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Zelicha H, Kaplan A, Yaskolka Meir A, Rinott E, Tsaban G, Blüher M, Klöting N, Ceglarek U, Isermann B, Stumvoll M, Chassidim Y, Shelef I, Hu FB, Shai I. Altered proteome profiles related to visceral adiposity may mediate the favorable effect of green Mediterranean diet: the DIRECT-PLUS trial. Obesity (Silver Spring) 2024. [PMID: 38757229 DOI: 10.1002/oby.24036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 03/08/2024] [Accepted: 03/19/2024] [Indexed: 05/18/2024]
Abstract
OBJECTIVE The objective of this study was to explore the effects of a green Mediterranean (green-MED) diet, which is high in dietary polyphenols and green plant-based protein and low in red/processed meat, on cardiovascular disease and inflammation-related circulating proteins and their associations with cardiometabolic risk parameters. METHODS In the 18-month weight loss trial Dietary Intervention Randomized Controlled Trial Polyphenols Unprocessed Study (DIRECT-PLUS), 294 participants with abdominal obesity were randomized to basic healthy dietary guidelines, Mediterranean (MED), or green-MED diets. Both isocaloric MED diet groups consumed walnuts (28 g/day), and the green-MED diet group also consumed green tea (3-4 cups/day) and green shakes (Mankai plant shake, 500 mL/day) and avoided red/processed meat. Proteome panels were measured at three time points using Olink CVDII. RESULTS At baseline, a dominant protein cluster was significantly related to higher phenotypic cardiometabolic risk parameters, with the strongest associations attributed to magnetic resonance imaging-assessed visceral adiposity (false discovery rate of 5%). Overall, after 6 months of intervention, both the MED and green-MED diets induced improvements in cardiovascular disease and proinflammatory risk proteins (p < 0.05, vs. healthy dietary guidelines), with the green-MED diet leading to more pronounced beneficial changes, largely driven by dominant proinflammatory proteins (IL-1 receptor antagonist protein, IL-16, IL-18, thrombospondin-2, leptin, prostasin, galectin-9, and fibroblast growth factor 21; adjusted for age, sex, and weight loss; p < 0.05). After 18 months, proteomics cluster changes presented the strongest correlations with visceral adiposity reduction. CONCLUSIONS Proteomics clusters may enhance our understanding of the favorable effect of a green-MED diet that is enriched with polyphenols and low in red/processed meat on visceral adiposity and cardiometabolic risk.
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Affiliation(s)
- Hila Zelicha
- The Health and Nutrition Innovative International Research Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er Sheva, Israel
| | - Alon Kaplan
- The Health and Nutrition Innovative International Research Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er Sheva, Israel
| | - Anat Yaskolka Meir
- The Health and Nutrition Innovative International Research Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er Sheva, Israel
| | - Ehud Rinott
- The Health and Nutrition Innovative International Research Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er Sheva, Israel
| | - Gal Tsaban
- The Health and Nutrition Innovative International Research Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er Sheva, Israel
| | - Matthias Blüher
- Helmholtz Institute for Metabolic, Obesity and Vascular Research (HI-MAG) of the Helmholtz Zentrum München at the University of Leipzig and University Hospital Leipzig, Leipzig, Germany
| | - Nora Klöting
- Helmholtz Institute for Metabolic, Obesity and Vascular Research (HI-MAG) of the Helmholtz Zentrum München at the University of Leipzig and University Hospital Leipzig, Leipzig, Germany
| | - Uta Ceglarek
- Department of Medicine, University of Leipzig, Leipzig, Germany
| | - Berend Isermann
- Department of Medicine, University of Leipzig, Leipzig, Germany
| | | | - Yoash Chassidim
- Department of Engineering, Sapir Academic College, Sapir, Israel
| | - Ilan Shelef
- Soroka University Medical Center, Be'er Sheva, Israel
| | - Frank B Hu
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA
- Harvard Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA
| | - Iris Shai
- The Health and Nutrition Innovative International Research Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er Sheva, Israel
- Department of Medicine, University of Leipzig, Leipzig, Germany
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA
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Naser JA, Lee E, Pislaru SV, Tsaban G, Malins JG, Jackson JI, Anisuzzaman DM, Rostami B, Lopez-Jimenez F, Friedman PA, Kane GC, Pellikka PA, Attia ZI. Artificial intelligence-based classification of echocardiographic views. Eur Heart J Digit Health 2024; 5:260-269. [PMID: 38774376 PMCID: PMC11104471 DOI: 10.1093/ehjdh/ztae015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Revised: 02/21/2024] [Accepted: 02/22/2024] [Indexed: 05/24/2024]
Abstract
Aims Augmenting echocardiography with artificial intelligence would allow for automated assessment of routine parameters and identification of disease patterns not easily recognized otherwise. View classification is an essential first step before deep learning can be applied to the echocardiogram. Methods and results We trained two- and three-dimensional convolutional neural networks (CNNs) using transthoracic echocardiographic (TTE) studies obtained from 909 patients to classify nine view categories (10 269 videos). Transthoracic echocardiographic studies from 229 patients were used in internal validation (2582 videos). Convolutional neural networks were tested on 100 patients with comprehensive TTE studies (where the two examples chosen by CNNs as most likely to represent a view were evaluated) and 408 patients with five view categories obtained via point-of-care ultrasound (POCUS). The overall accuracy of the two-dimensional CNN was 96.8%, and the averaged area under the curve (AUC) was 0.997 on the comprehensive TTE testing set; these numbers were 98.4% and 0.998, respectively, on the POCUS set. For the three-dimensional CNN, the accuracy and AUC were 96.3% and 0.998 for full TTE studies and 95.0% and 0.996 on POCUS videos, respectively. The positive predictive value, which defined correctly identified predicted views, was higher with two-dimensional rather than three-dimensional networks, exceeding 93% in apical, short-axis aortic valve, and parasternal long-axis left ventricle views. Conclusion An automated view classifier utilizing CNNs was able to classify cardiac views obtained using TTE and POCUS with high accuracy. The view classifier will facilitate the application of deep learning to echocardiography.
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Affiliation(s)
- Jwan A Naser
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Eunjung Lee
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Sorin V Pislaru
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Gal Tsaban
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Jeffrey G Malins
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - John I Jackson
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - D M Anisuzzaman
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Behrouz Rostami
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Francisco Lopez-Jimenez
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Paul A Friedman
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Garvan C Kane
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Patricia A Pellikka
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Zachi I Attia
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
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Goldberg DT, Yaskolka Meir A, Tsaban G, Rinott E, Kaplan A, Zelicha H, Klöting N, Ceglarek U, Iserman B, Shelef I, Rosen P, Blüher M, Stumvoll M, Etzion O, Stampfer MJ, Hu FB, Shai I. Novel proteomic signatures may indicate MRI-assessed intrahepatic fat state and changes: The DIRECT PLUS clinical trial. Hepatology 2024:01515467-990000000-00821. [PMID: 38537153 DOI: 10.1097/hep.0000000000000867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 03/03/2024] [Indexed: 05/08/2024]
Abstract
BACKGROUND AND AIMS We demonstrated in the randomized 18-month DIRECT PLUS trial (n = 294) that a Mediterranean (MED) diet, supplemented with polyphenol-rich Mankai duckweed, green tea, and walnuts and restricted in red/processed meat, caused substantial intrahepatic fat (IHF%) loss compared with 2 other healthy diets, reducing NAFLD by half, regardless of similar weight loss. Here, we investigated the baseline proteomic profile associated with IHF% and the changes in proteomics associated with IHF% changes induced by lifestyle intervention. APPROACH AND RESULTS We calculated IHF% by proton magnetic resonance spectroscopy (normal IHF% <5% and abnormal IHF% ≥5%). We assayed baseline and 18-month samples for 95 proteomic biomarkers.Participants (age = 51.3 ± 10.8 y; 89% men; and body mass index = 31.3 ± 3.9 kg/m 2 ) had an 89.8% 18-month retention rate; 83% had eligible follow-up proteomics measurements, and 78% had follow-up proton magnetic resonance spectroscopy. At baseline, 39 candidate proteins were significantly associated with IHF% (false discovery rate <0.05), mostly related to immune function pathways (eg, hydroxyacid oxidase 1). An IHF% prediction based on the DIRECT PLUS by combined model ( R2 = 0.47, root mean square error = 1.05) successfully predicted IHF% ( R2 = 0.53) during testing and was stronger than separately inputting proteins/traditional markers ( R2 = 0.43/0.44). The 18-month lifestyle intervention induced changes in 18 of the 39 candidate proteins, which were significantly associated with IHF% change, with proteins related to metabolism, extracellular matrix remodeling, and immune function pathways. Thrombospondin-2 protein change was higher in the green-MED compared to the MED group, beyond weight and IHF% loss ( p = 0.01). Protein principal component analysis revealed differences in the third principal component time distinct interactions across abnormal/normal IHF% trajectory combinations; p < 0.05 for all). CONCLUSIONS Our findings suggest novel proteomic signatures that may indicate MRI-assessed IHF state and changes during lifestyle intervention. Specifically, carbonic anhydrase 5A, hydroxyacid oxidase 1, and thrombospondin-2 protein changes are independently associated with IHF% change, and thrombospondin-2 protein change is greater in the green-MED/high polyphenols diet.
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Affiliation(s)
- Dana T Goldberg
- The Health & Nutrition Innovative International Research Center, Department of Epidemiology, Biostatistics and Community Health Sciences, Faculty of Health Sciences, School of Public Health, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Anat Yaskolka Meir
- The Health & Nutrition Innovative International Research Center, Department of Epidemiology, Biostatistics and Community Health Sciences, Faculty of Health Sciences, School of Public Health, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Gal Tsaban
- The Health & Nutrition Innovative International Research Center, Department of Epidemiology, Biostatistics and Community Health Sciences, Faculty of Health Sciences, School of Public Health, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Ehud Rinott
- The Health & Nutrition Innovative International Research Center, Department of Epidemiology, Biostatistics and Community Health Sciences, Faculty of Health Sciences, School of Public Health, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Alon Kaplan
- The Health & Nutrition Innovative International Research Center, Department of Epidemiology, Biostatistics and Community Health Sciences, Faculty of Health Sciences, School of Public Health, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Hila Zelicha
- The Health & Nutrition Innovative International Research Center, Department of Epidemiology, Biostatistics and Community Health Sciences, Faculty of Health Sciences, School of Public Health, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Nora Klöting
- Department of Medicine, University of Leipzig, Leipzig, Germany
| | - Uta Ceglarek
- Department of Medicine, University of Leipzig, Leipzig, Germany
- Institute of Laboratory Medicine, Clinical Chemistry, and Molecular Diagnostics, University of Leipzig Medical Center, Leipzig, Germany
| | - Berend Iserman
- Department of Medicine, University of Leipzig, Leipzig, Germany
- Institute of Laboratory Medicine, Clinical Chemistry, and Molecular Diagnostics, University of Leipzig Medical Center, Leipzig, Germany
| | - Ilan Shelef
- Department of Diagnostic Imaging, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Philip Rosen
- Department of Diagnostic Imaging, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Matthias Blüher
- Department of Medicine, University of Leipzig, Leipzig, Germany
- Helmholtz Institute for Metabolic, Obesity and Vascular Research (HI-MAG) of the Helmholtz Zentrum München at the University of Leipzig and University Hospital Leipzig, Leipzig, Germany
| | - Michael Stumvoll
- Department of Medicine, University of Leipzig, Leipzig, Germany
- Helmholtz Institute for Metabolic, Obesity and Vascular Research (HI-MAG) of the Helmholtz Zentrum München at the University of Leipzig and University Hospital Leipzig, Leipzig, Germany
| | - Ohad Etzion
- Department of Gastroenterology and Liver Diseases, Soroka University Medical Center, Beersheba, Israel
| | - Meir J Stampfer
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Medicine, Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Frank B Hu
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Medicine, Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Iris Shai
- The Health & Nutrition Innovative International Research Center, Department of Epidemiology, Biostatistics and Community Health Sciences, Faculty of Health Sciences, School of Public Health, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- Department of Medicine, University of Leipzig, Leipzig, Germany
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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Finkelstein O, Levakov G, Kaplan A, Zelicha H, Meir AY, Rinott E, Tsaban G, Witte AV, Blüher M, Stumvoll M, Shelef I, Shai I, Riklin Raviv T, Avidan G. Deep learning-based BMI inference from structural brain MRI reflects brain alterations following lifestyle intervention. Hum Brain Mapp 2024; 45:e26595. [PMID: 38375968 PMCID: PMC10878010 DOI: 10.1002/hbm.26595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 11/16/2023] [Accepted: 01/03/2024] [Indexed: 02/21/2024] Open
Abstract
Obesity is associated with negative effects on the brain. We exploit Artificial Intelligence (AI) tools to explore whether differences in clinical measurements following lifestyle interventions in overweight population could be reflected in brain morphology. In the DIRECT-PLUS clinical trial, participants with criterion for metabolic syndrome underwent an 18-month lifestyle intervention. Structural brain MRIs were acquired before and after the intervention. We utilized an ensemble learning framework to predict Body-Mass Index (BMI) scores, which correspond to adiposity-related clinical measurements from brain MRIs. We revealed that patient-specific reduction in BMI predictions was associated with actual weight loss and was significantly higher in active diet groups compared to a control group. Moreover, explainable AI (XAI) maps highlighted brain regions contributing to BMI predictions that were distinct from regions associated with age prediction. Our DIRECT-PLUS analysis results imply that predicted BMI and its reduction are unique neural biomarkers for obesity-related brain modifications and weight loss.
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Affiliation(s)
- Ofek Finkelstein
- Department of Cognitive and Brain SciencesBen‐Gurion University of the NegevBeer ShevaIsrael
| | - Gidon Levakov
- Department of Cognitive and Brain SciencesBen‐Gurion University of the NegevBeer ShevaIsrael
| | - Alon Kaplan
- The Health & Nutrition Innovative International Research Center, Faculty of Health SciencesBen Gurion University of the NegevBeer ShevaIsrael
- The Chaim Sheba Medical Center, Tel HashomerRamat‐GanIsrael
| | - Hila Zelicha
- The Health & Nutrition Innovative International Research Center, Faculty of Health SciencesBen Gurion University of the NegevBeer ShevaIsrael
| | - Anat Yaskolka Meir
- The Health & Nutrition Innovative International Research Center, Faculty of Health SciencesBen Gurion University of the NegevBeer ShevaIsrael
| | - Ehud Rinott
- The Health & Nutrition Innovative International Research Center, Faculty of Health SciencesBen Gurion University of the NegevBeer ShevaIsrael
| | - Gal Tsaban
- The Health & Nutrition Innovative International Research Center, Faculty of Health SciencesBen Gurion University of the NegevBeer ShevaIsrael
- Soroka University Medical CenterBeer ShevaIsrael
| | - Anja Veronica Witte
- Department of Neurology, Max Planck‐Institute for Human Cognitive and Brain Sciences, and Cognitive NeurologyUniversity of Leipzig Medical CenterLeipzigGermany
| | | | | | - Ilan Shelef
- The Health & Nutrition Innovative International Research Center, Faculty of Health SciencesBen Gurion University of the NegevBeer ShevaIsrael
- Soroka University Medical CenterBeer ShevaIsrael
| | - Iris Shai
- The Health & Nutrition Innovative International Research Center, Faculty of Health SciencesBen Gurion University of the NegevBeer ShevaIsrael
- Department of Nutrition, Harvard T.H. Chan School of Public HealthBostonMassachusettsUSA
| | - Tammy Riklin Raviv
- The School of Electrical and Computer EngineeringBen Gurion University of the NegevBeer ShevaIsrael
| | - Galia Avidan
- Department of PsychologyBen‐Gurion University of the NegevBeer ShevaIsrael
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Westreich R, Tsaban G, Barrett O, Kezerle L, Tsadok MA, Akriv A, Bachrach A, Leventer-Roberts M, Senderey AB, Haim M. Estimated glomerular filtration rate and the risk of stroke in individuals with diabetes mellitus and atrial fibrillation insight from a large contemporary population study. J Thromb Thrombolysis 2024; 57:322-329. [PMID: 37945939 DOI: 10.1007/s11239-023-02913-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/22/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND Diabetes mellitus (DM) is associated with increased risk of embolic complications in non-valvular atrial fibrillation (NVAF). Impaired renal function (IRF) increases the risk of stroke as well, but this finding is not consistent among all studies. Our aim was to assess the incidence rates and risk of ischemic stroke and mortality by baseline Estimated Glomerular Filtration Rate (eGFR) levels Among individuals with AF and DM. METHODS A prospective, historical cohort study using the Clalit Health Services electronic medical records database. Among patients with AF and DM, we compared three groups according to eGFR levels: eGFR ≥ 60, between 30 and 60, and ≤ 30 (mL/min/1.73m2). RESULTS A total of 17,567 cases were included in the final analysis; of them, 11,013 (62.7%) had eGFR ≥ 60, 4930 (28%) had eGFR between 30 and 60, and 1624 (9.24%) with eGFR ≤ 30. The incidence of stroke per 100 person-years in the three study groups was: 1.88, 2.69, and 3.34, respectively (p < 0.001). IRF was associated with increased risk of stroke in univariate analysis, but not after multivariate adjustment (Adjusted Hazard Ratio (AHR) 0.96 {95%CI; 0.74-1.25} for eGFR 30-60 and 0.96 {95%CI; 0.60-1.55} for eGFR ≤ 30). Mortality per 100 person-years was 10.78, 21.49, and 41.55, respectively (p < 0.001). IRF was associated with increased mortality risk in univariate analysis, as well as in multivariate analysis (AHR 1.08 {95%CI; 0.98-1.18} for eGFR 30-60, and 1.59 {95%CI; 1.37-1.85} for eGFR ≤ 30. CONCLUSION In patients with NVAF and DM, IRF was not associated with an increased risk of stroke, but severe IRF (eGFR ≤ 30) was associated with increased mortality risk.
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Affiliation(s)
- Roi Westreich
- Cardiac Electrophysiology and Pacing, Cardiology Department, Soroka Medical Center, Ben- Gurion University of the Negev, PO Box 141, 84101, Beer-Sheva, Beer-Sheva, Israel.
| | - Gal Tsaban
- Cardiac Electrophysiology and Pacing, Cardiology Department, Soroka Medical Center, Ben- Gurion University of the Negev, PO Box 141, 84101, Beer-Sheva, Beer-Sheva, Israel
| | - Orit Barrett
- Cardiac Electrophysiology and Pacing, Cardiology Department, Soroka Medical Center, Ben- Gurion University of the Negev, PO Box 141, 84101, Beer-Sheva, Beer-Sheva, Israel
| | - Louise Kezerle
- Cardiac Electrophysiology and Pacing, Cardiology Department, Soroka Medical Center, Ben- Gurion University of the Negev, PO Box 141, 84101, Beer-Sheva, Beer-Sheva, Israel
| | - Meytal Avgil Tsadok
- Clalit Research Institute, Clalit Health Services, Chief Physician's Office, Tel Aviv, Israel
| | - Amichay Akriv
- Clalit Research Institute, Clalit Health Services, Chief Physician's Office, Tel Aviv, Israel
| | - Asaf Bachrach
- Clalit Research Institute, Clalit Health Services, Chief Physician's Office, Tel Aviv, Israel
| | - Maya Leventer-Roberts
- Clalit Research Institute, Clalit Health Services, Chief Physician's Office, Tel Aviv, Israel
| | - Adi Berliner Senderey
- Clalit Research Institute, Clalit Health Services, Chief Physician's Office, Tel Aviv, Israel
| | - Moti Haim
- Cardiac Electrophysiology and Pacing, Cardiology Department, Soroka Medical Center, Ben- Gurion University of the Negev, PO Box 141, 84101, Beer-Sheva, Beer-Sheva, Israel
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Tsaban G, Ostrovsky D, Alnsasra H, Burrack N, Gordon M, Babayev AS, Omari Y, Kezerle L, Shamia D, Bereza S, Konstantino Y, Haim M. Amiodarone and pulmonary toxicity in atrial fibrillation: a nationwide Israeli study. Eur Heart J 2024; 45:379-388. [PMID: 37939798 DOI: 10.1093/eurheartj/ehad726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 08/08/2023] [Accepted: 10/12/2023] [Indexed: 11/10/2023] Open
Abstract
BACKGROUND AND AIMS Amiodarone-related interstitial lung disease (ILD) is the most severe adverse effect of amiodarone treatment. Most data on amiodarone-related ILD are derived from periods when amiodarone was given at higher doses than currently used. METHODS A nationwide population-based study was conducted among patients with incident atrial fibrillation (AF) between 1 December 1999 and 31 December 31 2021. Amiodarone-exposed patients were matched 1:1 with controls unexposed to amiodarone based on age, sex, ethnicity, and AF diagnosis duration. The final patient cohort included only matched pairs where amiodarone therapy was consistent throughout follow-up. Directed acyclic graphs and inverse probability treatment weighting (IPTW) modelling were used. Patients with either prior ILD or primary lung cancer (PLC) were excluded. The primary outcome was the incidence of any ILD. Secondary endpoints were death and PLC. RESULTS The final cohort included 6039 amiodarone-exposed patients who were matched with unexposed controls. The median age was 73.3 years, and 51.6% were women. After a mean follow-up of 4.2 years, ILD occurred in 242 (2.0%) patients. After IPTW, amiodarone exposure was not significantly associated with ILD [hazard ratio (HR): 1.45, 95% confidence interval (CI): 0.97, 2.44, P = 0.09]. There was a trivial higher relative risk of ILD among amiodarone-exposed patients between Years 2 and 8 of follow-up [maximal risk ratio (RR): 1.019]. Primary lung cancer occurred in 97 (0.8%) patients. After IPTW, amiodarone was not associated with PLC (HR: 1.18, 95% CI: 0.76, 2.08, P = 0.53). All-cause death occurred in 2185 (18.1%) patients. After IPTW, amiodarone was associated with reduced mortality risk (HR: 0.65, 95% CI: 0.60, 0.72, P < 0.001). The results were consistent across a variety of sensitivity analyses. CONCLUSION In a contemporary AF population, low-dose amiodarone was associated with a trend towards increased risk of ILD (15%-45%) but a clinically negligible change in absolute risk (maximum of 1.8%), no increased risk of PLC, and a lower risk of all-cause mortality.
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Affiliation(s)
- Gal Tsaban
- Cardiology Department, Soroka University Medical Center, P.O. Box 151, 101 Rager Boulevard, Beersheva 84101, Israel
- Faculty of Health Sciences, Ben Gurion University of the Negev, P.O. Box 653, Beersheva 84105, Israel
| | - Daniel Ostrovsky
- Faculty of Health Sciences, Ben Gurion University of the Negev, P.O. Box 653, Beersheva 84105, Israel
- Clinical Research Center, Soroka University Medical Center, Beersheva, Israel
| | - Hilmi Alnsasra
- Cardiology Department, Soroka University Medical Center, P.O. Box 151, 101 Rager Boulevard, Beersheva 84101, Israel
- Faculty of Health Sciences, Ben Gurion University of the Negev, P.O. Box 653, Beersheva 84105, Israel
| | - Nitzan Burrack
- Faculty of Health Sciences, Ben Gurion University of the Negev, P.O. Box 653, Beersheva 84105, Israel
- Clinical Research Center, Soroka University Medical Center, Beersheva, Israel
| | - Michal Gordon
- Clinical Research Center, Soroka University Medical Center, Beersheva, Israel
| | - Amit Shira Babayev
- Clinical Research Center, Soroka University Medical Center, Beersheva, Israel
| | - Yara Omari
- Faculty of Health Sciences, Ben Gurion University of the Negev, P.O. Box 653, Beersheva 84105, Israel
| | - Louise Kezerle
- Cardiology Department, Soroka University Medical Center, P.O. Box 151, 101 Rager Boulevard, Beersheva 84101, Israel
- Faculty of Health Sciences, Ben Gurion University of the Negev, P.O. Box 653, Beersheva 84105, Israel
| | - David Shamia
- Cardiology Department, Soroka University Medical Center, P.O. Box 151, 101 Rager Boulevard, Beersheva 84101, Israel
- Faculty of Health Sciences, Ben Gurion University of the Negev, P.O. Box 653, Beersheva 84105, Israel
| | - Sergey Bereza
- Cardiology Department, Soroka University Medical Center, P.O. Box 151, 101 Rager Boulevard, Beersheva 84101, Israel
- Faculty of Health Sciences, Ben Gurion University of the Negev, P.O. Box 653, Beersheva 84105, Israel
| | - Yuval Konstantino
- Cardiology Department, Soroka University Medical Center, P.O. Box 151, 101 Rager Boulevard, Beersheva 84101, Israel
- Faculty of Health Sciences, Ben Gurion University of the Negev, P.O. Box 653, Beersheva 84105, Israel
| | - Moti Haim
- Cardiology Department, Soroka University Medical Center, P.O. Box 151, 101 Rager Boulevard, Beersheva 84101, Israel
- Faculty of Health Sciences, Ben Gurion University of the Negev, P.O. Box 653, Beersheva 84105, Israel
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Kamer O, Rinott E, Tsaban G, Kaplan A, Yaskolka Meir A, Zelicha H, Knights D, Tuohy K, Fava F, Uwe Scholz M, Ziv O, Rubin E, Blüher M, Stumvoll M, Ceglarek U, Clément K, Koren O, Hu FB, Stampfer MJ, Wang DD, Youngster I, Shai I. Successful weight regain attenuation by autologous fecal microbiota transplantation is associated with non-core gut microbiota changes during weight loss; randomized controlled trial. Gut Microbes 2023; 15:2264457. [PMID: 37796016 PMCID: PMC10557561 DOI: 10.1080/19490976.2023.2264457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Accepted: 09/25/2023] [Indexed: 10/06/2023] Open
Abstract
We previously reported that autologous-fecal-microbiota-transplantation (aFMT), following 6 m of lifestyle intervention, attenuated subsequent weight regain and insulin rebound for participants consuming a high-polyphenol green-Mediterranean diet. Here, we explored whether specific changes in the core (abundant) vs. non-core (low-abundance) gut microbiome taxa fractions during the weight-loss phase (0-6 m) were differentially associated with weight maintenance following aFMT. Eighty-two abdominally obese/dyslipidemic participants (age = 52 years; 6 m weightloss = -8.3 kg) who provided fecal samples (0 m, 6 m) were included. Frozen 6 m's fecal samples were processed into 1 g, opaque and odorless aFMT capsules. Participants were randomly assigned to receive 100 capsules containing their own fecal microbiota or placebo over 8 m-14 m in ten administrations (adherence rate > 90%). Gut microbiome composition was evaluated using shotgun metagenomic sequencing. Non-core taxa were defined as ≤ 66% prevalence across participants. Overall, 450 species were analyzed. At baseline, 13.3% were classified as core, and Firmicutes presented the highest core proportion by phylum. During 6 m weight-loss phase, abundance of non-core species changed more than core species (P < .0001). Subject-specific changes in core and non-core taxa fractions were strongly correlated (Jaccard Index; r = 0.54; P < .001). Following aFMT treatment, only participants with a low 6 m change in core taxa, and a high change in non-core taxa, avoided 8-14 m weight regain (aFMT = -0.58 ± 2.4 kg, corresponding placebo group = 3.18 ± 3.5 kg; P = .02). In a linear regression model, low core/high non-core 6 m change was the only combination that was significantly associated with attenuated 8-14 m weight regain (P = .038; P = .002 for taxa patterns/treatment intervention interaction). High change in non-core, low-abundance taxa during weight-loss might mediate aFMT treatment success for weight loss maintenance.ClinicalTrials.gov: NCT03020186.
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Affiliation(s)
- Omer Kamer
- Faculty of Health Sciences, Ben-Gurion University of the Negev, The International Center of Health, Innovation & Nutrition On the memory of Manya Igel, Beer-Sheva, Israel
| | - Ehud Rinott
- Department of Medicine, Hebrew University and Hadassah Medical Center, Jerusalem, Israel
| | - Gal Tsaban
- Faculty of Health Sciences, Ben-Gurion University of the Negev, The International Center of Health, Innovation & Nutrition On the memory of Manya Igel, Beer-Sheva, Israel
| | - Alon Kaplan
- Faculty of Health Sciences, Ben-Gurion University of the Negev, The International Center of Health, Innovation & Nutrition On the memory of Manya Igel, Beer-Sheva, Israel
| | - Anat Yaskolka Meir
- Faculty of Health Sciences, Ben-Gurion University of the Negev, The International Center of Health, Innovation & Nutrition On the memory of Manya Igel, Beer-Sheva, Israel
| | - Hila Zelicha
- Faculty of Health Sciences, Ben-Gurion University of the Negev, The International Center of Health, Innovation & Nutrition On the memory of Manya Igel, Beer-Sheva, Israel
| | - Dan Knights
- BioTechnology Institute, University of Minnesota, St Paul, USA
- Department of Computer Science and Engineering, University of Minnesota, Minneapolis, USA
| | - Kieran Tuohy
- Department of Food Quality and Nutrition, Research and Innovation Centre, Fondazione Edmund Mach, Trento, Italy
- School of Food Science & Nutrition, University of Leeds, Leeds, UK
| | - Francesca Fava
- Department of Food Quality and Nutrition, Research and Innovation Centre, Fondazione Edmund Mach, Trento, Italy
| | - Matthias Uwe Scholz
- Department of Food Quality and Nutrition, Research and Innovation Centre, Fondazione Edmund Mach, Trento, Italy
| | - Oren Ziv
- Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
| | - Elad Rubin
- Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
| | - Matthias Blüher
- Department of Medicine, University of Leipzig, Leipzig, Germany
- Helmholtz Institute for Metabolic, Obesity and Vascular Research (HI-MAG) of the Helmholtz Zentrum München at the University of Leipzig and University Hospital Leipzig, Leipzig, Germany
| | - Michael Stumvoll
- Department of Medicine, University of Leipzig, Leipzig, Germany
- Helmholtz Institute for Metabolic, Obesity and Vascular Research (HI-MAG) of the Helmholtz Zentrum München at the University of Leipzig and University Hospital Leipzig, Leipzig, Germany
| | - Uta Ceglarek
- Department of Medicine, University of Leipzig, Leipzig, Germany
| | - Karine Clément
- Inserm, Nutrition and obesities: systemic approaches, nutriOmicsn Research Unit, Nutrition Department, Pitié-Salpêtrière Hospital, Assistance-Publique Hopitaux de Paris, Sorbonne University, Paris, France
| | - Omry Koren
- Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
| | - Frank B. Hu
- Harvard T.H. Chan School of Public Health, Boston, USA
- Department of Medicine, Channing Division of Network Medicine, Department of Medicine, Harvard Medical School and Brigham and Women’s Hospital, Boston, USA
| | - Meir J. Stampfer
- Harvard T.H. Chan School of Public Health, Boston, USA
- Department of Medicine, Channing Division of Network Medicine, Department of Medicine, Harvard Medical School and Brigham and Women’s Hospital, Boston, USA
| | - Dong D. Wang
- Harvard T.H. Chan School of Public Health, Boston, USA
| | - Ilan Youngster
- Pediatric Division and Center for Microbiome Research, Shamir Medical Center, Be’er Ya’akov, Israel
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Iris Shai
- Faculty of Health Sciences, Ben-Gurion University of the Negev, The International Center of Health, Innovation & Nutrition On the memory of Manya Igel, Beer-Sheva, Israel
- Harvard T.H. Chan School of Public Health, Boston, USA
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Alufer L, Tsaban G, Rinott E, Kaplan A, Meir AY, Zelicha H, Ceglarek U, Isermann B, Blüher M, Stumvoll M, Stampfer MJ, Shai I. Long-term green-Mediterranean diet may favor fasting morning cortisol stress hormone; the DIRECT-PLUS clinical trial. Front Endocrinol (Lausanne) 2023; 14:1243910. [PMID: 38034010 PMCID: PMC10682947 DOI: 10.3389/fendo.2023.1243910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 10/23/2023] [Indexed: 12/02/2023] Open
Abstract
Background Fasting morning cortisol (FMC) stress hormone levels, are suggested to reflect increased cardiometabolic risk. Acute response to weight loss diet could elevate FMC. Richer Polyphenols and lower carbohydrates diets could favor FMC levels. We aimed to explore the effect of long-term high polyphenol Mediterranean diet (green-MED) on FMC and its relation to metabolic health. Methods We randomized 294 participants into one of three dietary interventions for 18-months: healthy dietary guidelines (HDG), Mediterranean (MED) diet, and Green-MED diet. Both MED diets were similarly hypocaloric and lower in carbohydrates and included walnuts (28 g/day). The high-polyphenols/low-meat Green-MED group further included green tea (3-4 cups/day) and a Wolffia-globosa Mankai plant 1-cup green shakeFMC was obtained between 07:00-07:30AM at baseline, six, and eighteen-months. Results Participants (age=51.1years, 88% men) had a mean BMI of 31.3kg/m2, FMC=304.07nmol\L, and glycated-hemoglobin-A1c (HbA1c)=5.5%; 11% had type 2 diabetes and 38% were prediabetes. Baseline FMC was higher among men (308.6 ± 90.05nmol\L) than women (269.6± 83.9nmol\L;p=0.02). Higher baseline FMC was directly associated with age, dysglycemia, MRI-assessed visceral adiposity, fasting plasma glucose (FPG), high-sensitivity C-reactive-protein (hsCRP), testosterone, Progesterone and TSH levels (p ≤ 0.05 for all). The 18-month retention was 89%. After 6 months, there were no significant changes in FMC among all intervention groups. However, after 18-months, both MED groups significantly reduced FMC (MED=-1.6%[-21.45 nmol/L]; Green-MED=-1.8%[-26.67 nmol/L]; p<0.05 vs. baseline), as opposed to HDG dieters (+4%[-12 nmol/L], p=0.28 vs. baseline), whereas Green-MED diet FMC change was significant as compared to HDG diet group (p=0.048 multivariable models). Overall, 18-month decrease in FMC levels was associated with favorable changes in FPG, HbA1c, hsCRP, TSH, testosterone and MRI-assessed hepatosteatosis, and with unfavorable changes of HDLc (p<0.05 for all, weight loss adjusted, multivariable models). Conclusion Long-term adherence to MED diets, and mainly green-MED/high polyphenols diet, may lower FMC, stress hormone, levels,. Lifestyle-induced FMC decrease may have potential benefits related to cardiometabolic health, irrespective of weight loss. Clinical trial registration ClinicalTrials.gov, identifier NCT03020186.
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Affiliation(s)
- Liav Alufer
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Gal Tsaban
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Ehud Rinott
- Department of Medicine, Hebrew University and Hadassah Medical Center, Jerusalem, Israel
| | - Alon Kaplan
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Anat Yaskolka Meir
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Hila Zelicha
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Uta Ceglarek
- Department of Medicine, University of Leipzig, Leipzig, Germany
| | - Berend Isermann
- Department of Medicine, University of Leipzig, Leipzig, Germany
| | - Matthias Blüher
- Department of Medicine, University of Leipzig, Leipzig, Germany
- Helmholtz Institute for Metabolic, Obesity and Vascular Research (HI-MAG) of the Helmholtz Zentrum München at the University of Leipzig and University Hospital Leipzig, Leipzig, Germany
| | - Michael Stumvoll
- Department of Medicine, University of Leipzig, Leipzig, Germany
- Helmholtz Institute for Metabolic, Obesity and Vascular Research (HI-MAG) of the Helmholtz Zentrum München at the University of Leipzig and University Hospital Leipzig, Leipzig, Germany
| | - Meir J. Stampfer
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, United States
- Channing Division of Network Medicine, Department of Medicine, Harvard Medical School and Brigham and Women’s Hospital, Boston, MA, United States
| | - Iris Shai
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- Department of Medicine, University of Leipzig, Leipzig, Germany
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, United States
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Sapir O, Lopez-Jimenez F, Tsaban G. Habits and heartbeats: learning from historical longitudinal data on primary prevention of atrial fibrillation. Eur J Prev Cardiol 2023; 30:1789-1790. [PMID: 37697416 DOI: 10.1093/eurjpc/zwad298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 09/08/2023] [Indexed: 09/13/2023]
Affiliation(s)
- Orly Sapir
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First street SW, Rochester, MN 55905, USA
| | - Francisco Lopez-Jimenez
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First street SW, Rochester, MN 55905, USA
| | - Gal Tsaban
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First street SW, Rochester, MN 55905, USA
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Alnsasra H, Tsaban G, Weinstein JM, Nasasra M, Ovdat T, Beigel R, Orvin K, Haim M. Sex differences in ventricular arrhythmia, atrial fibrillation and atrioventricular block complicating acute myocardial infarction. Front Cardiovasc Med 2023; 10:1217525. [PMID: 37928761 PMCID: PMC10620835 DOI: 10.3389/fcvm.2023.1217525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 08/22/2023] [Indexed: 11/07/2023] Open
Abstract
Background Acute myocardial infarction (AMI) complicated by tachyarrhythmias or high-grade atrioventricular block (HAVB) may lead to increased mortality. Purpose To evaluate the sex differences in patients with AMI complicated by tachyarrhythmias and HAVB and their associated outcomes. Materials and methods We analyzed the incidence rates of arrhythmias following AMI from the Acute Coronary Syndrome Israeli Survey database from 2000 to 2018. We assessed the differences in arrhythmias incidence and the associated mortality risk between men and women. Results This cohort of 14,280 consecutive patients included 3,159 (22.1%) women and 11,121 (77.9%) men. Women were less likely to experience early ventricular tachyarrhythmia (VTA), (1.6% vs. 2.3%, p = 0.034), but had similar rates of late VTA (2.3% vs. 2.2%, p = 0.62). Women were more likely to experience atrial fibrillation (AF) (8.6% vs. 5.0%, p < 0.001) and HAVB (3.7% vs. 2.3%, p < 0.001). The risk of early VTAs was similar in men and women [adjusted Odds Ratio (aOR) = 0.76, p = 0.09], but women had a higher risk of AF (aOR = 1.27, p = 0.004) and HAVB (aOR = 1.30, p = 0.03). Early [adjusted hazard ratio (aHR) = 2.84, p < 0.001] and late VTA (aHR =- 4.59, p < 0.001), AF (aHR = 1.52, p < 0.001) and HAVB (aHR = 2.83, p < 0.001) were associated with increased 30-day mortality. Only late VTA (aHR = 2.14, p < 0.001) and AF (aHR = 1.44, p = 0.002) remained significant in the post 30 days period. Conclusions During AMI women experienced more AF and HAVB but fewer early VTAs than men. Early and late VTAs, AF, and HAVB were associated with increased 30-day mortality. Only late VTA and AF were associated with increased post-30-day mortality.
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Affiliation(s)
- Hilmi Alnsasra
- Department of Cardiology, Soroka University Medical Center, Beersheva, Israel
- Faculty of Health Sciences, Ben Gurion University of the Negev, Beersheva, Israel
| | - Gal Tsaban
- Department of Cardiology, Soroka University Medical Center, Beersheva, Israel
- Faculty of Health Sciences, Ben Gurion University of the Negev, Beersheva, Israel
| | - Jean Marc Weinstein
- Department of Cardiology, Soroka University Medical Center, Beersheva, Israel
- Faculty of Health Sciences, Ben Gurion University of the Negev, Beersheva, Israel
| | - Mhamad Nasasra
- Department of Cardiology, Soroka University Medical Center, Beersheva, Israel
- Faculty of Health Sciences, Ben Gurion University of the Negev, Beersheva, Israel
| | - Tal Ovdat
- Lev Leviev Heart and Vascular Center, Sheba Medical Center, Tel Hashomer, Israel
| | - Roy Beigel
- Lev Leviev Heart and Vascular Center, Sheba Medical Center, Tel Hashomer, Israel
| | - Katia Orvin
- Department of Cardiology, Rabin Medical Center, Petah Tikva, Israel
| | - Moti Haim
- Department of Cardiology, Soroka University Medical Center, Beersheva, Israel
- Faculty of Health Sciences, Ben Gurion University of the Negev, Beersheva, Israel
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11
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Peles I, Barrett O, Cafri C, Garcia-Garcia H, Tsaban G, El-Nasasra A, Abramowitz Y, Shmueli H, Rosenstein G, Merkin M, Zahger D, Koifman E. Predictors of Adverse Outcome in High-Risk Percutaneous Coronary Interventions Patients. Can J Cardiol 2023; 39:1369-1379. [PMID: 37127066 DOI: 10.1016/j.cjca.2023.04.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 04/10/2023] [Accepted: 04/14/2023] [Indexed: 05/03/2023] Open
Abstract
BACKGROUND Identifying high-risk percutaneous coronary intervention (PCI) patients is challenging. We aimed to evaluate which high-risk patients are prone to adverse events. METHODS We performed a retrospective study including consecutive high-risk PCIs from 2005 to 2018 in a large tertiary medical centre. Patients with unprotected left main (LM) disease, last patent coronary vessel, or 3-vessel coronary artery disease with left ventricular ejection fraction < 35% were included. A predictive 30-day major adverse cardiac events (MACE) score consisting of any myocardial infarction, all-cause death, or target-vessel revascularisation was constructed. RESULTS From 2005 to 2018, a total of 1890 patients who underwent PCI met the predefined high-risk PCI criteria. Mortality rate was 8.8% at 30 days and 20.7% at 1 year, and 30-day MACE rate was 14.2% and 33.5% at 1 year. Predictors of short-term MACE were New York Heart Association functional class (NYHA) 4 (hazard ratio [HR] 6.65; P < 0.001), systolic blood pressure (SBP) < 90 mm Hg (HR 4.93; P < 0.001), creatinine > 1.3 mg/dL (HR 3.57; P < 0.001), hemoglobin < 11.0 g/dL (HR 3.07; P < 0.001), pulmonary artery systolic pressure > 50 mm Hg (HR 2.06; P < 0.001), atrial fibrillation (HR 1.74; P < 0.001), and LM disease (HR 2.04; P < 0.001) or last patent vessel (HR 1.70; P = 0.002). A score constructed from these parameters reached a sensitivity of 90% and a specificity of 81% with areas under the receiver operating characteristic curve of 0.92 for MACE and 0.94 with 89% sensitivity and 87% specificity for all-cause mortality. CONCLUSIONS Specific features such as LM lesion or last patent conduit, pulmonary hypertension, atrial fibrillation, anemia, and renal failure, along with low SBP and NYHA 4, aid risk stratification and consideration of further treatment measures.
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Affiliation(s)
- Ido Peles
- Clinical Research Center, Soroka University Medical Center, Beer-Sheva, Israel; Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel; Joyce and Irving Goldman Medical School, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Orit Barrett
- Clinical Research Center, Soroka University Medical Center, Beer-Sheva, Israel; Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel; Department of Cardiology, Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Carlos Cafri
- Joyce and Irving Goldman Medical School, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel; Department of Cardiology, Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | | | - Gal Tsaban
- Joyce and Irving Goldman Medical School, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel; Department of Cardiology, Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Aref El-Nasasra
- Department of Cardiology, Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Yigal Abramowitz
- Joyce and Irving Goldman Medical School, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel; Department of Cardiology, Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Hezzy Shmueli
- Department of Cardiology, Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Gabriel Rosenstein
- Joyce and Irving Goldman Medical School, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel; Department of Cardiology, Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Miri Merkin
- Joyce and Irving Goldman Medical School, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel; Department of Cardiology, Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Doron Zahger
- Joyce and Irving Goldman Medical School, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel; Department of Cardiology, Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Edward Koifman
- Joyce and Irving Goldman Medical School, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel; Department of Cardiology, Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel; Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
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12
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Yaskolka Meir A, Keller M, Hoffmann A, Rinott E, Tsaban G, Kaplan A, Zelicha H, Hagemann T, Ceglarek U, Isermann B, Shelef I, Blüher M, Stumvoll M, Li J, Haange SB, Engelmann B, Rolle-Kampczyk U, von Bergen M, Hu FB, Stampfer MJ, Kovacs P, Liang L, Shai I. The effect of polyphenols on DNA methylation-assessed biological age attenuation: the DIRECT PLUS randomized controlled trial. BMC Med 2023; 21:364. [PMID: 37743489 PMCID: PMC10519069 DOI: 10.1186/s12916-023-03067-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 07/31/2023] [Indexed: 09/26/2023] Open
Abstract
BACKGROUND Epigenetic age is an estimator of biological age based on DNA methylation; its discrepancy from chronologic age warrants further investigation. We recently reported that greater polyphenol intake benefitted ectopic fats, brain function, and gut microbiota profile, corresponding with elevated urine polyphenols. The effect of polyphenol-rich dietary interventions on biological aging is yet to be determined. METHODS We calculated different biological aging epigenetic clocks of different generations (Horvath2013, Hannum2013, Li2018, Horvath skin and blood2018, PhenoAge2018, PCGrimAge2022), their corresponding age and intrinsic age accelerations, and DunedinPACE, all based on DNA methylation (Illumina EPIC array; pre-specified secondary outcome) for 256 participants with abdominal obesity or dyslipidemia, before and after the 18-month DIRECT PLUS randomized controlled trial. Three interventions were assigned: healthy dietary guidelines, a Mediterranean (MED) diet, and a polyphenol-rich, low-red/processed meat Green-MED diet. Both MED groups consumed 28 g walnuts/day (+ 440 mg/day polyphenols). The Green-MED group consumed green tea (3-4 cups/day) and Mankai (Wolffia globosa strain) 500-ml green shake (+ 800 mg/day polyphenols). Adherence to the Green-MED diet was assessed by questionnaire and urine polyphenols metabolomics (high-performance liquid chromatography quadrupole time of flight). RESULTS Baseline chronological age (51.3 ± 10.6 years) was significantly correlated with all methylation age (mAge) clocks with correlations ranging from 0.83 to 0.95; p < 2.2e - 16 for all. While all interventions did not differ in terms of changes between mAge clocks, greater Green-Med diet adherence was associated with a lower 18-month relative change (i.e., greater mAge attenuation) in Li and Hannum mAge (beta = - 0.41, p = 0.004 and beta = - 0.38, p = 0.03, respectively; multivariate models). Greater Li mAge attenuation (multivariate models adjusted for age, sex, baseline mAge, and weight loss) was mostly affected by higher intake of Mankai (beta = - 1.8; p = 0.061) and green tea (beta = - 1.57; p = 0.0016) and corresponded with elevated urine polyphenols: hydroxytyrosol, tyrosol, and urolithin C (p < 0.05 for all) and urolithin A (p = 0.08), highly common in green plants. Overall, participants undergoing either MED-style diet had ~ 8.9 months favorable difference between the observed and expected Li mAge at the end of the intervention (p = 0.02). CONCLUSIONS This study showed that MED and green-MED diets with increased polyphenols intake, such as green tea and Mankai, are inversely associated with biological aging. To the best of our knowledge, this is the first clinical trial to indicate a potential link between polyphenol intake, urine polyphenols, and biological aging. TRIAL REGISTRATION ClinicalTrials.gov, NCT03020186.
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Affiliation(s)
- Anat Yaskolka Meir
- The Health & Nutrition Innovative International Research Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, P.O. Box 653, 8410501, Be'er Sheva, Israel
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, 655 Huntington Avenue, Boston, MA, 02115, USA
| | - Maria Keller
- Helmholtz Institute for Metabolic, Obesity and Vascular Research (HI-MAG) of the Helmholtz Center Munich at the University of Leipzig and University Hospital Leipzig, 04103, Leipzig, Germany
- Medical Department III - Endocrinology, Nephrology, Rheumatology, University of Leipzig Medical Center, University of Leipzig, Liebigstrasse 21, 04103, Leipzig, Germany
| | - Anne Hoffmann
- Helmholtz Institute for Metabolic, Obesity and Vascular Research (HI-MAG) of the Helmholtz Center Munich at the University of Leipzig and University Hospital Leipzig, 04103, Leipzig, Germany
| | - Ehud Rinott
- The Health & Nutrition Innovative International Research Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, P.O. Box 653, 8410501, Be'er Sheva, Israel
| | - Gal Tsaban
- The Health & Nutrition Innovative International Research Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, P.O. Box 653, 8410501, Be'er Sheva, Israel
- Soroka University Medical Center, 84101, Be'er Sheva, Israel
| | - Alon Kaplan
- The Health & Nutrition Innovative International Research Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, P.O. Box 653, 8410501, Be'er Sheva, Israel
| | - Hila Zelicha
- The Health & Nutrition Innovative International Research Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, P.O. Box 653, 8410501, Be'er Sheva, Israel
| | - Tobias Hagemann
- Helmholtz Institute for Metabolic, Obesity and Vascular Research (HI-MAG) of the Helmholtz Center Munich at the University of Leipzig and University Hospital Leipzig, 04103, Leipzig, Germany
| | - Uta Ceglarek
- Institute of Laboratory Medicine, Clinical Chemistry, and Molecular Diagnostics, University of Leipzig Medical Center, 04103, Leipzig, Germany
| | - Berend Isermann
- Institute of Laboratory Medicine, Clinical Chemistry, and Molecular Diagnostics, University of Leipzig Medical Center, 04103, Leipzig, Germany
| | - Ilan Shelef
- Soroka University Medical Center, 84101, Be'er Sheva, Israel
| | - Matthias Blüher
- Helmholtz Institute for Metabolic, Obesity and Vascular Research (HI-MAG) of the Helmholtz Center Munich at the University of Leipzig and University Hospital Leipzig, 04103, Leipzig, Germany
- Medical Department III - Endocrinology, Nephrology, Rheumatology, University of Leipzig Medical Center, University of Leipzig, Liebigstrasse 21, 04103, Leipzig, Germany
| | - Michael Stumvoll
- Helmholtz Institute for Metabolic, Obesity and Vascular Research (HI-MAG) of the Helmholtz Center Munich at the University of Leipzig and University Hospital Leipzig, 04103, Leipzig, Germany
- Medical Department III - Endocrinology, Nephrology, Rheumatology, University of Leipzig Medical Center, University of Leipzig, Liebigstrasse 21, 04103, Leipzig, Germany
| | - Jun Li
- Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital and, Harvard Medical School, Boston, MA, 02115, USA
| | - Sven-Bastian Haange
- Department of Molecular Systems Biology, Helmholtz Centre for Environmental Research GmbH, 04318, Leipzig, Germany
| | - Beatrice Engelmann
- Department of Molecular Systems Biology, Helmholtz Centre for Environmental Research GmbH, 04318, Leipzig, Germany
| | - Ulrike Rolle-Kampczyk
- Department of Molecular Systems Biology, Helmholtz Centre for Environmental Research GmbH, 04318, Leipzig, Germany
| | - Martin von Bergen
- Department of Molecular Systems Biology, Helmholtz Centre for Environmental Research GmbH, 04318, Leipzig, Germany
- Institute of Biochemistry, Faculty of Life Sciences, University of Leipzig, 04103, Leipzig, Germany
| | - Frank B Hu
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, 655 Huntington Avenue, Boston, MA, 02115, USA
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, 02115, USA
| | - Meir J Stampfer
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, 02115, USA
| | - Peter Kovacs
- Medical Department III - Endocrinology, Nephrology, Rheumatology, University of Leipzig Medical Center, University of Leipzig, Liebigstrasse 21, 04103, Leipzig, Germany.
| | - Liming Liang
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, 655 Huntington Avenue, Boston, MA, 02115, USA.
| | - Iris Shai
- The Health & Nutrition Innovative International Research Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, P.O. Box 653, 8410501, Be'er Sheva, Israel.
- Helmholtz Institute for Metabolic, Obesity and Vascular Research (HI-MAG) of the Helmholtz Center Munich at the University of Leipzig and University Hospital Leipzig, 04103, Leipzig, Germany.
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA.
- Faculty of Medicine, Leipzig University, Leipzig, 04103, Germany.
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Alnsasra H, Tsaban G, Solomon A, Khalil F, Aboalhasan E, Azab AN, Azuri J, Hammerman A, Arbel R. Dapagliflozin versus empagliflozin in patients with chronic kidney disease. Front Pharmacol 2023; 14:1227199. [PMID: 37601066 PMCID: PMC10436293 DOI: 10.3389/fphar.2023.1227199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 07/24/2023] [Indexed: 08/22/2023] Open
Abstract
Background and Aim: Dapagliflozin and empagliflozin have demonstrated favorable clinical outcomes among patients with chronic kidney disease (CKD). However, their comparative monetary value for improving outcomes in CKD patients is unestablished. We examined the cost-per-outcome implications of utilizing dapagliflozin as compared to empagliflozin for prevention of renal and cardiovascular events in CKD patients. Methods: For calculation of preventable events we divided the allocated budget by the cost needed to treat (CNT) for preventing a single renal or cardiovascular event. CNT was derived by multiplying the annualized number needed to treat (aNNT) by the annual therapy cost. The aNNTs were determined based on data from the DAPA-CKD and EMPEROR-KIDNEY trials. The budget limit was defined based on the threshold recommended by the United States' Institute for Clinical and Economic Review. Results: The aNNT was 42 both dapagliflozin (95% confidence interval [CI]: 34-59) and empagliflozin (CI: 33-66). The CNT estimates for the prevention of one primary event for dapagliflozin and empagliflozin were comparable at $201,911 (CI: $163,452-$283,636) and $209,664 (CI: $164,736-$329,472), respectively. However, diabetic patients had a higher CNT with dapagliflozin ($201,911 [CI: $153,837-$346,133]) than empagliflozin ($134,784 [CI: $109,824-$214,656]), whereas non-diabetic patients had lower CNT for dapagliflozin ($197,103 [CI: $149,029-$346,133]) than empagliflozin ($394,368 [CI: $219,648-$7,093,632]). The CNT for preventing CKD progression was higher for dapagliflozin ($427,858 [CI: $307,673-$855,717]) than empagliflozin ($224,640 [CI: $169,728-$344,448]). For preventing cardiovascular death (CVD), the CNT was lower for dapagliflozin ($1,634,515 [CI: $740,339-∞]) than empagliflozin ($2,990,208 [CI: $1,193,088-∞]). Conclusion: Among patients with CKD, empagliflozin provides a better monetary value for preventing the composite renal and cardiovascular events in diabetic patients while dapagliflozin has a better value for non-diabetic patients. Dapagliflozin provides a better monetary value for the prevention of CVD, whereas empagliflozin has a better value for the prevention of CKD progression.
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Affiliation(s)
- Hilmi Alnsasra
- Department of Cardiology, Soroka University Medical Center, Beersheba, Israel
- Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheva, Israel
| | - Gal Tsaban
- Department of Cardiology, Soroka University Medical Center, Beersheba, Israel
- Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheva, Israel
| | - Adam Solomon
- Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheva, Israel
| | - Fouad Khalil
- Sanford School of Medicine, University of South Dakota, Vermillion, SD, United States
| | - Enis Aboalhasan
- Maximizing Health Outcomes Research Lab, Sapir College, Sderot, Israel
| | - Abed N. Azab
- Department of Cardiology, Soroka University Medical Center, Beersheba, Israel
- Department of Nursing, Department of Clinical Biochemistry and Pharmacology, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheva, Israel
| | - Joseph Azuri
- Diabetes Clinic, Maccabi Healthcare Services, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ariel Hammerman
- Department of Pharmaceutical Technology Assessment, Clalit Health Services Headquarters, Tel Aviv, Israel
| | - Ronen Arbel
- Maximizing Health Outcomes Research Lab, Sapir College, Sderot, Israel
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14
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Westreich R, Tsaban G, Neumann Y, Abu Salman A, Braver O, Braiman D, Zamed T, Neuhaus ZF, Deutsch O, Palmon A, Maimon N, Zahger D, Abramowitz Y. Development of saliva-based cardiac troponin I point-of-care test using alpha-amylase depletion: a feasibility study. Coron Artery Dis 2023; 34:351-355. [PMID: 37335230 DOI: 10.1097/mca.0000000000001257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/21/2023]
Abstract
INTRODUCTION Cardiac troponin (cTn) is the biomarker of choice for detection of myocardial injury. There is a great need for simple point-of-care (POC) troponin testing among patients with chest pain, mainly in the prehospital setting. The purpose of this study was to evaluate the presence of cardiac troponin I (cTnI) in saliva of patients with myocardial injury using alpha-amylase depletion technique. METHODS Saliva samples were collected from 40 patients with myocardial injury who were tested positive for conventional high-sensitivity cardiac troponin T (cTnT) blood tests, and from 66 healthy volunteers. Saliva samples were treated for the removal of salivary alpha-amylase. Treated and untreated samples were tested with blood cTnI Rapid Diagnostic Test. Salivary cTnI levels were compared to blood cTnT levels. RESULTS Thirty-six of 40 patients with positive blood cTnT had positive salivary samples for cTnI following alpha-amylase depletion treatment (90.00% sensitivity). Moreover, three of the four negative saliva samples were obtained from patients with relatively low blood cTnT levels of 100 ng/L or less (96.88% sensitivity for 100 ng/L and above). The negative predictive value was 93.65% and rose up to 98.33% considering the 100 ng/L cutoff. Positive predictive values were 83.72% and 81.58%, respectively. Among 66 healthy volunteers and 7 samples yielded positive results (89.39% specificity). CONCLUSION In this preliminary work, the presence of cTnI in saliva was demonstrated for the first time to be feasibly identified by a POC oriented assay. The specific salivary alpha-amylase depletion technique was shown to be crucial for the suggested assay.
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Affiliation(s)
- Roi Westreich
- Department of Cardiology, Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheva
| | - Gal Tsaban
- Department of Cardiology, Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheva
| | - Yoav Neumann
- Department of D&R, Faculty of Dental Medicine, Hebrew University, Jerusalem, Israel
| | - Amjad Abu Salman
- Department of Cardiology, Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheva
| | - Omri Braver
- Department of Cardiology, Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheva
| | - Dana Braiman
- Department of Cardiology, Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheva
| | - Tali Zamed
- Department of Cardiology, Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheva
| | - Zipora Feiga Neuhaus
- Department of Cardiology, Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheva
| | - Omer Deutsch
- Department of D&R, Faculty of Dental Medicine, Hebrew University, Jerusalem, Israel
| | - Aaron Palmon
- Department of D&R, Faculty of Dental Medicine, Hebrew University, Jerusalem, Israel
| | - Nimrod Maimon
- Department of Cardiology, Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheva
| | - Doron Zahger
- Department of Cardiology, Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheva
| | - Yigal Abramowitz
- Department of Cardiology, Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheva
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15
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Hoffmann A, Meir AY, Hagemann T, Czechowski P, Müller L, Engelmann B, Haange SB, Rolle-Kampczyk U, Tsaban G, Zelicha H, Rinott E, Kaplan A, Shelef I, Stumvoll M, Blüher M, Liang L, Ceglarek U, Isermann B, von Bergen M, Kovacs P, Keller M, Shai I. A polyphenol-rich green Mediterranean diet enhances epigenetic regulatory potential: the DIRECT PLUS randomized controlled trial. Metabolism 2023:155594. [PMID: 37236302 DOI: 10.1016/j.metabol.2023.155594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 05/16/2023] [Accepted: 05/18/2023] [Indexed: 05/28/2023]
Abstract
BACKGROUND The capacity of a polyphenol-enriched diet to modulate the epigenome in vivo is partly unknown. Given the beneficial metabolic effects of a Mediterranean (MED) diet enriched in polyphenols and reduced in red/processed meat (green-MED), as previously been proven by the 18-month DIRECT PLUS randomized controlled trial, we analyzed the effects of the green-MED diet on methylome and transcriptome levels to highlight molecular mechanisms underlying the observed metabolic improvements. METHODS Our study included 260 participants (baseline BMI = 31.2 kg/m2, age = 5 years) of the DIRECT PLUS trial, initially randomized to one of the intervention arms: A. healthy dietary guidelines (HDG), B. MED (440 mg polyphenols additionally provided by walnuts), C. green-MED (1240 mg polyphenols additionally provided by walnuts, green tea, and Mankai: green duckweed shake). Blood methylome and transcriptome of all study subjects were analyzed at baseline and after completing the 18-month intervention using Illumina EPIC and RNA sequencing technologies. RESULTS A total of 1573 differentially methylated regions (DMRs; false discovery rate (FDR) < 5 %) were found in the green-MED compared to the MED (177) and HDG (377) diet participants. This corresponded to 1753 differentially expressed genes (DEGs; FDR < 5 %) in the green-MED intervention compared to MED (7) and HDG (738). Consistently, the highest number (6 %) of epigenetic modulating genes was transcriptionally changed in subjects participating in the green-MED intervention. Weighted cluster network analysis relating transcriptional and phenotype changes among participants subjected to the green-MED intervention identified candidate genes associated with serum-folic acid change (all P < 1 × 10-3) and highlighted one module including the KIR3DS1 locus, being negatively associated with the polyphenol changes (e.g. P < 1 × 10-4), but positively associated with the MRI-assessed superficial subcutaneous adipose area-, weight- and waist circumference- 18-month change (all P < 0.05). Among others, this module included the DMR gene Cystathionine Beta-Synthase, playing a major role in homocysteine reduction. CONCLUSIONS The green-MED high polyphenol diet, rich in green tea and Mankai, renders a high capacity to regulate an individual's epigenome. Our findings suggest epigenetic key drivers such as folate and green diet marker to mediate this capacity and indicate a direct effect of dietary polyphenols on the one‑carbon metabolism.
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Affiliation(s)
- Anne Hoffmann
- Helmholtz Institute for Metabolic, Obesity and Vascular Research (HI-MAG) of the Helmholtz Center Munich at the University of Leipzig and University Hospital Leipzig, Leipzig 04103, Germany
| | - Anat Yaskolka Meir
- The Health & Nutrition Innovative International Research Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, 84101 Beer-Sheva, Israel; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
| | - Tobias Hagemann
- Helmholtz Institute for Metabolic, Obesity and Vascular Research (HI-MAG) of the Helmholtz Center Munich at the University of Leipzig and University Hospital Leipzig, Leipzig 04103, Germany
| | - Paul Czechowski
- Helmholtz Institute for Metabolic, Obesity and Vascular Research (HI-MAG) of the Helmholtz Center Munich at the University of Leipzig and University Hospital Leipzig, Leipzig 04103, Germany
| | - Luise Müller
- Medical Department III - Endocrinology, Nephrology, Rheumatology, University of Leipzig Medical Center, Leipzig 04103, Germany
| | - Beatrice Engelmann
- Department of Molecular Systems Biology, Helmholtz Centre for Environmental Research - UFZ, 04318 Leipzig, Germany
| | - Sven-Bastiaan Haange
- Department of Molecular Systems Biology, Helmholtz Centre for Environmental Research - UFZ, 04318 Leipzig, Germany
| | - Ulrike Rolle-Kampczyk
- Department of Molecular Systems Biology, Helmholtz Centre for Environmental Research - UFZ, 04318 Leipzig, Germany
| | - Gal Tsaban
- The Health & Nutrition Innovative International Research Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, 84101 Beer-Sheva, Israel; Soroka University Medical Center, 84101 Beer-Sheva, Israel
| | - Hila Zelicha
- The Health & Nutrition Innovative International Research Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, 84101 Beer-Sheva, Israel
| | - Ehud Rinott
- The Health & Nutrition Innovative International Research Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, 84101 Beer-Sheva, Israel
| | - Alon Kaplan
- The Health & Nutrition Innovative International Research Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, 84101 Beer-Sheva, Israel
| | - Ilan Shelef
- Soroka University Medical Center, 84101 Beer-Sheva, Israel
| | - Michael Stumvoll
- Helmholtz Institute for Metabolic, Obesity and Vascular Research (HI-MAG) of the Helmholtz Center Munich at the University of Leipzig and University Hospital Leipzig, Leipzig 04103, Germany; Medical Department III - Endocrinology, Nephrology, Rheumatology, University of Leipzig Medical Center, Leipzig 04103, Germany; Deutsches Zentrum für Diabetesforschung e.V., 85764 Neuherberg, Germany
| | - Matthias Blüher
- Helmholtz Institute for Metabolic, Obesity and Vascular Research (HI-MAG) of the Helmholtz Center Munich at the University of Leipzig and University Hospital Leipzig, Leipzig 04103, Germany; Medical Department III - Endocrinology, Nephrology, Rheumatology, University of Leipzig Medical Center, Leipzig 04103, Germany
| | - Liming Liang
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
| | - Uta Ceglarek
- Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, Universitätsklinikum Leipzig, Leipzig University, 04103 Leipzig, Germany
| | - Berend Isermann
- Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, Universitätsklinikum Leipzig, Leipzig University, 04103 Leipzig, Germany
| | - Martin von Bergen
- Department of Molecular Systems Biology, Helmholtz Centre for Environmental Research - UFZ, 04318 Leipzig, Germany; Institute of Biochemistry, Faculty of Life Sciences, University of Leipzig, 04103 Leipzig, Germany
| | - Peter Kovacs
- Medical Department III - Endocrinology, Nephrology, Rheumatology, University of Leipzig Medical Center, Leipzig 04103, Germany
| | - Maria Keller
- Helmholtz Institute for Metabolic, Obesity and Vascular Research (HI-MAG) of the Helmholtz Center Munich at the University of Leipzig and University Hospital Leipzig, Leipzig 04103, Germany; Medical Department III - Endocrinology, Nephrology, Rheumatology, University of Leipzig Medical Center, Leipzig 04103, Germany.
| | - Iris Shai
- The Health & Nutrition Innovative International Research Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, 84101 Beer-Sheva, Israel; Medical Department III - Endocrinology, Nephrology, Rheumatology, University of Leipzig Medical Center, Leipzig 04103, Germany; Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA.
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16
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Tsaban G, Shalev A, Katz A, Yaskolka Meir A, Rinott E, Zelicha H, Kaplan A, Wolak A, Bluher M, Stampfer MJ, Shai I. Effect of Lifestyle Modification and Green Mediterranean Diet on Proximal Aortic Stiffness. J Am Coll Cardiol 2023; 81:1659-1661. [PMID: 37076220 DOI: 10.1016/j.jacc.2023.02.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 01/25/2023] [Accepted: 02/21/2023] [Indexed: 04/21/2023]
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17
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Alnsasra H, Tsaban G, Solomon A, Khalil F, Aboalhasan E, Weinstein JM, Azuri J, Hammerman A, Arbel R. Effect of Dapagliflozin Versus Empagliflozin on Cardiovascular Death in Patients with Heart Failure Across the Spectrum of Ejection Fraction: Cost per Outcome Analysis. Am J Cardiovasc Drugs 2023; 23:323-328. [PMID: 37067768 DOI: 10.1007/s40256-023-00578-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/13/2023] [Indexed: 04/18/2023]
Abstract
BACKGROUND Dapagliflozin and empagliflozin have shown clinical benefits in patients with heart failure (HF). Their comparative monetary value remains undetermined, and we therefore sought to compare the cost-per-outcome implications of utilizing dapagliflozin versus empagliflozin to prevent cardiovascular death (CVD) in patients with HF across the spectrum of ejection fraction. METHODS We estimated the cost needed to treat (CNT) to prevent one CVD with either dapagliflozin or empagliflozin. CNT was estimated by multiplying the annualized number needed to treat (aNNT) by the annual cost of therapy. The aNNTs were calculated based on data from the DAPA-HF and DELIVER trials for dapagliflozin, and the EMPEROR-Reduced and EMPEROR-Preserved trials for empagliflozin. Drug costs were calculated as 75% of the 2022 US National Average Drug Acquisition Cost. RESULTS The aNNT to prevent one event of CVD was 110 (95% confidence interval [CI] 58-∞) for dapagliflozin in a pooled analysis of DAPA-HF and DELIVER versus 204 (95% CI 71-∞) for empagliflozin in a pooled analysis of the EMPEROR-Reduced and EMPEROR-Preserved trials. The annual costs of therapy were $4807 and $4992, respectively. The corresponding CNTs were $528,770 (95% CI $278,806-∞) for dapagliflozin and $1,018,368 (95% CI $354,432-∞) for empagliflozin. This remained consistent in Europe, using the price estimates in Germany, with CNT (€77,490 for dapagliflozin and €143,708 for empagliflozin). CONCLUSION In incorporating data from all four outcomes trials of sodium-glucose cotransporter 2 inhibitors, dapagliflozin provides better monetary value for preventing CVD events in patients with HF across the spectrum of ejection fraction.
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Affiliation(s)
- Hilmi Alnsasra
- Department of Cardiology, Soroka University Medical Center, Rager Av., POB 84101, Beersheva, Israel.
- Faculty of Health Sciences, Ben Gurion University of the Negev, Beersheva, Israel.
| | - Gal Tsaban
- Department of Cardiology, Soroka University Medical Center, Rager Av., POB 84101, Beersheva, Israel
- Faculty of Health Sciences, Ben Gurion University of the Negev, Beersheva, Israel
| | - Adam Solomon
- Faculty of Health Sciences, Ben Gurion University of the Negev, Beersheva, Israel
| | - Fouad Khalil
- Sanford School of Medicine, University of South Dakota, Vermillion, SD, USA
| | - Enis Aboalhasan
- Maximizing Health Outcomes Research Lab, Sapir College, Sderot, Israel
| | - Jean Marc Weinstein
- Department of Cardiology, Soroka University Medical Center, Rager Av., POB 84101, Beersheva, Israel
- Faculty of Health Sciences, Ben Gurion University of the Negev, Beersheva, Israel
| | - Joseph Azuri
- Diabetes Clinic, Central District, Maccabi Healthcare Services, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ariel Hammerman
- Department of Pharmaceutical Technology Assessment, Clalit Health Services Headquarters, Tel-Aviv, Israel
| | - Ronen Arbel
- Maximizing Health Outcomes Research Lab, Sapir College, Sderot, Israel
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18
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Levakov G, Kaplan A, Yaskolka Meir A, Rinott E, Tsaban G, Zelicha H, Blüher M, Ceglarek U, Stumvoll M, Shelef I, Avidan G, Shai I. The effect of weight loss following 18 months of lifestyle intervention on brain age assessed with resting-state functional connectivity. eLife 2023; 12:e83604. [PMID: 37022140 PMCID: PMC10174688 DOI: 10.7554/elife.83604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 03/31/2023] [Indexed: 04/07/2023] Open
Abstract
Background Obesity negatively impacts multiple bodily systems, including the central nervous system. Retrospective studies that estimated chronological age from neuroimaging have found accelerated brain aging in obesity, but it is unclear how this estimation would be affected by weight loss following a lifestyle intervention. Methods In a sub-study of 102 participants of the Dietary Intervention Randomized Controlled Trial Polyphenols Unprocessed Study (DIRECT-PLUS) trial, we tested the effect of weight loss following 18 months of lifestyle intervention on predicted brain age based on magnetic resonance imaging (MRI)-assessed resting-state functional connectivity (RSFC). We further examined how dynamics in multiple health factors, including anthropometric measurements, blood biomarkers, and fat deposition, can account for changes in brain age. Results To establish our method, we first demonstrated that our model could successfully predict chronological age from RSFC in three cohorts (n=291;358;102). We then found that among the DIRECT-PLUS participants, 1% of body weight loss resulted in an 8.9 months' attenuation of brain age. Attenuation of brain age was significantly associated with improved liver biomarkers, decreased liver fat, and visceral and deep subcutaneous adipose tissues after 18 months of intervention. Finally, we showed that lower consumption of processed food, sweets and beverages were associated with attenuated brain age. Conclusions Successful weight loss following lifestyle intervention might have a beneficial effect on the trajectory of brain aging. Funding The German Research Foundation (DFG), German Research Foundation - project number 209933838 - SFB 1052; B11, Israel Ministry of Health grant 87472511 (to I Shai); Israel Ministry of Science and Technology grant 3-13604 (to I Shai); and the California Walnuts Commission 09933838 SFB 105 (to I Shai).
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Affiliation(s)
- Gidon Levakov
- Department of Brain and Cognitive Sciences, Ben-Gurion University of the NegevBeer ShevaIsrael
| | - Alon Kaplan
- The Health & Nutrition Innovative International Research Center, Faculty of Health Sciences, Ben-Gurion University of the NegevBeer ShevaIsrael
- Department of Internal Medicine D, Chaim Sheba Medical CenterRamat-GanIsrael
| | - Anat Yaskolka Meir
- The Health & Nutrition Innovative International Research Center, Faculty of Health Sciences, Ben-Gurion University of the NegevBeer ShevaIsrael
| | - Ehud Rinott
- The Health & Nutrition Innovative International Research Center, Faculty of Health Sciences, Ben-Gurion University of the NegevBeer ShevaIsrael
| | - Gal Tsaban
- The Health & Nutrition Innovative International Research Center, Faculty of Health Sciences, Ben-Gurion University of the NegevBeer ShevaIsrael
| | - Hila Zelicha
- The Health & Nutrition Innovative International Research Center, Faculty of Health Sciences, Ben-Gurion University of the NegevBeer ShevaIsrael
| | | | - Uta Ceglarek
- Department of Medicine, University of LeipzigLeipzigGermany
| | | | - Ilan Shelef
- Department of Diagnostic Imaging, Soroka Medical CenterBeer ShevaIsrael
| | - Galia Avidan
- Department of Psychology, Ben-Gurion University of the NegevBeer ShevaIsrael
| | - Iris Shai
- The Health & Nutrition Innovative International Research Center, Faculty of Health Sciences, Ben-Gurion University of the NegevBeer ShevaIsrael
- Department of Medicine, University of LeipzigLeipzigGermany
- Department of Nutrition, Harvard T.H. Chan School of Public HealthBostonUnited States
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19
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Ofir N, Mizrakli Y, Greenshpan Y, Gepner Y, Sharabi O, Tsaban G, Zelicha H, Yaskolka Meir A, Ceglarek U, Stumvoll M, Blüher M, Chassidim Y, Rudich A, Reiner-Benaim A, Shai I, Shelef I, Gazit R. Vertebrae but not femur marrow fat transiently decreases in response to body weight loss in an 18-month randomized control trial. Bone 2023; 171:116727. [PMID: 36898571 DOI: 10.1016/j.bone.2023.116727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 02/06/2023] [Accepted: 03/05/2023] [Indexed: 03/11/2023]
Abstract
BACKGROUND Increased levels of bone marrow adipose tissue (BMAT) are negatively associated with skeletal health and hematopoiesis. BMAT is known to increase with age; however, the effect of long-term weight loss on BMAT is still unknown. OBJECTIVE In this study, we examined BMAT response to lifestyle-induced weight loss in 138 participants (mean age 48 y; mean body mass index 31 kg/m2), who participated in the CENTRAL-MRI trial. METHODS Participants were randomized for dietary intervention of low-fat or low-carb, with or without physical activity. Magnetic resonance imaging (MRI) was used to quantify BMAT and other fat depots at baseline, six and eighteen months of intervention. Blood biomarkers were also measured at the same time points. RESULTS At baseline, the L3 vertebrae BMAT is positively associated with age, HDL cholesterol, HbA1c and adiponectin; but not with other fat depots or other metabolic markers tested. Following six months of dietary intervention, the L3 BMAT declined by an average of 3.1 %, followed by a return to baseline after eighteen months (p < 0.001 and p = 0.189 compared to baseline, respectively). The decrease of BMAT during the first six months was associated with a decrease in waist circumference, cholesterol, proximal-femur BMAT, and superficial subcutaneous adipose tissue (SAT), as well as with younger age. Nevertheless, BMAT changes did not correlate with changes in other fat depots. CONCLUSIONS We conclude that physiological weight loss can transiently reduce BMAT in adults, and this effect is more prominent in younger adults. Our findings suggest that BMAT storage and dynamics are largely independent of other fat depots or cardio-metabolic risk markers, highlighting its unique functions.
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Affiliation(s)
- Noa Ofir
- The Shraga Segal Department for Microbiology Immunology and Genetics, Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er Sheva, Israel; National Institute for Biotechnology in the Negev, Ben-Gurion University of the Negev, Be'er Sheva, Israel; Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er-Sheva, Israel
| | - Yuval Mizrakli
- The Shraga Segal Department for Microbiology Immunology and Genetics, Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er Sheva, Israel; National Institute for Biotechnology in the Negev, Ben-Gurion University of the Negev, Be'er Sheva, Israel
| | - Yariv Greenshpan
- The Shraga Segal Department for Microbiology Immunology and Genetics, Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er Sheva, Israel; National Institute for Biotechnology in the Negev, Ben-Gurion University of the Negev, Be'er Sheva, Israel; Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er-Sheva, Israel
| | - Yftach Gepner
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er-Sheva, Israel; Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Sylvan Adams Sports Institute, Tel-Aviv University, Tel-Aviv, Israel
| | - Omri Sharabi
- The Shraga Segal Department for Microbiology Immunology and Genetics, Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er Sheva, Israel; National Institute for Biotechnology in the Negev, Ben-Gurion University of the Negev, Be'er Sheva, Israel; Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er-Sheva, Israel
| | - Gal Tsaban
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er-Sheva, Israel
| | - Hila Zelicha
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er-Sheva, Israel
| | - Anat Yaskolka Meir
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er-Sheva, Israel
| | - Uta Ceglarek
- Institute of Laboratory Medicine, University of Leipzig Medical Center, Germany
| | | | | | | | - Assaf Rudich
- National Institute for Biotechnology in the Negev, Ben-Gurion University of the Negev, Be'er Sheva, Israel; Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er-Sheva, Israel
| | - Anat Reiner-Benaim
- Department of Epidemiology, Biostatistics and Community Health Sciences, School of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er Sheva, Israel
| | - Iris Shai
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er-Sheva, Israel
| | - Ilan Shelef
- Soroka University Medical Center, Beer-Sheva, Israel
| | - Roi Gazit
- The Shraga Segal Department for Microbiology Immunology and Genetics, Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er Sheva, Israel; National Institute for Biotechnology in the Negev, Ben-Gurion University of the Negev, Be'er Sheva, Israel; Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er-Sheva, Israel.
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20
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Wizman B, Haim M, Peles I, Westreich R, Abu-Salman A, Tsaban G, Yasoor N, Barrett O, Konstantino Y. Clinical Outcomes of Patients with COVID-19 Infection and Cardiac Implantable Electronic Devices. Isr Med Assoc J 2023; 25:177-181. [PMID: 36946660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
BACKGROUND Existing cardiac disease contributes to poor outcome in patients with coronavirus disease 2019 (COVID-19). Little information exists regarding COVID-19 infection in patients with a cardiac implantable electronic device (CIED). OBJECTIVES To assess the association between CIEDs and severity of COVID-19 infection. METHODS We performed a retrospective analysis including 13,000 patients > 18 years old with COVID-19 infection between January and December 2020. Patients with COVID-19 who had a permanent pacemaker or defibrillator were matched 1:4 based on age and sex followed by univariate and multivariate analyses. Baseline characteristics and clinical outcomes were assessed. RESULTS Forty patients with CIED and 160 patients without CIED were included in the current analysis. Mean age was 72.6 ± 13 years, and approximately 50% were females. Majority of the patients in the study arm had a pacemaker (63%), whereas only 15 patients (37%) had a defibrillator. Patients with COVID-19 and CIED presented more often with atrial fibrillation, coronary artery disease, heart failure, hypertension, diabetes, and chronic kidney disease. They were more likely to be hospitalized in the intensive care unit (ICU) and required more ventilatory support (35% vs. 18.3%). Thirty-day mortality (22.5% vs. 13.8%) and 1-year mortality (25% vs. 15%) were higher among patients with COVID-19 and CIED. CONCLUSIONS Patients with COVID-19 and CIED had a significantly higher prevalence of co-morbidities that were associated with increased mortality. Although, CIED by itself was not found as an independent risk factor for morbidity and mortality, it may serve as a warning for severe illness with COVID-19.
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21
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Shamia D, Abramowitz Y, Tsaban G. Global and regional cardiovascular risk and mortality: a right, but a long way to go. Eur J Prev Cardiol 2023; 30:274-275. [PMID: 36573754 DOI: 10.1093/eurjpc/zwac313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- David Shamia
- Division of Cardiology, Soroka University Medical Center, Yitzhack I. Rager Blvd 151, PO Box 84101, Beersheva, Israel
| | - Yigal Abramowitz
- Division of Cardiology, Soroka University Medical Center, Yitzhack I. Rager Blvd 151, PO Box 84101, Beersheva, Israel
| | - Gal Tsaban
- Division of Cardiology, Soroka University Medical Center, Yitzhack I. Rager Blvd 151, PO Box 84101, Beersheva, Israel
- Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Ben-Gurion Blvd. 1, 8484105, Beersheva, Israel
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22
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Gohar E, Herling A, Mazuz M, Tsaban G, Gat T, Kobal S, Fuchs L. Artificial Intelligence (AI) versus POCUS Expert: A Validation Study of Three Automatic AI-Based, Real-Time, Hemodynamic Echocardiographic Assessment Tools. J Clin Med 2023; 12:jcm12041352. [PMID: 36835888 PMCID: PMC9959768 DOI: 10.3390/jcm12041352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 01/23/2023] [Accepted: 02/03/2023] [Indexed: 02/10/2023] Open
Abstract
BACKGROUND Point Of Care Ultra-Sound (POCUS) is an operator dependent modality. POCUS examinations usually include 'Eyeballing' the inspected anatomical structure without conducting accurate measurements due to complexity and insufficient time. Automatic real time measuring tools can make accurate measurements fast and simple and dramatically increase examination reliability while saving the operator much time and effort. In this study we aim to assess three automatic tools which are integrated into the Venue™ device by GE: the automatic ejection fraction, velocity time integral, and inferior vena cava tools in comparison to the gold standard-an examination by a POCUS expert. METHODS A separate study was conducted for each of the three automatic tools. In each study, cardiac views were acquired by a POCUS expert. Relevant measurements were taken by both an auto tool and a POCUS expert who was blinded to the auto tool's measurement. The agreement between the POCUS expert and the auto tool was measured for both the measurements and the image quality using a Cohen's Kappa test. RESULTS All three tools have shown good agreement with the POCUS expert for high quality views: auto LVEF (0.498; p < 0.001), auto IVC (0.536; p = 0.009), and the auto VTI (0.655; p = 0.024). Auto VTI has also shown a good agreement for medium quality clips (0.914; p < 0.001). Image quality agreement was significant for the auto EF and auto IVC tools. CONCLUSIONS The Venue™ show a high agreement with a POCUS expert for high quality views. This shows that auto tools can provide reliable real time assistance in performing accurate measurements, but do not reduce the need of a good image acquisition technique.
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Affiliation(s)
- Eyal Gohar
- Ben-Gurion University of the Negev, Beer Sheva 8410501, Israel
| | - Amit Herling
- Ben-Gurion University of the Negev, Beer Sheva 8410501, Israel
| | - Mor Mazuz
- Ben-Gurion University of the Negev, Beer Sheva 8410501, Israel
| | - Gal Tsaban
- Soroka Medical Center, Beer Sheva 84101, Israel
| | - Tomer Gat
- Soroka Medical Center, Beer Sheva 84101, Israel
- Correspondence:
| | | | - Lior Fuchs
- Soroka Medical Center, Beer Sheva 84101, Israel
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23
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Tsaban G, Zahger D, Abramowitz Y. Editorial Commentary: The COURAGE to face ISCHEMIA: Applying data from randomized studies to real-life. Trends Cardiovasc Med 2023; 33:131-132. [PMID: 34801663 DOI: 10.1016/j.tcm.2021.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 11/13/2021] [Indexed: 02/07/2023]
Affiliation(s)
- Gal Tsaban
- Department of Cardiology, Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheva, Israel
| | - Doron Zahger
- Department of Cardiology, Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheva, Israel
| | - Yigal Abramowitz
- Department of Cardiology, Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheva, Israel.
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24
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Tsaban G, Peles I, Barrett O, Abramowitz Y, Shmueli H, Alnsasra H, Cafri C, Zahger D, Koifman E. Nonobstructive coronary atherosclerosis is associated with adverse prognosis among patients diagnosed with myocardial infarction without obstructive coronary arteries. Atherosclerosis 2023; 366:8-13. [PMID: 36652749 DOI: 10.1016/j.atherosclerosis.2023.01.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 12/10/2022] [Accepted: 01/11/2023] [Indexed: 01/14/2023]
Abstract
BACKGROUND AND AIMS The prognostic impact of nonobstructive coronary artery disease (CAD), as opposed to normal coronary arteries, on long-term outcomes of patients with myocardial infarction with no obstructive coronary arteries (MINOCA) is unclear. We aimed to address the association between nonobstructive-CAD and major adverse events (MAE) following MINOCA. METHODS We conducted a retrospective cohort study of consecutive MINOCA patients admitted to a large referral medical center between 2005 and 2018. Patients were classified according to coronary angiography as having either normal-coronaries or nonobstructive-CAD. The primary outcome was MAE, defined as the composite of all-cause mortality and recurrent acute coronary syndrome (ACS). RESULTS Of the 1544 MINOCA patients, 651 (42%) had normal coronaries, and 893 (58%) had CAD. The mean age was 61.2 ± 12.6 years, and 710 (46%) were females. Nonobstructive-CAD patients were older and less likely to be females, with higher rates of diabetes, hypertension, dyslipidemia, atrial fibrillation, and chronic renal-failure (p < 0.05). At a median follow-up of 7 years, MAE occurred in 203 (23%) patients and 67 (10%) patients in the nonobstructive-CAD and normal-coronaries groups, respectively (p < 0.01). In multivariable models, nonobstructive -CAD was significantly associated with long-term MAE [adjusted-hazard-ratio (aHR):1.67, 95% confidence-interval (95%CI):1.25-2.23; p < 0.001]. Other factors associated with a higher MAE-risk were older-age (aHR:1.05,95%CI:1.03-1.06; p < 0.001) and left ventricular ejection-fraction<40% (aHR:3.04,95%CI:2.03-4.57; p < 0.001), while female-sex (aHR:0.72, 95%CI: 0.56-0.94; p=0.014) and sinus rhythm at presentation (aHR:0.66, 95%CI: 0.44-0.98; p=0.041) were associated with lower MAE-risk. CONCLUSIONS In MINOCA, nonobstructive-CAD is independently associated with a higher MAE-risk than normal-coronaries. This finding may promote risk-stratification of patients with nonobstructive-CAD-MINOCA who require tighter medical follow-up and treatment optimization.
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Affiliation(s)
- Gal Tsaban
- Faculty of Health Sciences, Ben Gurion University of the Negev, Beersheba, Israel; Department of Cardiology, Soroka University Medical Center, Beersheba, Israel.
| | - Ido Peles
- Faculty of Health Sciences, Ben Gurion University of the Negev, Beersheba, Israel; Clinical Research Center, Soroka University Medical Center, Beersheba, Israel
| | - Orit Barrett
- Department of Cardiology, Soroka University Medical Center, Beersheba, Israel; Clinical Research Center, Soroka University Medical Center, Beersheba, Israel
| | - Yigal Abramowitz
- Faculty of Health Sciences, Ben Gurion University of the Negev, Beersheba, Israel; Department of Cardiology, Soroka University Medical Center, Beersheba, Israel
| | - Hezzy Shmueli
- Faculty of Health Sciences, Ben Gurion University of the Negev, Beersheba, Israel; Department of Cardiology, Soroka University Medical Center, Beersheba, Israel
| | - Hilmi Alnsasra
- Faculty of Health Sciences, Ben Gurion University of the Negev, Beersheba, Israel; Department of Cardiology, Soroka University Medical Center, Beersheba, Israel
| | - Carlos Cafri
- Faculty of Health Sciences, Ben Gurion University of the Negev, Beersheba, Israel; Department of Cardiology, Soroka University Medical Center, Beersheba, Israel
| | - Doron Zahger
- Faculty of Health Sciences, Ben Gurion University of the Negev, Beersheba, Israel; Department of Cardiology, Soroka University Medical Center, Beersheba, Israel
| | - Edward Koifman
- Department of Cardiology, Meir Medical Center, Kfar Saba, Israel
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25
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Gabay O, Cherki T, Tsaban G, Bichovsky Y, Nesher L. The Safety and Impact of Raising the Urine Culture Reporting Threshold in Hospitalized Patients. J Clin Med 2022; 11:jcm11237014. [PMID: 36498590 PMCID: PMC9740109 DOI: 10.3390/jcm11237014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 11/21/2022] [Accepted: 11/25/2022] [Indexed: 11/29/2022] Open
Abstract
Objective: To assess the impact of changing the reporting threshold policy of positive urine cultures in hospitalized non-pregnant adults from 104 CFU/mL to 105 CFU/mL on the unwarranted use of antibiotics and patient safety. Setting: A 1100-bed tertiary-care hospital in southern Israel. Methods: As an intervention, we changed urine culture reporting policy for patients admitted to general medical wards. If culture grew ≥105 CFU/mL, it was reported with pathogen and antibiotic susceptibility data, if it grew ≤104 CFU/mL, it was reported as "low growth". The withheld information was available upon request. We retrospectively collected data on all patients in a four-month period following the intervention and report using STROBE guidelines. Results: 7808 patients were admitted, in whom 3523 urine cultures were obtained. A total of 496 grew a pathogen, 51 were excluded (candida spp. positive, history of urinary surgery, obtained from catheter). A total of 300 were reported as positive and 145 were reported as low-growth. A higher rate of patients in the low-growth group were not treated with antibiotics 45/145(31%) vs. 56/300(18.7%) in the positive group p = 0.015 and the antibiotic duration of treatment was shorter by day 5 (IQR 0.9) vs. 6 (IQR 0.9) p = 0.015. No between-group difference was observed in recurrent admission rates, pyelonephritis within 30 days, bacteremia or all-cause mortality. Conclusions: Changing the reporting threshold of positive urine culture results from 104 CFU/mL to 105 CFU/mL in hospitalized patients reduced the number of patients who were unnecessarily treated for asymptomatic bacteriuria without negatively impacting patient safety. We urge microbiological laboratories to consider this change in threshold as part of an antimicrobial stewardship program.
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26
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Tsaban G, Gordon M, Omari Y, Kezerle L, Alnsasra H, Buturlin K, Bareza S, Wagshal A, Novack V, Konstantino Y, Haim M. Chronic amiodarone therapy and mortality among atrial fibrillation patients; insights from a real-life contemporary population. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Although associated with potentially serious side effects, amiodarone is the most effective pharmacotherapy to achieve rhythm control among patients with atrial fibrillation (AF). Recent clinical trials advocate early rhythm control in AF. The effect of amiodarone treatment on mortality among patients with AF in real-life remains largely debatable. The primary aim of this analysis was to compare all-cause mortality rates across amiodarone treatment status
Methods
This is a retrospective study among patients from the Southern district of Clalit Health Services in Israel between January 1st, 1999 and July 1st, 2021 including all prevalent atrial fibrillation cases, hospitalized with AF as a primary diagnosis. Patients treated with amiodarone were matched in a 1:1 manner with controls not exposed to amiodarone based on age, sex, living area, and atrial fibrillation diagnosis duration. To avoid immortal time bias, follow-up times of the matched controls were left adjudicated to truncate the amiodarone-free period of their matched cases. We performed survival analyses using multivariable Cox regression controlling for potential confounders.
Results
During the study period, 7,048 patients who initiated amiodarone treatment were identified, of whom 6,449 were matched with controls. The mean age was 71.5 years, and 46.4% were women among the matched population. At baseline, the amiodarone-treatment group had higher rates of diabetes (38.3% vs. 32.6%, chronic renal failure (17.2% vs. 10.8%), coronary heart disease (31.6% vs. 19.6%) peripheral vascular disease (13.1% vs. 9.8%), and congestive heart failure (33.8% vs. 20.7%; p<0.001 for all). The amiodarone-treatment group had higher rates of oral-anticoagulant therapy (82.0% vs. 59.4%, p<0.001). During a mean follow-up time of 5.7 years, 2849 (44.2%) patients died in the amiodarone group and 3072 (47.6%) patients in the control group [adjusted-hazard-ratio: 0.85 (confidence-interval 95%: 0.80,0.91), p<0.001].
Conclusion
In a large contemporary real-life population with AF, amiodarone treatment was associated with a lower risk for death, despite a higher burden of comorbidities among patients treated with amiodarone. These results support findings from randomized clinical trials advocating aggressive rhythm control therapy to reduce mortality and suggest that amiodarone is a potentially effective treatment to achieve this aim.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- G Tsaban
- Soroka University Medical Center, Heart Institute , Beer Sheva , Israel
| | - M Gordon
- Soroka University Medical Center, Clinical Research Center , Beer Sheva , Israel
| | - Y Omari
- Ben Gurion University of the Negev, Faculty of Health Sciences , Beer Sheva , Israel
| | - L Kezerle
- Soroka University Medical Center, Heart Institute , Beer Sheva , Israel
| | - H Alnsasra
- Soroka University Medical Center, Heart Institute , Beer Sheva , Israel
| | - K Buturlin
- Soroka University Medical Center, Heart Institute , Beer Sheva , Israel
| | - S Bareza
- Soroka University Medical Center, Heart Institute , Beer Sheva , Israel
| | - A Wagshal
- Soroka University Medical Center, Heart Institute , Beer Sheva , Israel
| | - V Novack
- Soroka University Medical Center, Clinical Research Center , Beer Sheva , Israel
| | - Y Konstantino
- Soroka University Medical Center, Heart Institute , Beer Sheva , Israel
| | - M Haim
- Soroka University Medical Center, Heart Institute , Beer Sheva , Israel
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27
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Tsaban G, Gordon M, Omari Y, Kezerle L, Alnsasra H, Buturlin K, Bareza S, Wagshal A, Konnstantino Y, Novack V, Haim M. Amiodarone and lung toxicity in a real-life contemporary population. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Amiodarone-induced lung toxicity (ALT) is severe and potentially fatal. Most data on ALT are derived from previous decades when amiodarone was administrated chronically in higher doses, while currently, low-dose amiodarone 200 mg is routinely used. Whether low-dose amiodarone treatment is associated with ALT remains untested.
Methods
This is a retrospective study among patients from the Southern district of Clalit Health Services (CHS) in Israel between 1st January 1999 and 1st July 2021. The study population comprised solely of patients with atrial fibrillation since this is the most prevalent condition for prescribing amiodarone. Patients treated with amiodarone were matched in a 1:1 manner with controls not exposed to amiodarone based on age, sex, living area, and atrial fibrillation diagnosis duration. To avoid immortal time bias, follow-up times of the matched controls were left adjudicated to truncate the amiodarone-free period of their matched cases. Patients with prior interstitial lung disease (ILD) were excluded. The primary outcome was the incidence of any ILD. We performed survival analyses using multivariable Cox regression controlling for potential confounders.
Results
During the study period, 7,048 patients who initiated amiodarone treatment were identified, of whom 6,449 were matched with controls. The mean age was 71.5 years, and 46.4% were women among the matched population. The amiodarone-treatment group had higher rates of smoking (30.3% vs. 26.8%, p<0.001), rheumatic disease (4.5% vs. 3.5%, p=0.003), background myocardial infarction (31.6% vs. 19.6%), renal failure (17.2% vs. 10.8%) and congestive heart failure (33.8% vs. 20.7%; p<0.05 for all). During the study, with a mean follow-up time of 5.6 years, ILD occurred in 357 (5.5%) patients in the amiodarone group and 289 (4.5%) patients in the control group [adjusted hazard ratio: 1.09 (confidence interval 95%: 0.91, 1.3), p=0.4].
Conclusion
In a large contemporary real-life population, the incidence of ILD during 5.6 years was relatively low, and treatment with low-dose amiodarone was not associated with an increased risk of ILD. These results, if confirmed by other cohorts, may call for a change in the surveillance policy of patients treated with amiodarone
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- G Tsaban
- Soroka University Medical Center, Heart Institute , Beer Sheva , Israel
| | - M Gordon
- Soroka University Medical Center, Clinical Research Center , Beer Sheva , Israel
| | - Y Omari
- Ben Gurion University of the Negev, Faculty of Health Sciences , Beer Sheva , Israel
| | - L Kezerle
- Soroka University Medical Center, Heart Institute , Beer Sheva , Israel
| | - H Alnsasra
- Soroka University Medical Center, Heart Institute , Beer Sheva , Israel
| | - K Buturlin
- Soroka University Medical Center, Heart Institute , Beer Sheva , Israel
| | - S Bareza
- Soroka University Medical Center, Heart Institute , Beer Sheva , Israel
| | - A Wagshal
- Soroka University Medical Center, Heart Institute , Beer Sheva , Israel
| | - Y Konnstantino
- Soroka University Medical Center, Heart Institute , Beer Sheva , Israel
| | - V Novack
- Soroka University Medical Center, Clinical Research Center , Beer Sheva , Israel
| | - M Haim
- Soroka University Medical Center, Heart Institute , Beer Sheva , Israel
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28
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Tsaban G, Shalev A, Katz A, Yaskolka Meir A, Rinott E, Zelicha H, Kaplan A, Bluher M, Ceglarek U, Stumvoll M, Stampfer MJ, Shai I. The effect of distinct dietary interventions on proximal aortic stiffness; the DIRECT-PLUS randomized controlled trial. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Proximal aortic stiffness (PAS) reflects arterial aging and is strongly associated with increased cardiovascular risk. Plant-rich, specifically Mediterranean-style, diets are associated with reduced cardiovascular risk. The effect of dietary interventions on PAS remains unclear.
Methods
We randomized participants with abdominal-obesity/dyslipidemia to healthy-dietary-guidelines (HDG), Mediterranean, or green-Mediterranean diets combined with physical activity (PA). Both Mediterranean diets were similarly hypocaloric and included 28g/day walnuts. The green-Mediterranean group also consumed green tea (3–4 cups/day) and a Wolffia-globosa (Mankai) plant green-shake. PAS was estimated based on aortic-arch pulse-wave-velocity using magnetic resonance imaging (MRI) at baseline and after 18-months.
Results
Among 294 participants [age=51±10.6 years, body-mass-index 31.3±4.0 kg/m2, PAS = 6.1±2.7 m/sec, retention rate = 89.8%], 281 had valid PAS measurements. Higher PAS was mostly associated with aging, hypertension, dyslipidemia, diabetes, and increased visceral adiposity (p<0.05 for all). After 18-months of intervention, all diet groups significantly reduced their PAS ([HDG: −4.8% (interquartile-range [IQR]: −22.3 to 8.7); Mediterranean: −7.3%, IQR (−20.8 to 11.9); green-Mediterranean: −14.0%, IQR (−27.0 to 2.4); p<0.05 for within-groups changes).
Green-Mediterranean dieters had significantly greater PAS reduction than HDG dieters (p=0.007), also after controlling for age, sex, baseline-PAS, and Δweight. Further adjustment to baseline dyslipidemia, diabetes, and hypertension also revealed significant differences in PAS reduction between green-Mediterranean and Mediterranean groups (p=0.027). Specifically, greater green tea consumption was associated with greater PAS regression (p=0.04). ΔPAS was significantly associated with improvements in Δlow-density-lipoprotein cholesterol and Δtotal-cholesterol (p<0.05, multivariable models). All lifestyle intervention showed aortic age regression as compared to the expected (1.8±0.14 years vs.: HDG: −2.9±7.5 years; MED: −4.1±7.4 years; green-MED:-4.9±8.0 years; p<0.001).
Conclusions
Higher PAS is strongly related to aging and is associated with traditional cardiovascular risk factors. Lifestyle intervention promotes PAS reduction. Green-Mediterranean diet may be associated with more remarkable aortic rejuvenation.
Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): The Deutsche Forschungsgemeinschaft (DFG, German Research Foundation); the Israel Ministry of Health
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Affiliation(s)
- G Tsaban
- Soroka University Medical Center, Heart Institute , Beer Sheva , Israel
| | - A Shalev
- Soroka University Medical Center, Heart Institute , Beer Sheva , Israel
| | - A Katz
- Ben Gurion University of the Negev, Faculty of Health Sciences , Beer Sheva , Israel
| | - A Yaskolka Meir
- Ben Gurion University of the Negev, Faculty of Health Sciences , Beer Sheva , Israel
| | - E Rinott
- Ben Gurion University of the Negev, Faculty of Health Sciences , Beer Sheva , Israel
| | - H Zelicha
- Ben Gurion University of the Negev, Faculty of Health Sciences , Beer Sheva , Israel
| | - A Kaplan
- Ben Gurion University of the Negev, Faculty of Health Sciences , Beer Sheva , Israel
| | - M Bluher
- University of Leipzig, Department of Medicine , Leipzig , Germany
| | - U Ceglarek
- University of Leipzig, Department of Medicine , Leipzig , Germany
| | - M Stumvoll
- University of Leipzig, Department of Medicine , Leipzig , Germany
| | - M J Stampfer
- Harvard T. H. Chan School of Public Health, Division of Network Medicine , Boston , United States of America
| | - I Shai
- Ben Gurion University of the Negev, Faculty of Health Sciences , Beer Sheva , Israel
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Shamia D, Tsaban G, Baham L, Raviv Y, Haim M. Cardiac dysrhythmias among coronavirus-19 recovered symptomatic patients. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
The coronavirus (COVID-19) pandemic, which affected millions of people worldwide, is associated with a chronic fatigue sequela, also known as long-COVID. While various adverse effects of COVID-19 on the cardiovascular system were reported, the prolonged sequela of COVID-19 on heart rhythm remains unknown.
Aim
To describe the prevalence of cardiac dysrhythmias among patients who presented with Long Covid following recovery from COVID-19 infection.
Methods
We conducted a prospective study among 87 patients who suffered from Long Covid syndrome following recovery from COVID-19 and were treated in the COVID-19 recovery clinic between December 2020 and June 2021. All patients were referred for transthoracic echocardiography (TTE) and 24-hour Holter examination.
Results
The mean age was 52+13 years, and 52 (59.8%) patients were females. Seventy-nine (90.8%) of the patients had normal sinus rhythm without evidence of any arrhythmias. Atrial premature beats were recorded in 70 (80.5%) patients with a median of 6/day (interquartile range 3–20/day; maximum: 5180/day). Ventricular premature beats were recorded in 50 (57.5%) patients with a median of 4/day (interquartile range 2–19/day; maximum: 6847/day). Overall, seven patients (8%) had sustained atrial dysrhythmias: one had atrial fibrillation, one had atrial flutter, and five had atrial tachycardia. Sixty-six (75.9%) patients underwent TTE, which was mainly unremarkable as 65 patients had a normal left ventricular function, and three (4.5%) patients had evidence of pulmonary hypertension.
Discussion
Cardiac arrhythmias are not uncommon among symptomatic COVID-19 recovered patients. Atrial arrhythmias were most common, with an up to 8% incidence rate. These findings may suggest that atrial dysrhythmias may be associated with long-term symptomatic sequela of COVID-19 infection.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- D Shamia
- Soroka University Medical Center, Department of Cardiology , Beer Sheva , Israel
| | - G Tsaban
- Soroka University Medical Center, Department of Cardiology , Beer Sheva , Israel
| | - L Baham
- Soroka University Medical Center, Pulmonology Service , Beer Sheva , Israel
| | - Y Raviv
- Soroka University Medical Center, Pulmonology Service , Beer Sheva , Israel
| | - M Haim
- Soroka University Medical Center, Department of Cardiology , Beer Sheva , Israel
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Tsaban G, Barret O, Peles I, Abramowitz Y, Shmueli H, Cafri C, Zahger D, Koifman E. Prognostic factors of patients with myocardial infarction with nonobstructive coronary artery disease: a seven-year longitudinal follow-up. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Myocardial infarction with nonobstructive coronary arteries (MINOCA) is a common condition associated with major adverse events (MAE). Unlike obstructive coronary artery disease (OCAD), data regarding the prognosis of MINOCA are scarce.
Methods
We conducted a retrospective study among consecutive patients with MINOCA in a large tertiary medical center in Israel between the years 2005–2018. We assessed parameters associated with MAE, defined as all-cause mortality or recurrent MI. Patients with probable alternative cause for myocardial injury, as stress-induced cardiomyopathy and myocarditis, were excluded.
Results
Among 36,501 admitted with AMI during the study period, 1,544 patients (4.2%) had MINOCA. The mean age was 61±13, and 710 (46%) were females. At a median follow-up of 7 years, the MAE rate was 17%, as 153 (9.9%) died, and 117 (7.5%) had recurrent MI. ST-elevation MI at presentation and older age were associated with increased 30-day MAE. In multivariate models, independent factors associated with MAE were female gender (HR=0.58; 95% CI 0.43–0.76), age (HR=1.04; 95% CI 1.03–1.05), left ventricular ejection fraction (LVEF) <40% (HR=2.68; 95% CI 1.74–4.12), increased serum-creatinine (HR=1.11; 95% CI 1.02–1.21), higher hemoglobin (HR=0.81; 95% CI 0.76–0.88), and documented sinus rhythm (HR=0.58; 95% CI 0.38–0.86).
Conclusion
MINOCA carries an increased risk for long-term MAE. Among MINOCA patients older age, LVEF <40%, and increased serum-creatinine are associated with increased MAE risk, while female gender, higher hemoglobin, and sinus rhythm are associated with lower MAE risk.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- G Tsaban
- Soroka University Medical Center , Beer Sheva , Israel
| | - O Barret
- Soroka University Medical Center, Heart Institute , Beer Sheva , Israel
| | - I Peles
- Soroka University Medical Center, Clinical Research Center , Beer Sheva , Israel
| | - Y Abramowitz
- Soroka University Medical Center, Heart Institute , Beer Sheva , Israel
| | - H Shmueli
- Soroka University Medical Center, Heart Institute , Beer Sheva , Israel
| | - C Cafri
- Soroka University Medical Center, Heart Institute , Beer Sheva , Israel
| | - D Zahger
- Soroka University Medical Center, Heart Institute , Beer Sheva , Israel
| | - E Koifman
- Soroka University Medical Center, Heart Institute , Beer Sheva , Israel
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Tsaban G, Gordon M, Omari Y, Kezerle L, Alnsasra H, Buturlin K, Bareza S, Wagshal A, Novack V, Konnstantino Y, Haim M. Amiodarone therapy and risk of primary lung cancer; insights from a real-life contemporary population study. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Amiodarone is the most effective antiarrhythmic therapy to maintain sinus rhythm in atrial fibrillation (AF) patients. There is a controversy regarding the association of amiodarone therapy with an increased risk of lung cancer. We aimed to assess the relationship between amiodarone treatment and primary lung cancer (PLC) incidence in a contemporary population of AF patients.
Methods
This is a retrospective study among patients from the Southern district of Clalit Health Services in Israel between 1st January 1999 and 1st July 2021. The study population comprised solely of patients with atrial fibrillation since this is the most prevalent condition for prescribing amiodarone. Patients treated with amiodarone were matched in a 1:1 manner with controls not exposed to amiodarone based on age, sex, living area, and atrial fibrillation diagnosis duration. To avoid immortal time bias, follow-up times of the matched controls were left adjudicated to truncate the amiodarone-free period of their matched cases. Patients with prior PLC were excluded. The primary outcome was the incidence of any PLC. We performed survival analyses using multivariable Cox regression controlling for potential confounders.
Results
During the study period, 7,048 patients who initiated amiodarone treatment were identified, of whom 6,449 were matched with controls. The mean age was 71.5 years, and 46.4% were women among the matched population. The amiodarone-treatment group had higher rates of smoking (30.3% vs. 26.8%), prior non-lung-related malignancy (14.9% vs. 13.5%), rheumatic disease (4.5% vs. 3.5%), diabetes (38.3% vs. 32.6%), history of myocardial infarction (316% vs. 19.6%), renal failure (17.2% vs. 10.8%) and congestive heart failure (33.8% vs. 20.7%); p<0.05 for all. During the study, with a mean follow-up time of 5.7 years, PLC occurred in 94 (1.5%) patients in the amiodarone group and 79 (1.2%) patients in the control group [adjusted-hazard-ratio (aHR) 1.10 (confidence-interval 95% (CI95%, 0.78,1.55), p=0.6]. Factors independently associated with increased PLC risk were smoking [aHR 4.25 CI95% (3.01,5.99), p<0.001], non-lung-related malignancy [aHR 1.56, CI95% (1.00,2.42), p=0.050], and peripheral vascular disease [aHR 1.77, CI95% (1.16,2.71), p=0.008]
Conclusion
Chronic amiodarone treatment is not associated with increased risk for PLC. Smoking and prior non-lung-related malignancy and peripheral vascular disease were independently associated with increased PLC risk, suggesting that such patients should undergo closer surveillance for early detection of PLC.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- G Tsaban
- Soroka University Medical Center, Heart Institute , Beer Sheva , Israel
| | - M Gordon
- Soroka University Medical Center, Clinical Research Center , Beer Sheva , Israel
| | - Y Omari
- Ben Gurion University of the Negev, Faculty of Health Sciences , Beer Sheva , Israel
| | - L Kezerle
- Soroka University Medical Center, Heart Institute , Beer Sheva , Israel
| | - H Alnsasra
- Soroka University Medical Center, Heart Institute , Beer Sheva , Israel
| | - K Buturlin
- Soroka University Medical Center, Heart Institute , Beer Sheva , Israel
| | - S Bareza
- Soroka University Medical Center, Heart Institute , Beer Sheva , Israel
| | - A Wagshal
- Soroka University Medical Center, Heart Institute , Beer Sheva , Israel
| | - V Novack
- Soroka University Medical Center, Clinical Research Center , Beer Sheva , Israel
| | - Y Konnstantino
- Soroka University Medical Center, Heart Institute , Beer Sheva , Israel
| | - M Haim
- Soroka University Medical Center, Heart Institute , Beer Sheva , Israel
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Tsaban G, Barret O, Peles I, Abramowitz Y, Shmueli H, Cafri C, Zahger D, Koifman E. The prognostic impact of coronary anatomy in myocardial infarction with nonobstructive coronary artery disease: a seven-year longitudinal follow-up. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Myocardial infarction with nonobstructive coronary arteries (MINOCA) is a common condition associated with major adverse events (MAE) that may occur presence of normal or nonobstructive coronary artery anatomy (NCAA and NOCAA, respectively). The prognostic impact presence of NOCAA on long-term outcomes of MINOCA patients remains unclear.
Methods
This is a retrospective study among consecutive MINOCA patients in a large referral medical center in Israel between the years 2005–2018. Patients with probable alternative cause for myocardial injury, as stress-induced cardiomyopathy and myocarditis, were excluded. Patients were classified according to their coronary angiography diagnosis into NCAA and NOCAA. The primary outcome was MAE, defined as the composite of all-cause mortality and recurrent acute coronary syndrome (ACS). We performed survival analyses using multivariable Cox regression, controlling for potential cofounders.
Results
Among 36,501 admitted with AMI during the study period, 1,544 patients (4.2%) had MINOCA. Among MINOCA patients, 651 (42%) had NCAA, and 893 (58%) had NOCAA. The mean age was 61.2±12.6 years, and 710 (46.0%) were females. The NOCAA group had more females and were older with higher rates of diabetes, hypertension, dyslipidemia, atrial fibrillation, and chronic renal failure (p<0.05 for all). At a median follow-up of 7 years, MAE occurred in 203 (22.7%) patients and 67 (10.3%) patients in the NOCAA and NCAA groups, respectively (p<0.01). In fully-adjusted multivariable model, NOCAA remained a significant risk factor for long-term MAE [adjusted-hazard-ratio (aHR) 1.67, 95% confidence-interval (95% CI) 1.25–2.23; p<0.001; figure]. Other factors associated with MAE were older age (aHR 1.05, 95% CI 1.03–1.06; p<0.001), left ventricular ejection fraction (LVEF) <40% (aHR 3.04, 95% CI 2.03–4.57; p<0.001)
Conclusion
Among MINOCA patients, NOCAA was associated with a worse long-term prognosis than NCAA. Other risk factors for long-term MAE were older age and LVEF <40%, while female sex and sinus rhythm at presentation were associated with lower MAE risk.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- G Tsaban
- Soroka University Medical Center , Beer Sheva , Israel
| | - O Barret
- Soroka University Medical Center, Heart Institute , Beer Sheva , Israel
| | - I Peles
- Soroka University Medical Center, Clinical Research Center , Beer Sheva , Israel
| | - Y Abramowitz
- Soroka University Medical Center, Heart Institute , Beer Sheva , Israel
| | - H Shmueli
- Soroka University Medical Center, Heart Institute , Beer Sheva , Israel
| | - C Cafri
- Soroka University Medical Center, Heart Institute , Beer Sheva , Israel
| | - D Zahger
- Soroka University Medical Center, Heart Institute , Beer Sheva , Israel
| | - E Koifman
- Soroka University Medical Center, Heart Institute , Beer Sheva , Israel
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Alnsasra H, Tsaban G, Cooper J, Haim M. Sex differences among patients with tachyarrhythmias and bradyarrhythmias following acute myocardial infarction. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Acute myocardial infarction (AMI) is commonly complicated by ventricular, supraventricular tachycardias and high-grade atrioventricular block (HAVB) which may result in increased morbidity and mortality.
Purpose
To evaluate the sex differences in tachyarrhythmias and HAVB, and their associated outcomes following AMI.
Methods
Using the Acute Coronary Syndrome Israeli Survey (ACSIS) survey database from 2000–2018, we analyzed the specific incidence rates for arrhythmias including: sustained ventricular tachycardia (VT), ventricular fibrillation (VF), new-onset atrial fibrillation (AF) and HAVB in men and women after AMI. Unadjusted and multivariable-adjusted logistic regression analyses were performed to assess the sex differences of in-hospital arrhythmias after AMI. Multivariate cox proportional hazard models were performed to assess the impact of arrhythmias on 1-year mortality.
Results
In this cohort study of 14280 patients with 3159 (22.1%) women and 11121 (77.9%) men, 316 (2.2%) experienced ventricular arrhythmias (VAs) (sustained VT or secondary VF) with similar rates among men and women (2.3% and 2.2%, respectively, p=0.62). Compared to men, women were less likely to experience primary VF (1.6% vs 2.3%, p=0.034), but more likely to experience AF (8.6% and 5.0%, p<0.001). 372 (2.6%) patients experienced HAVB with higher rates of HAVB in women than men (3.7% and 2.3%, respectively, p<0.001).
After multivariate analyses, the association with primary VF was attenuated (adjusted Odds Ratio (OR) = 0.80, p=0.15) but women remained more likely to experience AF (adjusted OR =1.24, p=0.01) and HAVB (adjusted OR =1.28, p=0.04). The occurrence of VAs was found to be associated with increased mortality in both men (adjusted Hazard Ratio (HR) =3.68, p<0.01) and women (adjusted HR=3.87, p<0.01) without a significant difference between the groups (p for interaction=0.203). The occurrence of AF was found to be associated with increased mortality in both men (adjusted HR=1.64, p<0.001) and women (adjusted HR=1.34, p<0.001) with a significant difference between the groups (p for interaction<0.001). HAVB was found to be associated with increased mortality in both men (adjusted HR=2.31, p<0.001) and women (adjusted HR=2.26, p<0.001) without a significant difference between the groups (p of interaction=0.21).
Conclusions
The incidence rates of VAs after AMI were similar in men and women, except for primary VF, which was more common among men. Women experienced more AF and HAVB than men. VAs, AF and HAVB were found to be associated with increased mortality.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- H Alnsasra
- Soroka University Medical Center , Beer Sheva , Israel
| | - G Tsaban
- Soroka University Medical Center , Beer Sheva , Israel
| | - J Cooper
- Soroka University Medical Center , Beer Sheva , Israel
| | - M Haim
- Soroka University Medical Center , Beer Sheva , Israel
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Zelicha H, Kloting N, Kaplan A, Yaskolka Meir A, Rinott E, Tsaban G, Chassidim Y, Bluher M, Ceglarek U, Isermann B, Stumvoll M, Quayson RN, von Bergen M, Engelmann B, Rolle-Kampczyk UE, Haange SB, Tuohy KM, Diotallevi C, Shelef I, Hu FB, Stampfer MJ, Shai I. The effect of high-polyphenol Mediterranean diet on visceral adiposity: the DIRECT PLUS randomized controlled trial. BMC Med 2022; 20:327. [PMID: 36175997 PMCID: PMC9523931 DOI: 10.1186/s12916-022-02525-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 08/11/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Mediterranean (MED) diet is a rich source of polyphenols, which benefit adiposity by several mechanisms. We explored the effect of the green-MED diet, twice fortified in dietary polyphenols and lower in red/processed meat, on visceral adipose tissue (VAT). METHODS In the 18-month Dietary Intervention Randomized Controlled Trial PoLyphenols UnproceSsed (DIRECT-PLUS) weight-loss trial, 294 participants were randomized to (A) healthy dietary guidelines (HDG), (B) MED, or (C) green-MED diets, all combined with physical activity. Both isocaloric MED groups consumed 28 g/day of walnuts (+ 440 mg/day polyphenols). The green-MED group further consumed green tea (3-4 cups/day) and Wolffia globosa (duckweed strain) plant green shake (100 g frozen cubes/day) (+ 800mg/day polyphenols) and reduced red meat intake. We used magnetic resonance imaging (MRI) to quantify the abdominal adipose tissues. RESULTS Participants (age = 51 years; 88% men; body mass index = 31.2 kg/m2; 29% VAT) had an 89.8% retention rate and 79.3% completed eligible MRIs. While both MED diets reached similar moderate weight (MED: - 2.7%, green-MED: - 3.9%) and waist circumference (MED: - 4.7%, green-MED: - 5.7%) loss, the green-MED dieters doubled the VAT loss (HDG: - 4.2%, MED: - 6.0%, green-MED: - 14.1%; p < 0.05, independent of age, sex, waist circumference, or weight loss). Higher dietary consumption of green tea, walnuts, and Wolffia globosa; lower red meat intake; higher total plasma polyphenols (mainly hippuric acid), and elevated urine urolithin A polyphenol were significantly related to greater VAT loss (p < 0.05, multivariate models). CONCLUSIONS A green-MED diet, enriched with plant-based polyphenols and lower in red/processed meat, may be a potent intervention to promote visceral adiposity regression. TRIAL REGISTRATION ClinicalTrials.gov , NCT03020186.
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Affiliation(s)
- Hila Zelicha
- Faculty of Health Sciences, The Health & Nutrition Innovative International Research Center, Ben-Gurion University of the Negev, P.O. Box 653, 84105, Be'er Sheva, Israel
| | - Nora Kloting
- Department of Medicine, University of Leipzig, Leipzig, Germany
| | - Alon Kaplan
- Faculty of Health Sciences, The Health & Nutrition Innovative International Research Center, Ben-Gurion University of the Negev, P.O. Box 653, 84105, Be'er Sheva, Israel
| | - Anat Yaskolka Meir
- Faculty of Health Sciences, The Health & Nutrition Innovative International Research Center, Ben-Gurion University of the Negev, P.O. Box 653, 84105, Be'er Sheva, Israel
| | - Ehud Rinott
- Faculty of Health Sciences, The Health & Nutrition Innovative International Research Center, Ben-Gurion University of the Negev, P.O. Box 653, 84105, Be'er Sheva, Israel
| | - Gal Tsaban
- Faculty of Health Sciences, The Health & Nutrition Innovative International Research Center, Ben-Gurion University of the Negev, P.O. Box 653, 84105, Be'er Sheva, Israel
| | - Yoash Chassidim
- Department of Engineering, Sapir Academic College, Ashkelon, Israel
| | - Matthias Bluher
- Helmholtz Institute for Metabolic, Obesity and Vascular Research (HI-MAG) of the Helmholtz Zentrum München at the University of Leipzig and University Hospital Leipzig, Leipzig, Germany
| | - Uta Ceglarek
- Department of Medicine, University of Leipzig, Leipzig, Germany
| | - Berend Isermann
- Department of Medicine, University of Leipzig, Leipzig, Germany
| | | | | | | | | | | | | | - Kieran M Tuohy
- Department of Food Quality and Nutrition, Research and Innovation Centre, Fondazione Edmund Mach, San Michele all'Adige, Trentino, Italy
| | - Camilla Diotallevi
- Department of Food Quality and Nutrition, Research and Innovation Centre, Fondazione Edmund Mach, San Michele all'Adige, Trentino, Italy
| | - Ilan Shelef
- Soroka University Medical Center, Be'er Sheva, Israel
| | - Frank B Hu
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Harvard Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA.,Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Meir J Stampfer
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Harvard Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA.,Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Iris Shai
- Faculty of Health Sciences, The Health & Nutrition Innovative International Research Center, Ben-Gurion University of the Negev, P.O. Box 653, 84105, Be'er Sheva, Israel. .,Department of Medicine, University of Leipzig, Leipzig, Germany. .,Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
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Dogosh AA, Adawi A, El Nasasra A, Cafri C, Barrett O, Tsaban G, Barashi R, Koifman E. Comparison of Transcatheter Aortic Valve Implantation Devices in Aortic Stenosis: A Network Meta-Analysis of 42,105 Patients. J Clin Med 2022; 11:jcm11185299. [PMID: 36142947 PMCID: PMC9506011 DOI: 10.3390/jcm11185299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 08/26/2022] [Accepted: 09/01/2022] [Indexed: 11/29/2022] Open
Abstract
Background: In recent years, trans-catheter aortic valve implantation (TAVI) has emerged as an excellent alternative to surgical aortic valve replacement (SAVR). Currently, there are several approved devices on the market, yet comparisons among them are scarce. We aimed to compare the various devices via a network meta-analysis. Methods: We performed a network meta-analysis including randomized controlled trials (RCTs) and propensity-matched studies that provide comparisons of either a single TAVI with SAVR or two different TAVI devices and report clinical outcomes. Results: We included 12 RCT and 13 propensity-matched studies comprising 42,105 patients, among whom 27,134 underwent TAVI using various valve systems (Sapien & Sapien XT, Sapien 3, Corvalve, Evolut & Evolut Pro, Acurate Neo, Portico). The mean follow-up time was 23.4 months. Sapien 3 was superior over SAVR in the reduction of all-cause mortality (OR = 0.53; 95%CrI 0.31–0.91), while no significant difference existed between other devices and SAVR. Aortic regurgitation was more frequent among TAVI devices compared to SAVR. There was no significant difference between the various THVs and SAVR in cardiovascular mortality, myocardial infarction, NYHA class III-IV, and endocarditis. Conclusions: Newer generation TAVI devices, especially Sapien 3 and Evolut R/Pro are associated with improved outcomes compared to SAVR and other devices of the older generation.
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Affiliation(s)
- Ala Abu Dogosh
- Soroka Medical Center, Heart Institute, Ben-Gurion University of the Negev, Beer Sheva 84101, Israel
| | - Ahlam Adawi
- Soroka Medical Center, Heart Institute, Ben-Gurion University of the Negev, Beer Sheva 84101, Israel
| | - Aref El Nasasra
- Soroka Medical Center, Heart Institute, Ben-Gurion University of the Negev, Beer Sheva 84101, Israel
| | - Carlos Cafri
- Soroka Medical Center, Heart Institute, Ben-Gurion University of the Negev, Beer Sheva 84101, Israel
| | - Orit Barrett
- Soroka Medical Center, Heart Institute, Ben-Gurion University of the Negev, Beer Sheva 84101, Israel
| | - Gal Tsaban
- Soroka Medical Center, Heart Institute, Ben-Gurion University of the Negev, Beer Sheva 84101, Israel
| | - Rami Barashi
- Meir Medical Center, Tel Aviv University, Tel Aviv 6423906, Israel
| | - Edward Koifman
- Meir Medical Center, Tel Aviv University, Tel Aviv 6423906, Israel
- Correspondence: ; Tel.: +972-(0)9-747-1450
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36
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Tsaban G, Alnsasra H, El Nasasra A, Abu-Salman A, Abu-Dogosh A, Weissberg I, Golan YBB, Barrett O, Westreich R, Aboalhasan E, Azuri J, Hammerman A, Arbel R. Aspirin with Low-Dose Ticagrelor or with Low-Dose Rivaroxaban for Secondary Prevention: A Cost per Outcome Analysis. Am J Cardiovasc Drugs 2022; 22:677-683. [DOI: 10.1007/s40256-022-00543-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/01/2022] [Indexed: 11/01/2022]
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37
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Ben Shabat I, Ben Shabat MH, Ben Abraham S, Sagy I, Tsaban G, Cohen-Lahav M, Goldinger G, Peled M, Bartal C. Reliability of blood tests taken from the peripheral intravenous catheter. Medicine (Baltimore) 2022; 101:e29268. [PMID: 35839005 DOI: 10.1097/md.0000000000029268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
We aimed to compare the reliability of laboratory blood tests using 2 sampling methods, via a peripheral venous catheter (PVC) vs direct venipuncture stab (DVS), we evaluated the effect of time elapsed since PVC insertion, PVC diameter, and administration of saline and/or antibiotic infusion through PVC on the blood test results. A prospective comparative study was conducted between May 2018 and July 2019. Patients aged ≥ 18 years and admitted to our department with a 20G/22G PVC inserted within the last 24 hours were enrolled. Blood samples were collected from each participant in the morning, and a second sample was drawn using PVC. Dependent variables included the percentage of hemolysis, failure rate, complete blood count, biochemical testing parameters, and coagulation functions. A total of 211 patients participated in the study. In total, 237 blood tests were conducted, of which 167 were performed on day 1 and the remaining on day 2, with a second blood sample collected from 26 patients on day 2. Twenty-one participants received 22G PVC, and 23 participants received active infusion. No significant differences were found in failure rates when each subgroup was compared with the primary day 1 group. The intraclass correlation coefficient indicated significant correlations among all the indices in all groups. Both blood sampling methods (PVC and direct venipuncture) can be used interchangeably for routine laboratory tests on days 1 and 2 after PVC insertion using 20G/22G PVC or infused PVC.
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Affiliation(s)
- Idan Ben Shabat
- Internal Medicine Division, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Michal Hoffman Ben Shabat
- Internal Medicine Division, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Shai Ben Abraham
- Internal Medicine Division, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Iftach Sagy
- Internal Medicine Division, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Gal Tsaban
- Internal Medicine Division, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Merav Cohen-Lahav
- Division of Biochemistry Laboratory, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Gil Goldinger
- Internal Medicine Division, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Michal Peled
- Internal Medicine Division, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Carmi Bartal
- Internal Medicine Division, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Tsaban G, Alnsasra H, El Nasasra A, Aboalhasan E, Azuri J, Hammerman A, Arbel R. Colchicine for secondary prevention of cardiovascular disease, a cost per outcome analysis. Eur J Prev Cardiol 2022. [DOI: 10.1093/eurjpc/zwac056.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Introduction
Pharmacological modulation of systemic inflammation significantly reduced cardiovascular risk among patients with coronary artery disease (CAD), beyond guideline-directed therapy. However, most anti-inflammatory therapies substantially increase the risk of infections. Low-dose (LD) Colchicine is currently the only non-lipid-lowering anti-inflammatory agent effective for secondary prevention of cardiovascular diseases that does not significantly increase infection risk. The clinical cost-effectiveness of LD Colchicine to prevent major adverse cardiovascular events (MACE) remains unexplored.
Methods
We calculated the annualized number needed to treat (aNNT) to prevent MACE with LD Colchicine based on the outcome data of the LoDoCo2 trial. We then analyzed the annualized cost needed to treat (aCNT) of LD Colchicine to prevent one MACE. We estimated the aCNT by multiplying the aNNT by the annual cost of therapy. LD Colchicine costs were based on 75% of the 2021 US National Average Drug Acquisition Cost listing and EU prices.
Results
In LoDoCo2, the aNNT for avoiding MACE with LD Colchicine was 150 (95% CI: 97-524). The annual cost of LD Colchicine is $1,889 and €352 in the US and EU, respectively. The corresponding aCNTs to prevent one MACE were 282,610$ (95% CI: 184,025$-989,137$) and 82,815€ (34,154€-184,502€) in the US and EU, respectively.
Conclusion
LD Colchicine might serve as an effective treatment strategy to reduce secondary cardiovascular risk among patients with CAD. The CNTs of LD Colchicine are sensitive to the drug’s pricing and thus differ between the US and the EU.
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Affiliation(s)
- G Tsaban
- Soroka University Medical Center, Heart Institute, Beer Sheva, Israel
| | - H Alnsasra
- Soroka University Medical Center, Heart Institute, Beer Sheva, Israel
| | - A El Nasasra
- Soroka University Medical Center, Heart Institute, Beer Sheva, Israel
| | - E Aboalhasan
- Sapir College, Maximizing Health Outcomes Research Lab, Sderot, Israel
| | - J Azuri
- Tel Aviv University, Sackler Faculty of Medicine, Tel Aviv, Israel
| | - A Hammerman
- Clalit Health services, Department of Pharmaceutical Technology Assessment, Tel Aviv, Israel
| | - R Arbel
- Sapir College, Maximizing Health Outcomes Research Lab, Sderot, Israel
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Alnsasra H, Tsaban G, Aboalhasan E, El Nasasra A, Azuri J, Hammerman A, Arbel R. Sacubitril/valsartan versus in empagliflozin heart failure with preserved ejection fraction. Eur J Prev Cardiol 2022. [DOI: 10.1093/eurjpc/zwac056.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Heart failure with preserved ejection fraction (HFpEF) is associated with frequent hospitalizations and an increased risk of death. Empagliflozin was recently reported to reduce the combined risk of cardiovascular death or hospitalization for heart failure (HF) among patients with HFpEF, whereas Sacubitril/Valsartan has shown only marginal significance benefits in these patients. We aimed to compare the value for money of these treatments.
Methods
We compared the annualized Cost Needed to Treat (CNT) to prevent the composite outcome of HF hospitalization and cardiovascular death with Empagliflozin or Sacubitril/Valsartan. The CNT was estimated by multiplying the drug-specific annual cost and the annualized Number Needed-to-Treat (aNNT) which was calculated based on data from the EMPEROR-Preserved and PARAGON -HF trials for Empagliflozin and Sacubitril-Valsartan, respectively. Costs were based on 2021 US prices. We performed scenario analyses to attenuate the differences between the studies’ populations. Subgroup analyses were performed across diabetes status.
Results
The aNNT with Empagliflozin in EMPEROR-Preserved was 61 (95% CI: 41-128) versus 53 (28-∞) with Sacubitril-Valsartan in PARAGON-HF, with an annual cost of 4,797$ versus 6,298 $, respectively. The corresponding CNTs were therefore $292,620 (95% CI: 196,679 - 614,023) for Empagliflozin and $333,834 (95% CI: 176,365 - ∞) for Sacubitril-Valsartan. In diabetic patients, the corresponding CNTs were $254,244 (95% CI: 158,303 - 882,659) for Empagliflozin versus $308,639
(95% CI: 132, 2740 - ∞) for Sacubitril-Valsartan. In non-diabetic patients, the corresponding CNTs were $326,200 (95% CI: 201,476 - 1,443,914) for Empagliflozin versus $333,834 (170,066 - ∞) for Sacubitril-Valsartan.
Conclusion
Empagliflozin provides better value for money than Sacubitril-Valsartan in preventing HF hospitalizations and cardiovascular death among patients with HFpEF. This difference was more pronounced among patients with diabetes.
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Affiliation(s)
- H Alnsasra
- Soroka University Medical Center, Heart Institute, Beer Sheva, Israel
| | - G Tsaban
- Soroka University Medical Center, Heart Institute, Beer Sheva, Israel
| | - E Aboalhasan
- Sapir College, Maximizing Health Outcomes Research Lab, Sderot, Israel
| | - A El Nasasra
- Soroka University Medical Center, Heart Institute, Beer Sheva, Israel
| | - J Azuri
- Tel Aviv University, Sackler Faculty of Medicine, Tel Aviv, Israel
| | - A Hammerman
- Clalit Health services, Department of Pharmaceutical Technology Assessment, Tel Aviv, Israel
| | - R Arbel
- Sapir College, Maximizing Health Outcomes Research Lab, Sderot, Israel
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Rinott E, Meir AY, Tsaban G, Zelicha H, Kaplan A, Knights D, Tuohy K, Scholz MU, Koren O, Stampfer MJ, Wang DD, Shai I, Youngster I. The effects of the Green-Mediterranean diet on cardiometabolic health are linked to gut microbiome modifications: a randomized controlled trial. Genome Med 2022; 14:29. [PMID: 35264213 PMCID: PMC8908597 DOI: 10.1186/s13073-022-01015-z] [Citation(s) in RCA: 37] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 01/24/2022] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Previous studies have linked the Mediterranean diet (MED) with improved cardiometabolic health, showing preliminary evidence for a mediating role of the gut microbiome. We recently suggested the Green-Mediterranean (Green-MED) diet as an improved version of the healthy MED diet, with increased consumption of plant-based foods and reduced meat intake. Here, we investigated the effects of MED interventions on the gut microbiota and cardiometabolic markers, and the interplay between the two, during the initial weight loss phase of the DIRECT-PLUS trial. METHODS In the DIRECT-PLUS study, 294 participants with abdominal obesity/dyslipidemia were prospectively randomized to one of three intervention groups: healthy dietary guidelines (standard science-based nutritional counseling), MED, and Green-MED. Both isocaloric MED and Green-MED groups were supplemented with 28g/day walnuts. The Green-MED group was further provided with daily polyphenol-rich green tea and Mankai aquatic plant (new plant introduced to a western population). Gut microbiota was profiled by 16S rRNA for all stool samples and shotgun sequencing for a select subset of samples. RESULTS Both MED diets induced substantial changes in the community structure of the gut microbiome, with the Green-MED diet leading to more prominent compositional changes, largely driven by the low abundant, "non-core," microorganisms. The Green-MED diet was associated with specific microbial changes, including enrichments in the genus Prevotella and enzymatic functions involved in branched-chain amino acid degradation, and reductions in the genus Bifidobacterium and enzymatic functions responsible for branched-chain amino acid biosynthesis. The MED and Green-MED diets were also associated with stepwise beneficial changes in body weight and cardiometabolic biomarkers, concomitantly with the increased plant intake and reduced meat intake. Furthermore, while the level of adherence to the Green-MED diet and its specific green dietary components was associated with the magnitude of changes in microbiome composition, changes in gut microbial features appeared to mediate the association between adherence to the Green-MED and body weight and cardiometabolic risk reduction. CONCLUSIONS Our findings support a mediating role of the gut microbiome in the beneficial effects of the Green-MED diet enriched with Mankai and green tea on cardiometabolic risk factors. TRIAL REGISTRATION The study was registered on ClinicalTrial.gov ( NCT03020186 ) on January 13, 2017.
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Affiliation(s)
- Ehud Rinott
- Faculty of Health Sciences, Ben-Gurion University of the Negev, 84105, Beer-Sheva, Israel
| | - Anat Yaskolka Meir
- Faculty of Health Sciences, Ben-Gurion University of the Negev, 84105, Beer-Sheva, Israel
| | - Gal Tsaban
- Faculty of Health Sciences, Ben-Gurion University of the Negev, 84105, Beer-Sheva, Israel
| | - Hila Zelicha
- Faculty of Health Sciences, Ben-Gurion University of the Negev, 84105, Beer-Sheva, Israel
| | - Alon Kaplan
- Faculty of Health Sciences, Ben-Gurion University of the Negev, 84105, Beer-Sheva, Israel
| | - Dan Knights
- BioTechnology Institute, University of Minnesota, Saint Paul, MN, 55108, USA
- Department of Computer Science and Engineering, University of Minnesota, Minneapolis, MN, 55455, USA
| | - Kieran Tuohy
- Department of Food Quality and Nutrition, Research and Innovation Centre, Fondazione Edmund Mach, Via E. Mach 1, San Michele all'Adige, 38016, Trento, Italy
- University of Leeds, School of Food Science and Nutrition, Leeds, LS2 9JT, UK
| | - Matthias Uwe Scholz
- Department of Food Quality and Nutrition, Research and Innovation Centre, Fondazione Edmund Mach, Via E. Mach 1, San Michele all'Adige, 38016, Trento, Italy
| | - Omry Koren
- Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
| | - Meir J Stampfer
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Harvard T.H. Chan School of Public Health, Boston, USA
| | - Dong D Wang
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Iris Shai
- The Health & Nutrition Innovative International Research Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
| | - Ilan Youngster
- Pediatric Division and Center for Microbiome Research, Shamir Medical Center, Be'er Ya'akov, Israel.
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
- Pediatric Infectious Diseases Unit and the Center for Microbiome Research, Shamir Medical Center, 70300, Zerifin, Israel.
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Fraiha YA, Weistriech R, Fridman V, Haviv Y, Abramowitz Y, Cohen M, Tsaban G, Salman AA. URINE TROPONIN EXCRETION IN PATIENTS WITH AND WITHOUT RENAL FAILURE. J Am Coll Cardiol 2022. [DOI: 10.1016/s0735-1097(22)02114-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Tsaban G, Barrett O, Peles I, Abramowitz Y, Shmueli H, Cafri C, Zahger D, Novack V, Koifman E. CRT-100.45 Long-Term Prognosis Following Myocardial Infarction With Nonobstructive Coronary Artery Disease: A Seven-Year Longitudinal Follow-Up. JACC Cardiovasc Interv 2022. [DOI: 10.1016/j.jcin.2022.01.106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Tsaban G, Yaskolka Meir A, Zelicha H, Rinott E, Kaplan A, Shalev A, Katz A, Brikner D, Blüher M, Ceglarek U, Stumvoll M, Stampfer MJ, Shai I. Diet-induced Fasting Ghrelin Elevation Reflects the Recovery of Insulin Sensitivity and Visceral Adiposity Regression. J Clin Endocrinol Metab 2022; 107:336-345. [PMID: 34643713 DOI: 10.1210/clinem/dgab681] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Indexed: 01/15/2023]
Abstract
CONTEXT Lower fasting ghrelin levels (FGL) are associated with obesity and metabolic syndrome. OBJECTIVE We aimed to explore the dynamics of FGL during weight loss and its metabolic and adiposity-related manifestations beyond weight loss. METHODS This was a secondary analysis of a clinical trial that randomized participants with abdominal obesity/dyslipidemia to 1 of 3 diets: healthy dietary guidelines (HDG), Mediterranean diet (MED), or green-MED diet, all combined with physical activity (PA). Both MED diets were similarly hypocaloric and included 28 g/day walnuts. The green-MED group further consumed green tea (3-4 cups/day) and a Wolffia globosa (Mankai) plant green shake. We measured FGL and quantified body fat depots by magnetic resonance imaging at baseline and after 18 months. RESULTS Among 294 participants (body mass index = 31.3 kg/m2; FGL = 504 ± 208 pg/mL; retention rate = 89.8%), lower FGL was associated with unfavorable cardiometabolic parameters such as higher visceral adipose tissue (VAT), intrahepatic fat, leptin, and blood pressure (P < 0.05 for all; multivariate models). The ∆FGL18-month differed between men (+7.3 ± 26.6%) and women (-9.2% ± 21.3%; P = 0.001). After 18 months of moderate and similar weight loss among the MED groups, FGL increased by 1.3%, 5.4%, and 10.5% in HDG, MED, and green-MED groups, respectively (P = 0.03 for green-MED vs HDG); sex-stratified analysis revealed similar changes in men only. Among men, FGL18-month elevation was associated with favorable changes in insulin resistance profile and VAT regression, after adjusting for relative weight loss (HbA1c: r = -0.216; homeostatic model of insulin resistance: r = -0.154; HDL-c: r = 0.147; VAT: r = -0.221; P < 0.05 for all). Insulin resistance and VAT remained inversely related with FGL elevation beyond that explained by weight loss (residual regression analyses; P < 0.05). CONCLUSION Diet-induced FGL elevation may reflect insulin sensitivity recovery and VAT regression beyond weight loss, specifically among men. Green-MED diet is associated with greater FGL elevation.
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Affiliation(s)
- Gal Tsaban
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- Soroka University Medical Center, Beer-Sheva, Israel
| | - Anat Yaskolka Meir
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Hila Zelicha
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Ehud Rinott
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Alon Kaplan
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Aryeh Shalev
- Soroka University Medical Center, Beer-Sheva, Israel
| | - Amos Katz
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Dov Brikner
- Nuclear Research Center Negev, Department of Medicine, Dimona, Israel
| | - Matthias Blüher
- Department of Medicine, University of Leipzig, Leipzig, Germany
| | - Uta Ceglarek
- Department of Medicine, University of Leipzig, Leipzig, Germany
| | | | - Meir J Stampfer
- Harvard T.H. Chan School of Public Health and Channing Division of Network Medicine, Department of Medicine, Harvard Medical School and Brigham and Women's Hospital, Boston, MA, USA
| | - Iris Shai
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- Harvard T.H. Chan School of Public Health and Channing Division of Network Medicine, Department of Medicine, Harvard Medical School and Brigham and Women's Hospital, Boston, MA, USA
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Tsaban G. Routine periodic fasting reduces all-cause mortality and heart failure incidence: new insights on old habits. Eur J Prev Cardiol 2022; 28:1782-1783. [DOI: 10.1093/eurjpc/zwaa057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Gal Tsaban
- The S. Daniel Abraham International Center for Health and Nutrition, Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, P.O. Box 653, 84105, Beersheba, Israel
- Internal Medicine Department E, Soroka University Medical Center, Yitzhack I. Rager Blvd. 151, 84101, Beersheba, Israel
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Kaplan A, Zelicha H, Yaskolka Meir A, Rinott E, Tsaban G, Levakov G, Prager O, Salti M, Yovell Y, Ofer J, Huhn S, Beyer F, Witte V, Villringer A, Meiran N, B Emesh T, Kovacs P, von Bergen M, Ceglarek U, Blüher M, Stumvoll M, Hu FB, Stampfer MJ, Friedman A, Shelef I, Avidan G, Shai I. The effect of a high-polyphenol Mediterranean diet (Green-MED) combined with physical activity on age-related brain atrophy: the Dietary Intervention Randomized Controlled Trial Polyphenols Unprocessed Study (DIRECT PLUS). Am J Clin Nutr 2022; 115:1270-1281. [PMID: 35021194 PMCID: PMC9071484 DOI: 10.1093/ajcn/nqac001] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Accepted: 01/08/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The effect of diet on age-related brain atrophy is largely unproven. OBJECTIVES We aimed to explore the effect of a Mediterranean diet (MED) higher in polyphenols and lower in red/processed meat (Green-MED diet) on age-related brain atrophy. METHODS This 18-mo clinical trial longitudinally measured brain structure volumes by MRI using hippocampal occupancy score (HOC) and lateral ventricle volume (LVV) expansion score as neurodegeneration markers. Abdominally obese/dyslipidemic participants were randomly assigned to follow 1) healthy dietary guidelines (HDG), 2) MED, or 3) Green-MED diet. All subjects received free gym memberships and physical activity guidance. Both MED groups consumed 28 g walnuts/d (+440 mg/d polyphenols). The Green-MED group consumed green tea (3-4 cups/d) and Mankai (Wolffia-globosa strain, 100 g frozen cubes/d) green shake (+800 mg/d polyphenols). RESULTS Among 284 participants (88% men; mean age: 51 y; BMI: 31.2 kg/m2; APOE-ε4 genotype = 15.7%), 224 (79%) completed the trial with eligible whole-brain MRIs. The pallidum (-4.2%), third ventricle (+3.9%), and LVV (+2.2%) disclosed the largest volume changes. Compared with younger participants, atrophy was accelerated among those ≥50 y old (HOC change: -1.0% ± 1.4% compared with -0.06% ± 1.1%; 95% CI: 0.6%, 1.3%; P < 0.001; LVV change: 3.2% ± 4.5% compared with 1.3% ± 4.1%; 95% CI: -3.1%, -0.8%; P = 0.001). In subjects ≥ 50 y old, HOC decline and LVV expansion were attenuated in both MED groups, with the best outcomes among Green-MED diet participants, as compared with HDG (HOC: -0.8% ± 1.6% compared with -1.3% ± 1.4%; 95% CI: -1.5%, -0.02%; P = 0.042; LVV: 2.3% ± 4.7% compared with 4.3% ± 4.5%; 95% CI: 0.3%, 5.2%; P = 0.021). Similar patterns were observed among younger subjects. Improved insulin sensitivity over the trial was the parameter most strongly associated with brain atrophy attenuation (P < 0.05). Greater Mankai, green tea, and walnut intake and less red and processed meat were significantly and independently associated with reduced HOC decline (P < 0.05). Elevated urinary concentrations of the polyphenols urolithin-A (r = 0.24; P = 0.013) and tyrosol (r = 0.26; P = 0.007) were significantly associated with lower HOC decline. CONCLUSIONS A Green-MED (high-polyphenol) diet, rich in Mankai, green tea, and walnuts and low in red/processed meat, is potentially neuroprotective for age-related brain atrophy.This trial was registered at clinicaltrials.gov as NCT03020186.
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Affiliation(s)
- Alon Kaplan
- The Health & Nutrition Innovative International Research Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Hila Zelicha
- The Health & Nutrition Innovative International Research Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Anat Yaskolka Meir
- The Health & Nutrition Innovative International Research Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Ehud Rinott
- The Health & Nutrition Innovative International Research Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Gal Tsaban
- The Health & Nutrition Innovative International Research Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel,Soroka University Medical Center, Beer-Sheva, Israel
| | - Gidon Levakov
- Department of Cognitive and Brain Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel,Zlotowski Center for Neuroscience, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Ofer Prager
- Zlotowski Center for Neuroscience, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Moti Salti
- Zlotowski Center for Neuroscience, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Yoram Yovell
- Department of Medical Neurobiology, The Hebrew University-Hadassah School of Medicine, Jerusalem, Israel
| | - Jonathan Ofer
- Zlotowski Center for Neuroscience, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Sebastian Huhn
- Helmholtz Centre for Environmental Research (UFZ), Leipzig, Germany
| | - Frauke Beyer
- Department of Neurology, Max-Planck-Institute for Human Cognitive and Brain Sciences, and Cognitive Neurology, University of Leipzig Medical Center, Leipzig, Germany
| | - Veronica Witte
- Department of Neurology, Max-Planck-Institute for Human Cognitive and Brain Sciences, and Cognitive Neurology, University of Leipzig Medical Center, Leipzig, Germany
| | - Arno Villringer
- Department of Neurology, Max-Planck-Institute for Human Cognitive and Brain Sciences, and Cognitive Neurology, University of Leipzig Medical Center, Leipzig, Germany
| | - Nachshon Meiran
- Department of Cognitive and Brain Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Tamar B Emesh
- Department of Cognitive and Brain Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Peter Kovacs
- Integrated Research and Treatment Center (IFB) Adiposity Diseases, Leipzig University Medical Center, Leipzig, Germany
| | - Martin von Bergen
- Department of Molecular Systems Biology, Helmholtz Centre for Environmental Research (UFZ), Leipzig, Germany
| | - Uta Ceglarek
- Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, University Hospital Leipzig, Leipzig, Germany
| | - Matthias Blüher
- Department of Medicine, Leipzig University, Leipzig, Germany
| | | | - Frank B Hu
- Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA, USA,Department of Medicine, Harvard Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Meir J Stampfer
- Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA, USA,Department of Medicine, Harvard Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Alon Friedman
- Zlotowski Center for Neuroscience, Ben-Gurion University of the Negev, Beer-Sheva, Israel,Department of Medical Neuroscience, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Ilan Shelef
- The Health & Nutrition Innovative International Research Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel,Soroka University Medical Center, Beer-Sheva, Israel
| | - Galia Avidan
- Department of Cognitive and Brain Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel,Zlotowski Center for Neuroscience, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Iris Shai
- Address correspondence to I Shai (e-mail: )
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Tsaban G. Statins and lipoprotein(a); facing the residual risk. Eur J Prev Cardiol 2021; 29:777-778. [PMID: 34904162 DOI: 10.1093/eurjpc/zwab178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Gal Tsaban
- Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beersheba, Israel.,Department of Cardiology, Heart Institute, Rager Av. 101, Beersheba, 84101, Israel
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Yaskolka Meir A, Rinott E, Tsaban G, Zelicha H, Kaplan A, Rosen P, Shelef I, Youngster I, Shalev A, Blüher M, Ceglarek U, Stumvoll M, Tuohy K, Diotallevi C, Vrhovsek U, Hu F, Stampfer M, Shai I. Effect of green-Mediterranean diet on intrahepatic fat: the DIRECT PLUS randomised controlled trial. Gut 2021; 70:2085-2095. [PMID: 33461965 PMCID: PMC8515100 DOI: 10.1136/gutjnl-2020-323106] [Citation(s) in RCA: 106] [Impact Index Per Article: 35.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 11/23/2020] [Accepted: 11/28/2020] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To examine the effectiveness of green-Mediterranean (MED) diet, further restricted in red/processed meat, and enriched with green plants and polyphenols on non-alcoholic fatty liver disease (NAFLD), reflected by intrahepatic fat (IHF) loss. DESIGN For the DIRECT-PLUS 18-month randomized clinical trial, we assigned 294 participants with abdominal obesity/dyslipidaemia into healthy dietary guidelines (HDG), MED and green-MED weight-loss diet groups, all accompanied by physical activity. Both isocaloric MED groups consumed 28 g/day walnuts (+440 mg/day polyphenols provided). The green-MED group further consumed green tea (3-4 cups/day) and Mankai (a Wolffia globosa aquatic plant strain; 100 g/day frozen cubes) green shake (+1240 mg/day total polyphenols provided). IHF% 18-month changes were quantified continuously by proton magnetic resonance spectroscopy (MRS). RESULTS Participants (age=51 years; 88% men; body mass index=31.3 kg/m2; median IHF%=6.6%; mean=10.2%; 62% with NAFLD) had 89.8% 18-month retention-rate, and 78% had eligible follow-up MRS. Overall, NAFLD prevalence declined to: 54.8% (HDG), 47.9% (MED) and 31.5% (green-MED), p=0.012 between groups. Despite similar moderate weight-loss in both MED groups, green-MED group achieved almost double IHF% loss (-38.9% proportionally), as compared with MED (-19.6% proportionally; p=0.035 weight loss adjusted) and HDG (-12.2% proportionally; p<0.001). After 18 months, both MED groups had significantly higher total plasma polyphenol levels versus HDG, with higher detection of Naringenin and 2-5-dihydroxybenzoic-acid in green-MED. Greater IHF% loss was independently associated with increased Mankai and walnuts intake, decreased red/processed meat consumption, improved serum folate and adipokines/lipids biomarkers, changes in microbiome composition (beta-diversity) and specific bacteria (p<0.05 for all). CONCLUSION The new suggested strategy of green-Mediterranean diet, amplified with green plant-based proteins/polyphenols as Mankai, green tea, and walnuts, and restricted in red/processed meat can double IHF loss than other healthy nutritional strategies and reduce NAFLD in half. TRIAL REGISTRATION NUMBER NCT03020186.
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Affiliation(s)
- Anat Yaskolka Meir
- Department of Public Health, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Ehud Rinott
- Department of Public Health, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Gal Tsaban
- Department of Public Health, Ben-Gurion University of the Negev, Beer-Sheva, Israel,Division of Cardiology, Soroka Medical Center, Beer Sheva, Israel
| | - Hila Zelicha
- Department of Public Health, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Alon Kaplan
- Department of Public Health, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Philip Rosen
- Division of Diagnostic and Interventional Imaging, Soroka University Medical Center, Beer Sheva, Israel
| | - Ilan Shelef
- Division of Diagnostic and Interventional Imaging, Soroka University Medical Center, Beer Sheva, Israel
| | - Ilan Youngster
- Pediatric Division and Center for Microbiome Research, Shamir Medical Center, Be’er Ya’akov, Israel
| | - Aryeh Shalev
- Division of Cardiology, Soroka Medical Center, Beer Sheva, Israel
| | - Matthias Blüher
- Medical Department III – Endocrinology, Nephrology, Rheumatology, Leipzig University, Leipzig, Germany
| | - Uta Ceglarek
- Institute for Laboratory Medicine, Leipzig University, Leipzig, Germany
| | - Michael Stumvoll
- Medical Department III – Endocrinology, Nephrology, Rheumatology, Leipzig University, Leipzig, Germany
| | - Kieran Tuohy
- Food Quality and Nutrition, Research and Innovation Centre, Fondazione Edmund Mach, San Michelle All'Adige, Italy
| | - Camilla Diotallevi
- Food Quality and Nutrition, Research and Innovation Centre, Fondazione Edmund Mach, San Michelle All'Adige, Italy,Faculty of Science and Technology, Free University of Bozen-Bolzano, Bolzano, Italy
| | - Urska Vrhovsek
- Faculty of Science and Technology, Free University of Bozen-Bolzano, Bolzano, Italy
| | - Frank Hu
- Department of Nutrition, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA,Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Meir Stampfer
- Department of Nutrition, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA,Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Iris Shai
- Department of Public Health, Ben-Gurion University of the Negev, Beer-Sheva, Israel .,Department of Nutrition, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
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Tsaban G, Bilitzky-Kopit A, Yaskolka Meir A, Zelicha H, Gepner Y, Shelef I, Orr O, Chassidim Y, Sarusi B, Ceglarek U, Stumvoll M, Blüher M, Stampfer MJ, Shai I, Schwarzfuchs D. The Effect of Weight-Loss Interventions on Cervical and Chin Subcutaneous Fat Depots; the CENTRAL Randomized Controlled Trial. Nutrients 2021; 13:nu13113827. [PMID: 34836081 PMCID: PMC8617936 DOI: 10.3390/nu13113827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 10/24/2021] [Accepted: 10/26/2021] [Indexed: 11/16/2022] Open
Abstract
Accumulation of cervical and chin subcutaneous adipose tissues (SAT) represent known phenotypes of obesity. We aimed to evaluate the sensitivity of these fat storages to long-term weight-loss directed lifestyle-intervention and to assess their relations to bodily-adiposity, insulin-resistance, and cardiometabolic risk; We randomly assigned 278 participants with abdominal-obesity/dyslipidemia to low-fat or Mediterranean/low-carbohydrate diets +/- physical-activity. All participants underwent an 18 month whole-body magnetic resonance imaging follow-up, from which we assessed cervical and chin SAT-areas; Participants (age = 48 years; 90% men; body-mass-index = 30.9 kg/m2) had an 18-month adherence-rate of 86%. Cervical-SAT and chin-SAT decreased after 6-months (-13.1% and -5.3%, respectively, p < 0.001). After 18-months only cervical-SAT remained decreased compared to baseline (-5%, p < 0.001). Cervical and chin-SAT 18-month changes were associated with changes in weight (r = 0.70, r = 0.66 respectively; <0.001 for both) and visceral-adipose-tissue (VAT; r = 0.35, r = 0.42 respectively; <0.001 for both). After adjustment to VAT, waist-circumference, or weight-changes, chin-SAT 18-month reduction was associated with favorable changes in fasting-glucose (β = 0.10; p = 0.05), HbA1c (β = 0.12; p = 0.03), and homeostasis-model-assessment-of-insulin-resistance (β = 0.12; p = 0.03). Cervical-SAT 18-month reduction was associated with decreased triglycerides (β = 0.16; p = 0.02) and leptin (β = 0.19; p = 0.01) independent of VAT; Cervical and chin-SATs are dynamic fat depots that correspond with weight-loss and are associated with changes in cardiometabolic profile. In long-term, chin-SAT displays a larger rebound compared with cervical-SAT. Chin-SAT accumulation is associated with in insulin-resistance, independent of central obesity. (ClinicalTrials identifier NCT01530724).
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Affiliation(s)
- Gal Tsaban
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 84105, Israel; (A.B.-K.); (A.Y.M.); (H.Z.); (O.O.); (I.S.)
- Department of Cardiology, Soroka University Medical Center, Beer-Sheva 84101, Israel
- Correspondence: ; Tel.: +972-8-647-7449/3
| | - Avital Bilitzky-Kopit
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 84105, Israel; (A.B.-K.); (A.Y.M.); (H.Z.); (O.O.); (I.S.)
| | - Anat Yaskolka Meir
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 84105, Israel; (A.B.-K.); (A.Y.M.); (H.Z.); (O.O.); (I.S.)
| | - Hila Zelicha
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 84105, Israel; (A.B.-K.); (A.Y.M.); (H.Z.); (O.O.); (I.S.)
| | - Yftach Gepner
- Department of Epidemiology and Preventive Medicine, Sackler Faculty of Medicine, and Sylvan Adams Sports Institute, School of Public Health, Tel-Aviv University, Tel-Aviv 96678, Israel;
| | - Ilan Shelef
- Division of Clinical Radiology, Soroka University Medical Center, Beer-Sheva 84101, Israel;
| | - Omri Orr
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 84105, Israel; (A.B.-K.); (A.Y.M.); (H.Z.); (O.O.); (I.S.)
| | - Yoash Chassidim
- Research Center, Soroka University Medical Center, Beer-Sheva 84101, Israel;
| | - Benjamin Sarusi
- Department of Medicine, Nuclear Research Center Negev, Dimona 84190, Israel; (B.S.); (D.S.)
| | - Uta Ceglarek
- Department of Medicine, University of Leipzig, 04103 Leipzig, Germany; (U.C.); (M.S.); (M.B.)
| | - Michael Stumvoll
- Department of Medicine, University of Leipzig, 04103 Leipzig, Germany; (U.C.); (M.S.); (M.B.)
| | - Matthias Blüher
- Department of Medicine, University of Leipzig, 04103 Leipzig, Germany; (U.C.); (M.S.); (M.B.)
| | - Meir J. Stampfer
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA;
| | - Iris Shai
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 84105, Israel; (A.B.-K.); (A.Y.M.); (H.Z.); (O.O.); (I.S.)
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA;
| | - Dan Schwarzfuchs
- Department of Medicine, Nuclear Research Center Negev, Dimona 84190, Israel; (B.S.); (D.S.)
- Emergency Medicine Division, Soroka University Medical Center, Beer-Sheva 84101, Israel
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Rinott E, Youngster I, Meir AY, Tsaban G, Kaplan A, Zelicha H, Rubin E, Koren O, Shai I. Autologous fecal microbiota transplantation can retain the metabolic achievements of dietary interventions. Eur J Intern Med 2021; 92:17-23. [PMID: 33883079 DOI: 10.1016/j.ejim.2021.03.038] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 03/24/2021] [Accepted: 03/26/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND We recently reported that autologous fecal microbiota transplantation (aFMT), derived from the time of maximal weight-loss and administrated in the regain-phase, might preserve weight loss and glycemic control in moderately obese subjects, and is associated with specific microbiome signatures. Here, we sought to explore the global effect of aFMT on adipokines, inflammatory markers and blood cholesterol and on the overall gut microbiome preservation. METHODS In the DIRECT-PLUS weight-loss trial, abdominally obese participants were randomized to three distinct weight-loss diets. Following the expected weight loss phase (0-6 m), 90 participants were randomized to receive their personal frozen fecal microbiota or placebo oral capsules (ten 1 g-capsules over ten sessions-total=100 g) during the expected weight regain phase (8-14 m). RESULTS Of the 90 participants (age=52 yr; 0-6 m weight loss=-8.3 kg), 95.6% ingested at least 80/100 oral aFMT/placebo capsules over 6 months. Overall, the gut microbiome community structure was associated with plasma levels of leptin, cholesterol and interleukin-6 at baseline and after 6 m, whereas 6 m (weight loss phase) changes in specific microbiome species associated with the dynamic of leptin and inflammatory biomarkers. Following the 8-14 m aFMT administration phase, aFMT maintained decreased levels of leptin (ΔaFMT=-3.54 ng/mL vs. Δplacebo=-0.82 ng/mL;P = 0.04), C-reactive-protein (ΔaFMT=-1.45 mg/L vs. Δplacebo=-0.66 mg/L;P = 0.009), Interleukin-6 (ΔaFMT=-0.03pg/mL vs. Δplacebo=1.11pg/mL;P = 0.03) and total cholesterol (ΔaFMT=2.2 mg/dl vs. Δplacebo=13.1 mg/dl;P = 0.04) achieved in the weight loss phase. Overall, aFMT induced a significant preservatory effect on personal gut microbiome global composition (P = 0.03;Jensen-Shannon distance), as compared to placebo. CONCLUSIONS aFMT treatment in the regain phase might retain weight-loss induced metabolic benefits. These findings may suggest a novel aFMT treatment approach for personal metabolic attainment preservation.
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Affiliation(s)
- Ehud Rinott
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Ilan Youngster
- Pediatric Division and Center for Microbiome Research, Shamir Medical Center, Be'er Ya'akov, Israel; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Anat Yaskolka Meir
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Gal Tsaban
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Alon Kaplan
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Hila Zelicha
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Elad Rubin
- Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
| | - Omry Koren
- Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
| | - Iris Shai
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel; Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
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50
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Tsaban G, Galante O, Almog Y, Ullman Y, Fuchs L. Feasibility of machine integrated point of care lung ultrasound automatic B-lines tool in the Corona-virus 2019 critical care unit. Crit Care 2021; 25:345. [PMID: 34560883 PMCID: PMC8464101 DOI: 10.1186/s13054-021-03770-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Accepted: 09/13/2021] [Indexed: 12/03/2022]
Affiliation(s)
- Gal Tsaban
- Medical Intensive Care Unit, Soroka University Medical Center, P.O.B 151, Beersheva, Israel.,Department of Cardiology, Soroka University Medical Center, Beersheva, Israel.,Faculty of Health Sciences, Ben Gurion University of the Negev, Beersheva, Israel
| | - Ori Galante
- Medical Intensive Care Unit, Soroka University Medical Center, P.O.B 151, Beersheva, Israel.,Faculty of Health Sciences, Ben Gurion University of the Negev, Beersheva, Israel
| | - Yaniv Almog
- Medical Intensive Care Unit, Soroka University Medical Center, P.O.B 151, Beersheva, Israel.,Faculty of Health Sciences, Ben Gurion University of the Negev, Beersheva, Israel
| | - Yuval Ullman
- Medical Intensive Care Unit, Soroka University Medical Center, P.O.B 151, Beersheva, Israel.,Faculty of Health Sciences, Ben Gurion University of the Negev, Beersheva, Israel
| | - Lior Fuchs
- Medical Intensive Care Unit, Soroka University Medical Center, P.O.B 151, Beersheva, Israel. .,Faculty of Health Sciences, Ben Gurion University of the Negev, Beersheva, Israel.
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