Smart insulin pens promising in diabetes management: Study shows link between treatment adherence and CGM outcomes

Germany: In the realm of diabetes management, the integration of technology has revolutionized treatment approaches, offering patients innovative solutions to monitor and control their condition better. A recent study investigating the association between treatment adherence and continuous glucose monitoring (CGM) outcomes among individuals with diabetes utilizing smart insulin pens in real-world settings has unveiled promising insights into the efficacy of these devices.

The combined analysis of real-world smart pen and CGM data revealed that missing two basal or four bolus insulin doses over 14 days would be tied with a clinically relevant reduction in time in range (TIR). Smart insulin pens provide valuable insights into treatment injection behaviors.

“Adults with diabetes receiving basal and bolus insulin through a smart pen miss about six doses every 14 days,” the researchers reported in Diabetes Care. Each missed basal or bolus insulin dose is tied to a reduction in time in range.”

Thomas Danne, Hanover Medical School, Hanover, Germany, and colleagues aimed to evaluate the association of insulin injection adherence, smart insulin pen engagement, and glycemic control using real-world data from 16 countries from adults self-administering basal insulin degludec and bolus insulin with a smart insulin pen (NovoPen 6 or NovoPen Echo Plus) alongside CGM.

For this purpose, data aggregation was done over 14-day periods. Treatment adherence was defined according to the number of missed basal and missed bolus insulin doses and smart pen engagement as per the number of days with data uploads.

The researchers analyzed data from 3,945 adults, including 25,157 14-day periods with ≥70% CGM coverage.

The researchers reported the following findings:

  • On average, 0.2 basal and 6.0 bolus insulin doses were missed over 14 days.
  • The estimated probability of missing at least one basal insulin dose over 14 days was 17.6%.
  • Missing one basal or bolus insulin dose per 14 days was associated with a significant decrease in the percentage of time with glucose levels in range (TIR) of −2.8% and −1.7%, respectively; therefore, missing two basal or four bolus doses would decrease TIR by >5%.
  • Smartpen engagement was associated positively with glycemic outcomes.

The integration of smart insulin pens into routine diabetes management regimens holds promise for optimizing treatment adherence and ultimately improving glycemic control. As technology continues to evolve, studies such as these contribute valuable insights that pave the way for advancements in diabetes care, offering hope for a future where individuals can better manage their condition and enjoy improved quality of life.

Reference:

Thomas Danne, Michael Joubert, Niels Væver Hartvig, Anne Kaas, Nikoline Nygård Knudsen, Julia K. Mader; Association Between Treatment Adherence and Continuous Glucose Monitoring Outcomes in People With Diabetes Using Smart Insulin Pens in a Real-World Setting. Diabetes Care 2024; dc232176. https://doi.org/10.2337/dc23-2176

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Consumption of certain food additive emulsifiers associated with risk of developing type 2 diabetes: Study

In Europe and North America, 30 to 60% of dietary energy intake in adults comes from ultra-processed foods. An increasing number of epidemiological studies suggest a link between higher consumption levels of ultra-processed foods with higher risks of diabetes and other metabolic disorders.

Emulsifiers are among the most commonly used additives. They are often added to processed and packaged foods such as certain industrial cakes, biscuits and desserts, as well as yoghurts, ice creams, chocolate bars, industrial breads, margarines and ready-to-eat or ready-to-heat meals, in order to improve their appearance, taste and texture and lengthen shelf life. These emulsifiers include for instance mono- and diglycerides of fatty acids, carrageenans, modified starches, lecithins, phosphates, celluloses, gums and pectins.

As with all food additives, the safety of emulsifiers had been previously evaluated by food safety and health agencies based on the scientific evidence that was available at the time of their evaluation. However, some recent studies suggest that emulsifiers may disrupt the gut microbiota and increase the risk of inflammation and metabolic disruption, potentially leading to insulin resistance and the development of diabetes.

For the first time worldwide, a team of researchers in France has studied the relationships between the dietary intakes of emulsifiers, assessed over a follow-up period of maximum 14 years, and the risk of developing type 2 diabetes in a large study in the general population.

The results are based on the analysis of data from 104 139 adults in France (average age 43 years; 79% women) who participated in the NutriNet-Santé web-cohort study (see box below) between 2009 and 2023.

The participants completed at least two days of dietary records, collecting detailed information on all foods and drinks consumed and their commercial brands (in the case of industrial products). These dietary records were repeated every six months for 14 years, and were matched against databases in order to identify the presence and amount of food additives (including emulsifiers) in the products consumed. Laboratory assays were also performed in order to provide quantitative data. This allowed a measurement of chronic exposure to these emulsifiers over time.

During follow-up, participants reported the development of diabetes (1056 cases diagnosed), and reports were validated using a multi-source strategy (including data on diabetes medication use). Several well-known risk factors for diabetes, including age, sex, weight (BMI), educational level, family history, smoking, alcohol and levels of physical activity, as well as the overall nutritional quality of the diet (including sugar intake) were taken into account in the analysis.

After an average follow-up of seven years, the researchers observed that chronic exposure – evaluated by repeated data – to the following emulsifiers was associated with an increased risk of type 2 diabetes:

  • carrageenans (total carrageenans and E407; 3% increased risk per increment of 100 mg per day)
  • tripotassium phosphate (E340; 15% increased risk per increment of 500 mg per day)
  • mono- and diacetyltartaric acid esters of mono- and diglycerides of fatty acids (E472e; 4% increased risk per increment of 100 mg per day)
  • sodium citrate (E331; 4% increased risk per increment of 500 mg per day)
  • guar gum (E412; 11% increased risk per increment of 500 mg per day)
  • gum arabic (E414; 3% increased risk per increment of 1000 mg per day)
  • xanthan gum (E415; 8% increased risk per increment of 500 mg per day)

This study constitutes an initial exploration of these relationships, and further investigations are now needed to establish causal links. The researchers mentioned several limitations of their study, such as the predominance of women in the sample, a higher level of education than the general population, and generally more health-promoting behaviours among the NutriNet-Santé study participants. Therefore caution is needed when extrapolating the conclusions to the entire French population.

The study is nevertheless based on a large sample size, and the researchers have accounted for a large number of factors that could have led to confounding bias. They also used unique, detailed data on exposure to food additives, down to the commercial brand name of the industrial products consumed. In addition, the results remain consistent through various sensitivity analyses, which reinforces their reliability.

‘These findings are issued from a single observational study for the moment, and cannot be used on their own to establish a causal relationship. They need to be replicated in other epidemiological studies worldwide, and supplemented with toxicological and interventional experimental studies, to further inform the mechanisms linking these food additive emulsifiers and the onset of type 2 diabetes. However, our results represent key elements to enrich the debate on re-evaluating the regulations around the use of additives in the food industry, in order to better protect consumers,’ explain Mathilde Touvier, Research Director at Inserm, and Bernard Srour, Junior Professor at INRAE, lead authors of the study.

Among the next steps, the research team will be looking at variations in certain blood markers and the gut microbiota linked to the consumption of these additives, to better understand the underlying mechanisms. The researchers will also look at the health impact of additive mixtures and their potential ‘cocktail effects.’ They will also work in collaboration with toxicologists to test the impact of these exposures in in vitro and in vivo experiments, to gather more arguments in favour of a causal link.

Reference:

Clara Salame, Guillaume Javaux, Laury Sellem, Emilie Viennois, Fabien Szabo de Edelenyi, Cédric Agaësse, Food additive emulsifiers and the risk of type 2 diabetes: analysis of data from the NutriNet-Santé prospective cohort study, The Lancet Diabetes & Endocrinology, https://doi.org/10.1016/S2213-8587(24)00086-X.

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ECG Abnormalities common in Hypokalemia but poor predictors of acute illness and short-term mortality: Study

Denmark: A recent multicenter cohort study has shed light on the prevalence and prognostic significance of electrocardiographic (ECG) abnormalities in patients with hypokalemia. The study, conducted across multiple medical centers, underscores the importance of vigilant monitoring and proactive management of electrolyte imbalances to mitigate potential cardiac complications.

The study published in the Journal of Internal Medicine found ECG abnormalities common in hypokalemic patients. However, they are poor predictors of acute illness and short-term mortality under the current standard of care.

Hypokalemia, characterized by low levels of potassium in the blood, is a common electrolyte disorder with diverse etiologies ranging from gastrointestinal losses to renal disorders and medication side effects. While its clinical manifestations vary widely, cardiac involvement represents a significant concern due to the critical role of potassium in maintaining myocardial excitability and contractility.

Helene Kildegaard, University of Southern Denmark, Odense, Denmark, and colleagues aimed to determine the prevalence and prognostic value of ECG abnormalities in hypokalemic patients in a multicentered cohort study.

The study included all adult patients with an ECG and potassium level <4.4 mmol/L recorded at arrival to four emergency departments (ED) in Denmark and Sweden. The researchers investigated the relationship between potassium levels and heart rate, QRS duration, corrected QT (QTc) interval, ST-segment depressions, T-wave flattening, and T-wave inversion using computerized measurements from ECGs. Within strata of potassium levels, they further estimated the hazard ratio (HR) for 7-day mortality, ventricular arrhythmia or cardiac arrest diagnosis, and admission to the intensive care unit (ICU). They compared patients with and without specific ECG abnormalities matched 1:2 on propensity scores.

The study led to the following findings:

  • Among 79,599 included patients, decreasing potassium levels were associated with a concentration-dependent increase in all investigated ECG variables.
  • ECG abnormalities were present in 40% of hypokalemic patients ([K+] <3.5 mmol/L), with T-wave flattening, ST-segment depression, and QTc prolongation occurring in 27%, 16%, and 14%.
  • In patients with mild hypokalemia ([K+] 3.0–3.4 mmol/L), a heart rate >100 bpm, ST-depressions, and T-wave inversion were associated with increased HRs for 7-day mortality and ICU admission, whereas only a heart rate >100 bpm predicted both mortality and ICU admission among patients with [K+] <3.0 mmol/L.
  • HR estimates were, however, similar to those in eukalemic patients.
  • The low number of events with ventricular arrhythmia limited evaluation for this outcome.

“The findings showed that although electrocardiogram abnormalities are common, they are poor predictors of acute illness and short-term mortality,” the researchers wrote.

As healthcare providers strive to optimize patient outcomes, the insights gleaned from this multicenter cohort study offer valuable guidance in navigating the complexities of managing electrolyte disturbances and mitigating associated cardiac risks. Vigilance, early intervention, and a multidisciplinary approach remain paramount in safeguarding the cardiac health of individuals with hypokalemia.

Reference:

Kildegaard, H., Brabrand, M., Forberg, J. L., Platonov, P., Lassen, A. T., & Ekelund, U. (2024). Prevalence and prognostic value of electrocardiographic abnormalities in hypokalemia: A multicenter cohort study. Journal of Internal Medicine, 295(4), 544-556. https://doi.org/10.1111/joim.13757

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Premature menopause may increase risk of musculoskeletal pain and sarcopenia, claims study

Musculoskeletal pain is a prevalent menopause symptom, which helps explain why women typically experience more pain than men, especially around the age of 50 years. Beyond pain, muscle function and mass are also affected by menopause. A new study suggests premature surgical menopause can lead to an increased risk of muscle disorders. Results of the survey are published online today in Menopause, the journal of The Menopause Society.

The highly publicized Study of Women’s Health Across the Nation spotlighted a number of symptoms that are common during the menopause transition. Among other findings, it confirmed that muscle stiffness complaints were most prevalent during menopause, affecting 54% of US women aged 40 to 55 years.

This is also the time when ovarian hormone levels decrease significantly. In women who have experienced premature menopause, either spontaneous or surgical, the decrease is even more prominent. In addition, testosterone levels have also been shown to fall significantly in women with premature menopause.

These facts led researchers to conduct a new study specifically designed to evaluate the effect of different types of menopause on muscle discomfort and function in late-postmenopausal women aged 55 years and older. The study, which included nearly 650 women, concluded that women experiencing premature surgical menopause were more likely to develop musculoskeletal discomfort and sarcopenia than those with natural menopause at age 45 years or older. They theorized that the pain and decline in muscle mass in the late-postmenopause stage was more closely linked to hormone deficiency than to chronologic age alone.

Survey results are published in the article “Association of muscle disorders in late postmenopausal women according to the type of experienced menopause.”

“This study highlights the potential long-term musculoskeletal effects of premature surgical menopause, which causes a more abrupt and complete loss of ovarian hormones, including estrogen and testosterone, than natural menopause. The use of hormone therapy until the natural age of menopause has the potential to mitigate some of the adverse long-term effects of early estrogen loss,” says Dr. Stephanie Faubion, medical director for The Menopause Society.

Reference:

Vallejo MS, Blümel JE, Chedraui P, Tserotas K, Salinas C, Rodrigues MA, Rodríguez DA, Rey C, Ojeda E, Ñañez M, Monterrosa-Castro Á, Gómez-Tabares G, Espinoza MT, Escalante C, Elizalde A, Dextre M, Calle A, Aedo S. Association of muscle disorders in late postmenopausal women according to the type of experienced menopause. Menopause. 2024 Apr 30. doi: 10.1097/GME.0000000000002367.

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USPSTF issues updated recommendation on breast cancer screening that supports screening starting in women at age 40

USA: In a move aimed at improving early detection and reducing mortality rates associated with breast cancer, the US Preventive Services Task Force (USPSTF) has released its latest recommendation statement on breast cancer screening. The updated guidelines, published in the Journal of the American Medical Association (JAMA), provide valuable insights into the benefits and potential harms of various screening modalities, empowering healthcare providers and patients to make informed decisions regarding breast cancer prevention and detection.

The USPSTF’s newly published final recommendations support breast cancer screening starting in women at age 40, but they don’t go as far as many screening advocates had hoped.

In addition to the recommendation for biennial breast cancer screening for women ages 40 to 74, the take force stuck with its draft recommendations from 2023, reporting that it found insufficient evidence for screening women 75 and older. The USPSTF concluded that there was insufficient evidence to recommend supplemental screening with MRI or ultrasound in women, irrespective of breast density.

Breast cancer remains a significant public health concern, with millions of women worldwide being diagnosed each year. Early detection through screening plays a crucial role in improving survival rates and facilitating timely interventions. However, the optimal age to initiate screening, the frequency of screening mammography, and the utility of additional screening modalities such as magnetic resonance imaging (MRI) have been topics of debate and ongoing research.

A systematic review was commissioned by USPSTF to evaluate the comparative effectiveness of different mammography-based breast cancer screening strategies by age to start and stop screening, modality, screening interval, use of supplemental imaging, or personalization of screening for breast cancer on the incidence of and progression to advanced breast cancer, breast cancer morbidity, and breast cancer-specific or all-cause mortality, and collaborative modeling studies to complement the evidence from the review.

The recommendation updates the 2016 recommendation on breast cancer screening. In 2016, the USPSTF recommended biennial screening mammography for women aged 50 to 74 years and individualizing the decision to undergo screening for women aged 40 to 49 years based on factors such as individual risk and personal preferences and values.

For the current recommendation, the USPSTF recommends biennial screening mammography for women aged 40 to 74 years. The USPSTF again finds that the evidence is insufficient to assess the balance of harms and benefits of supplemental screening for breast cancer using breast ultrasonography or MRI in women identified to have dense breasts on an otherwise negative screening mammogram and the balance of benefits and harms of screening mammography in women 75 years or older. Current evidence suggests that digital mammography and DBT are effective primary screening modalities.

The USPSTF concludes, “the current evidence is insufficient to assess the balance of harms and benefits of supplemental screening for breast cancer using breast ultrasonography or MRI in women identified to have dense breasts on an otherwise negative screening mammogram.”

In conclusion, to achieve the benefit of screening and mitigate disparities in breast cancer mortality by ethnicity and race, it is important that all persons with abnormal screening mammography results receive equitable and appropriate follow-up evaluation and additional testing, inclusive of indicated biopsies, and that all persons with breast cancer diagnosis receive effective treatment.

Reference:

US Preventive Services Task Force. Screening for Breast Cancer: US Preventive Services Task Force Recommendation Statement. JAMA. Published online April 30, 2024. doi:10.1001/jama.2024.5534

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Erenumab reduces rosacea-associated flushing and erythema symptoms: JAMA

A recent study published in the Journal of American Medical Association found promising results after investigating the use of erenumab which is a drug primarily used for migraine prevention, for treating rosacea symptoms. 

The open-label trial conducted at the Danish Headache Center of Copenhagen University Hospital, Rigshospitalet involved 30 participants who were administered 140 mg of erenumab subcutaneously every four weeks for a total of 12 weeks. The study was conducted from June 2020 to May 2021 to assess the effectiveness of erenumab in reducing the severe redness and flushing associated with rosacea. The primary focus of the research was to assess the change in the number of days participants experienced moderate to extreme flushing when compared to their condition at the beginning of the study. The secondary outcomes included changes in days with moderate to severe erythema or facial redness.

The key findings from the trial were;

At the end of the 12-week period, the participants reported a significant reduction in the number of days with flushing, this was from an average of 23.6 days at baseline to 16.7 days.

Also, the days with noticeable redness decreased from 15.2 to 7.1 days on average. These changes suggest that erenumab could potentially offer relief to the individuals with distressing rosacea symptoms.

While the treatment was generally well-tolerated, some adverse effects were noted, including mild to moderate constipation, transient worsening of flushing, bloating and upper respiratory tract infections.

These side effects are in line with what has been previously documented with the use of erenumab in migraine treatment. Only one serious adverse event was reported which was a case of gallstones that lead to hospitalization, which did not convince the research team as mediated by the drug.

The findings are significant as they point towards a new application for CGRP-receptor inhibitors like erenumab in treating skin conditions beyond their current use in neurology. CGRP (Calcitonin Gene-Related Peptide) has been linked to the pathogenesis of rosacea influencing vascular and inflammatory processes in the skin. Erenumab may help manage symptoms that are often resistant to other treatments by inhibiting this pathway. Despite these promising results, larger randomized clinical trials are imperative to confirm these findings and better understand the potential of CGRP inhibitors in treating rosacea.

Source:

Wienholtz, N. K. F., Christensen, C. E., Do, T. P., Frifelt, L. E. W., Snellman, J., Lopez-Lopez, C. L., Egeberg, A., Thyssen, J. P., & Ashina, M. (2024). Erenumab for Treatment of Persistent Erythema and Flushing in Rosacea. In JAMA Dermatology. American Medical Association (AMA). https://doi.org/10.1001/jamadermatol.2024.0408

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FDA approves dissolving stent for endovascular treatment of peripheral artery disease below knee

The US Food and Drug Administration has approved Esprit BTK everolimus-eluting scaffold system for chronic limb-threatening ischemia (CLTI) below the knee.It is first drug-eluting resorbable scaffold approved for peripheral artery disease.

The Esprit BTK System is designed to keep arteries open and deliver a drug (Everolimus) to support vessel healing prior to completely dissolving.

Until today, there were no stents or drug-coated balloons approved for use below the knee in the U.S. The standard of care has been balloon angioplasty, which relies on a small balloon delivered via a catheter to the blockage to compress it against the arterial wall, opening the vessel and restoring blood flow. However, blockages treated only with balloon angioplasty have poor short- and long-term results, and in many instances the vessels become blocked again, requiring additional treatment.

The Esprit BTK System is a first-of-its-kind dissolvable stent and is comprised of material similar to dissolving sutures. The device is implanted during a catheter-based minimally invasive procedure via a small incision in the leg. Once the blockage is open, the Esprit BTK scaffold helps heal the vessel and provides support for approximately three years until the vessel is strong enough to remain open on its own.

“The FDA approval of Abbott’s Esprit BTK System marks a significant milestone in our fight against peripheral artery disease below the knee and should usher in a new era of improved outcomes for people worldwide,” said Sahil A. Parikh, M.D., Columbia University Irving Medical Center, and one of the principal investigators of the LIFE-BTK trial. “By introducing a treatment option that is superior to balloon angioplasty, Abbott is changing the landscape of CLTI therapy.”

The LIFE-BTK trial, which evaluated Abbott’s Esprit BTK System, was presented in October 2023 as a late-breaking clinical trial at the 35th Transcatheter Cardiovascular Therapeutics (TCT) Conference in San Francisco and simultaneously published in the New England Journal of Medicine. The results of the trial demonstrated that the Esprit BTK System reduces disease progression and helps improve medical outcomes compared to balloon angioplasty, the current standard of care.

PAD is highly prevalent, yet many people have never heard of the condition. More than 20 million people in the U.S. are living with this painful disease and only 10% of those people have been diagnosed. CLTI is a serious form of PAD that occurs when arteries become clogged with plaque, preventing blood flow and oxygen from reaching the lower leg and foot. People living with CLTI often experience extreme pain, open wounds that don’t heal and, in some cases, may have to resort to amputation. Over a five-year period, CLTI has a lower survival rate than breast, colorectal and prostate cancer combined.

“At Abbott, we’ve recognized the significant burden of disease and limited treatment options available for people living with the most severe form of PAD. That’s why we’re revolutionizing treatments with resorbable scaffold technology below the knee,” said Julie Tyler, senior vice president of Abbott’s vascular business. “Our resorbable program is focused on meeting unmet needs in the peripheral anatomy to help people live better and fuller lives.”

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Omega-6 fatty acid arachidonic acid may reduce risk of bipolar disorder, finds study

A genetic propensity to higher circulating levels of lipids containing arachidonic acid, an omega-6 polyunsaturated fatty acid found in eggs, poultry, and seafood, has been found to be linked with a lower risk for bipolar disorder, according to a new study in Biological Psychiatry, published by Elsevier. This new evidence paves the way for potential lifestyle or dietary interventions.

Bipolar disorder is a debilitating mood disorder characterized by recurring episodes of mania and depression. Although its etiology is still unclear, previous studies have shown that bipolar disease is highly heritable. The findings of this study indicate a link between bipolar disorder and altered metabolite levels, supporting the notion that circulating metabolites play an important etiological role in bipolar disease and other psychiatric disorders.

Lead investigator David Stacey, PhD, Australian Centre for Precision Health, University of South Australia; UniSA Clinical and Health Sciences; and South Australian Health and Medical Research Institute, Adelaide, Australia, explains, “Accumulating evidence indicates a role for metabolites in bipolar disorder and other psychiatric disorders. By identifying metabolites that play causal roles in bipolar disorder, we hoped to be able to highlight potential lifestyle or dietary interventions.”

By applying Mendelian randomization, a powerful causal inference method, the researchers identified 33 out of 913 metabolites studied present in the blood that were associated with bipolar disorder, most of them lipids.

Researchers also found that a bipolar disorder risk gene cluster (FADS1/2/3), which encodes enzymes associated with lipid metabolism, mediated the association between bipolar disorder and the levels of arachidonic acid and other metabolites.

Commenting on the findings, John Krystal, MD, Editor of Biological Psychiatry, says, “Arachidonic acid is typically a widely present omega-6 fatty acid in the body and brain that contributes to the health of cell membranes. This study provides a fascinating step forward in the effort to develop blood biomarkers of bipolar disorder risk, particularly in those patients with bipolar disorder and risk gene variations in the FADS1/2/3 gene cluster.”

Dr. Stacey notes, “Intriguingly, we observed a pattern whereby a genetic propensity to higher levels of lipids containing an arachidonic acid fatty acid side chain was associated with a lower risk of bipolar disorder, while the inverse was true of lipids containing a linoleic acid side chain. Since arachidonic acid is synthesized from linoleic acid in the liver, this suggests arachidonic acid synthesizing pathways are important for bipolar disorder.”

Given its presence in human milk, arachidonic acid is considered essential for infant brain development and is added to infant formula in many countries. Therefore, it may exert an effect on bipolar disorder risk by affecting neurodevelopmental pathways, which would be consistent with contemporary views of bipolar disorder as a neurodevelopmental disorder. Arachidonic acid can be sourced directly from meat and seafood products or synthesized from dietary linoleic acid (e.g., nuts, seeds, and oils).

Dr. Stacey concludes, “To our knowledge, ours is the first study to highlight a potential causal role between arachidonic acid and bipolar disorder. Preclinical studies and randomized controlled trials will be necessary to determine the preventive or therapeutic value of arachidonic acid supplements, perhaps with a particular focus on people with a compromised arachidonic acid synthesizing pathway or with poor natural dietary sources. Our findings also support potential avenues for precision health interventions focused on early life nutrition to ensure that infants and children are receiving enough arachidonic acid and other polyunsaturated fatty acids to support optimal brain development, which may also reduce the risk of bipolar disorder.”

Reference:

David Stacey, Beben Benyamin, S. Hong Lee, Elina Hyppönen, A Metabolome-Wide Mendelian Randomization Study Identifies Dysregulated Arachidonic Acid Synthesis as a Potential Causal Risk Factor for Bipolar Disorder, Biological Psychiatry, https://doi.org/10.1016/j.biopsych.2024.02.1005

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High serum Vitamin D levels significantly linked to protection of caries development in children, reveals study

High serum Vitamin D levels are significantly linked to the protection of caries development in children, reveals a study published in the Dentistry Journal.

This systematic review critically evaluates the association between serum Vitamin D levels and dental caries incidence in the permanent teeth of children and adolescents. The search strategy comprised three databases (PubMed, Scopus, Embase), up to November 2023, targeting studies on the correlation between Vitamin D and dental caries in permanent dentition. The eligibility criteria focused on observational studies involving children and adolescents aged 12 to 19 years with permanent dentition. The screening process, guided by the PRISMA guidelines and the Newcastle–Ottawa Scale for quality assessment, resulted in the inclusion of eight studies conducted across various global regions from 2013 to 2023. The analysis revealed that Vitamin D insufficiency and deficiency were prevalent among the study populations, ranging from 17.3% to 69.4%. Specifically, children and adolescents with Vitamin D insufficiency (<50 nmol/L) were found to have significantly higher odds of developing caries, with odds ratios (ORs) ranging from 1.13 to 2.57. Conversely, two studies indicated a protective effect of higher Vitamin D levels, with an OR of 0.80 and 0.59, respectively, for caries among children and adolescents with serum levels ≥ 50 nmol/L, suggesting an inverse relationship between Vitamin D status and caries risk. The results indicate both the protective role of adequate serum levels of Vitamin D above 20 ng/mL and the increased risk associated with insufficient levels below this threshold. However, the variations in study quality, methodologies and geographic settings underscore the challenges in drawing universal conclusions. Despite these limitations, our review suggests that improving Vitamin D status could be a beneficial component of preventive strategies against dental caries in children and adolescents, warranting further research to clarify the clinical significance of our findings.

Reference:

Buzatu R, Luca MM, Bumbu BA. A Systematic Review of the Relationship between Serum Vitamin D Levels and Caries in the Permanent Teeth of Children and Adolescents. Dentistry Journal. 2024; 12(4):117. https://doi.org/10.3390/dj12040117

Keywords:

High, serum, Vitamin D levels, significantly, protection, caries, development, children, study, Dentistry Journal, vitamin D; dental caries; permanent dentition; child; adolescent; stomatology, Buzatu R, Luca MM, Bumbu B

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Sibling death in childhood tied to increased risk of early-onset cardiovascular disease: JAMA

Denmark: Individuals who experience the death of a sibling in childhood may be at greater risk of early-onset cardiovascular disease (CVD), a recent study published in JAMA Network Open.

The researchers suggest that extra support to these individuals may help mitigate the potential negative effects of bereavement on cardiovascular health.

The cohort study of more than 2.0 million participants born in Denmark revealed that sibling death in childhood and early adulthood was linked with increased risk of overall and most specific early-onset cardiovascular diseases among bereaved siblings, strength of associations varied by cause of age and death difference between sibling pairs.

There has been an increase in the incidence and prevalence of CVD over the past few decades among children, adolescents, and young adults, posing a concerning economic loss and public health burden. Previous studies have indicated that psychological stress following bereavement may lead to CVD development. The loss of a child, a spouse, a parent, or other family members was linked with increased risks of type-specific CVDs, including stroke, ischemic heart disease (IHD), myocardial infarction (MI), atrial fibrillation (AF), cerebrovascular disease, pulmonary embolism, and heart failure.

Sibling death is a highly traumatic event, but empirical evidence is limited on the association of sibling death in childhood and early adulthood with subsequent risk of incident CVD. To fill this knowledge gap, Chen Huang, Fudan University, Shanghai, China, and colleagues aimed to evaluate the association between sibling death in the early decades of life and subsequent risk of incident early-onset CVD in a population-based cohort study.

The study included 2 098 659 individuals born in Denmark from 1978 to 2018. Follow-up started at age 1 year or the date of the first sibling’s birth, whichever occurred later, and it ended at the first diagnosis of CVD, emigration, the date of death, or December 31, 2018, whichever came first. The outcome was early-onset CVD.

The study revealed the following findings:

  • The study included 2 098 659 individuals (51.30% male; median age at death of sibling, 11.48 years).
  • During the median follow-up of 17.52 years, 1286 and 76 862 individuals in the bereaved and nonbereaved groups, respectively, were diagnosed with CVD.
  • Sibling death in childhood and early adulthood was associated with a 17% increased risk of overall CVD (HR, 1.17; cumulative incidence in bereaved individuals, 1.96%; cumulative incidence in nonbereaved individuals at age 41 years, 1.35%; cumulative incidence difference: 0.61%).
  • Increased risks were also observed for most type-specific CVDs, in particular for myocardial infarction (HR, 1.66), heart failure (HR, 1.50), and ischemic heart disease (HR, 1.52).
  • The association was observed whether the sibling died due to CVD (HR, 2.54) or non-CVD (HR, 1.13) causes.
  • The increased CVD risk was more pronounced for individuals who lost a twin or younger sibling (HR, 1.25) than an elder sibling (HR, 1.11).

The findings show an increased risk of overall and most type-specific early-onset CVDs with sibling death in childhood and early adulthood; the strength of these associations differed by death cause and the age difference between sibling pairs. The risk was the highest shortly after the bereavement, particularly for adolescents, but persisted in the long run.

“The findings highlight the need for extra attention and both mental and social support to bereaved siblings to reduce CVD risk later in life,” the researchers wrote.

Reference:

Huang C, Peng J, Lee PMY, et al. Sibling Death in Childhood and Early Adulthood and Risk of Early-Onset Cardiovascular Disease. JAMA Netw Open. 2024;7(1):e2350814. doi:10.1001/jamanetworkopen.2023.50814

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