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The Evidence Speaks (August 2017)

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We’re proud to introduce our Evidence Speaks series, a recurring feature highlighting the latest in CHÉOS research. This series features summaries of select publications as well as in-depth features on the latest work from our investigators.

In the early days of CHÉOS, the Centre had a series known as “The Evidence Speaks,” a monograph series to keep media and the research community up-to-date with CHÉOS’ current research results in the health outcomes field.

Lv J, Zhang H, Wong MG, Jardine MJ, Hladunewich M,…Barbour S, Levin A, et al; the TESTING Study Group. Effect of oral methylprednisolone on clinical outcomes in patients with IgA nephropathy: The TESTING Randomized Clinical Trial. JAMA. 2017 Aug 1;318(5):432-42.

Immunoglobulin A (IgA) nephropathy is the most common disease of the glomerulus, a part of the kidney, and is particularly prevalent in the Asia-Pacific region. Development of end-stage kidney disease is common in people with IgA nephropathy despite guideline-recommended treatment. Although this type of nephropathy is mediated by the immune system, there is a lack of high-quality evidence to support the efficacy of immunosuppressive therapy in treating it. Accordingly, the Therapeutic Evaluation of Steroids in IgA Nephropathy Global (TESTING) study, in which Drs. Sean Barbour and Adeera Levin were co-authors and contributors, set out to test the ability of corticosteroids in preventing poor outcomes in people with high-risk nephropathy. Two-hundred and sixty-two participants were enrolled and were randomized to either methylprednisolone or placebo. The study was terminated early due to an increase in serious adverse events (SAEs)—mostly infections—in the treatment group. Despite the observation of some improvement in primary outcomes, the early termination of the study prevented the authors from making strong conclusions about treatment efficacy. The observed SAEs may affect clinical decision making and guideline development and the authors suggest that future studies could use concurrent antibiotic therapy to reduce the risk of infection during corticosteroid therapy.

Thomson KC, Guhn M, Richardson CG, Ark TK, Shoveller J. Profiles of children’s social-emotional health at school entry and associated income, gender and language inequalities: a cross-sectional population-based study in British Columbia, Canada. BMJ Open. 2017 Jul 26;7(7):e015353.

Social-emotions vulnerabilities experienced in early childhood, such as anxiety, aggression, depression, and hyperactivity, can have serious implications throughout childhood, adolescence, and adulthood. Dr. Chris Richardson, along with researchers from UBC’s Human Early Learning Partnership, sought to test whether problematic patterns of psychosocial functioning could be identified at the time of school entry; this age was chosen because it is a period of distinct change in social development and environment as well as cognition. The researchers gathered a sample of 35,818 children attending kindergarten at public schools in B.C. between 2004 and 2007 and measured indicators of social-emotional health using subscales from the Early Development Instrument, a measure of school readiness routinely administered during kindergarten. Secondary measures, such as family income and ESL status, were gathered using MSP and Ministry of Education records. Children were categorized into one of six groups based on social-emotional subscales; 58% had high social-emotional functioning, while 42% had vulnerability in at least one area and 9% had multiple vulnerabilities. The proportion of children from low-income families increased at each lower level of social-emotional health. Boys were more likely to demonstrate high aggression and hyperactivity and were underrepresented in the highest health group. Children who spoke English as second language had relatively strong social competence but lower readiness to explore. The results of this study demonstrate the prevalence of social-emotional vulnerabilities in B.C. children at school entry and identify potential areas that could be addressed through programs to promote social-emotional health.

Tu AW, Humphries KH, Lear SA. Longitudinal changes in visceral and subcutaneous adipose tissue and metabolic syndrome: Results from the Multicultural Community Health Assessment Trial (M-CHAT). Diabetes Metab Syndr. 2017 Jul 8 epub ahead of print.

Obesity has been clearly linked to a range of cardiovascular and metabolic diseases such as hypertension, diabetes, and stroke. However, where fat is deposited in the body may have disparate effects on health. Visceral adipose tissue (VAT), which is deposited amongst the abdominal organs, is associated with increased cardiometabolic risk factors and development of metabolic syndrome. Conversely, subcutaneous abdominal adipose tissue (SAT), fat located under the abdominal skin, is not as strongly linked to health risk. Metabolic syndrome is the co-occurrence of multiple, interconnected metabolic risk factors and is associated with the development of cardiovascular disease and type 2 diabetes. The Multicultural Community Health Assessment Trial (M-CHAT), conducted by Dr. Karin Humphries and researchers from UBC and SFU, was designed to compare body fat distributions and health outcomes in four different ethnic populations. Participants resided in Metro Vancouver, were between the ages of 30 and 65, and of Aboriginal, European, Chinese, or South Asian origin; an equal number of participants categorized as normal, overweight, or obese were recruited for each ethnic group. Five-hundred and ninety-eight participants completed baseline assessments and had at least one follow-up visit. A longitudinal increase in VAT was associated with an increased risk of developing metabolic syndrome and dyslipidemia (high-risk triglycerides levels). Between participants, an increase in VAT was associated with having lower healthy cholesterol and high-risk fasting glucose levels. Sex and ethnicity did not moderate the association between VAT accumulation and metabolic syndrome. SAT was not significantly associated with any increase in metabolic syndrome or metabolic risk factors. This study suggests that the increased risk of metabolic syndrome in obesity is a result of VAT specifically.

Health research in the heart of Vancouver