Modifiable Risk Factor For Development Research Articles

Neighborhood location and nutritional resources as a risk factor for congenital heart disease in the fetus.

Congenital heart disease (CHD) is the most common birth defect, influenced by maternal health, environmental conditions, and genetics. Maternal health and nutrition, particularly maternal diabetes, is a modifiable risk factor for development of CHD in the fetus. However, the importance of food access during pregnancy on the development of CHD remains unknown. The objective of this study was to investigate the association between maternal neighborhood characteristics, particularly food access, and occurrence of prenatally diagnosed CHD. A retrospective case series studied maternal-fetal dyads with prenatally diagnosed CHD between 2019 and 2021 in Washington, DC. Moran's I of maternal addresses evaluated geographic clustering of disease. Negative binomial regression assessed association between census tract demographics and population-adjusted CHD rate. A total of 307 dyads were analyzed. Global Moran's I showed significant CHD clustering (p-value = .004). However, degree of clustering was not clinically meaningful. After adjusting for neighborhood socioeconomic status, residing in food deserts was not a predictor for CHD. However, neighborhoods with a higher percentage of households receiving Supplemental Nutrition Assistance Program (SNAP) benefits were associated with higher rates of conotruncal heart defects (Incident Rate Ratio [IRR] = 1.04, CI = 1.01-1.08) and aggregate CHD (IRR = 1.03, CI = 1.01-1.05). Neighborhood location and food access were not associated with CHD. However, increased enrollment in SNAP was associated with higher rates of CHD. The association between CHD and SNAP benefits warrants further exploration. Understanding food access and maternal nutrition may illuminate disparities in the burden of CHD.

Early Functional Status Change After Cardiopulmonary Resuscitation in a Pediatric Heart Center: A Single-Center Retrospective Study.

Children with cardiac disease are at significantly higher risk for in-hospital cardiac arrest (CA) compared with those admitted without cardiac disease. CA occurs in 2-6% of patients admitted to a pediatric intensive care unit (ICU) and 4-6% of children admitted to the pediatric cardiac-ICU. Treatment of in-hospital CA with cardiopulmonary resuscitation (CPR) results in return of spontaneous circulation in 43-64% of patients and survival rate that varies from 20 to 51%. We aimed to investigate the change in functional status of survivors who experienced an in-hospital CA using the functional status scale (FSS) in our heart center by conducting a retrospective study of all patients 0-18years who experienced CA between June 2015 and December 2020 in a free-standing university-affiliated quaternary children's hospital. Of the 165 CA patients, 61% (n = 100) survived to hospital discharge. The non-survivors had longer length from admission to CA, higher serum lactate levels peri-CA, and received higher number of epinephrine doses. Using FSS, of the survivors, 26% developed new morbidity, and 9% developed unfavorable outcomes. There was an association of unfavorable outcomes with longer CICU-LOS and number of epinephrine doses given. Sixty-one-percent of CA patients survived to hospital discharge. Of the survivors, 26% developed new morbidity and 91% had favorable outcomes. Future multicenter studies are needed to help better identify modifiable risk factors for development of poor outcomes and help improve outcomes of this fragile patient population.

Using consensus methods to prioritize modifiable risk factors for development of manifestations of frailty in hospitalized older adults.

The aim of the study was to reach consensus on modifiable risk factors for a novel system of care to address Manifestations of Frailty in hospitalized older adults. Consensus study. A modified nominal group technique, incorporating expert group face-to-face interaction, review of existing evidence and pre/post-meeting questionnaire completion was undertaken November 2019-February 2020. Seventy-one risk factors, within seven risk factor domains (pain, medication, fluid and nutrition intake, mobility, elimination, infection, additional patient factors) were considered. It was agreed that 44 risk factors incorporating patient, organizational and environmental risk factors were modifiable and should be included in a novel system of care.

Correction of Potentially Modifiable Components of Metabolic Syndrome for the Primary Prevention of Atrial Fibrillation in Comorbid Patients with Premature Atrial Complexes

AIM: The study aimed to evaluate the influence of the correction of potentially modifiable risk factors for the development of atrial fibrillation (AF) as primary prevention of AF in patients with metabolic syndrome (MS) and premature atrial complexes (PAC).
 MATERIALS AND METHODS: We monitored 856 MS patients with PAC, aged 5872 (mean age, 66.4 0.7) years, in the north-western region of the Russian Federation. A 5-year risk of AF was calculated in all patients after the examination by determining the potential prognostic time range for Af development and its index of probable occurrence (RCHARGE-AF) using the CHARGE-AF model. The correction of potentially modifiable MS components and risk factors for AF development (smoking cessation, elimination of physical inactivity, etc.) until their target values were achieved was offered to all patients. The follow-up endpoint was the preservation of sinus rhythm or AF registration.
 RESULTS: All patients with MS were distributed into three groups. Group I consisted of 557 (65.07%) patients with incomplete correction of risk factors, and group II included 93 (10.86%) who achieved the target values of all potentially modifiable factors for AF development. The control group included the remaining patients without quantitative and qualitative changes in the dynamics AF predictors. No significant differences were found between the groups in terms of sex, age, concomitant diseases, and risk factors for AF. The achievement of the target values of the main MS components, including body mass index and/or waist circumference, correlated with the performance of regular aerobic exercises (odds ratio [OR] = 8.9), adherence to a diet (OR = 7.5), duration of MS diagnosis 20 years before the start of correction (OR = 12.8), and intake of a glucagon-like peptide-1 receptor agonist (Liraglutide) (OR = 5.4).
 In the control group, group I, and group II, AF development did not differ significantly and was registered in 192 (93.20%), 491 (88.15%), and 79 (84.95%) patients (p 0.05), respectively.
 CONCLUSIONS: In MS patients with PAC and a high 5-year risk of AF, the correction of potentially modifiable risk factors for AF development, as its primary prevention, is ineffective. The determination of the RCHARGE-AF index in MS patients with PAC in dynamics indicates the efficiency of the correction of potentially modifiable risk factors for AF development, but it does not determine the degree of the risk of its occurrence.
 The authors declare no conflict of interest.

DISTRIBUTION OF SPOT URINARY ELECTROLYTES AND THEIR PREDICTED 24 HOUR LEVELS BY ETHNICITY ASSOCIATIONS WITH MORTALITY IN A LONGITUDNAL COHORT

Objective: Hypertension is a modifiable risk factor for development of cardiovascular disease. Increased urinary sodium excretion, representing high dietary sodium intake is associated with hypertension. Observational cohort studies consistently demonstrate a low sodium intake is also associated with increased mortality. It is not known what the optimal amount of salt intake is good for cardiovascular health. Hypertension is a modifiable risk factor for development of cardiovascular disease. Increased urinary sodium excretion, representing high dietary sodium intake is associated with hypertension. Observational cohort studies consistently demonstrate a low sodium intake is also associated with increased mortality. It is not known what the optimal amount of salt intake is good for cardiovascular health. Design and method: Urine samples were obtained from 331 people [100 Afro-Caribbean (AC), 118 European and 113 Gujarati Indians] to estimate 24-hour sodium and potassium excretion. Association between estimated urinary sodium, potassium and creatinine excretion to composite outcome of major cardiovascular event and death were examined. We also aimed to study if ethnicity influenced this relationship. Results: We noted heterogeneity in association between sodium, potassium, creatinine excretion and mortality. Significantly higher, age-sex adjusted, spot urinary sodium (OR- 2.7; CI – 1.9–3.2) and creatinine (OR- 1.7; CI – 1.2–2.2) levels were seen in AC men who also had higher mean diastolic blood pressure (84 ± 5.5 vs 78 ± 3.3; p < 0.05). Overall, 42.9% (n = 142) of the cohort were hypertensive. Of the 331 eligible participants at baseline, a total 69 cardiovascular deaths were recorded. Spot sodium levels were higher in those who died from cardiovascular causes [(125.3; CI- 116.9, 133.7) mmol/l] vs [(108.7; CI - 99.4 – 118.0); p = 0.02]. Survival was associated with a urinary sodium below and urinary potassium above the median. There was no survival advantage associated with differences in creatinine output. Conclusions: This study estimates a sodium intake of between 2.0 g/day and 2.5 g/day as being associated with a lower risk of death and cardiovascular events. A higher potassium excretion was associated with a lower risk of death and cardiovascular events. Creatinine output made no difference to survival advantage.

Risk factors associated with retinopathy in young people with type 1 diabetes in Bangladesh.

ObjectivesDiabetic retinopathy (DR) is the most common microvascular complications seen in children and adolescents with type 1 diabetes. The aim of this study was to evaluate the prevalence of retinopathy and its association with other risk factors in young people with type 1 diabetes.MethodsThis study was a cross‐sectional study, which was done as part of the ongoing complication assessment in the paediatric diabetes clinic in BIRDEM (Bangladesh Institute of Research and Rehabilitation of Diabetes Endocrine and Metabolic Disorders), a tertiary care hospital. Children, adolescents and young adults with type 1 diabetes who were having diabetes duration >2 years were included in this study. Retinopathy was detected using fundal photography, and grading was done by National Screening Committee of UK by trained ophthalmologists.ResultsDiabetic retinopathy was observed in 44 (6.6%) patients. Majority (95.4%) of them had early diabetic retinopathy in the form of mild NPDR (nonproliferative diabetic retinopathy) (R1). Patients with retinopathy had higher HbA1c 9.6[8.4‐12.3] vs 9.1 [7.9‐10.8] (P = .013), longer duration of diabetes 7.6 [5.5‐10.7] vs 6.0 [4.5‐8.2] years (P = .001) and were older 21.5 [18.0‐23.0] vs 18 [16.0‐21.0] years (P = .0001) compared with those without retinopathy. On multivariate regression analysis, higher age and median HbA1c were significantly associated with DR.ConclusionsHigher HbA1c was the only modifiable risk factor for development of DR in our study population. Early detection of DR with improvement of glycaemic control may reduce the risk of progression of severe stages of the disease.

Family history (FH) of gastrointestinal (GI) cancer and behavioral risks: Analysis of an Internet-based risk assessment tool.

807 Background: Certain behaviors are known modifiable risk factors for development of GI cancers. The relationship between family history (FH) of GI cancers and individuals’ behaviors is not well understood, but is important for risk assessment/ counseling. Methods: The OncoLink “Reduce My Risk” tool is a publicly available online survey created in 2009 to provide customized information regarding cancer risk. Details of this survey have been reported; research is IRB-approved. Differences between those with v. without FH of GI cancers were analyzed using chi-square test. Results: 28,001 surveys were submitted. Median age was 26y (18-101), 60% female, 87% lived in North America, 76% White/Non-Hispanic, 64% reported FH of cancer. Individuals with FH of CRC reported eating less red meat (31% v. 34%, p = 0.007), processed grains (55% v. 59%, p < 0.001), or charred meats (14% v. 19%, p < 0.001), but were equally likely to be vegetarian (9% v. 10%, p = 0.059). Those with FH of esophageal cancer were more likely to have GERD (16% v. 9%), smoke > = 1 pack per day (7% vs. 4%) and drink alcohol (63% v. 55%) (p < 0.001 for all). Those with FH of gastric cancer were more likely to have H. Pylori or gastric ulcers (5% v. 3%, p < 0.001), but no difference in the consumption of smoked/salted foods (27% v. 25%, p = 0.20). Those with FH of HCC reported no differences in alcohol consumption (56% v. 55%, p = 0.41) or hepatitis B virus (HBV) vaccination (62% v. 62%, p = 0.66). Those with FH of anal cancer were more likely to have receptive anal intercourse (26% v. 16%, p < 0.001) but showed no differences in human papillomavirus (HPV) vaccination (21% v. 22%, p = 0.91). Those with FH of HCC (15% v. 13%, p = 0.035), gastric (16% v. 13%, p = 0.001), esophageal (17% v. 13%, p < 0.001), and anal (21% vs. 13%, p < 0.001) cancers were more likely to be smokers; those with a FH of CRC were less likely (11% v. 13%, p = 0.006), and those with FH of pancreatic (12% vs. 13%, p = 0.71) or cholangiocarcinoma (15% vs. 13%, p = 0.59) showed no difference. Conclusions: Many individuals with a FH of GI cancers engage in behavioral and other modifiable risk factors that increase risk for GI and other cancers. Future work should explore utility of targeted intervention and screening.

Interventions on Modifiable Risk Factors for the Development of Psoriatic Arthritis

Purpose of the review Prevention of the development of a disease is one of the most effective and desirable outcomes in medicine. Several modifiable risk factors for the development of psoriatic arthritis (PsA) have been studied. The following review will focus on modifiable risk factors for PsA development and the evidence on interventions that may have the potential to prevent PsA.

Determinants of frailty development and progression using a multidimensional frailty index: Evidence from the English Longitudinal Study of Ageing.

ObjectiveTo identify modifiable risk factors for development and progression of frailty in older adults living in England, as conceptualised by a multidimensional frailty index (FI).MethodsData from participants aged 50 and over from the English Longitudinal Study of Ageing (ELSA) was used to examine potential determinants of frailty, using a 56-item FI comprised of self-reported health conditions, disabilities, cognitive function, hearing, eyesight, depressive symptoms and ability to carry out activities of daily living. Cox proportional hazards regression models were used to measure frailty development (n = 7420) and linear regression models to measure frailty progression over 12 years follow-up (n = 8780).ResultsIncreasing age (HR: 1.08 (CI: 1.08–1.09)), being in the lowest wealth quintile (HR: 1.79 (CI: 1.54–2.08)), lack of educational qualifications (HR: 1.19 (CI: 1.09–1.30)), obesity (HR: 1.33 (CI: 1.18–1.50) and a high waist-hip ratio (HR: 1.25 (CI: 1.13–1.38)), being a current or previous smoker (HR: 1.29 (CI: 1.18–1.41)), pain (HR: 1.39 (CI: 1.34–1.45)), sedentary behaviour (HR: 2.17 (CI: 1.76–2.78) and lower body strength (HR: 1.07 (CI: 1.06–1.08)), were all significant risk factors for frailty progression and incidence after simultaneous adjustment for all examined factors.ConclusionThe findings of this study suggest that there may be scope to reduce both frailty incidence and progression by trialling interventions aimed at reducing obesity and sedentary behaviour, increasing intensity of physical activity, and improving success of smoking cessation tools. Furthermore, improving educational outcomes and reducing poverty may also reduce inequalities in frailty.

Cardiorespiratory fitness and long-term risk of sleep apnea: A national cohort study.

Sleep apnea is increasing in prevalence, and is an important cause of cardiometabolic diseases and mortality worldwide. Its only established modifiable risk factor is obesity; however, up to half of all sleep apnea cases may occur in non-obese persons, and hence there is a pressing need to identify other modifiable risk factors to facilitate more effective prevention. We sought to examine, for the first time, cardiorespiratory fitness in relation to the risk of sleep apnea, independent of obesity. A national cohort study was conducted to examine cardiorespiratory fitness in all 1,547,478 Swedish military conscripts during 1969-1997 (97%-98% of all 18-year-old men) in relation to risk of sleep apnea through 2012 (maximum age 62 years). Cardiorespiratory fitness was measured as maximal aerobic workload in Watts, and sleep apnea was identified from nationwide outpatient and inpatient diagnoses. A total of 44,612 (2.9%) men were diagnosed with sleep apnea in 43.7 million person-years of follow-up. Adjusting for age, height, weight, socioeconomic factors and family history of sleep apnea, low cardiorespiratory fitness at age 18 years was associated with a significantly increased risk of sleep apnea in adulthood (lowest versus highest cardiorespiratory fitness tertile: incidence rate ratio, 1.44; 95% confidence interval, 1.40-1.49; p < 0.001; continuous cardiorespiratory fitness per 100 Watts: incidence rate ratio, 0.71; 95% confidence interval, 0.70-0.73; p < 0.001). An increased risk was observed even among men with normal body mass index (lowest versus highest cardiorespiratory fitness tertile: incidence rate ratio, 1.30; 95% confidence interval, 1.26-1.35; p < 0.001). These findings identify low cardiorespiratory fitness early in life as a new modifiable risk factor for development of sleep apnea in adulthood.

Benzodiazepines and Development of Delirium in Critically Ill Children: Estimating the Causal Effect.

Benzodiazepine use may be associated with delirium in critically ill children. However, benzodiazepines remain the first-line sedative choice in PICUs. Objectives were to determine the temporal relationship between administration of benzodiazepines and delirium development, control for time-varying covariates such as mechanical ventilation and opiates, and evaluate the association between dosage of benzodiazepines and subsequent delirium. Retrospective observational study. Academic tertiary care PICU. All consecutive admissions from January 2015 to June 2015. Retrospective assessment of benzodiazepine exposure in a population that had been prospectively screened for delirium. All subjects were prospectively screened for delirium throughout their stay, using the Cornell Assessment for Pediatric Delirium, with daily cognitive status assigned as follows: delirium, coma, or normal. Multivariable mixed effects modeling determined predictors of delirium overall, followed by subgroup analysis to assess effect of benzodiazepines on subsequent development of delirium. Marginal structural modeling was used to create a pseudorandomized sample and control for time-dependent variables, obtaining an unbiased estimate of the relationship between benzodiazepines and next day delirium. The cumulative daily dosage of benzodiazepines was calculated to test for a dose-response relationship. Benzodiazepines were strongly associated with transition from normal cognitive status to delirium, more than quadrupling delirium rates (odds ratio, 4.4; CI, 1.7-11.1; p < 0.002). Marginal structural modeling demonstrated odds ratio 3.3 (CI, 1.4-7.8), after controlling for time-dependent confounding of cognitive status, mechanical ventilation, and opiates. With every one log increase in benzodiazepine dosage administered, there was a 43% increase in risk for delirium development. Benzodiazepines are an independent and modifiable risk factor for development of delirium in critically ill children, even after carefully controlling for time-dependent covariates, with a dose-response effect. This temporal relationship suggests causality between benzodiazepine exposure and pediatric delirium and supports limiting the use of benzodiazepines in critically ill children.

Anesthesia and analgesia for gynecological surgery.

High-quality analgesia has been linked to improved patient satisfaction as well as improved short-term and long-term postoperative outcomes. Acute surgical pain is a modifiable risk factor for development of chronic postoperative pain, which is reported by up to 26% of gynecologic surgical patients. In other surgical populations, multimodal analgesia has shown improved pain control and decreased reliance on opioids. This review examines recent evidence for various analgesic modalities applied specifically to the gynecologic surgical population. Nonopioid agents like acetaminophen, nonsteroidal anti-inflammatories, and gamma-aminobutyric acid analogs resulted in reduction in postoperative pain and opioid consumption. Application of regional anesthetic techniques had a favorable effect that persisted beyond the immediate recovery period. Preemptive analgesia remains unproven. The best evidence for effective combinations comes from ERAS studies that incorporated multimodal analgesia into a systemic approach geared towards early discharge. Multimodal analgesia had demonstrated advantages for all types of gynecological surgeries in terms of improving postoperative pain control and minimizing opioid-related adverse effects. Multimodal analgesia includes acetaminophen, NSAIDS, and gamma-aminobutyric acid analogs combined with intraoperative nonopioid analgesics such as ketamine, regional anesthesia or intrathecal morphine. Further research should focus on determining most effective combinations and doses of multimodal analgesia.

Lack of improvement in antimicrobial prescribing after a diagnosis of Clostridium difficile and impact on recurrence

Antimicrobial use is one of the largest modifiable risk factors for development of Clostridium difficile infection (CDI). We sought to determine if a recent diagnosis of CDI affected the appropriateness of subsequent antimicrobial prescribing. This study is a retrospective electronic chart review of the Greater Los Angeles Veterans Administration. Medication administration records were reviewed for all patients with new CDI from 2015-2016 to determine the appropriateness (drug choice, duration, and dosage) of all non-CDI antimicrobials prescribed within 90 days pre- and post-initial CDI (iCDI) positive testing. Of the 210 patients diagnosed with new-onset iCDI, 140 met inclusion criteria. Of antimicrobial courses prescribed, 40.6% of pre-iCDI were inappropriate compared with 43.1% of post-iCDI, demonstrating no difference in prescribing habits (P = .717). Thirty-three patients developed recurrent CDI (rCDI). After adjustment for other known risk factors, inappropriate antimicrobial use was associated with a significant increased risk of recurrence compared with appropriate use alone (odds ratio [OR], 6.19; 95% confidence interval [CI], 1.45-26.42). Antimicrobial use in general was associated with increased recurrence compared with no antimicrobial use post-iCDI (OR, 2.6; 95% CI, 1.16-5.84); however, after adjustment, it was no longer significant (OR, 2.13; 95% CI, 0.90-5.04). The appropriateness of antimicrobial prescribing was not affected by the diagnosis of recent CDI. Inappropriate antimicrobial use after iCDI was associated with higher risk of rCDI.

Optic nerve cupping and lamina cribrosa sclerae depth as a resultant of translaminar pressure difference

PurposeThe aim of the research was to evaluate correlation between translaminar pressure difference (TLPD) and optic nerve head (ONH) morphology parameters: lamina cribrosa sclerae depth (LCD) and optic nerve cupping (ONC).MethodsStudy included 42 eyes of 25 patients qualified to undergo lumbar puncture (LP) due to neurological circumstances. LCD, ONC and intraocular pressure (IOP) were measured 1–3 h prior to LP during ophthalmic examination. IOP was measured using Goldmann applanation tonometry. ONH morphology parameters: LCD and ONC were assessed using enhanced depth imaging optical coherence tomography (EDI‐OCT). CSFP was measured during lumbar puncture. TLPD was calculated as a difference between IOP (mmHg) and CSFP (mmHg).Results20 female eyes and 22 male eyes were included in the study. Mean age of female subjects was 44.1 ± 18.00 while the mean age of male subjects was 54.73 ± 13.57. LCD was revealed to be significantly deeper in male population (mean 365.83 μm vs. 296.07 μm). Statistical analysis revealed a strong positive correlation between LCD and TLPD (p &lt; 0.0001, R = 0.78) and between LCD and ONC (p &lt; 0.0001, R = 0.71).ConclusionsThere is a strong positive correlation between TLPD and ONH morphology parameters. LCD and ONC should therefore be viewed as a resultant of two pressure compartments: IOP and CSFP. Intraocular pressure is since many years a confirmed modifiable risk factor for development and progression of glaucomatous neuropathy. CSFP was also proved to be significantly lower among primary open angle glaucoma subjects. In future LCD and ONC as a resultant of TLPD could therefore play a role in assessing the risk of glaucomatous neuropathy progression. According to significant correlation between TLPD and ONH morphology parameters, combined LCD and IOP measurement could moreover play a role as a non‐invasive CSFP assessment tool.

A Study on The Prevalence And Risk Factors Associated with Peripheral Vascular Disease In Type2 Diabetes Mellitus

A Study on The Prevalence And Risk Factors Associated with Peripheral Vascular Disease In Type2 Diabetes Mellitus

Obesity-related endometrial cancer: an update on survivorship approaches to reducing cardiovascular death

As the rate of obesity increases worldwide, so will the number of women diagnosed with obesity-related malignancy. The strongest correlation between obesity and cancer is endometrial cancer (EC). Obesity is the most significant modifiable risk factor for development of EC and also contributes to the most common cause of death in EC survivors-cardiovascular disease (CVD). Most cancer survivors after diagnosis do not implement lifestyle changes aimed at weight-loss and CVD risk reduction. This selective review highlights recent novel and unique approaches for managing CVD co-morbidities in EC survivorship.

Independent risk factors for prolonged postoperative ileus development

BackgroundPostoperative ileus (POI) has a significant impact on patient wellbeing, and with a 15% incidence in colectomy patients costs US hospitals >$1.3 billion per year. Although some causative mechanisms have been identified, little is known about what places patients at risk for ileus. We aimed to identify factors that independently influence the development of POI. Materials and methodsPatients who underwent elective surgery between 2011 and 2012 were identified from the colectomy-specific American College of Surgeons National Surgical Quality Improvement Program database. Descriptive statistics were calculated, and demographics, comorbidities, preoperative treatments, and operative characteristics were evaluated as risk factors using multivariate analyses. ResultsA total of 9734 patients were included in this analysis; 1364 (14%) were found to have POI. Patients who developed an ileus were more likely to develop any postoperative complication, to be readmitted, and require reoperation compared with patients without POI. In addition, we identified 13 independent risk factors for POI. ConclusionsFive modifiable risk factors for development of POI were identified as follows: smoking, weight loss, preoperative oral antibiotics, mechanical bowel preparation, and surgical approach. These identifications provide insight into possible targets for preoperative modification, which may lead to improvements in patients' quality of life and influence outcomes such as postoperative complications, readmission, and reoperation.

Novel Risk Factors for Type 2 Diabetes in African-Americans.

In the USA, compared to whites, African-Americans are disproportionately impacted by the diabetes epidemic. Traditional diabetes risk factors, such as obesity, are more common among African-Americans, but these traditional risk factors do not explain all of the disparity in diabetes risk. Recent research has identified novel environmental, lifestyle, physiologic, and genetic risk factors for diabetes, some of which appear to impact African-Americans more than whites. This manuscript reviews the recent literature to highlight some of these novel risk factors that may be contributing to the racial disparity in diabetes risk. Further study is needed of the modifiable risk factors for development of interventions to reduce the risk of diabetes in African-Americans, as well as other high-risk populations.

Immunosuppression and Post-transplant Hyperglycemia.

Post-transplant diabetes mellitus is a significant risk factor for cardiovascular disease in solid organ transplantation. The main underlying pathophysiological mechanism of PTDM is pancreatic beta cell dysfunction in the context of insulin resistance, but the relative importance of each of these important components of glycemic metabolism is under intense debate. We searched MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials to January 15, 2015. We selected systematic reviews and meta-analyses and randomized clinical trials. When no such reports were found for a given topic or drug, observational studies were included in the assessment. There are agents with known diabetogenic effects: corticosteroids, calcineurin inhibitors including tacrolimus and cyclosporine, as well as the mammalian target of rapamycin inhibitors (sirolimus and everolimus). The association between the use of induction agents and PTDM is very scarce. No diabetogenic effects have been found with the use of azathioprine, mycophenolate mofetil and its derivatives. Immunosuppression is the major modifiable risk factor for development of PTDM but risk versus benefit analysis is required to balance risk of developing PTDM versus rejection. Caution is advisable in immunosuppressant adjustments in the event that PTDM develops based on current evidence. Physicians should choose and use immunosuppression regimens shown to have the best outcome for patient and graft survival, irrespective of PTDM risk.

Neuropsychiatric Symptoms Implicated in Conversion From MCI to Dementia

Back to table of contents Previous article Next article Clinical and Research NewsFull AccessNeuropsychiatric Symptoms Implicated in Conversion From MCI to DementiaMark MoranMark MoranSearch for more papers by this authorPublished Online:3 Apr 2015https://doi.org/10.1176/appi.pn.2015.3b9AbstractNeuropsychiatric symptoms may be etiologic for dementia through neuroendocrine axis activation, or they may interact synergistically with a biological factor; either of these suggests that treating neuropsychiatric symptoms might delay dementia onset.Neuropsychiatric symptoms in the presence of mild cognitive impairment (MCI), including depression, appear to significantly increase the risk of conversion to dementia—either amnestic or Alzheimer’s type dementia—according to a report published February 20 in AJP in Advance.Researchers at Johns Hopkins University School of Medicine and in the United Kingdom searched PubMed (from 1946) and Web of Knowledge (from 1900) through May 22, 2013 (updated June 5, 2014), using a variety of terms such as “mild cognitive,” “cognitive impairment,” and “age associated cognitive decline” included in longitudinal studies reporting potentially modifiable risk factors for incident dementia in people with MCI. There were 76 eligible articles reporting epidemiologic and clinical studies.A principal finding from the study was that diabetes, prediabetes, metabolic syndrome, and low serum folate levels increased risk of conversion from amnestic MCI to Alzheimer’s dementia and from any type or nonamnestic MCI to all-cause dementia. But the researchers also found that the presence of neuropsychiatric symptoms predicted conversion to all-cause dementia. Among the findings are the following:There is evidence that more depressive symptoms predict conversion from any-type MCI to all-cause dementia from epidemiologic studies, but the evidence is inconsistent in clinical studies; it is also inconsistent as to whether depressive symptoms predict conversion from amnestic MCI to Alzheimer’s dementia or to any-cause dementia. There is evidence from clinical studies that the presence of neuropsychiatric symptoms in people with any-type MCI, but not their overall levels of symptoms, predicts conversion to all-cause dementia. There is inconsistent evidence about whether anxiety symptoms are associated with conversion from amnestic MCI to Alzheimer’s dementia and about whether apathy predicts the risk of conversion from amnestic MCI to Alzheimer’s dementia or from any-type MCI to dementia.“A third to three-quarters of people with MCI have neuropsychiatric symptoms, most commonly depression, anxiety, apathy, and irritability,” the researchers stated. “Neuropsychiatric symptoms predicted conversion from any-type MCI to all-cause dementia. Neuropsychiatric symptoms may be etiologic for dementia, for example through neuroendocrine axis activation, or they may interact synergistically with a biological factor, such as genetic predisposition. Either of these putative relationships suggests that treating neuropsychiatric symptoms could theoretically delay dementia.” Dilip Jeste, M.D., said that between 35 percent and 45 percent of people with mild cognitive impairment develop dementia within three years and that the financial costs of dementia exceed those of heart disease and cancer.Dilip Jeste, M.D.Dilip Jeste, M.D., a past APA president and a professor of psychiatry and neurosciences and the Estelle and Edgar Levi Chair in Aging at the University of California, San Diego, said that the costs associated with dementia make identification of risk factors a valuable public-health task. “This is an important paper based on a careful meta-analysis of 76 published articles reporting longitudinal studies on potentially modifiable risk factors for development of dementia in persons with mild cognitive impairment, or MCI,” he told Psychiatric News. “In DSM-5, dementia and MCI are labeled major and minor neurocognitive disorders, respectively. In general, between 35 percent and 45 percent of people with MCI develop dementia within three years. The total financial cost of dementia exceeds that of heart disease and cancer. Therefore, identifying and controlling risk factors for developing dementia among older adults with MCI is of clear public-health significance.“These authors report that diabetes, pre-diabetes, metabolic syndrome, neuropsychiatric symptoms including depression, and lower serum folate levels were associated with variably increased risk of dementia, whereas the Mediterranean diet seemed to reduce the risk of developing dementia in patients with MCI,” Jeste added. “These findings suggest that control and prevention of diabetes, treatment of depressive and other neuropsychiatric symptoms, and use of a Mediterranean diet and of folate supplements may be helpful in lowering the risk of dementia in persons with MCI. A word of caution in interpreting the present results is that they are not based on large, randomized, controlled trials in individuals with MCI. Associations do not necessarily indicate causality or even directionality. Nonetheless, the recommendations should be helpful in at least some people and are consistent with good clinical practice.” ■“Modifiable Predictors of Dementia in Mild Cognitive Impairment: A Systematic Review and Meta-Analysis” can be accessed here. ISSUES NewArchived