Jackie Syrop

A new study of obese adolescents highlighted the link between obesity and chronic musculoskeletal (MSK) pain and limitations on physical function and quality of life (QOL).

The Teen-Longitudinal Assessment of Bariatric (Teen-LABS) study collected data between February 28, 2007 and December 30, 2011, on 233 adolescents who underwent weight-loss surgery at five US centers.

Their primary goal was to evaluate associations between MSK pain and self-reported physical function as well as weight-related QOL. The team also evaluated the association between MSK pain and high-sensitivity C-reactive protein (CRP), a marker of systemic inflammation correlated with pain and joint disease. Results were reported in 

The team used a visual analog scale to assess MSK pain and pain intensity of the lower back, hips, knees, and ankles/fees. The also utilized the Health Assessment Questionnaire Disability Index to better understand the self-reported physical function status, and used the Impact of Weight on Quality of Life-Kids (WRQOL) to measure weight-related QOL.

Naturally adjustments were made for sex, race, age at surgery, body mass index, and clinical depressive symptoms.

Among the 233 study participants (predominantly female, white, and non-Hispanic), 49% had poor functional status and 76% had MSK pain.

Lower back pain was prevalent (63%), followed by ankle/foot (53%), knee (49%), and hip (31%) pain; 26% had pain at all 4 sites. Compared with pain-free participants, those reporting lower extremity pain had greater odds of having poor physical functioning (

 <.01). Compared with pain-free participants, those reporting lower extremity pain had significantly lower WRQOL scores and physical comfort scores.

No significant relationship was witnessed between MSK pain and high-sensitivity CRP.

The investigators recommend a longitudinal follow-up in this cohort to find whether weight loss surgery reverses pain and physical function limitations and improves QOL.

Articles

A new study of obese adolescents highlighted the link between obesity and chronic musculoskeletal (MSK) pain and limitations on physical function and quality of life (QOL). 

Musculoskeletal Pain, Limited Physical Function in Obese Teens

Colorectal surgery is often performed for inflammatory disease or malignancy—known risk factors for venous thromboembolism (VTE). Although a patient safety priority, comprehensive recommendations for these VTE patients are lacking. Most patients receive perioperative and in-hospital VTE chemoprophylaxis, but extended prophylaxis rates lag.

Better definitions of specific risk factors and identification of preventive strategies to lower overall VTE risk in this patient population are needed. Thus, there is great interest in finding methods to reduce the rate of VTE in patients undergoing colorectal surgery.

Washington State researchers have published results of a study of a large statewide cohort of patients undergoing colorectal surgery in

, which examined whether VTE incidence had changed in light of differences in chemoprophylaxis use.

Investigators also aimed to characterize patient, procedural, and postoperative factors associated with VTE in over 16,000 patients from 52 state hospitals who underwent colorectal surgery between January 1, 2006, and December 31, 2011.

They measured VTE complications in-hospital and up to 90 days after surgery.

Among these patients, the use of perioperative and in-hospital VTE chemoprophylaxis increased significantly from 31.6% to 86.4% and from 59.6% to 91.4%, respectively, by 2011 (

<.001). Overall, 10.6% were discharged on a chemoprophylaxis regimen. The incidence of VTE was 2.2%.

Patents undergoing abdominal operations had a higher rate of 90-day VTE versus patients undergoing pelvic operations. Those with operations for cancer had a similar incidence of 90-day VTE compared with those having an operation for nonmalignant processes. Additionally, there was no significant decrease in VTE over time.

Researchers concluded that post-discharge undoubtedly needs quality improvement implementation, because 40% of VTEs occurred during this period. However, future studies are necessary to investigate extended prophylaxis. 

Colorectal surgery is often performed for inflammatory disease or malignancy-known risk factors for venous thromboembolism (VTE). Although a patient safety priority, comprehensive recommendations for these VTE patients are lacking. Most patients receive perioperative and in-hospital VTE chemoprophylaxis, but extended prophylaxis rates lag. 

Despite Steady Increase in Chemoprophylaxis Use, Annual VTE Incidence Low

The global pandemic of diabetes poses a huge public health challenge to every nation. In 2014 more than 380 million people around the world were living with diabetes—8.3% of the adult population. That number is expected to increase to 592 million by 2035.

In more recent years, diabetes has no longer become a disease of the affluent. Lower socioeconomic groups in high-income countries are disproportionately affected; 77% of the world’s people with diabetes live in low- and middle-income countries. And diabetes is no longer a disease of older people, as almost half of those with diabetes are in the 40- to 50-year-old age range.

In 2013 diabetes was associated with $548 billion in health care expenses globally, a figure that will increase when indirect costs are added in from lost productivity and comorbidities. This tremendous cost threatens to overwhelm health systems and reverse any gains in economic development in less wealthy countries.

 Viewpoint opinion piece, Frank B. Hu, MD, PhD and Ambika Satija, BA, Harvard T.H. Chan School of Public Health, and JoAnn E. Manson, MD, DrPH, of Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, argued that the consequences of diabetes on human health and economics must be fully recognized throughout the world, and policymakers and the public must together address the urgent need for solutions.

This is especially hard, because diabetes (in particular, type 2 diabetes) is determined by a multifactorial mix of genetic, epigenetic, and lifestyle factors that interact and occur within a larger environment. As countries around the world develop economically, people abandon traditional diets and active lifestyle in favor of more Westernized diets with highly processed foods and refined carbohydrates.

Traditionally, obesity prevention has focused on encouraging individual behavior change while paying little attention to the broader environmental forces influencing human behavior.

Although individual responsibility and good health provider counseling remain important, the public should not forget that the importance of societal, environmental, and public policy factors has increased. Concrete actions must be undertaken to transform the currently “obesogenic” and “diabetogenic” environments into more wholesome living spaces and communities, the authors state.

To that end, policy initiatives are necessary for effective solutions. For instance, macrolevel environmental change should be introduced to create more sustainable improvements in individual health behaviors to influence obesity prevalence and diabetes burden in the entire population.

By influencing food and agricultural production and subsidization, policy initiatives can alter the food system of a country, creating a more healthy food environment that influences better food choices. Greater incentives for activity can be offered, especially in populations at high risk of developing diabetes.

For example, Mexico is the one of the first countries to implement an excise tax on sugar-sweetened beverages; preliminary studies have shown a 10% reduction in purchases of taxed sugar-sweetened beverages and concomitant increase in the purchase of untaxed beverages without added sugar.

Most policy changes that could affect diet and physical activities are within the domain of government, which is where action must begin, according to Hu and his colleagues. However, most agricultural, nutrition, and urban planning policies worldwide are not conducive to nutritious eating and active living.

“To align these policies with health goals, multisectorial efforts are needed because prevention is beyond the scope of any single governmental agency, usual models, or health care system,” Hu et al noted.

Urban planning and transportation policies can easily help make physical environments friendlier to the use of public transportation, walking, and biking; financial incentives can provide for the production and consumption of vegetables, fruits, whole grains, nuts and legumes; and tax policies can be used to discourage consumption of unhealthy foods such as sugar-sweetened beverages.

All stakeholders, including the government, food industry, health professionals, urban planners, media, nongovernmental organizations, communities, and individuals, must get involved to make a change of this nature and curb the diabetes pandemic.

The global pandemic of diabetes poses a huge public health challenge to every nation. In 2014 more than 380 million people around the world were living with diabetes-8.3% of the adult population. That number is expected to increase to 592 million by 2035. 

The Diabetes Pandemic Requires Global Policy Solutions

Overt hyperthyroidism is a known risk factor for osteoporosis and fractures. More subtle alterations in thyroid function, such as those that occur in subclinical thyroid dysfunction, may also be associated with increased fracture risk and bone loss, but until recently no clinical trials have adequately explored that issue.

Now Manuel Blum MD, and colleagues have published a study in 

 concluding that subclinical hyperthyroidism is associated with an increased risk of hip and other fractures, especially among those with thyroid-stimulating hormone (TSH) levels <0.10 mlU/mL and those with endogenous subclinical hyperthyroidism.

The findings were derived from a pooled analysis of individual participant data from multiple large cohorts assessing the association of subclinical thyroid dysfunction with risk for hip fractures as well as nonspine, clinical spine, and fractures of any location. Blum et al performed a systematic literature search in MEDLINE and EMBASE from inception to March 26, 2015, with no language restriction, for prospective cohorts of adults with baseline TSH and free thyroxine (FT

 levels and follow-up for incident fractures. The primary outcome was hip fracture; other fractures were secondary outcomes.

Individual data were obtained from 13 prospective cohorts in the United States, Japan, Europe, and Australia. Levels of thyroid function were defined as euthyroidism (TSH = 0.45-4.49 mIU/L), subclinical hyperthyroidism (TSH<0.45 mIU/L), and subclinical hypothyroidism (TSH≥ 4.50-19.99 mlU/L) with normal thyroxine concentrations.

Among 70,298 participants, 4092 (5.8%) had subclinical hypothyroidism and 2219 (3.2%) had subclinical hyperthyroidism. During 762,401 person-years of follow-up, hip fractures occurred in 2975 participants (4.6%); any fracture occurred in 2528 participants (9.0%); nonspine fracture in 2018 participants (8.4%), and spine fracture in 296 participants (1.3%).

The hazard ratio (HR) in age- and sex-adjusted analyses for subclinical hyperthyroidism versus euthyroidism was 1.36 for hip fracture; HR for any fracture was 1.28, for nonspine fracture, 1.16; and for spine fracture, 1.51.

Lower TSH was associated with higher fracture rates. For TSH <0.10 mIU/mL, HR was 1.61 for hip fracture; for any fracture, HR was 1.98; for nonspine fracture, HR was 1.61; and HR for spine fracture was 3.57. Risks were similar after adjusting for other fracture risk factors. Endogenous subclinical hyperthyroidism was associated with HRs of 1.52 for hip fracture, 1.42 for any fracture, and 1.74 for spine fracture.

No association was found between subclinical hypothyroidism and fracture risk.

The authors concluded that further study is needed to determine whether treating subclinical hyperthyroidism can prevent fractures. 

Overt hyperthyroidism is a known risk factor for osteoporosis and fractures. More subtle alterations in thyroid function, such as those that occur in subclinical thyroid dysfunction, may also be associated with increased fracture risk and bone loss, but until recently no clinical trials have adequately explored that issue. 