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Blood Oct 2015Iron supplements acutely increase hepcidin, but the duration and magnitude of the increase, its dose dependence, and its effects on subsequent iron absorption have not... (Comparative Study)
Comparative Study Randomized Controlled Trial
Iron supplements acutely increase hepcidin, but the duration and magnitude of the increase, its dose dependence, and its effects on subsequent iron absorption have not been characterized in humans. Better understanding of these phenomena might improve oral iron dosing schedules. We investigated whether the acute iron-induced increase in hepcidin influences iron absorption of successive daily iron doses and twice-daily iron doses. We recruited 54 nonanemic young women with plasma ferritin ≤20 µg/L and conducted: (1) a dose-finding investigation with 40-, 60-, 80-, 160-, and 240-mg labeled Fe as [(57)Fe]-, [(58)Fe]-, or [(54)Fe]-FeSO4 given at 8:00 am fasting on 1 or on 2 consecutive days (study 1, n = 25; study 2, n = 16); and (2) a study giving three 60-mg Fe doses (twice-daily dosing) within 24 hours (study 3, n = 13). In studies 1 and 2, 24 hours after doses ≥60 mg, serum hepcidin was increased (P < .01) and fractional iron absorption was decreased by 35% to 45% (P < .01). With increasing dose, fractional absorption decreased (P < .001), whereas absolute absorption increased (P < .001). A sixfold increase in iron dose (40-240 mg) resulted in only a threefold increase in iron absorbed (6.7-18.1 mg). In study 3, total iron absorbed from 3 doses (2 mornings and an afternoon) was not significantly greater than that from 2 morning doses. Providing lower dosages (40-80 mg Fe) and avoiding twice-daily dosing maximize fractional absorption. The duration of the hepcidin response supports alternate day supplementation, but longer-term effects of these schedules require further investigation. These clinical trials were registered at www.ClinicalTrials.gov as #NCT01785407 and #NCT02050932.
Topics: Administration, Oral; Adolescent; Adult; Biological Availability; Biomarkers; Case-Control Studies; Cross-Over Studies; Dietary Supplements; Drug Administration Schedule; Female; Ferritins; Follow-Up Studies; Hepcidins; Humans; Intestinal Absorption; Iron; Iron, Dietary; Male; Middle Aged; Prognosis; Young Adult
PubMed: 26289639
DOI: 10.1182/blood-2015-05-642223 -
JAMA Neurology Aug 2023Questions remain concerning treatment efficacy for the common condition of benign paroxysmal positional vertigo (BPPV). (Randomized Controlled Trial)
Randomized Controlled Trial
IMPORTANCE
Questions remain concerning treatment efficacy for the common condition of benign paroxysmal positional vertigo (BPPV).
OBJECTIVE
To compare the effectiveness of the Semont-plus maneuver (SM-plus) and the Epley maneuver (EM) for treatment of posterior canal benign paroxysmal positional vertigo (pcBPPV) canalolithiasis.
DESIGN, SETTING, AND PARTICIPANTS
This prospective randomized clinical trial was performed at 3 national referral centers (in Munich, Germany; Siena, Italy; and Bruges, Belgium) over 2 years, with a follow-up to 4 weeks after the initial examination. Recruitment took place from June 1, 2020, until March 10, 2022. Patients were selected randomly during routine outpatient care after being referred to 1 of the 3 centers. Two hundred fifty-three patients were assessed for eligibility. After consideration of the exclusion criteria as well as informed consent, 56 patients were excluded and 2 declined to participate, with 195 participants included in the final analysis. The analysis was prespecified and per-protocol.
INTERVENTIONS
After being randomized to the SM-plus or the EM group, patients received 1 initial maneuver from a physician, then subsequently performed self-maneuvers at home 3 times in the morning, 3 times at noon, and 3 times in the evening.
MAIN OUTCOME AND MEASURES
Patients had to document whether they could provoke positional vertigo every morning. The primary end point was the number of days until no positional vertigo could be induced on 3 consecutive mornings. The secondary end point was the effect of the single maneuver performed by the physician.
RESULTS
Of the 195 participants included in the analysis, the mean (SD) age was 62.6 (13.9) years, and 125 (64.1%) were women. The mean (SD) time until no positional vertigo attacks could be induced in the SM-plus group was 2.0 (1.6) days (median, 1 [range, 1-8] day; 95% CI, 1.64-2.28 days); in the EM group, 3.3 (3.6) days (median, 2 [range, 1-20] days; 95% CI, 2.62-4.06 days) (P = .01; α = .05, 2-tailed Mann-Whitney test). For the secondary end point (effect of a single maneuver), no significant difference was detected (67 of 98 [68.4%] vs 61 of 97 [62.9%]; P = .42; α = .05). No serious adverse event was detected with both maneuvers. Nineteen patients (19.6%) in the EM group and 24 (24.5%) in the SM-plus group experienced relevant nausea.
CONCLUSIONS AND RELEVANCE
The SM-plus self-maneuver is superior to the EM self-maneuver in terms of the number of days until recovery in pcBPPV.
TRIAL REGISTRATION
ClinicalTrials.gov Identifier: NCT05853328.
Topics: Humans; Female; Middle Aged; Male; Benign Paroxysmal Positional Vertigo; Prospective Studies; Physical Therapy Modalities; Treatment Outcome; Ambulatory Care
PubMed: 37358870
DOI: 10.1001/jamaneurol.2023.1408 -
Scandinavian Journal of Work,... Jul 2019Objectives Unhealthy dietary profiles contribute to the elevated risk of chronic diseases for shift workers. There has been limited investigation into factors associated...
Objectives Unhealthy dietary profiles contribute to the elevated risk of chronic diseases for shift workers. There has been limited investigation into factors associated both with shift work and diet, such as sleep and mood, that may further influence food intake among shift workers. The aim of this study was to explore the relationship between shift work, sleep, mood, and diet. Methods Shift working nurses [N=52; 46 female; age: mean 39.8 (SD 12.4) years] participated in a 14-day, repeated measures, within- and between-subjects design study. Analyses included data from 40 nurses over 181 shifts. Food diaries were completed for a minimum of three days per shift type (morning, afternoon, night). Foodworks nutrition software was used to determine energy intake in kilojoules and macronutrient intake (as a percentage of total energy intake). Mood (happiness, anxiety, depressive mood, stress, and tiredness) was measured using visual analog scales. Sleep was estimated using actigraphy. Demographic and work-related variables (covariates) were measured using a modified version of the Standard Shiftwork Index. A path analysis was conducted using generalized structural equation modelling with a random effect of participant ID. Predictors were selected using purposive selection of covariates (an alternative to stepwise modelling) and final models included important predictors only. Results Compared to night and morning shifts, results showed that working an afternoon shift was associated with a lower energy intake (β= -1659.4, P<0.01) and lower levels of stress (β= -5.6, P<0.01). Higher levels of stress were associated with a higher energy intake (β=35.3, P<0.01) and a higher percentage of fat (ß=0.1, P=0.05) and saturated fat (β=0.1, P<0.01). Compared to the other shift types, morning shift was associated with lower carbohydrates (β= -4.3, P<0.01) and night shift was associated with lower protein (β= -2.7, P=0.03). Lower sleep efficiency was associated with a higher carbohydrate intake (β= -0.4, P<0.01) and a lower protein intake (β=0.25, P<0.01) Conclusions Results suggest that compared to nights and mornings, afternoon shifts were associated with reduced energy consumption. Negative mood (stress, depression, and anxiety) mediated the association between shift type and energy intake. Negative mood was also associated with higher fat intake. Dietary interventions for shift workers should consider the role of mood as well as shift type.
Topics: Adult; Affect; Circadian Rhythm; Diet; Energy Intake; Fatigue; Female; Humans; Male; Middle Aged; Occupational Health; Occupational Stress; Shift Work Schedule; Sleep; Socioeconomic Factors
PubMed: 30806474
DOI: 10.5271/sjweh.3803 -
Cardiology in Review Mar 2024The aim of the present paper is to explore the option of chronotherapy of hypertension and its effectiveness in blood pressure (BP) lowering compared with its standard...
The aim of the present paper is to explore the option of chronotherapy of hypertension and its effectiveness in blood pressure (BP) lowering compared with its standard daily treatment. The treatment of BP has gone through many different schemes over the years. From no treatment in the early 1930s, to step care, to multiple drug combinations, or to single daily drug combinations with 2-3 drugs, still BP is not well controlled in a significant number of patients. Recently, the role of the circadian rhythm in the treatment of hypertension has been tested by several studies comparing the evening versus the morning drug administration with no clear evidence of superiority of either mode of drug administration. However, in cases of morning surge of BP, nocturnal hypertension, and renal disease, the evening drug administration has been more effective than the morning drug administration, and thus, more preferable. In order to get a better perspective on this approach of hypertension treatment, a Medline search of the English literature was contacted between 2010 and 2023 using the terms BP control, circadian rhythm, morning drug administration, evening drug administration, and 38 pertinent papers were selected for analysis. Careful review of the selected papers showed that chronotherapy of hypertension is effective. However, the overall effectiveness of evening drug administration compared with the morning administration is not significantly more effective compared to the morning administration and more work is needed in this field.
PubMed: 38506526
DOI: 10.1097/CRD.0000000000000644 -
Nutrients Dec 2023Numerous observational studies have documented an association between the circadian rhythm and the composition of the gut microbiota. However, the bidirectional causal...
BACKGROUND
Numerous observational studies have documented an association between the circadian rhythm and the composition of the gut microbiota. However, the bidirectional causal effect of the morning chronotype on the gut microbiota is unknown.
METHODS
A two-sample Mendelian randomization study was performed, using the summary statistics of the morning chronotype from the European Consortium and those of the gut microbiota from the largest available genome-wide association study meta-analysis, conducted by the MiBioGen consortium. The inverse variance-weighted (IVW), weighted mode, weighted median, MR-Egger regression, and simple mode methods were used to examine the causal association between the morning chronotype and the gut microbiota. A reverse Mendelian randomization analysis was conducted on the gut microbiota, which was identified as causally linked to the morning chronotype in the initial Mendelian randomization analysis. Cochran's Q statistics were employed to assess the heterogeneity of the instrumental variables.
RESULTS
Inverse variance-weighted estimates suggested that the morning chronotype had a protective effect on Family ( = -0.072; 95% CI: -0.143, -0.001; = 0.047), Genus ( = -0.112; 95% CI: -0.184, -0.039; = 0.002), and Genus ( = -0.072; 95% CI: -0.143, -0.001; = 0.047). In addition, the gut microbiota (Family (OR = 0.925; 95% CI: 0.857, 0.999; = 0.047), Genus (OR = 0.915; 95% CI: 0.858, 0.975; = 0.007), and Genus (OR = 0.925; 95% CI: 0.857, 0.999; = 0.047)) demonstrated positive effects on the morning chronotype. No significant heterogeneity in the instrumental variables, or in horizontal pleiotropy, was found.
CONCLUSION
This two-sample Mendelian randomization study found that Family , Genus , and Genus were causally associated with the morning chronotype. Further randomized controlled trials are needed to clarify the effects of the gut microbiota on the morning chronotype, as well as their specific protective mechanisms.
Topics: Bacteroides; Bacteroidetes; Chronotype; Gastrointestinal Microbiome; Genome-Wide Association Study; Mendelian Randomization Analysis
PubMed: 38201876
DOI: 10.3390/nu16010046 -
European Respiratory Review : An... Jan 2017Morning symptoms are common in chronic obstructive pulmonary disease (COPD). Many COPD patients consider the morning as the most troublesome part of the day, in which... (Review)
Review
Morning symptoms are common in chronic obstructive pulmonary disease (COPD). Many COPD patients consider the morning as the most troublesome part of the day, in which they experience more symptoms and physical activity limitations.To systematically report evidence of the association between morning symptoms and physical activity in COPD patients, a literature search was conducted using relevant MESH terms and text words in PubMed, Embase, Web of Science, COCHRANE, CINAHL and PsycINFO. Quality of the articles was assessed with validated checklists.Eight studies were included. Morning symptoms were present in 39.8-94.4%. In 37.0-90.6% of all COPD patients, there was an association between physical activity and morning symptoms. However, causality could not be proved. Morning symptoms were associated with a sedentary lifestyle (p<0.05). Treatment in line with the guidelines improved the degree of activity limitations due to morning symptoms (p<0.0001).Across all disease stages, COPD patients experience morning symptoms which are negatively associated with physical activity. Physicians should consider morning symptoms as a treatment goal. Pharmacotherapy may improve the degree of activity limitations due to morning symptoms. More objective research should focus on symptoms, activity limitations and physical inactivity of COPD patients, especially in the morning.
Topics: Adult; Aged; Circadian Rhythm; Disease Progression; Exercise; Exercise Tolerance; Female; Humans; Lung; Male; Middle Aged; Pulmonary Disease, Chronic Obstructive; Risk Factors; Sedentary Behavior; Severity of Illness Index; Time Factors
PubMed: 28049127
DOI: 10.1183/16000617.0033-2016 -
Journal of Hypertension Aug 2017: The aim of the current article is to review the current evidence on the role of morning blood pressure (BP) in the management of hypertension. Morning BP surge had... (Review)
Review
: The aim of the current article is to review the current evidence on the role of morning blood pressure (BP) in the management of hypertension. Morning BP surge had been and will continue to be a hot topic of hypertension research. However, more evidence is needed to prove its clinical usefulness in the management of hypertension. Masked morning hypertension, as the other forms of masked hypertension, requires more research. The concept of morning BP monitoring could be clinically relevant in the therapeutic management of hypertension and in the prevention of cardiovascular complications by defining and treating morning hypertension. Antihypertensive medication is usually taken in the morning. The presence of uncontrolled morning BP during trough effect hours could be a hallmark of inadequate antihypertensive regimen, such as, for instance, the use of short-acting or intermediate-acting drugs, under dosing of drugs, or no or low use of combination therapy. To improve the management of hypertension in general and morning hypertension in particular, long-acting antihypertensive drugs should be used in appropriate often full dosages and in proper combinations. The clinical usefulness of antihypertensive drugs of specific mechanisms against morning BP or split or timed dosing of long-acting drugs in controlling morning BP remains under investigation. In conclusion, there is some evidence that morning BP is critical in the incidence of cardiovascular complications. However, proving its clinical usefulness in the management of hypertension requires further research.
Topics: Antihypertensive Agents; Blood Pressure; Blood Pressure Monitoring, Ambulatory; Circadian Rhythm; Humans; Hypertension
PubMed: 28379890
DOI: 10.1097/HJH.0000000000001379 -
Frontiers in Endocrinology 2021Biochemically monitoring 21-hydroxylase deficiency (21-OHD) is challenging. Serum/blood 17-hydroxyprogesterone (17OHP) measurements are normally used for this purpose....
BACKGROUND
Biochemically monitoring 21-hydroxylase deficiency (21-OHD) is challenging. Serum/blood 17-hydroxyprogesterone (17OHP) measurements are normally used for this purpose. Urinary pregnanetriol (PT), a urinary metabolite of 17OHP, may also be used. Based on auxological data, we previously reported that the optimal first morning PT value fell in the range of 2.2-3.3 mg/gCr (95% confidence interval of the mean) and 0.59-6.0 mg/gCr (10 - 90 percentile) for monitoring 21-OHD treatment. No report thus far has directly compared the first morning urinary PT value with the 17OHP value at various times during the day.
OBJECTIVE
To explore the correlation between the first morning urinary PT value before glucocorticoid administration and the serum/blood 17OHP value at three time points, namely, before and two and four hours after glucocorticoid administration.
DESIGN
This was a prospective study done at two children's hospitals.
METHODS
In total, 25 patients with 21-OHD aged 3-25 years were recruited. Their urinary PT levels and 17OHP levels were measured for three days within a total period of one week. The first morning PT value was collected on all three days. Dried blood spots and serum were used to measure 17OHP.
RESULTS
The range for the first morning PT value for all the samples (n=69) was 0.10-56.1 mg/gCr. A significant, positive correlation was found between the first morning PT and 17OHP values before medication (r=0.87, p<0.01), and weaker correlation was observed between the first morning PT and 17OHP values after medication.
CONCLUSIONS
The first morning PT correlated more significantly with 17OHP before the morning medication. Measuring the first morning PT value may be more practical and useful for monitoring 21-OHD biochemically.
Topics: 17-alpha-Hydroxyprogesterone; Adolescent; Adrenal Hyperplasia, Congenital; Adult; Child; Child, Preschool; Humans; Pregnanetriol; Prospective Studies; Young Adult
PubMed: 35140686
DOI: 10.3389/fendo.2021.808254