Aims
To examine the association of alcohol consumption patterns with growth differentiation factor 15 (GDF‐15) in older drinkers, separately among individuals with cardiovascular disease ...(CVD)/diabetes and those without them, as GDF‐15 is a strong biomarker of chronic disease burden.
Design
Cross‐sectional study.
Setting
Population‐based study in Madrid (Spain).
Participants
A total of 2051 life‐time drinkers aged 65+ years included in the Seniors‐ENRICA‐2 study in 2015–17. Participants’ mean age was 71.4 years and 55.4% were men.
Measurements
According to their average life‐time alcohol intake, participants were classified as occasional (≤ 1.43 g/day), low‐risk (men: > 1.43–20 g/day; women: > 1.43–10 g/day), moderate‐risk (men: > 20–40 g/day; women: > 10–20 g/day) and high‐risk drinkers (men: > 40 g/day; women: > 20 g/day; or binge drinkers). We also ascertained wine preference (> 80% of alcohol derived from wine), drinking with meals and adherence to a Mediterranean drinking pattern (MDP) defined as low‐risk drinking, wine preference and one of the following: drinking only with meals; higher adherence to the Mediterranean diet; or any of these.
Findings
In participants without CVD/diabetes, GDF‐15 increased by 0.27% 95% confidence interval (CI) = 0.06%, 0.48% per 1 g/day increment in alcohol among high‐risk drinkers, but there was no clear evidence of association in those with lower intakes or in the overall group, or across categories of alcohol consumption status. Conversely, among those with CVD/diabetes, GDF‐15 rose by 0.19% (95% CI = 0.05%, 0.33%) per 1 g/day increment in the overall group and GDF‐15 was 26.89% (95% CI = 12.93%, 42.58%) higher in high‐risk versus low‐risk drinkers. Drinking with meals did not appear to be related to GDF‐15, but among those without CVD/diabetes, wine preference and adherence to the MDP were associated with lower GDF‐15, especially when combined with high adherence to the Mediterranean diet.
Conclusions
Among older life‐time drinkers in Madrid, Spain, high‐risk drinking was positively associated with growth differentiation factor 15 (a biomarker of chronic disease burden). There was inconclusive evidence of a beneficial association for low‐risk consumption.
This study aimed to evaluate discrepancies in potassium measurements between point-of-care testing (POCT) and central laboratory (CL) methods, focusing on the impact of hemolysis on these ...measurements and its impact in the clinical practice in the emergency department (ED).
A retrospective analysis was conducted using data from three European university hospitals: Technische Universitat Munchen (Germany), Hospital Universitario La Paz (Spain), and Erasmus University Medical Center (The Netherlands). The study compared POCT potassium measurements in EDs with CL measurements. Data normalization was performed in categories for potassium levels (kalemia) and hemolysis. The severity of discrepancies between POCT and CL potassium measurements was assessed using the reference change value (RCV).
The study identified significant discrepancies in potassium between POCT and CL methods. In comparing POCT normo- and mild hypokalemia against CL results, differences of -4.20 % and +4.88 % were noted respectively. The largest variance in the CL was a +4.14 % difference in the mild hyperkalemia category. Additionally, the RCV was calculated to quantify the severity of discrepancies between paired potassium measurements from POCT and CL methods. The overall hemolysis characteristics, as defined by the hemolysis gradient, showed considerable variation between the testing sites, significantly affecting the reliability of potassium measurements in POCT.
The study highlighted the challenges in achieving consistent potassium measurement results between POCT and CL methods, particularly in the presence of hemolysis. It emphasised the need for integrated hemolysis detection systems in future blood gas analysis devices to minimise discrepancies and ensure accurate POCT results.
The synovial fluid (SF) analysis involves a series of chemical and physical studies that allow opportune diagnosing of septic, inflammatory, non-inflammatory, and other pathologies in joints. Among ...the variety of analyses to be performed on the synovial fluid, the study of viscosity can help distinguish between these conditions, since this property is affected in pathological cases. The problem with viscosity measurement is that it usually requires a large sample volume, or the necessary instrumentation is bulky and expensive. This study compares the viscosity of normal synovial fluid samples with samples with infectious and inflammatory pathologies and classifies them using an ANN (Artificial Neural Network). For this purpose, a low-cost, portable QCR-based sensor (10 MHz) was used to measure the viscous responses of the samples by obtaining three parameters: Δf, ΔΓ (parameters associated with the viscoelastic properties of the fluid), and viscosity calculation. These values were used to train the algorithm. Different versions of the ANN were compared, along with other models, such as SVM and random forest. Thirty-three samples of SF were analyzed. Our study suggests that the viscosity characterized by our sensor can help distinguish infectious synovial fluid, and that implementation of ANN improves the accuracy of synovial fluid classification.
Background
Growth differentiation factor 15 (GDF‐15) is a biomarker for chronic disease burden that might explain the health effects of sedentary behaviours (SBs) and physical activity (PA). We ...examined associations of device‐measured sleep, SB and PA, and time reallocations among them, with GDF‐15 in older adults.
Methods
We used data from 2245 older adults participating in the Seniors‐ENRICA‐2 study. Wrist‐worn accelerometers were employed to ascertain total time in sleep, SB, light PA (LPA) and moderate‐to vigorous PA (MVPA). Associations between these activities and serum GDF‐15 levels were analysed using linear regression, including isotemporal substitution models for time reallocations among activities, and adjusted for potential confounders. Analyses were conducted separately in two groups (less active and more active individuals) according to the median total PA time.
Results
In the less active participants, 30 min/day more of MVPA were related to lower levels of GDF‐15 when replacing sleep (fully adjusted mean percentage differences 95% confidence interval in GDF‐15 of −9.2% −13.2, −5.0), SB (−9.8% −13.6, −5.8) and LPA (−5.8% −11.1, −0.3), whereas 30 min/day more of LPA were related to lower GDF‐15 when replacing both sleep (−3.6% −6.1, −1.0) and SB (−4.2% −6.7, −1.7). In the more active participants, 30 min/day more of MVPA were also associated with lower GDF‐15 when replacing sleep (−2.9% −5.3, −0.3), SB (−2.4% −4.6, −0.2) and LPA (−3.5% −6.6, −0.3), but no associations were found for more time in LPA. Spending more time in SB was associated with higher GDF‐15 levels only among those less active (1.9% 0.9, 2.9 per 30 min/day increment). Sleep time did not appear to be associated with GDF‐15.
Conclusions
The MVPA was inversely associated with GDF‐15, with stronger associations at lower PA volumes. Also, more LPA and less SB time were linked to lower GDF‐15 in the less active individuals. This suggests that simply moving more and sitting less may reduce chronic disease burden in older adults.
Background The Atellica Solution comprises chemistry (CH) and immunoassay (IM) analyzers. Recently, six early adopter clinical laboratories across Europe evaluated the analytical performance of 20 CH ...and IM assays. To measure analytical performance quality, Sigma metrics were calculated for individual-site and pooled-site results. Methods Precision, detection capability, linearity, and method comparison studies were performed according to Clinical Laboratory Standards Institute protocols. Global Sigma metrics across sites were calculated from pooled data at the medical decision level using total allowable error (TEa) goals from CLIA for CH assays, and TEa goals from RiliBÄK for IM assays; and, the equation: Sigma metrics=%TEa-%bias/%CV. A pooled %CV was calculated by combining the imprecision obtained from individual sites. Bias calculations were performed against the ADVIA Chemistry system or ADVIA Centaur system using Deming regression analysis (Passing-Bablok regression for electrolytes) on the pooled-site data. The 103 individual-site Sigma metric calculations used individual-site imprecision and pooled-bias. Results The limits of blank and detection results agreed with the manufacturer's claims. Most assays were linear across the assay range tested. Pooled Sigma metrics were good or better (>4 Sigma) for 18 of 20 assays; and, acceptable for urea nitrogen (3.1) and sodium (3.9), the latter values attributable to higher imprecision at one of five sites. Conclusions Sigma metrics for data generated across multiple real-world sites evaluating the Atellica Solution demonstrated good or better performance of greater than 4 Sigma for 18 of 20 assays tested. Overall, results verified the manufacturer's claims that methods were fit for use in clinical laboratories.
Growth Differentiation Factor 15 (GDF-15) is a cytokine produced in response to tissue injury and inflammatory states that may capture distinct pathways between the risk factors aggregated within ...metabolic syndrome (MS) and the development of diabetes and cardiovascular disease. This work aims to study the association of MS and its components with GDF-15 among older adults, examining the roles of body fat distribution, glucose metabolism, and inflammation. Data were taken from the Seniors-ENRICA-2 study in Spain, which included 1938 non-institutionalized individuals aged ≥65 years free of diabetes and cardiovascular disease. MS was defined as the presence of ≥3 of the following components: high waist circumference, elevated fasting blood glucose levels, raised blood pressure, increased triglyceride levels, and low serum high-density lipoprotein (HDL) cholesterol. Statistical analyses were performed with linear regression models and adjusted for potential sociodemographic and lifestyle confounders. MS was associated with higher GDF-15 levels (fully adjusted mean increase 95% confidence interval = 9.34% 5.16,13.7). The MS components showing the strongest associations were high waist circumference (6.74% 2.97,10.6), elevated glucose levels (4.91% 0.77,9.23), and low HDL-cholesterol (8.13% 3.51,13.0). High waist-to-hip ratio (7.07% 2.63,11.7), urine albumin (12.1% 2.57,22.5), and C-reactive protein (10.4% 3.89,17.3) were also associated with increased GDF-15. In conclusion, MS was associated with higher GDF-15 levels in older adults. Abdominal obesity, hyperglycemia –possibly linked to microvascular disease, as inferred from elevated urine albumin–, low HDL-cholesterol, and inflammation were the main drivers of this association.
Twenty years have passed since the identification of klotho and the fibroblast growth factor 23 (FGF23), the regulatory binomial of phosphate homeostasis. Being kidney the main source of klotho as ...well as a target organ in the phosphate regulation, most studies involving klotho and FGF23 had a “nephrocentric” focus. Considering that circulating FGF23 can reach exaggerated levels at the end stage of chronic kidney disease (CKD), the bias of this approach allowed to recognize the harmful “off target” klotho-independent effect of FGF23. All of these findings have caused a revolution on our previous knowledge about mineral homeostasis and currently, we are facing a new scenario in the clinical management of CKD, where FGF23 emerges simultaneously as an early biomarker of phosphate retention but also as a therapeutic target. In this review, we describe the disturbances of FGF23 in the CKD and we focus on how the maintenance of circulating FGF23 into a supraphysiological adaptive range from the initial stages of CKD and the control of “unlimited hyperphosphatonism” generated by the resistance to FGF23 action at end stages should emerge as new treatment paradigms in CKD-MBD. The recent development of an automated FGF23 assay, already validated for clinical use, should be the starting point to individualize all our knowledge from epidemiological studies and will allow us to use it properly for the patient’s personalized care. Then, now we are in the momentum to assess the discriminating thresholds to distinguish the physiological adaptive FGF23 elevation related to each CKD stage from the exaggerated increase that would be interpreted as a poor regulatory compensation that will requires the adoption of therapeutic intervention.
Ya han transcurrido veinte años desde la identificación del klotho y del Factor de crecimiento fibroblástico 23 (FGF23), el binomio regulador de la homeostasis del fosfato. Al ser el riñón la principal fuente de klotho y el órgano diana regulador del fosfato, la mayoría de estudios sobre klotho y FGF23 tuvieron una vertiente “nefrocéntrica”. Gracias al sesgo de este enfoque, los exagerados niveles circulantes de FGF23 observados en la enfermedad renal crónica (ERC) permitieron reconocer el efecto nocivo “off target” independiente de klotho que ejerce el FGF23. Todo esto ha revolucionado nuestra visión previa sobre la homeostasis mineral y a día de hoy, nos encontramos ante un nuevo escenario en el abordaje clínico del paciente renal, en el que el FGFG23 emerge como marcador precoz de retención de fosfato y simultáneamente como diana terapéutica. En esta revisión se abordan las alteraciones del FGF23 en la ERC y se plantea cómo el mantenimiento del FGF23 circulante en rango adaptativo suprafisiológico desde los estadios iniciales de ERC y el control del “hiperfosfatonismo ilimitado”, generado por la resistencia a la acción del FGFG23 en los estadios avanzados, deberían emerger como nuevos paradigmas de tratamiento en la CKD-MBD. El reciente desarrollo de un método automatizado para cuantificar FGF23, validado para uso clínico, marca el punto de partida para individualizar todo lo que sabemos por los estudios epidemiológicos y utilizarlo adecuadamente desde la cabecera del paciente. Ahora nos toca establecer los límites que discriminen el incremento adaptativo fisiológico de FGF23, para cada estadio de ERC, frente al aumento exagerado reflejo de una maladaptacion y que requiera la adopción de medidas terapéuticas.
High-sensitivity cardiac troponin T (hs-cTnT) and N-terminal pro-brain natriuretic peptide (NT-proBNP) are biomarkers of myocardial infarction and heart failure, respectively, and indicate ...cardiovascular risk. Since low physical activity (PA) and sedentary behavior (SB) are also associated with higher cardiovascular risk, and this association could be a consequence of higher levels of cardiac biomarkers, we examined the association of device-measured movement behaviors with hs-cTnT and NT-proBNP in older men and women without major cardiovascular disease (CVD).
We used data from 1939 older adults from the Seniors-ENRICA-2 study. Accelerometers were used to assess time spent in sleep, SB, light PA (LPA), and moderate-to-vigorous PA (MVPA). Linear regression models were fitted separately in eight strata defined by sex, by median total PA time, and by the presence of subclinical cardiac damage according to cardiac biomarkers levels.
In the less active men with subclinical cardiac damage, spending 30 min/day more of MVPA was associated with a mean percentage difference (MPD) (95% confidence interval) in hs-cTnT of - 13.1 (- 18.3, - 7.5); MPDs in NT-proBNP per 30 min/day increment were 5.8 (2.7, 8.9) for SB, - 19.3 (- 25.4, - 12.7) for LPA and - 23.1 (- 30.7, - 14.6) for MVPA. In women with subclinical cardiac damage who were less physically active, 30 min/day more of SB, LPA and MVPA were associated with MPDs in hs-cTnT of 2.1 (0.7, 3.6), - 5.1 (- 8.3, - 1.7) and - 17.5 (- 22.9, - 11.7), respectively, whereas in those more active, LPA and MVPA were associated with MPDs of 4.1 (1.2, 7.2) and - 5.4 (- 8.7, - 2.0), respectively. No associations were found with NT-proBNP in women.
The relationship between movement behaviors and cardiac biomarkers in older adults without major CVD depends on sex, subclinical cardiac damage and PA level. More PA and less SB were generally related to lower cardiac biomarkers levels among less active individuals with subclinical cardiac damage, with greater benefits for hs-cTnT in women than men and no benefits for NT-proBNP in women.
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