Medical Bulletin 11/ October/ 2024

A recent investigation into the impact of folic acid and vitamin B12 deficiency on essential hypertension in children and adolescents has revealed a significant correlation between these nutrient deficiencies and elevated blood pressure levels. The study that combined data from a nested case-control analysis and a cohort study unveils the crucial role these vitamins play in cardiovascular health during childhood.

The research found that deficiencies in folic acid and vitamin B12 are associated with higher BP levels in younger populations. The findings, published in the Journal of Human Hypertension, confirmed the importance of maintaining high levels of Folic acid and vitamin B12 in childhood by diet or supplementation.

Xiaohua Liang, Key Laboratory of Children’s Important Organ Development and Diseases of Chongqing Municipal Health Commission, Chongqing, China, and colleagues aimed to investigate the connection between serum levels of Folic acid or vitamin B12 and elevated BP in children and adolescents.

For this purpose, the researchers designed a nested case-control study and a cohort study to examine the relationship between serum folic acid (FA) or vitamin B12 (VB12) levels and elevated BP in children and adolescents. All participants were primary school students. The nested case-control study involved 326 subjects drawn from an established cohort. Additionally, the cohort study included 270 participants free of hypertension at baseline and was followed up in 2019.

The study led to the following findings:

• Folic acid and VB12 levels were lower in the elevated BP group than in the control group, and homocysteine levels were higher than those in the control group.

• In the elevated BP group, overweight/obese children had lower FA than overweight/obese children in the normal BP group.

• Folic acid was positively correlated with high-density lipoprotein and Apo lipoprotein A but negatively correlated with triglyceride (TG). FA was significantly correlated with elevated BP in children and adolescents, after adjusting VB12, and homocysteine, and the interaction effect of Folic acid*Homocysteine was significant.

• Both systolic and diastolic BP levels were statistically lower in the Folic acid high exposure group than in the Folic acid low exposure group in the cohort study.

"This study discovered a correlation between folic acid and vitamin B12 deficiencies in childhood and elevated blood pressure levels, suggesting that these deficiencies may influence BP through the regulation of lipid levels. The findings underscore the importance of maintaining adequate levels of Folic acid and vitamin B12 during childhood, either through diet or supplementation," the researchers concluded.

Reference: Liang, X., Huang, D., Bi, Y., He, Y., Mao, T., Liu, Q., Hu, G., Tong, J., Chen, L., Wang, Y., An, X., Jiang, X., & Tahir, M. F. (2024). The impact of folic acid/VB12 deficiency on essential hypertension in children and adolescents: From a nested case-control and a cohort study. Journal of Human Hypertension, 1-7. https://doi.org/10.1038/s41371-024-00955-w

A recent prospective randomized study has investigated the effects of continuous infusion versus bolus dosing of hydrocortisone in patients experiencing septic shock. The research is particularly significant given the critical role of corticosteroids in managing septic shock, a life-threatening condition often marked by severe infection and systemic inflammation.

The researchers demonstrated that continuous infusion and bolus dosing of hydrocortisone have similar effects on blood glucose levels in patients experiencing septic shock. The findings were published online in the Indian Journal of Critical Care Medicine.

Corticosteroids are advised for use in adult patients with septic shock who need vasopressors to maintain blood pressure. However, this treatment can increase the risk of hyperglycemia, which is linked to worse outcomes. Considering this, Rashmi Salhotra, Department of Anaesthesiology and Critical Care, University College of Medical Sciences and Guru Teg Bahadur Hospital, New Delhi, India, and colleagues conducted a prospective randomized study to compare the effects of continuous infusion versus bolus hydrocortisone on blood glucose levels in patients with septic shock.

Forty adult patients with sepsis and septic shock who required vasopressor support were randomly assigned to either group C, receiving a continuous infusion of hydrocortisone at 200 mg/day, or group B, receiving intermittent bolus doses of hydrocortisone at 50 mg IV every six hours.

The study compared several factors, including blood glucose levels, the frequency of hyperglycemic and hypoglycemic episodes, daily insulin requirements, the incidence and time to shock reversal, and the nursing workload involved in maintaining blood glucose within the target range of 82-180 mg/dL.

The study led to the following findings:

• The average blood glucose levels were similar between the two groups

• Additionally, the number of hyperglycemic and hypoglycemic episodes, daily insulin requirements, and nursing workload were comparable across the groups.

• Shock reversal occurred in 35% of patients in the continuous infusion group and 60% in the bolus group.

• The time to shock reversal and the duration of ICU stay were also statistically similar.

"Based on these findings, we conclude that continuous infusion and bolus dosing of hydrocortisone have similar effects on blood glucose control, insulin requirements, and the incidence of hyperglycemic and hypoglycemic episodes. Additionally, both treatment regimens are comparable regarding nursing workload, time to shock reversal, ICU mortality, and length of ICU stay," the researchers wrote.

Adding that, "However, the shock reversal rate appears to be clinically higher with the bolus regimen compared to the continuous infusion. Therefore, further studies to investigate this difference may be warranted."

Reference: Salhotra R, Sharahudeen A, Tyagi A, Rautela RS, Kemprai R. Effect of Continuous Infusion vs Bolus Dose of Hydrocortisone in Septic Shock: A Prospective Randomized Study. Indian J Crit Care Med 2024;28(9):837-841.

High dietary intake of Trans and Saturated fatty acids may exacerbate Atopic Dermatitis, finds study published in the Skin Health and Disease.

Numerous evidence has attributed diets with a high fatty acids (FAs) intake to be associated with atopic dermatitis (AD) development. Therefore, this study investigated the association between intake frequencies of five dietary Fatty acids and Atopic dermatitis exacerbations among young Chinese adults from Singapore and Malaysia. A validated International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire was investigator-administered to 13,561 subjects to collect information on socioeconomic, anthropometric, dietary and lifestyles habits, and personal/family medical histories. Six novel dietary indices were derived to analyse the associations between total Fatty acids, trans fatty acids (TFAs), saturated fatty acids (SFAs), monounsaturated fatty acids, linoleic acids, and alpha-linolenic acids in diets and Atopic dermatitis exacerbation. Synergy factor (SF) analysis was used to identify interactions between the dietary Fatty acids to influence disease susceptibility.

Results: In the multivariable model adjusted for age, gender, BMI, parental eczema, and lifestyle factors, a diet high in total estimated Fatty acids was strongly associated with Atopic dermatitis. Particularly, high estimated total Trans fatty acids and Saturated fatty acids were significantly associated with Atopic dermatitis exacerbations including chronic and current moderate-to-severe Atopic dermatitis. The association between Transfatty acid and Atopic dermatitis remained strong even controlled for the total Fatty acids in diets and false discovery rate corrected. Similarly, having high saturated fatty acids in diets was associated with Atopic dermatitis independently on the total Fatty acids in diets. Fatty acids in diets do not interact to influence Atopic dermatitis. Overall, these results highlighted an association between high dietary Transfatty acids and Saturated fatty acids and Atopic dermatitis exacerbations in an Asian population.

Reference: Lim JJ, Lim SW, Reginald K, Say Y-H, Liu MH, Chew FT. Association of frequent intake of trans fatty acids and saturated fatty acids in diets with increased susceptibility of atopic dermatitis exacerbation in young Chinese adults: a cross-sectional study in Singapore/Malaysia. Skin Health Dis. 2024; 4(4):e330. https://doi.org/10.1002/ski2.330

Glycated haemoglobin may predict disease severity in patients with non-alcoholic fatty liver disease, a study published in the Diabetes Research and Clinical Practice.

Currently, non-invasive scoring systems to stage the severity of non-alcoholic fatty liver disease (NAFLD) do not consider markers of glucose control; this study aimed to define the relationship between HbA1c and non-alcoholic fatty liver disease severity in patients with and without type 2 diabetes. Data were obtained from 857 patients with liver biopsy staged non-alcoholic fatty liver disease.

Paired biopsies from interventional studies were used to assess the impact of change in weight, HbA1c and active vs. placebo treatment on improvements in steatosis, non-alcoholic steatohepatitis (NASH), and fibrosis.

Results: In the discovery cohort (n = 687), risk of severe steatosis, non-alcoholic steatohepatitis and advanced fibrosis correlated positively with HbA1c, after adjustment for obesity and age. Following intervention, reduction in HbA1c was associated with improvements in steatosis and non-alcoholic steatohepatitis after adjustment for weight change and treatment, whilst fibrosis change was only associated with weight change and treatment.

HbA1c is highly informative in predicting non-alcoholic fatty liver disease severity and contributes more than BMI. Assessments of HbA1c must be a fundamental part of the holistic assessment of patients with non-alcoholic fatty liver disease and, alongside age, can be used to identify patients with highest risk of advanced disease.

Reference: Santo Colosimo, Hamish Miller, Dimitrios A. Koutoukidis, Thomas Marjot, Garry D. Tan, David J. Harman, Guruprasad P. Aithal, Pinelopi Manousou, Roberta Forlano, Richard Parker, David A. Sheridan, Philip N. Newsome, William Alazawi, Jeremy F. Cobbold, Jeremy W. Tomlinson. Glycated haemoglobin is a major predictor of disease severity in patients with NAFLD, Diabetes Research and Clinical Practice, 2024, 111820, ISSN 0168-8227, https://doi.org/10.1016/j.diabres.2024.111820.