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Greenberg J.A.,Brooklyn College | Greenberg J.A.,New York Obesity Research and Nutrition Center | Greenberg J.A.,St Lukes Roosevelt Hospital Center
American Journal of Clinical Nutrition | Year: 2013

Background: Recently a number of studies have found a lower risk of dying for obese individuals than for normal-weight individuals. The explanation for these paradoxical findings has not yet been identified. Objective: The objective was to assess whether this paradoxical pattern exists in the US population and whether it can be explained by reverse causation. Design: Survival analyses were used to calculate the RR of all-cause mortality for obesity by using data from 35,673 participants in NHANES I (1971-1975), NHANES II (1976-1980), and NHANES III (1988-1994), which reported 7087 deaths during 3 different 15-y follow-up periods. Results: With normal weight as a referent, a lower relative mortality risk of obesity was found only in NHANES III and only among men with a wide variety of preexisting serious illnesses. For this subgroup, the relative mortality risks in NHANES I, II, and III were 2.22 (95% CI: 1.45, 3.40), 0.89 (95% CI: 0.70, 1.15), and 0.65 (95% CI: 0.47, 0.91), respectively. Whereas the mortality rate among seriously ill normal-weight men did not change significantly between NHANES I and III, it did decrease significantly among seriously ill obese men, suggesting that reverse causation was not responsible for the lower relative mortality risk among seriously ill obese men in NHANES III. Conclusions: Only obese NHANES male participants with a wide variety of serious illnesses experienced lower mortality risk than their normal-weight counterparts and only in NHANES III. Reverse causation seems unlikely to have played a role. These conclusions require confirmation. © 2013 American Society for Nutrition. Source

Greenberg J.A.,Brooklyn College | Greenberg J.A.,St Lukes Roosevelt Hospital Center
Obesity | Year: 2013

Objective: Although obesity is a serious public health problem, there are few reliable measures of its health hazards in the United States. The objective of this study was to estimate how much earlier mortality is likely to occur for Americans who are obese (body mass index [BMI], ≥ 30). Design and Methods: Data from the National Health and Nutrition Examination Survey (NHANES) I (1971-1975), NHANES II (1976-1980), and NHANES III (1988-1994) for 37,632 participants who experienced 8,791 deaths during 15 years of follow-up were prospectively analyzed. The relative risk of death from all causes and its advancement period, adjusted for covariates, were calculated. Stratification was used to investigate the effects of pre-existing illness, smoking, and older age on the advancement period. Results: Compared to the participants of reference weight (BMI, 23 to <25 kg/m2), mortality was likely to occur 9.44 years (95% confidence interval [CI]: 0.72, 18.16) earlier for those who were obese (BMI, ≥ 30). For overweight (25 to <30 kg/m2), grade 1 obesity (BMI, 30 to <35) and grades 2-3 obesity (BMI, ≥ 35.0), the mortality was likely to occur earlier by 4.40 (-3.90, 12.70), 6.69 (-2.06, 15.43), and 14.16 (3.35, 24.97) years, respectively. These estimates apply to healthy nonsmoker young- and middle-aged (21-55 years) adults, who constituted an estimated 32.8% of Americans with age of >21 years between 1988 and 1994. Without stratifying simultaneously for preexisting illness, smoking, and age, values of the advancement period for obesity were markedly smaller than those observed for healthy nonsmoker young and middle-aged adults. Conclusions: For healthy nonsmokers young- and middle-aged adults who constitute about one-third of American adults, being obese is likely to hasten mortality by 9.44 years. Source

Silverberg J.I.,80 Lake Shore Drive | Silverberg N.B.,Northwestern University | Silverberg N.B.,St Lukes Roosevelt Hospital Center
Journal of Allergy and Clinical Immunology | Year: 2014

Background Previous studies suggested that atopic dermatitis (AD) is associated with aberrant immune responses, which might predispose toward both cutaneous and extracutaneous infections. The goal of this study was to determine whether childhood AD is associated with increased risk of warts, extracutaneous infections, and other atopic diseases and how these disorders cosegregate. Methods The 2007 National Health Interview Survey from a nationally representative sample of 9417 children age 0 to 17 years was used. Results Children with AD and other atopic disease had higher odds of warts. In contrast, children with AD with or without other atopic disease had higher odds of extracutaneous infections, including strep throat, other sore throat, head or chest cold, influenza/pneumonia, sinus infections, recurrent ear infections, chickenpox, and urinary tract infections (P <.0001). Children with AD and other atopic disease had a higher number of infections than those with either disorder by itself (P <.0001). Warts were also associated with increased odds of all extracutaneous infections (P <.0001), except recurrent ear infections. Children with warts and AD had a higher number of infections than those with either disorder alone (P <.0001). Finally, children with AD and warts had higher odds of ever receiving a diagnosis of asthma, current asthma, asthma exacerbation in the past year, hay fever, and food allergy. Children with AD with warts had even higher odds of asthma, hay fever, and food allergies than those with AD and no warts. Conclusions The associations between childhood AD, atopic disease, warts, and extracutaneous infections suggest that barrier disruption, immune disruption, or both contribute to susceptibility to warts and extracutaneous infections in children. © 2013 American Academy of Allergy, Asthma & Immunology. Source

Silverberg N.B.,St Lukes Roosevelt Hospital Center
Cutis; cutaneous medicine for the practitioner | Year: 2010

Pediatric psoriasis consists of infantile psoriasis, a self-limited disease of infancy; psoriasis with onset in childhood; and psoriasis with psoriatic arthritis. Approximately one-quarter to one-third of cases of psoriasis begin before 18 years of age. A variety of lesion types are seen in childhood, including plaque-type, guttate, nail-based, napkin, and erythrodermic disease. This article reviews current concepts in pediatric psoriasis. Part 2 will review therapeutics for psoriasis. Source

Bellmunt J.,University of the Sea | Dutcher J.,St Lukes Roosevelt Hospital Center
Annals of Oncology | Year: 2013

Background: Targeted therapies have shown profound effects on the outcome of patients with advanced renal cell carcinoma (RCC). However, the optimal treatment for RCC of non-clear cell histology (nccRCC)-typically excluded from trials of targeted agents-remains uncertain. Materials and methods: By carrying out extensive searches of PubMed and ASCO databases, we identified and summarised research into the biological characteristics, clinical behaviour and treatment of different histological subtypes of nccRCC, focusing on targeted therapy. Results: The available data suggest that treatments currently approved for RCC are active in ncc subtypes, although the overall clinical benefit may be less than for clear cell RCC. Temsirolimus has proven benefit over interferon-alfa (IFN-α) in patients with nccRCC, based on phase III data, while everolimus, sunitinib and sorafenib have all demonstrated some degree of activity in nccRCC in expanded-access trials. No clear picture has emerged of whether individual histological subtypes are particularly responsive to any individual treatment. Conclusions: Further molecular studies into the pathogenesis of RCC histological subtypes will help direct the development of novel, appropriate targeted agents. Clinical trials specifically designed to evaluate the role of targeted agents in nccRCC are ongoing, and data from trials with sunitinib and everolimus will be reported soon. © The Author 2013. All rights reserved. Source

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