Elevated fibroblast growth factor-23 (FGF23) is an established marker of cardiovascular disease. The underlying reason(s) for the rise accompanying cardiovascular health decline are unclear. Prior ...studies have shown that FGF23 concentrations are associated with markers of inflammation and insulin resistance but they have been limited by a focus on persons with chronic kidney disease (CKD) and lack of race and sex diversity. The objective of this study was to examine the associations of FGF23 and markers of inflammation, insulin resistance, and anthropometrics in a large cohort of community-dwelling adults.
Associations of FGF23 with markers of inflammation interleukin-6 (IL-6), IL-10, high sensitivity-CRP (hsCRP), insulin utilization resistin, adiponectin, homeostatic model assessment of insulin resistance (HOMA-IR) and anthropometrics BMI and waist circumference (WC) were examined cross-sectionally in a 1,040 participants randomly selected from the Reason for Geographic and Racial Differences in Stroke (REGARDS) Study, a national study of black and white adults ≥45 years. Effect modification by race and CKD status was tested, and stratified models were analyzed accordingly.
Median FGF23 concentration was 69.6 RU/ml (IQR: 53.2, 102.7). Higher quartiles of FGF23 were associated with higher mean concentrations of IL-6, IL-10, hsCRP and resistin (Ptrend<0.001 for all). There were no significant differences in HOMA-IR, adiponectin concentrations, BMI, or WC across FGF23 quartiles in the crude analyses. CKD significantly modified the relationships between FGF23 and inflammatory markers, HOMA-IR, BMI and WC (P ≤ 0.01 for all). In linear regression models adjusted for sociodemographic and clinical variables, FGF23 was positively associated with IL-6, hsCRP, IL-10, HOMA-IR, BMI and WC in individuals without CKD, but not among individuals with CKD. Additionally, FGF23 was positively associated with resistin irrespective of CKD status.
Elevated FGF23 concentrations may be considered a biomarker for decline in metabolic function among individuals with normal kidney function.
This field observational study describes the seasonal pattern of small lungworm infections under different grazing managements from August 2018 to March 2019. Live weight, lungworm and ...gastrointestinal nematode infection, as well as pasture type grazed and snail density, were measured at 5 farm visits. Across all visits and mobs, about one quarter to one half of sheep were positive for small lungworm, although prevalence was as low as 0% and as high as 78%. The density of the intermediate host molluscs was greater than 1600 snails/m2 in irrigated perennial lucerne pasture when it was grazed (‘Pasture A’), but was low (<300) in non‐irrigated perennial pasture (‘Pasture B’) and non‐irrigated forage crop (‘Pasture C’). Overall, non‐infected lambs had a similar live weight compared with the small lungworm infected lambs (mean difference −0.6 kg; 95% CI −1.6 to 0.2; P = 0.1). The odds ratio of small lungworm infection associated with a twofold increase in worm egg count was 1.7 (95% CI 1.1 to 2.7; P = 0.02). Rather than a distinct seasonal pattern of infection, we found that small lungworm can occur throughout the year, with prevalence most influenced by pasture type (irrigated vs dryland), grazing management and the population density of the intermediate hosts. Importantly, this study suggested that small lungworm infection did not reduce lamb live weights. It reinforced that to improve sheep productivity, well‐established determinants of production, such as correct grazing management to optimise pasture quality and strategies to reduce infections with gastrointestinal nematodes, should be the priority of farm managers.
This study explores the knowledge and practice of diabetes educators and dietitians on diet and lifestyle management in women with gestational diabetes mellitus (GDM). Diabetes educators and ...dietitians were recruited from three maternity hospitals in Adelaide (Australia), through snowball and purposive sampling. Thirteen semistructured interviews were conducted, audio recorded, transcribed verbatim, and analysed for codes and themes. Four themes emerged: guidelines and resources, dietary intervention, management delivery, and communication. Diabetes educators and dietitians demonstrated consistent knowledge of nutritional management for GDM and uniform delivery methods. However, a lack of culturally diverse resources was highlighted, along with a lack of continuity of care across the multidisciplinary team. Barriers towards uptake of dietary intervention were reflected by diabetes educators and dietitians as women showing signs of guilt and stress and disengaging from the service. Further exploration on the knowledge and practice of diabetes educators and dietitians for GDM to best inform implementation strategies for knowledge translation of nutritional management is needed. The indication of language and cultural barriers and resources highlight an ongoing key priority area to support the care of women of ethnic minorities.
Abstract Mechanical stimulation is necessary for maximization of geometrical properties of bone mineralization contributing to long-term strength. The amount of mineralization in bones has been ...reciprocally related to volume of bone marrow adipose tissue and this relationship is suggested to be an independent predictor of fracture. Physical activity represents an extrinsic factor that impacts both mineralization and marrow volume exerting permissive capacity of the growing skeleton to achieve its full genetic potential. Because geometry- and shape-determining processes primarily manifest during the linear growth period, the accelerated structural changes accompanying early childhood (ages 3 to 6 y) may have profound impact on lifelong bone health. The objective of this pilot study was to determine if a short-term physical activity intervention in young children would result in augmentation of geometric properties of bone. Three days per week the intervention group (n = 10) participated in 30 min of moderate intensity physical activity, such as jumping, hopping and running, and stretching activities, whereas controls (n = 10) underwent usual activities during the 10-week intervention period. Femoral bone marrow adipose tissue volume and total body composition were assessed by magnetic resonance imaging and dual-energy X-ray absorptiometry, respectively, at baseline and after 10 weeks. Although after 10-weeks, intergroup differences were not observed, a significant decrease in femoral marrow adipose tissue volume was observed in those participating in physical activity intervention. Our findings suggest that physical activity may improve bone quality via antagonistic effects on femoral bone marrow adipose tissue and possibly long-term agonistic effects on bone mineralization.
The role of vitamin D in cardiovascular health remains debated as results have been inconsistent. Previous studies have not considered the bioavailability of 25-hydroxy vitamin D 25(OH)D. Objectives ...of our study were to investigate the association between serum concentrations of total, free and bioavailable 25(OH)D and independent predictors of cardiovascular risk such as flow mediated dilatation (FMD) and augmentation index (AIx).
This cross-sectional study included 47 post-menarchal, adolescent females 31 African American (AA) and 16 European American (EA).
AIx was standardized to a heart rate of 75 beats/min (AIx75). Free and bioavailable 25(OH)D concentrations were calculated from standard formulas.
Mean age of the participants was 15.8 ± 1.4 years and mean body mass index was 23.1 ± 4.0 kg/m2. Serum total 25(OH)D was not associated with FMD, but was positively associated with AIx75 in the adjusted model (rho = 0.4, P = 0.03). AIx75 was positively associated with bioavailable 25(OH)D (rho = 0.4, P = 0.004) and free 25(OH)D (rho = 0.4, P = 0.009) and the associations persisted after adjusting for covariates. In race-specific analyses, total, free and bioavailable 25(OH)D were strongly positively associated with AIx75 in AA (rho = 0.5, 0.4, 0.4, respectively), which persisted even after adjusting for covariates. Whereas in EA there was an inverse association between total 25(OH)D and AIx75 in EA (rho = -0.6), which attenuated after adjusting for covariates.
Circulating total, free and bioavailable 25(OH)D were associated with arterial stiffness in adolescent girls, and these associations were race dependent. Notwithstanding, the implications of associations between vascular function indices and 25(OH)D remains unclear.
Abstract Background Circulating FGF21 levels are commonly elevated in disease states. There is limited information regarding concentrations of circulating FGF21 in the absence of disease, as well as ...age-related differences in body composition that may contribute to FGF21 regulation across groups. Objective The objectives of this study were to assess FGF21 levels across age groups (childhood to elder adulthood), and investigate whether body composition indices are associated with age-related differences in circulating FGF21. Materials and methods We cross-sectionally analyzed serum concentrations of FGF21 in 184 healthy subjects aged 5–80 y (45% male). Multiple linear regression was performed to assess the independent association of categorical age (children: 5–12 y, young adults: 20–29 y, adults: 30–50 y, older adults: 55–64 y, elder adults: 65–80 y) with FGF21 concentration taking into account DXA-measured body composition indices bone mineral density (BMD) and percent lean, trunk, and fat mass. We also stratified analysis by tertile of FGF21. Results Incremental increases in FGF21 levels were observed across age groups (youngest to highest). Age group was positively associated with FGF21 level independent of body composition indices (age group variable: β = 0.25, 0.24, 0.24, 0.23, all P < 0.0001, controlling for percent lean, BMD, percent fat, and percent trunk fat, respectively). By FGF21 tertile, age group was associated with FGF21 in the lowest tertile only ( β = 13.1, 0.19, 0.18, all P ≤ 0.01, accounting for percent lean, fat and trunk fat, respectively), but not when accounting for BMD. Conclusions Our findings in a healthy population display an age-related increase in serum FGF21, highlighting a potential age effect in response to metabolic demand over the lifecourse. FGF21 levels increase with age independently of body composition. At lower levels of FGF21, BMD, but not other body composition parameters, attenuates the association between FGF21 level and age, suggesting the metabolic demand of the skeleton may provide a link between FGF21 and energy metabolism.
A 4D CT protocol for detection of parathyroid lesions involves obtaining unenhanced, arterial, early, and delayed venous phase images. The aim of the study was to determine the ideal combination of ...phases that would minimize radiation dose without sacrificing diagnostic accuracy.
With institutional review board approval, the records of 29 patients with primary hyperparathyroidism who had undergone surgical exploration were reviewed. Four neuroradiologists who were blinded to the surgical outcome reviewed the imaging studies in 5 combinations (unenhanced and arterial phase; unenhanced, arterial, and early venous; all 4 phases; arterial alone; arterial and early venous phases) with an interval of at least 7 days between each review. The accuracy of interpretation in lateralizing an abnormality to the side of the neck (right, left, ectopic) and localizing it to a quadrant in the neck (right or left upper, right or left lower) was evaluated.
The lateralization and localization accuracy (90.5% and 91.5%, respectively) of the arterial phase alone was comparable with the other combinations of phases. There was no statistically significant difference among the different combinations of phases in their ability to lateralize or localize adenomas to a quadrant (P = .976 and .996, respectively).
Assessment of a small group of patients shows that adequate diagnostic accuracy for parathyroid adenoma localization may be achievable by obtaining arterial phase images alone. If this outcome can be validated prospectively in a larger group of patients, then the radiation dose can potentially be reduced to one-fourth of what would otherwise be administered.
Short-range elephant Loxodonta africana movements were examined in a heterogeneous landscape mosaic of settlements, crop fields and remnant forest in the Caprivi Strip, Namibia. We explored the ...penetration of the landscape through the use of permanent pathways and determined the impact of pathway use on crop-raiding location. Pathways were linear, devoid of vegetation and maintained by repeated movement. Functional connectivity of pathways was not species-specific, and pathways were used by various species. Elephants travelled in single file at night and we recorded selective pathway use: females selected pathways away from settlements to access water, whereas males used pathways among settlements to launch crop raids. Proximity of raided fields to the nearest pathway was the only significant spatial variable explaining crop-raiding location. Bulls were responsible for all crop-raiding incidents. We conclude that (1) pathways were the most significant spatial variable influencing which fields were raided, (2) crop-raiding from pathways may maximize foraging efficiency by reducing time spent and distance travelled while foraging, (3) pathways may facilitate penetration of the matrix by connecting predictable resources (crops) with preferred shelter areas, crossing points at roads and preferred drinking spots, and (4) access to the Kwandu River is restricted by settlements, predictably resulting in human–elephant conflict. By highlighting the relevance of pathways for movement of elephants we show that an understanding of the use of pathways is important for land-use planning in conservation landscapes, specifically with regard to human–elephant conflict. We also argue for the need to more fully explore pathway occurrence and use at larger spatial scales.
Higher body mass index (BMI) is paradoxically associated with lower mortality in persons with CKD, but whether cardiometabolic abnormalities modulate this association is unclear.
Participants with ...CKD from the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study (n=4374) were analyzed. The harmonized criteria for metabolic syndrome were used to define metabolic health, and participants were categorized into one of six mutually exclusive categories defined by combined measures of metabolic health (metabolically healthy, <3 criteria for metabolic syndrome; metabolically unhealthy, ≥3 criteria) and weight status (normal weight, BMI 18.5-24.9 kg/m(2); overweight, BMI 25-29.9 kg/m(2); obese, BMI ≥30 kg/m(2)). Cox models were used to estimate the hazard ratio (HR) of death as a function of each category.
A total of 683 deaths were observed over a mean 4.5 years of follow-up. In analyses adjusted for age, race, sex, and geographic region of residence, compared with metabolically healthy normal weight persons, the HRs of mortality in metabolically healthy overweight and obese persons were 0.68 (95% confidence interval 95% CI, 0.53 to 0.87) and 0.71 (95% CI, 0.51 to 0.98), respectively, whereas there were no statistically significant differences in survival among metabolically unhealthy overweight or obese individuals. After further adjustment for lifestyle, clinical and laboratory factors including markers of kidney function, the HR of mortality remained lower in metabolically healthy overweight individuals compared with metabolically healthy normal weight individuals (HR, 0.74; 95% CI, 0.57 to 0.96).
Metabolic abnormalities may attenuate the magnitude and strength of survival benefits associated with higher BMI in individuals with CKD.
The perispores of 48 species of bolbitidoid ferns (Mickelia,Arthrobotrya,Bolbitis,Elaphoglossum,Lomagramma, andTeratophyllum) were studied with an SEM. The species studied were those used in a ...published phylogenetic analysis. For each species, five perispore characters were scored and optimized onto a published molecular tree. A loose, nonappressed perispore with broad folds optimizes as ancestral for the bolbitidoids. The only exception isLomagramma, for which the perispore adheres tightly to the exospore—a character state that optimizes as a synapomorphy for that genus. In the bolbitidoids, thin crests evolved from broad folds seven times. The presence of thin crests inMickeliaoptimizes as a synapomorphy for that genus. The presence of fine surface detail, here termed “microstructure,” was present in nearly all bolbitidoids and optimized as ancestral. Microstructure consisted of spicules, minute crests, and verrucae. The presence of verrucae optimizes as a synapomorphy forLomagramma. The perispore ofBolbitis appendiculatais visually striking because it is highly reticulate throughout, a character that is autapomorphic in this analysis. No correspondence was observed between perispore characters and the transition series going from terrestrial (Bolbitis) to hemiepiphytic (Mickelia,Arthrobotrya,Lomagramma, andTeratophyllum) to epiphytic (Elaphoglossum) genera. The spore images of all species studied are publicly available athttp://www.plantsystematics.org.
PDF
