Dietary guidelines around the world recommend increased intakes of fruits and non-starchy vegetables for the prevention of chronic diseases and possibly obesity. This study aimed to describe the association between body mass index (BMI) and habitual fruit and vegetable consumption in a large sample of 246,995 Australian adults aged 45 + year who had been recruited for the “45 and Up” cohort study. Fruit and vegetable intake was assessed using validated short questions, while weight and height were self-reported. Multinomial logistic regression was used, by sex, to assess the association between fruit and vegetable intake and BMI. Compared to the referent normal weight category (BMI 18.5 to 24.9), the odds ratio (OR) of being in the highest vegetable intake quartile was 1.09 (95% confidence interval (CI) 1.04–1.14) for overweight women (BMI 25.0–29.9) and 1.18 (95% CI 1.12–1.24) for obese women. The association was in the opposite direction for fruit for overweight (OR 0.85; 95% CI 0.80–0.90) and obese women (OR 0.75; 95% CI 0.69–0.80). Obese and overweight women had higher odds of being in the highest intake quartile for combined fruit and vegetable intake, and were more likely to meet the “2 and 5” target or to have five or more serves of fruit and vegetables per day. In contrast, overweight men were less likely to be in high intake quartiles and less likely to meet recommended target of 5 per day, but there was no consistent relationship between obesity and fruit and vegetable intake. Underweight women and underweight men were less likely to be in the highest intake quartiles or to meet the recommended targets. These data suggest that improving adherence to dietary targets for fruit and vegetables may be a dietary strategy to overcome overweight among men, but that overweight and obese women are already adhering to these targets. The association between fruit and vegetable intake and underweight in adults suggests that improving fruit and vegetables intakes are important for the overall dietary patterns of people in this group.
We retrospectively studied vancomycin taper and pulse treatment on 100 consecutive, evaluable patients with recurrent Clostridium difficile infection. Following taper to once-daily vancomycin dosing, 22 of 36 patients (61%) who received every-other-day dosing (QOD) and 50 of 64 (81%) who received QOD followed by every-third-day dosing were cured (P = .03).
The pharmacokinetic profile of ceftaroline has not been well characterized in obese adults. The purpose of this study was to evaluate the pharmacokinetics of ceftaroline in 32 healthy adult volunteers aged 18 to 50 years in the normal, overweight, and obese body size ranges. Subjects were evenly assigned to 1 of 4 groups based on their body mass index (BMI) and total body weight (TBW) (ranges, 22.1 to 63.5 kg/m 2 and 50.1 to 179.5 kg, respectively). Subjects in the lower-TBW groups were matched by age, sex, race/ethnicity, and serum creatinine to the upper-BMI groups. Serial plasma and urine samples were collected over 12 h after the start of the infusion, and the concentrations of ceftaroline fosamil (prodrug), ceftaroline, and ceftaroline M-1 (inactive metabolite) were assayed. Noncompartmental and population pharmacokinetic analyses were used to evaluate the data. The mean plasma ceftaroline maximum concentration and area under the curve were ca. 30% lower in subjects with a BMI of >40 kg/m 2 compared to those <30 kg/m 2 . A five-compartment pharmacokinetic model with zero-order infusion and first-order elimination optimally described the plasma concentration-time profiles of the prodrug and ceftaroline. Estimated creatinine clearance (eCL CR ) and TBW best explained ceftaroline clearance and volume of distribution, respectively. Although lower ceftaroline plasma concentrations were observed in obese subjects, Monte Carlo simulations suggest the probability of target attainment is >90% when the MIC is <1 g/ml irrespective of TBW or eCL CR . No dosage adjustment for ceftaroline appears to be necessary based on TBW alone in adults with comparable eCL CR . Confirmation of these findings in infected obese patients is necessary to validate these findings in healthy volunteers. (This study has been registered at ClinicalTrials.gov under registration no. NCT01648127.) C eftaroline fosamil is a novel intravenously administered antimicrobial agent approved for use in the United States as a treatment of acute bacterial skin and skin structure infections (ABSSSIs) and community-acquired bacterial pneumonia (1, 2). Unlike other regulatory approved cephalosporins, ceftaroline is uniquely active in vitro against methicillin-resistant Staphylococcus aureus (MRSA) (1-3). The current dosage regimen of ceftaroline fosamil is a fixed-dose of 600 mg every 12 h irrespective of body size in adult patients. Upon administration, the prodrug ceftaroline fosamil is converted by phosphatases to the active form ceftaroline that is principally (60%) eliminated unchanged in urine and to a small (6%) extent as an inactive metabolite (ceftaroline-M1). The dose should be reduced in patients with renal impairment when the estimated creatinine clearance (eCL CR ) is Յ50 ml/min.Obesity is defined as a body mass index (BMI) of Ն30 kg/m 2 and has been independently associated with an increased risk of certain infections such as ABSSSIs (4-6). Some evidence suggests obese patients may be at risk of worse clinical outcomes attributed in part to ina...
Novel, post-vancomycin fidaxomicin chaser or fidaxomicin taper regimens may decrease subsequent CDI episodes and improve outcomes compared to standard 10 day treatment of mrCDI episodes with fidaxomicin, but randomized prospective comparative data are not yet available.
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