The Los Angeles Times reported a study by researchers at the Salk Institute in La Jolla “that detailed the consumption patterns of just over 150 nondieting, non-shift-working people in and around San Diego for three weeks,” showed “that a majority of people eat for stretches of 15 hours or longer most days – and fast for fewer than nine hours a night.” The study suggests that “Americans’ erratic, round-the-clock eating patterns...have probably contributed to an epidemic of obesity and Type 2 diabetes.” The findings were published in Cell Metabolism.
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HealthDay reported on a new study by Harvard scientists that examined the eating trends of over 133,000 American men and women who were followed for up to 24 years. The researchers found that the daily consumption of fruits and non-starchy vegetables was linked to reducing excessive weight gain. However, those who consumed starchy vegetables like potatoes, corn and peas gained weight over time. While the findings cannot prove a direct cause-and-effect relationship, the researchers said the study may “provide further food-specific guidance for the prevention of obesity, a primary risk factor for type 2 diabetes, cardiovascular diseases, cancers and many other health conditions.” The results were published Sept. 22 in the journal PLOS Medicine.
Experiments in mice indicate that traumatic brain injury produces an inflammatory response in the blood and organs, especially the liver. The liver responds with up to a thousand-fold increase in production of serum amyloid A1 (SAA1), which promotes inflammation in the brain, leading to chronic inflammation, nerve cell death, and reduced blood flow. Also, small doses of telmisartan, a hypertension drug, blocked production of one of the molecules in the protein’s biological pathway, leading to substantial reduction in inflammation. The findings are published in The American Journal of Pathology.
Medical Nutrition Therapy Slows CKD Patients’ Time to Dialysis Among CKD patients who were receiving care from a regional nephrology center in a rural state, those who received medical nutrition therapy (MNT) demonstrated a reduced eGFR decline at follow-up (dialysis initiation over a 10-year period or most recent laboratories if dialysis was not started) than those not receiving MNT (0.3 vs. 9.9 mL/min/1.73 m², respectively). The non-MNT group was 3-times more likely to initiate dialysis. Albumin and markers of CKD-MBD were more likely to be within normal limits in the MNT group. The Journal of Renal Nutrition study included 265 participants, 147 of whom received MNT.
EDITOR'S NOTE: Medical nutritional therapy is a Medicare benefit for patients with chronic kidney disease, kidney transplant, and diabetes. Our Internal Medicine Specialists office offers classes for patients and their families. Please call the office to schedule: 504-648-2520. The New York Times reports that “for the first time, a widely used modern diabetes” medication “has been shown to reduce deaths from cardiovascular disease, a long-sought goal of treatment, researchers announced” yesterday. Investigators found, “in a clinical trial,” that empagliflozin (Jardiance) “reduced the overall risk of having a heart attack or stroke, or of dying from cardiovascular causes, by 14 percent.” When “looking only at cardiovascular deaths, the reduction was 38 percent.” The research was presented at the annual meeting of the European Association for the Study of Diabetes and published in The New England Journal of Medicine.
Researchers who collected yearly urine samples from 3939 patients with chronic kidney disease (CKD) who were part of the Chronic Renal Insufficiency Cohort Study found that high levels of urinary excretion of both sodium and potassium were associated with faster disease progression. In addition, the study’s participants also consumed an average of 3700 mg of sodium per day, much higher than the recommended 2400 mg daily limit. The findings of the JASN study could possibly impact dietary recommendations to help safeguard patients’ health. The authors recommend clinical trials to test for further effects.
EDITORS NOTE-- Several of my patients have participated in the CRIC study for over ten years which is managed by Tulane and a consortium of other research centers in the Southern U.S. An international panel has published guidelines on the use of peripherally inserted central catheters (PICCs) across patient populations. PICC use was rated as inappropriate for peripherally compatible infusions when the proposed duration was ≤5 days. Midline catheters and ultrasonography-guided peripheral intravenous catheters were preferred to PICCs for use between 6 and 14 days in the guidelines, which are published in the Annals of Internal Medicine. In critically ill patients, non-tunneled central venous catheters were preferred over PICCs when used for ≤14 days. In patients with cancer, PICCs were rated as appropriate for irritant or vesicant infusion, regardless of duration.
Modern Healthcare (9/17, Subscription Publication) reports that Senate Health, Education, Labor and Pensions Committee Chairman Lamar Alexander (R-TN) “on Wednesday called for a delay and a phased-in implementation of Stage 3 of the electronic health-records program.” Alexander stated, “I believe we should delay until Jan. 1, 2017, making of the final rules for Stage 3 of the federal government’s program to require doctors and hospitals to create electronic health-record systems.” The Tennessee Republican added that the “modified rules already proposed for Stage 2 of this program should be adopted immediately because it will help most doctors and hospitals comply with the government’s requirements.”
The Morning Consult (9/17) notes that groups “such as the American Medical Association have called for delaying the Stage 3 rules because they say the technology isn’t widely available to carry out the requirements.” Antibacterial soap containing triclosan no better at killing germs than regular soap, study finds10/6/2015 The Huffington Post (9/16, Almendrala) reports that a study by a team of researchers at Korea University, Seoul found that antibacterial soap that contains the antibacterial and antifungal agent triclosan was “no better at killing germs than regular ol’ soap in both lab and real world experiments.” Researchers found that both versions of soap “killed 20 common, dangerous bacterial strains in a lab setting at about the same rate.” A real-world experiment confirmed the findings that “both versions of the soap similarly rid hands” of harmful bacteria. The study was published in Journal of Antimicrobial Chemotherapy.
TIME (9/17) adds that past concerns about too much exposure to triclosan compelled the FDA in 2013 to “require manufacturers to prove that antibacterial soaps are safe to use and more effective than traditional soaps.” High intensity intermittent training (HIIT) improved heart structure and diabetes control in a small group of patients with type 2 diabetes. In the study of 12 patients who participated in 12 weeks of HIIT and 11 control patients, HIIT improved cardiac structure and systolic function compared with no intervention. Also, early diastolic filling rates increased and peak torsion decreased in the treatment group. Following HIIT, there was a 39% relative reduction in liver fat and a reduction in HbA1c (7.1%–6.8% vs. 7.2%–7.4%). Changes in liver fat correlated with changes in HbA1c and 2-hour glucose in the Diabetologia study.
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