BMJ Open Diabetes Research & Care最新文献

{"title":"Weight stigma and bias: standards of care in overweight and obesity-2025.","authors":"Raveendhara R Bannuru","doi":"10.1136/bmjdrc-2025-004962","DOIUrl":"https://doi.org/10.1136/bmjdrc-2025-004962","url":null,"abstract":"<p><p>Weight bias involves negative attitudes and stereotypes towards individuals based on their weight, which can be explicit or implicit. This bias contributes to weight stigma, or the mistreatment and social devaluation of individuals based on weight. Weight stigma is linked to adverse physical and mental health outcomes, leading to reduced access and quality of healthcare for individuals with obesity. The American Diabetes Association (ADA)'s Obesity Association developed guidelines on recognizing and addressing weight bias and stigma. All healthcare professionals and staff should receive training on weight bias and stigma to improve care for individuals with obesity. Training should start early and continue throughout medical education and practice. Multicomponent training that combines education with hands-on learning is recommended to reduce explicit and implicit weight bias. Clinical practices, a potential source of stigmatization for people living with obesity, should be equipped with appropriate furniture and equipment to establish an inclusive environment. Privacy and sensitivity during anthropometric measurements are essential to minimize stigmatization. Healthcare professionals should use person-centered, non-judgmental language and engage individuals in shared decision-making to consider their health and goals. Asking permission to discuss weight and respecting individual preferences is crucial. The ADA's Obesity Association encourages adopting these guidelines to reduce weight bias and stigma, emphasizing education, inclusive clinical environments, and effective communication to improve obesity care.</p>","PeriodicalId":9151,"journal":{"name":"BMJ Open Diabetes Research & Care","volume":"13 Suppl 1","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144085870","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Weight stigma and bias: standards of care in overweight and obesity-2025.","authors":"Raveendhara R Bannuru","doi":"10.1136/bmjdrc-2025-004962","DOIUrl":"https://doi.org/10.1136/bmjdrc-2025-004962","url":null,"abstract":"<p><p>Weight bias involves negative attitudes and stereotypes towards individuals based on their weight, which can be explicit or implicit. This bias contributes to weight stigma, or the mistreatment and social devaluation of individuals based on weight. Weight stigma is linked to adverse physical and mental health outcomes, leading to reduced access and quality of healthcare for individuals with obesity. The American Diabetes Association (ADA)'s Obesity Association developed guidelines on recognizing and addressing weight bias and stigma. All healthcare professionals and staff should receive training on weight bias and stigma to improve care for individuals with obesity. Training should start early and continue throughout medical education and practice. Multicomponent training that combines education with hands-on learning is recommended to reduce explicit and implicit weight bias. Clinical practices, a potential source of stigmatization for people living with obesity, should be equipped with appropriate furniture and equipment to establish an inclusive environment. Privacy and sensitivity during anthropometric measurements are essential to minimize stigmatization. Healthcare professionals should use person-centered, non-judgmental language and engage individuals in shared decision-making to consider their health and goals. Asking permission to discuss weight and respecting individual preferences is crucial. The ADA's Obesity Association encourages adopting these guidelines to reduce weight bias and stigma, emphasizing education, inclusive clinical environments, and effective communication to improve obesity care.</p>","PeriodicalId":9151,"journal":{"name":"BMJ Open Diabetes Research & Care","volume":"13 3","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143969258","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Introduction and methodology: Standards of Care in Overweight and Obesity-2025.","authors":"Raveendhara R Bannuru","doi":"10.1136/bmjdrc-2025-004928","DOIUrl":"https://doi.org/10.1136/bmjdrc-2025-004928","url":null,"abstract":"<p><p>Obesity is a chronic, relapsing, and progressive disease requiring long-term, interprofessional treatment strategies to improve health outcomes. With over 40% of US adults and nearly 20% of children affected, obesity remains a significant public health concern. Despite the American Medical Association's recognition of obesity as a chronic disease, gaps persist in education, training, and access to effective treatments. These gaps contribute to inadequate obesity management and reinforce stigma and weight bias in healthcare settings.The Standards of Care in Overweight and Obesity-2025, developed by The Obesity Association^TM, a division of the American Diabetes Association^(R), (ADA's Obesity Association), will provide evidence-based recommendations for screening, diagnosis, and management of obesity and related complications. These guidelines will emphasize a complication-centric, risk-reduction approach rather than solely focusing on weight loss. The recommendations will be intended for healthcare professionals, including but not limited to primary care physicians, endocrinologists, obesity medicine physicians, dietitians, and behavioral health specialists, as well as policymakers and insurers.The guideline development will follow a rigorous methodology, incorporating evidence from systematic literature reviews, expert consensus, and public feedback. Recommendations will be graded based on the quality and certainity of supporting evidence, with the goal of annual updates to ensure alignment with the latest research. A stringent conflict-of-interest policy will be maintained to uphold guideline integrity.By promoting personalized and equitable obesity care, these guidelines will aim to bridge existing gaps in clinical practice, enhance treatment accessibility, and improve long-term health outcomes for individuals with overweight or obesity.</p>","PeriodicalId":9151,"journal":{"name":"BMJ Open Diabetes Research & Care","volume":"13 3","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143980287","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Relationship between time-varying achieved HbA_1c and risk of coronary artery disease events among common haptoglobin phenotype groups with type 2 diabetes: the ADVANCE study.","authors":"Leah E Cahill, Rachel A Warren, Samantha K Lavallée, Andrew P Levy, Allie S Carew, John Sapp, Michelle Samuel, Elizabeth Selvin, Neil Poulter, Michel Marre, Stephen Harrap, Giuseppe Mancia, Katie Harris, John Chalmers, Mark Woodward, Eric Rimm","doi":"10.1136/bmjdrc-2024-004713","DOIUrl":"https://doi.org/10.1136/bmjdrc-2024-004713","url":null,"abstract":"<p><strong>Introduction: </strong>This study sought to determine whether the association between attaining specific glycated hemoglobin (HbA_1c) targets (<7.0% (<53 mmol/mol) and ≥8.0% (≥64 mmol/mol) compared with 7.0%-7.9%) over time and risk of incident coronary artery disease (CAD) was dependent on haptoglobin (Hp) phenotype in the Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Release Controlled Evaluation (ADVANCE) study.</p><p><strong>Research design and methods: </strong>Prospectively collected HbA_1c data from the ADVANCE biomarker case-cohort study, updated at 6 months and every 12 months thereafter over a median of 5.0 (IQR 4.5-5.3) years, were analyzed in relation to incident CAD in the Hp2-2 (n=1323) and non-Hp2-2 (n=2069) phenotypes separately using weighted multivariable-adjusted Cox regression models. Additional a priori stratifications by sex, race, previous cardiovascular disease (CVD), and type 2 diabetes duration were performed.</p><p><strong>Results: </strong>Mean HbA_1c was similar in each phenotype group throughout the study. Compared with HbA_1c of 7.0%-7.9%, HbA_1c <7.0% was not associated with CAD risk for any phenotype group or subgroup. HbA_1c ≥8.0% compared with 7.0%-7.9% over time was associated with higher CAD risk for the Hp2-2 phenotype only (HR 1.53, 95% CI 1.01 to 2.32; no significant association in the non-Hp2-2 type: 1.26, 0.89 to 1.77, p-interaction=0.71); this was pronounced when those with previous CVD at baseline were excluded (Hp2-2: 2.80, 1.41 to 5.53, p-interaction=0.03). Compared with HbA_1c of <8.0%, having HbA_1c ≥8.0% was associated with a 59% higher CAD risk among participants with the Hp2-2 phenotype (1.59, 1.12 to 2.26) and a 39% higher CAD risk among participants without the Hp2-2 phenotype (1.39, 1.03 to 1.88, p-interaction=0.97).</p><p><strong>Conclusions: </strong>The present ADVANCE analysis suggests that not having HbA_1c ≥8.0%, rather than achieving HbA_1c <7.0%, was found to be particularly important for CAD prevention among people with type 2 diabetes and the common Hp2-2 phenotype. While the subgroup analyses were likely underpowered, their inclusion is hypothesis generating and can be used in future meta-analyses to improve power and generalizability.</p>","PeriodicalId":9151,"journal":{"name":"BMJ Open Diabetes Research & Care","volume":"13 3","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12056637/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143972108","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Editorial for CASPAR: a retrospective cohort study of the high-concentration capsaicin topical system in patients with painful diabetic peripheral neuropathy of the feet.","authors":"Sanjeev Sharma","doi":"10.1136/bmjdrc-2025-005098","DOIUrl":"https://doi.org/10.1136/bmjdrc-2025-005098","url":null,"abstract":"","PeriodicalId":9151,"journal":{"name":"BMJ Open Diabetes Research & Care","volume":"13 3","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12049960/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143963564","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"CASPAR: a retrospective cohort study of the high-concentration capsaicin topical system in patients with painful diabetic peripheral neuropathy of the feet.","authors":"Michael Überall, Tamara Quandel, Sylvia Engelen, Lucia Garcia-Guerra, Tawfik Fajri, Samuel Allen, Rita Freitas, Zoltan Kender, Marielle Eerdekens","doi":"10.1136/bmjdrc-2024-004864","DOIUrl":"https://doi.org/10.1136/bmjdrc-2024-004864","url":null,"abstract":"<p><strong>Introduction: </strong>Painful diabetic peripheral neuropathy (pDPN), a common complication of diabetes, is challenging to treat and negatively impacts quality of life (QoL). Many patients either fail to achieve adequate pain relief with current treatments or suffer from systemic side effects with oral options. This study used data from the German Pain e-Registry (GPeR) to evaluate the high-concentration capsaicin topical system (HCCTS) for treating pDPN of the feet.</p><p><strong>Research design and methods: </strong>This retrospective, non-interventional cohort study (CASPAR) included patients with pDPN of the feet who received ≥1 HCCTS treatment (~3-month treatment intervals) and contributed data to the GPeR for ≥12 months. Data were collected on pain intensity, QoL, sleep, mood, concomitant medication, and tolerability.</p><p><strong>Results: </strong>Overall, 365 patients with pDPN of the feet were included. Significant reductions in 24-hour average pain intensity (API) were observed from baseline to month 3 (following one HCCTS treatment). Further reductions in mean API score were seen over 12 months with ongoing treatments, whereas API increased in patients who discontinued treatment (baseline to month 12 mean API scores: 61.4 to 8.8 for four HCCTS [∆ -52.6], 59.3 to 16.7 for three HCCTS [∆ -42.6], 56.3 to 31.9 for two HCCTS [∆ -24.4], 57.5 to 51.4 for one HCCTS [∆ -6.1]). Similar trends were seen for sleep, mood, and QoL outcomes. There was a significant reduction in concomitant pain medication use in patients receiving ongoing HCCTS treatments. The most common adverse events were local application-site reactions.</p><p><strong>Conclusions: </strong>This real-world study in patients with pDPN of the feet demonstrates that ongoing HCCTS treatments continue to improve pain intensity, mood, and QoL, while concomitant medication use decreases. Benefits from treatment were lost following HCCTS discontinuation. These findings emphasize the importance of ongoing treatments to achieve the potential of HCCTS in improving outcomes for patients with pDPN.</p>","PeriodicalId":9151,"journal":{"name":"BMJ Open Diabetes Research & Care","volume":"13 3","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12049874/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143964169","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Disparities in technology utilization among youth with type 1 diabetes across diverse racial and socioeconomic backgrounds.","authors":"Alaa Al Nofal, Doha Hassan, Tamim Rajjo, Herbert C Heien, Rozalina G McCoy","doi":"10.1136/bmjdrc-2025-004935","DOIUrl":"https://doi.org/10.1136/bmjdrc-2025-004935","url":null,"abstract":"<p><strong>Background: </strong>Previous studies have demonstrated disparities in the utilization of diabetes technology among youth with type 1 diabetes (T1D) based on race and socioeconomic status (SES). Few studies have examined these differences on a national scale or among youth with commercial health insurance.</p><p><strong>Aim: </strong>To investigate differences in the fill rates of insulin pumps and continuous glucose monitors (CGMs) among commercially insured children with T1D across diverse racial and SES groups.</p><p><strong>Methods: </strong>Using medical and pharmacy claims included in the OptumLabs Data Warehouse, we calculated the proportion of youth <18 years with T1D who had a fill for an insulin pump or a CGM, overall and stratified by race/ethnicity and annual household income, between 2011 and 2021.</p><p><strong>Results: </strong>Among 13,246 youth with T1D, 36.1% had CGM and 30.9% had pump fills. White youth had higher CGM and pump fills than black (CGMs: 35.8% vs 22.5%; pumps: 31.9% vs 21.2%, p<0.001) and Hispanic (CGMs: 35.8% vs 32.6%, p=0.047; pumps: 31.9% vs 25.0%, p<0.001). Youth from households with income <US$40,000 had lower CGM and pump fills than those with income ≥US$200,000 (CGM 25.4% vs 43.8%; pumps: 22.4% vs 38.8%, p<0.001). Within similar incomes <US$40,000, black youth had fewer CGM and pump fills than white youth (CGM: 15.2% vs 27.9%, p=0.006; pumps: 12.9% vs 25.5%, p=0.004). This racial difference disappeared with income ≥US$200,000 (CGMs: 47.5% for black vs 43.1% for white; pumps: 45.9% for black vs 38.3% for white, p=0.45 and p=0.57, respectively).</p><p><strong>Conclusions: </strong>In a cohort of commercially insured youth with T1D, both race and income are important factors that can independently influence the use of diabetes technology. Racial disparities decrease with higher income and disappear at incomes ≥US$200,000. Black youth with income <US$40,000 are at the highest exclusion risk from essential technologies. Greater effort is needed at both the system and individual levels to mitigate these disparities.</p>","PeriodicalId":9151,"journal":{"name":"BMJ Open Diabetes Research & Care","volume":"13 3","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12049953/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143981465","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Glycemic and non-glycemic benefits of initial triple therapy versus sequential add-on therapy in patients with new-onset diabetes: results from the EDICT study.","authors":"Muhammad Abdul-Ghani, Curtiss Puckett, Siham Abdelgani, Aurora Merovci, Olga Lavrynenko, John Adams, Curtis Triplitt, Ralph A DeFronzo","doi":"10.1136/bmjdrc-2025-004981","DOIUrl":"https://doi.org/10.1136/bmjdrc-2025-004981","url":null,"abstract":"<p><strong>Introduction: </strong>To compare carotid intima-media thickness (cIMT) and liver fat content in subjects who maintained good glycemic control for 6 years on initial triple therapy with metformin/exenatide/pioglitazone versus sequential add-on therapy with metformin followed with glipizide and basal insulin in subjects with new-onset diabetes.</p><p><strong>Research design and methods: </strong>Liver fat content and cIMT were compared among patients with T2DM who received initial triple therapy with metformin/pioglitazone/exenatide (n=29) versus metformin, followed by stepwise addition of glipizide and then insulin glargine (n=26) and who maintained HbA1c<6.5% for 6 years in Efficacy and Durability of Initial Combination Therapy for Type 2 Diabetes.</p><p><strong>Results: </strong>After 6 years in subjects receiving initial triple therapy with metformin/pioglitazone/exenatide and subjects receiving sequential addition of metformin followed by glipizide and insulin glargine had a mean HbA1c of 5.7% vs 6.0%, respectively, p=NS. Nonetheless, subjects receiving sequential add-on therapy experienced a greater increase in cIMT and manifested greater liver fat content and fibrosis than subjects receiving initial triple therapy.</p><p><strong>Conclusions: </strong>Including pioglitazone plus exenatide in the glucose-lowering regimen slows the progression of cIMT and was associated with lower hepatic fat content and fibrosis compared with subjects receiving sequential add-on therapy without pioglitazone and exenatide despite comparable optimal glycemic control.</p><p><strong>Trial registration number: </strong>NCT01107717.</p>","PeriodicalId":9151,"journal":{"name":"BMJ Open Diabetes Research & Care","volume":"13 2","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12035423/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143971126","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"GLP-1 RA and dual GIP/GLP-1 RA treatment in MODY: a descriptive case series.","authors":"Alina Z Mehdi, Lily Deng, Colby L Chase, Maria Cristina Foss-Freitas, Brigid Gregg, Rochelle N Naylor, Elif A Oral, William H Herman, Mansa Krishnamurthy, David T Broome","doi":"10.1136/bmjdrc-2024-004885","DOIUrl":"https://doi.org/10.1136/bmjdrc-2024-004885","url":null,"abstract":"<p><strong>Introduction: </strong>Glucagon-like peptide-1 receptor agonists (GLP-1 RA) and dual glucose insulinotropic polypeptide (GIP)/GLP-1 RA are widely prescribed, but their effectiveness in different subtypes of maturity-onset diabetes of the young (MODY) is unknown.</p><p><strong>Research design and methods: </strong>We present a descriptive case series of individuals from two MODY cohorts who used GLP-1 RA or dual GIP/GLP-1 RA. Paired <i>t</i> tests were used to compare HbA1c, body mass index (BMI), and sulfonylurea (SU) dose before and after GLP-1 RA or dual GIP/GLP-1 RA therapy.</p><p><strong>Results: </strong>10 individuals (4 hepatocyte nuclear factor-1α (HNF1A)-MODY, 4 hepatocyte nuclear factor-4α (HNF4A)-MODY, 1 ATP-binding cassette transporter subfamily C member 8 (ABCC8)-MODY, 1 hepatocyte nuclear factor-1β (HNF1B)-MODY) were identified who used GLP-1 RA or dual GIP/GLP-1 RA. In patients with HNF1A-MODY and HNF4A-MODY, GLP-1 RA reduced HbA1c by 1.3% (p=0.010), BMI by 2.90 kg/m² (p=0.008), and total daily dose of SU by 66.6% (p=0.005). Dual GIP/GLP-1 RA treatment led to a non-statistically significant decrease in HbA1c of 1.8% (p=0.104), a statistically significant reduction in BMI of 8.73 kg/m² (p=0.010), and all patients discontinued SU (n=2) and one discontinued insulin. In patients with ABCC8-MODY and HNF1B-MODY, GLP-1 RA reduced HbA1c by 1.2% and 1.8%, BMI by 1.1 kg/m² and 1.2 kg/m², and the patients no longer required treatment with SU or insulin, respectively.</p><p><strong>Conclusions: </strong>GLP-1 RA and dual GIP/GLP-1 RA lowered HbA1c, BMI, and SU dose in patients with MODY.</p>","PeriodicalId":9151,"journal":{"name":"BMJ Open Diabetes Research & Care","volume":"13 2","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12020758/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143963931","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"AI-enabled opportunistic measurement of liver steatosis in coronary artery calcium scans predicts cardiovascular events and all-cause mortality: an AI-CVD study within the Multi-Ethnic Study of Atherosclerosis (MESA).","authors":"Morteza Naghavi, Kyle Atlas, Anthony Reeves, Chenyu Zhang, Jakob Wasserthal, Thomas Atlas, Claudia I Henschke, David F Yankelevitz, Javier J Zulueta, Matthew J Budoff, Andrea D Branch, Ning Ma, Rowena Yip, Wenjun Fan, Sion K Roy, Khurram Nasir, Sabee Molloi, Zahi Fayad, Michael V McConnell, Ioannis Kakadiaris, David J Maron, Jagat Narula, Kim Williams, Prediman K Shah, George Abela, Rozemarijn Vliegenthart, Daniel Levy, Nathan D Wong","doi":"10.1136/bmjdrc-2024-004760","DOIUrl":"https://doi.org/10.1136/bmjdrc-2024-004760","url":null,"abstract":"<p><strong>Introduction: </strong>About one-third of adults in the USA have some grade of hepatic steatosis. Coronary artery calcium (CAC) scans contain more information than currently reported. We previously reported new artificial intelligence (AI) algorithms applied to CAC scans for opportunistic measurement of bone mineral density, cardiac chamber volumes, left ventricular mass, and other imaging biomarkers collectively referred to as AI-cardiovascular disease (CVD). In this study, we investigate a new AI-CVD algorithm for opportunistic measurement of liver steatosis.</p><p><strong>Methods: </strong>We applied AI-CVD to CAC scans from 5702 asymptomatic individuals (52% female, age 62±10 years) in the Multi-Ethnic Study of Atherosclerosis. Liver attenuation index (LAI) was measured using the percentage of voxels below 40 Hounsfield units. We used Cox proportional hazards regression to examine the association of LAI with incident CVD and mortality over 15 years, adjusted for CVD risk factors and the Agatston CAC score.</p><p><strong>Results: </strong>A total of 751 CVD and 1343 deaths accrued over 15 years. Mean±SD LAI in females and males was 38±15% and 43±13%, respectively. Participants in the highest versus lowest quartile of LAI had greater incidence of CVD over 15 years: 19% (95% CI 17% to 22%) vs 12% (10% to 14%), respectively, p<0.0001. Individuals in the highest quartile of LAI (Q4) had a higher risk of CVD (HR 1.43, 95% CI 1.08 to 1.89), stroke (HR 1.77, 95% CI 1.09 to 2.88), and all-cause mortality (HR 1.36, 95% CI 1.10 to 1.67) compared with those in the lowest quartile (Q1), independent of CVD risk factors.</p><p><strong>Conclusion: </strong>AI-enabled liver steatosis measurement in CAC scans provides opportunistic and actionable information for early detection of individuals at elevated risk of CVD events and mortality, without additional radiation.</p>","PeriodicalId":9151,"journal":{"name":"BMJ Open Diabetes Research & Care","volume":"13 2","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11997824/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143972720","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}