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October 10 - 13, 2018
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Vol. 3 No. 33

Coaching stressed as key element
in battle to avoid bad eating habits

ONSET, WAREHAM, MASS. – A study noting the link between obesity among women in their 30s and subsequent development of breast cancer summons a strong, basic statement from one women’s-health expert.

“The pain of staying the same,” says R. Mimi Secor, senior faculty at Advanced Practice Education Associates (APEA), “has to be greater than the pain of change.”

The nurse practitioner (NP), national speaker, consultant, award-winning author and Metabolic & Endocrine Disease Summit (MEDS) faculty member points to the importance of coaching patients in order to sway them from bad eating habits, as well as unwise alcohol use.

The study published in April in BMC Public Health supports prevention efforts targeting weight in women below 40 and potentially lifelong alcohol consumption to reduce breast-cancer risk in middle-aged women. Its authors note correlations between stress and alcohol and between stress and obesity, with obesity occurring during the ages of 31-to-40 emerging as an independent breast-cancer predictor.

Dr. Secor---a resident of Onset, Wareham, Mass.---says NPs and physician assistants (PAs) should view this study as a reminder that “health, education, and coaching of patients is important for young women so they can control their weight, prepare and eat healthy foods, and not gain more than 30 pounds during pregnancy.”

“We need to take active roles,” she says, “in coaching, and look at patients’ mindsets, lifestyles, and challenges, and break down their goals into lifestyle changes. Clinicians need to get patients to record what foods they eat before making any adjustments, then look at the data and make precise, educated assessments. The best advice is driven by what patients tell us.”

People eat, Dr. Secor says, “for emotional reasons. There is addiction to food, caused by issues in their lives. Food is something we turn to, a security blanket. But patients can’t make changes without developing new habits. People eat junk food to help deal with stress; we try to get them to turn to exercise, meditation, or calling friends instead.”

Dr. Secor, who has been coached since 2000 to change eating habits, says clinicians “are short-circuited by time pressures. It is hit-and-run, with so many patients to deal with, leaving no time to be effective. We get them in, check the numbers, maybe do a quick exam. It is really important to be health-role models, to show we have made changes in our own lives.”

She adds that NPs and PAs “are all feeling the (time) crunch, and coaching is the first thing to go. Coaching holds them accountable, and it is driven by patients. We negotiate with them, have them take out their phones, set dates to check in with us, set timelines.”

Therapy, she stresses, “looks back---coaching looks forward.”

Dr. Secor offers these approaches to help women under 40 with weight issues:

  • State facts about links between obesity and breast cancer. “These studies illuminate the importance of controlling obesity at a young age, not just in their 30s, but teens, pre-teens.”
  • Urge lifetime health habits, with the assistance of family members, friends and co-workers. “People feel like alien life forms when they are trying to change eating habits and their friends are ordering burgers and fries.” She lives this reality at home: “I bought my husband a lemon cake yesterday; he keeps it in the garage.”
  • Work on patients’ mindsets. “Everybody brings their baggage.”
  • Note the ties, as noted in the study, between weight gain and alcohol use, to stress, which can spur over-eating and alcohol consumption. “Alcohol is empty calories and is a poison that shuts down metabolism. When you have an alcoholic drink with food, the food sits there, excessive calories. It is better to have a drink separately from food.”

Calling fear “a powerful agent of change,” Dr. Secor suggests that clinicians ask patients “on a scale of one-to-10, how committed they are. What is their self-esteem? Are they always trying to meet other’s needs instead of their own?”

Finally, Dr. Secor says women are generally unaware of the association between weight gain and breast cancer, which is something “we need to shout out from the mountain-tops.”

With technological help.

“We need more education for the masses,” she concludes. “We need to speak where people will listen. I communicate via podcasts, Facebook, as well as traditional media, though that is not where we reach younger people. We have a mandate to get our message out to the masses.”

CITATION: E.R. Miller, C. Wilson, et. al. Connecting the dots between breast cancer, obesity and alcohol consumption in middle-aged women: ecological and case control studies. BMC Public Health. Received: 1 September 2017. Accepted: 22 March 2018. Published: 6 April 2018. https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-018-5357-1

 


Diabetes-specific distress is detailed
in research on depression diagnosis

TRIPURA, INDIA – Recognizing depression with self-administered questionnaires may be influenced by concomitant presence of symptoms due to diabetes-specific distress, according to recently-published research.

The study published in July in Diabetes Research and Clinical Practice also indicates that proper diagnosis of depression may be established by structured clinical interviews and psycho-social management of type 2 diabetes (T2DM), and should possibly include assessment of depression and diabetes-specific distress.

Its authors include Mukut Roy, who is affiliated with Tripura Medical College, Tripura, India, and Nilanjan Sengupta, Nilratan Sircar Medical College, Kolkata, India.

The study included 250 adult patients with T2DM who were assessed for depression based on Beck Depression Inventory (BDI) and Diagnostic and Statistical Manual, Fourth edition (DSM IV) criteria.

Diabetes-specific distress was assessed as per Diabetes Distress Scale (DDS) scores.

Among the study population, based on BDI scores, 97 patients were found to suffer from depression; based on DSM IV criteria, prevalence of depression was 29.2%.

Sixty-two patients were found to suffer from diabetes-specific distress based on DDS scores.

Patients with severe diabetes-specific distress had associated matching of symptoms with mild depression based on BDI scores.

These same individuals were non-depressed as per DSM-IV criteria.

CITATION: Mukut Roy, Nilanjan Sengupta, et. al. Type 2 diabetes and influence of diabetes-specific distress on depression. Diabetes Research and Clinical Practice. Published online: July 15, 2018. Accepted: July 3, 2018. Received in revised form: February 15, 2018. Received: November 28, 2016. https://www.diabetesresearchclinicalpractice.com/article/S0168-8227(16)30734-3/fulltext?rss=yes

 

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Simple, inexpensive method cited
in kidney-organoid growth study

AUCKLAND, NEW ZEALAND – A study published in July in Stem Cell Reports indicates that researchers have established a simple-and-inexpensive method to grow kidney organoids in bulk from human-induced pluripotent stem cells.

Its authors---including Aneta Przepiorski and Veronika Sander, who are affiliated with the University of Auckland, Auckland, New Zealand---utilized a method involving the formation of embryoid bodies in the presence of a Wnt agonist followed by culture in medium supplemented with a substitute for fibroblast growth factor 9.

Highlights of the study include:
•    a technically-simple and cost-efficient protocol for kidney-organoid generation
•    tubular organoids are obtained rapidly, with high efficiency, yield, and robustness
•    organoids contain nephrons that correspond to human-fetal nephrons
•    the application to model congenital kidney defects is presented

The organoids showed optimal-tissue morphology at day 14; a comparison with fetal-human kidneys suggested that day-14 organoid tissue resembles late capillary loop-stage nephrons.

Deletion of HNF1B, a transcription factor linked to congenital kidney defects, interfered with tubulogenesis, validating the experimental system.

The researchers conclude that their approach for generating kidney organoids is simple, rapid, scalable, and works robustly for a range of different pluripotent stem-cell lines.

Their method, they report, overcomes many of the drawbacks hampering existing protocols, and provides the advance needed in order for kidney organoids to be effectively used for future applications, including drug testing and cell-replacement therapies where there is a requirement to generate large amounts of tissue.
 

CITATION: Aneta Przepiorski, Veronika Sander, et. al. A Simple Bioreactor-Based Method to Generate Kidney Organoids from Pluripotent Stem Cells. Stem Cell Reports. Published Online: July 19, 2018. Publication stage: In Press Corrected Proof. https://www.cell.com/stem-cell-reports/fulltext/S2213-6711(18)30281-9

 


Men with DS, high FRAX risk are said
at greater MOF, hip-fracture danger

MADISON, WIS. – Recent research indicates that men with both dysmobility syndrome (DS) and a Fracture Risk Assessment Tool (FRAX) risk above National Osteoporosis Foundation (NOF) treatment thresholds have higher major osteoporotic fracture (MOF) and hip-fracture risk than men with neither condition.

The study published in April in in the Journal of Bone and Mineral Research proposes the term DS to identify individuals with impaired musculoskeletal health, a risk factor for falls and fractures.

Its authors---including Bjoern Buehring and Karen E. Hansen, University of Wisconsin-Madison, Madison, Wis.---utilized their Osteoporotic Fractures in Men (MrOS) study, which enrolled 5,994 men aged 65-and-over between March, 2000, and April, 2002.

They used baseline data to determine whether DS increased fracture risk, independent of FRAX.

Men met DS criteria at baseline if they had three-or-more of the following: total body fat more-than-30%; spine or hip T‐score at least –2.5; grip strength less-than-30 kg; gait speed less-than-1.0 m/s; one-or-more falls within 12 months; and appendicular lean mass/height2 of less-than-7.26 kg/m2.

They examined whether baseline DS increased the risk of hip and MOFs over a median of 14 years.

Among 5,834 men, mean age 74 plus-or-minus six years, 471 had DS and 635 experienced an MOF, including 274 hip fractures.

Prediction of MOF using the FRAX score provided a concordance value of 0.67 plus-or-minus 0.012. Concordance increased to 0.69 plus-or-minus 0.012 by adding DS and to 0.70 plus-or-minus 0.012 by adding DS and age to the multivariate model.

Kaplan‐Meier curves indicated that men with both DS and a FRAX risk above the NOF treatment thresholds had higher MOF fracture risk than men with neither condition.

The researchers suggest further studies to determine the optimal criteria for DS, and to test DS as a predictor of falls and fractures, especially in women.
 

CITATION: Bjoern Buehring, Karen E. Hansen, et. al. Dysmobility Syndrome Independently Increases Fracture Risk in the Osteoporotic Fractures in Men (MrOS) Prospective Cohort Study. Journal of Bone and Mineral Research. First published: 27 April 2018. https://onlinelibrary.wiley.com/doi/abs/10.1002/jbmr.3455?af=R

 

Hypertensive disorders in pregnancy
linked to severe-maternal morbidity

SEATTLE – Hypertensive disorders in pregnancy are strongly associated with severe maternal morbidity in a dose-dependent relationship, according to a recent study suggesting that strategies to address rising maternal-morbidity rates should include early recognition and management of hypertension.

The study published in July in the American Journal of Obstetrics & Gynecology also indicates that prevention strategies focused on hypertension might also impact medically-indicated pre-term deliveries.

Its authors---including Jane Hitti and Laura Sienas, University of Washington Medical Center, Seattle---also found increased severe-maternal morbidity among American Indian/Alaskan Native women, a disadvantaged population in Washington State.

This, they indicate, underscores the role that socio-economic factors may play in adverse maternal-health outcomes. As 39% of severe-maternal morbidity diagnoses were present on admission, this measure, the researchers conclude, should be risk-adjusted if used as a quality metric for comparison between hospitals.

The researchers’ retrospective cross-sectional analysis assessed rates of severe-maternal morbidity diagnoses and procedures for all 7,025 women who delivered at the University of Washington Medical Center from Oct. 1, 2013, through May 31, 2017.

Severe-maternal morbidity was determined from pre-specified International Classification of Diseases diagnosis and procedure codes; all diagnoses were confirmed by chart review.
Of 7,025 deliveries, 284 had severe-maternal morbidity; 154 had transfusion only; 27 had other procedures; and 103 women had 149 severe-maternal morbidity diagnoses.

Severe preeclampsia occurred in 438 deliveries. Notably, hypertension was associated with severe-maternal morbidity in a dose-dependent fashion, with the strongest association observed for preeclampsia with severe features.

Severe-maternal morbidity was also significantly associated with preeclampsia without severe features, chronic hypertension, pre-term delivery, pre-gestational diabetes, and multiple gestation.

Among women with severe-maternal morbidity, over one third of pre-term births were associated with maternal hypertension. American Indian/Alaskan Native women had significantly higher severe-maternal morbidity rates compared to other racial/ethnic groups.

Overall, 39.6% of severe-maternal morbidity diagnoses were present on admission.
 

CITATION: Jane Hitti, MD, Laura Sienas, MD, et. al. Contribution of hypertension to severe maternal morbidity. American Journal of Obstetrics & Gynecology. Published online: July 15, 2018. Accepted: July 2, 2018. Received in revised form: June 29, 2018. Received: March 2, 2018. https://www.ajog.org/article/S0002-9378(18)30571-4/fulltext?rss=yes

 

Clinician Reviews article addresses
hypertension and diabetes issues

An article posted in August in Clinician Reviews addresses the issue of hypertension and diabetes. Written by Tracey T. Thurnes, MPAS, PA-C, who is affiliated with Elon University, Elon, N.C., the article notes that hypertension, a modifiable risk factor, is prevalent among diabetes patients. Thurnes reports that anti-hypertensive therapy in these patients reduces atherosclerotic cardiovascular disease (ASCVD), the leading cause of morbidity and mortality among those with diabetes, and that blood-pressure control---including lifestyle management---is recommended. The article can be accessed at https://www.mdedge.com/clinicianreviews/article/171416/endocrinology/hypertension-and-diabetes-addressing-common

 

 

Vol. 3 No. 32

Vitamin D deficiency study notes
importance of adiposity location

LAGUNA NIGUEL, CALIF. – Specific attention for vitamin D deficiency should be given to patients with a high amount of visceral adipose tissue (VAT), according to a recent study one medical expert says is notable in focusing on adiposity location in terms of vitamin D levels.

Research published in May in Endocrine Abstracts, based on a population-based cohort study of patients aged 45-to-65, notes that the relationship between different adiposity measures and 25(OH)D concentrations differed by gender. Among women, total body fat and VAT were inversely related to 25(OH)D concentrations; for men, VAT and hepatic fat were inversely related to 25(OH)D concentrations. In men and women, VAT was most strongly associated with 25(OH)D concentrations.

Ji Hyun Chun, PA-C, BC-ADM, OptumCare Medical Group, Laguna Niguel, Calif., and a faculty member of Metabolic & Disease Summit (MEDS), says that “what's new in this study is that it states that where the adiposity is matters in terms of vitamin D levels, subcutaneous versus visceral: There was higher correlation of visceral adiposity and chances of having low vitamin D.”

Chun, president of the American Society of Endocrine Physician Assistants (ASEPA), also stresses that this research supports the necessity of lifestyle changes to fight weight problems as well as the importance of vitamin D assessments and, when appropriate, supplementation.

He adds that “as vitamin D is a fat-soluble vitamin, patients with increased adiposity are at higher risk of lower circulating serum vitamin D levels. One has to have enough to saturate the adipose tissue before we have enough to circulate in the vascular system.”

Chun also says that visceral adiposity “is really the culprit of metabolic complications associated with obesity, rather than subcutaneous adiposity.”

He adds, though, that “it can work in both ways: We have to think, suspect, and screen for low vitamin D in patients with increased visceral adiposity, but also think, suspect, screen for visceral adiposity in obese patients with low vitamin D.”

The research, a cross-sectional analysis of baseline measurements of the Netherlands Epidemiology of Obesity study, is, says Chun, “an association study rather than causal-relation study, and is still ‘chicken-or-the-egg’ status.”

It is also one of countless indicators of the urgency of battling weight problems.

“No matter what,” Chun asserts, “lifestyle intervention to reduce fat burden is of utmost importance in any patients burdened by extra weight, not just to correct vitamin D problems, but for overall health status, obviously. We perhaps could use this study as another motivator, and reason, to encourage patients to improve their weight status.”

Chun also states that, “in the meantime, we could supplement them with vitamin D to keep their levels in adequate range. However, what is still to be answered is whether the detrimental effects on the bone metabolism from vitamin D deficiency is to the same degree in low vitamin D in obese individuals.”

Classic complications of vitamin D, he also notes, “would occur from severe vitamin D deficiencies. Those affected this way might actually have very low vitamin D status anywhere in the body.”

“Would having vitamin D stored in adipose tissue in obese individuals, and just not enough circulating in blood stream, have a protective role? I don't believe there is an answer to this, and it will be very hard to know. Obese individuals have slightly higher bone mineral density (higher bone mass) than those with normal body weight, yet they have higher risk of fracture, despite the higher BMD. Does this suggest defects in bone quality?”

He asks, too, whether health-care professionals should correlate the effects with parathyroid hormone (PTH).

“Does PTH” he asks, “start to rise at the same level of vitamin D in individuals with normal weight versus overweight, or start to rise at a different threshold? Is that threshold lower or higher?

CITATION: Rachida Rafiq, Floor Walschot, et. al. Associations of different body fat deposits with serum 25-hydroxyvitamin D concentrations. Endocrine Abstracts. (2018) 56 OC6. 5. May 2018. https://www.endocrine-abstracts.org/ea/0056/ea0056oc6.5

 


 

Level of urbanization is targeted
in research on obesity prevalence

HYATTSVILLE, MD. – A nationally-representative survey of adults in the United States indicates that the age-adjusted prevalence of obesity and severe obesity in 2013-to-2016 varied by level of urbanization.

The study published in June in the Journal of the American Medical Association  indicates a greater prevalence of obesity and severe obesity among adults living in non-metropolitan statistical areas compared with adults living in large metropolitan-statistical areas.

Its authors---including Craig M. Hales and Cheryl D. Fryar, National Center for Health Statistics, US Centers for Disease Control and Prevention, Hyattsville, MD.---utilized the 2001-to-2016 National Health and Nutrition Examination Survey.

That cross-sectional analysis involved 10,792 adults aged 20 or older and revealed differences in the prevalence of obesity and severe obesity by age group, race and Hispanic origin, and education level.

The prevalence of obesity was significantly greater among women living in non-metropolitan statistical areas (MSAs) compared with women living in large MSAs; the prevalence of severe obesity in non-MSAs was higher than in large MSAs among men and women.

Differences in age group, race and Hispanic origin, education level, or smoking status were not related to the differences in the prevalence of obesity and severe obesity by urbanization level.

During 2013-to-2016, 38.9% of U.S. adults had obesity, and 7.6% had severe obesity. Men living in medium or small MSAs had a higher age-adjusted prevalence of obesity compared with men living in large MSAs.

The age-adjusted prevalence among men living in non-MSAs was not significantly different compared with men living in large MSAs.

The age-adjusted prevalence of obesity was higher among women living in medium or small MSAs compared with women living in large MSAs, and among women living in non-MSAs compared with women living in large MSAs.

Similar patterns were seen for severe obesity, except that the difference between men living in large MSAs compared with non-MSAs was significant.

CITATION: Craig M. Hales, MD, Cheryl D. Fryar, MSPH, et. al. Differences in Obesity Prevalence by Demographic Characteristics and Urbanization Level Among Adults in the United States, 2013-2016. Journal of the American Medical Association  June 19, 2018. 2018;319(23):2419-2429. https://jamanetwork.com/journals/jama/article-abstract/2685156?utm_source=silverchair&utm_medium=email&utm_campaign=article_alert-jama&utm_content=etoc&utm_term=061918

 

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Sarcopenia, osteoporosis examined
in frailty-risk reduction assessment

TOKYO – Preventing osteoporosis and co-existence of osteoporosis and sarcopenia may help reduce frailty risk, according to a study published in June in Osteoporosis International.

Its authors---including Noriko Yoshimura and Shigeyuki Muraki, who are affiliated with The University of Tokyo---examined the contribution of sarcopenia and osteoporosis to the occurrence of frailty using four-year follow-up information of a population-based cohort study.

That four-year study involved 1,083 subjects aged 60-and-older; the prevalence of frailty was estimated to be 5.6%, and osteoporosis was found to be significantly associated with frailty.

The presence of both osteoporosis and sarcopenia increased the risk of frailty compared to the presence of osteoporosis or sarcopenia alone.

The second survey of the Research on Osteoarthritis/Osteoporosis Against Disability (ROAD) study was conducted between 2008-and-2010; the 1,083 subjects, including 372 men, completed all examinations on frailty, sarcopenia, and osteoporosis, defined using Fried’s definition, Asian Working Group for Sarcopenia criteria, and World Health Organization (WHO) criteria, respectively.

The third survey was conducted between 2012-and-2013; 749 of 1,083 participants enrolled from the second survey (248 men, 501 women) completed assessments identical to those in the second survey.

The prevalence of frailty in the second survey was 5.6% (men, 3.8%; women, 6.6%). The cumulative incidence of frailty was 1.2% per year (men, 0.8% per year; women, 1.3% per year).

After adjustment for confounding factors, logistic-regression analysis indicated that osteoporosis was significantly associated with the occurrence of frailty.
The occurrence of frailty significantly increased according to the presence of osteoporosis and sarcopenia.

CITATION: N. Yoshimura, S. Muraki, et. al. Do sarcopenia and/or osteoporosis increase the risk of frailty? A 4-year observation of the second and third ROAD study surveys. Osteoporosis International. First online: 21 June 2018. https://link.springer.com/article/10.1007%2Fs00198-018-4596-4

 


 

Chance of fracture is called elevated
for young, middle-aged adults with T1DM

CLAYTON, AUSTRALIA – A recent study indicates that in the absence of age‐related comorbidities, fracture risk remains significantly elevated in young- and middle‐aged adults with type 1 diabetes mellitus (T1DM).

The study published in June in Clinical Endocrinology also indicates that younger age does not mitigate against hip-fracture risk in T1DM and suggests that health professionals should be aware of this risk.

Its authors---including Eleanor P. Thong and Madhuni Herath, Monash Health, Clayton, Australia---urge further studies to evaluate the mechanisms of fracture in T1DM.

Their systematic review and meta‐analysis was designed to determine the fracture risk of T1DM patients aged 18 to 50, using Ovid MEDLINE, PubMed, EMBASE, EBM reviews, and relevant conference abstracts.

Six studies were included in the meta‐analysis; 1,724 fractures occurred in 35,925 patients with T1DM and 48,253 fractures occurred in 2,455,016 controls.

The risk ratio (RR) for all fractures was 1.88; 56 hip fractures occurred among 34,707 patients with T1DM and 594 hip fractures occurred in 2,295,177 controls.

The RR of hip fractures was 4.40; females and males with T1DM had RRs of 5.79 and 3.67, respectively.

CITATION: Eleanor P. Thong, Madhuni Herath, et. al. Fracture risk in young and middle-aged adults with Type 1 diabetes mellitus: a systematic review and meta-analysis. Clinical Endocrinology. First published: 7 June 2018. https://onlinelibrary.wiley.com/doi/abs/10.1111/cen.13761?af=R&

 

Smoking within 5 minutes of waking
tied to higher possibility of asthma

GRAND FORKS, N.D. – Research involving more than 4,000 subjects indicates that smoking within five minutes of waking---an indicator of nicotine dependence---is associated with a significantly-increased risk of lifetime asthma in smokers.

The study published in June in BMC Pulmonary Medicine indicates that more detailed risk assessment of smokers, closer monitoring, and increased support for smoking cessation for those at risk for asthma could ultimately reduce the disease burden associated with asthma.

Its authors, including Arielle S. Selya and Sunita Thapa, University of North Dakota, Grand Forks, N.D., drew their data from five pooled cross-sectional waves, from 2005-to-2014, of the National Health and Nutrition Examination Survey (NHANES), conducted by the Centers for Disease Control (CDC).

Their final sample consisted of 4,081 current adult smokers aged 20 or older.

Weighted logistic regressions were run, examining the relationship between smoking within five minutes of waking and outcomes of lifetime asthma, past-year asthma, and having had an asthma attack in the past year.
Control variables included:

  • demographics
  • smoking behavior
  • family history of asthma
  • depression
  • obesity
  • second-hand smoking exposure

After adjusting for smoking behavior, smoking within five minutes was associated with an approximately 50% increase in the odds of lifetime asthma and past-year asthma, respectively.
After additionally adjusting for demographics and other asthma-risk factors, smoking within five minutes of waking was associated with a four-fold increase in the odds of lifetime asthma.

CITATION: Arielle S. Selya, Sunita Thapa, et. al. Earlier smoking after waking and the risk of asthma: a cross-sectional study using NHANES data. BMC Pulmonary Medicine. Received: 2 April 2018. Accepted: 13 June 2018. Published: 18 June 2018. https://bmcpulmmed.biomedcentral.com/articles/10.1186/s12890-018-0672-y

 

Native Americans said to benefit
from IHS in kidney-disease fight

A Renal Consult article in Clinician Reviews in July reports on the successful efforts of  Indian Health Services (IHS) to reduce kidney disease among Native Americans. Written by Mandy E. Thompson, PA-C, who practices at the Kidney Center of Denver Health, and Robin Bassett, DNP, Nephrology and Hypertension Associates, Anchorage, the story details how IHS staffers integrated population- and team-based approaches to help cut the rate of diabetes-related kidney failure among Native Americans by 54% from 1996-to-2013. The article can be accessed at https://www.mdedge.com/clinicianreviews/article/169149/nephrology/how-ihs-reduced-kidney-disease-highest-risk-population

 

 

Vol. 3 No. 31

 

Vitamin D deficiency study notes
importance of adiposity location

LAGUNA NIGUEL, CALIF. – Specific attention for vitamin D deficiency should be given to patients with a high amount of visceral adipose tissue (VAT), according to a recent study one medical expert says is notable in focusing on adiposity location in terms of vitamin D levels.

Research published in May in Endocrine Abstracts, based on a population-based cohort study of patients aged 45-to-65, notes that the relationship between different adiposity measures and 25(OH)D concentrations differed by gender. Among women, total body fat and VAT were inversely related to 25(OH)D concentrations; for men, VAT and hepatic fat were inversely related to 25(OH)D concentrations. In men and women, VAT was most strongly associated with 25(OH)D concentrations.

Ji Hyun Chun, PA-C, BC-ADM, OptumCare Medical Group, Laguna Niguel, Calif., and a faculty member of Metabolic & Disease Summit (MEDS), says that “what's new in this study is that it states that where the adiposity is matters in terms of vitamin D levels, subcutaneous versus visceral: There was higher correlation of visceral adiposity and chances of having low vitamin D.”

Chun, president of the American Society of Endocrine Physician Assistants (ASEPA), also stresses that this research supports the necessity of lifestyle changes to fight weight problems as well as the importance of vitamin D assessments and, when appropriate, supplementation.

He adds that “as vitamin D is a fat-soluble vitamin, patients with increased adiposity are at higher risk of lower circulating serum vitamin D levels. One has to have enough to saturate the adipose tissue before we have enough to circulate in the vascular system.”

Chun also says that visceral adiposity “is really the culprit of metabolic complications associated with obesity, rather than subcutaneous adiposity.”

He adds, though, that “it can work in both ways: We have to think, suspect, and screen for low vitamin D in patients with increased visceral adiposity, but also think, suspect, screen for visceral adiposity in obese patients with low vitamin D.”

The research, a cross-sectional analysis of baseline measurements of the Netherlands Epidemiology of Obesity study, is, says Chun, “an association study rather than causal-relation study, and is still ‘chicken-or-the-egg’ status.”

It is also one of countless indicators of the urgency of battling weight problems.

“No matter what,” Chun asserts, “lifestyle intervention to reduce fat burden is of utmost importance in any patients burdened by extra weight, not just to correct vitamin D problems, but for overall health status, obviously. We perhaps could use this study as another motivator, and reason, to encourage patients to improve their weight status.”

Chun also states that, “in the meantime, we could supplement them with vitamin D to keep their levels in adequate range. However, what is still to be answered is whether the detrimental effects on the bone metabolism from vitamin D deficiency is to the same degree in low vitamin D in obese individuals.”

Classic complications of vitamin D, he also notes, “would occur from severe vitamin D deficiencies. Those affected this way might actually have very low vitamin D status anywhere in the body.”

“Would having vitamin D stored in adipose tissue in obese individuals, and just not enough circulating in blood stream, have a protective role? I don't believe there is an answer to this, and it will be very hard to know. Obese individuals have slightly higher bone mineral density (higher bone mass) than those with normal body weight, yet they have higher risk of fracture, despite the higher BMD. Does this suggest defects in bone quality?”

He asks, too, whether health-care professionals should correlate the effects with parathyroid hormone (PTH).

“Does PTH” he asks, “start to rise at the same level of vitamin D in individuals with normal weight versus overweight, or start to rise at a different threshold? Is that threshold lower or higher?

CITATION: Rachida Rafiq, Floor Walschot, et. al. Associations of different body fat deposits with serum 25-hydroxyvitamin D concentrations. Endocrine Abstracts. (2018) 56 OC6. 5. May 2018. https://www.endocrine-abstracts.org/ea/0056/ea0056oc6.5

 

 

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Level of urbanization is targeted
in research on obesity prevalence
 

HYATTSVILLE, MD. – A nationally-representative survey of adults in the United States indicates that the age-adjusted prevalence of obesity and severe obesity in 2013-to-2016 varied by level of urbanization.

The study published in June in the Journal of the American Medical Association indicates a greater prevalence of obesity and severe obesity among adults living in non-metropolitan statistical areas compared with adults living in large metropolitan-statistical areas.

Its authors---including Craig M. Hales and Cheryl D. Fryar, National Center for Health Statistics, US Centers for Disease Control and Prevention, Hyattsville, MD.---utilized the 2001-to-2016 National Health and Nutrition Examination Survey.
That cross-sectional analysis involved 10,792 adults aged 20 or older and revealed differences in the prevalence of obesity and severe obesity by age group, race and Hispanic origin, and education level.

The prevalence of obesity was significantly greater among women living in non-metropolitan statistical areas (MSAs) compared with women living in large MSAs; the prevalence of severe obesity in non-MSAs was higher than in large MSAs among men and women.

Differences in age group, race and Hispanic origin, education level, or smoking status were not related to the differences in the prevalence of obesity and severe obesity by urbanization level.

During 2013-to-2016, 38.9% of U.S. adults had obesity, and 7.6% had severe obesity. Men living in medium or small MSAs had a higher age-adjusted prevalence of obesity compared with men living in large MSAs.

The age-adjusted prevalence among men living in non-MSAs was not significantly different compared with men living in large MSAs.

The age-adjusted prevalence of obesity was higher among women living in medium or small MSAs compared with women living in large MSAs, and among women living in non-MSAs compared with women living in large MSAs.

Similar patterns were seen for severe obesity, except that the difference between men living in large MSAs compared with non-MSAs was significant.
 

CITATION: Craig M. Hales, MD, Cheryl D. Fryar, MSPH, et. al. Differences in Obesity Prevalence by Demographic Characteristics and Urbanization Level Among Adults in the United States, 2013-2016. Journal of the American Medical Association  June 19, 2018. 2018;319(23):2419-2429. https://jamanetwork.com/journals/jama/article-abstract/2685156?utm_source=silverchair&utm_medium=email&utm_campaign=article_alert-jama&utm_content=etoc&utm_term=061918

 

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Sarcopenia, osteoporosis examined
in frailty-risk reduction assessment
 

TOKYO – Preventing osteoporosis and co-existence of osteoporosis and sarcopenia may help reduce frailty risk, according to a study published in June in Osteoporosis International.

Its authors---including Noriko Yoshimura and Shigeyuki Muraki, who are affiliated with The University of Tokyo---examined the contribution of sarcopenia and osteoporosis to the occurrence of frailty using four-year follow-up information of a population-based cohort study.

That four-year study involved 1,083 subjects aged 60-and-older; the prevalence of frailty was estimated to be 5.6%, and osteoporosis was found to be significantly associated with frailty.

The presence of both osteoporosis and sarcopenia increased the risk of frailty compared to the presence of osteoporosis or sarcopenia alone.

The second survey of the Research on Osteoarthritis/Osteoporosis Against Disability (ROAD) study was conducted between 2008-and-2010; the 1,083 subjects, including 372 men, completed all examinations on frailty, sarcopenia, and osteoporosis, defined using Fried’s definition, Asian Working Group for Sarcopenia criteria, and World Health Organization (WHO) criteria, respectively.

The third survey was conducted between 2012-and-2013; 749 of 1,083 participants enrolled from the second survey (248 men, 501 women) completed assessments identical to those in the second survey.

The prevalence of frailty in the second survey was 5.6% (men, 3.8%; women, 6.6%). The cumulative incidence of frailty was 1.2% per year (men, 0.8% per year; women, 1.3% per year).

After adjustment for confounding factors, logistic-regression analysis indicated that osteoporosis was significantly associated with the occurrence of frailty.

The occurrence of frailty significantly increased according to the presence of osteoporosis and sarcopenia.
 

CITATION: N. Yoshimura, S. Muraki, et. al. Do sarcopenia and/or osteoporosis increase the risk of frailty? A 4-year observation of the second and third ROAD study surveys. Osteoporosis International. First online: 21 June 2018. https://link.springer.com/article/10.1007%2Fs00198-018-4596-4

 

 


 

Chance of fracture is called elevated
for young, middle-aged adults with T1DM
 

CLAYTON, AUSTRALIA – A recent study indicates that in the absence of age‐related comorbidities, fracture risk remains significantly elevated in young- and middle‐aged adults with type 1 diabetes mellitus (T1DM).

The study published in June in Clinical Endocrinology also indicates that younger age does not mitigate against hip-fracture risk in T1DM and suggests that health professionals should be aware of this risk.

Its authors---including Eleanor P. Thong and Madhuni Herath, Monash Health, Clayton, Australia---urge further studies to evaluate the mechanisms of fracture in T1DM.

Their systematic review and meta‐analysis was designed to determine the fracture risk of T1DM patients aged 18 to 50, using Ovid MEDLINE, PubMed, EMBASE, EBM reviews, and relevant conference abstracts.

Six studies were included in the meta‐analysis; 1,724 fractures occurred in 35,925 patients with T1DM and 48,253 fractures occurred in 2,455,016 controls.

The risk ratio (RR) for all fractures was 1.88; 56 hip fractures occurred among 34,707 patients with T1DM and 594 hip fractures occurred in 2,295,177 controls.

The RR of hip fractures was 4.40; females and males with T1DM had RRs of 5.79 and 3.67, respectively.
 

CITATION: Eleanor P. Thong, Madhuni Herath, et. al. Fracture risk in young and middle-aged adults with Type 1 diabetes mellitus: a systematic review and meta-analysis. Clinical Endocrinology. First published: 7 June 2018. https://onlinelibrary.wiley.com/doi/abs/10.1111/cen.13761?af=R&

 

 

Smoking within 5 minutes of waking
tied to higher possibility of asthma
 

GRAND FORKS, N.D. – Research involving more than 4,000 subjects indicates that smoking within five minutes of waking---an indicator of nicotine dependence---is associated with a significantly-increased risk of lifetime asthma in smokers.

The study published in June in BMC Pulmonary Medicine indicates that more detailed risk assessment of smokers, closer monitoring, and increased support for smoking cessation for those at risk for asthma could ultimately reduce the disease burden associated with asthma.

Its authors, including Arielle S. Selya and Sunita Thapa, University of North Dakota, Grand Forks, N.D., drew their data from five pooled cross-sectional waves, from 2005-to-2014, of the National Health and Nutrition Examination Survey (NHANES), conducted by the Centers for Disease Control (CDC).

Their final sample consisted of 4,081 current adult smokers aged 20 or older.

Weighted logistic regressions were run, examining the relationship between smoking within five minutes of waking and outcomes of lifetime asthma, past-year asthma, and having had an asthma attack in the past year.

Control variables included:

  • demographics
  • smoking behavior
  • family history of asthma
  • depression
  • obesity
  • second-hand smoking exposure

After adjusting for smoking behavior, smoking within five minutes was associated with an approximately 50% increase in the odds of lifetime asthma and past-year asthma, respectively.

After additionally adjusting for demographics and other asthma-risk factors, smoking within five minutes of waking was associated with a four-fold increase in the odds of lifetime asthma.
 

CITATION: Arielle S. Selya, Sunita Thapa, et. al. Earlier smoking after waking and the risk of asthma: a cross-sectional study using NHANES data. BMC Pulmonary Medicine. Received: 2 April 2018. Accepted: 13 June 2018. Published: 18 June 2018. https://bmcpulmmed.biomedcentral.com/articles/10.1186/s12890-018-0672-y

 

 

Native Americans said to benefit
from IHS in kidney-disease fight
 

A Renal Consult article in Clinician Reviews in July reports on the successful efforts of  Indian Health Services (IHS) to reduce kidney disease among Native Americans. Written by Mandy E. Thompson, PA-C, who practices at the Kidney Center of Denver Health, and Robin Bassett, DNP, Nephrology and Hypertension Associates, Anchorage, the story details how IHS staffers integrated population- and team-based approaches to help cut the rate of diabetes-related kidney failure among Native Americans by 54% from 1996-to-2013. The article can be accessed at https://www.mdedge.com/clinicianreviews/article/169149/nephrology/how-ihs-reduced-kidney-disease-highest-risk-population

 

 

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