Adherence of patients with type 2 diabetes mellitus with the SEMDSA lifestyle guidelines

Background: Type 2 diabetes mellitus (T2DM) is considered to be the fastest growing chronic disease in the world and thus multi-sectoral, population-based strategies and approaches are needed to address the modifiable risk factors involved in the development and treatment of T2DM. Evidence-based nutrition principles and recommendations are summarised by the Society for Endocrinology, Metabolism and Diabetes in South Africa (SEMDSA) into guidelines for the management of T2DM. This study aimed to determine the adherence of patients with T2DM with the SEMDSA lifestyle guidelines.Methods: A cross-sectional study was conducted in a private practice (n = 50), during which an interviewer-assisted questionnaire related to socio-demographics, diet and lifestyle was completed with each participant. Participants were also weighed and measured.Results: 88% of participants were overweight (22%) or obese (66%). Diets consumed were generally high in total energy (TE) (median: 13 272 kJ), low in carbohydrates (CHO) (56% of participants consumed < 45% of CHO from TE), high in saturated fat (92% consumed ≥ 7% from TE) and high in sodium (74% of participants consumed ≥ 2 300 mg sodium daily). Exercise was not commonplace; 84% of participants did not meet the guideline for aerobic exercise and 92% did not meet the guideline for resistance training.Conclusion: The adherence of participants to the SEMDSA guidelines was poor, thus increasing the risk of long-term complications and poor glycaemic control.Keywords: diet, lifestyle, private practice, SEMDSA guidelines, Type 2 diabete

Evaluation and quantification of associations between commonly suggested milk biomarkers and the proportion of grassland-based feeds in the diets of dairy cows

This study is a first step approach towards the prediction of the proportion of grassland-based feeds (%GB) in dairy cow diets with the aid of three different groups of milk biomarkers. We aimed to evaluate and quantify the associations between biomarkers commonly suggested in the literature and %GB in individual cows as a hypothesis-generating stage for the prospective establishment of accurate %GB prediction models. Consumers and governments financially encourage sustainable, local milk production making grass-based feeding, in grassland-dominated regions, of major interest. Milk from grassland-fed cows differs from that of other feeding systems by inferential fatty acids (FA), β-carotene content and yellow color; however, these biomarkers have not been evaluated together for their association with %GB. Using approved methods of parametric regression analysis, gas chromatography (GC), mid-infrared spectra (MIR) and color spectroscopy, we aimed to develop a first step towards an easy-to-implement, cost-effective milk-based control to estimate %GB in dairy cow diets. The underlying database was generated with 24 cows each fed one of 24 different diets gradually increasing in grass silage and decreasing in corn silage. Our results indicate that GC-measured α-linolenic acid, total n-3 FA and the n-6:n-3 ratio, MIR-estimated PUFA and milk red-green color index a* are robust milk biomarkers for constructing accurate prediction models to determine %GB. Based on simplified regression analysis, diets containing 75% GB should contain ≥ 0.669 and 0.852 g α-linolenic acid and total n-3 FA per 100 g total FA, respectively, and an n-6:n-3 FA ratio of < 2.02 measured with GC; estimated with MIR, polyunsaturated FA should be ≥ 3.13 g/100 g total FA. β-carotene was not a good predictor for estimating %GB. Unexpectedly, the milk became greener with increasing %GB (negative a* values, ‒6.416 for 75% GB), suggesting the red-green color index, not yellow-blue, as a suitable biomarker

Effect of Hydrocortisone on Mortality and Organ Support in Patients With Severe COVID-19: The REMAP-CAP COVID-19 Corticosteroid Domain Randomized Clinical Trial.

Importance: Evidence regarding corticosteroid use for severe coronavirus disease 2019 (COVID-19) is limited. Objective: To determine whether hydrocortisone improves outcome for patients with severe COVID-19. Design, Setting, and Participants: An ongoing adaptive platform trial testing multiple interventions within multiple therapeutic domains, for example, antiviral agents, corticosteroids, or immunoglobulin. Between March 9 and June 17, 2020, 614 adult patients with suspected or confirmed COVID-19 were enrolled and randomized within at least 1 domain following admission to an intensive care unit (ICU) for respiratory or cardiovascular organ support at 121 sites in 8 countries. Of these, 403 were randomized to open-label interventions within the corticosteroid domain. The domain was halted after results from another trial were released. Follow-up ended August 12, 2020. Interventions: The corticosteroid domain randomized participants to a fixed 7-day course of intravenous hydrocortisone (50 mg or 100 mg every 6 hours) (n = 143), a shock-dependent course (50 mg every 6 hours when shock was clinically evident) (n = 152), or no hydrocortisone (n = 108). Main Outcomes and Measures: The primary end point was organ support-free days (days alive and free of ICU-based respiratory or cardiovascular support) within 21 days, where patients who died were assigned -1 day. The primary analysis was a bayesian cumulative logistic model that included all patients enrolled with severe COVID-19, adjusting for age, sex, site, region, time, assignment to interventions within other domains, and domain and intervention eligibility. Superiority was defined as the posterior probability of an odds ratio greater than 1 (threshold for trial conclusion of superiority >99%). Results: After excluding 19 participants who withdrew consent, there were 384 patients (mean age, 60 years; 29% female) randomized to the fixed-dose (n = 137), shock-dependent (n = 146), and no (n = 101) hydrocortisone groups; 379 (99%) completed the study and were included in the analysis. The mean age for the 3 groups ranged between 59.5 and 60.4 years; most patients were male (range, 70.6%-71.5%); mean body mass index ranged between 29.7 and 30.9; and patients receiving mechanical ventilation ranged between 50.0% and 63.5%. For the fixed-dose, shock-dependent, and no hydrocortisone groups, respectively, the median organ support-free days were 0 (IQR, -1 to 15), 0 (IQR, -1 to 13), and 0 (-1 to 11) days (composed of 30%, 26%, and 33% mortality rates and 11.5, 9.5, and 6 median organ support-free days among survivors). The median adjusted odds ratio and bayesian probability of superiority were 1.43 (95% credible interval, 0.91-2.27) and 93% for fixed-dose hydrocortisone, respectively, and were 1.22 (95% credible interval, 0.76-1.94) and 80% for shock-dependent hydrocortisone compared with no hydrocortisone. Serious adverse events were reported in 4 (3%), 5 (3%), and 1 (1%) patients in the fixed-dose, shock-dependent, and no hydrocortisone groups, respectively. Conclusions and Relevance: Among patients with severe COVID-19, treatment with a 7-day fixed-dose course of hydrocortisone or shock-dependent dosing of hydrocortisone, compared with no hydrocortisone, resulted in 93% and 80% probabilities of superiority with regard to the odds of improvement in organ support-free days within 21 days. However, the trial was stopped early and no treatment strategy met prespecified criteria for statistical superiority, precluding definitive conclusions. Trial Registration: ClinicalTrials.gov Identifier: NCT02735707

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

Rapid responses in bovine milk fatty acid composition and phenol content to various tanniferous forages

acceptedVersionpublishedVersio

Rapid responses in bovine milk fatty acid composition and phenol content to various tanniferous forages

Milk and dairy products considerably contribute to the nutritional value of human diets. In order to benefit human nutrition bovine milk fatty acid composition and phenol content are effectively manipulated by the cow’s diet. However, response times taken for these alterations to occur have not been quantified. In the present study, fatty acid composition and phenol content of the milk were evaluated after three days of feeding six cows six different diets, supplemented with six different tanniferous plants (hazel, silver birch, blackcurrant, grape vine, wood avens and rosebay willow with total tannin concentrations of 26, 36, 42, 52, 55 and 79 g/kg dry matter, respectively). Lucerne was applied as the low-phenol control diet. Substantial changes in total phenols and fatty acids were found in milk samples after just three days. Proportions of cis-9 trans-11 C18:2 and trans-11 C18:1 declined by 29 and 68%, respectively, in comparison to milk from cows fed lucerne, indicating a definitive ruminal biohydrogenation response. However, there were no significant effects between test plants and lucerne when comparing C18:3 n-3 and C18:2 n-6 proportions in milk fat. So, it was demonstrated that phenols and certain individual fatty acids in bovine milk can be rapidly modified by adding specific tanniferous plants to the diet.ISSN:1230-138

Effects of incremental increases in grass silage proportions from different harvest years on methane emissions, urinary nitrogen losses, and protein and energy utilisation in dairy cows

Dairy cows, methane and global warming have become publicly related terms. However, appropriate dairy cow management may in fact be part of the climate solution when viewed as part of the biogenic carbon cycle. Accordingly, governments and consumers are encouraging more sustainable, locally produced, climate friendly dairy production that often includes grassland-based feeding. However, this system is presumed to result in greater methane emissions compared to corn silage- or concentrate-based diets. An increase in urine nitrogen, associated with increased ammonia and nitrous oxide emission potential, questions the environmental usefulness of this strategy pertaining to global warming. This study is the first to compare the effects of incremental increases of grass silage proportion on enteric methane production as well as N and energy losses in dairy cows. Twenty-four mid- to end-lactation dairy cows were each fed one of 24 different diets, from two different harvest years, gradually increasing in grassland-based feeds (grass silage and hay) from about 500 to 1000 g/kg and concomitantly decreasing in corn silage. Each cow underwent a 7-day total collection period and was housed for 48 h in respiration chambers. Incremental data were subjected to an approved parametric regression analysis approach. The dietary increase in grassland-based feeds did not impair milk yield, N and energy utilisation. Simplified regression equations revealed that, contrary to current assumptions, there was a decline in methane production from 373 to 303 g/day when increasing grassland-based feeds from 500 to 1000 g/kg diet, and there was a trend for a decline in emission intensity from 20.6 to 17.6 g/kg of energy-corrected milk. However, urine nitrogen emissions clearly increased even when related to nitrogen intake; the latter from 260 to 364 g/kg when increasing grassland-based feeds from 500 to 1000 g/kg. Methane and urine nitrogen emissions were not affected by year of harvest.ISSN:0931-2439ISSN:1439-039

Effects of early herbage cutting and vine leaves on methane emission, urine nitrogen losses, and the milk fatty acid profile of dairy cows

Methane mitigation in dairy cows is an essential part of combating global warming. Governments and consumers have become increasingly interested in herbage-based feeding, and premium prices are often paid for these types of dairy products. However, this feeding strategy is presumed to produce more methane per unit of feed or milk than corn silage- or concentrate-based diets due to higher fiber intakes. Immature herbage is preferred to maintain dairy cow performance, but the high content of N and digestible fiber may increase methane and urine N emissions compared with more mature herbage. Tannin-containing feeds, such as vine leaves (Vitis vinifera), may help to combat the emissions associated with feeding immature herbage. Our study aimed to evaluate differences between early-stage (ES; 21 d of regrowth) versus late-stage (LS; 42 d) herbage and the effects of vine leaves on methane and nitrogenous emissions and the milk fatty acid profile of dairy cows. Twenty-four mid- to late-lactating dairy cows were randomized to 4 dietary groups (n = 6) in a factorial study design. Each of the 4 diets contained 69% fresh mixed legume-grass herbage, 13% grass hay, and 5% concentrate on a dry matter (DM) basis. Two diets were based on immature fresh mixed legume-grass herbage and grass hay (ES), and 2 contained more mature fresh mixed legume-grass herbage and grass hay (LS). Of these, 1 contained 13% vine leaves (VL+) and the other an additional 13% hay (VL−). No significant differences were observed in DM intake or milk yield across the diets. Methane emission intensity was lowest with ES-VL+ diets compared with LS-VL− diets (−30%; 17.1 vs. 24.5 mg/kg of energy-corrected milk). Methane yield decreased by 17% and 20% when related to the intake of DM and digested organic matter for ES-VL+ compared with LS-VL− diets (16.9 vs. 20.3 g/kg of DM intake; 23.5 vs. 29.3 g/kg of digestible organic matter). Immature grass and vine leaf addition each caused about half of the respective declines. Cows consuming any of the ES diets and the LS-VL+ diet consumed and excreted (urinary N) significantly more N than those consuming LS diets. However, when related to N intake, no differences were recorded. Unexpectedly, vine leaves did not mitigate urine N excretion; however, they lowered the n-6:n-3 ratio and increased concentrations of vaccenic and rumenic acids in both ES and LS diets. Our results demonstrate that feeding immature herbage in combination with vine leaves reduces methane yield; however, the associated high urinary N losses need to be addressed.ISSN:0022-0302ISSN:1525-319

Rapid responses in bovine milk fatty acid composition and phenol content to various tanniferous forages

acceptedVersionpublishedVersio