Heads Up: July 10, 2008

Vitamin D Deficiency Among Asymptomatic Infants and Toddlers

Otherwise healthy infants and toddlers are frequently deficient in vitamin D, according to a study from the Archives of Pediatrics & Adolescent Medicine. Primary care physicians at an urban clinic assessed levels of 25 hydroxyvitamin D and parathyroid hormone levels for 365 children in a cross-sectional sample study. They found that 40% had levels less than optimum for bone health, and 12% were considered deficient in vitamin D. One-third of the deficient children had evidence of bone loss, and nearly 8% of the same group had bone changes consistent with rickets. The investigators, from Children’s Hospital Boston, noted that for infants, the strongest association with vitamin D deficiency was exclusive breastfeeding without vitamin D supplementation. For toddlers, it was low milk consumption.

Relation of Blood Urea Nitrogen to Long-term Mortality in Patients With Heart Failure

Previous research has indicated that blood urea nitrogen (BUN) can predict mortality in patients with heart failure (HF) and might do so more effectively than glomerular filtration rate (GFR). Now, a new study published in the American Journal of Cardiology provides further evidence for this. Researchers at the University of Virginia Health System in Charlottesville and Virginia Commonwealth University in Richmond assessed information from the charts of 444 HF patients with a mean ejection fraction of 38 ± 10%, mean age of 59 ± 11 years, median BUN of 14 mg/dL, and median GFR of 81 ml/min/1.73 m2. The scientists found that BUN was the strongest predictor of mortality with a 4% increase in risk for every 1-mg/dL increase in BUN. They also observed that for every 10 mg/dL above a BUN measurement of 17 mg/dL the risk of death increased by 21%. GFR was not an independent predictor of mortality in this population.

Screening for Type 2 Diabetes Mellitus in Adults: U.S. Preventive Services Task Force Recommendation Statement

The U.S. Preventive Services Task Force has updated its 2003 evidence review about screening for type 2 diabetes mellitus in adults. Basing its new recommendations on a systematic review of the literature that includes evidence from new trials as well as updates on earlier studies, the task force now suggests that asymptomatic adults with sustained blood pressure—either treated or untreated—of 135/80 mm Hg be screened for the disease. The task force also concludes that there is insufficient evidence to assess the balance of benefits and harms of routine screening for type 2 diabetes in asymptomatic adults with blood pressure of 135/80 mm Hg or lower. The recommendations were published in the Annals of Internal Medicine.

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