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Ultrasonographic criteria in the diagnosis of polycystic ovary syndrome: a systematic review and diagnostic meta-analysis.
Pea, J, Bryan, J, Wan, C, Oldfield, AL, Ganga, K, Carter, FE, Johnson, LM, Lujan, ME
Human reproduction update. 2024;(1):109-130
Abstract
BACKGROUND Polycystic ovary morphology (PCOM) on ultrasonography is considered as a cardinal feature of polycystic ovarian syndrome (PCOS). Its relevance as a diagnostic criterion for PCOS was reaffirmed in the most recent International Evidence-Based Guideline for the Assessment and Management of PCOS. However, there remains a lack of clarity regarding the best practices and specific ultrasonographic markers to define PCOM. OBJECTIVE AND RATIONALE The aim of this systematic review and diagnostic meta-analysis was to assess the diagnostic accuracy of various ultrasonographic features of ovarian morphology in the diagnosis of PCOS. SEARCH METHODS Relevant studies published from 1 January 1990 to 12 June 2023 were identified by a systematic search in PubMed, Web of Science, Scopus, CINAHL, and CENTRAL. Studies that generated diagnostic accuracy measures (e.g. proposed thresholds, sensitivity, specificity) for PCOS using the following ultrasonographic markers met criteria for inclusion: follicle number per ovary (FNPO) or per single cross-section (FNPS), ovarian volume (OV), and stromal features. Studies on pregnant or post-menopausal women were excluded. Risk of bias and applicability assessment for diagnostic test accuracy studies were determined using the QUADAS-2 and QUADAS-C tool for a single index test or between multiple index tests, respectively. Diagnostic meta-analysis was conducted using a bivariate model of pooled sensitivity and specificity, and visualized using forest plots and summary receiver-operating characteristic (SROC) curves. OUTCOMES From a total of 2197 records initially identified, 31 studies were included. Data from five and two studies were excluded from the meta-analysis due to duplicate study populations or limited data for the index test, leaving 24 studies. Pooled results of 20 adult studies consisted of 3883 control participants and 3859 individuals with PCOS. FNPO was the most accurate diagnostic marker (sensitivity: 84%, CI: 81-87%; specificity: 91%, CI: 86-94%; AUC: 0.905) in adult women. OV and FNPS had similar pooled sensitivities (OV: 81%, CI: 76-86%; FNPS 81%, CI: 70-89%) but inferior pooled specificities (OV: 81%, CI: 75-86%; FNPS 83%, CI: 75-88%) and AUCs (OV: 0.856; FNPS 0.870) compared to FNPO. Pooled results from four adolescent studies consisting of 210 control participants and 268 girls with PCOS suggested that OV may be a robust ultrasonographic marker for PCOS diagnosis albeit the current evidence remains limited. The majority of the studies had high risk of bias for the patient selection (e.g. lack of randomized/consecutive patient selection) and index test (e.g. lack of pre-proposed thresholds for comparison) domains across all ultrasonographic markers. As such, diagnostic meta-analysis was unable to determine the most accurate cutoff for ultrasonographic markers to diagnose PCOS. Subgroup analysis suggested that stratification based on previously proposed diagnostic thresholds, age, BMI, or technology did not account for the heterogeneity in diagnostic accuracy observed across the studies. Studies that diagnosed PCOS using the Rotterdam criteria had improved sensitivity for FNPO. Studies from North America had lower diagnostic accuracy when compared to Asian studies (FNPO: sensitivity) and European studies (OV: specificity, diagnostic odds ratio and positive likelihood ratio). Geographic differences in diagnostic accuracy may potentially be due to differences in age, BMI, and diagnostic criteria of the PCOS group across regions. WIDER IMPLICATIONS This diagnostic meta-analysis supports the use of FNPO as the gold standard in the ultrasonographic diagnosis of PCOS in adult women. OV and FNPS provide alternatives if total antral follicle counts cannot be accurately obtained. Our findings support the potential for ultrasonographic evidence of PCOM in adolescents as more data becomes available. Subgroup analysis suggests the need to investigate any relative contributions of geographical differences on PCOS phenotypes. These findings may provide the basis for the development of strategies and best practices toward a standardized definition of PCOM and a more accurate ultrasonographic evaluation of PCOS.
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The design and rationale of a multicenter real-world trial: The Southeastern Collaboration to Improve Blood Pressure Control in the US Black Belt - Addressing the Triple Threat.
Safford, MM, Cummings, DM, Halladay, J, Shikany, JM, Richman, J, Oparil, S, Hollenberg, J, Adams, A, Anabtawi, M, Andreae, L, et al
Contemporary clinical trials. 2023;:107183
Abstract
BACKGROUND Impoverished African Americans (AA) with hypertension face poor health outcomes. PURPOSE To conduct a cluster-randomized trial testing two interventions, alone and in combination, to improve blood pressure (BP) control in AA with persistently uncontrolled hypertension. METHODS We engaged primary care practices serving rural Alabama and North Carolina residents, and in each practice we recruited approximately 25 AA adults with persistently uncontrolled hypertension (mean systolic BP >140 mmHg over the year prior to enrollment plus enrollment day BP assessed by research assistants ≥140/90 mmHg). Practices were randomized to peer coaching (PC), practice facilitation (PF), both PC and PF (PC + PF), or enhanced usual care (EUC). Coaches met with participants from PC and PC + PF practices weekly for 8 weeks then monthly over one year, discussing lifestyle changes, medication adherence, home monitoring, and communication with the healthcare team. Facilitators met with PF and PC + PF practices monthly to implement ≥1 quality improvement intervention in each of four domains. Data were collected at 0, 6, and 12 months. RESULTS We recruited 69 practices and 1596 participants; 18 practices (408 participants) were randomized to EUC, 16 (384 participants) to PF, 19 (424 participants) to PC, and 16 (380 participants) to PC + PF. Participants had mean age 57 years, 61% were women, and 56% reported annual income <$20,000. LIMITATIONS The PF intervention acts at the practice level, possibly missing intervention effects in trial participants. Neither PC nor PF currently has established clinical reimbursement mechanisms. CONCLUSIONS This trial will fill evidence gaps regarding practice-level vs. patient-level interventions for rural impoverished AA with uncontrolled hypertension.
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Prevalence and determinants of Hyperpolypharmacy in adults with heart failure: an observational study from the National Health and Nutrition Examination Survey (NHANES).
Kennel, PJ, Kneifati-Hayek, J, Bryan, J, Banerjee, S, Sobol, I, Lachs, MS, Safford, MM, Goyal, P
BMC cardiovascular disorders. 2019;(1):76
Abstract
BACKGROUND While an expanding armamentarium of pharmacologic therapies has contributed to improved outcomes among adults with heart failure (HF) over the past two decades, this has also been accompanied by an increase in the number of medications taken by adults with HF. The use of at least 10 medications, defined as hyperpolypharmacy, is particularly notable given its association with adverse outcomes. We aimed to assess the prevalence and identify determinants of hyperpolypharmacy among adults with HF. METHODS We studied adults aged ≥50 years with self-reported HF from the National Health And Nutrition Examination Survey (NHANES) in 2003-2014. We calculated weighted means and percentages to describe patient characteristics. We conducted a multivariable Poisson regression analysis to identify factors independently associated with hyperpolypharmacy; we adjusted for survey sampling, socio-demographics, comorbidity, geriatric conditions, and health care utilization. We examined 947 participants, representing 4.6 million adults with HF. RESULTS The prevalence of hyperpolypharmacy was 26%. In a multivariable regression analysis, comorbidity count, ≥10 ambulatory contacts, and ≥ 3 hospitalizations were independently associated with hyperpolypharmacy. Interestingly, functional impairment and cognitive impairment were not independently associated with hyperpolypharmacy; while low annual household income and low educational status were each associated with an almost 2-fold increase in hyperpolypharmacy. CONCLUSION Hyperpolypharmacy is a common condition among adults with HF. We additionally found that low household income and low educational status are independently associated with hyperpolypharmacy, suggesting that non-medical factors may be contributing to this potentially harmful condition.
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A Mediterranean diet lowers blood pressure and improves endothelial function: results from the MedLey randomized intervention trial.
Davis, CR, Hodgson, JM, Woodman, R, Bryan, J, Wilson, C, Murphy, KJ
The American journal of clinical nutrition. 2017;(6):1305-1313
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Abstract
Background: The consumption of a Mediterranean diet (MedDiet) is associated with a lower risk of cardiovascular disease. However, its impact on blood pressure and endothelial function is not clear.Objective: We sought to determine the effects of adhering to the consumption of a MedDiet for 6 mo on blood pressure and endothelial function in older, healthy Australians.Design: A total of 166 men and women aged >64 y were allocated via minimization to consume either a MedDiet (n = 85) or their habitual diet (HabDiet; control: n = 81) for 6 mo. The MedDiet comprised mainly plant foods, abundant extra-virgin olive oil, and minimal red meat and processed foods. A total of 152 participants commenced the study, and 137 subjects completed the study. Home blood pressure was measured on 5 consecutive days at baseline (n = 149) and at 3 and 6 mo. Endothelial function (n = 82) was assessed by flow-meditated dilatation (FMD) at baseline and 6 mo. Dietary intake was monitored with the use of 3-d weighed food records. Data were analyzed with the use of linear mixed-effects models to determine adjusted between-group differences.Results: The MedDiet adherence score increased significantly in the MedDiet group but not in the HabDiet group (P < 0.001). The MedDiet, compared with the HabDiet, resulted in lower systolic blood pressure (P-diet × time interaction = 0.02) [mean: -1.3 mm Hg (95% CI: -2.2, -0.3 mm Hg; P = 0.008) at 3 mo and -1.1 mm Hg (95% CI: -2.0, -0.1 mm Hg; P = 0.03) at 6 mo]. At 6 mo, the percentage of FMD was higher by 1.3% (95% CI: 0.2%, 2.4%; P = 0.026) in the MedDiet group.Conclusion: Australian men and women who consumed a MedDiet for 6 mo had small but significantly lower systolic blood pressure and improved endothelial function. This trial was registered at www.anzctr.org.au as ACTRN12613000602729.
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The Mediterranean diet and age-related cognitive functioning: A systematic review of study findings and neuropsychological assessment methodology.
Knight, A, Bryan, J, Murphy, K
Nutritional neuroscience. 2017;(8):449-468
Abstract
OBJECTIVES The primary aims of this review were to identify studies investigating the association between the MedDiet pattern and age-related cognitive function, to determine the current status of knowledge, and to ascertain whether a lack of standardization with the operationalization of age-related cognitive function and differences in the chosen neuropsychological assessment methodology impacted on the results and findings. METHODS The systematic review protocol for this paper was carried out following the statement and general principles of PRISMA and the UK Centre for Reviews and Dissemination (CRD). RESULTS A systematic search of electronic databases yielded two cross-sectional studies, two cross-sectional/prospective studies, and 11 prospective studies for inclusion. Among this group of studies, conflicting results and conclusions regarding the efficacy of the MedDiet as a therapeutic approach for age-related cognitive function were found. Of importance, clear differences among studies in relation to neuropsychological assessment methodology were identified. Such disparity appeared to be one plausible factor contributing to the lack of consensus among study findings. DISCUSSION One of the important challenges for future research will be to aim toward some kind of standardized neuropsychological assessment criteria. This type of endeavor will enable the ability to validate with greater confidence, whether or not adherence to a MedDiet does promote benefit for age-related cognitive function.
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Cerebrovascular and cognitive benefits of high-oleic peanut consumption in healthy overweight middle-aged adults.
Barbour, JA, Howe, PRC, Buckley, JD, Bryan, J, Coates, AM
Nutritional neuroscience. 2017;(10):555-562
Abstract
OBJECTIVE Peanuts contain bioactive nutrients beneficial for vascular function. This study investigated whether consumption of unsalted peanuts (with skins) would enhance cerebrovascular perfusion and cognitive performance. METHOD In a randomized crossover trial, 61 volunteers (29 males/32 females, 65 ± 7 years, BMI 31 ± 4 kg/m2) consumed their habitual diet ± high-oleic peanuts (56-84 g/day), each for 12 weeks. Nutrient intakes, vascular and cognitive function were assessed at baseline and at the end of each 12-week phase. Differences between the ends of each phase were compared by general linear repeated measures ANOVA controlling for baseline. Pearson's correlation analyses determined relationships between differences in cerebrovascular reactivity (CVR) and cognitive function. RESULTS Intakes of bioactive nutrients increased during the peanut phase. CVR was 5% greater in the left middle cerebral artery (MCA) and 7% greater in the right MCA. Small artery elasticity was 10% greater after peanut consumption; large artery elasticity and blood pressure did not differ between phases. Measures of short-term memory, verbal fluency, and processing speed were also higher following the peanut phase; other cognitive measures did not change. Differences in CVR in the left MCA correlated with differences in delayed memory and recognition. DISCUSSION Regular peanut consumption improved cerebrovascular and cognitive function; increased intakes of bioactive nutrients may have mediated these improvements. This clinical trial was registered with the Australian Clinical Trials Registry (ACTRN 12612000192886).
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The Mediterranean Diet and Cognitive Function among Healthy Older Adults in a 6-Month Randomised Controlled Trial: The MedLey Study.
Knight, A, Bryan, J, Wilson, C, Hodgson, JM, Davis, CR, Murphy, KJ
Nutrients. 2016;(9)
Abstract
Evidence from a limited number of randomised controlled intervention trials (RCTs) have shown that a Mediterranean dietary pattern may reduce the risk of cognitive decline and enhance cognitive function among healthy older adults. However, there are currently no data in non-Mediterranean older adult populations. The present study aimed to address this gap by examining the effect of a Mediterranean dietary pattern (MedDiet) for six months on aspects of cognitive function in a randomised controlled intervention trial (the MedLey study) that extended for a duration of 18 months. In the final analysed cohort, a total of 137 men and women (mean age of 72.1 ± 5.0 years) randomly assigned to either a MedDiet or control diet (HabDiet) (i.e., habitual dietary intake), were assessed on a comprehensive neuropsychological test battery, including 11 individual tests. In multivariable-adjusted models, the MedDiet group did not perform significantly better than the HabDiet control group for executive functioning (adjusted mean differences: +2.53, 95% CI -2.59 to 7.65, p = 0.33); speed of processing (adjusted mean differences: +3.24, 95% CI -1.21 to 7.70, p = 0.15); memory (adjusted mean differences: +2.00, 95% CI -3.88 to 7.88, p = 0.50); visual-spatial ability (adjusted mean differences: +0.21, 95% CI -0.38 to 0.81, 0.48); and overall age-related cognitive performance (adjusted mean differences: +7.99, 95% CI -4.00 to 19.9, p = 0.19). In conclusion, this study did not find evidence of a beneficial effect of a MedDiet intervention on cognitive function among healthy older adults.
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Definition of the Mediterranean Diet; a Literature Review.
Davis, C, Bryan, J, Hodgson, J, Murphy, K
Nutrients. 2015;(11):9139-53
Abstract
Numerous studies over several decades suggest that following the Mediterranean diet (MedDiet) can reduce the risk of cardiovascular disease and cancer, and improve cognitive health. However, there are inconsistencies among methods used for evaluating and defining the MedDiet. Through a review of the literature, we aimed to quantitatively define the MedDiet by food groups and nutrients. Databases PubMed, MEDLINE, Science Direct, Academic Search Premier and the University of South Australia Library Catalogue were searched. Articles were included if they defined the MedDiet in at least two of the following ways: (1) general descriptive definitions; (2) diet pyramids/numbers of servings of key foods; (3) grams of key foods/food groups; and (4) nutrient and flavonoid content. Quantity of key foods and nutrient content was recorded and the mean was calculated. The MedDiet contained three to nine serves of vegetables, half to two serves of fruit, one to 13 serves of cereals and up to eight serves of olive oil daily. It contained approximately 9300 kJ, 37% as total fat, 18% as monounsaturated and 9% as saturated, and 33 g of fibre per day. Our results provide a defined nutrient content and range of servings for the MedDiet based on past and current literature. More detailed reporting amongst studies could refine the definition further.
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Effect of 12 Weeks High Oleic Peanut Consumption on Cardio-Metabolic Risk Factors and Body Composition.
Barbour, JA, Howe, PR, Buckley, JD, Bryan, J, Coates, AM
Nutrients. 2015;(9):7381-98
Abstract
Epidemiological evidence indicates an inverse association between nut consumption and obesity, inflammation, hyperlipidaemia and glucose intolerance. We investigated effects of high oleic peanut consumption vs. a nut free diet on adiposity and cardio-metabolic risk markers. In a randomised cross-over design, 61 healthy subjects (65 ± 7 years, body mass index (BMI) 31 ± 4 kg/m²) alternated either high oleic peanuts (15%-20% of energy) or a nut free diet for 12 weeks. Body composition and mass, waist circumference, C-reactive protein (CRP), lipids, glucose and insulin were assessed at baseline and after each phase. Repeated measures analysis of variance (ANOVA) compared the two diets. Consistent with other nut studies, there were no differences in lipids, CRP, glucose and insulin with peanut consumption. In contrast, some reports have demonstrated benefits, likely due to differences in the study cohort. Energy intake was 10% higher (853 kJ, p < 0.05), following peanut consumption vs. control, attributed to a 30% increase in fat intake (p < 0.001), predominantly monounsaturated (increase 22 g, p < 0.05). Despite greater energy intake during the peanut phase, there were no differences in body composition, and less than predicted increase (0.5 kg) in body weight for this additional energy intake, possibly due to incomplete nutrient absorption and energy utilisation.
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A randomised controlled intervention trial evaluating the efficacy of a Mediterranean dietary pattern on cognitive function and psychological wellbeing in healthy older adults: the MedLey study.
Knight, A, Bryan, J, Wilson, C, Hodgson, J, Murphy, K
BMC geriatrics. 2015;15:55
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Age-related mental decline is an increasing global health problem. Dementia and Alzheimer’s Disease are progressive conditions currently viewed as incurable with no lasting pharmaceutical options. Recent evidence has indicated that diet and lifestyle may help to delay the onset and progression of mental decline. This randomised controlled trial (RCT) will aim to assess the effect of a six months dietary intervention on several mental outcomes, cardiovascular changes and general well being for subjects aged sixty-five and older. The RCT will compare the Mediterranean diet (MedDiet) with continued habitual diet (HabDiet). The MedDiet subjects will follow the traditional Cretan Mediterranean diet. Compliance will be assessed using food questionnaires and multiple blood markers. This RCT will be one of the first worldwide to provide evidence for the cause-effect relationship between the MedDiet and age-related mental function in a healthy older adults. The RCT has recruited 166 participants so will provide robust evidence. Results have yet to be published.
Abstract
BACKGROUND The incidence of age-related cognitive decline is rising considerably around the world. There is evidence from a number of recent cross-sectional and prospective studies indicating positive associations between the Mediterranean dietary pattern (MedDiet) and improved cognitive outcomes among the elderly including, reduced age-related cognitive decline and enhanced age-related cognitive performance. However, to date no study has validated these associations in healthy older adult populations (≥65 years and above) with randomised evidence. The main aim of the present study is to provide justified evidence regarding the efficacy of a MedDiet approach to safely reduce the onset of cognitive decline, and promote optimal cognitive performance among healthy older adults using rigorous, randomised intervention methodology. METHODS/DESIGN MedLey is a 6-month, randomised controlled 2-cohort parallel group intervention trial, with initial assessment at baseline and repeated every three months. A sample of 166 healthy Australian men and women aged 65 years and above, with normal cognitive function and proficient in English language were recruited from metropolitan Adelaide, South Australia for the study. Participants randomly allocated to the experimental group are required to maintain an intervention dietary pattern based from the traditional Cretan MedDiet (i.e. vegetables, fruits, olive oil, legumes, fish, whole grain cereals, nuts and seeds and low consumption of processed foods, dairy products, red meat and vegetable oils) for six months, while those participants allocated to the control group are asked to maintain their customary lifestyle and diet. The primary outcome of interest is the quantitative difference in age-related cognitive performance, as measured by latent variables (cognitive constructs) sensitive to normal ageing and diet (i.e. speed of processing, memory, attention, executive functions, visual spatial and visuomotor ability). Secondary outcomes include change in biomarkers of inflammation, oxidative stress, lipid metabolism, glucose, insulin, blood flow velocity, and psychological well-being factors (i.e. stress, sleep, anxiety, depression). DISCUSSION To our knowledge this will be one of the first randomised clinical trials worldwide to provide evidence for the cause-effect relationship between the MedDiet and age-related cognitive function in a healthy older adult population (≥65 years and over). TRIAL REGISTRATION Australia and New Zealand Clinical Trials Register (ANZCTR): ACTRN12613000602729.