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Avoid Too Low or High Vitamin D Levels for Best Pregnancy Outcomes in Lupus
TOPLINE:
Both low and high levels of maternal 25-hydroxy [25(OH)] vitamin D are linked to an increased risk for adverse pregnancy outcomes in women with systemic lupus erythematosus (SLE), with levels of 40-59 ng/mL being associated with the lowest risk.
METHODOLOGY:
- Researchers analyzed 260 pregnancies in the Hopkins Lupus Cohort to examine the association between 25(OH) vitamin D levels and adverse pregnancy outcomes in women with SLE.
- The participants were required to have serum vitamin D levels measured during pregnancy and pregnancy-related outcomes data.
- The 25(OH) vitamin D levels were measured at visits every 6 weeks, and the participants were divided into six subgroups on the basis of the mean 25(OH) vitamin D levels: < 20 ng/dL, 20-29 ng/dL, 30-39 ng/dL, 40-49 ng/dL, 50-59 ng/dL, and ≥ 60 ng/dL.
- The adverse pregnancy outcomes included miscarriage, preterm delivery, and restricted intrauterine growth of the fetus.
- This study used a time-to-event analysis to assess the association between time-varying 25(OH) vitamin D levels and adverse pregnancy outcomes.
TAKEAWAY:
- Adverse pregnancy outcomes were observed in 45.3% of pregnancies; the risks for miscarriage and preterm delivery were significantly different across the six subgroups with varying vitamin D levels (P = .0045 and P = .0007, respectively).
- A U-shaped curve association was observed between vitamin D levels and adverse pregnancy outcomes, with the highest risk seen in patients with the lowest or highest levels of vitamin D during pregnancy, while the lowest risk was seen in those with vitamin D levels between 40 and 59 ng/mL.
- Low 25(OH) vitamin D levels during the second trimester resulted in premature delivery in 9 out of 10 pregnancies; however, a relationship between vitamin D levels in the first trimester and pregnancy outcomes was not observed.
- The time-to-event analysis showed that the U-shaped association between vitamin D levels and adverse pregnancy outcomes was still observed even after accounting for lupus disease activity; however, the elevated risk seen in individuals with the highest levels of vitamin D was no longer statistically significant.
IN PRACTICE:
“We recommend monitoring of maternal serum 25(OH) vitamin D levels throughout SLE pregnancies and supplementing patients with vitamin D insufficiency or deficiency, aiming for 25(OH) vitamin D range of 40-59 ng/mL. Over supplementation should be avoided,” the authors wrote.
SOURCE:
The study was led by Nima Madanchi, MD, Johns Hopkins University, Baltimore, and was published online on September 23, 2024, in Arthritis Care & Research.
LIMITATIONS:
This study could not prove a cause-and-effect relationship between vitamin D levels and adverse pregnancy outcomes. This study included only clinically identified pregnancies, potentially missing very early miscarriages. It also could not adjust for parity due to the unknown parity of the index pregnancy.
DISCLOSURES:
This Hopkins Lupus Cohort was supported by grants from the National Institutes of Health. The authors declared no conflicts of interest.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication. A version of this article first appeared on Medscape.com.
TOPLINE:
Both low and high levels of maternal 25-hydroxy [25(OH)] vitamin D are linked to an increased risk for adverse pregnancy outcomes in women with systemic lupus erythematosus (SLE), with levels of 40-59 ng/mL being associated with the lowest risk.
METHODOLOGY:
- Researchers analyzed 260 pregnancies in the Hopkins Lupus Cohort to examine the association between 25(OH) vitamin D levels and adverse pregnancy outcomes in women with SLE.
- The participants were required to have serum vitamin D levels measured during pregnancy and pregnancy-related outcomes data.
- The 25(OH) vitamin D levels were measured at visits every 6 weeks, and the participants were divided into six subgroups on the basis of the mean 25(OH) vitamin D levels: < 20 ng/dL, 20-29 ng/dL, 30-39 ng/dL, 40-49 ng/dL, 50-59 ng/dL, and ≥ 60 ng/dL.
- The adverse pregnancy outcomes included miscarriage, preterm delivery, and restricted intrauterine growth of the fetus.
- This study used a time-to-event analysis to assess the association between time-varying 25(OH) vitamin D levels and adverse pregnancy outcomes.
TAKEAWAY:
- Adverse pregnancy outcomes were observed in 45.3% of pregnancies; the risks for miscarriage and preterm delivery were significantly different across the six subgroups with varying vitamin D levels (P = .0045 and P = .0007, respectively).
- A U-shaped curve association was observed between vitamin D levels and adverse pregnancy outcomes, with the highest risk seen in patients with the lowest or highest levels of vitamin D during pregnancy, while the lowest risk was seen in those with vitamin D levels between 40 and 59 ng/mL.
- Low 25(OH) vitamin D levels during the second trimester resulted in premature delivery in 9 out of 10 pregnancies; however, a relationship between vitamin D levels in the first trimester and pregnancy outcomes was not observed.
- The time-to-event analysis showed that the U-shaped association between vitamin D levels and adverse pregnancy outcomes was still observed even after accounting for lupus disease activity; however, the elevated risk seen in individuals with the highest levels of vitamin D was no longer statistically significant.
IN PRACTICE:
“We recommend monitoring of maternal serum 25(OH) vitamin D levels throughout SLE pregnancies and supplementing patients with vitamin D insufficiency or deficiency, aiming for 25(OH) vitamin D range of 40-59 ng/mL. Over supplementation should be avoided,” the authors wrote.
SOURCE:
The study was led by Nima Madanchi, MD, Johns Hopkins University, Baltimore, and was published online on September 23, 2024, in Arthritis Care & Research.
LIMITATIONS:
This study could not prove a cause-and-effect relationship between vitamin D levels and adverse pregnancy outcomes. This study included only clinically identified pregnancies, potentially missing very early miscarriages. It also could not adjust for parity due to the unknown parity of the index pregnancy.
DISCLOSURES:
This Hopkins Lupus Cohort was supported by grants from the National Institutes of Health. The authors declared no conflicts of interest.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication. A version of this article first appeared on Medscape.com.
TOPLINE:
Both low and high levels of maternal 25-hydroxy [25(OH)] vitamin D are linked to an increased risk for adverse pregnancy outcomes in women with systemic lupus erythematosus (SLE), with levels of 40-59 ng/mL being associated with the lowest risk.
METHODOLOGY:
- Researchers analyzed 260 pregnancies in the Hopkins Lupus Cohort to examine the association between 25(OH) vitamin D levels and adverse pregnancy outcomes in women with SLE.
- The participants were required to have serum vitamin D levels measured during pregnancy and pregnancy-related outcomes data.
- The 25(OH) vitamin D levels were measured at visits every 6 weeks, and the participants were divided into six subgroups on the basis of the mean 25(OH) vitamin D levels: < 20 ng/dL, 20-29 ng/dL, 30-39 ng/dL, 40-49 ng/dL, 50-59 ng/dL, and ≥ 60 ng/dL.
- The adverse pregnancy outcomes included miscarriage, preterm delivery, and restricted intrauterine growth of the fetus.
- This study used a time-to-event analysis to assess the association between time-varying 25(OH) vitamin D levels and adverse pregnancy outcomes.
TAKEAWAY:
- Adverse pregnancy outcomes were observed in 45.3% of pregnancies; the risks for miscarriage and preterm delivery were significantly different across the six subgroups with varying vitamin D levels (P = .0045 and P = .0007, respectively).
- A U-shaped curve association was observed between vitamin D levels and adverse pregnancy outcomes, with the highest risk seen in patients with the lowest or highest levels of vitamin D during pregnancy, while the lowest risk was seen in those with vitamin D levels between 40 and 59 ng/mL.
- Low 25(OH) vitamin D levels during the second trimester resulted in premature delivery in 9 out of 10 pregnancies; however, a relationship between vitamin D levels in the first trimester and pregnancy outcomes was not observed.
- The time-to-event analysis showed that the U-shaped association between vitamin D levels and adverse pregnancy outcomes was still observed even after accounting for lupus disease activity; however, the elevated risk seen in individuals with the highest levels of vitamin D was no longer statistically significant.
IN PRACTICE:
“We recommend monitoring of maternal serum 25(OH) vitamin D levels throughout SLE pregnancies and supplementing patients with vitamin D insufficiency or deficiency, aiming for 25(OH) vitamin D range of 40-59 ng/mL. Over supplementation should be avoided,” the authors wrote.
SOURCE:
The study was led by Nima Madanchi, MD, Johns Hopkins University, Baltimore, and was published online on September 23, 2024, in Arthritis Care & Research.
LIMITATIONS:
This study could not prove a cause-and-effect relationship between vitamin D levels and adverse pregnancy outcomes. This study included only clinically identified pregnancies, potentially missing very early miscarriages. It also could not adjust for parity due to the unknown parity of the index pregnancy.
DISCLOSURES:
This Hopkins Lupus Cohort was supported by grants from the National Institutes of Health. The authors declared no conflicts of interest.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication. A version of this article first appeared on Medscape.com.
Weight Loss After Anti-Obesity Medications Linked to Reduced Gout Risk
TOPLINE:
A higher rate of weight loss within 1 year of initiating orlistat is associated with lower risks for incident gout and recurrent gout flares in individuals with body mass index (BMI) > 25, particularly if they have obesity or high baseline serum urate levels.
METHODOLOGY:
- Researchers conducted a population-based cohort study using data from The Health Improvement Network in the United Kingdom to examine the association between weight loss rates after the initiation of anti-obesity medication (orlistat) and the risk for incident gout and recurrent gout flares in patients with overweight or obesity.
- The risk for incident gout was analyzed in 131,000 patients with overweight or obesity (mean age, 45 years; 77.3% women; mean BMI, 37.2) who did not have gout before initiating orlistat.
- The risk for recurrent gout flares was evaluated in 3847 individuals with overweight or obesity (mean age, 56.6 years; 29.4% women; mean BMI, 38.5), who had gout before initiating orlistat.
- Participants were divided into four groups based on their rate of weight loss during the first year of orlistat use: Weight gain or stable (< 2%), slow (2% to < 5%), moderate (5% to < 10%), and fast (≥ 10%).
- The primary outcome was incident gout, and the secondary outcome was the rate of recurrent gout flares during the 5-year follow-up period after initiating orlistat.
TAKEAWAY:
- The 5-year risk for incident gout was the lowest among patients in the fast weight loss group (1.2%) and highest among those in the weight gain or stable weight group (1.6%).
- The risk for incident gout was lower in the fast (hazard ratio [HR], 0.73; 95% CI, 0.62-0.86) and moderate (HR, 0.82; 95% CI, 0.72-0.92) weight loss groups than in the weight gain or stable weight group.
- Similarly, faster weight loss rates were linked to lower rates of recurrent gout flares, with risk ratios of 0.71 (95% CI, 0.60-0.84) and 0.83 (95% CI, 0.71-0.96) in the fast and moderate weight loss groups, respectively.
- This study found that .
IN PRACTICE:
“Pharmacologic treatments, such as orlistat, present an alternative strategy for managing overweight and obesity. Our study provides empirical evidence of a dose-response effect of weight loss after initiating orlistat within 1 year lowers the risk of incident gout and recurrent gout flares,” the authors wrote.
SOURCE:
This study was led by Jie Wei, PhD, Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China, and was published online on September 19, 2024, in Arthritis & Rheumatology.
LIMITATIONS:
Despite adjustment for many variables, factors such as disease severity, exercise levels, and diet were not fully captured, which might have influenced the results. The lack of hospitalization data could have resulted in recurrent gout flares being underreported. The current study may have been subjected to bias due to potential exposure misclassification resulting from the timing of weight measurements and missing updated weight data.
DISCLOSURES:
This study was supported by the National Key Research and Development Plan, the National Natural Science Foundation of China, the Project Program of National Clinical Research Center for Geriatric Disorders, and other sources. No disclosures of interest were reported by the authors.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication. A version of this article first appeared on Medscape.com.
TOPLINE:
A higher rate of weight loss within 1 year of initiating orlistat is associated with lower risks for incident gout and recurrent gout flares in individuals with body mass index (BMI) > 25, particularly if they have obesity or high baseline serum urate levels.
METHODOLOGY:
- Researchers conducted a population-based cohort study using data from The Health Improvement Network in the United Kingdom to examine the association between weight loss rates after the initiation of anti-obesity medication (orlistat) and the risk for incident gout and recurrent gout flares in patients with overweight or obesity.
- The risk for incident gout was analyzed in 131,000 patients with overweight or obesity (mean age, 45 years; 77.3% women; mean BMI, 37.2) who did not have gout before initiating orlistat.
- The risk for recurrent gout flares was evaluated in 3847 individuals with overweight or obesity (mean age, 56.6 years; 29.4% women; mean BMI, 38.5), who had gout before initiating orlistat.
- Participants were divided into four groups based on their rate of weight loss during the first year of orlistat use: Weight gain or stable (< 2%), slow (2% to < 5%), moderate (5% to < 10%), and fast (≥ 10%).
- The primary outcome was incident gout, and the secondary outcome was the rate of recurrent gout flares during the 5-year follow-up period after initiating orlistat.
TAKEAWAY:
- The 5-year risk for incident gout was the lowest among patients in the fast weight loss group (1.2%) and highest among those in the weight gain or stable weight group (1.6%).
- The risk for incident gout was lower in the fast (hazard ratio [HR], 0.73; 95% CI, 0.62-0.86) and moderate (HR, 0.82; 95% CI, 0.72-0.92) weight loss groups than in the weight gain or stable weight group.
- Similarly, faster weight loss rates were linked to lower rates of recurrent gout flares, with risk ratios of 0.71 (95% CI, 0.60-0.84) and 0.83 (95% CI, 0.71-0.96) in the fast and moderate weight loss groups, respectively.
- This study found that .
IN PRACTICE:
“Pharmacologic treatments, such as orlistat, present an alternative strategy for managing overweight and obesity. Our study provides empirical evidence of a dose-response effect of weight loss after initiating orlistat within 1 year lowers the risk of incident gout and recurrent gout flares,” the authors wrote.
SOURCE:
This study was led by Jie Wei, PhD, Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China, and was published online on September 19, 2024, in Arthritis & Rheumatology.
LIMITATIONS:
Despite adjustment for many variables, factors such as disease severity, exercise levels, and diet were not fully captured, which might have influenced the results. The lack of hospitalization data could have resulted in recurrent gout flares being underreported. The current study may have been subjected to bias due to potential exposure misclassification resulting from the timing of weight measurements and missing updated weight data.
DISCLOSURES:
This study was supported by the National Key Research and Development Plan, the National Natural Science Foundation of China, the Project Program of National Clinical Research Center for Geriatric Disorders, and other sources. No disclosures of interest were reported by the authors.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication. A version of this article first appeared on Medscape.com.
TOPLINE:
A higher rate of weight loss within 1 year of initiating orlistat is associated with lower risks for incident gout and recurrent gout flares in individuals with body mass index (BMI) > 25, particularly if they have obesity or high baseline serum urate levels.
METHODOLOGY:
- Researchers conducted a population-based cohort study using data from The Health Improvement Network in the United Kingdom to examine the association between weight loss rates after the initiation of anti-obesity medication (orlistat) and the risk for incident gout and recurrent gout flares in patients with overweight or obesity.
- The risk for incident gout was analyzed in 131,000 patients with overweight or obesity (mean age, 45 years; 77.3% women; mean BMI, 37.2) who did not have gout before initiating orlistat.
- The risk for recurrent gout flares was evaluated in 3847 individuals with overweight or obesity (mean age, 56.6 years; 29.4% women; mean BMI, 38.5), who had gout before initiating orlistat.
- Participants were divided into four groups based on their rate of weight loss during the first year of orlistat use: Weight gain or stable (< 2%), slow (2% to < 5%), moderate (5% to < 10%), and fast (≥ 10%).
- The primary outcome was incident gout, and the secondary outcome was the rate of recurrent gout flares during the 5-year follow-up period after initiating orlistat.
TAKEAWAY:
- The 5-year risk for incident gout was the lowest among patients in the fast weight loss group (1.2%) and highest among those in the weight gain or stable weight group (1.6%).
- The risk for incident gout was lower in the fast (hazard ratio [HR], 0.73; 95% CI, 0.62-0.86) and moderate (HR, 0.82; 95% CI, 0.72-0.92) weight loss groups than in the weight gain or stable weight group.
- Similarly, faster weight loss rates were linked to lower rates of recurrent gout flares, with risk ratios of 0.71 (95% CI, 0.60-0.84) and 0.83 (95% CI, 0.71-0.96) in the fast and moderate weight loss groups, respectively.
- This study found that .
IN PRACTICE:
“Pharmacologic treatments, such as orlistat, present an alternative strategy for managing overweight and obesity. Our study provides empirical evidence of a dose-response effect of weight loss after initiating orlistat within 1 year lowers the risk of incident gout and recurrent gout flares,” the authors wrote.
SOURCE:
This study was led by Jie Wei, PhD, Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China, and was published online on September 19, 2024, in Arthritis & Rheumatology.
LIMITATIONS:
Despite adjustment for many variables, factors such as disease severity, exercise levels, and diet were not fully captured, which might have influenced the results. The lack of hospitalization data could have resulted in recurrent gout flares being underreported. The current study may have been subjected to bias due to potential exposure misclassification resulting from the timing of weight measurements and missing updated weight data.
DISCLOSURES:
This study was supported by the National Key Research and Development Plan, the National Natural Science Foundation of China, the Project Program of National Clinical Research Center for Geriatric Disorders, and other sources. No disclosures of interest were reported by the authors.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication. A version of this article first appeared on Medscape.com.
Diabetes Treatment May Lower Incidence of Uterine Fibroids
TOPLINE:
Diabetes is associated with a lower incidence of uterine fibroids in midlife women receiving diabetes treatment, especially metformin. The association between diabetes and the risk for uterine fibroids may vary based on menopausal status.
METHODOLOGY:
- Previous studies have provided inconsistent evidence regarding associations between the risk for uterine fibroids and markers of cardiometabolic health, such as fasting insulin, fasting glucose, and diabetes.
- Researchers conducted a prospective cohort study to examine the association of fasting levels of cardiometabolic blood biomarkers, diabetes, and diabetes treatment with the incidence of new fibroid diagnoses in midlife women.
- They included participants from the Study of Women’s Health Across the Nation cohort who reported fibroid diagnoses at enrollment and during 13 follow-up visits.
- At all visits, levels of glucose, insulin, and sex hormone–binding globulin (SHBG) were measured in fasting blood samples, and homeostatic model assessment for insulin resistance (HOMA-IR) was calculated.
- Discrete-time survival models were used to estimate the hazard ratios (HRs) for the associations of biomarkers and diabetes with fibroid diagnoses, adjusted for demographics and healthcare utilization.
TAKEAWAY:
- Researchers identified 2570 eligible women (median age, 45 years; 45% perimenopausal women), among whom approximately 3% had diabetes at baseline.
- Diabetes was associated with a 28% lower incidence of new fibroid diagnosis (adjusted HR, 0.72).
- This association was particularly strong among participants with treated diabetes, especially those on metformin, who had a 51% lower incidence of self-reported fibroids than those without diabetes. The estimates, however, had wide CIs suggesting uncertainty.
- Time-varying HOMA-IR and SHBG, insulin, and glucose levels were not significantly associated with the new fibroid diagnosis.
- When stratified by menopausal status, higher HOMA-IR and insulin levels were associated with a greater incidence of fibroid diagnosis during premenopause but not during perimenopause.
IN PRACTICE:
“Our findings contribute to preliminary evidence indicating a protective association between diabetes and risk of incident fibroids,” the authors wrote.
SOURCE:
The study was led by Susanna D. Mitro, Division of Research, Kaiser Permanente, Pleasanton, California, and was published online in The Journal of Clinical Endocrinology & Metabolism.
LIMITATIONS:
The study relied on self-reported fibroid diagnoses, which may result in the misclassification of cases. The sample size of participants with diabetes was small, which resulted in reduced precision and confidence in the findings. The baseline eligibility criteria (midlife participants with an intact uterus and no history of fibroid incidence) may have limited the generalizability of the findings to the wider population at risk for fibroids.
DISCLOSURES:
This study was supported by the National Institutes of Health (NIH), through the National Institute on Aging, the National Institute of Nursing Research, and the NIH Office of Research on Women’s Health. One author reported being a consultant and adviser for various pharmaceutical companies. Two other authors reported receiving salary support and royalties from various pharmaceutical companies and organizations.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication. A version of this article first appeared on Medscape.com.
TOPLINE:
Diabetes is associated with a lower incidence of uterine fibroids in midlife women receiving diabetes treatment, especially metformin. The association between diabetes and the risk for uterine fibroids may vary based on menopausal status.
METHODOLOGY:
- Previous studies have provided inconsistent evidence regarding associations between the risk for uterine fibroids and markers of cardiometabolic health, such as fasting insulin, fasting glucose, and diabetes.
- Researchers conducted a prospective cohort study to examine the association of fasting levels of cardiometabolic blood biomarkers, diabetes, and diabetes treatment with the incidence of new fibroid diagnoses in midlife women.
- They included participants from the Study of Women’s Health Across the Nation cohort who reported fibroid diagnoses at enrollment and during 13 follow-up visits.
- At all visits, levels of glucose, insulin, and sex hormone–binding globulin (SHBG) were measured in fasting blood samples, and homeostatic model assessment for insulin resistance (HOMA-IR) was calculated.
- Discrete-time survival models were used to estimate the hazard ratios (HRs) for the associations of biomarkers and diabetes with fibroid diagnoses, adjusted for demographics and healthcare utilization.
TAKEAWAY:
- Researchers identified 2570 eligible women (median age, 45 years; 45% perimenopausal women), among whom approximately 3% had diabetes at baseline.
- Diabetes was associated with a 28% lower incidence of new fibroid diagnosis (adjusted HR, 0.72).
- This association was particularly strong among participants with treated diabetes, especially those on metformin, who had a 51% lower incidence of self-reported fibroids than those without diabetes. The estimates, however, had wide CIs suggesting uncertainty.
- Time-varying HOMA-IR and SHBG, insulin, and glucose levels were not significantly associated with the new fibroid diagnosis.
- When stratified by menopausal status, higher HOMA-IR and insulin levels were associated with a greater incidence of fibroid diagnosis during premenopause but not during perimenopause.
IN PRACTICE:
“Our findings contribute to preliminary evidence indicating a protective association between diabetes and risk of incident fibroids,” the authors wrote.
SOURCE:
The study was led by Susanna D. Mitro, Division of Research, Kaiser Permanente, Pleasanton, California, and was published online in The Journal of Clinical Endocrinology & Metabolism.
LIMITATIONS:
The study relied on self-reported fibroid diagnoses, which may result in the misclassification of cases. The sample size of participants with diabetes was small, which resulted in reduced precision and confidence in the findings. The baseline eligibility criteria (midlife participants with an intact uterus and no history of fibroid incidence) may have limited the generalizability of the findings to the wider population at risk for fibroids.
DISCLOSURES:
This study was supported by the National Institutes of Health (NIH), through the National Institute on Aging, the National Institute of Nursing Research, and the NIH Office of Research on Women’s Health. One author reported being a consultant and adviser for various pharmaceutical companies. Two other authors reported receiving salary support and royalties from various pharmaceutical companies and organizations.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication. A version of this article first appeared on Medscape.com.
TOPLINE:
Diabetes is associated with a lower incidence of uterine fibroids in midlife women receiving diabetes treatment, especially metformin. The association between diabetes and the risk for uterine fibroids may vary based on menopausal status.
METHODOLOGY:
- Previous studies have provided inconsistent evidence regarding associations between the risk for uterine fibroids and markers of cardiometabolic health, such as fasting insulin, fasting glucose, and diabetes.
- Researchers conducted a prospective cohort study to examine the association of fasting levels of cardiometabolic blood biomarkers, diabetes, and diabetes treatment with the incidence of new fibroid diagnoses in midlife women.
- They included participants from the Study of Women’s Health Across the Nation cohort who reported fibroid diagnoses at enrollment and during 13 follow-up visits.
- At all visits, levels of glucose, insulin, and sex hormone–binding globulin (SHBG) were measured in fasting blood samples, and homeostatic model assessment for insulin resistance (HOMA-IR) was calculated.
- Discrete-time survival models were used to estimate the hazard ratios (HRs) for the associations of biomarkers and diabetes with fibroid diagnoses, adjusted for demographics and healthcare utilization.
TAKEAWAY:
- Researchers identified 2570 eligible women (median age, 45 years; 45% perimenopausal women), among whom approximately 3% had diabetes at baseline.
- Diabetes was associated with a 28% lower incidence of new fibroid diagnosis (adjusted HR, 0.72).
- This association was particularly strong among participants with treated diabetes, especially those on metformin, who had a 51% lower incidence of self-reported fibroids than those without diabetes. The estimates, however, had wide CIs suggesting uncertainty.
- Time-varying HOMA-IR and SHBG, insulin, and glucose levels were not significantly associated with the new fibroid diagnosis.
- When stratified by menopausal status, higher HOMA-IR and insulin levels were associated with a greater incidence of fibroid diagnosis during premenopause but not during perimenopause.
IN PRACTICE:
“Our findings contribute to preliminary evidence indicating a protective association between diabetes and risk of incident fibroids,” the authors wrote.
SOURCE:
The study was led by Susanna D. Mitro, Division of Research, Kaiser Permanente, Pleasanton, California, and was published online in The Journal of Clinical Endocrinology & Metabolism.
LIMITATIONS:
The study relied on self-reported fibroid diagnoses, which may result in the misclassification of cases. The sample size of participants with diabetes was small, which resulted in reduced precision and confidence in the findings. The baseline eligibility criteria (midlife participants with an intact uterus and no history of fibroid incidence) may have limited the generalizability of the findings to the wider population at risk for fibroids.
DISCLOSURES:
This study was supported by the National Institutes of Health (NIH), through the National Institute on Aging, the National Institute of Nursing Research, and the NIH Office of Research on Women’s Health. One author reported being a consultant and adviser for various pharmaceutical companies. Two other authors reported receiving salary support and royalties from various pharmaceutical companies and organizations.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication. A version of this article first appeared on Medscape.com.
ILD Subtypes in Rheumatoid Arthritis Carry Different Risk Factor Profiles
TOPLINE:
Older age, male sex, and seropositivity are linked to a higher risk for rheumatoid arthritis–interstitial lung disease (RA-ILD) with a usual interstitial pneumonia (UIP) pattern, while only seropositivity is associated with RA-ILD with a nonspecific interstitial pneumonia pattern (NSIP).
METHODOLOGY:
- Researchers conducted a case-control study using data from two cohorts in the Mass General Brigham Healthcare system to examine the risk factors associated with different subtypes of RA-ILD.
- They identified 208 patients with RA-ILD (mean age at RA diagnosis, 50.7 years; 67.3% women) and 547 control participants with RA but no ILD (mean age at RA diagnosis, 49.1 years; 78.1% women), who had high-resolution computed tomography (HRCT) imaging data available.
- RA-ILD subtypes such as RA-UIP, RA-NSIP, organizing pneumonia, and others were determined with HRCT scans.
- The associations between demographics, lifestyle, and serologic factors and RA-ILD subtypes were evaluated using multivariable logistic regression analysis.
TAKEAWAY:
- The RA-UIP subtype, the one with worst prognosis, was associated with older age during the time of RA diagnosis (odds ratio [OR], 1.03 per year; 95% CI, 1.01-1.05), male sex (OR, 2.15; 95% CI, 1.33-3.48), and seropositivity (OR, 2.08; 95% CI, 1.24-3.48).
- On the other hand, the RA-NSIP subtype was significantly associated only with seropositivity (OR, 3.21; 95% CI, 1.36-7.56).
- Nonfibrotic ILDs were significantly associated with positive smoking status (OR, 2.81; 95% CI, 1.52-5.21) and seropositivity (OR, 2.09; 95% CI, 1.19-3.67).
- The combination of male sex, seropositivity, and positive smoking status was associated with a nearly sevenfold increased risk for RA-UIP (OR, 6.89; 95% CI, 2.41-19.69), compared with having no RA-ILD risk factors.
IN PRACTICE:
“These findings suggest that RA-ILD subtypes may have distinct risk factor profiles and emphasize the importance of further efforts to understand RA-ILD disease heterogeneity to inform screening and prognostication strategies,” the authors wrote.
SOURCE:
The study was led by Gregory C. McDermott, MD, MPH, Brigham and Women’s Hospital, Boston, and was published online on September 11, 2024, in Arthritis Care & Research.
LIMITATIONS:
This study relied on HRCT imaging, which may have introduced selection bias within the control groups. RA disease activity measures were not available for the Mass General Brigham Biobank RA cohort, which limited the analysis of the influence of disease activity on the risk for RA-ILD. Both cohorts predominantly involved White patients, which may have limited the generalizability of the findings to more diverse populations.
DISCLOSURES:
Some authors were supported by the Rheumatology Research Foundation Scientist Development Award, a VERITY Pilot & Feasibility Research Award, the Société Française de Rhumatologie, the National Institute of Arthritis and Musculoskeletal and Skin Diseases, and other sources. The authors declared receiving grant support, consulting fees, and honoraria from various organizations and pharmaceutical companies.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication. A version of this article first appeared on Medscape.com.
TOPLINE:
Older age, male sex, and seropositivity are linked to a higher risk for rheumatoid arthritis–interstitial lung disease (RA-ILD) with a usual interstitial pneumonia (UIP) pattern, while only seropositivity is associated with RA-ILD with a nonspecific interstitial pneumonia pattern (NSIP).
METHODOLOGY:
- Researchers conducted a case-control study using data from two cohorts in the Mass General Brigham Healthcare system to examine the risk factors associated with different subtypes of RA-ILD.
- They identified 208 patients with RA-ILD (mean age at RA diagnosis, 50.7 years; 67.3% women) and 547 control participants with RA but no ILD (mean age at RA diagnosis, 49.1 years; 78.1% women), who had high-resolution computed tomography (HRCT) imaging data available.
- RA-ILD subtypes such as RA-UIP, RA-NSIP, organizing pneumonia, and others were determined with HRCT scans.
- The associations between demographics, lifestyle, and serologic factors and RA-ILD subtypes were evaluated using multivariable logistic regression analysis.
TAKEAWAY:
- The RA-UIP subtype, the one with worst prognosis, was associated with older age during the time of RA diagnosis (odds ratio [OR], 1.03 per year; 95% CI, 1.01-1.05), male sex (OR, 2.15; 95% CI, 1.33-3.48), and seropositivity (OR, 2.08; 95% CI, 1.24-3.48).
- On the other hand, the RA-NSIP subtype was significantly associated only with seropositivity (OR, 3.21; 95% CI, 1.36-7.56).
- Nonfibrotic ILDs were significantly associated with positive smoking status (OR, 2.81; 95% CI, 1.52-5.21) and seropositivity (OR, 2.09; 95% CI, 1.19-3.67).
- The combination of male sex, seropositivity, and positive smoking status was associated with a nearly sevenfold increased risk for RA-UIP (OR, 6.89; 95% CI, 2.41-19.69), compared with having no RA-ILD risk factors.
IN PRACTICE:
“These findings suggest that RA-ILD subtypes may have distinct risk factor profiles and emphasize the importance of further efforts to understand RA-ILD disease heterogeneity to inform screening and prognostication strategies,” the authors wrote.
SOURCE:
The study was led by Gregory C. McDermott, MD, MPH, Brigham and Women’s Hospital, Boston, and was published online on September 11, 2024, in Arthritis Care & Research.
LIMITATIONS:
This study relied on HRCT imaging, which may have introduced selection bias within the control groups. RA disease activity measures were not available for the Mass General Brigham Biobank RA cohort, which limited the analysis of the influence of disease activity on the risk for RA-ILD. Both cohorts predominantly involved White patients, which may have limited the generalizability of the findings to more diverse populations.
DISCLOSURES:
Some authors were supported by the Rheumatology Research Foundation Scientist Development Award, a VERITY Pilot & Feasibility Research Award, the Société Française de Rhumatologie, the National Institute of Arthritis and Musculoskeletal and Skin Diseases, and other sources. The authors declared receiving grant support, consulting fees, and honoraria from various organizations and pharmaceutical companies.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication. A version of this article first appeared on Medscape.com.
TOPLINE:
Older age, male sex, and seropositivity are linked to a higher risk for rheumatoid arthritis–interstitial lung disease (RA-ILD) with a usual interstitial pneumonia (UIP) pattern, while only seropositivity is associated with RA-ILD with a nonspecific interstitial pneumonia pattern (NSIP).
METHODOLOGY:
- Researchers conducted a case-control study using data from two cohorts in the Mass General Brigham Healthcare system to examine the risk factors associated with different subtypes of RA-ILD.
- They identified 208 patients with RA-ILD (mean age at RA diagnosis, 50.7 years; 67.3% women) and 547 control participants with RA but no ILD (mean age at RA diagnosis, 49.1 years; 78.1% women), who had high-resolution computed tomography (HRCT) imaging data available.
- RA-ILD subtypes such as RA-UIP, RA-NSIP, organizing pneumonia, and others were determined with HRCT scans.
- The associations between demographics, lifestyle, and serologic factors and RA-ILD subtypes were evaluated using multivariable logistic regression analysis.
TAKEAWAY:
- The RA-UIP subtype, the one with worst prognosis, was associated with older age during the time of RA diagnosis (odds ratio [OR], 1.03 per year; 95% CI, 1.01-1.05), male sex (OR, 2.15; 95% CI, 1.33-3.48), and seropositivity (OR, 2.08; 95% CI, 1.24-3.48).
- On the other hand, the RA-NSIP subtype was significantly associated only with seropositivity (OR, 3.21; 95% CI, 1.36-7.56).
- Nonfibrotic ILDs were significantly associated with positive smoking status (OR, 2.81; 95% CI, 1.52-5.21) and seropositivity (OR, 2.09; 95% CI, 1.19-3.67).
- The combination of male sex, seropositivity, and positive smoking status was associated with a nearly sevenfold increased risk for RA-UIP (OR, 6.89; 95% CI, 2.41-19.69), compared with having no RA-ILD risk factors.
IN PRACTICE:
“These findings suggest that RA-ILD subtypes may have distinct risk factor profiles and emphasize the importance of further efforts to understand RA-ILD disease heterogeneity to inform screening and prognostication strategies,” the authors wrote.
SOURCE:
The study was led by Gregory C. McDermott, MD, MPH, Brigham and Women’s Hospital, Boston, and was published online on September 11, 2024, in Arthritis Care & Research.
LIMITATIONS:
This study relied on HRCT imaging, which may have introduced selection bias within the control groups. RA disease activity measures were not available for the Mass General Brigham Biobank RA cohort, which limited the analysis of the influence of disease activity on the risk for RA-ILD. Both cohorts predominantly involved White patients, which may have limited the generalizability of the findings to more diverse populations.
DISCLOSURES:
Some authors were supported by the Rheumatology Research Foundation Scientist Development Award, a VERITY Pilot & Feasibility Research Award, the Société Française de Rhumatologie, the National Institute of Arthritis and Musculoskeletal and Skin Diseases, and other sources. The authors declared receiving grant support, consulting fees, and honoraria from various organizations and pharmaceutical companies.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication. A version of this article first appeared on Medscape.com.
Does Bariatric Surgery Also Improve Thyroid Function?
TOPLINE:
Metabolic/bariatric surgery (MBS) reduces thyroid-stimulating hormone (TSH), free triiodothyronine (fT3) levels, and thyroid hormone resistance indices in patients with obesity, changes strongly correlated with improvement in body composition.
METHODOLOGY:
- Recent studies have linked obesity with increased levels of TSH and thyroid hormones; however, the role that body fat distribution plays in this association remains unclear.
- This retrospective observational study evaluated the effects of MBS on thyroid hormone levels and thyroid hormone resistance in euthyroid individuals with obesity, focusing on the correlation with changes in body composition.
- Researchers included 470 patients with obesity (mean age, 33.4 years; mean body mass index [BMI], 37.9; 63.2% women) and 118 control individuals without obesity (mean BMI, 21.8), who had had normal levels of TSH, fT3, and free thyroxine.
- Among the patients with obesity, 125 underwent MBS and had thyroid tests both before and ≥ 3 months after surgery.
- Data on body composition and thyroid function were collected, and correlations between baseline and changes in thyroid function and body composition were assessed.
TAKEAWAY:
- Individuals with obesity had higher baseline TSH and fT3 levels (P < .001) and thyroid feedback quantile-based index (TFQI; P = .047) than those without obesity, with the values decreasing after MBS (all P < .001).
- Among individuals with obesity, preoperative TSH was positively correlated with the visceral fat area (VFA; P = .019) and body fat percentage (P = .013) and negatively correlated with skeletal muscle mass percentage (P = .024)
- The decrease in TSH post-surgery positively correlated with decreased VFA (P = .021) and decreased body fat percentage (P = .031).
- Decrease in VFA and body fat percentage after MBS was also associated with improved central thyroid hormone resistance indicated by TFQI.
IN PRACTICE:
“The relationship between obesity and [thyroid hormone] is bidirectional, indicating that addressing underlying thyroid disturbance could potentially benefit weight loss and metabolism,” the authors wrote.
SOURCE:
This study was led by Yu Yan, MD, Department of Pancreatic and Metabolic Surgery, Medical School of Southeast University, Nanjing Drum Tower Hospital, Nanjing, China, and published online in The Journal of Clinical Endocrinology & Metabolism.
LIMITATIONS:
The retrospective nature of this study limited the ability to definitively attribute changes in thyroid function and thyroid hormone resistance to changes in body composition. The relatively short duration of the study and the exclusion of individuals taking medications affecting thyroid function may also limit the generalizability of the findings.
DISCLOSURES:
This study was supported by the Fundings for Clinical Trials from the Affiliated Drum Tower Hospital, Nanjing University Medical School, Nanjing, China. The authors declared no potential conflicts of interest.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication. A version of this article first appeared on Medscape.com.
TOPLINE:
Metabolic/bariatric surgery (MBS) reduces thyroid-stimulating hormone (TSH), free triiodothyronine (fT3) levels, and thyroid hormone resistance indices in patients with obesity, changes strongly correlated with improvement in body composition.
METHODOLOGY:
- Recent studies have linked obesity with increased levels of TSH and thyroid hormones; however, the role that body fat distribution plays in this association remains unclear.
- This retrospective observational study evaluated the effects of MBS on thyroid hormone levels and thyroid hormone resistance in euthyroid individuals with obesity, focusing on the correlation with changes in body composition.
- Researchers included 470 patients with obesity (mean age, 33.4 years; mean body mass index [BMI], 37.9; 63.2% women) and 118 control individuals without obesity (mean BMI, 21.8), who had had normal levels of TSH, fT3, and free thyroxine.
- Among the patients with obesity, 125 underwent MBS and had thyroid tests both before and ≥ 3 months after surgery.
- Data on body composition and thyroid function were collected, and correlations between baseline and changes in thyroid function and body composition were assessed.
TAKEAWAY:
- Individuals with obesity had higher baseline TSH and fT3 levels (P < .001) and thyroid feedback quantile-based index (TFQI; P = .047) than those without obesity, with the values decreasing after MBS (all P < .001).
- Among individuals with obesity, preoperative TSH was positively correlated with the visceral fat area (VFA; P = .019) and body fat percentage (P = .013) and negatively correlated with skeletal muscle mass percentage (P = .024)
- The decrease in TSH post-surgery positively correlated with decreased VFA (P = .021) and decreased body fat percentage (P = .031).
- Decrease in VFA and body fat percentage after MBS was also associated with improved central thyroid hormone resistance indicated by TFQI.
IN PRACTICE:
“The relationship between obesity and [thyroid hormone] is bidirectional, indicating that addressing underlying thyroid disturbance could potentially benefit weight loss and metabolism,” the authors wrote.
SOURCE:
This study was led by Yu Yan, MD, Department of Pancreatic and Metabolic Surgery, Medical School of Southeast University, Nanjing Drum Tower Hospital, Nanjing, China, and published online in The Journal of Clinical Endocrinology & Metabolism.
LIMITATIONS:
The retrospective nature of this study limited the ability to definitively attribute changes in thyroid function and thyroid hormone resistance to changes in body composition. The relatively short duration of the study and the exclusion of individuals taking medications affecting thyroid function may also limit the generalizability of the findings.
DISCLOSURES:
This study was supported by the Fundings for Clinical Trials from the Affiliated Drum Tower Hospital, Nanjing University Medical School, Nanjing, China. The authors declared no potential conflicts of interest.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication. A version of this article first appeared on Medscape.com.
TOPLINE:
Metabolic/bariatric surgery (MBS) reduces thyroid-stimulating hormone (TSH), free triiodothyronine (fT3) levels, and thyroid hormone resistance indices in patients with obesity, changes strongly correlated with improvement in body composition.
METHODOLOGY:
- Recent studies have linked obesity with increased levels of TSH and thyroid hormones; however, the role that body fat distribution plays in this association remains unclear.
- This retrospective observational study evaluated the effects of MBS on thyroid hormone levels and thyroid hormone resistance in euthyroid individuals with obesity, focusing on the correlation with changes in body composition.
- Researchers included 470 patients with obesity (mean age, 33.4 years; mean body mass index [BMI], 37.9; 63.2% women) and 118 control individuals without obesity (mean BMI, 21.8), who had had normal levels of TSH, fT3, and free thyroxine.
- Among the patients with obesity, 125 underwent MBS and had thyroid tests both before and ≥ 3 months after surgery.
- Data on body composition and thyroid function were collected, and correlations between baseline and changes in thyroid function and body composition were assessed.
TAKEAWAY:
- Individuals with obesity had higher baseline TSH and fT3 levels (P < .001) and thyroid feedback quantile-based index (TFQI; P = .047) than those without obesity, with the values decreasing after MBS (all P < .001).
- Among individuals with obesity, preoperative TSH was positively correlated with the visceral fat area (VFA; P = .019) and body fat percentage (P = .013) and negatively correlated with skeletal muscle mass percentage (P = .024)
- The decrease in TSH post-surgery positively correlated with decreased VFA (P = .021) and decreased body fat percentage (P = .031).
- Decrease in VFA and body fat percentage after MBS was also associated with improved central thyroid hormone resistance indicated by TFQI.
IN PRACTICE:
“The relationship between obesity and [thyroid hormone] is bidirectional, indicating that addressing underlying thyroid disturbance could potentially benefit weight loss and metabolism,” the authors wrote.
SOURCE:
This study was led by Yu Yan, MD, Department of Pancreatic and Metabolic Surgery, Medical School of Southeast University, Nanjing Drum Tower Hospital, Nanjing, China, and published online in The Journal of Clinical Endocrinology & Metabolism.
LIMITATIONS:
The retrospective nature of this study limited the ability to definitively attribute changes in thyroid function and thyroid hormone resistance to changes in body composition. The relatively short duration of the study and the exclusion of individuals taking medications affecting thyroid function may also limit the generalizability of the findings.
DISCLOSURES:
This study was supported by the Fundings for Clinical Trials from the Affiliated Drum Tower Hospital, Nanjing University Medical School, Nanjing, China. The authors declared no potential conflicts of interest.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication. A version of this article first appeared on Medscape.com.
Rheumatology RCTs Have Lower Representation of Women as Authors
TOPLINE:
Women are underrepresented as authors in randomized controlled trials (RCTs) published in rheumatology from 2009 to 2023. RCTs from Africa had higher women representation as authors, while RCTs from Asia and Europe and industry-funded RCTs had lower representation of women.
METHODOLOGY:
- Researchers analyzed 1092 RCTs published in rheumatology from 2009 to 2023 involving 10,794 authors to evaluate the temporal trends and the factors influencing women’s authorship.
- The gender of authors was determined on the basis of their first names and countries of affiliation using a gender application programming interface service.
- The study assessed the association of women’s authorship with various factors using generalized estimating equations by considering women’s gender as the main binary outcome.
- Various covariates influencing women’s authorship such as geographic location, sponsorship type, intervention type, and journal impact factor were also evaluated.
TAKEAWAY:
- Overall, women accounted for 34.1% of authors in RCTs published in rheumatology from 2009 to 2023. They had less representation as first and last authors than men (36.8% vs 50.0% and 26.1% vs 61.2%, respectively).
- RCTs from Africa had higher odds of being authored by women than those from North America (odds ratio [OR], 2.34; 95% CI, 1.02-5.38). Women were also less represented as authors in RCTs from Asia and Europe.
- Their representation as authors was lower in industry-funded RCTs as well (OR, 0.64; 95% CI, 0.56-0.73).
- Women were less likely to be in senior author positions such as last (OR, 0.72) or penultimate (OR, 0.70; P < .001 for both) authors than in middle author positions.
IN PRACTICE:
“Implementing structured policies and supporting women through mentorship and leadership opportunities are crucial steps toward a more inclusive and dynamic research environment,” the authors wrote.
SOURCE:
This study was led by Kim Lauper, MD, Geneva University Hospitals, Division of Rheumatology and Faculty of Medicine, University of Geneva, Switzerland, and was published online on August 26, 2024, in medRxiv.
LIMITATIONS:
This study relied on binary gender data, which did not encompass nonbinary or other gender identities. Moreover, the accuracy of gender determination from names, although robust, had inherent limitations that could have affected the interpretation of results.
DISCLOSURES:
This study did not receive any funding. The authors declared no competing interests.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication. A version of this article appeared on Medscape.com.
TOPLINE:
Women are underrepresented as authors in randomized controlled trials (RCTs) published in rheumatology from 2009 to 2023. RCTs from Africa had higher women representation as authors, while RCTs from Asia and Europe and industry-funded RCTs had lower representation of women.
METHODOLOGY:
- Researchers analyzed 1092 RCTs published in rheumatology from 2009 to 2023 involving 10,794 authors to evaluate the temporal trends and the factors influencing women’s authorship.
- The gender of authors was determined on the basis of their first names and countries of affiliation using a gender application programming interface service.
- The study assessed the association of women’s authorship with various factors using generalized estimating equations by considering women’s gender as the main binary outcome.
- Various covariates influencing women’s authorship such as geographic location, sponsorship type, intervention type, and journal impact factor were also evaluated.
TAKEAWAY:
- Overall, women accounted for 34.1% of authors in RCTs published in rheumatology from 2009 to 2023. They had less representation as first and last authors than men (36.8% vs 50.0% and 26.1% vs 61.2%, respectively).
- RCTs from Africa had higher odds of being authored by women than those from North America (odds ratio [OR], 2.34; 95% CI, 1.02-5.38). Women were also less represented as authors in RCTs from Asia and Europe.
- Their representation as authors was lower in industry-funded RCTs as well (OR, 0.64; 95% CI, 0.56-0.73).
- Women were less likely to be in senior author positions such as last (OR, 0.72) or penultimate (OR, 0.70; P < .001 for both) authors than in middle author positions.
IN PRACTICE:
“Implementing structured policies and supporting women through mentorship and leadership opportunities are crucial steps toward a more inclusive and dynamic research environment,” the authors wrote.
SOURCE:
This study was led by Kim Lauper, MD, Geneva University Hospitals, Division of Rheumatology and Faculty of Medicine, University of Geneva, Switzerland, and was published online on August 26, 2024, in medRxiv.
LIMITATIONS:
This study relied on binary gender data, which did not encompass nonbinary or other gender identities. Moreover, the accuracy of gender determination from names, although robust, had inherent limitations that could have affected the interpretation of results.
DISCLOSURES:
This study did not receive any funding. The authors declared no competing interests.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication. A version of this article appeared on Medscape.com.
TOPLINE:
Women are underrepresented as authors in randomized controlled trials (RCTs) published in rheumatology from 2009 to 2023. RCTs from Africa had higher women representation as authors, while RCTs from Asia and Europe and industry-funded RCTs had lower representation of women.
METHODOLOGY:
- Researchers analyzed 1092 RCTs published in rheumatology from 2009 to 2023 involving 10,794 authors to evaluate the temporal trends and the factors influencing women’s authorship.
- The gender of authors was determined on the basis of their first names and countries of affiliation using a gender application programming interface service.
- The study assessed the association of women’s authorship with various factors using generalized estimating equations by considering women’s gender as the main binary outcome.
- Various covariates influencing women’s authorship such as geographic location, sponsorship type, intervention type, and journal impact factor were also evaluated.
TAKEAWAY:
- Overall, women accounted for 34.1% of authors in RCTs published in rheumatology from 2009 to 2023. They had less representation as first and last authors than men (36.8% vs 50.0% and 26.1% vs 61.2%, respectively).
- RCTs from Africa had higher odds of being authored by women than those from North America (odds ratio [OR], 2.34; 95% CI, 1.02-5.38). Women were also less represented as authors in RCTs from Asia and Europe.
- Their representation as authors was lower in industry-funded RCTs as well (OR, 0.64; 95% CI, 0.56-0.73).
- Women were less likely to be in senior author positions such as last (OR, 0.72) or penultimate (OR, 0.70; P < .001 for both) authors than in middle author positions.
IN PRACTICE:
“Implementing structured policies and supporting women through mentorship and leadership opportunities are crucial steps toward a more inclusive and dynamic research environment,” the authors wrote.
SOURCE:
This study was led by Kim Lauper, MD, Geneva University Hospitals, Division of Rheumatology and Faculty of Medicine, University of Geneva, Switzerland, and was published online on August 26, 2024, in medRxiv.
LIMITATIONS:
This study relied on binary gender data, which did not encompass nonbinary or other gender identities. Moreover, the accuracy of gender determination from names, although robust, had inherent limitations that could have affected the interpretation of results.
DISCLOSURES:
This study did not receive any funding. The authors declared no competing interests.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication. A version of this article appeared on Medscape.com.
Early Use of Steroids Linked to Prolonged Treatment in Early Rheumatoid Arthritis
TOPLINE:
A substantial proportion of older adults with early rheumatoid arthritis (RA) initiate glucocorticoids before receiving care from a rheumatologist. The early initiation of glucocorticoids in this group is associated with prolonged use.
METHODOLOGY:
- Researchers analyzed data from Medicare claims and Rheumatology Informatics System for Effectiveness registry of the American College of Rheumatology from 2016 to 2018 to assess the relationship between the timing of glucocorticoid initiation and the subsequent duration of glucocorticoid use in older adults with early RA in the United States.
- They included 1733 patients aged ≥ 65 years (mean age, 76 years; 67% women) with early RA.
- Glucocorticoid initiation was defined as the first use between 3 months before and 6 months after entrance into rheumatology care.
- The continuous administration of glucocorticoid therapy was monitored for all individuals who initiated glucocorticoid treatment for up to 12 months after entering rheumatology care.
- The primary outcome was the duration of continuous glucocorticoid use after entering rheumatology care.
TAKEAWAY:
- Glucocorticoids were initiated in 41% of patients, with 65% starting them before the initial RA diagnosis by a rheumatologist. The median duration of glucocorticoid use was 157 days.
- Patients with early RA who initiated glucocorticoids before entering rheumatology care showed a significantly longer duration of glucocorticoid use than those who initiated it later (median, 186 vs 97 days; P < .0001).
- Patients who initiated glucocorticoids before entering rheumatology care were 39% less likely to stop its use within 1 year (hazard ratio, 0.61; 95% CI, 0.51-0.74).
- The mean daily dose of glucocorticoids was < 5 mg/d for patients who received them for at least 3 months, indicating a trend toward low-dose, long-term use.
IN PRACTICE:
“Initiatives to reduce GC [glucocorticoid] exposure among patients with eRA [early RA] will likely require attention to rheumatology workforce shortages and close collaboration between rheumatologists and primary care clinicians to expedite referrals to rheumatology care,” the authors wrote.
SOURCE:
This study was led by Andriko Palmowski, MD, Department of Rheumatology and Clinical Immunology, Charité – Universitätsmedizin Berlin in Germany, and was published online in Seminars in Arthritis and Rheumatism.
LIMITATIONS:
The observational nature of this study limited the ability to establish causality between early glucocorticoid initiation and the prolonged use of glucocorticoids. Moreover, the study population was limited to older adults, which affected the generalizability of the findings to younger populations. It also did not account for the fact that patients with more severe early RA were more likely to start glucocorticoid therapy early and continue it for longer durations.
DISCLOSURES:
The study was supported by research grants from the Deutsche Autoimmun-Stiftung and other sources. Some authors declared receiving grant support, consultancy fees, honoraria, and travel expenses and had other ties with various pharmaceutical companies.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication. A version of this article first appeared on Medscape.com.
TOPLINE:
A substantial proportion of older adults with early rheumatoid arthritis (RA) initiate glucocorticoids before receiving care from a rheumatologist. The early initiation of glucocorticoids in this group is associated with prolonged use.
METHODOLOGY:
- Researchers analyzed data from Medicare claims and Rheumatology Informatics System for Effectiveness registry of the American College of Rheumatology from 2016 to 2018 to assess the relationship between the timing of glucocorticoid initiation and the subsequent duration of glucocorticoid use in older adults with early RA in the United States.
- They included 1733 patients aged ≥ 65 years (mean age, 76 years; 67% women) with early RA.
- Glucocorticoid initiation was defined as the first use between 3 months before and 6 months after entrance into rheumatology care.
- The continuous administration of glucocorticoid therapy was monitored for all individuals who initiated glucocorticoid treatment for up to 12 months after entering rheumatology care.
- The primary outcome was the duration of continuous glucocorticoid use after entering rheumatology care.
TAKEAWAY:
- Glucocorticoids were initiated in 41% of patients, with 65% starting them before the initial RA diagnosis by a rheumatologist. The median duration of glucocorticoid use was 157 days.
- Patients with early RA who initiated glucocorticoids before entering rheumatology care showed a significantly longer duration of glucocorticoid use than those who initiated it later (median, 186 vs 97 days; P < .0001).
- Patients who initiated glucocorticoids before entering rheumatology care were 39% less likely to stop its use within 1 year (hazard ratio, 0.61; 95% CI, 0.51-0.74).
- The mean daily dose of glucocorticoids was < 5 mg/d for patients who received them for at least 3 months, indicating a trend toward low-dose, long-term use.
IN PRACTICE:
“Initiatives to reduce GC [glucocorticoid] exposure among patients with eRA [early RA] will likely require attention to rheumatology workforce shortages and close collaboration between rheumatologists and primary care clinicians to expedite referrals to rheumatology care,” the authors wrote.
SOURCE:
This study was led by Andriko Palmowski, MD, Department of Rheumatology and Clinical Immunology, Charité – Universitätsmedizin Berlin in Germany, and was published online in Seminars in Arthritis and Rheumatism.
LIMITATIONS:
The observational nature of this study limited the ability to establish causality between early glucocorticoid initiation and the prolonged use of glucocorticoids. Moreover, the study population was limited to older adults, which affected the generalizability of the findings to younger populations. It also did not account for the fact that patients with more severe early RA were more likely to start glucocorticoid therapy early and continue it for longer durations.
DISCLOSURES:
The study was supported by research grants from the Deutsche Autoimmun-Stiftung and other sources. Some authors declared receiving grant support, consultancy fees, honoraria, and travel expenses and had other ties with various pharmaceutical companies.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication. A version of this article first appeared on Medscape.com.
TOPLINE:
A substantial proportion of older adults with early rheumatoid arthritis (RA) initiate glucocorticoids before receiving care from a rheumatologist. The early initiation of glucocorticoids in this group is associated with prolonged use.
METHODOLOGY:
- Researchers analyzed data from Medicare claims and Rheumatology Informatics System for Effectiveness registry of the American College of Rheumatology from 2016 to 2018 to assess the relationship between the timing of glucocorticoid initiation and the subsequent duration of glucocorticoid use in older adults with early RA in the United States.
- They included 1733 patients aged ≥ 65 years (mean age, 76 years; 67% women) with early RA.
- Glucocorticoid initiation was defined as the first use between 3 months before and 6 months after entrance into rheumatology care.
- The continuous administration of glucocorticoid therapy was monitored for all individuals who initiated glucocorticoid treatment for up to 12 months after entering rheumatology care.
- The primary outcome was the duration of continuous glucocorticoid use after entering rheumatology care.
TAKEAWAY:
- Glucocorticoids were initiated in 41% of patients, with 65% starting them before the initial RA diagnosis by a rheumatologist. The median duration of glucocorticoid use was 157 days.
- Patients with early RA who initiated glucocorticoids before entering rheumatology care showed a significantly longer duration of glucocorticoid use than those who initiated it later (median, 186 vs 97 days; P < .0001).
- Patients who initiated glucocorticoids before entering rheumatology care were 39% less likely to stop its use within 1 year (hazard ratio, 0.61; 95% CI, 0.51-0.74).
- The mean daily dose of glucocorticoids was < 5 mg/d for patients who received them for at least 3 months, indicating a trend toward low-dose, long-term use.
IN PRACTICE:
“Initiatives to reduce GC [glucocorticoid] exposure among patients with eRA [early RA] will likely require attention to rheumatology workforce shortages and close collaboration between rheumatologists and primary care clinicians to expedite referrals to rheumatology care,” the authors wrote.
SOURCE:
This study was led by Andriko Palmowski, MD, Department of Rheumatology and Clinical Immunology, Charité – Universitätsmedizin Berlin in Germany, and was published online in Seminars in Arthritis and Rheumatism.
LIMITATIONS:
The observational nature of this study limited the ability to establish causality between early glucocorticoid initiation and the prolonged use of glucocorticoids. Moreover, the study population was limited to older adults, which affected the generalizability of the findings to younger populations. It also did not account for the fact that patients with more severe early RA were more likely to start glucocorticoid therapy early and continue it for longer durations.
DISCLOSURES:
The study was supported by research grants from the Deutsche Autoimmun-Stiftung and other sources. Some authors declared receiving grant support, consultancy fees, honoraria, and travel expenses and had other ties with various pharmaceutical companies.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication. A version of this article first appeared on Medscape.com.
Do Cannabis Users Need More Anesthesia During Surgery?
TOPLINE:
However, the clinical relevance of this difference remains unclear.
METHODOLOGY:
- To assess if cannabis use leads to higher doses of inhalational anesthesia during surgery, the researchers conducted a retrospective cohort study comparing the average intraoperative minimum alveolar concentrations of volatile anesthetics (isoflurane and sevoflurane) between older adults who used cannabis products and those who did not.
- The researchers reviewed electronic health records of 22,476 patients aged 65 years or older who underwent surgery at the University of Florida Health System between 2018 and 2020.
- Overall, 268 patients who reported using cannabis within 60 days of surgery (median age, 69 years; 35% women) were matched to 1072 nonusers.
- The median duration of anesthesia was 175 minutes.
- The primary outcome was the intraoperative time-weighted average of isoflurane or sevoflurane minimum alveolar concentration equivalents.
TAKEAWAY:
- Cannabis users had significantly higher average minimum alveolar concentrations of isoflurane or sevoflurane than nonusers (mean, 0.58 vs 0.54; mean difference, 0.04; P = .021).
- The findings were confirmed in a sensitivity analysis that revealed higher mean average minimum alveolar concentrations of anesthesia in cannabis users than in nonusers (0.57 vs 0.53; P = .029).
- Although the 0.04 difference in minimum alveolar concentration between cannabis users and nonusers was statistically significant, its clinical importance is unclear.
IN PRACTICE:
“While recent guidelines underscore the importance of universal screening for cannabinoids before surgery, caution is paramount to prevent clinical bias leading to the administration of unnecessary higher doses of inhalational anesthesia, especially as robust evidence supporting such practices remains lacking,” the authors of the study wrote.
SOURCE:
This study was led by Ruba Sajdeya, MD, PhD, of the Department of Epidemiology at the University of Florida, Gainesville, and was published online in August 2024 in Anesthesiology.
LIMITATIONS:
This study lacked access to prescription or dispensed medications, including opioids, which may have introduced residual confounding. Potential underdocumentation of cannabis use in medical records could have led to exposure misclassification. The causality between cannabis usage and increased anesthetic dosing could not be established due to the observational nature of this study.
DISCLOSURES:
This study was supported by the National Institute on Aging, the National Institutes of Health, and in part by the University of Florida Clinical and Translational Science Institute. Some authors declared receiving research support, consulting fees, and honoraria and having other ties with pharmaceutical companies and various other sources.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication. A version of this article first appeared on Medscape.com.
TOPLINE:
However, the clinical relevance of this difference remains unclear.
METHODOLOGY:
- To assess if cannabis use leads to higher doses of inhalational anesthesia during surgery, the researchers conducted a retrospective cohort study comparing the average intraoperative minimum alveolar concentrations of volatile anesthetics (isoflurane and sevoflurane) between older adults who used cannabis products and those who did not.
- The researchers reviewed electronic health records of 22,476 patients aged 65 years or older who underwent surgery at the University of Florida Health System between 2018 and 2020.
- Overall, 268 patients who reported using cannabis within 60 days of surgery (median age, 69 years; 35% women) were matched to 1072 nonusers.
- The median duration of anesthesia was 175 minutes.
- The primary outcome was the intraoperative time-weighted average of isoflurane or sevoflurane minimum alveolar concentration equivalents.
TAKEAWAY:
- Cannabis users had significantly higher average minimum alveolar concentrations of isoflurane or sevoflurane than nonusers (mean, 0.58 vs 0.54; mean difference, 0.04; P = .021).
- The findings were confirmed in a sensitivity analysis that revealed higher mean average minimum alveolar concentrations of anesthesia in cannabis users than in nonusers (0.57 vs 0.53; P = .029).
- Although the 0.04 difference in minimum alveolar concentration between cannabis users and nonusers was statistically significant, its clinical importance is unclear.
IN PRACTICE:
“While recent guidelines underscore the importance of universal screening for cannabinoids before surgery, caution is paramount to prevent clinical bias leading to the administration of unnecessary higher doses of inhalational anesthesia, especially as robust evidence supporting such practices remains lacking,” the authors of the study wrote.
SOURCE:
This study was led by Ruba Sajdeya, MD, PhD, of the Department of Epidemiology at the University of Florida, Gainesville, and was published online in August 2024 in Anesthesiology.
LIMITATIONS:
This study lacked access to prescription or dispensed medications, including opioids, which may have introduced residual confounding. Potential underdocumentation of cannabis use in medical records could have led to exposure misclassification. The causality between cannabis usage and increased anesthetic dosing could not be established due to the observational nature of this study.
DISCLOSURES:
This study was supported by the National Institute on Aging, the National Institutes of Health, and in part by the University of Florida Clinical and Translational Science Institute. Some authors declared receiving research support, consulting fees, and honoraria and having other ties with pharmaceutical companies and various other sources.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication. A version of this article first appeared on Medscape.com.
TOPLINE:
However, the clinical relevance of this difference remains unclear.
METHODOLOGY:
- To assess if cannabis use leads to higher doses of inhalational anesthesia during surgery, the researchers conducted a retrospective cohort study comparing the average intraoperative minimum alveolar concentrations of volatile anesthetics (isoflurane and sevoflurane) between older adults who used cannabis products and those who did not.
- The researchers reviewed electronic health records of 22,476 patients aged 65 years or older who underwent surgery at the University of Florida Health System between 2018 and 2020.
- Overall, 268 patients who reported using cannabis within 60 days of surgery (median age, 69 years; 35% women) were matched to 1072 nonusers.
- The median duration of anesthesia was 175 minutes.
- The primary outcome was the intraoperative time-weighted average of isoflurane or sevoflurane minimum alveolar concentration equivalents.
TAKEAWAY:
- Cannabis users had significantly higher average minimum alveolar concentrations of isoflurane or sevoflurane than nonusers (mean, 0.58 vs 0.54; mean difference, 0.04; P = .021).
- The findings were confirmed in a sensitivity analysis that revealed higher mean average minimum alveolar concentrations of anesthesia in cannabis users than in nonusers (0.57 vs 0.53; P = .029).
- Although the 0.04 difference in minimum alveolar concentration between cannabis users and nonusers was statistically significant, its clinical importance is unclear.
IN PRACTICE:
“While recent guidelines underscore the importance of universal screening for cannabinoids before surgery, caution is paramount to prevent clinical bias leading to the administration of unnecessary higher doses of inhalational anesthesia, especially as robust evidence supporting such practices remains lacking,” the authors of the study wrote.
SOURCE:
This study was led by Ruba Sajdeya, MD, PhD, of the Department of Epidemiology at the University of Florida, Gainesville, and was published online in August 2024 in Anesthesiology.
LIMITATIONS:
This study lacked access to prescription or dispensed medications, including opioids, which may have introduced residual confounding. Potential underdocumentation of cannabis use in medical records could have led to exposure misclassification. The causality between cannabis usage and increased anesthetic dosing could not be established due to the observational nature of this study.
DISCLOSURES:
This study was supported by the National Institute on Aging, the National Institutes of Health, and in part by the University of Florida Clinical and Translational Science Institute. Some authors declared receiving research support, consulting fees, and honoraria and having other ties with pharmaceutical companies and various other sources.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication. A version of this article first appeared on Medscape.com.
GI Involvement Often Present at Time of Pediatric Lupus Diagnosis or Soon After
TOPLINE:
Gastrointestinal involvement is common in childhood-onset lupus, with more than half of the patients presenting with gastrointestinal symptoms at diagnosis. Abdominal pain and elevated hepatic transaminases are the most common initial signs.
METHODOLOGY:
- Researchers conducted a retrospective cohort study to explore the prevalence and characteristics of gastrointestinal involvement in childhood-onset systemic lupus erythematosus (SLE).
- They included 123 patients aged ≤ 18 years (82.1% girls) with childhood-onset SLE from 16 referral departments of pediatric rheumatology in Turkey who showed gastrointestinal system (GIS) involvement either during diagnosis or the course of the disease.
- The mean age at diagnosis was 12.5 years, and the median follow-up duration was 44.5 months.
- Demographic information, clinical manifestations, laboratory findings, radiological and endoscopic assessments, histopathologic analyses, treatments, and clinical outcomes were retrospectively extracted from patient records; disease activity and cumulative organ damage were also assessed.
TAKEAWAY:
- At the time of SLE diagnosis, 63.4% of patients presented with gastrointestinal involvement, while others (36.6%) developed gastrointestinal symptoms after a median of 12 months.
- Abdominal pain was the most common initial symptom, observed in 62.6% of patients, followed by elevated hepatic transaminases in 56.9%.
- The most common type of gastrointestinal involvement was autoimmune hepatitis (25.2%), followed by hepatic steatosis (13%), and lupus hepatitis (11.3%).
- The gastrointestinal manifestations were directly attributed to SLE in 82 patients, were drug related in 35 patients, and caused by comorbidities in 6 patients.
IN PRACTICE:
“It is crucial to consider SLE in the differential diagnosis of GIS [gastrointestinal system] manifestations in children. The inclusion of GIS involvement as a new diagnostic criterion may be warranted, given its potential prevalence that might be higher than currently recognized,” the authors wrote.
SOURCE:
This study was led by Hafize Emine Sönmez, MD, Department of Pediatric Rheumatology, Kocaeli University, İzmit, Turkey, and was published online in Lupus.
LIMITATIONS:
The retrospective nature of the study may have limited the ability to establish causality between gastrointestinal symptoms and SLE. This study also did not include a comparison between patients with childhood-onset SLE with gastrointestinal involvement and those without. Moreover, the study relied on patient records for data collection, which may have introduced bias.
DISCLOSURES:
This study did not receive any financial support. The authors declared no potential conflict of interest.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication. A version of this article first appeared on Medscape.com.
TOPLINE:
Gastrointestinal involvement is common in childhood-onset lupus, with more than half of the patients presenting with gastrointestinal symptoms at diagnosis. Abdominal pain and elevated hepatic transaminases are the most common initial signs.
METHODOLOGY:
- Researchers conducted a retrospective cohort study to explore the prevalence and characteristics of gastrointestinal involvement in childhood-onset systemic lupus erythematosus (SLE).
- They included 123 patients aged ≤ 18 years (82.1% girls) with childhood-onset SLE from 16 referral departments of pediatric rheumatology in Turkey who showed gastrointestinal system (GIS) involvement either during diagnosis or the course of the disease.
- The mean age at diagnosis was 12.5 years, and the median follow-up duration was 44.5 months.
- Demographic information, clinical manifestations, laboratory findings, radiological and endoscopic assessments, histopathologic analyses, treatments, and clinical outcomes were retrospectively extracted from patient records; disease activity and cumulative organ damage were also assessed.
TAKEAWAY:
- At the time of SLE diagnosis, 63.4% of patients presented with gastrointestinal involvement, while others (36.6%) developed gastrointestinal symptoms after a median of 12 months.
- Abdominal pain was the most common initial symptom, observed in 62.6% of patients, followed by elevated hepatic transaminases in 56.9%.
- The most common type of gastrointestinal involvement was autoimmune hepatitis (25.2%), followed by hepatic steatosis (13%), and lupus hepatitis (11.3%).
- The gastrointestinal manifestations were directly attributed to SLE in 82 patients, were drug related in 35 patients, and caused by comorbidities in 6 patients.
IN PRACTICE:
“It is crucial to consider SLE in the differential diagnosis of GIS [gastrointestinal system] manifestations in children. The inclusion of GIS involvement as a new diagnostic criterion may be warranted, given its potential prevalence that might be higher than currently recognized,” the authors wrote.
SOURCE:
This study was led by Hafize Emine Sönmez, MD, Department of Pediatric Rheumatology, Kocaeli University, İzmit, Turkey, and was published online in Lupus.
LIMITATIONS:
The retrospective nature of the study may have limited the ability to establish causality between gastrointestinal symptoms and SLE. This study also did not include a comparison between patients with childhood-onset SLE with gastrointestinal involvement and those without. Moreover, the study relied on patient records for data collection, which may have introduced bias.
DISCLOSURES:
This study did not receive any financial support. The authors declared no potential conflict of interest.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication. A version of this article first appeared on Medscape.com.
TOPLINE:
Gastrointestinal involvement is common in childhood-onset lupus, with more than half of the patients presenting with gastrointestinal symptoms at diagnosis. Abdominal pain and elevated hepatic transaminases are the most common initial signs.
METHODOLOGY:
- Researchers conducted a retrospective cohort study to explore the prevalence and characteristics of gastrointestinal involvement in childhood-onset systemic lupus erythematosus (SLE).
- They included 123 patients aged ≤ 18 years (82.1% girls) with childhood-onset SLE from 16 referral departments of pediatric rheumatology in Turkey who showed gastrointestinal system (GIS) involvement either during diagnosis or the course of the disease.
- The mean age at diagnosis was 12.5 years, and the median follow-up duration was 44.5 months.
- Demographic information, clinical manifestations, laboratory findings, radiological and endoscopic assessments, histopathologic analyses, treatments, and clinical outcomes were retrospectively extracted from patient records; disease activity and cumulative organ damage were also assessed.
TAKEAWAY:
- At the time of SLE diagnosis, 63.4% of patients presented with gastrointestinal involvement, while others (36.6%) developed gastrointestinal symptoms after a median of 12 months.
- Abdominal pain was the most common initial symptom, observed in 62.6% of patients, followed by elevated hepatic transaminases in 56.9%.
- The most common type of gastrointestinal involvement was autoimmune hepatitis (25.2%), followed by hepatic steatosis (13%), and lupus hepatitis (11.3%).
- The gastrointestinal manifestations were directly attributed to SLE in 82 patients, were drug related in 35 patients, and caused by comorbidities in 6 patients.
IN PRACTICE:
“It is crucial to consider SLE in the differential diagnosis of GIS [gastrointestinal system] manifestations in children. The inclusion of GIS involvement as a new diagnostic criterion may be warranted, given its potential prevalence that might be higher than currently recognized,” the authors wrote.
SOURCE:
This study was led by Hafize Emine Sönmez, MD, Department of Pediatric Rheumatology, Kocaeli University, İzmit, Turkey, and was published online in Lupus.
LIMITATIONS:
The retrospective nature of the study may have limited the ability to establish causality between gastrointestinal symptoms and SLE. This study also did not include a comparison between patients with childhood-onset SLE with gastrointestinal involvement and those without. Moreover, the study relied on patient records for data collection, which may have introduced bias.
DISCLOSURES:
This study did not receive any financial support. The authors declared no potential conflict of interest.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication. A version of this article first appeared on Medscape.com.
Weight Loss in Obesity May Create ‘Positive’ Hormone Changes
TOPLINE:
In middle-aged patients with severe obesity, changes in endogenous sex hormones may be proportional to the amount of weight loss after bariatric surgery and dietary intervention, leading to an improved hormonal balance, with more pronounced androgen changes in women.
METHODOLOGY:
- Obesity-related hormonal imbalances are common among those seeking weight loss treatment.
- This prospective observational study evaluated the incremental effect of weight loss by three bariatric procedures and a dietary intervention on endogenous sex hormones in men and women over 3 years.
- The study included 61 adults (median age, 50.9 years; baseline mean body mass index, 40.2; 72% women) from obesity clinics and private bariatric services in Sydney, Australia, between 2009 and 2012, who underwent bariatric surgery or received dietary interventions based on their probability of diabetes remission.
- The researchers evaluated weight loss and hormone levels at baseline and at 6, 12, 24, and 36 months.
- Changes in hormones were also compared among patients who received dietary intervention and those who underwent bariatric procedures such as Roux-en-Y gastric bypass, sleeve gastrectomy, and laparoscopic gastric banding.
TAKEAWAY:
- In women, testosterone levels decreased and sex hormone–binding globulin (SHBG) levels increased at 6 months; these changes were maintained at 24 and 36 months and remained statistically significant when controlled for age and menopausal status.
- In men, testosterone levels were significantly higher at 12, 24, and 36 months, and SHBG levels increased at 12 and 24 months. There were no differences in the estradiol levels among men and women.
- Women who underwent Roux-en-Y gastric bypass surgery experienced the greatest weight loss and the largest reduction (54%) in testosterone levels (P = .004), and sleeve gastrectomy led to an increase of 51% in SHBG levels (P = .0001), all compared with dietary interventions. In men, there were no differences in testosterone and SHBG levels between the diet and surgical groups.
IN PRACTICE:
“Ongoing monitoring of hormone levels and metabolic parameters is crucial for patients undergoing bariatric procedures to ensure long-term optimal health outcomes,” the authors wrote.
SOURCE:
This study was led by Malgorzata M. Brzozowska, MD, PhD, UNSW Sydney, Sydney, Australia, and was published online in the International Journal of Obesity.
LIMITATIONS:
The main limitations were a small sample size, lack of randomization, and absence of data on clinical outcomes related to hormone changes. Additionally, the researchers did not evaluate women for polycystic ovary syndrome or menstrual irregularities, and the clinical significance of testosterone reductions within the normal range remains unknown.
DISCLOSURES:
The study was funded by the National Health and Medical Research Council. Some authors have received honoraria and consulting and research support from various pharmaceutical companies.
A version of this article first appeared on Medscape.com.
TOPLINE:
In middle-aged patients with severe obesity, changes in endogenous sex hormones may be proportional to the amount of weight loss after bariatric surgery and dietary intervention, leading to an improved hormonal balance, with more pronounced androgen changes in women.
METHODOLOGY:
- Obesity-related hormonal imbalances are common among those seeking weight loss treatment.
- This prospective observational study evaluated the incremental effect of weight loss by three bariatric procedures and a dietary intervention on endogenous sex hormones in men and women over 3 years.
- The study included 61 adults (median age, 50.9 years; baseline mean body mass index, 40.2; 72% women) from obesity clinics and private bariatric services in Sydney, Australia, between 2009 and 2012, who underwent bariatric surgery or received dietary interventions based on their probability of diabetes remission.
- The researchers evaluated weight loss and hormone levels at baseline and at 6, 12, 24, and 36 months.
- Changes in hormones were also compared among patients who received dietary intervention and those who underwent bariatric procedures such as Roux-en-Y gastric bypass, sleeve gastrectomy, and laparoscopic gastric banding.
TAKEAWAY:
- In women, testosterone levels decreased and sex hormone–binding globulin (SHBG) levels increased at 6 months; these changes were maintained at 24 and 36 months and remained statistically significant when controlled for age and menopausal status.
- In men, testosterone levels were significantly higher at 12, 24, and 36 months, and SHBG levels increased at 12 and 24 months. There were no differences in the estradiol levels among men and women.
- Women who underwent Roux-en-Y gastric bypass surgery experienced the greatest weight loss and the largest reduction (54%) in testosterone levels (P = .004), and sleeve gastrectomy led to an increase of 51% in SHBG levels (P = .0001), all compared with dietary interventions. In men, there were no differences in testosterone and SHBG levels between the diet and surgical groups.
IN PRACTICE:
“Ongoing monitoring of hormone levels and metabolic parameters is crucial for patients undergoing bariatric procedures to ensure long-term optimal health outcomes,” the authors wrote.
SOURCE:
This study was led by Malgorzata M. Brzozowska, MD, PhD, UNSW Sydney, Sydney, Australia, and was published online in the International Journal of Obesity.
LIMITATIONS:
The main limitations were a small sample size, lack of randomization, and absence of data on clinical outcomes related to hormone changes. Additionally, the researchers did not evaluate women for polycystic ovary syndrome or menstrual irregularities, and the clinical significance of testosterone reductions within the normal range remains unknown.
DISCLOSURES:
The study was funded by the National Health and Medical Research Council. Some authors have received honoraria and consulting and research support from various pharmaceutical companies.
A version of this article first appeared on Medscape.com.
TOPLINE:
In middle-aged patients with severe obesity, changes in endogenous sex hormones may be proportional to the amount of weight loss after bariatric surgery and dietary intervention, leading to an improved hormonal balance, with more pronounced androgen changes in women.
METHODOLOGY:
- Obesity-related hormonal imbalances are common among those seeking weight loss treatment.
- This prospective observational study evaluated the incremental effect of weight loss by three bariatric procedures and a dietary intervention on endogenous sex hormones in men and women over 3 years.
- The study included 61 adults (median age, 50.9 years; baseline mean body mass index, 40.2; 72% women) from obesity clinics and private bariatric services in Sydney, Australia, between 2009 and 2012, who underwent bariatric surgery or received dietary interventions based on their probability of diabetes remission.
- The researchers evaluated weight loss and hormone levels at baseline and at 6, 12, 24, and 36 months.
- Changes in hormones were also compared among patients who received dietary intervention and those who underwent bariatric procedures such as Roux-en-Y gastric bypass, sleeve gastrectomy, and laparoscopic gastric banding.
TAKEAWAY:
- In women, testosterone levels decreased and sex hormone–binding globulin (SHBG) levels increased at 6 months; these changes were maintained at 24 and 36 months and remained statistically significant when controlled for age and menopausal status.
- In men, testosterone levels were significantly higher at 12, 24, and 36 months, and SHBG levels increased at 12 and 24 months. There were no differences in the estradiol levels among men and women.
- Women who underwent Roux-en-Y gastric bypass surgery experienced the greatest weight loss and the largest reduction (54%) in testosterone levels (P = .004), and sleeve gastrectomy led to an increase of 51% in SHBG levels (P = .0001), all compared with dietary interventions. In men, there were no differences in testosterone and SHBG levels between the diet and surgical groups.
IN PRACTICE:
“Ongoing monitoring of hormone levels and metabolic parameters is crucial for patients undergoing bariatric procedures to ensure long-term optimal health outcomes,” the authors wrote.
SOURCE:
This study was led by Malgorzata M. Brzozowska, MD, PhD, UNSW Sydney, Sydney, Australia, and was published online in the International Journal of Obesity.
LIMITATIONS:
The main limitations were a small sample size, lack of randomization, and absence of data on clinical outcomes related to hormone changes. Additionally, the researchers did not evaluate women for polycystic ovary syndrome or menstrual irregularities, and the clinical significance of testosterone reductions within the normal range remains unknown.
DISCLOSURES:
The study was funded by the National Health and Medical Research Council. Some authors have received honoraria and consulting and research support from various pharmaceutical companies.
A version of this article first appeared on Medscape.com.