Higher Estimated Net Endogenous Acid Production May Be Associated with Increased Prevalence of Nonalcoholic Fatty Liver Disease in Chinese Adults in Hong Kong

Nonalcoholic fatty liver disease (NAFLD) has been associated with reduced growth hormone levels and signaling. Such hormonal changes also occur in metabolic acidosis. Since mild metabolic acidosis can be diet induced, diet-induced acid load may constitute a nutritional factor with possible influence on NAFLD development. This study explored whether a higher diet-induced acid load is associated with an increased likelihood of NAFLD. Apparently healthy Chinese adults (330 male, 463 female) aged 19-72 years were recruited through population screening between 2008 and 2010 in a cross-sectional population-based study in Hong Kong. Estimated net endogenous acid production (NEAP) was calculated using Frassetto’s method and potential renal acid load (PRAL) was calculated using Remer’s method based on dietary data from a food frequency questionnaire. NAFLD was defined as intrahepatic triglyceride content at >5% by proton-magnetic resonance spectroscopy. Possible advanced fibrosis was defined as liver stiffness at >7.9 kPa by transient elastography. Multivariate logistic regression models were used to examine the association between each measure of dietary acid load and prevalent NAFLD or possible advanced fibrosis with adjustment for potential anthropometric and lifestyle factors. 220 subjects (27.7%) were diagnosed with NAFLD. Estimated NEAP was positively associated with the likelihood of having NAFLD after adjustment for age, sex, body mass index, current drinker status and the presence of metabolic syndrome [OR (95% CI) = 1.25 (1.02-1.52), p = 0.022]. The association was slightly attenuated but remained significant when the model was further adjusted for other dietary variables. No association between PRAL and NAFLD prevalence was observed. Both estimated NEAP and PRAL were not associated with the presence of possible advance fibrosis. Our findings suggest that there may be a modest association between diet-induced acid load and NAFLD. More studies are needed to ascertain the link between diet-induced acid load and NAFLD and to investigate the underlying mechanisms.     

Living on Climate-Changed Country: Indigenous Health,Well-Being and Climate Change in Remote Australian Communities

Closing the gap between the health and well-being status of Indigenous people living in remote areas of northern Australia and non-Indigenous Australians has long been a major target of federal health policy. With climate projections suggesting large increases in hot spells in desert regions and more extremes in rainfall in other areas of the north, direct and indirect impacts resulting from these changes are likely to further entrench this health and well-being disparity. This paper argues that it is time to explicitly draw on Indigenous definitions of health, which directly address the need to connect individual and community health to the health of their country, in order to develop effective climate adaptation and health strategies. We detail how current health policies overlook this ‘missing’ dimension of Indigenous connection to country, and why that is likely to be detrimental to the health and well-being of people living in remote communities in a climate-changed future.     

Extreme plasticity in life‐history strategy allows a migratory predator (jumbo squid) to cope with a changing climate

Dosidicus gigas (jumbo or Humboldt squid) is a semelparous, major predator of the eastern Pacific that is ecologically and commercially important. In the Gulf of California, these animals mature at large size (>55 cm mantle length) in 1–1.5 years and have supported a major commercial fishery in the Guaymas Basin during the last 20 years. An El Niño event in 2009–2010, was accompanied by a collapse of this fishery, and squid in the region showed major changes in the distribution and life‐history strategy. Large squid abandoned seasonal coastal‐shelf habitats in 2010 and instead were found in the Salsipuedes Basin to the north, an area buffered from the effects of El Niño by tidal upwelling and a well‐mixed water column. The commercial fishery also relocated to this region. Although large squid were not found in the Guaymas Basin from 2010 to 2012, small squid were abundant and matured at an unusually small mantle‐length (<30 cm) and young age (approximately 6 months). Juvenile squid thus appeared to respond to El Niño with an alternative life‐history trajectory in which gigantism and high fecundity in normally productive coastal‐shelf habitats were traded for accelerated reproduction at small size in an offshore environment. Both small and large mature squid, were present in the Salsipuedes Basin during 2011, indicating that both life‐ history strategies can coexist. Hydro‐acoustic data, reveal that squid biomass in this study area nearly doubled between 2010 and 2011, primarily due to a large increase in small squid that were not susceptible to the fishery. Such a climate‐driven switch in size‐at‐maturity may allow D. gigas to rapidly adapt to and cope with El Niño. This ability is likely to be an important factor in conjunction with longerterm climate‐change and the potential ecological impacts of this invasive predator on marine ecosystems.     

An Analysis of the Proportion of the U.S. Population that Ingests Soil or Other Non-Food Substances

Reliable quantitative data are lacking that document the prevalence of ingestion of soil and other “non-food” substances among U.S. children and adults. This article explores the proportion of the U.S. population that ingests substances such as soil, clay, starch, paint, or plaster. We compiled data from the National Health and Nutrition Examination Survey (NHANES) collected from years 1971–1975 (NHANES I) and 1976–1980 (NHANES II) because these particular surveys asked participants specific questions about non-food ingestion practices. We examined the prevalence of the behavior across multiple demographic variables, such as age, gender, education, and income level. Approximately 1% (NHANES II) to 2.5% (NHANES I) of the U.S. population ingests some type of non-food substance. The most notable variation across the demographic subgroups studied was the difference in estimated prevalence among young children (1 to <3 years) compared to older children and adults. Estimated prevalence was also higher among blacks compared to whites and within lower compared to higher socioeconomic groups. This analysis helps fill data gaps on the relative pattern of non-food ingestion practices on a national scale. This information provides perspective for risk assessors when evaluating exposure variables and for risk managers when weighing risk management alternatives.     

Clinical symptoms of skin, nails, and joints manifest independently in patients with concomitant psoriasis and psoriatic arthritis

This study correlated assessment tools for evaluating the severity of skin, nail, and joint symptoms in patients with psoriasis (Pso) and psoriatic arthritis (PsA). Adults with plaque Pso (with or without PsA) were enrolled from four U.S. institutions. Patients were evaluated using a novel 10-area Linear Psoriasis Area and Severity Index (XL-PASI), Psoriatic Arthritis Assessment (PsAA), Psoriatic Arthritis Screening and Evaluation Questionnaire (PASE), Nail Assessment (NA) and Joint Assessment (JA) tools, Psoriasis Weighted Extent and Severity Index (PWESI), and Lattice Physician Global Assessment (LS-PGA). Correlations between assessment tools and individual items in the assessment tools were performed. Data from 180 patients (55 with PsA) were analyzed. Highest correlations between tools (r = 0.77–0.88) were between the XL-PASI, PWESI and LS-PGA. Individual items in the XL-PASI correlated with items in the PWESI for extent skin symptoms, but not for all body areas. Overall, correlations were seen between hands and feet, between face and scalp, and between buttocks, chest, and back. Only low correlation was seen between items assessing joint symptoms with items assessing skin symptoms. These data support the notion that the complex phenotype of psoriatic disease requires instruments that assess the severity of skin, nails, and joints separately.     

Studies on the peptidase activity of transthyretin (TTR)

Transthyretin (TTR) is a plasma protein transporter of thyroxine (T₄) and retinol and also has peptidase activity. In order to characterize TTR peptidase activity we used fluorescence resonance energy transfer (FRET) peptides derived from Abz-KLRSSK-Q-EDDnp and from two portion-mixing libraries as substrates. Most of the susceptible FRET peptides were cleaved at more than one peptide bond, without particular substrate specificity. The more relevant observation was that the peptides containing E or D were cleaved at only one peptide bond and TTR was competitively inhibited by glutathione analog peptide γ-E-A-G-OH that contains two free carboxyl groups. The dependence on ionic interactions of TTR hydrolytic activity was confirmed by the large inhibitory effects of salt and ionic surfactants. TTR was not inhibited by any usual peptidase inhibitors, except by ortho-phenanthroline and EDTA. The mechanism of TTR catalysis was explored by the pH-profile of TTR hydrolytic activity in different temperatures and by proton inventory. The obtained pK and heat of ionization values suggest that a carboxylate and an ammonium group, possibly from a lysine side chain are involved. These results support the recently proposed inducible metalloprotease mechanism for TTR based on its 3D structure in presence of Zn²⁺ and a series of point mutations [Liz et al., Biochem. J 443 (2012) 769–778].     

Invasive Fungal Infections: A Continuing Challenge Report from the 17th International Symposium on Infections in the Immunocompromised Host, Genoa, Italy, 24–27 July 2012

The management of invasive fungal infections (IFIs) remains a challenge to the most experienced clinicians and mycologists as the therapeutic landscape continues to change. Delegates to the 17th International Symposium on Infections in the Immunocompromised Host heard that fungal epidemiology, patient demographics, diagnosis and treatment are all evolving. Diagnosis-driven therapy—pre-emptive or targeted—is the ideal approach to managing IFIs, but is dependent on reliable biomarker assays to identify, or at least strongly suggest, the organism(s) responsible. Biomarkers, however, are subject to ongoing research and so are also evolving. Some assays also may not be available in a particular centre. The same applies to investigations such as CT-scans and bronchoscopy that need to be performed in a timely fashion to help confirm an IFI. Thus, for patients with febrile neutropenia despite broad-spectrum antibiotic cover, clinicians without the appropriate diagnostic facilities prefer to start antifungal (AF) treatment immediately whilst attempting to confirm the diagnosis. Empirical therapy therefore looks likely to have a role for some time. For high-risk patients, such as those with haematological malignancies and/or undergoing haematopoietic stem cell transplantation (HSCT), the preferred strategy is to prevent IFIs using AF prophylaxis although regular screening with biomarkers is an alternative.