Wednesday, October 20, 2010

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

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.

Friday, October 15, 2010

Alcohol and Acute Ischemic Stroke Onset

Sehabis minum alkohol risiko stroke meningkat.

 
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.

Monday, October 11, 2010

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?

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.

Wednesday, October 6, 2010

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

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

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.

Tuesday, October 5, 2010

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.

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.

Monday, October 4, 2010

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

Asupan omega 3 dapat menurunkan tingkat depresi pada remaja pria

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.