- Year in review 2017: Interstitial lung disease, pulmonary vascular disease and sleep. [Review]
- RRespirology 2018 Feb 22
- Higher Risk of Abdominal Obesity, Elevated LDL Cholesterol and Hypertriglyceridemia, but not of Hypertension, in People Living with HIV: Results from the Copenhagen Comorbidity in HIV Infection (COCOMO) Study. [Journal Article]
- CIClin Infect Dis 2018 Feb 17
- CONCLUSIONS: Abdominal obesity was associated with proaterogenic metabolic factors including elevated LDL-C, hypertension and hypertriglyceridemia and remains a distinct HIV-related phenotype particularly among older PLWH. Effective interventions to reduce the apparent detrimental impact on cardiovascular risk from this phenotype are needed.
- Moderator's view: Low-protein diet in chronic kidney disease: effectiveness, efficacy and precision nutritional treatments in nephrology. [Journal Article]
- NDNephrol Dial Transplant 2018 Feb 19
- Intention-to-treat and per-protocol analyses provide complementary information about the usefulness of therapies. While intention-to-treat analyses of trials that tested low-protein diets remain deba...
Intention-to-treat and per-protocol analyses provide complementary information about the usefulness of therapies. While intention-to-treat analyses of trials that tested low-protein diets remain debated, per-protocol analyses of the same trials show that low protein intake actually reduces the risk of kidney failure. Per-protocol analyses are notoriously open to bias but intention-to-treat analyses are less immaculate than commonly realized because they critically depend on adherence to the treatment being tested and therefore may not be directly relevant for informing clinical decisions when different degrees of adherence to therapy occur. Over the last 20 years new statistical techniques censoring patients at the time when they become uncompliant and that adjust for confounding attributable to incomplete adherence, i.e. for prognostic factors that predict adherence to treatment, have been developed. These techniques can be usefully applied to reanalyse the Modification Diet in Renal Disease (MDRD) and other trials. Intensive surveillance of patients on a low-protein diet is fundamental for early detection of malnutrition. However, the resources demanded by such surveillance are likely superior to the actual dietitians workforce dedicated to follow-up of the chronic kidney disease (CKD) population. Surveillance efforts may perhaps be preferentially devoted to preselected patients, i.e. patients that maintain good compliance and an adequate metabolic and nutritional status, while patients who are resistant to educational efforts and show persisting uncompliance may be reallocated to a diet with a higher protein content, which poses a lower risk of malnutrition and other adverse health outcomes.
- Pro: The rationale for dietary therapy for patients with advanced chronic kidney disease. [Journal Article]
- NDNephrol Dial Transplant 2018 Feb 19
- Dietary treatment offers many benefits to patients with advanced chronic kidney disease (CKD) who are approaching the need for renal replacement therapy. A large number of these benefits are independ...
Dietary treatment offers many benefits to patients with advanced chronic kidney disease (CKD) who are approaching the need for renal replacement therapy. A large number of these benefits are independent of whether diets slow the rate of progression of CKD. These diets are low in protein and many minerals, and provide adequate energy for the CKD patient. The diets can reduce accumulation of potentially toxic metabolic products derived from protein and amino acid degradation, maintain a healthier balance of body water, sodium, potassium, phosphorus, calcium and other minerals, and prevent or improve protein-energy wasting. Such diets may enable patients to safely delay the onset of chronic dialysis therapy or kidney transplantation. Dietary therapy may also augment the effectiveness of infrequent or incremental dialysis by maintaining healthier metabolic and clinical status and may enable some end-stage renal disease patients to avoid the need for temporary placement of hemodialysis catheters while their arterial venous fistulae or grafts mature. The anxiety that many advanced CKD patients commonly experience with regard to starting dialysis may incentivize them to accept and adhere to dietary therapy.
- Obese Hypertensive Men Have Lower Circulating Proatrial Natriuretic Peptide Concentrations despite Greater Left Atrial Size. [Journal Article]
- AJAm J Hypertens 2018 Feb 17
- CONCLUSIONS: Despite greater left atrial size, obese hypertensive men have lower circulating MR-proANP concentrations compared with lean normotensive men.
- Pulmonary Arterial Hypertension and the Kidney: Getting to the Heart of the Matter. [Journal Article]
- AJAm J Nephrol 2018 Feb 22; 47(2):130-133
- Presence of Kidney Disease as an Outcome Predictor in Patients with Pulmonary Arterial Hypertension. [Journal Article]
- AJAm J Nephrol 2018 Feb 22; 47(2):134-143
- CONCLUSIONS: CKD is frequent at PAH diagnosis and is independently associated with increased mortality. Right heart failure may induce renal hypoperfusion and congestion, and is associated with eGFR decrease.
- Characterizing gestational weight gain in a cohort of Indigenous Australian women. [Journal Article]
- MMidwifery 2018 Jan 31; 60:13-19
- CONCLUSIONS: few women gained adequate gestational weight gain in this study. Culturally acceptable ways of addressing this issue are needed for this group of women, as inadequate and excessive rates of gestational weight gain have health implications for women and their offspring.a systematic approach to addressing gestational weight gain within antenatal care is required, including asking about diet and exercise, for all women identifying as Indigenous Australian.
- Dynamic fMRI networks predict success in a behavioral weight loss program among older adults. [Journal Article]
- NNeuroimage 2018 Feb 19
- More than one-third of adults in the United States are obese, with a higher prevalence among older adults. Obesity among older adults is a major cause of physical dysfunction, hypertension, diabetes,...
More than one-third of adults in the United States are obese, with a higher prevalence among older adults. Obesity among older adults is a major cause of physical dysfunction, hypertension, diabetes, and coronary heart diseases. Many people who engage in lifestyle weight loss interventions fail to reach targeted goals for weight loss, and most will regain what was lost within 1-2 years following cessation of treatment. This variability in treatment efficacy suggests that there are important phenotypes predictive of success with intentional weight loss that could lead to tailored treatment regimen, an idea that is consistent with the concept of precision-based medicine. Although the identification of biochemical and metabolic phenotypes are one potential direction of research, neurobiological measures may prove useful as substantial behavioral change is necessary to achieve success in a lifestyle intervention. In the present study, we use dynamic brain networks from functional magnetic resonance imaging (fMRI) data to prospectively identify individuals most likely to succeed in a behavioral weight loss intervention. Brain imaging was performed in overweight or obese older adults (age: 65-79 years) who participated in an 18-month lifestyle weight loss intervention. Machine learning and functional brain networks were combined to produce multivariate prediction models. The prediction accuracy exceeded 95%, suggesting that there exists a consistent pattern of connectivity which correctly predicts success with weight loss at the individual level. Connectivity patterns that contributed to the prediction consisted of complex multivariate network components that substantially overlapped with known brain networks that are associated with behavior emergence, self-regulation, body awareness, and the sensory features of food. Future work on independent datasets and diverse populations is needed to corroborate our findings. Additionally, we believe that efforts can begin to examine whether these models have clinical utility in tailoring treatment.
New Search Next
- The contribution of left heart disease in COPD patients with pulmonary hypertension. [Journal Article]
- HJHellenic J Cardiol 2018 Feb 19
- CONCLUSIONS: The use of echocardiographic criteria for the presence of PH is adequate for the screening of COPD patients. Patients with acute exacerbation of COPD and possible/likely PH demonstrate worse mortality compared to patients unlikely to have PH.