Clinical Briefs
April 30, 2016 3 minutes read
The Associations of Vitiligo
SOURCE: Gill L, Zarbo A, Isedeh P, et al. Comorbid autoimmune diseases in patients with vitiligo: A cross-sectional study. J Am Acad Dermatol 2016;74:295-302.
The cause of vitiligo (VTL) remains obscure, but it is generally recognized to be an autoimmune disorder, with components of genetic predisposition, environmental stressors, and oxidative stress that ultimately influence its presentation.
The most common disorder with which clinicians may associate VTL is hypothyroidism, which is also usually autoimmune (Hashimoto’s disease).
Gill et al reviewed autoimmune comorbidities associated with VTL in a large population (n = 1873) of VTL patients observed at the Henry Ford Health System in Detroit between 2002-2012.
A number of comorbid autoimmune disorders were significantly more frequently identified in the VTL population than in the comparator general U.S. population.
Included among these were hypothyroidism, alopecia areata, inflammatory bowel disease, pernicious anemia, lupus, myasthenia gravis, and Sjögren’s syndrome.
Overall, approximately 20% of VTL patients had one or more comorbid autoimmune disorders.
The authors suggested vigilance and appropriate screening for comorbid autoimmune disorders when patients present with VTL.
A Toast to Not So Fast
SOURCE: Goulden R. Moderate alcohol consumption is not associated with reduced all-cause mortality. Am J Med 2016;129:180-186.
Conventional and clinical wisdom says alcohol in moderation benefits one’s health.
Plenty of observational data show those who are non-drinkers and those who drink excessively have higher mortality than those who drink in moderation.
But observational studies can only generate hypotheses because such studies cannot prove causation. Have we jumped the gun on causation?
Goulden reported on 206,966 person-years of follow-up from the Health and Retirement Study, a cohort study comprised of a nationally representative sample of adults > 50 years of age (n = 24,029).
When adjusted for sociodemographic variables, health status, and functional status, there was no difference in all-cause mortality associated with moderate alcohol intake compared to other groups.
The relationship between moderate alcohol use and health benefits may have nothing to do with alcohol.
Might those who drink in moderation also practice moderation in other aspects of their lives, such as smoking, exercise, diet, and relationships, which could lead to better outcomes regardless of alcohol intake?
As usual, there are no simple answers.
What Should Americans Eat?
SOURCE: DeSalvo K, Olson R, Casavale KO. Dietary guidelines for Americans. JAMA 2016;316:457-458.
Since the National Nutrition Monitoring and Related Research Act of 1990, governmental agencies have provided the Dietary Guidelines, now called Dietary Guidelines for Americans (available at: http://1.usa.gov/1unIEvF).
The most recent edition, intended to inform diet for the 2015-2020 interval, contains several pertinent recommendations: 1) Limit added sugars to < 10% of calories/day (currently at 13%); 2) Limit saturated fats to < 10% of calories/day; 3) Limit sodium to < 2,300 mg/day (currently at 3,440 mg/day).
The 2010 Dietary Guidelines suggested limiting dietary cholesterol to 300 mg/day.
Because the guidelines advisory committee felt there was insufficient evidence to provide specific dietary cholesterol targets, comment on cholesterol was omitted from this document.
However, the healthy diet patterns suggested in the guidelines would inherently provide a dietary cholesterol of 100-300 mg/day.
The guidelines’ overarching message is consistent with much of current popular diet philosophy — A healthy eating pattern limits saturated fats, trans fats, added sugars, and sodium.
In this section: examining autoimmune disorders associated with vitiligo; moderate alcohol consumption is not associated with reduced all-cause mortality; and rethinking the American diet.
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