Mentally tiring work may increase diabetes risk in women

Women who find their jobs mentally tiring are more likely to develop type 2 diabetes, according to a study published in the  European Journal of Endocrinology .

The study findings suggest that mentally draining work, such as teaching, may increase the risk of diabetes in women. This suggests that employers and women should be more aware of the potential health risks associated with mentally tiring work.

Type 2 diabetes is an increasingly prevalent disease that places a huge burden on patients and society, and can lead to significant health problems including heart attacks, strokes, blindness and kidney failure. Numerous factors can increase the risk of developing type 2 diabetes including, obesity, diet, exercise, smoking or a family history of the disease. A recent review suggested that work-related stress might be associated with an increased risk of type 2 diabetes in women, but more investigation is needed.

In a French study, Dr Guy Fagherazzi and colleagues from the Centre for Research in Epidemiology and Population Health at Inserm, examined the effect of mentally tiring work on diabetes incidence in over 70,000 women, during a 22-year period. Approximately 75% of the women were in the teaching profession and 24% reported finding their work very mentally tiring at the beginning of the study. The study found that women were 21% more likely to develop type-2 diabetes if they found their jobs mentally tiring at the start of the study. This was independent of typical risk factors including age, physical activity level, dietary habits, smoking status, blood pressure, family history of diabetes and BMI.

Dr Guy Fagherazzi comments, “Although we cannot directly determine what increased diabetes risk in these women, our results indicate it is not due to typical type 2 diabetes risk factors. This finding underscores the importance of considering mental tiredness as a risk factor for diabetes among women.”

Dr Guy Fagherazzi states, “Both mentally tiring work and type 2 diabetes are increasingly prevalent phenomena. What we do know is that support in the workplace has a stronger impact on work-related stress in women than men. Therefore, greater support for women in stressful work environments could help to prevent chronic conditions such as type 2 diabetes.”

The team now plans to study how mentally tiring work affects patients with diabetes, including how they manage their treatment, their quality of life and the risks of diabetes-related complications. This research may help to identify new approaches that could help improve the lives of patients living with diabetes.

People with low oxytocin levels suffer reduced empathy

 

People suffering medical conditions causing low levels of oxytocin perform worse on empathy tasks, according to new research presented today at the Society for Endocrinology annual conference in Brighton. The research is the first to study humans with reduced oxytocin and suggests that hormone replacement could improve the psychological well-being of those living with low levels.

Oxytocin is often referred to as the ‘love hormone’ due to its role in human behaviours including sexual arousal, recognition, trust, anxiety and mother-infant bonding. It is produced by the hypothalamus – an area of the brain that controls mood and appetite – and stored in the pituitary gland, a pea-sized organ that sits in the base of the skull.

Researchers from the University of Cardiff investigated empathic behaviour in people who they suspected of having reduced oxytocin levels due to one of two medical conditions caused in response to pituitary surgery. The study assessed 20 people with cranial diabetes insipidus (CDI). In CDI, the body has reduced levels of ADH - a chemical also produced in the hypothalamus and structurally very similar to oxytocin. They also assessed 15 people with hypopituitarism (HP), a condition in which the pituitary gland does not release enough hormones. These two patient groups were compared to a group of 20 healthy controls.

The researchers gave all participants two tasks designed to test empathy, both relating to the recognition of emotional expression. They also measured each group’s oxytocin levels and found that the 35 CDI and HP participants had slightly lower oxytocin compared to the healthy controls, though a larger sample is required to establish statistical significance. They also saw that the CDI and HP groups performed significantly worse on empathy tasks, compared to controls. In particular, CDI participants’ ability to identify expressions was predicted by their oxytocin levels – those with the lowest levels of oxytocin produced the worst performances.

“This is the first study which looks at low oxytocin as a result of medical, as opposed to psychological, disorders,” said Katie Daughters, lead researcher. “If replicated, the results from our patient groups suggest it is also important to consider medical conditions carrying a risk of low oxytocin levels.”

“Patients who have undergone pituitary surgery, and in particular those who have acquired CDI as a consequence, may present with lower oxytocin levels. This could impact on their emotional behaviour, and in turn affect their psychological well-being. Perhaps we should be considering the introduction of oxytocin level checks in these cases.”

The researchers hope to expand their study in order to further replicate and confirm their findings. This study presents only preliminary results, and it has not been peer reviewed.

Maternal B12 deficiency may increase child’s risk of type-2 diabetes

Vitamin B12 deficiency during pregnancy may predispose children to metabolic problems such as type-2 diabetes, according to research presented today at the Society for Endocrinology’s annual conference in Brighton. These findings could lead to a review of current vitamin B12 requirements for pregnant women, whether through an improved diet or supplements.

Vitamin B12 is naturally found in animal products, including fish, meat, poultry, eggs and milk, meaning deficiency is more likely in those following a vegan diet. Previous studies show that mothers with low B12 levels had a higher BMI and were more likely to give birth to babies with low birth weight as well as high cholesterol levels. These children also had higher insulin resistance in childhood – a risk factor for type-2 diabetes.

In this study, a team of researchers at the University of Warwick hypothesised that the changes associated with B12 deficiency may be the result of abnormal levels of leptin - the hormone that tells us we are full after eating. Leptin is produced by our body’s fat cells and its levels rise in response to eating food. Whilst lean diets are associated with normal levels of leptin, obesity causes levels to rise and remain consistently higher than normal. This can eventually lead to leptin resistance, continued overeating, and an increased risk of insulin resistance, which leads to type-2 diabetes. Scientists and doctors therefore see leptin as providing an effective ‘marker’ for body fat.

The researchers found that babies born to mothers with B12 deficiency had higher than normal leptin levels. They hypothesised that maternal B12 deficiency can adversely program the leptin gene, changing the levels at which the hormone is produced whilst the foetus grows.

“The nutritional environment provided by the mother can permanently program the baby’s health,” said Dr Ponusammy Saravanan, senior author of the study. “We know that children born to under or over nourished mothers are at an increased risk of health problems such as type-2 diabetes, and we also see that maternal B12 deficiency may affect fat metabolism and contribute to this risk. This is why we decided to investigate leptin, the fat cell hormone.”

The next steps in the study will be to determine the details of how and why the leptin increase is seen in babies born to mothers with low B12. “The leptin can increase for two reasons,” said Dr Adaikala Antonysunil, who also worked on the study. “Either low B12 drives fat accumulation in the foetus, and this leads to increased leptin, or the low B12 actually causes chemical changes in the placental genes that produce leptin, making more of the hormone. As B12 is involved in methylation reactions in the body which can affect whether genes are turned on and off, we suspect it may be the latter.”

The research was presented as a conference abstract showing only preliminary results, and has not been peer reviewed.

  

Society for Endocrinology publishes guidance documents to tackle life-threatening endocrine emergencies

The Society for Endocrinology has today issued clinical guidance on the treatment of five life-threatening endocrine emergencies. Published in Endocrine Connections, the guidance will help non-endocrinology specialists better identify and tackle these poorly-understood conditions and avoid unnecessary deaths.

Endocrine emergencies can be life-threatening if non-endocrine healthcare professionals delay treatment due to not recognising symptoms. Each of the five new guidance documents has been written by endocrinologists with extensive experience and expertise for each relevant condition. Each guide considers the most up to date evidence available and has been peer-reviewed by the Society for Endocrinology Clinical Committee.

The five guidance documents cover:

·         Acute adrenal insufficiency

o   The guidance outlines key points in the recognition, management and treatment of this often under-recognised endocrine emergency

·         Severe symptomatic hyponatraemia

o    The particular strength of this guidance is that it emphasises the importance of assessing the severity of acute hyponatraemia and treating accordingly in the first instance

·         Acute hypocalcaemia

o   The guidance discusses the key causes and immediate management of the condition

·         Acute hypercalcaemia

o    The guidance points out the first step is rehydration with normal saline, and intravenous zoledronic acid is now the bisphosphonate of choice

·         Pituitary apoplexy

o   The guidance emphasises that this condition must be considered in patients with acute severe headache, visual defects and/or impairment of consciousness.

The guidance documents are available to download free from Endocrine Connections and the Society for Endocrinology website.

Happy cows make more nutritious milk

Daily infusions with a chemical commonly associated with feelings of happiness were shown to increase calcium levels in the blood of Holstein cows and the milk of Jersey cows that had just given birth. The results, published in the Journal of Endocrinology, could lead to a better understanding of how to improve the health of dairy cows, and keep the milk flowing.

Demand is high for milk rich in calcium: there is more calcium in the human body than any other mineral, and in the West dairy products such as milk, cheese and yoghurt are primary sources of calcium. But this demand can take its toll on milk-producing cows: roughly 5-10% of the North American dairy cow population suffers from hypocalcaemia – in which calcium levels are low. The risk of this disease is particularly high immediately before and after cows give birth.

Hypocalcaemia is considered a major health event in the life of a cow. It is associated with immunological and digestive problems, decreased pregnancy rates and longer intervals between pregnancies. These all pose a problem for dairy farmers, whose profitability depends upon regular pregnancies and a high-yield of calcium-rich milk.

Whilst there has been research into the treatment of hypocalcaemia, little research has focused on prevention. In rodents it has been shown that serotonin (a naturally-occurring chemical commonly associated with feelings of happiness) plays a role in maintaining calcium levels; based on this, a team from the University of Wisconsin-Madison, led by Dr Laura Hernandez, investigated the potential for serotonin to increase calcium levels in both the milk and blood of dairy cows. The team infused a chemical that converts to serotonin into 24 dairy cows, in the run up to giving birth. Half the cows were Jersey and half were Holstein – two of the most common breeds. Calcium levels in both the milk and circulating blood were measured throughout the experiment.

Whilst serotonin improved the overall calcium status in both breeds, this was brought about in opposite ways. Treated Holstein cows had higher levels of calcium in their blood, but lower calcium in their milk (compared to controls). The reverse was true in treated Jersey cows and the higher milk calcium levels were particularly obvious in Jerseys at day 30 of lactation – suggesting a role for serotonin in maintaining levels throughout lactation.

“By studying two breeds we were able to see that regulation of calcium levels is different between the two,” says Laura Hernandez. “Serotonin raised blood calcium in the Holsteins, and milk calcium in the Jerseys. We should also note that serotonin treatment had no effect on milk yield, feed intake or on levels of hormones required for lactation.”

The next steps are to investigate the molecular mechanism by which serotonin regulates calcium levels, and how this varies between breeds.

“We would also like to work on the possibility of using serotonin as a preventative measure for hypocalcaemia in dairy cows,” continues Laura Hernandez, “That would allow dairy farmers to maintain the profitability of their businesses, whilst making sure their cows stay healthy and produce nutritious milk.”

  

Exposure to chemicals in plastic and fungicides may irreversibly weaken children’s teeth

Chemicals commonly found in plastics and fungicides may be weakening children’s teeth by disrupting hormones that stimulate the growth of dental enamel, according to a new study presented today at the European Congress of Endocrinology.

Endocrine disruptors are chemicals that interfere with mammalian hormones. Bisphenol A (BPA) is one of the most prevalent, found in every-day items including refillable drink bottles and food storage containers. Vinclozolin is another endocrine disruptor that was commonly used as a fungicide in vineyards, golf courses and orchards.

Molar incisor hypermineralisation (MIH) is a pathology affecting up to 18% of children aged 6-9, in which the permanent first molars and incisors teeth that erupt have sensitive spots that become painful and are prone to cavities. These spots are found on dental enamel, the tough outer covering of teeth that protects it from physical and chemical damage. Unlike bone, enamel does not regrow and so any damage is irreversible. Previous rat studies have shown that MIH may result from exposure to BPA after finding similar damage to the enamel of rats that received a daily dose of BPA equivalent to normal human BPA exposure, though the exact mechanism of action remains unclear.

In this study, researchers from the French National Institute of Health and Medical Research (INSERM) gave rats daily doses of BPA alone or in combination with vinclozolin, equivalent to an average dose a human would experience daily, from birth till they were thirty days old. They then collected cells from the rats’ teeth surface and found that BPA and vinclozolin changed the expression of two genes controlling the mineralisation of tooth enamel.

In part two of their experiment, the team cultured and studied rat ameloblast cells, which deposit enamel during the development of teeth. They found that the presence of sex hormones like oestrogen and testosterone boosted the expression of genes making tooth enamel, especially male sex hormones. As BPA and vinclozolin are known to block the effect of male sex hormones, the findings reveal a potential mechanism by which endocrine disruptors are weakening teeth.

“Tooth enamel starts at the third trimester of pregnancy and ends at the age of 5, so minimising exposure to endocrine disruptors at this stage in life as a precautionary measure would be one way of reducing the risk of enamel weakening”, said Dr Katia Jedeon, lead author of the study.

Sitting down for long periods when pregnant linked to weight gain and depression

Women suffering from symptoms of depression during pregnancy are more likely to sit down for long periods of time in the second trimester, putting them at risk of greater weight gain and contracting gestational diabetes, according to a new study presented today at the Society for Endocrinology annual conference in Edinburgh.

The research highlights the need to address women’s physical and mental wellbeing from the early stages of pregnancy to help reduce the health risks associated with sedentary behaviour.

Sedentary behaviour has previously been linked to diabetes, obesity, heart disease and mental health problems, but its impact on the health of pregnant women is unclear. There are no UK guidelines for the intensity and duration of physical activity needed to keep pregnant women healthy.

In this study, researchers from the University of Warwick asked 1263 pregnant women to report on their level of physical activity and emotional wellbeing – in the first trimester of pregnancy and then again in the late stages of the second.

They found that overall, women with self-reported depression symptoms were more likely to sit down for longer periods – despite accounting for their BMI, age and socio-economic status. Pregnant women who spent more time sitting down in the second trimester also did less amounts of moderate or vigorous physical activity, and sedentary women gained significant amounts of weight between the first and second trimester.

Finally, the researchers also found that sedentary pregnant women had higher blood glucose levels around 28 weeks of gestation, putting them at higher risk of developing gestational diabetes.

“Pregnant women could benefit from early intervention to improve their physical and mental health and reduce the risks associated with sedentary behaviour”, said lead author of the study Dr Nithya Sukumar at Warwick Medical School. “Gestational diabetes can increase the risk of birth complications for the mother and baby and so it is important we minimise this risk by reducing the time that pregnant women spend sitting down”.

Co-lead author Dr Ponnusamy Saravanan said: “Encouraging women to take breaks from sitting down might be an easier public health policy to implement than increasing their physical activity during pregnancy. We believe reducing the sitting time has the potential to reduce pregnant women’s risk of gestational diabetes and reduce the metabolic risk factors of their newborns”.

Soybean foods may protect menopausal women against osteoporosis

Eating a diet rich in both soy protein and isoflavones can protect menopausal women from bone weakening and osteoporosis, according to the results of a preliminary study presented today at the Society for Endocrinology annual conference in Edinburgh.

Osteoporosis is a common condition where bones become brittle and fragile from tissue loss, causing 9 million fractures worldwide every year. In women, bone loss occurs most quickly in the years immediately after menopause because they produce less of the sex hormone oestrogen, which protects against bone loss.

Soybean foods contain chemicals known as isoflavones that are similar in structure to oestrogen and so could theoretically protect women against osteoporosis by mimicking the action of oestrogen.

In this study, researchers from the University of Hull gave two hundred women in early menopause a daily supplement containing soy protein with 66mg of isoflavones or a supplement with soy protein alone for six months. The researchers investigated changes in the women’s bone activity by measuring certain proteins (βCTX and P1NP) in their blood.

They found that the women on the soy diet with isoflavones had significantly lower levels of βCTX than the women on soy alone, suggesting that their rate of bone loss was slowing down and lowering their risk of developing osteoporosis. Women taking soy protein with isoflavones were also found to have decreased risk of cardiovascular disease than those taking soy alone.

Lead author of the study Thozhukat Sathyapalan said: “We found that soy protein and isoflavones are a safe and effective option for improving bone health in women during early menopause. The actions of soy appear to mimic that of conventional osteoporosis drugs.”

“The 66 mg of isoflavone that we use in this study is equivalent to eating an oriental diet, which is rich in soy foods. In contrast, we only get around 2-16 mg of isoflavone with the average western diet.”

“Supplementing our food with isoflavones could lead to a significant decrease in the number of women being diagnosed with osteoporosis.”

Researchers next aim to investigate the long-term health consequences of using soy protein and isoflavones supplements, and whether it may also have benefits beyond bone health.

Human stem cells may improve bone healing in diabetics

Adding stem cells from human bone marrow to a broken diabetic bone enhances the repair process, increasing the strength of the newly formed bone, according to a laboratory-based study presented at the European Congress of Endocrinology in Dublin. The work could potentially lead to more effective treatments for broken bones.

Bones of diabetic people are known to be more fragile than non-diabetic people and take longer to heal after fracturing. What’s more, diabetic people are more likely to sustain fractures as a result of fall than non-diabetics as they often suffer from impaired vision and reduced sensitivity in their feet.

The research team at the National University of Galway, led by Dr Cynthia Coleman, are aiming to harness the reparative properties of stem cells to improve fracture repair in diabetic patients.

The researchers added human bone marrow stem cells from a non-diabetic donor to a bone fracture in laboratory pre-clinical studies. They found that stem cells healed the broken bone more efficiently than those that did not receive stem cells. In addition, the healed bones resulting from stem cell treatment were found to be significantly stronger and able to withstand more stress than those in the control group.

Dr Coleman and her group have developed a sensitive test to allow them to detect the location and number of the stem cells after they’ve been added; they report that the stem cells do not permanently integrate into the host tissue but instead produce signals that encourage the host’s own cells to heal the fracture more efficiently.

Dr Coleman has said, “this basic science study allows us to better understand the role of stem cells in fracture repair and potential use in treating diabetic patients.” Her future work will involve learning more about the role of stem cells in healing so that we can one day use them in the clinic.

“Stem cells represent an exciting potential for improving the treatment and lessening the pain and discomfort of diabetic people who break bones.” 

Drawing tests show cured growth disorder patients do not feel cured

A simple drawing test could help doctors assess the psychological impact of the rare disease acromegaly, according to a new study published on Rare Disease Day 2015 in the European Journal of Endocrinology.

Commonly associated with gigantism, acromegaly can be treated by bringing excess growth hormone levels in the blood back to normal. However, physical symptoms like a protruding forehead and enlarged hands, feet and tongue can be difficult to reverse and many patients do not feel cured after being treated for the disease.

By asking them to draw their perceived symptoms, doctors can provide patients with a relatively easy and comfortable way of sharing their concerns without causing embarrassment.

To find out how useful a drawing test is in assessing the psychological impact of acromegaly, fifty adults considered completely cured of acromegaly were asked to draw three pictures: the first showing how they thought their bodies looked like before they developed the disease, the second showing their body during treatment and the third showing how they look like currently. The patients were also asked to fill in a questionnaire to determine their quality of life and another questionnaire to find out how they perceived their illness.

The researchers found that despite being technically cured, patients still suffered from negative feelings and perceptions related to acromegaly. The patients’ first drawings showed healthy individuals and reflected no pain, negative emotions or symptoms of acromegaly.

However, the head, hands and feet in the second and third drawings were significantly larger and wider compared to the first, suggesting the patients still perceived themselves as suffering from the symptoms of acromegaly despite having been treated successfully.

The researchers also found that patients who drew larger drawings of their symptoms had more negative perceptions about their illness and suffered from a lower quality of life.

“Patients are labelled ‘cured’ by medical doctors but still feel like a patient with acromegaly”, said lead author of the study and University of California at Merced researcher Dr Jitske Tiemensma. “It might be difficult for a patient to bring up lingering physical symptoms and medical doctors might not always recognise what’s going on”.

“We think that these drawings have the potential to function as a source of information healthcare providers are less likely to receive otherwise”, said Dr Tiemensma.

The researchers are next considering examining the use of drawings over the full course of acromegaly and how they expect to look like after treatment, to be able to later look back on it after being cured.

A disease or disorder is defined as rare in Europe when it affects less than 1 in 2000. One in 500,000 people are diagnosed with acromegaly each year, making it a very rare disease. Medical treatment can be expensive, ranging from €20-60,000 per year.