Visceral fat, not adiposity, marker of prediabetes, type 2 diabetes in obese adults

     Among obese adults, excess visceral fat and insulin resistance — not necessarily adiposity — are independently associated with incident prediabetes and type 2 disease.

     Ian J. Neeland, MD, of the University of Texas Southwestern Medical Center, and colleagues conducted a study involving 732 obese adults (BMI ≥30) aged 30 to 65 years without diabetes or cardiovascular disease. Patients were enrolled in the Dallas Heart Study between 2000 and 2002.

     The following measurements were obtained: BMI (using DXA and MRI); circulating adipokines and biomarkers of insulin resistance; dyslipidemia and inflammation; and subclinical atherosclerosis and cardiac structure and function (using CT and MRI), according to the study.

     The primary outcome was diabetes incidence during a median 7 years of follow-up. Researchers also determined the incidence of composite prediabetes or diabetes in a subgroup of 512 patients with normal fasting glucose at baseline.

     More than 10% of patients developed diabetes (11.5%) during the study. Results of a multivariable analysis revealed that several factors were independently associated with diabetes, including: higher baseline visceral fat mass (OR=2.4; 95% CI, 1.6-3.7); fructosamine level (OR=2.0; 95% CI, 1.4-2.7); fasting glucose level (OR=1.9; 95% CI, 1.4-2.6); family history of diabetes (OR=2.3; 95% CI, 1.3-4.3); systolic BP (OR=1.3; 95% CI, 1.1-1.5); and weight gain during follow-up (OR=1.06; 95% CI, 1.02-1.10).

     However, BMI, total body fat and abdominal subcutaneous fat were not associated with diabetes. Results from the subgroup analysis demonstrated that the composite of prediabetes or type 2 diabetes occurred among 39.1% of patients and was independently associated with baseline levels of: visceral fat mass, fasting glucose, insulin and fructosamine; older age; non-white race; family history of disease; and weight gain during follow-up (P<.05 for each).

     Similarly, however, there was no association with general adiposity measurements, they wrote.“These findings suggest that clinically measurable markers of adipose tissue distribution and insulin resistance may be useful in prediabetes and diabetes risk discrimination among obese individuals and support the notion of obesity as a heterogeneous disorder with distinct adiposity subphenotypes.”

Neeland IJ. JAMA. 2012;308:1150-1159.

Tomado de  Healio.com

IV Ampicillin Found Effective for VRE UTI

     Intravenous ampicillin is an effective first-line treatment for urinary tract infections caused by vancomycin-resistant enterococci, according to a review from Shands Hospital at the University of Florida in Gainesville.

     Although linezolid and daptomycin are sometimes used elsewhere to treat these infections, the hospital staff decided in 2000 to use intravenous ampicillin as the vancomycin-resistant enterococci (VRE) UTI treatment of choice. To prevent resistance, staff there wanted to keep newer, more powerful antibiotics in reserve for more complex infections, Shands infectious disease specialist Ken Klinker, Pharm.D., reported at the annual Interscience Conference on Antimicrobial Agents and Chemotherapy.

     The hospital staff reasoned that the high urine concentrations achieved by ampicillin would overwhelm VRE despite possible resistance to the antibiotic, Dr. Klinker said. The approach led to clinical cures in 64 of 70 patients (91%) and microbiologic cures in 40 of the 46 (87%) who had repeat urine cultures.  

     Patients received a median ampicillin dose of 4 g/day for an average of 4.25 days. When possible, they were then switched to oral ampicillin or amoxicillin.

Ampicillin "seems to work for us and has for many years," said coinvestigator and pharmacist Sam Borgert, also an infectious disease specialist at Shands. "Ampicillin should be considered a viable treatment option for patients with VRE UTI," the investigators concluded when presenting their findings.

    Most of the patients had grown out at least 10⁵ CFU/mL on urine culture and were clinically symptomatic. Enterococcus faecium was the predominant pathogen, and it tested almost uniformly resistant to ampicillin.

    The median age in the study was 60.5 years and median Charlson Comorbidity Index score was 6. Just over half of the participants were women.

A total of 48 patients had Foley catheters at baseline. Thirty-three of the 34 (97%) who had their catheter exchanged or removed cleared the infection. The cure rate was 57% (8 of 14) among patients who retained their catheter.

    "We can’t discern between drug therapy and catheter removal in terms of what drove the results. It’s probably a combination of both," Dr. Klinker said at the conference, which was sponsored by the American Society for Microbiology.

The few patients who failed ampicillin responded to alternate VRE therapies.

Dr. Klinker and Mr. Borgert said that they have no relevant disclosures.

TOMADO DE: internalmedicinenews.com. by ALEXANDER OTTO, Internal Medicine News Digital Network

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Progesterone Test Can Predict Viability of Pregnancy, Study Finds

 Measuring progesterone levels in women with pain or bleeding during early pregnancy is a useful way to help discriminate between a viable and a non-viable pregnancy, finds a study published on bmj.com today.

The results suggest that a low level of progesterone in these women can rule out a viable pregnancy in the vast majority of cases.

Vaginal bleeding or pain occurs in around a third of women in early pregnancy. Doctors use ultrasound to test whether it is a viable pregnancy or a non-viable pregnancy, such as a miscarriage or an ectopic pregnancy, but this can sometimes be inconclusive.

Some studies have suggested that a single progesterone measurement in early pregnancy may be a useful test, but results are conflicting.

So a team of UK and Dutch researchers set out to determine the accuracy with which a single progesterone measurement in early pregnancy can discriminate between a viable and a non-viable pregnancy.

They analysed the results of 26 studies involving 9,436 pregnant women. Seven studies looked at women with pain or bleeding and an inconclusive ultrasound assessment, while 19 studies looked at women with pain or bleeding alone.

Differences in study quality were taken into account to identify and minimise bias.

The results show that a single low progesterone measurement for women in early pregnancy presenting with bleeding or pain can discriminate between a viable and a non-viable pregnancy when an ultrasound investigation proves to be inconclusive.

For women with pain or bleeding who did not have an ultrasound, the progesterone test was less accurate in predicting viability of a pregnancy.

The researchers stress that low progesterone levels may occur in some viable pregnancies and, as such, "the test should be complemented by another test to increase its diagnostic accuracy."

They also suggest that "this test is highly accurate when complemented by ultrasound and could be added to the existing algorithms for the evaluation of women with pain or bleeding in early pregnancy as it can accelerate diagnosis."

BMJ-British Medical Journal. "Progesterone test can predict viability of pregnancy, study finds."ScienceDaily, 27 Sep. 2012. Web. 4 Oct. 2012.

Cardiac Benefits of Red Wine Not From the Alcohol

Drinking moderate amounts of nonalcoholic red wine -- but not its intoxicating equivalent -- lowered blood pressure in men with a high cardiovascular risk, a randomized, crossover study showed.

After 4 weeks of drinking the nonalcoholic wine, blood pressure fell by an average of 5.8/2.3 mm Hg (P menor 0.02), according to Ramon Estruch, PhD, of the University of Barcelona in Spain, and colleagues.

In contrast, drinking standard red wine for 4 weeks and gin during another 4-week period had no significant effect, although blood pressure did decrease a bit with the wine, the researchers reported online in Circulation Research. The changes in blood pressure with nonalcoholic red wine correlated significantly with changes in plasma nitric oxide, which increased by 4.1 µmol/L (P=0.041). Nitric oxide levels were not affected by the alcoholic beverages.

"Therefore, the blood pressure-lowering and nitric oxide-raising effects should be attributed to the red wine polyphenols and not to alcohol, which seems to counteract the effects of the nonalcoholic fraction of red wine," Estruch and colleagues wrote. "The daily consumption of dealcoholized red wine could be useful for the prevention of low-to-moderate hypertension," they concluded.

Moderate alcohol consumption has been associated with reduced cardiovascular risk, and red wine in particular is believed to be protective because of the high polyphenol content.

In vitro and experimental studies have suggested that the polyphenols found in red wine might lower blood pressure and increase endothelial nitric oxide, but the effects in humans had remained unclear.

The current study included 67 men (mean age 60) who had a high cardiovascular risk, defined as the presence of diabetes or at least three cardiovascular risk factors. After a 2-week, alcohol-free, run-in period, the men were randomized to complete three 4-week intervention periods -- without washout periods in between -- while maintaining a constant diet:

• 30 grams of alcohol per day in the form of red wine (about 9 ounces)
• About 9 ounces of nonalcoholic red wine per day
• 30 grams of alcohol per day in the form of gin (about 3.4 ounces)

The nonalcoholic and alcoholic red wines contained similar amounts of polyphenols. Gin does not contain polyphenols. During the study, there were no significant changes in body mass index, waist-to-hip ratio, or heart rate. The only significant changes observed were in systolic and diastolic blood pressure and plasma nitric oxide when the men were consuming nonalcoholic red wine. The researchers found significant differences in blood pressure and nitric oxide when comparing the nonalcoholic red wine group with the gin group. 

Although the reduction in blood pressure with nonalcoholic red wine was modest, decreases of 4 or 2 mm Hg in systolic or diastolic blood pressure, respectively, have been associated with a 14% relative reduction in the risk of coronary heart disease and a 20% relative reduction in stroke risk, lending clinical significance to the findings, according to the authors. The results of the study were largely the same when excluding individuals with hypertension and those taking antihypertensives, the researchers reported.

They acknowledged some limitations of the study, including the lack of information on the effects of longer-term consumption of the various drinks, the lack of measurements of endothelial function, and the inability to pinpoint the specific substances in red wine responsible for the observed effects.

Tomado de MedPage Today