Youth-onset type 2 diabetes in Israel: A national cohort.

BACKGROUND: Prevalence of youth-onset type 2 diabetes (T2D) has increased worldwide, paralleling the rise in pediatric obesity. Occurrence and clinical manifestations vary regionally and demographically. OBJECTIVES: We assessed the incidence, and clinical and demographic manifestations of youth-onset T2D in Israel. METHODS: In a national observational study, demographic, clinical, and laboratory data were collected from the medical records of children and adolescents, aged 10-18 years, diagnosed with T2D between the years 2008 and 2019. RESULTS: The incidence of youth-onset T2D in Israel increased significantly from 0.63/100,000 in 2008 to 3.41/100,000 in 2019. The study cohort comprised 379 individuals (228 girls [59.7%], 221 Jews [58.3%], mean age 14.7 ± 1.9 years); 73.1% had a positive family history of T2D. Mean body mass index (BMI) z-score was 1.96 ± 0.7, higher in Jews than Arabs. High systolic (≥ 130 mmHg) and diastolic blood pressure (≥ 85 mmHg) were observed in 33.7% and 7.8% of patients, respectively; mean glycosylated hemoglobin (A1c) level at diagnosis was 8.8 ± 2.5%. Dyslipidemia, with high triglyceride (>150 mg/dl) and low HDL-c (<40 mg/dl) levels, was found in 45.6% and 56.5%, respectively. Microalbuminuria and retinopathy were documented at diagnosis, 15.2% and 1.9%, respectively) and increased (36.7% and 4.6%, respectively) at follow-up of 2.9 ± 2.1 years. Criteria of metabolic syndrome were met by 224 (62.2%) patients, and fatty liver documented in 65%, mainly Jews. Psychosocial comorbidity was found in 31%. Treatment with metformin (45.6%), insulin (20.6%), and lifestyle modification (18%) improved glycemic control. CONCLUSION: Youth-onset T2D in Israel has increased significantly and presents a unique profile.

Characteristics and associated morbidities of young adults with misconceived food allergy: A cross-sectional study.

BACKGROUND: Many patients with self-reported food allergy are not allergic but suffer from similar burdens. We aimed to characterize young adults with misconceived food allergy. METHODS: A cross-sectional study of individuals (n = 12,592) aged 17-18 years, recruited to the Israel Defense Forces (IDF) at a single urban-area recruitment center over a six month-period. All participants underwent a comprehensive medical and psychological evaluation. Cognitive tests were performed and a Combined Intellectual-Education score assigned. Participants who reported food elimination due to allergy were skin-tested and underwent oral food challenges, when indicated. The characteristics, psychological evaluation and cognitive tests of individuals with no reported food allergy (n = 12,444), misconceived food allergy (n = 64) and true food allergy (n = 84) were compared. FINDINGS: The prevalence of atopic co-morbidities was higher in recruits reporting compared to those not reporting food allergy while the rate of other co-morbidities was comparable. Anxiety disorder was diagnosed significantly more in individuals who reported food allergy (4·1%) compared to those who did not (1·7%) (p = 0·04). Further analysis revealed that this diagnosis was concentrated in individuals with misconceived (8/64, 12·5%) compared to true food allergy (2/84, 2·4%), (p = 0·02). Patients with misconceived food allergy were mostly of female sex, had lower Combined Intellectual-Education scores compared to patients with true (p = 0·001) and no reported food allergy (p = 0·01), and required the longest mean evaluation time (147·6 ± 109·4 days). INTERPRETATION: Patients with misconceived food allergy have higher rates of anxiety disorder and are often from a lower educational level and of female sex. Medical and educational attention is required to improve care of this specific population. FUNDING: The research reported in this publication was supported by the Israel Defense Forces (IDF) Medical Corps and Directorate of Defense Research & Development, Israeli Ministry of Defense (IMOD DDR&D).

The Prevalence of Food Allergy in Young Israeli Adults.

BACKGROUND: Information regarding the prevalence of food allergy (FA) among adults is limited due to their inaccessibility for thorough epidemiological evaluations. OBJECTIVE: To evaluate the prevalence of FA among Israeli young adults. METHODS: All recruits (n = 12,592, ages 17-18 years) signing up over 6 months at a single recruitment center of the Israeli army were evaluated for FA. The evaluation included a frontal interview by physicians who used a focused screening set of questions, medical documentation collection, tests of IgE reactivity, and oral food challenges. The latter were performed at an allergy care institute in ambiguous cases. A prediction model for the identification of individuals with true allergy among recruits eliminating foods due to suspected FA was developed using multivariable logistic regression. RESULTS: Foods elimination due to suspected FA was reported by 148 recruits (1.2%). After diagnostic testing, FA was confirmed in 0.67% (84 of 12,592). The prevalence of food elimination versus diagnosed allergy was 0.2%/0.16% milk, 0.2%/0.14% peanuts, 0.13%/0.09% fish, 0.1%/0.09% sesame, 0.04%/0.015% egg, and 0.36%/0.28% tree nuts, respectively. On multivariable logistic regression analysis, male gender (adjusted odds ratio [OR] = 3.2, 95% confidence interval [CI]: 1.4-7.7), report of a common food allergen (OR = 3.6, 95% CI: 1.4-9.3), previous allergist evaluation for FA (OR = 7.8, 95% CI: 3-20.2), and FA reactions within the past 2 years (OR = 2.8, 95% CI: 1.2-6.7) were significantly identified as independent predictors of true FA. CONCLUSIONS: The prevalence of FA among Israeli young adults is lower than reported for other western countries. Reliance on food elimination alone does not accurately rule in FA. The use of the identified predictors for FA can facilitate large-scale epidemiological studies in adults.