Last data update: Apr 22, 2024. (Total: 46599 publications since 2009)
Records 1-30 (of 41 Records) |
Query Trace: Egan K [original query] |
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A U.S. lead exposure hotspots analysis
Zartarian VG , Xue J , Poulakos AG , Tornero-Velez R , Stanek LW , Snyder E , Helms Garrison V , Egan K , Courtney JG . Environ Sci Technol 2024 To identify U.S. lead exposure risk hotspots, we expanded upon geospatial statistical methods from a published Michigan case study. The evaluation of identified hotspots using five lead indices, based on housing age and sociodemographic data, showed moderate-to-substantial agreement with state-identified higher-risk locations from nine public health department reports (45-78%) and with hotspots of children's blood lead data from Michigan and Ohio (e.g., Cohen's kappa scores of 0.49-0.63). Applying geospatial cluster analysis and 80th-100th percentile methods to the lead indices, the number of U.S. census tracts ranged from ∼8% (intersection of indices) to ∼41% (combination of indices). Analyses of the number of children <6 years old living in those census tracts revealed the states (e.g., Illinois, Michigan, New Jersey, New York, Ohio, Pennsylvania, Massachusetts, California, Texas) and counties with highest potential lead exposure risk. Results support use of available lead indices as surrogates to identify locations in the absence of consistent, complete blood lead level (BLL) data across the United States. Ground-truthing with local knowledge, additional BLL data, and environmental data is needed to improve identification and analysis of lead exposure and BLL hotspots for interventions. While the science evolves, these screening results can inform "deeper dive" analyses for targeting lead actions. |
Implementation Strategies to Improve Blood Pressure Control in the United States: A Scientific Statement From the American Heart Association and American Medical Association
Abdalla M , Bolen SD , Brettler J , Egan BM , Ferdinand KC , Ford CD , Lackland DT , Wall HK , Shimbo D . Hypertension 2023 80 (10) e143-e157 Hypertension is one of the most important risk factors that contribute to incident cardiovascular events. A multitude of US and international hypertension guidelines, scientific statements, and policy statements have recommended evidence-based approaches for hypertension management and improved blood pressure (BP) control. These recommendations are based largely on high-quality observational and randomized controlled trial data. However, recent published data demonstrate troubling temporal trends with declining BP control in the United States after decades of steady improvements. Therefore, there is a widening disconnect between what hypertension experts recommend and actual BP control in practice. This scientific statement provides information on the implementation strategies to optimize hypertension management and to improve BP control among adults in the United States. Key approaches include antiracism efforts, accurate BP measurement and increased use of self-measured BP monitoring, team-based care, implementation of policies and programs to facilitate lifestyle change, standardized treatment protocols using team-based care, improvement of medication acceptance and adherence, continuous quality improvement, financial strategies, and large-scale dissemination and implementation. Closing the gap between scientific evidence, expert recommendations, and achieving BP control, particularly among disproportionately affected populations, is urgently needed to improve cardiovascular health. |
An introduction to the Marburg virus vaccine consortium, MARVAC
Cross RW , Longini IM , Becker S , Bok K , Boucher D , Carroll MW , Díaz JV , Dowling WE , Draghia-Akli R , Duworko JT , Dye JM , Egan MA , Fast P , Finan A , Finch C , Fleming TR , Fusco J , Geisbert TW , Griffiths A , Günther S , Hensley LE , Honko A , Hunegnaw R , Jakubik J , Ledgerwood J , Luhn K , Matassov D , Meshulam J , Nelson EV , Parks CL , Rustomjee R , Safronetz D , Schwartz LM , Smith D , Smock P , Sow Y , Spiropoulou CF , Sullivan NJ , Warfield KL , Wolfe D , Woolsey C , Zahn R , Henao-Restrepo AM , Muñoz-Fontela C , Marzi A . PLoS Pathog 2022 18 (10) e1010805 The emergence of Marburg virus (MARV) in Guinea and Ghana triggered the assembly of the MARV vaccine "MARVAC" consortium representing leaders in the field of vaccine research and development aiming to facilitate a rapid response to this infectious disease threat. Here, we discuss current progress, challenges, and future directions for MARV vaccines. |
Lead data mapping to prioritize US locations for whole-of-government exposure prevention efforts: State of the science, federal collaborations, and remaining challenges
Zartarian V , Poulakos A , Garrison VH , Spalt N , Tornero-Velez R , Xue J , Egan K , Courtney J . Am J Public Health 2022 112 S658-s669 For this state-of-science overview of geospatial approaches for identifying US communities with high lead-exposure risk, we compiled and summarized public data and national maps of lead indices and models, environmental lead indicators, and children's blood lead surveillance data. Currently available indices and models are primarily constructed from housing-age and sociodemographic data; differing methods, variables, data, weighting schemes, and geographic scales yield maps with different exposure risk profiles. Environmental lead indicators are available (e.g., air, drinking water, dust, soil) at different spatial scales, but key gaps remain. Blood lead level data have limitations as testing, reporting, and completeness vary across states. Mapping tools and approaches developed by federal agencies and other groups for different purposes present an opportunity for greater collaboration. Maps, data visualization tools, and analyses that synthesize available geospatial efforts can be evaluated and improved with local knowledge and blood lead data to refine identification of high-risk locations for prioritizing prevention efforts and targeting risk-reduction strategies. Remaining challenges are discussed along with a work-in-progress systematic approach for cross-agency data integration, toward advancing "whole-of-government" public health protection from lead exposures. (Am J Public Health. 2022;112(S7):S658-S669. https://doi.org/10.2105/AJPH.2022.307051). |
Using small area prevalence survey methods to conduct blood lead assessments among children
Egan KB , Dignam T , Brown MJ , Bayleyegn T , Blanton C . Int J Environ Res Public Health 2022 19 (10) INTRODUCTION: Prevalence surveys conducted in geographically small areas such as towns, zip codes, neighborhoods or census tracts are a valuable tool for estimating the extent to which environmental risks contribute to children's blood lead levels (BLLs). Population-based, cross-sectional small area prevalence surveys assessing BLLs can be used to establish a baseline lead exposure prevalence for a specific geographic region. MATERIALS AND METHODS: The required statistical methods, biological and environmental sampling, supportive data, and fieldwork considerations necessary for public health organizations to rapidly conduct child blood lead prevalence surveys at low cost using small area, cluster sampling methodology are described. RESULTS: Comprehensive small area prevalence surveys include partner identification, background data collection, review of the assessment area, resource availability determinations, sample size calculations, obtaining the consent of survey participants, survey administration, blood lead analysis, environmental sampling, educational outreach, follow-up and referral, data entry/analysis, and report production. DISCUSSION: Survey results can be used to estimate the geographic distribution of elevated BLLs and to investigate inequitable lead exposures and risk factors of interest. CONCLUSIONS: Public health officials who wish to assess child and household-level blood lead data can quickly apply the data collection methodologies using this standardized protocol here to target resources and obtain assistance with these complex procedures. The standardized methods allow for comparisons across geographic areas and over time. |
Proceedings From a National Heart, Lung, and Blood Institute and the Centers for Disease Control and Prevention Workshop to control hypertension
Commodore-Mensah Y , Loustalot F , Himmelfarb CD , Desvigne-Nickens P , Sachdev V , Bibbins-Domingo K , Clauser SB , Cohen DJ , Egan BM , Fendrick AM , Ferdinand KC , Goodman C , Graham GN , Jaffe MG , Krumholz HM , Levy PD , Mays GP , McNellis R , Muntner P , Ogedegbe G , Milani RV , Polgreen LA , Reisman L , Sanchez EJ , Sperling LS , Wall HK , Whitten L , Wright JT , Wright JS , Fine LJ . Am J Hypertens 2022 35 (3) 232-243 Hypertension treatment and control prevent more cardiovascular events than management of other modifiable risk factors. Although the age-adjusted proportion of US adults with controlled blood pressure (BP) defined as <140/90 mm Hg, improved from 31.8% in 1999-2000 to 48.5% in 2007-2008, it remained stable through 2013-2014 and declined to 43.7% in 2017-2018. To address the rapid decline in hypertension control, the National Heart, Lung, and Blood Institute and the Division for Heart Disease and Stroke Prevention of the Centers for Disease Control and Prevention convened a virtual workshop with multidisciplinary national experts. Also, the group sought to identify opportunities to reverse the adverse trend and further improve hypertension control. The workshop immediately preceded the Surgeon General's Call to Action to Control Hypertension, which recognized a stagnation in progress with hypertension control. The presentations and discussions included potential reasons for the decline and challenges in hypertension control, possible "big ideas," and multisector approaches that could reverse the current trend while addressing knowledge gaps and research priorities. The broad set of "big ideas" was comprised of various activities that may improve hypertension control, including: interventions to engage patients, promotion of self-measured BP monitoring with clinical support, supporting team-based care, implementing telehealth, enhancing community-clinical linkages, advancing precision population health, developing tailored public health messaging, simplifying hypertension treatment, using process and outcomes quality metrics to foster accountability and efficiency, improving access to high-quality health care, addressing social determinants of health, supporting cardiovascular public health and research, and lowering financial barriers to hypertension control. |
Blood pressure control among non-Hispanic Black adults is lower than non-Hispanic White adults despite similar treatment with anti-hypertensive medication: NHANES 2013-2018
Hayes DK , Jackson SL , Li Y , Wozniak G , Tsipas S , Hong Y , Thompson-Paul AM , Wall HK , Gillespie C , Egan BM , Ritchey MD , Loustalot F . Am J Hypertens 2022 35 (6) 514-525 BACKGROUND: Controlled blood pressure can prevent or reduce adverse health outcomes. Social and structural determinants may contribute to the disparity that despite equivalent proportions on anti-hypertensive medication, non-Hispanic Black (Black) adults have lower blood pressure control and more cardiovascular events than non-Hispanic White (White) adults. METHODS: Data from 2013-2018 National Health and Nutrition Examination Survey were pooled to assess control among Black and White adults by anti-hypertensive medication use and selected characteristics using the 2017 American College of Cardiology/American Heart Association (ACC/AHA) Blood Pressure Guideline definition (systolic blood pressure <130mm Hg and diastolic blood pressure <80mm Hg) among 4,739 adults. RESULTS: Among those treated with anti-hypertensive medication, an estimated 34.9% of Black and 45.0% of White adults had controlled blood pressure. Control was lower for Black and White adults among most subgroups of age, sex, education, insurance status, usual source of care, and poverty-income ratio. Black adults had higher use of diuretics (28.5%--Black adults vs. 23.5%--White adults) and calcium channel blockers (24.2%--Black adults vs. 14.7%--White adults) compared to White adults. Control among Black adults was lower than White adults across all medication classes including diuretics (36.1%--Black adults vs. 47.3%--White adults), calcium channel blockers (30.2%--Black adults vs. 40.1%--White adults), and number of medication classes used. CONCLUSIONS: Sub-optimal blood pressure control rates and disparities warrant increased efforts to improve control, which could include addressing social and structural determinants along with emphasizing implementation of the 2017 ACC/AHA Blood Pressure Guideline into clinical practice. |
Blood Lead Levels in U.S. Children Ages 1-11 Years, 1976-2016
Egan KB , Cornwell CR , Courtney JG , Ettinger AS . Environ Health Perspect 2021 129 (3) 37003 BACKGROUND: Lead can adversely affect child health across a wide range of exposure levels. We describe the distribution of blood lead levels (BLLs) in U.S. children ages 1-11 y by selected sociodemographic and housing characteristics over a 40-y period. METHODS: Data from the National Health and Nutrition Examination Survey (NHANES) II (1976-1980), NHANES III (Phase 1: 1988-1991 and Phase II: 1991-1994), and Continuous NHANES (1999-2016) were used to describe the distribution of BLLs (in micrograms per deciliter; 1 μg/dL = 0.0483 μmol/L) in U.S. children ages 1-11 y from 1976 to 2016. For all children with valid BLLs (n = 27,122), geometric mean (GM) BLLs [95% confidence intervals (CI)] and estimated prevalence ≥ 5 μg/dL (95% CI) were calculated overall and by selected characteristics, stratified by age group (1-5 y and 6-11 y). RESULTS: The GM BLL in U.S. children ages 1-5 y declined from 15.2 μg/dL (95% CI: 14.3, 16.1) in 1976-1980 to 0.83 μg/dL (95% CI: 0.78, 0.88) in 2011-2016, representing a 94.5% decrease over time. For children ages 6-11 y, GM BLL declined from 12.7 μg/dL (95% CI: 11.9, 13.4) in 1976-1980 to 0.60 μg/dL (95% CI: 0.58, 0.63) in 2011-2016, representing a 95.3% decrease over time. Even so, for the most recent period (2011-2016), estimates indicate that approximately 385,775 children ages 1-11 y had BLLs greater than or equal to the CDC blood lead reference value of 5 μg/dL. Higher GM BLLs were associated with non-Hispanic Black race/ethnicity, lower family income-to-poverty-ratio, and older housing age. DISCUSSION: Overall, BLLs in U.S. children ages 1-11 y have decreased substantially over the past 40 y. Despite these notable declines in population exposures to lead over time, higher GM BLLs are consistently associated with risk factors such as race/ethnicity, poverty, and housing age that can be used to target blood lead screening efforts. https://doi.org/10.1289/EHP7932. |
Decreases in Young Children Who Received Blood Lead Level Testing During COVID-19 - 34 Jurisdictions, January-May 2020.
Courtney JG , Chuke SO , Dyke K , Credle K , Lecours C , Egan KB , Leonard M . MMWR Morb Mortal Wkly Rep 2021 70 (5) 155-161 Exposure to lead, a toxic metal, can result in severe effects in children, including decreased ability to learn, permanent neurologic damage, organ failure, and death. CDC and other health care organizations recommend routine blood lead level (BLL) testing among children as part of well-child examinations to facilitate prompt identification of elevated BLL, eliminate source exposure, and provide medical and other services (1). To describe BLL testing trends among young children during the coronavirus disease 2019 (COVID-19) pandemic, CDC analyzed data reported from 34 state and local health departments about BLL testing among children aged <6 years conducted during January-May 2019 and January-May 2020. Compared with testing in 2019, testing during January-May 2020 decreased by 34%, with 480,172 fewer children tested. An estimated 9,603 children with elevated BLL were missed because of decreased BLL testing. Despite geographic variability, all health departments reported fewer children tested for BLL after the national COVID-19 emergency declaration (March-May 2020). In addition, health departments reported difficulty conducting medical follow-up and environmental investigations for children with elevated BLLs because of staffing shortages and constraints on home visits associated with the pandemic. Providers and public health agencies need to take action to ensure that children who missed their scheduled blood lead screening test, or who required follow-up on an earlier high BLL, be tested as soon as possible and receive appropriate care. |
Within-trial cost-effectiveness of a structured lifestyle intervention in adults with overweight/obesity and type 2 diabetes: Results from the Action for Health in Diabetes (Look AHEAD) Study
Zhang P , Atkinson KM , Bray G , Chen H , Clark JM , Coday M , Dutton GR , Egan C , Espeland MA , Evans M , Foreyt JP , Greenway FL , Gregg EW , Hazuda HP , Hill JO , Horton ES , Hubbard VS , Huckfeldt PJ , Jackson SD , Jakicic JM , Jeffery RW , Johnson KC , Kahn SE , Killean T , Knowler WC , Korytkowski M , Lewis CE , Maruthur NM , Michaels S , Montez MG , Nathan DM , Patricio J , Peters A , Pi-Sunyer X , Pownall H , Redmon B , Rushing JT , Steinburg H , Wadden TA , Wing RR , Wyatt H , Yanovski SZ . Diabetes Care 2020 44 (1) 67-74 OBJECTIVE: To assess the cost-effectiveness (CE) of an intensive lifestyle intervention (ILI) compared with standard diabetes support and education (DSE) in adults with overweight/obesity and type 2 diabetes, as implemented in the Action for Health in Diabetes study. RESEARCH DESIGN AND METHODS: Data were from 4,827 participants during their first 9 years of the study participation from 2001 to 2012. Information on Health Utilities Index Mark 2 (HUI-2) and HUI-3, Short-Form 6D (SF-6D), and Feeling Thermometer (FT), cost of delivering the interventions, and health expenditures was collected during the study. CE was measured by incremental CE ratios (ICERs) in costs per quality-adjusted life year (QALY). Future costs and QALYs were discounted at 3% annually. Costs were in 2012 U.S. dollars. RESULTS: Over the 9 years studied, the mean cumulative intervention costs and mean cumulative health care expenditures were $11,275 and $64,453 per person for ILI and $887 and $68,174 for DSE. Thus, ILI cost $6,666 more per person than DSE. Additional QALYs gained by ILI were not statistically significant measured by the HUIs and were 0.07 and 0.15, respectively, measured by SF-6D and FT. The ICERs ranged from no health benefit with a higher cost based on HUIs to $96,458/QALY and $43,169/QALY, respectively, based on SF-6D and FT. CONCLUSIONS: Whether ILI was cost-effective over the 9-year period is unclear because different health utility measures led to different conclusions. |
Sociodemographic determinants of Life's Simple 7: Implications for achieving cardiovascular health and health equity goals
Egan BM , Li J , Sutherland SE , Jones DW , Ferdinand KC , Hong Y , Sanchez E . Ethn Dis 2020 30 (4) 637-650 BACKGROUND: Life's Simple 7 (LS7; nutrition, physical activity, cigarette use, body mass index, blood pressure, cholesterol, glucose) predicts cardiovascular health. The principal objective of our study was to define demographic and socioeconomic factors associated with LS7 to better inform programs addressing cardiovascular health and health equity. METHODS: National Health and Nutrition Examination Surveys 1999-2016 data were analyzed on non-Hispanic White [NHW], NH Black [NHB], and Hispanic adults aged ≥20 years without cardiovascular disease. Each LS7 variable was assigned 0, 1, or 2 points for poor, intermediate, and ideal levels, respectively. Composite LS7 scores were grouped as poor (0-4 points), intermediate (5-9), and ideal (10-14). RESULTS: 32,803 adults were included. Mean composite LS7 scores were below ideal across race/ethnicity groups. After adjusting for confounders, NHBs were less likely to have optimal LS7 scores than NHW (multivariable odds ratios (OR .44; 95% CI .37-.53), whereas Hispanics tended to have better scores (1.18; .96-1.44). Hispanics had more ideal LS7 scores than NHBs, although Hispanics had lower incomes and less education, which were independently associated with fewer ideal LS7 scores. Adults aged ≥45 years were less likely to have ideal LS7 scores (.11; .09-.12) than adults aged <45 years. CONCLUSIONS: NHBs were the least likely to have optimal scores, despite higher incomes and more education than Hispanics, consistent with structural racism and Hispanic paradox. Programs to optimize lifestyle should begin in childhood to mitigate precipitous age-related declines in LS7 scores, especially in at-risk groups. Promoting higher education and reducing poverty are also important. |
Notes from the Field: Brucella abortus RB51 infections associated with consumption of raw milk from Pennsylvania - 2017 and 2018
Gruber JF , Newman A , Egan C , Campbell C , Garafalo K , Wolfgang DR , Weltman A , Kline KE , Watkins SM , Robbe-Austerman S , Quance C , Thacker T , Kharod G , Negron ME , Schroeder B . MMWR Morb Mortal Wkly Rep 2020 69 (15) 482-483 In December 2018, the Pennsylvania Department of Agriculture (PDA) and Pennsylvania Department of Health (PADOH) were notified of a New York patient with brucellosis caused by infection with Brucella abortus RB51, the live attenuated vaccine strain of B. abortus used to prevent brucellosis in cattle (1). Brucellosis is a serious zoonotic infection caused by the bacteria Brucella spp. The most common sign is fever, followed by osteoarticular symptoms, sweating, and constitutional symptoms (2). Without proper treatment, infection can become chronic and potentially life-threatening (2). The patient had consumed raw (unpasteurized) milk from dairy A in Pennsylvania.* In July 2017, Texas health officials documented the first human case of domestically acquired RB51 infection associated with raw milk consumption from a Texas dairy (3). In October 2017, a second RB51 case associated with raw milk consumption was documented in New Jersey†; the milk source was not identified at the time. |
Associations of blood lead levels with asthma and blood eosinophils in U.S. children
Cornwell CR , Egan KB , Zahran HS , Mirabelli MC , Hsu J , Chew GL . Pediatr Allergy Immunol 2020 31 (6) 695-699 U.S. children are exposed to lead through lead-based paint, lead-contaminated dust in older homes and through contaminated water, air, soil, or consumer and imported products(1,2) . Approximately 24 million housing units have one or more lead-based paint hazards, including 3.6 million homes with children aged </=6 years(1) . Epidemiologic studies have reported positive associations between lead and elevated immunoglobulin E (IgE) in children(3-5) ; IgE is often associated with allergic asthma(6) . |
Blood lead levels in U.S. women of childbearing age, 1976-2016
Ettinger AS , Egan KB , Homa DM , Brown MJ . Environ Health Perspect 2020 128 (1) 17012 BACKGROUND: Lead can adversely affect maternal and child health across a wide range of exposures; developing fetuses and breastfeeding infants may be particularly vulnerable. We describe the distribution of blood lead levels (BLLs) in U.S. women of childbearing age and associations with sociodemographic, reproductive, smoking, and housing characteristics over a 40-y period. METHODS: Data from the National Health and Nutrition Examination Survey (NHANES) II, NHANES III Phase I and Phase II, and 1999-2016 continuous NHANES were used to describe the distribution of BLLs (given in micrograms per deciliter; 1mug/dL=0.0483mumol/L) in U.S. women 15-49 years of age between 1976 and 2016. For all women with valid BLLs (n=22,408), geometric mean (GM) BLLs and estimated prevalence of BLLs >/=5mug/dL were calculated overall and by selected demographic characteristics. For NHANES II, estimated prevalence of BLLs >/=10 and >/=20mug/dL were also calculated. RESULTS: The most recent GM BLLs (2007-2010 and 2011-2016, respectively) were 0.81mug/dL [95% confidence interval (CI): 0.79, 0.84] and 0.61mug/dL (95% CI: 0.59, 0.64). In comparison, GM BLLs in earlier periods (1976-1980, 1988-1991, and 1991-1994) were 10.37mug/dL (95% CI: 9.95, 10.79), 1.85mug/dL (95% CI: 1.75, 1.94), and 1.53mug/dL (95% CI: 1.45, 1.60), respectively. In 2011-2016, 0.7% of women of childbearing age had BLLs >/=5mug/dL, and higher BLLs were associated with older age, other race/ethnicity, birthplace outside the United States, four or more live births, exposure to secondhand tobacco smoke, and ever pregnant or not currently pregnant. DISCUSSION: Lead exposure in U.S. women of childbearing age is generally low and has substantially decreased over this 40-y period. However, based on these estimates, there are still at least 500,000 U.S. women being exposed to lead at levels that may harm developing fetuses or breastfeeding infants. Identifying high-risk women who are or intend to become pregnant remains an important public health issue. https://doi.org/10.1289/EHP5925. |
History of cardiovascular disease, intensive lifestyle intervention, and cardiovascular outcomes in the Look AHEAD Trial
Lewis CE , Bantle JP , Bertoni AG , Blackburn G , Brancati FL , Bray GA , Cheskin LJ , Curtis JM , Egan C , Evans M , Foreyt JP , Ghazarian S , Barone Gibbs B , Glasser SP , Gregg EW , Hazuda HP , Hesson L , Hill JO , Horton ES , Hubbard VS , Jakicic JM , Jeffery RW , Johnson KC , Kahn SE , Kitabchi AE , Kitzman D , Knowler WC , Lipkin E , Michaels S , Montez MG , Nathan DM , Nyenwe E , Patricio J , Peters A , Pi-Sunyer X , Pownall H , Reboussin DM , Ryan DH , Wadden TA , Wagenknecht LE , Wyatt H , Wing RR , Yanovski SZ . Obesity (Silver Spring) 2020 28 (2) 247-258 OBJECTIVE: To examine the effects of an intensive lifestyle intervention (ILI) on cardiovascular disease (CVD), the Action for Health in Diabetes (Look AHEAD) trial randomized 5,145 participants with type 2 diabetes and overweight/obesity to a ILI or diabetes support and education. Although the primary outcome did not differ between the groups, there was suggestive evidence of heterogeneity for prespecified baseline CVD history subgroups (interaction P = 0.063). Event rates were higher in the ILI group among those with a CVD history (hazard ratio 1.13 [95% CI: 0.90-1.41]) and lower among those without CVD (hazard ratio 0.86 [95% CI: 0.72-1.02]). METHODS: This study conducted post hoc analyses of the rates of the primary composite outcome and components, adjudicated cardiovascular death, nonfatal myocardial infarction (MI), stroke, and hospitalization for angina, as well as three secondary composite cardiovascular outcomes. RESULTS: Interaction P values for the primary and two secondary composites were similar (0.060-0.064). Of components, the interaction was significant for nonfatal MI (P = 0.035). This interaction was not due to confounding by baseline variables, different intervention responses for weight loss and physical fitness, or hypoglycemic events. In those with a CVD history, statin use was high and similar by group. In those without a CVD history, low-density lipoprotein cholesterol levels were higher (P = 0.003) and statin use was lower (P </= 0.001) in the ILI group. CONCLUSIONS: Intervention response heterogeneity was significant for nonfatal MI. Response heterogeneity may need consideration in a CVD-outcome trial design. |
Brucella exposure risk events in ten clinical laboratories, New York City, 2015 - 2017
Ackelsberg J , Liddicoat A , Burke T , Szymczak WA , Levi MH , Ostrowsky B , Hamula C , Patel G , Kopetz V , Saverimuttu J , Sordillo EM , D'Souza D , Mitchell EA , Lowe W , Khare R , Tang YW , Bianchi AL , Egan C , Perry MJ , Hughes S , Rakeman JL , Adams E , Kharod GA , Tiller R , Saile E , Lee S , Gonzalez E , Hoppe B , Leviton IM , Hacker S , Ni KF , Orsini RL , Jhaveri S , Mazariegos I , Dingle T , Koll B , Stoddard RA , Galloway R , Hoffmaster A , Fine A , Lee E , Dentinger C , Harrison E , Layton M . J Clin Microbiol 2019 58 (2) During 2015-2017, 11 confirmed brucellosis cases were reported in New York City, leading to 10 Brucella exposure risk events ("Brucella events") in 7 clinical laboratories (CLs). Most patients traveled to endemic countries and presented with histories and findings consistent with brucellosis. CLs were not notified that specimens might yield a hazardous organism, as clinicians did not consider brucellosis until notified that bacteremia with Brucella was suspected.In 3 Brucella events, CLs did not suspect that slow-growing, small Gram-negative bacteria might be harmful. Matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS), with limited capacity to identify biological threat agents (BTAs), was used during 4 Brucella events that accounted for 84% of exposures. In 3 of these incidents, initial staining of liquid media showed Gram-positive rods or cocci, including some cocci in chains, suggesting streptococci. Over 200 occupational exposures occurred when the unknown isolates were manipulated and/or tested on open benches, including procedures that could generate infectious aerosols. During 3 Brucella events, CLs examined and/or manipulated isolates in a biological safety cabinet (BSC); in each, CLs had isolated Brucella previously.Centers for Disease Control and Prevention recommendations to prevent laboratory-acquired brucellosis (LAB) were followed; no seroconversions or LAB cases occurred.Laboratory assessments were conducted after Brucella events to identify facility-specific risks and mitigations. With increasing MALDI-TOF MS use, CLs are well-advised to adhere strictly to safe work practices, such as handling and manipulating all slow-growing organisms in BSCs and not using MALDI-TOF for identification until BTAs have been ruled out. |
Molecular Characterization of Clostridium botulinum Harboring the bont/B7 Gene.
Halpin JL , Dykes JK , Katz L , Centurioni DA , Perry MJ , Egan CT , Luquez C . Foodborne Pathog Dis 2019 16 (6) 428-433 Clostridium botulinum produces botulinum neurotoxin (BoNT), which is the causative agent of botulism, a rare but serious disease that can result in death if not treated. Infant botulism occurs when C. botulinum colonizes the intestinal tract of infants and produces BoNT. It has been proposed that infants under the age of 1 year are uniquely susceptible to colonization by C. botulinum as their intestinal microbiota is not fully developed and provides little competition, allowing C. botulinum to thrive and produce BoNT in the gut. There are seven well-characterized serotypes (A-G) of BoNT identified by the ability of specific antitoxins to neutralize BoNTs. Molecular technology has allowed researchers to narrow these further into subtypes based on nucleic acid sequences of the botulinum toxin (bont) gene. One of the most recently recognized subtypes for bont/B is subtype bont/B7. We identified through whole genome sequencing five C. botulinum isolates harboring bont/B7 from CDC's strain collection, including patient isolates and an epidemiologically linked isolate from an opened infant formula container. In this study, we report the results of whole genome sequencing analysis of these C. botulinum subtype bont/B7 isolates. Average nucleotide identity and high quality single nucleotide polymorphism (hqSNP) analysis resulted in two major clades. The epidemiologically linked isolates differed from each other by 2-6 hqSNPs, and this clade separated from the other isolates by 95-119 hqSNPs, corroborating available epidemiological evidence. |
Notes from the Field: Botulism outbreak associated with home-canned peas - New York City, 2018
Bergeron G , Latash J , Da Costa-Carter CA , Egan C , Stavinsky F , Kileci JA , Winstead A , Zhao B , Perry MJ , Chatham-Stephens K , Sarpel D , Hughes S , Conlon MA , Edmunds S , Mohanraj M , Rakeman JL , Centurioni DA , Luquez C , Chiefari AK , Harper S . MMWR Morb Mortal Wkly Rep 2019 68 (10) 251-252 On June 6, 2018, at 1:30 p.m., the New York City Department of Health and Mental Hygiene was notified of three related women who had arrived at a hospital 4 hours earlier for evaluation for acute nausea, dizziness, blurred vision, slurred speech, ptosis, thick-feeling tongue, and shortness of breath. Two patients developed respiratory failure, requiring intubation and mechanical ventilation in the emergency department, and the third patient was intubated at 7 p.m. that evening. The combination of cranial nerve palsies and respiratory failure in multiple patients suggested botulism, a paralytic illness caused by botulinum neurotoxin (BoNT), most commonly produced by Clostridium botulinum. |
CNS melioidosis in a traveler returning from Cabo, Mexico
Donahue MA , Newcomb G , Spinella S , Prasad P , Liesveld J , Egan CT , Smith GL , Newman AP , Bower WA , Blaney DD , Gee JE , Elrod MG , Chuang S , Babu TM . Open Forum Infect Dis 2019 6 (2) ofz005 Melioidosis is caused by the gram-negative bacillus Burkholderia pseudomallei, endemic to northern Australia and Southeast Asia. We present a patient who traveled to Mexico, returned to the United States, and developed progressive manifestations of melioidosis, culminating as central nervous system disease. Standard therapy was contraindicated, and a prolonged intensive phase was employed. |
Integrating childhood and adult blood lead surveillance to improve identification and intervention efforts
Egan KB , Tsai RJ , Chuke SO . J Public Health Manag Pract 2019 25 S98-s104 The Centers for Disease Control and Prevention (CDC) collects information on blood lead levels (BLLs) in the United States through the Childhood Blood Lead Surveillance (CBLS) system (<16 years of age) and the Adult Blood Lead Epidemiology and Surveillance (ABLES) program (>/=16 years of age). While both of these state-based national programs share the mutual goal of monitoring and reducing lead exposure in the US population, blood lead data for children and adults are maintained in separate data collection systems. This limits the ability to fully describe lead exposure in the US population across these 2 distinct population groups from sources such as take-home and maternal-child lead exposure. In addition, at the state level, having a unified system to collect, maintain, and analyze child and adult blood lead data provides a more efficient use of limited resources. Based on feedback from state partners, CDC is working to integrate CBLS and ABLES data collection systems at the national level. Several states have developed or are developing an integrated child and adult blood lead data collection system. We highlight efforts undertaken in Wisconsin, Minnesota, North Carolina, Iowa, and Oregon to investigate workplace and take-home lead exposure. Integrating blood lead surveillance data at the national level will enhance CDC's ability to monitor sources of lead exposure from both the home and work environments including paint, water, soil, dust, consumer products, and lead-related industries. Together, an integrated child and adult blood lead surveillance system will offer a coordinated, comprehensive, and systematic public health approach to the surveillance and monitoring of reported BLLs across the US population. |
Physical function following a long-term lifestyle intervention among middle aged and older adults with type 2 diabetes: The Look AHEAD Study
Houston DK , Neiberg RH , Miller ME , Hill JO , Jakicic JM , Johnson KC , Gregg EW , Hubbard VS , Pi-Sunyer X , Rejeski WJ , Wing RR , Bantle JP , Beale E , Berkowitz RI , Cassidy-Begay M , Clark JM , Coday M , Delahanty LM , Dutton G , Egan C , Foreyt JP , Greenway FL , Hazuda HP , Hergenroeder A , Horton ES , Jeffery RW , Kahn SE , Kure A , Knowler WC , Lewis CE , Martin CK , Michaels S , Montez MG , Nathan DM , Patricio J , Peters A , Pownall H , Regensteiner J , Steinburg H , Wadden TA , White K , Yanovski SZ , Zhang P , Kritchevsky SB . J Gerontol A Biol Sci Med Sci 2018 73 (11) 1552-1559 Background: Lifestyle interventions have been shown to improve physical function over the short term; however, whether these benefits are sustainable is unknown. The long-term effects of an intensive lifestyle intervention (ILI) on physical function were assessed using a randomized post-test design in the Look AHEAD trial. Methods: Overweight and obese (body mass index >/= 25 kg/m2) middle-aged and older adults (aged 45-76 years at enrollment) with type 2 diabetes enrolled in Look AHEAD, a trial evaluating an ILI designed to achieve weight loss through caloric restriction and increased physical activity compared to diabetes support and education (DSE), underwent standardized assessments of performance-based physical function including a 4- and 400-m walk, lower extremity physical performance (expanded Short Physical Performance Battery, SPPBexp), and grip strength approximately 11 years postrandomization and 1.5 years after the intervention was stopped (n = 3,783). Results: Individuals randomized to ILI had lower odds of slow gait speed (<0.8 m/s) compared to those randomized to DSE (adjusted OR [95% CI]: 0.84 [0.71 to 0.99]). Individuals randomized to ILI also had faster gait speed over 4- and 400-m (adjusted mean difference [95% CI]: 0.019 [0.007 to 0.031] m/s, p = .002, and 0.023 [0.012 to 0.034] m/sec, p < .0001, respectively) and higher SPPBexp scores (0.037 [0.011 to 0.063], p = .005) compared to those randomized to DSE. The intervention effect was slightly larger for SPPBexp scores among older versus younger participants (0.081 [0.038 to 0.124] vs 0.013 [-0.021 to 0.047], p = .01). Conclusions: An intensive lifestyle intervention has modest but significant long-term benefits on physical function in overweight and obese middle-aged and older adults with type 2 diabetes. ClinicalTrials.gov Identifier: NCT00017953. |
Public health response to an imported case of canine melioidosis
Ryan CW , Bishop K , Blaney DD , Britton SJ , Cantone F , Egan C , Elrod MG , Frye CW , Maxted AM , Perkins G . Zoonoses Public Health 2018 65 (4) 420-424 Melioidosis in humans presents variably as fulminant sepsis, pneumonia, skin infection and solid organ abscesses. It is caused by Burkholderia pseudomallei, which in the United States is classified as a select agent, with "potential to pose a severe threat to both human and animal health, to plant health or to animal and plant products" (Federal Select Agent Program, http://www.selectagents.gov/, accessed 22 September 2016). Burkholderia pseudomallei is found in soil and surface water in the tropics, especially South-East Asia and northern Australia, where melioidosis is endemic. Human cases are rare in the United States and are usually associated with travel to endemic areas. Burkholderia pseudomallei can also infect animals. We describe a multijurisdictional public health response to a case of subclinical urinary B. pseudomallei infection in a dog that had been adopted into upstate New York from a shelter in Thailand. Investigation disclosed three human contacts with single, low-risk exposures to the dog's urine at his residence, and 16 human contacts with possible exposure to his urine or culture isolates at a veterinary hospital. Contacts were offered various combinations of symptom/fever monitoring, baseline and repeat B. pseudomallei serologic testing, and antibiotic post-exposure prophylaxis, depending on the nature of their exposure and their personal medical histories. The dog's owner accepted recommendations from public health authorities and veterinary clinicians for humane euthanasia. A number of animal rescue organizations actively facilitate adoptions into the United States of shelter dogs from South-East Asia. This may result in importation of B. pseudomallei into almost any community, with implications for human and animal health. |
The effect of intentional weight loss on fracture risk in persons with diabetes: results from the Look AHEAD Randomized Clinical Trial
Johnson KC , Bray GA , Cheskin LJ , Clark JM , Egan CM , Foreyt JP , Garcia KR , Glasser S , Greenway FL , Gregg EW , Hazuda HP , Hergenroeder A , Hill JO , Horton ES , Jakicic JM , Jeffery RW , Kahn SE , Knowler WC , Lewis CE , Miller M , Montez MG , Nathan DM , Patricio JL , Peters AL , Pi-Sunyer X , Pownall HJ , Reboussin D , Redmon JB , Steinberg H , Wadden TA , Wagenknecht LE , Wing RR , Womack CR , Yanovski SZ , Zhang P , Schwartz AV . J Bone Miner Res 2017 32 (11) 2278-2287 Intentional weight loss is an important treatment option for overweight persons with type 2 diabetes mellitus (DM), but the effects on long term fracture risk are not known. The purpose of this Look AHEAD analysis was to evaluate whether long term intentional weight loss would increase fracture risk in overweight or obese persons with DM. Look AHEAD is a multicenter, randomized clinical trial. Recruitment began in August 2001 and follow-up continued for a median of 11.3 years at 16 academic centers. 5145 persons aged 45 - 76 with DM were randomized to either an intensive lifestyle intervention (ILI) with reduced calorie consumption and increased physical activity designed to achieve and maintain ≥7% weight loss or to diabetes support and education intervention (DSE). Incident fractures were ascertained every 6 months by self-report and confirmed with central adjudication of medical records.The baseline mean age of participants was 59 years, 60% were women, 63% were Caucasian, and the mean BMI was 36 kg/m2 . Weight loss over the intervention period (median 9.6 years) was 6.0% in ILI and 3.5% in DSE. 731 participants had a confirmed incident fracture (358 in DSE v. 373 in ILI). There were no statistically significant differences in incident total or hip fracture rates between the ILI and DSE groups. However, compared to the DSE group, the ILI group had a statistically significant 39% increased risk of a frailty fracture (HR = 1.39, 95% CI 1.02, 1.89).An intensive lifestyle intervention resulting in long term weight loss in overweight / obese adults with DM was not associated with an overall increased risk of incident fracture but may be associated with an increased risk of frailty fracture. When intentional weight loss is planned, consideration of bone preservation and fracture prevention is warranted. This article is protected by copyright. All rights reserved. |
Managerial practices regarding workers working while ill
Norton DM , Brown LG , Frick R , Carpenter LR , Green AL , Tobin-D'Angelo M , Reimann DW , Blade H , Nicholas DC , Egan JS , Everstine K . J Food Prot 2015 78 (1) 187-95 Surveillance data indicate that handling of food by an ill worker is a cause of almost half of all restaurant-related outbreaks. The U.S. Food and Drug Administration (FDA) Food Code contains recommendations for food service establishments, including restaurants, aimed at reducing the frequency with which food workers work while ill. However, few data exist on the extent to which restaurants have implemented FDA recommendations. The Centers for Disease Control and Prevention's Environmental Health Specialists Network (EHS-Net) conducted a study on the topic of ill food workers in restaurants. We interviewed restaurant managers (n = 426) in nine EHS-Net sites. We found that many restaurant policies concerning ill food workers do not follow FDA recommendations. For example, one-third of the restaurants' policies did not specifically address the circumstances under which ill food workers should be excluded from work (i.e., not be allowed to work). We also found that, in many restaurants, managers are not actively involved in decisions about whether ill food workers should work. Additionally, almost 70% of managers said they had worked while ill; 10% said they had worked while having nausea or "stomach flu," possible symptoms of foodborne illness. When asked why they had worked when ill, a third of the managers said they felt obligated to work or their strong work ethic compelled them to work. Other reasons cited were that the restaurant was understaffed or no one was available to replace them (26%), they felt that their symptoms were mild or not contagious (19%), they had special managerial responsibilities that no one else could fulfill (11%), there was non-food handling work they could do (7%), and they would not get paid if they did not work or the restaurant had no sick leave policy (5%). Data from this study can inform future research and help policy makers target interventions designed to reduce the frequency with which food workers work while ill. |
Impact of an intensive lifestyle intervention on use and cost of medical services among overweight and obese adults with type 2 diabetes: the action for health in diabetes
Espeland MA , Glick HA , Bertoni A , Brancati FL , Bray GA , Clark JM , Curtis JM , Egan C , Evans M , Foreyt JP , Ghazarian S , Gregg EW , Hazuda HP , Hill JO , Hire D , Horton ES , Hubbard VS , Jakicic JM , Jeffery RW , Johnson KC , Kahn SE , Killean T , Kitabchi AE , Knowler WC , Kriska A , Lewis CE , Miller M , Montez MG , Murillo A , Nathan DM , Nyenwe E , Patricio J , Peters AL , Pi-Sunyer X , Pownall H , Redmon JB , Rushing J , Ryan DH , Safford M , Tsai AG , Wadden TA , Wing RR , Yanovski SZ , Zhang P . Diabetes Care 2014 37 (9) 2548-56 OBJECTIVE: To assess the relative impact of an intensive lifestyle intervention (ILI) on use and costs of health care within the Look AHEAD trial. RESEARCH DESIGN AND METHODS: A total of 5,121 overweight or obese adults with type 2 diabetes were randomly assigned to an ILI that promoted weight loss or to a comparison condition of diabetes support and education (DSE). Use and costs of health-care services were recorded across an average of 10 years. RESULTS: ILI led to reductions in annual hospitalizations (11%, P = 0.004), hospital days (15%, P = 0.01), and number of medications (6%, P < 0.001), resulting in cost savings for hospitalization (10%, P = 0.04) and medication (7%, P < 0.001). ILI produced a mean relative per-person 10-year cost savings of $5,280 (95% CI 3,385-7,175); however, these were not evident among individuals with a history of cardiovascular disease. CONCLUSIONS: Compared with DSE over 10 years, ILI participants had fewer hospitalizations, fewer medications, and lower health-care costs. |
Neurovirulence and immunogenicity of attenuated recombinant vesicular stomatitis viruses in nonhuman primates
Clarke DK , Nasar F , Chong S , Johnson JE , Coleman JW , Lee M , Witko SE , Kotash CS , Abdullah R , Megati S , Luckay A , Nowak B , Lackner A , Price RE , Little P , Kalyan N , Randolf V , Javadian A , Zamb TJ , Parks CL , Egan MA , Eldridge J , Hendry M , Udem SA . J Virol 2014 88 (12) 6690-6701 In previous work, a prototypic recombinant vesicular stomatitis virus Indiana serotype (rVSIV) vector expressing simian immunodeficiency virus (SIV) gag and human immunodeficiency virus type 1 (HIV-1) env antigens protected nonhuman primates (NHPs) from disease following challenge with an HIV-1/SIV recombinant (SHIV). However, when tested in a stringent NHP neurovirulence (NV) model, this vector was not adequately attenuated for clinical evaluation. For the work described here, the prototypic rVSIV vector was attenuated by combining specific G protein truncations with either N gene translocations or mutations (M33A and M51A) that ablate expression of subgenic M polypeptides, by incorporation of temperature-sensitive mutations in the N and L genes, and by deletion of the VSIV G gene to generate a replicon that is dependent on trans expression of G protein for in vitro propagation. When evaluated in a series of NHP NV studies, these attenuated rVSIV variants caused no clinical disease and demonstrated a very significant reduction in neuropathology compared to wild-type VSIV and the prototypic rVSIV vaccine vector. In spite of greatly increased in vivo attenuation, some of the rVSIV vectors elicited cell-mediated immune responses that were similar in magnitude to those induced by the much more virulent prototypic vector. These data demonstrate novel approaches to the rational attenuation of VSIV NV while retaining vector immunogenicity and have led to identification of an rVSIV N4CT1gag1 vaccine vector that has now successfully completed phase I clinical evaluation. IMPORTANCE: The work described in this article demonstrates a rational approach to the attenuation of vesicular stomatitis virus neurovirulence. The major attenuation strategy described here will be most likely applicable to other members of the Rhabdoviridae and possibly other families of nonsegmented negative-strand RNA viruses. These studies have also enabled the identification of an attenuated, replication-competent rVSIV vector that has successfully undergone its first clinical evaluation in humans. Therefore, these studies represent a major milestone in the development of attenuated rVSIV, and likely other vesiculoviruses, as a new vaccine platform(s) for use in humans. |
Sylvatic typhus associated with flying squirrels (Glaucomys volans) in New York State, United States
Prusinski MA , White JL , Wong SJ , Conlon MA , Egan C , Kelly-Cirino CD , Laniewicz BR , Backenson PB , Nicholson WL , Eremeeva ME , Karpathy SE , Dasch GA , White DJ . Vector Borne Zoonotic Dis 2014 14 (4) 240-4 Sylvatic typhus is an infrequent, potentially life-threatening emerging zoonotic disease. In January of 2009, the New York State Department of Health was notified of a familial cluster of two suspected cases. Due to the paucity of typhus cases in New York, epidemiologic and environmental investigations were conducted to establish rickettsial etiology and determine potential sources of infection. Patients presented with symptoms consistent with typhus, and serologic testing of each patient confirmed infection with typhus group rickettsiae. Serologic analysis of blood obtained from southern flying squirrels (Glaucomys volans) captured from the attic crawlspace above an enclosed front porch of the cases' residence indicated evidence of infection with Rickettsia prowazekii, with 100% seroprevalence (n=11). Both patients reported spending significant time on the porch and hearing animal activity above the ceiling prior to onset of illness, implicating these flying squirrels as the likely source of infection. |
Food worker experiences with and beliefs about working while ill
Carpenter LR , Green AL , Norton DM , Frick R , Tobin-D'Angelo M , Reimann DW , Blade H , Nicholas DC , Egan JS , Everstine K , Brown LG , Le B . J Food Prot 2013 76 (12) 2146-54 Transmission of foodborne pathogens from ill food workers to diners in restaurants is an important cause of foodborne illness outbreaks. The U.S. Food and Drug Administration recommends that food workers with vomiting or diarrhea (symptoms of foodborne illness) be excluded from work. To understand the experiences and characteristics of workers who work while ill, workplace interviews were conducted with 491 food workers from 391 randomly selected restaurants in nine states that participated in the Environmental Health Specialists Network of the Centers for Disease Control and Prevention. Almost 60% of workers recalled working while ill at some time. Twenty percent of workers said that they had worked while ill with vomiting or diarrhea for at least one shift in the previous year. Factors significantly related to workers having said that they had worked while ill with vomiting or diarrhea were worker sex, job responsibilities, years of work experience, concerns about leaving coworkers short staffed, and concerns about job loss. These findings suggest that the decision to work while ill with vomiting or diarrhea is complex and multifactorial. |
Algal bloom-associated disease outbreaks among users of freshwater lakes - United States, 2009-2010
Hilborn ED , Roberts VA , Backer L , Deconno E , Egan JS , Hyde JB , Nicholas DC , Wiegert EJ , Billing LM , Diorio M , Mohr MC , Hardy JF , Wade TJ , Yoder JS , Hlavsa MC . MMWR Morb Mortal Wkly Rep 2014 63 (1) 11-5 Harmful algal blooms (HABs) are excessive accumulations of microscopic photosynthesizing aquatic organisms (phytoplankton) that produce biotoxins or otherwise adversely affect humans, animals, and ecosystems. HABs occur sporadically and often produce a visible algal scum on the water. This report summarizes human health data and water sampling results voluntarily reported to CDC's Waterborne Disease and Outbreak Surveillance System (WBDOSS) via the National Outbreak Reporting System (NORS) and the Harmful Algal Bloom-Related Illness Surveillance System (HABISS)* for the years 2009-2010. For 2009-2010, 11 waterborne disease outbreaks associated with algal blooms were reported; these HABs all occurred in freshwater lakes. The outbreaks occurred in three states and affected at least 61 persons. Health effects included dermatologic, gastrointestinal, respiratory, and neurologic signs and symptoms. These 11 HAB-associated outbreaks represented 46% of the 24 outbreaks associated with untreated recreational water reported for 2009-2010, and 79% of the 14 freshwater HAB-associated outbreaks that have been reported to CDC since 1978. Clinicians should be aware of the potential for HAB-associated illness among patients with a history of exposure to freshwater. |
Cardiovascular effects of intensive lifestyle intervention in type 2 diabetes
Wing RR , Bolin P , Brancati FL , Bray GA , Clark JM , Coday M , Crow RS , Curtis JM , Egan CM , Espeland MA , Evans M , Foreyt JP , Ghazarian S , Gregg EW , Harrison B , Hazuda HP , Hill JO , Horton ES , Hubbard VS , Jakicic JM , Jeffery RW , Johnson KC , Kahn SE , Kitabchi AE , Knowler WC , Lewis CE , Maschak-Carey BJ , Montez MG , Murillo A , Nathan DM , Patricio J , Peters A , Pi-Sunyer X , Pownall H , Reboussin D , Regensteiner JG , Rickman AD , Ryan DH , Safford M , Wadden TA , Wagenknecht LE , West DS , Williamson DF , Yanovski SZ . N Engl J Med 2013 369 (2) 145-54 BACKGROUND: Weight loss is recommended for overweight or obese patients with type 2 diabetes on the basis of short-term studies, but long-term effects on cardiovascular disease remain unknown. We examined whether an intensive lifestyle intervention for weight loss would decrease cardiovascular morbidity and mortality among such patients. METHODS: In 16 study centers in the United States, we randomly assigned 5145 overweight or obese patients with type 2 diabetes to participate in an intensive lifestyle intervention that promoted weight loss through decreased caloric intake and increased physical activity (intervention group) or to receive diabetes support and education (control group). The primary outcome was a composite of death from cardiovascular causes, nonfatal myocardial infarction, nonfatal stroke, or hospitalization for angina during a maximum follow-up of 13.5 years. RESULTS: The trial was stopped early on the basis of a futility analysis when the median follow-up was 9.6 years. Weight loss was greater in the intervention group than in the control group throughout the study (8.6% vs. 0.7% at 1 year; 6.0% vs. 3.5% at study end). The intensive lifestyle intervention also produced greater reductions in glycated hemoglobin and greater initial improvements in fitness and all cardiovascular risk factors, except for low-density-lipoprotein cholesterol levels. The primary outcome occurred in 403 patients in the intervention group and in 418 in the control group (1.83 and 1.92 events per 100 person-years, respectively; hazard ratio in the intervention group, 0.95; 95% confidence interval, 0.83 to 1.09; P=0.51). CONCLUSIONS: An intensive lifestyle intervention focusing on weight loss did not reduce the rate of cardiovascular events in overweight or obese adults with type 2 diabetes. (Funded by the National Institutes of Health and others; Look AHEAD ClinicalTrials.gov number, NCT00017953.). |
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