Recurrent Clostridioides difficile Infection and Outcome of Fecal Microbiota Transplantation Use: A Population-Based Assessment.

Background: Fecal microbiota transplantation (FMT) is recommended for the treatment of recurrent Clostridioides difficile infection (rCDI). In the current study, we evaluated rates of rCDI and subsequent FMT in a large metropolitan area. We compared demographic and clinical differences in FMT recipients and nonrecipients and quantified differences in outcomes based on treatment modality. Methods: A retrospective community-wide cohort study was conducted using surveillance data from the Georgia Emerging Infections Program, the Georgia Discharge Data System, and locally maintained lists of FMTs completed across multiple institutions to evaluate all episodes of C. difficile infection (CDI) in this region between 2016 and 2019. Cases were limited to patients with rCDI and ≥1 documented hospitalization. A propensity-matched cohort was created to compare rates of recurrence and mortality among matched patients based on FMT receipt. Results: A total of 3038 (22%) of 13 852 patients with CDI had rCDI during this period. In a propensity-matched cohort, patients who received an FMT had lower rates of rCDI (odds ratio, 0.6 [95% confidence interval, .38-.96) and a lower mortality rate (0.26 [.08-.82]). Of patients with rCDI, only 6% had received FMT. Recipients were more likely to be young, white, and female and less likely to have renal disease, diabetes, or liver disease, though these chronic illnesses were associated with higher rates of rCDI. Conclusions: These data suggest FMT has been underused in a population-based assessment and that FMT substantially reduced risk of recurrence and death.

Food Acquisition Practices, Body Mass Index, and Dietary Outcomes by Level of Rurality.

PURPOSE: Rural residents are more likely to be obese than urban residents. Research on how people navigate their local food environments through food acquisition behaviors, such as food shopping and restaurant use, in different types of communities may help to create a deeper understanding of the multilevel determinants of obesity. METHODS: Data are from a national sample of US adults ages 18-75. Respondents were recruited from an online survey panel in 2015 and asked about food shopping, restaurant use, diet and weight (N = 3,883). Comparisons were made by level of rurality as assessed by Rural-Urban Continuum Codes (RUCC) and self-reported rurality of the area around their home. FINDINGS: Food acquisition behaviors varied minimally by RUCC-defined level of rurality, with the exceptions of type and distance to primary food store. Rural residents drove further and were more likely to shop at small grocery stores and supercenters than were residents of semiurban or urban counties. In contrast, all of the food acquisition behaviors varied by self-reported rurality of residential areas. Respondents living in rural areas shopped for groceries less frequently, drove further, more commonly shopped at small grocery stores and supercenters, and used restaurants less frequently. In multivariable analyses, rural, small town, and suburban areas were each significantly associated with BMI and fruit and vegetable intake, but not percent energy from fat. CONCLUSION: Findings show that self-reported rurality of residential area is associated with food acquisition behaviors and may partly explain rural-urban differences in obesity and diet quality.

Home gardening and associations with fruit and vegetable intake and BMI.

OBJECTIVE: To understand who engages in home gardening and whether gardening is associated with fruit and vegetable intake and weight status. DESIGN: A national cross-sectional survey. SETTING: Online survey panel in the USA. PARTICIPANTS: Adults aged 18-75 years representing the US population with respect to gender, age, race/ethnicity, income and geographic region (n 3889). RESULTS: Approximately 30 % of survey respondents reported growing edible plants in a home garden. Gardeners were more likely to be White or Asian, employed, have higher income, be married, have children in the household and live in rural areas. Gardeners were less likely to be obese and more likely to meet US dietary recommendations for fruit and vegetable consumption. In multivariable analyses, home gardens remained associated with fruit and vegetable intake and BMI when controlling for a range of socio-demographic characteristics and level of rurality. CONCLUSIONS: The current study identifies who is gardening in the USA and provides useful information for public health efforts to increase gardening as a nutrition intervention. Future research should examine the benefits of home gardening and interventions to increase home gardening using more rigorous designs.

Association of metabolic syndrome and patatin-like phospholipase 3 - rs738409 gene variant in non-alcoholic fatty liver disease among a Chennai-based south Indian population.

BACKGROUND: Non-alcoholic fatty liver disease (NAFLD) is commonly diagnosed in patients presenting with metabolic syndrome (MetS) and has been associated with single nucleotide polymorphisms of rs738409 in the patatin-like phospholipase domain containing 3 (PNPLA3) gene. This association remains to be investigated in the South Indian population. We aimed to determine the association of the PNPLA3 rs738409 gene polymorphism with MetS and NAFLD among a Chennai-based population. METHODS: The study comprised 105 NAFLD cases and 102 controls. All subjects were genotyped for the PNPLA3 rs738409 variant and MetS was defined according to the National Cholesterol Education Program - Adult Treatment Panel III criteria. Our case-control study showed the association of the variant with NAFLD and MetS. RESULTS: The PNPLA3 rs738409 variant was associated with NAFLD and the genotype frequencies (CC/CG/GG) were 19 (18.1%), 50 (47.6%) and 36 (34.3%) in the NAFLD group and 59 (57.8%), 29 (28.4%) and 14 (13.7%) in the control group respectively. We also confirmed the interaction between the PNPLA3 rs738409 polymorphism and MetS with respect tto elevated triglyceride levels. However, an association with elevated waist circumference, fasting glucose, blood pressure and decreased high-density lipoprotein cholesterol was not observed in the present study. CONCLUSIONS: The PNPLA3 rs738409 gene polymorphism increases the risk of NAFLD by up to four-fold in subjects with an elevated level of triglyceride independent of other features of MetS.