Sonographic assessment of abdominal fat distribution in infancy

There is growing evidence that not only the total amount of fat, but also the distribution of body fat determines risks for metabolic and cardiovascular disease. Developmental studies on factors influencing body fat distribution have been hampered by a lack of appropriate techniques for measuring intraabdominal fat in early life. Sonography, which is an established method for assessing abdominal fat distribution in adults, has not yet been evaluated in infants. To adapt the sonographic measurement of abdominal fat distribution to infants and study its reliability. The Generation R study, a population-based prospective cohort study. We included 212 one- and 227 two-year old Dutch infants in the present analysis. Sixty-two infants underwent replicate measurements to assess reproducibility. We developed a standardized protocol to measure the thickness of (1) subcutaneous and (2) preperitoneal fat in the upper abdomen of infants. To this end we defined infancy specific measurement areas to quantify fat thickness. Reproducibility of fat measurements was good to excellent with intraclass correlation coefficients of 0.93–0.97 for intra-observer agreement and of 0.89–0.95 for inter-observer agreement. We observed a pronounced increase in preperitoneal fat thickness in the second year of life while subcutaneous fat thickness increased only slightly, resulting in an altered body fat distribution. Gender did not significantly influence fat distribution in the first two years of life. Our age specific protocol for the sonographic measurement of central subcutaneous and preperitoneal fat is a reproducible method that can be instrumental for investigating fat distribution in early life

Pooled analysis of WHO Surgical Safety Checklist use and mortality after emergency laparotomy

Background The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy. Methods In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation. Results Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89.6 per cent) compared with that in countries with a middle (753 of 1242, 60.6 per cent; odds ratio (OR) 0.17, 95 per cent c.i. 0.14 to 0.21, P <0001) or low (363 of 860, 422 per cent; OR 008, 007 to 010, P <0.001) HDI. Checklist use was less common in elective surgery than for emergency laparotomy in high-HDI countries (risk difference -94 (95 per cent c.i. -11.9 to -6.9) per cent; P <0001), but the relationship was reversed in low-HDI countries (+121 (+7.0 to +173) per cent; P <0001). In multivariable models, checklist use was associated with a lower 30-day perioperative mortality (OR 0.60, 0.50 to 073; P <0.001). The greatest absolute benefit was seen for emergency surgery in low- and middle-HDI countries. Conclusion Checklist use in emergency laparotomy was associated with a significantly lower perioperative mortality rate. Checklist use in low-HDI countries was half that in high-HDI countries.Peer reviewe

Evaluation of appendicitis risk prediction models in adults with suspected appendicitis

Background Appendicitis is the most common general surgical emergency worldwide, but its diagnosis remains challenging. The aim of this study was to determine whether existing risk prediction models can reliably identify patients presenting to hospital in the UK with acute right iliac fossa (RIF) pain who are at low risk of appendicitis. Methods A systematic search was completed to identify all existing appendicitis risk prediction models. Models were validated using UK data from an international prospective cohort study that captured consecutive patients aged 16–45 years presenting to hospital with acute RIF in March to June 2017. The main outcome was best achievable model specificity (proportion of patients who did not have appendicitis correctly classified as low risk) whilst maintaining a failure rate below 5 per cent (proportion of patients identified as low risk who actually had appendicitis). Results Some 5345 patients across 154 UK hospitals were identified, of which two‐thirds (3613 of 5345, 67·6 per cent) were women. Women were more than twice as likely to undergo surgery with removal of a histologically normal appendix (272 of 964, 28·2 per cent) than men (120 of 993, 12·1 per cent) (relative risk 2·33, 95 per cent c.i. 1·92 to 2·84; P < 0·001). Of 15 validated risk prediction models, the Adult Appendicitis Score performed best (cut‐off score 8 or less, specificity 63·1 per cent, failure rate 3·7 per cent). The Appendicitis Inflammatory Response Score performed best for men (cut‐off score 2 or less, specificity 24·7 per cent, failure rate 2·4 per cent). Conclusion Women in the UK had a disproportionate risk of admission without surgical intervention and had high rates of normal appendicectomy. Risk prediction models to support shared decision‐making by identifying adults in the UK at low risk of appendicitis were identified

Global variation in anastomosis and end colostomy formation following left-sided colorectal resection

Background End colostomy rates following colorectal resection vary across institutions in high-income settings, being influenced by patient, disease, surgeon and system factors. This study aimed to assess global variation in end colostomy rates after left-sided colorectal resection. Methods This study comprised an analysis of GlobalSurg-1 and -2 international, prospective, observational cohort studies (2014, 2016), including consecutive adult patients undergoing elective or emergency left-sided colorectal resection within discrete 2-week windows. Countries were grouped into high-, middle- and low-income tertiles according to the United Nations Human Development Index (HDI). Factors associated with colostomy formation versus primary anastomosis were explored using a multilevel, multivariable logistic regression model. Results In total, 1635 patients from 242 hospitals in 57 countries undergoing left-sided colorectal resection were included: 113 (6·9 per cent) from low-HDI, 254 (15·5 per cent) from middle-HDI and 1268 (77·6 per cent) from high-HDI countries. There was a higher proportion of patients with perforated disease (57·5, 40·9 and 35·4 per cent; P < 0·001) and subsequent use of end colostomy (52·2, 24·8 and 18·9 per cent; P < 0·001) in low- compared with middle- and high-HDI settings. The association with colostomy use in low-HDI settings persisted (odds ratio (OR) 3·20, 95 per cent c.i. 1·35 to 7·57; P = 0·008) after risk adjustment for malignant disease (OR 2·34, 1·65 to 3·32; P < 0·001), emergency surgery (OR 4·08, 2·73 to 6·10; P < 0·001), time to operation at least 48 h (OR 1·99, 1·28 to 3·09; P = 0·002) and disease perforation (OR 4·00, 2·81 to 5·69; P < 0·001). Conclusion Global differences existed in the proportion of patients receiving end stomas after left-sided colorectal resection based on income, which went beyond case mix alone

Perfil dietético, estado nutricional e prevalência de obesidade centralizada em praticantes de futebol recreativo Perfil dietético, estado nutricional y prevalencia de obesidad centralizada en practicantes de fútbol recreativo Dietetic profile, nutritional status and prevalence of central obesity in recreative soccer practitioners

O objetivo do estudo foi avaliar o perfil dietético, estado nutricional e a prevalência de obesidade centralizada (OC) em praticantes de futebol recreativo. MÉTODOS: Amostra: 40 indivíduos (38,6 &plusmn; 7,4 anos) do gênero masculino. Para a avaliação do consumo habitual (CH), foi utilizado um questionário quantitativo de freqüência alimentar. O estado nutricional foi avaliado por meio do índice de massa corporal (IMC). A OC foi definida como circunferência abdominal (CIRCAB) superior a 102cm. RESULTADOS: Predomínio de indivíduos da classe social "B" (80,0%), brancos (67,5%), casados (62,5%) e funcionários públicos (52,5%). As médias mostraram: massa corporal de 77,2 &plusmn; 11,8kg, estatura de 1,71 &plusmn; 0,1m, IMC de 26,4 &plusmn; 3,1kg/m², CIRCAB de 92,3 &plusmn; 8,8cm, CH de 2.623,2 &plusmn; 438,5kcal. As proporções de nutrientes foram de 48,2 &plusmn; 5,7% de carboidratos, 17,6 &plusmn; 2,4% de proteínas, 34,9 &plusmn; 4,2% de lipídeos totais, 568,2 &plusmn; 112,7mg de colesterol e 20,2 &plusmn; 6,1g de fibras dietéticas. No estado nutricional, 35,0% são eutróficos, 52,5% apresentam sobrepeso e 12,5% são obesos. Em relação ao padrão de obesidade, 12,5% apresentam gordura centralizada. Entre as correlações observou-se forte associação entre CIRCAB x IMC (r = 0,91) e CIRCAB x massa corporal (r = 0,88). CONCLUSÃO: Os futebolistas devem ser orientados sobre a importância da adequação nutricional para melhora da qualidade da vida e do desempenho esportivo, fato relacionado com as proporções de nutrientes encontrados, que evidenciaram reduzida ingestão de carboidratos e alta ingestão de proteínas e colesterol dietético. O estado nutricional mostrou valores prevalentes de sobrepeso e obesidade. A OC mostrou-se evidente, fato preocupante devido à associação desse padrão de obesidade com várias doenças crônicas não-transmissíveis.<br>El objetivo de este estudio ha sido el de evaluar el perfil dietético, estado nutricional y la prevalencia de la obesidad centralizada (OC) en practicantes de fútbol recreativo. MÉTODOS: Muestra: 40 individuos (38,6 &plusmn; 7,4 años) del género masculino. Para la evaluación del consumo habitual (CH), fue utilizado un cuestionario cuantitativo de la frecuencia alimentar. El estado nutricional fue evaluado mediante el Índice de Masa Corporal (IMC). La OC fue definida como la circunferencia abdominal (CIRCAB) superior a 102cm. RESULTADOS: Predominio de individuos de clase social "B" (80,0%), blancos (67,5%), casados (62,5%) y funcionarios públicos (52,5%). Las medias mostraron: masa corporal de 77,2 &plusmn; 11,8kg, estatura 1,71 &plusmn; 0,1m, IMC 26,4 &plusmn; 3,1kg/m², CIRCAB 92,3 &plusmn; 8,8cm, CH 2623,2 &plusmn; 438,5kcal y las proporciones de nutrientes fue 48,2 &plusmn; 5,7% carbohidratos, 17,6 &plusmn; 2,4% proteínas, 34,9 &plusmn; 4,2% lípidos totales, 568,2 &plusmn; 112,7mg colesterol y 20,2 &plusmn; 6,1g fibras dietéticas. En el estado nutricional, 35,0% son eutróficos, 52,5% presentan sobrepeso y 12,5% son obesos. En relación al padrón de obesidad, 12,5% presentan grasa centralizada. Entre las correlaciones se observó una fuerte asociación entre CIRCAB X IMC (r = 0,91) y CIRCAB X masa corporal (r = 0,88). CONCLUSIÓN: Los futbolistas deben ser orientados sobre la importancia de la adecuación nutricional para mejorar la calidad de vida y el desempeño deportivo, hecho éste relacionado con las proporciones de nutrientes encontrados que evidenciaron reducida ingestión de carbohidratos y alta ingestión de proteínas y colesterol dietético. El estado nutricional mostró valores de prevalencia de sobrepeso y obesidad. La OC se mostró evidente, hecho bastante preocupante debido a la asociación de este padrón de obesidad con varias enfermedades crónicas no transmisibles.<br>The aim of the study was to evaluate the diet profile, nutritional status and centralized obesity (CO) prevalence in recreative soccer practitioners. METHODS: Sample: 40 male individuals (38.6 &plusmn; 7.4 years). To evaluate the habitual consumption (HC) it was used a quantitative of meal frequency. The nutritional status was evaluated by the Body Mass Index (BMI). The CO was defined as waist circumference (WCIRC) above 102 cm. RESULTS: There was a predominance of "B" social class individuals (80.0%), white ones (67.5%), married (62.5%) and public workers (52.5%). The average showed: body mass of 77.2 &plusmn; 11.8 kg, as high as 1.71 &plusmn; 0.1 m, BMI 26.4 &plusmn; 3.1 kg/m² and WCIRC 92.3 &plusmn; 8.8 cm, HC 2623.2 &plusmn; 438.5 kcal and the nutrients proportions was 48.2 &plusmn; 5.7% carbohydrates, 17.6 &plusmn; 2.4% proteins, 34.9 &plusmn; 4.2% total fat, 568.2 &plusmn; 112.7 mg cholesterol and 20.2 &plusmn; 6.1 g diet fibers. In relation to nutritional status, 35.0% are eutrophic, 52.5% present overweight and 12.5% present obesity. In relation to the obesity pattern, 12.5% present centralized fat. Among the correlations it was observed a strong association between WCIRC x IMC (r = 0.91) and WCIRC x body mass (r = 0,88). CONCLUSION: The soccer practitioners must be orientated over the nutritional adequation importance to life quality and sports practice, fact that is related to nutrients proportions that showed carbohydrates uptake reduction and high cholesterol and proteins uptake. The nutritional status showed values prevalence of overweight and obesity. The OC showed evident, that is dangerous because of the association of this obesity pattern with various chronic diseases that aren't transmissible