Tag: pubmed

Clin Nutr ESPEN. 2024 Aug;62:128-136. doi: 10.1016/j.clnesp.2024.04.019. Epub 2024 May 23.

ABSTRACT

BACKGROUND: Previous studies have shown a strong correlation between gut microbiota and diabetes and its associated complications. We aimed to evaluate the causal relationships between the gut microbiota, gut metabolites, and diabetic neuropathy.

METHODS: Summary statistics of 211 gut microbiota and 12 gut-related metabolites (β-hydroxybutyric acid, betaine, trimethylamine-N-oxide, carnitine, choline, glutamate, kynurenine, phenylalanine, propionic acid, serotonin, tryptophan, and tyrosine) were obtained from previous genome-wide association studies (GWAS). A two-sample Mendelian randomization (MR) design was used to estimate the effects of gut microbiota and gut metabolites on the risk of diabetic neuropathy based on FinnGen GWAS.

RESULTS: Higher levels of Acidaminococcaceae (OR = 0.62; 95%CI = 0.46 to 0.84; P = 0.002), Peptococcaceae (OR = 0.70; 95%CI = 0.54 to 0.90; P = 0.006), and Eubacterium coprostanoligenes group (OR = 0.68; 95%CI = 0.50 to 0.93; P = 0.016) are genetically determined to provide protection against diabetic neuropathy. Conversely, the presence of Alistipes (OR = 1.65; 95%CI = 1.18 to 2.31; P = 0.003), ChristensenellaceaeR7 group (OR = 1.52; 95%CI = 1.03 to 2.23; P = 0.033), Eggerthella (OR = 1.28; 95%CI = 1.05 to 1.55; P = 0.014), RuminococcaceaeUCG013 (OR = 1.35; 95%CI = 1.01 to 1.82; P = 0.046), and Firmicutes (OR = 1.42; 95%CI = 1.05 to 1.93; P = 0.023) increases the risk of diabetic neuropathy. Moreover, a correlation has been identified between diabetic neuropathy and two gut metabolites: betaine (OR = 0.95; 95%CI = 0.90 to 1.00; P = 0.033) and tyrosine (OR = 1.03; 95%CI = 1.01 to 1.06; P = 0.019). Sensitivity analysis indicated robust results with no sign of heterogeneity or pleiotropy.

CONCLUSION: The present study elucidated the impact of specific gut microbiota and gut metabolites on the susceptibility to diabetic neuropathy. Interventions targeting the improvement of the gut microbiota diversity and composition hold considerable promise as a potential strategy.

PMID:38901934 | DOI:10.1016/j.clnesp.2024.04.019

Clin Nutr ESPEN. 2024 Aug;62:120-127. doi: 10.1016/j.clnesp.2024.05.010. Epub 2024 May 18.

ABSTRACT

BACKGROUND: Malnutrition is present in 20-50% of hospital patients but its recognition is often neither timely nor complete. The Global Leadership Initiative on Malnutrition (GLIM) aims to improve this, but its successful implementation may be compromised by its dependence on (a choice of) prior screening tools and difficulties in consistent assessment of muscle mass.

AIMS: To explore different approaches to screening and muscle assessment in GLIM and to offer simpler choices for its more widespread application.

METHODS: (1) Data from 300 consenting in-patients provided Nutritional Risk Screening (NRS-2002), Malnutrition Universal Screening Tool (MUST), and Subjective Global Assessment (SGA) scores. GLIM scoring was preceded by NRS-2002 or MUST (using threshold scores of 1 or 2 for MUST), or no prior screening. The results of GLIM scoring preceded by different screening approaches were compared with those of SGA. (2) The literature on mid-upper arm circumference (MUAC) and calf circumference (CC) as simple, non-invasive, objective methods of muscle assessment methods was reviewed (3) The cumulative times taken to obtain GLIM scores were measured and corrected for the different screening strategies.

RESULTS: (1) Participants’ mean age was 60 years, 157 (52%) were female and mean BMI was 27.8 kg/m². In comparison with SGA, GLIM with no prior screening had the highest sensitivity (65%) and negative predictive value (NPV) (76%), but the lowest specificity (90%) and positive predictive value (PPV) (84%). The equivalent figures for GLIM with prior MUST “1” were 62%, 75%, 93% and 88%; with prior NRS-2002, 55%∗, 73%, 98%∗ and 95%∗; and with prior MUST “2”, 44%∗, 69%∗, 98%∗, 95%∗. The area under an ROC curve was the highest (0.78) when GLIM was performed without screening or with prior MUST “1”. (2) Being less affected by oedema and gender differences than calf circumference, MUAC could serve as a standard globally accessible muscle mass assessment method which can be supplemented by technical approaches if available and deemed necessary. (3) The overall per-capita time requirement of GLIM was 240-245 s without prior screening, and was increased by 2-3% with prior MUST “1”, by 27-29% with prior NRS-2002 and decreased by 8-9% with prior MUST “2”.

CONCLUSIONS: Preceding GLIM by screening can decrease its sensitivity and increase overall time utilisation; “gold standard” muscle assessment is not globally accessible. Our results therefore support considering using GLIM as a combined screening and assessment tool, with MUAC as the method of muscle assessment which can be supplemented by technical approaches if available and deemed necessary. This could potentially both simplify the use of GLIM and improve the early detection of malnutrition. ∗Indicates statistically significant difference from use of GLIM without prior screening.

PMID:38901933 | DOI:10.1016/j.clnesp.2024.05.010

Clin Nutr ESPEN. 2024 Aug;62:108-114. doi: 10.1016/j.clnesp.2024.04.022. Epub 2024 May 22.

ABSTRACT

Diet and inflammation may contribute to the development of multiple sclerosis (MS). The aim of this systematic review and meta-analysis was to assess the association between proinflammatory diet, as estimated by the Dietary Inflammatory Index (DII®), and the likelihood of developing MS or other demyelinating autoimmune diseases. A systematic search was performed of search engines and databases (PubMed, ISI Web of Sciences, Scopus, and Embase) to identify relevant studies before 10th June 2023. The search identified 182 potential studies, from which 39 full-text articles were screened for relevance. Five articles with case-control design (n = 4,322, intervention group: 1714; control group: 2608) met the study inclusion criteria. The exposure variable was DII, with studies using two distinct models: quartile-based comparisons of DII and assessment of continuous DII. The meta-analysis of high versus low quartiles of DII with four effect sizes showed a significant association with MS/demyelinating autoimmune disease likelihood, with an odds ratio (OR) of 3.26 (95% confidence interval (CI) 1.16, 9.10). The meta-analysis of four studies with DII fit as a continuous variable showed a 31% increased likelihood of MS per unit increment; which was not statistically significant at the nominal alpha equals 0.05 (OR 1.31; 95% CI 0.95, 1.81). In conclusion, this systematic review and meta-analysis provides evidence of a positive association between higher DII scores with the likelihood of developing MS, highlighting that diet-induced inflammation could play a role in MS or other demyelinating autoimmune diseases risk.

PMID:38901931 | DOI:10.1016/j.clnesp.2024.04.022

Clin Nutr ESPEN. 2024 Aug;62:1-9. doi: 10.1016/j.clnesp.2024.04.021. Epub 2024 May 10.

ABSTRACT

BACKGROUND & AIMS: Resistant starch (RS) is a prebiotic fiber that has been scientifically shown to control the development of obesity. Prebiotic role of RS has also seen to be very important as it helps gut bacteria to regulate fermentation and fatty acid production. This study aimed to check the different levels of RS on glycemic index, oxidative stress and mineral absorption rate in healthy rat models. To evaluate these objectives, the trial was conducted for 40 days of follow up; 10 days were the adjustment period and the collection period over 30 days.

METHODS: Thirty-six healthy female Wistar rats were divided into 4 groups of (9 animals each) NC (Normal Control: without resistant starch), RS_0.20 (resistant starch: 0.20 g/kg body weight), RS_0.30 (resistant starch: 0.30 g/kg body weight), RS_0.40 (resistant starch: 0.40 g/kg body weight). All the diets were isocaloric and isonitroginous.

RESULTS: The impact of different levels of RS on the dry-matter intake (DMI) presented statistically significant results (p ≤ 0.05): DMI was reduced in RS _(0.02) fed rats as compared to NC rats in first 3 weeks; and after 4th and 5th weeks, there was a DMI reduction of 28% in RS _(0.04) fed rats. Moreover, there was no significant increase in the nutrient intake in all RS diets. The dry-matter (DM) digestibility was statistically significantly (P ≤ 0·05), which increased in all rats fed with different level of RS. The weight loss showed statistically significant results: RS _(0.04) exhibited 19 g reduction in weight as compared with NC rats. Significant increase was observed in total oxidant status (TOS), in all the RS fed rats when compared with NC rats. The levels of Mg, Ca, Fe and Zn were shown to be decrease in feces analysis, which proves their better absorbance in gut. Statistically significant increase was observed in antioxidant capacity, whereas significant decrease was observed in the total weight of the animals, showing the role of RS in controlling obesity.

CONCLUSIONS: Overall, significant results were found in all dosage level of RS but long term administration of the higher dosage level (RS_0.40) may need to be studied for enhanced results. RS can help improve insulin sensitivity in overweight adults.

PMID:38901928 | DOI:10.1016/j.clnesp.2024.04.021

Neurologia (Engl Ed). 2024 Jul-Aug;39(6):496-504. doi: 10.1016/j.nrleng.2021.09.016.

ABSTRACT

BACKGROUND: Despite comprehensive study, the aetiology of stroke is not identified in 35% of cases.

AIMS: We conducted a study to assess the diagnostic capacity of N-terminal pro-B-type natriuretic peptide (NT-proBNP) in the identification of ischaemic stroke of cardioembolic origin. The secondary purpose of the study was to evaluate the prognostic value of NT-proBNP for predicting 90-day all-cause mortality.

METHODS: We designed a prospective observational study including patients hospitalised due to stroke between March 2019 and March 2020. Blood samples were collected on admission to the emergency department and serum NT-proBNP levels were determined. Statistical analysis was performed using a bivariate logistic regression model and receiver operating characteristic (ROC) and Kaplan-Meier curves. Statistical significance was established at p<.05.

RESULTS: The study included 207 patients with first ischaemic stroke. Plasma NT-proBNP levels were significantly higher (p<.001) in the cardioembolic stroke group (2069pg/mL±488.5). ROC curves showed that NT-proBNP>499pg/mL was the optimum value for diagnosing cardioembolic ischaemic stroke (sensitivity, 82%; specificity, 80%). Moreover, plasma NT-proBNP levels>499pg/mL were independently associated with cardioembolic stroke (OR: 9.881; p=.001). Finally, NT-proBNP>1500pg/mL was useful for predicting 90-day mortality (sensitivity, 70%; specificity, 93%).

CONCLUSIONS: NT-proBNP was independently associated with cardioembolic stroke and should be quantified in blood tests within 24h of stroke onset. High plasma levels (>499pg/mL) may indicate an underlying cardioembolic cause, which should be further studied, while NT-proBNP >1500pg/mL was associated with increased 90-day mortality.

PMID:38901926 | DOI:10.1016/j.nrleng.2021.09.016

BMJ Open Qual. 2024 Jun 19;13(2):e002732. doi: 10.1136/bmjoq-2023-002732.

ABSTRACT

BACKGROUND: Evaluation of quality of care in oncology is key in ensuring patients receive adequate treatment. American Society of Clinical Oncology’s (ASCO) Quality Oncology Practice Initiative (QOPI) Certification Program (QCP) is an international initiative that evaluates quality of care in outpatient oncology practices.

METHODS: We retrospectively reviewed free-text electronic medical records from patients with breast cancer (BR), colorectal cancer (CRC) or non-small cell lung cancer (NSCLC). In a baseline measurement, high scores were obtained for the nine disease-specific measures of QCP Track (2021 version had 26 measures); thus, they were not further analysed. We evaluated two sets of measures: the remaining 17 QCP Track measures, as well as these plus other 17 measures selected by us (combined measures). Review of data from 58 patients (26 BR; 18 CRC; 14 NSCLC) seen in June 2021 revealed low overall quality scores (OQS)-below ASCO’s 75% threshold-for QCP Track measures (46%) and combined measures (58%). We developed a plan to improve OQS and monitored the impact of the intervention by abstracting data at subsequent time points.

RESULTS: We evaluated potential causes for the low OQS and developed a plan to improve it over time by educating oncologists at our hospital on the importance of improving collection of measures and highlighting the goal of applying for QOPI certification. We conducted seven plan-do-study-act cycles and evaluated the scores at seven subsequent data abstraction time points from November 2021 to December 2022, reviewing 404 patients (199 BR; 114 CRC; 91 NSCLC). All measures were improved. Four months after the intervention, OQS surpassed the quality threshold and was maintained for 10 months until the end of the study (range, 78-87% for QCP Track measures; 78-86% for combined measures).

CONCLUSIONS: We developed an easy-to-implement intervention that achieved a fast improvement in OQS, enabling our Medical Oncology Department to aim for QOPI certification.

PMID:38901878 | DOI:10.1136/bmjoq-2023-002732

BMJ Ment Health. 2024 Jun 19;27(1):e300999. doi: 10.1136/bmjment-2024-300999.

NO ABSTRACT

PMID:38901870 | DOI:10.1136/bmjment-2024-300999

BMJ. 2024 Jun 20;385:e076478. doi: 10.1136/bmj-2023-076478.

NO ABSTRACT

PMID:38901868 | DOI:10.1136/bmj-2023-076478

BMJ Health Care Inform. 2024 Jun 19;31(1):e101065. doi: 10.1136/bmjhci-2024-101065.

ABSTRACT

OBJECTIVES: Risk stratification tools that predict healthcare utilisation are extensively integrated into primary care systems worldwide, forming a key component of anticipatory care pathways, where high-risk individuals are targeted by preventative interventions. Existing work broadly focuses on comparing model performance in retrospective cohorts with little attention paid to efficacy in reducing morbidity when deployed in different global contexts. We review the evidence supporting the use of such tools in real-world settings, from retrospective dataset performance to pathway evaluation.

METHODS: A systematic search was undertaken to identify studies reporting the development, validation and deployment of models that predict healthcare utilisation in unselected primary care cohorts, comparable to their current real-world application.

RESULTS: Among 3897 articles screened, 51 studies were identified evaluating 28 risk prediction models. Half underwent external validation yet only two were validated internationally. No association between validation context and model discrimination was observed. The majority of real-world evaluation studies reported no change, or indeed significant increases, in healthcare utilisation within targeted groups, with only one-third of reports demonstrating some benefit.

DISCUSSION: While model discrimination appears satisfactorily robust to application context there is little evidence to suggest that accurate identification of high-risk individuals can be reliably translated to improvements in service delivery or morbidity.

CONCLUSIONS: The evidence does not support further integration of care pathways with costly population-level interventions based on risk prediction in unselected primary care cohorts. There is an urgent need to independently appraise the safety, efficacy and cost-effectiveness of risk prediction systems that are already widely deployed within primary care.

PMID:38901863 | DOI:10.1136/bmjhci-2024-101065

Chron Respir Dis. 2024 Jan-Dec;21:14799731241264789. doi: 10.1177/14799731241264789.

ABSTRACT

Background: Previous studies have focused on demographic factors that might predict non-completion of pulmonary rehabilitation (PR). We aimed to identify key modifiable factors that promote completion of PR. Methods: A mixed methods survey was offered to participants completing a discharge assessment following PR. Descriptive statistics and inductive thematic analysis were used to analyse the survey responses, with investigator triangulation. Results: 62 of 187 (33%) patients attending a PR discharge assessment between November 2022 and April 2023 returned the anonymised survey. Desire to improve health and wellbeing was the main reason for both initially committing to a course and for continuing with PR past transient thoughts of leaving. The positive impact of staff was the second most common reason. The enjoyment of the PR programme, being held accountable to attend classes, and the importance of other group members were other key themes identified. Conclusions: In conclusion, our findings suggest PR services need to implement strategies which ensure regular promotion and reinforcement of the health benefits of PR as well as implementation of PR modalities which best monopolise on the positive impact skilled staff have on motivating patients to complete PR.

PMID:38901833 | DOI:10.1177/14799731241264789