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.