glycaemic foods ) to one that favours fat storage , that is the principal driver behind a positive energy balance .
A problem with the EBM noted by the authors is that it does not explain the biological cause of weight gain . For example , a teenage growth spurt necessitates an increased consumption of calories , but whether increased energy consumption drives growth or if growth drives an increased consumption cannot be explained by the model .
In discussing the implications of the CIM , the authors explain how national dietary guidelines need to change and emphasise the importance of incorporating more low glycaemic index foods , for example , nuts , seeds , avocado etc , into the nation ’ s diet . Carbohydrates , while still required , can then be obtained from whole fruits , legumes and non-starchy vegetables .
The authors conclude that there is a need for more rigorous research to test the CIM and EBMs and that , in doing so , a new amalgamated model could emerge . Nevertheless , they highlight the urgency of such work given the current obesity epidemic and the failure of the EBM to contain the problem .
References 1 Ludwig DS et al . The carbohydrate-insulin model : a physiological perspective on the obesity pandemic . Am J Clin Nutr 2021 . https :// doi . org / 10.1093 / ajcn / nqab270 2 Obesity . NHS . www . nhs . uk / conditions / obesity / ( accessed September 2021 ).
cases ( pericarditis ) after at least one dose of the BNT162b vaccine . For the Moderna vaccine , the corresponding figures were 6.15 cases ( myocarditis ) and 3.84 cases ( pericarditis ) after a single dose of the vaccine .
In discussing their findings , the authors noted that younger patients more frequently reported either condition and that they predominately occurred after the second dose . They concluded that both myocarditis and pericarditis were rare events with a mild clinical course and followed by a full recovery in most cases .
Elevated cardiovascular risk profile in patients with autoimmune diseases
Autoimmune diseases have a common underlying proinflammatory component , which potentially increases cardiovascular disease risk .
Both rheumatoid arthritis ( RA ) and systemic lupus erythematosus ( SLE ) are autoimmune diseases and although each are clinically distinct , there is a commonality in that RA and SLE are associated with tissue and organ damage , and this arises due to the presence of destructive autoantibodies . In both RA and SLE there is increased production of pro-inflammatory cytokines , such as interleukin-1 and tumour necrosis factor ( in RA ) and interferongamma and tumour necrosis factor in SLE . Cardiovascular risk is largely dependent upon the level of atherosclerosis in both medium and large arterial vessels which , in turn , arises from endothelial dysfunction . Moreover , endothelial dysfunction can be induced by many different physiological stimuli including hypertension , diabetes , ageing and , in relation to autoimmune diseases , elevated levels of pro-inflammatory cytokines . 1 This link between inflammatory autoimmune diseases and cardiovascular risk led a team from the Department of Health Promotion , University of Palermo , Italy , to undertake a systematic review and meta-analysis assessing the relationship between symptomatic cardiovascular events in patients with RA and SLE . 2
The research team sought only prospective cohort studies in patients aged between 18 and 60 years , with either RA or SLE , and which evaluated the incidence of symptomatic cardiovascular diseases ( for example , myocardial ischaemia , stroke , peripheral vascular disease ) in patients followed up over a 5-year period .
Findings Whereas 2355 articles were originally identified by the literature search , only 14 were included in the final analysis : 4 examined cardiovascular risk in RA patients , 8 in SLE , and 2 in patients with both diseases . These studies included 20,288 patients with a mean age ranging from 40.9 to 69 years who were followed for between 5 and 14.4 years . Among those with RA , there was a 55 % increased risk of a symptomatic cardiovascular event ( relative risk , RR = 1.55 , 95 % CI 1.18 – 2.02 ). When stratifying by age , those under 60 years of age had a higher risk ( RR = 1.95 , 95 % CI 1.41 – 2.79 ) compared with those over 60 years of age ( RR = 1.43 , 96 % CI 1.16 – 1.75 ).
In patients with SLE , the risk of a symptomatic cardiovascular event was nearly doubled ( RR = 1.98 , 95 % CI 1.18 – 3.31 ) compared with those without the disease . As with RA , the risk was also increased among younger patients ( RR = 1.98 for those aged < 46 ) compared with older patients ( RR = 1.89 for those > 46 years ).
The authors concluded that the presence of an elevated cardiovascular risk among younger patients with both autoimmune diseases highlighted the need for cardiovascular preventative strategies to reduce this risk .
References 1 Gimbrone MA et al . Endothelial dysfunction and the pathobiology of atherosclerosis . Circ Res 2016 ; 118 ( 4 ): 620 – 36 . 2 Restivo V et al . Systematic review and metaanalysis of cardiovascular risk in rheumatological disease : Symptomatic and non-symptomatic events in rheumatoid arthritis and systemic lupus erythematosus . Autoimmun Rev 2021 ; doi : 10.1016 / j . autrev . 2021.102925 .
References 1 Kang M , An J . Viral myocarditis [ updated 2021 ] In : StatPearls [ internet ]. www . ncbi . nlm . nih . gov / books / NBK459259 / 2 Awan A et al . Acute Pericarditis : Descriptive Study and Etiology Determination in a Predominantly African American Population . Cureus 2017 ; 9 ( 7 ): e1431 3 Israeli Ministry of Health . Press release . www . gov . il / en / departments / news / 01062021-03 . 4 Lane S . Reports of myocarditis and pericarditis following mRNA COVID-19 vaccines : a review of spontaneously reported data from the UK , Europe and the US . MedRxiv preprint 2021 . https :// doi . org / 1 0.1101 / 2021.09.09.21263342 hospitalpharmacyeurope . com | 2021 | Issue 99 | 33