundation of a healthy life begins in pregnancy and early adversity can have detrimental long-term consequences for affected children.Objective:This paper examines the effects of the Incredible Years Parents and Babies program (IYPB) at one-year follow-up when offered as a universal parenting intervention to parents with newborn infants.Method:We conducted a pragmatic, two-arm, parallel pilot randomized controlled trial; 112 families with newborns were randomized to IYPB intervention (n = 76) or usual care (n = 36). The IYPB program is a group intervention with eight two-hour sessions. Follow-up outcomes collected a year after the intervention ended include parental stress, depression, well-being, reflective function, sense of competence, and child cognitive and socio-emotional development.Results:There were no intervention effects on any of the primary or secondary parent-reported outcomes at one-year follow-up when the children were 18 months old. When examining the lowest-functioning mothers in moderator analyses, we found that mothers assigned to the IYPB group reported significantly lower scores for the interest and curiosity subscale of the parent reflective function scale than control mothers (β=-1,07 [-2.09,-0.06]).Conclusion:We found no long-term effects of the IYPB when offered as a universal intervention for a relatively well-functioning group of parents with infants in a setting with a high standard of usual care. The intervention was developed for more vulnerable families in settings with a low level of universal care and the program may be effective for families in those circumstances.

Neurostructural correlate of math anxiety in the brain of children

Adequate mathematical competencies are currently indispensable in professional and social life. However, mathematics is often associated with stress and frustration and the confrontation with tasks that require mathematical knowledge triggers anxiety in many children. We examined if there is a relationship between math anxiety and changes in brain structure in children with and without developmental dyscalculia. Our findings showed that math anxiety is related to altered brain structure. In particular, the right amygdala volume was reduced in individuals with higher math anxiety. In conclusion, math anxiety not only hinders children in arithmetic development, but it is associated with altered brain structure in areas related to fear processing. This emphasizes the far-reaching outcome emotional factors in mathematical cognition can have and encourages educators and researchers alike to consider math anxiety to prevent detrimental long-term consequences on school achievement and quality of life, especially in children with developmental dyscalculia.

Effect of movement-related pain on behaviour and corticospinal excitability changes associated with arm movement preparation.

Experimental pain or its anticipation influence motor preparation processes as well as upcoming movement execution, but the underlying physiological mechanisms remain unknown. Our results showed that movement-related pain modulates corticospinal excitability during motor preparation. In accordance with the pain adaptation theory, corticospinal excitability was higher when the muscle has an antagonist (vs. an agonist) role for the upcoming movement associated with pain. Anticipation of movement-related pain also affects motor initiation and execution, with slower movement initiation (longer reaction times) and faster movement execution compared to movements that do not evoke pain. These results confirm the implementation of protective strategies during motor preparation known to be relevant for acute pain, but which may potentially have detrimental long-term consequences and lead to the development of chronic pain. When a movement repeatedly generates pain, we anticipate movement-related pain and establish self-protective strategies during motor preparation, but the underlying mechanisms remains poorly understood. The current study investigated the effect of movement-related pain anticipation on the modulation of behaviour and corticospinal excitability during the preparation of arm movements. Participants completed an instructed-delay reaction-time (RT) task consisting of elbow flexions and extensions instructed by visual cues. Nociceptive laser stimulations (unconditioned stimuli) were applied to the lateral epicondyle during movement execution in a specific direction (CS+) but not in the other (CS-), depending on experimental group. During motor preparation, transcranial magnetic stimulation was used to measure corticospinal excitability in the biceps brachii (BB). RT and peak end-point velocity were also measured. Neurophysiological results revealed an opposite modulation of corticospinal excitability in BB depending on whether it plays an agonist (i.e. flexion) or antagonist (i.e. extension) role for the CS+ movements (P<0.001). Moreover, behavioural results showed that for the CS+ movements RT did not change relative to baseline, whereas the CS- movements were initiated more quickly (P=0.023) and the CS+ flexion movements were faster relative to the CS- flexion movements (P<0.001). This is consistent with the pain adaptation theory which proposes that in order to protect the body from further pain, agonist muscle activity is reduced and antagonist muscle activity is increased. If these strategies are initially relevant and lead to short-term pain alleviation, they may potentially have detrimental long-term consequences and lead to the development of chronic pain.

Resveratrol Intake During Pregnancy and Lactation Modulates the Early Metabolic Effects of Maternal Nutrition Differently in Male and Female Offspring.

Poor maternal nutrition can have detrimental long-term consequences on energy homeostasis in the offspring. Resveratrol exerts antioxidant and antiobesity actions, but its impact during development remains largely unknown. We hypothesized that resveratrol intake during pregnancy and lactation could improve the effects of poor maternal nutrition on offspring metabolism. Wistar rats received a low-fat diet (LFD; 10.2% kcal from fat) or high-fat diet (HFD; 61.6% kcal from fat), with half of each group receiving resveratrol in their drinking water (50 mg/L) during pregnancy and lactation. Body weight (BW) of dams was measured at treatment onset and weaning [postnatal day (PND) 21] and of pups at birth and PND21, at which time dams and pups were euthanized. Although HFD dams consumed more energy, their BW at the end of lactation was unaffected. Mean litter size was not modified by maternal diet or resveratrol. At birth, male offspring from HFD and resveratrol (HFD + R) dams weighed less than those from LFD and resveratrol (LFD + R) dams. On PND21, pups of both sexes from HFD dams weighed more, had more visceral adipose tissue (VAT) and subcutaneous adipose tissue (SCAT), and had higher serum leptin levels than those from LFD dams. Resveratrol reduced BW, leptin, VAT, and SCAT, with females being more affected, but increased glycemia. Neuropeptide levels were unaffected by resveratrol. In conclusion, resveratrol intake during pregnancy and lactation decreased BW and adipose tissue content in offspring of dams on an HFD but did not affect offspring from LFD-fed dams, suggesting that the potential protective effects of resveratrol during gestation/lactation are diet dependent.

Childhood adversity, social support networks and well-being among youth aging out of care: An exploratory study of mediation

The goals of the present study are to examine the relationship between childhood adversity and adult well-being among vulnerable young adults formerly placed in substitute care, and to investigate how characteristics of their social support networks mediate this association.A sample of 345 Israeli young adults (ages 18–25), who had aged out of foster or residential care, responded to standardized self-report questionnaires tapping their social support network characteristics (e.g., network size or adequacy) vis-à-vis several types of social support (emotional, practical, information and guidance), experiences of childhood adversity, and measures of well-being (psychological distress, loneliness, and life satisfaction).Structural equation modelling (SEM) provided support for the mediating role of social support in the relationship between early adversity and adult well-being. Although network size, frequency of contact with its members, satisfaction with support, and network adequacy, were all negatively related to early adversity, only network adequacy showed a major and consistent contribution to the various measures of well-being. While patterns were similar across the types of support, the effects of practical and guidance support were most substantial.The findings suggest that the detrimental long-term consequences of early adversity on adult well-being are related not only to impaired structural aspects of support (e.g., network size), but also to a decreased ability to recognize available support and mobilize it. Practical and guidance support, more than emotional support, seem to be of critical importance.

Struggling for Stability: International Support for Peace and Democracy in Post-Civil War Nepal

Struggling for Stability: International Support for Peace and Democracy in Post-Civil War Nepal

The effects of Arnebia euchroma ointment on second-degree burn wounds: a randomized clinical trial

Ethnobotanical relevanceBurn injuries can cause detrimental long-term consequences and call for immediate management. Avicenna's Canon of Medicine, describing the use of Abu-Khalsa (Arnebia euchroma) (AE) as being effective for burn healing. The purpose of this study was to evaluate the healing effects of AE ointment (AEO) on patients with a second-degree burn wound and compare its results with silver sulfadiazine cream (SSD). Materials and methodsIn this prospective, single-blind clinical trial, 45 patients with similar types of second-degree burns at two different sites of the body were randomly assigned to the two treatment groups. One burn wound site of the patient was treated with SSD and another similar burn wound site with AEO once a day until complete healing was achieved. Wound size and percentage of wound healing were evaluated at 15 days. Satisfaction, clinical adverse events such as pain, burning, warming, erythema, edema, infection, inflammation, and general wound area were assessed on a visual analogue scales, and 6-point scales. ResultsThe healing time was significantly shorter in the site treated with AEO than SSD (13.9±5.3 vs. 17.5±6.9 days, respectively). The severity of pain and burning were reduced in the AEO site compared with SSD site at the time of dressing change, while the warming score was significantly higher in the AEO wound area. Side-effects were lower in the site treated with AEO. ConclusionIn this clinical study, we demonstrated that AEO has benefits over SSD in the treatment of second-degree burn wounds and wound healing and is a viable medication for the management of second-degree burns.

Longitudinal Evaluation of Stair Walking Biomechanics in Patients with ACL Injury.

After anterior cruciate ligament (ACL) injury and reconstruction, abnormal biomechanics during daily tasks may have prominent and detrimental long-term consequences on knee joint health. The purpose of this study was to longitudinally evaluate hip and knee joint biomechanics during stair ascent and descent in patients with acute ACL injury and at return to activity after ACL reconstruction. Twenty individuals with unilateral ACL injury (age, 20.9 ± 4.4 yr; height, 172.4 ± 7.5 cm; mass, 76.2 ± 12.2 kg) that were scheduled to undergo surgical reconstruction were compared with 20 healthy matched controls (age, 21.7 ± 3.7 yr; height, 173.7 ± 9.9 cm; mass, 76.1 ± 19.7 kg). Lower extremity biomechanics were recorded using three-dimensional motion analysis during stair ascent and descent at two testing sessions (before surgery and at approximately 6 months after surgery or when they were allowed to return to unrestricted physical activity). Time between sessions for healthy participants was matched on the basis of the ACL group. Peak sagittal and frontal plane knee and hip joint angles and moments, joint angles at initial contact, and joint excursions across stance phase were evaluated. The ACL-injured limb of patients experienced smaller knee extension moments than the uninjured limb and healthy controls during stair ascent and descent (P < 0.05) before and 6 months after ACL reconstruction. During stair ascent, ACL patients experienced more extended knee joint positions and less sagittal plane knee joint excursions, coupled with greater frontal plane hip joint excursions (P < 0.05). Patients with ACL injury experience reductions in knee flexion angle and knee extension moments during stair walking. These alterations were observed both before and after reconstruction, suggesting that early gait retraining interventions may be beneficial in these patients.

Notes on family caregiving in acute and critical care

Having spent more than 15 years of our careers observing patient care and communication in the ICU setting, we recognize the important role family caregivers play at the bedside of acute and critically ill older adults. Over these years, like many of you, we have also experienced the privilege and pathos of serving as family caregivers for older adult family members during hospitalization and at home. While this is a normal part of life and love and being in family, recent evidence points to the importance of re-examining what we mean by “family-centered care,” particularly in critical care environments, with the goal of preventing potentially detrimental long-term consequences affecting family caregivers of critically ill patients. Critical illness has immediate and prolonged psychological effects on family caregivers. This is true for family caregivers of ICU survivors as well as for bereaved family members of patients who die in the ICU. Post-intensive care syndrome in family caregivers (PICS-F) is a constellation of mental health problems, e.g., anxiety, depression, sleep disorders, post-traumatic stress disorder, and complicated grief, experienced by family caregivers arising from and persisting for 1-year or more after a patient’s critical illness 1

Goal Difficulty and Openness to Interpersonal Goal Support.

When people pursue important goals, they are often surrounded by close others who could provide help and support for the achievement of these goals. The present work investigated whether people are more likely to be open to such interpersonal goal support from a romantic partner when they perceive their goals as being easy versus difficult. Using a multiple methods approach, three studies revealed that, compared with the pursuit of easy goals, when people pursue difficult goals, they are less likely to seek out and be open to support from their romantic partner. Studies 2 and 3 revealed that the effect of goal difficulty on openness to support was partially mediated by loss in self-efficacy. Finally, Study 3 revealed that lack of openness to support can have detrimental long-term consequences for the relationship, as it undermines relationship well-being.

Sodium Thiosulfate

Calcification of the medial layer of arteries, often termed Monckeberg’s arteriosclerosis , is common in CKD and present in most patients with ESRD ([1][1]). Although it likely has detrimental long-term consequences, it is generally a chronic, asymptomatic condition. However, in a few patients,

Evolution of restraint in a structured rock-paper-scissors community.

It is not immediately clear how costly behavior that benefits others evolves by natural selection. By saving on inherent costs, individuals that do not contribute socially have a selective advantage over altruists if both types receive equal benefits. Restrained consumption of a common resource is a form of altruism. The cost of this kind of prudent behavior is that restrained individuals give up resources to less-restrained individuals. The benefit of restraint is that better resource management may prolong the persistence of the group. One way to dodge the problem of defection is for altruists to interact disproportionately with other altruists. With limited dispersal, restrained individuals persist because of interaction with like types, whereas it is the unrestrained individuals that must face the negative long-term consequences of their rapacity. Here, we study the evolution of restraint in a community of three competitors exhibiting a nontransitive (rock-paper-scissors) relationship. The nontransitivity ensures a form of negative feedback, whereby improvement in growth of one competitor has the counterintuitive consequence of lowering the density of that improved player. This negative feedback generates detrimental long-term consequences for unrestrained growth. Using both computer simulations and evolution experiments with a nontransitive community of Escherichia coli, we find that restrained growth can evolve under conditions of limited dispersal in which negative feedback is present. This research, thus, highlights a set of ecological conditions sufficient for the evolution of one form of altruism.

Remedying Hyperopia: The Effects of Self-Control Regret on Consumer Behavior

The self-control literature is premised on the notion of myopia (shortsightedness or present-biased preferences) and assumes that choosing vices generates regret. An alternative perspective suggests that consumers often suffer from a reverse self-control problem—namely, excessive farsightedness and overcontrol, or “hyperopia.” This research examines whether consumers can foresee the detrimental long-term consequences of hyperopia. Five studies demonstrate that anticipating long-term regret relaxes self-control and motivates consumers to counteract their righteousness. Consumers are more likely to select indulgences and luxuries when they judge the longer-term regrets of others, anticipate their own regret in the distant future, and reflect on their regret regarding an actual decision made in the more distant past. The article concludes with two field experiments that examine the effect of anticipatory regret on real consumer purchases at a shopping mall and during Thanksgiving. These experiments demonstrate that anticipating long-term regret leads consumers to buy pleasurable products rather than practical necessities and to spend more on shopping. The implications for marketers and consumers are discussed.

Is selection required for the accumulation of somatic mitochondrial DNA mutations in post-mitotic cells?

Mitochondrial DNA (mtDNA) mutations accumulate in the skeletal muscle of patients with mtDNA disease, and also as part of healthy ageing. Simulations of human muscle fibres suggest that, over many decades, the continuous destruction and copying of mtDNA (relaxed replication) can lead to dramatic changes in the percentage level of mutant mtDNA in non-dividing cells through random genetic drift. This process should apply to both pathogenic and neutral mutations. To test this hypothesis we sequenced the entire mitochondrial genome for 20 muscle fibres from a healthy elderly 85-year-old individual, chosen because of the low frequency of cytochrome c oxidase negative fibres. Phenotypically neutral single base substitutions were detected in 15% of the healthy fibres, supporting the hypothesis that positive selection is not essential for the clonal expansion of mtDNA point mutations during human life. Treatments that enhance mtDNA replication, such as vigorous excercise, could amplify this process, with potentially detrimental long-term consequences.

Programming of appetite and type 2 diabetes

In the past decade, epidemiological findings and data from experimental studies in animals have shown that the structure and function of the organism can be programmed during critical periods of development which can lead to detrimental long-term consequences for the health of an individual. Low birth weight has been linked to many adult diseases in humans including type 2 diabetes. The full detrimental effects of early growth restriction are often accompanied by the presence of obesity, which itself might be a manifestation of programmed appetite regulation in fetal and neonatal life. The understanding of interactions between leptin and insulin and their roles in glucose and body weight regulation provides clues towards mechanisms underlying altered appetite regulation and increased risk of type 2 diabetes in low birth weight individuals. Molecular mechanisms involved might include epigenetic alteration of the fetal genome in response to maternal nutrition.