Objective: The insulin-like growth factor (IGF) system has been implicated in the aetiopathogenesis of cancer, cardiovascular disease and diabetes. Since dietary factors and ethnicity are considered contributory to the development of these diseases, we examined the IGF system in relation to nutritional intake by ethnic group. Design, subjects and setting: Dietary intake in 257 subjects of White European, African-Caribbean and Pakistani ethnic origin living in Manchester, UK was assessed using ethnic-group-specific food-frequency questionnaires to assess habitual nutrient intake over the previous 12 months. Fasting IGF-I, IGF-II and IGF-binding protein-1 (IGFBP-1) concentrations were determined and their relationship to specific dietary constituents was analysed. Results: Analysis by quintiles of nutrient intake showed a significant increase in circulating IGF-I concentration with increasing dietary fat intake (F for trend ¼ 3.9, P , 0:01), saturated fat intake ðF ¼ 3:3; P ¼ 0:01Þ and for protein intake ðF ¼ 4:2; P , 0:01Þ: There was also a significant increase in IGF-II by quintiles of dietary protein intake ðF ¼ 2:7; P , 0:05Þ: There was a trend for increasing IGF-I with increasing energy intake. The relationships between circulating concentration of IGFBP-1, an acute regulator of IGF action, and fat/protein intake were opposite to those for IGF-I and IGF-II. Multiple linear regression modelling showed that people of Pakistani origin and older subjects had lower levels of IGF-I (Pakistani origin vs. others, P , 0:001) (age, P , 0:001 for both). There was an independent inverse relationship between IGF-I and dietary carbohydrate intake ðP ¼ 0:036Þ: Conclusions: This study provides evidence for a dietary contribution to regulation of the IGF system, although the effects of ethnicity on circulating IGF levels remain dominant. We propose that the IGF system's influences on cancer risk in specific ethnic groups are potentially modifiable by dietary intervention.

Candida spp. is associated with two distinctive patterns of protracted ulceration in diabetic feet which improve following systemic antifungal therapy. Diabet. Med. 18, 567-572 (2001)

Background: The insulin-like growth factor (IGF) system is implicated in the pathogenesis of diabetes and cardiovascular disease. Objective: We report the effects of total energy intake on the IGF system in two populations with markedly different dietary macronutrient intake and cardiovascular event rate. Design, subjects and setting: Dietary macronutrient intake was measured in a specific Gujarati migrant community in Sandwell, UK (n ¼ 205) compared with people still resident in the same villages of origin in India (n ¼ 246). Fasting IGF-I, IGF-binding protein (IGFBP)-1 and IGFBP-3, insulin and glucose (0 and 2-hour) were measured. Results: Total energy and total fat intake were higher in UK migrants, as were IGFBP-3 and IGF-I (mean (95% confidence interval): 145.9 (138.1 -153.6) vs. 100.9 (94.6-107.3) ng ml