Few studies have examined both the relative magnitude of association and the discriminative capability of multiple indicators of obesity with cardiovascular disease (CVD) mortality risk. We conducted ...an individual‐participant meta‐analysis of nine cohort studies of men and women drawn from the British general population resulting in sample of 82 864 individuals. Body mass index (BMI), waist circumference (WC) and waist‐to‐hip ratio (WHR) were measured directly. There were 6641 deaths (1998 CVD) during a mean of 8.1 years of follow‐up. After adjustment, a one SD higher in WHR and WC was related to a higher risk of CVD mortality (hazard ratio 95% CI): 1.15 (1.05–1.25) and 1.15 (1.04–1.27), respectively. The risk of CVD mortality also increased linearly across quintiles of both these abdominal obesity markers with a 66% increased risk in the highest quintile of WHR. In age‐ and sex‐adjusted models only, BMI was related to CVD mortality but not in any other analyses. No major differences were revealed in the discrimination capabilities of models with BMI, WC or WHR for cardiovascular or total mortality outcomes. In conclusion, measures of abdominal adiposity, but not BMI, were related to an increased risk of CVD mortality. No difference was observed in discrimination capacities between adiposity markers.
The aim of this study was to assess the association between obesity and the risk of intensive care unit (ICU) admission and death among patients hospitalized for influenza A (H1N1) viral infection. A ...systematic review of the Medline and Cochrane databases using ‘obesity', ‘hospitalization', ‘influenza A viral infection', various synonyms, and reference lists of retrieved articles from January 2009 to January 2010. Studies comparing the prevalence of obesity among patients with confirmed infection for influenza A virus and who were either hospitalized or admitted to ICU/died were included. A total of 3059 subjects from six cross-sectional studies, who were hospitalized for influenza A (H1N1) viral infection, were included in this meta-analysis. Severely obese H1N1 patients (body mass index ≥ 40 kg m⁻², n = 804) were as twice as likely to be admitted to ICU or die (odds ration: 2.01, 95% confidence interval: 1.29-3.14, P < 0.002) compared with H1N1 patients who were not severely obese. Having a body mass index ≥ 30 kg m⁻² was similarly associated with a more than twofold increased risk of ICU admission or death although this did not reach statistical significance (2.14, 0.92-4.99, P < 0.07). This meta-analysis supports the view that obesity is associated with higher risks of ICU admission or death in patients with influenza A (H1N1) infection. Therefore, morbid obese patients should be monitored more intensively when hospitalized.
Disturbances in the oral microbiome are associated with periodontal disease initiation and progression and diabetes mellitus (DM), but how this contributes to the cause-and-effect relationship ...between periodontal disease and DM is poorly understood. We examined the bacterial composition in plaque samples from 128 South Africans with periodontal disease across glycemic statuses using 16S rDNA sequencing of regions 2, 3, 4, 6-7, 8, and 9. Of the 9 phyla identified, Firmicutes, Proteobacteria, Bacteroidetes, Fusobacteria, and Actinobacteria made up >98%. Fusobacteria and Actinobacteria were significantly more abundant in subjects with diabetes, while Proteobacteria were less abundant. However, in the presence of gingival bleeding and DM, as compared with DM without gingival bleeding, Actinobacteria were markedly reduced while Bacteroidetes were more abundant. In contrast, no differences in Actinobacteria or Bacteroidetes abundance were observed between DM with and without pocket depth (PD) ≥4 mm. At the genus level, similar changes in relative abundance were observed in the presence of DM and periodontal disease. Our findings remained in conditional logistic regression models adjusted for age, sex, waist circumference, and the 5 most dominant phyla. For example, Actinobacteria significantly increased the odds of diabetes by 10% in subjects with gingival bleeding, while Fusobacteria increased this odd by 14%; yet, among subjects with PD ≥4 mm, Fusobacteria decreased the odds of DM by 47%. Our findings have confirmed the alterations in the composition of the oral microbiota across glycemic statuses as well as different stages of periodontal disease. However, it is not clear whether these differences were the consequence of hyperglycemia or the presence of periodontal diseases. Therefore, we recommend further investigations in a longitudinal study design.
Dyslipidaemia and hypertension care have not been reported in large samples of community-based participants with known diabetes (KD) nor compared with individuals at high risk for diabetes.
To ...describe the management and associations of dyslipidaemia and hypertension in adults with KD, newly diagnosed diabetes (NDD) and normoglycaemia.
This urban population-based cross-sectional study comprised participants with KD, NDD and normoglycaemia. Participants at high risk for diabetes but without KD underwent oral glucose tolerance tests; those who were subsequently classified as NDD or normoglycaemic were included in this study. Data collection comprised administered questionnaires, clinical measurements and biochemical analyses. Multivariable logistic regressions determined the associations with hypertension and dyslipidaemia management in separate models.
Among 618 participants (82% women), aged median 58 years, there were 339 participants with KD, 70 with NDD and 209 with normoglycaemia. Prevalence of hypertension (BP ≥140/90 mmHg or on treatment) and dyslipidaemia (raised low-density lipoprotein cholesterol >3 mmol/L or on treatment) was highest in KD (89% and 83%) compared with NDD (64% and 74%) and normoglycaemia (66% for both) (p<0.001). Detected or known hypertension was highest in KD (97.4%), followed by NDD (88.9%) and normoglycaemia (80.3%). Among participants with known or detected hypertension, those with KD were most likely to be treated (90.2%) compared with NDD (77.5%) and normoglycaemia (74.5.%). Hypertension control among participants on treatment was highest in KD (69.5%) compared with NDD (51.6%) and normoglycaemia (61.0%). Participants with KD had significantly higher rates of previously detected dyslipidaemia (85.1%) compared with NDD (36.5%) and normoglycaemia (35.5%). KD participants were also more likely to be treated for their previously detected dyslipidaemia (85.4%) and to be controlled when on treatment (56.3%) compared with their counterparts (NDD: 63.2% and 33.3%, normoglycaemia: 61.2% and 43.3%, respectively). Diabetes control was poor; only 20% of those with KD had HbA1c <7%. In the regression models, compared with normoglycaemia, KD was associated with hypertension detection (odds ratio (OR) 6.91, 95% confidence interval (CI) 2.25 - 21.22) and control (OR 2.05, 95% CI 1.04 - 4.02). KD compared with normoglycaemia was associated with dyslipidaemia detection (OR 10.29, 95% CI 5.21 - 20.32) and treatment (OR 3.94, 95% CI 1.68 - 9.27). Sociodemographic and cardiovascular disease risk factors were generally not associated with hypertension or dyslipidaemia management.
Albeit that diabetes control was poor and required better management, dyslipidaemia and hypertension prevalence were higher and better managed in KD than NDD and normoglycaemia. Different approaches are required to improve glucose control in KD, better identify NDD and monitor and prevent diabetes in high-risk individuals. Also important would be to improve care of hypertension and dyslipidaemia in those without KD.
Aims
To formulate a combined cardiovascular risk score in diabetes that could be useful both to physicians and healthcare funders.
Methods
Data were derived from the Action in Diabetes and Vascular ...Disease: Preterax and Diamicron Modified Release Controlled Evaluation Observational (ADVANCE‐ON) study, a randomized controlled trial (mean duration 5 years) with a post‐randomization follow‐up (mean 4.9 years), that included 11 140 high‐risk patients with diabetes. The outcome analysed was the occurrence of either fatal or non‐fatal macrovascular or renal disease. A Cox regression model was used to determine weightings in the risk score. The resultant score was recalibrated to each of three major global regions, as covered by the ADVANCE‐ON study.
Results
Over a median of 9.9 years, 1145 patients experienced at least one component of the combined outcome event. The resultant score, the AD‐ON risk score, incorporated 13 demographic or clinical variables. Its discrimination was modest c‐statistic = 0.668 (95% confidence interval 0.651, 0.685) but its calibration was excellent (predicted and observed risks coincided well, within disparate global regions). In terms of the integrated discrimination improvement index, its performance was marginally superior, over a 10‐year risk horizon, to existing risk scores in clinical use, from a restricted version of the same data, for macrovascular and renal disease separately.
Conclusions
The AD‐ON risk score has advantages over the existing vascular risk scores in diabetes that used data from the original ADVANCE trial, which treat macrovascular and renal diseases separately. These advantages include its simplicity of use and global application.
To evaluate the viability of leveraging an existing screening programme (the South African Diabetes Prevention Programme (SA-DPP)) to screen for chronic kidney disease (CKD), by assessing the yield ...of CKD cases among those participating in the programme.
Observational study conducted between 2017 and 2019.
16 resource-poor communities in Cape Town, South Africa.
690 participants, aged between 25 and 65 years, identified as at high risk for type 2 diabetes mellitus (T2DM) by the African Diabetes Risk Score.
The prevalence of CKD among those participating in the SA-DPP.
Of the 2173 individuals screened in the community, 690 participants underwent further testing. Of these participants, 9.6% (n=66) and 18.1% (n=125) had screen-detected T2DM and CKD (defined as an estimated glomerular filtration rate (eGFR) of<60 mL/min/1.73 m
and/or albumin-to-creatinine ratio >3 mg/mmol), respectively. Of those with CKD, 73.6% (n=92), 17.6% (n=22) and 8.8% (n=11) presented with stages 1, 2 and 3, respectively. Of the participants with an eGFR <60 mL/min/1.73 m
, 36.4% had no albuminuria and of those with normal kidney function (eGFR ≥90 mL/min/1.73 m
), 10.2% and 3.8% had albuminuria stages 2 and 3, respectively. Of those with T2DM and hypertension, 22.7% and 19.8% had CKD, respectively.
The fact that almost one in five participants identified as high risk for T2DM had CKD underscores the value of including markers of kidney function in an existing screening programme. By using an opportunistic approach to screen high-risk individuals, those with CKD can be identified and appropriately treated to reduce disease progression.
BackgroundAlthough subclinical hypothyroidism in pregnancy is one of the established risk factors for pre-eclampsia, the link between iodine deficiency, the main cause of hypothyroidism, and ...pre-eclampsia remains uncertain. We conducted a systematic review to determine the iodine nutrition status of pregnant women with and without pre-eclampsia and the risk of pre-eclampsia due to iodine deficiency.MethodsMEDLINE, EMBASE, Google Scholar, Scopus and Africa-Wide Information were searched up to 30th June 2020. Random-effect model meta-analysis was used to pool mean difference in urinary iodine concentration (UIC) between pre-eclamptic and normotensive controls and pool ORs and incidence rates of pre-eclampsia among women with UIC <150 µg/L.ResultsFive eligible studies were included in the meta-analysis. There was a significant difference in the pooled mean UIC of 254 pre-eclamptic women and 210 normotensive controls enrolled in three eligible case–control studies (mean UIC 164.4 µg/L (95% CI 45.1 to 283.6, p<0.01, I2 >50)). The overall proportions of pre-eclampsia among women with UIC <150 µg/L and UIC >150 µg/L in two cross-sectional studies were 203/214 and 67/247, respectively, with a pooled OR of 0.01 (95% CI 0 to 4.23, p=0.14, I2 >50) for pre-eclampsia among women with UIC >150 µg/L. The overall incidence of pre-eclampsia among women with UIC <150 µg/L and UIC >150 µg/L in two cohort studies was 6/1411 and 3/2478, respectively, with a pooled risk ratio of 2.85 (95% CI 0.42 to 20.05, p=0.09, I2 <25).ConclusionAlthough pre-eclamptic women seem to have lower UIC than normotensive pregnant women, the available data are insufficient to provide a conclusive answer on association of iodine deficiency with pre-eclampsia risk.PROSPERO registration numberCRD42018099427.
The relationship between diet quality and development of obesity is complex and unresolved. The aim of this study was to assess and compare the predictive value of six different dietary scores on ...both relative weight change and the risk of obesity after 13 years of follow-up in adults aged 45 years and older.
Six scores reflecting adherence to different nutritional recommendations (the French Programme National Nutrition Santé-Guideline Score (PNNS-GS), the Dietary Guidelines for Americans Index (DGAI), the Diet Quality Index-International (DQI-I), the Mediterranean Diet Scale (MDS), the relative Mediterranean Diet Score (rMED) and the Mediterranean Style Dietary Pattern Score (MSDPS)) were estimated in 3151 participants in the French SU.VI.MAX (SUpplémentation en VItamines et Minéraux AntioXydants) study. Associations of dietary scores with 13-year weight change were assessed through multivariate linear regression models, and obesity risk was analyzed with logistic regression, providing odds ratios (OR) and 95% confidence intervals (CI).
Except for the MSDPS, higher scores, that is, better adherence to nutritional guidelines or to a Mediterranean diet, were associated with lower weight gain in men (all P-value for trend <0.05). In addition, among men, ORs for becoming obese after 13 years associated with a 1 s.d. increase in dietary scores ranged from 0.63, 95% CI: 0.51, 0.78 for DGAI to 0.72, 95% CI: 0.59, 0.88 for MDS. These associations were weaker or not statistically significant in women.
Overall, the six dietary scores predicted obesity risk equally well. Among French adults, strong adherence to dietary guidelines appears to be protective with regard to weight gain and obesity, especially in men.
Background: Sympathetic activation is an important metabolic adaptation limiting weight gain. Propensity of weight gain associated with β-blocker therapy in the obese modern population is unknown. ...Objective: To determine whether chronic β-blocker therapy reduces energy expenditure (EE) and increases body weight. Methods: We undertook (i) a mechanistic study comparing EE, diet-induced thermogenesis and habitual activity between healthy volunteers (n=11) with uncomplicated hypertension treated with a β-blocker and anthropometrically matched controls (n=19) and (ii) three cross-sectional studies comparing body weight, body mass index (BMI) and waist circumference between β-blocker treated and untreated patients from ambulatory patients attending (a) diabetes outpatient clinic (n=214), (b) hypertension outpatient (n=84) and (c) participants in a multi-centre type 2 diabetes trial (ADVANCE) (n=11140). Results: Among weight-matched β-blocker users, diet-induced thermogenesis, fat oxidation rate and weekly habitual activity were lower by 50% (P<0.01), 32% (P=0.04) and 30% (P<0.01), respectively, compared with controls. In β-blocker treated patients, the adjusted mean body weight was 9.2±1.2 kg (P=0.0002) higher among those attending the diabetes clinic, 17.2±3.2 kg (P=0.004) higher among those attending the hypertension clinic and 5.2±0.7 kg (P=0.0003) higher at baseline among participants in the ADVANCE trial compared with patients not treated with β-blockers. BMI displayed a similar difference. Conclusions: EE is reduced and body weight increased in chronic β-blocker users. We hypothesise that chronic β-blockade causes obesity by blunting EE.
A recent overview of all CVD models applicable to diabetes patients is not available.
To review the primary prevention studies that focused on the development, validation and impact assessment of a ...cardiovascular risk model, scores or rules that can be applied to patients with type 2 diabetes.
Systematic review.
Medline was searched from 1966 to 1 April 2011.
A study was eligible when it described the development, validation or impact assessment of a model that was constructed to predict the occurrence of cardiovascular disease in people with type 2 diabetes, or when the model was designed for use in the general population but included diabetes as a predictor.
A standardized form was sued to extract all data of the CVD models.
45 prediction models were identified, of which 12 were specifically developed for patients with type 2 diabetes. Only 31% of the risk scores has been externally validated in a diabetes population, with an area under the curve ranging from 0.61 to 0.86 and 0.59 to 0.80 for models developed in a diabetes population and in the general population, respectively. Only one risk score has been studied for its effect on patient management and outcomes. 10% of the risk scores are advocated in national diabetes guidelines.
Many cardiovascular risk scores are available that can be applied to patients with type 2 diabetes. A minority of these risk scores has been validated and tested for its predictive accuracy, with only a few showing a discriminative value of ≥0.80. The impact of applying these risk scores in clinical practice is almost completely unknown, but their use is recommended in various national guidelines.
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