Perut buncit berakibat gangguan ingatan

Hubungan antara obesitas dan penyakit jantung serta diabetes telah banyak diketahui. Penelitian ini mencari hubungan antara obesitas dan dementia (gangguan ingatan). Diteliti >6500 subyek, dari catatan medis 36 tahun kemudian, sebanyak 1049 pasien (15.9%) didiagnosis dementia.

 

Peneliti mendapatkan bahwa subyek dengan sagittal abdominal diameter (SAD) terbesar (the highest quintiles) berisiko 3 kali lebih besar untuk terkena dementia dibanding mereka dengan SAD terkecil (the lowest quintiles).

 

Bila menyertakan indeks massa tubuh, subyek obes (IMT>30) dan SAD terbesar menghadapi risiko 3,6 kali.

 

Kesimpulan obesitas sentral meningkatkan risiko dementia terlepas dari diabetes dan penyakit jantung. Mekanisme hubungan obesitas dan dementia perlu diteliti lebih lanjut.

Abstract

Neurology, September 30 2008;71:1057-1064 © 2008 American Academy of Neurology
Central obesity and increased risk of dementia more than three decades later.

R. A. Whitmer, PhD, D. R. Gustafson, PhD, E. Barrett-Connor, MD, M. N. Haan, DrPH, E. P. Gunderson, PhD and K. Yaffe, MD

From Kaiser Permanente Division of Research (R.A.W., E.P.G.), Oakland, CA; Goteberg University (D.R.G.), Goteberg, Sweden; the Department of Family Medicine (E.B.-C.), University of California, La Jolla; the Department of Epidemiology (M.N.H.), University of Michigan, Ann Arbor; and the Departments of Psychiatry, Neurology and Epidemiology (K.Y.), University of California, San Francisco.

Background: Numerous reports show that a centralized distribution of adiposity is a more dangerous risk factor for cardiovascular disease and diabetes than total body obesity. No studies have evaluated whether the same pattern exists with dementia. The objective was to evaluate the association between midlife central obesity and risk of dementia three decades later.

Methods: A longitudinal analysis was conducted of 6,583 members of Kaiser Permanente of Northern California who had their sagittal abdominal diameter (SAD) measured in 1964 to 1973. Diagnoses of dementia were from medical records an average of 36 years later, January 1, 1994, to June 16, 2006. Cox proportional hazard models adjusted for age, sex, race, education, marital status, diabetes, hypertension, hyperlipidemia, stroke, heart disease, and medical utilization were conducted.

Results: A total of 1,049 participants (15.9%) were diagnosed with dementia. Compared with those in the lowest quintile of SAD, those in the highest had nearly a threefold increased risk of dementia (hazard ratio, 2.72; 95% CI, 2.33–3.33), and this was only mildly attenuated after adding body mass index (BMI) to the model (hazard ratio, 1.92; 95% CI, 1.58–2.35). Those with high SAD (>25 cm) and normal BMI had an increased risk (hazard ratio, 1.89; 95% CI, 0.98–3.81) vs those with low SAD (<25 cm) and normal BMI (18.5–24.9 kg/m²), whereas those both obese (BMI >30 kg/m²) and with high SAD had the highest risk of dementia (HR, 3.60; 95% CI, 2.85–4.55).

Conclusions: Central obesity in midlife increases risk of dementia independent of diabetes and cardiovascular comorbidities. Fifty percent of adults have central obesity; therefore, mechanisms linking central obesity to dementia need to be unveiled.

Perut buncit meningkatkan risiko kematian

Dalam penelitian multisenter di Eropa terhadap 360 ribu partisipan yang di-follow-up selama hampir 10 tahun, ditemukan bahwa risiko kematian pada pria dan wanita dengan lingkar pinggang besar (the highest quintile) meningkat masing-masing 2.05 kali dan 1.78 kali. Demikian pula untuk waist-to-hip ratio besar (the highest quintile) meningkat masing-masing 1.68 dan 1.51.

 

Risiko terendah adalah yang mempunyai indeks massa tubuh <25.3 untuk pria dan <24.3 untuk wanita.

 

Kesimpulan baik general adiposity maupun abdominal adiposity berhubungan dengan risiko kematian. Sebaiknya dilakukan pengukuran lingkar pingang, waist-to-hip ratio, dan indeks massa tubuh untuk menilai risiko kematian.

 

 

 

N Engl J Med 359(20):2105-2120, 13 November 2008 © 2008 to the Massachusetts Medical Society
General and Abdominal Adiposity and Risk of Death in Europe.

T. Pischon, H. Boeing, K. Hoffmann, et al.

 

ABSTRACT

Background Previous studies have relied predominantly on the body-mass index (BMI, the weight in kilograms divided by the square of the height in meters) to assess the association of adiposity with the risk of death, but few have examined whether the distribution of body fat contributes to the prediction of death.

Methods We examined the association of BMI, waist circumference, and waist-to-hip ratio with the risk of death among 359,387 participants from nine countries in the European Prospective Investigation into Cancer and Nutrition (EPIC). We used a Cox regression analysis, with age as the time variable, and stratified the models according to study center and age at recruitment, with further adjustment for educational level, smoking status, alcohol consumption, physical activity, and height.

Results During a mean follow-up of 9.7 years, 14,723 participants died. The lowest risks of death related to BMI were observed at a BMI of 25.3 for men and 24.3 for women. After adjustment for BMI, waist circumference and waist-to-hip ratio were strongly associated with the risk of death. Relative risks among men and women in the highest quintile of waist circumference were 2.05 (95% confidence interval [CI], 1.80 to 2.33) and 1.78 (95% CI, 1.56 to 2.04), respectively, and in the highest quintile of waist-to-hip ratio, the relative risks were 1.68 (95% CI, 1.53 to 1.84) and 1.51 (95% CI, 1.37 to 1.66), respectively. BMI remained significantly associated with the risk of death in models that included waist circumference or waist-to-hip ratio (P<0.001).

Conclusions These data suggest that both general adiposity and abdominal adiposity are associated with the risk of death and support the use of waist circumference or waist-to-hip ratio in addition to BMI in assessing the risk of death.

Kopi menghambat pertumbuhan janin

Bagi ibu hamil yang gemar minum kopi ada baiknya memperhatikan penelitian berikut.

Penelitian ini dilakukan di Inggris terhadap >2600 ibu hamil normal (usia kehamilan 8-12 minggu).

Hasil penelitian menunjukkan bahwa semakin besar konsumsi kafein selama kehamilan semakin besar pula risiko gangguan pertumbuhan janin.

Sehingga dianjurkan untuk mengurangi konsumsi kafein sebelum dan selama hamil.

 

Abstract

BMJ 3 November 2008;337:a2332 © 2008 BMJ Publishing Group Ltd
Maternal caffeine intake during pregnancy and risk of fetal growth restriction: a large prospective observational study. CARE Study Group.

 

Objective To examine the association of maternal caffeine intake with fetal growth restriction.

Design Prospective longitudinal observational study.

Setting Two large UK hospital maternity units.

Participants 2635 low risk pregnant women recruited between 8-12 weeks of pregnancy.

Investigations Quantification of total caffeine intake from 4 weeks before conception and throughout pregnancy was undertaken with a validated caffeine assessment tool. Caffeine half life (proxy for clearance) was determined by measuring caffeine in saliva after a caffeine challenge. Smoking and alcohol were assessed by self reported status and by measuring salivary cotinine concentrations.

Main outcome measures Fetal growth restriction, as defined by customised birth weight centile, adjusted for alcohol intake and salivary cotinine concentrations.

Results Caffeine consumption throughout pregnancy was associated with an increased risk of fetal growth restriction (odds ratios 1.2 (95% CI 0.9 to 1.6) for 100-199 mg/day, 1.5 (1.1 to 2.1) for 200-299 mg/day, and 1.4 (1.0 to 2.0) for >300 mg/day compared with <100 mg/day; test for trend P<0.001). Mean caffeine consumption decreased in the first trimester and increased in the third. The association between caffeine and fetal growth restriction was stronger in women with a faster compared to a slower caffeine clearance (test for interaction, P=0.06).

Conclusions Caffeine consumption during pregnancy was associated with an increased risk of fetal growth restriction and this association continued throughout pregnancy. Sensible advice would be to reduce caffeine intake before conception and throughout pregnancy.

Vitamin tidak mencegah kanker

Suplemen vitamin dianggap berperan penting untuk mencegah kanker.

 

Penelitian yang dilakukan terhadap >5000 wanita berusia >42 tahun selama >7 tahun, membandingkan secara random efek suplementasi vitamin (folat, vitamin B6 dan vitamin B12) terhadap plasebo, membuktikan bahwa pemberian folat, vitamin B6 dan vitamin B12 tidak signifikan mencegah kanker.

 

Abstrak

 

Effect of Combined Folic Acid, Vitamin B₆, and Vitamin B₁₂ on Cancer Risk in Women

A Randomized Trial

Shumin M. Zhang, MD, ScD; Nancy R. Cook, ScD; Christine M. Albert, MD, MPH; J. Michael Gaziano, MD, MPH; Julie E. Buring, ScD; JoAnn E. Manson, MD, DrPH

JAMA. 2008;300(17):2012-2021.

Context  Folate, vitamin B₆, and vitamin B₁₂ are thought to play an important role in cancer prevention.

Objective  To evaluate the effect of combined folic acid, vitamin B₆, and vitamin B₁₂ treatment on cancer risk in women at high risk for cardiovascular disease.

Design, Setting, and Participants  In the Women's Antioxidant and Folic Acid Cardiovascular Study, 5442 US female health professionals aged 42 years or older, with preexisting cardiovascular disease or 3 or more coronary risk factors, were randomly assigned to receive either a daily combination of folic acid, vitamin B₆, and vitamin B₁₂ or a matching placebo. They were treated for 7.3 years from April 1998 through July 31, 2005.

Intervention  Daily supplementation of a combination of 2.5 mg of folic acid, 50 mg of vitamin B₆, and 1 mg of vitamin B₁₂ (n = 2721) or placebo (n = 2721).

Main Outcome Measures  Confirmed newly diagnosed total invasive cancer or breast cancer.

Results  A total of 379 women developed invasive cancer (187 in the active treatment group and 192 in the placebo group). Compared with placebo, women receiving the active treatment had similar risk of developing total invasive cancer (101.1/10 000 person-years for the active treatment group vs 104.3/10 000 person-years for placebo group; hazard ratio [HR], 0.97; 95% confidence interval [CI], 0.79-1.18; P = .75), breast cancer (37.8/10 000 person-years vs 45.6/10 000 person-years, respectively; HR, 0.83; 95% CI, 0.60-1.14; P = .24), or any cancer death (24.6/10 000 person-years vs 30.1/10 000 person-years, respectively; HR, 0.82; 95% CI, 0.56-1.21; P = .32).

Conclusion  Combined folic acid, vitamin B₆, and vitamin B₁₂ treatment had no significant effect on overall risk of total invasive cancer or breast cancer among women during the folic acid fortification era.

Omega3 mencegah gagal jantung

Gagal jantung merupakan penyebab morbiditas dan mortalitas kardiovaskuler. Beberapa penelitian menunjukkan manfaat asam lemak tak jenuh n-3 (n-3 polyunsaturated fatty acids disingkat PUFA) dalam menurunkan mortalitas karena efek anti-inflamasi dan aman serta toleransi yang baik. Penelitian GISSI-HF adalah penelitian double blind multicenter yang dilakukan pada 326 pusat kardiologi dan 31 pusat internist di Italia, melibatkan hampir 7000 subyek dan follow-up selama 4 tahun.

 

Hasil penelitian mendukung temuan sebelumnya. Sehingga disimpulkan bahwa pemberian n-3 PUFA 1000mg memberikan benefit dalam hal menurunkan morbiditas dan mortalitas kardiovaskuler pada pasien2 gagal jantung.

 

The Lancet, Volume 372, Issue 9645, Pages 1223 - 1230, 4 October 2008

 

Effect of n-3 polyunsaturated fatty acids in patients with chronic heart failure (the GISSI-HF trial): a randomised, double-blind, placebo-controlled trial

 

Background

 

Several epidemiological and experimental studies suggest that n-3 polyunsaturated fatty acids (PUFA) can exert favourable effects on atherothrombotic cardiovascular disease, including arrhythmias. We investigated whether n-3 PUFA could improve morbidity and mortality in a large population of patients with symptomatic heart failure of any cause.

Methods

We undertook a randomised, double-blind, placebo-controlled trial in 326 cardiology and 31 internal medicine centres in Italy. We enrolled patients with chronic heart failure of New York Heart Association class II—IV, irrespective of cause and left ventricular ejection fraction, and randomly assigned them to n-3 PUFA 1 g daily (n=3494) or placebo (n=3481) by a concealed, computerised telephone randomisation system. Patients were followed up for a median of 3·9 years (IQR 3·0—4·5). Primary endpoints were time to death, and time to death or admission to hospital for cardiovascular reasons. Analysis was by intention to treat.

Findings

We analysed all randomised patients. 955 (27%) patients died from any cause in the n-3 PUFA group and 1014 (29%) in the placebo group (adjusted hazard ratio [HR] 0·91 [95·5% CI 0·833—0·998], p=0·041). 1981 (57%) patients in the n-3 PUFA group and 2053 (59%) in the placebo group died or were admitted to hospital for cardiovascular reasons (adjusted HR 0·92 [99% CI 0·849—0·999], p=0·009). In absolute terms, 56 patients needed to be treated for a median duration of 3·9 years to avoid one death or 44 to avoid one event like death or admission to hospital for cardiovascular reasons. In both groups, gastrointestinal disorders were the most frequent adverse reaction (96 [3%] n-3 PUFA group vs 92 [3%] placebo group).

Interpretation

A simple and safe treatment with n-3 PUFA can provide a small beneficial advantage in terms of mortality and admission to hospital for cardiovascular reasons in patients with heart failure in a context of usual care.

Konsumsi alkohol memperkecil volume otak

Konsumsi alkohol terrbukti menurunkan risiko penyakit kardiovaskuler. Pengaruhnya pada otak belum diketahui.

 

Adakah hubungan konsumsi alkohol terhadap volume otak? Subyek penelitian sebanyak 1.839 orang dan diteliti selama 2 tahun.

 

Hasil penelitian menunjukkan hubungan linier negatif antara konsumsi alkohol dan volume otak. Artinya semakin besar konsumsi alkohol maaka semakin berkurang volume otak.

 

Carol Ann Paul, MS; Rhoda Au, PhD; Lisa Fredman, PhD; Joseph M. Massaro, PhD; Sudha Seshadri, MD; Charles DeCarli, MD; Philip A. Wolf, MD

Arch Neurol. 2008;65(10):1363-1367.

Background  While adults who drink low to moderate amounts of alcohol have lower rates of cardiovascular disease than other adults, the effect of alcohol on the brain is less clear. There is evidence that drinking large amounts of alcohol is related to brain atrophy. It is uncertain what the effects of low to moderate consumption might be.

Objective  To determine whether consumption of smaller amounts of alcohol negatively affects brain volume or is protective in reducing the well-documented age-related decline in brain volume.

Design  Total cerebral brain volume (TCBV) was computed, correcting for head size. Multivariate linear regression models were used to evaluate the association between 5 categories of alcohol consumption (abstainers, former drinkers, low, moderate, high) and TCBV, adjusting for age, sex, education, height, body mass index (calculated as weight in kilograms divided by height in meters squared), and the Framingham Stroke Risk Profile. Pairwise comparisons were also conducted between the alcohol consumption groups.

Participants  A total of 1839 subjects from the Framingham Offspring Study who had magnetic resonance imaging of the brain between 1999 and 2001.

Results  Most participants reported low alcohol consumption, and men were more likely than women to be moderate or heavy drinkers. There was a significant negative linear relationship between alcohol consumption and TCBV (r = –0.25; P < .001). This relationship was modified by sex, with alcohol consumption having a stronger association with TCBV in women than in men (r = –0.29 vs –0.20).

Conclusions  In contrast to studies on cardiovascular disease, this study found that moderate alcohol consumption was not protective against normal age-related differences in total brain volume. Rather, the more alcohol consumed, the smaller the total brain volume.

Operasi bariatrik di Australia

Dalam 17 tahun terakhir terjadi peningkatan 20 kali insiden operasi bariatrik (operasi untuk mengatasi obesitas). 5 years survival rate sesuai dengan populasi umum. 30-day postoperative mortalitas rendah (0.07%) dan <10% pasien mengalami komplikasi. Prosedur gastric reduction lebih aman dibanding prosedur bypass-type.

MJA 18 August 2008; 189 (4): 198-202 © The Medical Journal of Australia 2008
Incidence of bariatric surgery and postoperative outcomes: a population-based analysis in Western Australia. Fiona J Smith, C D'Arcy J Holman, Rachael E Moorin and David R Fletcher. Correspondence to: Fiona J Smith

 

Objective:

To investigate the incidence of bariatric surgery and postoperative outcomes in a population-based cohort of patients in Western Australia over a 17-year period.

Design and setting:

A population-based incidence study of all bariatric procedures (n = 1403) performed in WA hospitals over the period 1988–2004, based on hospital morbidity and death data from the WA Data Linkage System.

Main outcome measures:

Changes in incidence of bariatric procedures over time; mortality and complications within 30 days after surgery; survival rates after surgery relative to age-, sex-, and period-matched survival rates in the general population; factors predictive of re-admission to hospital.

Results:

The incidence of bariatric surgery increased from 1.2 procedures per 100 000 person-years in 1988 to 24.2 procedures per 100 000 person-years in 2004. Although some of this was ascribed to a rising prevalence of obesity generally, there was a 13-fold increase in the bariatric procedure rate within the obese population itself. At 5 years, the relative survival rate in bariatric patients was the same as the survival rate in the general population. Within the 30-day postoperative period, mortality was low (0.07%) and 9.6% of patients experienced complications. Those who had bypass-type procedures were more likely to be re-admitted within 30 days than those who had gastric reduction procedures (adjusted hazard ratio, 5.80 [95% CI, 3.42–9.84]).

Conclusion:

The use of bariatric surgery increased 20-fold over the study period. Relative survival after surgery was in line with population norms. The observed low mortality rates and moderate level of complications are similar to findings in other studies in which the proportion of reduction procedures has been high.

Manfaat teh hijau untuk diabetesi

Penelitian tentang efek teh hijau dilakukan pada 60 orang berusia 32-73 tahun, yang kadar gula darah puasa >110mg/dL atau gula darah sewaktu >140mg/dL. Subyek dibagi 2 kelompok, kelompok pertama mendapat teh hijau (green tea-extract powder mengandung 544 mg polyphenols (456 mg catechins) setiap hari selama 2 bulan kemudian dihentikan dan diamati selama 2 bulan, kelompok kedua diamati selama 2 bulan kemudian mendapat teh hijau selama 2 bulan.

Hasil penelitian menunjukkan penurunan signifikan kadar HbA1c dan penurunan tekanan darah diastolik. Kesimpulan untuk pra-diabetesi, minum teh hijau setiap hari dapat menurunkan kadar gula darah.

Original Article

European Journal of Clinical Nutrition (2008) 62, 953–960;

Randomized controlled trial for an effect of green tea-extract powder supplementation on glucose abnormalities

Y Fukino¹, A Ikeda², K Maruyama^1,2, N Aoki³, T Okubo⁴ and H Iso²

1. ¹Department of Nutritional Sciences, School of Food and Nutritional Sciences, University of Shizuoka, Suruga-ku, Shizuoka-shi, Japan
2. ²Public Health, Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University, Suita-shi, Osaka, Japan
3. ³Department of Public Health, Hamamatsu University School of Medicine, Hamamatsu-shi, Japan
4. ⁴Central Research Laboratories, Taiyou Kagaku Co. Ltd., Yokkaichi, Mie, Japan

Correspondence: Dr Y Fukino, School of Food and Nutritional Sciences, University of Shizuoka, 52-1 Yada, Shizuoka-shi 422-8526, Japan. E-mail: fukino@u-shizuoka-ken.ac.jp

Objective:

We examined whether green tea-extract powder supplementation improves glucose abnormality.

Methods:

The study was conducted for volunteers who resided in eastern communities of Shizuoka Prefecture and who had fasting blood glucose levels of 6.1 mmol/l or nonfasting blood glucose levels of 7.8 mmol/l in a recent health check-up. Sixty subjects aged 32–73 years (49 males and 11 females) participated in the trial. The Early intervention group consumed a packet of green tea-extract powder containing 544 mg polyphenols (456 mg catechins) daily for the first 2 months and then entered the 2-month nonintervention period. The Later intervention group was observed for the first 2 months and then consumed green tea-extract powder as described above for the subsequent 2 months. Using the two-period crossover design, we analyzed the changes in fasting hemoglobin A1c level and other biomarkers in blood samples collected at baseline, 2 months and 4 months.

Results:

A significant reduction in hemoglobin A1c level and a borderline significant reduction in diastolic blood pressure were associated with the intervention. The intervention caused no significant changes in weight, body mass index, body fat, systolic blood pressure, fasting serum glucose level, homeostasis model assessment index, serum lipid level or hypersensitive C-reactive protein.

Conclusion:

Daily supplementary intake of green tea-extract powder lowered the hemoglobin A1c level in individuals with borderline diabetes.

Metabolically benign obesity

Identification and Characterization of Metabolically Benign Obesity in Humans

Norbert Stefan, MD; Konstantinos Kantartzis, MD; Jürgen Machann, PhD; Fritz Schick, PhD; Claus Thamer, MD; Kilian Rittig, MD; Bernd Balletshofer, MD; Fausto Machicao, PhD; Andreas Fritsche, MD; Hans-Ulrich Häring, MD

Arch Intern Med. 2008;168(15):1609-1616.

Background  Obesity represents a risk factor for insulin resistance, type 2 diabetes mellitus, and atherosclerosis. In addition, for any given amount of total body fat, an excess of visceral fat or fat accumulation in the liver and skeletal muscle augments the risk. Conversely, even in obesity, a metabolically benign fat distribution phenotype may exist.

Methods  In 314 subjects, we measured total body, visceral, and subcutaneous fat with magnetic resonance (MR) tomography and fat in the liver and skeletal muscle with proton MR spectroscopy. Insulin sensitivity was estimated from oral glucose tolerance test results. Subjects were divided into 4 groups: normal weight (body mass index [BMI] [calculated as weight in kilograms divided by height in meters squared], <25.0), overweight (BMI, 25.0-29.9), obese–insulin sensitive (IS) (BMI, 30.0 and placement in the upper quartile of insulin sensitivity), and obese–insulin resistant (IR) (BMI, 30.0 and placement in the lower 3 quartiles of insulin sensitivity).

Results  Total body and visceral fat were higher in the overweight and obese groups compared with the normal-weight group (P < .05); however, no differences were observed between the obese groups. In contrast, ectopic fat in skeletal muscle (P < .001) and particularly the liver (4.3% ± 0.6% vs 9.5% ± 0.8%) and the intima-media thickness of the common carotid artery (0.54 ± 0.02 vs 0.59 ± 0.01 mm) were lower and insulin sensitivity was higher (17.4 ± 0.9 vs 7.3 ± 0.3 arbitrary units) in the obese-IS vs the obese-IR group (P < .05). Unexpectedly, the obese-IS group had almost identical insulin sensitivity and the intima-media thickness was not statistically different compared with the normal-weight group (18.2 ± 0.9 AU and 0.51 ± 0.02 mm, respectively).

Conclusions  A metabolically benign obesity that is not accompanied by insulin resistance and early atherosclerosis exists in humans. Furthermore, ectopic fat in the liver may be more important than visceral fat in the determination of such a beneficial phenotype in obesity.

Manfaat pemberian vitamin B pada penyakit jantung koroner

Suatu studi observasi melaporkan hubungan antara kadar homosistein dan risiko penyakit kardiovaskuler. Pemberian asam folat dan vitamin B12 diketahui dapat menurunkan kadar homosistein. Penelitian ini ingin mengetahui pengaruh asam folat dan vitamin B6 dan B12 untuk pencegahan sekunder pada pasien penyakit jantung koroner (PJK) dan stenosis klep aorta.

 

Penelitian dilakukan terhadap >3000 pasien yang menjalani prosedur angiografi dan berlangsung selama 7 tahun.

 

Setelah 1 tahun terjadi penurunan kadar homosistein kelompok yang mendapat asam folat dan vitamin B12. Tapi penurunan kadar homosistein ini tidak berpengaruh terhadap mortalitas dan cardiovascular events.

 

Kesimpulan penelitian ini tidak mendukung penggunaan vitamin B untuk preventif sekunder pasien dengan PJK.

 

Abstract

 

JAMA. Vol. 300 No. 7, August 20, 2008;300(7):795-804. © 2008 American Medical Association.
Mortality and cardiovascular events in patients treated with homocysteine-lowering B vitamins after coronary angiography.

Marta Ebbing, MD; Øyvind Bleie, MD, PhD; Per Magne Ueland, MD, PhD et al.

 

Context  Observational studies have reported associations between circulating total homocysteine concentration and risk of cardiovascular disease. Oral administration of folic acid and vitamin B₁₂ can lower plasma total homocysteine levels.

Objective  To assess the effect of treatment with folic acid and vitamin B₁₂ and the effect of treatment with vitamin B₆ as secondary prevention in patients with coronary artery disease or aortic valve stenosis.

Design, Setting, and Participants  Randomized, double-blind controlled trial conducted in the 2 university hospitals in western Norway in 1999-2006. A total of 3096 adult participants undergoing coronary angiography (20.5% female; mean age, 61.7 years) were randomized. At baseline, 59.3% had double- or triple-vessel disease, 83.7% had stable angina pectoris, and 14.9% had acute coronary syndromes.

Interventions  Using a 2 x 2 factorial design, participants were randomly assigned to 1 of 4 groups receiving daily oral treatment with folic acid, 0.8 mg, plus vitamin B₁₂, 0.4 mg, plus vitamin B₆, 40 mg (n = 772); folic acid plus vitamin B₁₂ (n = 772); vitamin B₆ alone (n = 772); or placebo (n = 780).

Main Outcome Measures  The primary end point was a composite of all-cause death, nonfatal acute myocardial infarction, acute hospitalization for unstable angina pectoris, and nonfatal thromboembolic stroke.

Results  Mean plasma total homocysteine concentration was reduced by 30% after 1 year of treatment in the groups receiving folic acid and vitamin B₁₂. The trial was terminated early because of concern among participants due to preliminary results from a contemporaneous Norwegian trial suggesting adverse effects from the intervention. During a median 38 months of follow-up, the primary end point was experienced by a total of 422 participants (13.7%): 219 participants (14.2%) receiving folic acid/vitamin B₁₂ vs 203 (13.1%) not receiving such treatment (hazard ratio, 1.09; 95% confidence interval, 0.90-1.32; P = .36) and 200 participants (13.0%) receiving vitamin B₆ vs 222 (14.3%) not receiving vitamin B₆ (hazard ratio, 0.90; 95% confidence interval, 0.74-1.09; P = .28).

Conclusions  This trial did not find an effect of treatment with folic acid/vitamin B₁₂ or vitamin B₆ on total mortality or cardiovascular events. Our findings do not support the use of B vitamins as secondary prevention in patients with coronary artery disease.

Diet untuk menurunkan BB

Penelitian ini membandingkan efektivitas dan keamanan diet untuk menurunkan berat badan (BB).

 

Penelitian dilakukan random random terhadap 322 subyek obese selama 2 tahun. Ada 3 jenis diet yang digunakan yaitu 1) rendah lemak, rendah kalori; 2) Mediterranean, rendah kalori; atau 3) rendah karbohidrat, tanpa pembatasan kalori.

 

Kepatuhan mengikuti diet >95% tahun pertama dan >84% tahun kedua.

 

Penurunan BB terbesar dicapai dengan diet rendah lemak. Penurunan terkecil oleh diet rendah lemak rendah kalori. Penurunan rasio kolesterol total terhadap HDL terbaik dicapai dengan diet rendah karbohidrat. Sedangkan untuk penderita diabetes yang terbaik adalah diet Mediterranean.

Abstract

 

N Engl J Med 359(3):229-241, 17 July 2008 © 2008

Weight Loss with a Low-Carbohydrate, Mediterranean, or Low-Fat Diet

Iris Shai, R.D., Ph.D., Dan Schwarzfuchs, M.D., Yaakov Henkin, M.D., Danit R. Shahar, R.D., Ph.D., Shula Witkow, R.D., M.P.H., Ilana Greenberg, R.D., M.P.H., Rachel Golan, R.D., M.P.H., Drora Fraser, Ph.D., Arkady Bolotin, Ph.D., Hilel Vardi, M.Sc., Osnat Tangi-Rozental, B.A., Rachel Zuk-Ramot, R.N., Benjamin Sarusi, M.Sc., Dov Brickner, M.D., Ziva Schwartz, M.D., Einat Sheiner, M.D., Rachel Marko, M.Sc., Esther Katorza, M.Sc., Joachim Thiery, M.D., Georg Martin Fiedler, M.D., Matthias Blüher, M.D., Michael Stumvoll, M.D., Meir J. Stampfer, M.D., Dr.P.H., for the Dietary Intervention Randomized Controlled Trial (DIRECT) Group

 

Background Trials comparing the effectiveness and safety of weight-loss diets are frequently limited by short follow-up times and high dropout rates.

Methods In this 2-year trial, we randomly assigned 322 moderately obese subjects (mean age, 52 years; mean body-mass index [the weight in kilograms divided by the square of the height in meters], 31; male sex, 86%) to one of three diets: low-fat, restricted-calorie; Mediterranean, restricted-calorie; or low-carbohydrate, non–restricted-calorie.

Results The rate of adherence to a study diet was 95.4% at 1 year and 84.6% at 2 years. The Mediterranean-diet group consumed the largest amounts of dietary fiber and had the highest ratio of monounsaturated to saturated fat (P<0.05 for all comparisons among treatment groups). The low-carbohydrate group consumed the smallest amount of carbohydrates and the largest amounts of fat, protein, and cholesterol and had the highest percentage of participants with detectable urinary ketones (P<0.05 for all comparisons among treatment groups). The mean weight loss was 2.9 kg for the low-fat group, 4.4 kg for the Mediterranean-diet group, and 4.7 kg for the low-carbohydrate group (P<0.001 for the interaction between diet group and time); among the 272 participants who completed the intervention, the mean weight losses were 3.3 kg, 4.6 kg, and 5.5 kg, respectively. The relative reduction in the ratio of total cholesterol to high-density lipoprotein cholesterol was 20% in the low-carbohydrate group and 12% in the low-fat group (P=0.01). Among the 36 subjects with diabetes, changes in fasting plasma glucose and insulin levels were more favorable among those assigned to the Mediterranean diet than among those assigned to the low-fat diet (P<0.001 for the interaction among diabetes and Mediterranean diet and time with respect to fasting glucose levels).

Conclusions Mediterranean and low-carbohydrate diets may be effective alternatives to low-fat diets. The more favorable effects on lipids (with the low-carbohydrate diet) and on glycemic control (with the Mediterranean diet) suggest that personal preferences and metabolic considerations might inform individualized tailoring of dietary interventions.

Pengaruh sarapan pada murid sekolah

Apakah sarapan mempengaruhi fungsi kognitif dan emosi murid di sekolah?

 

Penelitian dilakukan secara random pada 104 murid berusia 13-20 tahun.

 

Hasil penelitian menunjukkan peningkatan memori visuospatial pada murid laki2, peningkatan kewaspadaan (alertness) pada semua murid. Murid laki2 merasa emosi lebih positif. Namun tidak ada perubahan pada daya perhatian (sustained attention).

 

Kesimpulan sarapan memberikan efek positif pada murid sekolah.

 

 

PEDIATRICS Vol. 122 No. 2 August 2008, pp. 279-284

ARTICLE

Influence of Having Breakfast on Cognitive Performance and Mood in 13- to 20-Year-Old High School Students: Results of a Crossover Trial

Katharina Widenhorn-Müller, PhD^a, Katrin Hille, PhD^a, Jochen Klenk, MPH^b and Ulrike Weiland, MD^a

^a Centre for Neuroscience and Learning
^b Institute of Epidemiology, Ulm University, Ulm, Germany

OBJECTIVE. The goal was to determine whether breakfast had effects on the cognitive performance and mood of high school students.

METHODS. A crossover trial was performed in boarding schools, involving 104 students between 13 and 20 years of age. The participants were randomly assigned to 2 equal-size groups on the morning of the first testing day. One half of the total sample received a standardized breakfast, whereas the other half received no breakfast. Seven days later, the treatment order was reversed. Measurements of cognitive function included standardized tests of attention and concentration, as well as tests of verbal and spatial memory. In addition, mood was rated with a self-administered questionnaire covering the dimensions of positive and negative affect, information uptake, arousal, and alertness. Statistical analysis consisted of repeated-measures analysis of variance.

RESULTS. Breakfast had no effect on sustained attention among high school students. Visuospatial memory was improved in male students. Self-reported alertness improved significantly in the entire study population. Male students reported feeling more positive after consuming breakfast, compared with the fasting condition.

CONCLUSIONS. This crossover trial demonstrated positive short-term effects of breakfast on cognitive functioning and self-reported alertness in high school students.

Gemar minum manis menyebabkan diabetes

Penelitian ini mencari hubungan antara minum manis (sugar-sweetened beverages) dengan peningkatan berat badan dan timbulnya diabetes tipe 2.

 

Subyek penelitian adalah 59 ribu wanita Afrika-Amerika yang di follow-up dari tahun 1995 sampai 2001.

 

Hasil penelitian menunjukkan asupan minuman manis (soft drink dan jus buah) meningkatkan risiko diabetes tipe 2. Minum >2 soft drink meningkatkan insiden sebesar 1,24 kali, sedangkan jus buah (sugar-sweetened) meningkatkan insiden sebesar 1,31 kali. Untuk soft drink ada hubungan dengan indeks massa tubuh sedangkan untuk jus buah tidak.

 

Kesimpulan minum manis -baik soft drink maupun jus buah yang dianggap lebih sehat- terbukti meningkatkan risiko diabetes pada wanita Afrika-Amerika.

 

Abstract

 

Sugar-Sweetened Beverages and Incidence of Type 2 Diabetes Mellitus in African American Women

Julie R. Palmer, ScD; Deborah A. Boggs, MS; Supriya Krishnan, DSc; Frank B. Hu, MD; Martha Singer, MPH; Lynn Rosenberg, ScD

Arch Intern Med. 2008;168(14):1487-1492.

Background  Type 2 diabetes mellitus is an increasingly serious health problem among African American women. Consumption of sugar-sweetened drinks was associated with an increased risk of diabetes in 2 studies but not in a third; however, to our knowledge, no data are available on African Americans regarding this issue. Our objective was to examine the association between consumption of sugar-sweetened beverages, weight gain, and incidence of type 2 diabetes mellitus in African American women.

Methods  A prospective follow-up study of 59 000 African American women has been in progress since 1995. Participants reported on food and beverage consumption in 1995 and 2001. Biennial follow-up questionnaires ascertained new diagnoses of type 2 diabetes. The present analyses included 43 960 women who gave complete dietary and weight information and were free from diabetes at baseline. We identified 2713 incident cases of type 2 diabetes mellitus during 338 884 person-years of follow-up. The main outcome measure was the incidence of type 2 diabetes mellitus.

Results  The incidence of type 2 diabetes mellitus was higher with higher intake of both sugar-sweetened soft drinks and fruit drinks. After adjustment for confounding variables including other dietary factors, the incidence rate ratio for 2 or more soft drinks per day was 1.24 (95% confidence interval, 1.06-1.45). For fruit drinks, the comparable incidence rate ratio was 1.31 (95% confidence interval, 1.13-1.52). The association of diabetes with soft drink consumption was almost entirely mediated by body mass index, whereas the association with fruit drink consumption was independent of body mass index.

Conclusions  Regular consumption of sugar-sweetened soft drinks and fruit drinks is associated with an increased risk of type 2 diabetes mellitus in African American women. While there has been increasing public awareness of the adverse health effects of soft drinks, little attention has been given to fruit drinks, which are often marketed as a healthier alternative to soft drinks.

Author Affiliations: Slone Epidemiology Center, Boston University (Drs Palmer, Krishnan, and Rosenberg and Ms Boggs), Department of Nutrition, Harvard School of Public Health (Dr Hu), and Section of Preventive Medicine and Epidemiology, Department of Medicine, Boston University School of Medicine (Ms Singer), Boston, Massachusetts.

Kurang vitamin D meningkatkan kematian

Penelitian ini mempertegas temuan sebelumnya bahwa kadar vitamin D serum rendah berhubungan dengan penyakit kardiovaskuler dan penyait lainnya.

 

Dilakukan kohort prospektif terhadap 3258 pasien calon angiografi koroner, median umur 62 tahun. Follow up selama 7,7 tahun.

 

Sebanyak 22,6% pasien meninggal. Pasien yang termasuk kuartil terendah kadar 25-hidroksivitamin D dan 1,25-dihidroksivitamin D mempunyai risiko kematian (all diseases) 2,08 kali lebih besar dibanding pasien yang kadar vitamin D-nya tinggi. Sedangkan Hazard ratio untuk kematian kardiovaskuler adalah 2,22 kali lebih besar.

 

Kesimpulan kadar vitamin D rendah secara independen berhubungan dengan kematian kardiovaskuler dan penyakit lain (all cause).

 

Abstract

 

Independent Association of Low Serum 25-Hydroxyvitamin D and 1,25-Dihydroxyvitamin D Levels With All-Cause and Cardiovascular Mortality

Harald Dobnig, MD; Stefan Pilz, MD; Hubert Scharnagl, PhD; Wilfried Renner, PhD; Ursula Seelhorst, MA; Britta Wellnitz, LLD; Jürgen Kinkeldei, DEng; Bernhard O. Boehm, MD; Gisela Weihrauch, MSc; Winfried Maerz, MD

Arch Intern Med. 2008;168(12):1340-1349.

Background  In cross-sectional studies, low serum levels of 25-hydroxyvitamin D are associated with higher prevalence of cardiovascular risk factors and disease. This study aimed to determine whether endogenous 25-hydroxyvitamin D and 1,25-dihydroxyvitamin D levels are related to all-cause and cardiovascular mortality.

Methods  Prospective cohort study of 3258 consecutive male and female patients (mean [SD] age, 62 [10] years) scheduled for coronary angiography at a single tertiary center. We formed quartiles according to 25-hydroxyvitamin D and 1,25-dihydroxyvitamin D levels within each month of blood drawings. The main outcome measures were all-cause and cardiovascular deaths.

Results  During a median follow-up period of 7.7 years, 737 patients (22.6%) died, including 463 deaths from cardiovascular causes. Multivariate-adjusted hazard ratios (HRs) for patients in the lower two 25-hydroxyvitamin D quartiles (median, 7.6 and 13.3 ng/mL [to convert 25-hydroxyvitamin D levels to nanomoles per liter, multiply by 2.496]) were higher for all-cause mortality (HR, 2.08; 95% confidence interval [CI], 1.60-2.70; and HR, 1.53; 95% CI, 1.17-2.01; respectively) and for cardiovascular mortality (HR, 2.22; 95% CI, 1.57-3.13; and HR, 1.82; 95% CI, 1.29-2.58; respectively) compared with patients in the highest 25-hydroxyvitamin D quartile (median, 28.4 ng/mL). Similar results were obtained for patients in the lowest 1,25-dihydroxyvitamin D quartile. These effects were independent of coronary artery disease, physical activity level, Charlson Comorbidity Index, variables of mineral metabolism, and New York Heart Association functional class. Low 25-hydroxyvitamin D levels were significantly correlated with variables of inflammation (C-reactive protein and interleukin 6 levels), oxidative burden (serum phospholipid and glutathione levels), and cell adhesion (vascular cell adhesion molecule 1 and intercellular adhesion molecule 1 levels).

Conclusions  Low 25-hydroxyvitamin D and 1,25-dihydroxyvitamin D levels are independently associated with all-cause and cardiovascular mortality. A causal relationship has yet to be proved by intervention trials using vitamin D.

Author Affiliations: Division of Endocrinology and Nuclear Medicine, Department of Internal Medicine (Dr Dobnig), and Clinical Institute of Medical and Chemical Laboratory Diagnostics (Drs Scharnagl, Renner, and Maerz and Ms Weihrauch), Medical University of Graz, Graz, Austria; and Department of Public Health, Social and Preventive Medicine, Mannheim Medical Faculty, University of Heidelberg, Heidelberg (Dr Pilz), LURIC Study Nonprofit LLC, Freiburg (Ms Seelhorst and Dr Wellnitz), Synlab Center of Laboratory Diagnostics Stuttgart, Leinfelden-Echterdingen (Dr Kinkeldei), Division of Endocrinology and Diabetes, Department of Internal Medicine, University of Ulm, Ulm (Dr Boehm), and Synlab Center of Laboratory Diagnostics Heidelberg, Eppelheim (Dr Maerz), Germany.

Margarin dilarang di California

California adalah negara bagian pertama yang melarang penggunaan asam lemak trans dalam makanan.

Asam lemak trans terkandung dalam margarin setelah proses shortening.

Asam lemak trans adalah salah satu penyebab utama aterosklerosis.

Sumber Associated Press
'California bans restaurants from using trans fat'
July 26, 2008 3:47 AM ET

Suplementasi gizi meningkatkan fungsi intelektual

Penelitian ini menarik sekali karena dilakukan prospektif kohort pada 2392 anak di pedesaan di Guatemala pada tahun 1969 sampai 1977.

 

30 tahun kemudian dilakukan pengukuran skor test Serie Interamericana (InterAmerican Series) dan test Raven Progressive Matrices, pada tahun 2002 dan 2004.

 

Hasil test menunjukkan bahwa anak2 yang mendapat suplementasi protein skornya meningkat masing2 3.46 poin(95% confidence interval, –1.26 to 8.18) dan 1.74 poin (95% confidence interval, 0.53-2.95).

 

Kesimpulan gizi baik pada fase awal kehidupan akan meningkatkan fungsi intelektual pada usia dewasa.

 

Berikut ini abstrak penelitian

Nutritional Supplementation in Early Childhood, Schooling, and Intellectual Functioning in Adulthood

A Prospective Study in Guatemala

Aryeh D. Stein, MPH, PhD; Meng Wang, MS; Ann DiGirolamo, PhD; Ruben Grajeda, MD; Usha Ramakrishnan, PhD; Manuel Ramirez-Zea, MD, PhD; Kathryn Yount, PhD; Reynaldo Martorell, PhD

Arch Pediatr Adolesc Med. 2008;162(7):612-618.

Objective  To estimate the association of improved nutrition in early life with adult intellectual functioning, controlling for years of schooling.

Design  Prospective cohort study.

Setting  Four villages in Guatemala, as well as locations within Guatemala to which cohort members migrated.

Participants  Individuals who had participated as children in a nutrition supplementation intervention trial from March 1, 1969, through February 28, 1977 (N = 2392). From May 1, 2002, through April 30, 2004, adequate information for analysis was obtained from 1448 of 2118 individuals (68.4%) not known to have died.

Interventions  Individuals exposed to atole (a protein-rich enhanced nutrition supplement) at birth through age 24 months were compared with those exposed to the supplement at other ages or to fresco, a sugar-sweetened beverage. We measured years of schooling by interview.

Main Outcome Measures  Scores on the Serie Interamericana (InterAmerican Series) tests of reading comprehension and the Raven Progressive Matrices, obtained from May 1, 2002, through April 30, 2004.

Results  In models controlling for years of schooling and other predictors of intellectual functioning, exposure to atole at birth to age 24 months was associated with an increase of 3.46 points (95% confidence interval, –1.26 to 8.18) and 1.74 points (95% confidence interval, 0.53-2.95) on the InterAmerican Series and Raven Progressive Matrices tests, respectively. There was no statistical interaction between exposure to atole at birth to age 24 months and years of schooling on either outcome (P = .24 and P = .60, respectively).

Conclusion  Improved early-life nutrition is associated with increased intellectual functioning in adulthood after taking into account the effect of schooling.

Author Affiliations: Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia (Drs Stein, DiGirolamo, Ramakrishnan, Yount, and Martorell and Ms Wang); and Unit of Public Policies, Institute of Nutrition of Central America and Panama, Guatemala City, Guatemala (Drs Grajeda and Ramirez-Zea).

Makanan sehat mengurangi risiko diabetes dan penyakit jantung

Penelitian ini menilai hubungan pola makan dan risiko diabetes, penyakit jantung koroner (PJK), dan kematian. Analisis prospektif dilakukan terhadap 7.731 pria dan wanita berumur rata² 50 tahun dan difollow up selama 15 tahun.

 

Berdasarkan pola makan dibagi dalam 4 kelompok:

1.      Tidak sehat (roti putih, daging olahan, gorengan dan susu full cream, n=2665)

2.      Manis (roti putih, biscuit, cakes, daging olahan, high-fat dairy products, n=1042)

3.      Mediterranean-like (buah, sayur, nasi, pasta, wine, n=1361)

4.      Sehat  (buah, sayur, whole-meal bread, low-fat dairy, dan sedikit alkohol, n = 2663)

 

Hasil penelitian menunjukkan bahwa pola makan sehat mengurangi risiko PJK (fatal dan non-fatal) dan diabetes dengan rasio Hazard 0,71 dan 0,74.

 

Kesimpulan penelitian ini membuktikan bahwa pola makan yang sehat dapat mengurangi risiko diabetes dan PJK.

 

 

American Journal of Clinical Nutrition 87(5):1414-1421, May 2008© 2008 to the American Society for Nutrition
Dietary patterns and 15-y risks of major coronary events, diabetes, and mortality

Eric J Brunner, Annhild Mosdøl, Daniel R Witte, Pekka Martikainen, Mai Stafford, Martin J Shipley and Michael G Marmot

Background: Few studies have examined the long-term effect of habitual diet on risks of incident diabetes, coronary heart disease, and mortality.

Objective: We analyzed the prospective relation of dietary patterns with incident chronic disease and mortality during 15 y of follow-up in the Whitehall II study.

Design: We conducted a prospective analysis (106 633 person-years at risk) among men and women (n = 7731) with a mean age of 50 y at the time of dietary assessment (127-item food-frequency questionnaire). Coronary death or nonfatal myocardial infarction and incident diabetes were verified by record tracing and oral-glucose-tolerance tests.

Results: Cluster analysis identified 4 dietary patterns at baseline. The patterns were termed unhealthy (white bread, processed meat, fries, and full-cream milk; n = 2665), sweet (white bread, biscuits, cakes, processed meat, and high-fat dairy products; n = 1042), Mediterranean-like (fruit, vegetables, rice, pasta, and wine; n = 1361), and healthy (fruit, vegetables, whole-meal bread, low-fat dairy, and little alcohol; n = 2663). Compared with the unhealthy pattern, the healthy pattern reduced the risk of coronary death or nonfatal myocardial infarction and diabetes; hazard ratios (95% CI) were 0.71 (0.51, 0.98) and 0.74 (0.58, 0.94), respectively, after adjustment for age, sex, ethnicity, dietary energy misreporting, social position, smoking status, and leisure-time physical activity. Dietary pattern was not associated with all-cause mortality. Residual confounding by socioeconomic factors was unlikely to account for the observed dietary effects.

Conclusions: The healthy eating pattern reduced risks of diabetes and major coronary events. Such dietary patterns offer considerable health benefits to individuals and contribute to public health.

Strategi menjaga berat badan

Penelitian berikut membandingkan strategi mempertahankan penurunan berat badan. Para ahli melakukan randomized two-phase trial terhadap >1000 penderita obesitas disertai hipertensi dan dyslipidemia, yang telah mengalami penurunan berat badan minimal 4 kg dalam 6 bulan (fase 1).

Subyek di-randomized untuk fase 2, intervensi untuk mempertahankan penurunan berat badan selama 30 bulan berikut kelompok 1) monthly personal contact, kelompok 2)unlimited access to an interactive technology-based intervention, atau kelompok 3)self-directed control.

 

Hasilnya BB rata2 96,7 kg. Penurunan BB fase 1 rata2 8,5 kg. Setelah randomization kelompok 1 BB naik 4,0 kg ; kelompok 3 BB naik 5,5 kg. Kelompok 2 mengalami kenaikan BB lebih kecil dibanding kelompok 3 tapi perbedaannya tidak bermakna. Setelah 30 bulan juga ada perbedaan bermakna antara kelompok 1 dan kelompok 2. Pada akhir penelitian 71% subyek BB-nya tetap di bawah BB awal.

 

Kesimpulan sebagian besar penderita obesitas yang berhasil menurunkan BB berhasil mempertahankan BB-nya. Kontrol setiap bulan (monthly brief personal contact) merupakan cara terbaik untuk mempertahankan BB.

 

Berikut ini abstract dari penelitian tersebut

 

JAMA 2008;299(10): 1139-1148. Vol. 299 No. 10, March 12, 2008 © 2008 American Medical Association.
Comparison of Strategies for Sustaining Weight Loss. The Weight Loss Maintenance Laura P. Svetkey, MD; Victor J. Stevens, PhD; Phillip J. Brantley, PhD;  Lawrence J. Appel, MD; Jack F. Hollis, PhD; Catherine M. Loria, PhD; William M. Vollmer, PhD; Christina M. Gullion, PhD; Kristine Funk; Patti Smith; Carmen Samuel-Hodge, PhD; Valerie Myers, PhD; Lillian F. Lien, MD; Daniel Laferriere; Betty Kennedy, PhD; Gerald J. Jerome, PhD; Fran Heinith; David W. Harsha, PhD; Pamela Evans; Thomas P. Erlinger, MD; Arline T. Dalcin; Janelle Coughlin, PhD; Jeanne Charleston; Catherine M. Champagne, PhD; Alan Bauck; Jamy D. Ard, MD; Kathleen Aicher; for the Weight Loss Maintenance Collaborative Research Group

 

Context  Behavioral weight loss interventions achieve short-term success, but re-gain is common.

Objective  To compare 2 weight loss maintenance interventions with a self-directed control group.

Design, Setting, and Participants  Two-phase trial in which 1032 overweight or obese adults (38% African American, 63% women) with hypertension, dyslipidemia, or both who had lost at least 4 kg during a 6-month weight loss program (phase 1) were randomized to a weight-loss maintenance intervention (phase 2). Enrollment at 4 academic centers occurred August 2003-July 2004 and randomization, February-December 2004. Data collection was completed in June 2007.

Interventions  After the phase 1 weight-loss program, participants were randomized to one of the following groups for 30 months: monthly personal contact, unlimited access to an interactive technology–based intervention, or self-directed control.

Main Outcome  Changes in weight from randomization.

Results  Mean entry weight was 96.7 kg. During the initial 6-month program, mean weight loss was 8.5 kg. After randomization, weight regain occurred. Participants in the personal-contact group regained less weight (4.0 kg) than those in the self-directed group (5.5 kg; mean difference at 30 months, –1.5 kg; 95% confidence interval [CI], –2.4 to –0.6 kg; P = .001). At 30 months, weight regain did not differ between the interactive technology–based (5.2 kg) and self-directed groups (5.5 kg; mean difference –0.3 kg; 95% CI, –1.2 to 0.6 kg; P = .51); however, weight regain was lower in the interactive technology–based than in the self-directed group at 18 months (mean difference, –1.1 kg; 95% CI, –1.9 to –0.4 kg; P = .003) and at 24 months (mean difference, –0.9 kg; 95% CI, –1.7 to –0.02 kg; P = .04). At 30 months, the difference between the personal-contact and interactive technology–based group was –1.2 kg (95% CI –2.1 to –0.3; P = .008). Effects did not differ significantly by sex, race, age, and body mass index subgroups. Overall, 71% of study participants remained below entry weight.

Conclusions  The majority of individuals who successfully completed an initial behavioral weight loss program maintained a weight below their initial level. Monthly brief personal contact provided modest benefit in sustaining weight loss, whereas an interactive techonology–based intervention provided early but transient benefit.

Pola makan dan Timbulnya Sindroma Metabolik

Penelitian tentang hubungan antara sindroma metabolic dan asupan makanan dilakukan atas >9.500 partisipan berusia 45-64 tahun dan diikuti selama 9 tahun. Selama penelitian insiden sindroma metabolik sebesar 3.782

 

Hasil penelitian menunjukkan bahwa pola Western diet berhubungan dengan timbulnya sindroma metabolic, terutama asupan daging, gorengan, dan diet soda. Sebaliknya susu (dairy product) justru memberikan proteksi.

 

Kesimpulan Western diet, terutama daging, gorengan dan diet soda menyebabkan timbulnya sindroma metabolic, namun dairy product dapat mencegah sindroma metabolik.

 

Circulation. 2008;117:754-761. February 12, 2008 © 2008 American Heart Association, Inc.
Dietary Intake and the Development of the Metabolic Syndrome. The Atherosclerosis Risk in Communities Study. Pamela L. Lutsey, MPH; Lyn M. Steffen, PhD, MPH, RD; June Stevens, PhD, MS, RD  

 

Background— The role of diet in the origin of metabolic syndrome (MetSyn) is not well understood; thus, we sought to evaluate the relationship between incident MetSyn and dietary intake using prospective data from 9514 participants (age, 45 to 64 years) enrolled in the Atherosclerosis Risk in Communities (ARIC) study.

 

Methods and Results— Dietary intake was assessed at baseline via a 66-item food frequency questionnaire. We used principal-components analysis to derive "Western" and "prudent" dietary patterns from 32 food groups and evaluated 10 food groups used in previous studies of the ARIC cohort. MetSyn was defined by American Heart Association guidelines. Proportional-hazards regression was used. Over 9 years of follow-up, 3782 incident cases of MetSyn were identified. After adjustment for demographic factors, smoking, physical activity, and energy intake, consumption of a Western dietary pattern (P_trend=0.03) was adversely associated with incident MetSyn. After further adjustment for intake of meat, dairy, fruits and vegetables, refined grains, and whole grains, analysis of individual food groups revealed that meat (P_trend<0.001), fried foods (P_trend=0.02), and diet soda (P_trend=< 0.001) also were adversely associated with incident MetSyn, whereas dairy consumption (P_trend=0.006) was beneficial. No associations were observed between incident MetSyn and a prudent dietary pattern or intakes of whole grains, refined grains, fruits and vegetables, nuts, coffee, or sweetened beverages.

 

Conclusions— These prospective findings suggest that consumption of a Western dietary pattern, meat, and fried foods promotes the incidence of MetSyn, whereas dairy consumption provides some protection. The diet soda association was not hypothesized and deserves further study.

Kegemukan meningkatkan risiko kanker

Kegemukan yang diukur dengan peningkatan indeks massa tubuh (IMT) berhubungan dengan risiko terjadinya penyakit kanker pada usia dewasa. Peneliti dari UK dan Swiss mendapatkan bahwa risiko kanker berhubungan dengan peningkatan IMT sebesar 5 kg/m2.

 

Hasil penelitian menunjukkan pada laki2 peningkatan IMT berhubungan signifikan dengan adenokarsinoma esophagus (RR 1.52) dan tiroid (1.33), usus besar (1.24) dan kanker ginjal (1.24). Pada wanita peningkatan IMT berhubungan signifikan dengan adenokarsinoma endometrium (1.59), kantung empedu (1.59), esophagus (1.51) dan ginjal (1.34). Selain itu juga didapatkan hubungan (RR <1.20) pada laki2 untuk kanker rectal, melanoma maligna, sedangkan pada wanita kanker payudara, pancreas, tiroid dan kolon; serta untuk laki dan perempuan leukemia, multiple pyeloma dan limfoma non-Hodgkin. Temuan ini berlaku untuk populasi di Amerika, Eropa, Australia dan Asia-Pasifik.

 

Kesimpulan peningkatan IMT berhubungan dengan peningkatan risiko penyakit keganasan.

 

The Lancet 22 February 2008 Vol 371 Issue 9612 Pp 569-578 (doi:10.1016/S0140-6736(08)60269-X) © 2008 Elsevier Ltd.
Body-mass index and incidence of cancer: a systematic review and meta-analysis of prospective observational studies, Dr Andrew G Renehan PhD, Margaret Tyson PhD, Matthias Egger MD, Richard F Heller MD and Marcel Zwahlen PhD.

 

Background

Excess bodyweight, expressed as increased body-mass index (BMI), is associated with the risk of some common adult cancers. We did a systematic review and meta-analysis to assess the strength of associations between BMI and different sites of cancer and to investigate differences in these associations between sex and ethnic groups.

 

Methods

We did electronic searches on Medline and Embase (1966 to November 2007), and searched reports to identify prospective studies of incident cases of 20 cancer types. We did random-effects meta-analyses and meta-regressions of study-specific incremental estimates to determine the risk of cancer associated with a 5 kg/m² increase in BMI.

 

Findings

We analysed 221 datasets (141 articles), including 282 137 incident cases. In men, a 5 kg/m² increase in BMI was strongly associated with oesophageal adenocarcinoma (RR 1·52, p<0·0001) and with thyroid (1·33, p=0·02), colon (1·24, p<0·0001), and renal (1·24, p <0·0001) cancers. In women, we recorded strong associations between a 5 kg/m² increase in BMI and endometrial (1·59, p<0·0001), gallbladder (1·59, p=0.04), oesophageal adenocarcinoma (1·51, p<0·0001), and renal (1·34, p<0·0001) cancers. We noted weaker positive associations (RR <1·20) between increased BMI and rectal cancer and malignant melanoma in men; postmenopausal breast, pancreatic, thyroid, and colon cancers in women; and leukaemia, multiple myeloma, and non-Hodgkin lymphoma in both sexes. Associations were stronger in men than in women for colon (p<0·0001) cancer. Associations were generally similar in studies from North America, Europe and Australia, and the Asia–Pacific region, but we recorded stronger associations in Asia–Pacific populations between increased BMI and premenopausal (p=0·009) and postmenopausal (p=0·06) breast cancers.

 

Interpretation

Increased BMI is associated with increased risk of common and less common malignancies. For some cancer types, associations differ between sexes and populations of different ethnic origins. These epidemiological observations should inform the exploration of biological mechanisms that link obesity with cancer.