Estimating usual intakes mainly affects the micronutrient distribution among infants, toddlers and pre-schoolers from the 2012 Mexican National Health and Nutrition Survey

Abstract Objective To compare estimates from one day with usual intake estimates to evaluate how the adjustment for within-person variability affected nutrient intake and adequacy in Mexican children. Design In order to obtain usual nutrient intakes, the National Cancer Institute’s method was used to correct the first 24 h dietary recall collected in the entire sample ( n 2045) with a second 24 h recall collected in a sub-sample ( n 178). We computed estimates of one-day and usual intakes of total energy, fat, Fe, Zn and Na. Setting 2012 Mexican National Health and Nutrition Survey. Subjects A total of 2045 children were included: 0–5·9 months old ( n 182), 6–11·9 months old ( n 228), 12–23·9 months old ( n 537) and 24–47·9 months old ( n 1098). From these, 178 provided an additional dietary recall. Results Although we found small or no differences in energy intake (kJ/d and kcal/d) between one-day v . usual intake means, the prevalence of inadequate and excessive energy intake decreased somewhat when using measures of usual intake relative to one day. Mean fat intake (g/d) was not different between one-day and usual intake among children >6 months old, but the prevalence of inadequate and excessive fat intake was overestimated among toddlers and pre-schoolers when using one-day intake ( P< 0·05). Compared with usual intake, estimates from one day yielded overestimated prevalences of inadequate micronutrient intakes but underestimated prevalences of excessive intakes among children aged >6 months. Conclusions There was overall low variability in energy and fat intakes but higher for micronutrients. Because the usual intake distributions are narrower, the prevalence of inadequate/excessive intakes may be biased when estimating nutrient adequacy if one day of data is used

Recruitment of the human Cdt1 replication licensing protein by the loop domain of Hec1 is required for stable kinetochore–microtubule attachment

Cdt1, a protein critical for replication origin licensing in G1 phase is degraded during S phase but re-accumulates in G2 phase. We now demonstrate that human Cdt1 has a separable essential mitotic function. Cdt1 localizes to kinetochores during mitosis through interaction with the Hec1 component of the Ndc80 complex. G2-specific depletion of Cdt1 arrests cells in late prometaphase due to abnormally unstable kinetochore-microtubule (kMT) attachments and Mad1-dependent spindle assembly checkpoint activity. Cdt1 binds a unique loop extending from the rod domain of Hec1 that we show is also required for kMT attachment. Mutation of the loop domain prevents Cdt1 kinetochore localization and arrests cells in prometaphase. Super-resolution fluorescence microscopy indicates that Cdt1 binding to the Hec1 loop domain promotes a microtubule-dependent conformational change in the Ndc80 complex in vivo. These results support the conclusion that Cdt1 binding to Hec1 is essential for an extended Ndc80 configuration and stable kinetochore microtubule attachment

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

Sodium: Why the Concern?

Concerned that indiscriminate use of salt and other sodium compounds contributes to the incidence and severity of hypertension and other ailments, the Food and Drug Administration (FDA) has started a campaign to persuade Americans to cut excess sodium from their diets. One step in that campaign will be an effort to encourage industry to add less sodium to processed foods. FDA will propose requiring manufacturers to disclose the amount of sodium in products when they use a nutrition label. In addition, FDA will consider legislative options for including sodium labeling on products without nutrition labeling where the need is evident. Finally, it plans to monitor changes in sodium consumption to see whether progress is achieved

Developing and measuring progress toward collaborative, integrated, interdisciplinary health care teams

In this article we report the results of a longitudinal study of an intervention to enhance interdisciplinary team functioning in a primary care setting. Components of the team development intervention are outlined. Team members\u27 assessments of progress towards expressing values consistent with an effective team--as measured through the System for the Multiple Level Observation of Groups (SYMLOG)--are presented and discussed. Institutional, organizational, and team related supports and barriers that affect the development of collaborative, integrated teams are identified and discussed; implications for ensuring teams\u27 success are presented