Medical licensing examinations in both Sweden and the US favor pharmacology over lifestyle.

Low priority of disease prevention and health promotion in medical education may contribute to lack of lifestyle-counseling in clinical practice. Pharmacology-related knowledge is valued 5 times higher compared to lifestyle-related knowledge in examinations on noncommunicable diseases (NCDs) in undergraduate medical education in Sweden. This study aims to establish (i) whether medical licensing examinations are biased to favor pharmacology- over lifestyle-related knowledge and (ii) whether such a bias is present in both Sweden and the US. We identified 204 NCD-related questions from previous Swedish licensing examinations, and 77 cases from a U.S. question bank commonly used to prepare for the United States Medical Licensing Examination® (USMLE®) Step 3. With the help of expected correct answers, we determined distribution of points attainable for knowledge in the respective category (lifestyle / pharmacology / other) for 5 major NCDs: coronary heart disease (CHD), chronic obstructive pulmonary disease (COPD), diabetes, hypertension, and stroke. The percentage of points attainable for lifestyle-related knowledge was 6.7 (95% CI 4.1-9.3) in Sweden and 4.6 (95%CI 0.0-9.1) in the U.S. The respective percentages for pharmacology-related knowledge were 32.6 (95% CI 26.3-38.8) and 44.5 (95% CI 33.2-55.8) percent. The pharmacology vs. lifestyle-quotas were 4.9 in Sweden and 9.8 in the U.S. Likelihoods of equal emphasis on lifestyle and pharmacology in NCDs was < 0.001 in both countries. There is a marked preference for pharmacology over lifestyle in medical licensing examinations in both Sweden and the U.S. Newly qualified doctors may be inadequately prepared to address preventable causes of NCDs.

Combined low-saturated fat intake and high fitness may counterbalance diabetogenic effects of obesity: the DR's EXTRA Study.

We report associations of saturated fat (SF) intake with impaired fasting glucose (IFG), impaired glucose tolerance (IGT), concurrent IFG+IGT and type 2 diabetes (T2DM) at different levels of cardiorespiratory fitness and body mass index (BMI). In a population-based sample (n=1261, age 58-78 years), oral glucose tolerance, 4-day food intake and maximal oxygen uptake were measured. High intake of SF (>11.4 E%) was associated with elevated risk for IFG (4.36; 1.93-9.88), concurrent IFG+IGT (6.03; 1.25-29.20) and T2DM (4.77; 1.93-11.82) in the category of high BMI (>26.5) and high fitness, whereas there was no significantly elevated risk in individuals reporting low intake of SF. Concurrent high BMI and low fitness were associated with elevated risks. In general, SF intake and fitness did not differentiate the risk of abnormal glucose metabolism among subjects with low BMI. Limited intake of SF may protect from diabetogenic effects of adiposity, but only in individuals with high level of fitness.

Dietary associations with prediabetic states--the DR's EXTRA Study (ISRCTN45977199).

BACKGROUND/OBJECTIVES: Impaired fasting plasma glucose (IFG) and impaired glucose tolerance (IGT) predict development of type 2 diabetes (T2D), but display different pathophysiology for T2D. We studied the association of selected food items and nutrients with IFG, IGT and combined IFG and IGT (IFG+IGT), independent of cardiorespiratory fitness (VO(2max)). SUBJECTS/METHODS: In a population-based sample of 1261 individuals, aged 58-78 years, we identified 126 subjects with IFG, 97 with IGT and 49 with simultaneous IFG and IGT by an oral glucose tolerance test. Dietary intake was assessed by 4-day food records. Cardiorespiratory fitness was assessed by defining maximal oxygen uptake (VO(2max)) from respiratory gas analysis during a maximal symptom-limited exercise stress test on a bicycle ergometer. RESULTS: Increased intake of saturated fat was associated with higher odds for IFG (OR 1.07; 1.01-1.14) after adjustment for age, gender, VO(2max) and energy misreporting variable. Consumption of additional whole-grain bread (50 g/1000 kcal) and intake of dietary fiber (g/1000 kcal) were inversely associated with IGT (OR 0.61; 0.41-0.92, OR 0.91; CI 0.85-0.97, respectively). CONCLUSION: Dietary fiber and sources of cereal fiber are negatively associated with IGT, and saturated fat intake is positively associated with IFG, but not with IGT. The present data give practical dietary means at the population level for the elimination of prediabetic conditions.

The current standard measure of cardiorespiratory fitness introduces confounding by body mass: the DR's EXTRA study.

OBJECTIVE: Cardiorespiratory fitness is currently estimated by dividing maximal oxygen consumption (VO(2max)) by body weight (per-weight standard). However, the statistically correct way to neutralize the effect of weight on VO(2max) in a given population is adjustment for body weight by regression techniques (adjusted standard). Our objective is to quantify the bias introduced by the per-weight standard in a population distributed across different categories of body mass. DESIGN: This is a cross-sectional study. SUBJECTS AND METHODS: Baseline measures from participants of the Dose-Responses to Exercise Training Study (DR's EXTRA), 635 men (body mass index (BMI): 19-47 kg m⁻²) and 638 women (BMI: 16-49 kg m⁻²) aged 57-78 years who performed oral glucose tolerance tests and maximal exercise stress tests with direct measurement of VO(2max). We compare the increase in VO(2max) implied by the per-weight standard with the real increase of VO(2max) per kg body weight. A linear logistic regression model estimates odds for abnormal glucose metabolism (either impaired fasting glycemia or impaired glucose tolerance or Type 2 diabetes) of the least-fit versus most-fit quartile according to both per-weight standard and adjusted standard. RESULTS: The per-weight standard implies an increase of VO(2max) with 20.9 ml min⁻¹ in women and 26.4 ml min⁻¹ in men per additional kg body weight. The true increase per kg is only 7.0 ml min⁻¹ (95% confidence interval: 5.3-8.8) and 8.0 ml min⁻¹ (95% confidence interval: 5.3-10.7), respectively. Risk for abnormal glucose metabolism in the least-fit quartile of the population is overestimated by 52% if the per-weight standard is used. CONCLUSIONS: In comparisons across different categories of body mass, the per-weight standard systematically underestimates cardiorespiratory fitness in obese subjects. Use of the per-weight standard markedly inflates associations between poor fitness and co-morbidities of obesity.

Diet, fitness and metabolic syndrome--the DR's EXTRA study.

BACKGROUND AND AIMS: To study the independent and combined associations of diet and cardiorespiratory fitness with the prevalence of the metabolic syndrome (MetS). METHODS AND RESULTS: We studied a population-based random sample of 663 men and 671 women 57-78 years of age at baseline of an ongoing randomised controlled trial. Based on a 4-day food record a diet score was created according to goals achieved (vegetables ≥400 g/day, fish ≥2 servings/week, fibre ≥14 g/1000 kcal, saturated fat <10 E%/day). Cardiorespiratory fitness was measured as maximal oxygen uptake (VO(2 max)) in a maximal symptom-limited bicycle ergometer test. MetS was defined by the National Cholesterol Education Program criteria. The lowest prevalence of MetS (5%) was observed among individuals in the highest VO(2 max) tertile and achieving 3-4 dietary goals. The highest prevalence (55%) was observed among those in the lowest VO(2 max) tertile and achieving none of the dietary goals. Among individuals in the highest VO(2 max) tertile, the odds ratio of having MetS was 0.04 (95% CI 0.02-0.10) for those achieving 3-4 dietary goals, 0.07 (0.04-0.14) for those achieving 1-2 dietary goals, and 0.16 (0.07-0.37) for those achieving none of the dietary goals compared with individuals in the lowest VO(2 max) tertile and achieving none of the goals after adjustment for confounding factors. CONCLUSION: Healthy diet and higher levels of cardiorespiratory fitness are associated with a reduced risk of having MetS. However, fitness seems to have a stronger association with MetS than diet.

The ability to bind albumin is correlated with nitric oxide sensitivity in Moraxella catarrhalis.

Moraxella catarrhalis is sensitive to NO generators, e.g. S-nitroso-N-acetylpenicillamine (SNAP) and sodium nitroprusside (SNP), but can spontaneously develop higher SNP tolerance. Using SDS-PAGE of outer membrane proteins and immunoblotting for serum albumin, we found that the wild strain bound more blood-medium-derived albumin than the SNP-resistant variant did. There was a negative correlation between NO tolerance and the presence of serum albumin in the medium. We suggest that M. catarrhalis can change its surface properties to avoid binding albumin and thereby increase its resistance to NO. Growth of Moraxella is affected by iron, and that may have influenced our results. Using chrome azurol S plates as an indicator, we noted that both albumin and SNP have a strong affinity for iron(III).