Adverse Health-related Outcomes Research Articles

Feelings of guilt in the general adult population: prevalence, intensity and association with depression

ABSTRACT To feel guilty can motivate for prosocial behavior but may also lead to negative health-related outcomes. The aim of this study was to provide epidemiological information on guilt feelings in the German general adult population. Based on findings from a nation-wide telephone survey (n=1,003 adultsaged 18+ years), we calculated weighted point prevalence rates for guilt feelings and used multivariable logistic regression analyses to evaluate the association between the guilt feelings and covariates. Prevalence of current guilt feelings was 10.6% (95%-CI=8.7-12.6). About one fourth of the adults with current guilt feelings rated the intensity of their feelings as ‘rather strong’ or ‘very strong’. To feel guilty was unrelated to age, sex and education, but significantly associated with depression. The weighted prevalence of guilt feelings in adults with major depression was 37.4% (95%-CI=26.2-48.7) compared to 8.1% (95%-CI=6.4-9.9) in adults without. A substantial part of the German adult population is confronted with guilt feelings. Feeling guilty seems to be less dependent on rather global socio-demographic characteristics than on others factors like depression. More efforts have to be made to identify those specific circumstances, under which feelings of guilt lead to adverse health-related outcomes and to provide corresponding treatment approaches.

Sarcopenia: prevalence, associated factors, and the risk of mortality and disability in Japanese older adults.

BackgroundThere is limited evidence on sarcopenia in Asian populations. This study aimed to clarify the prevalence, associated factors, and the magnitude of association with mortality and incident disability for sarcopenia and combinations of its components among Japanese community‐dwelling older adults.MethodsWe conducted a 5.8 year prospective study of 1851 Japanese residents aged 65 years or older (50.5% women; mean age 72.0 ± 5.9) who participated in health check‐ups. Sarcopenia was defined according to the Asian Working Group for Sarcopenia 2019 algorithm. Appendicular lean mass index (ALMI) was measured using direct segmental multi‐frequency bioelectrical impedance analysis. A Cox proportional hazards regression model was used to identify associations of sarcopenia and the combinations of its components with all‐cause mortality and incident disability.ResultsThe prevalence of sarcopenia was 11.5% (105/917) in men and 16.7% (156/934) in women. Significant sarcopenia‐related factors other than ageing were hypoalbuminaemia, cognitive impairment, low activity, and recent hospitalization (all P‐values <0.05) among men and cognitive impairment (P = 0.004) and depressed mood (P < 0.001) among women. Individuals with sarcopenia had higher risks of mortality [hazard ratios (95% confidence interval): 2.0 (1.2–3.5) in men and 2.3 (1.1–4.9) in women] and incident disability [1.6 (1.0–2.7) in men and 1.7 (1.1–2.7) in women]. Compared with the individuals without any sarcopenia components, those having low grip strength and/or slow gait speed without low ALMI tended to have an increased risk of disability [1.4 (1.0–2.0), P = 0.087], but not mortality [1.3 (0.8–2.2)]. We did not find increased risks of these outcomes in participants having low ALMI in the absence of low grip strength and slow gait speed [1.2 (0.8–1.9) for mortality and 0.9 (0.6–1.3) for incident disability].ConclusionsJapanese older men and women meeting Asian criteria of sarcopenia had increased risks of all‐cause mortality and disability. There were no significant increased risks of death or incident disability for both participants with muscle weakness and/or low performance without low muscle mass and those with low muscle mass with neither muscle weakness nor low performance. Further studies are needed to examine the interaction between muscle loss, muscle weakness, and low performance for adverse health‐related outcomes.

Determinants of Health-Related Quality of Life and Physical Performance-Based Components of Frailty in Patients Undergoing Hemodialysis

Health-related quality of life (HRQoL) measures capture the patient's experience of the burden of chronic disease and are strongly associated with adverse health-related outcomes across multiple populations. The SF-36 score is the most widely used HRQoL measure among patients with end-stage renal disease. Current understanding of determinants of the physical component summary (PCS) and the mental component summary (MCS) and their association with objectively measured physical performance and activity is limited. As an index of HRQoL, we prospectively examined the association of SF-36 and its component scores with physical function among 155 incident dialysis patients from the Hemodialysis Center. We investigated associations of HRQoL with the physical performance-based components of the frailty using multivariate linear and logistic regression after adjustment for confounders. Impaired physical performance was defined as having either slow usual gait speed or weak handgrip strength based on standardized and validated criteria derived from a large cohort study of older adults. The patients had a mean age of 65±11years, and 52.3% were male. After adjusting confounders, lower PCS was independently associated with decreased physical performance and reduced physical activity, but MCS was not associated. Among the PCS subscales, only physical functioning 10 (PF-10) was consistently associated with outcomes, and every 1 point increase in PF-10 score was associated with 4% lower odds of impaired physical performance (95% confidence interval 2-7, P=.01) after adjustment. SF-36, especially PF-10, is a valid surrogate that discriminates low physical performance and physical inactivity in the absence of formal physical function testing in patients on hemodialysis. The routine implementation of the PF-10 in clinical care has important clinical implications for medical management and therapeutic decision-making in patients undergoing hemodialysis.

Sarcopenia and adverse health-related outcomes: An umbrella review of meta-analyses of observational studies.

ObjectiveThe purpose of this umbrella review was to assess the associations between sarcopenia and adverse health‐related outcomes.DesignAn umbrella review of meta‐analyses of observational studies.Setting and ParticipantsPatients with sarcopenia and controls without sarcopenia were included.MeasuresThe PubMed, Web of Science and Embase were searched for relevant systematic review and meta‐analysis. AMSTAR and GRADE system were used for methodological quality and evidence quality assessments, respectively.ResultsTotally 54 outcomes extracted from 30 meta‐analyses were analyzed. Twenty out of 21 prognostic outcomes indicated that sarcopenia was significantly associated with poorer prognosis of gastric cancer, hepatocellular cancer, urothelial cancer, head and neck cancer, hematological malignancy, pancreatic cancer, breast cancer, colorectal cancer, lung cancer, esophageal cancer, and ovarian cancer. Besides, 10 out of 16 postoperative outcomes suggested that sarcopenia significantly increased the risk of multiple postoperative complications and prolonged the length of hospitalization of patients with digestive cancer. In age‐related outcomes, sarcopenia significantly increased the risk of dysphagia, cognitive impairment, fractures, falls, hospitalization, and all‐cause mortality of elderly populations. Moreover, sarcopenia was also associated with higher level of albuminuria, risk of depression, and several metabolic diseases.Conclusions and ImplicationsSarcopenia significantly affected a wide range of adverse health‐related outcomes, particularly in patients of tumor and elderly populations. Because evidences of most outcomes were rated as “low” and “very low,” more prospective cohort studies are required in the future.

Diagnosis and Management of Frailty in Primary Health Care.

Disability in older adults has become a significant burden, both individually and socially, due to the rapidly aging population in Korea. It is important to manage both frailty and chronic diseases to delay disability. Frailty, which is considered to be a transition phase between healthy status and disability, is defined as a significant decline in functional reserves of multiple organ systems and the resultant extreme vulnerability to stressors, leading to a higher risk of adverse health-related outcomes. The frailty phenotype and frailty index are the most commonly used methods to diagnose frailty. Frailty is related to physical, psychological, cognitive, and social dysfunction, and is sometimes caused by chronic disease. Therefore, primary care providers are ideally situated to incorporate the concept of frailty into their practice, as they are champions in comprehensive care. Although the identification and treatment of frailty is not yet standard practice in primary care, primary care physicians must use the electronic frailty index to identify frailty in all the patients aged ≥65 years in the United Kingdom. In Canada, some insurance companies and governments are using a similar program, which is called the Community Actions and Resources Empowering Seniors model. The clinical practice guidelines of the International Conference of Frailty and Sarcopenia Research, as well as some additional references, will be introduced. Here, we review the current literature on how to diagnose and manage frailty in primary care.

Characterizing profiles of polysubstance use among high school students in Baltimore, Maryland: A latent class analysis

BackgroundAdolescent drug use has long term health consequences, like substance use disorders and psychiatric illnesses. Proximal health risks, especially for overdose, are amplified when multiple substances are combined. Existing literature on polysubstance use among adolescents has largely focused on alcohol, tobacco, and marijuana, but has largely excluded other drugs like opioids. Understanding how adolescents combine illicit drugs is essential for intervening to prevent poor health outcomes. MethodsWe aimed to explore patterns of lifetime polysubstance use among adolescents in Baltimore City. We used data on 9th-12th graders recruited to participate in the 2017 local Baltimore Youth Risk Behavior Survey who reported any lifetime drug use (n = 387; 60 % female, 77 % non-Hispanic Black). We then conducted a latent class analysis using 10 indicators of lifetime drug and alcohol use. After selecting the class model, we tested for associations between the class profiles and race, sex, school grade, and lifetime injection drug use. ResultsWe identified three profiles of lifetime polysubstance use in our sample: alcohol and marijuana (68.6 % of sample), polysubstance (22.0 %), and alcohol/pain medication/inhalant use (9.4 %). Members of the polysubstance use class were more likely to be male and to report injection drug use. ConclusionsUnderstanding broader patterns of drug use beyond alcohol, tobacco and marijuana among adolescents is a crucial step towards preventing adverse drug and health-related outcomes later in life. More research is needed to characterize the full health impact of youth polysubstance use patterns and related risk behaviors like injection drug use.

Longitudinal analyses of epigenetic pathways in deployed active duty Service Members

BackgroundPre‐deployment identification of risk/ resilience factors is crucial in developing strategies to reduce or prevent post‐traumatic stress (PTSD) symptoms in military personnel. Management of PTSD is complicated because of the overlapping symptoms with the comorbid conditions and the diagnostic reliance on self‐report and time consuming psychological evaluation. A more comprehensive understanding of molecular pathophysiology of PTSD could facilitate an unbiased biomarker‐driven next‐generation intervention strategy. Herein, we study the epigenomic consequences of combat elicited PTSD in a longitudinal manner using blood methylation analysis.MethodsBlood samples were collected pre‐deployment, immediately post‐deployment, and at a three month follow‐up. This study assessed participants prior to stressor exposure during the index deployment and included comprehensive whole blood analysis. We collected self‐reports such as PTSD Checklist for DSM‐5 (PCL‐5) along with clinical tests. DNA methylation assays were carried out using Illumina 450K , followed by repeated‐measures ANOVA, correlation analysis, and PTSD differential analysis to characterize methylation status alterations associated with significant PTSD Check List (PCL) changes (PCL difference &gt;10).ResultsWe identified 64 subjects with changes in PCL scores of 10 across the three phases of the sample collection. The correlation analysis between DNA methylation and the PCL5 trend identified genes from T cell pathways, dopamine receptor signaling and fatty acid activation pathways. We observed shifts in DNA methylation that distinguish PTSD from controls and also that tracks PTSD as measured by PCL5.ConclusionsWe observed shifts in DNA methylation related to deployment related adverse health outcomes. Active Duty cohort represented a real‐world scenario measured stress before and a short time after combat‐related trauma. Future work will integrate these epigenetic data with other molecular and clinical findings to better understand PTSD co‐morbidities, as well as susceptibility and resiliency.Support or Funding InformationResearch was conducted in compliance with all Federal requirements. The views expressed are those of the authors and do not constitute endorsement by the U.S. Army.

Crosstalk Between the Gut Microbiome and Bioactive Lipids: Therapeutic Targets in Cognitive Frailty.

Cognitive frailty is a geriatric condition defined by the coexistence of cognitive impairment and physical frailty. This “composite” aging phenotype is associated with a higher risk of several adverse health-related outcomes, including dementia. In the last decade, cognitive frailty has gained increased attention from the scientific community that has focused on understanding the clinical impact and the physiological and pathological mechanisms of development and on identifying preventive and/or rehabilitative therapeutic interventions. The emergence of gut microbiome in neural signaling increased the interest in targeting the gut–brain axis as a modulation strategy. Multiple studies on gastroenteric, metabolic, and neurodegenerative diseases support the existence of a wide bidirectional communication network of signaling mediators, e.g., bioactive lipids, that can modulate inflammation, gut permeability, microbiota composition, and the gut–brain axis. This crosstalk between the gut–brain axis, microbiome, and bioactive lipids may emerge as the basis of a promising therapeutic strategy to counteract cognitive frailty. In this review, we summarize the evidence in the literature regarding the link between the gut microbiome, brain, and several families of bioactive lipids. In addition, we also explore the applicability of several bioactive lipid members as a potential routes for therapeutic interventions to combat cognitive frailty.

Sarcopenia Definition: The Position Statements of the Sarcopenia Definition and Outcomes Consortium.

To develop an evidence-based definition of sarcopenia that can facilitate identification of older adults at risk for clinically relevant outcomes (eg, self-reported mobility limitation, falls, fractures, and mortality), the Sarcopenia Definition and Outcomes Consortium (SDOC) crafted a set of position statements informed by a literature review and SDOC's analyses of eight epidemiologic studies, six randomized clinical trials, four cohort studies of special populations, and two nationally representative population-based studies. Thirteen position statements related to the putative components of a sarcopenia definition, informed by the SDOC analyses and literature synthesis, were reviewed by an independent international expert panel (panel) iteratively and voted on by the panel during the Sarcopenia Position Statement Conference. Four position statements related to grip strength, three to lean mass derived from dual-energy x-ray absorptiometry (DXA), and four to gait speed; two were summary statements. The SDOC analyses identified grip strength, either absolute or scaled to measures of body size, as an important discriminator of slowness. Both low grip strength and low usual gait speed independently predicted falls, self-reported mobility limitation, hip fractures, and mortality in community-dwelling older adults. Lean mass measured by DXA was not associated with incident adverse health-related outcomes in community-dwelling older adults with or without adjustment for body size. The panel agreed that both weakness defined by low grip strength and slowness defined by low usual gait speed should be included in the definition of sarcopenia. These position statements offer a rational basis for an evidence-based definition of sarcopenia. The analyses that informed these position statements are summarized in this article and discussed in accompanying articles in this issue of the journal. J Am Geriatr Soc 68:1410-1418, 2020.

Examining the relationship between rheumatoid arthritis, multimorbidity and adverse health-related outcomes: A systematic review protocol.

Background:Rheumatoid arthritis (RA) is a chronic autoimmune disorder characterised by articular inflammation and systemic complications. Multimorbidity (the presence of two or more long-term health conditions) is highly prevalent in people with RA but the effect of multimorbidity on mortality and other health-related outcomes is poorly understood.Objective:To determine what is known about the effect, if any, of multimorbidity on mortality and health-related outcomes in individuals with RA.Design:Systematic review of the literature. The following electronic medical databases will be searched: MEDLINE, Embase, Cumulative Index to Nursing and Allied Health Literature, PsycINFO, The Cochrane Library and Scopus. Included studies will be quality appraised using the Quality in Prognostic Studies tool developed by the Cochrane Prognosis Methods Group. A narrative synthesis of findings will be undertaken and meta-analyses considered, if appropriate. This protocol adheres to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols 2015 guidelines, ensuring the quality of the review.Conclusions:Understanding the influence of multimorbidity on mortality and other health-related outcomes in RA will provide an important basis of knowledge with the potential to improve future clinical management of RA. PROSPERO registration number: CRD42019137756.

Sarcopenia and health-related outcomes: an umbrella review of observational studies.

The clinical relevance of sarcopenia has increasingly been recognized. However, whether it is associated with the development of other medical conditions is still unclear. Therefore, we aimed to capture the scale of outcomes that have been associated with the presence of sarcopenia and systematically assess the quality, strength, and credibility of these associations using an umbrella review methodology. A systematic review in several databases was carried out, until 20th February 2019. For each association, random-effects summary effect size, 95% confidence intervals (CIs), heterogeneity (I2), evidence for small-study effect, evidence for excess significance bias, and 95%-prediction intervals were estimated. We used these metrics to categorize the evidence of significant outcomes (p < 0.05) from class I (convincing) to class IV (weak), according to pre-established criteria. From 358 abstracts, 6 meta-analyses with 14 associations were included. Sarcopenia was associated with higher risk of other comorbidities and mortality in 11 of 14 outcomes explored. However, only 3 outcomes (i.e., association between sarcopenia and increased risk of death in community-dwelling older people [odds ratio, OR = 3.60; 95% CI 2.96-4.37; n = 14,305], disability [OR = 3.04; 95% CI 1.80-5.12; n = 8569], and falls [OR = 1.60; 95% CI 1.31-1.97; n = 12,261]) presented a highly suggestive evidence (class II). Other association was classified as having only a weak evidence. Sarcopenia is associated with several adverse health-related outcomes in older people, and its associations with mortality, disability, and falls are supported by a highly suggestive evidence. The effect of interventions on sarcopenia to improve these outcomes needs to be investigated.

The relationship between common geriatric syndromes and potentially inappropriate medication use among older adults.

Polypharmacy and inappropriate medication use in older adults is a major public health problem associated with morbidity and mortality. Aging is associated with metabolic changes and decreased drug clearance, increased drug-drug interactions, prescribing cascades, and potentially inappropriate medication (PIM) use. The purpose of this study was to evaluate the association between a common geriatric syndromes and PIM use among older adults. Study participants were recruited among patients admitted to Istanbul Medical School Geriatrics outpatient clinic between June 2000 and June 2014 and were evaluated retrospectively by a geriatrician using the patients' records according to Beers 2012 criteria. Among the 667 enrolled patients, 421 (63.1%) were women and 246 (36.9%) were men. The use of PIM was not associated with age or sex. Polypharmacy (OR 4.86, 95% CI 3.25-7.27, p < 0.001), malnutrition (OR 2.69, 95% CI 1.52-4.76, p = 0.001), depression (OR 2.61, 95% CI 1.7-3.95, p < 0.001), presence of fall in the previous year (OR 2.24, 95% CI 1.51-3.32, p < 0.001), and dementia (OR 1.69, 95% CI 1.08-2.65, p = 0.021) were independently associated with the use of PIM. The results of our study suggest that PIM use is independently associated with presence of polypharmacy, malnutrition, depression, falls and dementia in older outpatients. Identifying the association of inappropriate medication use with common geriatric syndromes in older people can help to prevent, delay, and reduce PIM use and related adverse health outcomes.

Achieving CLARITY on bisphenol A, brain and behaviour.

There is perhaps no endocrine disrupting chemical more controversial than bisphenol A (BPA). Comprising a high-volume production chemical used in a variety of applications, BPA has been linked to a litany of adverse health-related outcomes, including effects on brain sexual differentiation and behaviour. Risk assessors preferentially rely on classical guideline-compliant toxicity studies over studies published by academic scientists, and have generally downplayed concerns about the potential risks that BPA poses to human health. It has been argued, however, that, because traditional toxicity studies rarely contain neural endpoints, and only a paucity of endocrine-sensitive endpoints, they are incapable of fully evaluating harm. To address current controversies on the safety of BPA, the United States National Institute of Environmental Health Sciences, the National Toxicology Program (NTP), and the US Food and Drug Administration established the Consortium Linking Academic and Regulatory Insights on BPA Toxicity (CLARITY-BPA). CLARITY-BPA performed a classical regulatory-style toxicology study (Core study) in conjunction with multiple behavioural, molecular and cellular studies conducted by academic laboratories (grantee studies) using a collaboratively devised experimental framework and the same animals and tissues. This review summarises the results from the grantee studies that focused on brain and behaviour. Evidence of altered neuroendocrine development, including age- and sex-specific expression of oestrogen receptor (ER)α and ERβ, and the abrogation of brain and behavioural sexual dimorphisms, supports the conclusion that developmental BPA exposure, even at doses below what regulatory agencies regard as "safe" for humans, contribute to brain and behavioural change. The consistency and the reproducibility of the effects across CLARITY-BPA and prior studies using the same animal strain and almost identical experimental conditions are compelling. Combined analysis of all of the data from the CLARITY-BPA project is underway at the NTP and a final report expected in late 2019.

Assessment of physical functioning in the clinical care of the patient with advanced kidney disease.

Maintenance of independent living is the top health priority among patients with advanced chronic kidney disease (CKD). Mobility limitation is often the first sign of functional limitation leading to loss of independence. Regular assessments of physical capacity can help provide kidney health providers identify patients at risk of frailty and other adverse health-related outcomes that contribute to the loss of functional independence. These physical capacities can be measured with commonly used self-reported measures of physical function or by objective physical performance testing. The current review describes commonly used assessments of self-reported physical function and physical performance. First, we describe the disablement process and how these assessments can be performed with commonly used quality of life instruments measuring self-reported physical function or objective physical performance tests. Second, we identify the determinants and correlates of self-reported physical function and physical performance and their contribution to the frailty phenotype. Third, we describe the association of physical capacities with clinical outcomes. We conclude with on possible approach to identifying and intervening on persons with CKD at high risk of functional decline.

Dietary Change Scenarios and Implications for Environmental, Nutrition, Human Health and Economic Dimensions of Food Sustainability.

Demand side interventions, such as dietary change, can significantly contribute towards the achievement of 2030 national sustainable development goals. However, most previous studies analysing the consequences of dietary change focus on a single dimension of sustainability (e.g., environment) using a limited number of indicators and dietary scenarios. A multi-dimension and multi-indicator analysis can identify the potential trade-offs. Here, starting from the current food consumption data (year 2011), we first designed nine alternative dietary scenarios (healthy Swiss diet, healthy global diet, vegetarian, vegan, pescatarian, flexitarian, protein-oriented and meat-oriented diets and a food greenhouse gas tax diet). Next we calculated three nutritional quality (nutrient balance score, disqualifying nutrient score, percent population with adequate nutrition), five environmental (greenhouse gas, water, land, nitrogen and phosphorus use), one economic (daily food expenditure) and one human health indicator (DALYs) for current and alternative diets. We found that transition towards a healthy diet following the guidelines of Swiss society of nutrition is the most sustainable option and is projected to result in 36% lesser environmental footprint, 33% lesser expenditure and 2.67% lower adverse health outcome (DALYs) compared with the current diet. On the other extreme, transition towards a meat or protein oriented diet can lead to large increases in diet related adverse health outcomes, environmental footprint, daily food expenditure and a reduction in intakes of essential nutrients (for Vitamin C, Fibre, Potassium and Calcium). We found that shifting to the vegetarian and vegan diet scenarios might lead to a reduction in intakes of certain micronutrients currently supplied primarily by animal-sourced foods (Vitamin B12, Choline and Calcium). Results show that achieving a sustainable diet would entail a high reduction in the intake of meat and vegetable oils and a moderate reduction in cereals, roots and fish products and at the same time increased intake of legumes, nuts, seeds, fruits and vegetables. We identify several current data and research gaps that need to be filled in order to get more accurate results. Overall, our analysis underscores the need to consider multiple indicators while assessing the dietary sustainability and provides a template to conduct such studies in other countries and settings. Future efforts should focus on assessing the potential of different interventions and policies that can help transition the population from current to sustainable dietary patterns.

Comparison of laboratory indices of non-alcoholic fatty liver disease for the detection of incipient kidney dysfunction.

Non-alcoholic fatty liver disease (NAFLD) is closely linked to insulin resistance and related adverse health outcomes. We investigated the non-invasive index of NAFLD that has the best performance in estimating the renal manifestations of metabolic disturbances. This nation-wide, cross-sectional study included 11,836 subjects, using various non-invasive assessments comprising routinely measured clinical and laboratory variables. The subjects were native Koreans aged 20 years or older and had no diabetes, history of liver or kidney disease. All participants were divided into quintiles according to their fibrosis-4 (FIB-4) results. Participants in the highest quintile were more hypertensive and obese with greater glycemic exposure, poor lipid profiles, and impaired kidney function, than those in the other quintiles. Multiple logistic regression, adjusted for age, sex, smoking, systolic blood pressure, white blood cell, platelet, fasting plasma glucose, and triglyceride, demonstrated that FIB-4, the hepatic steatosis index, the aspartate aminotransferase/alanine aminotransferase (AST/ALT) ratio, Gholam’s model for non-alcoholic steatohepatitis, and the BARD score were independently associated with kidney dysfunction. ROC curve analysis revealed that FIB-4 (AUC = 0.6227, 95% CI [0.5929–0.6526], p = 0.0258) was the most precise in predicting kidney dysfunction. Our findings suggest that FIB-4 may be a favorable screening tool for the renal manifestation of hepatic metabolic disturbances.

Sarcopenia associates with increased hospitalization rates and reduced survival in patients with chronic pancreatitis

BackgroundObjectives: Malnutrition is a well-known complication of chronic pancreatitis and alterations in body composition are common in this context. We investigated the prevalence of sarcopenia in patients with chronic pancreatitis, its associated risk factors and health-related outcome. MethodsThis was a prospective cohort study of chronic pancreatitis outpatients. Bioelectric impedance was used to measure body composition, and a handheld dynamometer and the timed-up-and-go test characterized muscle function. Several demographic and disease characteristics, including exocrine pancreatic insufficiency (EPI), were analyzed for their association with sarcopenia. The EORCT QLQ-C30 questionnaire was used to document life quality, and associations between sarcopenia and the number of hospital admissions, the number of in-hospital days and survival over the next 12 months were analyzed. ResultsA total of 182 patients were enrolled in the study. The prevalence of sarcopenia was 17.0% (95% CI; 11.9–23.3) and 74% of sarcopenic patients had a BMI in the normal or overweight range (BMI >18.5 kg/m2). EPI was an independent risk factor for sarcopenia (OR 3.8 95% CI [1.2–12.5]; p = 0.03). Several QLQ-C30 scales and items were associated with sarcopenia including physical functioning (p < 0.001) and global health (p = 0.003). During follow-up, sarcopenia was associated with an increased risk of hospitalization (OR 2.2 95% CI [0.9–5.0]; p = 0.07), increased number of in-hospital days (p < 0.001), and reduced survival (HR 6.7 [95% CI; 1.8–25.0]; p = 0.005). ConclusionSarcopenia is a common complication of chronic pancreatitis and associates with adverse health-related outcomes. As sarcopenia is not recognized by conventional anthropometric parameters in the majority of patients, systematic nutritional assessment should be prioritized.

The Influence of Lifestyle Behaviors on the Incidence of Frailty.

Frailty is a clinical state defined as an increase in an individual's vulnerability to developing adverse health-related outcomes. We propose that healthy behaviors could lower the incidence of frailty. The aim is to describe the association between healthy behaviors (physical activity, vaccination, tobacco use, and cancer screening) and the incidence of frailty. This is a secondary longitudinal analysis of the Mexican Health and Aging Study (MHAS) cohort. MHAS is a population-based cohort, of community-dwelling Mexican older adults. With five assessments currently available, for purposes of this work, 2012 and 2015 waves were used. A total of 6,087 individuals 50-year or older were included. Frailty was defined using a 39-item frailty index. Healthy behaviors were assessed with questions available in MHAS. Individuals without frailty in 2012 were followed-up three years in order to determine their frailty incidence, and its association with healthy behaviors. Multivariate logistic regression models were used to assess the odds of frailty occurring according to the four health-related behaviors mentioned above. At baseline (2012), 55.2% of the subjects were male, the mean age was 62.2 (SD ± 8.5) years old. The overall incidence (2015) of frailty was 37.8%. Older adults physically active had a lower incidence of frailty (48.9% vs. 42.2%, p< 0.0001). Of the activities assessed in the adjusted multivariate models, physical activity was the only variable that was independently associated with a lower risk of frailty (odds ratio: 0.79, 95% confidence interval 0.71-0.88, p< 0.001). Physically active older adults had a lower 3-year incidence of frailty even after adjusting for confounding variables. Increasing physical activity could therefore represent a strategy for reducing the incidence of frailty. Other so-called healthy behaviors were not associated with incident frailty, however there is still uncertainty on the interpretation of those results.

CLARITY-BPA academic laboratory studies identify consistent low-dose Bisphenol A effects on multiple organ systems.

Bisphenol A (BPA) is a high-production chemical used in a variety of applications worldwide. While BPA has been documented as an endocrine-disrupting chemical (EDC) having adverse health-related outcomes in multiple studies, risk assessment for BPA has lagged due to reliance on guideline toxicology studies over academic ones with end-points considered more sensitive and appropriate. To address current controversies on BPA safety, the United States National Institute of Environmental Health Sciences (NIEHS), the National Toxicology Program (NTP) and the Food and Drug Administration (FDA) established the Consortium Linking Academic and Regulatory Insights on BPA Toxicity (CLARITY-BPA) using the NCTR Sprague-Dawley rats. The goal of CLARITY-BPA is to perform a traditional regulatory toxicology study (Core study) in conjunction with multiple behavioural, molecular and cellular studies by academic laboratories focused on previously identified BPA-sensitive organ systems (Academic studies). Combined analysis of the data from both study types will be undertaken by the NTP with the aim of resolving uncertainties on BPA toxicity. To date, the Core study has been completed and a draft report released. Most of the academic studies have also been finalized and published in peer-reviewed journals. In light of this important milestone, the PPTOX-VI meeting held in the Faroe Islands, 27-30 May 2018 devoted a plenary session to CLARITY-BPA with presentations by multiple investigators with the purpose of highlighting key outcome. This MiniReview synthesizes the results of three academic studies presented at this plenary session, evaluates recently published findings by other CLARITY-BPA academic studies to provide an early combined overview of this emerging data and places this in the context of the Core study findings. This co-ordinated effort revealed a plethora of significant BPA effects across multiple organ systems and BPA doses with non-monotonic responses across the dose range utilized. Remarkably consistent across most studies, including the Core study, are low-dose effects (2.5, 25 and 250μg BPA/kg body-weight). Collectively, the findings highlighted herein corroborate a significant body of evidence that documents adverse effects of BPA at doses relevant to human exposures and emphasizes the need for updated risk assessment analysis.

The ‘Survivorship Passport’ for childhood cancer survivors

BackgroundCurrently, there are between 300,000 and 500,000 childhood cancer survivors (CCSs) in Europe. A significant proportion is at high risk, and at least 60% of them develop adverse health-related outcomes that can appear several years after treatment completion. Many survivors are unaware of their personal risk, and there seems to be a general lack of information among healthcare providers about pathophysiology and natural history of treatment-related complications. This can generate incorrect or delayed diagnosis and treatments. MethodThe Survivorship Passport (SurPass) consists of electronic documents, which summarise the clinical history of the childhood or adolescent cancer survivor. It was developed by paediatric oncologists of the PanCare and SIOPE networks and IT experts of Cineca, together with parents, patients, and survivors' organisations within the European Union–funded European Network for Cancer research in Children and Adolescents. It consists of a template of a web-based, simply written document, translatable in all European languages, to be given to each CCS. The SurPass provides a summary of each survivor's clinical history, with detailed information about the original cancer and of treatments received, together with personalised follow-up and screening recommendations based on guidelines published by the International Guidelines Harmonization Group and PanCareSurFup. ResultsThe SurPass data schema contains a maximum of 168 variables and uses internationally approved nomenclature, except for radiotherapy fields, where a new classification was defined by radiotherapy experts. The survivor-specific screening recommendations are mainly based on treatment received and are automatically suggested, thanks to built-in algorithms. These may be adapted and further individualised by the treating physician in case of special disease and survivor circumstances. The SurPass was tested at the Istituto Giannina Gaslini, Italy, and received positive feedback. It is now being integrated at the institutional, regional and national level. ConclusionsThe SurPass is potentially an essential tool for improved and more harmonised follow-up of CCS. It also has the potential to be a useful tool for empowering CCSs to be responsible for their own well-being and preventing adverse events whenever possible. With sufficient commitment on the European level, this solution should increase the capacity to respond more effectively to the needs of European CCS.