Diagnostic and clinical significance of antigen-specific pancreatic antibodies in inflammatory bowel diseases: A meta-analysis

BACKGROUND Non-invasive criteria are needed for Crohn’s disease(CD)diagnosis,with several biomarkers being tested.Results of individual diagnostic test accuracy studies assessing the diagnostic value of pancreatic autoantibodies-to-glycoprotein-2(anti-GP2)tests for the diagnosis of CD appear promising.AIM To systematically review and meta-analyze evidence on the diagnostic accuracy of anti-GP2 tests in patients with suspected/confirmed CD.METHODS An electronic search was conducted on PubMed,Cochrane-CENTRAL and grey literature(CRD42019125947).The structured research question in PICPTR format was“Population”including patients with symptoms akin to CD,the“Index test”being anti-GP2 testing,the“Comparator”involved standard CD diagnosis,the“Purpose of test”being diagnostic,“Target disorder”was CD,and the“Reference standard”included standard clinical,radiological,endoscopical,and histological CD diagnostic criteria.Quality was assessed with the Quality Assessment of Diagnostic Accuracy Studies-2 tool and hierarchical models were employed to synthesize the data.RESULTS Out of 722 studies retrieved,15 were meta-analyzed.Thirteen studies had industry-related conflicts-of-interest,and most included healthy donors as controls(spectrum bias).For the combination of IgA and/or IgG anti-GP2 test,the summary sensitivity was 20%(95%confidence interval:10%-29%)at a median specificity of 97%.If the test was applied in 10000 suspected patients,9669 would be true negatives and in 26,the diagnosis would be missed.In this hypothetical cohort,the anti-GP2 would fail to produce a diagnosis for 81.3%of the positive cases.Low summary points of sensitivity and high specificity were estimated for the IgG or IgA anti-GP2 test.Analogous results were observed when the analyses were restricted using specific cut-offs,or when ulcerative colitis patients were used as comparators.CONCLUSION Anti-GP2 tests demonstrate low sensitivity and high specificity.These results indicate that caution is required before relying on its diagnostic value.Additionally,the need for improving the methodology of diagnostic test accuracy studies is evident.     

Diabetic Peripheral Neuropathy as a Predictor of Asymptomatic Myocardial Ischemia in Type 2 Diabetes Mellitus: A Cross-Sectional Study

Introduction

Diabetic peripheral neuropathy (DPN) is one of the most common complications of diabetes and has been associated with cardiovascular disease, the leading cause of mortality in diabetes. As asymptomatic myocardial ischemia (MI) is frequent in diabetes, we hypothesized that DPN may be associated with MI in patients with type 2 diabetes mellitus and no history of cardiovascular events.

Methods

Eighty-two patients with DPN (n = 41) or without DPN (n = 41) were included. Among the DPN group, 15 had active foot ulcers. All subjects underwent Technetium-99 m sestamibi single-photon emission computed tomographic imaging for the estimation of myocardial ischemia, expressed as Summed Stress Score (SSS). The Neuropathy Disability Score (NDS) was used to quantify DPN and abnormal ratio of the longest electrocardiographic RR interval between the 28th and 32nd beats, after standing to the shortest interval between the 13th and 17th beats (RR ratio) was used as an index of cardiovascular autonomic neuropathy (CAN).

Results

Abnormal SSS was observed in 9.8% of patients without DPN and in 46.3% of patients with DPN (p < 0.001). In the multivariate analysis, NDS was the strongest predictor for SSS (β = 0.32, p = 0.003). When excluding patients with abnormal RR ratio (β = 0.32, p = 0.003) or with foot ulcers (β = 0.24, p = 0.04), this association remained significant. The RR ratio was also significantly associated with SSS in univariate (ρ = ?0.30, p = 0.005) and multiple regressions (β = 0.24, p = 0.02).

Conclusions

MI was strongly associated with DPN, and this association remained significant in patients with normal RR ratio. These results suggest that DPN assessment could help in identifying patients at risk of cardiovascular disease (CVD).

     

A preliminary case-control study on nutritional status, body composition, and glycemic control of Greek children and adolescents with type 1 diabetes

Background: Because scientific data on the diet of diabetic Greek youngsters are scarce, diabetic experts use findings from international studies. However, because of diet variations between countries, this may result in problems in diabetes control. The aim of the present pilot study was to assess body composition, nutritional status, and diabetes control in Greek youngsters with type 1 diabetes mellitus (T1DM). Methods: Twenty‐four children and adolescents with diabetes, aged 4–16 years, and the same number of age‐ and sex‐matched controls participated in the study. Anthropometry included stature, weight, and body fat determined by bioelectrical impedance analysis. Body mass index (BMI), fat mass index (FMI), fat‐free mass index (FFMI), and z‐scores were calculated. Diabetes control was evaluated through glycosylated hemoglobin (HbA1c) and dietary intake was recorded for 3 days. Results: The FFMI, BMI z‐score and weight‐for‐age z‐score were lower in controls compared with diabetic youngsters (P ≤ 0.001, P ≤ 0.02, and P ≤ 0.01, respectively). Three diabetic participants were overweight (12.5%) and two controls were underweight (8.3%). The energy and nutrient intake was similar between the two groups, and all participants consumed a diet high in fats and proteins at the expense of carbohydrates. Dietary fat was highly correlated with BMI in both groups. The consumption of vitamin D was inadequate in the diabetic participants, but they had a higher intake of antioxidant vitamins, vitamin B₆, and folate compared with the control group. Conclusions: In conclusion, youngsters with T1DM failed to adhere to the macronutrient recommendations for diabetes, but dietary patterns were similar in both the diabetic and control groups. The control of diabetes was not associated with any nutrient or anthropometric variable.     

Assessing the Physiological Effects of Traditional Regional Diets Targeting the Prevention of Cardiovascular Disease: A Systematic Review of Randomized Controlled Trials Implementing Mediterranean,New Nordic,Japanese, Atlantic,Persian and Mexican Dietary Interventions

Traditional regional diets are considered as sustainable dietary patterns, while many have been examined with regard to their health benefits. The aim of the present systematic review was to aggerate all evidence on the physiological effects of regional diets among adults at high risk for cardiovascular disease (CVD). Three databases were searched for randomized controlled trials (RCTs) implementing any regional diet (Mediterranean (MedD), Persian, Southern European Atlantic, Japanese, Chinese, new Nordic, or other) while examining cardiovascular risk factors among adults at increased risk. Primary outcomes included anthropometric indices and secondary outcomes involved blood lipid concentrations, glucose metabolism, inflammation and other markers of CVD progression. Twenty RCTs fulfilled the study’s criteria and were included in the qualitative synthesis, with the majority implementing a MedD. Adherence to most of the regional diets induced a reduction in the BW and anthropometric indices of the participants. The majority of RCTs with blood pressure endpoints failed to note a significant reduction in the intervention compared to the comparator arm, with the exception of some new Nordic and MedD ones. Despite the interventions, inflammation markers remained unchanged except for CRP, which was reduced in the intervention groups of one new Nordic, the older Japanese, and the Atlantic diet RCTs. With regard to blood lipids, regional diet interventions either failed to induce significant differences or improved selective blood lipid markers of the participants adhering to the experimental regional diet arms. Finally, in the majority of RCTs glucose metabolism failed to improve. The body of evidence examining the effect of regional dietary patterns on CVD risk among high-risk populations, while employing an RCT design, appears to be limited, with the exception of the MedD. More research is required to advocate for the efficacy of most regional diets with regard to CVD.     

Food insecurity and Mediterranean diet adherence among Greek university students

Aim

To assess Mediterranean diet (MD) adherence and food insecurity (FI) among university students in Greece.

The effect of active warm-up and stretching on the flexibility of adolescent soccer players

AIM: The purpose of the investigation was to examine in field conditions the acute effects of passive stretching after a general warming-up bout as well as the effects of passive stretching alone. METHODS: Eighteen adolescent team soccer players participated in this study performing 3 different flexibility-training protocols in separate training sessions. In the first treatment stretching protocol a general warm-up was performed where subjects jogged for 20 minutes. The second treatment stretching protocol consisted of the same general warm-up followed by passive stretching of the lower extremities and the trunk, whereas the third and final treatment stretching protocol consisted of passive stretching alone, without any jogging. Passive range of joint motion was examined in hip flexion, hip extension, hip abduction, ankle dorsiflexion, knee flexion and trunk flexion using a goniometer and a flexometer. RESULTS: The general warming-up session induced a significantly increased range of motion only at the ankle dorsiflexion joint (P<0.05). Results also suggest that passive stretching alone and passive stretching after a general warming-up bout both induced a significantly increased range in all lower extremity joints and trunk flexion (P<0.001). CONCLUSIONS: Improvements in flexibility are observed after passive muscle elongation, irrespective of warming-up.     

Greater Mediterranean diet adherence is observed in Dutch compared with Greek university students

Background and aims

Research has demonstrated that Mediterranean youth appear to abandon the traditional diet. The present study aimed to assess Mediterranean diet (MD) adherence in Greek university students, compared with a non-Mediterranean (Dutch) population.

Methods and results

The MD was assessed through the MD score (MedDietScore, MDS) in 100 nutrition students from Amsterdam and 85 from Thessaloniki. Subjects at both sites demonstrated average MDS, which was higher in the Dutch sample (27.5 ± 3.9) compared to the Greek (26.1 ± 3.4) (p ≤ 0.001). The highest score was observed in Amsterdam (39). Potatoes, non-refined cereals, vegetables and olive oil were more frequently consumed by Dutch students (p ≤ 0.001), but the Greeks demonstrated a higher legume intake (p ≤ 0.05). The Dutch diet comprised 17% protein, 50% carbohydrate and 33% fat, whereas the Greeks consumed 14% protein, 48% carbohydrate and 38% fat (p ≤ 0.001 and p ≤ 0.031 for between-country protein and fat intake, respectively). In Amsterdam, significantly greater amounts of polyunsaturated (PUFA) and monounsaturated (MUFA) fatty acids as a percentage of energy intake (p ≤ 0.001, p ≤ 0.01) were consumed.

Conclusion

The findings indicate that the MD has been transmitted to non-Mediterranean populations, probably as a result of its declared health benefits. However, it is alarming that an average adherence score was demonstrated by the Greek nutrition students and this is indicative of the need for new approaches in transmitting the Mediterranean dietary pattern.     

Keratosis lichenoides chronica: a case report

Keratosis lichenoides chronica (KLC) is a rare chronic hyperkeratotic disorder that typically affects patients aged 20 to 50 years. Its distinct clinical presentation in the pediatric population has raised speculation that the adult and pediatric variants of this disorder may be entirely separate disease entities. We present a case of adult-type KLC manifesting during childhood in a 14-year-old adolescent girl. We also review the literature on this rare disorder.