Dietary Glycemic Load and Index and Risk of Coronary Heart Disease in a Large Italian Cohort The EPICOR Study

Diet tinggi glycemic load (GL) dan tinggi glycemic index (GI) berhubungan dengan timbulnya penyakit jantung koroner (PJK) pada perempuan, tetapi tidak pada lelaki.

Arch Intern Med 170(7):640-647, 12 April 2010 © 2010 to the American Medical Association
Dietary Glycemic Load and Index and Risk of Coronary Heart Disease in a Large Italian Cohort-The EPICOR Study. Sabina Sieri, Vittorio Krogh, Franco Berrino, et al. 

Background  Dietary glycemic load (GL) and glycemic index (GI) in relation to cardiovascular disease have been investigated in a few prospective studies with inconsistent results, particularly in men. The present EPICOR study investigated the association of GI and GL with coronary heart disease (CHD) in a large and heterogeneous cohort of Italian men and women originally recruited to the European Prospective Investigation into Cancer and Nutrition study.

Methods  We studied 47 749 volunteers (15 171 men and 32 578 women) who completed a dietary questionnaire. Multivariate Cox proportional hazards modeling estimated adjusted relative risks (RRs) of CHD and 95% confidence intervals (CIs).

Results  During a median of 7.9 years of follow-up, 463 CHD cases (158 women and 305 men) were identified. Women in the highest carbohydrate intake quartile had a significantly greater risk of CHD than did those in the lowest quartile (RR, 2.00; 95% CI, 1.16-3.43), with no association found in men (P = .04 for interaction). Increasing carbohydrate intake from high-GI foods was also significantly associated with greater risk of CHD in women (RR, 1.68; 95% CI, 1.02-2.75), whereas increasing the intake of low-GI carbohydrates was not. Women in the highest GL quartile had a significantly greater risk of CHD than did those in the lowest quartile (RR, 2.24; 95% CI, 1.26-3.98), with no significant association in men (P = .03 for interaction).

Conclusion  In this Italian cohort, high dietary GL and carbohydrate intake from high-GI foods increase the overall risk of CHD in women but not men.

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Salam sehat,
Dr. David Fadjar Putra, MS
Spesialis Gizi Klinik
@
www.kliniknutrisi.com
kliniknutrisi.blogspot.com

Effects of treatment in women with gestational diabetes mellitus: systematic review and meta-analysis

Diabetes dalam kehamilan perlu penanganan untuk mengurangi risiko komplikasi perinatal.

BMJ 340:c1395, 1 April 2010 © Horvath et al 2010
Effects of treatment in women with gestational diabetes mellitus: systematic review and meta-analysis. Karl Horvath, Klaus Koch, Klaus Jeitler, et al. 

Objective To summarise the benefits and harms of treatments for women with gestational diabetes mellitus.

Design Systematic review and meta-analysis of randomised controlled trials.

Data sources Embase, Medline, AMED, BIOSIS, CCMed, CDMS, CDSR,CENTRAL, CINAHL, DARE, HTA, NHS EED, Heclinet, SciSearch, severalpublishers' databases, and reference lists of relevant secondary literature up to October 2009.

Review methods Included studies were randomised controlled trials of specific treatment for gestational diabetes compared with usual care or "intensified" compared with "less intensified" specific treatment.

Results Five randomised controlled trials matched the inclusion criteria for specific versus usual treatment. All studies used a two step approach with a 50 g glucose challenge test or screening for risk factors, or both, and a subsequent 75 g or 100 g oral glucose tolerance test. Meta-analyses did not show significant differences for most single end points judged to be of directclinical importance. In women specifically treated for gestational diabetes, shoulder dystocia was significantly less common (odds ratio 0.40, 95% confidence interval 0.21 to 0.75), and one randomised controlled trial reported a significant reduction of pre-eclampsia (2.5 v 5.5%, P=0.02). For the surrogate end point of large for gestational age infants, the odds ratio was 0.48 (0.38 to 0.62). In the 13 randomised controlled trials of different intensities of specific treatments, meta-analysis showed a significant reduction of shoulder dystocia in women with more intensive treatment (0.31, 0.14 to 0.70).

Conclusions Treatment for gestational diabetes, consisting of treatment to lower blood glucose concentration alone or with special obstetric care, seems to lower the risk for some perinatal complications. Decisions regarding treatment should take into account that the evidence of benefit is derived from trials for which women were selected with a two step strategy (glucose challenge test/screening for risk factors and oral glucose tolerance test).

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Salam sehat,
Dr. David Fadjar Putra, MS
Spesialis Gizi Klinik
@
www.kliniknutrisi.com
kliniknutrisi.blogspot.com

Vitamin D deficiency is highly prevalent in COPD and correlates with variants in the vitamin D-binding gene

Defisiensi vitamin D sering terjadi pada COPD, dan berhubungan dengan beratnya serangan.

Dianjurkan pemberian suplemen vitamin D pada penderita COPD berat, terutama bagi penderita dengan varian gen rs7041.

Thorax 65:215-220, March 2010 © 2010 BMJ Publishing Group Ltd & British Thoracic Society
Vitamin D deficiency is highly prevalent in COPD and correlates with variants in the vitamin D-binding gene. Wim Janssens, Roger Bouillon, Bart Claes, et al. 

Abstract

Introduction Vitamin D deficiency has been associated with many chronic illnesses, but little is known about its relationship with chronic obstructive pulmonary disease (COPD).

Objectives Serum 25-hydroxyvitamin D (25-OHD) levels were measured in 414 (ex)-smokers older than 50 years and the link between vitamin D status and presence of COPD was assessed. The rs7041 and rs4588 variants in the vitamin D-binding gene (GC) were genotyped and their effects on 25-OHD levels were tested.

Results In patients with COPD, 25-OHD levels correlated significantly with forced expiratory volume in 1 s (FEV₁) (r=0.28, p<0.0001). Compared with 31% of the smokers with normal lung function, as many as 60% and 77% of patients with GOLD (Global Initiative for Obstructive Lung Disease) stage 3 and 4 exhibited deficient 25-OHD levels <20 ng/ml (p<0.0001). Additionally, 25-OHD levels were reduced by 25% in homozygous carriers of the rs7041 at-risk T allele (p<0.0001). This correlation was found to be independent of COPD severity, smoking history, age, gender, body mass index, corticosteroid intake, seasonal variation and rs4588 (p<0.0001). Notably, 76% and 100% of patients with GOLD stage 3 and 4 homozygous for the rs7041 T allele exhibited 25-OHD levels <20 ng/ml. Logistic regression corrected for age, gender and smoking history further revealed that homozygous carriers of the rs7041 T allele exhibited an increased risk for COPD (OR 2.11; 95% CI 1.20 to 3.71; p=0.009).

Conclusion Vitamin D deficiency occurs frequently in COPD and correlates with severity of COPD. The data warrant vitamin D supplementation in patients with severe COPD, especially in those carrying at-risk rs7041 variants.

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Salam sehat,
Dr. David Fadjar Putra, MS
Spesialis Gizi Klinik
@
www.kliniknutrisi.com
kliniknutrisi.blogspot.com

Apakah statin dapat menurunkan tekanan darah ?

Apakah pemberian preparat statin dapat menurunkan tekanan darah ?

Penelitian dari berikut ini tidak mendapatkan efek penurunan tekanan darah dari pemberian statin.

BMJ 340: c1197, 25 March 2010 © 2010 Mancia et al.
Statins, antihypertensive treatment, and blood pressure control in clinic and over 24 hours: evidence from PHYLLIS randomised double blind trial. Giuseppe Mancia, Gianfranco Parati, Miriam Revera, et al. 

Objective To investigate the possibility that statins reduce blood pressure as well as cholesterol concentrations through clinic and 24 hour ambulatory blood pressure monitoring.

Design Randomised placebo controlled double blind trial.

Setting 13 hospitals in Italy

Participants 508 patients with mild hypertension and hypercholesterolaemia,aged 45 to 70 years.

Intervention Participants were randomised to antihypertensive treatment (hydrochlorothiazide 25 mg once daily or fosinopril 20 mg once daily) with or without the addition of a statin (pravastatin 40 mg once daily).

Main outcome measures Clinic and ambulatory blood pressure measuredevery year throughout an average 2.6 year treatment period.

Results Both the group receiving antihypertensive treatment without pravastatin (n=254) (with little change in total cholesterol) and the group receiving antihypertensive treatment with pravastatin (n=253) (with marked and sustained reduction in total cholesterol and low density lipoprotein cholesterol) had a clear cut sustained reduction in clinic measured systolic and diastolic blood pressure as well as in 24 hour, and day and night, systolic and diastolic blood pressure. Pravastatin performed slightly worse than placebo, and between group differences did not exceed 1.9 (95% confidenceinterval –0.6 to 4.3, P=0.13) mm Hg throughout the treatment period. This was also the case when participants who remained on monotherapy with hydrochlorothiazide or fosinopril throughout the study were considered separately.

Conclusions Administration of a statin in hypertensive patients in whom blood pressure is effectively reduced by concomitant antihypertensive treatment does not have an additional blood pressure lowering effect.

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Salam sehat,
Dr. David Fadjar Putra, MS
Spesialis Gizi Klinik
@
www.kliniknutrisi.com
kliniknutrisi.blogspot.com

Physical activity and weight gain prevention

Pada perempuan dengan IMT <25 olahraga dapat mencegah kenaikan berat badan. Pada IMT >25 kemungkinan faktor diet lebih berperan.

Perempuan yang berhasil mempertahankan BB (naik <2,3kg selama 13 tahun) rata2 melakukan olahraga selama 60 menit per hari dengan intensitas sedang.

JAMA 303(12):1173-1179, 24 March 2010 © 2010 the American Medical Association
Physical Activity and Weight Gain Prevention. I-Min Lee, Luc Djoussé, Howard D. Sesso, Lu Wang, and Julie E. Buring. 

Context  The amount of physical activity needed to prevent long-term weight gain is unclear. In 2008, federal guidelines recommended at least 150 minutes per week (7.5 metabolic equivalent [MET] hours per week) of moderate-intensity activity for "substantial health benefits."

Objective  To examine the association of different amounts of physical activity with long-term weight changes among women consuming a usual diet.

Design, Setting, and Participants  A prospective cohort study involving 34 079 healthy US women (mean age, 54.2 years) from 1992-2007. At baseline and months 36, 72, 96, 120, 144, and 156, women reported their physical activity and bodyweight. Women were classified as expending less than 7.5, 7.5 to less than 21, and 21 or more MET hours per week of activity at each time. Repeated-measures regression prospectively examined physical activity and weight change over intervals averaging 3 years.

Main Outcome Measure  Change in weight.

Results  Women gained a mean of 2.6 kg throughout the study. A multivariate analysis comparing women expending 21 or more MET hours per week with those expending from 7.5 to less than 21 MET hours per week showed that the latter group gained a mean (SD) 0.11 kg (0.04 kg; P = .003) over a mean interval of 3 years, and those expending less than 7.5 MET hours per week gained 0.12 kg (0.04; P = .002). There was a significant interaction with body mass index (BMI), such that there was an inverse dose-response relation between activity levels and weight gain among women with a BMI of less than 25 (P for trend < .001) but no relation among women with a BMI from 25 to 29.9 (P for trend = .56) or with a BMI of 30.0 or higher (P for trend = .50). A total of 4540 women (13.3%) with a BMI lower than 25 at study start successfully maintained their weight by gaining less than 2.3 kg throughout. Their mean activity level over the study was 21.5 MET hours per week ( 60 minutes a day of moderate-intensity activity).

Conclusions  Among women consuming a usual diet, physical activity was associated with less weight gain only among women whose BMI was lower than 25. Women successful in maintaining normal weight and gaining fewer than 2.3 kg over 13 years averaged approximately 60 minutes a day of moderate-intensity activity throughout the study.

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Salam sehat,
Dr. David Fadjar Putra, MS
Spesialis Gizi Klinik
@
www.kliniknutrisi.com
kliniknutrisi.blogspot.com

Can diet and weight loss reverse carotid atherosclerosis?

Penurunan berat badan dapat menurunkan ketebalan lapisan intima media arteri carotis

Circulation 121:1200-1208, March 2010 © 2010 American Heart Association, Inc.
Dietary Intervention to Reverse Carotid Atherosclerosis. Iris Shai, J. David Spence, Dan Schwarzfuchs, et al. 

Background— It is currently unknown whether dietary weight loss interventions can induce regression of carotidatherosclerosis.

Methods and Results— In a 2-year Dietary Intervention Randomized Controlled Trial–Carotid (DIRECT-Carotid) study, participants were randomized to low-fat, Mediterranean, or low-carbohydrate diets and were followed for changes in carotid artery intima-media thickness, measured with standard B-mode ultrasound, and carotid vessel wall volume (VWV), measured with carotid 3D ultrasound. Of 140 complete images of participants (aged 51 years; body mass index, 30 kg/m²; 88% men), higher baseline carotid VWV was associated with increased intima-media thickness, age, male sex, baseline weight, blood pressure, and insulin levels (P<0.05 for all). After 2 years of dietary intervention, we observed a significant 5% regression in mean carotidVWV (–58.1 mm^3; 95% confidence interval, –81.0 to –35.1 mm³; P<0.001), with no differences in the low-fat, Mediterranean, or low-carbohydrate groups (–60.69 mm³, –37.69 mm³, –84.33 mm³, respectively; P=0.28). Mean change in intima-media thickness was –1.1% (P=0.18). A reduction in the ratio of apolipoprotein B₁₀₀ to apolipoprotein A1 was observed in the low-carbohydrate compared with the low-fat group (P=0.001). Participants who exhibited carotidVWV regression (mean decrease, –128.0 mm³; 95% confidence interval, –148.1 to –107.9 mm³) compared with participants who exhibited progression (meanincrease, +89.6 mm³; 95% confidence interval, +66.6 to +112.6 mm³) had achieved greater weight loss (–5.3 versus –3.2 kg; P=0.03), greater decreases in systolic blood pressure (–6.8 versus –1.1 mm Hg; P=0.009) and total homocysteine (–0.06 versus +1.44 µmol/L; P=0.04), and a higher increase of apolipoprotein A1 (+0.05 versus –0.00 g/L; P=0.06). In multivariate regression models, only the decrease in systolic blood pressure remained a significant independent modifiablepredictor of subsequent greater regression in both carotid VWV (β=0.23; P=0.01) and intima-media thickness (β=0.28; P=0.008) levels.

Conclusions— Two-year weight loss diets can induce a significant regression of measurable carotid VWV. The effect is similar in low-fat, Mediterranean, or low-carbohydrate strategies and appears to be mediated mainly by the weight loss–induced decline in blood pressure.

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Salam sehat,
Dr. David Fadjar Putra, MS
Spesialis Gizi Klinik
@
www.kliniknutrisi.com
kliniknutrisi.blogspot.com

Fruits or vegetables

As you know fruits and vegetables are at the pinnacle of the Healthiest Way of Eating.

That being said, Readers ask me whether fruits and vegetables are equally important. Here's what I tell them:We included a long list of both fruits and vegetables in the World's Healthiest Foods, and we did so not only for health and nourishment reasons, but also because of the beauty and diversity of these foods.

There are so many unique fruits and vegetables growing on the earth! The colors, shapes, and tastes of these foods are totally unique and unsurpassed within the food world! It's impossible for us to imagine the experience of the World's Healthiest Foods without ample amounts of fruits and vegetables.

When you compare fruits and vegetables on a nutritional basis, however, there is no question that vegetables are more nutrient dense and contain a much wider variety of nutrients than fruits.

If you think about the lives of the plants, this difference makes sense. In the world of vegetables, we eat many parts of the plants that either grow very close to the soil (like stems and stalks) or beneath the ground itself (like roots) This closeness to the soil brings the plant into contact with the diversity of soil minerals, and almost all vegetables are richer in minerals than fruits for this reason.

Fruits are also more of an end-stage occurrence: in the case of an apple tree, for example, the tree has already lived and developed for a good number of years before it produces a significant amount of edible fruit. Unlike a root, which is in charge of nutrient delivery from the soil up into the rest of the plant, the fruit (like an apple) is not nearly as active in supporting the life of the plant (although it's seeds are dramatically important in allowing the tree to produce new offspring and create future generations of apple trees).

Because the stems and stalks and roots are more involved in the plant's life support, they also tend to have a greater variety of vitamins (especially B complex vitamins) than fruits.Most fruits have a concentrated amount of sugar, and for this reason, are higher-calorie and less nutrient dense than most vegetables.

Starchy root vegetables like potatoes are closer to fruits in calorie content, but green leafy vegetables are enormously lower in calories and greater in nutrient density.

In summary, if you had to choose between fruits and vegetables as a foundation for your health, you would do best to select vegetables because of their greater nutrient diversity and nutrient density. Luckily, however, it is not an either-or situation, and you can take pleasure in the delights of both fruits and vegetables while increasing your reliance on the World's Healthiest Foods!

By George Mateljan

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