Association of morning fasting blood glucose variability with insulin antibodies and clinical factors in type 1 diabetes.

The fasting blood glucose concentration in type 1 diabetes may vary without being much affected by diet and exercise. This study aimed to identify association of morning fasting blood glucose concentration variability with insulin antibodies and clinical factors. The subjects in this study were 54 patients with type 1 diabetes who had high variation of fasting blood glucose. The insulin antibody level was measured, and correlations of glycemic variability with antibody levels, binding rates, and other clinical factors were investigated. The standard deviation (SD) of the 30-day morning self-monitored fasting blood glucose concentration (FBG SD) was evaluated as an index of glycemic variability. The mean glucose level was 159.8±42.1 mg/dL and the FBG SD was 47.5±22.0 mg/dL. Glycemic variability (FBG SD) was positively correlated with insulin antibody level, but not with insulin antibody binding rate, and had a negative correlation with C-peptide immunoreactivity/plasma glucose (CPR/PG) and positive correlations with diabetes duration, basal insulin dose and bolus insulin dose. Glycemic variability was not correlated with BMI, HbA1c or age. In multiple regression analysis of glycemic variability, CPR/PG was the only significant related factor. The results showed that glycemic variability was mainly influenced by endogenous insulin secretion capacity and was high in patients with high insulin antibody levels. In some patients with a high insulin antibody titer, the antibody may have an effect on the variability of the fasting glucose concentration in type 1 diabetes.

Possible sarcopenia and its association with hospital-associated dysphagia and decline in physical function: Findings from a heart failure patients prospective cohort study.

BACKGROUND & AIMS: There is limited evidence regarding the association of sarcopenia with dysphagia and physical function in patients with heart failure. This study examined the association between possible sarcopenia and both swallowing and physical function in individuals with acute heart failure (AHF). METHODS: This prospective cohort study included hospitalized patients with AHF. Possible sarcopenia was assessed on admission using calf circumference and grip strength according to an international diagnostic criteria. The primary outcome was dysphagia at discharge using the Food Intake Level Scale (FILS), and the secondary outcome was physical function at discharge using the Barthel Index (BI). Multiple regression analysis and logistic regression, adjusted for potential confounders, were used to examine the association between possible sarcopenia at admission and FILS and BI at discharge. RESULTS: A total of 320 patients (mean age 81.5 years; 170 women) were included in the analysis; 199 (59.4%) were diagnosed with possible sarcopenia. Multivariate analysis showed that possible sarcopenia at admission was significantly associated with FILS at discharge (ß = -0.1204; p = 0.039). Possible sarcopenia at admission was not significantly associated with BI at discharge (OR = 2.066; 95% CI, 0.910-4.692, p = 0.083). CONCLUSIONS: Possible sarcopenia was associated with decline in swallowing function during hospitalization in patients with AHF. These findings highlight the need for early detection and treatment of possible sarcopenia in this setting.

Association of resting energy expenditure-based energy intake sufficiency with functional recovery, dysphagia, and 1-year mortality following heart failure: A prospective observational study.

AIM: Evidence for the influence of resting energy expenditure (REE)-based energy intake on the outcomes of patients with heart failure (HF) is scarce. This study evaluates the relationship between REE-based energy intake sufficiency and clinical outcomes in hospitalized HF patients. METHODS: This prospective observational study included newly admitted patients with acute HF. REE was measured using indirect calorimetry at baseline and total energy consumption (TEE) was calculated by multiplying REE with activity index. Energy intake (EI) was recorded, and the patients were classified into two groups, namely, the energy intake sufficiency (i.e., EI/TEE ≥1) and energy intake deficiency groups (i.e., EI/TEE <1). The primary outcome was the performance of activities of daily living, assessed using the Barthel Index, at discharge. Other outcomes included dysphagia at discharge and all-cause 1-year mortality following discharge. Dysphagia was defined as a Food Intake Level Scale (FILS) score of <7. Multivariable analyses and Kaplan-Meier estimates were used to determine the association of energy sufficiency both at baseline and at discharge with the outcomes of interest. RESULTS: The analysis included 152 patients (mean age, 79.7 years; 51.3% women); of them, 40.1% and 42.8% had inadequate energy intake both at baseline and at discharge, respectively. In multivariable analyses, energy intake sufficiency at discharge was significantly associated with the BI (ß = 0.136, p = 0.002) and FILS score (odds ratio = 0.027, p < 0.001) at discharge. Moreover, energy intake sufficiency at discharge was associated with 1-year mortality after discharge (p < 0.001). CONCLUSION: Adequate energy intake during hospitalization was associated with improved physical and swallowing functions and 1-year survival in HF patients. Adequate nutritional management is essential for hospitalized HF patients, suggesting that adequate energy intake may lead to optimal outcomes.

Association of poor oral health with increased incidence of dysphagia and impaired improvement in nutritional status among patients with acute heart failure: a prospective cohort study.

AIMS: This study aimed to clarify the association between oral health and the incidence of dysphagia as well as the recovery of nutritional status and improvement of dysphagia in hospitalized patients with acute heart failure. METHODS: Hospitalized patients with AHF were prospectively enrolled. Oral health was evaluated using the Japanese Version of the Oral Health Assessment Tool (OHAT-J) after circulation dynamics improved (defined as baseline), and participants were classified into good and poor oral health groups (OHAT-J 0-2 and ≧ 3, respectively). The primary outcome measure was the incidence of dysphagia evaluated using the Food Intake Level Scale (FILS) at baseline. Secondary outcome measures were nutritional status and FILS score at discharge. Nutritional status was assessed using the Mini Nutritional Assessment Short Form (MNA-SF). Univariate and multivariate logistic regression analyses were used to determine the association between oral health and the study outcomes. RESULTS: Of the 203 recruited patients (mean age, 79.5 years; 50.7% female), 83 (40.9%) were in the poor oral health group. Participants with poor oral health were significantly older, had lower skeletal muscle mass and strength, lower nutrient intake and nutritional status, worse swallowing status, as well as lower cognitive level, and physical function than those with good oral health. In multivariate logistic regression analyses, baseline poor oral health was significantly associated with the incidence of dysphagia (odds ratio = 1.036, P = 0.020), as well as with the improvement in nutritional status (odds ratio = 0.389, P = 0.046) and dysphagia (odds ratio = 0.199, P = 0.026) at discharge. CONCLUSIONS: Poor baseline oral health was associated with the incidence of dysphagia, as well as with the lack of improvement in nutritional status and dysphagia in patients with acute heart failure.

Role of systemic inflammation in functional recovery, dysphagia, and 1-y mortality in heart failure: A prospective cohort study.

OBJECTIVES: This study evaluated the relationship between systemic inflammation and clinical outcomes in people hospitalized with acute heart failure (AHF). METHODS: We prospectively enrolled people newly hospitalized with AHF after excluding those with concomitant infectious or inflammatory diseases. Systemic inflammation was evaluated using the modified Glasgow Prognostic Score (mGPS) at hospitalization, and participants were classified into low-grade and high-grade inflammation groups (mGPS 0-1 and 2, respectively). The primary outcome measure was functional recovery, evaluated using the Barthel Index gain. Secondary outcome measures were dysphagia at discharge and all-cause 1-y mortality after discharge. Multivariable analyses and Kaplan-Meier estimates were used to determine the association between systemic inflammation and study outcomes. RESULTS: A total of 184 participants (mean age, 79.1 y; 48.4% female, 51.6% male) were included; 148 (80.4%) and 36 (19.6%), respectively, had low-grade and high-grade inflammation. Participants with high-grade inflammation were significantly older, had lower body mass index and muscle strength, and had lower nutrient intake, swallowing status, and Barthel Index than those with low-grade inflammation. In multivariable analyses, mGPS was significantly associated with Barthel Index gain (ß = -0.229, P = 0.004) and Food Intake Level Scale (odds ratio = 5.067, P = 0.034) at discharge; mGPS was associated with 1-y mortality after discharge (P = 0.003). CONCLUSIONS: Baseline systemic inflammation was negatively associated with improvements in physical function and dysphagia and with 1-y survival in people with AHF. These findings highlight the importance of focusing on the assessment of systemic inflammation to accurately predict the functional prognosis of people with AHF.

Changes in insulin requirements during pregnancy in Japanese women with type 1 diabetes.

AIMS: We investigated the changes in insulin requirements, and other relevant factors, in pregnant Japanese women with type 1 diabetes. METHODS: This retrospective observational study was conducted on 77 singleton pregnant women with type 1 diabetes, treated with multiple daily injections of insulin. We examined changes in daily insulin dose during pregnancy and defined the increased insulin doses as the ratio of maximum dose to the pre-pregnancy dose. The relationship between the increased insulin doses and maternal features or pregnancy outcomes was investigated. RESULTS: The insulin dose gradually increased during pregnancy, reaching a maximum dose that was 1.6 times of that prior to pregnancy, at 35 weeks of gestation. A negative significant correlation was observed between the insulin dose increases and duration of diabetes (p = 0.008). Greater increases in insulin doses were noted in women with multiparity, compared to nulliparity (p = 0.047). Multiple regression analyses revealed that shorter duration of diabetes was independently associated with the increases in insulin dose during pregnancy. CONCLUSIONS: Women with a longer duration of diabetes required smaller increases in insulin dose during pregnancy, suggesting that long diabetic duration may decrease placental function. Further investigations are needed to clarify the mechanisms that the duration of diabetes influences on insulin requirement during pregnancy.

[Evaluation of a community-based health education program for salt reduction through media campaigns].

PURPOSE: To provide the strategies, achievement and evaluation of a community health education program for salt reduction with media campaigns. METHODS: The intervention community was Kyowa town (A district of Chikusei city, census population in 1985 = 16,792) where we have systematically conducted a community-based blood pressure control program since 1981, and health education on reduction of salt intake since 1983 for primary prevention of hypertension. The education program was performed through media campaigns including use of banners, signboards, posters, and calendars with health catchphrases. We also used catchphrase-labeled envelopes when sending documents from the municipal health center to individuals. Health festivals were held annually to enhance health consciousnesses and to improve health behavior. Some of the posters and calligraphy were painted or drawn by elementary schoolchildren as part of their education. The program was evaluated by repeated questionnaires and examination of salt concentrations of miso soup and dietary salt intake. RESULTS: Between 1983 and 1988, the prevalence of persons who were aware that health consultation including blood pressure measurements were available at the town office increased from 65% to 84%. The prevalence of those who knew the salt intake goal (10 g or less/day) increased from 47% to 63% and that of those who reported to reduce salt intake also increased from 38% to 58%. As for salt concentrations of miso soup, the proportion with less than 1.1% increased from 47% to 66% between 1985 and 2004. Age-adjusted mean salt intake for persons aged 40-69 years declined from 14 g to 11 g in men and from 12 g to 10 g in women between 1982-1986 and 2000-2004. CONCLUSION: A long-term systemic education program through media campaigns proved feasible with the cooperation of community leaders, schools and food associations.