High variability of body mass index independently linked to incident heart failure, reveals study

USA: In a groundbreaking study that may have profound implications for cardiovascular health, researchers have uncovered a significant association between high variability of body mass index (BMI) and heart failure (HF) incidence. This finding, published in the Journal of the American Heart Association, underscores the importance of maintaining stable body weight in mitigating the risk of developing this life-threatening condition.

The UK Biobank study analyzing data from over 99,000 participants revealed that higher variability in BMI is independently linked to a heightened heart failure risk.

“Over a median follow-up of 12.5 years, subjects with higher BMI variability showed an increased risk of HF incidence (HR: 1.05 – 1.07), independent of confounding factors and BMI change rate,” the researchers reported.

Longitudinal health records capture fluctuation in body mass index, which independently predicts the incidence of heart failure, the study stated.

Heart failure, a chronic and progressive condition characterized by the heart’s inability to pump blood efficiently, poses a significant public health challenge worldwide. While obesity has long been recognized as a major risk factor for heart failure, the impact of fluctuations in body weight on cardiovascular health has garnered increasing attention in recent years.

Against the above background, Chang Liu, Department of Epidemiology Emory University Rollins School of Public Health Atlanta GA, and colleagues aimed to investigate the association between BMI variability and incident HF.

In the UK Biobank, a prospective cohort was established after excluding participants with prevalent HF or cancer at enrollment. 99 368 White participants with ≥3 BMI measures during >2 years preceding enrollment were included, with a median follow-up of 12.5 years.

The within-participant variability of body mass index was evaluated using standardized SD and coefficient of variation. The association of BMI variability with incident HF was evaluated using Fine and Gray’s competing risk model, adjusting for confounding factors and participant-specific rate of BMI change.

The researchers found that higher BMI variability measured in both SD and coefficient of variation was significantly associated with higher risk in HF incidence (SD: hazard ratio [HR], 1.05; coefficient of variation: HR, 1.07).

The findings showed that BMI fluctuation is an independent predictor of heart failure incidence with consistent associations across risk factor subgroups.

The research underscores the need for exploring the mechanisms driving longitudinal BMI changes and their specific associations with heart failure subtypes.

“Future studies focusing on the underlying mechanisms and drivers of longitudinal body mass index change could lead to new insights into weight management strategies for heart failure prevention and intervention,” the researchers concluded.

Reference:

Liu C, Chiang Y, Hui Q, Zhou JJ, Wilson PWF, Joseph J, Sun YV. High Variability of Body Mass Index Is Independently Associated With Incident Heart Failure. J Am Heart Assoc. 2024 May 7;13(9):e031861. doi: 10.1161/JAHA.123.031861. Epub 2024 Apr 30. PMID: 38686888.

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Study Finds Association Between Lung Function and Incident Depression

China: In a groundbreaking study involving over 280,000 participants, researchers have discovered a significant association between lung function and the onset of depression. This prospective cohort study sheds light on the intricate biological pathways linking respiratory health to mental well-being.

The study, published in BMC Medicine, revealed that the higher risk of depression development was associated with impaired lung function. Moreover, the association might be mediated partially by biomarkers, including erythrocytes, systemic inflammation, and renal and liver function.

“In a cohort of patients with varying lung function assessed through values of forced vital capacity (FVC) and forced expiratory volume in 1 s (FEV1), and no previous depression, participants with the lowest lung function had increased depression levels versus individuals with better levels of lung function,” the researchers reported.

Lung health is increasingly being recognized as an important factor in mental health. However, there is a need to determine prospective evidence on lung function with incident depression. Considering this, Bao-Peng Liu, Cheeloo College of Medicine, Shandong University, Jinan, China, and colleagues aimed to examine the prospective association between impaired lung function and incident depression and the underlying biological mechanisms.

The prospective cohort study enrolled 280,032 non-depressed individuals with valid lung function measurements from the UK Biobank. Lung function assessment was done through FVC or FEV1. The associations between lung function and incident depression were estimated using Cox proportional hazard models. Mediation analyses were fitted to examine the potential mediating role of metabolites and biomarkers in the association.

The study led to the following findings:

· During a median follow-up of 13.91 years, 3.4% of participants developed depression.

· Individuals in the highest quartile had a lower risk of depression (FVC % predicted: HR = 0.880; FEV1% predicted: HR = 0.854) compared with those in the lowest quartile of the lung function indices.

· The restricted cubic splines suggested lung function indices had reversed J-shaped associations with incident depression.

· Impaired lung function yielded similar risk estimates (HR = 1.124).

· Biomarkers involving systemic inflammation, erythrocytes, and liver and renal function may be potential mediators in the lung function-depression association.

In conclusion, the study revealed an association between impaired lung function and an increased risk of developing depression. Regular lung function screening in routine practice holds the potential to identify at-risk populations and the development of personalized interventions, yielding profound public and clinical health implications.

“Our findings underscored that the biomarkers involving erythrocytes, systemic inflammation, and renal and liver function may partially mediate this association, but these mediation findings should be interpreted with caution due to potential temporal ambiguity,” the researchers wrote. “Further studies are warranted with repeatedly measured data to replicate our mediation findings.”

Reference:

Hu, W., Liu, BP. & Jia, CX. Association and biological pathways between lung function and incident depression: a prospective cohort study of 280,032 participants. BMC Med 22, 160 (2024). https://doi.org/10.1186/s12916-024-03382-3

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Cardiac myosin inhibitors coupled with recreational exercises effective option for HCM management, recommend new ACC guidelines

The American College of Cardiology (ACC) and the American Heart Association (AHA) today released a new clinical guideline for effectively managing individuals diagnosed with hypertrophic cardiomyopathy (HCM). The guideline reiterates the importance of collaborative decision-making with patients who have HCM and provides updated recommendations for the most effective treatment pathways for adult and pediatric patients.

HCM is an inherited cardiac condition most often caused by a gene mutation that makes the heart muscle too thick (hypertrophy), which impairs its ability to adequately pump blood throughout the body. HCM affects approximately 1 in every 500 individuals; however, a significant portion of cases remain undiagnosed because many people do not exhibit symptoms. Occasionally, the first time HCM is diagnosed is after a sudden death. People who do have symptoms may experience episodes of fainting, chest pain, shortness of breath or irregular heartbeats.

“Incorporating the most recent data, this new guideline equips clinicians with the latest recommendations for the treatment of HCM,” said Steve R. Ommen, MD, FACC, medical director of the Mayo Hypertrophic Cardiomyopathy Clinic and chair of the guideline writing committee. “We’re seeing more evidence that patients with HCM can return to their normal daily lives with proper care and management.”

Updated recommendations in the guideline reflect recent evidence about HCM treatment and management including new forms of pharmacologic management; participation in vigorous recreational activities and competitive sports; and risk stratification for sudden cardiac death (SCD) with an emphasis on pediatric patients.

The guideline includes recommendations for adding cardiac myosin inhibitors, a new class of medication for patients with symptomatic obstructive HCM who do not get adequate symptom relief from first-line drug therapy. Symptomatic obstructive HCM is a type of HCM where the heart muscle is restricted. Cardiac myosin inhibitors are the first FDA-approved class of medication to specifically target the thickening of the heart muscle instead of treating the symptoms, however they are monitored under the FDA’s Risk Evaluation and Mitigation Strategies (REMS) program, which may create additional steps and time for both the clinician and the patient. Clinicians require special training to prescribe the medication, and patients require regular screenings.

“These new drugs offer an alternative for patients who have failed first-line therapy and either want to delay or possibly avoid more aggressive options,” Ommen said. “With this guideline, we’re providing clinicians with point-of-care guidance about effectively using this first-in-class, evidence-based treatment option and improving their patients’ quality of life.”

In addition to medication treatment, growing evidence is showing that the benefits of exercise outweigh the potential risks for patients with HCM. Low to moderate intensity recreational exercise should be part of how HCM patients manage their overall health. For some HCM patients, competitive sports may be considered in consultation with HCM clinical specialists.

“Recommendations for physical activity continue to evolve with research,” Ommen said. “As part of a healthy lifestyle, patients with HCM are now encouraged to engage in low-to-moderate intensity physical activities. We’re seeing how vigorous physical activities can be reasonable for some individuals. With shared decision-making between the clinician and the patient, some patients may even be able to return to competitive sports.”

Poorly managed HCM may lead to many complications including SCD. The new guideline includes recommendations for assessing and managing the risk of SCD by establishing clear risk markers. Guidance for integrating risk markers with tools to estimate an individual patient’s SCD risk score is recommended to aid in the patient/clinician shared decision-making regarding implantable cardioverter defibrillator placement, incorporating a patient’s personal level of risk tolerance and specific treatment goals including quality of life.

Several recommendations in the new guideline extend to pediatric patients. A specific pediatric risk stratification for SCD is emphasized, with risk calculators specific to children and adolescents and stressing the importance of HCM centers with expertise in pediatrics. The new guideline extends exercise stress testing recommendations to include children diagnosed with HCM to help determine functional capacity and provide prognostic feedback.

The 2024 AHA/ACC/AMSSM/HRS/PACES/SCMR Guideline for the Management of Hypertrophic Cardiomyopathy is published simultaneously today in the Journal of the American College of Cardiology andJournal of the American College of Cardiology.

Reference:

Megan Coylewright, Morgane Cibotti-Sun, Mykela M. Moore, 2024 Hypertrophic Cardiomyopathy Guideline-at-a-Glance, Journal of the American College of Cardiology, 2024, https://doi.org/10.1016/j.jacc.2024.04.002.

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No separate preoperative Fasting Guidelines required for Diabetics to prevent perioperative pulmonary aspiration: Study

Researchers have found that people with diabetes do not have higher gastric volumes than those without diabetes after following standard preoperative fasting instructions. The study was published in the journal Anaesthesiology by Perlas and colleagues. The findings offer reassurance that standard fasting instructions are effective for both diabetic and nondiabetic patients.

Preoperative fasting guidelines are in place to minimize the risk of perioperative pulmonary aspiration. The prospective study examined the gastric contents of individuals with and without diabetes following standard fasting guidelines: stopping solids 8 hours before surgery and clear liquids 2 hours prior. Participants underwent gastric ultrasound assessments of their gastric volumes. The study examined 84 individuals with diabetes (85% with type 2) and 96 without diabetes, all undergoing elective surgery and found no significant differences in gastric volume or in the proportion with a “full stomach” based on the American Society of Anesthesiologists (ASA) guidelines.

The key findings of the study were as follows:

  • The mean gastric volume was 0.81 mL/kg in individuals with diabetes and 0.87 mL/kg in those without diabetes.

  • A “full stomach” designation, as per ASA guidelines, was seen in 15.5% of individuals with diabetes and 11.5% without diabetes, indicating a similar risk for both groups.

  • No significant difference in gastric volume between individuals with diabetes and those without after following preoperative fasting guidelines.

  • The proportion of individuals with a “full stomach” according to ASA guidelines was 15.5% for individuals with diabetes and 11.5% for those without.

  • The study reinforces the effectiveness of standard fasting guidelines in minimizing perioperative risks in diabetic and nondiabetic patients alike.

The study suggests that preoperative fasting instructions are effective in achieving empty stomachs for patients with diabetes and those without. However, there were some study limitations, including the exclusion of participants with a BMI > 40, limiting the generalizability of the findings.

The study did not include participants taking glucagon-like peptide-1 (GLP-1) receptor agonists, which have become a common treatment for type 2 diabetes and obesity. These medications delay gastric emptying and could pose a risk of perioperative aspiration. The new ASA guidelines recommend withholding daily-dosed GLP-1 agonists on the day of surgery and weekly formulations a week prior.

The study suggests that standard preoperative fasting guidelines are effective for people with diabetes, as they do not experience higher gastric volumes compared to nondiabetic individuals. This supports the practice of using the same fasting protocols for patients with diabetes, provided they do not exhibit symptoms of gastroparesis. The findings pave the way for further research into the impacts of medications like GLP-1 receptor agonists on perioperative risks and their interaction with fasting guidelines.

Reference:

Perlas, A., Xiao, M. Z. X., Tomlinson, G., Jacob, B., Abdullah, S., Kruisselbrink, R., & Chan, V. W. S. (2024). Baseline gastric volume in fasting diabetic patients is not higher than that in nondiabetic patients: A cross-sectional noninferiority study. Anesthesiology, 140(4), 648–656. https://doi.org/10.1097/aln.0000000000004815

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Tricuspid regurgitation velocity tied to kidney, cerebrovascular disease in children with sickle cell disease: Study

USA: A cross-sectional, multicenter study has shed light on a concerning association between elevated tricuspid regurgitation velocity (TRV) and the prevalence of cerebrovascular and kidney diseases in children diagnosed with sickle cell disease (SCD). The findings, published in Pediatric Blood & Cancer, underscore the importance of vigilant monitoring and early intervention strategies for pediatric patients grappling with this inherited blood disorder.

According to the study, approximately 1 in 5 children with sickle cell disease in two large clinical cohorts experienced elevated tricuspid regurgitation velocity, a surrogate marker for pulmonary hypertension.

Evidence from the study revealed pediatric patients with a history of cerebrovascular disease (CVD) and chronic kidney disease (CKD) showed a higher prevalence of abnormal TRV, indicating the need for an echocardiogram in clinical assessment.

Sickle cell disease, characterized by abnormal hemoglobin molecules in red blood cells, is known for its diverse array of complications, including organ damage and impaired blood flow. Among these complications, cerebrovascular and kidney diseases stand out due to their severity and potential long-term impact on patients’ health.

Tricuspid regurgitation velocity, measured by echocardiography, is a surrogate marker for pulmonary hypertension. Not many pediatric studies have considered the association between TRV and surrogate markers of end-organ disease.

Led by Chibuzo Ilonze, University of Alabama at Birmingham, Birmingham, Alabama, USA, the cross-sectional study evaluated the prevalence of elevated TRV ≥2.5 m/s and its associations with renal and cerebrovascular outcomes in children with SCD 1–21 years of age in two large sickle cell cohorts, the Sickle Cell Clinical Research and Intervention Program (SCCRIP) cohort, and the University of Alabama at Birmingham (UAB) sickle cell cohort at St. Jude Children’s Research Hospital.

The researchers hypothesized that patients with SCD and elevated TRV would have higher odds of having either persistent albuminuria or cerebrovascular disease.

The study revealed the following findings:

  • One hundred and sixty-six children from the UAB cohort (mean age: 13.49 ± 4.47 years) and 325 children from the SCCRIP cohort (mean age: 13.41 ± 3.99 years) were identified with echocardiograms.
  • The prevalence of an elevated TRV was 21% in both UAB and SCCRIP cohorts.
  • Elevated TRV was significantly associated with cerebrovascular disease (odds ratio [OR] 1.88) and persistent albuminuria (OR 1.81) after adjusting for age, sex, treatment, and site.

In conclusion, the researchers showed that elevated TRV is associated with a history of CVD and albuminuria. The findings suggest that adolescent patients may benefit from universal echocardiography performed at a steady state if they have been identified with either cerebrovascular disease or albuminuria.

As the medical community continues to unravel the complexities of sickle cell disease, studies like this serve as critical milestones in advancing our understanding of its pathophysiology and informing evidence-based strategies for patient management. Moving forward, concerted efforts are warranted to integrate these findings into clinical practice guidelines and enhance the holistic care provided to children battling this chronic condition.

“Future prospective studies are needed to determine if children with surrogate makers of cardio-renal or cardiac-CVD disease are at risk of increased morbidity such as exercise intolerance, poor quality of life, and early mortality,” the researchers wrote.

Reference:

Ilonze, C., Rai, P., Galadanci, N., Zahr, R., Okhomina, V. I., Kang, G., Padmanabhan, D., Lebensburger, J., & Alishlash, A. S. Association of elevated tricuspid regurgitation velocity with cerebrovascular and kidney disease in children with sickle cell disease. Pediatric Blood & Cancer, e31002. https://doi.org/10.1002/pbc.31002

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Lidocaine gel useful anesthetic technique for nonsurgical periodontal therapy: Study

Lidocaine gel useful anesthetic technique for nonsurgical periodontal therapy in patients averse to injections suggests a study published in the Journal of Periodontology.

A study was done to compare acceptance and preference of topical lidocaine gel anesthesia with articaine injection anesthesia in patients with moderate periodontitis undergoing scaling and root debridement. Ninety-one patients completed this randomized multicenter split-mouth controlled study and underwent two separate periodontal treatment sessions on different days, one with a topical intrapocket lidocaine gel application and the other with an articaine injection anesthesia in a different order depending on randomization. Parameters measured were the patients’ preference for topical lidocaine gel anesthesia or injection anesthesia with articaine (primary efficacy criterion), their maximum and average pain, and their intensity of numbness as well as experience of side effects; the probing depth; and the dentists’ preference and their evaluations of handling/application, onset and duration of anesthetic effect, and patient compliance. Results: After having experienced both alternatives, 58.3% of the patients preferred the topical lidocaine gel instillation into the periodontal pockets. The safety profile of the lidocaine gel differed positively from the safety profile of articaine injection in type and frequency of adverse drug reactions. The dentistsʼ acceptance and preference regarding either anesthetic method studied were balanced. Instillation of lidocaine gel into the periodontal pocket is a preferred alternative to injection anesthesia for most of the patients and an equivalent alternative for dentists in nonsurgical periodontal therapy.

Reference:

Dörfer C, Chmiela K, Arweiler NB, Petersilka GJ, Dommisch H. Evaluation of acceptance and preference of topical lidocaine application versus articaine injection anesthesia after nonsurgical periodontal treatment: A randomized clinical trial. J Periodontol. 2023; 1-11. https://doi.org/10.1002/JPER.23-0466

Keywords:

Lidocaine gel, useful, anesthetic, technique, nonsurgical, periodontal, therapy, patients, averse, injections, study, Dörfer C, Chmiela K, Arweiler NB, Petersilka GJ, Dommisch H.

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Both targeted and whole-body NB-UVB are effective treatment options for acral vitiligo patients: Study

India: In a groundbreaking development in acral vitiligo treatment, a split-body randomized controlled trial has demonstrated the efficacy of whole-body and targeted narrowband ultraviolet B (NB-UVB) phototherapy. The trial, conducted by a team of dermatologists, reveals promising results in stabilizing acral vitiligo with minimal repigmentation beyond the wrists and ankles.

Both whole-body and targeted NB-UVB are effective treatment options for patients with acral vitiligo; however, the feet and hands are more resistant to treatment, the study stated.

“At the end of the treatment, over 50% repigmentation was achieved in 42.2% of the limbs in the whole-body phototherapy group and 37.5% of the limbs in the targeted phototherapy group. There was no repigmentation in any of the lesions distal to the ankle and wrist in both groups,” the researchers reported.

Vitiligo, a chronic skin condition characterized by depigmentation, affects millions worldwide, causing significant psychological and emotional distress for those afflicted. Acral vitiligo, specifically involving the extremities such as hands and feet, presents unique challenges due to its resistance to traditional treatments.

In vitiligo, narrowband ultraviolet B phototherapy promotes stability and repigmentation. No studies have compared targeted NB-UVB with whole-body NB-UVB treating acral vitiligo. Therefore, Keshavamurthy Vinay, Post Graduate Institute of Medical Education and Research, Chandigarh, India, and colleagues aimed to compare whole-body NB-UVB with targeted NB-UVB in inducing stability and repigmentation in acral vitiligo.

For this purpose, the researchers recruited thirty-two patients with bilaterally symmetrical acral vitiligo lesions (distal to elbows and knees). Patients received whole-body NB-UVB treatment, with one foot and one hand shielded until knee and elbow followed by targeted NB-UVB treatment on the shielded side.

Patients were assessed at intervals of 4 weeks for 24 weeks using Vitiligo Skin Activity Score (VSAS), Vitiligo Disease Activity (VIDA) score, Vitiligo Area Scoring Index (determined through fingertip method, using the method for calculating facial-VASI), and degree of repigmentation.

The researchers reported the following findings:

  • After 12 weeks, 87.5% of patients achieved a VIDA score of 3, with none having active disease at 24 weeks.
  • Over 50% repigmentation was observed in 42.2% and 37.5% of limbs in whole-body and targeted groups, respectively.
  • No improvement in F-VASI scores of hands and feet (distal to wrist and ankles) was noted with either modality over the 24 weeks.

In conclusion, the study showed comparable repigmentation rates between whole-body and targeted narrowband ultraviolet B groups. The limited effectiveness of phototherapy in the repigmentation of feet and hands underscores an important therapeutic gap.

Reference:

Thind, A., Vinay, K., Mehta, H., Bishnoi, A., Kumaran, M. S., & Parsad, D. (2024). Whole-body and targeted narrowband ultraviolet B phototherapy effectively stabilize acral vitiligo with negligible repigmentation beyond wrists and ankles: Results from a split-body randomized controlled trial. Photodermatology, Photoimmunology & Photomedicine, 40(2), e12960. https://doi.org/10.1111/phpp.12960

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Higher olive oil intake associated with lower risk of dementia-related death: JAMA

Researchers have found that higher olive oil intake is associated with a significantly lower risk of dementia-related mortality. This study was published in the journal JAMA Network Open by Tessier and colleagues. According to a prospective study of over 90,000 healthcare professionals. Consuming at least 7 g of olive oil daily—about half a tablespoon—was linked to a 28% reduction in the risk of dementia-related death compared with individuals who never or rarely consumed olive oil over a 28-year follow-up period.

Dementia is a complex condition often characterized by gradual onset and slow progression, making it challenging to study dementia-related mortality. Olive oil, a key component of the Mediterranean diet, has been shown to have anti-inflammatory and neuroprotective properties due to its high content of monounsaturated fatty acids, vitamin E, and polyphenols. This study aimed to investigate the relationship between olive oil intake and dementia-related mortality.

The study analyzed data from 60,582 women in the Nurses’ Health Study and 31,801 men in the Health Professionals Follow-up Study from 1990 to 2018. Participants were free of cardiovascular disease and cancer at baseline and reported their olive oil intake on food frequency questionnaires every four years. Scores on the Alternative Healthy Eating Index and alternative Mediterranean diet scale were used to assess overall diet quality.

The key findings of the study were as follows:

  • Over the 28 years of follow-up, 4,751 dementia-related deaths occurred. Participants with higher olive oil intake had significantly lower dementia-related mortality.

  • Consuming at least 7 g of olive oil daily was associated with an adjusted 28% lower risk of dementia-related death (HR 0.72, 95% CI 0.64-0.81).

  • The relationship between olive oil intake and dementia-related death was significant for women (adjusted HR 0.67, 95% CI 0.59-0.77) but not men (HR 0.87, 95% CI 0.69-1.09).

  • Replacing 5 g of margarine or mayonnaise with olive oil daily was associated with an 8-14% lower risk of dementia mortality.

  • Substitutions for other vegetable oils or butter were not significant.

  • The association remained consistent even after adjusting for the presence of an APOE4 allele (adjusted HR comparing high vs. low olive oil intake of 0.66, 95% CI 0.54-0.81; P for trend <0.001).

This study suggests that higher olive oil intake is associated with a lower risk of dementia-related mortality. Olive oil’s potential benefits may be related to its positive effects on vascular health and anti-inflammatory properties. Further research may be needed to better understand the relationship between diet and dementia, but these findings support current dietary guidelines recommending olive oil consumption for overall health, including brain-related health.

Reference:

Tessier, A.-J., Cortese, M., Yuan, C., Bjornevik, K., Ascherio, A., Wang, D. D., Chavarro, J. E., Stampfer, M. J., Hu, F. B., Willett, W. C., & Guasch-Ferré, M. (2024). Consumption of Olive oil and diet quality and risk of dementia-related death. JAMA Network Open, 7(5), e2410021. https://doi.org/10.1001/jamanetworkopen.2024.10021

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Antioxidant-rich diets may improve outcomes in Endometriosis-related rheumatoid arthritis in women: Study

Antioxidant-rich diets may improve outcomes in Endometriosis-related rheumatoid arthritis in women suggests a study published in the International Journal of Women’s Health.

A study was done to evaluate the association between the Composite Dietary Antioxidant Index (CDAI) and the risk of endometriosis (EM)-related rheumatoid arthritis (RA) in women of childbearing age. Using the data from the National Health and Nutrition Examination Survey database, this cross-sectional study included women of childbearing age. The CDAI was obtained by summing the standardized Z-values of the dietary intakes. EM was diagnosed based on a questionnaire-based survey. The outcome of this study was the presence of RA, which was defined by a questionnaire. The associations of CDAI and EM with the risk of RA were determined using weighted logistic analysis. Additive interaction was evaluated using the relative excess risk due to interaction (RERI), the attributable proportion due to interaction (AP), and the synergy index (S). Results: In total, 3803 patients were included, of which 74 patients (1.99%) were with RA. A lower CDAI [odds ratio (OR): 1.85, 95% confidence interval (CI): 1.12 to 3.04, P= 0.015] and the presence of EM (OR: 3.05, 95% CI: 1.19 to 7.81, P= 0.023) was associated with the risk of RA. The result demonstrated an additive interaction of a lower CDAI and the presence of EM on the risk of RA (OR: 6.19, 95% CI: 2.33 to 16.43, P < 0.001, P of trend =0.007). Nevertheless, there was no significant additive interaction after being assessed by the RERI, AP, and S. However, a joint effect of a lower CDAI and EM on the risk of RA (OR: 3.94, 95% CI: 1.35 to 11.51, P= 0.013) was observed. The study identified EM, and lower CDAI, was related to the risk of RA. Lower CDAI score was also associated with the risk of EM-related RA. This study indicates the importance of antioxidant intake in daily diet for the management of EM-related RA.

Reference:

Hu H, Wang X, Ren Y, Zhang T, Sun L. Association Between Composite Dietary Antioxidant Index and the Risk of Endometriosis-Related Rheumatoid Arthritis in Women of Childbearing Age: A Cross-Sectional Study Based on the National Health and Nutrition Examination Survey Database. Int J Womens Health. 2024;16:717-726

https://doi.org/10.2147/IJWH.S453602

Keywords:

Antioxidant-rich, diets, improve, outcomes, Endometriosis-related, rheumatoid arthritis, women, study,composite dietary antioxidant index, endometriosis, International Journal of Women’s Health, arthritis, cross-sectional study, Hu H, Wang X, Ren Y, Zhang T, Sun L.

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KDIGO Releases 2024 Clinical Practice Guideline for Chronic Kidney Disease Evaluation and Management

USA: In a significant stride towards enhancing the quality of care for individuals living with chronic kidney disease (CKD), the Kidney Disease: Improving Global Outcomes (KDIGO) initiative has unveiled its latest clinical practice guideline for CKD evaluation and management. This eagerly anticipated guideline, released in 2024 and published in Kidney International, consolidates the latest evidence-based recommendations to guide healthcare professionals in delivering optimal care for CKD patients worldwide.

Chronic kidney disease poses a substantial public health challenge, affecting millions of individuals globally and imposing a significant burden on healthcare systems. Despite advances in CKD research and management, significant variations in clinical practice persist, highlighting the need for standardized guidelines to promote consistency and excellence in care delivery.

Led by a multidisciplinary panel of renowned experts in nephrology, the KDIGO 2024 guideline represents a comprehensive synthesis of the most up-to-date evidence and clinical insights in the field. Drawing upon rigorous systematic reviews and meta-analyses, the guideline offers practical recommendations across the spectrum of CKD evaluation, diagnosis, and management.

Furthermore, the guideline offers clear recommendations for the management of CKD complications and comorbidities, including hypertension, diabetes, and cardiovascular disease. By addressing these modifiable risk factors comprehensively, healthcare providers can mitigate the progression of CKD and reduce the burden of associated complications, ultimately improving patient outcomes and quality of life. The key recommendations are given below:

Evaluation of CKD

  • In adults at risk for CKD, we recommend using a creatinine-based estimated glomerular filtration rate (eGFRcr). If cystatin C is available, the GFR category should be estimated from the combination of creatinine and cystatin C (creatinine and cystatin C–based estimated glomerular filtration rate [eGFRcr-cys]).
  • The researchers suggest performing a kidney biopsy as an acceptable, safe, diagnostic test to evaluate cause and guide treatment decisions when clinically appropriate.
  • The researchers recommend using eGFRcr-cys in clinical situations when eGFRcr is less accurate, and GFR affects clinical decision-making.
  • Using a validated GFR estimating equation to derive GFR from serum filtration markers (eGFR) rather than relying on the serum filtration markers alone.
  • The researchers suggest that point-of-care testing (POCT) may be used for creatinine and urine albumin measurement where access to a laboratory is limited or providing a test at the point-of-care facilitates the clinical pathway.

Risk assessment in people with CKD

  • In people with CKD G3–G5, we recommend using an externally validated risk equation to estimate the absolute risk of kidney failure.

Delaying CKD progression and managing its complications

  • The researchers recommend that people with CKD be advised to undertake moderate-intensity physical activity for a cumulative duration of at least 150 minutes per week, or to a level compatible with their cardiovascular and physical tolerance.
  • Maintaining a protein intake of 0.8 g/kg body weight/d in adults with CKD G3–G5 is suggested.
  • The researchers suggest that sodium intake be < 2g of sodium per day (or < 90 mmol of sodium per day, or < 5 g of sodium chloride per day) in people with CKD.
  • The researchers suggest that adults with high BP and CKD be treated with a target systolic blood pressure (SBP) of < 120 mm Hg, when tolerated, using standardized office BP measurement.
  • The researchers suggest that in children with CKD, 24-hour mean arterial pressure (MAP) by ambulatory blood pressure monitoring (ABPM) should be lowered to £50th percentile for age, sex, and height.
  • The team recommends starting renin-angiotensin-system inhibitors (RASi) (angiotensin-converting enzyme inhibitor [ACEi] or angiotensin II receptor blocker [ARB]) for people with CKD and severely increased albuminuria (G1–G4, A3) without diabetes.
  • Starting RASi (ACEi or ARB) for people with CKD and moderately increased albuminuria (G1–G4, A2) without diabetes is suggested.
  • Starting RASi (ACEi or ARB) for people with CKD and moderately to severely increased albuminuria (G1–G4, A2 and A3) with diabetes is recommended.
  • The team recommends avoiding any combination of ACEi, ARB, and direct renin inhibitor (DRI) therapy in people with CKD, with or without diabetes.
  • Not using agents to lower serum uric acid in people with CKD and asymptomatic hyperuricemia to delay CKD progression, is recommended.
  • The team recommends people with CKD and symptomatic hyperuricemia should be offered uric acid–lowering intervention.
  • In adults with T2D and CKD who have not achieved individualized glycemic targets despite the use of metformin and SGLT2 inhibitor treatment, or who are unable to use those medications, we recommend a long-acting GLP-1 RA.
  • The researchers recommend non–vitamin K antagonist oral anticoagulants (NOACs) in preference to vitamin K antagonists (e.g., warfarin) for thromboprophylaxis in atrial fibrillation in people with CKD G1–G4.
  • They suggest that in stable stress-test confirmed ischemic heart disease, an initial conservative approach using intensive medical therapy is an appropriate alternative to an initial invasive strategy.
  • They recommend oral low-dose aspirin for the prevention of recurrent ischemic cardiovascular disease events (i.e., secondary prevention) in people with CKD and established ischemic cardiovascular disease.
  • They suggest not using agents to lower serum uric acid in people with CKD and asymptomatic hyperuricemia to delay CKD progression.
  • They recommend people with CKD and symptomatic hyperuricemia should be offered uric acid–lowering intervention.

As healthcare systems worldwide grapple with the challenges posed by the rising prevalence of CKD, the release of the KDIGO 2024 clinical practice guideline heralds a new era of evidence-based, patient-centered care for individuals affected by this chronic condition. By adhering to these recommendations, healthcare professionals can strive towards achieving optimal outcomes and improving the lives of CKD patients on a global scale.

In conclusion, the KDIGO 2024 clinical practice guideline for CKD evaluation and management represents a milestone achievement in nephrology, offering a roadmap for healthcare providers to navigate the complexities of CKD care with confidence and competence. As implementation efforts gain momentum, the guideline has the potential to revolutionize CKD management practices and pave the way for a brighter future for individuals living with this challenging condition.

Reference:

Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group. KDIGO 2024 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. Kidney Int. 2024;105(4S):S117–S314.

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