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In genetically predisposed individuals, ingestion of gluten may cause an inflammatory response leading to celiac disease. Aronsson and colleagues enrolled 6605 children in a prospective observational birth cohort study and found that higher gluten intake during the first 5 years of life was associated with increased risk of celiac disease autoimmunity and celiac disease among genetically predisposed children. In an Editorial, Leonard and Fasano discuss the relationship of diet to the development of chronic disease.
Hypertension is a risk factor for cerebral small vessel ischemic disease. Nasrallah and colleagues conducted a trial substudy of 670 hypertensive adults and found that targeting a systolic blood pressure of less than 120 mm Hg compared with less than 140 mm Hg was associated with a smaller increase in cerebral white matter lesion volume and a greater decrease in total brain volume. In an Editorial, Prabhakaran discusses the potential benefits of midlife blood pressure control for late-life brain health.
Editorial and Related Article
The relationship of late-life blood pressure, past hypertension, and cognitive functioning is unclear. Walker and colleagues followed 4761 participants in a long-term cohort study and found that a pattern of sustained hypertension from midlife to late life and a pattern of midlife hypertension followed by late-life hypotension, compared with midlife and late-life normal blood pressure, were associated with increased risks of subsequent dementia.
Exposure to ambient air pollution is associated with respiratory morbidity and mortality. In a cohort study involving 7071 adults, Wang and colleagues found that long-term exposure to specific air pollutants was associated with worsening emphysema.
Summary Video and CME
Extracorporeal life support provides gas exchange for patients with severe respiratory or cardiovascular impairment. Brodie and colleagues review the use of extracorporeal life support in adult patients who have respiratory failure, massive pulmonary embolism, or acute decompensation of pulmonary hypertension.
Author Audio Interview
Bone turnover markers, which can be measured in blood or urine, reflect current bone metabolism. This JAMA Insights article by Bauer discusses the use of bone turnover markers for drug development and clinical research studies.
This JAMA Clinical Challenge by Riley and colleagues presents a 41-year-old woman with progressive cough and dyspnea who had evidence of emphysema, bronchiectasis, and severe airway obstruction. What would you do next?
Highlights. JAMA. 2019;322(6):479–588. doi:10.1001/jama.2018.15454
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