Reproducibility, accuracy and concordance of Accutrend Plus for measuring circulating lipid concentration in adults

Can we trust published evidence on point-of-care tests for cholesterol? A rapid review

OBJECTIVES

There is a need to better inform clinicians and decision-makers in primary or community care settings on selecting the appropriate point-of-care tests (POCTs) for screening purposes (as a part of the NHS Health Check Programme). Here we provide an overview of the published analytic validity and diagnostic accuracy studies on POCTs for measuring blood lipids that are available on the UK market to determine whether they meet the accuracy specifications based on the 1995 US National Cholesterol Education Program (NCEP) recommendations.

DESIGN

Rapid review of analytical validity and diagnostic accuracy studies.

DATA SOURCES

On 12 May 2023, Medline and Embase were searched. Google Scholar was manually scrutinised to identify additional studies. Key article reference lists were also hand-searched.

ELIGIBILITY CRITERIA

We included analytical validity and diagnostic accuracy studies that compared POCT to laboratory testing (or another POCT) performance for measuring at least total cholesterol (TC) and high-density lipoprotein cholesterol (HDL-C).

DATA EXTRACTION AND SYNTHESIS

Identified studies were independently reviewed by two researchers using standardised methods of screening. Where necessary, conflicts were resolved by a third reviewer. Title and abstract as well as full texts were screened using prespecified inclusion and exclusion criteria. The quality of identified studies was assessed using QUADAS-2 for diagnostic accuracy studies and a modified quality appraisal tool for studies of diagnostic reliability (QAREL) for analytical validity studies. We assessed the quality of analytical and diagnostic accuracy studies and compared the accuracy of the POCTs for TC, triglyceride (TG), HDL-C and low-density lipoprotein cholesterol (LDL-C) against NCEP standards for mean per cent bias, coefficient of variation or total error. We narratively synthesised analytical and clinical validity evidence from retrieved studies.

RESULTS

This study examined analytical and diagnostic accuracy evidence for the selected POCTs. Through the review of 22 studies, 6 POCTs were identified. All retrieved studies were analytical validity assessments, while five of them also reported diagnostic accuracy information. The majority of evidence focused on Cholestech LDX, CardioChek PA and Accutrend Plus. Evidence of between and within-study heterogeneity was found. Precision measures often showed systematic differences between the POCT and reference standards. Most devices, except for Elemark, met at least one NCEP standard for either TC, TG, HDL-C, or LDL-C.

CONCLUSIONS

We found that evidence for two of the devices mostly met the requirements of the NCEP standard of evidence for bias and precision and could be recommended to general practitioners to use in the NHS Health Check programme. These were the Cholestech LDX and the Cobas b101 system.

Effects of the Omaha System- and HeartScore®-Based Impaired-Risk Perception Reduction Program on the Risk Perception of Individuals Aged 50-65 Years: A One-Group Pre-Test-Post-Test Study

PURPOSE

This study evaluates the impact of interventions in the Omaha System and HeartScore®-based program to reduce impaired-risk perception.

DESIGN

and setting: This study utilized a one-group pre-test-post-test design.

SUBJECTS

The program was conducted among participants aged over 50 years from different social settings.

INTERVENTION

The program had three parts: a briefing on HeartScore® recommendations, Omaha System interventions, and referral to a doctor.

MEASURES

HeartScore® determined cardiovascular disease (CVD) risk, body mass index (BMI) was calculated from height and weight, and the International PA Questionnaire evaluated physical activity (PA) levels. Self-assessment was used to perceived CVD risk, BMI, and PA.

ANALYSIS

We used the Wilcoxon signed-rank test to compare the pre-test and post-test scores of the Omaha System, the problem rating scale (PRS) subscales and McNemar test to measure changes in CVD risk perception, BMI, and PA level.

RESULTS

310 high-risk individuals out of 522 had impaired perception of their CVD risk. Only 201 responded to follow-up phone calls. Interventions based on HeartScore® and Omaha System improved CVD risk and PA perceptions (P < .001) but not BMI. The program significantly increased knowledge, status, and behavior scores (P < .001). After participating, 39% saw a cardiologist, and 57.2% saw a family physician within six months to reduce impaired risk perception. CVD risk perception increased to the actual level after the intervention, mostly in the group with low education level.

CONCLUSIONS

The program using the Omaha System and HeartScore® can help middle-aged individuals better understand their risk of cardiovascular disease.

Undiagnosed and Untreated Peripheral Complications of Diabetes: Findings from a Pilot Study on Diabetes-Related Foot Diseases (DFD) in Patients with Glycemic Disorders

BACKGROUND Diabetes-related foot disease (DFD) is a serious complication of diabetes, increasing the risk of amputation. Coimplications are preventable, but most diabetics do not receive proper screening and treatment, despite indications. This study was a pilot screening of diabetes-related foot disease in a group of people with glycemic disorders. MATERIAL AND METHODS We recruited 143 volunteers over 40 years of age. In the final analysis, we included 85 people diagnosed with glycemic disorders (diabetes or prediabetes), for whom we performed a total of 170 foot measurements. We screened for peripheral artery disease using: foot pulse, ankle-brachial index (manual and automatic), toe-brachial index, and transcutaneous oxygen pressure (TcPO2). To screen for diabetic peripheral neuropathy, we used indicators of loss of protective sensation: pressure perception and temperature perception, and plantar pressure distribution. RESULTS A history of diabetes was reported by 26 (30.6%) of the subjects. Disorders of at least 1 foot occurred in 20 (66.7%) subjects with diagnosed diabetes and in 10 (17%) subjects declaring no diabetes. Higher risk and DFD category were correlated with duration of diabetes (r=0.68, p=0.007), glycemic levels (r=0.56, p=0.001), age (r=0.57, p=0.007), and the presence of other diabetes complications. The best predictor of risk in DFD was manual ABI, p=0.001; followed by automatic ABI, p=0.006. CONCLUSIONS Our results showed that peripheral complications of diabetes, such as DFD, often remain undiagnosed and untreated despite the high risk of developing ulcers. There is a need for multi-center screening studies.

Validation of lipid profile measurement methods and establishment of reference values in a sub-Saharan African population

Validated reference values and procedures are needed to ensure optimal diagnosis of dyslipidemia in sub-Saharan Africa. We aimed to validate an analysis method and establish reference intervals of lipid profile parameters in Cameroonians using this method. On a cross-sectional study conducted from November 2019 to August 2020 in Yaoundé, we have analyzed blood samples with Cobas® 6000. We subscribed to ASQUALAB's External Quality Assessments (EQA) and Outsourced Internal Quality Controls (IQC). Reproducibility, repeatability, correctness accuracy and uncertainty were evaluated using IQC. Consenting adult participants were conveniently sampled, excluding those with any condition that may affect lipid profile. Descriptive statistics were reported accordingly, agreement was assessed with Bland-Altman analysis, and reference intervals were defined according to CLSI and IFCC recommendations. The coefficients of variation for repeatability, reproducibility, and correctness bias ranged between 0.6% and 6%, with all values within the normal range. Expanded uncertainty of total cholesterol, HDL and triglycerides measurements were, respectively, 0.45, 0.24 and 0.18. We included 422 participants with a mean age of 30.2 (10.9) years and 248 (58.8%) females. Reference intervals for total cholesterol, HDL, triglycerides and LDL were, respectively, 2.94-6.02 mmol/L, 0.90-2.06 mmol/L, 0.35-1.36 mmol/L, 1.37-4.13 mmol/L. These intervals were similar between sex and ethnic groups, but lower in younger participants. Lipid profile measurement with Cobas® 6000 is a reliable and accurate analysis in our context. Specific reference intervals must be used in African population, with further studies need for different age subgroups.

New App-Based Dietary and Lifestyle Intervention on Weight Loss and Cardiovascular Health

Consumer digital technology is rapidly evolving, allowing users to manage their health in a simple, non-invasive manner. However, there are few studies revealing if using digital technology as part of an intervention really has an impact in consumer health compared with traditional strategies. The objective of the current study is to compare two groups (MTB; n = 18, 46.1 ± 10.4 years and MTBAPP; n = 19, 45.3 ± 6.40 years) of overweight, prehypertensive individuals in losing weight and lowering their blood pressure. Both were provided with nutritionist-guided recommendations, a wearable tracking device and a dietary supplement that has previously been proven to help lose body weight and lower blood pressure. In addition, one of the groups (MTBAPP) used a mobile app specifically designed for the intervention. Blood pressure, body composition, triglyceride level, peak expiratory flow, forced expiratory volume in the first second and maximum oxygen volume were measured at different time points. In addition, participants were monitored with an activity bracelet throughout the intervention. As a result, both groups significantly lost body weight, while the group using the app additionally improved blood pressure levels and lowered fat mass. Furthermore, the app users significantly increased the number of daily steps and decreased sedentary time. In conclusion, the addition of a mobile app with daily reminders to follow healthy lifestyle recommendations increased physical activity and overall improved blood pressure and fat mass levels when compared with a group performing the same intervention but in absence of the mobile application.

Effectiveness of a nurse-led physical activity intervention to decrease cardiovascular disease risk in middle-aged adults: A pilot randomized controlled study

The purpose of this study was to evaluate the effectiveness of the nurse-led physical activity (PA) intervention on cardiovascular disease (CVD) risk reduction in individuals with moderate risk. A randomized controlled pilot trial was conducted with 12 individuals who have moderate cardiovascular risk meeting the inclusion criteria. Eleven individuals in the intervention group participated in a 12-week PA program (outdoor group walking with the group 5 days in a week, each lasting for 40 minutes) guided by a nurse. For determining the risk level of CVD, the "HeartScore program" was used. Height, weight, blood pressure, and cholesterol values of individuals in the intervention group were measured. At the end of nurse-led outdoor walking activity with the group for 12 weeks, systolic blood pressure (P = .041) and cholesterol (P = .001) values of individuals in the intervention group decreased based on the baseline levels and accordingly CVD risk levels decreased significantly (P = .019). There was no significant difference in the control group. This study demonstrates that health care professionals working in the family health centers can easily determine the CVD risk with the HeartScore. Outdoor group walking program guided by a nurse is effective in decreasing the CVD risk level.

Methods and rationale to assess the efficacy of a parenting intervention targeting diet improvement and substance use prevention among Latinx adolescents

Latinx adolescents are at higher risk for chronic diseases relative to adolescents of other ethnic groups, in part because of their lack of adherence to diet recommendations and their higher rates of substance use. Given the proximal influence of family factors during the developmental stage of adolescence, parenting interventions may be an effective way to promote healthy nutrition and substance use prevention simultaneously. This article describes the design and theoretical rationale of a study assessing the effects of Families Preparing the New Generation Plus (FPNG Plus), a 10-week culturally-tailored nutrition and substance use prevention parenting program, on diet and substance use outcomes among Latinx middle school students (6th-8th grade). The 3-arm cluster randomized controlled trial compares FPNG Plus (substance use prevention and healthy nutrition), FPNG (substance use prevention only), and a comparison condition (focusing on academic success) in 1494 parent-child dyads from 18 schools, randomized at the school level. Adolescents and parents will complete surveys pre- and post-intervention, and 16-weeks after program participation, regarding diet behaviors, substance use, and parenting practices. A random subsample of 126 dyads (42 from each program), will participate in additional data collection to assess the home food environment, detailed dietary intake (via two 24-h recalls), and provide biomarkers of cardiometabolic risk (blood pressure, total cholesterol and HbA1c). If successful, this study will provide evidence contributing to helping Latinx parents assist their adolescent children develop and maintain long-lasting positive lifestyle behaviors in order to prevent concurrent substance use and diet-related chronic diseases.

The sensitivity, specificity, and agreement of a point of care method: an assessment of the diagnostic accuracy

The use of new technologies can improve screening in communities with difficult access to health. This article aims to evaluate the sensitivity, specificity, and agreement of a point of care test in comparison to laboratory methods for the determination of glucose (GLI), triglyceride (TG), and total cholesterol (TC) concentrations. This prospective study used data from the remaining adult population of quilombolas in Brazil. Laboratory tests using conventional methods for the analysis of venipuncture samples were used as a standard method to measure the concentrations of GLI (mg/dL), TG (mg/dL), and TC (mg/dL) and compared to the metered dose from the collection of fingertip capillary blood (point of care). Contingency tables (2x2) were used to estimate the sensitivity and specificity of the methods. Lin and Bland & Altman coefficients were used to statistically assess agreement, the level of significance was 5%. There was substantial agreement between the methods for measuring TG and poor agreement for of TC and GLI. Analysis of the Bland & Altman coefficients revealed that the fingertip method did not produce good measures. The point of care method did not offer a good ability to measure compared to that of the reference laboratory method.

Metabolic Changes in Children that Received Chemotherapy

Cancer treatments are associated with short and long-effects. Epidemiological reports have revealed clinical features of metabolic syndrome (MS), obesity or overweight in young cancer survivors. The aim of the study was to examine the prevalence of unhealthy weight status and risk factors associated with MS related to chemotherapy. We study 52 pediatric cancer patients and analyze cholesterol, triglycerides, glycosylated hemoglobin, body mass index, waist circumference (WC), FINDRISC test. All the parameters were analyzed according to the percentile corresponding to sex and age of each child. The data show an important modification in weight, body mass index, and WC as in triglycerides, and cholesterol that could be associated with the development of MS. The variance analysis showed that the WC, triglycerides, and cholesterol are statistically correlated in our population. A follow-up for MS in children cancer survivor should be considered necessary.

Cardiovascular disease risk in Turkish family health centers

Cardiovascular diseases (CVDs) are the leading cause of death both worldwide and in Turkey. The risk of CVD increases among those who are middle aged and among people with certain sociodemographic factors related to that risk. The objective of this study was to determine the prevalence of the risk of CVD and assess the factors related to this risk among adults aged 40-65 years. The study consisted of 327 individuals (208 [63.6%] women and 119 [36.4%] men) from a family health center (FHC) in Antalya, Turkey, who volunteered to participate in the study. The average age of the patients was 52.7 years. This cross-sectional study was conducted between April and September of 2016. The risk levels of the participants were calculated using the HeartScore program in 4 categories (low, moderate, high, and very high risk). In addition, sociodemographic and medical data were collected from the participants, as well. It was found that 3.4% of the patients were at a very high risk, 8% were at a high risk, 22% were at a moderate risk, and 66.7% were at a low risk of CVD. Major variables increasing this risk included diastolic hypertension by 7.49 (3.77-14.88) times. The individuals who completed secondary and high school had 2.44 times greater risk compared with those who completed primary school and lower education; moreover, those who completed university and higher education had the 2.24 times greater risk. Cardiovascular risk screening is important for apparently healthy individuals. The HeartScore program is practical for nurses and other health care professionals in FHCs to estimate individuals' risk of CVD.

[The importance of biomedical indicators in sexual functioning in healthy Portuguese adults]

BACKGROUND

The aim of this study was to investigate the influence of biomedical indicators, such as body mass index, blood glucose, total cholesterol, triglycerides, systolic blood pressure and diastolic blood pressure, on sexual functioning in Portuguese adults.

METHODS

The sample consisted of 225 healthy individuals (non-smokers, women not taking contraceptive pill), aged 18-89 years (mean = 41 years), of whom 107 were males and 117 females. A Sociodemographic Questionnaire, the Portuguese version of the Massachusetts General Hospital Sexual Functioning Questionnaire (MGH-SFQ) and biomedical indicators measurement devices were applied.

RESULTS

59.6% (N = 134) of the participants presented levels for global sexual functioning below the expected values. Men scored better overall sexual functioning when compared to women, as well as the group of younger participants. Significant correlational values between BMI (r = -253, p <.001), glycemic index (r = -.230, p <.001), total cholesterol (r = -144, p < .05) and sexual functioning were obtained. The hierarchical regression model allowed to demonstrate the mediating effect of the biomedical variables on sexual functioning, explaining 31% (r2 = .31; p <.001) of the total variance.

DISCUSSION AND CONCLUSIONS

This research makes it possible to highlight the importance of biomedical indicators in sexual functioning, helping professionals working in this area to be aware of how biomedical contexts interfere with sexual expression.

Cross-sectional surveillance study to phenotype lorry drivers' sedentary behaviours, physical activity and cardio-metabolic health

OBJECTIVES

Elevated risk factors for a number of chronic diseases have been identified in lorry drivers. Unhealthy lifestyle behaviours such as a lack of physical activity (PA) and high levels of sedentary behaviour (sitting) likely contribute to this elevated risk. This study behaviourally phenotyped UK lorry drivers' sedentary and non-sedentary behaviours during workdays and non-workdays and examined markers of drivers cardio-metabolic health.

SETTING

A transport company from the East Midlands, UK.

PARTICIPANTS

A sample of 159 male heavy goods vehicle drivers (91% white European; (median (range)) age: 50 (24, 67) years) completed the health assessments. 87 (age: 50.0 (25.0, 65.0); body mass index (BMI): 27.7 (19.6, 43.4) kg/m²) provided objective information on sedentary and non-sedentary time.

OUTCOMES

Participants self-reported their sociodemographic information. Primary outcomes: sedentary behaviour and PA, assessed over 7 days using an activPAL3 inclinometer. Cardio-metabolic markers included: blood pressure (BP), heart rate, waist circumference (WC), hip circumference, body composition and fasted capillary blood glucose, triglycerides, high-density lipopreotein cholesterol, low-density lipoprotein cholesterol (LDL-C) and total cholesterol (TC) levels. These cardio-metabolic markers were treated as secondary outcomes.

RESULTS

Lorry drivers presented an unhealthy cardio-metabolic health profile (median (IQR) systolic BP: 129 (108.5, 164) mm Hg; diastolic BP: 81 (63, 104) mm Hg; BMI: 29 (20, 47) kg/m²; WC: 102 (77.5, 146.5) cm; LDL-C: 3 (1, 6) mmol/L; TC: 4.9 (3, 7.5) mmol/L). 84% were overweight or obese, 43% had type 2 diabetes or prediabetes and 34% had the metabolic syndrome. The subsample of lorry drivers with objective postural data (n=87) accumulated 13 hours/day and 8 hours/day of sedentary behaviour on workdays and non-workdays (p<0.001), respectively. On average, drivers accrued 12 min/day on workdays and 6 min/day on non-workdays of moderate-to-vigorous PA (MVPA).

CONCLUSION

Lorry drivers demonstrate a high-risk cardio-metabolic profile and are highly sedentary and physically inactive. Interventions to reduce sitting and increase MVPA during breaks and leisure time to improve cardio-metabolic health are urgently needed. Educational programmes to raise awareness about diet and exercise are recommended.

Validation of a triglyceride meter for use in pregnancy

Background

Elevated maternal triglycerides have been associated with adverse pregnancy outcomes including an increased risk of preeclampsia and macrosomia. A valid triglyceride meter would allow the examination of maternal postprandial triglycerides in a systematic manner. A non-fasting venous and two capillary measurements (using the Roche Accutrend® Plus meter) of triglycerides were measured in 40 participants at a mean of 36 weeks gestation.

Findings

The two methods were highly correlated (r = 0.89, P <0.0001), and the distributions were similar (mean difference 0.01 mmol/L (SD 0.47)), t = 0.18, P =0.86). Passing Bablok equation was: y = −0.01 + 0.98 × [95% CI intercept −0.51 – 0. 38; 95% CI slope 0.85-1.15). The estimated bias was −0.01 mmol/L (95% CI −0.93 – 0.91)).

Conclusions

This study demonstrated the Accutrend® Plus meter provides results that correlate strongly with the reference method, with low bias, when used in late pregnancy.

Design and challenges of a randomized controlled trial for reducing risk factors of metabolic syndrome in Mexican women through water intake

OBJECTIVE

To describe the design, methods, and challenges encountered during a randomized clinical trial aimed to promote water intake for reducing risks of metabolic syndrome in Mexican women.

MATERIALS AND METHODS

In a randomized clinical trial in Cuernavaca, Mexico, overweight and obese (body mass index [BMI] ≥ 25 < 39) women, 18 - < 45 years old with an intake of sugar-sweetened beverages ≥ 250 kilocalories per day (kcal/day) were randomly allocated to the water and education provision group (n = 120) or the education provision only group (n = 120).

RESULTS

We screened 1 756 women. The main difficulties encountered were identifying participants with the recruitment criteria, delivering water to participants, and the time demanded from the study participants.

CONCLUSIONS

The trial's main challenges were difficulties surrounding recruitment, delivery of the intervention, and the time demanded from the study participants. Modifications were effectively implemented without jeopardizing the original protocol.

Use of anthropometry for the prediction of regional body tissue distribution in adults: benefits and limitations in clinical practice

Regional body composition changes with aging. Some of the changes in composition are considered major risk factors for developing obesity related chronic diseases which in turn may lead to increased mortality in adults. The role of anthropometry is well recognized in the screening, diagnosis and follow-up of adults for risk classification, regardless of age. Regional body composition is influenced by a number of intrinsic and extrinsic factors. Therapeutic measures recommended to lower cardiovascular disease risk include lifestyle changes. The aim of this review is to systematically summarize studies that assessed the relationships between anthropometry and regional body composition. The potential benefits and limitations of anthropometry for use in clinical practice are presented and suggestions for future research given.

Validity of a portable glucose, total cholesterol, and triglycerides multi-analyzer in adults

This study investigated the accuracy and precision of the Accutrend Plus system to determine blood glucose, total cholesterol, and plasma triglycerides in adults and evaluated its efficiency in measuring these blood variables. The sample consisted of 53 subjects (≥ 18 years). For blood variable laboratory determination, venous blood samples were collected and processed in a Labmax 240 analyzer. To measure blood variables with the Accutrend Plus system, samples of capillary blood were collected. In the analysis, the following tests were included: Wilcoxon and Student's t-tests for paired samples, Lin's concordance coefficient, Bland-Altman method, receiver operating characteristic curve, McNemar test, and k statistics. The results show that the Accutrend Plus system provided significantly higher values (p ≤ .05) of glucose and triglycerides but not of total cholesterol (p > .05) as compared to the values determined in the laboratory. However, the system showed good reproducibility (Lin's coefficient: glucose = .958, triglycerides = .992, total cholesterol = .940) and high concordance with the laboratory method (Lin's coefficient: glucose = .952, triglycerides = .990, total cholesterol = .944) and high sensitivity (glucose = 80.0%, triglycerides = 90.5%, total cholesterol = 84.4%) and specificity (glucose = 100.0%, triglycerides = 96.9%, total cholesterol = 95.2%) in the discrimination of high values of the three blood variables analyzed. It could be concluded that despite the tendency to overestimate glucose and triglyceride levels, a portable multi-analyzer is a valid alternative for the monitoring of metabolic disorders and cardiovascular risk factors.