Lifestyle factors, dietary patterns, and social determinants of social and eating jetlag: A cross-sectional survey

Social jetlag (SJL) and, more recently, eating jetlag have been linked with an increased risk of non-communicable diseases. Here we aim to investigate lifestyle factors (diet, eating behavior, smoking, perceived stress, time spent sedentary/day) and social determinants (education level, employment status, and place of residence) associated with SJL corrected for sleep duration (SJLsc) and eating jetlag. Self-declared data on age, gender, lifestyle, and eating behavior were collected online from March 2021 to February 2022 of 432 adults. Principal component analysis was used to extract three dietary patterns (Prudent, Western, and Risky). Prevalence of SJLsc was 35.2%, with no significant difference between men and women (p = 0.558). Adults with SJLsc had significantly larger eating jetlag (56.0 min vs 41.2 min, p = 0.001). Increasing SJLsc duration was associated with an increased adherence to a Risky dietary pattern (standardized β coefficient = .165, p = 0.012); increasing eating jetlag duration was associated with an increased adherence to a Western dietary pattern (standardized β coefficient = .127, p = 0.039) and a shorter sleep duration (standardized βcoefficient = -0.147, p = 0.011). Among social determinants analyzed, only being a student or employed was associated with eating jetlag (standardized β coefficient = 0.125, p = 0.044), while none displayed any relationship with SJLsc. Our survey provides evidence on a risky behavior among young persons with SJLsc and eating jetlag, characterized by a higher alcohol consumption, and a diet rich in processed meat and high-fat food, eating during nights, and shorter sleep duration with potential long-term negative health outcomes.

Translation, cultural adaptation and validation of the revised patients' attitudes towards deprescribing (rPATD) questionnaire in Romanian older adults

BACKGROUND

Deprescribing is part of ensuring appropriate medication use and may reduce medication-related harm. Capturing the beliefs and attitudes of patients towards deprescribing by using a validated tool may support optimizing medication use in practice.

OBJECTIVES

To translate, culturally adapt and validate the revised Patients' Attitudes Towards Deprescribing (rPATD) questionnaire in Romanian and to investigate the attitudes and beliefs of older adults towards deprescribing.

METHODS

The rPATD questionnaire was translated using forward-backward translation into Romanian and culturally adapted. The psychometric properties were evaluated in older adults ≥65 years of age. Structural validity was assessed by item load on factors using an exploratory factor analysis (EFA) which was compared to the original English version and the internal consistency by Cronbach's alpha. Construct validity was evaluated by calculating the Spearman's rank correlation coefficients between the factor scores obtained using the revised version of the Romanian rPATD and scores on the Beliefs about Medicines Questionnaire (BMQ) Specific Concerns Romanian version. Floor and ceiling effect were also examined.

RESULTS

We translated the questionnaire and administered it to 224 participants (median age 72 years [interquartile range: 68.0; 77.0]). In the EFA individual items loaded onto 4 factors, grouped similarly to the English version (Involvement, Burden, Appropriateness, Concerns about Stopping factors). Two items from each of the Involvement and Appropriateness factors were removed to improve factor loading and avoid cross-loading. The Cronbach's alpha values for the 4 factors ranged between 0.522 and 0.773. The scores for Burden and Concerns about Stopping factors were found to be positively correlated with BMQ Specific Concerns score. We identified a ceiling effect for one of the four factors (Involvement) and no floor effects.

CONCLUSIONS

The Romanian rPATD was validated in 4 factor structure similar to the original English questionnaire. The Romanian version of the questionnaire may support the health care professionals in Romania to initiate and support patient-centered deprescribing.

Chronic disruption of circadian rhythm with mistimed sleep and appetite - an exploratory research

This research aimed to explore the relation of social jetlag (SJL) with perceived appetite, and hormones involved in hunger regulation in healthy subjects in free-living conditions (study registration number: ACTRN12618001182280). Eighty normally diurnally active men and women were enrolled in 4 study groups according to the presence of SJL and sleep deprivation (2 groups with SJL with or without sleep deprivations and 2 groups without SJL with or without sleep deprivation) matched 1:1:1:1 for age, gender, and body mass index. Appetite was assessed in fasting state, by measuring acylated ghrelin level and using 100 mm visual analog scales. Persons with SJL had a higher perceived appetite for pork, poultry, fish, eggs, milk, and dairy products and higher acylated ghrelin levels than those without SJL. When considering the presence of sleep deprivation, subjects with SJL, with and without sleep deprivation, reported a higher perceived appetite than group with sleep deprivation alone. They also reported later meal times for lunch and dinner, had more frequently a snack before sleep and reported eating more frequently while watching TV or playing on computer, suggesting poorer eating habits in these subjects. In conclusion, independent of sleep duration, SJL is associated with an increased appetite for caloric dense food, suggesting an increased incentive value of food in these subjects and an anticipated pleasure of ingesting these foods.

Uric Acid and Arterial Stiffness

Hyperuricemia is usually associated with hypertension, diabetes mellitus, metabolic syndrome and chronic kidney disease. Accumulating data from epidemiological studies indicate an association of increased uric acid (UA) with cardiovascular diseases. Possible pathogenic mechanisms include enhancement of oxidative stress and systemic inflammation caused by hyperuricemia. Arterial stiffness may be one of the possible pathways between hyperuricemia and cardiovascular disease, but a clear relationship between increased UA and vascular alterations has not been confirmed. The review summarizes the epidemiological studies investigating the relationship between UA and arterial stiffness and highlights the results of interventional studies evaluating arterial stiffness parameters in patients treated with UA-lowering drugs.

Pain in bilateral knee osteoarthritis - correlations between clinical examination, radiological, and ultrasonographical findings

AIMS

The aim of the study was to evaluate the correlations between clinical symptoms (pain), physical examination, ultrasound (US), and radiological findings in patients with bilateral knee osteoarthritis (OA).

MATERIAL AND METHODS

Knee pain was appreciated during medial and lateral palpation of each knee joint and using visual analogue scale (VAS) and The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). US evaluation (osteophytes, meniscal protrusion, synovial fluid, femoral hyaline cartilage thickness) and radiological assessment (osteophytes, femoral-tibial space, Kellgren-Lawrence [K-L] score, enthesopathies) were performed by two examiners blinded to the clinical results and to each other. All these findings were scored with a five-point scale.

RESULTS

A total of 52 consecutive patients aged 63.44+/-9.49 were examined, 33 (80.5%) being females. In patients with bilateral knee OA the pain, evaluated by WOMAC score and VAS, was correlated with the presence of osteophytes and cartilage thickness but no association with medial meniscal protrusion and effusion was demonstrated. Pain produced by palpation of the knee was strongly associated with the presence of medial osteophytes. VAS and WOMAC scores increased with the severity of radiological and US findings. The presence of osteophytes and articular cartilage damage at US examination were strongly and positively correlated with radiological K-L score. US examiners agreement was good for osteophytes and moderate for meniscal protrusion, cartilage damage, and synovial fluid. The cartilage damage score was the only independent predictor for VAS scale; for WOMAC score the sex, cartilage damage, the presence of medial osteophytes and lateral meniscal protrusion were the independent predictors.

CONCLUSION

Pain intensity was correlated with the severity of US findings, cartilage damage score being an independent predictor for both VAS and WOMAC scores. Medial osteophytes and lateral meniscal protrusion and are independent predictors for WOMAC score.

Fenofibrate improves endothelial function and plasma myeloperoxidase in patients with type 2 diabetes mellitus: an open-label interventional study

BACKGROUND

Fenofibrate offers a number of benefits on the cardiovascular system and it is plausible that its anti-inflammatory, anti-oxidant and anti-fibrotic effects and enhancement of cardiac metabolic performances may account for its direct cardioprotective effects.In this study we aimed to investigate the effect of fenofibrate on endothelial function assesed by vascular studies and levels of soluble E-selectin (sE-selectin) as well as the effect on plasma myeloperoxidase (MPO) in patients with type 2 diabetes mellitus (T2DM) without previous use of lipid-lowering medication.

METHODS

27 patients (14 men and 13 women) with T2DM and good glycemic control (HbA1c: min 5.9%, max: 7.1%) treated with metformin monotherapy, without previous use of lipid-lowering medication were enrolled in this study. Vascular studies included measures of brachial artery diameter before and after release of a suprasystolic ischemia. FMD was calculated as the percent (%) change in arterial diameter following reactive hyperemia. Student's paired t test and Wilcoxon Signed Ranks Test were used to compare values before and after fenofibrate therapy.

RESULTS

Fenofibrate therapy significantly increased post ischemia mean brachial artery diameter at 60 s (from 4.7 [4.4; 5.0] mm to 4.9 [4.6; 5.2] mm, p = 0.01) and at 90 s (from 4.7 [4.4; 5.0] mm to 4.9 [4.6; 5.1], p = 0.02). FMD response to hyperaemia at 60 s increased with 4.5 ± 13.7% (median value pre- treatment: 22.2%, median value post- treatment 25.0%, z = -2.9, p = 0.004). After 8 weeks of fenofibrate therapy, plasma MPO levels decreased to 49.5 [30.3; 71.5] ng/ml (% change from baseline = 4.6%, z = -2.2, p = 0.03) and mean plasma sE-selectin levels decreased to 67.1 [54.4; 79.8] ng/ml, (% change from baseline = 2.6%, p = 0.03).

CONCLUSION

In patients with T2DM without previous treatment for dyslipidemia, short-term treatment with fenofibrate improved vascular endothelial function as demonstrated by increased post ischemia mean brachial artery diameter, increased FMD and decreased plasma sE-selectin and favorably affected plasma MPO levels. Therefore, fenofibrate may be considered a protective cardiovascular drug in this group of patients.

TRIAL REGISTRATION

(Australian New Zealand Clinical Trials Registry ANZCTR12612000734864).

Assessing health related quality of life in diabetic patients

INTRODUCTION

The number of people with diabetes mellitus (DM) is increasing. For chronic illnesses such as DM, where there is no cure, it is important to establish that therapy really makes people feel better. The purpose of the study was to analyze the quality of life in a group of diabetic patients without major complications.

SUBJECTS AND METHODS

The study group consisted of 50 patients, males and females, aged 60 (+/- 6), diagnosed with type 2 DM and followed up at an outpatient clinic. The Romanian version of the SF-36 questionnaire was used as a health survey tool to measure the quality of life (QOL) of patients in the study.

RESULTS

Validity (coefficient alpha Cronbach) was > 0.7 for all scales except social functioning. QOL scores for study group were significantly lower compared with general population. Examining the effects of insulin use and QOL, there are no significant differences between patients following insulin therapy and patients with other therapeutic protocols. Role limitations due to emotional problems correlate with disease duration. Statistical analysis demonstrates a significant correlation between energy/fatigue scores and HbA1c. There are no other statistically significant correlations between SF-36 scores and other variables analyzed.

DISCUSSIONS AND CONCLUSIONS

Patients with DM have statistically significant impairment of all aspects of QOL, not simply physical functioning. DM put a substantial burden on affected individuals by influencing physical, psychological and social aspects of QOL. The progressive nature of type 2 DM and the real risk for developing chronic complications certifies that insulin use will be a reality for most diabetic patients, but its use did not seem to have a negative impact upon QOL. Glycemic control becomes an important measurement for preventing long-terms complications and provides a better QOL to diabetic patient. This end-point should be a much more important target for healthcare interventions.

Heart rate variability and diastolic dysfunction in patients with type 2 diabetes mellitus

Cardiovascular autonomic neuropathy is a common form of autonomic dysfunction in diabetes mellitus (DM) and associates abnormalities in heart rate control and in vascular dynamics. This study evaluates the impact of diabetes mellitus on left ventricular diastolic dysfunction (LVDD) and heart rate variability in a group of type 2 diabetes mellitus without signs of cardiovascular disease. The study group consisted of 58 patients, aged 61 ± 8 years, diagnosed with type 2 DM. The subjects were selected from a series of 104 consecutive diabetic patients. All the subjects were on oral therapy or on diet for DM, and ECG was normal for all the subjects. The control group consisted of 45 healthy subjects, matched for age and sex. Heart rate variability was measured using a 24-h ECG monitoring system, and standard 2D and Doppler echocardiography was performed in all the subjects. There are significant differences between groups regarding disease duration, longer in patients with impaired relaxation (11.22 ± 9.17 vs. 8.31 ± 8.95 years), and disease control, worse in impaired relaxation group. Heart rate in impaired relaxation group is significantly higher than in controls, and higher, but not significantly, when compared with normal group (91 ± 10, vs. 88 ± 11 and 71 ± 11, respectively). Cardiac autonomic neuropathy was associated with LVDD in patients with type 2 DM, but without clinically manifest heart disease. Twenty-four-hour ECG monitoring and echocardiography can detect diabetic cardiomyopathy in early stages and should be performed in all subjects.

Vitamin K and vascular calcifications

The role of vitamin K in the synthesis of some coagulation factors is well known. The implication of vitamin K in vascular health was demonstrated in many surveys and studies conducted over the past years on the vitamin K-dependent proteins non-involved in coagulation processes. The vitamin K-dependent matrix Gla protein is a potent inhibitor of the arterial calcification, and may become a non-invasive biochemical marker for vascular calcification. Vitamin K(2) is considered to be more important for vascular system, if compared to vitamin K(1). This paper is reviewing the data from recent literature on the involvement of vitamin K and vitamin K-dependent proteins in cardiovascular health.

Autonomic neuropathy and plasma catecholamine in patients with diabetes mellitus

BACKGROUND

Cardiovascular autonomic neuropathy (CAN) is a common form of autonomic dysfunction in diabetes mellitus (DM) patients, but it can be asymptomatic for years. Low baseline plasma noradrenaline levels have been found in diabetic patients, but this decrease seems to associate clinically severe autonomic neuropathy.

PURPOSE

To evaluate the impact of DM on heart rate variability (HRV) parameters and to determine the correlations with plasma adrenaline and noradrenaline, as a possible mechanism of early disruption in HRV.

METHODS

A group of 34 patients with type 2 diabetes mellitus, without clinical signs of CAN, was enrolled. HRV (as a measure of autonomic balance) was measured using a 24 hour ECG monitoring system in all subjects during normal daily activity. Plasma catecholamines and other laboratory markers were measured.

RESULTS

HRV parameters are lower in DM group as compared with control group. More than half of the patients had HRV parameters below the normal range (54%). There are lower levels of noradrenaline value in DM, as compared with controls, but the difference is not statistically significant (p = 0.08). Adrenaline levels were similar in both groups.

DISCUSSION AND CONCLUSION

CAN is best evaluated using heart rate variability (HRV) on 24 hours recordings. There is a tendency for HRV parameters to decrease even in asymptomatic patients, especially after years of evolution. We did not find significant correlations between HRV and plasma catecholamine, even if noradrenaline was lower in DM patients. Holter monitoring remains a reliable method for early diagnosis of CAN.

Paraneoplastic hypertrophic osteoarthropathy: evaluation at 25 years after pneumectomy

Finger clubbing, which involves distal phalanx thickening and nail convexity, has been known since antiquity. Observations made in modern times by Bamberger (1889), Pierre Marie (1890), and other investigators led to identification of various causes of this digital anomaly which can be the first manifestation of a severe organic disease. Undoubtedly, this somatic abnormality, often associated with arthralgia and bone pain (full-blown hypertrophic osteoarthropathy -- HOA), is most often a harbinger of lung cancer. Paraneoplastic HOA is probably the best known and the most extensively studied paraneoplastic syndrome in human pathology. The familial or idiopathic HOA (pachydermoperiostosis) appears at puberty and is not associated with other underlying diseases. We present the case of a 58-year-old male with HOA, associated with spinocellular lung cancer, who survived 25 years after pneumonectomy.

Health-related quality of life of diabetic patients

Health-related quality of life (HRQOL) provides a multidimensional perspective that encompasses a patient's physical, emotional, and social functioning. Generally, patients with more than one co-morbid condition report the poorest level of HRQOL, but some chronic conditions, like diabetes mellitus, are strongly associated with poor HRQOL. Diabetes mellitus permanently changes a patient's life. Measures of QOL in chronically ill patients provide an important source of medical information in addition to laboratory or diagnostic tests and are becoming increasingly relevant to controlled clinical trials. Different instruments (questionnaires) have been developed to measure the psychological, physical, and social aspects of QOL for diabetes patients.

Cardiovascular autonomic neuropathy in diabetes mellitus

Diabetes mellitus (DM) is a disease of modem world, with a great impact on the life of the affected individual. Autonomic neuropathy (AN), also called visceral neuropathy, is a disease of the autonomic nervous system affecting mostly the internal organs. The diagnosis of AN can be made in early stages, and is called sub-clinical neuropathy. Cardiovascular autonomic neuropathy (CAN) correlates with a lot of signs and symptoms, which are more or less specific. CAN is associated with poor prognosis and may result in severe symptomatic diseases, but it is also associated with silent ischemia. In conclusion, CAN is a very important complication of both type 1 and type 2 diabetes which can be early diagnosed by some specific test and should be taken into account in all the cases, even in the asymptomatic ones.