Thursday, December 10, 2009

Ezetimibe vs. niacin added to statins for secondary prevention of CAD

Penelitian ini membandingkan efektivitas NIACIN vs EZETIMIBE dalam hal meningkatkan kadar kolesterol HDL dan menurunkan kadar kolesterol LDL serta perbedaan rerata ketebalan carotid intima media setelah 14 bulan intervensi pada pasien yang mendapatkan preparat statin.
 
Hasilnya pada kelompok niacin terjadi peningkatan HDL, penurunan LDL dan trigliserida secara signifikan. Kelompok ezetimibe terjadi penurunan HDL, LDL dan trigliserida. Dalam hal ketebalan carotid intima media niacin lebih unggul.
Anehnya pada kelompok ezetimibe penurunan LDL berhubungan signifikan dengan penebalan carotid intima media (R=–0.31, P<0.001).
Insiden kejadian kardiovaskuler mayor pada kelompok niacin lebih rendah dibanding kelompok ezetimibe (1% vs. 5%, P=0.04 by the chi-square test).
 

 
N Engl J Med 361(22):2113-2122, 26 November 2009. © 2009 to the Massachusetts Medical Society
Extended-Release Niacin or Ezetimibe and Carotid Intima-Media Thickness. Allen J. Taylor, Todd C. Villines, Eric J. Stanek, et al. 

ABSTRACT

Background Treatment added to statin monotherapy to further modify the lipid profile may include combination therapy to either raise the high-density lipoprotein (HDL) cholesterol level or further lower the low-density lipoprotein (LDL) cholesterol level.

Methods We enrolled patients who had coronary heart disease or a coronary heart disease risk equivalent, who were receiving long-term statin therapy, and in whom an LDL cholesterol level under 100 mg per deciliter (2.6 mmol per liter) and an HDL cholesterol level under 50 mg per deciliter for men or 55 mg per deciliter for women (1.3 or 1.4 mmol per liter, respectively) had been achieved. The patients were randomly assigned to receive extended-release niacin (target dose, 2000 mg per day) or ezetimibe (10 mg per day). The primary end point was the between-group difference in the change from baseline in the mean common carotid intima–media thickness after 14 months. The trial was terminated early, on the basis of efficacy, according to a prespecified analysisconducted after 208 patients had completed the trial.

Results The mean HDL cholesterol level in the niacin group increased by 18.4% over the 14-month study period, to 50 mg per deciliter (P<0.001), and the mean LDL cholesterol level in the ezetimibe group decreased by 19.2%, to 66 mg per deciliter (1.7 mmol per liter) (P<0.001). Niacin therapy significantly reduced LDL cholesterol and triglyceride levels; ezetimibe reduced the HDL cholesterol and triglyceride levels. As compared with ezetimibe,niacin had greater efficacy regarding the change in mean carotid intima–media thickness over 14 months (P=0.003), leading to significant reduction of both mean (P=0.001) and maximal carotid intima–media thickness (P≤0.001 for all comparisons). Paradoxically, greater reductions in the LDL cholesterol level in association with ezetimibe were significantly associated with an increase in the carotid intima–media thickness (R=–0.31, P<0.001). The incidence of major cardiovascular events was lower in the niacin group than in the ezetimibe group (1% vs. 5%, P=0.04 by the chi-square test).

Conclusions This comparative-effectiveness trial shows that the use of extended-release niacin causes a significant regression of carotid intima–media thickness when combined with a statin and that niacin is superior to ezetimibe. 

Physical activity in early adolescence predicts later adiposity

Anak yang aktif berolah raga pada awal pubertas mempunyai massa lemak yang lebih kecil.
Kesimpulan anak perlu aktif berolah raga dalam upaya pencegahan obesitas.
 
Abstract
 
BMJ 339:b4544, 26 November 2009. © 2009 to the BMJ Publishing Group Ltd.
Prospective associations between objective measures of physical activity and fat mass in 12-14 year old children: the Avon Longitudinal Study of Parents and Children (ALSPAC). Chris J Riddoch, Sam D Leary, Andy R Ness, et al.
 
Objective To investigate associations between physical activity at age 12 and subsequent adiposity at age 14.

Design Prospective birth cohort study with data collected between 2003 and 2007.

Setting Original recruitment in 1991-2 of 14 541 pregnant women living in the former County of Avon (United Kingdom).

Participants At age 12, 11 952 children were invited to attend the research clinic. Of these, 7159 attended, and 4150 (1964 boys, 2186 girls) provided sufficient data on exposure, outcome, and confounding variables.

Main outcome measure Fat mass at age 14, measured by dual emission x ray absorptiometry, associated with physical activity at age 12, measured by accelerometry.

Results Prospective associations of fat mass at age 14 (outcome) with physical activity at age 12 (exposure) were strong for both total activity (accelerometer counts/min) and for daily amount of moderate-vigorous physical activity (min/day). An extra 15 minutes of moderate-vigorous physical activity per day at age 12 was associated with lower fat mass at age 14 in boys (by 11.9% (95% confidence interval 9.5% to 14.3%)) and girls (by 9.8% (6.7% to 12.8%)). The proportion of physical activity due to moderate-vigorous physical activity was between 20% and 30% in boys and girls at the two ages.

Conclusions Higher levels of physical activity, in particular activity of moderate to higher intensities, are prospectively associated with lower levels of fat mass in early adolescence. Interventions to raise levels of physical activity in children are likely to be important in the fight against obesity.

Thursday, December 3, 2009

Cancer Incidence and Mortality After Treatment With Folic Acid and Vitamin B12

Hati2 mengkonsumsi suplemen asam folat dan vitamin B12
 
Dua penelitian dengan desain randomized controlled trials terhadap 6.837 pasien penyakit jantung iskemik dari tahun 1998-2005 yang dilakukan di Norwegia mendapatkan bahwa suplementasi dengan asam folat dan vitamin B12 meningkatkan risiko kanker (hazard ratio [HR], 1.21; 95% confidence interval [CI], 1.03-1.41; P = .02). Dan meningkatkan kematian (from any cause) (HR, 1.18; 95% CI, 1.04-1.33; P = .01). Ini terutama disebabkan peningkatan insiden kanker paru pada kelompok yang mendapatkan asam folat dan vitamin B12.
 

JAMA302(19):2119-2126, 18 November 2009. © 2009 to the American Medical Association.
Cancer Incidence and Mortality After Treatment With Folic Acid and Vitamin B12. Marta Ebbing, Kaare Harald Bønaa, Ottar Nygård, et al.

Context  Recently, concern has been raised about the safety of folic acid, particularly in relation to cancer risk.

Objective  To evaluate effects of treatment with B vitamins on cancer outcomes and all-cause mortality in 2 randomized controlled trials.

Design, Setting, and Participants  Combined analysis and extended follow-up of participants from 2 randomized, double-blind, placebo-controlled clinical trials (Norwegian Vitamin Trial and Western Norway B Vitamin Intervention Trial). A total of6837 patients with ischemic heart disease were treated with B vitamins or placebo between 1998 and 2005, and were followed up through December 31, 2007.

Interventions  Oral treatment with folic acid (0.8 mg/d) plus vitamin B12 (0.4 mg/d) and vitamin B6 (40 mg/d) (n = 1708);folic acid (0.8 mg/d) plus vitamin B12 (0.4 mg/d) (n = 1703); vitamin B6 alone (40 mg/d) (n = 1705); or placebo (n = 1721).

Main Outcome Measures  Cancer incidence, cancer mortality, and all-cause mortality.

Results  During study treatment, median serum folate concentration increased more than 6-fold among participants given folic acid. After a median 39 months of treatment and an additional 38 months of posttrial observational follow-up, 341 participants (10.0%) who received folic acid plus vitamin B12 vs 288 participants (8.4%) who did not receive such treatment were diagnosed with cancer (hazard ratio [HR], 1.21; 95% confidence interval [CI], 1.03-1.41; P = .02). A total of 136 (4.0%) who received folic acid plus vitamin B12 vs 100 (2.9%) who did not receive such treatment died from cancer (HR, 1.38; 95% CI, 1.07-1.79; P = .01). A total of 548 patients (16.1%) who received folic acid plus vitamin B12 vs 473 (13.8%) who did not receive such treatment died from any cause (HR, 1.18; 95% CI, 1.04-1.33; P = .01). Results were mainly driven by increased lung cancer incidence in participants who received folic acid plus vitamin B12. Vitamin B6treatment was not associated with any significant effects.

Conclusion  Treatment with folic acid plus vitamin B12 was associated with increased cancer outcomes and all-causemortality in patients with ischemic heart disease in Norway, where there is no folic acid fortification of foods.

Thursday, November 12, 2009

Evaluating the Incremental Benefits of Raising HDL-Cholesterol Levels During Lipid Therapy After Adjustment for the Reductions in Other Blood Lipid Levels

Penelitian ini menilai pengaruh HDL-C sebagai target terapi terhadap kejadian kardiovaskuler.

Subyek diambil dari studi Framingham dari tahun 1975 sampai 2003.

Hasil penelitian menunjukkan bahwa HDL-C merupakan faktor risiko independen yang kuat terhadap kejadian kardiovaskuler (hazard ratio 0,79 setiap kenaikan 5mg/dL ; 95% confidence interval, 0.67-0.93). 

Kesimpulan terapi untuk peningkatan HDL-C  adalah hal yang penting untuk mencegah kejadian kardiovaskuler.

Abstract.

Arch Intern Med 169(19):1775-1780, 26 October 2009. © 2009 to the Amercian Medical Association
Evaluating the Incremental Benefits of Raising High-Density Lipoprotein Cholesterol Levels During Lipid Therapy After Adjustment for the Reductions in Other Blood Lipid Levels. Steven A. Grover, Mohammed Kaouache, Lawrence Joseph, Philip Barter, Jean Davignon. 

Background  The role of high-density lipoprotein cholesterol (HDL-C) as a therapeutic target to prevent cardiovascular (CV) events remains unclear. We examined data from the Framingham Offspring Study from 1975 through 2003 to determine whether increases in HDL-C levels after lipid therapy was started were independently associated with a reduction in CV events.

Methods  Using Cox proportional-hazards regression, we evaluated the risk of a CV event associated with changes in blood lipid levels among individuals who started lipid therapy. The independent effect of HDL-C levels on future CV risk (averagefollow-up, 8 years) was estimated after adjustment for changes in low-density lipoprotein cholesterol, plasma triglycerides,and pretreatment blood lipid levels. Potential confounders (eg, smoking status, weight, and the use of β-blockers) werethen added to the model. Interactions between blood lipid levels were also explored.

Results  The change in HDL-C level was a strong independent risk factor for CV events (hazard ratio, 0.79 per 5-mg/dL increase; 95% confidence interval, 0.67-0.93) after adjustment for the other lipid changes associated with treatment. This relationship remained stable across a wide range of patient subgroups and did not appear to be associated with a specific drug class. An important interaction was observed: the lower the pretreatment low-density lipoprotein cholesterol level, the greater the impact of raising the HDL-C.

Conclusions  Raising HDL-C levels with commonly used lipid medications appears to be an important determinant of the benefits associated with lipid therapy. These results support the further evaluation of therapies to raise HDL-C levels to prevent CV events.

Thursday, October 15, 2009

Association of the Mediterranean Dietary Pattern With the Incidence of Depression

Diet mediterrania dapat mengurangi risiko depresi karena  diduga berhubungan dengan reaksi inflamasi, vaskuler dan metabolisme.
 
Peneliti dari Spanyol melakukan desain kohort terhadap >10.000 orang dewasa sehat sejak tahun 1999 sampai sekarang.
Setelah median follow-up selama 4,4 tahun ternyata mereka yang paling patuh mengikuti pola diet mediterrania mempunyai risiko lebih rendah untuk terjadinya depresi secara signifikan.
Bahan makanan yang paling berpengaruh adalah buah, kacang2an, rasio MUFA:SAFA, dan polong2an
 
Disimpulkan bahwa diet mediterrania mempunyai fungsi protektif terhadap depresi
 

 
Arch Gen Psychiatry 66(10):1090-1098, October 2009 © 2009 to the American Medical Association
Association of the Mediterranean Dietary Pattern With the Incidence of Depression-The Seguimiento Universidad de Navarra/University of Navarra Follow-up (SUN) Cohort. Almudena Sanchez-Villegas, Miguel Delgado-Rodriguez, Alvaro Alonso, et al.
 
Context  Adherence to the Mediterranean dietary pattern (MDP) is thought to reduce inflammatory, vascular, and metabolic processes that may be involved in the risk of clinical depression.

Objective  To assess the association between adherence to the MDP and the incidence of clinical depression.

Design  Prospective study that uses a validated 136-item food frequency questionnaire to assess adherence to the MDP. The MDP score positively weighted the consumption of vegetables, fruit and nuts, cereal, legumes, and fish; the monounsaturated- to saturated-fatty-acids ratio; and moderate alcohol consumption, whereas meat or meat products and whole-fat dairy were negatively weighted.

Setting  A dynamic cohort of university graduates (Seguimiento Universidad de Navarra/University of Navarra Follow-up [SUN] Project).

Participants  A total of 10 094 initially healthy Spanish participants from the SUN Project participated in the study. Recruitment began on December 21, 1999, and is ongoing.

Main Outcome Measure  Participants were classified as having incident depression if they were free of depression and antidepressant medication at baseline and reported a physician-made diagnosis of clinical depression and/or antidepressant medication use during follow-up.

Results  After a median follow-up of 4.4 years, 480 new cases of depression were identified. The multiple adjusted hazard ratios (95% confidence intervals) of depression for the 4 upper successive categories of adherence to the MDP (taking the category of lowest adherence as reference) were 0.74 (0.57-0.98), 0.66 (0.50-0.86), 0.49 (0.36-0.67), and 0.58 (0.44-0.77) (P for trend <.001). Inverse dose-response relationships were found for fruit and nuts, the monounsaturated- to saturated-fatty-acids ratio, and legumes.

Conclusions  Our results suggest a potential protective role of the MDP with regard to the prevention of depressive disorders; additional longitudinal studies and trials are needed to confirm these findings.

Thursday, October 1, 2009

Physical Activity, Function, and Longevity Among the Very Old

Penelitian kohort terhadap 1.861 manula berusia >70 tahun membuktikan bahwa melanjutkan atau bahkan memulai aktifitas fisik pada usia lanjut sekalipun akan bermanfaat meningkatkan angka survival dan status fungsional.
 
Arch Intern Med 169(16):1476-1483, 14 September 2009 © 2009 to the American Medical Association
Physical Activity, Function, and Longevity Among the Very Old. Jochanan Stessman, Robert Hammerman-Rozenberg, Aaron Cohen, Eliana Ein- Mor, Jeremy M. Jacobs.
 
Background  Recommendations encouraging physical activity (PA) set no upper age limit, yet evidence supporting the benefits of PA among the very old is sparse. We examined the effects of continuing, increasing, or decreasing PA levels on survival, function, and health status among the very old.

Methods  Mortality data from ages 70 to 88 years and health, comorbidity, and functional status at ages 70, 78, and 85 years were assessed through the Jerusalem Longitudinal Cohort Study (1990-2008). A representative sample of 1861 people born in 1920 and 1921 enrolled in this prospective study, resulting in 17 109 person-years of follow-up for all-cause mortality.

Results  Among physically active vs sedentary participants, respectively, at age 70, the 8-year mortality was 15.2% vs 27.2% (P < .001); at age 78, the 8-year mortality was 26.1% vs 40.8% (P <.001); and at age 85 years, the 3-year mortality was 6.8% vs 24.4% (P < .001). In Cox proportional-hazards models adjusting for mortality risk factors, lower mortality was associated with PA level at ages 70 (hazard ratio, 0.61; 95% confidence interval, 0.38-0.96), 78 (0.69; 0.48-0.98), and 85 (0.42; 0.25-0.68). A significant survival benefit was associated with initiating PA between ages 70 and 78 years (P = .04) and ages 78 and 85 years (P < .001). Participation in higher levels of PA, compared with being sedentary, did not show a dose-dependent association with mortality. The PA level at age 78 was associated with remaining independent while performing activities of daily living at age 85 (odds ratio, 1.92; 95% confidence interval, 1.11-3.33).

Conclusions  Among the very old, not only continuing but also initiating PA was associated with better survival and function. This finding supports the encouragement of PA into advanced old age.

Thursday, September 17, 2009

The Prevalence of Vitamin B12 Deficiency in Patients with Type 2 Diabetes: A Cross-Sectional Study

Penelitian ini menunjukkan prevalensi defisiensi vitaminB12 pada pasien diabetes tipe 2, terutama yang mendapatkan metformin. Perlu suplementasi multivitamin untuk mengatasi hal ini. 
 

The Journal of the American Board of Family Medicine September-October 2009 22 (5): 528-534 (2009) © 2009 American Board of Family Medicine
The Prevalence of Vitamin B12 Deficiency in Patients with Type 2 Diabetes: A Cross-Sectional Study. Matthew C. Pflipsen, MD, Robert C. Oh, MD, MPH, Aaron Saguil, MD, MPH, Dean A. Seehusen, MD, MPH, FAAFP and Richard Topolski, PhD.
 
Purpose: The purpose of this study is to define the prevalence of vitamin B12 deficiency in a type 2 diabetic population within a primary care practice. Metformin use and advanced age are associated with vitamin B12 deficiency and often present in type 2 diabetic patients, yet the prevalence of vitamin B12 deficiency in the diabetic population is unknown.

Methods: We conducted a cross-sectional study of 203 outpatient type 2 diabetic patients at a large military primary care clinic. Patients completed a survey and had B12 levels measured. Patients with borderline B12 levels also had methylmalonic acid and homocysteine levels drawn. Serum B12 levels <100 pg/mL or serum B12 levels of 100 to 350 pg/mL with elevation of serum methylmalonic acid >243 nmol/L or homocysteine >11.9 nmol/L defined B12 deficiency. Descriptive statistics described frequency and means. {chi}2 and student's t tests were used to analyze associations between categorical and continuous variables, respectively. Multivariate logistical regression identified covariates independently associated with B12 deficiency.

Results: Twenty-two percent (n = 44) of diabetic patients had metabolically confirmed B12 deficiency. Patients on metformin had lower serum B12 levels (425.99 pg/mL vs 527.49 pg/mL; P = .012) and were at increased risk for B12 deficiency (P = .04), as defined by a serum B12 level <350 pg/mL. Prevalence of B12 deficiency was significantly lower for patients using a multivitamin (odds ratio, 0.31; 95% CI, 0.15–0.63).

Conclusions: Our results found a 22% prevalence of metabolically confirmed B12 deficiency in the primary care type 2 diabetic population. Although further research needs to be performed to determine the clinical implications of our findings, B12 deficiency should be considered in type 2 diabetic patients, especially those taking metformin. Furthermore, a daily multivitamin may protect against B12 deficiency.

Effects of a Mediterranean-Style Diet on the Need for Antihyperglycemic Drug Therapy in Patients With Newly Diagnosed Type 2 Diabetes

Studi randomized ini membandingkan antara efek diet low-carbohydrate Mediterranean-style (LC) dengan diet low-fat  (LF) untuk orang2 yang baru terdiagnosis DM tipe 2. Setelah 4 tahun pasien yang menjalankan diet  LC 44% perlu obat antihiperglikemia, sedangkan pasien yang menjalankan diet LF 70% perlu obat antihiperglikemia (absolute difference, –26.0 percentage points [95% CI, –31.1 to –20.1 percentage points]; hazard ratio, 0.63 [CI, 0.51 to 0.86]; hazard ratio adjusted for weight change, 0.70 [CI, 0.59 to 0.90]; P < 0.001).  Pasien yang menjalankan diet LC juga mengalami penurunan BB lebih besar dan mengalami perbaikan kontrol glikemik sera risiko koroner yang lebih rendah dibandingkan yang menjalankan diet LF. 

Satu lagi bukti bahwa diet rendah karbohidrat (Mediterrania style) lebih unggul dibandingkan diet rendah lemak.

Annals of Internal Medicine 151(5):306-314, 1 September 2009 © 2009 to the American College of Physicians
Effects of a Mediterranean-Style Diet on the Need for Antihyperglycemic Drug Therapy in Patients With Newly Diagnosed Type 2 Diabetes-A Randomized Trial. Katherine Esposito, Maria Ida Maiorino, Miryam Ciotola, et al.

Background: Low-carbohydrate and low-fat calorie-restricted diets are recommended for weight loss in overweight and obese people with type 2 diabetes.

Objective: To compare the effects of a low-carbohydrate Mediterranean-style or a low-fat diet on the need for antihyperglycemic drug therapy in patients with newly diagnosed type 2 diabetes.

Design: Single-center, randomized trial. Randomization was computer-generated and unstratified. Allocation was concealed in sealed study folders held in a central, secure location until participants gave informed consent. Participants and investigators were aware of treatment assignment, and assessors of the primary outcome were blinded.

Setting: Teaching hospital in Naples, Italy.

Patients: 215 overweight people with newly diagnosed type 2 diabetes who were never treated with antihyperglycemic drugs and had hemoglobin A1c (HbA1c) levels less than 11%.

Intervention: Mediterranean-style diet (<50% of daily calories from carbohydrates) (n = 108) or a low-fat diet (<30% of daily calories from fat) (n = 107).

Measurements: Start of antihyperglycemic drug therapy, defined by protocol as indicated for follow-up HbA1c level greater than 7% (primary outcome), and changes in weight, glycemic control, and coronary risk factors (secondary outcomes).

Results: After 4 years, 44% of patients in the Mediterranean-style diet group and 70% in the low-fat diet group required treatment (absolute difference, –26.0 percentage points [95% CI, –31.1 to –20.1 percentage points]; hazard ratio, 0.63 [CI, 0.51 to 0.86]; hazard ratio adjusted for weight change, 0.70 [CI, 0.59 to 0.90]; P < 0.001). Participants assigned to the Mediterranean-style diet lost more weight and experienced greater improvements in some glycemic control and coronary risk measures than did those assigned to the low-fat diet.

Limitations: Investigators responsible for initiating drug therapy were not blinded to treatment assignment. Dietary intake was self-reported.

Conclusion: Compared with a low-fat diet, a low-carbohydrate, Mediterranean-style diet led to more favorable changes in glycemic control and coronary risk factors and delayed the need for antihyperglycemic drug therapy in overweight patients with newly diagnosed type 2 diabetes.

Friday, September 11, 2009

Cinnamon dapat menurunkan kadar HbA1C pasien DM tipe 2

Satu gram cinnamon (kayu manis) setiap hari dapat menurunkan kadar HbA1C pada pasien dengan diabetes tipe 2. Temuan ini dibuktikan dalam penelitian dengan desain randomized controlled trial.

The Journal of the American Board of Family Medicine September-October 22 (5): 507-512 (2009) ©
Effectiveness of Cinnamon for Lowering Hemoglobin A1C in Patients with Type 2 Diabetes: A Randomized, Controlled Trial. Paul Crawford, MD.

Original Research

Effectiveness of Cinnamon for Lowering Hemoglobin A1C in Patients with Type 2 Diabetes: A Randomized, Controlled Trial

Paul Crawford, MD

From the Nellis Family Medicine Residency, Mike O'Callaghan Federal Hospital, Las Vegas, NV

Correspondence: Corresponding author: Paul Crawford, MD, Assistant Residency Director, Nellis Family Medicine Residency, Mike O'Callaghan Federal Hospital, 4700 Las Vegas Blvd N, Las Vegas, NV 89191 (E-mail: paul.crawford@nellis.af.mil )

Purpose: Multiple trials in the past have shown conflicting results of whether cinnamon lowers glucose or hemoglobin A1C (HbA1C). The purpose of this study was to determine whether cinnamon lowers HbA1C in patients with type 2 diabetes. I performed a randomized, controlled trial to evaluate whether daily cinnamon plus usual care versus usual care alone lowers HbA1c.

Methods: I randomized 109 type 2 diabetics (HbA1C >7.0) from 3 primary care clinics caring for pediatric, adult, and geriatric patients at a United States military base. Participants were randomly allocated to either usual care with management changes by their primary care physician or usual care with management changes plus cinnamon capsules, 1g daily for 90 days. HbA1c was drawn at baseline and 90 days and compared with intention-to-treat analysis. This study was approved by an institutional review board.

Results: Cinnamon lowered HbA1C 0.83% (95% CI, 0.46–1.20) compared with usual care alone lowering HbA1C 0.37% (95% CI, 0.15–0.59).

Conclusions: Taking cinnamon could be useful for lowering serum HbA1C in type 2 diabetics with HbA1C >7.0 in addition to usual care.

Friday, September 4, 2009

Soluble or insoluble fibre in irritable bowel syndrome in primary care?

Serat larut atau tak larut untuk pasien dengan irritable bowel syndrome

Penelitian ini membuktikan serat larut (psilium) lebih baik bagi pasien irritable bowel syndrome
 
Published 27 August 2009, doi:10.1136/bmj.b3154
Cite this as: BMJ 2009;339:b3154

Research

Soluble or insoluble fibre in irritable bowel syndrome in primary care? Randomised placebo controlled trial

C J Bijkerk, general practitioner1, N J de Wit, associate professor of general practice1, J W M Muris, associate professor of general practice2, P J Whorwell, professor of medicine and gastroenterology3, J A Knottnerus, professor of general practice2, A W Hoes, professor of clinical epidemiology and general practice1
1 Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, PO Box 85500, 3508 GA Utrecht, Netherlands, 2 Department of General Practice, Care and Public Health Research Institute (CAPHRI), Maastricht University, 6200 MD Maastricht, Netherlands, 3 Department of Medicine and Gastroenterology, University of Manchester, Manchester, M23 9LT
Objective To determine the effectiveness of increasing the dietary content of soluble fibre (psyllium) or insoluble fibre (bran) in patients with irritable bowel syndrome.
Design Randomised controlled trial.
Setting General practice.
Participants 275 patients aged 18-65 years with irritable bowel syndrome.
Interventions 12 weeks of treatment with 10 g psyllium (n=85), 10 g bran (n=97), or 10 g placebo (rice flour) (n=93).
Main outcome measures The primary end point was adequate symptom relief during at least two weeks in the previous month, analysed after one, two, and three months of treatment to assess both short term and sustained effectiveness. Secondary end points included irritable bowel syndrome symptom severity score, severity of abdominal pain, and irritable bowel syndrome quality of life scale.
Results The proportion of responders was significantly greater in the psyllium group than in the placebo group during the first month (57% v 35%; relative risk 1.60, 95% confidence interval 1.13 to 2.26) and the second month of treatment (59% v 41%; 1.44, 1.02 to 2.06). Bran was more effective than placebo during the third month of treatment only (57% v 32%; 1.70, 1.12 to 2.57), but this was not statistically significant in the worst case analysis (1.45, 0.97 to 2.16). After three months of treatment, symptom severity in the psyllium group was reduced by 90 points, compared with 49 points in the placebo group (P=0.03) and 58 points in the bran group (P=0.61 versus placebo). No differences were found with respect to quality of life. Fifty four (64%) of the patients allocated to psyllium, 54 (56%) in the bran group, and 56 (60%) in the placebo group completed the three month treatment period. Early dropout was most common in the bran group; the main reason was that the symptoms of irritable bowel syndrome worsened.
Conclusions Psyllium offers benefits in patients with irritable bowel syndrome in primary care.
Trial registration Clinical trials NCT00189033


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Wednesday, August 19, 2009

Perioperative Safety in the Longitudinal Assessment of Bariatric Surgery

N Engl J Med 361(5):445-454, 30 July 2009 © 2009 to the Massachusetts Medical Society
Perioperative Safety in the Longitudinal Assessment of Bariatric Surgery. The Longitudinal Assessment of Bariatric Surgery (LABS) Consortium.
 
ABSTRACT
Background To improve decision making in the treatment of extreme obesity, the risks of bariatric surgical procedures require further characterization.
Methods We performed a prospective, multicenter, observational study of 30-day outcomes in consecutive patients undergoing bariatric surgical procedures at 10 clinical sites in the United States from 2005 through 2007. A composite end point of 30-day major adverse outcomes (including death; venous thromboembolism; percutaneous, endoscopic, or operative reintervention; and failure to be discharged from the hospital) was evaluated among patients undergoing first-time bariatric surgery.
Results There were 4776 patients who had a first-time bariatric procedure (mean age, 44.5 years; 21.1% men; 10.9% nonwhite; median body-mass index [the weight in kilograms divided by the square of the height in meters], 46.5). More than half had at least two coexisting conditions. A Roux-en-Y gastric bypass was performed in 3412 patients (with 87.2% of the procedures performed laparoscopically), and laparoscopic adjustable gastric banding was performed in 1198 patients; 166 patients underwent other procedures and were not included in the analysis. The 30-day rate of death among patients who underwent a Roux-en-Y gastric bypass or laparoscopic adjustable gastric banding was 0.3%; a total of 4.3% of patients had at least one major adverse outcome. A history of deep-vein thrombosis or pulmonary embolus, a diagnosis of obstructive sleep apnea, and impaired functional status were each independently associated with an increased risk of the composite end point. Extreme values of body-mass index were significantly associated with an increased risk of the composite end point, whereas age, sex, race, ethnic group, and other coexisting conditions were not.
Conclusions The overall risk of death and other adverse outcomes after bariatric surgery was low and varied considerably according to patient characteristics. In helping patients make appropriate choices, short-term safety should be considered in conjunction with both the long-term effects of bariatric surgery and the risks associated with being extremely obese.

Wednesday, August 12, 2009

Efek probiotik pada anak

 

Penelitian menilai pengaruh pemberian probiotik pada anak terhadap gejala 'masuk angin' (cold) dan 'influenza-like' selama musim dingin.

Desain penelitian double-blind, placebo-controlled dengan subyek 326 anak berusia 3-5 tahun. Subyek dibagi 3 kelompok, plasebo (N=104), Lactobacillus acidophilus NCFM (N = 110), atau kombinasi L acidophilus NCFM dan Bifidobacterium animalis subsp lactis Bi-07 (N = 112). Diberikan probiotik dua kali sehari selama 6 bulan.

  1. Hasilnya penelitian menunjukkan  pemberian probiotik tunggal dan kombinasi mengurangi insidan demam sebesar 53.0% (P = .0085) dan 72.7% (P = .0009).

  2. Mengurangi insidan batuk sebesar 41.4% (P = .027) and 62.1% (P = .005).

  3. Mengurangi insiden pilek (rhinorrhea) sebesar 28.2% (P = .68) and 58.8% (P = .03).

  4. Durasi demam, batuk dan pilek juga berkurang signifikan dibanding plasebo sebesar 32% (single strain; P = .0023) dan 48% (strain combination; P < .001).

  5. Sehingga penggunaan antibiotika dapat diturunkan signifikan sebesar 68.4% (single strain; P = .0002) dan 84.2% (strain combination; P < .0001) dibanding plasebo.

  6. Jumlah hari absen pada kelompok yang mendapat probiotik juga berkurang signifikan sebesar 31.8% (single strain; P = .002) dan 27.7% (strain combination; P < .001) dibanding plasebo.

Kesimpulan pemberian probiotik setiap hari selama 6 bulan merupakan cara yang aman dan efektif untuk mengurangi insiden demam, batuk dan pilek, sehingga mengurangi pemberian antibiotika dan sekaligus mengurangi jumlah hari absen pada anak prasekolah usia 3-5 tahun. 

Pediatrics Vol. 124 No. 2 August 2009, pp. e172-e179 © American Academy of Pediatrics.
Probiotic Effects on Cold and Influenza-Like Symptom Incidence and Duration in Children. Gregory J. Leyer, PhD, Shuguang Li, MS, Mohamed E. Mubasher, PhDc Cheryl Reifer, PhD and Arthur C. Ouwehand, PhD.
Probiotic Effects on Cold and Influenza-Like Symptom Incidence and Duration in Children

OBJECTIVE: Probiotic consumption effects on cold and influenza-like symptom incidence and duration were evaluated in healthy children during the winter season.

METHODS: In this double-blind, placebo-controlled study, 326 eligible children (3–5 years of age) were assigned randomly to receive placebo (N = 104), Lactobacillus acidophilus NCFM (N = 110), or L acidophilus NCFM in combination with Bifidobacterium animalis subsp lactis Bi-07 (N = 112). Children were treated twice daily for 6 months.

RESULTS: Relative to the placebo group, single and combination probiotics reduced fever incidence by 53.0% (P = .0085) and 72.7% (P = .0009), coughing incidence by 41.4% (P = .027) and 62.1% (P = .005), and rhinorrhea incidence by 28.2% (P = .68) and 58.8% (P = .03), respectively. Fever, coughing, and rhinorrhea duration was decreased significantly, relative to placebo, by 32% (single strain; P = .0023) and 48% (strain combination; P < .001). Antibiotic use incidence was reduced, relative to placebo, by 68.4% (single strain; P = .0002) and 84.2% (strain combination; P < .0001). Subjects receiving probiotic products had significant reductions in days absent from group child care, by 31.8% (single strain; P = .002) and 27.7% (strain combination; P < .001), compared with subjects receiving placebo treatment.

CONCLUSION: Daily dietary probiotic supplementation for 6 months was a safe effective way to reduce fever, rhinorrhea, and cough incidence and duration and antibiotic prescription incidence, as well as the number of missed school days attributable to illness, for children 3 to 5 years of age.

Friday, July 24, 2009

Low-carb vs high-carb terhadap BB dan profil lipid

Diet rendah karbohidrat tinggi protein hewani (Atkins) dapat menurunkan berat badan (BB) namun terhadap kolesterol LDL (LDL-C) pengaruhnya kurang baik. Dalam penelitian ini protein hewani diganti bahan nabati (diet "Eco-Atkins" atau Atkins nabati) kemudian dibandingkan dengan diet tinggi karbohidrat dalam hal menurunkan BB dan LDL-C.
 
Diet Atkins nabati mengandung 26% karbohidrat, 31% protein nabati dan 43% minyak nabati.
Diet tinggi karbohidrat lakto-ovo vegetarian mengandung 58% karbohidrat, 16% protein dan 25% lemak.
 
Dilakukan studi paralel selama 4 minggu.
 
Hasilnya: dalam hal penurunan BB kedua diet sama (turun 4.0 kg). Dalam hal penurunan LDL, rasio total kolesterol-HDL, rasio apolipoprotein B-apolipoprotein AI lebih besar diet rendah karbohidrat (masing2 –8.1% [P = .002], –8.7% [P = .004], and –9.6% [P = .001] ). Juga terjadi penurunan tekanan sistolik dan diastolik (masing2 –1.9% [P = .052] and –2.4% [P = .02] ).
 
Kesimpulan diet rendah karbohidrat protein nabati (Atkins nabati) lebih unggul dibanding diet tinggi karbohidrat dalam hal memperbaiki faktor risiko kardiovaskuler. Hal mana tidak terjadi pada diet Atkins. 
 
The Effect of a Plant-Based Low-Carbohydrate ("Eco-Atkins") Diet on Body Weight and Blood Lipid Concentrations in Hyperlipidemic Subjects

David J. A. Jenkins, MD; Julia M. W. Wong, RD; Cyril W. C. Kendall, PhD; Amin Esfahani, MSc; Vivian W. Y. Ng, RD; Tracy C. K. Leong, BASc; Dorothea A. Faulkner, PhD; Ed Vidgen, BSc; Kathryn A. Greaves, PhD; Gregory Paul, PhD; William Singer, MD

Arch Intern Med. 2009;169(11):1046-1054.

Background  Low-carbohydrate, high–animal protein diets, which are advocated for weight loss, may not promote the desired reduction in low-density lipoprotein cholesterol (LDL-C) concentration. The effect of exchanging the animal proteins and fats for those of vegetable origin has not been tested. Our objective was to determine the effect on weight loss and LDL-C concentration of a low-carbohydrate diet high in vegetable proteins from gluten, soy, nuts, fruits, vegetables, cereals, and vegetable oils compared with a high-carbohydrate diet based on low-fat dairy and whole grain products.

Methods  A total of 47 overweight hyperlipidemic men and women consumed either (1) a low-carbohydrate (26% of total calories), high–vegetable protein (31% from gluten, soy, nuts, fruit, vegetables, and cereals), and vegetable oil (43%) plant-based diet or (2) a high-carbohydrate lacto-ovo vegetarian diet (58% carbohydrate, 16% protein, and 25% fat) for 4 weeks each in a parallel study design. The study food was provided at 60% of calorie requirements.

Results  Of the 47 subjects, 44 (94%) (test, n = 22 [92%]; control, n = 22 [96%]) completed the study. Weight loss was similar for both diets (approximately 4.0 kg). However, reductions in LDL-C concentration and total cholesterol–HDL-C and apolipoprotein B–apolipoprotein AI ratios were greater for the low-carbohydrate compared with the high-carbohydrate diet (–8.1% [P = .002], –8.7% [P = .004], and –9.6% [P = .001], respectively). Reductions in systolic and diastolic blood pressure were also seen (–1.9% [P = .052] and –2.4% [P = .02], respectively).

Conclusion  A low-carbohydrate plant-based diet has lipid-lowering advantages over a high-carbohydrate, low-fat weight-loss diet in improving heart disease risk factors not seen with conventional low-fat diets with animal products.

 

Thursday, July 9, 2009

Alcohol 'flush' signals cancer risk in Asians

Orang Asia timur yang mengalami flush saat minum alkohol menghadapi risiko kanker esofagus bila minum banyak alkohol.
Hal ini disebabkan kurangnya enzim ALDH2 yang mengubah acetaldehyde menjadi acetate (bentuk senyawa aman).
Mereka yang mempunyai defisiensi gen ALDH2 mengalami flushing, mual dan takikardia bila meminum alkohol.
36% orang Asia timur mempunyai defisiensi gen ALDH2.
 
 
Alcohol 'flush' signals cancer risk in Asians
David Brill
Medical Tribune
 
East Asians who "flush" when drinking alcohol could be at increased risk of esophageal cancer if they do not drink responsibly, a recent study has warned.
 
The characteristic red cheeks and nausea are a well-recognized phenomenon, but few people are aware that the underlying enzyme deficiency also predisposes heavy drinkers to squamous cell esophageal carcinoma, say the researchers.
 
With some 36 percent of East Asians displaying the flush response, there is potential to save "a substantial number of lives" by counseling affected individuals against heavy drinking. [PLoS Med 2009 Mar 24;6(3):e50]
 
"Cancer of the esophagus is particularly deadly, with 5-year survival rates ranging from 12 to 31 percent throughout the world," said lead researcher Dr. Philip Brooks, of the US National Institute on Alcohol Abuse and Alcoholism. "And we estimate that at least 540 million people have this alcohol-related increased risk for esophageal cancer.
 
"We hope that by raising awareness of this important public health problem, affected individuals who drink will reduce their cancer risk by limiting their alcohol consumption," he said.
 
Flushing is caused by a deficiency in aldehyde dehydrogenase 2 (ALDH2) – an enzyme which breaks down acetaldehyde, a carcinogenic by-product of ethanol metabolism. People with normal ALDH2 function can convert acetaldehyde safely into acetate, but in ALDH2-deficient individuals it accumulates in the body, leading to facial redness, nausea and tachycardia.
 
In people who are homozygous for the ALDH2-deficiency gene, the response to alcohol is so unpleasant that they cannot consume large quantities, and are thereby protected from the associated risk of esophageal cancer.
 
Heterozygotes, however, can develop tolerance to acetaldehyde and may become heavy drinkers. Studies from Japan and Taiwan have shown that ALDH2-deficient heterozygotes who drink heavily are over 10 times as likely to develop esophageal cancer, [Jpn J Clin Oncol 2003 Mar;33(3):111-21; Int J Cancer 2008 Mar 15;122(6):1347-56]
 
Dr. Michael Wang, a radiation oncology consultant at the National Cancer Centre Singapore, agreed that the link between flushing and esophageal cancer is not likely to be common knowledge among doctors.
 
"From the article, it is fair to comment that there is a causative relation between deficiency of the gene and increased risk of esophageal cancer," he said.
 
"However, there has been a lot of material published since the 1970s regarding this condition. This relationship may be confounded by smoking, which is also related to esophageal cancer. Before we say something drastic like 'people who flush when drinking have a higher risk of contracting esophageal cancer,' we should research all the previously published articles."
 
Wang added that all heavy alcohol drinkers should be counseled, since drinking also predisposes people to other medical conditions and to drunk driving.
 
The study authors advise clinicians to determine whether East Asian patients are ALDH2 deficient by asking simple questions about their history of flushing when drinking alcohol. Identified flushers should then be advised of their cancer risk and encouraged to moderate their consumption, they say.

Wednesday, June 24, 2009

Red Yeast Rice for Dyslipidemia in Statin-Intolerant Patients

Red yeast rice (RYR) dapat digunakan untuk menurunkan kadar kolesterol LDL pada pasien yang tidak bisa diberikan preparat statin
 

Annals of Internal Medicine 150(12):830-839, 16 June 2009 © 2009 to the American College of Physicians
Red Yeast Rice for Dyslipidemia in Statin-Intolerant Patients-A Randomized Trial. David J. Becker, Ram Y. Gordon, Steven C. Halbert, Benjamin French, Patti B. Morris, and Daniel J. Rader.
 

16 June 2009 | Volume 150 Issue 12 | Pages 830-839

Background: Red yeast rice is an herbal supplement that decreases low-density lipoprotein (LDL) cholesterol level.

Objective: To evaluate the effectiveness and tolerability of red yeast rice and therapeutic lifestyle change to treat dyslipidemia in patients who cannot tolerate statin therapy.

Design: Randomized, controlled trial.

Setting: Community-based cardiology practice.

Patients: 62 patients with dyslipidemia and history of discontinuation of statin therapy due to myalgias.

Intervention: Patients were assigned by random allocation software to receive red yeast rice, 1800 mg (31 patients), or placebo (31 patients) twice daily for 24 weeks. All patients were concomitantly enrolled in a 12-week therapeutic lifestyle change program.

Measurements: Primary outcome was LDL cholesterol level, measured at baseline, week 12, and week 24. Secondary outcomes included total cholesterol, high-density lipoprotein (HDL) cholesterol, triglyceride, liver enzyme, and creatinine phosphokinase (CPK) levels; weight; and Brief Pain Inventory score.

Results: In the red yeast rice group, LDL cholesterol decreased by 1.11 mmol/L (43 mg/dL) from baseline at week 12 and by 0.90 mmol/L (35 mg/dL) at week 24. In the placebo group, LDL cholesterol decreased by 0.28 mmol/L (11 mg/dL) at week 12 and by 0.39 mmol/L (15 mg/dL) at week 24. Low-density lipoprotein cholesterol level was significantly lower in the red yeast rice group than in the placebo group at both weeks 12 (P < 0.001) and 24 (P = 0.011). Significant treatment effects were also observed for total cholesterol level at weeks 12 (P < 0.001) and 24 (P = 0.016). Levels of HDL cholesterol, triglyceride, liver enzyme, or CPK; weight loss; and pain severity scores did not significantly differ between groups at either week 12 or week 24.

Limitation: The study was small, was single-site, was of short duration, and focused on laboratory measures.

Conclusion: Red yeast rice and therapeutic lifestyle change decrease LDL cholesterol level without increasing CPK or pain levels and may be a treatment option for dyslipidemic patients who cannot tolerate statin therapy.

Friday, May 15, 2009

Determining optimal approaches for weight maintenance

Penelitian ini menilai efektivitas 2 program pendukung dan dua jenis diet dalam mempertahankan penurunan berat badan.
 
Diikuti oleh 200 wanita yang telah berhasil turun >5% BB, desain randomized controlled, 2x2 faktorial. Dibandingkan antara program pendukung intensif terhadap program pendukung sederhana. Dan dibandingkan antara diet tinggi karbohidrat terhadap diet tinggi mono-unsaturated fatty acid (MUFA)
 
Setelah 2 tahun didapatkan tidak ada beda signifikan antara kedua program pendukung.
Sedangkan diet tinggi MUFA menyebabkan kadar kolesterol total dan LDL lebih tinggi signifikan dibanding konsumsi diet tinggi karbohidrat.
 
Kesimpulan setelah berhasil mencapai penurunan BB sebaiknya diikuti dengan program pendukung, meskipun sederhana (dan murah) namun terbukti dapat mempertahankan penurunan BB.
 
Research

CMAJ. May 12, 2009; 180 (10). doi:10.1503/cmaj.080974. © 2009 Canadian Medical Association or its licensors

Determining optimal approaches for weight maintenance: a randomized controlled trial

Kelly S. Dale, PhD MSc, Kirsten A. McAuley, MBChB PhD, Rachael W. Taylor, PhD BSc, Sheila M. Williams, DSc BSc, Victoria L. Farmer, MSc, Paul Hansen, PhD MEc, Sue M. Vorgers, RN, Alexandra W. Chisholm, MCApSc PhD and Jim I. Mann, DM PhD

From the Departments of Human Nutrition (Dale, McAuley, Taylor, Vorgers, Chisholm, Mann), Preventive and Social Medicine (Williams), and Economics (Hansen), University of Otago; and the Edgar National Centre for Diabetes Research (McAuley, Taylor, Farmer, Mann), Dunedin, New Zealand

Background: Weight regain often occurs after weight loss in overweight individuals. We aimed to compare the effectiveness of 2 support programs and 2 diets of different macronutrient compositions intended to facilitate long-term weight maintenance.

Methods: Using a 2 x 2 factorial design, we randomly assigned 200 women who had lost 5% or more of their initial body weight to an intensive support program (implemented by nutrition and activity specialists) or to an inexpensive nurse-led program (involving "weigh-ins" and encouragement) that included advice about high-carbohydrate diets or relatively high-monounsaturated-fat diets.

Results: In total, 174 (87%) participants were followed-up for 2 years. The average weight loss (about 2 kg) did not differ between those in the support programs (0.1 kg, 95% confidence interval [CI] –1.8 to 1.9, p = 0.95) or diets (0.7 kg, 95% CI –1.1 to 2.4, p = 0.46). Total and low-density lipoprotein (LDL) cholesterol levels were significantly higher among those on the high-monounsaturated-fat diet (total cholesterol: 0.17 mmol/L, 95% CI 0.01 to 0.33; p = 0.040; LDL cholesterol: 0.16 mmol/L, 95% CI 0.01 to 0.31; p = 0.039) than among those on the high-carbohydrate diet. Those on the high-monounsaturated-fat diet also had significantly higher intakes of total fat (5% total energy, 95% CI 3% to 6%, p < 0.001) and saturated fat (2% total energy, 95% CI 1% to 2%, p < 0.001). All of the other clinical and laboratory measures were similar among those in the support programs and diets.

Interpretation: A relatively inexpensive program involving nurse support is as effective as a more resource-intensive program for weight maintenance over a 2-year period. Diets of different macronutrient composition produced comparable beneficial effects in terms of weight loss maintenance.

Friday, April 17, 2009

Indeks massa tubuh sebagai prediktor mortalitas

Hubungan antara indeks massa tubuh (IMT) dan mortalitas terlihat dalam penelitian prospektif berikut yang melibatkan 900 ribu subyek dewasa.
 
Kematian terendah adalah pada IMT 22,5 - 25 kg/m2.
 
Setiap peningkatan IMT 5 kg/m2 meningkatkan kematian (overall mortality) 30%.
Untuk kematian akibat penyakit vaskuler meningkat 40%.
Untuk kematian akibat diabetik, penyakit ginjal, dan penyakit hati meningkat 60-120%.
Untuk kematian akibat penyakit keganasan meningkat 10%.
Untuk penyakit pernapasan meningkat 20%.
 
IMT <22,5 kg/m2 terjadi peningkatan kematian akibat penyakit pernapasan dan kanker paru, terutama bagi perokok.
 
IMT 30-35 kg/m2 angka survival berkurang 2-4 tahun. IMT 40-45 kg/m2 angka survival berkurang 8-10 tahun (setara efek merokok)
 
 
The Lancet, Volume 373, Issue 9669, Pages 1083 - 1096, 28 March 2009
 
Body-mass index and cause-specific mortality in 900 000 adults: collaborative analyses of 57 prospective studies
 

Background

The main associations of body-mass index (BMI) with overall and cause-specific mortality can best be assessed by long-term prospective follow-up of large numbers of people. The Prospective Studies Collaboration aimed to investigate these associations by sharing data from many studies.

Methods

Collaborative analyses were undertaken of baseline BMI versus mortality in 57 prospective studies with 894 576 participants, mostly in western Europe and North America (61% [n=541 452] male, mean recruitment age 46 [SD 11] years, median recruitment year 1979 [IQR 1975—85], mean BMI 25 [SD 4] kg/m2). The analyses were adjusted for age, sex, smoking status, and study. To limit reverse causality, the first 5 years of follow-up were excluded, leaving 66 552 deaths of known cause during a mean of 8 (SD 6) further years of follow-up (mean age at death 67 [SD 10] years): 30 416 vascular; 2070 diabetic, renal or hepatic; 22 592 neoplastic; 3770 respiratory; 7704 other.

Findings

In both sexes, mortality was lowest at about 22·5—25 kg/m2. Above this range, positive associations were recorded for several specific causes and inverse associations for none, the absolute excess risks for higher BMI and smoking were roughly additive, and each 5 kg/m2 higher BMI was on average associated with about 30% higher overall mortality (hazard ratio per 5 kg/m2 [HR] 1·29 [95% CI 1·27—1·32]): 40% for vascular mortality (HR 1·41 [1·37—1·45]); 60—120% for diabetic, renal, and hepatic mortality (HRs 2·16 [1·89—2·46], 1·59 [1·27—1·99], and 1·82 [1·59—2·09], respectively); 10% for neoplastic mortality (HR 1·10 [1·06—1·15]); and 20% for respiratory and for all other mortality (HRs 1·20 [1·07—1·34] and 1·20 [1·16—1·25], respectively). Below the range 22·5—25 kg/m2, BMI was associated inversely with overall mortality, mainly because of strong inverse associations with respiratory disease and lung cancer. These inverse associations were much stronger for smokers than for non-smokers, despite cigarette consumption per smoker varying little with BMI.

Interpretation

Although other anthropometric measures (eg, waist circumference, waist-to-hip ratio) could well add extra information to BMI, and BMI to them, BMI is in itself a strong predictor of overall mortality both above and below the apparent optimum of about 22·5—25 kg/m2. The progressive excess mortality above this range is due mainly to vascular disease and is probably largely causal. At 30—35 kg/m2, median survival is reduced by 2—4 years; at 40—45 kg/m2, it is reduced by 8—10 years (which is comparable with the effects of smoking). The definite excess mortality below 22·5 kg/m2 is due mainly to smoking-related diseases, and is not fully explained.

Thursday, April 16, 2009

Kebiasaan minum teh panas dan kanker esofagus

Bagi penggemar minuman bersuhu tinggi sebaiknya berhati2 karena suhu tinggi berhubungan dengan timbulnya kanker esofagus.

Hal ini dibuktikan dalam penelitian di Iran. Minum teh panas berisiko 2 kali sedangkan minum teh sangat panas berisiko 8 kali terjadinya kanker esofagus. Minum teh lebih 2-3 menit setelah dituang berisiko 2,5 kali. Minum teh kurang 2 menit setelah dituang berisiko 5,5 kali.

 

Tea drinking habits and oesophageal cancer in a high risk area in northern Iran: population based case-control study

Farhad Islami, research fellow1,2,3, Akram Pourshams, associate professor1, Dariush Nasrollahzadeh, PhD student1,4, Farin Kamangar, research fellow5, Saman Fahimi, PhD student1,6, Ramin Shakeri, research fellow1, Behnoush Abedi-Ardekani, pathologist1, Shahin Merat, associate professor1, Homayoon Vahedi, associate professor1, Shahryar Semnani, associate professor and director7, Christian C Abnet, investigator5, Paul Brennan, group head2, Henrik Møller, professor and director3, Farrokh Saidi, professor1, Sanford M Dawsey, senior investigator5, Reza Malekzadeh, professor and director1, Paolo Boffetta, group head and cluster coordinator2

1 Digestive Disease Research Center, Shariati Hospital, Tehran University of Medical Sciences, 14117 Tehran, Iran, 2 International Agency for Research on Cancer, Lyon, France, 3 King's College London, Thames Cancer Registry, London, 4 Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden, 5 Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA, 6 Department of Public Health and Primary Care, Institute of Public Health, University of Cambridge, Cambridge, 7 Golestan Research Center of Gastroenterology and Hepatology, Gorgan University of Medical Sciences, Gorgan, Iran

Objective To investigate the association between tea drinking habits in Golestan province, northern Iran, and risk of oesophageal squamous cell carcinoma.

Design Population based case-control study. In addition, patterns of tea drinking and temperature at which tea was drunk were measured among healthy participants in a cohort study.

Setting Golestan province, northern Iran, an area with a high incidence of oesophageal squamous cell carcinoma.

Participants 300 histologically proved cases of oesophageal squamous cell carcinoma and 571 matched neighbourhood controls in the case-control study and 48 582 participants in the cohort study.

Main outcome measure Odds ratio of oesophageal squamous cell carcinoma associated with drinking hot tea.

Results Nearly all (98%) of the cohort participants drank black tea regularly, with a mean volume consumed of over one litre a day. 39.0% of participants drank their tea at temperatures less than 60°C, 38.9% at 60-64°C, and 22.0% at 65°C or higher. A moderate agreement was found between reported tea drinking temperature and actual temperature measurements (weighted {kappa} 0.49). The results of the case-control study showed that compared with drinking lukewarm or warm tea, drinking hot tea (odds ratio 2.07, 95% confidence interval 1.28 to 3.35) or very hot tea (8.16, 3.93 to 16.9) was associated with an increased risk of oesophageal cancer. Likewise, compared with drinking tea four or more minutes after being poured, drinking tea 2-3 minutes after pouring (2.49, 1.62 to 3.83) or less than two minutes after pouring (5.41, 2.63 to 11.1) was associated with a significantly increased risk. A strong agreement was found between responses to the questions on temperature at which tea was drunk and interval from tea being poured to being drunk (weighted {kappa} 0.68).

Conclusion Drinking hot tea, a habit common in Golestan province, was strongly associated with a higher risk of oesophageal cancer.