Circulating adiponectin levels are paradoxically associated with mortality rate. A systematic review and meta-analysis. Online supplemental material

<p>Online supplemental material of paper entitled: "Circulating adiponectin levels are paradoxically associated with mortality rate. A systematic review and meta-analysis. It contains 2 tables describing papers included in the meta-analysis and quality assessment of them along with figures of additional analyses: funnel plots, forest plots and subgroup analyses</p

Baseline characteristics of community-dwelling older patients with diabetes mellitus divided according to their Multidimensional Prognostic Index (MPI) grade based on the Standardized Multidimensional Assessment Schedule for Adults and Aged Persons (SVaMA).

<p>VADL: activities of daily living; VCOG: cognitive status; VIP: Nursing Care Needs; VMOB: mobility; VPIA: pressure sores risk; VSOC: social support</p><p>* Number of all medications per month, taken before the patient’s enrollment</p><p>^ ev/py: events/person-years, ir%: incidence rate (number of events per 100 person-years)</p><p>Baseline characteristics of community-dwelling older patients with diabetes mellitus divided according to their Multidimensional Prognostic Index (MPI) grade based on the Standardized Multidimensional Assessment Schedule for Adults and Aged Persons (SVaMA).</p

Target Values of Cardiovascular Risk Factors Are Not Associated with All-Cause Mortality in Patients with Type 2 Diabetes Mellitus

<div><p>Background</p><p>To investigate prospectively the relationship between target values of glycated hemoglobin, blood pressure and LDL-cholesterol, as considered in a combined fashion, and all-cause mortality in patients with type 2 diabetes mellitus.</p><p>Methods</p><p>Two cohorts of patients with type 2 diabetes mellitus, the Gargano Mortality Study (n=810) and the Foggia Mortality Study (n=929), were investigated. A weighted target risk score was built as a weight linear combination of the recommended targets reached by each patient.</p><p>Results</p><p>In the Gargano Mortality Study and in the Foggia Mortality Study (mean follow up=7.4 and 5.5 years, respectively), 161 (19.9%) and 220 (23.7%) patients died, with an age and sex adjusted annual incidence rate of 2.1 and 2.8 per 100 person-years, respectively. In both study samples the weighted target risk score tended to be linearly associated with all-cause mortality (HR for one point increment=1.30, 95% CI: 1.11-1.53, p=0.001, and HR=1.08, 95% CI: 0.95-1.24, p=0.243, respectively). When the two cohorts were pooled and analyzed together, a clear association between weighted target risk score and all-cause mortality was observed (HR for one point increment=1.17, 95% CI:1.05-1.30, p=0.004). This counterintuitive association was no longer observable in a model including age, sex, body mass index, smoking habit, estimated glomerular filtration rate, albuminuria and anti-diabetic, anti-hypertensive and anti-dyslipidemic treatment as covariates (HR for one point increment=0.99, 95% CI: 0.87-1.12, p=0.852).</p><p>Conclusions</p><p>In a real life clinical set of patients with type 2 diabetes mellitus, the combination of recommended target values of established cardiovascular risk factors is not associated with all-cause mortality.</p></div

Cognitive Impairment in Myotonic Dystrophy Type 1 Is Associated with White Matter Damage

<div><p>Objective</p><p>To investigate grey (GM) and white matter (WM) abnormalities and their effects on cognitive and behavioral deficits in a large, phenotypically and genotypically well-characterized cohort of classic adult (aDM1, age at onset ≥20 years) or juvenile (jDM1, age at onset <20 years) patients with myotonic dystrophy type 1 (DM1).</p><p>Methods</p><p>A case-control study including 51 DM1 patients (17 jDM1 and 34 aDM1) and 34 controls was conducted at an academic medical center. Clinical, cognitive and structural MRI evaluations were obtained. Quantitative assessments of regional GM volumes, WM hyperintensities (WMHs), and microstructural WM tract damage were performed. The association between structural brain damage and clinical and cognitive findings was assessed.</p><p>Results</p><p>DM1 patients showed a high prevalence of WMHs, severe regional GM atrophy including the key nodes of the sensorimotor and main cognitive brain networks, and WM microstructural damage of the interhemispheric, corticospinal, limbic and associative pathways. WM tract damage extends well beyond the focal WMHs. While aDM1 patients had severe patterns of GM atrophy and WM tract damage, in jDM1 patients WM abnormalities exceeded GM involvement. In DM1, WMHs and microstructural damage, but not GM atrophy, correlated with cognitive deficits.</p><p>Conclusions</p><p>WM damage, through a disconnection between GM structures, is likely to be the major contributor to cognitive impairment in DM1. Our MRI findings in aDM1 and jDM1 patients support the hypothesis of a degenerative (premature aging) origin of the GM abnormalities and of developmental changes as the principal substrates of microstructural WM alterations in DM1.</p></div

Pre-matching baseline characteristics of community-dwelling older patients with diabetes mellitus according to statin use.

<p>VCOG: cognitive status; VIP: Nursing Care Needs; VPIA: pressure sores risk; VADL: activities of daily living; VMOB: mobility; VSOC: social support; MPI: Multidimensional Prognostic Index</p><p>MPI-SVaMA: Multidimensional Prognostic Index based on the Standardized Multidimensional Assessment Schedule for Adults and Aged Persons</p><p>* Number of all medications prescribed within one year before patient’s enrollment</p><p>Pre-matching baseline characteristics of community-dwelling older patients with diabetes mellitus according to statin use.</p

Baseline clinical features of 1739 patients with type 2 diabetes from Gargano Mortality Study and Foggia Mortality Study.

<p>Data are reported as mean±standard deviation or frequencies (n) and percentages (%), for continuous and categorical variables, respectively.</p><p>GMS: Gargano Mortality Study; FMS: Foggia Mortality Study; BMI: body mass index; LDL: low density lipoprotein; e-GFR: estimated-glomerular filtration rate; OAD: oral antidiabetes drugs.</p><p>Baseline clinical features of 1739 patients with type 2 diabetes from Gargano Mortality Study and Foggia Mortality Study.</p

Voxel-based morphometry results in patients with myotonic dystrophy 1 compared with age-matched healthy controls adjusting for age and total intracranial volume.

<p>Regions of grey matter atrophy are shown in yellow-to-red and overlaid on the coronal, sagittal and axial sections of the Montreal Neurological Institute standard brain in radiological convention (right is left). Results are displayed at p<0.05 corrected for multiple comparisons.</p

Neuropsychological and behavioural data of DM1 patients.

<p>Values are means ± standard deviations (% of subjects with abnormal test score compared with normative data of reference, see text for further details).</p>#<p>p<0.05 in aDM1 <i>vs</i> jDM1 patients (Poisson model, false-discovery rate adjusted for multiple comparisons;</p><p>*age-adjusted p values). Abbreviations: ACE-R, Addenbrooke’s Cognitive Examination–Revised; aDM1, Myotonic dystrophy type 1 with adult onset (≥20 years); BNT, Boston Naming Test; DM1, Myotonic dystrophy type 1; HDRS, Hamilton Depression Rating Scale; HARS, Hamilton Anxiety Rating Scale; jDM1, Myotonic dystrophy type 1 with early onset (<20 years); ns, not significant; RAVLT, Rey Auditory Verbal Learning test; TMT, Trials Making Test; VOT, Visual Organization Test; WAIS, Wechsler-Adult Intelligence Scale.</p

Survival adjusted curves from fully-adjusted multivariable Cox regression, according to the various groups of target attainment.

<p>Survival adjusted curves from fully-adjusted multivariable Cox regression, according to the various groups of target attainment.</p

Tract-based spatial statistics results in patients with myotonic dystrophy 1 compared with age-matched healthy controls and relationship between the Addenbrooke’s Cognitive Examination–Revised (ACE-R) orientation and attention subscores and mean diffusivity values.

<p>Analyses were adjusted for age. A–C: Voxelwise group differences are shown in blue (mean diffusivity) and red (fractional anisotropy). D) Regions where MD values correlated with the ACE-R orientation and attention subscores are shown in blue. Results are overlaid on the sagittal and axial sections of the Montreal Neurological Institute standard brain in radiological convention (right is left), and displayed at p<0.05 corrected for multiple comparisons. The white matter skeleton is green.</p