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Objective Leptin is an adipokine that regulates body weight and appetite. It is also an inflammatory cytokine that influences immune reactivity and autoimmunity. Leptin levels are increased in obesity and are higher in women than in men. We aimed to determine whether leptin levels, independent of sex and body mass index ( BMI), are associated with thyroid autoimmunity. Design This study uses data from The Third National Health and Nutrition Examination Survey ( NHANES III) to test the association of leptin and thyroid autoimmunity, independent of BMI. Measurements Thyroid-stimulating hormone, thyroxine, antithyroid peroxidase ( TPO) antibodies and leptin levels were measured in 2902 men and 3280 women within the NHANES III population. BMI was calculated from height and weight. Results Women had significantly higher leptin levels and anti- TPO antibody titres than men. Correlation analyses demonstrated that leptin levels were associated with anti- TPO antibody levels in the total population, but when men and women were analysed separately, this association was lost. We then stratified men and women into obese ( BMI > 30) or nonobese ( BMI ≤ 30) subgroups and determined the association between leptin levels and anti- TPO antibody titres for each subgroup. Using regression analysis, we found that increased leptin levels correlated with thyroid autoantibodies in nonobese males, but not in obese males or in females. Conclusions Leptin levels correlated with thyroid autoantibody titres in nonobese males. This association was not found in females. Sex and body habitus should therefore be considered in studying the role of leptin in other autoimmune conditions. [ABSTRACT FROM AUTHOR]

Aim: To investigate if patients with diabetes taking metformin have better outcomes versus those not taking metformin following an emergency room visit for influenza. Methods: Using electronic medical records, we performed a retrospective chart review of all adult patients with a diagnosis of diabetes seen in any Duke University Medical Center‐affiliated emergency department for influenza over a 6‐year period. We documented patient characteristics and comorbidities, and compared outcomes for patients taking metformin versus patients not taking metformin using both univariable and multivariable analyses. Our primary outcome was hospital admission rate. Secondary outcomes were in‐hospital length of stay and in‐hospital death. Results: Our cohort included 1023 adult patients with diabetes, of whom 59.9% were female. The mean age was 62.9 years, 58.4% were African American, 36.1% were White, and 81.9% were obese or overweight. Of these patients, 347 (34%) were taking metformin. Patients with diabetes taking metformin were less likely to be hospitalized following an emergency department visit for influenza than patients with diabetes not taking metformin (56.8% vs. 70.1%; p < 0.001). Of those patients admitted, there was no statistically significant difference in length of stay or death. Conclusions: In patients with diabetes, metformin use is associated with lower rate of hospitalization following an emergency department visit for influenza. [ABSTRACT FROM AUTHOR]

Background: Malnutrition, including obesity and undernutrition, among children is increasing in prevalence and is common among children on renal replacement therapy. The effect of malnutrition on the pre‐transplant immune system and how the pediatric immune system responds to the insult of both immunosuppression and allotransplantation is unknown. We examined the relationship of nutritional status with post‐transplant outcomes and characterized the peripheral immune cell phenotypes of children from the Immune Development of Pediatric Transplant (IMPACT) study. Methods: Ninety‐eight patients from the IMPACT study were classified as having obesity, undernutrition, or normal nutrition‐based pre‐transplant measurements. Incidence of infectious and alloimmune outcomes at 1‐year post‐transplantation was compared between nutritional groups using Gray's test and Fine‐Gray subdistribution hazards model. Event‐free survival was estimated by Kaplan–Meier method and compared between groups. Differences in immune cell subsets between nutritional groups over time were determined using generalized estimating equations accounting for the correlation between repeated measurements. Results: We did not observe that nutritional status was associated with infectious or alloimmune events or event‐free survival post‐transplant. We demonstrated that children with obesity had distinct T‐and B‐cell signatures relative to those with undernutrition and normal nutrition, even when controlling for immunosuppression. Children with obesity had a lower frequency of CD8 Tnaive cells 9‐month post‐transplant (p <.001), a higher frequency of CD4 CD57 + PD1‐ T cells, and lower frequencies of CD57‐PD1+ CD8 and CD57‐PD1‐ CD8 T cells at 12‐month transplant (p <.05 for all). Conclusions: Children with obesity have distinct immunophenotypes that may influence the tailoring of immunosuppression. [ABSTRACT FROM AUTHOR]