11 results
Editorial: nutrition at key stages of the lifecycle
- Julie Abayomi, Margaret Charnley, Genevieve Stone, Katie Lane, Leo Stevenson, Ian Davies, Richard Webb
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- Journal:
- Proceedings of the Nutrition Society , First View
- Published online by Cambridge University Press:
- 19 January 2024, pp. 1-7
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Nutritional requirements of individuals vary across the lifecycle, according to activity, age and gender. To optimize human health, consideration of nutritional priorities at each stage is needed. This conference brought together multidisciplinary experts in maternal and child nutrition and health, cardiometabolic and plant-based nutrition and dietitians involved in the care of vulnerable populations, plus nutritional metabolism, health and ageing. The presentations highlighted the most important nutrition research in these areas, updating knowledge and suggesting how dietary advice and policy could be adapted to incorporate research findings. With the global increase in non-communicable disease (NCD) and nutrition being considered as a key modifiable risk factor for the prevention and management of NCD, this conference was much needed.
Dietary habits are associated with the prevalence of type 2 diabetes: a study among a middle eastern population
- Sajedeh Mahdi, Mohsen Mazidi, Ian G. Davies, Sara Beigrezaei, Hassan Mozaffari-Khosravi, Masoud Mirzaei, Katie E. Lane, Sayyed Saeid Khayyatzadeh
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- Journal:
- Journal of Nutritional Science / Volume 11 / 2022
- Published online by Cambridge University Press:
- 19 September 2022, e78
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Worldwide type 2 diabetes (T2D) prevalence is increasing dramatically. The present study aimed to evaluate the association between dietary habits and T2D in an Iranian adult population using a cross-sectional analysis of the Shahedieh cohort study. Participants were adults aged 35–70 years (n 9261) from Zarch and Shahedieh, Yazd, Iran, who attended the baseline phase of the Shahedieh cohort study. Dietary habits including meal frequency, fried-food consumption, adding salt to prepared meals and grilled-food consumption were assessed by a standard questionnaire. T2D was defined as fasting plasma glucose (FPG) ≥126 mg/dl according to the American Diabetes Association. Multiple logistic regression assessed the association between dietary habits and T2D. Individuals who consumed a meal more than six times per day compared to three times per day had greater odds for T2D (OR 2⋅503, 95 % CI 1⋅651, 3⋅793). These associations remained significant in a fully adjusted model. There was a significant association between greater intakes of fried foods and prevalence of T2D (OR 1⋅294, 95 % CI 1⋅004, 1⋅668) in the adjusted model. No significant associations were observed between other dietary habits (adding salt to prepared meals and grilled-food consumption) and odds of T2D in all crude and adjusted models. In conclusion, we have highlighted the association between meal and fried-food consumption frequencies with risk of T2D. Large longitudinal studies in different ethnicities are needed to confirm these associations.
Pattern analysis of vegan eating reveals healthy and unhealthy patterns within the vegan diet
- Catherine T Gallagher, Paul Hanley, Katie E Lane
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- Journal:
- Public Health Nutrition / Volume 25 / Issue 5 / May 2022
- Published online by Cambridge University Press:
- 11 May 2021, pp. 1310-1320
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Objective:
This study aimed to identify the types of foods that constitute a vegan diet and establish patterns within the diet. Dietary pattern analysis, a key instrument for exploring the correlation between health and disease, was used to identify patterns within the vegan diet.
Design:A modified version of the EPIC-Norfolk FFQ was created and validated to include vegan foods and launched on social media.
Setting:UK participants, recruited online.
Participants:A convenience sample of 129 vegans voluntarily completed the FFQ. Collected data were converted to reflect weekly consumption to enable factor and cluster analyses.
Results:Factor analysis identified four distinct dietary patterns including: (1) convenience (22 %); (2) health conscious (12 %); (3) unhealthy (9 %) and (4) traditional vegan (7 %). Whilst two healthy patterns were defined, the convenience pattern was the most identifiable pattern with a prominence of vegan convenience meals and snacks, vegan sweets and desserts, sauces, condiments and fats. Cluster analysis identified three clusters, cluster 1 ‘convenience’ (26·8 %), cluster 2 ‘traditional’ (22 %) and cluster 3 ‘health conscious’ (51·2 %). Clusters 1 and 2 consisted of an array of ultraprocessed vegan food items. Together, both clusters represent almost half of the participants and yielding similar results to the predominant dietary pattern, strengthens the factor analysis.
Conclusions:These novel results highlight the need for further dietary pattern studies with full nutrition and blood metabolite analysis in larger samples of vegans to enhance and ratify these results.
The effect of a low carbohydrate high fat diet on emerging biochemical markers of cardiometabolic risk
- Deaglan McCullough, Tanja Harrison, Katie Lane, Lynne Boddy, Farzad Amirabdollahian, Michael Schmidt, Kevin Enright, Claire Stewart, Ian Davies
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- Journal:
- Proceedings of the Nutrition Society / Volume 79 / Issue OCE2 / 2020
- Published online by Cambridge University Press:
- 10 June 2020, E530
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Worldwide, cardiovascular disease (CVD) is the number 1 cause of mortality and is associated with insulin resistance (IR). Emerging biomarkers such as FGF21 and adiponectin are associated with cardiometabolic risk. Low carbohydrate, high fat (LCHF) diets have been reported to reduce cardiometabolic risk markers; however, few studies have compared a LCHF diet vs. a high carbohydrate (HC), lower fat diet under ad libitum conditions on adiponectin and FGF21. The purpose of this study was to investigate the effects of an ad libitum LCHF vs. HC diet on IR, FGF21 and adiponectin in 16 healthy adults. Ethical approval: Liverpool John Moores University Research Ethics Committee (16/ELS/029); registered with ClinicalTrials.gov (Ref. NCT03257085). Participants were randomly assigned to a HC diet (n = 8, the UK Eatwell guidelines; ≥ 50% of energy from carbohydrates) or a LCHF diet (n = 8, consume < 50 g/day of carbohydrates). All provided plasma samples at 0, 4 and 8 weeks. FGF21 (R&D Systems) was analysed via ELISA and adiponectin, insulin and glucose were analysed via immunoassay technology (Randox Evidence Investigator™ Metabolic Syndrome Arrays I & II). Mann Whitney, Friedmans, Wilcoxon tests and 2×3 ANOVA (IBM SPSS 25®) were undertaken to investigate significant differences between and within groups. The homeostatic model assessment (HOMA) was used to calculate IR. FGF21 significantly (P = 0.04) decreased (Mdn, IQR:148.16, 78.51–282.02 to 99.4, 39.87–132.29 pg/ml) after 4 weeks and significantly (P = 0.02) increased (Mdn, IQR:167.38, 80.82–232.89 pg/ml) by 8 weeks vs. baseline with LCHF. No significant differences (P > 0.05) were observed between groups. Adiponectin was significantly (P = 0.03) different at week 4 only between groups. Adiponectin increased after 4 weeks (Mdn, IQR:13.44, 9.12–25.47 to 16.64, 11.96–21.51 ng/ml) but was only significantly (P = 0.03) different by 8 weeks vs. baseline in the HC group (Mdn, IQR:16, 10.8–27.43 ng/ml). Adiponectin remained unchanged (P = 0.96) in the LCHF group. HOMA significantly decreased with both diets after 8 weeks only (mean ± SD, LCHF: 2.9 ± 1.3 to 1.8 ± 0.8, HC: 2.5 ± 0.6 to 1.9 ± 0.6, P = 0.008) but was not significantly (P = 0.60) different between groups. These preliminary data reveal that while both diets improved insulin sensitivity, they may do so by different mechanisms. Future studies are warranted to investigate further, how a LCHF vs. HC diet affects FGF21 and adiponectin, and the subsequent regulation of IR. Furthermore, studies that extend these findings by determining the impact of LCHF vs. HC on peripheral metabolism to determine potential nutrition-mediated mechanisms of metabolic adaptation are warranted.
The effect of a low carbohydrate high fat diet on apolipoproteins and cardiovascular risk
- Deaglan McCullough, Tanja Harrison, Katie Lane, Lynne Boddy, Farzad Amirabdollahian, Michael Schmidt, Kevin Enright, Claire Stewart, Ian Davies
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- Journal:
- Proceedings of the Nutrition Society / Volume 79 / Issue OCE2 / 2020
- Published online by Cambridge University Press:
- 10 June 2020, E677
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Apolipoproteins (apo) regulate lipoprotein characteristics and lipid metabolism. ApoC-III is a regulator of triglyceride-rich lipoprotein (TRL) metabolism and apolipoproteins are important biomarkers for cardiovascular disease (CVD) risk prediction. A low carbohydrate high fat (LCHF) diet improves cardiometabolic risk, especially via reduction of TRL. However, few studies have compared a LCHF vs. a high carbohydrate (HC), lower fat diet under ad libitum conditions on apoC-III levels. The objectives of this investigation were to measure the effect of a LCHF vs. a HC diet on apoC-III, apoA1, apoB and apoB/apoA1 in 16 healthy Caucasian adults aged 19–64. Ethical approval: Liverpool John Moores University Research Ethics Committee (16/ELS/029); registered with ClinicalTrials.gov (Ref. NCT03257085). Participants randomly assigned to a HC diet (UK Eatwell guidelines; ≥ 50% of energy from carbohydrates) (n = 8), or a LCHF diet (consume < 50 g/day of carbohydrates) (n = 8) provided plasma samples at 0, 4 and 8 weeks. ApoA1 and apoB were analysed by an automated chemistry analyser (Daytona, Randox Laboratories Ltd, UK). ApoC-III was analysed via ELISA (Thermo Fisher Ltd, USA). Factorial 2×3 ANOVA and ANCOVA (IBM SPSS 25®) were undertaken to investigate significant differences and to control for variables influenced by baseline measures and visceral adipose tissue (VAT). Results show 0, 4, and 8 weeks respectively: ApoC-III (LCHF: 19.12 ± 9.14, 16.05 ± 7.95, 15.11 ± 3.17 mg/dl; HC: 22.13 ± 8.38, 28.22 ± 13.85, 22.22 ± 7.7 mg/dl) showed no significant (P = 0.319) change. No significant (P = 0.23) change was also observed in ApoB (LCHF: 107.25 ± 20.35, 111.38 ± 24.81, 111.43 ± 19.93 mg/dl; HC: 94.38 ± 20.79, 105.00 ± 20.13, 99.00 ± 29.09 mg/dl). Similarly apoA1 (LCHF: 158.71 ± 14.27, 166.50 ± 23.09, 173.00 ± 29.42 mg/dl; HC: 164.71 ± 30.25, 172.50 ± 29.44, 174.00 ± 32.83 mg/dl) showed no significant change (P = 0.76). This resulted in a relatively unchanged apoB/A1 throughout the study in both diets (P = 0.30). No significant (P > 0.05) differences were found after 4 weeks or between groups also. ANCOVA revealed a trend (P = 0.06) in apoC-III for a difference between groups (LCHF: Δ-6.6 mg/dl vs. HC: Δ1.2 mg/dl) after 8 weeks but no significant (P > 0.05) changes in other apolipoproteins were detected. These preliminary data reveal that a LCHF diet does not improve the apolipoprotein profile; however, when accounting for other metabolic risk factors (i.e. VAT) there was a trend towards lowering apoC-III levels (P = 0.06). Modulation of apoC-III may lead to improved lipid metabolism, but higher-powered studies are warranted before any improvement on CVD risk can be inferred.
Very low-carbohydrate high-fat diets are superior to low-fat diets in improving cardiovascular markers: meta-analysis of large, long-term randomised controlled trials
- Teuta Gjuladin-Hellon, Ian Davies, Jackie Fealey, Alexander Montasem, Katie Lane
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- Journal:
- Proceedings of the Nutrition Society / Volume 79 / Issue OCE2 / 2020
- Published online by Cambridge University Press:
- 10 June 2020, E134
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Our recent study (1) showed that the amount of dietary carbohydrates in obesity interventions has differential effects on cardiovascular risk markers (CVM) and effects magnitude depends on intervention duration. Very-low carbohydrate high-fat diets (VLCD) were superior in ameliorating lipid markers compared to high-carbohydrate low-fat diets (LFD).
We updated our systematic review and meta-analysis to include long-term effects of VLCD (< 50 g /day) on weight, glucose, total cholesterol, insulin and blood pressure (BP) among overweight/obese adults in comparison to LFD.
Medline, PubMed, Cochrane Central, and CINAHLPlus were searched to identify large (n > 100) randomised controlled trials (RCT) with duration ≥ 6 months. Risk of bias, a random effects model and subgroup analyses based on duration of follow-up were performed using Review Manager. Results were reported according to PRISMA.
Four open label RCT (n = 723; 362 VLCD; 361 LFD) with some form of behavioral intervention and duration 6–24 months were identified. VLCD showed more favorable effects on diastolic BP at 6 months (-1.96; 95%CI, -2.99 to 00.93; P = 0.0002) and 24 months (-2.69; 95%CI, -4.87 to -0.51; P = 0.001), near significant level at 12 months (-1.79; 95%CI, -3.56 to 0.04; P = 0.05) and an overall total favourable effect (-1.98; 95%CI, -2.73 to -1.22). The decrease in systolic BP was greater among VLCD for the whole period and the overall total effect reached the level of significance (-1.76; 95%CI, -3.56 to 0.04; P = 0.05). VLCD showed beneficial effect on total cholesterol level at 6 and 12 months (-0.01 mmol/L; 95%CI, -0.01 to –0.00; P = 0.002 and -0.01 mmol/L; 95%CI, -0.01 to –0.00; P = 0.005, respectively). The mean changes in weight, and fasting glucose and insulin levels revealed non-significant differences between both diets at any measured time, although these parameters decreased within both groups compared to baseline.
VLCD led to significant total weighted mean decrease of diastolic BP and near significant decrease of systolic BP independent of changes in body weight, fasting glucose or insulin levels. The present data on decreased levels of diastolic BP and total cholesterol, combined with our recently published results on increased HDL-cholesterol, decreased triglycerides and no significant effect on LDL-cholesterol (1) provide evidence that VLCD are superior to LFD in improving traditional CVM in longer term.
The effectiveness of a low-fat vegan diet for the prevention and management of type 2 diabetes: A systematic review
- Alex Webb, Katie Lane
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- Journal:
- Proceedings of the Nutrition Society / Volume 79 / Issue OCE2 / 2020
- Published online by Cambridge University Press:
- 10 June 2020, E408
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Global diabetes prevalence is projected to rise from 382 million in 2013 to 592 million in 2030 with type 2 diabetes (T2D) accounting for 90–95% of cases(1,2). Approximately 4.7 million people in the UK had diabetes in 2018, this is estimated to rise to over 5 million by 2025(2) costing the NHS £15.1bn by 2035(3).
Low-fat vegan (LFV) diets are associated with improvements in T2D biomarkers(4) however, to date no systematic review has evaluated the effectiveness of LFV diets in prevention and management of T2D. The aim of this study was to assess effects of LFV diets on T2D biomarkers in controlled trials for those with, or at risk of developing T2D.
The review followed the PRISMA checklist for systematic reviews and used Cochrane Collaboration search strategies, which support the identification of randomised controlled trials (RCT's)(5). Searches were conducted and titles and abstracts screened for relevance by two independent review authors (AW or KEL). Studies that evaluated a LFV diet to reduce the risk of, or manage T2D using controlled trials were included with publication range from January 2003 to June 2018.
Search criteria identified 130 articles, which reduced to 21 upon abstract and title screening. Further application of inclusion/exclusion criteria led to identification of six key studies. Four studies were RCT's, and two were cluster-controlled trials at corporate sites, one of which was randomised. In three of the studies participants were previously diagnosed with T2D, in two of the studies participants had a BMI ≥ 25 kg/m2 and/or were previously diagnosed with T2D, and one study had participants with BMI between 28 and 40 kg/m2. Four studies had a control group (non-intervention) two of which had a conventional diabetes diet (American Dietetic Association(6)) as a comparison group. Mean study length was 28.3 weeks; ranging from 16–74 weeks. An intention-to-treat and medication adjusted analysis was carried out; significant effects for BMI, body weight, HbA1c, fasting plasma glucose, LDL, HDL and total cholesterol were reported in most of the studies.
Results from this systematic review demonstrate that a LFV diet is an effective alternative therapy to improve T2D biomarkers in those with, or at elevated risk of developing the disease. The LFV diet showed consistent positive effects on T2D biomarkers. Its effects are comparable to conventional T2D diets and energy restrictive diets, despite absence of restrictions on energy intake or portion sizes.
Electrospun Fibers for Controlled Release of Nanoparticle-Assisted Phage Therapy Treatment of Topical Wounds
- Jessica M. Andriolo, Nathan J. Sutton, John P. Murphy, Lane G. Huston, Emily A. Kooistra-Manning, Robert F. West, Marisa L. Pedulla, M. Katie Hailer, Jack L. Skinner
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- Journal:
- MRS Advances / Volume 3 / Issue 50 / 2018
- Published online by Cambridge University Press:
- 11 June 2018, pp. 3019-3025
- Print publication:
- 2018
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Bacterial cultures exposed to iron-doped apatite nanoparticles (IDANPs) prior to the introduction of antagonistic viruses experience up to 2.3 times the bacterial destruction observed in control cultures. Maximum antibacterial activity of these bacteria-specific viruses, or phage, occurs after bacterial cultures have been exposed to IDANPs for 1 hr prior to phage introduction, demonstrating that IDANP-assisted phage therapy would not be straight forward, but would instead require controlled time release of IDANPs and phage. These findings motivated the design of an electrospun nanofiber mesh treatment delivery system that allows burst release of IDANPs, followed by slow, consistent release of phage for treatment of topical bacterial infections. IDANPs resemble hydroxyapatite, a biocompatible mineral analogous to the inorganic constituent of mammalian bone, which has been approved by the Food and Drug Administration for many biomedical purposes. The composite nanofiber mesh was designed for IDANP-assisted phage therapy treatment of topical wounds and consists of a superficial, rapid release layer of polyethylene oxide (PEO) fibers doped with IDANPs, followed by inner, coaxial polycaprolactone / polyethylene glycol (PCL/PEG) blended polymer fiber layer for slower phage delivery. Our investigations have established that IDANP-doped PEO fibers are effective vehicles for dissemination of IDANPs for bacterial exposure and resultant increased bacterial death by phage. In this work, slower delivery of the phage behind IDANPs was accomplished using coaxial, electrospun fibers composed of PCL/PEG polymer blend.
Contributors
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- By Brittany L. Anderson-Montoya, Heather R. Bailey, Carryl L. Baldwin, Daphne Bavelier, Jameson D. Beach, Jeffrey S. Bedwell, Kevin B. Bennett, Richard A. Block, Deborah A. Boehm-Davis, Corey J. Bohil, David B. Boles, Avinoam Borowsky, Jessica Bramlett, Allison A. Brennan, J. Christopher Brill, Matthew S. Cain, Meredith Carroll, Roberto Champney, Kait Clark, Nancy J. Cooke, Lori M. Curtindale, Clare Davies, Patricia R. DeLucia, Andrew E. Deptula, Michael B. Dillard, Colin D. Drury, Christopher Edman, James T. Enns, Sara Irina Fabrikant, Victor S. Finomore, Arthur D. Fisk, John M. Flach, Matthew E. Funke, Andre Garcia, Adam Gazzaley, Douglas J. Gillan, Rebecca A. Grier, Simen Hagen, Kelly Hale, Diane F. Halpern, Peter A. Hancock, Deborah L. Harm, Mary Hegarty, Laurie M. Heller, Nicole D. Helton, William S. Helton, Robert R. Hoffman, Jerred Holt, Xiaogang Hu, Richard J. Jagacinski, Keith S. Jones, Astrid M. L. Kappers, Simon Kemp, Robert C. Kennedy, Robert S. Kennedy, Alan Kingstone, Ioana Koglbauer, Norman E. Lane, Robert D. Latzman, Cynthia Laurie-Rose, Patricia Lee, Richard Lowe, Valerie Lugo, Poornima Madhavan, Leonard S. Mark, Gerald Matthews, Jyoti Mishra, Stephen R. Mitroff, Tracy L. Mitzner, Alexander M. Morison, Taylor Murphy, Takamichi Nakamoto, John G. Neuhoff, Karl M. Newell, Tal Oron-Gilad, Raja Parasuraman, Tiffany A. Pempek, Robert W. Proctor, Katie A. Ragsdale, Anil K. Raj, Millard F. Reschke, Evan F. Risko, Matthew Rizzo, Wendy A. Rogers, Jesse Q. Sargent, Mark W. Scerbo, Natasha B. Schwartz, F. Jacob Seagull, Cory-Ann Smarr, L. James Smart, Kay Stanney, James Staszewski, Clayton L. Stephenson, Mary E. Stuart, Breanna E. Studenka, Joel Suss, Leedjia Svec, James L. Szalma, James Tanaka, James Thompson, Wouter M. Bergmann Tiest, Lauren A. Vassiliades, Michael A. Vidulich, Paul Ward, Joel S. Warm, David A. Washburn, Christopher D. Wickens, Scott J. Wood, David D. Woods, Motonori Yamaguchi, Lin Ye, Jeffrey M. Zacks
- Edited by Robert R. Hoffman, Peter A. Hancock, University of Central Florida, Mark W. Scerbo, Old Dominion University, Virginia, Raja Parasuraman, George Mason University, Virginia, James L. Szalma, University of Central Florida
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- Book:
- The Cambridge Handbook of Applied Perception Research
- Published online:
- 05 July 2015
- Print publication:
- 26 January 2015, pp xi-xiv
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- By Núria Duran Adroher, Sergio Aguilar-Gaxiola, Jordi Alonso, Ali Obaid Al-Hamzawi, Laura Helena Andrade, Matthias C. Angermeyer, James Anthony, Corina Benjet, Guilherme Borges, Joshua Breslau, Evelyn J. Bromet, Ronny Bruffaerts, Brendan Bunting, Huibert Burger, José Miguel Caldas de Almeida, Graça Cardoso, Somnath Chatterji, Wai Tat Chiu, Giovanni de Girolamo, Ron de Graaf, Peter de Jonge, Koen Demyttenaere, John Fayyad, Alize J. Ferrari, Silvia Florescu, Anne M. Gadermann, Meyer Glantz, Jen Green, Michael J. Gruber, Oye Gureje, Josep Maria Haro, Yanling He, Steven G. Heeringa, Hristo Hinkov, Chiyi Hu, Yueqin Huang, Irving Hwang, Robert Jin, Elie G. Karam, Norito Kawakami, Ronald C. Kessler, Lola Kola, Viviane Kovess-Masféty, Michael C. Lane, Carmen Lara, William LeBlanc, Sing Lee, Jean-Pierre Lépine, Daphna Levinson, Zhaorui Liu, Gustavo Loera, Herbert Marschinger, Katie A. McLaughlin, Maria Elena Medina-Mora, Elizabeth Miller, Samuel D. Murphy, Aimee Nasser Karam, Matthew K. Nock, Mark A. Oakley Browne, Siobhan O’Neill, Johan Ormel, Beth-Ellen Pennell, Maria V. Petukhova, José Posada-Villa, Rajesh Sagar, Mohammad Salih Khalaf, Nancy A. Sampson, Kathleen Saunders, Michael Schoenbaum, Kate M. Scott, Soraya Seedat, Victoria Shahly, Dan J. Stein, Hisateru Tachimori, Nezar Ismet Taib, Adley Tsang, T. Bedirhan Üstün, Maria Carmen Viana, Gemma Vilagut, Michael R. Von Korff, J. Elisabeth Wells, Harvey A. Whiteford, David R. Williams, Ben Wu, Miguel Xavier, Alan M. Zaslavsky
- Edited by Jordi Alonso, Universitat Pompeu Fabra, Barcelona, Somnath Chatterji, World Health Organization, Geneva, Yanling He
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- Book:
- The Burdens of Mental Disorders
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- 09 May 2013, pp ix-xii
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Clostridium difficile Infection in Ohio Hospitals and Nursing Homes During 2006
- Robert J. Campbell, Lynn Giljahn, Kim Machesky, Katie Cibulskas-White, Lisa M. Lane, Kyle Porter, John O. Paulson, Forrest W. Smith, L. Clifford McDonald
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- Journal:
- Infection Control & Hospital Epidemiology / Volume 30 / Issue 6 / June 2009
- Published online by Cambridge University Press:
- 02 January 2015, pp. 526-533
- Print publication:
- June 2009
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Context.
Healthcare data suggest that the incidence and severity of Clostridium difficile infection (CDI) in hospitals are increasing. However, the overall burden of disease and the mortality rate associated with CDI, including the contribution from cases of infection that occur in nursing homes, are poorly understood.
Objective.To describe the epidemiology, disease burden, and mortality rate of healthcare-onset CDI.
Methods.In 2006, active public reporting of healthcare-onset CDI, using standardized case definitions, was mandated for all Ohio hospitals and nursing homes. Incidence rates were determined and stratified according to healthcare facility characteristics. Death certificates that listed CDI were analyzed for trends.
Results.There were 14,329 CDI cases reported, including 6,376 cases at 210 hospitals (5,217 initial cases [ie, cases identified more than 48 hours after admission to a healthcare facility in patients who had not had CDI during the previous 6 months] and 1,159 recurrent cases [ie, cases involving patients who had had CDI during the previous 6 months]) and 7,953 cases at 955 nursing homes (4,880 initial and 3,073 recurrent cases). After adjusting for missing data, the estimated total was 18,200 cases of CDI, which included 7,000 hospital cases (5,700 initial and 1,300 recurrent cases) and 11,200 nursing homes cases (6,900 initial and 4,300 recurrent cases). The rate for initial cases was 6.4-7.9 cases/10,000 patient-days for hospitals and 1.7-2.9 cases/10,000 patient-days for nursing homes. The rate for initial cases in nursing homes decreased during the study (P < .001). Nonpediatric hospital status (P = .011), a smaller number of beds (P = .003), and location in the eastern or northeastern region of the state (P = .011) were each independently associated with a higher rate of initial cases in hospitals. Death certificates for 2006 listed CDI among the causes of death for 893 Ohio residents; between 2000 and 2006, this number increased more than 4-fold.
Conclusion.Healthcare-onset CDI represents a major public health threat that, when considered in the context of an increasing mortality rate, should justify a major focus on prevention efforts.