JAMA : the journal of the American Medical Association
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Type 2 diabetes in normal-weight adults (body mass index [BMI] <25) is a representation of the metabolically obese normal-weight phenotype with unknown mortality consequences. ⋯ Adults who were normal weight at the time of incident diabetes had higher mortality than adults who are overweight or obese.
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For more than 20 years, primary prevention of coronary heart disease has included strategies intended to improve overall serum lipid concentrations among youths. ⋯ Between 1988-1994 and 2007-2010, a favorable trend in serum lipid concentrations was observed among youths in the United States but almost 1 in 10 had elevated TC in 2007-2010.
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Persons born outside the United States comprise about 13% of the US population, and the challenges these persons face in accessing health care may lead to poorer human immunodeficiency virus (HIV) disease outcomes. ⋯ Among persons in 46 US states and 5 US territories who received a diagnosis of HIV from 2007 through 2010, 16.2% were born outside the United States. Compared with US-born persons diagnosed with HIV, persons born outside the United States had different epidemiologic characteristics.
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Nonalcoholic fatty liver disease (NAFLD) is one of the most common hepatic disorders in the United States, but uncertainty remains as to the optimal way to manage it. Using the case of Mr T, a 60-year-old man with obesity, diabetes mellitus, and increased serum transaminase levels, an evidence-based approach to diagnosis and treatment is discussed. Diagnosis of NAFLD is based on patient clinical profile and risk factors for metabolic syndrome, the exclusion of other liver diseases, radiologic imaging and sometimes biopsy. ⋯ Simple steatosis has a benign natural history, but NASH is progressive and may lead to cirrhosis, liver failure, and liver cancer. An evidence-based approach to treatment is limited by lack of large randomized trials, particularly of combinations of therapies, but weight loss, exercise, and medical therapies targeted at the mechanism of liver injury in NASH are recommended. Improved noninvasive diagnostic tests, a clearer understanding of the natural history of NAFLD, and large, well-designed clinical trials are needed.