Cognitive effects of intentional weight loss in elderly obese individuals with mild cognitive impairment

Posted on January 15, 2016 by Maurice Preter MD

 

 

http://press.endocrine.org/doi/abs/10.1210/jc.2015-2315

Cognitive effects of intentional weight loss in elderly obese individuals with mild cognitive impairment

Address all correspondence and requests for reprints to: Dr.Nidia Celeste Horie Ph.D. nidiachorie@yahoo.com.br

Faculdade de Medicina da Universidade de São Paulo – Endocrinology R Dr Ené as de Carvalho Aguiar, 155 8andar, Endocrinologia Sao Paulo SP BRAZIL 05403–000 55–011–99640 6475

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Received: May 17, 2015
Accepted: December 11, 2015
First Published Online: December 29, 2015

Abstract

Context:

Obesity in midlife is a risk factor for dementia, but it is unknown if caloric restriction-induced weight loss could prevent cognitive decline and therefore dementia in elderly patients with cognitive impairment.

Objective:

To evaluate the cognitive effect of intentional weight loss in obese elderly patients with mild cognitive impairment (MCI), considering the influence of age, apolipoprotein E genotype (APOE), physical activity, biochemical markers and diet.

Design:

Single-center, prospective controlled trial.

Setting:

Academic medical center

Participants:

Eighty obese patients with MCI, aged 60 or older (68.1±4.9 years, body mass index (BMI) 35.5±4.4kg/m2, 83.7% women, 26.3% APOE4 carriers).

Intervention:

Random allocation to conventional medical care alone (n=40) or together with nutritional counselling (n=40) in group meetings aiming to promote weight loss through caloric restriction for 12 months.

Outcome:

Measurements: Clinical data, body composition, neuropsychological tests (main outcome), serum biomarkers, APOE genotype, physical performance, dietary recalls.

Results:

Seventy-five patients completed the follow-up. BMI, on average, decreased 1.7 ±1.8kg/m2 (p=0.021), and most of the cognitive tests improved, without difference between the groups. In analysis with linear generalized models, the BMI decrease was associated with improvements in verbal memory, verbal fluency, executive function and global cognition, after adjustment for education, gender, physical activity and baseline tests: this association was strongest in younger seniors (for memory and fluency) and in APOE4 carriers (for executive function). Changes in HOMA-IR, C-reactive protein, leptin and intake of energy, carbohydrates and fats were associated with improvement in cognitive tests.

Conclusions:

Intentional weight loss through diet was associated with cognitive improvement in patients with MCI.

Affiliations
  • 1Obesity and Metabolic Syndrome Group- Sao Paulo University, School of Medicine;
  • 2Psychology Division- Hospital das Clínicas, Sao Paulo University;
  • 3Institute of Psychiatry – Sao Paulo University, School of Medicine;
  • 4Nutrition Division- Clinical Hospital – Sao Paulo University, School of Medicine;
  • 5Discipline of Geriatrics – Sao Paulo University, School of Medicine;
  • 6Division of Clinical Immunology and Allergy- Sao Paulo University, School of Medicine

– See more at: http://press.endocrine.org/doi/abs/10.1210/jc.2015-2315#sthash.JzKKeyZO.dpuf

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Proton Pump Inhibitor Use and the Risk of Chronic Kidney Disease

Posted on January 15, 2016 by Maurice Preter MD

Proton Pump Inhibitor Use and the Risk of Chronic Kidney Disease

http://archinte.jamanetwork.com/article.aspx?articleid=2481157

Benjamin Lazarus, MBBS1,2; Yuan Chen, MS1; Francis P. Wilson, MD, MS3; Yingying Sang, MS1; Alex R. Chang, MD, MS4; Josef Coresh, MD, PhD1,5; Morgan E. Grams, MD, PhD1,5
JAMA Intern Med. Published online January 11, 2016. doi:10.1001/jamainternmed.2015.7193
Text Size: A A A

 

Importance  Proton pump inhibitors (PPIs) are among the most commonly used drugs worldwide and have been linked to acute interstitial nephritis. Less is known about the association between PPI use and chronic kidney disease (CKD).

Objective  To quantify the association between PPI use and incident CKD in a population-based cohort.

Design, Setting, and Participants  In total, 10 482 participants in the Atherosclerosis Risk in Communities study with an estimated glomerular filtration rate of at least 60 mL/min/1.73 m2 were followed from a baseline visit between February 1, 1996, and January 30, 1999, to December 31, 2011. The data was analyzed from May 2015 to October 2015. The findings were replicated in an administrative cohort of 248 751 patients with an estimated glomerular filtration rate of at least 60 mL/min/1.73 m2 from the Geisinger Health System.

Exposures  Self-reported PPI use in the Atherosclerosis Risk in Communities study or an outpatient PPI prescription in the Geisinger Health System replication cohort. Histamine2 (H2) receptor antagonist use was considered a negative control and active comparator.

Main Outcomes and Measures  Incident CKD was defined using diagnostic codes at hospital discharge or death in the Atherosclerosis Risk in Communities Study, and by a sustained outpatient estimated glomerular filtration rate of less than 60 mL/min/1.73 m2 in the Geisinger Health System replication cohort.

Results  Among 10 482 participants in the Atherosclerosis Risk in Communities study, the mean (SD) age was 63.0 (5.6) years, and 43.9% were male. Compared with nonusers, PPI users were more often of white race, obese, and taking antihypertensive medication. Proton pump inhibitor use was associated with incident CKD in unadjusted analysis (hazard ratio [HR], 1.45; 95% CI, 1.11-1.90); in analysis adjusted for demographic, socioeconomic, and clinical variables (HR, 1.50; 95% CI, 1.14-1.96); and in analysis with PPI ever use modeled as a time-varying variable (adjusted HR, 1.35; 95% CI, 1.17-1.55). The association persisted when baseline PPI users were compared directly with H2 receptor antagonist users (adjusted HR, 1.39; 95% CI, 1.01-1.91) and with propensity score–matched nonusers (HR, 1.76; 95% CI, 1.13-2.74). In the Geisinger Health System replication cohort, PPI use was associated with CKD in all analyses, including a time-varying new-user design (adjusted HR, 1.24; 95% CI, 1.20-1.28). Twice-daily PPI dosing (adjusted HR, 1.46; 95% CI, 1.28-1.67) was associated with a higher risk than once-daily dosing (adjusted HR, 1.15; 95% CI, 1.09-1.21).

Conclusions and Relevance  Proton pump inhibitor use is associated with a higher risk of incident CKD. Future research should evaluate whether limiting PPI use reduces the incidence of CKD.

 

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Erectile dysfunction? – Eat berries!

Posted on January 15, 2016 by Maurice Preter MD

http://ajcn.nutrition.org/content/early/2016/01/06/ajcn.115.122010.abstract

Dietary flavonoid intake and incidence of erectile dysfunction1

  1. Aedín Cassidy2,
  2. Mary Franz3, and
  3. Eric B Rimm3–6*

+Author Affiliations


  1. 2Department of Nutrition, Norwich Medical School, University of East Anglia, Norwich, United Kingdom;

  2. 3Departments of Nutrition and

  3. 4Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA; and

  4. 5Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital; and

  5. 6Harvard Medical School, Boston, MA

+Author Notes

  • ↵1 Supported by research grants CA55075, HL35464, and UM1 CA167552 from the NIH and the Biotechnology and Biological Sciences Research Council, United Kingdom (reference BB/J004545/1); AC is a Royal Society Wolfson Research Merit Award Holder. This is an open access article distributed under the CC-BY license (http://creativecommons.org/licenses/by/3.0/).

  1. ↵*To whom correspondence should be addressed. E-mail: erimm@hsph.harvard.edu.

Abstract

Background: The predominant etiology for erectile dysfunction (ED) is vascular, but limited data are available on the role of diet. A higher intake of several flavonoids reduces diabetes and cardiovascular disease risk, but no studies have examined associations between flavonoids and erectile function.

Objective: This study examined the relation between habitual flavonoid subclass intakes and incidence of ED.

Design: We conducted a prospective study among 25,096 men from the Health Professionals Follow-Up Study. Total flavonoid and subclass intakes were calculated from food-frequency questionnaires collected every 4 y. Participants rated their erectile function in 2000 (with historical reporting from 1986) and again in 2004 and 2008.

Results: During 10 y of follow-up, 35.6% reported incident ED. After multivariate adjustment, including classic cardiovascular disease risk factors, several subclasses were associated with reduced ED incidence, specifically flavones (RR = 0.91; 95% CI: 0.85, 0.97; P-trend = 0.006), flavanones (RR = 0.89; 95% CI: 0.83, 0.95; P-trend = 0.0009), and anthocyanins (RR = 0.91; 95% CI: 0.85, 0.98; P-trend = 0.002) comparing extreme intakes. The results remained statistically significant after additional adjustment for a composite dietary intake score. In analyses stratified by age, a higher intake of flavanones, anthocyanins, and flavones was significantly associated with a reduction in risk of ED only in men <70 y old and not older men (11–16% reduction in risk; P-interaction = 0.002, 0.03, and 0.007 for flavones, flavanones, and anthocyanins, respectively). In food-based analysis, higher total intake of fruit, a major source of anthocyanins and flavanones, was associated with a 14% reduction in risk of ED (RR = 0.86; 95% CI: 0.79, 0.92; P = 0.002).

Conclusions: These data suggest that a higher habitual intake of specific flavonoid-rich foods is associated with reduced ED incidence. Intervention trials are needed to further examine the impact of increasing intakes of commonly consumed flavonoid-rich foods on men’s health.

 

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Meta-analyses with industry involvement are massively published and report no caveats for antidepressants.

Posted on November 26, 2015 by Maurice Preter MD
J Clin Epidemiol. 2015 Sep 21. pii: S0895-4356(15)00429-1. doi: 10.1016/j.jclinepi.2015.08.021. [Epub ahead of print]

Meta-analyses with industry involvement are massively published and report no caveats for antidepressants.

Abstract

OBJECTIVES:

To identify the impact of industry involvement in the publication and interpretation of meta-analyses of antidepressant trials in depression.

STUDY DESIGN AND SETTING:

Using MEDLINE, we identified all meta-analyses evaluating antidepressants for depression published in January 2007-March 2014. We extracted data pertaining to author affiliations, conflicts of interest, and whether the conclusion of the abstract included negative statements on whether the antidepressant(s) were effective or safe.

RESULTS:

We identified 185 eligible meta-analyses. Fifty-four meta-analyses (29%) had authors who were employees of the assessed drug manufacturer, and 147 (79%) had some industry link (sponsorship or authors who were industry employees and/or had conflicts of interest). Only 58 meta-analyses (31%) had negative statements in the concluding statement of the abstract. Meta-analyses including an author who were employees of the manufacturer of the assessed drug were 22-fold less likely to have negative statements about the drug than other meta-analyses [1/54 (2%) vs. 57/131 (44%); P < 0.001].

CONCLUSION:

There is a massive production of meta-analyses of antidepressants for depression authored by or linked to the industry, and they almost never report any caveats about antidepressants in their abstracts. Our findings add a note of caution for meta-analyses with ties to the manufacturers of the assessed products.

Copyright © 2015 Elsevier Inc. All rights reserved.

KEYWORDS:

Antidepressants; Competing interests; Conflicts of interest; Depression; Industry sponsor; Meta-analyses

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Smartphone apps in epilepsy care

Posted on November 26, 2015 by Maurice Preter MD

Abstract

Objectives

To evaluate the applications of mobile phones in the day to day care of epileptic patients as a diagnostic, prognostic and therapeutic tool.

Methods

Detailed search of various mobile applications in the field of epileptology was made in MEDLINE, Cochrane Central Register of Controlled Trials, EMBASE, CINAHL, LILACS and corresponding developer websites of mobile applications were also looked into regarding their technical specifications and user friendliness.

Results

A plethora of apps are available across various mobile platforms especially Android, iOS and Windows. Careful selection and application of such apps by both the healthcare providers, the epileptic patients and their caregivers with proper understanding of their potential benefits as well as limitations will result in better diagnosis, prognosis and treatment of epilepsy.

Conclusion

The field of medicine is rapidly inculcating advanced cutting edge technologies for better diagnosis of diseases and better targeted therapy to such diseases. Hi tech electronic gadgets, in particular, are now becoming part and parcel of patient care in many specialties. The advent of the modern portable computers has revolutionised almost every specialty. The field of mobile technology is advancing with a break neck pace, with increase in mobile subscribers, advanced handsets practically like digital personal assistants with advanced capabilities. The possibilities of using such rapidly evolving mobile technology in the field of medicine are endless. This article explores such possibilities in the field of epileptology after analysing the current and existing applications of mobile phones in care of the epileptic patients worldwide.

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