Low stress resistance leads to type 2 diabetes: study
A recent study published in Diabetologia has found 18-year-old men with low stress resistance have a 50% higher risk of developing type 2 diabetes in their lifetime. The population-based study examined all 1 534 425 military conscripts in Sweden during 1969–1997 who underwent psychological assessment to determine stress resilience. They were followed up for diagnoses of type 2 diabetes from 1987 to 2012, with the maximum attained age of 62 years. After adjusting for body mass index, family history of diabetes, and individual and neighbourhood socioeconomic factors, the research found 34 008 men had been diagnosed with type 2 diabetes. The study found the 20% of men with the lowest resistance to stress were 51% more likely to have been diagnosed with diabetes than the 20% with the highest resistance to stress. The authors admit lifestyle behaviours related to stress, including smoking, unhealthy diet and lack of physical activity, could be related to the increased risk of diabetes. The authors conclude: “These findings suggest that psychosocial function and ability to cope with stress may play an important long-term role in aetiological pathways for type 2 diabetes. Additional studies will be needed to elucidate the specific underlying causal factors, which may help inform more effective preventive interventions across the lifespan.” Read more at doctorportal.
Potato consumption linked to gestational diabetes
A study published in the BMJ has found a link between a woman’s pre-pregnancy consumption of potatoes and her chances of suffering gestational diabetes mellitus (GDM). The researchers tracked 15 632 women over a 10-year period, during which there were 21 693 singleton pregnancies among the group. Of these pregnancies, 854 were affected by GDM. After taking into account risk factors such as age, family history of diabetes, diet quality, physical activity and body mass index, researchers found that higher total potato consumption was significantly associated with a risk of GDM. The researchers found that if women substituted two servings of potatoes a week with other vegetables, wholegrains or legumes, there was a 9%–12% lower risk of developing GDM. They say one explanation of the findings is that potatoes have a high glycaemic index, which can trigger a rise in blood sugar levels thanks to the high starch content. The most recent Australian dietary guidelines, released in 2015, say Australians need to eat less starchy vegetables. The authors of the study admit that the observational nature of their study means no definite conclusions can be drawn about cause and effect. However, they conclude: “Higher levels of potato consumption before pregnancy are associated with greater risk of GDM, and substitution of potatoes with other vegetables, legumes, or whole grain foods might lower the risk.” Read more at doctorportal.
Case report: facial papules in Birt-Hogg-Dubé syndrome
The general practitioner and the dermatologist are uniquely placed to consider the diagnosis of Birt-Hogg-Dubé syndrome (BHD) when consulted by a patient requesting removal of multiple facial papules, according to a case report published today in the MJA. BHD is a rare, autosomal dominant, hereditary cancer syndrome caused by germline mutations in the folliculin gene (FLCN). The incidence of BHD is about one in 200 000 of the population; however, it is likely underdiagnosed because of low clinical awareness. Early recognition of BHD is crucial, given the high risk of renal neoplasm development, which, if detected early, is curable. Unexplained spontaneous pneumothorax and basal lung cysts should also raise suspicion of BHD. Referral for genetic testing and multidisciplinary care is essential. Routine renal radiographic screening is recommended for affected individuals aged under 40 years and, given the likelihood of multiple tumours, nephron-sparing surgery is preferred.
Ethics and law: time for a review of compensated transnational surrogacy
It is time to openly debate how Australia should balance the desire for childbearing through surrogacy with the limited domestic availability of women willing to act as surrogates, according to an ethics and law article published today in the MJA. Commercial or compensated surrogacy involves providing payment for a woman to gestate a fetus to term and then hand over the child to the commissioning parent(s). Compensated surrogacy is currently restricted by law or regulation in all Australian states and territories. New South Wales, Queensland and the Australian Capital Territory also restrict commissioning transnational compensated surrogacy, although there is evidence that this is not acting as a deterrent. Ethical issues arising in transnational compensated surrogacy include concerns relating to exploitation, commodification and welfare. The current status quo is unsatisfactory on legal, ethical and practical grounds, says the author.

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