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Background There is limited understanding on whether and how socioeconomic status (SES), particularly educational attainment and household income, impacts on telomere length in an Australian rural context. Additionally, it is unknown whether access to health services via the Australian public or private health system influences telomere length. Aim This study investigates whether there is a relationship between telomere length and SES indicators (income, education) as well as health insurance status in a rural Australian population. Methods Samples were drawn from the Australian Rural Victoria cross-sectional Crossroads Study. Leucocyte telomere length (LTL) was measured using a multiplex quantitative polymerase chain reaction method. Results Among 1424 participants, we did not find a significant main effect association with LTL across education, income level and health insurance. An exploratory finding was sex may influence the relationship between educational attainment and LTL (P =  0.021). In males, but not females, higher education was associated with longer LTL by 0.033 [95% confidence interval (CI) 0.002–0.063, P =  0.035]; in those with low education attainment, male participants had shorter LTL by 0.058 (95% CI −0.086 to −0.029) than female participants (P  <   0.0001). Conclusion Being male and having lower education attainment was associated with shorter telomere length in our rural population. Evidence from our study supports the importance of education on LTL in males in rural Australia. Our studies also support previous findings that LTL in later life may not be closely associated with indicators of SES. [ABSTRACT FROM AUTHOR]

Aim: To determine risk factors associated with neonatal hypoglycaemia and hyperbilirubinaemia, and assess their impact on neonatal outcomes in pregnancies complicated by gestational diabetes mellitus (GDM). Methods: Retrospective review investigating all pregnancies complicated by GDM at Campbelltown Hospital (Sydney, Australia) between 1 January 2013 and 31 December 2015. Main outcomes measured were neonatal hypoglycaemia (capillary glucose levels < 1.8 mmol/l) and hyperbilirubinaemia (total serum bilirubin levels greater than age‐appropriate thresholds for phototherapy). Adjusted odds ratios [95% confidence interval (CI)] are shown, calculated by multivariable logistic regression. Results: Some 60 (7.8%) infants developed hypoglycaemia, 58 (7.5%) developed hyperbilirubinaemia and 13 (1.7%) developed both. Risk of developing hypoglycaemia increased 1.8‐fold (95% CI 1.3–2.6, P < 0.001) per gestational week at GDM diagnosis, 1.1‐fold (95% CI 1.0–1.3, P = 0.04) per mmol/l maternal fasting glucose, 6.2‐fold (95% CI 2.6–16.2, P < 0.001) with maternal history of macrosomia, 10.8‐fold (95% CI 4.1–27.6, P < 0.001) with multiple pregnancy and 1.1‐fold (95% CI 1.0–1.3, P = 0.04) per gestational week at birth. Risk of hyperbilirubinaemia increased with multiple pregnancy (26.4; 95% CI 11.7–59.7, P < 0.001), and 1.5‐fold (95% CI 1.1–2.1, P = 0.01) per gestational week at GDM diagnosis. Hypoglycaemia was associated with a 2.8‐fold (95% CI 1.1–7.1, P = 0.03) increased risk of macrosomia, a 5.4‐fold (95% CI 1.1–27.3, P = 0.04) excess risk of shoulder dystocia and a 6.4‐fold increased risk of 5‐min APGAR ≤ 7 (95% CI 1.2–1.7, P < 0.001). Hyperbilirubinaemia was associated with an excess risk of polycythaemia (packed cell volume > 0.6; 97.1, 95% CI 38.9–241.5, P < 0.001). Conclusions: Neonatal hypoglycaemia and hyperbilirubinaemia largely occur in different pregnancies. Both are associated with earlier GDM diagnosis; however, hypoglycaemia is more associated with maternal glycaemia and its sequelae, and hyperbilirubinaemia is associated with polycythaemia. What's new?: Neonatal hypoglycaemia and neonatal hyperbilirubinaemia are common complications of gestational diabetes mellitus (GDM).Both adverse neonatal outcomes are linked with poor maternal glycaemic control.However, this study has found that only neonatal hypoglycemia is independently associated with higher maternal fasting glucose on oral glucose tolerance test.The overlap between neonatal hypoglycaemia and neonatal hyperbilirubinaemia was minimal, occurring in different babies, with different characteristics.The clinical implications of these results warrant consideration of current GDM models of care which recommend diagnosis and treatment of GDM from 24 weeks onwards. [ABSTRACT FROM AUTHOR]

Aim The utility of HbA1c in diabetes diagnosis is reduced in settings associated with altered haemoglobin glycation. We have studied whether HbA1c varies with mean cell volume and mean cell haemoglobin concentration as measures of haemoglobin metabolism. Methods Randomly selected adults from rural Victoria, Australia, were invited for biomedical assessment. After excluding patients with known diabetes and/or serum creatinine ⩾ 0.12 mmol/l, 1315 adults were included. Demography, arthropometric measurements, oral glucose tolerance test, analyses of full blood count and HbA1c were undertaken. Results After adjusting for age, sex, ethnicity, BMI, town and socio-economic status, there were no significant differences in haemoglobin, mean cell volume or mean cell haemoglobin concentration by glycaemic status (defined by oral glucose tolerance test). HbA1c was significantly and independently associated with fasting glucose, town, mean cell haemoglobin concentration, ethnicity, age and BMI among men < 50 years (R2 = 33.8%); fasting glucose, 2-h glucose, mean cell haemoglobin concentration and town among men ⩾ 50 years (R2 = 47.9%); fasting glucose, mean cell volume, mean cell haemoglobin concentration, town, 2-h glucose and age among women < 50 years (R2 = 46.3%); fasting glucose, mean cell haemoglobin concentration, mean cell volume and 2-h glucose among women ⩾ 50 years (R2 = 51.6%). A generalized linear model showed a gradient from an adjusted mean HbA1c of 36 (95% CI 34-38) mmol/mol with a mean cell haemoglobin concentration of ⩽ 320 g/l to 30 (95% CI 29-31) mmol/mol with a mean cell haemoglobin concentration of > 370 g/l. The gradient across mean cell volume was negative, but only by 1 mmol/mol (0.1%) HbA1c. Conclusion A mean HbA1c difference of 5 mmol/mol (0.5%) across the mean cell haemoglobin concentration reference range suggests that an accompanying full blood count examination may be required for its use in the diagnosis of diabetes. Further studies are required to confirm this. [ABSTRACT FROM AUTHOR]

Aim To examine the association between lung function and metabolic syndrome/Type 2 diabetes. Methods A total of 1454 adults from rural Victoria, Australia, from randomly selected households included in the Crossroads study, provided spirometric measurements including forced vital capacity, forced expiratory volume in 1 s, predicted percentage value of forced expiratory volume in 1 s and forced vital capacity predicted percentage value. Assessments also included HbA1c, metabolic syndrome components and a 75-g oral glucose tolerance test. The area under the receiver-operating characteristic curves for waist circumference were compared with those for combinations of waist circumference and raw spirometric measures (forced vital capacity and forced expiratory volume in 1 s) for identifying metabolic syndrome or Type 2 diabetes. Results Partipants with a greater number of metabolic syndrome components were more likely to have reduced lung function, particularly if Type 2 diabetes was present: the predicted value of forced expiratory volume in 1 s decreased by 5-6% for participants with 2-4 metabolic syndrome components, and by 9% for those with Type 2 diabetes. The risk of metabolic syndrome or Type 2 diabetes was inversely associated with higher spirometry values (forced expiratory volume in 1 s percentage predicted value: odds ratio for 2-4 metabolic syndrome components 0.36-0.21 in women and 0.32-0.30 men; the odds ratio for Type 2 diabetes was 0.36 in women and 0.28 in men). Receiver-operating characteristic curve analysis for identifying metabolic syndrome and Type 2 diabetes revealed significant differences between the area under the receiver-operating characteristic curve with waist circumference alone and that for the combination of waist circumference with lung capacity measures. Conclusion Pulmonary function is lower in people with metabolic syndrome and Type 2 diabetes. Spirometry variables are independent predictors of metabolic syndrome and Type 2 diabetes. [ABSTRACT FROM AUTHOR]

Aims The definition of metabolic syndrome (MS) continues to be debated and does not include abnormal liver function tests (LFTs). This study aims to determine: (1) the association between the five ATP3 MS diagnostic components and different LFTs, and (2) the association between raised LFTs and prevalent cardiovascular disease (CVD). Methods A total of 1357 patients, without alcoholism or known liver disease, from randomly selected households from rural Victoria, Australia, attended for biomedical assessment. Receiver operating characteristic (ROC) areas under the curve (AUC) were determined for associations between the ATP3 diagnostic components, and between LFTs and ATP3 diagnostic components. Results The range of ROC AUC for ATP3 diagnostic components was 0.60–0.77. Waist had the strongest association and blood pressure the weakest. The strength of association between ATP3 diagnostic components and gamma GT (GGT) was similar (0.63–0.72), but was less for alanine transaminase and aspartate transaminase. Using the ROC-derived GGT cut-off (men 27 IU, women 20 IU), those with MS and a high GGT had more CVD than those with MS and a low GGT, and those without MS (18% vs. 10% vs. 7%, respectively; P < 0.001). Among those with MS, after adjusting for covariates, the odds ratio of CVD was 2.66 (1.18–5.96) for a high GGT compared to a low GGT. CVD was not significantly more prevalent in MS patients with a low GGT compared to non-MS patients. Conclusions We suggest that including a raised GGT in the criteria for MS could increase its predictive nature for CVD. Prospective studies are needed to confirm this finding. [ABSTRACT FROM AUTHOR]

OBJECTIVES:To establish whether choice and availability of takeaway and restaurant food consumption are associated with increased obesity.DESIGN:Crossroads Undiagnosed Disease Study: a cross-sectional study undertaken between June 2001 and March 2003.SETTING:A regional centre and six shire capitals of variables size in rural Victoria, Australia.PARTICIPANTS:In total, 1454 residents of randomly selected households.MEASUREMENTS:Obesity (by body mass index (BMI) or waist circumference), weekly recreational activity, self-reported frequency of takeaway consumption, number of local takeaway and restaurant food outlets in the area.RESULTS:The prevalence of obesity ranged from 25.5-30.8%and was higher than the general Australian population among both men and women. Those in the regional centre were less likely than those in large and small shire capitals to participate in recreational activity of 150?min or more (39.7 vs 48.4%, 46.0%respectively, P=0.023) and yet reported better access to facilities and amenities for physical activity. Recreational activity of=150?min/week was associated with 0.75 (0.58-0.97) fold less risk of obesity. BMI was unrelated to takeaway consumption. Waist circumference was significantly lower among those eating no takeaways, but similar whether takeaways were consumed<1/month or=1/week. Increased takeaway consumption was associated with increased consumption of higher fat preparations of dairy and meat products. Availability of takeaway outlets and restaurants was unrelated to obesity.CONCLUSION:The obesity epidemic exists among those without significant consumption of or availability to takeaway foods. In a setting of easy availability of food, the obesity epidemic relates strongly to reduced physical activity, but not to consumption of takeaway food.International Journal of Obesity (2005) 29, 703-710. doi:10.1038/sj.ijo.0802941 Published online 5 April 2005 [ABSTRACT FROM AUTHOR]

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