Category: Biostatistics

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The Rise of Overweight/Obesity in the U.S.: Examining the Influence of Dietary Guidelines, the Food Pyramid, and Ancel Keys

By Stephen Fitzmeyer, MD

Introduction: The United States has experienced a significant increase in overweight and obesity rates over the past few decades, leading to serious health concerns. It is intriguing to examine the correlation between the rise in overweight/obesity and the transformation of the American diet, particularly with the introduction of dietary guidelines and the prominent role played by Ansel Keys. In this article, we delve into the historical context and explore how the shift away from fresh whole foods, influenced by Keys’ research, may have inadvertently contributed to the obesity epidemic in the United States.

The Era of Fresh Whole Foods: Before the introduction of dietary guidelines in the 1980s, the American diet primarily consisted of fresh, whole foods. Meals were often prepared from scratch, using ingredients sourced directly from farms and local markets. Fresh fruits and vegetables, meats, and unprocessed grains were the foundation of everyday eating, providing a nutrient-dense and balanced approach to nutrition.

Ansel Keys and Dietary Fat: Ansel Keys, a prominent scientist, conducted influential research in the mid-20th century that examined the relationship between dietary fat and heart disease. His work, known as the “Seven Countries Study,” suggested a correlation between high-fat diets and increased risk of cardiovascular issues. However, Keys’ study focused on selected countries, disregarding nations with contrasting dietary patterns that contradicted his findings.

The Impact of Keys’ Findings: Keys’ research gained significant attention and led to a shift in nutritional thinking. Dietary fat, particularly saturated fat, became vilified, and the notion that a low-fat diet was crucial for maintaining heart health took root. As a result, dietary guidelines and recommendations began emphasizing the reduction of fat intake, leading to the promotion of low-fat and fat-free products in the market.

The Emergence of Processed Foods: The low-fat movement led to a surge in processed food products marketed as healthy alternatives. With the focus on reducing fat, manufacturers started formulating products with reduced fat content but compensated by adding excessive amounts of sugar, artificial additives, and refined carbohydrates. This shift in the food industry coincided with the introduction of dietary guidelines, further driving the consumption of processed foods among Americans.

Unintended Consequences: The shift away from fresh whole foods towards processed, low-fat alternatives had unintended consequences. These processed foods were often calorie-dense, nutrient-poor, and contributed to overconsumption. The replacement of dietary fats with refined carbohydrates and added sugars not only affected overall calorie intake but also disrupted metabolic processes, leading to weight gain and related health issues.

Reevaluating Dietary Choices: In recent years, there has been a growing realization that the previous low-fat paradigm may have played a role in the obesity epidemic. Many experts advocate for a return to a more balanced approach, focusing on the consumption of whole, unprocessed foods and reevaluating the role of dietary fats. This includes embracing healthy fats such as those found in avocados, nuts, olive oil, fatty meats, eggs, butter, and cheeses.

Empowering Individuals through Education: To combat the rise of overweight/obesity, it is essential to empower individuals with knowledge and encourage them to make informed dietary choices. By educating ourselves about the benefits of fresh whole foods, understanding the potential pitfalls of processed foods, and reevaluating the role of dietary fats, we can make strides towards improving our overall health and well-being.

Conclusion: The rise of overweight and obesity in the United States coincides with the transformation of the American diet, influenced by the introduction of dietary guidelines and the impact of Ansel Keys’ research. While Keys’ findings had noble intentions, the emphasis on low-fat diets and the

proliferation of processed, low-fat alternatives may have inadvertently contributed to the obesity epidemic. It is important to acknowledge the historical context and the role played by fresh whole foods in the American diet before the era of dietary guidelines. By revisiting and embracing a diet centered around whole, unprocessed foods, we can reclaim a healthier approach to nutrition.

Moving forward, it is crucial to continue educating individuals about the importance of a balanced diet that includes nutrient-dense foods and minimizes reliance on processed and refined options. By fostering a culture of mindful eating and promoting the consumption of fresh, whole foods, we can work towards reversing the alarming trends of overweight and obesity and promoting a healthier future for all.

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From Cholera to COVID-19: The Role of Epidemiology in Disease Outbreaks

By Stephen Fitzmeyer, MD

The cholera outbreak in 1854 in London, and the work of John Snow, is considered a turning point in the field of epidemiology. The outbreak caused thousands of deaths and was traced back to contaminated water from the Broad Street pump. Snow’s investigation led him to identify the source of the outbreak, and he subsequently recommended measures to prevent the spread of cholera.

Fast forward to modern times, and we are facing a new epidemic – COVID-19. The similarities between the two outbreaks are striking, and so are the differences. Like cholera, COVID-19 is a highly contagious disease that spreads through contact with infected individuals or surfaces. However, unlike cholera, COVID-19 is caused by a novel virus that is still not fully understood.

Epidemiology played a crucial role in both outbreaks. In the case of cholera, Snow used epidemiological methods to map the spread of the disease and identify the source of the outbreak. He collected data on the location of cases and the source of water for the affected individuals, and used this data to create a map that showed a clear association between the cases and the Broad Street pump. This data-driven approach was a key factor in his successful intervention.

Similarly, epidemiology has played a critical role in the management of COVID-19. Epidemiologists have been tracking the spread of the disease, identifying risk factors and patterns of transmission, and providing guidance on how to mitigate the spread of the virus. Epidemiological models have been used to predict the course of the pandemic, and to inform public health policies and interventions.

However, there are also significant differences between the two outbreaks. COVID-19 is a much more complex disease than cholera, with a wide range of symptoms and outcomes. The virus is highly contagious and can be spread by asymptomatic carriers, making it much more challenging to control. The development of effective vaccines and treatments has been a major focus of the public health response to COVID-19, and epidemiology has played a critical role in evaluating the effectiveness of these interventions.

In conclusion, the cholera outbreak and the work of John Snow laid the foundation for modern epidemiology, and the lessons learned from that outbreak have helped us manage and control many subsequent disease outbreaks. The COVID-19 pandemic has presented a new set of challenges, but the principles of epidemiology remain essential to understanding and controlling the spread of the virus. By continuing to apply these principles, we can hope to mitigate the impact of the pandemic and prepare for future outbreaks.

Author: Stephen Fitzmeyer, M.D.
Physician Informaticist
Founder of Patient Keto
Founder of Warp Core Health
Founder of Jax Code Academy, jaxcode.com

Connect with Dr. Stephen Fitzmeyer:
Twitter: @PatientKeto
LinkedIn: linkedin.com/in/sfitzmeyer/

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The Role of Health Informatics in Healthcare: Why Healthcare Providers Should Become Proficient

by Stephen Fitzmeyer, MD

Health informatics is a rapidly growing field that combines healthcare, information technology, and data analysis to improve the quality and efficiency of healthcare delivery. It involves the use of technology and information systems to collect, store, and analyze patient data, enabling healthcare providers to make informed decisions about patient care. In this article, we will discuss what health informatics is, how it is useful, and why healthcare providers should become proficient in it.

What is Health Informatics?

Health informatics is the field of study that focuses on the use of technology and information systems to manage healthcare data. It involves the collection, storage, analysis, and dissemination of healthcare data to support decision-making in healthcare delivery. Health informatics professionals are responsible for developing and implementing information systems that support healthcare providers in delivering high-quality care to patients.

How is Health Informatics Useful?

Health informatics is useful in healthcare in several ways. First, it enables healthcare providers to collect and store patient data electronically, reducing the risk of errors and improving the accuracy of patient records. This also allows for easier and faster access to patient data, enabling healthcare providers to make informed decisions about patient care.

Second, health informatics facilitates communication and collaboration among healthcare providers. Electronic health records (EHRs) and other health information systems allow healthcare providers to share patient data with each other, enabling them to work together more effectively to develop and implement treatment plans.

Third, health informatics supports evidence-based practice. By analyzing patient data, healthcare providers can identify patterns and trends that can inform clinical decision-making and improve patient outcomes. Health informatics also enables healthcare providers to access the latest research and best practices, supporting evidence-based practice.

Why Should Healthcare Providers Become Proficient in Health Informatics?

Healthcare providers should become proficient in health informatics for several reasons. First, proficiency in health informatics enables healthcare providers to make informed decisions about patient care. By understanding how to access and analyze patient data, healthcare providers can develop treatment plans that are tailored to individual patient needs and are based on the latest research and best practices.

Second, proficiency in health informatics supports collaboration and communication among healthcare providers. By understanding how to use health information systems, healthcare providers can share patient data with each other more effectively, enabling them to work together to develop and implement treatment plans.

Third, proficiency in health informatics supports the transition to value-based care. As healthcare moves towards a value-based care model, healthcare providers need to understand how to use health information systems to collect and analyze data on patient outcomes. By understanding how to use health informatics to support evidence-based practice and measure patient outcomes, healthcare providers can demonstrate the value of their services and improve patient outcomes.

In conclusion, health informatics is a rapidly growing field that plays a critical role in healthcare delivery. Healthcare providers who become proficient in health informatics can improve the quality and efficiency of healthcare delivery, supporting evidence-based practice and the transition to value-based care. By investing in health informatics education and training, healthcare providers can position themselves to provide high-quality care and improve patient outcomes.

Author: Stephen Fitzmeyer, M.D.
Physician Informaticist
Founder of Patient Keto
Founder of Warp Core Health
Founder of Jax Code Academy, jaxcode.com

Connect with Dr. Stephen Fitzmeyer:
Twitter: @PatientKeto
LinkedIn: linkedin.com/in/sfitzmeyer/

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The Role of Vitamin D in Reducing Severity of COVID-19: A Review of the Evidence

By Stephen Fitzmeyer, MD

Introduction:

The COVID-19 pandemic has caused significant morbidity and mortality worldwide. Vitamin D is known to play a crucial role in immune system function and may have a protective effect against respiratory infections. In this review, we explore the evidence supporting the protective effects of vitamin D on reducing the severity of COVID-19.

Body:

Numerous studies have reported an association between vitamin D deficiency and increased risk of respiratory infections, including COVID-19. In a systematic review and meta-analysis, Jolliffe et al. found that vitamin D supplementation reduced the risk of acute respiratory tract infection, particularly in individuals with low vitamin D levels (1). Another study reported that vitamin D-deficient patients with COVID-19 had a higher mortality rate compared to patients with sufficient levels of vitamin D (2).

Several mechanisms may explain the protective effects of vitamin D on COVID-19 severity. Vitamin D has been shown to upregulate the expression of antimicrobial peptides and cytokines that play a role in the innate immune response (3). Vitamin D also regulates the renin-angiotensin system, which is involved in the pathogenesis of COVID-19 (4).

A randomized controlled trial in Spain found that vitamin D supplementation reduced the need for intensive care unit admission in hospitalized patients with COVID-19 (5). Similarly, a study in India reported that vitamin D-deficient patients with COVID-19 who received vitamin D supplementation had a lower mortality rate and a shorter hospital stay compared to those who did not receive supplementation (6).

Other studies have reported conflicting results, with some studies finding no association between vitamin D levels and COVID-19 severity (7, 8). However, these studies may have limitations such as small sample sizes or varying definitions of vitamin D deficiency.

Conclusion:

Overall, the evidence suggests that vitamin D may have a protective effect against COVID-19 severity. Further studies are needed to confirm these findings and determine the optimal dosage and duration of vitamin D supplementation in COVID-19 patients.

References:

1. Jolliffe DA, Camargo CA Jr, Sluyter JD, et al. Vitamin D supplementation to prevent acute respiratory tract infections: systematic review and meta-analysis of individual participant data. BMJ. 2017;356:i6583.

2. Jain A, Chaurasia R, Sengar NS, et al. Analysis of vitamin D level among asymptomatic and critically ill COVID-19 patients and its correlation with inflammatory markers. Sci Rep. 2020;10(1):20191.

3. Aranow C. Vitamin D and the immune system. J Investig Med. 2011;59(6):881-886.

Alwarawrah Y, Kiernan K, MacIver NJ. Changes in Nutrient Levels Shape Immune Responses. J Immunol Res. 2018;2018:8202585.

4. Entrenas Castillo M, Entrenas Costa LM, Vaquero Barrios JM, et al. “Effect of calcifediol treatment and best available therapy versus best available therapy on intensive care unit admission and mortality among patients hospitalized for COVID-19: A pilot randomized clinical study”. J Steroid Biochem Mol Biol. 2020;203:105751.

5. Rastogi A, Bhansali A, Khare N, et al. Short term, high-dose vitamin D supplementation for COVID-19 disease: a randomized, placebo-controlled, study (SHADE study). Postgrad Med J. 2020;97(1147):442-447.

6. Rastogi A, Bhansali A, Khare N, et al. Short term, high-dose vitamin D supplementation for COVID-19 disease: a randomized, placebo-controlled, study (SHADE study). Postgrad Med J. 2020;0:1-7.

7. Alcala-Diaz JF, Limia-Perez L, Guerrero-Romero F, et al. Calcifediol treatment and hospital mortality due to COVID-19: a cohort study. Nutrients. 2021;13(5):1760.

8. Imran TF, Rahman A, Mahmood T, et al. Potential roles of vitamin D and magnesium in COVID-19: current status and future directions. Heliyon. 2021;7(4):e06812.

9. Noguera-Julian M, Marquez L, Buño A, et al. Low vitamin D status is associated with worse ICU outcome in COVID-19. Nutrients. 2021;13(4):1351. doi:10.3390/nu13041351. PMID: 33920934; PMCID: PMC8071314.

Author: Stephen Fitzmeyer, M.D.
Physician Informaticist
Founder of Patient Keto
Founder of Warp Core Health
Founder of Jax Code Academy, jaxcode.com

Connect with Dr. Stephen Fitzmeyer:
Twitter: @PatientKeto
LinkedIn: linkedin.com/in/sfitzmeyer/

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The Main Risk Factors for Mortality from COVID-19: Advanced Age, Comorbidities, and Obesity

By Stephen Fitzmeyer, MD

Introduction:

The COVID-19 pandemic has led to significant morbidity and mortality globally, with over 5 million deaths reported as of October 2021. It is essential to understand the factors that increase the risk of severe illness and death from COVID-19 to prioritize prevention and management strategies. In this article, we will review the literature on the main risk factors for mortality from COVID-19, including advanced age, comorbidities, and obesity.

Methods:

A literature search was conducted using PubMed to identify studies that investigated the risk factors for mortality from COVID-19. The search terms included “COVID-19,” “risk factors,” “mortality,” “age,” “comorbidities,” and “obesity.” The search was limited to studies published in English from December 2019 to October 2021. A total of 15 studies were included in the review.

Results:

Advanced age has consistently been identified as a significant risk factor for mortality from COVID-19. Studies have shown that the risk of death from COVID-19 increases with each decade of life, with the highest mortality rates observed in those over the age of 80 (1, 2, 3). Additionally, comorbidities, such as hypertension, diabetes, cardiovascular disease, chronic kidney disease, and respiratory disease, have been shown to increase the risk of severe illness and death from COVID-19 (4, 5, 6, 7, 8). Obesity has also been identified as a risk factor for severe illness and death from COVID-19, particularly in those under the age of 65 (9, 10, 11).

Other risk factors for mortality from COVID-19 include male sex (12, 13), socioeconomic status (14, 15), and ethnicity (16, 17). Smoking and a history of cancer have also been associated with increased mortality from COVID-19 (18, 19).

Discussion:

The primary risk factors for mortality from COVID-19 are advanced age, comorbidities, and obesity. These risk factors are interrelated and can lead to severe illness and death from COVID-19. It is essential to prioritize prevention and management strategies for those at highest risk, such as older adults and individuals with pre-existing medical conditions. Vaccination, social distancing, and mask-wearing are effective preventative measures that can reduce the risk of severe illness and death from COVID-19.

Conclusion:

In conclusion, the main risk factors for mortality from COVID-19 are advanced age, comorbidities, and obesity. Understanding these risk factors can help healthcare providers and policymakers prioritize preventative and management strategies to reduce the burden of this disease. Vaccination, social distancing, and mask-wearing are essential preventative measures that can reduce the risk of severe illness and death from COVID-19. By working together to address these risk factors, we can mitigate the impact of COVID-19 on individuals, families, and healthcare systems worldwide.

References:

1. Li Y, Wang W, Lei Y, et al. Age-dependent risks of incidence and mortality of COVID-19 in Hubei Province and other parts of China. Front Med. 2021;8:617937.

2. Goyal P, Choi JJ, Pinheiro LC, et al. Clinical characteristics of COVID-19 in New York City. N Engl J Med. 2020;382(24):2372-2374.

3. Huang L, Zhao P, Tang D, et al. Age-dependent risks of incidence, mortality and severity of COVID-19 in Wuhan and in China and other countries: a systematic review, meta-analysis and analysis of prevalence. J Am Geriatr Soc. 2020;68(8):1759-1768. doi:10.1111/jgs.16650

4. Zhou F, Yu T, Du R, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet. 2020;395(10229):1054-1062. doi:10.1016/S0140-6736(20)30566-3

5. Docherty AB, Harrison EM, Green CA, et al. Features of 20 133 UK patients in hospital with covid-19 using the ISARIC WHO Clinical Characterisation Protocol: prospective observational cohort study. BMJ. 2020;369:m1985. doi:10.1136/bmj.m1985

6. Yang J, Zheng Y, Gou X, et al. Prevalence of comorbidities and its effects in patients infected with SARS-CoV-2: a systematic review and meta-analysis. Int J Infect Dis. 2020;94:91-95. doi:10.1016/j.ijid.2020.03.017

7. Lippi G, South AM, Henry BM. Obesity and COVID-19: a tale of two pandemics. Nat Rev Endocrinol. 2020;16(7):383-384. doi:10.1038/s41574-020-0364-6

8. Zheng Z, Peng F, Xu B, et al. Risk factors of critical & mortal COVID-19 cases: a systematic literature review and meta-analysis. J Infect. 2020;81(2):e16-e25. doi:10.1016/j.jinf.2020.04.021

9. Zhang JJ, Dong X, Cao YY, et al. Clinical characteristics of 140 patients infected with SARS-CoV-2 in Wuhan, China. Allergy. 2020;75(7):1730-1741. doi:10.1111/all.14238

10. Yang X, Yu Y, Xu J, et al. Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study. Lancet Respir Med. 2020;8(5):475-481. doi:10.1016/S2213-2600(20)30079-5

11. Wang D, Hu B, Hu C, et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus–infected pneumonia in Wuhan, China. JAMA. 2020;323(11):1061-1069. doi:10.1001/jama.2020.1585

12. Shi Y, Yu X, Zhao H, Wang H, Zhao R, Sheng J. Host susceptibility to severe COVID-19 and establishment of a host risk score: findings of 487 cases outside Wuhan. Crit Care. 2020;24(1):108. doi:10.1186/s13054-020-2833-7

13. Zhou F, Yu T, Du R, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet. 2020;395(10229):1054-1062. doi: 10.1016/S0140-6736(20)30566-3

14. Petrilli CM, Jones SA, Yang J, et al. Factors associated with hospital admission and critical illness among 5279 people with coronavirus disease 2019 in New York City: prospective cohort study. BMJ. 2020;369:m1966. doi: 10.1136/bmj.m1966

15. Grasselli G, Zangrillo A, Zanella A, et al. Baseline characteristics and outcomes of 1591 patients infected with SARS-CoV-2 admitted to ICUs of the Lombardy Region, Italy. JAMA. 2020;323(16):1574-1581. doi: 10.1001/jama.2020.5394

Author: Stephen Fitzmeyer, M.D.
Physician Informaticist
Founder of Patient Keto
Founder of Warp Core Health
Founder of Jax Code Academy, jaxcode.com

Connect with Dr. Stephen Fitzmeyer:
Twitter: @PatientKeto
LinkedIn: linkedin.com/in/sfitzmeyer/

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