Geriatric Update May 27, 2024

A review of 15 articles with 50 total flights analyzed by flight duration both as a categorical variable—short (<3 h), medium (3–6 h), or long flights (>6 h)—and as a continuous variable with COVID case counts. Compared to short flights without masking, medium and long flights without masking were associated with 4.66-fold increase (95% CI: [1.01, 21.52]; p < 0.0001) and 25.93-fold increase in incidence rates (95% CI: [4.1, 164]; p < 0.0001), respectively; long flights with enforced masking had no transmission reported. A 1 h increase in flight duration was associated with 1.53-fold (95% CI: [1.19, 1.66]; p < 0.001) increase in the incidence rate ratio of cases.

And: Of 415,737 UK Biobank participants, aged 40-69 years, regular fish oil supplementation was associate with mixed results:  With higher risk for people without cardiovascular disease, for the transition, from healthy status to

• atrial fibrillation hazard ratios were 1.13 (95% confidence interval 1.10 to 1.17)

• stroke 1.05 (1.00 to 1.11).

For participants with a diagnosis of a known cardiovascular disease, regular use of fish oil supplements was beneficial for transitions from:

• atrial fibrillation to major adverse cardiovascular events (hazard ratio 0.92, 0.87 to 0.98),

• atrial fibrillation to myocardial infarction (0.85, 0.76 to 0.96),

• heart failure to death (0.91, 0.84 to 0.99).

I caution as the effect size is so small and in observational studies we feel that a hazard ratio of >2 is significant, but the size of the study is impressive. 

Bicycling, whether outdoors or in a spinning class, may help prevent knee arthritis and pain. Individuals who biked at any point in their lives were 17% less likely to develop knee pain and 21% less likely to develop arthritis with pain in the knee joint, according to an analysis of data from more than 2,600 people in their 60s.

In this randomized clinical trial of 262 adults, compared with placebo, 2 g/d of krill oil supplementation did not improve knee pain as measured on a visual analog scale (range, 0-100, with 0 indicating least pain) (mean difference, 0.30; 95% CI, −6.9 to 6.4; P = .94) over 24 weeks.

Among people with type 2 diabetes, using insulin, sodium-glucose cotransporter 2 inhibitors (SGLT2) were associated with a reduced risk for diabetic macular oedema but not diabetic retinopathy. The use of glucagon-like peptide 1 receptor agonists (GLP1) was associated with an increased diabetic retinopathy risk, a previously reported finding that is noted in some of the product labels.

Use of GLP-1 meds slows the gut and has led to some surgeries being postponed due to residuals in the stomach.  This study showed that the incidence of postoperative respiratory complications was 3.5% for those taking a GLP-1 and 4.0% for those without (odds ratio [OR], 0.85; 95% CI, 0.70-1.04; P = .12), in 23,679 patients undergoing emergency surgery, with 3502 (14.8%) on a GLP-1.

In practice we don't let risk of diabetes determine whether to start a statin. Although low and medium statins increase in new-onset diabetes by 10% and high potency by 36%, participants without baseline diabetes, mean glucose increased by 0.04 mmol/L (0.7 mg/dL) with both low-intensity or moderate-intensity and high-intensity statins, and mean HbA1c increased by 0.06% with low-intensity or moderate-intensity statins and 0.08% with high-intensity statins. This is probably not enough to even warrant medication adjustments.

March 4 I wrote about emulsifiers’ association with increasing risk of cancer, particularly breast and prostate cancer 45-48%. This study showed increased risk of type 2 diabetes, and with higher intake levels, higher risk. And as part of ultra-processed food, emulsifiers are associated with higher risk of cognitive impairment (hazard ratio [HR] = 1.16, 95% CI 1.09–1.24,

Compared with individuals without type 2 diabetes, those with HbA1c levels higher or lower than the target range (<7.0% for cognitively intact, to <8.5% for cognitively impaired) had a higher risk of death (HR, 1.70 for HbA1c levels above target and HR, 2.15 for HbA1c levels below target). The retrospective cohort study included 1,528 and 468 patients aged ≥65 years without and with type 2 diabetes, respectively, who were visiting a memory clinic. As we ;move away from meds that cause hypoglycemia (insulin and sulfonylurea) to metformin, GLP-1, DPP-4, SGLT-2, we should see this improve. 

Insulin resistance is more prominent in men than women. In obesity, BMI >30, adipocyte insulin sensitivity (half maximum effective hormone concentration) were tenfold lower and maximal antilipolytic effect 10% lower, in men than women. The mechanism involves less efficient insulin-mediated inhibition of adipocyte lipolysis, increased basal rate of lipolysis and decreased adipose expression of a key element of insulin signaling, IRS1.

In 46 large samples of grossly normal human pancreas with a machine-learning histological analysis, found on average 13 Pancreatic intraepithelial neoplasias (PanINs) per cm3 in the normal intact adult pancreas. I don’t know what implications that has for the upcoming blood test for pancreatic cancer, I wrote about April 22.

A Cochrane review of 34 studies (15 prevention, 19 treatment) involving 8526 participants showed little to no benefit of zinc for the common cold. When zinc is used for cold treatment, there may be a reduction in the mean duration of the cold in days (MD -2.37, 95% CI -4.21 to -0.53; I² = 97%; 8 studies, 972 participants; low-certainty evidence).

Keep in mind that high levels of zinc over 18 mg daily will lead over time to sideroblastic anemia due to blockage of copper absorption.

A podcast describes H1N1 presence in milk and that pasteurization kills virus and prevents transmission. 

Thank you, Joe for sending this study on copper-coated nanotextured stainless steel induces a reduction of 97% in Gram-negative Escherichia coli and 99% Gram-positive Staphylococcus epidermidis bacteria within 30 minutes.

And: secondary analyses, melatonin supplement use appeared to attenuate the positive association between long-term shift work (>5 years) and risk of cardiovascular disease (p interaction=0.013) among the female nurses, but not in other populations and not for diabetes patients.

And: Intravenous acetaminophen was safe but did not significantly improve days alive and free of organ support in 447 critically ill sepsis patients.

Audio-only telehealth visits were approved during the pandemic health emergency and will expire in December 2024. Its use among traditional Medicare beneficiaries declined from 31% of all telehealth visits in 2020 to 25.4% in 2022, and telephone users were more likely to be dually eligible, have medically complex conditions, be Black and older, and reside in rural areas compared with the 17.5% of beneficiaries who received video-based telehealth visits.

The Senate Finance Committee has launched a bipartisan push to reform the 26% cut in Medicare reimbursement since 2001.

Thank you, Dr. Tobias for sending this information on the federal trade commission finalizing the rule to prevent employers from enforcing noncompetes. This would lower healthcare costs by $194 billion over the next decade, while freeing up physicians to more easily move between employers. The U.S. Chamber of Commerce — the largest business lobby in the nation — plans to sue over the rule.