Anemia and obesity: a paradox of the nutritional transition in Brazil

The aim of this study was to analyze the growing prevalence of anemia and overweight/obesity as contrasting trends in Brazil's nutritional transition. Twenty-eight studies published on anemia in children and childbearing-age women were selected, based on statistical representativeness, standardization of laboratory methods, and World Health Organization criteria. Overweight/obesity in adults was assessed by body mass index: 25 to 29.9 kg/m(2) (overweight) and > or =30 kg/m(2) (obesity). Three surveys were compared for analysis of tendencies: 1974/1975 (36.4%), 1989 (53.5%), and 2002/2003 (51.9%) for overweight/obesity prevalence. In the most representative study on anemia among children (< 11 g/dL), the prevalence increased from 22.0% (1974) to 46.9% (1995/1996). For pregnant woman (< 11 g/dL), results ranged from 14.7 to 40.4%. Prevalence of anemia among children and overweight/obesity among adults showed similar tendencies over time. Recent evidence of reduction in anemia can be attributed to flour supplementation with iron and folic acid. Anemia and overweight/obesity are associated with significant changes in food intake as a substratum of the nutritional transition.     

Antiphospholipid antibodies in acute coronary syndrome

The authors examined the presence of antiphospholipid antibodies in acute coronary syndrome. As their results show the frequency of antibodies against B2-glycoprotein I is significantly higher (14.4%) than the presence of these antibodies in a healthy control group (2%). Occurrence of antibodies against B2-glycoprotein I is much more higher than the occurrence of IgG- or IgM type antibodies against cardiolipin or lupus anticoagulant. CONCLUSIONS: The authors emphasize the possible role of anti-B2-glycoprotein I antibodies in thrombotic process of acute coronary syndrome. The previous ischaemic stroke was significantly more frequent in those patients medical history in whose serums antibodies against B2-glycoprotein I were present, so the presence of this thrombophil factor in acute coronary syndrome points out the importance of secunder antithrombotic prevention.     

The obesity paradox: Understanding the effect of obesity on mortality among individuals with cardiovascular disease

ObjectiveTo discuss possible explanations for the obesity paradox and explore whether the paradox can be attributed to a form of selection bias known as collider stratification bias.MethodThe paper is divided into three parts. First, possible explanations for the obesity paradox are reviewed. Second, a simulated example is provided to describe collider stratification bias and how it could generate the obesity paradox. Finally, an example is provided using data from 17,636 participants in the US National and Nutrition Examination Survey (NHANES III). Generalized linear models were fit to assess the effect of obesity on mortality both in the general population and among individuals with diagnosed cardiovascular disease (CVD). Additionally, results from a bias analysis are presented.ResultsIn the general population, the adjusted risk ratio relating obesity and all-cause mortality was 1.24 (95% CI 1.11, 1.39). Adjusted risk ratios comparing obese and non-obese among individuals with and without CVD were 0.79 (95% CI 0.68, 0.91) and 1.30 (95% CI = 1.12, 1.50), indicating that obesity has a protective association among individuals with CVD.ConclusionResults demonstrate that collider stratification bias is one plausible explanation for the obesity paradox. After conditioning on CVD status in the design or analysis, obesity can appear protective among individuals with CVD.     

Low-carbohydrate diets cause obesity, low-carbohydrate diets reverse obesity: a metabolic mechanism resolving the paradox

High-fat diets produce obesity in part because, per calorie, glucose produces greater post-prandial thermogenesis than lipids, an effect probably mediated by glucose-sensing neurons. A very low-carbohydrate/high-fat/high-protein Atkins-type diet produces obesity but is marginally ketogenic in mice. In contrast, high-sucrose/low-fat diets, and very low-carbohydrate/high-fat/low-protein (anti-epileptic) ketogenic diets reverse diet-induced obesity independent of caloric intake. We propose that a non-ketogenic high-fat diet reduces glucose metabolism and signaling in glucose-sensing neurons, thereby reducing post-prandial thermogenesis, and that a ketogenic high-fat diet does not reduce glucose signaling, thereby preventing and/or reversing obesity.     

可溶性血栓调节蛋白在急性冠脉综合征中的临床意义

目的 测定急性冠脉综合征(ACS)患者可溶性血栓调节蛋白(sTM)水平并探讨其临床意义.方法 用ELISA法测定48例ACS患者(ACS组)及10例对照者(对照组)sTM水平,并对冠状动脉造影结果、各种冠心病危险因子和主要心脏不良事件与sTM水平之间的关系进行统计分析.结果 ACS组sTM水平高于对照组[(3.674±71)μg/L比(2.34±0.43)μg/L,P<0.05].危险因子数>2个患者的sTM水平高于危险因子数≤2个患者[(4.93±2.76)μg/L比(3.13±0.81)μg/L,P<0.05];病变血管数>2支患者的sTM水平高于病变血管数≤2支患者[(4.60±2.83)μg/L比(2.91±0.23)μg/L,P<0.05].sTM>3.2 μg/L患者的主要心脏不良事件发生率显著高于sTM≤3.2 μg/L患者(70.0%比35.7%,P<0.05).结论 sTM水平是反映内皮细胞损伤程度和范围的良好标志,它与冠心病危险因子的损伤作用有关,并对ACS的病变范围和预后有提示意义.     

Percutaneous coronary intervention in patients with acute coronary syndrome: focus on bivalirudin

Previously, indirect thrombin inhibitors such as unfractionated heparin or low-molecular-weight heparin were used as a standard anticoagulation during percutaneous coronary intervention to prevent procedural thrombotic complications but at a risk of hemorrhagic complications. More recently, bivalirudin, a member of the direct thrombin inhibitor class, has been shown to have 1) predictable pharmacokinetics, 2) ability to inhibit free- and clot-bound thrombin, 3) no properties of platelet activation, 4) avoidance of heparin-induced thrombocytopenia, and 5) a significant reduction of bleeding without a reduction in thrombotic or ischemic endpoints compared to heparin and glycoprotein IIbIIIa inhibitors when used in patients presenting with acute coronary syndrome who are planned for an invasive treatment strategy.     

The obesity paradox in elderly patients with heart failure: analysis of nutritional status

ObjectiveThe obesity paradox refers to the improved survival of obese compared with non-obese elderly or diseased patients for reasons that are not clear. To assess the relative roles of fat and other factors in this improved survival, we analyzed the prognostic value of overweight and obesity elderly patients with heart failure (HF), controlling for other nutritional data such as midarm anthropometrics, serum proteins, and muscle strength.MethodsTwo hundred forty-four patients (83.2 ± 0.5 y old) hospitalized for HF were included. A nutritional survey was performed in all patients. After discharge, the patients were followed up by telephone.ResultsFourteen patients (5.7%) died during hospitalization. The median survival was 984 d. Patients with better nutritional status as assessed by the body mass index (BMI), subjective score, midarm muscle area, triceps skinfold thickness, handgrip, lymphocyte count, and serum albumin, prealbumin, and cholesterol levels showed better short- and long-term prognoses. Obese patients with a BMI above 30 kg/m² showed a better long-term prognosis than those with a BMI from 25 to 30 kg/m², those with a BMI from 20 to 25 kg/m², and those with a BMI lower than 20 kg/m². However, survival was not significantly related to a triceps skinfold thickness above the 95th percentile. Obese and overweight patients were younger and had better a nutritional status than those with a normal or decreased BMI as shown by the anthropometrics, subjective score, handgrip, lymphocyte count, hemoglobin, and serum albumin, prealbumin, and cholesterol levels. All the nutritional data correlated closely with each other. New York Heart Association class also correlated with nutrition-derived data: as the HF class increased, the nutritional status deteriorated. On multivariate analysis, to predict long-term survival, neither BMI nor triceps skinfold thickness showed an independent predictive value, whereas a larger midarm muscle area did.ConclusionThe obesity paradox was confirmed in this series of elderly patients with HF. Those with a high BMI and improved survival had a better nutritional status and New York Heart Association functional class than those with a lower BMI, which may explain the differences in survival.     

The paradox of Prader–Willi syndrome: a genetic model of starvation

This narrative review of the correlates of effective parent-provider communication and relevant interventions indicates that effective parent-provider communication is associated with parental satisfaction with care, adherence to treatment recommendations, and enhanced discussion of psychosocial concerns. Moreover, interventions designed to improve parent-provider communication resulted in more discussion of psychosocial concerns, better recall of information from the visit, and improved parent-provider communication. Recommendations for the development of more effective studies of parent-provider communication and relevant interventions in paediatric primary care include the need for theoretical models to help guide research, the development of reliable and valid self-report measures of communication, the assessment of clinically relevant correlates of parent-provider communication, and the study of children's roles in communication with their paediatricians.
Read and do likewise!     

急性冠脉综合征冠状动脉造影特点

目的了解急性冠脉综合征(ACS)冠脉血管病变情况,为临床分析病情、制定治疗方案提供客观依据.方法对其造影显示的冠脉病变支数、部位、狭窄程度、危险分层及相关因素进行分析.结果 148例确诊ACS患者纳入研究范围,不稳定型心绞痛(UAP)66例,急性心肌梗死(AMI)82例.单支病变94例,占63.5%,双支42例,占28.4%,三支11例,占7.4%;犯罪血管分布中左前降支(LAD)81例,占54.7%,左回旋支(LCX)13例,占8.7%,右冠状动脉(RCA)53例,占35.8%,左主干1例,占0.7%.犯罪血管狭窄程度及危险程度分层中,狭窄在50%～74%者35例,占23.6%,狭窄在75%～99%者82例,占55.4%,完全闭塞者24例(其中AMI 20例,UAP 4例),占16.2%,狭窄<50%者7例,占4.7%.犯罪血管危险程度分层中,低危者27例,占18.2%,中危者54例,占36.5%,高危者53例,占35.8%,极高危者7例,占4.7%;中、高危病变共计107例,占总数的72.3%.结论 ACS患者冠脉造影显示大部分有严重的冠脉病变,部分完全闭塞,应积极考虑急诊PTCA及支架术等介入治疗或外科手术,血运重建,改善预后.     

Selenium and coronary heart disease: a meta-analysis

BACKGROUND: It is hypothesized that low selenium concentrations are associated with an increased risk of cardiovascular disease and that selenium supplements prevent coronary heart disease. OBJECTIVE: The objective was to perform a meta-analysis on the association of selenium biomarkers with coronary heart disease endpoints in observational studies and on the efficacy of selenium supplements in preventing coronary heart disease endpoints in randomized trials. DESIGN: The MEDLINE and the Cochrane Library databases were searched for studies conducted from 1966 through 2005. Relative risks were pooled by using an inverse-variance weighted random-effects model. RESULTS: Twenty-five observational studies (14 cohort and 11 case-control studies) that measured blood or toenail selenium concentrations and 6 randomized trials that evaluated supplements containing selenium met our inclusion criteria. The pooled relative risk in a comparison of the highest with the lowest selenium concentration categories was 0.85 (95% CI: 0.74, 0.99) in cohort studies and 0.43 (0.29, 0.66) in case-control studies. In observational studies, a 50% increase in selenium concentrations was associated with a 24% (7%, 38%) reduction in coronary heart disease risk. In randomized trials, the pooled relative risk in a comparison of supplements containing selenium with placebo was 0.89 (0.68, 1.17). CONCLUSIONS: Selenium concentrations were inversely associated with coronary heart disease risk in observational studies. Because observational studies have provided misleading evidence for other antioxidants, the validity of this association is uncertain. Few randomized trials have addressed the cardiovascular efficacy of selenium supplementation, and their findings are still inconclusive. Evidence from large ongoing trials is needed to establish low selenium concentrations as a cardiovascular disease risk factor. Currently, selenium supplements should not be recommended for cardiovascular disease prevention.     

多ADP-核糖聚合酶Val762Ala多态性与急性冠状动脉综合征的关系

目的探讨多ADP-核糖聚合酶[poly(ADP-ribose)polymerase,PARP]单核苷酸多态性位点Val762Ala基因多态性与急性冠状动脉综合征(acute coronary syndrome,ACS)的关系。方法选择2007年7月—2008年4月经冠状动脉造影确诊的ACS患者84例为病例组和非ACS患者87例为对照组,检测两组PARP的表达,并采用Se-quenom公司MassARRAY时间飞行质谱生物芯片系统单核苷酸多态性基因型分析技术对其进行PARP基因单核苷酸位点Val762Ala基因分型。比较两组间Val762Ala的基因型分布。结果定量分析可见病例组血浆PARP水平明显高于对照组(P0.05)。Val762Ala位点成功分型率为98.5%,病例组与对照组TC+CC基因型频率分别为86.9%和20.7%,两组差异有统计学意义(P0.05)。结论 PARP水平与冠状动脉粥样斑块稳定性有相关性,可能是致冠状动脉斑块破裂的重要原因之一。Val762Ala多态性与粥样硬化斑块破裂可能存在相关性。     

急性冠脉综合征抗血小板治疗进展

急性冠脉综合征(acute coronary syndrome,ACS)是由于局部血管炎症、内皮功能不良、血管痉挛、血流剪切力等因素造成的不稳定斑块(易损斑块)的纤维帽破裂,激活血小板进而引起冠状动脉内血栓形成所致心肌缺血的一组进展性疾病谱,包括不稳定性心绞痛(UA)、非ST段抬高性心肌梗死(NSTEMI),ST段抬高性心肌梗死(STEMI).从上述特点可以看出,ACS发病的核心病理基础是冠状动脉内血栓形成,其中血小板活化是血栓形成的关键和始动因素.     

急性冠脉综合征抗血小板治疗进展

急性冠脉综合征（acute coronary syndrome，ACS）是由于局部血管炎症、内皮功能不良、血管痉挛、血流剪切力等因素造成的不稳定斑块（易损斑块）的纤维帽破裂，激活血小板进而引起冠状动脉内血栓形成所致心肌缺血的一组进展性疾病谱，包括不稳定性心绞痛（UA）、非ST段抬高性心肌梗死（NSTEMI），ST段抬高性心肌梗死（STEMI）。从上述特点可以看出．ACS发病的核心病理基础是冠状动脉内血栓形成，其中血小板活化是血栓形成的关键和始动因素。     

急性冠状动脉综合征合并低T3综合征的临床特点分析

目的 探讨急性冠状动脉综合征(ACS)合并低T3综合征的临床特点及其与预后的相关性.方法 选择ACS合并低游离三碘甲腺原氨酸(FT3)水平的住院患者87例(低FT3组),另外选择64例FT3水平正常的ACS患者作为对照组,均行冠状动脉造影检查.抽取患者空腹静脉血检测FT3、N-末端脑钠肽前体(NT-proBNP)、心肌肌钙蛋白Ⅰ(cTnI)、超敏C反应蛋白(hs-CRP)水平;记录两组单支病变、2支病变与多支病变的患者数量.结果 与对照组比较,低FT3组NT-proBNP、cTnI及hs-CRP均显著升高[(1242.14±226.32) ng/L比(1126.36±195.55) ng/L,(0.92±0.23) ng/L比(0.84±0.19) ng/L,(6.46±2.25) mg/L 比(5.71±1.78) mg/L](P＜ 0.01或＜0.05).两组FT3水平均与NT-proBNP、cTnI及hs-CRP呈显著负相关(P＜0.05).两组冠状动脉病变数量比较差异无统计学意义(x2=4.512,P=0.105).结论 ACS患者血清FT3水平与病情的严重程度有良好相关性,与冠状动脉病变数量无明显相关性,对预后有一定预测价值.