Dietary Intervention in Infancy and Later Signs of Beta-Cell Autoimmunity

Paparan dini terhadap protein tertentu pada bayi dengan genetic susceptibility untuk diabetes tipe 1 akan meningkatkan risiko timbulnya autoimun terhadap sel beta.

Penelitian ini menguji hipotesis bahwa susu formula protein terhidrolisa akan menurunkan insiden timbulnya autoantibodi untuk bayi2 tersebut.

Terbukti intervensi diet pada bayi2 tersebut mempengaruhi marker autoimun terhadap sel beta yang dalam jangka panjang akan menuju pada timbulnya diabetes tipe 1.

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N Engl J Med 363:1900-1908, 11 November 2010 © 2010 to the Massachusetts Medical Society
Dietary Intervention in Infancy and Later Signs of Beta-Cell Autoimmunity.
Mikael Knip, Suvi M. Virtanen, Karri Seppa, et al.

BACKGROUND
Early exposure to complex dietary proteins may increase the risk of beta-cell autoimmunity and type 1 diabetes in children with genetic susceptibility. We tested the hypothesis that supplementing breast milk with highly hydrolyzed milk formula would decrease the cumulative incidence of diabetes-associated autoantibodies in such children.
METHODS
In this double-blind, randomized trial, we assigned 230 infants with HLA-conferred susceptibility to type 1 diabetes and at least one family member with type 1 diabetes to receive either a casein hydrolysate formula or a conventional, cow's-milk–based formula (control) whenever breast milk was not available during the first 6 to 8 months of life. Autoantibodies to insulin, glutamic acid decarboxylase (GAD), the insulinoma-associated 2 molecule (IA-2), and zinc transporter 8 were analyzed with the use of radiobinding assays, and islet-cell antibodies were analyzed with the use of immunofluorescence, during a median observation period of 10 years (mean, 7.5). The children were monitored for incident type 1 diabetes until they were 10 years of age.
RESULTS
The unadjusted hazard ratio for positivity for one or more autoantibodies in the casein hydrolysate group, as compared with the control group, was 0.54 (95% confidence interval [CI], 0.29 to 0.95), and the hazard ratio adjusted for an observed difference in the duration of exposure to the study formula was 0.51 (95% CI, 0.28 to 0.91). The unadjusted hazard ratio for positivity for two or more autoantibodies was 0.52 (95% CI, 0.21 to 1.17), and the adjusted hazard ratio was 0.47 (95% CI, 0.19 to 1.07). The rate of reported adverse events was similar in the two groups.
CONCLUSIONS
Dietary intervention during infancy appears to have a long-lasting effect on markers of beta-cell autoimmunity — markers that may reflect an autoimmune process leading to type 1 diabetes.

N-3 Fatty Acids and Cardiovascular Events after Myocardial Infarction

Asam lemak omega3 terbukti mempunyai efek protektif untuk penyakit kardiovaskuler. Penelitian ini ingin melihat efek protektif untuk pasien yang sudah mengalami infark miokard.

Ternyata pemberian omega3 dosis kecil dalam bentuk EPA, DHA maupun ALA tidak menurunkan kejadian kardiovaskuler bagi pasien yang sudah mengalami infark miokard.

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N Engl J Med 363:2015-2026, 18 November 2010 © 2010 to the Massachusetts Medical Society
N-3 Fatty Acids and Cardiovascular Events after Myocardial Infarction.

Daan Kromhout, Erik J. Giltay, and Johanna M. Geleijnse, for the Alpha Omega Trial Group.

BACKGROUND
Results from prospective cohort studies and randomized, controlled trials have provided evidence of a protective effect of n−3 fatty acids against cardiovascular diseases. We examined the effect of the marine n−3 fatty acids eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) and of the plant-derived alpha-linolenic acid (ALA) on the rate of cardiovascular events among patients who have had a myocardial infarction.
METHODS
In a multicenter, double-blind, placebo-controlled trial, we randomly assigned 4837 patients, 60 through 80 years of age (78% men), who had had a myocardial infarction and were receiving state-of-the-art antihypertensive, antithrombotic, and lipid-modifying therapy to receive for 40 months one of four trial margarines: a margarine supplemented with a combination of EPA and DHA (with a targeted additional daily intake of 400 mg of EPA–DHA), a margarine supplemented with ALA (with a targeted additional daily intake of 2 g of ALA), a margarine supplemented with EPA–DHA and ALA, or a placebo margarine. The primary end point was the rate of major cardiovascular events, which comprised fatal and nonfatal cardiovascular events and cardiac interventions. Data were analyzed according to the intention-to-treat principle, with the use of Cox proportional-hazards models.
RESULTS
The patients consumed, on average, 18.8 g of margarine per day, which resulted in additional intakes of 226 mg of EPA combined with 150 mg of DHA, 1.9 g of ALA, or both, in the active-treatment groups. During the follow-up period, a major cardiovascular event occurred in 671 patients (13.9%). Neither EPA–DHA nor ALA reduced this primary end point (hazard ratio with EPA–DHA, 1.01; 95% confidence interval [CI], 0.87 to 1.17; P=0.93; hazard ratio with ALA, 0.91; 95% CI, 0.78 to 1.05; P=0.20). In the prespecified subgroup of women, ALA, as compared with placebo and EPA–DHA alone, was associated with a reduction in the rate of major cardiovascular events that approached significance (hazard ratio, 0.73; 95% CI, 0.51 to 1.03; P=0.07). The rate of adverse events did not differ significantly among the study groups.
CONCLUSIONS
Low-dose supplementation with EPA–DHA or ALA did not significantly reduce the rate of major cardiovascular events among patients who had had a myocardial infarction and who were receiving state-of-the-art antihypertensive, antithrombotic, and lipid-modifying therapy.

Vitamin C - vitamin E dan katarak

Suplementasi vitamin C dan vitamin E tidak berguna menurunkan risiko katarak

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Age-Related Cataract in a Randomized Trial of Vitamins E and C in Men
William G. Christen, ScD; Robert J. Glynn, ScD; Howard D. Sesso, ScD; Tobias Kurth, MD; Jean MacFadyen, BA;Vadim Bubes, PhD; Julie E. Buring, ScD; JoAnn E. Manson, MD; J. Michael Gaziano, MD

Arch Ophthalmol. 2010;128(11):1397-1405. doi:10.1001/archophthalmol.2010.266

Objective  To test whether supplementation with alternate-day vitamin E or daily vitamin C affects the incidence of age-related cataract in a large cohort of men.
Methods  In a randomized, double-masked, placebo-controlled trial, 11 545 apparently healthy US male physicians 50years or older without a diagnosis of cataract at baseline were randomly assigned to receive 400 IU of vitamin E or placebo on alternate days and 500 mg of vitamin C or placebo daily.
Main Outcome Measure  Incident cataract responsible for a reduction in best-corrected visual acuity to 20/30 or worse based on self-report confirmed by medical record review.
Application to Clinical Practice  Long-term use of vitamin E and C supplements has no appreciable effect on cataract.
Results  After 8 years of treatment and follow-up, 1174 incident cataracts were confirmed. There were 579 cataracts in the vitamin E–treated group and 595 in the vitamin E placebo group (hazard ratio, 0.99; 95% confidence interval, 0.88-1.11). For vitamin C, there were 593 cataracts in the treated group and 581 in the placebo group (hazard ratio, 1.02; 95% confidence interval, 0.91-1.14).
Conclusion  Long-term alternate-day use of 400 IU of vitamin E and daily use of 500 mg of vitamin C had no notable beneficial or harmful effect on the risk of cataract.

Perlukah suplementasi DHA pada ibu hamil ?

Suplementasi DHA pada ibu hamil tidak mengurangi tingkat depresi post partum ibu maupun meningkatkan fungsi kognitif dan bahasa pada anaknya

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JAMA 304(15):1675-1683, 20 October 2010 © 2010 American Medical Association
Effect of DHA Supplementation During Pregnancy on Maternal Depression and Neurodevelopment of Young Children
A Randomized Controlled Trial
Maria Makrides, BSc, BND, PhD; Robert A. Gibson, BSc, PhD; Andrew J. McPhee, MBBS; Lisa Yelland, BSc;Julie Quinlivan, MBBS, PhD; Philip Ryan, MBBS, BSc; and the DOMInO Investigative Team

JAMA. 2010;304(15):1675-1683. doi:10.1001/jama.2010.1507
Context  Uncertainty about the benefits of dietary docosahexaenoic acid (DHA) for pregnant women and their children exists, despite international recommendations that pregnant women increase their DHA intakes.
Objective  To determine whether increasing DHA during the last half of pregnancy will result in fewer women with highlevels of depressive symptoms and enhance the neurodevelopmental outcome of their children.
Design, Setting, and Participants  A double-blind, multicenter, randomized controlled trial (DHA to Optimize Mother Infant Outcome [DOMInO] trial) in 5 Australian maternity hospitals of 2399 women who were less than 21 weeks' gestation with singleton pregnancies and who were recruited between October 31, 2005, and January 11, 2008. Follow-up of children (n = 726) was completed December 16, 2009.
Intervention  Docosahexaenoic acid–rich fish oil capsules (providing 800 mg/d of DHA) or matched vegetable oilcapsules without DHA from study entry to birth.
Main Outcome Measures  High levels of depressive symptoms in mothers as indicated by a score of more than 12 on the Edinburgh Postnatal Depression Scale at 6 weeks or 6 months postpartum. Cognitive and language development in children as assessed by the Bayley Scales of Infant and Toddler Development, Third Edition, at 18 months.
Results  Of 2399 women enrolled, 96.7% completed the trial. The percentage of women with high levels of depressive symptoms during the first 6 months postpartum did not differ between the DHA and control groups (9.67% vs 11.19%; adjusted relative risk, 0.85; 95% confidence interval [CI], 0.70-1.02; P = .09). Mean cognitive composite scores (adjusted mean difference, 0.01; 95% CI, –1.36 to 1.37; P = .99) and mean language composite scores (adjusted mean difference, –1.42; 95% CI, –3.07 to 0.22; P = .09) of children in the DHA group did not differ from children in the control group.
Conclusion  The use of DHA-rich fish oil capsules compared with vegetable oil capsules during pregnancy did not result in lower levels of postpartum depression in mothers or improved cognitive and language development in their offspring during early childhood.

Long-term Effects of a Lifestyle Intervention on Weight and Cardiovascular Risk Factors in Individuals With Type 2 Diabetes Mellitus

Intensive lifestyle intervention bagi penderita diabetes tipe 2 dalam jangka panjang dapat menurunkan berat badan, memperbaiki tingkat fitness, memperbaiki kontrol glikemik, dan menurunkan risiko kardiovaskuler

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Arch Intern Med 170(17):1566-1575, 27 September 2010 © 2010 to the American Medical Association
Long-term Effects of a Lifestyle Intervention on Weight and Cardiovascular Risk Factors in Individuals With Type 2 Diabetes Mellitus-Four- Year Results of the Look AHEAD Trial. The Look AHEAD Research Group.

Background  Lifestyle interventions produce short-term improvements in glycemia and cardiovascular disease (CVD) riskfactors in individuals with type 2 diabetes mellitus, but no long-term data are available. We examined the effects of lifestyle intervention on changes in weight, fitness, and CVD risk factors during a 4-year study.
Methods  The Look AHEAD (Action for Health in Diabetes) trial is a multicenter randomized clinical trial comparing theeffects of an intensive lifestyle intervention (ILI) and diabetes support and education (DSE; the control group) on the incidence of major CVD events in 5145 overweight or obese individuals (59.5% female; mean age, 58.7 years) with type 2 diabetes mellitus. More than 93% of participants provided outcomes data at each annual assessment.
Results  Averaged across 4 years, ILI participants had a greater percentage of weight loss than DSE participants (–6.15% vs –0.88%; P < .001) and greater improvements in treadmill fitness (12.74% vs 1.96%; P < .001), hemoglobin A1clevel (–0.36% vs –0.09%; P < .001), systolic (–5.33 vs –2.97 mm Hg; P < .001) and diastolic (–2.92 vs –2.48 mm Hg;P = .01) blood pressure, and levels of high-density lipoprotein cholesterol (3.67 vs 1.97 mg/dL; P < .001) and triglycerides (–25.56 vs –19.75 mg/dL; P < .001). Reductions in low-density lipoprotein cholesterol levels were greater in DSE than ILI participants (–11.27 vs –12.84 mg/dL; P = .009) owing to greater use of medications to lower lipid levels in the DSE group. At 4 years, ILI participants maintained greater improvements than DSE participants in weight, fitness, hemoglobin A1c levels, systolic blood pressure, and high-density lipoprotein cholesterol levels.
Conclusions  Intensive lifestyle intervention can produce sustained weight loss and improvements in fitness, glycemiccontrol, and CVD risk factors in individuals with type 2 diabetes. Whether these differences in risk factors translate to reduction in CVD events will ultimately be addressed by the Look AHEAD trial.

Alcohol and Acute Ischemic Stroke Onset

Sehabis minum alkohol risiko stroke meningkat.

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Stroke. 2010;41:1845.© 2010 American Heart Association, Inc.

Original Contributions;Clinical Science

Alcohol and Acute Ischemic Stroke Onset
The Stroke Onset Study
Elizabeth Mostofsky, MPH; Mary R. Burger, MD; Gottfried Schlaug, MD, PhD; Kenneth J. Mukamal, MD, MPH;Wayne D. Rosamond, PhD Murray A. Mittleman, MD, DrPH

From the Cardiovascular Epidemiology Research Unit (E.M., K.J.M., M.A.M.), Department of Medicine, Department of Neurology (G.S.), and the Division of General Medicine & Primary Care (K.J.M.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass; the Department of Epidemiology (E.M., M.A.M.), Harvard School of Public Health, Boston, Mass.; Cincinnati Children's Hospital Medical Center Heart Institute (M.R.B.), Cincinnati, Ohio; and the Department of Epidemiology (W.D.R.), University of North Carolina School of Public Health, Chapel Hill, NC.

Abstract
Background and Purpose— Previous research suggests that regular heavy alcohol consumption increases the risk for ischemic stroke, whereas frequent light to moderate alcohol intake may decrease the risk. However, the risk of ischemic stroke associated with transient exposure to alcohol remains unclear. In this study, we used a case–crossover approach to test the hypothesis that alcohol consumption affects the acute risk of ischemic stroke, to determine the length of time between alcohol intake and the onset of symptoms (induction time), and to examine whether the risk varies by the type of alcohol.
Methods— In this multicenter study, we interviewed 390 patients (209 men, 181 women) between January 2001 and November 2006 (median 3 days after stroke). Alcohol consumption in the hour before stroke symptoms was compared with its expected frequency based on the usual frequency of alcohol consumption over the prior year.
Results— Of the 390 patients, 248 (64%) reported alcohol consumption in the prior year, 104 within 24 hours and 14 within 1 hour of stroke onset. The relative risk of stroke in the hour after consuming alcohol was 2.3 (95% CI, 1.4 to 4.0; P=0.002). The relative risks were similar for different types of alcoholicbeverages and when the sample was restricted to those who were not simultaneously exposed to other potential triggers.
Conclusions— The risk of stroke onset is transiently elevated in the hour after alcohol ingestion.

Homocysteine-Lowering by B Vitamins Slows the Rate of Accelerated Brain Atrophy in Mild Cognitive Impairment

Suplemen vitamin B6, B12 dan asam folat akan menurunkan kadar homosistein. Penurunan kadar homosistein akan memperlambat atrofi otak, sehingga menjaga fungsi kognitif pada usia lanjut. Apakah suplemen ini dapat juga mencegah Alzheimer?

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Homocysteine-Lowering by B Vitamins Slows the Rate of Accelerated Brain Atrophy in Mild Cognitive Impairment: A Randomized Controlled Trial
A. David Smith, Stephen M. Smith, Celeste A. de Jager1, Philippa Whitbread, Carole Johnston, Grzegorz Agacinski, Abderrahim Oulhaj, Kevin M. Bradley, Robin Jacoby, Helga Refsum

Background
An increased rate of brain atrophy is often observed in older subjects, in particular those who suffer from cognitive decline. Homocysteine is a risk factor for brain atrophy, cognitive impairment and dementia. Plasma concentrations of homocysteine can be lowered by dietary administration of B vitamins.
Objective
To determine whether supplementation with B vitamins that lower levels of plasma total homocysteine can slow the rate of brain atrophy in subjects with mild cognitive impairment in a randomised controlled trial (VITACOG, ISRCTN 94410159).
Methods and Findings
Single-center, randomized, double-blind controlled trial of high-dose folic acid, vitamins B6 and B12in 271 individuals (of 646 screened) over 70 y old with mild cognitive impairment. A subset (187) volunteered to have cranial MRI scans at the start and finish of the study. Participants were randomly assigned to two groups of equal size, one treated with folic acid (0.8 mg/d), vitamin B12(0.5 mg/d) and vitamin B6 (20 mg/d), the other with placebo; treatment was for 24 months. The main outcome measure was the change in the rate of atrophy of the whole brain assessed by serial volumetric MRI scans.
Results
A total of 168 participants (85 in active treatment group; 83 receiving placebo) completed the MRI section of the trial. The mean rate of brain atrophy per year was 0.76% [95% CI, 0.63–0.90] in the active treatment group and 1.08% [0.94–1.22] in the placebo group (P = 0.001). The treatment response was related to baseline homocysteine levels: the rate of atrophy in participants with homocysteine >13 µmol/L was 53% lower in the active treatment group (P = 0.001). A greater rate of atrophy was associated with a lower final cognitive test scores. There was no difference in serious adverse events according to treatment category.
Conclusions and Significance
The accelerated rate of brain atrophy in elderly with mild cognitive impairment can be slowed by treatment with homocysteine-lowering B vitamins. Sixteen percent of those over 70 y old have mild cognitive impairment and half of these develop Alzheimer's disease. Since accelerated brain atrophy is a characteristic of subjects with mild cognitive impairment who convert to Alzheimer's disease, trials are needed to see if the same treatment will delay the development of Alzheimer's disease.

Rising Stroke Rates Among Middle-Aged Women in the United States

Peningkatan prevalensi obesitas dan sindroma metabolik menyebabkan peningkatan prevalensi stroke pada wanita

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Stroke. 2010;41:1371

Weight of the Obesity Epidemic
Rising Stroke Rates Among Middle-Aged Women in the United States
Amytis Towfighi, MD; Ling Zheng, PhD Bruce Ovbiagele, MD

From the Department of Neurology (A.T., L.Z.), University of Southern California, Los Angeles, Calif; and the Department of Neurology (B.O.), University of California at Los Angeles, Los Angeles, Calif.

Background and Purpose— Recent US nationally representative data revealed that among individuals aged 45 to 54 years, women's stroke prevalence was double that of men's. The purpose of this study was to determine if the sex disparity existed previously.
Methods— We assessed sex-specific stroke and vascular risk factor prevalence among individuals aged 35 to 64 years who participated in the National Health and Nutrition Examination Surveys (NHANES), a cross-sectional, nationally representative survey conducted in 2 waves: 1988 to 1994 (n=7234) and 1999 to 2004 (n=6499).
Results— Women aged 35 to 54 years who participated in NHANES from 1999 to 2004 were 3 times more likely to have experienced a stroke compared with similarly aged women in NHANES 1988 to 1994 (1.8% versus 0.6%,P=0.003), but stroke prevalence among men did not change (0.9% versus 1.0%, nonsignificant). Among women, the prevalence of obesity (15.2% versus 17.9%, P=0.08), morbid obesity (12.8% versus 17.5%, P=0.003), abdominal obesity (47.4% versus 58.9%, P<0.0001), hypertriglyceridemia (22.91% versus 26.78%, P=0.035), and hypertension (33.04% versus 37.43%, P=0.03) was lower in NHANES 1988 to 1994 compared with the morerecent NHANES wave. Higher waist circumference was the only independent stroke risk factor for women aged 35 to 54 years in NHANES 1999 to 2004 (OR per 15-cm increase in waist circumference=1.02, 95% CI 1.00 to 1.04).
Conclusions— Stroke prevalence among women aged 35 to 54 years has tripled over the past 2 decades, at the same time remaining stable among men. Prevalence of obesity and 3 metabolic syndrome components increased; they may be key factors in the increase in women's stroke prevalence.

Low-Carbohydrate Diets and All-Cause and Cause-Specific Mortality

Diet rendah karbohidrat kaya sayuran menurunkan risiko kematian termasuk kematian akibat penyakit kardiovaskuler. Sebaliknya, diet rendah karbohidrat kaya sumber hewani meningkatkan risiko kematian pada pria dan wanita.

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Annals of Internal Medicine

September 7, 2010 vol. 153 no. 5 289-298

 

Low-Carbohydrate Diets and All-Cause and Cause-Specific Mortality
Two Cohort Studies
Teresa T. Fung, ScD; Rob M. van Dam, PhD; Susan E. Hankinson, ScD;Meir Stampfer, MD, DrPH; Walter C. Willett, MD, DrPH; and Frank B. Hu, MD, PhD

Abstract

Background: Data on the long-term association between low-carbohydrate diets and mortality are sparse.
Objective: To examine the association of low-carbohydrate diets with mortality during 26 years of follow-up in women and 20 years in men.
Design: Prospective cohort study of women and men who were followed from 1980 (women) or 1986 (men) until 2006. Low-carbohydrate diets, either animal-based (emphasizing animal sources of fat and protein) or vegetable-based (emphasizing vegetable sources of fat and protein), were computed from several validated food-frequency questionnaires assessed during follow-up.
Setting: Nurses' Health Study and Health Professionals' Follow-up Study.
Participants: 85 168 women (aged 34 to 59 years at baseline) and 44 548 men (aged 40 to 75 years at baseline) without heart disease, cancer, or diabetes.
Measurements: Investigators documented 12 555 deaths (2458 cardiovascular-related and 5780 cancer-related) in women and 8678 deaths (2746 cardiovascular-related and 2960 cancer-related) in men.
Results: The overall low-carbohydrate score was associated with a modest increase in overall mortality in a pooled analysis (hazard ratio [HR] comparing extreme deciles, 1.12 [95% CI, 1.01 to 1.24]; P for trend = 0.136). The animal low-carbohydrate score was associated with higher all-cause mortality (pooled HR comparing extreme deciles, 1.23 [CI, 1.11 to 1.37]; P for trend = 0.051), cardiovascular mortality (corresponding HR, 1.14 [CI, 1.01 to 1.29]; P for trend = 0.029), and cancer mortality (corresponding HR, 1.28 [CI, 1.02 to 1.60]; P for trend = 0.089). In contrast, a higher vegetable low-carbohydrate score was associated with lower all-cause mortality (HR, 0.80 [CI, 0.75 to 0.85]; P for trend ≤ 0.001) and cardiovascular mortality (HR, 0.77 [CI, 0.68 to 0.87]; P for trend < 0.001).
Limitations: Diet and lifestyle characteristics were assessed with some degree of error. Sensitivity analyses indicated that results were probably not substantively affected by residual confounding or an unmeasured confounder. Participants were not a representative sample of the U.S. population.
Conclusion: A low-carbohydrate diet based on animal sources was associated with higher all-cause mortality in both men and women, whereas a vegetable-based low-carbohydrate diet was associated with lower all-cause and cardiovascular disease mortality rates.

Fish and n-3 Polyunsaturated Fatty Acid Intake and Depressive Symptoms

Asupan omega 3 dapat menurunkan tingkat depresi pada remaja pria

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PEDIATRICS Vol. 126 No. 3 September 2010, pp. e623-e630

Fish and n-3 Polyunsaturated Fatty Acid Intake and Depressive Symptoms: Ryukyus Child Health Study

Kentaro Murakami, PhDa,Yoshihiro Miyake, MD, PhDb,Satoshi Sasaki, MD, PhDa,Keiko Tanaka, DDS, PhDb,Masashi Arakawa, PhDc
a Department of Social and Preventive Epidemiology, School of Public Health, University of Tokyo, Tokyo, Japan;
b Department of Public Health, Faculty of Medicine, Fukuoka University, Fukuoka, Japan; and
c Field Science for Health and Recreation, Faculty of Tourism Sciences and Industrial Management, University of the Ryukyus, Okinawa, Japan

BACKGROUND Epidemiologic evidence on the role of fish and long-chain n-3 polyunsaturated fatty acid intake on depression during adolescence is sparse.
OBJECTIVE We examined the association between fish, eicosapentaenoic acid (EPA), and docosahexaenoic acid (DHA) intake and depressivesymptoms in a group of adolescents.
SUBJECTS AND METHOD This cross-sectional study, conducted in all public junior high schools in Naha City and Nago City, Okinawa, Japan, included3067 boys and 3450 girls aged 12 to 15 years (52.3% of the eligible sample). Dietary intake was assessed by using a validated, self-administered diet-history questionnaire. Depressive symptoms were defined as present when participants had a Center for Epidemiologic Studies Depression scale score of 16.
RESULTS The prevalence of depressive symptoms was 22.5% for boys and 31.2% for girls. For boys, fish intake was inversely associated with depressive symptoms (adjusted odds ratio [OR] for depressive symptoms in the highest [compared with the lowest] quintile of intake: 0.73 [95% confidence interval (CI): 0.55–0.97]; P for trend = .04). EPA intake showed an inverse associationwith depressive symptoms (OR: 0.71 [95% CI: 0.54–0.94]; P = .04). DHA intake also showed a similar inverse, albeit nonsignificant, association (OR: 0.79 [95% CI: 0.59–1.05]; P = .11). Inaddition, intake of EPA plus DHA was inversely associated with depressive symptoms (OR: 0.72 [95% CI: 0.55–0.96]; P = .08). Conversely, no such associations were observed among girls.
CONCLUSIONS Higher intake of fish, EPA, and DHA was independently associated with a lower prevalence of depressive symptoms in early male, but not female, adolescents.

Fruit and vegetable intake and incidence of type 2 diabetes mellitus

Asupan sayuran bardaun hijau dapat menurunkan risiko diabetes tipe 2 sebesar 14%

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BMJ 2010; 341:c4229

Research

Fruit and vegetable intake and incidence of type 2 diabetes mellitus: systematic review and meta-analysis
Patrice Carter, research nutritionist1, Laura J Gray, research associate in medical statistics2, Jacqui Troughton, senior research associate3,Kamlesh Khunti, professor of primary care diabetes and vascular medicine2,Melanie J Davies, professor of diabetes medicine1

Abstract
Objective To investigate the independent effects of intake of fruit and vegetables on incidence of type 2 diabetes.
Design Systematic review and meta-analysis.
Data sources Medline, Embase, CINAHL, British Nursing Index (BNI), and the Cochrane library were searched for medical subject headings and keywords on diabetes, prediabetes, fruit, and vegetables. Expert opinions were sought and reference lists of relevant articles checked.
Study selection Prospective cohort studies with an independent measure of intake of fruit, vegetables, or fruit and vegetables and data on incidence of type 2 diabetes.
Results Six studies met the inclusion criteria; four of these studies also provided separate information on the consumption of green leafy vegetables. Summary estimates showed that greater intake of green leafy vegetables was associated with a 14% (hazard ratio 0.86, 95% confidence interval 0.77 to 0.97) reduction in risk of type 2 diabetes (P=0.01). The summary estimates showed no significant benefits of increasing the consumption of vegetables, fruit, or fruit and vegetables combined.
Conclusion Increasing daily intake of green leafy vegetables could significantly reduce the risk of type 2 diabetes and should be investigated further.

Intake of artificially sweetened soft drinks and risk of preterm delivery

Minuman mengandung pemanis (artifisial) meningkatkan risiko kelahiran prematur.

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Am J Clin Nutr 92: 626-633, 2010. First published June 30, 2010; doi:10.3945/ajcn.2009.28968
American Journal of Clinical Nutrition, doi:10.3945/ajcn.2009.28968
Vol. 92, No. 3, 626-633, September 2010

ORIGINAL RESEARCH COMMUNICATION

Intake of artificially sweetened soft drinks and risk of preterm delivery: a prospective cohort study in 59,334 Danish pregnant women

Thorhallur I Halldorsson, Marin Strøm, Sesilje B Petersen and Sjurdur F Olsen

Background: Sugar-sweetened soft drinks have been linked to a number of adverse health outcomes such as high weight gain. Therefore, artificially sweetened soft drinks are often promoted as an alternative. However, the safety of artificial sweeteners has been disputed, and consequences of high intakes of artificial sweeteners for pregnant women have been minimally addressed.
Objective: We examined the association between intakes of sugar-sweetened and artificially sweetened soft drinks and preterm delivery.
Design: We conducted prospective cohort analyses of 59,334 women from the Danish National Birth Cohort (1996–2002). Soft drink intake was assessed in midpregnancy by using a food-frequency questionnaire. Preterm delivery ( lt 37 wk) was the primary outcome measure. Covariate information was assessed by telephone interviews.
Results: There was an association between intake of artificially sweetened carbonated and noncarbonated soft drinks and an increased risk of preterm delivery (P for trend: le 0.001, both variables). In comparison with women with no intake of artificially sweetened carbonated soft drinks, the adjusted odds ratio for women who consumed ge 1 serving of artificially sweetened carbonated soft drinks/d was 1.38 (95% CI: 1.15, 1.65). The corresponding odds ratio for women who consumed ge 4 servings of artificially sweetened carbonated soft drinks/d was 1.78 (95% CI: 1.19, 2.66). The association was observed for normal-weight and overweight women. A stronger increase in risk was observed for early preterm and moderately preterm delivery than with late-preterm delivery. No association was observed for sugar-sweetened carbonated soft drinks (P for trend: 0.29) or for sugar-sweetened noncarbonated soft drinks (P for trend: 0.93).
Conclusions: Daily intake of artificially sweetened soft drinks may increase the risk of preterm delivery. Further studies are needed to reject or confirm these findings.

Obesity in Early Adulthood as a Risk Factor for Psoriatic Arthritis

Obesitas merupakan faktor risiko psoriasis, demikian juga untuk artritis psoriasis.

Kelebihan lemak berhubungan dengan peningkatan kadar sitokin inflamasi. Peningkatan sitokin inflamasi berhubungan dengan psoriasis.

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Obesity in Early Adulthood as a Risk Factor for Psoriatic Arthritis
Razieh Soltani-Arabshahi, MD; Bob Wong, PhD; Bing-Jian Feng, PhD; David E. Goldgar, PhD; Kristina Callis Duffin, MD;Gerald G. Krueger, MD

Arch Dermatol. 2010;146(7):721-726. doi:10.1001/archdermatol.2010.141
Objective  To study whether obesity increases the risk of psoriatic arthritis (PsA), given that obesity is a risk factor for psoriasis and is associated with more severe disease.
Design  Case series. We used Cox regression analysis to study the relationship between obesity and PsA while controlling for age at psoriasis onset, current body mass index (BMI), sex, family history of psoriasis, worst-ever body surface area (BSA) involvement, Koebner phenomenon, and nail involvement.
Setting  Dermatology clinics at the University of Utah School of Medicine.
Patients  Volunteer sample of patients with dermatologist-diagnosed psoriasis enrolled in the Utah Psoriasis Initiative from November 2002 to October 2008 (943 subjects; 50.2% women, 49.8% men).
Main Outcome Measures  Physician diagnosis of PsA from self-report questionnaire.
Results  In our subjects, we found that BMI at age 18 years was predictive of PsA (odds ratio [OR], 1.06) (P < .01)over and above control variables. Other variables that were predictors of PsA included younger age at psoriasis onset (odds ratio [OR], 0.98) (P < .01), female sex (OR, 1.45) (P = .01), higher worst-ever BSA involvement with psoriasis (OR, 1.01) (P = .04), Koebner phenomenon (OR, 1.59) (P < .01), and nail involvement (OR, 1.76) (P < .01). Current BMI and family history of psoriasis were not significant predictors of PsA.
Conclusions  This study suggests that obesity at age 18 years increases the risk of developing PsA. Adiposity is associated with higher levels of inflammatory cytokines known to be associated with psoriasis. This inflammatory milieu could increase the risk of PsA in predisposed subjects. Prevention and early treatment of obesity may decrease the risk of PsA.

Lingkar pinggang membesar = risiko kematian meningkat

Pada pria, lingkar pinggang (LP) >=120cm menghadapi risiko kematian dua kali lebih besar dibanding LP <90.

Pada wanita LP >=110cm menghadapi risiko kematian dua kali lebih besar dibanding LP <75cm.

LP semakin besar akan meningkatkan risiko kematian.

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Waist Circumference and All-Cause Mortality in a Large US Cohort

Eric J. Jacobs, PhD; Christina C. Newton, MSPH; Yiting Wang, PhD; Alpa V. Patel, PhD; Marjorie L. McCullough, ScD;Peter T. Campbell, PhD; Michael J. Thun, MD; Susan M. Gapstur, PhD

Arch Intern Med. 2010;170(15):1293-1301. doi:10.1001/archinternmed.2010.201

Background  Waist circumference (WC), a measure of abdominal obesity, is associated with higher mortality independent of body mass index (BMI). Less is known about the association between WC and mortality within categories of BMI or for the very high levels of WC that are now common.
Methods  We examined the association between WC and mortality among 48 500 men and 56 343 women, 50 years or older, in the Cancer Prevention Study II Nutrition Cohort. A total of 9315 men and 5332 women died between 1997 and the end of follow-up in 2006.
Results  After adjustment for BMI and other risk factors, very high levels of WC were associated with an approximately2-fold higher risk of mortality in men and women (among men, relative risk [RR] = 2.02; 95% confidence interval [CI], 1.71-2.39 for WC >=120 cm compared with <90 cm; among women, RR = 2.36; 95% CI, 1.98-2.82 for WC >=110 cmcompared with <75 cm). The WC was positively associated with mortality within all categories of BMI. In men, a 10-cm increase in WC was associated with RRs of 1.16 (95% CI, 1.09-1.23), 1.18 (95% CI, 1.12-1.24), and 1.21 (95% CI, 1.13-1.30) within normal (18.5 to <25), overweight (25 to <30), and obese (>=30) BMI categories, respectively. In women, corresponding RRs were 1.25 (95% CI, 1.18-1.32), 1.15 (95% CI, 1.08-1.22), and 1.13 (95% CI, 1.06-1.20).
Conclusion  These results emphasize the importance of WC as a risk factor for mortality in older adults, regardless ofBMI.

Lorcaserin untuk obesitas

Locarserin, obat baru untuk obesitas, terbukti efektif menurunkan berat badan

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Multicenter, Placebo-Controlled Trial of Lorcaserin for Weight Management
Steven R. Smith, M.D., Neil J. Weissman, M.D., Christen M. Anderson, M.D., Ph.D., Matilde Sanchez, Ph.D., Emil Chuang, M.D., Scott Stubbe, M.B.A., Harold Bays, M.D. and William R. Shanahan, M.D. and the Behavioral Modification and Lorcaserin for Overweight and Obesity Management (BLOOM) Study Group
N Engl J Med 2010; 363:245-256July 15, 2010

BACKGROUND
Lorcaserin is a selective serotonin 2C receptor agonist that could be useful in reducing body weight.

METHODS
In this double-blind clinical trial, we randomly assigned 3182 obese or overweight adults (mean body-mass index [the weight in kilograms divided by the square of the height in meters] of 36.2) to receive lorcaserin at a dose of 10 mg, or placebo, twice daily for 52 weeks. All patients also underwent diet and exercise counseling. At week 52, patients in the placebo group continued to receive placebo but patients in the lorcaserin group were randomly reassigned to receive either placebo or lorcaserin. Primary outcomes were weight loss at 1 year and maintenance of weight loss at 2 years. Serial echocardiography was used to identify patients in whom valvulopathy (as defined by the Food and Drug Administration) developed.

RESULTS
At 1 year, 55.4% of patients (883 of 1595) receiving lorcaserin and 45.1% of patients (716 of 1587) receiving placebo remained in the trial; 1553 patients continued into year 2. At 1 year, 47.5% of patients in the lorcaserin group and 20.3% in the placebo group had lost 5% or more of their body weight (P<0.001), corresponding to an average loss of 5.8±0.2 kg with lorcaserin and 2.2±0.1 kg with placebo during year 1 (P<0.001). Among the patients who received lorcaserin during year 1 and who had lost 5% or more of their baseline weight at 1 year, the loss was maintained in more patients who continued to receive lorcaserin during year 2 (67.9%) than in patients who received placebo during year 2 (50.3%, P<0.001). Among 2472 patients evaluated at 1 year and 1127 evaluated at 2 years, the rate of cardiac valvulopathy was not increased with the use of lorcaserin. Among the most frequent adverse events reported with lorcaserin were headache, dizziness, and nausea. The rates of serious adverse events in the two groups were similar.

CONCLUSIONS
In conjunction with behavioral modification, lorcaserin was associated with significant weight loss and improved maintenance of weight loss, as compared with placebo.

Low carb or low fat diet ?

Diet manakah yang lebih baik, apakah rendah karbohidrat atau rendah lemak ? 

Setelah 2 tahun kedua diet menghasilkan penurunan berat badan, tidak ada perbedaan bermakna pada komposisi tubuh, bone mineral density. Keunggulan diet rendah karbohidrat adalah peningkatan kolesterol-HDL yang signifikan, sehingga lebih menurunkan risiko kardiovaskuler.

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Annals of Internal Medicine vol. 153 no. 3 147-157
August 3, 2010

Weight and Metabolic Outcomes After 2 Years on a Low-Carbohydrate Versus Low-Fat Diet

A Randomized Trial

Gary D. Foster, PhD; Holly R. Wyatt, MD; James O. Hill, PhD;Angela P. Makris, PhD, RD; Diane L. Rosenbaum, BA; Carrie Brill, BS;Richard I. Stein, PhD; B. Selma Mohammed, MD, PhD; Bernard Miller, MD; Daniel J. Rader, MD; Babette Zemel, PhD; Thomas A. Wadden, PhD;Thomas Tenhave, PhD; Craig W. Newcomb, MS; and Samuel Klein, MD

Background: Previous studies comparing low-carbohydrate and low-fat diets have not included a comprehensive behavioral treatment, resulting in suboptimal weight loss.
Objective: To evaluate the effects of 2-year treatment with a low-carbohydrate or low-fat diet, each of which was combined with a comprehensive lifestyle modification program.
Design: Randomized parallel-group trial. (ClinicalTrials.gov registration number:NCT00143936)
Setting: 3 academic medical centers.
Patients: 307 participants with a mean age of 45.5 years (SD, 9.7 years) and mean body mass index of 36.1 kg/m2 (SD, 3.5 kg/m2).
Intervention: A low-carbohydrate diet, which consisted of limited carbohydrate intake (20 g/d for 3 months) in the form of low–glycemic index vegetables with unrestricted consumption of fat and protein. After 3 months, participants in the low-carbohydrate diet group increased their carbohydrate intake (5 g/d per wk) until a stable and desired weight was achieved. A low-fat diet consisted of limited energy intake (1200 to 1800 kcal/d; ≤30% calories from fat). Both diets were combined with comprehensive behavioral treatment.
Measurements: Weight at 2 years was the primary outcome. Secondary measures included weight at 3, 6, and 12 months and serum lipid concentrations, blood pressure, urinary ketones, symptoms, bone mineral density, and body composition throughout the study.
Results: Weight loss was approximately 11 kg (11%) at 1 year and 7 kg (7%) at 2 years. There were no differences in weight, body composition, or bone mineral density between the groups at any time point. During the first 6 months, the low-carbohydrate diet group had greater reductions in diastolic blood pressure, triglyceride levels, and very-low-density lipoprotein cholesterol levels, lesser reductions in low-density lipoprotein cholesterol levels, and more adverse symptoms than did the low-fat diet group. The low-carbohydrate diet group had greater increases in high-density lipoprotein cholesterol levels at all time points, approximating a 23% increase at 2 years.
Limitation: Intensive behavioral treatment was provided, patients with dyslipidemia and diabetes were excluded, and attrition at 2 years was high.
Conclusion: Successful weight loss can be achieved with either a low-fat or low-carbohydrate diet when coupled with behavioral treatment. A low-carbohydrate diet is associated with favorable changes in cardiovascular disease risk factors at 2 years.

Vitamin D dan fungsi kognitif manula

Penelitian ini mendapatkan bahwa kadar vitamin D yang rendah berhubungan dengan penurunan fungsi kognitif pada manula

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Vitamin D and Risk of Cognitive Decline in Elderly Persons

David J. Llewellyn, PhD; Iain A. Lang, PhD; Kenneth M. Langa, MD, PhD; Graciela Muniz-Terrera, PhD;Caroline L. Phillips, MS; Antonio Cherubini, MD; Luigi Ferrucci, MD, PhD; David Melzer, PhD

Arch Intern Med. 2010;170(13):1135-1141. doi:10.1001/archinternmed.2010.173

Background  To our knowledge, no prospective study has examined the association between vitamin D and cognitive decline or dementia.
Methods  We determined whether low levels of serum 25-hydroxyvitamin D (25[OH]D) were associated with an increased risk of substantial cognitive decline in the InCHIANTI population–based study conducted in Italy between 1998 and 2006 with follow-up assessments every 3 years. A total of 858 adults 65 years or older completed interviews, cognitive assessments, and medical examinations and provided blood samples. Cognitive decline was assessed using the Mini-Mental State Examination (MMSE), and substantial decline was defined as 3 or more points. The Trail-Making Tests A and B were also used, and substantial decline was defined as the worst 10% of the distribution of decline or as discontinued testing.
Results  The multivariate adjusted relative risk (95% confidence interval [CI]) of substantial cognitive decline on the MMSE in participants who were severely serum 25(OH)D deficient (levels <25 nmol/L) in comparison with those with sufficient levels of 25(OH)D (75 nmol/L) was 1.60 (95% CI, 1.19-2.00). Multivariate adjusted random-effects models demonstrated that the scores of participants who were severely 25(OH)D deficient declined by an additional 0.3 MMSE points per year more than those with sufficient levels of 25(OH)D. The relative risk for substantial decline on Trail-Making Test B was 1.31 (95% CI, 1.03-1.51) among those who were severely 25(OH)D deficient compared with those with sufficient levels of 25(OH)D. No significant association was observed for Trail-Making Test A.
Conclusion  Low levels of vitamin D were associated with substantial cognitive decline in the elderly population studied over a 6-year period, which raises important new possibilities for treatment and prevention.

Penurunan berat badan mengurangi hot flush

Penelitian ini membuktikan bahwa menurunkan berat badan pada wanita menopause yang overweight dan obes, akan mengurangi hot flushes.

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An Intensive Behavioral Weight Loss Intervention and Hot Flushes in Women

Alison J. Huang, MD; Leslee L. Subak, MD; Rena Wing, PhD; Delia Smith West, PhD; Alexandra L. Hernandez, MPH;Judy Macer, BSc; Deborah Grady, MD; for the Program to Reduce Incontinence by Diet and Exercise Investigators

Arch Intern Med. 2010;170(13):1161-1167. doi:10.1001/archinternmed.2010.162

Background  Higher body mass index is associated with worse hot flushes during menopause but the effect of weight loss on flushing is unclear.
Methods  Self-administered questionnaires were used to assess bothersome hot flushes in a 6-month randomized controlled trial of an intensive behavioral weight loss program (intervention) vs a structured health education program (control) in 338 women who were overweight or obese and had urinary incontinence. Weight, body mass index, abdominal circumference, physical activity, calorie intake, blood pressure, and physical and mental functioning were assessed at baseline and at 6 months. Repeated-measures proportional odds models examined intervention effects on bothersome hot flushes and potential mediating factors.
Results  Approximately half of participants (n = 154) were at least slightly bothered by hot flushes at baseline. Among these women, the intervention was associated with greater improvement in bothersome flushes vs control (odds ratio [OR] for improvement by 1 Likert category, 2.25; 95% confidence interval [CI], 1.20-4.21). Reductions in weight (OR, 1.32; 95% CI, 1.08-1.61; per 5-kg decrease), body mass index (1.17; 1.05-1.30; per 1-point decrease), and abdominal circumference (1.32; 1.07-1.64; per 5-cm decrease) were each associated with improvement in flushing, but changes in physical activity, calorie intake, blood pressure, and physical and mental functioning were not related. The effect of the intervention on flushing was modestly diminished after adjustment for multiple potential mediators (OR, 1.92; 95% CI, 0.95-3.89).
Conclusion  Among women who were overweight or obese and had bothersome hot flushes, an intensive behavioral weight loss intervention resulted in improvement in flushing relative to control.

Intervensi gizi untuk pasien diabetes tipe 2

Penelitian ini membuktikan bahwa diet dapat memperbaiki parameter glikemik dan antropometrik untuk penderita diabetes tipe 2 yang belum terkontrol dengan pengobatan.

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BMJ 2010;341:c3337

Nutritional intervention in patients with type 2 diabetes who are hyperglycaemic despite optimised drug treatment—Lifestyle Over and Above Drugs in Diabetes (LOADD) study: randomised controlled trial

Kirsten J Coppell, senior research fellow1, Minako Kataoka, research dietitian2, Sheila M Williams, research associate professor3, Alex W Chisholm, senior lecturer nutrition2, Sue M Vorgers, research nurse2, Jim I Mann, professor of human nutrition and medicine1
1 Edgar National Centre for Diabetes and Obesity Research, Department of Medical and Surgical Sciences, University of Otago, PO Box 913, Dunedin 9054, New Zealand, 2 Department of Human Nutrition, University of Otago, 3Department of Preventive and Social Medicine, University of Otago

Objective To determine the extent to which intensive dietary intervention can influence glycaemic control and risk factors for cardiovascular disease in patients with type 2 diabetes who are hyperglycaemic despite optimised drug treatment.
Design Randomised controlled trial.
Setting Dunedin, New Zealand.
Participants 93 participants aged less than 70 years with type 2 diabetes and a glycated haemoglobin (HbA1c) of more than 7% despite optimised drug treatments plus at least two of overweight or obesity, hypertension, and dyslipidaemia.
Intervention Intensive individualised dietary advice (according to the nutritional recommendations of the European Association for the Study of Diabetes) for six months; both the intervention and control participants continued with their usual medical surveillance.
Main outcome measures HbA1c was the primary outcome. Secondaryoutcomes included measures of adiposity, blood pressure, and lipid profile.
Results After adjustment for age, sex, and baseline measurements, the difference in HbA1c between the intervention and control groups at six months (–0.4%, 95% confidence interval –0.7% to –0.1%) was highly statistically significant (P=0.007), as were the decreases in weight (–1.3 kg, –2.4 to –0.1 kg; P=0.032), body mass index (–0.5, –0.9 to –0.1; P=0.026), and waist circumference (–1.6 cm, –2.7 to –0.5 cm; P=0.005). A decrease in saturated fat (–1.9% total energy, –3.3% to –0.6%; P=0.006) and an increase in protein (1.6% total energy, 0.04% to 3.1%; P=0.045) in the intervention group were the most striking differences in nutritional intake between the two groups.
Conclusions Intensive dietary advice has the potential to appreciably improve glycaemic control and anthropometric measures in patients with type 2 diabetes and unsatisfactory HbA1c despite optimised hypoglycaemic drug treatment.

Effects of Homocysteine-Lowering With Folic Acid Plus Vitamin B12 vs Placebo on Mortality and Major Morbidity in Myocardial Infarction Survivors

Suplementasi asam folat dan vitamin B12 untuk menurunkan kadar homosistein dalam jangka panjang tidak berhasil menekan kejadian vaskuler.

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Abstract

 

Effects of Homocysteine-Lowering With Folic Acid Plus Vitamin B12 vs Placebo on Mortality and Major Morbidity in Myocardial Infarction Survivors
A Randomized Trial
Study of the Effectiveness of Additional Reductions in Cholesterol and Homocysteine (SEARCH) Collaborative Group*

JAMA. 2010;303(24):2486-2494.
Context  Blood homocysteine levels are positively associated with cardiovascular disease, but it is uncertain whether the association is causal.
Objective  To assess the effects of reducing homocysteine levels with folic acid and vitamin B12 on vascular and nonvascular outcomes.
Design, Setting, and Patients  Double-blind randomized controlled trial of 12 064 survivors of myocardial infarction in secondary care hospitals in the United Kingdom between 1998 and 2008.
Interventions  2 mg folic acid plus 1 mg vitamin B12 daily vs matching placebo.
Main Outcome Measures  First major vascular event, defined as major coronary event (coronary death, myocardial infarction, or coronary revascularization), fatal or nonfatal stroke, or noncoronary revascularization.
Results  Allocation to the study vitamins reduced homocysteine by a mean of 3.8 µmol/L (28%). During 6.7 years of follow-up, major vascular events occurred in 1537 of 6033 participants (25.5%) allocated folic acid plus vitamin B12 vs 1493 of 6031 participants (24.8%) allocated placebo (risk ratio [RR], 1.04; 95% confidence interval [CI], 0.97-1.12;P = .28). There were no apparent effects on major coronary events (vitamins, 1229 [20.4%], vs placebo, 1185 [19.6%]; RR, 1.05; 95% CI, 0.97-1.13), stroke (vitamins, 269 [4.5%], vs placebo, 265 [4.4%]; RR, 1.02; 95% CI, 0.86-1.21), or noncoronary revascularizations (vitamins, 178 [3.0%], vs placebo, 152 [2.5%]; RR, 1.18; 95% CI, 0.95-1.46). Nor were there significant differences in the numbers of deaths attributed to vascular causes (vitamins, 578 [9.6%], vs placebo, 559 [9.3%]) or nonvascular causes (vitamins, 405 [6.7%], vs placebo, 392 [6.5%]) or in the incidence of any cancer (vitamins, 678 [11.2%], vs placebo, 639 [10.6%]).
Conclusion  Substantial long-term reductions in blood homocysteine levels with folic acid and vitamin B12 supplementation did not have beneficial effects on vascular outcomes but were also not associated with adverse effects on cancer incidence.

Food Combination and Alzheimer Disease Risk

Pola diet dapat menurunkan risiko penyakit alzheimer pada usia lanjut (>65 tahun)

Yaitu diet yang tinggi sayur, kacang2an, ikan, tomat, unggas, buah sementara rendah high-fat dairy products, daging merah, organ meat, dan butter

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Food Combination and Alzheimer Disease Risk
A Protective Diet

Yian Gu, PhD; Jeri W. Nieves, PhD; Yaakov Stern, PhD; Jose A. Luchsinger, MD, MPH; Nikolaos Scarmeas, MD, MS

Arch Neurol. 2010;67(6):699-706. Published online April 12, 2010 (doi:10.1001/archneurol.2010.84).

Objective  To assess the association between food combination and Alzheimer disease (AD) risk. Because foods are not consumed in isolation, dietary pattern (DP) analysis of food combination, taking into account the interactions among food components, may offer methodological advantages.

Design  Prospective cohort study.

Setting  Northern Manhattan, New York, New York.

Patients or Other Participants  Two thousand one hundred forty-eight community-based elderly subjects (aged >65 years) without dementia in New York provided dietary information and were prospectively evaluated with the same standardized neurological and neuropsychological measures approximately every 1.5 years. Using reduced rank regression, we calculated DPs based on their ability to explain variation in 7 potentially AD-related nutrients: saturated fatty acids, monounsaturated fatty acids, n-3 polyunsaturated fatty acids, n-6 polyunsaturated fatty acids, vitamin E, vitamin B12, and folate. The associations of reduced rank regression–derived DPs with AD risk were then examined using a Cox proportional hazards model.

Main Outcome Measure  Incident AD risk.

Results  Two hundred fifty-three subjects developed AD during a follow-up of 3.9 years. We identified a DP stronglyassociated with lower AD risk: compared with subjects in the lowest tertile of adherence to this pattern, the AD hazard ratio (95% confidence interval) for subjects in the highest DP tertile was 0.62 (0.43-0.89) after multivariable adjustment (P for trend = .01). This DP was characterized by higher intakes of salad dressing, nuts, fish, tomatoes, poultry, cruciferous vegetables, fruits, and dark and green leafy vegetables and a lower intake of high-fat dairy products, red meat, organ meat, and butter.

Conclusion  Simultaneous consideration of previous knowledge regarding potentially AD-related nutrients and multiple food groups can aid in identifying food combinations that are associated with AD risk.

Effect of diet on asthma and allergic sensitisation

Diet berhubungan dengan asma. Konsumsi buah, sayuran dan ikan mencegah asma, sedangkan banyak konsumsi burger meningkatkan asma. Pola diet Mediterrania memberikan efek proteksi terhadap asma pada anak.

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Thorax 2010;65:516-522

Effect of diet on asthma and allergic sensitisation in the International Study on Allergies and Asthma in Childhood (ISAAC) Phase Two

Gabriele Nagel1, Gudrun Weinmayr1, Andrea Kleiner1, Luis Garcia-Marcos2,David P Strachan3, the ISAAC Phase Two Study Group

Abstract

Background The increasing prevalence of asthma and allergy might be related to diet, particularly in Western countries. A study was undertaken to assess the association between dietary factors, asthma and allergy in a large international study including objective measurements of atopy.

Methods Between 1995 and 2005, cross-sectional studies were performed in 29 centres in 20 countries. Parental questionnaires were used to collect information on allergic diseases and exposure factors and data from 50 004 randomly selected schoolchildren (8–12 years, 29 579 with skin prick testing) were analysed. Random effect models for meta-analysis were applied to calculate combined ORs.

Results Fruit intake was associated with a low prevalence of current wheeze in affluent (ORadj 0.86, 95% CI 0.73 to 1.02) and non-affluent countries (ORadj 0.71, 95% CI 0.57 to 0.88). Consumption of fish in affluent countries (ORadj 0.85, 95% CI 0.74 to 0.97) and of cooked green vegetables in non-affluent countries (ORadj 0.78, 95% CI 0.65 to 0.95) was associated with a lower prevalence of current wheeze. Overall, more frequent consumption of fruit, vegetables and fish was associated with a lower lifetime prevalence of asthma, whereas high burger consumption was associated with higher lifetime asthma prevalence. None of the food items was associated with allergic sensitisation. Except for fruit juice and fruit consumption, no associations were found with atopic wheeze. Food selection according to the 'Mediterranean diet' was associated with a lower prevalence of current wheeze and asthma ever (ptrend=0.03).

Conclusion Diet is associated with wheeze and asthma but not with allergic sensitisation in children. These results provide further evidence that adherence to the 'Mediterranean diet' may provide some protection against wheeze and asthma in childhood.

White Rice, Brown Rice, and Risk of Type 2 Diabetes

Substitusi nasi putih dengan nasi tumbuk akan menurunkan risiko diabetes tipe 2.

Konsumsi karbohidrat sebaiknya berupa biji2an (whole grains) dan menghindari refined grains untuk mencegah diabetes tipe 2.

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Abstrak

 

White Rice, Brown Rice, and Risk of Type 2 Diabetes in US Men and Women
Qi Sun, MD, ScD; Donna Spiegelman, ScD; Rob M. van Dam, PhD; Michelle D. Holmes, MD, DrPH; Vasanti S. Malik, MSc;Walter C. Willett, MD, DrPH; Frank B. Hu, MD, PhD

Arch Intern Med. 2010;170(11):961-969.

Background  Because of differences in processing and nutrients, brown rice and white rice may have different effects on risk of type 2 diabetes mellitus. We examined white and brown rice consumption in relation to type 2 diabetes risk prospectively in the Health Professionals Follow-up Study and the Nurses' Health Study I and II.

Methods  We prospectively ascertained and updated diet, lifestyle practices, and disease status among 39 765 men and 157 463 women in these cohorts.

Results  After multivariate adjustment for age and other lifestyle and dietary risk factors, higher intake of white rice (>5 servings per week vs <1 per month) was associated with a higher risk of type 2 diabetes: pooled relative risk (95%confidence interval [CI]), 1.17 (1.02-1.36). In contrast, high brown rice intake (>2 servings per week vs <1 per month) was associated with a lower risk of type 2 diabetes: pooled relative risk, 0.89 (95% CI, 0.81-0.97). We estimated that replacing 50 g/d (uncooked, equivalent to one-third serving per day) intake of white rice with the same amount of brown rice was associated with a 16% (95% CI, 9%-21%) lower risk of type 2 diabetes, whereas the same replacement with whole grains as a group was associated with a 36% (30%-42%) lower diabetes risk.

Conclusions  Substitution of whole grains, including brown rice, for white rice may lower risk of type 2 diabetes. Thesedata support the recommendation that most carbohydrate intake should come from whole grains rather than refined grains to help prevent type 2 diabetes.

 

Effects of fibrates on cardiovascular outcomes: a systematic review and meta-analysis

Fibrat dapat mengurangi risiko kardiovaskuler terutama koroner.

Fibrat juga dapat mengurangi progresi albuminuria.

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The Lancet, Volume 375, Issue 9729, Pages 1875 - 1884, 29 May 2010

Effects of fibrates on cardiovascular outcomes: a systematic review and meta-analysis

Min Jun MSc a, Celine Foote MBBS a, Jicheng Lv MD a b, Prof Bruce Neal MBChB a, Anushka Patel MD a, Stephen J Nicholls MBBS c,Prof Diederick E Grobbee MD d, Prof Alan Cass MBBS a, Prof John Chalmers MBBS a, Dr Vlado Perkovic MBBS a

Summary

Background
Several clinical trials have reported inconsistent findings for the effect of fibrates on cardiovascular risk. We undertook a systematic review and meta-analysis to investigate the effects of fibrates on major clinical outcomes.
Methods
We systematically searched Medline, Embase, and the Cochrane Library for trials published between 1950 and March, 2010. We included prospective randomised controlled trials assessing the effects of fibrates on cardiovascular outcomes compared with placebo. Summary estimates of relative risk (RR) reductions were calculated with a random effects model. Outcomes analysed were major cardiovascular events, coronary events, stroke, heart failure, coronary revascularisation, all-cause mortality, cardiovascular death, non-vascular death, sudden death, new onset albuminuria, and drug-related adverse events.
Findings
We identified 18 trials providing data for 45 058 participants, including 2870 major cardiovascular events, 4552 coronary events, and 3880 deaths. Fibrate therapy produced a 10% RR reduction (95% CI 0—18) for major cardiovascular events (p=0·048) and a 13% RR reduction (7—19) for coronary events (p<0·0001), but had no benefit on stroke (−3%, −16 to 9; p=0·69). We noted no effect of fibrate therapy on the risk of all-cause mortality (0%, −8 to 7; p=0·92), cardiovascular mortality (3%, −7 to 12; p=0·59), sudden death (11%, −6 to 26; p=0·19), or non-vascular mortality (−10%, −21 to 0·5; p=0·063). Fibrates reduced the risk of albuminuria progression by 14% (2—25; p=0·028). Serious drug-related adverse events were not significantly increased by fibrates (17 413 participants, 225 events; RR 1·21, 0·91—1·61; p=0·19), although increases in serum creatinine concentrations were common (1·99, 1·46—2·70; p<0·0001).
Interpretation
Fibrates can reduce the risk of major cardiovascular events predominantly by prevention of coronary events, and might have a role in individuals at high risk of cardiovascular events and in those with combined dyslipidaemia.

Konsumsi kacang memperbaiki profil lipid

Konsumsi kacang2an 67 g per hari dapat memperbaiki profil lipid (menurunkan kolesterol total, LDL dan trigliserid)

 

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Nut Consumption and Blood Lipid Levels
A Pooled Analysis of 25 Intervention Trials
Joan Sabaté, MD, DrPH; Keiji Oda, MA, MPH; Emilio Ros, MD, PhD

Arch Intern Med. 2010;170(9):821-827.

Background  Epidemiological studies have consistently associated nut consumption with reduced risk for coronary heart disease. Subsequently, many dietary intervention trials investigated the effects of nut consumption on blood lipid levels. The objectives of this study were to estimate the effects of nut consumption on blood lipid levels and to examine whether different factors modify the effects.

Methods  We pooled individual primary data from 25 nut consumption trials conducted in 7 countries among 583 men and women with normolipidemia and hypercholesterolemia who were not taking lipid-lowering medications. In a pooled analysis, we used mixed linear models to assess the effects of nut consumption and the potential interactions.

Results  With a mean daily consumption of 67 g of nuts, the following estimated mean reductions were achieved: total cholesterol concentration (10.9 mg/dL [5.1% change]), low-density lipoprotein cholesterol concentration (LDL-C) (10.2 mg/dL [7.4% change]), ratio of LDL-C to high-density lipoprotein cholesterol concentration (HDL-C) (0.22 [8.3% change]), and ratio of total cholesterol concentration to HDL-C (0.24 [5.6% change]) (P < .001 for all) (to convert all cholesterol concentrations to millimoles per liter, multiply by 0.0259). Triglyceride levels were reduced by 20.6 mg/dL (10.2%) in subjects with blood triglyceride levels of at least 150 mg/dL (P < .05) but not in those with lower levels (to convert triglyceride level to millimoles per liter, multiply by 0.0113). The effects of nut consumption were dose related, and different types of nuts had similar effects on blood lipid levels. The effects of nut consumption were significantly modified by LDL-C, body mass index, and diet type: the lipid-lowering effects of nut consumption were greatest among subjects with high baseline LDL-C and with low body mass index and among those consuming Western diets.

Conclusion  Nut consumption improves blood lipid levels in a dose-related manner, particularly among subjects with higher LDL-C or with lower BMI.

Effect of B-Vitamin Therapy on Progression of Diabetic Nephropathy

Penderita nefropati diabetik sering disertai dengan hiperhomosisteinemia, sehingga diberikan terapi vitamin B untuk menurunkan kadar homosistein.

Tapi ternyata pemberian terapi vitamin B menyebabkan penurunan GFR lebih besar, dan meningkatkan risiko vascular events (myocardial infarction, stroke, revascularization, and all-cause mortality)

 

Effect of B-Vitamin Therapy on Progression of Diabetic Nephropathy

A Randomized Controlled Trial

Andrew A. House, MD; Misha Eliasziw, PhD; Daniel C. Cattran, MD; David N. Churchill, MD; Matthew J. Oliver, MD;Adrian Fine, MD; George K. Dresser, MD; J. David Spence, MD

JAMA. 2010;303(16):1603-1609.

Context  Hyperhomocysteinemia is frequently observed in patients with diabetic nephropathy. B-vitamin therapy (folicacid, vitamin B6, and vitamin B12) has been shown to lower the plasma concentration of homocysteine.
Objective  To determine whether B-vitamin therapy can slow progression of diabetic nephropathy and prevent vascular complications.
Design, Setting, and Participants  A multicenter, randomized, double-blind, placebo-controlled trial (Diabetic Intervention with Vitamins to Improve Nephropathy [DIVINe]) at 5 university medical centers in Canada conducted between May 2001 and July 2007 of 238 participants who had type 1 or 2 diabetes and a clinical diagnosis of diabetic nephropathy.
Intervention  Single tablet of B vitamins containing folic acid (2.5 mg/d), vitamin B6 (25 mg/d), and vitamin B12 (1 mg/d), or matching placebo.
Main Outcome Measures  Change in radionuclide glomerular filtration rate (GFR) between baseline and 36 months. Secondary outcomes were dialysis and a composite of myocardial infarction, stroke, revascularization, and all-cause mortality. Plasma total homocysteine was also measured.
Results  The mean (SD) follow-up during the trial was 31.9 (14.4) months. At 36 months, radionuclide GFR decreased by a mean (SE) of 16.5 (1.7) mL/min/1.73 m2 in the B-vitamin group compared with 10.7 (1.7) mL/min/1.73 m2 in the placebo group (mean difference, –5.8; 95% confidence interval [CI], –10.6 to –1.1; P = .02). There was no difference in requirement of dialysis (hazard ratio [HR], 1.1; 95% CI, 0.4-2.6; P = .88). The composite outcome occurred more often in the B-vitamin group (HR, 2.0; 95% CI, 1.0-4.0; P = .04). Plasma total homocysteine decreased by a mean (SE) of 2.2 (0.4) µmol/L at 36 months in the B-vitamin group compared with a mean (SE) increase of 2.6 (0.4) µmol/L in the placebo group (mean difference, –4.8; 95% CI, –6.1 to –3.7; P < .001, in favor of B vitamins).
Conclusion  Among patients with diabetic nephropathy, high doses of B vitamins compared with placebo resulted in a greater decrease in GFR and an increase in vascular events.

Lemak tak jenuh mengurangi risiko penyakit jantung koroner

Telah diketahui bahwa mengurangi asupan minyak jenuh (saturated fat disingkat SFA) akan menurunkan risiko penyakit jantung koroner (PJK).

Bagaimana efek minyak tak jenuh ganda (polyunsaturated fat disingkat PUFA).

Penelitian ini membuktikan bahwa asupan PUFA ternyata dapat menurunkan risiko PJK.

 

Dianjurkan untuk mengganti minyak SFA dengan minyak PUFA dalam makanan sehari2.

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Abstrak

PLoS Med 7(3):e1000252, 23 March 2010 © 2010 Mozaffarian et al
Effects on Coronary Heart Disease of Increasing Polyunsaturated Fat in Place of Saturated Fat: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Mozaffarian D, Micha R and Wallace S.

Background
Reduced saturated fat (SFA) consumption is recommended to reduce coronary heart disease (CHD), but there is an absence of strong supporting evidence from randomized controlled trials (RCTs) of clinical CHD events and few guidelines focus on any specific replacement nutrient. Additionally, some public health groups recommend lowering or limiting polyunsaturated fat (PUFA) consumption, a major potential replacement for SFA.

Methods and Findings
We systematically investigated and quantified the effects of increased PUFA consumption, as a replacement for SFA, on CHD endpoints in RCTs. RCTs were identified by systematic searches of multiple online databases through June 2009, grey literature sources, hand-searching related articles and citations, and direct contacts with experts to identify potentially unpublished trials. Studies were included if they randomized participants to increased PUFA for at least 1 year without major concomitant interventions, had an appropriate control group, and reported incidence of CHD (myocardial infarction and/or cardiac death). Inclusions/exclusions were adjudicated and data were extracted independently and in duplicate by two investigators and included population characteristics, control and intervention diets, follow-up duration, types of events, risk ratios, and SEs. Pooled effects were calculated using inverse-variance-weighted random effects meta-analysis. From 346 identified abstracts, eight trials met inclusion criteria, totaling 13,614 participants with 1,042 CHD events. Average weighted PUFA consumption was 14.9% energy (range 8.0%–20.7%) in intervention groups versus 5.0% energy (range 4.0%–6.4%) in controls. The overall pooled risk reduction was 19% (RR = 0.81, 95% confidence interval [CI] 0.70–0.95, p = 0.008), corresponding to 10% reduced CHD risk (RR = 0.90, 95% CI = 0.83–0.97) for each 5% energy of increased PUFA, without evidence for statistical heterogeneity (Q-statistic p = 0.13; I2 = 37%). Meta-regression identified study duration as an independent determinant of risk reduction (p = 0.017), with studies of longer duration showing greater benefits.

Conclusions
These findings provide evidence that consuming PUFA in place of SFA reduces CHD events in RCTs. This suggests that rather than trying to lower PUFA consumption, a shift toward greater population PUFA consumption in place of SFA would significantly reduce rates of CHD.

Terapi homeopati = plasebo

Buat mereka yang bersedia mengeluarkan banyak uang untuk terapi homeopati, penelitian berikut ini perlu dicermati.

Penelitian ini mendapatkan bahwa terapi homeopati hanya berefek plasebo.

MJA 192(8):458-460, 19 April 2010 © The Medical Journal of Australia 2010
Homeopathy: what does the "best" evidence tell us? Edzard Ernst.

Abstract

Objective: To evaluate the evidence for and against the effectiveness of homeopathy.
Data sources: The Cochrane Database of Systematic Reviews (generally considered to be the most reliable source of evidence) was searched in January 2010.
Study selection: Cochrane reviews with the term "homeopathy" in the title, abstract or keywords were considered. Protocols of reviews were excluded. Six articles met the inclusion criteria.
Data extraction: Each of the six reviews was examined for specific subject matter; number of clinical trials reviewed; total number of patients involved; and authors' conclusions. The reviews covered the following conditions: cancer, attention-deficit hyperactivity disorder, asthma, dementia, influenza and induction of labour.
Data synthesis: The findings of the reviews were discussed narratively (the reviews' clinical and statistical heterogeneity precluded meta-analysis).
Conclusions: The findings of currently available Cochrane reviews of studies of homeopathy do not show that homeopathic medicines have effects beyond placebo.

Terlalu banyak minum cola dapat menurunkan kesuburan

Terlalu banyak minum cola dapat menurunkan kualitas dan kuantitas sperma

American Journal of Epidemiology 171(8):883-891, published online 25 March 2010 © The Author 2010
Caffeine Intake and Semen Quality in a Population of 2,554 Young Danish Men. Tina Kold Jensen, Shanna H. Swan, Niels E. Skakkebæk, Sanne Rasmussen and Niels Jørgensen. 

Caffeine Intake and Semen Quality in a Population of 2,554 Young Danish Men

The authors examined the association between semen quality and caffeine intake among 2,554 young Danish men recruited when they were examined to determine their fitness for military service in 2001–2005. The men delivered a semen sample and answered a questionnaire including information about caffeine intake from various sources, from which total caffeine intake was calculated. Moderate caffeine and cola intakes (101–800 mg/day and <14 0.5-L bottles of cola/week) compared with low intake (<100 mg/day, no cola intake) were not associated with semen quality. High cola (>14 0.5-L bottles/week) and/or caffeine (>800mg/day) intake was associated with reduced sperm concentration and total sperm count, although only significant for cola. High-intake cola drinkers had an adjusted sperm concentration and total sperm count of 40 mill/mL (95% confidence interval (CI): 32, 51) and 121 mill (95% CI: 92, 160), respectively, compared with 56 mill/mL (95% CI: 50, 64) and 181 mill (95% CI: 156, 210) in non-cola-drinkers, which could not be attributed to the caffeine they consumed because it was <140 mg/day. Therefore, the authors cannot exclude the possibility of a threshold above which cola, and possibly caffeine, negatively affects semen quality. Alternatively, the less healthy lifestyle of these men may explain these findings.

Mengurangi konsumsi garam akan mencegah stroke dan serangan jantung

Mengurangi konsumsi garam akan mencegah stroke dan serangan jantung, sehingga dapat menurunkan biaya pemeliharaan kesehatan.

Annals of Internal Medicine, vol. 152 no. 8 481-7

Abstract

Background: Sodium consumption raises blood pressure, increasing the risk for heart attack and stroke. Several countries, including the United States, are considering strategies to decrease population sodium intake.

Objective: To assess the cost-effectiveness of 2 population strategies to reduce sodium intake: government collaboration with food manufacturers to voluntarily cut sodium in processed foods, modeled on the United Kingdom experience, and a sodium tax.

Design: A Markov model was constructed with 4 health states: well, acute myocardial infarction (MI), acute stroke, and history of MI or stroke.

Data Sources: Medical Panel Expenditure Survey (2006), Framingham Heart Study (1980 to 2003), Dietary Approaches to Stop Hypertension trial, and other published data.

Target Population: U.S. adults aged 40 to 85 years.

Time Horizon: Lifetime.

Perspective: Societal.

Outcome Measures: Incremental costs (2008 U.S. dollars), quality-adjusted life-years (QALYs), and MIs and strokes averted.

Results of Base-Case Analysis: Collaboration with industry that decreases mean population sodium intake by 9.5% averts 513 885 strokes and 480 358 MIs over the lifetime of adults aged 40 to 85 years who are alive today compared with the status quo, increasing QALYs by 2.1 million and saving $32.1 billion in medical costs. A tax on sodium that decreases population sodium intake by 6% increases QALYs by 1.3 million and saves $22.4 billion over the same period.

Results of Sensitivity Analysis: Results are sensitive to the assumption that consumers have no disutility with modest reductions in sodium intake.

Limitation: Efforts to reduce population sodium intake could result in other dietary changes that are difficult to predict.

Conclusion: Strategies to reduce sodium intake on a population level in the United States are likely to substantially reduce stroke and MI incidence, which would save billions of dollars in medical expenses.

Kombinasi terapi lipid tidak efektif

Penelitian ini membuktikan bahwa terapi dislipidemia dengan kombinasi statin dan fenofibrat tidak efektif

N Engl J Med 362(17):1563-1574, 29 April 2010 © 2010 to the Massachusetts Medical Society
Effects of Combination Lipid Therapy in Type 2 Diabetes Mellitus-The ACCORD Study Group. Henry N. Ginsberg, Marshall B. Elam, Laura C. Lovato, et al. 

ABSTRACT

Background We investigated whether combination therapy with a statin plus a fibrate, as compared with statin monotherapy, would reduce the risk of cardiovascular disease in patients with type 2 diabetes mellitus who were at high risk for cardiovascular disease.

Methods We randomly assigned 5518 patients with type 2 diabetes who were being treated with open-label simvastatin to receive either masked fenofibrate or placebo. The primary outcome was the first occurrence of nonfatal myocardial infarction, nonfatal stroke, or death from cardiovascular causes. The mean follow-up was 4.7 years.

Results The annual rate of the primary outcome was 2.2% in the fenofibrate group and 2.4% in the placebo group (hazard ratio in the fenofibrate group, 0.92; 95% confidence interval [CI], 0.79 to 1.08; P=0.32). There were also no significant differences between the two study groups with respect to any secondary outcome.Annual rates of death were 1.5% in the fenofibrate group and 1.6% in the placebo group (hazard ratio, 0.91; 95% CI, 0.75 to 1.10; P=0.33). Prespecified subgroup analyses suggested heterogeneity in treatment effect according to sex, with a benefit for men and possible harm for women (P=0.01 for interaction), and a possible interaction according to lipid subgroup, with a possible benefit for patients with both a high baseline triglyceridelevel and a low baseline level of high-density lipoprotein cholesterol (P=0.057 for interaction).

Conclusions The combination of fenofibrate and simvastatin did not reduce the rate of fatal cardiovascular events, nonfatal myocardial infarction, or nonfatal stroke, as compared with simvastatin alone. These results do not support the routine use of combination therapy with fenofibrate and simvastatin to reduce cardiovascular risk in the majority of high-risk patients with type 2 diabetes.