Global Differences in Risk Factors, Etiology, and Outcome of Ischemic Stroke in Young Adults-A Worldwide Meta-analysis: The GOAL Initiative

BACKGROUND AND OBJECTIVES

There is a worldwide increase in the incidence of stroke in young adults, with major regional and ethnic differences. Advancing knowledge of ethnic and regional variation in causes and outcomes will be beneficial in implementation of regional health care services. We studied the global distribution of risk factors, causes, and 3-month mortality of young patients with ischemic stroke, by performing a patient data meta-analysis from different cohorts worldwide.

METHODS

We performed a pooled analysis of individual patient data from cohort studies that included consecutive patients with ischemic stroke aged 18-50 years. We studied differences in prevalence of risk factors and causes of ischemic stroke between different ethnic and racial groups, geographic regions, and countries with different income levels. We investigated differences in 3-month mortality by mixed-effects multivariable logistic regression.

RESULTS

We included 17,663 patients from 32 cohorts in 29 countries. Hypertension and diabetes were most prevalent in Black (hypertension, 52.1%; diabetes, 20.7%) and Asian patients (hypertension 46.1%, diabetes, 20.9%). Large vessel atherosclerosis and small vessel disease were more often the cause of stroke in high-income countries (HICs; both p < 0.001), whereas "other determined stroke" and "undetermined stroke" were higher in low and middle-income countries (LMICs; both p < 0.001). Patients in LMICs were younger, had less vascular risk factors, and despite this, more often died within 3 months than those from HICs (odds ratio 2.49; 95% confidence interval 1.42-4.36).

DISCUSSION

Ethnoracial and regional differences in risk factors and causes of stroke at young age provide an understanding of ethnic and racial and regional differences in incidence of ischemic stroke. Our results also highlight the dissimilarities in outcome after stroke in young adults that exist between LMICs and HICs, which should serve as call to action to improve health care facilities in LMICs.

The Contributions of Food Groups to the Daily Caloric Intake in Mongolian Population: A Mon-Timeline Study

(1) Background: The "Ger Recommendations" have been advised to promote a healthy diet in Mongolia. These recommendations emphasize the ratio of six macro-food components to ensure proper nutrition. In this study, the ratio of these six groups to the total daily caloric intake was determined. (2) Methods: This study was conducted as part of a study at the Clinical Cohort ("Mon-Timeline") of the Mongolian National University of Medical Science. A macro-community ratio was calculated using a 24-h dietary recall diary of a total of 498 people. (3) Results: The mean age of the study participants was 43.9 ± 12.9 years. Among them, 21.8% (n = 110) were male. Of the total calories, 44.7% were grains, 29.2% were meat and protein products, 9.3% were fats, 7.1% were dairy products, 6.6% were vegetables, and 3.1% were fruits. According to the ratio of the six groups in the Ger Recommendations, meat and grains exceeded the recommended amount, while fruits, milk, and vegetables were consumed less. It has been observed that the older a person ages, the closer they are to following these recommendations. In terms of gender, women consumed more fruit and milk than men. (4) Conclusions: The ratio of macronutrients in the daily caloric intake of Mongolians is inadequate. Therefore, knowledge about the "Ger Recommendations" needs to be studied in relation to people's healthy eating knowledge and attitudes. If necessary, the appropriate awareness needs to be increased to educate the public on proper eating habits.

Dementia risk among Mongolian population with type 2 diabetes: a matched case-control study

People with diabetes have a higher risk of cognitive impairment than people without diabetes, and recently it is being considered a complication of diabetes mellitus (DM). Because of drastic lifestyle changes in the Mongolian population, diabetes prevalence is increasing rapidly. The rapid increase of diabetes prevalence and its poor control in Mongolia suggest that there might be significant cognitive impairment in the diabetes population. In this case-control study, we compared the Mini-Mental State Examination score to the risk of cognitive impairment, indicating vascular dementia in people with and without diabetes. Upon obtaining their informed consent, each subject was tested with Mini-Mental State Examination. We involved age and gender-matched diabetic (n = 131) and non-diabetic (n = 131) subjects. The mean age was 61.3 ± 8.5 and 61.0 ± 8.7 in people with and without diabetes, respectively, and 35.9% of the participants were male. According to study groups, the Mini-Mental State Examination scores were significantly different: 26.1 ± 3.7 and 27.5 ± 2.6 for people with and without diabetes, respectively. In logistic regression analysis, age was significantly associated with Mini-Mental State Examination score (Beta coefficient = 1.22; 1.11-1.35, P < 0.001) in people without diabetes after adjustments for potential confounders. However, age was not significantly associated with MMSE scores in people with diabetes mellitus. Thus, diabetes duration and poor control may contribute to developing cognitive impairment in people with diabetes. In conclusion, there might be a high prevalence of vascular dementia in people with type 2 diabetes mellitus. However, since Mini-Mental State Examination is sensitive to dementia and not specific to vascular dementia, further studies involving neuroimaging and neurological examination are needed to fully elucidate the link between type 2 diabetes and vascular dementia in dementia in a Mongolian population.

Prevalence of restless leg syndrome in Mongolian adults: Mon-TimeLine study

We conducted an epidemiologic study based on survey neuroscience screening for restless leg syndrome in the Mongolian to determine the prevalence of restless leg syndrome. We used baseline data from the Mon-TimeLine study, a multidisciplinary, prospective, population-based cohort study. The total number of participants (n = 1572) ranged from 18 to 65 years of age. We found the prevalence of restless leg syndrome to be 6.6% (n = 103), among which 4.1% (n = 16) were males and 7.3% (n = 87) were females. The peak prevalence age for both genders was 45-55, and we found a positive correlation with body mass index (P < 0.05). Most cases were mild (44.7%) or moderate (35.9%), but 18.4% and 1% of the cases were severe or very severe, respectively. The severe groups showed a positive association with chronic kidney disease, as well as with gastritis. In conclusion, the prevalence of restless leg syndrome in Mongolia approximates that in other countries.

Global Outcome Assessment Life-long after stroke in young adults initiative-the GOAL initiative: study protocol and rationale of a multicentre retrospective individual patient data meta-analysis

INTRODUCTION

Worldwide, 2 million patients aged 18-50 years suffer a stroke each year, and this number is increasing. Knowledge about global distribution of risk factors and aetiologies, and information about prognosis and optimal secondary prevention in young stroke patients are limited. This limits evidence-based treatment and hampers the provision of appropriate information regarding the causes of stroke, risk factors and prognosis of young stroke patients.

METHODS AND ANALYSIS

The Global Outcome Assessment Life-long after stroke in young adults (GOAL) initiative aims to perform a global individual patient data meta-analysis with existing data from young stroke cohorts worldwide. All patients aged 18-50 years with ischaemic stroke or intracerebral haemorrhage will be included. Outcomes will be the distribution of stroke aetiology and (vascular) risk factors, functional outcome after stroke, risk of recurrent vascular events and death and finally the use of secondary prevention. Subgroup analyses will be made based on age, gender, aetiology, ethnicity and climate of residence.

ETHICS AND DISSEMINATION

Ethical approval for the GOAL study has already been obtained from the Medical Review Ethics Committee region Arnhem-Nijmegen. Additionally and when necessary, approval will also be obtained from national or local institutional review boards in the participating centres. When needed, a standardised data transfer agreement will be provided for participating centres. We plan dissemination of our results in peer-reviewed international scientific journals and through conference presentations. We expect that the results of this unique study will lead to better understanding of worldwide differences in risk factors, causes and outcome of young stroke patients.

Up-regulation of insulin-like growth factor-II receptor in reactive astrocytes in the spinal cord of amyotrophic lateral sclerosis transgenic rats

Amyotrophic lateral sclerosis (ALS) is a fatal neurodegenerative disease caused by selective motor neuron death. We developed a rat model of ALS expressing a human cytosolic copper-zinc superoxide dismutase (SOD1) transgene with two ALS-associated mutations: glycine to alanine at position 93 (G93A) and histidine to arginine at position 46 (H46R). Although the mechanism of ALS is still unclear, there are many hypotheses concerning its cause, including loss of neurotrophic support to motor neurons. Recent evidence suggests that insulin-like growth factors (IGFs) act as neurotrophic factors, and promote the survival and differentiation of neuronal cells including motor neurons. Their ability to enhance the outgrowth of spinal motor neurons suggests their potential as a therapeutic agent for the patients with ALS. In this study, we investigated IGF-II receptor immunoreactivity in the anterior horns of the lumbar level of the spinal cord in SOD1 transgenic rats with the H46R mutation of different ages as well as in normal littermates. The double-immunostaining for IGF-II receptor and glial fibrillary acidic protein (GFAP) demonstrated co-localization on reactive astrocytes ((**)p < 0.001) in the end-stage transgenic rats, whereas it was not evident at the pre-symptomatic stage or at the onset of the disease. Our results demonstrated the IGF-II receptor up-regulation in reactive astrocytes in the spinal cord of transgenic rats, which may reflect a protective response against the loss of IGF-related trophic factors. We suggest that IGF receptors may play a key role in the pathogenesis, and may have therapeutic implications in ALS.