Impact of nonoptimal intakes of saturated, polyunsaturated, and trans fat on global burdens of coronary heart disease

Background: Saturated fat (SFA), ω‐6 (n‐6) polyunsaturated fat (PUFA), and trans fat (TFA) influence risk of coronary heart disease (CHD), but attributable CHD mortalities by country, age, sex, and time are unclear. Methods and Results: National intakes of SFA, n‐6 PUFA, and TFA were estimated using a Bayesian hierarchical model based on country‐specific dietary surveys; food availability data; and, for TFA, industry reports on fats/oils and packaged foods. Etiologic effects of dietary fats on CHD mortality were derived from meta‐analyses of prospective cohorts and CHD mortality rates from the 2010 Global Burden of Diseases study. Absolute and proportional attributable CHD mortality were computed using a comparative risk assessment framework. In 2010, nonoptimal intakes of n‐6 PUFA, SFA, and TFA were estimated to result in 711 800 (95% uncertainty interval [UI] 680 700–745 000), 250 900 (95% UI 236 900–265 800), and 537 200 (95% UI 517 600–557 000) CHD deaths per year worldwide, accounting for 10.3% (95% UI 9.9%–10.6%), 3.6%, (95% UI 3.5%–3.6%) and 7.7% (95% UI 7.6%–7.9%) of global CHD mortality. Tropical oil–consuming countries were estimated to have the highest proportional n‐6 PUFA– and SFA‐attributable CHD mortality, whereas Egypt, Pakistan, and Canada were estimated to have the highest proportional TFA‐attributable CHD mortality. From 1990 to 2010 globally, the estimated proportional CHD mortality decreased by 9% for insufficient n‐6 PUFA and by 21% for higher SFA, whereas it increased by 4% for higher TFA, with the latter driven by increases in low‐ and middle‐income countries. Conclusions: Nonoptimal intakes of n‐6 PUFA, TFA, and SFA each contribute to significant estimated CHD mortality, with important heterogeneity across countries that informs nation‐specific clinical, public health, and policy priorities.peer-reviewe

Incident type 2 diabetes attributable to suboptimal diet in 184 countries

The global burden of diet-attributable type 2 diabetes (T2D) is not well established. This risk assessment model estimated T2D incidence among adults attributable to direct and body weight-mediated effects of 11 dietary factors in 184 countries in 1990 and 2018. In 2018, suboptimal intake of these dietary factors was estimated to be attributable to 14.1 million (95% uncertainty interval (UI), 13.8–14.4 million) incident T2D cases, representing 70.3% (68.8–71.8%) of new cases globally. Largest T2D burdens were attributable to insufficient whole-grain intake (26.1% (25.0–27.1%)), excess refined rice and wheat intake (24.6% (22.3–27.2%)) and excess processed meat intake (20.3% (18.3–23.5%)). Across regions, highest proportional burdens were in central and eastern Europe and central Asia (85.6% (83.4–87.7%)) and Latin America and the Caribbean (81.8% (80.1–83.4%)); and lowest proportional burdens were in South Asia (55.4% (52.1–60.7%)). Proportions of diet-attributable T2D were generally larger in men than in women and were inversely correlated with age. Diet-attributable T2D was generally larger among urban versus rural residents and higher versus lower educated individuals, except in high-income countries, central and eastern Europe and central Asia, where burdens were larger in rural residents and in lower educated individuals. Compared with 1990, global diet-attributable T2D increased by 2.6 absolute percentage points (8.6 million more cases) in 2018, with variation in these trends by world region and dietary factor. These findings inform nutritional priorities and clinical and public health planning to improve dietary quality and reduce T2D globally.publishedVersio

Switch from intravenous to subcutaneous immunoglobulin in CIDP and MMN: improved tolerability and patient satisfaction

Objectives: To assess clinical outcomes and patient satisfaction in patients with chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) or multifocal motor neuropathy (MMN) who were switched from intravenous immunoglobulin (IVIG) to subcutaneous immunoglobulin (SCIG). Methods: Eight consecutive patients, four with MMN and four with CIDP, already on long-term, hospital-based IVIG were switched to home-based SCIG. These patients were selected on the basis of their requirement for relatively low treatment doses, problems experienced with IVIG, and their willingness to switch to SCIG. Results: After a mean 33 [standard deviation (SD) 19] months receiving SCIG, 7 patients remained neurologically stable and 6 remained on a similar mean weekly immunoglobulin dose relative to their original intravenous dose. A good outcome was reported by 7 of the 8 patients: there were improvements in nausea and headache ( n = 4), need to travel to hospital ( n = 4), venous access problems ( n = 3), immunoglobulin-induced neutropenia ( n = 3), treatment wearing-off fluctuations ( n = 2), IVIG-induced allergy requiring antihistamine/hydrocortisone ( n = 1) and time taken off work ( n = 1). The eighth patient required increasing doses of immunoglobulin to maintain strength but still wanted to continue SCIG. Seven patients completed a questionnaire: there was a very high overall satisfaction level with immunoglobulin treatment [mean 96 (SD 5), visual analogue scale (VAS) where 0 = very unsatisfied, 100 = very satisfied]; and very strong preference for subcutaneous over intravenous immunoglobulin (VAS mean 93 [SD 12] where 0 = prefer IVIG, 100 = prefer SCIG). Conclusions: In seven of the eight patients, SCIG gave improved tolerability and patient satisfaction with similar efficacy compared with IVIG

Elucidating autoimmune nodopathies and the CIDP spectrum.

This scientific commentary refers to ‘Antibodies to the Caspr1/contactin-1 complex in chronic inflammatory demyelinating polyradiculoneuropathy’, by Pascual-Go~ni et al. (doi:10.1093/brain/awab014)

European Federation of Neurological Societies/Peripheral Nerve Society Guideline on management of multifocal motor neuropathy. Report of a Joint Task Force of the European Federation of Neurological Societies and the Peripheral Nerve Society - first revision

A European Federation of Neurological Societies/Peripheral Nerve Society consensus guideline on the definition, investigation, and treatment of multifocal motor neuropathy (MMN) was published in 2006. The aim is to revise this guideline. Disease experts considered references retrieved from MEDLINE and Cochrane Systematic Reviews published between August 2004 and July 2009 and prepared statements that were agreed to in an iterative fashion. The Task Force agreed on Good Practice Points to define clinical and electrophysiological diagnostic criteria for MMN, investigations to be considered, and principal recommendations for treatmen

Smoldering Combustion

Smoldering combustion is the slow, low temperature, flameless burning of porous fuels and is the most persistent type of combustion phenomena. It is especially common in porous fuels which form a char on heating, like cellulosic insulation, polyurethane foam or peat. Smoldering combustion is among the leading causes of residential fires, and it is a source of safety concerns in industrial premises as well as in commercial and space flights. Smoldering is also the dominant combustion phenomena in megafires in natural deposits of peat and coal which are the largest and longest burning fires on Eartht