The effect of autoimmune skin disorders on post-operative outcomes following arthroplasty.

INTRODUCTION: The impact of autoimmune skin disorders on post-operative outcomes after TJA is conflicting and studies are limited by small sample sizes. The purpose of this study is to analyze a range of common autoimmune skin disorders and identify whether an increased risk of post-operative complication exists after total joint arthroplasty. METHODS: Data was collected from NIS database for patients diagnosed with autoimmune skin disorder (psoriasis, lupus, scleroderma, atopic dermatitis) and who underwent total hip arthroplasty (THA), total knee arthroplasty (TKA), or other TJA (shoulder elbow, wrist, ankle) between 2016 and 2019. Demographic, social, and comorbidity data was collected. Multivariate regression analyses were performed to assess the independent influence of autoimmune skin disorder on each post-operative outcome including implant infection, transfusion, revision, length of stay, cost, and mortality. RESULTS: Among 55,755 patients with autoimmune skin disease who underwent TJA, psoriasis was associated with increased risk of periprosthetic joint infection following THA (odds ratio 2.44 [1.89-3.15]) and increased risk of transfusion following TKA (odds ratio 1.33 [1.076-1.64]). Similar analyses were performed for systemic lupus erythematosus, atopic dermatitis, and scleroderma, however no statistically significant associations were observed in any of the six collected post-operative outcomes. CONCLUSION: This study suggests psoriasis is an independent risk factor for poorer post-operative outcomes following total joint arthroplasty, however similar risk was not observed for other autoimmune skin disorders such as lupus, atopic dermatitis, or scleroderma.

Validation of a Dietary Screening Tool in a Middle-Aged Appalachian Population.

Proactive nutrition screening is an effective public health strategy for identifying and targeting individuals who could benefit from making dietary improvements for primary and secondary prevention of disease. The Dietary Screening Tool (DST) was developed and validated to assess nutritional risk among rural older adults. The purpose of this study was to evaluate the utility and validity of the DST to identify nutritional risk in middle-aged adults. This cross-sectional study in middle-aged adults (45-64 year olds, n = 87) who reside in Appalachia, examined nutritional status using an online health survey, biochemical measures, anthropometry, and three representative 24-h dietary recalls. The Healthy Eating Index (HEI) was calculated to describe overall diet quality. Adults identified by the DST with a nutrition risk had lower HEI scores (50 vs. 64, p < 0.001) and were much more likely to also be considered at dietary risk by the HEI (OR 11.6; 3.2-42.6) when compared to those not at risk. Those at risk had higher energy-adjusted total fat, saturated fat, and added sugar intakes and lower intakes of dietary fiber, and several micronutrients than those classified as not at risk by the DST. Similarly, the at-risk group had significantly lower serum levels of α-carotene, ß-carotene, cryptoxanthin, lutein, and zeaxanthin but did not differ in retinol or methylmalonic acid compared with those not at risk. The DST is a valid tool to identify middle-aged adults with nutritional risk.

Poor Dietary Guidelines Compliance among Low-Income Women Eligible for Supplemental Nutrition Assistance Program-Education (SNAP-Ed).

The Supplemental Nutrition Assistance Program-Education (SNAP-Ed) program aims to improve nutritional intakes of low-income individuals (<185% poverty threshold). The objective of this study was to describe the compliance with Dietary Guidelines for Americans (DGA) recommendations for fruits, vegetables, and whole grains among SNAP-Ed eligible (n = 3142) and ineligible (n = 3168) adult women (19-70 years) nationwide and SNAP-Ed participating women in Indiana (n = 2623), using the NHANES 2007-2012 and Indiana SNAP-Ed survey data, respectively. Sensitivity analysis further stratified women by race/ethnicity and by current SNAP participation (<130% poverty threshold). Nationally, lower-income women were less likely to meet the fruit (21% vs. 25%) and vegetable (11% vs. 19%) guidelines than higher-income women, but did not differ on whole grains, which were ~5% regardless of income. The income differences in fruit and vegetable intakes were driven by non-Hispanic whites. Fewer SNAP-Ed-eligible U.S. women met fruit (21% vs. 55%) and whole grain (4% vs. 18%) but did not differ for vegetable recommendations (11% vs. 9%) when compared to Indiana SNAP-Ed women. This same trend was observed among current SNAP participants. Different racial/ethnic group relationships with DGA compliance were found in Indiana compared to the nation. Nevertheless, most low-income women in the U.S. are at risk of not meeting DGA recommendations for fruits (79%), vegetables (89%), and whole grains (96%); SNAP-Ed participants in Indiana had higher compliance with DGA recommendations. Increased consumption of these three critical food groups would improve nutrient density, likely reduce calorie consumption by replacing high calorie choices, and improve fiber intakes.

Discrepancy between Knowledge and Perceptions of Dietary Omega-3 Fatty Acid Intake Compared with the Omega-3 Index.

Little is known about the relationship between perceptions of nutrient adequacy and biomarkers of nutrition status. This cross-sectional study of U.S. and German adults (n = 200; 18-80 years) compared dietary practices, knowledge, and beliefs of omega-3 fatty acids (O3-FA) with the omega-3 index (O3-I), an erythrocyte-based biomarker associated with cardiovascular disease (CVD) risk. More than half of adults believed that O3-FAs are beneficial for heart and brain health and could correctly identify the food sources of O3-FA. However, the mean O3-I in the U.S. (4.3%) and Germany (5.5%) puts the majority of adults sampled (99%) in intermediate or high CVD-risk categories. More Americans were considered at high CVD-risk (40%) when compared with Germans (10%). In the U.S., but not Germany, women had a significantly higher O3-I than men (4.8% vs. 3.8%, p < 0.001). In the intermediate CVD-risk group, about one-third of adults in both countries (30% in the U.S. and 27% in Germany) believed their diet was adequate in O3-FA. Notably, mean O3-I concentrations did not significantly differ with dietary perceptions of adequacy. More adults in Germany (26%) than in the U.S. (10%) believed that dietary supplements are needed to achieve a balanced diet. In spite of adequate knowledge about food sources and a consistent belief that O3-FA are important for health, very few participants had O3-I concentrations in the range for CVD protection.

Total Usual Intake of Shortfall Nutrients Varies With Poverty Among US Adults.

OBJECTIVE: To examine shortfall nutrient intakes (ie, calcium, folate, potassium, magnesium, and vitamins A, C, D, and E) by poverty-to-income ratio (PIR). DESIGN: National Health and Nutrition Examination Survey 2011-2012, a nationally representative, cross-sectional survey. PARTICIPANTS: US adults with complete data on poverty status and diet were included (n = 4,524). ANALYSIS: The National Cancer Institute method was used to estimate total usual micronutrient intakes from foods, beverages, medications, and dietary supplements reported on 2 24-hour dietary recalls using measurement error correction. MAIN OUTCOME MEASURES: Calcium, folate, potassium, magnesium, and vitamins A, C, D, and E across 3 PIR categories: <130%, 130% to 350%, and ≥350%. RESULTS: Mean intakes of folate, vitamin C, and vitamin D were significantly greater in men, and magnesium in women, across all PIR categories. Except for calcium in men and vitamin C in women, the highest PIR category had significantly higher mean total usual intakes of all remaining shortfall micronutrients. Importantly, men and women in the highest PIR category (≥350%) were significantly less likely to have intakes below the Estimated Average Requirement across all micronutrients compared with those in the lower PIR categories. CONCLUSIONS AND IMPLICATIONS: Even with dietary supplements, large proportions of US adults have micronutrient intakes below the Estimated Average Requirement. Adults at the highest adjusted income have higher micronutrient intakes and lower risk of inadequacy than those with lower incomes.

Correspondence of folate dietary intake and biomarker data.

Background: Public health concerns with regard to both low and high folate status exist in the United States. Recent publications have questioned the utility of self-reported dietary intake data in research and monitoring.Objectives: The purpose of this analysis was to examine the relation between self-reported folate intakes and folate status biomarkers and to evaluate their usefulness for several types of applications.Design: We examined usual dietary intakes of folate by using the National Cancer Institute method to adjust two 24-h dietary recalls (including dietary supplements) for within-person variation and then compared these intakes with serum and red blood cell (RBC) folate among 4878 men and nonpregnant, nonlactating women aged ≥19 y in NHANES 2011-2012, a nationally representative, cross-sectional survey, with respect to consistency across prevalence estimates and rank order comparisons.Results: There was a very low prevalence (<1%) of folate deficiency when serum (<7 nmol/L) and RBC (<305 nmol/L) folate were considered, whereas a higher proportion of the population reported inadequate total dietary folate intakes (6%). Similar patterns of change occurred between intakes and biomarkers of folate status when distributions were examined (i.e., dose response), particularly when diet was expressed in µg. Intakes greater than the Tolerable Upper Intake Level greatly increased the odds of having high serum folate (OR: 17.6; 95% CI: 5.5, 56.0).Conclusions: When assessing folate status in the United States, where fortification and supplement use are common, similar patterns in the distributions of diet and biomarkers suggest that these 2 types of status indicators reflect the same underlying folate status; however, the higher prevalence estimates for inadequate intakes compared with biomarkers suggest, among other factors, a systematic underestimation bias in intake data. Caution is needed in the use of dietary folate data to estimate the prevalence of inadequacy among population groups. The use of dietary data for rank order comparisons or to estimate the potential for dietary excess is likely more reliable.

The Nutritional Status of HIV-Infected US Adults.

Background: Nutrition is critical to HIV mortality and morbidity. Improved treatment modalities have increased life expectancy of HIV-infected individuals. More than 1 million US adults are living with HIV, but little is known about their nutritional status. Objective: We aimed to characterize the nutritional status of those living with HIV with the use of the NHANES 2003-2014. Methods: The NHANES is a nationally representative, cross-sectional survey of the US population and includes a household interview, medical examination, and two 24-h dietary recalls; survey weights are applied to make the data nationally representative. HIV antibodies were ascertained initially by immunoassay and confirmed with Western blot. NHANES 2003-2014 data were analyzed for HIV-positive (n = 87) and HIV-negative (n = 15,868) US adults (aged 19-49 y). Body mass index (BMI), waist circumference, dietary intakes, and nutritional biomarkers were estimated and compared by HIV status, stratified by sex. Results: HIV-infected men and women had higher serum protein, lower serum albumin, and lower serum folate than did non-HIV-infected adults. HIV-positive women had significantly higher BMI, prevalence of overweight or obesity, and waist circumference risk and substantially lower serum 25-hydroxyvitamin D concentrations (44 compared with 65 nmol/L) than did HIV-negative women. When compared with HIV-negative women, HIV-positive women had lower intakes of some key nutrients such as fiber, vitamin E, vitamin K, magnesium, and potassium but had higher intakes of protein and niacin. Conclusions: The NHANES data suggest that HIV infection is associated with poorer markers of some nutritional status indicators; however, the US population prevalence of HIV is <0.5%. Given the small sample size, not only in this study but also in the United States, much more targeted research is needed to better understand the multitude of factors that influence the nutritional status among those living with HIV in the United States, especially among women.

Racecadotril in the Management of Rotavirus and Non-rotavirus Diarrhea in Under-five Children: Two Randomized, Double-blind, Placebo-controlled Trials.

OBJECTIVE: To study the effect of racecadotril on reduction in the duration of acute rotavirus and non-rotavirus diarrhea. DESIGN: Two randomized double-blind placebo-controlled trials. SETTING: Community-based trial in an urban area in Vellore, hospital-based trial at a secondary hospital in Vellore. PARTICIPANTS: 199 and 130 3-59 month old children in the community- and hospital-based trials, respectively. METHODS: Racecadotril (1.5 mg/kg/dose, thrice a day for three days) or placebo were given to manage acute diarrhea in both trials. MAIN OUTCOME MEASURE: Median duration of diarrhea. RESULTS: Among 124 children completing the hospital trial, the median duration of diarrhea was 25 h in both arms (P=0.5); median total stool weight was 74 g/kg and 53.5 g/kg in racecadotril group and placebo group, respectively (P=0.4); and average fluid intake per day was 3.6 mL/kg/h and 3mL/kg/h in racecadotril and placebo arms, respectively (P=0.3). Among rotavirus-positive children, median duration of diarrhea was 26.9 h and 30.2 h in racecadotril and placebo arms, respectively (P=0.7). In the community, 196 completed the trial, the median duration of diarrhea was 2 days for both arms (P=0.8) and rotavirus positive children had similar outcomes with median diarrheal duration of 3 d in both arms (P=0.4). CONCLUSIONS: Treatment with racecadotril did not reduce diarrheal duration, stool volume or the requirement for fluid replacement in children with acute gastroenteritis, both with and without rotavirus infection.

Nutrition in Cardioskeletal Health.

Bone and heart health are linked through a variety of cellular, endocrine, and metabolic mechanisms, including the bidirectional effects of mineral-regulating hormones parathyroid hormone and fibroblast growth factor 23. Nutrition plays an important role in the development of both cardiovascular and bone disease. This review describes current knowledge on the relations between the cardiovascular system and bone and the influence of key nutrients involved in mineral metabolism-calcium, vitamin D, and phosphorus-on heart and bone health, as well as the racial/ethnic differences in cardiovascular disease and osteoporosis and the influence that nutrition has on these disparities.

Toxicity and clinical outcomes in patients with HIV on zidovudine and tenofovir based regimens: a retrospective cohort study.

BACKGROUND: Adverse drug reactions are a major concern with zidovudine/stavudine treatment regimens. The less toxic tenofovir regimen is an alternative, but is seldom considered due to the higher costs. This study compared adverse drug reactions and other clinical outcomes resulting from the use of these two treatment regimens in India. METHODS: Baseline, clinical characteristics and follow-up outcomes were collected by chart reviews of HIV-positive adults and compared using univariate/multivariate analysis, with and without propensity score adjustments. RESULTS: Data were collected from 129 and 92 patients on zidovudine (with lamivudine and nevirapine) and tenofovir (with emtricitabine and efavirenz) regimens, respectively. Compared to patients receiving the zidovudine regimen, patients receiving the tenofovir regimen had fewer adverse drug reactions (47%, 61/129 vs 11%, 10/92; p<0.01), requiring fewer regimen changes (36%, 47/129 vs 3%, 3/92; p0.01). With the propensity score, the zidovudine regimen had 8 times more adverse drug reactions (p<0.01). Opportunistic infections were similar between regimens without propensity score, while the zidovudine regimen had 1.2 times (p=0.63) more opportunistic infections with propensity score. Patients on the tenofovir regimen gained more weight. Increase in CD4 levels and treatment adherence (>95%) was similar across regimens. CONCLUSIONS: Patients on a tenofovir regimen have better clinical outcomes and improved general health than patients on the zidovudine regimen.

Estimating Sodium and Potassium Intakes and Their Ratio in the American Diet: Data from the 2011-2012 NHANES.

BACKGROUND: The dietary sodium-to-potassium ratio (Na:K) is shown to be more strongly associated with an increased risk of cardiovascular disease (CVD) and CVD-related mortality than either sodium or potassium intake alone. OBJECTIVE: The aim was to estimate the Na:K in the diet of US adults. METHODS: Among US adults from the 2011-2012 NHANES (≥20 y; 2393 men and 2337 women), the National Cancer Institute method was used to estimate sodium and potassium intakes, Na:K, and the percentage of individuals with Na:K <1.0 utilizing the complex, stratified, multistage probability cluster sampling design. RESULTS: Overall, women had a significantly lower Na:K than men (mean ± SE: 1.32 ± 0.02 compared with 1.45 ± 0.02). Non-Hispanic whites had a significantly lower Na:K than non-Hispanic blacks and non-Hispanic Asians (1.34 ± 0.02 compared with 1.54 ± 0.03 and 1.49 ± 0.04, respectively). Only 12.2% ± 1.5% of US adults had a Na:K < 1.0. The Na:K decreased linearly as age increased. Most adults (90% ± 0.8%) had sodium intakes >2300 mg/d, whereas <3% had potassium intakes >4700 mg/d. Grains and vegetables were among the highest contributors to sodium intakes for adults with Na:K < 1.0, compared with protein foods and grains for those with Na:K ≥ 1.0. Vegetables and milk and dairy products constituted the primary dietary sources of potassium for individuals with Na:K < 1.0, whereas mixed dishes and protein foods contributed the most potassium for individuals with ratios ≥1.0. Individuals with a Na:K < 1.0 were less likely to consume mixed dishes and condiments and were more likely to consume vegetables, milk and dairy products, and fruit than those with a Na:K ≥ 1.0. CONCLUSION: Only about one-tenth of US adults have a Na:K consistent with the WHO guidelines for reduced risk of mortality. Continued efforts to reduce sodium intake in tandem with novel strategies to increase potassium intake are warranted.

Cost estimation of first-line antiretroviral therapy with zidovudine/stavudine as the nucleoside backbone in India: a pilot study.

BACKGROUND: In India, a zidovudine-based regimen is preferred as the first-line drug treatment for HIV, despite high rates of drug toxicity. This study estimates the treatment costs for HIV. METHODS: Eligible patients were enrolled from Antiretroviral Therapy Center, Christian Medical College, India. Baseline demographic and clinical characteristics, medical and nonmedical expenditure, and lost income were collected. RESULTS: Of 41 patients enrolled and followed for 6 months, HIV treatment toxicity and opportunistic infections were reported by 12 (29%) and 13 (31.7%) patients, respectively. The median total costs, direct costs, and out-of-pocket expenditure were Indian rupees (INR) 9418 (US$181), 8727 (US$168), and 7157 (US$138), respectively. Diagnostic tests accounted for 58% of the expenses. HIV treatment accounted for 34% of the median income earned INR 21 000 (US$404). Expenditure for treatment with toxicity was 44% higher than without toxicity. CONCLUSION: Current treatment is associated with toxicity, increasing treatment costs and imposing a significant economic burden.