Two new studies from different parts of the world have identified an increase in the incidence of type 1 diabetes in children since the COVID-19 pandemic began, but the reasons still aren’t clear.

The findings from the two studies, in Germany and the United States, align closely, endocrinologist Jane J. Kim, MD, professor of pediatrics and principal investigator of the U.S. study, told this news organization. “I think that the general conclusion based on their data and our data is that there appears to be an increased rate of new type 1 diabetes diagnoses in children since the onset of the pandemic.”

Dr. Kim noted that because her group’s data pertain to just a single center, she is “heartened to see that the [German team’s] general conclusions are the same as ours.” Moreover, she pointed out that other studies examining this question came from Europe early in the pandemic, whereas “now both they [the German group] and we have had the opportunity to look at what’s happening over a longer period of time.”

But the reason for the association remains unclear. Some answers may be forthcoming from a database designed in mid-2020 specifically to examine the relationship between COVID-19 and new-onset diabetes. Called CoviDiab, the registry aims “to establish the extent and characteristics of new-onset, COVID-19–related diabetes and to investigate its pathogenesis, management, and outcomes,” according to the website.

The first new study, a multicenter German diabetes registry study, was published online Jan. 17 in Diabetes Care by Clemens Kamrath, MD, of Justus Liebig University, Giessen, Germany, and colleagues.

The other, from Rady Children’s Hospital of San Diego, was published online Jan. 24 in JAMA Pediatrics by Bethany L. Gottesman, MD, and colleagues, all with the University of California, San Diego.
 

Mechanisms likely to differ for type 1 versus type 2 diabetes

Neither the German nor the U.S. investigators were able to directly correlate current or prior SARS-CoV-2 infection in children with the subsequent development of type 1 diabetes.

Earlier this month, a study from the U.S. Centers for Disease Control and Prevention did examine that issue, but it also included youth with type 2 diabetes and did not separate out the two groups.

Dr. Kim said her institution has also seen an increase in type 2 diabetes among youth since the COVID-19 pandemic began but did not include that in their current article.

“When we started looking at our data, diabetes and COVID-19 in adults had been relatively well established. To see an increase in type 2 [diabetes] was not so surprising to our group. But we had the sense we were seeing more patients with type 1, and when we looked at our hospital that was very much the case. I think that was a surprise to people,” said Dr. Kim.

Although a direct effect of SARS-CoV-2 on pancreatic beta cells has been proposed, in both the German and San Diego datasets the diagnosis of type 1 diabetes was confirmed with autoantibodies that are typically present years prior to the onset of clinical symptoms.

The German group suggests possible other explanations for the link, including the lack of immune system exposure to other common pediatric infections during pandemic-necessitated social distancing – the so-called hygiene hypothesis – as well as the possible role of psychological stress, which several studies have linked to type 1 diabetes.

But as of now, Dr. Kim said, “Nobody really knows.” 
 

Is the effect direct or indirect?

Using data from the multicenter German Diabetes Prospective Follow-up Registry, Dr. Kamrath and colleagues compared the incidence of type 1 diabetes in children and adolescents from Jan. 1, 2020 through June 30, 2021 with the incidence in 2011-2019.

During the pandemic period, a total of 5,162 youth were newly diagnosed with type 1 diabetes at 236 German centers. That incidence, 24.4 per 100,000 patient-years, was significantly higher than the 21.2 per 100,000 patient-years expected based on the prior decade, with an incidence rate ratio of 1.15 (P < .001). The increase was similar in both males and females.

There was a difference by age, however, as the phenomenon appeared to be limited to the preadolescent age groups. The incidence rate ratios (IRRs) for ages below 6 years and 6-11 years were 1.23 and 1.18 (both P < .001), respectively, compared to a nonsignificant IRR of 1.06 (P = .13) in those aged 12-17 years.

Compared with the expected monthly incidence, the observed incidence was significantly higher in June 2020 (IRR, 1.43; P = .003), July 2020 (IRR, 1.48; P < 0.001), March 2021 (IRR, 1.29; P = .028), and June 2021 (IRR, 1.39; P = .01).

Among the 3,851 patients for whom data on type 1 diabetes-associated autoantibodies were available, the adjusted rates of autoantibody negativity did not differ from 2018-2019 during the entire pandemic period or during the year 2020 or the first half of 2021.  

“Therefore, the increase in the incidence of type 1 diabetes in children appears to be due to immune-mediated type 1 diabetes. However, because autoimmunity and progressive beta-cell destruction typically begin long before the clinical diagnosis of type 1 diabetes, we were surprised to see the incidence of type 1 diabetes followed the peak incidence of COVID-19 and also the pandemic containment measures by only approximately 3 months,” Dr. Kamrath and colleagues write.

Taken together, they say, the data suggest that “the impact on type 1 diabetes incidence is not due to infection with SARS-CoV-2 but rather a consequence of environmental changes resulting from the pandemic itself or pandemic containment measures.”
 

Similar findings at a U.S. children’s hospital

In the cross-sectional study in San Diego, Dr. Gottesman and colleagues looked at the electronic medical records (EMRs) at Rady Children’s Hospital for patients aged younger than 19 years with at least one positive type 1 diabetes antibody titer.

During March 19, 2020 to March 18, 2021, a total of 187 children were admitted for new-onset type 1 diabetes, compared with just 119 the previous year, a 57% increase.

From July 2020 through February 2021, the number of new type 1 diabetes diagnoses significantly exceeded the number expected based on a quarterly moving average of each of the preceding 5 years.

Only four of the 187 patients (2.1%) diagnosed during the pandemic period had a COVID-19 infection at the time of presentation. Antibody testing to assess prior infection wasn’t feasible, and now that children are receiving the vaccine – and therefore most will have antibodies – “we’ve lost our window of opportunity to look at that question,” Dr. Kim noted.   

As has been previously shown, there was an increase in the percentage of patients presenting with diabetic ketoacidosis during the pandemic compared with the prior 5 years (49.7% vs. 40.7% requiring insulin infusion). However, there was no difference in mean age at presentation, body mass index, A1c, or percentage requiring admission to intensive care.

Because these data only go through March 2021, Dr. Kim noted, “We need to see what’s happening with these different variants. We’ll have a chance to look in a month or two to see the effects of Omicron on the rates of diabetes in the hospital.”
 

Will CoviDiab answer the question?

Data from CoviDiab will include diabetes type in adults and children, registry coprincipal investigator Francesco Rubino, MD, of King’s College London, told this news organization.

“We aimed at having as many as possible cases of new-onset diabetes for which we can have also a minimum set of clinical data including type of diabetes and A1c. By looking at this information we can infer whether a role of COVID-19 in triggering diabetes is clinically plausible – or not – and what type of diabetes is most frequently associated with COVID-19 as this also speaks about mechanisms of action.”

Dr. Rubino said that the CoviDiab team is approaching the data with the assumption that, at least in adults diagnosed with type 2 diabetes, the explanation might be that the person already had undiagnosed diabetes or that the hyperglycemia may be stress-induced and temporary.

“We’re looking at this question with a skeptical eye ... Is it just an association, or does the virus have a role in inducing diabetes from scratch, or can the virus advance pathophysiology in a way that it ends up in full-blown diabetes in predisposed individuals?”

While no single study will prove that SARS-CoV-2 causes diabetes, “combining observations from various studies and approaches we may get a higher degree of certainty,” Dr. Rubino said, noting that the CoviDiab team plans to publish data from the first 800 cases “soon.”

Dr. Kim has reported no relevant financial relationships. Dr. Rubino has reported receiving grants from Ethicon and Medtronic, personal fees from GI Dynamic, Keyron, Novo Nordisk, Ethicon, and Medtronic.

A version of this article first appeared on Medscape.com.

Two new studies from different parts of the world have identified an increase in the incidence of type 1 diabetes in children since the COVID-19 pandemic began, but the reasons still aren’t clear.

The findings from the two studies, in Germany and the United States, align closely, endocrinologist Jane J. Kim, MD, professor of pediatrics and principal investigator of the U.S. study, told this news organization. “I think that the general conclusion based on their data and our data is that there appears to be an increased rate of new type 1 diabetes diagnoses in children since the onset of the pandemic.”

Dr. Kim noted that because her group’s data pertain to just a single center, she is “heartened to see that the [German team’s] general conclusions are the same as ours.” Moreover, she pointed out that other studies examining this question came from Europe early in the pandemic, whereas “now both they [the German group] and we have had the opportunity to look at what’s happening over a longer period of time.”

But the reason for the association remains unclear. Some answers may be forthcoming from a database designed in mid-2020 specifically to examine the relationship between COVID-19 and new-onset diabetes. Called CoviDiab, the registry aims “to establish the extent and characteristics of new-onset, COVID-19–related diabetes and to investigate its pathogenesis, management, and outcomes,” according to the website.

The first new study, a multicenter German diabetes registry study, was published online Jan. 17 in Diabetes Care by Clemens Kamrath, MD, of Justus Liebig University, Giessen, Germany, and colleagues.

The other, from Rady Children’s Hospital of San Diego, was published online Jan. 24 in JAMA Pediatrics by Bethany L. Gottesman, MD, and colleagues, all with the University of California, San Diego.
 

Mechanisms likely to differ for type 1 versus type 2 diabetes

Neither the German nor the U.S. investigators were able to directly correlate current or prior SARS-CoV-2 infection in children with the subsequent development of type 1 diabetes.

Earlier this month, a study from the U.S. Centers for Disease Control and Prevention did examine that issue, but it also included youth with type 2 diabetes and did not separate out the two groups.

Dr. Kim said her institution has also seen an increase in type 2 diabetes among youth since the COVID-19 pandemic began but did not include that in their current article.

“When we started looking at our data, diabetes and COVID-19 in adults had been relatively well established. To see an increase in type 2 [diabetes] was not so surprising to our group. But we had the sense we were seeing more patients with type 1, and when we looked at our hospital that was very much the case. I think that was a surprise to people,” said Dr. Kim.

Although a direct effect of SARS-CoV-2 on pancreatic beta cells has been proposed, in both the German and San Diego datasets the diagnosis of type 1 diabetes was confirmed with autoantibodies that are typically present years prior to the onset of clinical symptoms.

The German group suggests possible other explanations for the link, including the lack of immune system exposure to other common pediatric infections during pandemic-necessitated social distancing – the so-called hygiene hypothesis – as well as the possible role of psychological stress, which several studies have linked to type 1 diabetes.

But as of now, Dr. Kim said, “Nobody really knows.” 
 

Is the effect direct or indirect?

Using data from the multicenter German Diabetes Prospective Follow-up Registry, Dr. Kamrath and colleagues compared the incidence of type 1 diabetes in children and adolescents from Jan. 1, 2020 through June 30, 2021 with the incidence in 2011-2019.

During the pandemic period, a total of 5,162 youth were newly diagnosed with type 1 diabetes at 236 German centers. That incidence, 24.4 per 100,000 patient-years, was significantly higher than the 21.2 per 100,000 patient-years expected based on the prior decade, with an incidence rate ratio of 1.15 (P < .001). The increase was similar in both males and females.

There was a difference by age, however, as the phenomenon appeared to be limited to the preadolescent age groups. The incidence rate ratios (IRRs) for ages below 6 years and 6-11 years were 1.23 and 1.18 (both P < .001), respectively, compared to a nonsignificant IRR of 1.06 (P = .13) in those aged 12-17 years.

Compared with the expected monthly incidence, the observed incidence was significantly higher in June 2020 (IRR, 1.43; P = .003), July 2020 (IRR, 1.48; P < 0.001), March 2021 (IRR, 1.29; P = .028), and June 2021 (IRR, 1.39; P = .01).

Among the 3,851 patients for whom data on type 1 diabetes-associated autoantibodies were available, the adjusted rates of autoantibody negativity did not differ from 2018-2019 during the entire pandemic period or during the year 2020 or the first half of 2021.  

“Therefore, the increase in the incidence of type 1 diabetes in children appears to be due to immune-mediated type 1 diabetes. However, because autoimmunity and progressive beta-cell destruction typically begin long before the clinical diagnosis of type 1 diabetes, we were surprised to see the incidence of type 1 diabetes followed the peak incidence of COVID-19 and also the pandemic containment measures by only approximately 3 months,” Dr. Kamrath and colleagues write.

Taken together, they say, the data suggest that “the impact on type 1 diabetes incidence is not due to infection with SARS-CoV-2 but rather a consequence of environmental changes resulting from the pandemic itself or pandemic containment measures.”
 

Similar findings at a U.S. children’s hospital

In the cross-sectional study in San Diego, Dr. Gottesman and colleagues looked at the electronic medical records (EMRs) at Rady Children’s Hospital for patients aged younger than 19 years with at least one positive type 1 diabetes antibody titer.

During March 19, 2020 to March 18, 2021, a total of 187 children were admitted for new-onset type 1 diabetes, compared with just 119 the previous year, a 57% increase.

From July 2020 through February 2021, the number of new type 1 diabetes diagnoses significantly exceeded the number expected based on a quarterly moving average of each of the preceding 5 years.

Only four of the 187 patients (2.1%) diagnosed during the pandemic period had a COVID-19 infection at the time of presentation. Antibody testing to assess prior infection wasn’t feasible, and now that children are receiving the vaccine – and therefore most will have antibodies – “we’ve lost our window of opportunity to look at that question,” Dr. Kim noted.   

As has been previously shown, there was an increase in the percentage of patients presenting with diabetic ketoacidosis during the pandemic compared with the prior 5 years (49.7% vs. 40.7% requiring insulin infusion). However, there was no difference in mean age at presentation, body mass index, A1c, or percentage requiring admission to intensive care.

Because these data only go through March 2021, Dr. Kim noted, “We need to see what’s happening with these different variants. We’ll have a chance to look in a month or two to see the effects of Omicron on the rates of diabetes in the hospital.”
 

Will CoviDiab answer the question?

Data from CoviDiab will include diabetes type in adults and children, registry coprincipal investigator Francesco Rubino, MD, of King’s College London, told this news organization.

“We aimed at having as many as possible cases of new-onset diabetes for which we can have also a minimum set of clinical data including type of diabetes and A1c. By looking at this information we can infer whether a role of COVID-19 in triggering diabetes is clinically plausible – or not – and what type of diabetes is most frequently associated with COVID-19 as this also speaks about mechanisms of action.”

Dr. Rubino said that the CoviDiab team is approaching the data with the assumption that, at least in adults diagnosed with type 2 diabetes, the explanation might be that the person already had undiagnosed diabetes or that the hyperglycemia may be stress-induced and temporary.

“We’re looking at this question with a skeptical eye ... Is it just an association, or does the virus have a role in inducing diabetes from scratch, or can the virus advance pathophysiology in a way that it ends up in full-blown diabetes in predisposed individuals?”

While no single study will prove that SARS-CoV-2 causes diabetes, “combining observations from various studies and approaches we may get a higher degree of certainty,” Dr. Rubino said, noting that the CoviDiab team plans to publish data from the first 800 cases “soon.”

Dr. Kim has reported no relevant financial relationships. Dr. Rubino has reported receiving grants from Ethicon and Medtronic, personal fees from GI Dynamic, Keyron, Novo Nordisk, Ethicon, and Medtronic.

A version of this article first appeared on Medscape.com.

Two new studies from different parts of the world have identified an increase in the incidence of type 1 diabetes in children since the COVID-19 pandemic began, but the reasons still aren’t clear.

The findings from the two studies, in Germany and the United States, align closely, endocrinologist Jane J. Kim, MD, professor of pediatrics and principal investigator of the U.S. study, told this news organization. “I think that the general conclusion based on their data and our data is that there appears to be an increased rate of new type 1 diabetes diagnoses in children since the onset of the pandemic.”

Dr. Kim noted that because her group’s data pertain to just a single center, she is “heartened to see that the [German team’s] general conclusions are the same as ours.” Moreover, she pointed out that other studies examining this question came from Europe early in the pandemic, whereas “now both they [the German group] and we have had the opportunity to look at what’s happening over a longer period of time.”

But the reason for the association remains unclear. Some answers may be forthcoming from a database designed in mid-2020 specifically to examine the relationship between COVID-19 and new-onset diabetes. Called CoviDiab, the registry aims “to establish the extent and characteristics of new-onset, COVID-19–related diabetes and to investigate its pathogenesis, management, and outcomes,” according to the website.

The first new study, a multicenter German diabetes registry study, was published online Jan. 17 in Diabetes Care by Clemens Kamrath, MD, of Justus Liebig University, Giessen, Germany, and colleagues.

The other, from Rady Children’s Hospital of San Diego, was published online Jan. 24 in JAMA Pediatrics by Bethany L. Gottesman, MD, and colleagues, all with the University of California, San Diego.
 

Mechanisms likely to differ for type 1 versus type 2 diabetes

Neither the German nor the U.S. investigators were able to directly correlate current or prior SARS-CoV-2 infection in children with the subsequent development of type 1 diabetes.

Earlier this month, a study from the U.S. Centers for Disease Control and Prevention did examine that issue, but it also included youth with type 2 diabetes and did not separate out the two groups.

Dr. Kim said her institution has also seen an increase in type 2 diabetes among youth since the COVID-19 pandemic began but did not include that in their current article.

“When we started looking at our data, diabetes and COVID-19 in adults had been relatively well established. To see an increase in type 2 [diabetes] was not so surprising to our group. But we had the sense we were seeing more patients with type 1, and when we looked at our hospital that was very much the case. I think that was a surprise to people,” said Dr. Kim.

Although a direct effect of SARS-CoV-2 on pancreatic beta cells has been proposed, in both the German and San Diego datasets the diagnosis of type 1 diabetes was confirmed with autoantibodies that are typically present years prior to the onset of clinical symptoms.

The German group suggests possible other explanations for the link, including the lack of immune system exposure to other common pediatric infections during pandemic-necessitated social distancing – the so-called hygiene hypothesis – as well as the possible role of psychological stress, which several studies have linked to type 1 diabetes.

But as of now, Dr. Kim said, “Nobody really knows.” 
 

Is the effect direct or indirect?

Using data from the multicenter German Diabetes Prospective Follow-up Registry, Dr. Kamrath and colleagues compared the incidence of type 1 diabetes in children and adolescents from Jan. 1, 2020 through June 30, 2021 with the incidence in 2011-2019.

During the pandemic period, a total of 5,162 youth were newly diagnosed with type 1 diabetes at 236 German centers. That incidence, 24.4 per 100,000 patient-years, was significantly higher than the 21.2 per 100,000 patient-years expected based on the prior decade, with an incidence rate ratio of 1.15 (P < .001). The increase was similar in both males and females.

There was a difference by age, however, as the phenomenon appeared to be limited to the preadolescent age groups. The incidence rate ratios (IRRs) for ages below 6 years and 6-11 years were 1.23 and 1.18 (both P < .001), respectively, compared to a nonsignificant IRR of 1.06 (P = .13) in those aged 12-17 years.

Compared with the expected monthly incidence, the observed incidence was significantly higher in June 2020 (IRR, 1.43; P = .003), July 2020 (IRR, 1.48; P < 0.001), March 2021 (IRR, 1.29; P = .028), and June 2021 (IRR, 1.39; P = .01).

Among the 3,851 patients for whom data on type 1 diabetes-associated autoantibodies were available, the adjusted rates of autoantibody negativity did not differ from 2018-2019 during the entire pandemic period or during the year 2020 or the first half of 2021.  

“Therefore, the increase in the incidence of type 1 diabetes in children appears to be due to immune-mediated type 1 diabetes. However, because autoimmunity and progressive beta-cell destruction typically begin long before the clinical diagnosis of type 1 diabetes, we were surprised to see the incidence of type 1 diabetes followed the peak incidence of COVID-19 and also the pandemic containment measures by only approximately 3 months,” Dr. Kamrath and colleagues write.

Taken together, they say, the data suggest that “the impact on type 1 diabetes incidence is not due to infection with SARS-CoV-2 but rather a consequence of environmental changes resulting from the pandemic itself or pandemic containment measures.”
 

Similar findings at a U.S. children’s hospital

In the cross-sectional study in San Diego, Dr. Gottesman and colleagues looked at the electronic medical records (EMRs) at Rady Children’s Hospital for patients aged younger than 19 years with at least one positive type 1 diabetes antibody titer.

During March 19, 2020 to March 18, 2021, a total of 187 children were admitted for new-onset type 1 diabetes, compared with just 119 the previous year, a 57% increase.

From July 2020 through February 2021, the number of new type 1 diabetes diagnoses significantly exceeded the number expected based on a quarterly moving average of each of the preceding 5 years.

Only four of the 187 patients (2.1%) diagnosed during the pandemic period had a COVID-19 infection at the time of presentation. Antibody testing to assess prior infection wasn’t feasible, and now that children are receiving the vaccine – and therefore most will have antibodies – “we’ve lost our window of opportunity to look at that question,” Dr. Kim noted.   

As has been previously shown, there was an increase in the percentage of patients presenting with diabetic ketoacidosis during the pandemic compared with the prior 5 years (49.7% vs. 40.7% requiring insulin infusion). However, there was no difference in mean age at presentation, body mass index, A1c, or percentage requiring admission to intensive care.

Because these data only go through March 2021, Dr. Kim noted, “We need to see what’s happening with these different variants. We’ll have a chance to look in a month or two to see the effects of Omicron on the rates of diabetes in the hospital.”
 

Will CoviDiab answer the question?

Data from CoviDiab will include diabetes type in adults and children, registry coprincipal investigator Francesco Rubino, MD, of King’s College London, told this news organization.

“We aimed at having as many as possible cases of new-onset diabetes for which we can have also a minimum set of clinical data including type of diabetes and A1c. By looking at this information we can infer whether a role of COVID-19 in triggering diabetes is clinically plausible – or not – and what type of diabetes is most frequently associated with COVID-19 as this also speaks about mechanisms of action.”

Dr. Rubino said that the CoviDiab team is approaching the data with the assumption that, at least in adults diagnosed with type 2 diabetes, the explanation might be that the person already had undiagnosed diabetes or that the hyperglycemia may be stress-induced and temporary.

“We’re looking at this question with a skeptical eye ... Is it just an association, or does the virus have a role in inducing diabetes from scratch, or can the virus advance pathophysiology in a way that it ends up in full-blown diabetes in predisposed individuals?”

While no single study will prove that SARS-CoV-2 causes diabetes, “combining observations from various studies and approaches we may get a higher degree of certainty,” Dr. Rubino said, noting that the CoviDiab team plans to publish data from the first 800 cases “soon.”

Dr. Kim has reported no relevant financial relationships. Dr. Rubino has reported receiving grants from Ethicon and Medtronic, personal fees from GI Dynamic, Keyron, Novo Nordisk, Ethicon, and Medtronic.

A version of this article first appeared on Medscape.com.

Dietary guidelines provide scientifically sound and practical advice that, if followed by every person, would probably result in less obesity, type 2 diabetes, cardiovascular disease, cancer, and bone loss. But few US adults meet these recommendations, according to a recent report in the CDC’s Morbidity and Mortality Weekly Report (MMWR).¹

Data from the 2019 Behavioral Risk Factor Surveillance system indicate that only 12.3% of US adults consumed the recommended amount of fruit and 10% the recommended amount of vegetables (more on that shortly). Women were more likely than men to meet the requirements for fruit (14.5% vs 10.1%) and vegetable (12.4% vs 7.6%) intake. The vegetable recommendation was more likely to be met by those in higher income households than those in the lowest income categories (12.2% vs 6.8%).¹

Just what’s recommended? The most recent dietary guidelines from the Department of Agriculture suggest that adults should consume 1.5 to 2 cup-equivalents of fruits and 2 to 3 cup-equivalents of vegetables each day.² What is a cup-equivalent? Examples include: 1 cup of a raw, or cooked, vegetable or fruit; 1 cup of fruit juice; 2 cups of leafy salad greens; or 1/2 cup of a dried fruit or vegetable. Additional recommendations are that added sugar constitute < 10% of calories per day, saturated fat < 10% of calories per day, and sodium < 2300 mg per day.

Simplify the message to this … There’s an easy message for clinicians to provide to patients: Consume 2 cups of fruit and 2 to 3 cups of vegetables per day; increase intake of whole grains, seafood, nuts, and seeds; choose fat-free and low-fat dairy products; and avoid sugary beverages and foods. But as we know, recommending that patients do something and actually having them do it are often 2 different things. So how can we tip the scales in a healthier direction?

Advise patients not to go it alone. The US Preventive Services Task Force recommends intensive behavioral interventions to alter eating habits. These interventions include individual or group counseling sessions over extended periods (eg, 6 hours of contact time over 6 to 18 months), including some 1-on-1 time with a specially trained professional, such as a primary care physician, nurse, registered dietitian, or nutritionist. The good news is that, for those with cardiovascular risk factors (dyslipidemia, elevated blood pressure, type 2 diabetes, and hypertension), this is a level “B” recommendation—meaning these interventions should be covered by commercial health insurance with no out-of-pocket cost to patients.³

Dietary guidelines provide scientifically sound and practical advice that, if followed by every person, would probably result in less obesity, type 2 diabetes, cardiovascular disease, cancer, and bone loss. But few US adults meet these recommendations, according to a recent report in the CDC’s Morbidity and Mortality Weekly Report (MMWR).¹

Data from the 2019 Behavioral Risk Factor Surveillance system indicate that only 12.3% of US adults consumed the recommended amount of fruit and 10% the recommended amount of vegetables (more on that shortly). Women were more likely than men to meet the requirements for fruit (14.5% vs 10.1%) and vegetable (12.4% vs 7.6%) intake. The vegetable recommendation was more likely to be met by those in higher income households than those in the lowest income categories (12.2% vs 6.8%).¹

Just what’s recommended? The most recent dietary guidelines from the Department of Agriculture suggest that adults should consume 1.5 to 2 cup-equivalents of fruits and 2 to 3 cup-equivalents of vegetables each day.² What is a cup-equivalent? Examples include: 1 cup of a raw, or cooked, vegetable or fruit; 1 cup of fruit juice; 2 cups of leafy salad greens; or 1/2 cup of a dried fruit or vegetable. Additional recommendations are that added sugar constitute < 10% of calories per day, saturated fat < 10% of calories per day, and sodium < 2300 mg per day.

Simplify the message to this … There’s an easy message for clinicians to provide to patients: Consume 2 cups of fruit and 2 to 3 cups of vegetables per day; increase intake of whole grains, seafood, nuts, and seeds; choose fat-free and low-fat dairy products; and avoid sugary beverages and foods. But as we know, recommending that patients do something and actually having them do it are often 2 different things. So how can we tip the scales in a healthier direction?

Advise patients not to go it alone. The US Preventive Services Task Force recommends intensive behavioral interventions to alter eating habits. These interventions include individual or group counseling sessions over extended periods (eg, 6 hours of contact time over 6 to 18 months), including some 1-on-1 time with a specially trained professional, such as a primary care physician, nurse, registered dietitian, or nutritionist. The good news is that, for those with cardiovascular risk factors (dyslipidemia, elevated blood pressure, type 2 diabetes, and hypertension), this is a level “B” recommendation—meaning these interventions should be covered by commercial health insurance with no out-of-pocket cost to patients.³

Dietary guidelines provide scientifically sound and practical advice that, if followed by every person, would probably result in less obesity, type 2 diabetes, cardiovascular disease, cancer, and bone loss. But few US adults meet these recommendations, according to a recent report in the CDC’s Morbidity and Mortality Weekly Report (MMWR).¹

Data from the 2019 Behavioral Risk Factor Surveillance system indicate that only 12.3% of US adults consumed the recommended amount of fruit and 10% the recommended amount of vegetables (more on that shortly). Women were more likely than men to meet the requirements for fruit (14.5% vs 10.1%) and vegetable (12.4% vs 7.6%) intake. The vegetable recommendation was more likely to be met by those in higher income households than those in the lowest income categories (12.2% vs 6.8%).¹

Just what’s recommended? The most recent dietary guidelines from the Department of Agriculture suggest that adults should consume 1.5 to 2 cup-equivalents of fruits and 2 to 3 cup-equivalents of vegetables each day.² What is a cup-equivalent? Examples include: 1 cup of a raw, or cooked, vegetable or fruit; 1 cup of fruit juice; 2 cups of leafy salad greens; or 1/2 cup of a dried fruit or vegetable. Additional recommendations are that added sugar constitute < 10% of calories per day, saturated fat < 10% of calories per day, and sodium < 2300 mg per day.

Simplify the message to this … There’s an easy message for clinicians to provide to patients: Consume 2 cups of fruit and 2 to 3 cups of vegetables per day; increase intake of whole grains, seafood, nuts, and seeds; choose fat-free and low-fat dairy products; and avoid sugary beverages and foods. But as we know, recommending that patients do something and actually having them do it are often 2 different things. So how can we tip the scales in a healthier direction?

Advise patients not to go it alone. The US Preventive Services Task Force recommends intensive behavioral interventions to alter eating habits. These interventions include individual or group counseling sessions over extended periods (eg, 6 hours of contact time over 6 to 18 months), including some 1-on-1 time with a specially trained professional, such as a primary care physician, nurse, registered dietitian, or nutritionist. The good news is that, for those with cardiovascular risk factors (dyslipidemia, elevated blood pressure, type 2 diabetes, and hypertension), this is a level “B” recommendation—meaning these interventions should be covered by commercial health insurance with no out-of-pocket cost to patients.³

The Diagnosis: Gamasoidosis

An entomologist confirmed the specimen as an avian mite in either the Dermanyssus or Ornithonyssus genera (quiz image [bottom]). The patient was asked whether any bird had nested around her bedroom, and she affirmed that a woodpecker had nested outside her bedroom closet that spring. She subsequently discovered it had burrowed a hole into her closet wall. She and her husband removed the nest, and within 4 weeks, the eruption permanently cleared.

Gamasoidosis, or avian mite dermatitis, often is an overlooked, difficult-to-make diagnosis that is increasing in prevalence.¹ Bird mites are ectoparasitic arthropods that are 0.3 to 1 mm in length. They have egg-shaped bodies with 4 pairs of legs; they are a translucent brown color before feeding and red after feeding.² Although most avian mites cannot subsist off human blood, if the mites are without an avian host, such as after affected birds abandon their nests, the mites will bite humans.³ Studies have discovered the presence of mammalian erythrocytes in the digestive tracts of one species of bird mite, Dermanyssus gallinae, suggesting that at least one form of avian mite may feed off humans but typically cannot reproduce without an avian blood meal.⁴ Individuals with gamasoidosis often are exposed to avian mites by owning birds as pets, rearing chickens or messenger pigeons, or having bird’s nests around their bedrooms or air conditioning units.¹

Most people who develop avian mite dermatitis are the only affected member of the family to develop pruritus and papules since the reaction requires both bites and hypersensitivity to them; however, there are cases of nuclear families all reacting to avian mite bites.^2,4 As in this case, hypersensitivity to avian mite bites causes exquisitely pruritic 2- to 5-mm papules, vesicles, or urticarial lesions that may be diagnosed as papular urticaria or misdiagnosed as scabies. Although bird mites may carry bacteria such as Salmonella, Spirochaete, Rickettsia, and Pasteurella, they have not demonstrated an ability to pass these on to human vectors.^5,6

Bird mites will spend most of their lives on avian hosts but can spread to humans through direct contact or through air.⁷ Mites can go through floors, walls, ceilings, or most commonly through ventilation or air conditioning units. Increasing urbanization, especially in warmer climates where avian mites thrive, has increased the prevalence of gamasoidosis.¹

Avian mite dermatitis commonly can be mistaken for scabies, but the mites can be seen with the naked eye and cannot form burrows, unlike scabies.^4,8 Avian mites usually are not found on human skin since they leave the host after feeding and move with surprising speed.⁸ Pediculosis corporis (body lice) results from an infestation of Pediculus humanus corporis. At 2- to 4-mm long, this louse is much larger than a bird mite. Body lice rarely are found on the skin but rather live and lay eggs on clothing, particularly along the seams. The body louse has an elongated body with 3 segments and short antennae. Pthirus pubis (pubic lice) measure 1.5 to 2.0 mm in adulthood and have wider, more crablike bodies compared to body or hair lice or avian mites. Lice, being insects, have 6 legs as opposed to mites, being arachnids, having 8 legs. Cheyletiella are 0.5-mm long, nonburrowing mites commonly found on cats, dogs, and rabbits. Cheyletiella blakei affects cats. They look somewhat similar to bird mites but have hooklike palps extending from their heads instead of antennae.

Antihistamines and topical corticosteroids may reduce discomfort from avian bites but are not curative.^2,9 The most efficient way to treat gamasoidosis is to remove any affected birds or nearby bird’s nests, as the mites cannot survive more than a few weeks to months without feeding on an avian host.⁸ It also may be necessary to fumigate infested rooms.¹⁰

The diagnosis of avian mite dermatitis often is missed to the frustration of the patient and clinician alike. Becoming familiar with this bite reaction will help clinicians diagnose this dermatologic conundrum.

The Diagnosis: Gamasoidosis

An entomologist confirmed the specimen as an avian mite in either the Dermanyssus or Ornithonyssus genera (quiz image [bottom]). The patient was asked whether any bird had nested around her bedroom, and she affirmed that a woodpecker had nested outside her bedroom closet that spring. She subsequently discovered it had burrowed a hole into her closet wall. She and her husband removed the nest, and within 4 weeks, the eruption permanently cleared.

Gamasoidosis, or avian mite dermatitis, often is an overlooked, difficult-to-make diagnosis that is increasing in prevalence.¹ Bird mites are ectoparasitic arthropods that are 0.3 to 1 mm in length. They have egg-shaped bodies with 4 pairs of legs; they are a translucent brown color before feeding and red after feeding.² Although most avian mites cannot subsist off human blood, if the mites are without an avian host, such as after affected birds abandon their nests, the mites will bite humans.³ Studies have discovered the presence of mammalian erythrocytes in the digestive tracts of one species of bird mite, Dermanyssus gallinae, suggesting that at least one form of avian mite may feed off humans but typically cannot reproduce without an avian blood meal.⁴ Individuals with gamasoidosis often are exposed to avian mites by owning birds as pets, rearing chickens or messenger pigeons, or having bird’s nests around their bedrooms or air conditioning units.¹

Most people who develop avian mite dermatitis are the only affected member of the family to develop pruritus and papules since the reaction requires both bites and hypersensitivity to them; however, there are cases of nuclear families all reacting to avian mite bites.^2,4 As in this case, hypersensitivity to avian mite bites causes exquisitely pruritic 2- to 5-mm papules, vesicles, or urticarial lesions that may be diagnosed as papular urticaria or misdiagnosed as scabies. Although bird mites may carry bacteria such as Salmonella, Spirochaete, Rickettsia, and Pasteurella, they have not demonstrated an ability to pass these on to human vectors.^5,6

Bird mites will spend most of their lives on avian hosts but can spread to humans through direct contact or through air.⁷ Mites can go through floors, walls, ceilings, or most commonly through ventilation or air conditioning units. Increasing urbanization, especially in warmer climates where avian mites thrive, has increased the prevalence of gamasoidosis.¹

Avian mite dermatitis commonly can be mistaken for scabies, but the mites can be seen with the naked eye and cannot form burrows, unlike scabies.^4,8 Avian mites usually are not found on human skin since they leave the host after feeding and move with surprising speed.⁸ Pediculosis corporis (body lice) results from an infestation of Pediculus humanus corporis. At 2- to 4-mm long, this louse is much larger than a bird mite. Body lice rarely are found on the skin but rather live and lay eggs on clothing, particularly along the seams. The body louse has an elongated body with 3 segments and short antennae. Pthirus pubis (pubic lice) measure 1.5 to 2.0 mm in adulthood and have wider, more crablike bodies compared to body or hair lice or avian mites. Lice, being insects, have 6 legs as opposed to mites, being arachnids, having 8 legs. Cheyletiella are 0.5-mm long, nonburrowing mites commonly found on cats, dogs, and rabbits. Cheyletiella blakei affects cats. They look somewhat similar to bird mites but have hooklike palps extending from their heads instead of antennae.

Antihistamines and topical corticosteroids may reduce discomfort from avian bites but are not curative.^2,9 The most efficient way to treat gamasoidosis is to remove any affected birds or nearby bird’s nests, as the mites cannot survive more than a few weeks to months without feeding on an avian host.⁸ It also may be necessary to fumigate infested rooms.¹⁰

The diagnosis of avian mite dermatitis often is missed to the frustration of the patient and clinician alike. Becoming familiar with this bite reaction will help clinicians diagnose this dermatologic conundrum.

The Diagnosis: Gamasoidosis

An entomologist confirmed the specimen as an avian mite in either the Dermanyssus or Ornithonyssus genera (quiz image [bottom]). The patient was asked whether any bird had nested around her bedroom, and she affirmed that a woodpecker had nested outside her bedroom closet that spring. She subsequently discovered it had burrowed a hole into her closet wall. She and her husband removed the nest, and within 4 weeks, the eruption permanently cleared.

Gamasoidosis, or avian mite dermatitis, often is an overlooked, difficult-to-make diagnosis that is increasing in prevalence.¹ Bird mites are ectoparasitic arthropods that are 0.3 to 1 mm in length. They have egg-shaped bodies with 4 pairs of legs; they are a translucent brown color before feeding and red after feeding.² Although most avian mites cannot subsist off human blood, if the mites are without an avian host, such as after affected birds abandon their nests, the mites will bite humans.³ Studies have discovered the presence of mammalian erythrocytes in the digestive tracts of one species of bird mite, Dermanyssus gallinae, suggesting that at least one form of avian mite may feed off humans but typically cannot reproduce without an avian blood meal.⁴ Individuals with gamasoidosis often are exposed to avian mites by owning birds as pets, rearing chickens or messenger pigeons, or having bird’s nests around their bedrooms or air conditioning units.¹

Most people who develop avian mite dermatitis are the only affected member of the family to develop pruritus and papules since the reaction requires both bites and hypersensitivity to them; however, there are cases of nuclear families all reacting to avian mite bites.^2,4 As in this case, hypersensitivity to avian mite bites causes exquisitely pruritic 2- to 5-mm papules, vesicles, or urticarial lesions that may be diagnosed as papular urticaria or misdiagnosed as scabies. Although bird mites may carry bacteria such as Salmonella, Spirochaete, Rickettsia, and Pasteurella, they have not demonstrated an ability to pass these on to human vectors.^5,6

Bird mites will spend most of their lives on avian hosts but can spread to humans through direct contact or through air.⁷ Mites can go through floors, walls, ceilings, or most commonly through ventilation or air conditioning units. Increasing urbanization, especially in warmer climates where avian mites thrive, has increased the prevalence of gamasoidosis.¹

Avian mite dermatitis commonly can be mistaken for scabies, but the mites can be seen with the naked eye and cannot form burrows, unlike scabies.^4,8 Avian mites usually are not found on human skin since they leave the host after feeding and move with surprising speed.⁸ Pediculosis corporis (body lice) results from an infestation of Pediculus humanus corporis. At 2- to 4-mm long, this louse is much larger than a bird mite. Body lice rarely are found on the skin but rather live and lay eggs on clothing, particularly along the seams. The body louse has an elongated body with 3 segments and short antennae. Pthirus pubis (pubic lice) measure 1.5 to 2.0 mm in adulthood and have wider, more crablike bodies compared to body or hair lice or avian mites. Lice, being insects, have 6 legs as opposed to mites, being arachnids, having 8 legs. Cheyletiella are 0.5-mm long, nonburrowing mites commonly found on cats, dogs, and rabbits. Cheyletiella blakei affects cats. They look somewhat similar to bird mites but have hooklike palps extending from their heads instead of antennae.

Antihistamines and topical corticosteroids may reduce discomfort from avian bites but are not curative.^2,9 The most efficient way to treat gamasoidosis is to remove any affected birds or nearby bird’s nests, as the mites cannot survive more than a few weeks to months without feeding on an avian host.⁸ It also may be necessary to fumigate infested rooms.¹⁰

The diagnosis of avian mite dermatitis often is missed to the frustration of the patient and clinician alike. Becoming familiar with this bite reaction will help clinicians diagnose this dermatologic conundrum.

The widely held notion that consuming small to moderate amounts of alcohol is good for cardiovascular health is not supported by the data, the World Heart Federation says in a new policy brief.

In fact, the evidence is clear that any level of drinking can contribute to loss of a healthy life, the organization says.

“Over the past several decades, the prevalence of cardiovascular disease has nearly doubled, and alcohol has played a major role in the incidence of much of it,” the WHF said in the brief.

“The portrayal of alcohol as necessary for a vibrant social life has diverted attention from the harms of alcohol use, as have the frequent and widely publicized claims that moderate drinking, such as a glass of red wine a day, can offer protection against cardiovascular disease,” Monika Arora, PhD, member of the WHF advocacy committee and coauthor of the brief, said in a news release.

“These claims are at best misinformed and at worst an attempt by the alcohol industry to mislead the public about the danger of their product,” Dr. Arora added.

The WHF conclusions follow a report in the Lancet based on the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD), which found that there is no safe level of alcohol consumption.

In 2019, nearly 2.4 million deaths were attributed to alcohol, accounting for 4.3% of all deaths globally and 12.6% of deaths in men 15 to 49 years of age.

Even small amounts of alcohol have been shown to raise the risk for cardiovascular disease, including coronary disease, stroke, heart failure, hypertensive heart disease, cardiomyopathy, atrial fibrillation, and aneurysm, the WHF notes.

Studies that claim otherwise are largely based on purely observational research, which fails to account for relevant cofactors, the organization writes.

Based on their summary of the evidence to date, there is no reliable correlation between moderate alcohol consumption and a lower risk for cardiovascular disease.

Alcohol use is also a “major avoidable risk factor” for cancer, digestive diseases, intentional and unintentional injuries, and several infectious diseases, the WHF says.

Alcohol use also has significant economic and social costs, which include costs to individuals and health systems, productivity losses, as well as the increased risk for violence, homelessness, and criminal activity.

The WHF policy brief calls for “urgent and decisive action” to tackle the unprecedented rise in alcohol-related death and disability worldwide.

Recommended actions include boosting restrictions on alcohol availability; advancing and enforcing drinking and driving countermeasures; increasing access to screening, brief interventions, and treatment for alcohol use disorder; enforcing bans on alcohol advertising; establishing a uniform minimum legal drinking age; and mandating health warnings on alcohol products.

A version of this article first appeared on Medscape.com.

The widely held notion that consuming small to moderate amounts of alcohol is good for cardiovascular health is not supported by the data, the World Heart Federation says in a new policy brief.

In fact, the evidence is clear that any level of drinking can contribute to loss of a healthy life, the organization says.

“Over the past several decades, the prevalence of cardiovascular disease has nearly doubled, and alcohol has played a major role in the incidence of much of it,” the WHF said in the brief.

“The portrayal of alcohol as necessary for a vibrant social life has diverted attention from the harms of alcohol use, as have the frequent and widely publicized claims that moderate drinking, such as a glass of red wine a day, can offer protection against cardiovascular disease,” Monika Arora, PhD, member of the WHF advocacy committee and coauthor of the brief, said in a news release.

“These claims are at best misinformed and at worst an attempt by the alcohol industry to mislead the public about the danger of their product,” Dr. Arora added.

The WHF conclusions follow a report in the Lancet based on the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD), which found that there is no safe level of alcohol consumption.

In 2019, nearly 2.4 million deaths were attributed to alcohol, accounting for 4.3% of all deaths globally and 12.6% of deaths in men 15 to 49 years of age.

Even small amounts of alcohol have been shown to raise the risk for cardiovascular disease, including coronary disease, stroke, heart failure, hypertensive heart disease, cardiomyopathy, atrial fibrillation, and aneurysm, the WHF notes.

Studies that claim otherwise are largely based on purely observational research, which fails to account for relevant cofactors, the organization writes.

Based on their summary of the evidence to date, there is no reliable correlation between moderate alcohol consumption and a lower risk for cardiovascular disease.

Alcohol use is also a “major avoidable risk factor” for cancer, digestive diseases, intentional and unintentional injuries, and several infectious diseases, the WHF says.

Alcohol use also has significant economic and social costs, which include costs to individuals and health systems, productivity losses, as well as the increased risk for violence, homelessness, and criminal activity.

The WHF policy brief calls for “urgent and decisive action” to tackle the unprecedented rise in alcohol-related death and disability worldwide.

Recommended actions include boosting restrictions on alcohol availability; advancing and enforcing drinking and driving countermeasures; increasing access to screening, brief interventions, and treatment for alcohol use disorder; enforcing bans on alcohol advertising; establishing a uniform minimum legal drinking age; and mandating health warnings on alcohol products.

A version of this article first appeared on Medscape.com.

The widely held notion that consuming small to moderate amounts of alcohol is good for cardiovascular health is not supported by the data, the World Heart Federation says in a new policy brief.

In fact, the evidence is clear that any level of drinking can contribute to loss of a healthy life, the organization says.

“Over the past several decades, the prevalence of cardiovascular disease has nearly doubled, and alcohol has played a major role in the incidence of much of it,” the WHF said in the brief.

“The portrayal of alcohol as necessary for a vibrant social life has diverted attention from the harms of alcohol use, as have the frequent and widely publicized claims that moderate drinking, such as a glass of red wine a day, can offer protection against cardiovascular disease,” Monika Arora, PhD, member of the WHF advocacy committee and coauthor of the brief, said in a news release.

“These claims are at best misinformed and at worst an attempt by the alcohol industry to mislead the public about the danger of their product,” Dr. Arora added.

The WHF conclusions follow a report in the Lancet based on the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD), which found that there is no safe level of alcohol consumption.

In 2019, nearly 2.4 million deaths were attributed to alcohol, accounting for 4.3% of all deaths globally and 12.6% of deaths in men 15 to 49 years of age.

Even small amounts of alcohol have been shown to raise the risk for cardiovascular disease, including coronary disease, stroke, heart failure, hypertensive heart disease, cardiomyopathy, atrial fibrillation, and aneurysm, the WHF notes.

Studies that claim otherwise are largely based on purely observational research, which fails to account for relevant cofactors, the organization writes.

Based on their summary of the evidence to date, there is no reliable correlation between moderate alcohol consumption and a lower risk for cardiovascular disease.

Alcohol use is also a “major avoidable risk factor” for cancer, digestive diseases, intentional and unintentional injuries, and several infectious diseases, the WHF says.

Alcohol use also has significant economic and social costs, which include costs to individuals and health systems, productivity losses, as well as the increased risk for violence, homelessness, and criminal activity.

The WHF policy brief calls for “urgent and decisive action” to tackle the unprecedented rise in alcohol-related death and disability worldwide.

Recommended actions include boosting restrictions on alcohol availability; advancing and enforcing drinking and driving countermeasures; increasing access to screening, brief interventions, and treatment for alcohol use disorder; enforcing bans on alcohol advertising; establishing a uniform minimum legal drinking age; and mandating health warnings on alcohol products.

A version of this article first appeared on Medscape.com.

Disruption of the bacteria in the gut is linked with susceptibility to long COVID-19 syndrome, according to new findings.

While links have been found between the gut’s microbiome and COVID-19, as well as other diseases, this is the first published research to show a link specifically to COVID’s long-term effects, the investigators, based at the Chinese University of Hong Kong, wrote in Gut.

Courtesy Dr. Siew Ng

“To our knowledge, this is the first study to show that altered gut microbiome composition is strongly associated with persistent symptoms in patients with COVID-19 up to 6 months after clearance of SARS-CoV-2 virus,” said Siew Ng, MBBS, PhD, associate director at the university’s Center for Gut Microbiota Research.

At three hospitals, the researchers enrolled 106 patients with COVID-19 from February to August 2020 with stool samples at admission and at 1 month and 6 months after discharge, and compared them with people who did not have COVID, recruited in 2019. The severity of COVID in the enrolled patients was mostly mild to moderate.

At 3 months, 86 of the patients with COVID had post–acute COVID-19 syndrome (PACS) – defined as at least one persistent, otherwise unexplained symptom 4 weeks after clearance of the virus. And 81 patients had PACS at 6 months, most commonly fatigue, poor memory, hair loss, anxiety, and trouble sleeping.

Using stool samples for their analysis, the researchers found that, broadly, the diversity of the types of bacteria, and the abundance of these bacteria, were significantly lower at 6 months for those with PACS, compared with those without PACS and with controls (P < .05 and P < .0001, respectively). Among those with PACS, 28 bacteria species were diminished and 14 were enriched, both at baseline and follow-up. Those patients who had COVID but not PACS showed just 25 alterations of bacteria species at the time of hospital admission, and they all normalized by 6 months.

Having respiratory symptoms at 6 months was linked with higher levels of opportunistic pathogens such as Streptococcus anginosus and S. vestibularis. Neuropsychiatric symptoms and fatigue were associated with nosocomial pathogens that are linked to opportunistic infections, such as Clostridium innocuum and Actinomyces naeslundii (P < .05).

Bacteria known for producing butyrate, a beneficial fatty acid, were significantly depleted in those patients with hair loss. And certain of these bacteria, including Bifidobacterium pseudocatenulatum and Faecalibacterium prausnitzii, had the largest inverse correlations with PACS at 6 months (P < .05), the researchers found.

“Particular gut microbial profiles may indicate heightened susceptibility,” Dr. Ng said.

Although the findings were drawn from patients with earlier strains of the COVID-19 virus, the findings still apply to new variants, including Omicron, since these pose the same problem of persistent disruption of the immune system, Dr. Ng said.

Her group is conducting trials to look at how modulating the microbiome might prevent long COVID and boost antibodies after vaccination in high-risk people, she said.

“Gut microbiota influences the health of the host,” Dr. Ng said. “It provides crucial benefits in the form of immune system development, prevention of infections, nutrient acquisition, and brain and nervous system functionality. Considering the millions of people infected during the ongoing pandemic, our findings are a strong impetus for consideration of microbiota modulation to facilitate timely recovery and reduce the burden of post–acute COVID-19 syndrome.”

Courtesy Dr. John Haran

John Haran, MD, PhD, associate professor of microbiology and physiological systems and emergency medicine at the University of Massachusetts, Worcester, said the research adds to the evidence base on the gut microbiome’s links to COVID, but there was likely be no clinical impact yet. Still, he said the findings linking specific species to specific symptoms was particularly interesting.

“Very early on during hospitalization, [the researchers] saw these differences and correlated out with people who have longer symptoms, and especially different groups of people that have longer symptoms, too,” said Dr. Haran, who has done research on the topic. “It’s very different if you have different symptoms, for example, you keep coughing for months versus you have brain fog and fatigue, or other debilitating symptoms.”

Dr. Haran noted that the findings didn’t identify bacteria types especially linked to COVID, but rather species that have already been found to be associated with a “bad” microbiome. He also pointed out that the patients enrolled in the study were not vaccinated, because vaccines weren’t available at the time. Still, further study to see whether modulation of gut bacteria can be a therapy seems worthwhile.

“Microbiome modulation is pretty safe, and that’s really the next big step that needs to be taken in this,” he said.

For now, the findings don’t give the clinician much new ammunition for treatment.

“We’re not there yet,” he added. “It’s not as if clinicians are going to tell their COVID patients: ‘Go out and buy some kale.’ ”

Eugene Chang, MD, professor of medicine at the University of Chicago, who has studied the gut microbiome and gastrointestinal disease, said it’s “too preliminary” to say whether the findings could lead to a clinical impact. The measures used merely identify the microbes present, but not what they are doing.

“These measures are unlikely to perform well enough to be useful for risk assessment or predicting clinical outcomes,” he said. “That being said, advances in technology are being made where next generations of metrics could be developed and useful as stratifiers and predictors of risk.”

Seeing shifting patterns associated with certain symptoms, he said, is “notable because it suggests that the disturbances of the gut microbiota in PACS are significant.”

But he said it’s important to know whether these changes are a cause of PACS in some way or just an effect of it.

“If causative or contributory – this has to be proven – then ‘microbiota modulation’ would make sense and could be a priority for development,” he said. “If merely an effect, these metrics and better ones to come could be useful as predictors or measures of the patient’s general state of health.”

As seen in his group’s work and other work, he said, “the gut microbiota is highly sensitive to changes in their ecosystem, which is influenced by the health state of the patient.”

Dr. Ng, Dr. Haran, and Dr. Chang reported no relevant disclosures.

This article was updated Jan. 27, 2022.

Disruption of the bacteria in the gut is linked with susceptibility to long COVID-19 syndrome, according to new findings.

While links have been found between the gut’s microbiome and COVID-19, as well as other diseases, this is the first published research to show a link specifically to COVID’s long-term effects, the investigators, based at the Chinese University of Hong Kong, wrote in Gut.

Courtesy Dr. Siew Ng

“To our knowledge, this is the first study to show that altered gut microbiome composition is strongly associated with persistent symptoms in patients with COVID-19 up to 6 months after clearance of SARS-CoV-2 virus,” said Siew Ng, MBBS, PhD, associate director at the university’s Center for Gut Microbiota Research.

At three hospitals, the researchers enrolled 106 patients with COVID-19 from February to August 2020 with stool samples at admission and at 1 month and 6 months after discharge, and compared them with people who did not have COVID, recruited in 2019. The severity of COVID in the enrolled patients was mostly mild to moderate.

At 3 months, 86 of the patients with COVID had post–acute COVID-19 syndrome (PACS) – defined as at least one persistent, otherwise unexplained symptom 4 weeks after clearance of the virus. And 81 patients had PACS at 6 months, most commonly fatigue, poor memory, hair loss, anxiety, and trouble sleeping.

Using stool samples for their analysis, the researchers found that, broadly, the diversity of the types of bacteria, and the abundance of these bacteria, were significantly lower at 6 months for those with PACS, compared with those without PACS and with controls (P < .05 and P < .0001, respectively). Among those with PACS, 28 bacteria species were diminished and 14 were enriched, both at baseline and follow-up. Those patients who had COVID but not PACS showed just 25 alterations of bacteria species at the time of hospital admission, and they all normalized by 6 months.

Having respiratory symptoms at 6 months was linked with higher levels of opportunistic pathogens such as Streptococcus anginosus and S. vestibularis. Neuropsychiatric symptoms and fatigue were associated with nosocomial pathogens that are linked to opportunistic infections, such as Clostridium innocuum and Actinomyces naeslundii (P < .05).

Bacteria known for producing butyrate, a beneficial fatty acid, were significantly depleted in those patients with hair loss. And certain of these bacteria, including Bifidobacterium pseudocatenulatum and Faecalibacterium prausnitzii, had the largest inverse correlations with PACS at 6 months (P < .05), the researchers found.

“Particular gut microbial profiles may indicate heightened susceptibility,” Dr. Ng said.

Although the findings were drawn from patients with earlier strains of the COVID-19 virus, the findings still apply to new variants, including Omicron, since these pose the same problem of persistent disruption of the immune system, Dr. Ng said.

Her group is conducting trials to look at how modulating the microbiome might prevent long COVID and boost antibodies after vaccination in high-risk people, she said.

“Gut microbiota influences the health of the host,” Dr. Ng said. “It provides crucial benefits in the form of immune system development, prevention of infections, nutrient acquisition, and brain and nervous system functionality. Considering the millions of people infected during the ongoing pandemic, our findings are a strong impetus for consideration of microbiota modulation to facilitate timely recovery and reduce the burden of post–acute COVID-19 syndrome.”

Courtesy Dr. John Haran

John Haran, MD, PhD, associate professor of microbiology and physiological systems and emergency medicine at the University of Massachusetts, Worcester, said the research adds to the evidence base on the gut microbiome’s links to COVID, but there was likely be no clinical impact yet. Still, he said the findings linking specific species to specific symptoms was particularly interesting.

“Very early on during hospitalization, [the researchers] saw these differences and correlated out with people who have longer symptoms, and especially different groups of people that have longer symptoms, too,” said Dr. Haran, who has done research on the topic. “It’s very different if you have different symptoms, for example, you keep coughing for months versus you have brain fog and fatigue, or other debilitating symptoms.”

Dr. Haran noted that the findings didn’t identify bacteria types especially linked to COVID, but rather species that have already been found to be associated with a “bad” microbiome. He also pointed out that the patients enrolled in the study were not vaccinated, because vaccines weren’t available at the time. Still, further study to see whether modulation of gut bacteria can be a therapy seems worthwhile.

“Microbiome modulation is pretty safe, and that’s really the next big step that needs to be taken in this,” he said.

For now, the findings don’t give the clinician much new ammunition for treatment.

“We’re not there yet,” he added. “It’s not as if clinicians are going to tell their COVID patients: ‘Go out and buy some kale.’ ”

Eugene Chang, MD, professor of medicine at the University of Chicago, who has studied the gut microbiome and gastrointestinal disease, said it’s “too preliminary” to say whether the findings could lead to a clinical impact. The measures used merely identify the microbes present, but not what they are doing.

“These measures are unlikely to perform well enough to be useful for risk assessment or predicting clinical outcomes,” he said. “That being said, advances in technology are being made where next generations of metrics could be developed and useful as stratifiers and predictors of risk.”

Seeing shifting patterns associated with certain symptoms, he said, is “notable because it suggests that the disturbances of the gut microbiota in PACS are significant.”

But he said it’s important to know whether these changes are a cause of PACS in some way or just an effect of it.

“If causative or contributory – this has to be proven – then ‘microbiota modulation’ would make sense and could be a priority for development,” he said. “If merely an effect, these metrics and better ones to come could be useful as predictors or measures of the patient’s general state of health.”

As seen in his group’s work and other work, he said, “the gut microbiota is highly sensitive to changes in their ecosystem, which is influenced by the health state of the patient.”

Dr. Ng, Dr. Haran, and Dr. Chang reported no relevant disclosures.

This article was updated Jan. 27, 2022.

Disruption of the bacteria in the gut is linked with susceptibility to long COVID-19 syndrome, according to new findings.

While links have been found between the gut’s microbiome and COVID-19, as well as other diseases, this is the first published research to show a link specifically to COVID’s long-term effects, the investigators, based at the Chinese University of Hong Kong, wrote in Gut.

Courtesy Dr. Siew Ng

“To our knowledge, this is the first study to show that altered gut microbiome composition is strongly associated with persistent symptoms in patients with COVID-19 up to 6 months after clearance of SARS-CoV-2 virus,” said Siew Ng, MBBS, PhD, associate director at the university’s Center for Gut Microbiota Research.

At three hospitals, the researchers enrolled 106 patients with COVID-19 from February to August 2020 with stool samples at admission and at 1 month and 6 months after discharge, and compared them with people who did not have COVID, recruited in 2019. The severity of COVID in the enrolled patients was mostly mild to moderate.

At 3 months, 86 of the patients with COVID had post–acute COVID-19 syndrome (PACS) – defined as at least one persistent, otherwise unexplained symptom 4 weeks after clearance of the virus. And 81 patients had PACS at 6 months, most commonly fatigue, poor memory, hair loss, anxiety, and trouble sleeping.

Using stool samples for their analysis, the researchers found that, broadly, the diversity of the types of bacteria, and the abundance of these bacteria, were significantly lower at 6 months for those with PACS, compared with those without PACS and with controls (P < .05 and P < .0001, respectively). Among those with PACS, 28 bacteria species were diminished and 14 were enriched, both at baseline and follow-up. Those patients who had COVID but not PACS showed just 25 alterations of bacteria species at the time of hospital admission, and they all normalized by 6 months.

Having respiratory symptoms at 6 months was linked with higher levels of opportunistic pathogens such as Streptococcus anginosus and S. vestibularis. Neuropsychiatric symptoms and fatigue were associated with nosocomial pathogens that are linked to opportunistic infections, such as Clostridium innocuum and Actinomyces naeslundii (P < .05).

Bacteria known for producing butyrate, a beneficial fatty acid, were significantly depleted in those patients with hair loss. And certain of these bacteria, including Bifidobacterium pseudocatenulatum and Faecalibacterium prausnitzii, had the largest inverse correlations with PACS at 6 months (P < .05), the researchers found.

“Particular gut microbial profiles may indicate heightened susceptibility,” Dr. Ng said.

Although the findings were drawn from patients with earlier strains of the COVID-19 virus, the findings still apply to new variants, including Omicron, since these pose the same problem of persistent disruption of the immune system, Dr. Ng said.

Her group is conducting trials to look at how modulating the microbiome might prevent long COVID and boost antibodies after vaccination in high-risk people, she said.

“Gut microbiota influences the health of the host,” Dr. Ng said. “It provides crucial benefits in the form of immune system development, prevention of infections, nutrient acquisition, and brain and nervous system functionality. Considering the millions of people infected during the ongoing pandemic, our findings are a strong impetus for consideration of microbiota modulation to facilitate timely recovery and reduce the burden of post–acute COVID-19 syndrome.”

Courtesy Dr. John Haran

John Haran, MD, PhD, associate professor of microbiology and physiological systems and emergency medicine at the University of Massachusetts, Worcester, said the research adds to the evidence base on the gut microbiome’s links to COVID, but there was likely be no clinical impact yet. Still, he said the findings linking specific species to specific symptoms was particularly interesting.

“Very early on during hospitalization, [the researchers] saw these differences and correlated out with people who have longer symptoms, and especially different groups of people that have longer symptoms, too,” said Dr. Haran, who has done research on the topic. “It’s very different if you have different symptoms, for example, you keep coughing for months versus you have brain fog and fatigue, or other debilitating symptoms.”

Dr. Haran noted that the findings didn’t identify bacteria types especially linked to COVID, but rather species that have already been found to be associated with a “bad” microbiome. He also pointed out that the patients enrolled in the study were not vaccinated, because vaccines weren’t available at the time. Still, further study to see whether modulation of gut bacteria can be a therapy seems worthwhile.

“Microbiome modulation is pretty safe, and that’s really the next big step that needs to be taken in this,” he said.

For now, the findings don’t give the clinician much new ammunition for treatment.

“We’re not there yet,” he added. “It’s not as if clinicians are going to tell their COVID patients: ‘Go out and buy some kale.’ ”

Eugene Chang, MD, professor of medicine at the University of Chicago, who has studied the gut microbiome and gastrointestinal disease, said it’s “too preliminary” to say whether the findings could lead to a clinical impact. The measures used merely identify the microbes present, but not what they are doing.

“These measures are unlikely to perform well enough to be useful for risk assessment or predicting clinical outcomes,” he said. “That being said, advances in technology are being made where next generations of metrics could be developed and useful as stratifiers and predictors of risk.”

Seeing shifting patterns associated with certain symptoms, he said, is “notable because it suggests that the disturbances of the gut microbiota in PACS are significant.”

But he said it’s important to know whether these changes are a cause of PACS in some way or just an effect of it.

“If causative or contributory – this has to be proven – then ‘microbiota modulation’ would make sense and could be a priority for development,” he said. “If merely an effect, these metrics and better ones to come could be useful as predictors or measures of the patient’s general state of health.”

As seen in his group’s work and other work, he said, “the gut microbiota is highly sensitive to changes in their ecosystem, which is influenced by the health state of the patient.”

Dr. Ng, Dr. Haran, and Dr. Chang reported no relevant disclosures.

This article was updated Jan. 27, 2022.

The goal of this activity is to improve healthcare providers’ knowledge on the treatment of patients with acute bacterial skin and skin structure infections (ABSSSI) in the outpatient setting as well as how to best incorporate novel antimicrobials into patient care plans.

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The goal of this activity is to improve healthcare providers’ knowledge on the treatment of patients with acute bacterial skin and skin structure infections (ABSSSI) in the outpatient setting as well as how to best incorporate novel antimicrobials into patient care plans.

Click here to access this content now 

The goal of this activity is to improve healthcare providers’ knowledge on the treatment of patients with acute bacterial skin and skin structure infections (ABSSSI) in the outpatient setting as well as how to best incorporate novel antimicrobials into patient care plans.

Click here to access this content now 

Key clinical point: General anesthesia administered during major surgery poses a similar risk of postoperative migraine as neuraxial anesthesia.

Main finding: General anesthesia was not associated with a significantly higher risk of postoperative migraine compared with neuraxial anesthesia (adjusted odds ratio [aOR] 0.93; P = .357), even across patient subgroups varying in age (≥65 years: aOR 0.94; P = .698; <65 years: aOR 0.93; P = .397) or migraine subtype (with aura: aOR 1.02; P = .929; without aura: aOR 0.73; P = .069).

Study details: The data come from a nationwide population-based cohort study that matched 68,131 patients with no prior history of migraine undergoing major surgery with general anesthesia with an equal number of those undergoing neuraxial anesthesia-supported surgery.

Disclosures: The study was sponsored by Taipei Medical University, Taiwan. The authors declared having no conflicts of interest.

Source: Liao C-Y et al. Int J Environ Res Public Health. 2021;19(1):362 (Dec 30). Doi: 10.3390/ijerph19010362.

Key clinical point: General anesthesia administered during major surgery poses a similar risk of postoperative migraine as neuraxial anesthesia.

Main finding: General anesthesia was not associated with a significantly higher risk of postoperative migraine compared with neuraxial anesthesia (adjusted odds ratio [aOR] 0.93; P = .357), even across patient subgroups varying in age (≥65 years: aOR 0.94; P = .698; <65 years: aOR 0.93; P = .397) or migraine subtype (with aura: aOR 1.02; P = .929; without aura: aOR 0.73; P = .069).

Study details: The data come from a nationwide population-based cohort study that matched 68,131 patients with no prior history of migraine undergoing major surgery with general anesthesia with an equal number of those undergoing neuraxial anesthesia-supported surgery.

Disclosures: The study was sponsored by Taipei Medical University, Taiwan. The authors declared having no conflicts of interest.

Source: Liao C-Y et al. Int J Environ Res Public Health. 2021;19(1):362 (Dec 30). Doi: 10.3390/ijerph19010362.

Key clinical point: General anesthesia administered during major surgery poses a similar risk of postoperative migraine as neuraxial anesthesia.

Main finding: General anesthesia was not associated with a significantly higher risk of postoperative migraine compared with neuraxial anesthesia (adjusted odds ratio [aOR] 0.93; P = .357), even across patient subgroups varying in age (≥65 years: aOR 0.94; P = .698; <65 years: aOR 0.93; P = .397) or migraine subtype (with aura: aOR 1.02; P = .929; without aura: aOR 0.73; P = .069).

Study details: The data come from a nationwide population-based cohort study that matched 68,131 patients with no prior history of migraine undergoing major surgery with general anesthesia with an equal number of those undergoing neuraxial anesthesia-supported surgery.

Disclosures: The study was sponsored by Taipei Medical University, Taiwan. The authors declared having no conflicts of interest.

Source: Liao C-Y et al. Int J Environ Res Public Health. 2021;19(1):362 (Dec 30). Doi: 10.3390/ijerph19010362.

Key clinical point: When administered prophylactically, propranolol, topiramate, flunarizine, and cyproheptadine are effective at improving the health-related quality of life in pediatric patients with migraine.

Main finding: The before vs. after mean Pediatric Migraine Disability Assessment scores showed significant improvement with prophylactic topiramate (11.33 ± 13.82 vs. 33.50 ± 13.97), propranolol (12.58 ± 15.67 vs. 30.16 ± 22.97), cyproheptadine (17.00 ± 17.43 vs. 27.33 ± 19.22), or flunarizine (17.50 ± 20.14 vs. 29.89 ± 21.53; all P < .001).

Study details: The data are derived from a retrospective review study including 186 pediatric patients (aged 6 to 18 years) with migraine who were being treated prophylactically for at least 6 months with either topiramate (n = 30), cyproheptadine (n = 45), propranolol (n = 55), or flunarizine (n = 56).

Disclosures: The authors did not receive any financial aid for the study. No conflicts of interest were reported.

Source: Tekin H et al. Pediatr Int. 2021 (Dec 14). Doi: 10.1111/ped.15094.

Key clinical point: When administered prophylactically, propranolol, topiramate, flunarizine, and cyproheptadine are effective at improving the health-related quality of life in pediatric patients with migraine.

Main finding: The before vs. after mean Pediatric Migraine Disability Assessment scores showed significant improvement with prophylactic topiramate (11.33 ± 13.82 vs. 33.50 ± 13.97), propranolol (12.58 ± 15.67 vs. 30.16 ± 22.97), cyproheptadine (17.00 ± 17.43 vs. 27.33 ± 19.22), or flunarizine (17.50 ± 20.14 vs. 29.89 ± 21.53; all P < .001).

Study details: The data are derived from a retrospective review study including 186 pediatric patients (aged 6 to 18 years) with migraine who were being treated prophylactically for at least 6 months with either topiramate (n = 30), cyproheptadine (n = 45), propranolol (n = 55), or flunarizine (n = 56).

Disclosures: The authors did not receive any financial aid for the study. No conflicts of interest were reported.

Source: Tekin H et al. Pediatr Int. 2021 (Dec 14). Doi: 10.1111/ped.15094.

Key clinical point: When administered prophylactically, propranolol, topiramate, flunarizine, and cyproheptadine are effective at improving the health-related quality of life in pediatric patients with migraine.

Main finding: The before vs. after mean Pediatric Migraine Disability Assessment scores showed significant improvement with prophylactic topiramate (11.33 ± 13.82 vs. 33.50 ± 13.97), propranolol (12.58 ± 15.67 vs. 30.16 ± 22.97), cyproheptadine (17.00 ± 17.43 vs. 27.33 ± 19.22), or flunarizine (17.50 ± 20.14 vs. 29.89 ± 21.53; all P < .001).

Study details: The data are derived from a retrospective review study including 186 pediatric patients (aged 6 to 18 years) with migraine who were being treated prophylactically for at least 6 months with either topiramate (n = 30), cyproheptadine (n = 45), propranolol (n = 55), or flunarizine (n = 56).

Disclosures: The authors did not receive any financial aid for the study. No conflicts of interest were reported.

Source: Tekin H et al. Pediatr Int. 2021 (Dec 14). Doi: 10.1111/ped.15094.

Key clinical point: Alpha-lipoic acid (ALA) supplementation may serve as a potential adjunct treatment option for migraine.

Main finding: ALA supplementation vs. placebo over 3 months caused a significant decrease in baseline mean headache severity (−3.59 vs. −0.70; P < .001), frequency of attacks/month (−2.55 vs. −0.40; P = .001), headache diary result (−158.79 vs. −38.63; P = .003), headache impact test-6 (HIT-6) score (−20.09 vs. −2.83; P < .001), and migraine headache index score (MHIS, −65.32 vs. −0.33; P < .001).

Study details: This was a randomized, double-blind trial including 92 female patients aged 20-50 years with episodic migraine who were randomly assigned to receive ALA (n = 47) or placebo (n = 45) for 3 months.

Disclosures: The study received financial support from the Isfahan University of Medical Sciences, Isfahan, Iran. The authors reported no potential conflict of interests.

Source: Kelishadi MR et al. Sci Rep. 2022;12:271 (Jan 7). Doi: 10.1038/s41598-021-04397-z.

Key clinical point: Alpha-lipoic acid (ALA) supplementation may serve as a potential adjunct treatment option for migraine.

Main finding: ALA supplementation vs. placebo over 3 months caused a significant decrease in baseline mean headache severity (−3.59 vs. −0.70; P < .001), frequency of attacks/month (−2.55 vs. −0.40; P = .001), headache diary result (−158.79 vs. −38.63; P = .003), headache impact test-6 (HIT-6) score (−20.09 vs. −2.83; P < .001), and migraine headache index score (MHIS, −65.32 vs. −0.33; P < .001).

Study details: This was a randomized, double-blind trial including 92 female patients aged 20-50 years with episodic migraine who were randomly assigned to receive ALA (n = 47) or placebo (n = 45) for 3 months.

Disclosures: The study received financial support from the Isfahan University of Medical Sciences, Isfahan, Iran. The authors reported no potential conflict of interests.

Source: Kelishadi MR et al. Sci Rep. 2022;12:271 (Jan 7). Doi: 10.1038/s41598-021-04397-z.

Key clinical point: Alpha-lipoic acid (ALA) supplementation may serve as a potential adjunct treatment option for migraine.

Main finding: ALA supplementation vs. placebo over 3 months caused a significant decrease in baseline mean headache severity (−3.59 vs. −0.70; P < .001), frequency of attacks/month (−2.55 vs. −0.40; P = .001), headache diary result (−158.79 vs. −38.63; P = .003), headache impact test-6 (HIT-6) score (−20.09 vs. −2.83; P < .001), and migraine headache index score (MHIS, −65.32 vs. −0.33; P < .001).

Study details: This was a randomized, double-blind trial including 92 female patients aged 20-50 years with episodic migraine who were randomly assigned to receive ALA (n = 47) or placebo (n = 45) for 3 months.

Disclosures: The study received financial support from the Isfahan University of Medical Sciences, Isfahan, Iran. The authors reported no potential conflict of interests.

Source: Kelishadi MR et al. Sci Rep. 2022;12:271 (Jan 7). Doi: 10.1038/s41598-021-04397-z.

Key clinical point: Patients with migraine are at an increased risk of myocardial infarction (MI) and stroke, and those with migraine with aura are also at an increased risk of overall cardiovascular mortality.

Main finding: Migraine showed a positive association with MI (hazard ratio [HR] 1.36; P < .001), unspecified stroke (HR 1.30; P = .01), ischemic stroke (HR 1.35; P = .03), and hemorrhagic stroke (HR 1.43; P = .02). Migraine with aura was positively associated with cardiovascular mortality (HR 1.27; P < .001).

Study details: Findings are from a meta-analysis of 18 prospective cohort studies including 362,434 patients with migraine and 1,323,714 control participants.

Disclosures: BYQ Tan declared receiving the Ministry of Health Healthcare Research Scholarship, Singapore, and the Chan Heng Leong Research Award. CH Sia received financial support from the National University of Singapore Yong Loo Lin School of Medicine’s Junior Academic Faculty Scheme. The authors declared no competing interests.

Source: Ng CYH et al. J Neurol. 2022 (Jan 8). Doi: 10.1007/s00415-021-10930-x.

Key clinical point: Patients with migraine are at an increased risk of myocardial infarction (MI) and stroke, and those with migraine with aura are also at an increased risk of overall cardiovascular mortality.

Main finding: Migraine showed a positive association with MI (hazard ratio [HR] 1.36; P < .001), unspecified stroke (HR 1.30; P = .01), ischemic stroke (HR 1.35; P = .03), and hemorrhagic stroke (HR 1.43; P = .02). Migraine with aura was positively associated with cardiovascular mortality (HR 1.27; P < .001).

Study details: Findings are from a meta-analysis of 18 prospective cohort studies including 362,434 patients with migraine and 1,323,714 control participants.

Disclosures: BYQ Tan declared receiving the Ministry of Health Healthcare Research Scholarship, Singapore, and the Chan Heng Leong Research Award. CH Sia received financial support from the National University of Singapore Yong Loo Lin School of Medicine’s Junior Academic Faculty Scheme. The authors declared no competing interests.

Source: Ng CYH et al. J Neurol. 2022 (Jan 8). Doi: 10.1007/s00415-021-10930-x.

Key clinical point: Patients with migraine are at an increased risk of myocardial infarction (MI) and stroke, and those with migraine with aura are also at an increased risk of overall cardiovascular mortality.

Main finding: Migraine showed a positive association with MI (hazard ratio [HR] 1.36; P < .001), unspecified stroke (HR 1.30; P = .01), ischemic stroke (HR 1.35; P = .03), and hemorrhagic stroke (HR 1.43; P = .02). Migraine with aura was positively associated with cardiovascular mortality (HR 1.27; P < .001).

Study details: Findings are from a meta-analysis of 18 prospective cohort studies including 362,434 patients with migraine and 1,323,714 control participants.

Disclosures: BYQ Tan declared receiving the Ministry of Health Healthcare Research Scholarship, Singapore, and the Chan Heng Leong Research Award. CH Sia received financial support from the National University of Singapore Yong Loo Lin School of Medicine’s Junior Academic Faculty Scheme. The authors declared no competing interests.

Source: Ng CYH et al. J Neurol. 2022 (Jan 8). Doi: 10.1007/s00415-021-10930-x.