Does Menu Labeling Lead to Healthier Food Choices?

By Lea Borgi, MD
May 16, 2018

Americans consume about a third of their calories outside the home,1 but estimating the calorie count of a restaurant’s meal can be extremely difficult. In a cross-sectional study of 1,877 adults and 330 school age children, two thirds of participants underestimated the calories of fast food meals.2 The larger the ingested meal, the larger the discrepancy between the estimated and the actual calorie content of that meal. In another study, participants consistently underestimated both the fat and calorie content of a range of menu items, where the actual content was up to 2 times greater than expected by consumers.3 Continue reading “Does Menu Labeling Lead to Healthier Food Choices?”

Food and Chemicals: An Unwanted Phthalate Partnership

By Lea Borgi, MD
April 24, 2018

Restaurant meals have more calories, salt, and fat than meals consumed at home.1 Additionally, eating out has been associated with an increased risk of obesity and hypertension.2

The Study

A recently published study found that there is even more reason for concern when it comes to food prepared away from home.3 Indeed, in an analysis of participants in the National Health and Nutrition Examination (NHANES), dining out was associated with a higher exposure to phthalate, an endocrine disrupting chemical (EDC).3 Phthalates, also called plasticizers, are found in several products, including food packaging and personal care products.4 By measuring urinary phthalate metabolites, authors were able to estimate individuals’ cumulative phthalate exposure. Continue reading “Food and Chemicals: An Unwanted Phthalate Partnership”

Assessing the Risks in Live Kidney Donation

By Martina McGrath, MD
February 13, 2018

Kidney transplantation is a life-saving procedure and is associated with at least a doubling in life expectancy of transplant recipients.1 Live-donor kidneys provide better kidney function and longer transplant survival than those from deceased donors. However, live donation is not entirely without risk, Continue reading “Assessing the Risks in Live Kidney Donation”

Type 1 Diabetes: Not Just a Disease of the Young

By Connor Emdin
January 30, 2018

Type 1 diabetes (T1D) is commonly thought of as a disease of children and young adults, with a peak age of diagnosis around 14 years.1 However, adults with T1D may be misdiagnosed as having type 2 diabetes (T2D) due to the much greater prevalence of T2D in older ages.2 Such misdiagnosis of T1D as T2D may have important clinical consequences. Individuals with undiagnosed T1D may be less likely to receive insulin therapy and may present with diabetic ketoacidosis, a life-threatening emergency characterized by elevated blood glucose and ketone levels.3 Continue reading “Type 1 Diabetes: Not Just a Disease of the Young”

Sodium Restriction in Patients with Reduced GFR: Blood Pressure Benefits

By Martina McGrath, MD
October 18, 2017

The typical US diet is comprised of 3.4g of sodium per day on average, whereas current recommendations suggest that sodium intake should be limited to <2g/day for the general population1 and possibly lower for those with hypertension or cardiovascular disease.2 Continue reading “Sodium Restriction in Patients with Reduced GFR: Blood Pressure Benefits”

Increased Risk of Adverse Pregnancy Outcomes after Recovery from Acute Kidney Injury

By Martina McGrath, MD
September 26, 2017

Women with advanced chronic kidney disease (CKD) have long been known to be at increased risk of complications in pregnancy including preeclampsia, pre-term birth, small-for-dates offspring, and progression of underlying CKD following pregnancy.1 However, several recent studies have highlighted a less obvious connection between earlier stages of renal disease and adverse pregnancy outcomes.2,3 Continue reading “Increased Risk of Adverse Pregnancy Outcomes after Recovery from Acute Kidney Injury”

Palliative Care in Advanced Heart Failure

By Connor Emdin
September 20, 2017

Heart failure (HF) is the leading cause of hospitalization for adults over the age of 65 in the United States and is associated with poor short-term survival, with an estimated median survival of 1.5-3 years after diagnosis.1,2 In addition to causing significant morbidity and mortality, HF is associated with reduced quality of life, spiritual distress, depression, and anxiety.3
Continue reading “Palliative Care in Advanced Heart Failure”

Vitamin D Supplementation and Reduced Risk of Upper Respiratory Tract Infections

By Martina M. McGrath, MD
August 30, 2017

As the cooler weather descends and the school year starts, we are again entering the season of viruses, colds, flu, and miscellaneous sniffles. Aside from vaccination and good hand hygiene, what else can we recommend to our patients to reduce their risk of upper respiratory tract infection?

A large meta-analysis of 25 randomized controlled trials of vitamin D supplementation and respiratory tract infections was published in the BMJ earlier this year.1 The researchers accessed patient-level data on 10,933 trial participants treated with supplemental vitamin D versus placebo. The trials included all age ranges, from birth to adults in their 70s , and had varied dosing regimens for vitamin D supplementation. Continue reading “Vitamin D Supplementation and Reduced Risk of Upper Respiratory Tract Infections”

Cardiac Risk Assessment in Young Adults: Predictive Value via the CARDIA Study

By Martina M. McGrath, MD
August 22, 2017

Metabolic changes leading to the development of atherosclerosis can start early in life, and are frequently unrecognized in their early stages. For example, obesity in childhood and young adulthood has repeatedly been shown to increase the risk of cardiovascular disease (CVD) later in life.1,2 Given the current epidemic of obesity, inactivity, and poor diet, this is an issue of great public health importance. Tools aimed at young people that encourage early recognition of modifiable risk factors could have major clinical impact in the long term. However, estimating a young person’s risk of CVD, in the absence of typical CV risk factors such as diabetes or hypertension has proven challenging. The Framingham risk score and similar cardiac risk estimating equations are useful tools in middle-aged and older adults but are poorly validated in younger people due to their low absolute risk and the frequent lack of traditional CV risk factors. Continue reading “Cardiac Risk Assessment in Young Adults: Predictive Value via the CARDIA Study”

Underutilization of Epinephrine for Anaphylaxis in Children

By Martina M. McGrath, MD
August 15, 2017

Food allergies are increasingly common and are reported to affect up to 7% of children.1 The most severe form of allergy is anaphylaxis, which is a rapid onset, potentially life-threatening, allergic reaction. Treatment is by urgent administration of intramuscular epinephrine, and early administration is associated with decreased severity of reaction and reductions in mortality.2 Despite the widespread availability of epinephrine, and extensive efforts in education of families and caregivers about recognition of anaphylaxis, delays in recognizing severe reactions and administering the appropriate treatment are still common.2,3 Continue reading “Underutilization of Epinephrine for Anaphylaxis in Children”