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* Vitamin D


* Personalized Exercise and Blood Pressure Preschool and Later BMI



To update its 2014 recommendation, the US Preventive Services Task Force (USPSTF) commissioned a systematic review on screening for vitamin D deficiency, including the benefits and harms of screening and early treatment. We are well aware that vitamin D is a fat-soluble vitamin that performs an important role in calcium homeostasis and bone metabolism and it also affects many other cellular regulatory functions outside the skeletal system. Its requirements may vary by individual, so no single-serum vitamin D level cut point defines deficiency, and no consensus exists regarding the precise serum levels of vitamin D that represent optimal health or sufficiency. The USPSTF looked at individuals in community-dwelling, nonpregnant adults who have no signs or symptoms of vitamin D deficiency or conditions for which vitamin D treatment is recommended. The USPSTF concluded that the current evidence is insufficient to make a recommendation about screening for vitamin D deficiency in asymptomatic adults.


Source: Screening for vitamin D deficiency in adults: US Preventive Services Task Force recommendation statement. JAMA. 2021;325(14):1436-1442 doi:10.1001/jama.2021.3069

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The US Food and Drug Administration (FDA) released the latest results of its Food Safety and Nutrition Survey designed to assess consumers' awareness, knowledge, understanding, and reported behaviors relating to a variety of food safety- and nutrition-related topics. The survey was sent by mail to respondents, who could then submit it online or by mail. It incorporates approximately 4400 responses collected during October and November of 2019.


Among the key findings are the following:


* Most consumers are familiar with the Nutrition Facts label: 87% of respondents have looked at the Nutrition Facts label on food packages. The top 4 items that consumers look for on the label are calories, total sugar, sodium, and serving size. Consumers report using the label most frequently for seeing "how high or low the food is in things like calories, salt, vitamins, or fat," "for getting a general idea of the nutritional content of the food," and "to compare different food items with each other."


* Most consumers have seen menu labeling at restaurants: Most respondents (70%) reported that they have seen calorie information on menus and menu boards. Of those who have seen such information, 53% reported using the calorie information, and most often indicated using it to avoid ordering high-calorie menu items.


* Consumers are familiar with the front of package claims: More than 80% of respondents have seen claims such as "No added sugar," "Whole grain," "Organic," Gluten free," "Low fat," "No artificial ingredients," "Low sugar," and "No artificial colors."


* Handwashing practices vary depending on the occasion: Consumers are more likely to wash hands with soap after touching raw meat (76%), than before preparing food (68%) or after cracking raw eggs (39%).


* Most consumers own a food thermometer but use it depending on what is being cooked: Sixty-two of respondents (62%) reported owning a food thermometer. Usage among those who own food thermometers and cook the food ranges from 85% for whole chickens, 79% for beef, lamb, or pork roasts, to 40% for chicken parts, 36% for burgers, 23% for egg dishes, and 20% for frozen meals.



The findings are designed to help the US Food and Drug Administration make better informed regulatory, policy, education, and other risk management decisions to promote and protect public health.


The survey combines the previously separate Food Safety Survey and Health and Diet Survey, which were last conducted in 2016 and 2014, respectively.





Populations of African descent in the United States have high rates of type 2 diabetes, but they may be incorrectly represented as a single group when actually they vary a lot depending on their origin. Therefore, the current glycated hemoglobin A1c (HbA1c) cutoffs (5.7% to <6.5% for prediabetes; >=6.5% for type 2 diabetes) may perform suboptimally in evaluating glycemic status among African descent groups.


Researchers conducted a review of US-based evidence documenting HbA1c performance to assess glycemic status among African American, Afro-Caribbean, and African people. Hemoglobin A1c results from an exhaustive search of the literature from 2000 to 2020 were compared with other ethnic groups or validated against the oral glucose tolerance test (OGTT), fasting plasma glucose, or previous diagnosis. Study results were classified by the risk of false positives and false negatives in assessing glycemic status. In 5 studies of African American people, the HbA1c test increased risk of false positives compared with White populations, regardless of glycemic status. Three studies of African Americans found that HbA1c of 5.7% to less than 6.5% or HbA1c of 6.5% or higher generally increased risk of overdiagnosis compared with OGTT or previous diagnosis. In 1 study of Afro-Caribbean people, HbA1c of 6.5% or higher detected fewer type 2 diabetes cases because of a greater risk of false negatives. Compared with the OGTT, HbA1c tests in 4 studies of Africans found that HbA1c of 5.7% to less than 6.5% or HbA1c of 6.5% or higher leads to underdiagnosis.


The report concludes that HbA1c criteria inadequately characterize glycemic status among heterogeneous African descent populations. It may be that more research is needed to determine optimal HbA1c cutoffs or other test strategies that account for risk profiles unique to African American, Afro-Caribbean, and African people living in the United States.


Source:Prev Chronic Dis. Published online March 11, 2021.



Recommendations for prescribing exercise to control high blood pressure (BP) have been put forward by various medical organizations and expert panels, but finding the bandwidth to craft personalized exercise training for their patients poses a challenge for clinicians.


Now, European cardiology societies have issued a consensus statement that offers a sort of algorithm for developing personalized exercise programs as part of overall management approach for patients with or at risk of high BP.


The statement, published in the European Journal of Preventive Cardiology and issued by the European Association of Preventive Cardiology and the European Society of Cardiology Council on Hypertension, claims to be the first document to focus on personalized exercise for BP.


The statement draws on a systematic review, including meta-analyses, to produce guidance on how to lower BP in 3 specific types of patients: those with hypertension (>140/90 mm Hg), high-normal BP (130-139/85-89 mm Hg), and normal BP (<130/84 mm Hg).


The recommendations are for these 3 specific groups and also provide guidance for combined exercise-that is, blending aerobic exercise with resistance training (RT).


The European consensus statement includes the expected range of BP lowering for each activity. For example, aerobic exercise for patients with hypertension should lead to a reduction from -4.9 to -12 mm Hg systolic and -3.4 to -5.8 mm Hg diastolic.


The consensus statement recommends the following exercise priorities based on a patient's BP:


* Hypertension: Aerobic training as a first-line exercise therapy and low- to moderate-intensity RT-equally using dynamic and isometric RT-as a second-line therapy. In non-White patients, dynamic RT should be considered as a first-line therapy. Resistance training can be combined with aerobic exercise on an individual basis if the clinician determines either form of RT would provide a metabolic benefit.


* High-to-normal BP: Dynamic RT as a first-line exercise, which the systematic review determined led to greater BP reduction than that of aerobic training.


* Normal BP: Isometric RT may be indicated as a first-line intervention in individuals with a family or gestational history or obese or overweight people currently with normal BP.



This advice includes a caveat: "The number of studies is limited and the 95% confidence intervals are large," the authors noted. Aerobic training is also an option in these patients, with more high-quality meta-analyses than the recommendation for isometric RT. They note that more research is needed to validate the BP-lowering effects of combined exercise.


The statement acknowledges the difficulty clinicians face in managing patients with high BP, and it points out existing knowledge gaps, although most importantly, it raises awareness for using exercise as part of a multifaceted, integrated approach to hypertension management.


Source: Parati G, Caravita S. Personalized exercise prescription as a tool for hypertension management and cardiovascular prevention: evidence and pending issues. Eur J Prev Cardiol. 2021;zwab002.