The Role of Fructose in Public Health and Obesity

We are in the so-called nutritional transition, in which obesity and its comorbidities have emerged as an important research topic, and the information on food composition is fundamental to promote nutritional safety. Fructose is the sweetest carbohydrate, and this sweetness, along with its low cost, is the key factor for its use in commercial drinks and sweets. The global average consumption of fructose per capita has increased from 56 g/day in 1986 to 65 g/day in 2007. Experimental models associate high fructose intake with the development of obesity and induced insulin resistance. In recent studies, diabetic patients have been reported to use fructose more frequently than glucose. Fructose acts differently in the hypothalamus and generates less satiety than glucose;thus, fructose has a high lipogenic potential. Replacing fructose with another isocaloric carbohydrate is associated with better glycemic control.

COVID-19 Vaccine Allocation: Modeling Health Outcomes and Equity Implications of Alternative Strategies

Given the scarcity of safe and effective COVID-19 vaccines,a chief policy question is how to allocate them among different sociodemographic groups.This paper evaluates COVID-19 vaccine prioritization strategies proposed to date,focusing on their stated goals;the mechanisms through which the selected allocations affect the course and burden of the pandemic;and the main epidemiological,economic,logistical,and political issues that arise when setting the prioritization strategy.The paper uses a simple,agestratified susceptible–exposed–infectious–recovered model applied to the United States to quantitatively assess the performance of alternative prioritization strategies with respect to avoided deaths,avoided infections,and life-years gained.We demonstrate that prioritizing essential workers is a viable strategy for reducing the number of cases and years of life lost,while the largest reduction in deaths is achieved by prioritizing older adults in most scenarios,even if the vaccine is effective at blocking viral transmission.Uncertainty regarding this property and potential delays in dose delivery reinforce the call for prioritizing older adults.Additionally,we investigate the strength of the equity motive that would support an allocation strategy attaching absolute priority to essential workers for a vaccine that reduces infectionfatality risk.

Healthy diet,depression and quality of life:A narrative review of biological mechanisms and primary prevention opportunities

Unipolar depressive disorder(UDD)affects more than 264 million people worldwide and was projected well before the severe acute respiratory syndrome coronavirus 2 pandemic to be the leading cause of disability-adjusted life years lost in 2030.It is imperative for leading economies to implement preventive strategies targeted towards UDD,given consistent policies are currently lacking.Recently established similarities between the aetiological hypotheses of depression and cardiometabolic diseases are shifting paradigms within this field.It is believed that dietary practices could potentially reduce the incidence of depression;similar to their effects on metabolism.Thus,the aim of this review was to compile current evidence on healthy dietary patterns as suitable contributors towards primary prevention strategies against UDD.Most of the well-known biological mechanisms behind depression have been positively associated with healthful diets and dietary patterns to varying degrees.Interestingly,a common factor of UDD is the production and overall effects of inflammatory cytokines,such as interleukin-6,tumor necrosis factor-α,and Creactive protein.These compounds have been associated with depressive symptoms,disturbances in neuroendocrine function,leaky gut,monoamine activity and brain function,while also being key factors in the development of cardiometabolic diseases.The Mediterranean diet(MD)in particular,is well supported by first-level evidence regarding its preventive qualities against metabolic and cardiovascular diseases and thus considered a model for healthy eating by various organizations.In one of the few clinical trials investigating these associations,the PREDIMED trial,individuals with diabetes assigned to a MD supplemented with mixed tree nuts experienced a 41%relative risk reduction for developing depression.Lastly,there is a need to include health related quality of life as an indicator of physical and mental well-being,considering its putative associations with depression and suicide risk.Going forward,focusing on clinical trials,using precise nutritional assessments,and identifying nutritional biomarkers which may be related to depression are needed to fully support the implementation of dietary recommendations in the field of psychiatry.

The association of diet quality and physical activity with cardiovascular disease and mortality in 85,545 older Australians:A longitudinal study

Background:A quality diet and an active lifestyle are both important cornerstones of cardiovascular disease(CVD)prevention.However,despite their interlinked effects on metabolic health,the 2 behaviors are rarely considered jointly,particularly within the context of CVD prevention.We examined the independent,interactive,and joint associations of diet and physical activity with CVD hospitalization,CVD mortality,and all-cause mortality.Methods:CVD-free Australian participants aged 4574 years(n=85,545)reported physical activity,diet,sociodemographic,and lifestyle characteristics at baseline(20062009)and follow-up(20122015),and data were linked to hospitalization and death registries(03/31/2019 for CVD hospitalization and all-cause mortality and 12/08/2017 for CVD mortality).Diet quality was categorized as low,medium,and high based on meeting dietary recommendations.Physical activity was operationalized as(a)total moderate-to-vigorous physical activity(MVPA)as per guidelines,and(b)the composition of MVPA as the ratio of vigorous-intensity physical activity(VPA)to total MVPA.We used a left-truncated cause-specific Cox proportional hazards model using time-varying covariates.Results:During a median of 10.7 years of follow-up,6576 participants were admitted to the hospital for CVD and 6581 died from all causes(876 from CVD during 9.3 years).A high-quality diet was associated with a 17%lower risk of all-cause mortality than a low-quality diet,and the highest MVPA category(compared with the lowest)was associated with a 44%and 48%lower risk of CVD and all-cause mortality,respectively.Multiplicative interactions between diet and physical activity were non-significant.For all outcomes,the lowest risk combinations involved a high-quality diet and the highest MVPA categories.Accounting for total MVPA,some VPA was associated with further risk reduction of CVD hospitalization and all-cause mortality.Conclusion:For CVD prevention and longevity,one should adhere to both a healthy diet and an active lifestyle and incorporate some VPA when possible.

Diabetic and Prediabetic Profile of Patients in a Family Health Care Unit of Salvador, Northeastern Brazil

Diabetes Mellitus is one of the most prevalent diseases in the world. In Brazil, 8.7% of the population between 20 and 79 years of age has diabetes, estimating 11.6 million diabetics. It is commonly associated with other co-morbidities such as hypertension, dyslipidemia and obesity, which put these patients into a high cardiovascular risk profile. This study was performed using the medical records of enrolled population attending a Family Health Unit of Alto do Coqueirinho, Salvador, Northeastern Brazil, consisting of one doctor, one nurse, one dentist, one nursing technician and six community health workers. Medical records and data provided by the system of the Primary Care Information (SIAB), showed total of 2495 patients. Considering the prevalence morbidities in this population, hypertension was present in 9.8% of patients and Type 2 Diabetes in only 3.6%. Since the prevalence of morbidities is the key indicator to the development of public health policies, it seems important a better knowledge on the prevalence rates of diabetes, prediabetes and its co-morbidities of this population. Future plans and projects for health professionals will be based on a consistent medical record.

Prevalence of Cholelithiasis in Patients with Type 2 Diabetes and Obesity in a Basic Family Health Centre in Irecê, Northeastern Brazil

Cholelithiasis is a common disease in the general population. One of its risk factors is the type 2 diabetes mellitus, related to metabolic abnormalities associated to overweight, obesity, insulin resistance, hypertriglyceridemia and dietary habits. The main risk factors to cholelithiasis are genetic susceptibility, ileum resection, diabetes mellitus, obesity, hemolytic anemia, age, estrogens and cirrhosis. This study aims to make a correlation between diabetes mellitus and obesity versus prevalence of cholelithiasis in these patients.

A life course health development model of HIV vulnerabilities and resiliencies in young transgender women in Peru

Background Globally transgender women(TW)are at heightened vulnerability for HIV infection.In Lima Peru,sharp increases in HIV prevalence are seen among TW ages 25 years and older highlighting the need for early HIV prevention efforts for young TW.This study conducted in-depth qualitative interviews to elucidate the social and developmental contexts of HIV vulnerability for young TW in Lima Peru.Methods Between November 2019 and February 2020,young TW ages 16-24 years(n=21)in Lima Peru were purposively sampled using in-person(e.g.,face-to-face outreach)and online(e.g.,social media,networking websites)social network-based methods.Interviews were conducted in Spanish and a rapid qualitative analysis was conducted using a modified immersion crystallization methodology to identify themes.Results Five themes emerged,informing the conceptualization of a Life Course Health Development Model of HIV Vulnerabilities and Resiliencies:(1)interpersonal contexts(family,school,partners,sexual debut,trans mothers);(2)structural vulnerabilities(poverty,educational constraints,migration,hostile environments,sex work,police violence);(3)concomitant mental health and psychosocial factors(discrimination,violence,depression,suicidality,substance use,life hopes/dreams/future expectations);(4)gender affirmation processes(gender identity development,hormones,surgery,legal name/gender marker change);(5)HIV prevention and treatment barriers(PrEP uptake,HIV care,condom use,risk reduction).Conclusions Young TW experience formidable developmental challenges associated with transphobia,violence,and pre-maturely facing accelerated milestones.Developmentally and culturally appropriate interventions to mitigate HIV vulnerability in Peru are needed,including those that consider co-occurring stigma-related conditions in adolescence and young adulthood.

Impact of D-dimer on in-hospital mortality following aortic dissection:A systematic review and meta-analysis

BACKGROUND The utility of D-dimer(DD)as a biomarker for acute aortic dissection(AD)is recognized.Yet,its predictive value for in-hospital mortality remains uncertain and subject to conflicting evidence.AIM To conduct a meta-analysis of AD-related in-hospital mortality(ADIM)with elevated DD levels.METHODS We searched PubMed,Scopus,Embase,and Google Scholar for AD and ADIM literature through May 2022.Heterogeneity was assessed using I2 statistics and effect size(hazard or odds ratio)analysis with random-effects models.Sample size,study type,and patients’mean age were used for subgroup analysis.The significance threshold was P<0.05.RESULTS Thirteen studies(3628 patients)were included in our study.The pooled prevalence of ADIM was 20%(95%CI:15%-25%).Despite comparable demographic characteristics and comorbidities,elevated DD values were associated with higher ADIM risk(unadjusted effect size:1.94,95%CI:1.34-2.8;adjusted effect size:1.12,95%CI:1.05-1.19,P<0.01).Studies involving patients with a mean age of<60 years exhibited an increased mortality risk(effect size:1.43,95%CI:1.23-1.67,P<0.01),whereas no significant difference was observed in studies with a mean age>60 years.Prospective and larger sample size studies(n>250)demonstrated a heightened likelihood of ADIM associated with elevated DD levels(effect size:2.57,95%CI:1.30-5.08,P<0.01 vs effect size:1.05,95%CI:1.00-1.11,P=0.05,respectively).CONCLUSION Our meta-analysis shows elevated DD increases in-hospital mortality risk in AD patients,highlighting the need for larger,prospective studies to improve risk prediction models.

Healthy lifestyles in relation to cardiometabolic diseases among schoolteachers:A cross-sectional study

Background:We aimed to explore the associations of adherence to an overall healthy lifestyle with cardiometabolic diseases(CMDs)among schoolteachers in China.Methods:We conducted a cross-sectional analysis among 2983 teachers(aged 39.8±9.3 years,73.8%women)in Zhejiang Province,China.A healthy lifestyle score(0–7)was constructed based on seven low-risk factors:healthy diet,noncurrent smoking,noncurrent drinking,regular exercise,normal body mass index(BMI),adequate sleep duration,and limited sedentary behavior.CMDs included self-reported hyperlipidemia,hypertension,diabetes,coronary heart disease,and stroke.Multivariable-adjusted logistic regression models were used to evaluate the associations between healthy lifestyle and CMD.Results:A total of 493(16.5%)participants had at least one CMD,with hyperlipidemia,hypertension,and diabetes being the three leading CMDs.ach point increment in a healthy lifestyle score was associated with 20%lower odds of having CMD(p-trend<0.001).Compared with 0–3 low-risk factors,the odds ratios(ORs)and 95%confidence intervals(CIs)were 0.66(0.50–0.88)for 4 low-risk factors and 0.51(0.39–0.67)for 5–7 low-risk factors.We observed independent associations for normal BMI(OR=0.50,95%CI=0.40–0.63),noncurrent drinking(OR=0.53,95%CI=0.36–0.77),and limited sedentary behavior(OR=0.77,95%CI=0.62–0.96)in relation to CMD.Healthy diet(OR=0.75,95%CI=0.55–1.01)exhibited marginally significant association with CMD.Conclusions:Our findings suggest that adherence to an overall healthy lifestyle is associated with lower odds of CMD among schoolteachers.

Predictive effects of bilirubin on response of colorectal cancer to irinotecan-based chemotherapy

AIM: To examine the predictive effects of baseline serum bilirubin levels and UDP-glucuronosyltransferase(UGT) 1A1*28 polymorphism on response of colorectal cancer to irinotecan-based chemotherapy.METHODS: The present study was based on a prospective multicenter longitudinal trial of Chinese metastatic colorectal cancer(m CRC) patients treated with irinotecan-based chemotherapy(NCT01282658). Baseline serum bilirubin levels, including total bilirubin(TBil) and unconjugated bilirubin(UBil), were measured,and genotyping of UGT1A1*28 polymorphism was performed. Receiver operating characteristic curve(ROC) analysis was used to determine cutoff values of TBil and UBil. The TBil values were categorized into > 13.0 or ≤ 13.0 groups; the UBil values were categorized into > 4.1 or ≤ 4.1 groups. Combining the cutoff values of TBil and UBil, which was recorded as Co Bil, patients were classified into three groups. The classifier's performance of UGT1A1*28 and Co Bil for predicting treatment response was evaluated by ROC analysis. Associations between response and Co Bil or UGT1A1*28 polymorphism were estimated using simple and multiple logistic regression models. RESULTS: Among the 120 m CRC patients, the serum bilirubin level was significantly different between the UGT1A1*28 wild-type and mutant genotypes. Patients with the mutant genotype had an increased likelihood of a higher TBil(P = 0.018) and a higher UBil(P = 0.014) level compared with the wild-type genotype. Patients were stratified into three groups based on Co Bil. Group 1 was patients with TBil > 13.0 and UBil > 4.1; Group 2 was patients with TBil ≤ 13.0 and UBil > 4.1; and Group 3 was patients with TBil ≤ 13.0 and UBil ≤ 4.1. Patients in Group 3 had more than a 10-fold higher likelihood of having a response in the simple(OR = 11.250; 95%CI: 2.286-55.367; P = 0.003) and multiple(OR = 16.001; 95%CI: 2.802-91.371; P = 0.002) analyses compared with the Group 1 individuals. Patients carrying the UGT1A1*28(TA)7 allele were 4-fold less likely to present with a response compared with the individuals harboring a homozygous(TA)6 genotype in the simple(OR = 0.267; 95%CI: 0.100-0.709; P = 0.008) and multiple(OR = 0.244; 95%CI: 0.088-0.678; P = 0.007) analyses. Classifier's performance of Co Bil and UGT1A1*28 were comparable.CONCLUSION: Co Bil and UGT1A1*28 are both independent biomarkers for predicting the treatment response of m CRC patients to irinotecan-based chemotherapy. After validation, Co Bil, an easily determinable index in the clinic, might be helpful in facilitating stratification of m CRC patients for individualized treatment options.

The Influence of Secular Trends in Body Height and Weight on the Prevalence of Overweight and Obesity among Chinese Children and Adolescents

Objective To explore the influence of secular trends in body height and weight on the prevalence of overweight and obesity among Chinese children and adolescents. Methods The data were obtained from five cross-sectional Chinese National Surveys on Students＇ Constitution and Health. Overweight/obesity was defined as BMI-for-age Z-score of per the Wold Health Organization （WHO） reference values. Body height and weight for each sex and age were standardized to those reported in 1985 （standardized height＂ SHY, standardized weight： SWY） and for each sex and year at age 7 （standardized height： SHA; standardized weight： SWA） using the Z-score method. Results The prevalence of overweight/obesity in Chinese children was 20.2% among boys and 10.7% among girls in 2010 and increased continuously from 1985 to 2010. Among boys and girls of normal weight, SHY and SHA were significantly greater than SWY and SWA, respectively （P 〈 0.001）. Among boys and girls with overweight/obesity, SHY was significantly lower than SWY （P 〈 0.001）, and showed an obvious decreasing trend after age 12. SHA was lower than SWA among overweight boys aged 7-8 years and girls aged 7-9 years. SHY/SHW and SHA/SWA among normal-weight groups were greater than among overweight and obese groups （P 〈 0.001）. Conclusion The continuous increase in the prevalence of overweight/obesity among Chinese children may be related to a rapid increase in body weight before age 9 and lack of secular increase in body height after age 12.

From Bench to the Clinic: The Path to Translation of Nanotechnology-Enabled mRNA SARS-CoV-2 Vaccines

During the last decades,the use of nanotechnology in med icine has effectively been translated to the design of drug delivery systems,nanostructured tissues,diagnostic platforms,and novel nanomaterials against several human diseases and infectious pathogens.Nanotechnology-enabled vaccines have been positioned as solutions to mitigate the pandemic outbreak caused by the novel pathogen severe acute respiratory syndrome coronavirus 2.To fast-track the development of vaccines,unprecedented industrial and academic collaborations emerged around the world,resulting in the clinical translation of effective vaccines in less than one year.In this article,we provide an overview of the path to translation from the bench to the clinic of nanotechnology-enabled messenger ribonucleic acid vaccines and examine in detail the types of delivery systems used,their mechanisms of action,obtained results during each phase of their clinical development and their regulatory approval process.We also analyze how nanotechnology is impacting global health and economy during the COVID-19 pandemic and beyond.

Insight into interactions of olivine-scCO_2-water system at 140C and15 MPa during CO_2 mineral sequestration

CO_2 mineral sequestration(in ultrabasic or basaltic rocks) has been considered as a promising long-term and stable approach to reduce CO_2 in the atmosphere and would counteract the effect of global warming.Meanwhile, clays are widely found in ultrabasic reservoirs. In our study, clays were observed in natural olivine samples, which were used for laboratory experiments in a supercritical CO_2 system at 140C and15 MPa. Initial olivine samples were crushed into two sizes which were large grains of w850-1000 mm and powder particles of w75-150 mm, with the durations of 400 and 1000 h for the powder and grains,respectively. The results showed amorphous silica was newly formed and this passivating layer could mitigate the water-rock interaction to some extent, but it would not play a long-term prohibited effect on secondary mineral carbonate formation as it is a Fe(III) free silica coating. More interestingly, the secondary carbonates were observed to form near the surface sites where locates more clays. Our findings provide insights into the reaction mechanisms of olivine-scCO_2-water interaction process in natural ultrabasic rocks.

Prevalence of dementia and the attributable contributions of modifiable risk factors in China

With the largest ageing population in the world,China is faced with the huge chal-lenge of dementia.-However,previously reported estimates on the prevalence of dementia among Chinese older adults were inconsistent,varying from 2%to 13%.5°It is crucial for dementia prevention to determine the number of cases that could be delayed or prevented,but how to do this remains unclear.To address these research gaps,we aimed to provide population estimates of the prevalence of dementia in China and estimate the population attributable fractions(PAFs)of potentially modifiable risk factors.

Conflicts of interest in nutritional sciences: The forgotten bias in meta-analysis

Awareness of conflicts of interest(COI) in medicine began in the 1980 s. More recently, the problem has gained notoriety in nutritional sciences. COI with industry could bias study conclusions in the context of research activities and scientific publications on nutritional sciences. The issue of COI in nutritional sciences deserves more attention and requires careful analyses as biased information can negatively impact the development of dietary guidelines and, ultimately, population health. Decision-making is generally based on available, published evidence, but when the results are ambivalent, it is easier to opt for the status quo and ask for more studies. Readers might wonder if research is subsidized by industry as a counterbalancing strategy based on levels of evidence-only to slow down eminent positions and/or legislation on the food sector? How can this problem be overcome without producing paranoia and Mc Carthyism while trying to be as methodological as possible?

Replacement of leisure-time sedentary behavior with various physical activities and the risk of dementia incidence and mortality:A prospective cohort study

Background:Whether or not there is targeted pharmacotherapy for dementia,an active and healthy lifestyle that includes physical activity(PA)may be a better option than medication for preventing dementia.We examined the association between leisure-time sedentary behavior(SB)and the risk of dementia incidence and mortality.We further quantified the effect on dementia risk of replacing sedentary time with an equal amount of time spent on different physical activities.Methods:In the UK Biobank,484,169 participants(mean age=56.5 years;45.2%men)free of dementia were followed from baseline(2006-2010)through July 30,2021.A standard questionnaire measured individual leisure-time SB(watching TV,computer use,and driving)and PA(walking for pleasure,light and heavy do-it-yourself activity,strenuous sports,and other exercise)frequency and duration in the 4 weeks prior to evaluation.Apolipoprotein E(APOE)genotype data were available for a subset of 397,519(82.1%)individuals.A Cox proportional hazard model and an isotemporal substitution model were used in this study.Results:During a median 12.4 years of follow-up,6904 all-cause dementia cases and 2115 deaths from dementia were recorded.In comparison to participants with leisure-time SB<5 h/day,the hazard ratio((HR),95%confidence interval(95%CI))of dementia incidence was 1.07(1.02-1.13)for 5-8 h/day and 1.25(1.13-1.38)for>8 h/day,and the HR of dementia mortality was 1.35(1.12-1.61)for>8 h/day.A 1 standard deviation increment of sedentary time(2.33 h/day)was strongly associated with a higher incidence of dementia and mortality(HR=1.06,95%CI:1.03-1.08 and HR=1.07,95%CI:1.03-1.12,respectively).The association between sedentary time and the risk of developing dementia was more profound in subjects<60 years than in those>60 years(HR=1.26,95%CI:1.00-1.58 vs.HR=1.21,95%CI:1.08-1.35 in>8 h/day,p for interaction=0.013).Replacing 30 min/day of leisure sedentary time with an equal time spent in total PA was associated with a6%decreased risk and 9%decreased mortality from dementia,with exercise(e.g.,swimming,cycling,aerobics,bowling)showing the strongest benefit(HR=0.82,95%CI:0.78-0.86 and HR=0.79,95%CI:0.72-0.86).Compared with APOEε4 noncarriers,APOEε4 carriers are more likely to see a decrease in Alzheimer’s disease incidence and mortality when PA is substituted for SB.Conclusion:Leisure-time SB was positively associated with the risk of dementia incidence and mortality.Replacing sedentary time with equal time spent doing PA may be associated with a significant reduction in dementia incidence and mortality risk.

Polycystic Ovary Syndrome and the Role of Metformin in Ovulation Induction

The Polycystic Ovary Syndrome (PCOS) is frequently associated with comorbidities such as obesity, reduced glucose tolerance, hypertension, macrovascular disease and dyslipidemia. The Metabolic syndrome occurs in 30% of women with PCOS. Metformin has increasingly been used in this therapy due to its effects in reducing insulin resistance. Treatment of PCOS aims to reduce the symptoms of hyperandrogenism, regularize the menstrual cycle, reduce metabolic abnormalities, and lower the risk of type 2 diabetes mellitus and of cardiovascular disease. Additionally it is important to prevent hyperplasia and endometrial cancer, and to offer contraception to those who do not wish pregnancy, and to help to induce ovulation to those who do. The effectiveness of metformin in this treatment is assessed in the light of the current best evidence.

Artificial Sweeteners as a Cause of Obesity: Weight Gain Mechanisms and Current Evidence

The obesity epidemic gathers growing media attention recently, as overweight and obesity’s prevalence keeps rising. This comes along with an increase in the intake of artificial sweeteners in food products. A causal relationship between the consumption of sweeteners and obesity is so far not clear in the medical literature. This paper describes the development of artificial sweeteners in a historical context. It collects epidemiological and experimental evidence that possibly relates the use of artificial sweeteners with weight gain. Finally, these effects are explained based on the neuroscience of food reward, the possible effects of glucose on the metabolism and the association between sweeteners and gut microbiota.

A Comprehensive View on the Progress of Organoid Research with an Emphasis on its Relevance to Disease Characterization

INTRODUCTION Organoids are primary tissue or stem cells derived cell aggregates that have the capacity for self-organization,self-renewal,and the capacity to mimic cellular and tissue level functions.Organoids can overcome the shortcomings of traditional 2D cell culture models and closely mimic 3D primary tissue composition.

Targeted genotyping for the prediction of celiac disease autoimmunity development in patients with type 1 diabetes and their family members

BACKGROUND Patients with type 1 diabetes (T1D) and their first-degree relatives (FDRs) have an increased risk of developing celiac disease (CD) compared to the general population. This is largely explained by the shared association with major histocompatibility class II human leukocyte antigen (HLA) DQ2 and/or DQ8 between the two disease states. AIM To describe the frequency of CD autoimmunity (CDA) and the distribution of HLA and haptoglobin genotypes in patients with T1D and their FDRs. Additionally, we aimed at identifying predictors associated with an increased risk of developing CDA in patients with T1D and their family members. METHODS We obtained clinical information and blood samples from 1027 participants (302 with T1D and 725 FDRs) over a five-year period. Samples were tested for autoantibodies associated with CD, HLA-DQ alleles, and haptoglobin genotype.We fit univariate and multiple logistic regression models for CDA separately for subjects with T1D and for FDRs of subjects with T1D. RESULTS Implementation of a screening program increased the frequency of CDA by 2- fold in participants with T1D and 2.8-fold in their FDRs. Multivariate analysis found that, in participants with T1D, having both DR7-DQ2 and DR4-DQ8 was associated with an increased frequency of CDA. In FDRs of T1D patients, reported CD in the family was associated with an increased frequency of CDA during screening. Haptoglobin 2 genotype was not associated with developing CDA in the multivariate analysis. CONCLUSION Patients with T1D and their FDRs have a high frequency of CDA. Carrying both DR7-DQ2 and DR4-DQ8 was associated with development of CDA in patients with T1D.