Divya K

TOPLINE:

A clinically significant association exists between fructose and fructan malabsorption in certain patients with irritable bowel syndrome (IBS), indicating that some may benefit from eliminating both carbohydrates.

METHODOLOGY:

• Previous research has focused on fructose or fructan malabsorption separately in patients with IBS, rather than together in the same cohort.
• Researchers conducted a retrospective review of electronic medical records obtained from January 2017 to June 2022 at a single US medical clinic from patients with IBS who had undergone fructose and fructan hydrogen breath tests (HBTs).
• Patients were advised to have a low-carbohydrate dinner the day before, and fast for at least 12 hours prior to the HBT.
• Separate fructose and fructan HBTs were performed at baseline and again on separate days (minimum 1 day between HBTs) by administering a 25-g fructose or 10-g insulin solution and noting the breath hydrogen readings every 30 minutes for 3 hours. Breath hydrogen levels ≥ 20 ppm indicated a positive malabsorption result for either of the carbohydrates.
• The HBT results were compared to study the association between fructose and fructan malabsorption.

TAKEAWAY:

• Among 186 patients (median age, 36.7 years; 37.6% men), 38.2% tested positive for fructose malabsorption, 48.9% for fructan malabsorption, and 22.6% for both.
• There was a significant association between positive fructose and positive fructan HBT readings (P = .0283).
• Patients who tested positive for fructose or fructan malabsorption had a 1.951 times higher likelihood of testing positive for the other carbohydrate (95% CI, 1.072-3.476).

IN PRACTICE:

“The positive association between fructose and fructan malabsorption in patients with IBS suggests that fructan malabsorption should be suspected in a patient who tests positive for fructose malabsorption, and vice versa,” the authors wrote.

SOURCE:

The study, led by Twan Sia, MD, Boston Specialists, Boston, was published online in BMC Gastroenterology.

LIMITATIONS:

The findings may have limited generalizability, as it included patients primarily from the northeastern region of the United States. The study limited HBT to 3 hours, beyond which rises in hydrogen gas might have been missed. Moreover, the use of an absolute hydrogen threshold of 20 ppm differs from that used in most other studies.

DISCLOSURES:

This study did not receive any specific grant from any funding agencies. One of the authors declared being a consultant for various pharmaceutical companies.
 

A version of this article appeared on Medscape.com.

TOPLINE:

A clinically significant association exists between fructose and fructan malabsorption in certain patients with irritable bowel syndrome (IBS), indicating that some may benefit from eliminating both carbohydrates.

METHODOLOGY:

• Previous research has focused on fructose or fructan malabsorption separately in patients with IBS, rather than together in the same cohort.
• Researchers conducted a retrospective review of electronic medical records obtained from January 2017 to June 2022 at a single US medical clinic from patients with IBS who had undergone fructose and fructan hydrogen breath tests (HBTs).
• Patients were advised to have a low-carbohydrate dinner the day before, and fast for at least 12 hours prior to the HBT.
• Separate fructose and fructan HBTs were performed at baseline and again on separate days (minimum 1 day between HBTs) by administering a 25-g fructose or 10-g insulin solution and noting the breath hydrogen readings every 30 minutes for 3 hours. Breath hydrogen levels ≥ 20 ppm indicated a positive malabsorption result for either of the carbohydrates.
• The HBT results were compared to study the association between fructose and fructan malabsorption.

TAKEAWAY:

• Among 186 patients (median age, 36.7 years; 37.6% men), 38.2% tested positive for fructose malabsorption, 48.9% for fructan malabsorption, and 22.6% for both.
• There was a significant association between positive fructose and positive fructan HBT readings (P = .0283).
• Patients who tested positive for fructose or fructan malabsorption had a 1.951 times higher likelihood of testing positive for the other carbohydrate (95% CI, 1.072-3.476).

IN PRACTICE:

“The positive association between fructose and fructan malabsorption in patients with IBS suggests that fructan malabsorption should be suspected in a patient who tests positive for fructose malabsorption, and vice versa,” the authors wrote.

SOURCE:

The study, led by Twan Sia, MD, Boston Specialists, Boston, was published online in BMC Gastroenterology.

LIMITATIONS:

The findings may have limited generalizability, as it included patients primarily from the northeastern region of the United States. The study limited HBT to 3 hours, beyond which rises in hydrogen gas might have been missed. Moreover, the use of an absolute hydrogen threshold of 20 ppm differs from that used in most other studies.

DISCLOSURES:

This study did not receive any specific grant from any funding agencies. One of the authors declared being a consultant for various pharmaceutical companies.
 

A version of this article appeared on Medscape.com.

TOPLINE:

A clinically significant association exists between fructose and fructan malabsorption in certain patients with irritable bowel syndrome (IBS), indicating that some may benefit from eliminating both carbohydrates.

METHODOLOGY:

• Previous research has focused on fructose or fructan malabsorption separately in patients with IBS, rather than together in the same cohort.
• Researchers conducted a retrospective review of electronic medical records obtained from January 2017 to June 2022 at a single US medical clinic from patients with IBS who had undergone fructose and fructan hydrogen breath tests (HBTs).
• Patients were advised to have a low-carbohydrate dinner the day before, and fast for at least 12 hours prior to the HBT.
• Separate fructose and fructan HBTs were performed at baseline and again on separate days (minimum 1 day between HBTs) by administering a 25-g fructose or 10-g insulin solution and noting the breath hydrogen readings every 30 minutes for 3 hours. Breath hydrogen levels ≥ 20 ppm indicated a positive malabsorption result for either of the carbohydrates.
• The HBT results were compared to study the association between fructose and fructan malabsorption.

TAKEAWAY:

• Among 186 patients (median age, 36.7 years; 37.6% men), 38.2% tested positive for fructose malabsorption, 48.9% for fructan malabsorption, and 22.6% for both.
• There was a significant association between positive fructose and positive fructan HBT readings (P = .0283).
• Patients who tested positive for fructose or fructan malabsorption had a 1.951 times higher likelihood of testing positive for the other carbohydrate (95% CI, 1.072-3.476).

IN PRACTICE:

“The positive association between fructose and fructan malabsorption in patients with IBS suggests that fructan malabsorption should be suspected in a patient who tests positive for fructose malabsorption, and vice versa,” the authors wrote.

SOURCE:

The study, led by Twan Sia, MD, Boston Specialists, Boston, was published online in BMC Gastroenterology.

LIMITATIONS:

The findings may have limited generalizability, as it included patients primarily from the northeastern region of the United States. The study limited HBT to 3 hours, beyond which rises in hydrogen gas might have been missed. Moreover, the use of an absolute hydrogen threshold of 20 ppm differs from that used in most other studies.

DISCLOSURES:

This study did not receive any specific grant from any funding agencies. One of the authors declared being a consultant for various pharmaceutical companies.
 

A version of this article appeared on Medscape.com.

TOPLINE:

Antiepileptic and anti-infectious agents were the most common drugs associated with Stevens-Johnson syndrome (SJS)/toxic epidermal necrolysis (TEN) in children in an analysis of a World Health Organization (WHO) database.

METHODOLOGY:

• SJS and TEN are rare, life-threatening mucocutaneous reactions mainly associated with medications, but large pharmacovigilance studies of drugs associated with SJS-TEN in the pediatric population are still lacking.
• Using the WHO’s pharmacovigilance database (VigiBase) containing individual case safety reports from January 1967 to July 2022, researchers identified 7342 adverse drug reaction reports of SJS-TEN in children (younger than 18 years; median age, 9 years) in all six continents. Median onset was 5 days, and 3.2% were fatal.
• They analyzed drugs reported as suspected treatments, and for each molecule, they performed a case–non-case study to assess a potential pharmacovigilance signal by computing the information component (IC).
• A positive IC value suggested more frequent reporting of a specific drug-adverse reaction pair. A positive IC025, a traditional threshold for statistical signal detection, is suggestive of a potential pharmacovigilance signal.

TAKEAWAY:

• Overall, 165 drugs were associated with a diagnosis of SJS-TEN; antiepileptic and anti-infectious drugs were the most common drug classes represented.
• The five most frequently reported drugs were carbamazepine (11.7%), lamotrigine (10.6%), sulfamethoxazole-trimethoprim (9%), acetaminophen (8.4%), and phenytoin (6.6%). The five drugs with the highest IC025 were lamotrigine, carbamazepine, phenobarbital, phenytoin, and nimesulide.
• All antiepileptics, many antibiotic families, dapsone, antiretroviral drugs, some antifungal drugs, and nonsteroidal anti-inflammatory drugs were identified in reports, with penicillins the most frequently reported antibiotic family and sulfonamides having the strongest pharmacovigilance signal.
• Vaccines were not associated with significant signals.

IN PRACTICE:

The study provides an update on “the spectrum of drugs potentially associated with SJS-TEN in the pediatric population,” the authors concluded, and “underlines the importance of reporting to pharmacovigilance the suspicion of this severe side effect of drugs with the most precise and detailed clinical description possible.”

[embed:render:related:node:263873]

SOURCE:

The study, led by Pauline Bataille, MD, of the Department of Pediatric Dermatology, Hôpital Necker-Enfants Malades, Paris City University, France, was published online in the Journal of the European Academy of Dermatology and Venereology.

LIMITATIONS:

Limitations include the possibility that some cases could have had an infectious or idiopathic cause not related to a drug and the lack of detailed clinical data in the database.

DISCLOSURES:

This study did not receive any funding. The authors declared no conflict of interest.

A version of this article first appeared on Medscape.com.

TOPLINE:

Antiepileptic and anti-infectious agents were the most common drugs associated with Stevens-Johnson syndrome (SJS)/toxic epidermal necrolysis (TEN) in children in an analysis of a World Health Organization (WHO) database.

METHODOLOGY:

• SJS and TEN are rare, life-threatening mucocutaneous reactions mainly associated with medications, but large pharmacovigilance studies of drugs associated with SJS-TEN in the pediatric population are still lacking.
• Using the WHO’s pharmacovigilance database (VigiBase) containing individual case safety reports from January 1967 to July 2022, researchers identified 7342 adverse drug reaction reports of SJS-TEN in children (younger than 18 years; median age, 9 years) in all six continents. Median onset was 5 days, and 3.2% were fatal.
• They analyzed drugs reported as suspected treatments, and for each molecule, they performed a case–non-case study to assess a potential pharmacovigilance signal by computing the information component (IC).
• A positive IC value suggested more frequent reporting of a specific drug-adverse reaction pair. A positive IC025, a traditional threshold for statistical signal detection, is suggestive of a potential pharmacovigilance signal.

TAKEAWAY:

• Overall, 165 drugs were associated with a diagnosis of SJS-TEN; antiepileptic and anti-infectious drugs were the most common drug classes represented.
• The five most frequently reported drugs were carbamazepine (11.7%), lamotrigine (10.6%), sulfamethoxazole-trimethoprim (9%), acetaminophen (8.4%), and phenytoin (6.6%). The five drugs with the highest IC025 were lamotrigine, carbamazepine, phenobarbital, phenytoin, and nimesulide.
• All antiepileptics, many antibiotic families, dapsone, antiretroviral drugs, some antifungal drugs, and nonsteroidal anti-inflammatory drugs were identified in reports, with penicillins the most frequently reported antibiotic family and sulfonamides having the strongest pharmacovigilance signal.
• Vaccines were not associated with significant signals.

IN PRACTICE:

The study provides an update on “the spectrum of drugs potentially associated with SJS-TEN in the pediatric population,” the authors concluded, and “underlines the importance of reporting to pharmacovigilance the suspicion of this severe side effect of drugs with the most precise and detailed clinical description possible.”

[embed:render:related:node:263873]

SOURCE:

The study, led by Pauline Bataille, MD, of the Department of Pediatric Dermatology, Hôpital Necker-Enfants Malades, Paris City University, France, was published online in the Journal of the European Academy of Dermatology and Venereology.

LIMITATIONS:

Limitations include the possibility that some cases could have had an infectious or idiopathic cause not related to a drug and the lack of detailed clinical data in the database.

DISCLOSURES:

This study did not receive any funding. The authors declared no conflict of interest.

A version of this article first appeared on Medscape.com.

TOPLINE:

Antiepileptic and anti-infectious agents were the most common drugs associated with Stevens-Johnson syndrome (SJS)/toxic epidermal necrolysis (TEN) in children in an analysis of a World Health Organization (WHO) database.

METHODOLOGY:

• SJS and TEN are rare, life-threatening mucocutaneous reactions mainly associated with medications, but large pharmacovigilance studies of drugs associated with SJS-TEN in the pediatric population are still lacking.
• Using the WHO’s pharmacovigilance database (VigiBase) containing individual case safety reports from January 1967 to July 2022, researchers identified 7342 adverse drug reaction reports of SJS-TEN in children (younger than 18 years; median age, 9 years) in all six continents. Median onset was 5 days, and 3.2% were fatal.
• They analyzed drugs reported as suspected treatments, and for each molecule, they performed a case–non-case study to assess a potential pharmacovigilance signal by computing the information component (IC).
• A positive IC value suggested more frequent reporting of a specific drug-adverse reaction pair. A positive IC025, a traditional threshold for statistical signal detection, is suggestive of a potential pharmacovigilance signal.

TAKEAWAY:

• Overall, 165 drugs were associated with a diagnosis of SJS-TEN; antiepileptic and anti-infectious drugs were the most common drug classes represented.
• The five most frequently reported drugs were carbamazepine (11.7%), lamotrigine (10.6%), sulfamethoxazole-trimethoprim (9%), acetaminophen (8.4%), and phenytoin (6.6%). The five drugs with the highest IC025 were lamotrigine, carbamazepine, phenobarbital, phenytoin, and nimesulide.
• All antiepileptics, many antibiotic families, dapsone, antiretroviral drugs, some antifungal drugs, and nonsteroidal anti-inflammatory drugs were identified in reports, with penicillins the most frequently reported antibiotic family and sulfonamides having the strongest pharmacovigilance signal.
• Vaccines were not associated with significant signals.

IN PRACTICE:

The study provides an update on “the spectrum of drugs potentially associated with SJS-TEN in the pediatric population,” the authors concluded, and “underlines the importance of reporting to pharmacovigilance the suspicion of this severe side effect of drugs with the most precise and detailed clinical description possible.”

[embed:render:related:node:263873]

SOURCE:

The study, led by Pauline Bataille, MD, of the Department of Pediatric Dermatology, Hôpital Necker-Enfants Malades, Paris City University, France, was published online in the Journal of the European Academy of Dermatology and Venereology.

LIMITATIONS:

Limitations include the possibility that some cases could have had an infectious or idiopathic cause not related to a drug and the lack of detailed clinical data in the database.

DISCLOSURES:

This study did not receive any funding. The authors declared no conflict of interest.

A version of this article first appeared on Medscape.com.

TOPLINE:

Tocilizumab administration results in high remission rates in adult-onset Still’s disease (AOSD), but the recurrence rate increases on tocilizumab discontinuation, with a longer tocilizumab interval and lower prednisolone dose being critical for successful tocilizumab withdrawal.

METHODOLOGY:

• Tocilizumab is effective in reducing systemic inflammation and lowering glucocorticoid doses in patients with AOSD; however, the possibility of tocilizumab withdrawal has not been explored.
• This retrospective study assessed whether tocilizumab can be discontinued after achieving remission in 48 patients with AOSD.
• The systemic feature score, Pouchot score, and modified Pouchot score were used to evaluate the disease activity.
• Remission was characterized by the absence of symptoms related to Still’s disease, normal levels of erythrocyte sedimentation rate and C-reactive protein, and absence of treatment intensification requirement.
• Recurrence after tocilizumab discontinuation was defined as a disease flare with AOSD treatment intensification that necessitated either a ≥ 1.5-fold increase in glucocorticoid dosage and/or the initiation of a biologic agent.

TAKEAWAY:

• Over a median observation period of 5.1 years, 38 (79.2%) patients achieved remission at 6 months, of which 13 discontinued tocilizumab and the remaining 25 continued it.
• Among patients who discontinued tocilizumab on achieving remission, recurrence was noted in 50% within a year, typically after a mean period of 5.5 months after discontinuation.
• Patients in remission with longer tocilizumab intervals (> 14 days; P < .0002) or lower prednisolone doses (< 7 mg/d; P = .001) at the time of tocilizumab discontinuation showed better recurrence-free rates than those without.
• The duration of tocilizumab use, systemic feature score, and serum ferritin levels at tocilizumab discontinuation were not significantly different between patients who experienced recurrence and those who did not.

IN PRACTICE:

“Stable conditions with extended intervals of tocilizumab administration and very low doses of concomitant glucocorticoids are essential for successful discontinuation,” the authors wrote.

SOURCE:

The study was led by Hiroya Tamai, Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan, and published online in Rheumatology (Oxford).

LIMITATIONS:

The study was limited by its retrospective study design and a small sample size. Moreover, there could have been a selection bias as the attending physicians could use their discretion to initiate or stop tocilizumab treatment. The absence of a universally agreed-upon definition for remission or recurrence in AOSD made comparing the findings of this study with those of others challenging.

DISCLOSURES:

This study did not receive any specific funding from any bodies in public, commercial, or nonprofit sectors. Some of the authors reported receiving honoraria and research support from various pharmaceutical companies.
 

A version of this article appeared on Medscape.com.

TOPLINE:

Tocilizumab administration results in high remission rates in adult-onset Still’s disease (AOSD), but the recurrence rate increases on tocilizumab discontinuation, with a longer tocilizumab interval and lower prednisolone dose being critical for successful tocilizumab withdrawal.

METHODOLOGY:

• Tocilizumab is effective in reducing systemic inflammation and lowering glucocorticoid doses in patients with AOSD; however, the possibility of tocilizumab withdrawal has not been explored.
• This retrospective study assessed whether tocilizumab can be discontinued after achieving remission in 48 patients with AOSD.
• The systemic feature score, Pouchot score, and modified Pouchot score were used to evaluate the disease activity.
• Remission was characterized by the absence of symptoms related to Still’s disease, normal levels of erythrocyte sedimentation rate and C-reactive protein, and absence of treatment intensification requirement.
• Recurrence after tocilizumab discontinuation was defined as a disease flare with AOSD treatment intensification that necessitated either a ≥ 1.5-fold increase in glucocorticoid dosage and/or the initiation of a biologic agent.

TAKEAWAY:

• Over a median observation period of 5.1 years, 38 (79.2%) patients achieved remission at 6 months, of which 13 discontinued tocilizumab and the remaining 25 continued it.
• Among patients who discontinued tocilizumab on achieving remission, recurrence was noted in 50% within a year, typically after a mean period of 5.5 months after discontinuation.
• Patients in remission with longer tocilizumab intervals (> 14 days; P < .0002) or lower prednisolone doses (< 7 mg/d; P = .001) at the time of tocilizumab discontinuation showed better recurrence-free rates than those without.
• The duration of tocilizumab use, systemic feature score, and serum ferritin levels at tocilizumab discontinuation were not significantly different between patients who experienced recurrence and those who did not.

IN PRACTICE:

“Stable conditions with extended intervals of tocilizumab administration and very low doses of concomitant glucocorticoids are essential for successful discontinuation,” the authors wrote.

SOURCE:

The study was led by Hiroya Tamai, Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan, and published online in Rheumatology (Oxford).

LIMITATIONS:

The study was limited by its retrospective study design and a small sample size. Moreover, there could have been a selection bias as the attending physicians could use their discretion to initiate or stop tocilizumab treatment. The absence of a universally agreed-upon definition for remission or recurrence in AOSD made comparing the findings of this study with those of others challenging.

DISCLOSURES:

This study did not receive any specific funding from any bodies in public, commercial, or nonprofit sectors. Some of the authors reported receiving honoraria and research support from various pharmaceutical companies.
 

A version of this article appeared on Medscape.com.

TOPLINE:

Tocilizumab administration results in high remission rates in adult-onset Still’s disease (AOSD), but the recurrence rate increases on tocilizumab discontinuation, with a longer tocilizumab interval and lower prednisolone dose being critical for successful tocilizumab withdrawal.

METHODOLOGY:

• Tocilizumab is effective in reducing systemic inflammation and lowering glucocorticoid doses in patients with AOSD; however, the possibility of tocilizumab withdrawal has not been explored.
• This retrospective study assessed whether tocilizumab can be discontinued after achieving remission in 48 patients with AOSD.
• The systemic feature score, Pouchot score, and modified Pouchot score were used to evaluate the disease activity.
• Remission was characterized by the absence of symptoms related to Still’s disease, normal levels of erythrocyte sedimentation rate and C-reactive protein, and absence of treatment intensification requirement.
• Recurrence after tocilizumab discontinuation was defined as a disease flare with AOSD treatment intensification that necessitated either a ≥ 1.5-fold increase in glucocorticoid dosage and/or the initiation of a biologic agent.

TAKEAWAY:

• Over a median observation period of 5.1 years, 38 (79.2%) patients achieved remission at 6 months, of which 13 discontinued tocilizumab and the remaining 25 continued it.
• Among patients who discontinued tocilizumab on achieving remission, recurrence was noted in 50% within a year, typically after a mean period of 5.5 months after discontinuation.
• Patients in remission with longer tocilizumab intervals (> 14 days; P < .0002) or lower prednisolone doses (< 7 mg/d; P = .001) at the time of tocilizumab discontinuation showed better recurrence-free rates than those without.
• The duration of tocilizumab use, systemic feature score, and serum ferritin levels at tocilizumab discontinuation were not significantly different between patients who experienced recurrence and those who did not.

IN PRACTICE:

“Stable conditions with extended intervals of tocilizumab administration and very low doses of concomitant glucocorticoids are essential for successful discontinuation,” the authors wrote.

SOURCE:

The study was led by Hiroya Tamai, Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan, and published online in Rheumatology (Oxford).

LIMITATIONS:

The study was limited by its retrospective study design and a small sample size. Moreover, there could have been a selection bias as the attending physicians could use their discretion to initiate or stop tocilizumab treatment. The absence of a universally agreed-upon definition for remission or recurrence in AOSD made comparing the findings of this study with those of others challenging.

DISCLOSURES:

This study did not receive any specific funding from any bodies in public, commercial, or nonprofit sectors. Some of the authors reported receiving honoraria and research support from various pharmaceutical companies.
 

A version of this article appeared on Medscape.com.

TOPLINE:

Higher consumption of ultraprocessed food (UPF) is associated with an increased risk of developing irritable bowel syndrome (IBS), with a significant dose-response relationship.

METHODOLOGY:

• The simultaneous rise in UPF consumption and IBS in recent years is concerning, but there is a lack of epidemiologic evidence regarding the link between UPF consumption and the risk of developing IBS.
• This study included 178,711 participants without IBS, inflammatory bowel disease, celiac disease, or cancer (mean age, 55.8 years; 53.1% women) from the UK Biobank who had completed a 24-hour diet recall questionnaire over five cycles.
• The researchers used the NOVA system to categorize food into four groups, ranging from unprocessed or minimally processed food to UPF. They calculated consumption of food in each group on the basis of portion sizes and UPF consumption as a percentage of total diet intake (as grams per day) using data from participants who completed at least two dietary cycles.
• The primary outcome was incident IBS.

TAKEAWAY:

• Over a median of 11.3 years of follow-up, 2690 incident IBS cases were reported.
• The mean UPF consumption was 21% of the total diet.
• For every 10% increase in UPF consumption, the risk for IBS also increased by 8%.
• The individuals in the highest quartile of UPF consumption had about a 20% higher risk for IBS than those in the lowest quartile.

IN PRACTICE:

“Our findings suggest that avoiding or lowering UPF consumption could be considered as a potential strategy to help reduce the increasing burden of IBS,” the authors wrote.

SOURCE:

The study, led by Shanshan Wu, PhD, Beijing Friendship Hospital, Capital Medical University, National Clinical Research Center for Digestive Disease, Beijing, China, was published online in Clinical Gastroenterology and Hepatology.

LIMITATIONS:

Questionnaire-based data could introduce misclassification and recall bias. Lifestyle factors (eg, smoking) or nutritional factors (eg, total intake of protein, fat, and carbohydrates) that may confound the association were not considered. The observational study design has inherent bias.

DISCLOSURES:

This study was supported by grants from the Beijing Nova Program, National Key Research and Development Program of China, and Beijing Science and Technology Project. The authors declared no conflicts of interest.

A version of this article appeared on Medscape.com.

TOPLINE:

Higher consumption of ultraprocessed food (UPF) is associated with an increased risk of developing irritable bowel syndrome (IBS), with a significant dose-response relationship.

METHODOLOGY:

• The simultaneous rise in UPF consumption and IBS in recent years is concerning, but there is a lack of epidemiologic evidence regarding the link between UPF consumption and the risk of developing IBS.
• This study included 178,711 participants without IBS, inflammatory bowel disease, celiac disease, or cancer (mean age, 55.8 years; 53.1% women) from the UK Biobank who had completed a 24-hour diet recall questionnaire over five cycles.
• The researchers used the NOVA system to categorize food into four groups, ranging from unprocessed or minimally processed food to UPF. They calculated consumption of food in each group on the basis of portion sizes and UPF consumption as a percentage of total diet intake (as grams per day) using data from participants who completed at least two dietary cycles.
• The primary outcome was incident IBS.

TAKEAWAY:

• Over a median of 11.3 years of follow-up, 2690 incident IBS cases were reported.
• The mean UPF consumption was 21% of the total diet.
• For every 10% increase in UPF consumption, the risk for IBS also increased by 8%.
• The individuals in the highest quartile of UPF consumption had about a 20% higher risk for IBS than those in the lowest quartile.

IN PRACTICE:

“Our findings suggest that avoiding or lowering UPF consumption could be considered as a potential strategy to help reduce the increasing burden of IBS,” the authors wrote.

SOURCE:

The study, led by Shanshan Wu, PhD, Beijing Friendship Hospital, Capital Medical University, National Clinical Research Center for Digestive Disease, Beijing, China, was published online in Clinical Gastroenterology and Hepatology.

LIMITATIONS:

Questionnaire-based data could introduce misclassification and recall bias. Lifestyle factors (eg, smoking) or nutritional factors (eg, total intake of protein, fat, and carbohydrates) that may confound the association were not considered. The observational study design has inherent bias.

DISCLOSURES:

This study was supported by grants from the Beijing Nova Program, National Key Research and Development Program of China, and Beijing Science and Technology Project. The authors declared no conflicts of interest.

A version of this article appeared on Medscape.com.

TOPLINE:

Higher consumption of ultraprocessed food (UPF) is associated with an increased risk of developing irritable bowel syndrome (IBS), with a significant dose-response relationship.

METHODOLOGY:

• The simultaneous rise in UPF consumption and IBS in recent years is concerning, but there is a lack of epidemiologic evidence regarding the link between UPF consumption and the risk of developing IBS.
• This study included 178,711 participants without IBS, inflammatory bowel disease, celiac disease, or cancer (mean age, 55.8 years; 53.1% women) from the UK Biobank who had completed a 24-hour diet recall questionnaire over five cycles.
• The researchers used the NOVA system to categorize food into four groups, ranging from unprocessed or minimally processed food to UPF. They calculated consumption of food in each group on the basis of portion sizes and UPF consumption as a percentage of total diet intake (as grams per day) using data from participants who completed at least two dietary cycles.
• The primary outcome was incident IBS.

TAKEAWAY:

• Over a median of 11.3 years of follow-up, 2690 incident IBS cases were reported.
• The mean UPF consumption was 21% of the total diet.
• For every 10% increase in UPF consumption, the risk for IBS also increased by 8%.
• The individuals in the highest quartile of UPF consumption had about a 20% higher risk for IBS than those in the lowest quartile.

IN PRACTICE:

“Our findings suggest that avoiding or lowering UPF consumption could be considered as a potential strategy to help reduce the increasing burden of IBS,” the authors wrote.

SOURCE:

The study, led by Shanshan Wu, PhD, Beijing Friendship Hospital, Capital Medical University, National Clinical Research Center for Digestive Disease, Beijing, China, was published online in Clinical Gastroenterology and Hepatology.

LIMITATIONS:

Questionnaire-based data could introduce misclassification and recall bias. Lifestyle factors (eg, smoking) or nutritional factors (eg, total intake of protein, fat, and carbohydrates) that may confound the association were not considered. The observational study design has inherent bias.

DISCLOSURES:

This study was supported by grants from the Beijing Nova Program, National Key Research and Development Program of China, and Beijing Science and Technology Project. The authors declared no conflicts of interest.

A version of this article appeared on Medscape.com.

TOPLINE:

Patients who undergo surgery for carpal tunnel syndrome (CTS) may have an increased risk of developing incident diabetes, showed a recent study.

METHODOLOGY:

• Diabetes has been shown to be a risk factor for CTS, the most common entrapment neuropathy, but it remains unclear whether CTS is associated with subsequent diabetes.
• Researchers used data from Danish national registries to evaluate the odds of developing diabetes in 83,466 patients (median age, 54 years; 67% women) who underwent surgery for CTS between January 1996 and December 2018.
• The study compared the risk of developing diabetes in patients who had CTS surgery with that of an age- and sex-matched cohort of individuals from the general population in a 1:5 ratio (n = 417,330).
• Patients were followed (median of 7.6 years) until either a diagnosis of diabetes during hospitalization or a prescription of a glucose-lowering drug, or until either death, emigration, or the end of the study period.
• Cause-specific Cox proportional hazard models were used to compare the odds of developing diabetes between the two groups.

TAKEAWAY:

• The cumulative incidence of diabetes was higher in the CTS group than in the age-matched controls (16.8% vs 10.3%).
• Patients who underwent surgery for CTS were at a higher risk of developing diabetes within 1 year of surgery (hazard ratio [HR], 1.72) and during the rest of the study period (> 1 year: HR, 1.66).
• The risk for incident diabetes after CTS surgery was higher among younger patients aged 18-39 years (adjusted HR, 2.77) than among older patients aged 70-79 years (adjusted HR, 1.29).
• Also, patients who had bilateral surgery had a higher risk of developing diabetes than the matched control population (adjusted HR, 1.86).

IN PRACTICE:

“Identifying patients who are at risk of DM [diabetes mellitus] may mediate earlier initiation of preventive strategies. However, other factors, such as obesity and A1c levels, may affect the association,” the authors wrote.

SOURCE:

The study led by Jeppe Ravn Jacobsen, MB, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark, was published online in Diabetes, Obesity, and Metabolism .

LIMITATIONS:

The study did not find an association between CTS and a future diagnosis of type 1 diabetes, which may be attributed to the fact that patients younger than 18 years were excluded. A proportion of the patients who underwent CTS may have had undetected prediabetes or diabetes at the time of CTS surgery. Moreover, the registry lacked information on potential confounders such as body mass index, smoking history, and blood samples. The association between CTS and diabetes may be attributable to shared risk factors for both, such as obesity.

DISCLOSURES:

The study was funded by an internal grant from the Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark. The authors declared no conflicts of interest.

A version of this article first appeared on Medscape.com.

TOPLINE:

Patients who undergo surgery for carpal tunnel syndrome (CTS) may have an increased risk of developing incident diabetes, showed a recent study.

METHODOLOGY:

• Diabetes has been shown to be a risk factor for CTS, the most common entrapment neuropathy, but it remains unclear whether CTS is associated with subsequent diabetes.
• Researchers used data from Danish national registries to evaluate the odds of developing diabetes in 83,466 patients (median age, 54 years; 67% women) who underwent surgery for CTS between January 1996 and December 2018.
• The study compared the risk of developing diabetes in patients who had CTS surgery with that of an age- and sex-matched cohort of individuals from the general population in a 1:5 ratio (n = 417,330).
• Patients were followed (median of 7.6 years) until either a diagnosis of diabetes during hospitalization or a prescription of a glucose-lowering drug, or until either death, emigration, or the end of the study period.
• Cause-specific Cox proportional hazard models were used to compare the odds of developing diabetes between the two groups.

TAKEAWAY:

• The cumulative incidence of diabetes was higher in the CTS group than in the age-matched controls (16.8% vs 10.3%).
• Patients who underwent surgery for CTS were at a higher risk of developing diabetes within 1 year of surgery (hazard ratio [HR], 1.72) and during the rest of the study period (> 1 year: HR, 1.66).
• The risk for incident diabetes after CTS surgery was higher among younger patients aged 18-39 years (adjusted HR, 2.77) than among older patients aged 70-79 years (adjusted HR, 1.29).
• Also, patients who had bilateral surgery had a higher risk of developing diabetes than the matched control population (adjusted HR, 1.86).

IN PRACTICE:

“Identifying patients who are at risk of DM [diabetes mellitus] may mediate earlier initiation of preventive strategies. However, other factors, such as obesity and A1c levels, may affect the association,” the authors wrote.

SOURCE:

The study led by Jeppe Ravn Jacobsen, MB, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark, was published online in Diabetes, Obesity, and Metabolism .

LIMITATIONS:

The study did not find an association between CTS and a future diagnosis of type 1 diabetes, which may be attributed to the fact that patients younger than 18 years were excluded. A proportion of the patients who underwent CTS may have had undetected prediabetes or diabetes at the time of CTS surgery. Moreover, the registry lacked information on potential confounders such as body mass index, smoking history, and blood samples. The association between CTS and diabetes may be attributable to shared risk factors for both, such as obesity.

DISCLOSURES:

The study was funded by an internal grant from the Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark. The authors declared no conflicts of interest.

A version of this article first appeared on Medscape.com.

TOPLINE:

Patients who undergo surgery for carpal tunnel syndrome (CTS) may have an increased risk of developing incident diabetes, showed a recent study.

METHODOLOGY:

• Diabetes has been shown to be a risk factor for CTS, the most common entrapment neuropathy, but it remains unclear whether CTS is associated with subsequent diabetes.
• Researchers used data from Danish national registries to evaluate the odds of developing diabetes in 83,466 patients (median age, 54 years; 67% women) who underwent surgery for CTS between January 1996 and December 2018.
• The study compared the risk of developing diabetes in patients who had CTS surgery with that of an age- and sex-matched cohort of individuals from the general population in a 1:5 ratio (n = 417,330).
• Patients were followed (median of 7.6 years) until either a diagnosis of diabetes during hospitalization or a prescription of a glucose-lowering drug, or until either death, emigration, or the end of the study period.
• Cause-specific Cox proportional hazard models were used to compare the odds of developing diabetes between the two groups.

TAKEAWAY:

• The cumulative incidence of diabetes was higher in the CTS group than in the age-matched controls (16.8% vs 10.3%).
• Patients who underwent surgery for CTS were at a higher risk of developing diabetes within 1 year of surgery (hazard ratio [HR], 1.72) and during the rest of the study period (> 1 year: HR, 1.66).
• The risk for incident diabetes after CTS surgery was higher among younger patients aged 18-39 years (adjusted HR, 2.77) than among older patients aged 70-79 years (adjusted HR, 1.29).
• Also, patients who had bilateral surgery had a higher risk of developing diabetes than the matched control population (adjusted HR, 1.86).

IN PRACTICE:

“Identifying patients who are at risk of DM [diabetes mellitus] may mediate earlier initiation of preventive strategies. However, other factors, such as obesity and A1c levels, may affect the association,” the authors wrote.

SOURCE:

The study led by Jeppe Ravn Jacobsen, MB, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark, was published online in Diabetes, Obesity, and Metabolism .

LIMITATIONS:

The study did not find an association between CTS and a future diagnosis of type 1 diabetes, which may be attributed to the fact that patients younger than 18 years were excluded. A proportion of the patients who underwent CTS may have had undetected prediabetes or diabetes at the time of CTS surgery. Moreover, the registry lacked information on potential confounders such as body mass index, smoking history, and blood samples. The association between CTS and diabetes may be attributable to shared risk factors for both, such as obesity.

DISCLOSURES:

The study was funded by an internal grant from the Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark. The authors declared no conflicts of interest.

A version of this article first appeared on Medscape.com.