Management of early renal failure helps in the reduction or prevention of end-stage renal disease. The monitoring of renal function is discussed, and the chapter includes a table that shows commonly used methods for monitoring. Risk factors for chronic renal failure include stroke and cardiac disease. Risk factors for renal disease progression are diabetes mellitus, hypertension, proteinuria, smoking, protein intake, and hyperlipidemia. Complications of chronic renal failure that are addressed include sodium and water imbalance, potassium imbalance, acidosis, calcium and phosphorus imbalance, and anemia. There is also a section that discusses the case for early referral to a nephrologist. Tables present the equations used to estimate the glomerular filtration rate (GFR); stages of chronic kidney disease and the appropriate steps in their management; risk factors for chronic kidney disease in which the testing of proteinuria and estimation of GFR are indicated; appropriate diet for patients who have chronic kidney disease; and guidelines for diagnosing and treating anemia resulting from chronic kidney disease. An algorithm outlines the steps in management of calcium and phosphate in patients with kidney disease. This review contains 3 figures, 10 tables and 50 references Key Words End-stage renal disease, chronic kidney disease, glomerular filtration rate, Modification of Diet in Renal Disease, Proteinuric renal disease, Hyperuricemia
{"title":"Management of Chronic Kidney Disease and its Complications","authors":"Joshua S. Hundert, Ajay K. Singh","doi":"10.2310/im.1053","DOIUrl":"https://doi.org/10.2310/im.1053","url":null,"abstract":"Management of early renal failure helps in the reduction or prevention of end-stage renal disease. The monitoring of renal function is discussed, and the chapter includes a table that shows commonly used methods for monitoring. Risk factors for chronic renal failure include stroke and cardiac disease. Risk factors for renal disease progression are diabetes mellitus, hypertension, proteinuria, smoking, protein intake, and hyperlipidemia. Complications of chronic renal failure that are addressed include sodium and water imbalance, potassium imbalance, acidosis, calcium and phosphorus imbalance, and anemia. There is also a section that discusses the case for early referral to a nephrologist. Tables present the equations used to estimate the glomerular filtration rate (GFR); stages of chronic kidney disease and the appropriate steps in their management; risk factors for chronic kidney disease in which the testing of proteinuria and estimation of GFR are indicated; appropriate diet for patients who have chronic kidney disease; and guidelines for diagnosing and treating anemia resulting from chronic kidney disease. An algorithm outlines the steps in management of calcium and phosphate in patients with kidney disease.\u0000\u0000This review contains 3 figures, 10 tables and 50 references\u0000Key Words End-stage renal disease, chronic kidney disease, glomerular filtration rate, Modification of Diet in Renal Disease, Proteinuric renal disease, Hyperuricemia","PeriodicalId":11220,"journal":{"name":"DeckerMed Medicine","volume":"33 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91495751","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Delivering bad news is a critical part of the patient-physician relationship. Historically, physicians have withheld or incompletely related the diagnosis and prognosis of a patient’s disease. However, the trajectory of medical practice and patient expectations mandates a change in communicating bad news. Poor communication of bad news also affects physician job satisfaction and increases burnout. Empathy is crucial to communicating bad news well. It is a very complex emotion that requires the physician to identify the patient’s reaction to the news being delivered and to react to the patient in a supportive manner. Patients do not find it helpful when the physician underplays the bad part of the news. Emerging research shows that patients prefer pairing of bad news with hope to provide anchors in the overwhelming conversation but not to take away from the gravity of the news. Family and friends can help ameliorate or, unfortunately, augment patient anxiety. Physicians have to be cognizant of the dynamics family and friends bring to the interaction as well. A patient-centered approach—a combination of evidence-based medicine and patient goal-oriented medicine—to delivering bad news is most likely to benefit the patient-physician relationship and decision-making process. The SPIKES and the Expanded Four Habits Model can be used as guidelines for communicating bad news. This review contains 1 figure and 38 references. Key words: communicating bad news, empathy, Expanded Four Habits Model, patient-centered care, SPIKES
{"title":"Communication of Bad News","authors":"P. Mohabir, P. Balakrishnan","doi":"10.2310/im.8024","DOIUrl":"https://doi.org/10.2310/im.8024","url":null,"abstract":"Delivering bad news is a critical part of the patient-physician relationship. Historically, physicians have withheld or incompletely related the diagnosis and prognosis of a patient’s disease. However, the trajectory of medical practice and patient expectations mandates a change in communicating bad news. Poor communication of bad news also affects physician job satisfaction and increases burnout. Empathy is crucial to communicating bad news well. It is a very complex emotion that requires the physician to identify the patient’s reaction to the news being delivered and to react to the patient in a supportive manner. Patients do not find it helpful when the physician underplays the bad part of the news. Emerging research shows that patients prefer pairing of bad news with hope to provide anchors in the overwhelming conversation but not to take away from the gravity of the news. Family and friends can help ameliorate or, unfortunately, augment patient anxiety. Physicians have to be cognizant of the dynamics family and friends bring to the interaction as well. A patient-centered approach—a combination of evidence-based medicine and patient goal-oriented medicine—to delivering bad news is most likely to benefit the patient-physician relationship and decision-making process. The SPIKES and the Expanded Four Habits Model can be used as guidelines for communicating bad news.\u0000This review contains 1 figure and 38 references.\u0000Key words: communicating bad news, empathy, Expanded Four Habits Model, patient-centered care, SPIKES","PeriodicalId":11220,"journal":{"name":"DeckerMed Medicine","volume":"4 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78960613","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
In this review, we provide an overview of the most current evidence on the prevalence, risk factors, and consequences of medication non-adherence (NA) in liver transplant recipients. Despite the improvement in long-term liver transplantation outcomes, medication NA is the leading cause of graft failure, graft rejection, and poor clinical outcomes. We examine methods of measuring NA as well as interventions that have been carried out to improve medication adherence and posttransplantation outcomes. Common risk factors for NA include low social support, medication-related factors (eg. side effects), regimen complexity, younger age, financial barriers, and low literacy. Additionally, we discuss special at-risk populations with pretransplantation substance abuse or psychiatric comorbidities as well as adolescents making a transition into adulthood and independent self-care. Multifaceted interventions that are personalized and specific to identified adherence barriers for high-risk groups seem to be the most promising approach to improve medication NA and posttransplantation outcomes. This review contains 4 figures, 5 tables, and 53 references Key Words: electronic monitoring, immunosuppression, liver transplantation, medication, nonadherence, noncompliance, tacrolimus standard deviation, transplantation outcomes
{"title":"Adherence to Posttransplantation Medical Regimen","authors":"Lauren S. Jones, M. Serper","doi":"10.2310/im.14060","DOIUrl":"https://doi.org/10.2310/im.14060","url":null,"abstract":"In this review, we provide an overview of the most current evidence on the prevalence, risk factors, and consequences of medication non-adherence (NA) in liver transplant recipients. Despite the improvement in long-term liver transplantation outcomes, medication NA is the leading cause of graft failure, graft rejection, and poor clinical outcomes. We examine methods of measuring NA as well as interventions that have been carried out to improve medication adherence and posttransplantation outcomes. Common risk factors for NA include low social support, medication-related factors (eg. side effects), regimen complexity, younger age, financial barriers, and low literacy. Additionally, we discuss special at-risk populations with pretransplantation substance abuse or psychiatric comorbidities as well as adolescents making a transition into adulthood and independent self-care. Multifaceted interventions that are personalized and specific to identified adherence barriers for high-risk groups seem to be the most promising approach to improve medication NA and posttransplantation outcomes.\u0000\u0000This review contains 4 figures, 5 tables, and 53 references\u0000\u0000Key Words: electronic monitoring, immunosuppression, liver transplantation, medication, nonadherence, noncompliance, tacrolimus standard deviation, transplantation outcomes","PeriodicalId":11220,"journal":{"name":"DeckerMed Medicine","volume":"40 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88816174","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The medical management of pulmonary arterial hypertension (PAH) has advanced considerably over the years. Once the diagnosis of PAH is made, the medical management includes both conventional and PAH-pathway specific therapies. Five different classes of drugs are now available targeting the endothelin, prostacyclin, and nitric oxide pathways (i.e. endothelin receptor antagonists, phosphodiesterase-5 inhibitors, soluble guanylate cyclase stimulators, prostacyclin analogues, and prostacyclin receptor agonists). These targeted therapies are approved for treatment of patients with PAH and chronic thromboembolic pulmonary hypertension (CTEPH) only. Long-term and event-driven studies of novel drugs have led to further improvement in the medical management of PAH and CTEPH. In this review, we will focus on the medical management of patients with PAH and CTEPH. This review contains 4 figures, 6 Tables and 30 references Keywords: Pulmonary arterial hypertension, Chronic thromboembolic pulmonary hypertension, Medical management, Pulmonary vasodilators, Phosphodiesterase inhibitor, Soluble guanylate cyclase stimulator, Endothelin receptor antagonist, Prostacyclin receptor agonist
{"title":"Medical Management of Pulmonary Arterial Hypertension","authors":"I. Singh, A. Waxman","doi":"10.2310/im.1646","DOIUrl":"https://doi.org/10.2310/im.1646","url":null,"abstract":"The medical management of pulmonary arterial hypertension (PAH) has advanced considerably over the years. Once the diagnosis of PAH is made, the medical management includes both conventional and PAH-pathway specific therapies. Five different classes of drugs are now available targeting the endothelin, prostacyclin, and nitric oxide pathways (i.e. endothelin receptor antagonists, phosphodiesterase-5 inhibitors, soluble guanylate cyclase stimulators, prostacyclin analogues, and prostacyclin receptor agonists). These targeted therapies are approved for treatment of patients with PAH and chronic thromboembolic pulmonary hypertension (CTEPH) only. Long-term and event-driven studies of novel drugs have led to further improvement in the medical management of PAH and CTEPH. In this review, we will focus on the medical management of patients with PAH and CTEPH.\u0000\u0000This review contains 4 figures, 6 Tables and 30 references\u0000\u0000Keywords: Pulmonary arterial hypertension, Chronic thromboembolic pulmonary hypertension, Medical management, Pulmonary vasodilators, Phosphodiesterase inhibitor, Soluble guanylate cyclase stimulator, Endothelin receptor antagonist, Prostacyclin receptor agonist","PeriodicalId":11220,"journal":{"name":"DeckerMed Medicine","volume":"5 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74787260","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Populations that consume more dietary fiber have less chronic disease. According to the 2002 Dietary Reference Intakes (DRIs), dietary fiber includes carbohydrates and lignin that are intrinsic and intact in plants that are not digested and absorbed in the small intestine. Functional fiber consists of isolated or purified carbohydrates that are not digested and absorbed in the small intestine that confer beneficial physiologic effects in humans. Total fiber is the sum of dietary fiber and functional fiber. Fibers alter laxation, attenuate the rise in blood glucose, and normalize blood cholesterol. The solubility of fibers was originally thought to determine physiologic properties, with soluble fiber linked to cholesterol-lowering properties and insoluble fiber linked to laxation effects. The DRI Committee recommended that other descriptors for fiber be developed, suggesting viscosity and fermentability. Manufacturers are allowed to list total dietary fiber, soluble fiber, and insoluble fiber on the Nutrition Facts panel. DRIs recommend consumption of 14 g of dietary fiber per 1,000 kcal based on epidemiologic studies showing protection against cardiovascular disease. Usual intake of dietary fiber is only 15 g/day. Even with a fiber-rich diet, a supplement may be needed to bring fiber intakes into the recommended range. Dietary messages to increase consumption of high-fiber foods such as whole grains, pulses, fruits, and vegetables should be broadly supported by the medical profession. This review contains 3 Tables and 38 references Key words: constipation, diarrhea, dietary fiber, health claims, laxatives, plant foods, stool weight, transit time
{"title":"Fiber and Nutritional Health","authors":"J. Slavin","doi":"10.2310/im.9007","DOIUrl":"https://doi.org/10.2310/im.9007","url":null,"abstract":"Populations that consume more dietary fiber have less chronic disease. According to the 2002 Dietary Reference Intakes (DRIs), dietary fiber includes carbohydrates and lignin that are intrinsic and intact in plants that are not digested and absorbed in the small intestine. Functional fiber consists of isolated or purified carbohydrates that are not digested and absorbed in the small intestine that confer beneficial physiologic effects in humans. Total fiber is the sum of dietary fiber and functional fiber. Fibers alter laxation, attenuate the rise in blood glucose, and normalize blood cholesterol. The solubility of fibers was originally thought to determine physiologic properties, with soluble fiber linked to cholesterol-lowering properties and insoluble fiber linked to laxation effects. The DRI Committee recommended that other descriptors for fiber be developed, suggesting viscosity and fermentability. Manufacturers are allowed to list total dietary fiber, soluble fiber, and insoluble fiber on the Nutrition Facts panel. DRIs recommend consumption of 14 g of dietary fiber per 1,000 kcal based on epidemiologic studies showing protection against cardiovascular disease. Usual intake of dietary fiber is only 15 g/day. Even with a fiber-rich diet, a supplement may be needed to bring fiber intakes into the recommended range. Dietary messages to increase consumption of high-fiber foods such as whole grains, pulses, fruits, and vegetables should be broadly supported by the medical profession.\u0000 \u0000This review contains 3 Tables and 38 references\u0000\u0000Key words: constipation, diarrhea, dietary fiber, health claims, laxatives, plant foods, stool weight, transit time","PeriodicalId":11220,"journal":{"name":"DeckerMed Medicine","volume":"27 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84416058","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Many of today’s healthy adults will be plagued by chronic diseases, such as obesity, hypertension, heart disease, and diabetes, and be robbed of the quality of life they desire. According to the 2015–2020 Dietary Guidelines for Americans, about half of all American adults have one or more diet-related chronic diseases. The question, “What should healthy adults eat to stay healthy?” may seem simple. However, many primary care providers feel vulnerable answering questions about nutrition. This review serves as a summary of the most up-to-date guidelines about added sugars, sodium, types of fat, and cholesterol for healthy adults and a refresher for health care providers caring for them. Other important related issues, such as the latest recommendations for physical activity, the problem of adult weight gain, the need for adiposity screening, the powerful role of the primary care provider, and suggestions nutrition-focused primary care, are discussed. This review contains 5 Figures, 5 Tables and 137 references Key words: weight gain, cholesterol, Dietary Guidelines, sugar-sweetened beverages, adiposity, added sugar, hydrogenated oils, physical activity, waist-to-height ratio, nutrition-focused, Primary Care
{"title":"Nutrition for the Healthy Adult","authors":"Marijane G. Staniec","doi":"10.2310/im.9015","DOIUrl":"https://doi.org/10.2310/im.9015","url":null,"abstract":"Many of today’s healthy adults will be plagued by chronic diseases, such as obesity, hypertension, heart disease, and diabetes, and be robbed of the quality of life they desire. According to the 2015–2020 Dietary Guidelines for Americans, about half of all American adults have one or more diet-related chronic diseases. The question, “What should healthy adults eat to stay healthy?” may seem simple. However, many primary care providers feel vulnerable answering questions about nutrition. This review serves as a summary of the most up-to-date guidelines about added sugars, sodium, types of fat, and cholesterol for healthy adults and a refresher for health care providers caring for them. Other important related issues, such as the latest recommendations for physical activity, the problem of adult weight gain, the need for adiposity screening, the powerful role of the primary care provider, and suggestions nutrition-focused primary care, are discussed.\u0000\u0000This review contains 5 Figures, 5 Tables and 137 references\u0000Key words: weight gain, cholesterol, Dietary Guidelines, sugar-sweetened beverages, adiposity, added sugar, hydrogenated oils, physical activity, waist-to-height ratio, nutrition-focused, Primary Care","PeriodicalId":11220,"journal":{"name":"DeckerMed Medicine","volume":"21 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81184917","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Amanda K. Barks, P. Tran, M. Georgieff, Anne M. Maliszewski-Hall
Accumulating evidence suggests that the early-life environment has lasting effects on health and disease into adulthood. The current concept of developmental origins of adulthood disease has expanded beyond the original observation by Barker and colleagues correlating low birth weight with adulthood cardiovascular and metabolic disorders. Notably, the fetal-neonatal nutritional environment has a significant role in influencing an individual’s wellness in adulthood. During critical periods of fetal and neonatal development, tissues and organ systems are most vulnerable to nutrient deficiencies. Through fetal programming mechanisms such as epigenetic modification, a biochemical process that regulates gene expression without altering the genetic code, developing tissues adapt to nutrient-poor environments to preserve normal development of critical organ systems, including the brain. However, these programmed adaptations can have negative long-term health consequences if the postnatal environment does not match the fetal-neonatal environment in which the programming occurred. These long-term adverse health outcomes constitute the true cost to society, in both increased medical costs and the indirect cost of lost productivity. Here we review the effects of nutrient deficiencies on fetal programming and subsequent health outcomes, as well as the potential mechanisms that underlie fetal programming. This review contains 3 Figures, 2 Tables and 115 references Key words: critical period, epigenetics, fetal programming, iron, long-chain polyunsaturated fatty acids, neurodevelopment, nutrient deficiency, protein-energy, vitamins, zinc
{"title":"Nutrition and Fetal Origins of Diseases in Adults","authors":"Amanda K. Barks, P. Tran, M. Georgieff, Anne M. Maliszewski-Hall","doi":"10.2310/im.9016","DOIUrl":"https://doi.org/10.2310/im.9016","url":null,"abstract":"Accumulating evidence suggests that the early-life environment has lasting effects on health and disease into adulthood. The current concept of developmental origins of adulthood disease has expanded beyond the original observation by Barker and colleagues correlating low birth weight with adulthood cardiovascular and metabolic disorders. Notably, the fetal-neonatal nutritional environment has a significant role in influencing an individual’s wellness in adulthood. During critical periods of fetal and neonatal development, tissues and organ systems are most vulnerable to nutrient deficiencies. Through fetal programming mechanisms such as epigenetic modification, a biochemical process that regulates gene expression without altering the genetic code, developing tissues adapt to nutrient-poor environments to preserve normal development of critical organ systems, including the brain. However, these programmed adaptations can have negative long-term health consequences if the postnatal environment does not match the fetal-neonatal environment in which the programming occurred. These long-term adverse health outcomes constitute the true cost to society, in both increased medical costs and the indirect cost of lost productivity. Here we review the effects of nutrient deficiencies on fetal programming and subsequent health outcomes, as well as the potential mechanisms that underlie fetal programming.\u0000This review contains 3 Figures, 2 Tables and 115 references\u0000Key words: critical period, epigenetics, fetal programming, iron, long-chain polyunsaturated fatty acids, neurodevelopment, nutrient deficiency, protein-energy, vitamins, zinc","PeriodicalId":11220,"journal":{"name":"DeckerMed Medicine","volume":"3 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82912590","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Nutrition interventions are often designed to influence energy balance, ultimately optimizing the health of individuals or groups. Goals include weight loss in obese and overweight individuals or weight gain in growing children, pregnant women, and the underweight. In some cases, weight maintenance is the intention for healthy weight adults or children who have the opportunity to grow into their current weight. Determining the energy requirements for each person can help explain the presence or absence of weight changes and direct subsequent nutrition goals and interventions. Quantifying energy requirements also helps to avoid over- and under- feeding. This is particularly relevant in people suffering from acute or chronic disease or illness. In the acute care setting overfeeding can worsen metabolic disturbances including, but not limited to, hyperglycemia and hypercarbia while underfeeding can negatively impact immunity, organ function, and activities of daily living. This review contains 3 Figures, 5 Tables and 66 references Key words: nutrition, energy expenditure, body composition, calorimetry, bioelectrical impedance analysis (BIA), doubly-labeled water (DLW), reverse Fick equation, Harris-Benedict equation, Millfin-St. Jeor Equation, Owen Equation, Ireton-Jones Equations, Penn State Equations, hypocaloric feeding
{"title":"Determination of Energy Expenditure","authors":"Grace Phelan","doi":"10.2310/im.9004","DOIUrl":"https://doi.org/10.2310/im.9004","url":null,"abstract":"Nutrition interventions are often designed to influence energy balance, ultimately optimizing the health of individuals or groups. Goals include weight loss in obese and overweight individuals or weight gain in growing children, pregnant women, and the underweight. In some cases, weight maintenance is the intention for healthy weight adults or children who have the opportunity to grow into their current weight. Determining the energy requirements for each person can help explain the presence or absence of weight changes and direct subsequent nutrition goals and interventions. Quantifying energy requirements also helps to avoid over- and under- feeding. This is particularly relevant in people suffering from acute or chronic disease or illness. In the acute care setting overfeeding can worsen metabolic disturbances including, but not limited to, hyperglycemia and hypercarbia while underfeeding can negatively impact immunity, organ function, and activities of daily living.\u0000This review contains 3 Figures, 5 Tables and 66 references\u0000Key words: nutrition, energy expenditure, body composition, calorimetry, bioelectrical impedance analysis (BIA), doubly-labeled water (DLW), reverse Fick equation, Harris-Benedict equation, Millfin-St. Jeor Equation, Owen Equation, Ireton-Jones Equations, Penn State Equations, hypocaloric feeding","PeriodicalId":11220,"journal":{"name":"DeckerMed Medicine","volume":"78 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82476753","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Excess body weight is a risk factor for most cancers. Furthermore, obesity is associated with worsened prognosis after a cancer diagnosis and negatively affects the delivery of systemic therapy, contributes to morbidity of cancer treatment, and may raise the risk of second malignancies and comorbidities. However, an obesity paradox may be occurring in patients with cancer; this paradox has been observed when cancer patients with an elevated body mass index (BMI) have improved survival compared with normal-weight patients, and this has been observed in a variety of cancer patients. The reliance on BMI as a measure of body fatness has limitations in the cancer population; hence, the use of tools that directly measure body fat may be more predictive of cancer risk. Despite public health recommendations for achieving and maintaining a healthy weight for cancer prevention and survivorship, few studies have evaluated the effect of intentional body weight loss on cancer risk, although the evidence is suggestive of a relationship. Future research needs to elucidate if weight loss after a cancer diagnosis decreases the risk of recurrence and mortality, and if so, how much weight loss is needed. This review contains 4 figures, 1 table and 65 references Key words: body weight, cancer, interventions, lifestyle, morbidity, mortality, obesity, prevention, risk, sedentary, survivorship, weight loss
{"title":"Energy Balance, Exercise, and Cancer Risk","authors":"E. Trujillo","doi":"10.2310/im.9076","DOIUrl":"https://doi.org/10.2310/im.9076","url":null,"abstract":"Excess body weight is a risk factor for most cancers. Furthermore, obesity is associated with worsened prognosis after a cancer diagnosis and negatively affects the delivery of systemic therapy, contributes to morbidity of cancer treatment, and may raise the risk of second malignancies and comorbidities. However, an obesity paradox may be occurring in patients with cancer; this paradox has been observed when cancer patients with an elevated body mass index (BMI) have improved survival compared with normal-weight patients, and this has been observed in a variety of cancer patients. The reliance on BMI as a measure of body fatness has limitations in the cancer population; hence, the use of tools that directly measure body fat may be more predictive of cancer risk. Despite public health recommendations for achieving and maintaining a healthy weight for cancer prevention and survivorship, few studies have evaluated the effect of intentional body weight loss on cancer risk, although the evidence is suggestive of a relationship. Future research needs to elucidate if weight loss after a cancer diagnosis decreases the risk of recurrence and mortality, and if so, how much weight loss is needed.\u0000\u0000This review contains 4 figures, 1 table and 65 references\u0000Key words: body weight, cancer, interventions, lifestyle, morbidity, mortality, obesity, prevention, risk, sedentary, survivorship, weight loss","PeriodicalId":11220,"journal":{"name":"DeckerMed Medicine","volume":"182 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77542846","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Classification of spondyloarthritis (SpA) is aimed at including patients with radiographic evidence of sacroiliitis and those with early disease who do not yet meet radiographic criteria but have positive features on magnetic resonance imaging (MRI). Most studies report a prevalence of SpA of 0.1 to 0.6%. Human leukocyte antigen (HLA)-B27 contributes approximately 20% of the heritability of SpA, and non–major histocompatibility complex loci identified to date (n = 113) contribute another approximately 10%. To date, 160 subtypes of HLA-B*27 have been reported, although population-based disease association studies are limited to only a few subtypes. Subtypes HLA-B*27:05 and HLA-B*27:04 are examples of subtypes associated with disease, whereas HLA-B*27:06 and HLA-B*27:09 are nonassociated. Properties of the B27 molecule relevant to pathogenesis include antigen presentation, propensity to misfold, and formation of homodimers. Key pathways identified by genetic studies include the interleukin (IL)-23 and M1-aminopeptidase pathways. The latter pathway is involved in peptide trimming in the endoplasmic reticulum, changing both the length and amino acid composition of peptides available for HLA class I presentation. IL-23 is a key cytokine regulating expression of IL-17 in a specific T helper cell phenotype, Th17, and also a variety of cells of the innate immune system. The IL-23–IL-17 pathway has been directly implicated in inflammation at sites that are inflamed in SpA. Increasing evidence based on prospective clinical and imaging data supports a link between inflammation and ankylosis, especially if the resolution of inflammation is followed by the appearance of a particular type of reparative tissue, namely, fat metaplasia, on T1-weighted MRI. This review contains 8 figures, 5 tables and 33 references Key words: association, classification, genetics, heritability, innate immunity, prevalence, spondyloarthritis
{"title":"Seronegative Spondyloarthritis: Epidemiology, Pathogenesis, And Pathology","authors":"W. Maksymowych","doi":"10.2310/im.1592","DOIUrl":"https://doi.org/10.2310/im.1592","url":null,"abstract":"Classification of spondyloarthritis (SpA) is aimed at including patients with radiographic evidence of sacroiliitis and those with early disease who do not yet meet radiographic criteria but have positive features on magnetic resonance imaging (MRI). Most studies report a prevalence of SpA of 0.1 to 0.6%. Human leukocyte antigen (HLA)-B27 contributes approximately 20% of the heritability of SpA, and non–major histocompatibility complex loci identified to date (n = 113) contribute another approximately 10%. To date, 160 subtypes of HLA-B*27 have been reported, although population-based disease association studies are limited to only a few subtypes. Subtypes HLA-B*27:05 and HLA-B*27:04 are examples of subtypes associated with disease, whereas HLA-B*27:06 and HLA-B*27:09 are nonassociated. Properties of the B27 molecule relevant to pathogenesis include antigen presentation, propensity to misfold, and formation of homodimers. Key pathways identified by genetic studies include the interleukin (IL)-23 and M1-aminopeptidase pathways. The latter pathway is involved in peptide trimming in the endoplasmic reticulum, changing both the length and amino acid composition of peptides available for HLA class I presentation. IL-23 is a key cytokine regulating expression of IL-17 in a specific T helper cell phenotype, Th17, and also a variety of cells of the innate immune system. The IL-23–IL-17 pathway has been directly implicated in inflammation at sites that are inflamed in SpA. Increasing evidence based on prospective clinical and imaging data supports a link between inflammation and ankylosis, especially if the resolution of inflammation is followed by the appearance of a particular type of reparative tissue, namely, fat metaplasia, on T1-weighted MRI.\u0000\u0000This review contains 8 figures, 5 tables and 33 references\u0000Key words: association, classification, genetics, heritability, innate immunity, prevalence, spondyloarthritis","PeriodicalId":11220,"journal":{"name":"DeckerMed Medicine","volume":"51 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72561204","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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