Reviews & Analysis

Glucocorticoids can be given during pregnancy to develop lungs of babies at risk of preterm birth but the long-term effects could be detrimental to the child. A new study shows that term-born children from mothers treated with glucocorticoids during pregnancy had increased cortisol stress responses at 6–11 years of age, which were more pronounced in girls than boys.

In 2006, New York City (NYC) passed a pioneering law restricting the use of trans fat in chain restaurants. By carefully evaluating its policy experiment, NYC demonstrated the potential power of legal approaches to combat cardiovascular disease.

Short and long menstrual cycles have been associated with an increased risk of chronic diseases. Menstrual cycle length seems to be determined by the underlying hormonal profile—but could cycle length be a reliable indicator of hormone perturbations and disease risk in healthy regularly menstruating women?

Pregnancy has a considerable effect on maternal thyroid function. In this Review, the pros and cons of universal screening for thyroid disease during pregnancy versus targeted case finding are discussed and the changes in thyroid function that occur during pregnancy are detailed. Accordingly, best-practice guidance for thyroid function testing and treatment of hypothyroidism, hyperthyroidism and thyroid autoimmune disease during pregnancy are provided. In addition, an algorithm for diagnosing, monitoring and treating women who develop postpartum thyroiditis is provided.

Experimental and animal data suggest that maternal obesity adversely affects offspring health, but effects in humans are less clear. This Review evaluates the evidence for a causal effect of maternal increased adiposity and gestational weight gain on perinatal and long-term offspring outcomes in humans and explores the possible contribution of epigenetic modifications.

Early life experiences can affect cardiovascular risk and influence the development of metabolic problems later in life. In this Perspectives article, Gerthe Kerkhof and Anita Hokken-Koelega discuss how rapid weight gain in relation to length increase during the first few months of life can lead to an increased risk of obesity, diabetes mellitus and cardiovascular problems in adults.

MEN1 is a syndrome with a complex nature and specific international clinical practice guidelines outlining standards of care have been developed. Genetic testing is recommended for patients with MEN1 and their families; however, the ethical, social, psychological and financial implications of such tests should be taken into account.

A recent cohort study of gastric bypass surgery at US Veterans Affairs medical centres found that health-care expenditure was not reduced in the 3 years following surgery. Several earlier studies have reported savings, but should return on investment guide decision making in chronic disease management?

Normal gestation is characterized by dramatic changes in a number of endocrine systems and particularly by activation of the renin–angiotensin–aldosterone system and the hypothalamic–pituitary–adrenal axis. This Review provides an overview of adrenal steroid metabolism during pregnancy, focusing on diagnosis and treatment of the most common fetal and maternal adrenal disorders.

Pregnant women with type 1 diabetes mellitus have an increased risk of adverse pregnancy outcomes. This Review discusses the importance of preconception counselling and careful monitoring of glucose levels, and describes the use of insulin analogues to maintain tight glycaemic control from pregnancy planning through to breastfeeding.

The US Preventive Services Task Force has concluded that screening adults for obesity and offering them intensive, multicomponent behavioural interventions is beneficial. Although welcome, given the current obesity epidemic, are the recommendations too little too late?

In this Review, the possibilities for utilizing GLP-1 receptor agonists in individualized treatment for type 2 diabetes mellitus are discussed. The currently available compounds are evaluated in terms of their efficacy, duration of action and adverse effects. The feasibility of selecting a treatment option on the basis of an individual's clinical parameters and requirements is also touched upon.

Clinicians are responsible for selecting a suitable second-line treatment for patients with type 2 diabetes mellitus when metformin monotherapy fails. New evidence could aid clinicians in deciding between one of the most commonly used second-line agents, glimepiride, and the recently approved dipeptidyl peptidase 4 inhibitor linagliptin.

Vitamin D supplementation can reduce fracture risk. However, the risk reduction is minimal, and existing trials and meta-analyses of the effect of vitamin D on fracture risk have several limitations, mainly owing to lack of placebo groups for comparison or use of calcium, which could also affect fracture risk, as control.

Are high body iron stores associated with an increased risk of type 2 diabetes mellitus? Researchers from Germany suggest such an association exists, but in this population-based study, most participants had a serum ferritin level within the reference range. Furthermore, many factors contribute to serum ferritin level.

Clinical assessment of the hypothalamic–pituitary–adrenal axis relies on measuring total serum cortisol levels. However, most circulating cortisol is bound to carrier proteins and only free cortisol is biologically available. This Review examines factors that regulate peripheral and tissue glucocorticoid bioavailability and highlights specific clinical indications for the measurement of bioavailable glucocorticoids.

Smoking is a risk factor for Graves disease. However, Carlé et al. have demonstrated that individuals have a transient increased risk of developing overt autoimmune hypothyroidism in the first 2 years after quitting smoking. The mechanisms involved in these two opposing effects of smoking on the immune system are intriguing.

Acromegaly is caused by a growth-hormone-secreting pituitary adenoma. Mutations in the AIP gene predispose patients to young-onset pituitary adenomas that are resistant to somatostatin analogue therapy. Chalal et al. describe a potential mechanism by which AIP modulates responsiveness to somatostatin analogues and identify PLAGL1 as a potential modulator of therapeutic activity.

Type 2 diabetes mellitus (T2DM) is a major public health problem. However, few clinicians screen routinely to detect this problem early or manage hyperglycaemia aggressively if it is found. As even transient normalization of glucose levels in prediabetes reduces the risk of developing T2DM, these practices should change.

Obesity is a key feature of the metabolic syndrome and increased adiposity has been associated with inflammation in the visceral compartment. In this Review, the authors describe inflammatory processes that occur in adipose tissue, focussing on how adaptive immune system cells promote inflammation.