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Herrera Cuenca M, Proaño GV, Blankenship J, Cano-Gutierrez C, Chew STH, Fracassi P, Keller H, Venkatesh Mannar MG, Mastrilli V, Milewska M, Steiber A. Building Global Nutrition Policies in Health Care: Insights for Tackling Malnutrition from the Academy of Nutrition and Dietetics 2019 Global Nutrition Research and Policy Forum. J Acad Nutr Diet 2020; 120:1407-1416. [PMID: 32711857 DOI: 10.1016/j.jand.2020.03.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Indexed: 11/29/2022]
Abstract
Around the world, the burden of malnutrition remains high despite significant efforts to thwart both undernutrition and overnutrition. The links between food security, dietary choices, and health outcomes pose a dilemma: What can nutrition policymakers and health care professionals do to harness the benefits of nutrition to improve health outcomes for young and old? The Academy of Nutrition and Dietetics gathered a group of health care policymakers, physicians, and credentialed nutrition and dietetics practitioners from around the world for a Policy and Nutrition Forum that took place on August 31, 2019 in Krakow, Poland. Participants from countries in Asia, Europe, North America, and Latin America presented on nutrition and policy from their perspective and took part in discussions about the effects of nutrition policies on health and health care. To extend the conversation about food and nutrition and to build a healthier future for people worldwide, this report highlights information from the Forum.
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52
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Coleman JJ, Manavi K, Marson EJ, Botkai AH, Sapey E. COVID-19: to be or not to be; that is the diagnostic question. Postgrad Med J 2020; 96:392-398. [PMID: 32522844 PMCID: PMC7306267 DOI: 10.1136/postgradmedj-2020-137979] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 04/28/2020] [Accepted: 04/29/2020] [Indexed: 02/06/2023]
Abstract
Since the first cases in December 2019, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has rapidly spread across the globe, resulting in the COVID-19 pandemic. Early clinical experiences have demonstrated the wide spectrum of SARS-CoV-2 presentations, including various reports of atypical presentations of COVID-19 and possible mimic conditions.This article summarises the current evidence surrounding atypical presentations of COVID-19 including neurological, cardiovascular, gastrointestinal, otorhinolaryngology and geriatric features. A case from our hospital of pneumocystis pneumonia initially suspected to be COVID-19 forms the basis for a discussion surrounding mimic conditions of COVID-19. The dual-process model of clinical reasoning is used to analyse the thought processes used to make a diagnosis of COVID-19, including consideration of the variety of differential diagnoses.While SARS-CoV-2 is likely to remain on the differential diagnostic list for a plethora of presentations for the foreseeable future, clinicians should be cautious of ignoring other potential diagnoses due to availability bias. An awareness of atypical presentations allows SARS-CoV-2 to be a differential so that it can be appropriately investigated. A knowledge of infectious mimics prevents COVID-19 from overshadowing other diagnoses, hence preventing delayed diagnosis or even misdiagnosis and consequent adverse outcomes for patients.
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Affiliation(s)
- Jamie J Coleman
- School of Medicine, University of Birmingham, Birmingham, West Midlands, UK
- Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, West Midlands, UK
| | - Kaveh Manavi
- Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, West Midlands, UK
- Birmingham Acute Care Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - Ella J Marson
- School of Medicine, University of Birmingham, Birmingham, West Midlands, UK
- Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, West Midlands, UK
| | - Adam H Botkai
- School of Medicine, University of Birmingham, Birmingham, West Midlands, UK
- Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, West Midlands, UK
| | - Elizabeth Sapey
- Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, West Midlands, UK
- Birmingham Acute Care Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
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Portero de la Cruz S, Cebrino J. Prevalence and Determinants of Antibiotic Consumption in the Elderly during 2006-2017. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17093243. [PMID: 32384740 PMCID: PMC7246950 DOI: 10.3390/ijerph17093243] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 05/04/2020] [Accepted: 05/04/2020] [Indexed: 06/11/2023]
Abstract
Elderly people are a particularly important population with regard to antibiotic overuse, using around 50% more antibiotics per capita than younger adults. The aim of this study was to analyze the prevalence, associated factors and evolution over time of antibiotic consumption among the Spanish population aged ≥ 65 years from 2006 to 2017. A descriptive cross-sectional study was conducted using data from the Spanish National Health Survey in 2006, 2011/2012 and 2017, and from the European Health Survey in Spain in 2009 and 2014. The sample consisted of 26,891 non-institutionalized individuals ≥ 65 years. Antibiotic consumption was the dependent variable, and sociodemographic variables, lifestyle habits and health status were analyzed using a logistic regression model. The prevalence of antibiotic consumption was 4.94%, with a marked increase from 2006 (4.64%) to 2017 (5.81%) (p < 0.0001). Higher antibiotic consumption was associated with poor or very poor self-perceived health status, no polypharmacy and not having been in hospital during the previous twelve months, while a lower consumption was linked to being limited but not severely due to a health problem and not being at all limited.
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Affiliation(s)
- Silvia Portero de la Cruz
- Department of Nursing, Pharmacology and Physiotherapy, Faculty of Medicine and Nursing, University of Córdoba, Avda. Menéndez Pidal, S/N, 14071 Córdoba, Spain
| | - Jesús Cebrino
- Department of Preventive Medicine and Public Health, Faculty of Medicine, University of Seville, Avda. Doctor Fedriani, S/N, 41009 Seville, Spain;
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Ebersole JL, Al-Sabbagh M, Dawson DR. Heterogeneity of human serum antibody responses to P. gingivalis in periodontitis: Effects of age, race/ethnicity, and sex. Immunol Lett 2020; 218:11-21. [PMID: 31863783 PMCID: PMC6956649 DOI: 10.1016/j.imlet.2019.12.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 12/04/2019] [Accepted: 12/17/2019] [Indexed: 02/06/2023]
Abstract
Aging humans display an increased prevalence and severity of periodontitis, although the mechanisms underlying these findings remain poorly understood. This report examined antigenic diversity of P. gingivalis related to disease presence and patient demographics. Serum IgG antibody to P. gingivalis strains ATCC33277, FDC381, W50 (ATCC53978), W83, A7A1-28 (ATCC53977) and A7436 was measured in 426 participants [periodontally healthy (n = 61), gingivitis (N = 66) or various levels of periodontitis (N = 299)]. We hypothesized that antigenic diversity in P. gingivalis could contribute to a lack of "immunity" in the chronic infections of periodontal disease. Across the strains, the antibody levels in the oldest age group were lower than in the youngest groups, and severe periodontitis patients did not show higher antibody with aging. While 80 % of the periodontitis patients in any age group showed an elevated response to at least one of the P. gingivalis strains, the patterns of individual responses in the older group were also substantially different than the other age groups. Significantly greater numbers of older patients showed strain-specific antibody profiles to only 1 strain. The findings support that P. gingivalis may demonstrate antigenic diversity/drift within patients and could be one factor to help explain the inefficiency/ineffectiveness of the adaptive immune response in managing the infection.
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Affiliation(s)
- J L Ebersole
- Department of Biomedical Sciences, School of Dental Medicine, University of Nevada Las Vegas and Department of Periodontology, College of Dentistry, University of Kentucky, United States.
| | - M Al-Sabbagh
- Department of Biomedical Sciences, School of Dental Medicine, University of Nevada Las Vegas and Department of Periodontology, College of Dentistry, University of Kentucky, United States
| | - D R Dawson
- Department of Biomedical Sciences, School of Dental Medicine, University of Nevada Las Vegas and Department of Periodontology, College of Dentistry, University of Kentucky, United States
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Vellas C, Delobel P, de Souto Barreto P, Izopet J. COVID-19, Virology and Geroscience: A Perspective. J Nutr Health Aging 2020; 24:685-691. [PMID: 32744561 PMCID: PMC7301052 DOI: 10.1007/s12603-020-1416-2] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 06/08/2020] [Indexed: 02/06/2023]
Abstract
A new coronavirus, called SARS-CoV-2, was identified in Wuhan, China, in December 2019. The SARS-CoV-2 spread very rapidly, causing a global pandemic, Coronavirus Disease 2019 (COVID-19). Older adults have higher peak of viral load and, especially those with comorbidities, had higher COVID-19-related fatality rates than younger adults. In this Perspective paper, we summarize current knowledge about SARS-CoV-2 and aging, in order to understand why older people are more affected by COVID-19. We discuss about the possibility that the so-called "immunosenescence" and "inflammaging" processes, already present in a fraction of frail older adults, could allow the immune escape of SARS-CoV-2 leading to COVID-19 serious complications. Finally, we propose to use geroscience approaches to the field of COVID-19.
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Affiliation(s)
- C Vellas
- Camille Vellas, INSERM UMR1043 - CNRS UMR5282 Centre de Physiopathologie Toulouse-Purpan (CPTP), Toulouse, France,
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Meng L, Almeida LN, Clauder AK, Lindemann T, Luther J, Link C, Hofmann K, Kulkarni U, Wong DM, David JP, Manz RA. Bone Marrow Plasma Cells Modulate Local Myeloid-Lineage Differentiation via IL-10. Front Immunol 2019; 10:1183. [PMID: 31214168 PMCID: PMC6555095 DOI: 10.3389/fimmu.2019.01183] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Accepted: 05/09/2019] [Indexed: 12/16/2022] Open
Abstract
Bone marrow plasma cells have been reported to represent a major source of IL-10; however, the impact of plasma cell derived IL-10 in that tissue remains poorly understood. We confirm in this study that even in the absence of acute immune reactions, mature plasma cells represent the dominant IL-10+ cell population in the bone marrow, and identify myeloid-lineage cells as a main local target for plasma cell derived IL-10. Using Vert-X IL-10 transcriptional reporter mice, we found that more than 50% of all IL-10+ cells in bone marrow were CD138+ plasma cells, while other IL-10+ B lineage cells were nearly absent in this organ. Accordingly, IL-10 was found in the supernatants of short-term cultures of FACS-sorted bone marrow plasma cells, confirming IL-10 secretion from these cells. IL-10+ bone marrow plasma cells showed a B220-/CD19-/MHCII low phenotype suggesting that these cells represent a mature differentiation stage. Approximately 5% of bone marrow leucocytes expressed the IL-10 receptor (IL-10R), most of them being CD115+/Ly6C+/CD11c- monocytes. Compared to littermate controls, young B lineage specific IL-10 KO mice showed increased numbers of CD115+ cells but normal populations of other myeloid cell types in bone marrow. However, at 7 months of age B lineage specific IL-10 KO mice exhibited increased populations of CD115+ myeloid and CD11c+ dendritic cells (DCs), and showed reduced F4/80 expression in this tissue; hence, indicating that bone marrow plasma cells modulate the differentiation of local myeloid lineage cells via IL-10, and that this effect increases with age. The effects of B cell/plasma cell derived IL-10 on the differentiation of CD115+, CD11c+, and F4/80+ myeloid cells were confirmed in co-culture experiments. Together, these data support the idea that IL-10 production is not limited to early plasma cell stages in peripheral tissues but is also an important feature of mature plasma cells in the bone marrow. Moreover, we provide evidence that already under homeostatic conditions in the absence of acute immune reactions, bone marrow plasma cells represent a non-redundant source for IL-10 that modulates local myeloid lineage differentiation. This is particularly relevant in older individuals.
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Affiliation(s)
- Lingzhang Meng
- Institute for Systemic Inflammation Research, University of Lübeck, Lübeck, Germany.,Institute of Physiological Chemistry and Pathobiochemistry, University of Münster, Münster, Germany
| | | | - Ann-Katrin Clauder
- Institute for Systemic Inflammation Research, University of Lübeck, Lübeck, Germany
| | - Timo Lindemann
- Institute for Systemic Inflammation Research, University of Lübeck, Lübeck, Germany
| | - Julia Luther
- Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christopher Link
- Institute for Systemic Inflammation Research, University of Lübeck, Lübeck, Germany
| | - Katharina Hofmann
- Institute for Systemic Inflammation Research, University of Lübeck, Lübeck, Germany
| | - Upasana Kulkarni
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, United States
| | - David Ming Wong
- Institute for Systemic Inflammation Research, University of Lübeck, Lübeck, Germany
| | - Jean-Pierre David
- Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Rudolf Armin Manz
- Institute for Systemic Inflammation Research, University of Lübeck, Lübeck, Germany
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McGinnis CM, Homan K, Solomon M, Taylor J, Staebell K, Erger D, Raut N. Dysphagia: Interprofessional Management, Impact, and Patient-Centered Care. Nutr Clin Pract 2018; 34:80-95. [DOI: 10.1002/ncp.10239] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Affiliation(s)
| | - Kimberly Homan
- Sanford USD Medical Center; Sioux Falls South Dakota USA
| | - Meghan Solomon
- Sanford USD Medical Center; Sioux Falls South Dakota USA
| | - Julia Taylor
- Sanford USD Medical Center; Sioux Falls South Dakota USA
| | | | - Denise Erger
- Sanford USD Medical Center; Sioux Falls South Dakota USA
| | - Namrata Raut
- Sanford USD Medical Center; Sioux Falls South Dakota USA
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Peniche AG, Spinler JK, Boonma P, Savidge TC, Dann SM. Aging impairs protective host defenses against Clostridioides (Clostridium) difficile infection in mice by suppressing neutrophil and IL-22 mediated immunity. Anaerobe 2018; 54:83-91. [PMID: 30099125 PMCID: PMC6291369 DOI: 10.1016/j.anaerobe.2018.07.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Revised: 07/22/2018] [Accepted: 07/30/2018] [Indexed: 02/08/2023]
Abstract
BACKGROUND Morbidity and mortality associated with Clostridioides (formerly Clostridium) difficile infection (CDI) rises progressively with advanced age (≥65 years) due in part to perturbations of the gut microbiota and immune dysfunction. Epidemiological data of community-acquired CDI suggests increased susceptibility may begin earlier during middle-age (45-64 years) but the causation remains unknown. METHODS Middle-aged (12-14 months) and young (2-4 months) adult mice were infected with C. difficile, and disease severity, gut microbiome and innate immune response were compared. Cytokine reconstitution studies were performed in infected middle-aged mice. RESULTS Infection of middle-aged mice with C. difficile led to greater disease compared to young controls, which was associated with increases in C. difficile burden and toxin titers, and elevated bacterial translocation. With the exception of an expansion of C. difficile in middle-aged mice, microbiome analysis revealed no age-related differences. In contrast, middle-aged mice displayed a significant defect in neutrophil recruitment to the colon, with diminished levels of innate immune cytokines IL-6, IL-23 and IL-22. Importantly, recombinant IL-22 administration during CDI reduced morbidity and prevented death in middle-aged mice. CONCLUSION Increased susceptibility to C. difficile occurs in middle-aged mice modeling the community-acquired CDI demographics and is driven by an impaired innate immune response.
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Affiliation(s)
- Alex G Peniche
- Department of Internal Medicine, Galveston, TX, USA; Microbiology and Immunology, University of Texas Medical Branch, Galveston, TX, USA
| | - Jennifer K Spinler
- Department of Pathology & Immunology, Baylor College of Medicine, Houston, TX, USA; Texas Children's Microbiome Center, Department of Pathology, Texas Children's Hospital, Houston, TX, USA
| | - Prapaporn Boonma
- Department of Pathology & Immunology, Baylor College of Medicine, Houston, TX, USA; Texas Children's Microbiome Center, Department of Pathology, Texas Children's Hospital, Houston, TX, USA
| | - Tor C Savidge
- Department of Pathology & Immunology, Baylor College of Medicine, Houston, TX, USA; Texas Children's Microbiome Center, Department of Pathology, Texas Children's Hospital, Houston, TX, USA
| | - Sara M Dann
- Department of Internal Medicine, Galveston, TX, USA; Microbiology and Immunology, University of Texas Medical Branch, Galveston, TX, USA.
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