Analysis of vitamin K status, and its correlation with inflammation and cognition, in a well-phenotyped cohort of older Irish people

peer-reviewedHistorically, vitamin K is known for its role in blood clotting; however in recent years additional functions have been identified including a role in sphingolipid metabolism and as an anti-inflammatory agent. Studies have shown correlations between low vitamin K status and poor cognitive function while several biomarkers of inflammation are inversely correlated with cognition. The ELDERMET cohort, a group of well characterised subjects aged ≥ 64 years, were used in this study. The aim of this study was to identify potential associations between vitamin K status and cognition as well as any correlations between biomarkers of inflammation and cognition using a subgroup of the ELDERMET cohort. In addition the study aimed to ascertain significant differences in variables across living stratification i.e. the community dwelling subjects versus those in long term care. Subjects were divided into 4 groups based on their Mini Mental State Exam (MMSE) score. Vitamin K status was determined by measuring dietary and serum phylloquinone (vitamin K) status. Percent undercarboxylated osteocalcin (% ucOC) was also measured in serum as a long-term indicator of functional vitamin K status. Biomarkers of inflammation including high sensitivity C-reactive protein (hsCRP), Interleukin 6 (IL-6), Interleukin 8 (IL-8) and Tumour Necrosis Factor alpha (TNFα) were measured. Analysis of variance (ANOVA) revealed significant differences between markers of vitamin K status and inflammation and MMSE categories. Positive correlations were found between MMSE and serum and dietary phylloquinone. Inverse correlations were found between MMSE and other variables including %ucOC, hsCRP, IL-6, IL-8 and TNFα. Similarly, significant differences were found across living stratification for biomarkers of inflammation. Analysis of covariance (ANCOVA) showed a significant difference in dietary phylloquinone intake between those with severe cognitive impairment and those with normal cognitive function, and between those with moderate cognitive impairment and normal functionality. In addition, a significant difference between IL-6, TNFα and hsCRP was found especially between those with poor cognitive function and those with normal cognitive ability. This study adds to the growing body of evidence which suggests a role for vitamin K in cognitive function. Findings from this study have the potential to help inform public health policy and dietary recommendations aimed at promoting healthy aging

Analysis of vitamin K status, and its correlation with inflammation and cognition, in a well-phenotyped cohort of older Irish people

Historically, vitamin K is known for its role in blood clotting; however in recent years additional functions have been identified including a role in sphingolipid metabolism and as an anti-inflammatory agent. Studies have shown correlations between low vitamin K status and poor cognitive function while several biomarkers of inflammation are inversely correlated with cognition. The ELDERMET cohort, a group of well characterised subjects aged ≥ 64 years, were used in this study. The aim of this study was to identify potential associations between vitamin K status and cognition as well as any correlations between biomarkers of inflammation and cognition using a subgroup of the ELDERMET cohort. In addition the study aimed to ascertain significant differences in variables across living stratification i.e. the community dwelling subjects versus those in long term care. Subjects were divided into 4 groups based on their Mini Mental State Exam (MMSE) score. Vitamin K status was determined by measuring dietary and serum phylloquinone (vitamin K) status. Percent undercarboxylated osteocalcin (% ucOC) was also measured in serum as a long-term indicator of functional vitamin K status. Biomarkers of inflammation including high sensitivity C-reactive protein (hsCRP), Interleukin 6 (IL-6), Interleukin 8 (IL-8) and Tumour Necrosis Factor alpha (TNFα) were measured. Analysis of variance (ANOVA) revealed significant differences between markers of vitamin K status and inflammation and MMSE categories. Positive correlations were found between MMSE and serum and dietary phylloquinone. Inverse correlations were found between MMSE and other variables including %ucOC, hsCRP, IL-6, IL-8 and TNFα. Similarly, significant differences were found across living stratification for biomarkers of inflammation. Analysis of covariance (ANCOVA) showed a significant difference in dietary phylloquinone intake between those with severe cognitive impairment and those with normal cognitive function, and between those with moderate cognitive impairment and normal functionality. In addition, a significant difference between IL-6, TNFα and hsCRP was found especially between those with poor cognitive function and those with normal cognitive ability. This study adds to the growing body of evidence which suggests a role for vitamin K in cognitive function. Findings from this study have the potential to help inform public health policy and dietary recommendations aimed at promoting healthy aging

Vitamin K status and inflammation are associated with cognition in older Irish adults

Studies have shown associations between reduced vitamin K status and poor cognitive function. However, despite this apparent link, direct studies measuring cognitive function, vitamin K status and inflammation are lacking. In the current study, The ELDERMET cohort was investigated to identify associations between cognition, vitamin K status and inflammation. The primary aim of the ELDERMET study was to investigate the relationship between gut bacteria, diet, lifestyle and health in 500 older Irish adults. Significant differences in serum phylloquinone, dietary phylloquinone and inflammatory markers were found across varying levels of cognitive function, after controlling for sex, age, body mass index (BMI), triglycerides and blood pressure. In addition, significantly higher levels of dietary phylloquinone were found in those with better cognition compared to those with the poorest function. Higher levels of inflammatory were also associated with poor cognition. Furthermore, both dietary and serum phylloquinone were significant independent predictors of good cognitive function, after controlling for confounders. This study highlights the importance of dietary vitamin K as a potentially protective cognitive factor; it also provides evidence for the correlation between cognition and inflammation. Strategies should be devised by which elderly populations can access rich dietary sources of phylloquinone to maintain cognition

Prospective observational cohort study on grading the severity of postoperative complications in global surgery research

Background The Clavien–Dindo classification is perhaps the most widely used approach for reporting postoperative complications in clinical trials. This system classifies complication severity by the treatment provided. However, it is unclear whether the Clavien–Dindo system can be used internationally in studies across differing healthcare systems in high- (HICs) and low- and middle-income countries (LMICs). Methods This was a secondary analysis of the International Surgical Outcomes Study (ISOS), a prospective observational cohort study of elective surgery in adults. Data collection occurred over a 7-day period. Severity of complications was graded using Clavien–Dindo and the simpler ISOS grading (mild, moderate or severe, based on guided investigator judgement). Severity grading was compared using the intraclass correlation coefficient (ICC). Data are presented as frequencies and ICC values (with 95 per cent c.i.). The analysis was stratified by income status of the country, comparing HICs with LMICs. Results A total of 44 814 patients were recruited from 474 hospitals in 27 countries (19 HICs and 8 LMICs). Some 7508 patients (16·8 per cent) experienced at least one postoperative complication, equivalent to 11 664 complications in total. Using the ISOS classification, 5504 of 11 664 complications (47·2 per cent) were graded as mild, 4244 (36·4 per cent) as moderate and 1916 (16·4 per cent) as severe. Using Clavien–Dindo, 6781 of 11 664 complications (58·1 per cent) were graded as I or II, 1740 (14·9 per cent) as III, 2408 (20·6 per cent) as IV and 735 (6·3 per cent) as V. Agreement between classification systems was poor overall (ICC 0·41, 95 per cent c.i. 0·20 to 0·55), and in LMICs (ICC 0·23, 0·05 to 0·38) and HICs (ICC 0·46, 0·25 to 0·59). Conclusion Caution is recommended when using a treatment approach to grade complications in global surgery studies, as this may introduce bias unintentionally

The surgical safety checklist and patient outcomes after surgery: a prospective observational cohort study, systematic review and meta-analysis

© 2017 British Journal of Anaesthesia Background: The surgical safety checklist is widely used to improve the quality of perioperative care. However, clinicians continue to debate the clinical effectiveness of this tool. Methods: Prospective analysis of data from the International Surgical Outcomes Study (ISOS), an international observational study of elective in-patient surgery, accompanied by a systematic review and meta-analysis of published literature. The exposure was surgical safety checklist use. The primary outcome was in-hospital mortality and the secondary outcome was postoperative complications. In the ISOS cohort, a multivariable multi-level generalized linear model was used to test associations. To further contextualise these findings, we included the results from the ISOS cohort in a meta-analysis. Results are reported as odds ratios (OR) with 95% confidence intervals. Results: We included 44 814 patients from 497 hospitals in 27 countries in the ISOS analysis. There were 40 245 (89.8%) patients exposed to the checklist, whilst 7508 (16.8%) sustained ≥1 postoperative complications and 207 (0.5%) died before hospital discharge. Checklist exposure was associated with reduced mortality [odds ratio (OR) 0.49 (0.32–0.77); P\u3c0.01], but no difference in complication rates [OR 1.02 (0.88–1.19); P=0.75]. In a systematic review, we screened 3732 records and identified 11 eligible studies of 453 292 patients including the ISOS cohort. Checklist exposure was associated with both reduced postoperative mortality [OR 0.75 (0.62–0.92); P\u3c0.01; I2=87%] and reduced complication rates [OR 0.73 (0.61–0.88); P\u3c0.01; I2=89%). Conclusions: Patients exposed to a surgical safety checklist experience better postoperative outcomes, but this could simply reflect wider quality of care in hospitals where checklist use is routine

Critical care admission following elective surgery was not associated with survival benefit: prospective analysis of data from 27 countries

This was an investigator initiated study funded by Nestle Health Sciences through an unrestricted research grant, and by a National Institute for Health Research (UK) Professorship held by RP. The study was sponsored by Queen Mary University of London