Nutrition and Fetal Origins of Diseases in Adults
Latest Updates
Nutrition for the Healthy Adult
- Latest recommendations for added sugar
- New guidelines about dietary cholesterol—a license to consume as much as we want?
- The latest about processed meat; is any amount safe?
- Shift from single nutrients to whole foods and patterns of eating
- Using anthropometrics in the primary care setting to determine adiposity
Management of Non–Muscle-Invasive Bladder Cancer
- Molecular characterization of NMIBC by RNA sequencing has revealed molecular subtypes similar to muscle-invasive bladder cancer.
- Fluorescent cystoscopy in combination with white light cystoscopy at the time of transurethral bladder tumor resection reduces the risk of subsequent bladder tumor recurrence.
- Maintenance intravesical BCG therapy can be discontinued after 12 months in patients with intermediate-risk NMIBC but should be continued for 36 months in patients with high-risk NMIBC.
- The refinement of the definition of the “BCG refractory” and its replacement with the term “BCG unresponsive” by an FDA-AUA panel has contributed to active drug development and clinical trials in this disease state.
- Zika virus: Delayconception if potential exposure: 8 weeks: females or 3 months: males
- Subclinical hypothyroid: Treatment is associated with improved pregnancy outcomes when TSH levels are above 4 mIU/L.
- Tubal patency: Hysterosalpingo-contrast sonography was recently introduced as an additional screening method to assess tubal patency.
Energy Balance, Exercise, and Cancer Risk
- Obesity is the leading modifiable cause of cancer in the United States.
- Body Mass Index (BMI) as a measurer of body fatness has limitations in the cancer population.
- Dual-energy x-ray absorptiometry, bioelectrical impedance analysis, computed tomography, and magnetic resonance imaging may be used more frequently in cancer patients.
- Cancer patients with elevated BMIs have improved survival compared with normal-weight patients.
Seronegative Spondyloarthritis: Epidemiology, Pathogenesis, And Pathology
- Disease association with the IL23R gene and the key role of IL-23 in the activation and expansion of a distinct phenotype of T helper (Th) cell characterized by expression of IL-17, the Th17 cell, represents a major advance in our understanding of spondyloarthritis.
- Increasing evidence supports a role for innate lymphoid cells (ICLs) in the pathogenesis of spondyloarthritis, especially group 3 ILCs that produce IL‑17 and IL‑22.
- New genetic associations have been described with three new aminopeptidases (ERAP2, LNPEPP, and NPEPPS), protective variants having reduced rates of peptide cleavage, thereby changing both the length and amino acid composition of peptides available for binding to B27.
- A multidisciplinary, evidence-based, protocol-directed approach continues to be recommended for the treatment of severe traumatic brain injury.
- Treatment of severe traumatic brain injury is performed through a systematic, tiered approach, with escalation of therapy in the setting of refractory elevated intracranial pressure.
- Role of decompressive craniectomy for the control of refractory elevated intracranial pressure remains controversial and is not clearly associated with improved outcomes.
- Early use of hypothermia to control intracranial pressure is associated with higher rates of mortality.
Cerebral Metabolism and Blood Flow Following Traumatic Brain Injury
- Following brain injury, mechanisms that match nutrient supply to the cerebral metabolic demand are disrupted, leading to changes in the intracranial pressure, cerebral blood flow, and ischemia.
- Understanding the concept of cerebral autoregulation and what it means when it is disrupted can help the clinician prevent secondary brain injury and improve patient outcome.
