Healthy adults don’t need vitamin D pills
A SYSTEMATIC review by New Zealand researchers has found little evidence of an overall benefit in vitamin D supplementation for bone density in healthy adults, backing previous meta-analyses on the efficacy of the intervention in reducing the risk of fractures. The research, published in The Lancet, included 23 studies with nearly 4100 participants (92% women). Various supplement regimens were assessed, with most trials using daily oral dosing with an average 500 IU of vitamin D a day or less in six studies (n = 1648), 500–799 IU a day in four studies (n = 646), and 800 IU a day or more in 13 studies (n = 1788). Bone mineral density was measured in the lumbar spine, femoral neck, total hip, trochanter, total body or forearm. “The clinical implication of our findings is that the widespread use of vitamin D supplements for skeletal protection in adults without specific risk factors for vitamin D deficiency is not justified”, the researchers wrote. “This assertion complies with findings from previous meta-analyses of studies of fracture, and suggests that no basis exists for the notion that those studies failed to detect a clinically significant benefit as a result of deficiencies in design or execution.” An accompanying comment said that while vitamin D supplementation to prevent osteoporosis was not warranted in healthy adults, maintenance of vitamin D levels and sufficient dietary calcium in the elderly remained an effective approach to prevent hip fractures.
Simple question can predict surgery outcomes
SIMPLY asking older patients about a history of prior falls in preoperative assessments, regardless of the procedure, can predict adverse postoperative outcomes, according to research published in JAMA Surgery. The research included 235 patients, with a median age of 74 years, undergoing colorectal and cardiac surgery, with 33% reporting preoperative falls. The researchers found one or more postoperative complications occurred more frequently in patients with prior falls compared with non-fallers following colorectal (59% v 25%) and cardiac (39% v 15%) operations. These findings were independent of advancing chronological age. The need for discharge to an institutional care facility was more frequent among prior fallers in comparison with non-fallers in colorectal (52% v 6%) and cardiac (62% v 32%) groups, and in 30-day readmission rates in both groups. “Using the presence of geriatric syndromes to forecast adverse postoperative outcomes instead of chronic disease burden or single end-organ dysfunction is a departure from current strategies”, the researchers wrote. They said a history of falls had the potential to be included in surgical risk calculators.
Insulin production continues in type 1 diabetes
USING new ultrasensitive assays scientists have found that patients with type 1 diabetes have an enduring low level of insulin production including low-level C-peptide response to meals. The research, published in Diabetologia, “strongly supports the notion that the residual beta cells are functional”. The researchers said although it was known that patients with type 1 diabetes had detectable C-peptide, the latest findings showed “most people with type 1 diabetes have active beta cells”, even in those with very long disease duration. “The increase in C-peptide levels after a meal provides convincing evidence of functionally responsive beta cells”, the researchers wrote. “This implies that beta cells are either escaping immune attack or undergoing regeneration.” They said previous studies had not directly addressed the responsiveness of patients with long disease duration with very low C-peptide levels. The research involved 74 participants who had had type 1 diabetes for longer than 5 years (median age at diagnosis 16 years; interquartile range [IQR], 9–23 years) and had been on insulin since diagnosis. Median (IQR) duration of diabetes was 30 years (19–41 years), body mass index was 25 kg/m2 (23–28 kg/m2), HbA1c levels were 7.9% (7.2%–9.0%) and insulin dose was 0.55 U/kg/day (0.44–0.69 units). Post-stimulation serum C-peptide was detectable at very low levels (> 3.3 pmol/L) in 54 (73%) of patients. In those patients C-peptide either increased (n = 43, 80%) or stayed the same (n = 11) in response to a meal, with no indication of levels falling.
Benign polyps concern in colorectal screening
EXPERTS from a colorectal cancer program in Norway have raised concerns about the detection of an increasing number of benign polyps through colorectal cancer screening in an analysis published in the BMJ. The experts said new technologies were able to detect inconspicuous polyps of unknown clinical importance, which increased the need for “clear evidence on the natural course of polyps and their management”. They were most concerned about serrated polyps, which they said were “less understood and often more risky to remove than adenomas”. Recent guidelines had recommended removal of all serrated lesions except small lesions in the sigmoid colon or rectum, but evidence regarding risk–benefit was lacking. “The balance and quantification of harms and benefits are more important when screening a healthy population than when monitoring or testing patients with symptoms or at high risk of disease”, they wrote. “The change in guidelines towards an aggressive intervention strategy for serrated polyps may tilt the balance against screening if the improvements in mortality and incidence of colorectal cancer cannot be shown to outweigh the harms of intervention.” They said that with more polyps being detected as a result of screening, “we need to be able to quantify the gains and harms and share this information with screening participants. It is not enough simply to share a belief that we are doing good, partly motivated by fear of not doing enough.”
Brain injuries underdiagnosed in falls
CANADIAN research has raised questions about the potential underdiagnosis of fall-related brain injuries among residents of long-term aged care facilities. The research, published in the CMAJ, found more than one in three falls resulted in head impact, mostly on a rigid vinyl or linoleum floor. “In a third of cases, there was reported bruising, swelling or laceration, but no concussions were documented on fall incident reports”, the researchers wrote, calling for improved procedures to detect fall-related brain injuries. They had videoed 227 falls involving 133 residents with a mean age of 78 years at two long-term care facilities over 39 months. They found that hand impact occurred in 74% of falls but had no significant effect on the probability of head impact. An initial forward fall increased the probability of head impact compared with backward or sideways falls. The researchers said the study provided new evidence on the frequency and factors associated with head impact during falls among older adults in common areas of long-term care facilities. “We found that head impact occurred in 37% of falls. By any measure, this is an alarmingly high prevalence”, they wrote.