Fingerstick Blood Samples Research Articles

Cross-Validation of FITNESSGRAM® Health-Related Fitness Standards in Hungarian Youth

Purpose: The purpose of this study was to cross-validate FITNESSGRAM® aerobic and body composition standards in a representative sample of Hungarian youth. Method: A nationally representative sample (N = 405) of Hungarian adolescents from the Hungarian National Youth Fitness Study (ages 12–18.9 years) participated in an aerobic capacity assessment via treadmill test to maximum to determine peak oxygen consumption (VO2peak) and a bioelectrical impedance assessment to estimate percent body fat (%BF). Additionally, metabolic syndrome status was assessed via finger-stick blood sample. Youth were categorized into Healthy Fitness Zone (HFZ) and Needs Improvement (NI) groups based on Fitnessgram standards. Prevalence of metabolic syndrome was calculated and logistic regression was used to estimate odds of metabolic syndrome. Results: Hungarian youth were generally fit with a low prevalence of metabolic syndrome. Approximately 69% to 77% of boys and 55% to 57% of girls were classified into the HFZ based on %BF and VO2peak. Youth in the NI health risk zones for VO2peak and %BF were 4 times to 5 and 2 times to 3 times more likely to have metabolic syndrome than children in the lower-risk groups, respectively. Conclusions: Fitnessgram standards for aerobic capacity and body composition were associated with metabolic syndrome status, though odds ratios were larger for VO2peak than for %BF and varied by sex. Even though these standards were developed in U.S. youth, they can be applied in Hungary and still provide a criterion-referenced indication of fitness.

A Dual-Carbon-and-Nitrogen Stable Isotope Ratio Model Is Not Superior to a Single-Carbon Stable Isotope Ratio Model for Predicting Added Sugar Intake in Southwest Virginian Adults ,

Background: An objective measure of added sugar (AS) and sugar-sweetened beverage (SSB) intake is needed. The δ13C value of finger-stick blood is a novel validated biomarker of AS/SSB intake; however, nonsweetener corn products and animal protein also carry a δ13C value similar to AS sources, which may affect blood δ13C values. The δ15N value of blood has been proposed as a “correction factor” for animal protein intake.Objectives: The objectives were to 1) identify foods associated with δ13C and δ15N blood values, 2) determine the contribution of nonsweetener corn to the diet relative to AS intake, and 3) determine if the dual-isotope model (δ13C and δ15N) is a better predictor of AS/SSB intake than δ13C alone.Methods: A cross-sectional sample of southwest Virginian adults (n = 257; aged 42 ± 15 y; 74% overweight/obese) underwent dietary intake assessments and provided finger-stick blood samples, which were analyzed for δ13C and δ15N values by using natural abundance stable isotope mass spectrometry. Statistical analyses included ANOVAs, paired-samples t tests, and multiple linear regressions.Results: The mean ± SD daily AS intake was 88 ± 59 g and nonsweetener corn intake was 13 ± 13 g. The mean δ13C value was −19.1 ± 0.9‰, which was significantly correlated with AS and SSB intakes (r = 0.32 and 0.39, respectively; P ≤ 0.01). The δ13C value and nonsweetener corn intake and the δ15N value and animal protein intake were not correlated. AS intake was significantly greater than nonsweetener corn intake (mean difference = 76.2 ± 57.2 g; P ≤ 0.001). The δ13C value was predictive of AS/SSB intake (β range: 0.28–0.35; P ≤ 0.01); however, δ15N was not predictive and minimal increases in R2 values were observed when the δ15N value was added to the model.Conclusions: The data do not provide evidence that the dual-isotope method is superior for predicting AS/SSB intakes within a southwest Virginian population. Our results support the potential of the δ13C value of finger-stick blood to serve as an objective measure of AS/SSB intake. This trial was registered at clinicaltrials.gov as NCT02193009.

The Relationship Between Food Insecurity and Depression, Diabetes Distress and Medication Adherence Among Low-Income Patients with Poorly-Controlled Diabetes.

Food insecurity- lack of dependable access to adequate food-may play a role in poor diabetes control. We aimed to determine the relationship between food security status and depression, diabetes distress, medication adherence and glycemic control. Secondary analysis of baseline data from Peer Support for Achieving Independence in Diabetes, a randomized controlled trial that enrolled patients from November 2011 to October 2013. Participants had poorly controlled type 2 diabetes (A1c ≥ 8.0 % on eligibility screen), household income < 250 % of the federal poverty level, were 30-70 years old, and were recruited from a large public hospital, a VA medical center and a community-health center in King County, Washington. We measured food insecurity determined by the Department of Agriculture's 6-Item Food Security Module. Depression, diabetes distress and medication adherence measured by PHQ-8, Diabetes Distress Scale and Morisky Medication Adherence Scale, respectively. Diet was assessed through Summary of Diabetes Self-Care Activities and Starting the Conversation tool. Incidence of hypoglycemic episodes was by patient report. Glycemic control was assessed with glycosylated hemoglobin (A1c) values from fingerstick blood sample. The prevalence of food insecurity was 47.4 %. Chi-square tests revealed participants with food insecurity were more likely to be depressed (40.7 % vs. 15.4 %, p < 0.001), report diabetes distress (55.2 % vs. 33.8 %, p < 0.001) and have low medication adherence (52.9 % vs. 37.2 %, p = 0.02). Based on linear regression modeling, those with food insecurity had significantly higher mean A1c levels (β = 0.51; p = 0.02) after adjusting for sex, age, race/ethnicity, language, education, marital status, BMI, insulin use, depression, diabetes distress and low medication adherence. Almost half of participants had food insecurity. Food insecurity was associated with depression, diabetes distress, low medication adherence and worse glycemic control. Even with adjustment, people with food insecurity had higher mean A1c levels than their food-secure counterparts, suggesting there may be other mediating factors, such as diet, that explain the relationship between food security status and diabetes control.

Evaluation of a novel biomarker of added sugar intake (δ 13C) compared with self-reported added sugar intake and the Healthy Eating Index-2010 in a community-based, rural U.S. sample.

The δ 13C value of human blood is an emerging novel biomarker of added sugar (AS) intake for adults. However, no free-living, community-based assessments of comparative validity of this biomarker have been conducted. The purpose of the present investigation was to determine if Healthy Eating Index-2010 (HEI-2010) score, SoFAAS score (HEI-2010 sub-component for solid fat, alcohol and AS), AS and sugar-sweetened beverage (SSB) intakes were associated with δ 13C value of fingerstick blood in a community-based sample of adults, while controlling for relevant demographics. A cross-sectional analysis of data obtained from assessments of BMI, dietary intake using 24 h recalls and a fingerstick blood sample was completed. Statistical analyses included descriptive statistics, multiple linear regression and one-way ANOVA. Rural Southwest Virginia, U.S.A. Adults (n 216) aged >18 years who consumed at least 837 kJ/d (200 kcal/d) from SSB. This sample of adult participants with low socio-economic status demonstrated a mean HEI-2010 score of 43.4 (sd 12.2), mean SoFAAS score of 10.2 (sd 5.7), mean AS intake of 93 (sd 65) g/d and mean blood δ 13C value of -18.88 (sd 0.7) ‰. In four separate regression models, HEI-2010 (R 2=0.16), SoFAAS (R 2=0.19), AS (R 2=0.15) and SSB (R 2=0.14) predicted δ 13C value (all P≤0.001). Age was also predictive of δ 13C value, but not sex or race. These findings suggest that fingerstick δ 13C value has the potential to be a minimally invasive method for assessing AS and SSB intake and overall dietary quality in community-based settings. Strengths, limitations and future areas of research for using an objective δ 13C biomarker in diet-related public health studies are discussed.

Effects of soybean pectin on blood glucose and insulin responses in healthy men

Pectin is a soluble fiber with demonstrated health benefits such as the ability to lower blood glucose and cholesterol, increased satiety leading to lower caloric intake and improved insulin resistance. These benefits suggest that pectin may help in prevention and treatment of diseases such as diabetes and obesity. Soybean seed coats, a co‐product of soybean processing, are good source of fiber (pectin) and shows potential as a value‐added product. The objective of this study is to examine the effects of soy pectin on blood glucose and insulin responses. Using a randomized‐crossover design, fifteen healthy men were randomly assigned to two groups (control and soy pectin). Fasting finger‐stick blood samples were collected at 15 minutes before and 0, 15, 30, 45, 60, 75, 90, 120, and 180 minutes after consumption of control solution with added soy pectin or a control solution. Although no specific time interval was significantly different, a reduction in plasma glucose and insulin concentrations was observed. Compared with the control, mean glucose iAUC (incremental area under the curve) for the soy pectin treatment was lowered by ~13.2% from 5059 + 506 to 4390 + 387 µU (~3 h) L‐1. Results suggest soy pectin has a potential for use as a functional food ingredient to improve human health. Funding provided by Arkansas Soybean Promotion Board is greatly appreciated.

The potential for glycemic control monitoring and screening for diabetes at dental visits using oral blood.

We examined the potential for glycemic control monitoring and screening for diabetes in a dental setting among adults (n = 408) with or at risk for diabetes. In 2013 and 2014, we performed hemoglobin A1c (HbA1c) tests on dried blood samples of gingival crevicular blood and compared these with paired "gold-standard" HbA1c tests with dried finger-stick blood samples in New York City dental clinic patients. We examined differences in sociodemographics and diabetes-related risk and health care characteristics for 3 groups of at-risk patients. About half of the study sample had elevated HbA1c values in the combined prediabetes and diabetes ranges, with approximately one fourth of those in the diabetes range. With a correlation of 0.991 between gingival crevicular and finger-stick blood HbA1c, measures of concurrence between the tests were extremely high for both elevated HbA1c and diabetes-range HbA1c levels. Persons already diagnosed with diabetes and undiagnosed persons aged 45 years or older could especially benefit from HbA1c testing at dental visits. Gingival crevicular blood collected at the dental visit can be used to screen for diabetes and monitor glycemic control for many at-risk patients.

Effects of commercially available pneumatic compression on muscle glycogen recovery after exercise.

The purpose of this study was to investigate the effects of pneumatic compression pants on postexercise glycogen resynthesis. Active male subjects (n = 10) completed 2 trials consisting of a 90-minute glycogen depleting ride, followed by 4 hours of recovery with either a pneumatic compression device (PCD) or passive recovery (PR) in a random counterbalanced order. A carbohydrate beverage (1.8 g·kg bodyweight) was provided at 0 and 2 hours after exercise. Muscle biopsies (vastus lateralis) were obtained immediately and 4 hours after exercise for glycogen analyses. Blood samples were collected throughout recovery to measure glucose and insulin. Eight fingerstick blood samples for lactate were collected in the last 20 minutes of the exercise period and during the initial portion of the recovery period. Heart rate was monitored throughout the trial. During the PCD trial, subjects recovered using a commercially available recovery device (NormaTec PCD) operational at 0-60 and 120-180 minutes into recovery period. The same PCD was worn during the PR trial but was not turned on to create pulsatile pressures. There was no difference in muscle glycogen resynthesis during the recovery period (6.9 ± 0.8 and 6.9 ± 0.5 mmol·kg wet wt·h for the PR and PCD trials, respectively). Blood glucose, insulin, and lactate concentrations changed with respect to time but were not different between trials (p > 0.05). The use of PCD did not alter the rate of muscle glycogen resynthesis, blood lactate, or blood glucose and insulin concentrations associated with a postexercise oral glucose load.

Fatty acids and sleep in UK children: subjective and pilot objective sleep results from the DOLAB study – a randomized controlled trial

Sleep problems in children are associated with poor health, behavioural and cognitive problems, as are deficiencies of long-chain omega-3 fatty acids such as docosahexaenoic acid. Theory and some evidence support a role for these fatty acids in sleep regulation, but this issue has received little formal investigation. We examined associations between blood fatty acid concentrations (from fingerstick blood samples) and subjective sleep (using an age-standardized parent questionnaire) in a large epidemiological sample of healthy children aged 7–9 years (n = 395) from mainstream UK schools. In a randomized controlled trial, we then explored whether 16-week supplementation (600 mg day−1) with algal docosahexaenoic acid versus placebo might improve sleep in a subset of those children (n = 362) who were underperforming in reading. In a randomly selected subsample (n = 43), sleep was also assessed objectively via actigraphy. In 40% of the epidemiological sample, Child Sleep Habits Questionnaire scores indicated clinical-level sleep problems. Furthermore, poorer total sleep disturbance scores were associated weakly but significantly with lower blood docosahexaenoic acid (std coeff. −0.105*) and a lower docosahexaenoic acid : arachidonic acid ratio (std coeff. −0.119**). The treatment trial showed no significant effects on subjective sleep measures. However, in the small actigraphy subsample, docosahexaenoic acid supplementation led on average to seven fewer wake episodes and 58 min more sleep per night. Cautiously, we conclude that higher blood levels of docosahexaenoic acid may relate to better child sleep, as rated by parents. Exploratory pilot objective evidence from actigraphy suggests that docosahexaenoic acid supplementation may improve children's sleep, but further investigations are needed.

The RABiT: high-throughput technology for assessing global DSB repair

At the Center for High-Throughput Minimally Invasive Radiation Biodosimetry, we have developed a rapid automated biodosimetry tool (RABiT); this is a completely automated, ultra-high-throughput robotically based biodosimetry workstation designed for use following a large-scale radiological event, to perform radiation biodosimetry measurements based on a fingerstick blood sample. High throughput is achieved through purpose built robotics, sample handling in filter-bottomed multi-well plates and innovations in high-speed imaging and analysis. Currently, we are adapting the RABiT technologies for use in laboratory settings, for applications in epidemiological and clinical studies. Our overall goal is to extend the RABiT system to directly measure the kinetics of DNA repair proteins. The design of the kinetic/time-dependent studies is based on repeated, automated sampling of lymphocytes from a central reservoir of cells housed in the RABiT incubator as a function of time after the irradiation challenge. In the present study, we have characterized the DNA repair kinetics of the following repair proteins: γ-H2AX, 53-BP1, ATM kinase, MDC1 at multiple times (0.5, 2, 4, 7 and 24 h) after irradiation with 4 Gy γ rays. In order to provide a consistent dose exposure at time zero, we have developed an automated capillary irradiator to introduce DNA DSBs into fingerstick-size blood samples within the RABiT. To demonstrate the scalability of the laboratory-based RABiT system, we have initiated a population study using γ-H2AX as a biomarker.

Evaluation of Two Different Methods for Hemoglobin Screening of Blood Donors to Use in Mobile Blood Collection Team

AIM: The aim of the study is to compared two point-of care hemoglobin concentration measuring devices with laboratory measurements to determine their accuracy in mobile blood collection conditions. This two devices were the Pronto-7 (Masimo Corp., Irvine,CA) pulse co-oximeter and HemoCue Hb 201+ uses spectrophotometric method. METHODS: Blood samples were collected from 152 individuals. The samples were tested for total hemoglobin measurement by three different methods: noninvaziv pulse co-oximeter device Pronto-7, finger-stick blood sample on an automated spectrophotometric device HemoCue and venous samples on an automated hemotology analyzer (reference device) RESULTS: According to the venous samples (mean Hb value is 14.6 g/dl), the mean hemoglobin levels were detected slightly higher in the fingerstick samples (mean Hb value is 15.1 g/dl) and slightly lower in the pulse co-oximetry (mean Hb value is 14.1 g/dl). The sensivity of HemoCue, Pronto-7 was 97.7%, 81.6% and their specifity was 31.2% and %43.7, respectively. The positive predictive values (PPV) of HemoCue and Pronto-7 were high (92.3% and 92.5%, respectively) but both of their negative predictive values (NPV) were low (62.5% and 21.8%, respectively). Of blood donors, 88.4% (138/152) percent were correctly classified with HemoCue and 78.2% were with Pronto-7. COCLUSION: Taking automated laboratory hemoglobin measurement as a reference, Pronto-7 gave lower readings for Hb value and was less accurate than the Hemo-Cue system

Diagnostic Efficacy of Gingival Crevicular Blood for Assessment of Blood Glucose Levels in Dental Office: A cross Sectional Study

Objectives: The gingival crevicular blood (GCB) obtained during routine periodontal probing may be a source for blood glucose measurements. The aim of this study was to compare gingival crevicular blood and fingerstick blood glucose measurements using a glucometer against the conventional laboratory methods. Materials and Methods: The study group comprised of three groups. In the first group 30 patients with periodontitis and positive bleeding on probing were chosen. Blood samples of two sites intraorally were analyzed using a glucose self-monitoring device. The second and third group comprised of 50 diabetic and 50 non-diabetic patients. After testing fasting plasma glucose (FPG), fasting glucose levels in gingival crevicular blood (GCBG), and fasting capillary fingerstick blood (CFBG) samples were analyzed using same device. Results: Significant correlation (r= 0.93, p<0.001) was found between gingival crevicular blood glucose levels and capillary finger stick blood glucose levels. Considerable correlation (r=0.75, p<0.001) was found between levels of fasting gingival crevicular blood glucose and fasting blood glucose both in diabetic patients and the normal population. Conclusion: It is evident that the blood obtained during routine periodontal probing can be used for estimation of blood glucose levels. GCB can be used as a marker for blood glucose estimation using glucometer. The technique described is safe, easy to perform and helps to increase the frequency of diabetes screening in dental office.

Performance of Rapid Point-of-Care and Laboratory Tests for Acute and Established HIV Infection in San Francisco

BackgroundCurrent laboratory and point-of-care tests for HIV detect different analytes and use different sample types. Some have fast turnaround times (<1 hour). We investigated how HIV test choice could impact case finding by testing programs.MethodsWe analyzed 21,234 consecutive HIV tests with venous blood obtained by San Francisco HIV testing programs from 2003 to 2008. For a subset, oral fluid (n = 6446) or fingerstick blood (n = 8127) samples were also obtained for rapid testing. In all cases, HIV status was determined using an HIV antibody-plus-RNA test algorithm. We assessed how the screening antibody tests performed individually versus the gold standard of the full algorithm. We then evaluated the potential ability of other tests (including new tests) to detect more cases, by re-testing all specimens that had negative/discrepant antibody results on initial screening.FindingsThe antibody-RNA algorithm identified 58 acute and 703 established HIV infection cases. 1st-generation (Vironostika) and 3rd-generation (Genetic Systems) immunoassays had 92 and 96 percent sensitivity, respectively. The Oraquick rapid test had clinical sensitivity of only 86 percent on oral fluid samples, but 92 percent on finger-stick blood. Newer 4th-generation, antigen-antibody combo rapid immunoassay (ARCHITECT) detected HIV in 87 percent of all the acute cases that had been missed by one of the previous screening assays. A point-of-care 4th generation antigen-antibody combo rapid test (Determine) detected about 54 percent of such acute cases.ConclusionsOur study suggests that some rapid antibody blood tests will give similar case detection to laboratory antibody tests, but that oral fluid testing greatly reduces ability to detect HIV. New 4th-generation combo tests can detect the majority of acute infections detectable by HIV RNA but with rapid results. Using these tests as a primary screening assay in high-risk HIV testing programs could reduce or eliminate the need for HIV RNA testing.

Assessment of using fingerstick blood sample with i-STAT point-of-care device for cardiac troponin I assay

PurposesThe purpose of this study is to compare fingerstick point-of-care (POC) testing for cardiac troponin I to conventional venipuncture POC testing using the i-STAT device. Basic proceduresThis study was conducted with institutional review board approval in the emergency department (ED) of a 535-bed suburban level I trauma center from June to August 2011. Fingerstick blood samples were collected from consenting patients for whom standard-of-care venipuncture POC troponin (POCT) testing had been ordered as part of their workup. Cardiac troponin I (cTnI) assays were performed using the i-STAT 1 device (Abbott Point of Care, Princeton, NJ). The data were subjected to categorical comparison, linear regression, and Bland-Altman agreement analysis using SAS 9.2 software (SAS, Cary, NC). Main findingsEighty-nine cTnI levels were measured by both fingerstick and standard venipuncture ED POC testing. Four resulted in cartridge error; the remaining 85 were analyzed. Fingerstick testing, compared with standard ED POCT, has a positive predictive value of 1.00 (0.48, 1.00), negative predictive value of 0.96 (0.89, 0.99), sensitivity of 0.625 (0.24, 0.91), and specificity of 1.00 (0.95, 1.00). The relationship between methods appears linear, with linear regression equation ED POCT level = 0.0062 + 1.3752 * fingerstick level (P < 0.0001). Bland-Altman agreement analysis yielded a mean difference between fingerstick and ED POCT of −0.0095 with limits of agreement of −0.0625 to 0.0435. Principal conclusionsFingerstick cTnI testing using the i-STAT device is not accurate enough to determine the exact troponin level without the application of a corrective term. Fingerstick testing is, however, accurate in qualifying troponin levels as negative, borderline, or positive and is, therefore, capable of providing clinical information that may guide diagnostic and therapeutic decision making.

Impact of Interleukin 1 Gene Polymorphism and Smoking on Long-Term Stability Following Gingival Recession Treatment

Risk factors such as smoking, genetic factors, and tissue biotype play an important role in the etiology, predictability, and long-term stability of gingival recession treatment. This study was designed to evaluate the influence of interleukin 1 (IL-1) polymorphism and smoking on the stability of gingival recession treatment after 1 and 3 years. All patients (n = 55) were treated for type I and II recession defects using a connective tissue graft. Clinical evaluations were performed, which included assessment of vertical recession depth, gingival inflammation, and clinical attachment level. A fingerstick blood sample was collected using specially provided DNA filter paper and mailed for processing in a laboratory using polymerase chain reaction-based methodology. The results indicated that 19 subjects were genotype positive (34.5%). Treatment of the localized recessions was effective and provided a similar amount of coverage in genotype-positive and genotype-negative subjects within smoking and nonsmoking groups after 1 year. In a 3-year period, nonsmoking patients with positive IL-1 genotype lost approximately 20% of the root coverage gained at 1 year and were almost four times more inferior compared with genotype-negative patients. Patients who smoked and had a positive IL-1 genotype lost approximately 35% of the gained root coverage. IL-1 polymorphism and smoking habit did not affect gingival recession treatment at 1 year but had a great impact on long-term stability.

Evaluation of the validity of a rapid method for measuring high and low haemoglobin levels in whole blood donors.

Haemoglobin screening methods need to be highly sensitive to detect both low and high haemoglobin levels and avoid unnecessary rejection of potential blood donors. The aim of this study was to evaluate the accuracy of measurements by HemoCue in blood donors. Three hundred and fourteen randomly selected, prospective blood donors were studied. Single fingerstick blood samples were obtained to determine the donors' haemoglobin levels by HemoCue, while venous blood samples were drawn for measurement of the haemoglobin level by both HemoCue and an automated haematology analyser as the reference method. The sensitivity, specificity, predictive values and correlation between the reference method and HemoCue were assessed. Cases with a haemoglobin concentration in the range of 12.5-17.9 g/dL were accepted for blood donation. Analysis of paired results showed that haemoglobin levels measured by HemoCue were higher than those measured by the reference method. There was a significant correlation between the reference method and HemoCue for haemoglobin levels less than 12.5 g/dL. The correlation was less strong for increasing haemoglobin levels. Linear correlation was poor for haemoglobin levels over 18 g/dL. Thirteen percent of donors, who had haemoglobin levels close to the upper limit, were unnecessarily rejected. HemoCue is suitable for screening for anaemia in blood donors. Most donors at Yazd are males and a significant percentage of them have haemoglobin values close to the upper limit for acceptance as a blood donor; since these subjects could be unnecessarily rejected on the basis of HemoCue results and testing with this method is expensive, it is recommended that qualitative methods are used for primary screening and accurate quantitative methods used in clinically suspicious cases or when qualitative methods fail.

Prevalência e fatores determinantes da anemia em crianças assistidas em creches de Belo Horizonte - MG

To evaluate the prevalence and risk factors of anemia in children attending daycare centers in the city of Belo Horizonte. Cross-sectional study that evaluated 312 children aged 7 to 59 months attending daycare centers of the East Sanitary District of Belo Horizonte. The diagnosis of anemia was determined by finger stick blood samples, using the HemocueTM portable photometer, considering hemoglobin levels below 11.0 g/dL. Weight and height were measured and nutritional status of children was classified according to WHO 2006 criteria. Variables were collected through a questionnaire answered by children's parents or guardians, containing socioeconomic aspects, in addition to information on maternal and children's health. Multiple logistic regression was performed to assess the association between variables and anemia, with control for confounding variables. The prevalence of anemia in the population studied was 30.8%, with a higher prevalence in children ≤ 24 months of age (71.1%). Risk factors for anemia were age ≤ 24 months (OR: 9.08 CI: 3.96 to 20.83), and height-for-age < -1 z-score (OR: 2.1, CI: 1.20 to 3.62). The high prevalence of anemia in children attending day care centers in Belo Horizonte, especially those younger than 24 months and in children with height-for-age < - 1 z-score, demonstrates the importance of nutritional care to infants and strengthens the need for commitment of child care institutions in reducing this deficiency.

Sex Hormone-Binding Globulin and The Risk for Metabolic Syndrome in Children of South Asian Indian Origin

To determine whether the plasma level of sex hormone-binding globulin (SHBG) identifies South Asian Indian children at risk for metabolic syndrome. Adults and their children aged 5 to 9 years were recruited at the annual health fair at the Hindu temple serving the South Asian Indian community in Louisville, Kentucky. Anthropometric data were collected in adults and children, and blood pressure, lipid, and glucose levels were measured in adults. SHBG levels were measured in children using a fingerstick blood sample. In adults, metabolic syndrome was diagnosed according to the International Diabetes Federation criteria. Twelve months later, follow-up anthropometric data were obtained for a portion of the children. The study included 30 sets of parents and 30 children. The prevalence of metabolic syndrome among 310 adults attending the health fair was 42% in men and 39% in women. Children with 1 parent with metabolic syndrome had 24% lower SHBG levels that increased to 55% if both parents had metabolic syndrome. SHBG levels were inversely related to waist circumference and to body mass index percentile. Both SHBG and waist circumference predicted weight gain over 1 year in children. CONCLUSIONS Low SHBG levels were found in South Asian Indian children whose parents had attributes of metabolic syndrome. The dose dependency of SHBG is consistent with inheritance of a genetic trait, and if the results are applicable to other racial/ethnic groups, SHBG may be a useful marker to identify at-risk children for early intervention.

Accuracy of Noninvasive and Invasive Point-of-Care Total Blood Hemoglobin Measurement in an Outpatient Setting

Objective: The purpose of this study was to determine the accuracy of noninvasive hemoglobin measurement using pulse CO–oximetry (Pronto® SpHb®, Masimo Corp.) and a commonly used, invasive, point–of–care, automated spectrophotometer (HemoCue 201+®, HemoCue, Inc.), in comparison with hemoglobin measurements obtained from a laboratory hematology analyzer (measuring total blood hemoglobin) in the outpatient setting. Methods: Adult patients presenting to an outpatient research clinic were tested for total blood hemoglobin measurement by 3 methods: noninvasive pulse CO–oximetry (SpHb®), finger–stick blood sample on a point–of–care device, and venous sample on a laboratory hematology analyzer (reference device). Bias and standard deviation (SD) of SpHb® and HemoCue 201+® compared with the values obtained with the laboratory hematology analyzer were calculated and Bland–Altman graphs were generated. Results: Samples from 152 subjects were assessed (average age, 46 years; 69% female). The bias ± SD compared with the reference method was −0.5 ± 1.0 g/dL for SpHb® and 0.3 ± 1.0 g/dL for HemoCue 201+®. The Bland–Altman plots assessing agreement of the test methods to the reference method had limits of agreement of +2.5 to 1.5 g/dL for SpHb® and +1.7 to 2.3 g/dL for HemoCue 201+®. A noninvasive measurement could not be obtained in 4 subjects after 2 attempts (2.5% failure rate), whereas the HemoCue 201+® measurements were obtained for all subjects. Conclusion: Noninvasive SpHb® testing had bias and SD similar to those of HemoCue 201+®. Because SpHb® measurement is noninvasive, it may offer additional patient and provider benefits.

Weight Status, Physical Activity, and Vascular Health in 9- to 12-Year-Old Children

The purpose of this study was to determine the independent and joint association of weight status and physical activity on resting blood pressure and C-reactive protein in children. Participants were 174 (71 males, 103 females) children (mean age = 10.5 ± 0.4 yrs). Physical activity was self-reported, body mass index was calculated from measured height and body mass, and blood pressure was measured according to standard procedures. A subset of 91 children had C-reactive protein measured by fingerstick blood sample. Four weight/physical activity groups were created by cross tabulation of weight status classification and physical activity level. The prevalence of low physical activity (< 5 days/wk moderate-vigorous activity) did not differ between overweight and normal weight children (50%). Physical activity was not correlated with C-reactive protein (r = 0.01; P = 0.91) and C-reactive protein was not significantly different between physical activity groups (P = 0.87). Physical activity did not modify the difference in blood pressure or C-reactive protein within weight categories. Fatness (specifically overweight and obesity), but not physical activity, was shown to be associated with blood pressure and C-reactive protein levels in children. Physical activity did not attenuate blood pressure or C-reactive protein in overweight and obese children.

The association of mental conditions with blood glucose levels in older adults with diabetes

Objectives: People with diabetes must engage in several self-care activities to manage blood glucose; cognitive function and other affective disorders may affect self-care behaviors. We examined the executive function domain of cognition, depressive symptoms, and symptoms of generalized anxiety disorder (GAD) to determine which common mental conditions can co-occur with diabetes are associated with blood glucose levels. Methods: We conducted a cross-sectional in-person survey of 563 rural older adults (age 60 years or older) with diabetes that included African Americans, American Indians, and Whites from eight counties in south-central North Carolina. Hemoglobin A1C (A1C) was measured from a finger-stick blood sample to assess blood glucose control. Executive function, depressive symptoms, and symptoms of GAD were assessed using established measures and scoring procedures. Separate multivariate linear regression models were used to examine the association of executive function, depressive symptoms, and symptoms of GAD with A1C. Results: Adjusting for potential confounders including age, gender, education, ethnicity, marital status, history of stroke, heart disease, hypertension, diabetes knowledge, and duration of diabetes, executive function was significantly associated with A1C levels: every one-unit increase in executive function was associated with a 0.23 lower A1C value (p = 0.02). Symptoms of depression and GAD were not associated with A1C levels. Conclusions: Low executive function is potentially a barrier to self-care, the cornerstone of managing blood glucose levels. Training aids that compensate for cognitive impairments may be essential for achieving effective glucose control.