Previous studies indicate that the introduction of high-sensitivity troponin T (HsTnT) as a diagnostic tool for chest pain patients in the emergency department (ED) creates a high rate of ...false-positive tests. In the present study, we aimed to evaluate if the diagnostic performance of HsTnT for acute coronary syndrome (ACS) up to 3-4 h after presentation in elderly patients can be improved.
A total of 477 consecutive patients ≥ 75 years, admitted to in-hospital care for chest pain suspicious of ACS, were retrospectively included. HsTnT values at presentation (0 h) and at 3-4 h were analysed. Receiver operating characteristic (ROC) curves were created for absolute and relative changes from 0 to 3-4 h. ACS, non-elective percutaneous coronary intervention, coronary artery bypass grafting and death of all causes were recorded for all patients during a follow-up of 60 days. Sensitivity, specificity, negative predictive value (NPV) and positive predictive value (PPV) were analysed for different HsTnT cut-off values at 0 and 3-4 h and for the combination of a HsTnT at presentation and an absolute change from 0 to 3-4 h.
Twenty-seven percent of the patients had ACS and 21 % acute myocardial infarction (AMI) during the hospital stay. The standard cut-off 14 ng/L gave sensitivity and NPV for ACS of 88 and 90 % at 3-4 h. Specificity and PPV was 38 and 32 % respectively. Analysing for non-ST elevation myocardial infarction (NSTEMI) alone gave a sensitivity and NPV of 100 % but did not improve specificity and PPV. The area under the ROC-curve was larger for absolute than relative HsTnT changes from 0 to 3-4 h. A combination of HsTnT at presentation > 30 ng/L and/or a change > 5 ng/L up to 3-4 h gave a 63 % specificity and a PPV of 46 %, a 99 % sensitivity and a NPV of 99 % for NSTEMI.
Our study indicates that HsTnT can neither exclude nor confirm ACS within 3-4 h from presentation in patients ≥ 75 years. NSTEMI can be excluded with HsTnT within 3-4 h, but HsTnT cannot be used to rule in NSTEMI during the first 3-4 h, not even by using a combination of the initial HsTnT result and the change from 0 to 3-4 h. With combined criteria, the majority of the positive tests were still false positive. Our results indicate that in patients > 75 years, HsTnT should be used primarily as an early rule-out tool for AMI.
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IZUM, KILJ, NUK, PILJ, PNG, SAZU, UL, UM, UPUK
The aim of this study was to determine the effect of supplemental oxygen in patients with myocardial infarction (MI) on the composite of all-cause death, rehospitalization with MI, or heart failure ...related to baseline oxygen saturation. A secondary objective was to investigate outcomes in patients developing hypoxemia.
In the DETO2X-AMI (Determination of the Role of Oxygen in Suspected Acute Myocardial Infarction) trial, 6,629 normoxemic patients with suspected MI were randomized to oxygen at 6 l/min for 6 to 12 h or ambient air.
The study population of 5,010 patients with confirmed MI was divided by baseline oxygen saturation into a low-normal (90% to 94%) and a high-normal (95% to 100%) cohort. Outcomes are reported within 1 year. To increase power, all follow-up time (between 1 and 4 years) was included post hoc, and interaction analyses were performed with oxygen saturation as a continuous covariate.
The composite endpoint of all-cause death, rehospitalization with MI, or heart failure occurred significantly more often in patients in the low-normal cohort (17.3%) compared with those in the high-normal cohort (9.5%) (p < 0.001), and most often in patients developing hypoxemia (23.6%). Oxygen therapy compared with ambient air was not associated with improved outcomes regardless of baseline oxygen saturation (interaction p values: composite endpoint, p = 0.79; all-cause death, p = 0.33; rehospitalization with MI, p = 0.86; hospitalization for heart failure, p = 0.35).
Irrespective of oxygen saturation at baseline, we found no clinically relevant beneficial effect of routine oxygen therapy in normoxemic patients with MI regarding cardiovascular outcomes. Low-normal baseline oxygen saturation or development of hypoxemia was identified as an independent marker of poor prognosis. (An Efficacy and Outcome Study of Supplemental Oxygen Treatment in Patients With Suspected Myocardial Infarction; NCT01787110)
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Aim
Skinfold measurement is an inexpensive and widely used technique for assessing the percentage of body fat (%BF). This study assessed the accuracy of prediction equations for %BF based on skinfold ...measurements compared to dual‐energy X‐ray absorptiometry (DXA) in girls with type 1 diabetes and healthy age‐matched controls.
Methods
We included 49 healthy girls and 44 girls with diabetes aged 12–19 years old, comparing the predicted %BF based on skinfold measurements and the %BF values obtained by a Lunar DPX‐L scanner. The agreement between the methods was assessed using an Bland–Altman plot.
Results
The skinfold measurements were significantly higher in girls with diabetes (p = 0.003) despite a nonsignificant difference in total %BF (p = 0.1). A significant association between bias and %BF was found for all tested equations in the Bland–Altman plots. Regression analysis showed that the association between skinfold measurements and %BF measured by DXA differed significantly (p = 0.039) between the girls with diabetes and the healthy controls.
Conclusion
The accuracy of skinfold thickness equations for assessment of %BF in adolescent girls with diabetes is poor in comparison with DXA measurements as criterion. Our findings highlight the need for the development of new prediction equations for girls with type 1 diabetes.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SBCE, SBMB, UL, UM, UPUK
We investigated the associations of body fat percentage (BF%), objectively assessed moderate-to-vigorous physical activity (MVPA) and different types of physical activity assessed by a questionnaire ...with neuromuscular performance. The participants were 404 children aged 6-8 years. BF% was assessed using dual-energy x-ray absorptiometry and physical activity by combined heart rate and movement sensing and a questionnaire. The results of 50-m shuttle run, 15-m sprint run, hand grip strength, standing long jump, sit-up, modified flamingo balance, box-and-block and sit-and-reach tests were used as measures of neuromuscular performance. Children who had a combination of higher BF% and lower levels of physical activity had the poorest performance in 50-m shuttle run, 15-m sprint run and standing long jump tests. Higher BF% was associated with slower 50-m shuttle run and 15-m sprint times, shorter distance jumped in standing long jump test, fewer sit-ups, more errors in balance test and less cubes moved in box-and-block test. Higher levels of physical activity and particularly MVPA assessed objectively by combined accelerometer and heart rate monitor were related to shorter 50-m shuttle run and 15-m sprint times. In conclusion, higher BF% and lower levels of physical activity and particularly the combination of these two factors were associated with worse neuromuscular performance.
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BFBNIB, FSPLJ, GIS, IJS, KISLJ, NUK, PNG, UL, UM, UPUK
Background: The protective effect of physical activity (PA) on abdominal adiposity is unclear.
Objective: We examined whether PA independently predicted gains in body weight and abdominal adiposity.
...Design: In a prospective cohort study the EPIC (European Prospective Investigation into Cancer and Nutrition), we followed 84,511 men and 203,987 women for 5.1 y. PA was assessed by a validated questionnaire, and individuals were categorized into 4 groups (inactive, moderately inactive, moderately active, and active). Body weight and waist circumference were measured at baseline and self-reported at follow-up. We used multilevel mixed-effects linear regression models and stratified our analyses by sex with adjustments for age, smoking status, alcohol consumption, educational level, total energy intake, duration of follow-up, baseline body weight, change in body weight, and waist circumference (when applicable).
Results: PA significantly predicted a lower waist circumference (in cm) in men (β = −0.045; 95% CI: −0.057, −0.034) and in women (β = −0.035; 95% CI: −0.056, −0.015) independent of baseline body weight, baseline waist circumference, and other confounding factors. The magnitude of associations was materially unchanged after adjustment for change in body weight. PA was not significantly associated with annual weight gain (in kg) in men (β = −0.008; 95% CI: −0.02, 0.003) and women (β = −0.01; 95% CI: −0.02, 0.0006). The odds of becoming obese were reduced by 7% (P < 0.001) and 10% (P < 0.001) for a one-category difference in baseline PA in men and women, respectively.
Conclusion: Our results suggest that a higher level of PA reduces abdominal adiposity independent of baseline and changes in body weight and is thus a useful strategy for preventing chronic diseases and premature deaths.
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CMK, GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Some research suggests that parent or carer feeding practices may influence children's weight patterns, but longitudinal evidence is limited and inconsistent.
The aim of this study was to investigate ...the relation between various parent or carer feeding practices when a child is aged 7–8 y and proxy measurements of child adiposity at age 8–9 y (weight status, waist-to-height ratio, and body fat percentage).
The study was a secondary analysis of data from the West Midlands Active Lifestyle and Healthy Eating in Schoolchildren (WAVES) Study comprising a diverse sample of parents and carers and their children from 54 primary schools in the West Midlands, England n = 774 parent-child dyads (53% of the WAVES study sample). Information on feeding practices was collected with the use of subscales from the Comprehensive Feeding Practices Questionnaire, completed by the child's main parent or carer (self-defined). Child height, weight, bioelectrical impedance, and waist circumference were measured and converted into 3 proxy measurements of adiposity (weight status, waist-to-height ratio, and body fat percentage). Associations between these measurements and parent or carer feeding practices were examined with the use of mixed-effects logistic regression models.
Of the questionnaire respondents, 80% were mothers, 16% were fathers, and 4% were other carers. Median standardized subscale scores ranged from 1.7 (emotion regulation: IQR = 1.0) to 4.0 (monitoring and modeling: IQR = 1.5), and significantly different subscale scores were present between child weight statuses for emotion regulation, pressure to eat, and restriction for weight control. Logistic regression modeling showed that when baseline adiposity measures were included as covariates, all associations between parental feeding practices at age 7–8 y and measures of adiposity at age 8–9 y were attenuated.
Observed relations between various parental feeding practices and later adiposity are mitigated by inclusion of the baseline adiposity measure. This finding lends support to the theory of reverse causation, whereby the child's size may influence parental choice of specific feeding practices rather than the child's subsequent weight status being a consequence of these feeding practices.
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CMK, GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
PURPOSE:Accurate measurement of physical activity (PA) is a prerequisite to determine dose–response relationships between activity and health. The combination of HR and accelerometers (ACC) holds ...promise for improving the accuracy of PA assessment, but it is unclear how currently proposed modeling techniques compare and to what extent different levels of individual calibration (IC) of HR influence monitoring accuracy.
METHODS:A total of 10 men and women (25.8 ± 3.4 yr, 1.70 ± 0.1 m, 71.7 ± 11.8 kg, 24.4 ± 5.0 kg·m) were recruited for this study, in which IC of HR to PA energy expenditure (PAEE) during both arm crank and treadmill activity were available. Participants completed 6 h of free-living activity, during which PAEE (obtained with indirect calorimetry), HR, hip ACC, arm ACC, and leg ACC were collected. PAEE was then modeled from two different methods of combining HR and ACC (arm-leg HR+M and branched model), both with IC and group-level calibration (GC) of HR, and also from hip ACC estimates alone. Estimates of PAEE were compared with criterion values for PAEE.
RESULTS:Combined estimates of PAEE from the arm-leg HR+M and the branched model were similar when IC was used (R = 0.81, SEE = 0.55 METs and R = 0.75, SEE = 0.61 METs, respectively). When using GC, all estimates of PAEE had larger error, but the performance of the branched model suffered less than the arm-leg HR+M model (R = 0.75, SEE = 0.67 METs and R = 0.67, SEE = 0.88 METs, respectively). Both combination modeling techniques were more precise than single-measure hip ACC estimates (R = 0.41, SEE = 0.96 METs).
CONCLUSION:The combination of HR and ACC improves the accuracy of PAEE estimates and could be applied in large-scale epidemiological studies.
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