-
Chest Nov 2023Chronic obstructive pulmonary disease patient care must include confirming a diagnosis with postbronchodilator spirometry. Because of the clinical heterogeneity and the... (Meta-Analysis)
Meta-Analysis
Chronic obstructive pulmonary disease patient care must include confirming a diagnosis with postbronchodilator spirometry. Because of the clinical heterogeneity and the reality that airflow obstruction assessed by spirometry only partially reflects disease severity, a thorough clinical evaluation of the patient should include assessment of symptom burden and risk of exacerbations that permits the implementation of evidence-informed pharmacologic and nonpharmacologic interventions. This guideline provides recommendations from a comprehensive systematic review with a meta-analysis and expert-informed clinical remarks to optimize maintenance pharmacologic therapy for individuals with stable COPD, and a revised and practical treatment pathway based on new evidence since the 2019 update of the Canadian Thoracic Society (CTS) Guideline. The key clinical questions were developed using the Patients/Population (P), Intervention(s) (I), Comparison/Comparator (C), and Outcome (O) model for three questions that focuses on the outcomes of symptoms (dyspnea)/health status, acute exacerbations, and mortality. The evidence from this systematic review and meta-analysis leads to the recommendation that all symptomatic patients with spirometry-confirmed COPD should receive long-acting bronchodilator maintenance therapy. Those with moderate to severe dyspnea (modified Medical Research Council ≥ 2) and/or impaired health status (COPD Assessment Test ≥ 10) and a low risk of exacerbations should receive combination therapy with a long-acting muscarinic antagonist/long-acting ẞ2-agonist (LAMA/LABA). For those with a moderate/severe dyspnea and/or impaired health status and a high risk of exacerbations should be prescribed triple combination therapy (LAMA/LABA/inhaled corticosteroids) azithromycin, roflumilast or N-acetylcysteine is recommended for specific populations; a recommendation against the use of theophylline, maintenance systemic oral corticosteroids such as prednisone and inhaled corticosteroid monotherapy is made for all COPD patients.
Topics: Humans; Drug Therapy, Combination; Adrenergic beta-2 Receptor Agonists; Bronchodilator Agents; Canada; Pulmonary Disease, Chronic Obstructive; Muscarinic Antagonists; Administration, Inhalation; Dyspnea; Adrenal Cortex Hormones
PubMed: 37690008
DOI: 10.1016/j.chest.2023.08.014 -
Critical Care (London, England) Jul 2023This systematic review and meta-analysis aimed to investigate the clinical efficacy and safety of systemic corticosteroids in the treatment of patients with severe... (Meta-Analysis)
Meta-Analysis
Efficacy and safety of adjunctive corticosteroids in the treatment of severe community-acquired pneumonia: a systematic review and meta-analysis of randomized controlled trials.
BACKGROUND
This systematic review and meta-analysis aimed to investigate the clinical efficacy and safety of systemic corticosteroids in the treatment of patients with severe community-acquired pneumonia (sCAP).
METHODS
A comprehensive search was conducted using the Medline, Embase, ClinicalTrials.gov, and Scopus databases for articles published until April 24, 2023. Only randomized controlled trials (RCTs) that assessed the clinical efficacy and safety of adjunctive corticosteroids for treating sCAP were included. The primary outcome was the 30-day all-cause mortality.
RESULTS
A total of severe RCTs involving 1689 patients were included in this study. Overall, the study group had a lower mortality rate at day 30 than the control group (risk ratio [RR], 0.61; 95% CI 0.44 to 0.85; p < 0.01) with low heterogeneity (I = 0%, p = 0.42). Compared to the control group, the study group had a lower risk of the requirement of mechanical ventilation (RR 0.57; 95% CI 0.45 to 0.73; p < 0.001), shorter length of intensive care unit (MD - 0.8; 95% CI - 1.4 to - 0.1; p = 0.02), and hospital stay (MD - 1.1; 95% CI - 2.0 to - 0.1; p = 0.04). Finally, no significant difference was observed between the study and the control groups in terms of gastrointestinal tract bleeding (RR 1.03; 95% CI 0.49 to 2.18; p = 0.93), healthcare-associated infection (RR 0.89; 95% CI 0.60 to 1.32; p = 0.56), and acute kidney injury (RR 0.68; 95% CI 0.21 to 2.26; p = 0.53).
CONCLUSIONS
In patients with sCAP, adjunctive corticosteroids can provide survival benefits and improve clinical outcomes without increasing adverse events. However, because the pooled evidence remains inconclusive, further studies are required.
Topics: Humans; Randomized Controlled Trials as Topic; Adrenal Cortex Hormones; Pneumonia; Respiration, Artificial; Community-Acquired Infections
PubMed: 37422686
DOI: 10.1186/s13054-023-04561-z -
The Journal of Dermatological Treatment May 2022Topical corticosteroid withdrawal is an entity associated with chronic steroid use and misuse that has not been fully described. (Review)
Review
BACKGROUND
Topical corticosteroid withdrawal is an entity associated with chronic steroid use and misuse that has not been fully described.
OBJECTIVE
To further characterize this entity, elucidate relevant clinical features, and investigate possible treatments we provided an update to a systematic review done in 2015.
METHODS
We searched Ovid Medline, Pubmed, and Cochrane library for terms related to topical corticosteroid withdrawal from April 2014 to September 2020.
RESULTS
This entity usually occurs after prolonged use of moderate- to high-intensity topical steroid usage usually on the face. It is most common in women and many patients present due to improper use such as for cosmetic reasons. Symptoms include erythema, itchiness, and burning; secondary lesions are common scales.
LIMITATIONS
Due to the paucity of available study, we elected to include all articles found which led to limitations being lack of heterogeneity, diversity of outcome measures reported, and a higher risk of bias in some included studies.
CONCLUSION
Topical corticosteroid withdrawal should be suspected in patients presenting with prolonged usage, erythema, and burning or itch. Patient education and follow up is important to address improper usage. Future studies should focus on comparison group studies to investigate treatment and risk factors.
Topics: Adrenal Cortex Hormones; Dermatologic Agents; Female; Humans; Pruritus; Steroids
PubMed: 33499686
DOI: 10.1080/09546634.2021.1882659 -
JAMA Network Open Mar 2022The Global Initiative for Asthma (GINA) recommends 2 alternative treatments for patients receiving treatment at steps 3 to 5: single inhaler combination inhaled... (Meta-Analysis)
Meta-Analysis
IMPORTANCE
The Global Initiative for Asthma (GINA) recommends 2 alternative treatments for patients receiving treatment at steps 3 to 5: single inhaler combination inhaled corticosteroid-formoterol as both maintenance and reliever (SMART) or inhaled corticosteroid-long-acting β2-agonist as maintenance plus short-acting β2-agonist as reliever.
OBJECTIVE
To assess whether switching to SMART is associated with longer time to first severe asthma exacerbation compared with a step up or continuation of GINA treatment step with maintenance inhaled corticosteroid-long-acting β2-agonist plus short-acting β2-agonist reliever among patients with poorly controlled asthma.
DATA SOURCES
For this systematic review and meta-analysis, the literature, internal study databases at AstraZeneca and the Medical Research Institute of New Zealand, and references from a previous systematic review and meta-analysis on SMART were searched to identify randomized clinical trials published from January 1990 to February 2018, that compared budesonide-formoterol by SMART with maintenance inhaled corticosteroid-long-acting β2-agonist plus short-acting β2-agonist reliever.
STUDY SELECTION
Trials of at least 24 weeks' duration were included if they reported baseline data on GINA treatment step, asthma control status, and efficacy measures of severe exacerbations. Included patients were adults and adolescents with asthma and baseline Asthma Control Questionnaire 5-item version scores of 1.5 or higher.
DATA EXTRACTION AND SYNTHESIS
Patient-level data were identified by independent extraction, and analyses were performed using a fixed-effect model. Data analysis was performed from August 2018 to November 2021.
MAIN OUTCOMES AND MEASURES
The primary outcome was time to first severe asthma exacerbation associated with each treatment, analyzed by Cox proportional hazards regression.
RESULTS
Overall, 4863 patients were included (3034 [62.4%] female; mean [SD] age, 39.8 [16.3] years). Switching patients with uncontrolled asthma at GINA step 3 (n = 1950) to SMART at either step 3 or 4 was associated with a prolonged time to first severe asthma exacerbation, with a 29% reduced risk compared with stepping up to step 4 inhaled corticosteroid-long-acting β2-agonist maintenance plus short-acting β2-agonist reliever (hazard ratio, 0.71; 95% CI, 0.52-0.97). For patients with uncontrolled asthma at step 3 and step 4 (n = 2913), switching to SMART was associated with a prolonged time to first severe asthma exacerbation and a 30% reduced risk compared with remaining at the same treatment step (hazard ratio, 0.70; 95% CI, 0.58-0.85).
CONCLUSIONS AND RELEVANCE
In this systematic review and meta-analysis, for patients with poorly controlled asthma, SMART was associated with longer time to first severe asthma exacerbation compared with a step up or continuation of GINA step with maintenance inhaled corticosteroid-long-acting β2-agonist plus short-acting β2-agonist reliever. These findings suggest that if an adult or adolescent receiving treatment at GINA step 3 or 4 has poorly controlled asthma, it is preferable to switch to the SMART regimen rather than to step up or continue the GINA treatment step with maintenance inhaled corticosteroid-long-acting β2-agonist plus short-acting β2-agonist reliever therapy.
Topics: Administration, Inhalation; Adolescent; Adrenal Cortex Hormones; Adult; Anti-Asthmatic Agents; Asthma; Budesonide; Budesonide, Formoterol Fumarate Drug Combination; Drug Combinations; Female; Formoterol Fumarate; Humans; Male; Randomized Controlled Trials as Topic
PubMed: 35230437
DOI: 10.1001/jamanetworkopen.2022.0615 -
American Journal of Respiratory and... Feb 2020Systemic corticosteroid use to manage uncontrolled asthma and its associated healthcare burden may account for important health-related adverse effects. We conducted a...
Systemic corticosteroid use to manage uncontrolled asthma and its associated healthcare burden may account for important health-related adverse effects. We conducted a systematic literature review to investigate the real-world extent and burden of systemic corticosteroid use in asthma. We searched MEDLINE and Embase databases to identify English-language articles published in 2010-2017, using search terms for asthma with keywords for oral corticosteroids and systemic corticosteroids. Observational studies, prescription database analyses, economic analyses, and surveys on oral/systemic corticosteroid use in children (>5 yr old), adolescents (12-17 yr old), and adults with asthma were included. We identified and reviewed 387 full-text articles, and our review included data from 139 studies. The included studies were conducted in Europe, North America, and Asia. Overall, oral/systemic corticosteroids were commonly used for asthma management and were more frequently used in patients with severe asthma than in those with milder disease. Long-term oral/systemic corticosteroid use was, in general, less frequent than short-term use. Compared with no use, long-term and repeated short-term oral/systemic corticosteroid use were associated with an increased risk of acute and chronic adverse events, even when doses were comparatively low. Greater oral/systemic corticosteroid exposure was also associated with increased costs and healthcare resource use. This review provides a comprehensive overview of oral/systemic corticosteroid use and associated adverse events for patients with all degrees of asthma severity and exposure duration. We report that oral/systemic corticosteroid use is prevalent in asthma management, and the risks of acute and chronic complications increase with the cumulative oral corticosteroid dosage.
Topics: Adolescent; Adrenal Cortex Hormones; Asthma; Child; Child, Preschool; Humans
PubMed: 31525297
DOI: 10.1164/rccm.201904-0903SO -
Muscle & Nerve Oct 2022Prognostic factors in Duchenne muscular dystrophy (DMD) predict the disease course and may help individualize patient care. The aim was to summarize the evidence on... (Meta-Analysis)
Meta-Analysis
INTRODUCTION/AIMS
Prognostic factors in Duchenne muscular dystrophy (DMD) predict the disease course and may help individualize patient care. The aim was to summarize the evidence on prognostic factors that may support treatment decisions.
METHODS
We searched six databases for prospective studies that each included ≥50 DMD patients with a minimum follow-up of 1 y. Primary outcomes were age at loss of ambulation (LoA), pulmonary function (forced vital capacity percent of predicted, FVC%p), and heart failure.
RESULTS
Out of 5074 references, 59 studies were analyzed. Corticosteroid use was associated with a delayed LoA (pooled effect hazard ratio [HR] 0.42, 95% confidence interval [CI] 0.23-0.75, I2 94%), better pulmonary function tests (higher peak FVC%, prolonged time with FVC%p > 50%, and reduced need for assisted ventilation) and delayed cardiomyopathy. Longer corticosteroid treatment was associated with later LoA (>1 y compared to <1 y; pooled HR: 0.50, 95% CI 0.27-0.90) and early treatment start (aged <5 y) may be associated with early cardiomyopathy and higher fracture risk. Genotype appeared to be an independent driver of LoA in some studies. Higher baseline physical function tests (e.g., 6-minute walk test) were associated with delayed LoA. Left ventricular dysfunction and FVC <1 L increased and the use of angiotensin-converting enzyme (ACE) inhibitors reduced the risk of heart failure and death. Fusion surgery in scoliosis may potentially preserve pulmonary function.
DISCUSSION
Prognostic factors that may inform clinical decisions include age at corticosteroid treatment initiation and treatment duration, ACE-inhibitor use, baseline physical function tests, pulmonary function, and cardiac dysfunction.
Topics: Adrenal Cortex Hormones; Angiotensin-Converting Enzyme Inhibitors; Angiotensins; Cardiomyopathies; Disease Progression; Heart Failure; Humans; Muscular Dystrophy, Duchenne; Prognosis; Prospective Studies; Treatment Outcome
PubMed: 35860996
DOI: 10.1002/mus.27682 -
BMJ (Clinical Research Ed.) Aug 2023To systematically review the proportions of infants with early exposure to antenatal corticosteroids but born at term or late preterm, and short term and long term... (Meta-Analysis)
Meta-Analysis
The proportions of term or late preterm births after exposure to early antenatal corticosteroids, and outcomes: systematic review and meta-analysis of 1.6 million infants.
OBJECTIVE
To systematically review the proportions of infants with early exposure to antenatal corticosteroids but born at term or late preterm, and short term and long term outcomes.
DESIGN
Systematic review and meta-analyses.
DATA SOURCES
Eight databases searched from 1 January 2000 to 1 February 2023, reflecting recent perinatal care, and references of screened articles.
ELIGIBILITY CRITERIA FOR SELECTING STUDIES
Randomised controlled trials and population based cohort studies with data on infants with early exposure to antenatal corticosteroids (<34 weeks) but born at term (≥37 weeks), late preterm (34-36 weeks), or term/late preterm combined.
DATA EXTRACTION AND SYNTHESIS
Two reviewers independently screened titles, abstracts, and full text articles and assessed risk of bias (Cochrane risk of bias tool for randomised controlled trials and Newcastle-Ottawa scale for population based studies). Reviewers extracted data on populations, exposure to antenatal corticosteroids, and outcomes. The authors analysed randomised and cohort data separately, using random effects meta-analyses.
MAIN OUTCOME MEASURES
The primary outcome was the proportion of infants with early exposure to antenatal corticosteroids but born at term. Secondary outcomes included the proportions of infants born late preterm or term/late preterm combined after early exposure to antenatal corticosteroids and short term and long term outcomes versus non-exposure for the three gestational time points (term, late preterm, term/late preterm combined).
RESULTS
Of 14 799 records, the reviewers screened 8815 non-duplicate titles and abstracts and assessed 713 full text articles. Seven randomised controlled trials and 10 population based cohort studies (1.6 million infants total) were included. In randomised controlled trials and population based data, ∼40% of infants with early exposure to antenatal corticosteroids were born at term (low or very low certainty). Among children born at term, early exposure to antenatal corticosteroids versus no exposure was associated with increased risks of admission to neonatal intensive care (adjusted odds ratio 1.49, 95% confidence interval 1.19 to 1.86, one study, 5330 infants, very low certainty; unadjusted relative risk 1.69, 95% confidence interval 1.51 to 1.89, three studies, 1 176 022 infants, I=58%, τ=0.01, low certainty), intubation (unadjusted relative risk 2.59, 1.39 to 4.81, absolute effect 7 more per 1000, 95% confidence interval from 2 more to 16 more, one study, 8076 infants, very low certainty, one study, 8076 infants, very low certainty), reduced head circumference (adjusted mean difference -0.21, 95% confidence interval -0.29 to -0.13, one study, 183 325 infants, low certainty), and any long term neurodevelopmental or behavioural disorder in population based studies (eg, any neurodevelopmental or behavioural disorder in children born at term, adjusted hazard ratio 1.47, 95% confidence interval 1.36 to 1.60, one study, 641 487 children, low certainty).
CONCLUSIONS
About 40% of infants exposed to early antenatal corticosteroids were born at term, with associated adverse short term and long term outcomes (low or very low certainty), highlighting the need for caution when considering antenatal corticosteroids.
SYSTEMATIC REVIEW REGISTRATION
PROSPERO CRD42022360079.
Topics: Child; Infant, Newborn; Infant; Humans; Female; Pregnancy; Premature Birth; Infant, Premature; Adrenal Cortex Hormones; Glucocorticoids; Parturition
PubMed: 37532269
DOI: 10.1136/bmj-2023-076035 -
JAMA Network Open Apr 2023Interventions to reduce severe brain injury risk are the prime focus in neonatal clinical trials. (Meta-Analysis)
Meta-Analysis
IMPORTANCE
Interventions to reduce severe brain injury risk are the prime focus in neonatal clinical trials.
OBJECTIVE
To evaluate multiple perinatal interventions across clinical settings for reducing the risk of severe intraventricular hemorrhage (sIVH) and cystic periventricular leukomalacia (cPVL) in preterm neonates.
DATA SOURCES
MEDLINE, Embase, CENTRAL (Cochrane Central Register of Controlled Trials), and CINAHL (Cumulative Index to Nursing and Allied Health Literature) databases were searched from inception until September 8, 2022, using prespecified search terms and no language restrictions.
STUDY SELECTION
Randomized clinical trials (RCTs) that evaluated perinatal interventions, chosen a priori, and reported 1 or more outcomes (sIVH, cPVL, and severe brain injury) were included.
DATA EXTRACTION AND SYNTHESIS
Two co-authors independently extracted the data, assessed the quality of the trials, and evaluated the certainty of the evidence using the Cochrane GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) approach. Fixed-effects pairwise meta-analysis was used for data synthesis.
MAIN OUTCOMES AND MEASURES
The 3 prespecified outcomes were sIVH, cPVL, and severe brain injury.
RESULTS
A total of 221 RCTs that assessed 44 perinatal interventions (6 antenatal, 6 delivery room, and 32 neonatal) were included. Meta-analysis showed with moderate certainty that antenatal corticosteroids were associated with small reduction in sIVH risk (risk ratio [RR], 0.54 [95% CI, 0.35-0.82]; absolute risk difference [ARD], -1% [95% CI, -2% to 0%]; number needed to treat [NNT], 80 [95% CI, 48-232]), whereas indomethacin prophylaxis was associated with moderate reduction in sIVH risk (RR, 0.64 [95% CI, 0.52-0.79]; ARD, -5% [95% CI, -8% to -3%]; NNT, 20 [95% CI, 13-39]). Similarly, the meta-analysis showed with low certainty that volume-targeted ventilation was associated with large reduction in risk of sIVH (RR, 0.51 [95% CI, 0.36-0.72]; ARD, -9% [95% CI, -13% to -5%]; NNT, 11 [95% CI, 7-23]). Additionally, early erythropoiesis-stimulating agents (RR, 0.68 [95% CI, 0.57-0.83]; ARD, -3% [95% CI, -4% to -1%]; NNT, 34 [95% CI, 22-67]) and prophylactic ethamsylate (RR, 0.68 [95% CI, 0.48-0.97]; ARD, -4% [95% CI, -7% to 0%]; NNT, 26 [95% CI, 13-372]) were associated with moderate reduction in sIVH risk (low certainty). The meta-analysis also showed with low certainty that compared with delayed cord clamping, umbilical cord milking was associated with a moderate increase in sIVH risk (RR, 1.82 [95% CI, 1.03-3.21]; ARD, 3% [95% CI, 0%-6%]; NNT, -30 [95% CI, -368 to -16]).
CONCLUSIONS AND RELEVANCE
Results of this study suggest that a few interventions, including antenatal corticosteroids and indomethacin prophylaxis, were associated with reduction in sIVH risk (moderate certainty), and volume-targeted ventilation, early erythropoiesis-stimulating agents, and prophylactic ethamsylate were associated with reduction in sIVH risk (low certainty) in preterm neonates. However, clinicians should carefully consider all of the critical factors that may affect applicability in these interventions, including certainty of the evidence, before applying them to clinical practice.
Topics: Infant, Newborn; Pregnancy; Female; Humans; Ethamsylate; Parturition; Adrenal Cortex Hormones; Cerebral Hemorrhage; Indomethacin; Brain Injuries
PubMed: 37052920
DOI: 10.1001/jamanetworkopen.2023.7473 -
BMJ Open Aug 2019Adverse events (AEs) associated with short-term corticosteroid use for respiratory conditions in young children. (Meta-Analysis)
Meta-Analysis
OBJECTIVE
Adverse events (AEs) associated with short-term corticosteroid use for respiratory conditions in young children.
DESIGN
Systematic review of primary studies.
DATA SOURCES
Medline, Cochrane CENTRAL, Embase and regulatory agencies were searched September 2014; search was updated in 2017.
ELIGIBILITY CRITERIA
Children <6 years with acute respiratory condition, given inhaled (high-dose) or systemic corticosteroids up to 14 days.
DATA EXTRACTION AND SYNTHESIS
One reviewer extracted with another reviewer verifying data. Study selection and methodological quality (McHarm scale) involved duplicate independent reviews. We extracted AEs reported by study authors and used a categorisation model by organ systems. Meta-analyses used Peto ORs (pORs) and DerSimonian Laird inverse variance method utilising Mantel-Haenszel Q statistic, with 95% CI. Subgroup analyses were conducted for respiratory condition and dose.
RESULTS
Eighty-five studies (11 505 children) were included; 68 were randomised trials. Methodological quality was poor overall due to lack of assessment and inadequate reporting of AEs. Meta-analysis (six studies; n=1373) found fewer cases of vomiting comparing oral dexamethasone with prednisone (pOR 0.29, 95% CI 0.17 to 0.48; I=0%). The mean difference in change-from-baseline height after one year between inhaled corticosteroid and placebo was 0.10 cm (two studies, n=268; 95% CI -0.47 to 0.67). Results from five studies with heterogeneous interventions, comparators and measurements were not pooled; one study found a smaller mean change in height z-score with recurrent high-dose inhaled fluticasone over one year. No significant differences were found comparing systemic or inhaled corticosteroid with placebo, or between corticosteroids, for other AEs; CIs around estimates were often wide, due to small samples and few events.
CONCLUSIONS
Evidence suggests that short-term high-dose inhaled or systemic corticosteroids use is not associated with an increase in AEs across organ systems. Uncertainties remain, particularly for recurrent use and growth outcomes, due to low study quality, poor reporting and imprecision.
Topics: Acute Disease; Administration, Inhalation; Administration, Intravenous; Administration, Oral; Adrenal Cortex Hormones; Asthma; Bronchiolitis, Viral; Child, Preschool; Croup; Dexamethasone; Fluticasone; Glucocorticoids; Growth Disorders; Headache; Humans; Infant; Injections, Intramuscular; Pneumonia; Prednisone; Respiratory Sounds; Respiratory Tract Diseases; Respiratory Tract Infections; Tremor; Vomiting
PubMed: 31375615
DOI: 10.1136/bmjopen-2018-028511 -
Psychoneuroendocrinology Nov 2022Allostatic load (AL) refers to prolonged dysregulation related to chronic stress that affects brain regions such as the hippocampus, amygdala, and prefrontal cortex...
Allostatic load (AL) refers to prolonged dysregulation related to chronic stress that affects brain regions such as the hippocampus, amygdala, and prefrontal cortex (PFC). Higher levels of AL have been associated with poor health outcomes, including psychiatric disorders, cognitive decline, and chronic somatic conditions. However, still little is known about the relationship between AL and the brain, and the mechanisms explaining the damaging effects of stress-related biological dysregulations. Therefore, we aimed to perform a systematic review of studies investigating the association of the AL index with brain structure and functioning in adult populations. PubMed/MEDLINE, CINAHL, Academic Search Complete and Web of Science were searched from their inception until August, 9th 2021. A total of 13 studies were included in the qualitative synthesis. There was a high between-study heterogeneity with respect to the methods used to calculate the AL index and brain parameters. All studies confirmed the associations between a higher AL index and alterations in various brain areas, especially: 1) the hippocampus, white matter volume, gray matter volume, and density in the older adults; 2) the cortex, fornix, hippocampus and choroid plexus in patients with schizophrenia spectrum disorders; and 3) whole-brain white matter tracts, cortical gray matter volume, and cortical thickness in overweight subjects. Overall, the findings of this systematic review imply that an elevated AL index might be associated with various neurostructural and neurofunctional alterations. Some of these associations may appear regardless of clinical or non-clinical populations being investigated (e.g., white matter tracts), whereas others may appear in specific populations (e.g., cortical thinning in overweight/obesity and schizophrenia spectrum disorders). However, additional studies utilizing a consistent approach to calculating the AL index are needed to extend these findings and indicate populations that are most vulnerable to the damaging effects of AL.
Topics: Aged; Allostasis; Brain; Gray Matter; Humans; Overweight; White Matter
PubMed: 36113380
DOI: 10.1016/j.psyneuen.2022.105917