Vitamin and Mineral Deficiencies Are Highly Prevalent in Newly Diagnosed Celiac Disease Patients

Malabsorption, weight loss and vitamin/mineral-deficiencies characterize classical celiac disease (CD). This study aimed to assess the nutritional and vitamin/mineral status of current “early diagnosed” untreated adult CD-patients in the Netherlands. Newly diagnosed adult CD-patients were included (n = 80, 42.8 ± 15.1 years) and a comparable sample of 24 healthy Dutch subjects was added to compare vitamin concentrations. Nutritional status and serum concentrations of folic acid, vitamin A, B₆, B₁₂, and (25-hydroxy) D, zinc, haemoglobin (Hb) and ferritin were determined (before prescribing gluten free diet). Almost all CD-patients (87%) had at least one value below the lower limit of reference. Specifically, for vitamin A, 7.5% of patients showed deficient levels, for vitamin B₆ 14.5%, folic acid 20%, and vitamin B₁₂ 19%. Likewise, zinc deficiency was observed in 67% of the CD-patients, 46% had decreased iron storage, and 32% had anaemia. Overall, 17% were malnourished (>10% undesired weight loss), 22% of the women were underweight (Body Mass Index (BMI) < 18.5), and 29% of the patients were overweight (BMI > 25). Vitamin deficiencies were barely seen in healthy controls, with the exception of vitamin B₁₂. Vitamin/mineral deficiencies were counter-intuitively not associated with a (higher) grade of histological intestinal damage or (impaired) nutritional status. In conclusion, vitamin/mineral deficiencies are still common in newly “early diagnosed” CD-patients, even though the prevalence of obesity at initial diagnosis is rising. Extensive nutritional assessments seem warranted to guide nutritional advices and follow-up in CD treatment.     

Preferences for Colorectal Cancer Screening Techniques and Intention to Attend: a Multi-Criteria Decision Analysis

Background

Despite the expected health benefits of colorectal cancer screening programs, participation rates remain low in countries that have implemented such a screening program. The perceived benefits and risks of the colorectal cancer screening technique are likely to influence the decision to attend the screening program. Besides the diagnostic accuracy and the risks of the screening technique, which can affect the health of the participants, additional factors, such as the burden of the test, may impact the individuals’ decisions to participate. To maximise the participation rate of a screening program for a new colorectal cancer program in the Netherlands, it is important to know the preferences of the screening population for alternative screening techniques.

Objective

The aim of this study was to explore the impact of preferences for particular attributes of the screening tests on the intention to attend a colorectal cancer screening program.

Methods

We used a web-based questionnaire to elicit the preferences of the target population for a selection of colon-screening techniques. The target population consisted of Dutch men and women aged 55–75 years. The analytic hierarchy process (AHP), a technique for multi-criteria analysis, was used to estimate the colorectal cancer screening preferences. Respondents weighted the relevance of five criteria, i.e. the attributes of the screening techniques: sensitivity, specificity, safety, inconvenience, and frequency of the test. With regard to these criteria, preferences were estimated between four alternative screening techniques, namely, immunochemical fecal occult blood test (iFOBT), colonoscopy, sigmoidoscopy, and computerized tomographic (CT) colonography. A five-point ordinal scale was used to estimate the respondents’ intention to attend the screening. We conducted a correlation analysis on the preferences for the screening techniques and the intention to attend.

Results

We included 167 respondents who were consistent in their judgments of the relevance of the criteria and their preferences for the screening techniques. The most preferred screening method for the national screening program was CT colonography. Sensitivity (weight = 0.26) and safety (weight = 0.26) were the strongest determinants of the overall preferences for the screening techniques. However, the screening test with the highest intention to attend was iFOBT. Inconvenience (correlation [r] = 0.69), safety (r = 0.58), and the frequency of the test (r = 0.58) were most strongly related to intention to attend.

Conclusions

The multi-criteria decision analysis revealed the attributes of the screening techniques that are most important so as to increase intention to participate in a screening program. Even though the respondents may recognize the high importance of diagnostic effectiveness in the long term, their short-term decision to attend the screening tests may be less driven by this consideration. Our analysis suggests that inconvenience, safety, and frequency of the test are the strongest technique-related determinants of the respondents’ intention to participate in colorectal screening programs.     

Breast cancer subtyping by immunohistochemistry and histological grade outperforms breast cancer intrinsic subtypes in predicting neoadjuvant chemotherapy response

Intrinsic subtypes are widely accepted for the classification of breast cancer. Lacking gene expression data, surrogate classifications based on immunohistochemistry (IHC) have been proposed. A recent St. Gallen consensus meeting recommends to use this “surrogate intrinsic subtypes” for predicting adjuvant chemotherapy resistance, implying that “Surrogate Luminal A” breast cancers should only receive endocrine therapy. In this study we assessed both gene expression based intrinsic subtypes as well as surrogate intrinsic subtypes regarding their power to predict neoadjuvant chemotherapy benefit. Single institution data of 560 breast cancer patients were reviewed. Gene expression data was available for 247 patients. Subtypes were determined on the basis of IHC, Ki67, histological grade, endocrine responsiveness, and gene expression, and were correlated with chemotherapy response and recurrence-free survival. In ER+/HER2? tumors, a high histological grade was the best predictor for chemotherapy benefit, both in terms of pCR (p = 0.004) and recurrence-free survival (p = 0.002). The gene expression based and surrogate intrinsic subtype based on Ki67 had no predictive or prognostic value in ER+/HER2? tumors. Histological grade, ER, PR, and HER2 were the best predictive factors for chemotherapy response in breast cancer. We propose to continue the conventional use of these markers.     

Trends in caries prevalence in 5-, 7- and 11-year-old schoolchildren in The Hague between 1969 and 1989.

Starting in 1969, periodic cross-sectional examinations of schoolchildren have been carried out in the city of The Hague. In 1989 the periodic examinations were continued and, in general, caries prevalence was found to be very low; D3MFS values ranged between 1.5 and 2.2 at age 11.8 years. Compared to 1984, 5-year-old-children of low and medium socio-economic levels (SES) in 1989 had significantly higher d3mfs values (p less than 0.01), mainly due to a marked increase in decayed surfaces per child; a significant increase in caries experience of the deciduous dentition amongst 7-year-olds of low social level was found (p less than 0.01). A further reduction of D3MFS values for 7-year-old children of low and medium SES could be observed in 1989 compared to 1984. Between 1978 and 1989 a marked D3MFS reductions amongst 11-year-olds in the three social levels was found. Possible explanations for the observed differences in caries experience between 1984 and 1989 are discussed.     

The relationship between elastase and lactoferrin in healthy, gingivitis and periodontitis sites

OBJECTIVES: To compare the relative amounts of elastase (primary polymorphonuclear leucocyte granule constituent) and lactoferrin (secondary PMN granule constituent) in the gingival crevicular fluid (GCF) of healthy, gingivitis and periodontitis sites.
DESIGN: This cross-sectional study looked at the two GCF constituents in three categories of disease status within the same subject.
MATERIALS AND METHODS: Patients with chronic adult periodontitis were screened and those exhibiting all three types of sites ie periodontally healthy, gingivitis and periodontitis sites were recruited (n = 10) and had GCF collected from the three sites. Lactoferrin and elastase were measured in eluates of GCF by enzyme-linked immunosorbent assay.
RESULTS: The absolute amount of lactoferrin measured in ng per 30 s samples was significantly lower in healthy and gingivitis sites as compared to periodontitis sites however this difference failed to reach significance when the concentration of lactoferrin in GCF was used as the analytical unit. No significant differences were found for elastase levels at any sites when expressed as either absolute amounts or concentrations. Secondary granule release, as evidenced by lactoferrin levels, occurs during cell migration and the process is independent of primary granule release, which is thought to correlate with PMN activation. The relationship between granule constituents in the samples showed significant differences, the highest lactoferrinlelastase ratio being at periodontitis sites (P < 0.001).
CONCLUSIONS These findings imply a change in the relative amounts of elastase and lactoferrin released at different disease level sites, with an almost 10-fold increase in the proportion of lactoferrin to elastase in periodontitis sites over healthy and gingivitis sites. This variation in the release by PMNs of primary and secondary granule constituents may indicate alterations in PMN function in different disease environments.     

"Prosthetic condition" and satisfaction with dentures

This study introduces the concept of 'prosthetic condition', combining the professionally assessed complete denture quality and quality of the residual alveolar ridge. In a group of 397 complete maxillary and mandibular denture wearers the prosthetic condition was assessed and the denture satisfaction recorded. The total prosthetic condition (maxillary and mandibular combined) was good in 225 (57%), moderate in 81 (20%), and poor in 91 (23%) subjects; the mandibular prosthetic condition was good in 155 (39%), moderate in 148 (38%), and poor in 94 (23%) subjects; 297 (75%) subjects were satisfied with their dentures. None of the criteria used for the prosthetic condition could explain the denture satisfaction. Furthermore, there was no significant correlation between prosthetic condition and denture satisfaction.