Bone Mineral Loss and Fracture in Sarcoidosis: A Systematic Review and Meta-Analysis.

OBJECTIVES: This meta-analysis aims to investigate the possibility of bone mineral loss and fracture in sarcoidosis. MATERIALS AND METHODS: A comprehensive search of the MEDLINE and Embase databases was performed from inception through August 2017. The inclusion criterion was observational studies evaluating the association between sarcoidosis and bone mineral density (BMD) or fracture. The pooled odds ratio (OR) of fracture, standardized mean difference (SMD) of volumetric BMD and areal BMD, and their 95% confidence interval (CI) were calculated using a random-effects meta-analysis to compare risk between sarcoidosis and controls. The between-study heterogeneity of effect-size was quantified using the Q statistic and I2. RESULTS: Data were extracted from 10 studies involving a total of 6,448 sarcoidosis patients and 77,857 controls. The pooled result demonstrated no significant increased risk of fracture in sarcoidosis patients compared with controls (OR=1.68; 95% CI: 0.85-3.31, p value=0.14, I2=72%). There were no differences between the patients and controls in areal BMD (SMD= 0.21 g/cm2; 95% CI: -0.12-0.54, p value= 0.22, I2=0%) or volumetric BMD (SMD= 0.04 mg/cm3; 95% CI: -0.51-0.58, p value=0.89, I2=83%). CONCLUSION: Our study has not shown an increased risk of fracture or bone mineral loss in sarcoidosis. However, based on the currently available studies with heterogeneity in between, the conclusion for the osteoporosis screening and fracture risk assessment of patients with sarcoidosis cannot be drawn until more studies are available.

Changes in bone mineral density and bone metabolism after sleeve gastrectomy: a systematic review and meta-analysis.

BACKGROUND: Roux-en-Y gastric bypass surgery adversely affects bone health. The evidence is less well-described for sleeve gastrectomy (SG). OBJECTIVES: To better characterize bone metabolism changes after SG. SETTING: Systematic review and meta-analysis. METHODS: MEDLINE and EMBASE were searched through March 2019 for eligible studies assessing adults with obesity aged 18 years or older that underwent SG. Bone mineral density (BMD), serum calcium, serum phosphate, serum 25-hydroxyvitamin D, serum parathyroid hormone, or serum alkaline phosphatase were reported at baseline and after SG; and a follow-up duration was at least 6 months. Preoperative and postoperative mean of each outcome of interest and corresponding standard deviations were extracted from each study and the mean difference (MD) was calculated. Pooled MD was then calculated by combining MDs of each study using random-effects model. RESULTS: A total of 22 studies with 1905 patients with obesity that underwent SG were included. There were significant decreases in total hip BMD (pooled MD of -.06 g/cm2; 95% confidence interval -.09 to -.03; I2 = 0%) and femoral neck BMD (pooled MD of -.05 g/cm2; 95% confidence interval -.09 to -.02; I2 = 0%) after SG. No significant change in lumbar spine BMD was observed. There were significant increases in serum calcium, serum 25-hydroxyvitamin D, and serum phosphate. Serum parathyroid hormone was significantly decreased. Serum alkaline phosphatase was not significantly altered after SG. CONCLUSIONS: The present study found a decreased BMD among patients with obesity after SG.

Letter to Editor: Role of Pharmacotherapy in Patients With Coexisting Nonalcoholic Fatty Liver Disease and Type 2 Diabetes Mellitus.

We read with interest a recent article written by Yan et al.(1) The authors conducted a randomized trial in patients with coexisting type 2 diabetes mellitus (T2DM) and nonalcoholic fatty liver disease (NAFLD) to receive liraglutide, sitagliptin, or insulin glargine as add-on to metformin. The authors observed glycemic control and a reduction in body weight, intrahepatic lipid, and visceral adipose tissue in patients who received liraglutide or sitagliptin and then reported these add-on therapies to be novel pharmacotherapeutic therapies in patients with NAFLD and T2DM. However, the clinical meaningfulness of these pharmacologic treatments has not been conclusively established, especially since histopathology was not used to diagnose and determine the severity of NAFLD in that study. This article is protected by copyright. All rights reserved.

Improvement in pulmonary function in asthmatic patients after bariatric surgery: a systematic review and meta-analysis.

BACKGROUND: The association between obesity and asthma is well-established. Some evidence suggests that weight loss may improve asthma outcomes; however, the effect of bariatric surgery on pulmonary function in asthmatic patients remains inconclusive. This systematic review and meta-analysis of observational studies assessed the impact of bariatric surgery on patients with asthma. OBJECTIVES: To investigate the effect of bariatric surgery on pulmonary function in patients with asthma. SETTING: Systematic review and meta-analysis of published studies. METHODS: A comprehensive search of the MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials (CENTRAL) databases was conducted. The sole inclusion criterion was published studies that evaluated the effects of bariatric surgery on pulmonary function in asthmatic patients. The outcomes of interest were forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), and FEV1/FVC. A meta-analysis of studies comparing pre- and postsurgery spirometric measures, and of studies comparing surgery and control groups was performed. RESULTS: From 25 full-text articles, 6 observational studies met the inclusion criteria and were included in this meta-analysis based on the random-effects model. A significant increase in FEV1 and FVC was observed after bariatric surgery among studies without a control group (mean difference: .21 L, 95% confidence interval: .07-.35 for FEV1, and mean difference: .34 L, 95% confidence interval: .14-.53 for FVC). There was no significant change in FEV1/FVC after bariatric surgery compared with control. CONCLUSIONS: FEV1 and FVC were both found to be significantly improved after bariatric surgery; however, no significant postsurgical improvement was observed for FEV1/FVC.

Association between primary Sjogren's syndrome, arterial stiffness, and subclinical atherosclerosis: a systematic review and meta-analysis.

In rheumatoid arthritis and systemic lupus erythematosus, cardiovascular disease is frequently one of the leading causes of mortality or morbidity. Studies have shown that acute systemic inflammation and chronic systemic vasculitis are associated with endothelial dysfunction and atherosclerotic plaque formation, subsequently leading to cardiovascular disease. This meta-analysis aimed to explore the association of subclinical atherosclerosis and arterial stiffness in primary Sjogren's syndrome. A comprehensive search of the MEDLINE and Embase databases was performed from date of inception through August 2017. The inclusion criterion was observational studies evaluating the association between primary Sjogren's syndrome, subclinical atherosclerosis, and arterial stiffness by measuring pulse wave velocity (PWV) and intima-media thickness (IMT). Definitions of PSS and methods to assess PWV and IMT were recorded for each study. Different locations of IMT were evaluated including common carotid, internal carotid, and femoral arteries. The pooled mean difference (MD) of PWV and IMT and 95% confidence interval (CI) were calculated using a random-effect meta-analysis. The between-study heterogeneity of effect size was quantified using the Q statistic and I2. Data were extracted from eight observational studies involving 767 subjects. Pooled result demonstrated a significant increase in PWV in patients who have PSS compared with controls (MD = 1.30 m/s; 95% CI 0.48-2.12; p value = 0.002; I2 = 85%). Patients with PSS also have higher IMT (MD = 0.08 mm; 95% CI 0.04-0.11; p value < 0.01; I2 = 72%). Our study suggests that PSS is associated with arterial stiffness and subclinical atherosclerosis. Further studies need to be conducted to find the correlation of subclinical atherosclerosis in PSS with the cardiovascular event, the pathophysiological changes of arterial stiffness in PSS, and the benefit of statins, because controlling cardiovascular risk factors or disease activity could potentially help avoid progression of atherosclerosis to overt cardiovascular disease.

Metabolic Syndrome Increases Mortality Risk in Dialysis Patients: A Systematic Review and Meta-Analysis.

CONTEXT: Metabolic syndrome (MetS) is documented to increase the risk of mortality in the general population. However, there are reports of lower mortality in end stage renal disease (ESRD) patients with obesity. Since obesity is a major component of MetS, this meta-analysis was conducted to determine the risk of all-cause mortality, cardiovascular disease (CVD) mortality, and cardiovascular disease events (CVE) associated with MetS in ESRD subjects. EVIDENCE ACQUISITION: Eligible studies from inception to March 2017 assessing the clinical outcome of MetS in ESRD subjects were comprehensively searched in MEDLINE, EMBASE, and CENTRAL. ESRD participants treated with hemodialysis (HD) or peritoneal dialysis (PD) were included, but renal transplant subjects were excluded. Two authors independently assessed article quality and extracted the data. The primary outcome was all-cause mortality and, secondary outcomes were CVD death and CVE. RESULTS: Fifty full-text articles were reviewed and eight studies were included in the meta-analysis, based on the random effects model. ESRD subjects with MetS, as compared with the non-MetS, had significant increased risk of all-cause mortality (pooled RR = 1.92; 95% confidence interval [CI] 1.15 - 3.21; P = 0.01) and CVE (pooled RR = 6.42; 95% CI 2.00 - 20.58). Age, type of dialysis, triglycerides, and HDL-C were significant predictors of risk of mortality, based on univariate meta-regression analyses. CONCLUSIONS: Metabolic syndrome is associated with an increased risk of all-cause mortality in ESRD patients.

Association between Psoriasis and Helicobacter pylori Infection: A Systematic Review and Meta-analysis.

BACKGROUND/PURPOSE: Helicobacter pylori infection has been suggested as a culprit of various extragastrointestinal (GI) disorders. It is debatable whether H. pylori infection exacerbates or triggers the pathogenesis of psoriasis. This meta-analysis aimed to explore the association between psoriasis and H. pylori infection. MATERIALS AND METHODS: A comprehensive search of the MEDLINE and EMBASE databases was performed from inception through October 2017. The inclusion criterion was observational studies evaluating the association between psoriasis and H. pylori infection. The pooled odds ratio (OR) of H. pylori infection and their 95% confidence interval (CI) were calculated using a random-effects meta-analysis to compare risk between psoriasis patients and controls. The between-study heterogeneity of effect-size was quantified using the Q statistic and I2. RESULTS: Data were extracted from nine observational studies involving 1546 individuals. Pooled result demonstrated an increased H. pylori infection in psoriasis compared with controls (OR=1.58; 95% CI: 1.02-2.46, P =0.04, I2=64%). Subgroup analysis showed an increased risk of H. pylori infection in psoriasis measured with H. pylori IgG enzyme-linked immunosorbent assay (OR=3.11; 95% CI: 1.85-5.20, P <0.01, I2=10%) but not active infection measured with urea breath test (OR=0.88; 95% CI: 0.61-1.27, P =0.49, I2=0%). CONCLUSION: This meta-analysis has shown an increased H. pylori infection in patients with psoriasis. H. pylori infection in the past could play a role in the abnormal immunological cascade in the pathogenesis of psoriasis. Further studies to elucidate the inflammatory response in the pathogenesis of psoriasis are warranted.

Helicobacter pylori infection in systemic sclerosis: a systematic review and meta-analysis of observational studies.

OBJECTIVES: It has been proposed that Helicobacter pylori (H.pylori) infection causes several extra-gastrointestinal disorders. However, the role of H.pylori infection in the pathogenesis of systemic sclerosis (SSc) is still debatable. This meta-analysis is aimed at exploring the association between SSc and H.pylori infection. METHODS: A comprehensive search of the MEDLINE and EMBASE databases was performed from inception through February 2018. The inclusion criterion was observational studies evaluating H.pylori infection in SSc. The pooled odds ratio (OR) of H.pylori infection and their 95% confidence interval (CI) were calculated using a random-effects meta-analysis to compare risk between SSc patients and healthy controls. The between-study heterogeneity of effect-size was quantified using the Q statistic and I2. RESULTS: Data were extracted from 8 observational studies involving 1,446 subjects. The pooled results demonstrated an increased H.pylori infection in SSc compared with healthy controls (OR=2.10; 95% CI: 1.57-2.82, p value<0.01, I2=13%). Subgroup analysis showed an increased risk of H.pylori infection measured with H.pylori ELISA test (OR=2.49; 95% CI: 1.82-3.40, p value<0.01, I2=0%). CONCLUSIONS: Our study has shown that patients with SSc have an increased prior existence of H.pylori infection. This finding implies that the role of previous infection may cause an abnormal immunological cascade in the pathogenesis of SSc. Further studies that could elucidate the inflammatory response in the pathogenesis of SSc are warranted.

Association between primary Sjögren's syndrome, cardiovascular and cerebrovascular disease: a systematic review and meta-analysis.

OBJECTIVES: Acute systemic inflammation and chronic systemic vasculitis are associated with endothelial dysfunction and atherosclerotic plaque formation. Studies on cardiovascular or cerebrovascular events in primary Sjögren's syndrome (pSS) are limited, with conflicting results. This meta-analysis aimed to explore the risk of cardiovascular and cerebrovascular disease in pSS. METHODS: A comprehensive search of the MEDLINE and EMBASE databases was performed from date of inception through August 2017. The inclusion criterion was observational studies evaluating the association between pSS and cardiovascular disease or cerebrovascular event. Outcomes are diagnosis of ischaemic heart disease, myocardial infarction, ischaemic stroke or haemorrhagic stroke. The pooled odds ratio (OR) of the cerebrovascular event or cardiovascular disease and their 95% confidence interval (CI) were calculated using a random-effect meta-analysis to compare risk between patients with pSS and controls. The between-study heterogeneity of effect-size was quantified using the Q statistic and I2. RESULTS: Data were extracted from 10 observational studies involving 165,291 subjects. Pooled result demonstrated a significant increase in risk of having cardiovascular disease or cerebrovascular event in pSS patients compared with controls (OR=1.28; 95% CI: 0.11-1.46, p value<0.01, I2=68%). Subgroup analyses showed no difference in risk for cerebrovascular event (OR=1.31; 95% CI: 0.96-1.79, p value=0.09, I2=71%), but an increased risk of cardiovascular disease (OR=1.30; 95% CI: 1.09-1.55, p value=0.003, I2=74%). CONCLUSIONS: Our study has shown an increased risk of cardiovascular or cerebrovascular disease in patients with pSS. These results support multiple studies' finding of increased arterial stiffness in patients with pSS.

Atrial fibrillation is associated with sudden cardiac death: a systematic review and meta-analysis.

PURPOSE: Recent studies suggest that atrial fibrillation (AF) is associated with increased cardiovascular risk and mortality including sudden cardiac death (SCD). According to the Cardiovascular Heath Study cohort, the incident rate of SCD was higher in the AF population (2.9 per 1000 per year) compared with non-AF controls (1.3 per 1000 per year). In this study, we performed a systematic review and meta-analysis to explore the association between AF and SCD. METHODS: We comprehensively searched the databases of MEDLINE and EMBASE from inception to January 2017. Included studies were published prospective or retrospective cohort studies that compared the risk of developing SCD, defined by World Health Organization's criteria, in AF patients versus non-AF patients. Data from each study were combined using the random-effects, generic inverse variance method of DerSimonian and Laird to calculate the risk ratios and 95% confidence intervals. RESULTS: Twenty-seven studies from January 1991 to February 2017 involving 8401 AF patients and 67,608 non-AF controls were included in this meta-analysis. Compared with controls, AF patients had a significantly higher risk of SCD in overall analysis (pooled risk ratio = 2.04, 95% confidence interval: 1.77-2.35, p < 0.01, I2 = 42.66) as well as subgroups of general population studies, previous myocardial infarction or coronary artery disease, heart failure, hypertrophic cardiomyopathy (HCM), Brugada syndrome, and patients with either a pacemaker or implantable cardioverter defibrillator (ICD). In subgroup analysis of multivariate-adjusted studies, AF also had a significantly higher risk of SCD (pooled risk ratio = 2.22, 95% confidence interval = 1.59-3.09, p < 0.01, I2 = 73.95). Incident rate of SCD in AF was 2-fold higher than controls but not statistically significant (pooled rate ratio = 2.06, 95% confidence interval = 0.66-7.53, p = 0.292, I2 = 88.58). CONCLUSIONS: Our meta-analysis demonstrates a statistically significant increased risk of SCD with AF in the general population and in those with previous myocardial infarction, coronary artery disease, heart failure, HCM, Brugada syndrome, and an implanted rhythm device.

Association between sarcoidosis, pulse wave velocity, and other measures of subclinical atherosclerosis: a systematic review and meta-analysis.

Chronic inflammation from autoimmune diseases has shown to be a risk factor for atherosclerosis, subsequently leading to cardiovascular disease. Endothelial dysfunction is the early pathogenesis of atherosclerosis in chronic inflammation, but the risk of atherosclerosis in sarcoidosis is less well defined. This meta-analysis aimed to explore the association of subclinical atherosclerosis and arterial stiffness in sarcoidosis. A comprehensive search of the MEDLINE and EMBASE databases was performed from date of inception through August 2017. The inclusion criterion was observational studies evaluating the association between sarcoidosis, subclinical atherosclerosis, and arterial stiffness by measuring pulse wave velocity (PWV). Definitions of sarcoidosis and methods to assess PWV were recorded for each study. The pooled standardized mean difference (SMD) of PWV and 95% confidence interval (CI) was calculated using a random-effects meta-analysis. The between-study heterogeneity of effect size was quantified using the Q statistic and I 2 . Data were extracted from five observational studies involving 499 subjects. Pooled result demonstrated a significant increase in PWV in patients who have sarcoidosis compared with controls (SMD = 0.57 m/s; 95% CI 0.21-0.92, p value = 0.002, I 2 = 75%, P heterogeneity < 0.01). After excluding studies with low or moderate quality, there was an increase in PWV in sarcoidosis compared with controls (SMD = 0.29 m/s; 95% CI 0.00-0.57, p value = 0.05, I 2 = 55%, P heterogeneity = 0.08). Our study suggests that sarcoidosis is associated with increased arterial stiffness and therefore at risk of subclinical atherosclerosis. Prospective study is required to investigate the association of subclinical atherosclerosis causing overt cardiovascular disease in patients with sarcoidosis.

Whey Protein Supplementation Improves Body Composition and Cardiovascular Risk Factors in Overweight and Obese Patients: A Systematic Review and Meta-Analysis.

BACKGROUND: Previous literature shows possible benefits of whey protein supplementation in promoting weight loss. However, most studies do not have enough power to show beneficial effects on body composition and cardiovascular disease (CVD) risk factors. This meta-analysis evaluated effects of whey protein in individuals who are overweight and obese. METHODS: We comprehensively searched the databases of MEDLINE, Embase, and Cochrane databases. The inclusion criteria were published randomized control trials (RCTs) comparing whey protein supplementation to placebo or controls in individuals who are overweight or obese. The primary outcome was the differences in the change in body composition (body weight, waist circumference, total fat mass, body lean mass). We also examined the changes in CVD risk factors as secondary outcomes. We calculated pooled mean difference (MD) with 95% confidence intervals (CIs) using a random effects model. RESULTS: Nine RCTs were included in the meta-analysis. There was a significant reduction of body weight (MD = 0.56, 95% CI: 0.30-0.81), lean mass (MD = 0.77, 95% CI: 0.59-0.96), and fat mass (MD = 1.12, 95% CI: 0.77-1.47) favoring the whey protein group. There were improvements in multiple CVD risk factors including levels of systolic blood pressure, diastolic blood pressure, glucose, high-density lipoprotein, and total cholesterol (all p values <0.05). CONCLUSIONS: Whey protein supplementation seems to improve body weight, total fat mass, and some CVD risk factors in overweight and obese patients. Further studies regarding optimal dosage and duration of whey protein supplementation would be helpful to assess potential favorable effects in individuals who are overweight or obese.