27 research outputs found
General and Abdominal Adiposity and Risk of Death in Europe
Previous studies have relied predominantly on the body-mass index (BMI, the weight in kilograms divided by the square of the height in meters) to assess the association of adiposity with the risk of death, but few have examined whether the distribution of body fat contributes to the prediction of death. This study examined the association of BMI, waist circumference, and waist-to-hip ratio with the risk of death among 359,387 participants from nine countries in the European Prospective Investigation into Cancer and Nutrition (EPIC). A Cox regression analysis was used, with age as the time variable, and stratified the models according to study center and age at recruitment, with further adjustment for educational level, smoking status, alcohol consumption, physical activity, and height
Weight Loss with a Low-Carbohydrate, Mediterranean, or Low-Fat Diet
Weight Loss with a Low-Carbohydrate, Mediterranean, or Low-
Fat Diet (July 17, 2008;359:229-41). In Figure 3 (page 239), the
y-axis in Panel D should have been labeled \u93Change\u94 rather
than \u93Change (mg/dl).\u94 We regret the error. The article has
been corrected at NEJM.org.
Maternal and Neonatal Herpes Simplex Virus Infections (October
1, 2009;361:1376-85). An additional correction is described
in the Correspondence section of this issue of the Journal (Maternal
and Neonatal Herpes Simplex Virus Infections ([December
31, 2009;361:2678-9])
Maternal and Neonatal Herpes Simplex Virus Infections
To the Editor: In their informative review article
on infection with herpes simplex virus (HSV),
Corey and Wald (Oct. 1 issue)1 do not make it
clear to readers that universal prenatal herpes
screening is not recommended by any expert
panel that has reviewed this topic, including the
American College of Obstetricians and Gynecologists
(2007),2 the Centers for Disease Control
and Prevention (2006),3 and the U.S. Preventive
Services Task Force (2009).4
Neonatal herpes can be a devastating disease.
Yet, it should be made clear to providers who
care for pregnant women that routine prenatal
screening for HSV infection is not recommended
and should not be part of a standard prenatal
screening panel. New research findings may
emerge, but, currently, routine prenatal screening
for herpes continues to be a bad idea.5
Adam C. Urato, M.D
Dabigatran versus Warfarin in Patients with Atrial Fibrillation
To the Editor: Although Connolly et al. (Sept.
17 issue)1 have demonstrated a modest advantage
for dabigatran over warfarin in atrial fibrillation,
we think the benefit could be even greater.
Warfarin has many adverse properties. Vitamin
K content varies widely in foods. Warfarin
inhibits the synthesis of sequential enzymes in
the coagulation cascade, which imparts a drastically
steep dose\u96response relationship. The binding
of warfarin to plasma proteins and its metabolism
by cytochrome P-450 enzymes facilitate
drug interactions. These properties result in variability
in anticoagulant control, which is associated
with bleeding, thrombosis, and increased
risk of death.2-5
Dabigatran lacks these undesirable properties.
But the adoption of \u93one size fits all\u94 dosing has
probably undermined the performance of dabigatran
in the trial for the Randomized Evaluation
of Long-Term Anticoagulation Therapy (RE-LY).
Dabigatran appeared to be more efficacious in
patients who weighed less and in patients with
impaired renal function (in whom the drug accumulates),
pointing to significant interpatient
variability in response. Individualized dosing,
based on weight and estimated creatinine clearance,
might improve the drug\u92s risk\u96benefit ratio.
Dosing could be further refined with the use of
a single measurement of the drug level drawn at
steady state, if necessary. Such an approach
should be studied.
Donald Stuart Houston, M.D., Ph.D.
Ryan Zarychanski, M.D
Sex Hormone\u96Binding Globulin and Risk of Type 2 Diabetes
To the Editor: Ding et al. (Sept. 17 issue)1 found
that sex hormone\u96binding globulin, which is predominantly
expressed in hepatocytes, may protect
against type 2 diabetes. What variables in the
natural history of diabetes determine circulating
levels of sex hormone\u96binding globulin? Recently,
monosaccharide-induced hepatic lipogenesis,
but not insulin, was shown to suppress hepatic
production of sex hormone\u96binding globulin in
animals.2 Because this pathway is involved in the
pathogenesis of fatty liver, a major risk factor in
type 2 diabetes,3 we hypothesized that levels of
sex hormone\u96binding globulin decrease, particularly
under hepatic steatosis. In subjects who
underwent precise measurements of liver-fat and
body-fat distribution4 we observed that besides
sex and age, liver fat, but not visceral fat or total
body fat, was an independent predictor of levels
of sex hormone\u96binding globulin (Fig. 1A). During
a lifestyle intervention, an increase in levels of
sex hormone\u96binding globulin was more strongly
associated with a decrease in liver fat
Human GM-CSF Autoantibodies and Reproduction of Pulmonary Alveolar Proteinosis
To the Editor: Idiopathic pulmonary alveolar
proteinosis is a rare disease in which surfactant
lipids and proteins accumulate in pulmonary
alveolar macrophages and alveoli, resulting in respiratory
insufficiency and, in severe cases, respiratory
failure.1 Granulocyte\u96macrophage colonystimulating
factor (GM-CSF) autoantibodies occur
in these patients2 and may mediate the pathogenesis
of this disease, but they are also present
in healthy persons and in immune globulin prepared
from plasma obtained from healthy persons.
Since GM-CSF is required for surfactant
catabolism by alveolar macrophages in mice, we
hypothesized that high levels of GM-CSF autoantibodies
(i.e., levels sufficient to eliminate endogenous
GM-CSF priming of myeloid cells)
could cause idiopathic pulmonary alveolar proteinosis
by impairing surfactant clearance by alveolar
macrophages.3 We previously found that
high levels of GM-CSF autoantibodies are specifically
associated with idiopathic pulmonary
alveolar proteinosis4 and can be isolated in pure
form from these patients.5
We administered highly purified GM-CSF autoantibodies
derived from a patient with idiopathic
pulmonary alveolar proteinosis to healthy
nonhuman primates (Macaca fascicularis). These
autoantibodies were administered intravenously,
and serum levels of 40 \ub5g per milliliter or more
were maintained for 10 months. A marked reduction
in levels of GM-CSF\u96stimulated CD11b
in blood leukocytes indicated that GM-CSF signaling
was blocked; these results were identical
to those in patients with idiopathic pulmonary
alveolar proteinosis.
Recommended from our members
AIDS - medical and prevention studies
An article from The New England Journal of Medicine discussing recent medical progress in discovering how the human immunodeficiency virus (HIV) is transmitted and the groups that are at risk to become infected with the virus that progresses into the acquired immunodeficiency syndrome (AIDS)