Adult Chronic Disease Research Articles

Healthy dietary patterns and the risk of individual chronic diseases in community-dwelling adults

It is unclear regarding associations of dietary patterns with a wide range of chronic diseases and which dietary score is more predictive of major chronic diseases. Using the UK Biobank, we examine associations of four individual healthy dietary scores with the risk of 48 individual chronic diseases. Higher Alternate Mediterranean Diet score is associated with a lower risk of 32 (all 8 cardiometabolic disorders, 3 out of 10 types of cancers, 7 out of 10 psychological/neurological disorders, 5 out of 6 digestive disorders, and 9 out of 14 other chronic diseases). Alternate Healthy Eating Index-2010 and Healthful Plant-based Diet Index are inversely associated with the risk of 29 and 23 individual chronic diseases, respectively. A higher Anti-Empirical Dietary Inflammatory Index is associated with a lower risk of 14 individual chronic diseases and a higher incidence of two diseases. Our findings support dietary guidelines for the prevention of most chronic diseases.

Magnitude of risk factors for chronic noncommunicable diseases in adolescents and young adults in Brazil: A population-based study.

Estimate the magnitude and factors associated with risk factors for chronic noncommunicable diseases in adolescents and young adults in Brazil. Cross-sectional study that analyzed data from the 2019 National Health Survey. The population of interest was adolescents and young adults aged 15 to 24 years. Data were collected through individual interviews during home visits. Dependent variables included major risk factors for chronic noncommunicable diseases. Demographic and socioeconomic characteristics were used as independent variables. Multiple Poisson regression models were used to assess the relationship between independent variables and risk factors. A total of 10,460 individuals (5,001 men and 5,459 women) were included. Regardless of sex, the most prevalent risk factors were insufficient fruit and vegetable consumption (92.6%) and leisure-time physical inactivity (43.3%). The prevalence rates of tobacco smokers, alcohol consumption once a month or more, and alcohol abuse were 8.9%, 28.7%, and 18.5%, respectively. Regular consumption of soft drinks and/or artificial juices was described by 17.2%. The prevalence of overweight was 32.5%. Young adults, males, and individuals with lower educational levels, of black race/skin color, with lower household income, and residents of urban areas had a higher prevalence for most risk factors. Differences in the determinants were found for some factors. Inequalities between Brazilian regions were recorded for seven of the nine factors analyzed. The most socioeconomically developed regions had the highest prevalence of most risk factors. The high magnitude of risk factors indicates a potential increase in the burden of chronic noncommunicable diseases in a future scenario for Brazil.

Synergistic impact of co-exposures to whole blood metals on chronic kidney disease in general US adults: a cross‑sectional study of the National Health and Nutrition Examination Survey 2011-2020.

The impact of exposure to metals on chronic kidney disease (CKD) has only been investigated in two-way or single metal interactions in previous studies. We investigated the associations between five single metals in blood and their mixed exposure and CKD by using the machine learning approach. Relevant data were extracted from the National Health and Nutrition Examination Survey (NHANES 2011-2020), and the level of five metals in blood detected by inductively coupled plasma mass spectrometry was considered as exposures, namely, cadmium (Cd), lead (Pb), total mercury (Hg), manganese (Mn), and selenium (Se). The correlations between individual metal and metal mixtures and CKD were then evaluated by survey-multivariable logistic regression (SMLR), generalized weighted quantile sum (WQS), and Bayesian kernel machine regression (BKMR). Altogether, our study included 12,412 participants representing 572.6 million non-institutionalized US adults. Several single metals with the high quartile of exposure showed a positive association with the CKD ratio including Cd [(AOR = 1.873, 95% CI: 1.537, 2.284), Q4], Pb [(AOR = 1.559, 95% CI: 1.295, 1.880), Q4], and total Hg [(AOR = 1.169, 95% CI: 1.018, 1.343), Q2], while Mn [(AOR = 0.796, 95% CI: 0.684, 0.927), Q2] and Se [(AOR = 0.805, 95% CI: 0.664, 0.976), Q4] were negatively associated with the CKD ratio. In light of the positive fit of the WQS regression model, a significantly positive correlation was found between mixed metals and CKD (AOR = 1.373, 95% CI: 1.224, 1.539) after full covariate adjustment, and a similar finding was also detected in the BKMR model. Our study revealed that each single metal including Cd, Pb, and total Hg might have a positive association with CKD while this association was negative for both Mn and Se. The five metals might have a positive joint effect on CKD.

Demand and influencing factors of "Internet + Traditional Chinese Medicine" home nursing service for older adult patients with chronic diseases: a mixed research perspective.

In the context of global aging, the characteristics of chronic diseases seriously affect the quality of life of older adults. It is urgent to carry out continuous nursing basis for older adult patients with chronic diseases. In view of the remarkable efficacy of Chinese medicine in the treatment of chronic diseases, this study may help to understand the demand for "Internet + Chinese medicine" home care service and its influencing factors of older adult chronic disease patients, and to provide a reference basis for improving the quality of life of the older adult chronic disease population. This is a mixed study. The quantitative study adopted the convenience sampling method, and a total of 308 patients in a third-grade hospital in Shaanxi Province were investigated by general data questionnaire, traditional Chinese medicine service demand questionnaire, traditional Chinese medicine knowledge questionnaire, older adult Chinese medicine attitude questionnaire, and home care demand questionnaire from March to April 2022. In the qualitative study, semi-structured interviews were adopted, and patients were interviewed until the content was saturated. Colaizzi analysis method was used to analyze and summarize the topic of the interview data. 308 valid questionnaires were collected, and the patients scored (58.42 ± 17.16) on the demand for TCM nursing services, (59.86 ± 11.54) on the knowledge of TCM, (73.03 ± 9.11) on the attitude toward TCM, and (136.84 ± 46.39) on the demand for home care. The results of multiple linear regression showed that learning about the nursing service pathway, knowledge of general knowledge of Chinese medicine, and attitude toward Chinese medicine among the older adult and home care demand were the influencing factors of the demand for Chinese medicine nursing services for older adult patients with chronic diseases (p < 0.05). The results of the in-depth interviews were summarized into three themes: facilitating factor, hindering factor, and the "Internet + Chinese medicine" multiple needs of home care. Older adult patients with chronic diseases have a high intention of home care demand and they are affected by multiple factors. Consequently, the actual demand situation of older adult patients with chronic diseases should be used as a guide to provide directed and diversified Chinese medicine home care services to meet the individualized needs of the older adult.

Association of sarcopenia with rapid kidney function decline and chronic kidney disease in adults with normal kidney function.

The association between sarcopenia and kidney function remains poorly investigated. We aimed to evaluate the associations between sarcopenia status and kidney function (rapid kidney function decline and chronic kidney disease (CKD)) in middle-aged and older Chinese population. A total of 9375 participants from the China Health and Retirement Longitudinal Study 2011 were included in the cross-sectional analyses. A total of 5864 participants with eGFRcr-cys ≥ 60 ml/min per 1·73 m2 at baseline were included in the longitudinal analyses and were followed up in 2015. Sarcopenia status was defined according to the Asian Working Group for Sarcopenia 2019 criteria. In the cross-sectional analyses, possible sarcopenia and sarcopenia were significantly associated with an increased risk of CKD. During the 4 years of follow-up, 359 (6·12 %) participants experienced rapid decline in kidney function and 126 (2·15 %) participants developed CKD. After multivariable adjustment of baseline eGFRcr-cys level and other risk factors, possible sarcopenia (OR, 1·33; 95 % CI 1·01, 2·12) and sarcopenia (OR, 1·49; 95 % CI 1·05, 2·12) were associated with an increased risk of primary outcome (composite of rapid decline in kidney function (annualised decline in eGFRcr-cys ≥ 5 ml/min per 1·73 m2) and progression to CKD (eGFRcr-cys < 60 ml/min per 1·73 m2). Individuals with low muscle mass or low muscle strength alone also had an increased risk of rapid decline in kidney function and progression to CKD.

Minirehabilitation room for grandparents

Introduction: aging is a natural physiological process, but there are ways to prevent this natural wear and tear, such as geriatric rehabilitation, which guarantees healthy aging, through the practice of moderate physical activity. Objective: to rehabilitate older adults in the Medical Office, through the practice of physical exercises, using implements made of disposable and disused materials. Method: a descriptive, cross-sectional, innovative study was carried out. The universe was constituted by the 234 older adults of the 26th clinic of Pinar del Rio and the sample by the 33 selected by intentional sampling taking into account the inclusion and exclusion criteria. Results: the most frequent chronic diseases in older adults were arterial hypertension and diabetes, while dyslipoproteinemias and arthritis were the ones with the best response to geriatric rehabilitation. All the adults were satisfied with the benefits of rehabilitation. None were hospitalized, nor did any death occur. 100 % of the patients were satisfied with the rehabilitation. 336,55 cup were saved per unit of instruments made; total of 1191,5 cup and to the country, per benefited patient 32 053,44 cup per month, total 194 336,64 cup in the studied period. Conclusions: geriatric rehabilitation through the practice of physical exercise has beneficial effects on the life, mood and desire to live of older adults. Because of the biological, economic and social impact, this work was relevant in the Provincial Health Innovation Forum.

Prevalencia de daño renal temprano en adultos mayores

Introduction: Renal Chronic Disease is a clinical entity that constitutes the final road of multiple etiologies. Objective: determining the prevalence of renal damage early on older adults. Methods: an observational, descriptive and transverse study, that allowed to through the serum characterization of markers of renal functioning, like microalbuminuria, creatinine masking dear glomerular, came true to study the Polyclinic Turcios Lima's prevalence of the renal chronic disease in older adults, during the year 2022. Of 2500 patients ‘universe, they were once 1300 patients that fulfilled the criteria of inclusion were studied by means of probabilistic sampling. Each patient deemed a clinical evaluation as his basic team of health. The information gathered itself of the stories of individual health, interrogation, physical examination and data of laboratory. He determined the stocking, standard deviation and your confidence interval of the 95 % (IC 95 %), as well as the Chi-Square and the statistician Z with a significance level statistical of p≤0,05. Results: There was a lofty prevalence of the renal damage (19,46 %), of the ages of 70 to 79 years (37,54 %), of the feminine sex (73,51 %). They prevailed stadiums 1 (62,53 %) and 2 (29,07 %) of disease, and the category A1 of the microalbuminuria (48,61 %). The HTA (21,73 %) and obesity (19,39 %) predominated within the factors of risk, being diabetes mellitus (52,60 %) and the HTA (22,00 %) the main causes. Conclutions: the renal damage early is a prevalent health problem not identified of early way in the population older adult.

Professional Hats Aside: How Parent Cafés Reduce Perceived Power Differentials to Engage Caregivers in Adverse Childhood Experience Prevention Using the Protective Factors Framework

In the 25 years since adverse childhood experiences (ACEs) were identified as risk factors for chronic disease in adulthood, there has been limited research on multigenerational ACEs and prevention. Parent Cafés are a program model that engages caregivers in productive conversations centered on the protective factors framework. They integrate strategies of deprofessionalization, cocreation of programming, safe spaces, active listening, social supports, concrete resources, and self-directed or peer-guided cues to action, to optimize their impact. This article explains the development of the Parent Café model and discusses the benefits of its use of a non-expert-led structure, with support from theory and results from a pilot qualitative survey. Future practices should consider taking innovative approaches to adopting, integrating, and evaluating these strategies.

Physical Activity Levels in Leisure Time, Sociodemographic Characteristics, and Chronic Non-Communicable Diseases in Brazilian Older Adults: National Health Survey, 2019.

Health interventions for elderly people must understand the association between physical activity, sociodemographic factors, and non-communicable diseases. This study aimed to verify the association between physical activity in leisure time, sociodemographic factors, and NCDs in Brazilian older people. This is a descriptive study, with a cross-sectional design, carried out using secondary data from the 2019 National Health Survey-Brazil. It used data from 23,144 subjects aged over 60 years. Statistical analyses included descriptive and quantile regression with cutoff points 0.25, 0.50 (Median), 0.75, and 0.90 to verify the association between the variables. The statistical software R version 4.1.3 was used. Older people aged between 60 and 79 years were highlighted up to the 50th quantile. Females showed lower values in all quantiles, with emphasis from quantile 50 onwards. Subjects who self-declared as "white" showed significant differences up to quantile 50, not indicating significant values from this cutoff point. Residents of the rural area had lower values than residents of the urban area in all quantiles, with emphasis starting from the median. For cardiovascular diseases, it was found that subjects who did not report having this type of disease had better results for the amount of physical activity during leisure time, especially from the 75th quantile. It was concluded that there is a direct relationship between time spent in leisure-time performing physical activity, sociodemographic variables, and NCDs. It is necessary to review and validate cutoff points according to each category viewed, which can favor the adjustment of interventions according to each population. Actions of this nature can favor adherence by groups of older people to the weekly practice of physical activity.

THU340 Efficacy And Safety Of Low-dose Spironolactone On Chronic Kidney Disease In Adults With Type 2 Diabetes: A Multicenter, Randomized Clinical Trial

Abstract Disclosure: A. Oiwa: None. D. Hiwatashi: None. T. Takeda: None. T. Miyamoto: None. I. Kawata: None. M. Koinuma: None. S. Kubota: None. S. Takayama: None. M. Yamazaki: None. M. Komatsu: None. Objective: To evaluate the albuminuria-lowering effect and safety regarding hyperkalemia of adding low-dose spironolactone (12.5 mg/day) to the renin-angiotensin system (RAS) blockers in adults with chronic kidney disease and type 2 diabetes. Research Design and Methods: This was a multicenter, open-label, randomized controlled trial. We enrolled 130 Japanese individuals aged ≥20 years with type 2 diabetes and albuminuria (≥30 mg/gCre), estimated glomerular filtration ≥30 mL/min/1.73 m2, and serum potassium level &amp;lt;5.0 mEq/L. They were randomly assigned to the spironolactone-administered and control groups. The main outcomes were changes in urine albumin-to-creatinine ratio (UACR), serum potassium levels and renal function from baseline to the 24-week interventional period. Results: The spironolactone-administered group showed a significant reduction in UACR by a mean of 103.47 ± 340.80 mg/gCre from baseline compared with the control group that showed increased UACR by a mean of 63.93 ± 310.14 mg/gCre (p = 0.0007, Wilcoxon rank-sum test and T-test). As for serum potassium levels, although there was a statistically significant increase (p = 0.0026), none of the participants had a potassium level ≥5.5 mEq/L at 24 weeks. Further, there was a tendency that the higher the initial potassium level, the smaller the increase in serum potassium level (estimate −0.37, analysis of covariance). Conclusions: This study first demonstrated that low-dose spironolactone administration reliably reduced albuminuria and was safe against hyperkalemia. The administration of spironolactone, which is the oldest known and most cost-effective of all the other mineralocorticoid receptor antagonists, should be re-evaluated with consideration of lower doses. Presentation: Thursday, June 15, 2023

Dysanapsis and its role in the occurrence of chronic obstructive respiratory diseases in children and adults: A review

The literature review, written on the basis of world literature data and the results of the authors' own research, is devoted to an important pathogenetic mechanism of development and progression of chronic obstructive pulmonary diseases in children and adults dysanapsis, which is understood as a mismatch in the size or growth of the airways to the volume or growth of the lung parenchyma, while the diameter of the airways is disproportionately smaller than the volume of the lung parenchyma. Modern methods of diagnosis of dysanapsis are based on the use of computed tomography of the chest organs, spirometry (accounting for the volume of forced exhalation in 1 second, forced vital capacity of the lungs, calculation of the coefficient of dysanapsis). Dysanapsis, which has genetic and age-dependent mechanisms of formation, makes an important contribution to the development of bronchial hyperreactivity and bronchial asthma, especially in combination with overweight and obesity, determining the uncontrolled course of asthma. The phenomenon of dysanapsis can be explained by the clinical and functional indicators of the respiratory system (hypoxemia, bronchial obstruction) in premature infants, including patients with bronchopulmonary dysplasia, patients with postinfectious obliterating bronchiolitis. In addition, imbalance is an important pathogenetic component of chronic obstructive pulmonary disease, causing the defeat of patients with this disease, regardless of the presence and length of smoking.

Kappa opioid agonists in the treatment of itch: just scratching the surface?

Chronic pruritus is a debilitating condition affecting 23–44 million Americans. Recently, kappa opioid agonists (KOAs) have emerged as a novel class of potent antipruritic agents. In 2021, the Food and Drug Administration approved difelikefalin (Korsuva) for the treatment of moderate-to-severe pruritus associated with chronic kidney disease in adults undergoing hemodialysis. Difelikefalin is a potent, peripherally restricted KOA that is intravenously available. Although promising, difelikefalin is currently available as an intravenous composition only, limiting the scope of use. Oral formulations of difelikefalin did not meet the primary endpoint criteria in recent phase 2 clinical trials; however, additional clinical studies are ongoing. The future for KOAs in the treatment of pruritus is encouraging. Orally active pathway-biased KOAs, such as triazole 1.1, may serve as viable alternatives with broader applications. Extended-release compositions, such as the TP-2021 ProNeura subdermal implant, may circumvent the pharmacokinetic issues associated with peptide-based KOAs. Lastly, dual-acting kappa opioid receptor agonist/mu opioid receptor antagonists are orally bioavailable and may be useful in the treatment of various forms of chronic itch. In this review, we summarize the results of KOAs in clinical and preclinical trials and discuss future directions of drug development.

Minireview: Glucocorticoid-Leptin Crosstalk: Role of Glucocorticoid-Leptin Counterregulation in Metabolic Homeostasis and Normal Development.

Glucocorticoids and leptin are two important hormones that regulate metabolic homeostasis by controlling appetite and energy expenditure in adult mammals. Also, glucocorticoids and leptin strongly counterregulate each other, such that chronic stress-induced glucocorticoids upregulate the production of leptin and leptin suppresses glucocorticoid production directly via action on endocrine organs and indirectly via action on food intake. Altered glucocorticoid or leptin levels during development can impair organ development and increase the risk of chronic diseases in adults, but there are limited studies depicting the significance of glucocorticoid-leptin interaction during development and its impact on developmental programming. In mammals, leptin-induced suppression of glucocorticoid production is critical during development, where leptin prevents stress-induced glucocorticoid production by inducing a period of short-hyporesponsiveness when the adrenal glands fail to respond to certain mild to moderate stressors. Conversely, reduced or absent leptin signaling increases glucocorticoid levels beyond what is appropriate for normal organogenesis. The counterregulatory interactions between leptin and glucocorticoids suggest the potential significant involvement of leptin in disorders that occur from stress during development.

Type 2 Diabetes Mellitus and Sarcopenia as Comorbid Chronic Diseases in Older Adults: Established and Emerging Treatments and Therapies.

Type 2 diabetes mellitus (T2DM) and sarcopenia (low skeletal muscle mass and function) share a bidirectional relationship. The prevalence of these diseases increases with age and they share common risk factors. Skeletal muscle fat infiltration, commonly referred to as myosteatosis, may be a major contributor to both T2DM and sarcopenia in older adults via independent effects on insulin resistance and muscle health. Many strategies to manage T2DM result in energy restriction and subsequent weight loss, and this can lead to significant declines in muscle mass in the absence of resistance exercise, which is also a first-line treatment for sarcopenia. In this review, we highlight recent evidence on established treatments and emerging therapies targeting weight loss and muscle mass and function improvements in older adults with, or at risk of, T2DM and/or sarcopenia. This includes dietary, physical activity and exercise interventions, new generation incretin-based agonists and myostatin-based antagonists, and endoscopic bariatric therapies. We also highlight how digital health technologies and health literacy interventions can increase uptake of, and adherence to, established and emerging treatments and therapies in older adults with T2DM and/or sarcopenia.

A systematic analysis and future projections of the nutritional status and interpretation of its drivers among school-aged children in South-East Asian countries.

Nutrition inadequacy during childhood and adolescence can cause suboptimal growth, intergenerational effects on offspring and an increased risk of chronic diseases in adulthood. There is little information on the prevalence and drivers of malnutrition in children aged 5-19 years, in the South-East Asian setting, since most existing interventions have to date targeted undernutrition. We assessed the national prevalence of nutritional indicators, their trends, and associated risk factors among children aged 5-19 years from 11 countries of WHO South-East Asia Region (SEA Region) in order to provide evidence to guide future policy direction. We included 5,210,646 children for analysis from 345 studies and 25 survey datasets. A Newcastle-Ottawa Scale was used to assess the quality of the study. Bayesian regression models were used to estimate the prevalence of malnutrition between 2000 and 2030, and a series of subgroup analyses were performed to assess variation in pooled estimates by different socio-demographic and lifestyle factors. The protocol was registered with PROSPERO database (CRD42023400104). Overall, pooled analysis demonstrated that indicators of undernutrition in SEA is predicted to decrease between 2000 and 2030 including stunting (36.6%-27.2%), thinness (29.5%-6.2%), and underweight (29.2%-15.9%). However, a substantial increase in prevalence of overweight (6.0% in 2000-16.9% in 2030), and obesity (2.6%-9.5%) are predicted. The prevalence of micronutrient deficiencies between 2000 and 2030 is predicted to decrease-vitamin A by 84% and vitamin D by 53%. Parents' education levels and household wealth were inversely associated with malnutrition. Children's health-related behaviours, such as unhealthy dietary habits and spending more time watching TV, playing games, or using the computer, were associated with increased chance of overweight and obesity. There were no clear signs of publication bias in our study. Our analysis highlights the pattern of a double burden of malnutrition, with clear differences between different socio-demographic groups. Despite a substantial reduction in the prevalence of stunting, underweight, and anaemia since 2000, an emerging increase in overweight/obesity and micronutrient deficiencies warrants urgent attention. World Health Organization Regional Office for South-East Asia New Delhi, India.

Impact of Exclusive Breastfeeding on Anthropometry, Morbidity and Duration of Hospitalization of Infants Under Six Months of Age

Introduction: Breast milk is the best feed for the infants. Breast milk has got several immunological benefits protecting the infants from various infectious diseases and some chronic diseases of adulthood. Exclusively breastfed babies get less infected and have proper growth and development.&#x0D; Aims: To study the impact of exclusive breastfeeding on morbidity and hospital stay of infants of four weeks to six months of age.&#x0D; Methods: This was a hospital based cross sectional study done at Pediatric department of Nepalgunj Medical College, Nepalgunj, a tertiary care referral hospital in Nepal, conducted over a period of one year from January 2022 - December 2022. All the infants meeting the inclusion criteria were included for the study.&#x0D; Results: A total of 278 infants of 4 weeks to 6 months of age meeting inclusion criteria were included. More than sixty four percent infants were exclusively breastfed. The majority of patients belonged to modified kuppuswamy class 3. Significant impact on nutritional outcome was seen with feeding pattern as 1.7 higher times chance of being underweight in breastfeeding along with supplementary feeding with a highly significant p value of 0.002. Exclusively breastfed infants suffering from respiratory diseases, gastroenteritis, fever and due to other various morbidities were hospitalized for less than one week. Morbidity and hospital stay had a statistically significant relationship with feeding pattern. Higher morbidity was observed due to various diseases of infancy like respiratory diseases, gastroenteritis, sepsis, etc. in breastfeeding along with supplementary feeding group as compared to exclusively breastfeeding group.&#x0D; Conclusion: Statistically significant association was found in terms of morbidity, hospital stay and feeding pattern amongst exclusively breastfed infants and breastfeeding along with supplementary fed infants. Less morbidity and shorter hospital stay was observed in exclusively breastfed infants as compared to breastfeeding along with supplementary feeding infants.

Epidemiology and treatment of renal anaemia in Spain: RIKAS retrospective study

Background and objectiveStudies on the prevalence of anaemia in chronic kidney disease in adults not on dialysis (CKD-ND) and in dialysis programmes (CKD-D) in Spain are not recent or focus on certain subgroups. The aim of this study was to know the epidemiology and current treatment patterns of anaemia associated with CKD in Spain. Materials and methodsMulticentre, non-interventional, retrospective study with CKD-ND stage 3a-5 and CKD-D patients treated in Spain between 2015 and 2017 (RIKAS study). ResultsThe prevalence of anaemia in CKD-ND and CKD-D in 2015 was 33.8% and 91.5%, respectively, with similar results during 2016−2017. The prevalence of systemic inflammation in anaemic patients (18.1% and 51.8% for CKD-ND and CKD-D, respectively) was higher, especially in those treated with erythropoiesis-stimulating agents (ESA), compared to the general population with CKD-ND. After 12 months of follow-up, mean ferritin and transferrin saturation index (TSI) values in anaemic patients with CKD-ND were 187.1 ng/mL and 22.2%, respectively, while in CKD-D were 254.6 ng/mL and 20.2%. In ESA-treated patients, mean values were 190.6 ng/mL and 22.0% in ND-CKD, and 255.0 ng/mL and 20.2% in D-CKD. ConclusionsThe prevalence of anaemia and inflammation increased with the disease severity, being higher in D-CKD. Iron parameters in anaemic patients treated or not with ESA are insufficient according to the guidelines, so there is room for improvement in the treatment of anaemia associated with CKD.

Association between chronic obstructive pulmonary disease and cardiovascular disease in adults aged 40 years and above: data from NHANES 2013–2018

BackgroundChronic obstructive pulmonary disease (COPD) and cardiovascular disease (CVD) are two major age-related diseases prevalent in the elderly. However, it is unclear whether there is a higher prevalence of one or more CVDs in COPD patients compared to those without COPD, and the magnitude of this increased prevalence.MethodsThis population-based cross-sectional study was conducted using data from the National Health and Nutrition Examination Survey (NHANES) 2013–2018 among American adults aged 40 years and above. Multivariable logistic regression models (including unadjusted model, minimally adjusted model, and fully adjusted model) were conducted to investigate the association between COPD and the prevalence of one or more CVDs, including coronary heart disease, heart failure, angina pectoris, heart attack, diabetes, and stroke.ResultsThis study included 11,425 participants, consisting of 661 participants with COPD and 10,764 participants without COPD. COPD patients had a significantly higher prevalence of CVD than those without COPD (59.6% vs. 28.4%). After adjusting for covariates, COPD was significantly associated with the prevalence of one CVD (OR = 2.2, 95% CI = 1.6–3.0, p < 0.001), two or more CVDs (OR = 3.3, 95% CI = 2.2–5.0, p < 0.001), and three or more CVDs (OR = 4.3, 95% CI = 2.9–6.5, p < 0.001).ConclusionsPatients with COPD have a higher prevalence of one or more CVDs compared with those without COPD. Our findings highlight the importance of CVD prevention and management in patients with COPD.

Elevated serum leptin may be associated with disease activity and secondary osteoporosis in Chinese patients with rheumatoid arthritis.

Rheumatoid arthritis (RA) is a systemic chronic autoimmune disease in adults that is associated with significant joint issues and systemic inflammation. One of the signs of bone damage in RA is osteoporosis (OP). Leptin is an inflammatory protein that has been reported to be related to RA. The potential relationships among leptin, disease activity, and OP in Chinese patients with RA are not well known. In total, 245 patients with RA and 120 healthy controls were included in this study. Detailed data on the clinical characteristics and laboratory features were collected. Information about physical activity and functional status was recorded using specific questionnaires. Bone mineral density (BMD) was measured by dual-energy X-ray absorptiometry (DXA). The MECALL castor-50-hf model X-ray scanner was used for the two-hand (including wrist) photographs. Serum leptin levels differed significantly between the RA group and healthy control subjects (1.27/3.29 vs. 0.17/0.24, Z=13.29, P<0.001). The positive rate of leptin protein in RA patients was 86.35%, which was higher than that in controls (19.55%) (χ2=28.51, P<0.001). Pearson's correlation test showed that morning stiffness, disease duration, joint swelling, joint tenderness, swollen joint count (SJC), tender joint count (TJC), health assessment questionnaire (HAQ) score, and Sharp-van der Heijde method (Sharp) score were positively correlated with the level of serum leptin (r=0.212, r=0.312, r=0.322, r=0.501, r=0.291, r=0.334, P<0.05). There was a clear increasing trend in the level of serum leptin according to the different disease activity scores and in the 28 joint activity (DAS28) groups (F=13.936, P<0.001). Elevated leptin was a risk factor for increased disease activity and OP according to logistic regression analysis. The median leptin level differed significantly between the normal bone mass group, osteopenia group, and OP group (P<0.001). An increased serum leptin level was a risk factor for RA-induced osteoporosis according to logistic regression analysis (P<0.001). These results suggest that the level of serum leptin is associated with disease activity and secondary OP among Chinese patients with RA. Key Points • Serum leptin levels in RA patients are higher than those in normal control group. • Leptin was associated with disease activity. • Leptin was associated with the occurrence of systemic osteoporosis and affects bone erosion in RA patients.

Ethnic differences in kidney function in childhood: the Born in Bradford Cohort Renal Study

Background: Endstage kidney failure rates are higher in South Asians than in White Europeans. Low birth weight is associated with adult chronic kidney disease and is more common in South Asians. Foetal kidney size was smaller in South Asians in the Born in Bradford (BiB) birth cohort. As part of BiB follow up, we aimed to investigate if there were ethnic differences in kidney function and blood pressure in early childhood and whether this was different by foetal kidney size. Methods: Serum creatinine, cystatin C, urea, and urinary albumin to creatinine ratio (ACR), protein to creatinine ratio (PCR) and retinol binding protein (RBP) were analysed in blood and urine samples from those who participated in the BiB follow-up at 7-11 years. Ethnicity was categorised by parental self-report as White European and South Asian. Estimated glomerular filtration rate (eGFR) was calculated using Schwartz, and cystatin C Zappitelli and Filler equations. Linear regression was used to examine the association between ethnicity and eGFR, PCR and blood pressure. Results: 1591 children provided blood (n=1403) or urine (n=625) samples. Mean eGFR was 92 ml/min/1.73m2 (standard deviation (SD) 9) using Schwartz (n=1156) and 94 (SD 11) using Zappitelli (n=1257). CKD prevalence was rare (1 with eGFR &lt;60 ml/min/1.73m2, 14 (2.4%) had raised ACR (&gt;2.5 mg/mmol in boys/3.5 mg/mmol in girls). Diastolic blood pressure was higher in South Asian children (difference 2.04 mmHg, 95% CI 0.99 to 3.10) but was not significant in adjusted analysis. There was no evidence of association in adjusted models between ethnicity and any eGFR or urinary measure at this age. Conclusions: There was no evidence of significant ethnic differences in kidney function at pre-pubertal age despite differences in kidney volume at birth. Longitudinal follow-up is required to track ethnic patterns in kidney function and blood pressure as children develop through puberty.