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Liver injury is associated with severe coronavirus disease 2019 (COVID-19) infection: A systematic review and meta-analysis of retrospective studies.
Parohan, M, Yaghoubi, S, Seraji, A
Hepatology research : the official journal of the Japan Society of Hepatology. 2020;50(8):924-935
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Severe acute respiratory syndrome (SARS), Middle East respiratory syndrome (MERS) and Coronavirus disease 2019 (COVID-19) can cause intestinal, respiratory, neuronal and hepatic diseases, and may lead to respiratory distress syndrome, organ failure, and even death in severe cases. The aim of this study was to assess the association between serum levels of Aspartate aminotransferase [enzyme], Alanine aminotransferase [enzyme], total Bilirubin [yellowish blood pigment] and Albumin [protein] with severity of COVID-19 infection. This study is a systemic review and meta-analysis of 20 retrospective studies conducted in China. The sample size of studies ranged from 21 to 651 patients (mean age, 53.3 years). Results indicate that high serum levels of aspartate aminotransferase, alanine aminotransferase, total bilirubin and lower serum levels of albumin are associated with a significant increase in the severity of COVID-19 infection. Authors conclude that attention should be paid to monitor the occurrence of liver dysfunction in patients with COVID-19 infection.
Abstract
The coronavirus disease 2019 (COVID-19) outbreak is a major threat to human beings. Lung injury has been reported as the major outcome of COVID-19 infection. However, liver damage has also been considered to occur in severe cases. The current meta-analysis of retrospective studies was carried out to summarize available findings on the association between liver injury and severity of COVID-19 infection. Online databases including PubMed, Scopus, Web of Science, and Cochrane Library were searched to detect relevant publications up to 1 April 2020, using relevant keywords. To pool data, a fixed- or random-effects model was used depending on the heterogeneity between studies. Furthermore, publication bias test and sensitivity analysis were also applied. In total, 20 retrospective studies with 3428 COVID-19 infected patients (severe cases, n = 1455; mild cases, n = 1973), were included in this meta-analysis. Higher serum levels of aspartate aminotransferase (weighted mean difference, 8.84 U/L; 95% confidence interval [CI] 5.97 to 11.71; P < 0.001), alanine aminotransferase (weighted mean difference, 7.35 U/L; 95% CI, 4.77 to 9.93; P < 0.001), total bilirubin (weighted mean difference, 2.30 mmol/L; 95% CI, 1.24 to 3.36; P < 0.001), and lower serum levels of albumin (weighted mean difference, -4.24 g/L; 95% CI, -6.20 to -2.28; P < 0.001) were associated with a significant increase in the severity of COVID-19 infection. The incidence of liver injury, as assessed by serum analysis (aspartate aminotransferase, alanine aminotransferase, total bilirubin, and albumin levels), seems to be higher in patients with severe COVID-19 infection.
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Diet Behavior Change Techniques in Type 2 Diabetes: A Systematic Review and Meta-analysis.
Cradock, KA, ÓLaighin, G, Finucane, FM, McKay, R, Quinlan, LR, Martin Ginis, KA, Gainforth, HL
Diabetes care. 2017;40(12):1800-1810
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Dietary behaviour is intrinsically linked to type 2 diabetes. Dietary factors have been linked to the highest proportion of deaths in type 2 diabetes, stroke, and heart disease. Identifying effective ways to help suffers successfully change to more effective dietary behaviours may help condition management and reduce disease progression. The objective of the systemic review and meta-analysis was to identify dietary behaviour change techniques, intervention features, and specific diets associated with changes in blood glucose levels (HbA1c) and body weight in type 2 diabetes. It included 54 studies, all of whose participants have type 2 diabetes. High-protein diets and meal replacement programs produced the greatest reductions in blood glucose (measured by HbA1c). Behavioural change techniques including 'problem solving,' 'feedback on behaviour,' 'adding objects to the environment' and 'social comparison' as well as interventions that were build on behavioural change theory were associated with clinically significant reductions in blood glucose as measured by HbA1c (a reduction of ≥0.3% (3.3 mmol/mol). However, the findings show that changing or controlling (e.g. providing all food) dietary environmental factors may be more effective than strategies to change dietary behaviour to reduce blood glucose levels in adults with type 2 diabetes. The authors conclude that changing the dietary environment may be more important than focusing on dietary behaviour in type 2 diabetes treatment.
Abstract
OBJECTIVE Dietary behavior is closely connected to type 2 diabetes. The purpose of this meta-analysis was to identify behavior change techniques (BCTs) and specific components of dietary interventions for patients with type 2 diabetes associated with changes in HbA1c and body weight. RESEARCH DESIGN AND METHODS The Cochrane Library, CINAHL, Embase, PubMed, PsycINFO, and Scopus databases were searched. Reports of randomized controlled trials published during 1975-2017 that focused on changing dietary behavior were selected, and methodological rigor, use of BCTs, and fidelity and intervention features were evaluated. RESULTS In total, 54 studies were included, with 42 different BCTs applied and an average of 7 BCTs used per study. Four BCTs-"problem solving," "feedback on behavior," "adding objects to the environment," and "social comparison"-and the intervention feature "use of theory" were associated with >0.3% (3.3 mmol/mol) reduction in HbA1c. Meta-analysis revealed that studies that aimed to control or change the environment showed a greater reduction in HbA1c of 0.5% (5.5 mmol/mol) (95% CI -0.65, -0.34), compared with 0.32% (3.5 mmol/mol) (95% CI -0.40, -0.23) for studies that aimed to change behavior. Limitations of our study were the heterogeneity of dietary interventions and poor quality of reporting of BCTs. CONCLUSIONS This study provides evidence that changing the dietary environment may have more of an effect on HbA1c in adults with type 2 diabetes than changing dietary behavior. Diet interventions achieved clinically significant reductions in HbA1c, although initial reductions in body weight diminished over time. If appropriate BCTs and theory are applied, dietary interventions may result in better glucose control.
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The microbiome: A key regulator of stress and neuroinflammation.
Rea, K, Dinan, TG, Cryan, JF
Neurobiology of stress. 2016;4:23-33
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This study discusses the concept of intestinal microbiota as the key regulator involved in energy regulation, gut barrier function, protection from pathogens, and immune system function amongst others. The gut microbiota is the complex community of microorganisms that lives in the digestive tracts of humans. The main aim of this study is to summarise the role of gastrointestinal microbiota in fundamental physiological and pathophysiological processes and thereafter to understand and treat a range of stress and immune-related disorders. This review outlines the numerous complex relationships between gastrointestinal microbiota, stress and immune responses at the three critical stages of life The authors concluded that the evidence from this study suggests that resilience to stress and immune-related disorders and dysfunction of stress and immune systems may be dependent on the diversity and complexity of gastrointestinal microbiota. However, gut microbiota mediated relationship to stress and neuro-inflammation is still unconfirmed as previous studies mostly, have largely been, preclinical and further studies are warranted.
Abstract
There is a growing emphasis on the relationship between the complexity and diversity of the microorganisms that inhabit our gut (human gastrointestinal microbiota) and health/disease, including brain health and disorders of the central nervous system. The microbiota-gut-brain axis is a dynamic matrix of tissues and organs including the brain, glands, gut, immune cells and gastrointestinal microbiota that communicate in a complex multidirectional manner to maintain homeostasis. Changes in this environment can lead to a broad spectrum of physiological and behavioural effects including hypothalamic-pituitary-adrenal (HPA) axis activation, and altered activity of neurotransmitter systems and immune function. While an appropriate, co-ordinated physiological response, such as an immune or stress response are necessary for survival, a dysfunctional response can be detrimental to the host contributing to the development of a number of CNS disorders. In this review, the involvement of the gastrointestinal microbiota in stress-mediated and immune-mediated modulation of neuroendocrine, immune and neurotransmitter systems and the consequential behaviour is considered. We also focus on the mechanisms by which commensal gut microbiota can regulate neuroinflammation and further aim to exploit our understanding of their role in stress-related disorders as a consequence of neuroinflammatory processes.