Isolated Low Levels of High-Density Lipoprotein Cholesterol Are Associated With an Increased Risk of Coronary Heart Disease

Kadar kolesterol HDL rendah meningkatkan risiko PJK

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Circulation 124(19):2056-2064, 8 November 2011 © 2011 American Heart Association, Inc.
Isolated Low Levels of High-Density Lipoprotein Cholesterol Are Associated With an Increased Risk of Coronary Heart Disease An Individual Participant Data Meta-Analysis of 23 Studies in the Asia-Pacific Region.

Rachel R. Huxley, Federica Barzi, Tai Hing Lam, et al.

Abstract

 

Background—Previous studies have suggested that there is a novel dyslipidemic profile consisting of isolated low high-density lipoprotein cholesterol (HDL-C) level that is associated with increased risk of coronary heart disease, and that this trait may be especially prevalent in Asian populations.
Methods and Results—Individual participant data from 220 060 participants (87% Asian) in 37 studies from the Asia-Pacific region were included. Low HDL-C (HDL <1.03 mmol/L in men and <1.30 mmol/L in women) was seen among 33.1% (95% confidence interval [CI], 32.9–33.3) of Asians versus 27.0% (95% CI, 26.5–27.5) of non-Asians (P<0.001). The prevalence of low HDL-C in the absence of other lipid abnormalities (isolated low HDL-C) was higher in Asians compared with non-Asians: 22.4% (95% CI, 22.2–22.5) versus 14.5% (95% CI, 14.1–14.9), respectively (P<0.001). During 6.8 years of follow-up, there were 574 coronary heart disease and 739 stroke events. There was an inverse relationship between low HDL-C with coronary heart disease in all individuals (hazard ratio, 1.57; 95% CI, 1.31–1.87). In Asians, isolated low levels of HDL-C were as strongly associated with coronary heart disease risk as low levels of HDL-C combined with other lipid abnormalities (hazard ratio, 1.67 [95% CI, 1.27–2.19] versus 1.63 [95% CI, 1.24–2.15], respectively). There was no association between low HDL-C and stroke risk in this population (hazard ratio, 0.95 [95% CI, 0.78 to 1.17] with nonisolated low HDL-C and 0.81 [95% CI, 0.67–1.00] with isolated low HDL-C).
Conclusion—Isolated low HDL-C is a novel lipid phenotype that appears to be more prevalent among Asian populations, in whom it is associated with increased coronary risk. Further investigation into this type of dyslipidemia is warranted.

Low-Density Lipoproteins Containing Apolipoprotein C-III and the Risk of Coronary Heart Disease

Risiko PJK akibat LDL lebih disebabkan kandungan LDL yang mengandung apoC-III

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Circulation 124(19):2065-2072, 8 November 2011 © 2011 American Heart Association, Inc.
Low-Density Lipoproteins Containing Apolipoprotein C-III and the Risk of Coronary Heart Disease.

Carlos O. Mendivil, Eric B. Rimm, Jeremy Furtado, Stephanie E. Chiuve, Frank M. Sacks.

Abstract

 

Background—Low-density lipoprotein (LDL) that contains apolipoprotein (apo) C-III makes up only 10% to 20% of plasma LDL but has a markedly altered metabolism and proatherogenic effects on vascular cells.
Methods and Results—We examined the association between plasma LDL with apoC-III and coronary heart disease in 320 women and 419 men initially free of cardiovascular disease who developed a fatal or nonfatal myocardial infarction during 10 to 14 years of follow-up and matched controls who remained free of coronary heart disease. Concentrations of LDL with apoC-III (measured as apoB in this fraction) were associated with risk of coronary heart disease in multivariable analysis that included the ratio of total cholesterol to high-density lipoprotein cholesterol, LDL cholesterol, apoB, triglycerides, or high-density lipoprotein cholesterol and other risk factors. In all models, the relative risks for the top versus bottom quintile of LDL with apoC-III were greater than those for LDL without apoC-III. When included in the same multivariable-adjusted model, the risk associated with LDL with apoC-III (relative risk for top versus bottom quintile, 2.38; 95% confidence interval, 1.54–3.68; P for trend <0.001) was significantly greater than that associated with LDL without apoC-III (relative risk for top versus bottom quintile, 1.25; 95% confidence interval, 0.76–2.05; P for trend=0.97; P for interaction <0.001). This divergence in association with coronary heart disease persisted even after adjustment for plasma triglycerides.
Conclusions—The risk of coronary heart disease contributed by LDL appeared to result to a large extent from LDL that contains apoC-III.

Alkohol menyebabkan kanker payudara

Konsumsi alkohol meningkatkan risiko kanker payudara. Makin banyak alkohol makin tinggi risiko kanker payudara.

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JAMA 306(17):1884-1890, 2 November 2011 © 2011 American Medical Association
Moderate Alcohol Consumption During Adult Life, Drinking Patterns, and Breast Cancer Risk. Wendy Y. Chen, Bernard Rosner, Susan E. Hankinson, Graham A. Colditz, Walter C. Willett.

Abstract

Context Multiple studies have linked alcohol consumption to breast cancer risk, but the risk of lower levels of consumption has not been well quantified. In addition, the role of drinking patterns (ie, frequency of drinking and "binge" drinking) and consumption at different times of adult life are not well understood.
Objective To evaluate the association of breast cancer with alcohol consumption during adult life, including quantity, frequency, and age at consumption.
Design, Setting, and Participants Prospective observational study of 105 986 women enrolled in the Nurses' Health Study followed up from 1980 until 2008 with an early adult alcohol assessment and 8 updated alcohol assessments.
Main Outcome Measures Relative risks of developing invasive breast cancer.
Results During 2.4 million person-years of follow-up, 7690 cases of invasive breast cancer were diagnosed. Increasing alcohol consumption was associated with increased breast cancer risk that was statistically significant at levels as low as 5.0 to 9.9 g per day, equivalent to 3 to 6 drinks per week (relative risk, 1.15; 95% CI, 1.06-1.24; 333 cases/100 000 person-years). Binge drinking, but not frequency of drinking, was associated with breast cancer risk after controlling for cumulative alcohol intake. Alcohol intake both earlier and later in adult life was independently associated with risk.
Conclusions Low levels of alcohol consumption were associated with a small increase in breast cancer risk, with the most consistent measure being cumulative alcohol intake throughout adult life. Alcohol intake both earlier and later in adult life was independently associated with risk.

Tea and Coffee Consumption and MRSA Nasal Carriage

Konsumsi teh atau kopi panas menurunkan MRSA dalam hidung

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Annals of Family Medicine 9(4):299-304, July 2011 © 2011 Annals of Family Medicine, Inc.
Tea and Coffee Consumption and MRSA Nasal Carriage.

Eric M. Matheson, Arch G. Mainous III, Charles J. Everett, and Dana E. King.

Abstract

 

PURPOSE Hot tea and coffee have been found to have antimicrobial properties. The purpose of this study was to determine whether the consumption of tea, coffee, or both is associated with less frequent nasal carriage of methicillin-resistant Staphylococcus aureus (MRSA).
METHODS We performed a secondary analysis of data from the 2003–2004 National Health and Nutrition Examination Survey to investigate the relationship between the consumption of coffee, hot tea, cold tea, and soft drinks, and MRSA nasal carriage among the noninstitutionalized population of the United States.
RESULTS An estimated 2.5 million persons (1.4% of the population) were MRSA nasal carriers. In an adjusted logistic regression analysis controlling for age, race, sex, poverty-income ratio, current health status, hospitalization in the past 12 months, and use of antibiotics in the past month, individuals who reported consuming hot tea were one-half as likely to have MRSA nasal carriage relative to individuals who drank no hot tea (odds ratio = 0.47; 95% confidence interval, 0.31–0.71). Similarly, individuals who reported consuming coffee had about a one-half reduction in the risk of MRSA nasal carriage relative to individuals who drank no coffee (odds ratio = 0.47; 95% confidence interval, 0.24–0.93).
CONCLUSIONS Consumption of hot tea or coffee is associated with a lower likelihood of MRSA nasal carriage. Our findings raise the possibility of a promising new method to decrease MRSA nasal carriage that is safe, inexpensive, and easily accessible.

Alkohol meningkatkan kematian dan kanker (paru, kolorektal, prostat, payudara)

American Journal of Epidemiology published online 30 September 2011 © 2011  Johns Hopkins Bloomberg School of Public Health
Prospective Study of Alcohol Consumption Quantity and Frequency and Cancer-Specific Mortality in the US Population.

Rosalind A. Breslow, Chiung M. Chen, Barry I. Graubard and Kenneth J. Mukamal.

Prospective associations between quantity and frequency of alcohol consumption and cancer-specific mortality were studied using a nationally representative sample with pooled data from the 1988, 1990, 1991, and 1997–2004 administrations of the National Health Interview Survey (n = 323,354).

 

By 2006, 8,362 participants had died of cancer.

 

Cox proportional hazards regression was used to estimate relative risks.

 

Among current alcohol drinkers, for all-site cancer mortality, higher-quantity drinking (≥3 drinks on drinking days vs. 1 drink on drinking days) was associated with increased risk among men (relative risk (RR) = 1.24, 95% confidence interval (CI): 1.09, 1.41; P for linear trend = 0.001);

higher-frequency drinking (≥3 days/week vs. <1 day/week) was associated with increased risk among women (RR = 1.32, 95% CI: 1.13, 1.55; P-trend < 0.001).

 

Lung cancer mortality results were similar, but among never smokers, results were null.

For colorectal cancer mortality, higher-quantity drinking was associated with increased risk among women (RR = 1.93, 95% CI: 1.17, 3.18; P-trend = 0.03).

Higher-frequency drinking was associated with increased risk of prostate cancer (RR = 1.55, 95% CI: 1.01, 2.38; P for quadratic effect = 0.03) and tended to be associated with increased risk of breast cancer (RR = 1.44, 95% CI: 0.96, 2.17; P-trend = 0.06).

 

Epidemiologic studies of alcohol and cancer mortality should consider the independent effects of quantity and frequency.

Minimum amount of physical activity for reduced mortality and extended life expectancy

Dosis aktivitas fisik yang dianjurkan untuk mengurangi kematian adalah 15 min sehari atau 90 min seminggu berupa moderate-intensity exercise

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The Lancet 378(9798):1244-1253, 1 October 2011 © 2011 Elsevier Inc
Minimum amount of physical activity for reduced mortality and extended life expectancy: a prospective cohort study.

Chi Pang Wen, Jackson Pui Man Wai, Min Kuang Tsai et al.

Background
The health benefits of leisure-time physical activity are well known, but whether less exercise than the recommended 150 min a week can have life expectancy benefits is unclear. We assessed the health benefits of a range of volumes of physical activity in a Taiwanese population.
Methods
In this prospective cohort study, 416 175 individuals (199 265 men and 216 910 women) participated in a standard medical screening programme in Taiwan between 1996 and 2008, with an average follow-up of 8·05 years (SD 4·21). On the basis of the amount of weekly exercise indicated in a self-administered questionnaire, participants were placed into one of five categories of exercise volumes: inactive, or low, medium, high, or very high activity. We calculated hazard ratios (HR) for mortality risks for every group compared with the inactive group, and calculated life expectancy for every group.
Findings
Compared with individuals in the inactive group, those in the low-volume activity group, who exercised for an average of 92 min per week (95% CI 71—112) or 15 min a day (SD 1·8), had a 14% reduced risk of all-cause mortality (0·86, 0·81—0·91), and had a 3 year longer life expectancy. Every additional 15 min of daily exercise beyond the minimum amount of 15 min a day further reduced all-cause mortality by 4% (95% CI 2·5—7·0) and all-cancer mortality by 1% (0·3—4·5). These benefits were applicable to all age groups and both sexes, and to those with cardiovascular disease risks. Individuals who were inactive had a 17% (HR 1·17, 95% CI 1·10—1·24) increased risk of mortality compared with individuals in the low-volume group.
Interpretation
15 min a day or 90 min a week of moderate-intensity exercise might be of benefit, even for individuals at risk of cardiovascular disease.

Vitamin E and the Risk of Prostate Cancer

Suplementasi vitamin E dan selenium tidak mengurangi risiko kanker prostat. Sebaliknya suplementasi vitamin E justru meningkatkan risiko kanker prostat pada laki2 sehat

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JAMA 306(14):1549-1556, 12 October 2011 © 2011 American Medical Association
Vitamin E and the Risk of Prostate Cancer.

John J. Crowley, M. Scott Lucia, Phyllis J. Goodman, et al.

Context The initial report of the Selenium and Vitamin E Cancer Prevention Trial (SELECT) found no reduction in risk of prostate cancer with either selenium or vitamin E supplements but a statistically nonsignificant increase in prostate cancer risk with vitamin E. Longer follow-up and more prostate cancer events provide further insight into the relationship of vitamin E and prostate cancer.

Objective To determine the long-term effect of vitamin E and selenium on risk of prostate cancer in relatively healthy men.
Design, Setting, and Participants A total of 35 533 men from 427 study sites in the United States, Canada, and Puerto Rico were randomized between August 22, 2001, and June 24, 2004. Eligibility criteria included a prostate-specific antigen (PSA) of 4.0 ng/mL or less, a digital rectal examination not suspicious for prostate cancer, and age 50 years or older for black men and 55 years or older for all others. The primary analysis included 34 887 men who were randomly assigned to 1 of 4 treatment groups: 8752 to receive selenium; 8737, vitamin E; 8702, both agents, and 8696, placebo. Analysis reflect the final data collected by the study sites on their participants through July 5, 2011.
Interventions Oral selenium (200 μg/d from L-selenomethionine) with matched vitamin E placebo, vitamin E (400 IU/d of all rac-α-tocopheryl acetate) with matched selenium placebo, both agents, or both matched placebos for a planned follow-up of a minimum of 7 and maximum of 12 years.
Main Outcome Measures Prostate cancer incidence.
Results This report includes 54 464 additional person-years of follow-up and 521 additional cases of prostate cancer since the primary report. Compared with the placebo (referent group) in which 529 men developed prostate cancer, 620 men in the vitamin E group developed prostate cancer (hazard ratio [HR], 1.17; 99% CI, 1.004-1.36, P = .008); as did 575 in the selenium group (HR, 1.09; 99% CI, 0.93-1.27; P = .18), and 555 in the selenium plus vitamin E group (HR, 1.05; 99% CI, 0.89-1.22, P = .46). Compared with placebo, the absolute increase in risk of prostate cancer per 1000 person-years was 1.6 for vitamin E, 0.8 for selenium, and 0.4 for the combination.
Conclusion Dietary supplementation with vitamin E significantly increased the risk of prostate cancer among healthy men.

Coffee, Caffeine, and Risk of Depression Among Women

Satu lagi efek baik dari kopi (kafein), penelitian ini menunjukkan bahwa konsumsi kopi dapat menurunkan risiko depresi pada wanita.

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Arch Intern Med (17):1571-1578, 26 September 2011 © 2011 to the American Medical Association
Coffee, Caffeine, and Risk of Depression Among Women. Michel Lucas, Fariba Mirzaei, An Pan, et al.

Background  Caffeine is the world's most widely used central nervous system stimulant, with approximately 80% consumed in the form of coffee. However, studies that analyze prospectively the relationship between coffee or caffeine consumption and depression risk are scarce.
Methods  A total of 50 739 US women (mean age, 63 years) free of depressive symptoms at baseline (in 1996) were prospectively followed up through June 1, 2006. Consumption of caffeine was measured from validated questionnaires completed from May 1, 1980, through April 1, 2004, and computed as cumulative mean consumption with a 2-year latency period applied. Clinical depression was defined as self-reported physician-diagnosed depression and antidepressant use. Relative risks of clinical depression were estimated using Cox proportional hazards regression models.
Results  During 10 years of follow-up (1996-2006), 2607 incident cases of depression were identified. Compared with women consuming 1 or less cup of caffeinated coffee per week, the multivariate relative risk of depression was 0.85 (95% confidence interval, 0.75-0.95) for those consuming 2 to 3 cups per day and 0.80 (0.64-0.99; P for trend <.001) for those consuming 4 cups per day or more. Multivariate relative risk of depression was 0.80 (95% confidence interval, 0.68-0.95; Pfor trend = .02) for women in the highest (550 mg/d) vs lowest (<100 mg/d) of the 5 caffeine consumption categories. Decaffeinated coffee was not associated with depression risk.
Conclusions  In this large longitudinal study, we found that depression risk decreases with increasing caffeinated coffee consumption. Further investigations are needed to confirm this finding and to determine whether usual caffeinated coffee consumption can contribute to depression prevention.

Glycaemic control and incidence of heart failure

Kontrol glikemik (kadar HbA1c) berhubungan dengan risiko gagal jantung pada pasien DM tipe 1

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The Lancet 378(9786):140-146, 9 July 2011 © 2011 Elsevier Limited
Glycaemic control and incidence of heart failure in 20,985 patients with type 1 diabetes: an observational study.

Marcus Lind, Ioannis Bounias, Marita Olsson et al.

Background
Poor glycaemic control is associated with microvascular and macrovascular complications in type 1 diabetes, but whether glycaemic control is associated with heart failure in such patients is not known. We aimed to assess this association in a large cohort of patients with type 1 diabetes identified from the Swedish national diabetes registry.
Methods
We identified all patients (aged ≥18 years) with type 1 diabetes and no known heart failure who were registered in the national diabetes registry between January, 1998, and December, 2003. These patients were followed up until hospital admission for heart failure, death, or end of follow-up on Dec 31, 2009. We calculated incidence categorised by glycated haemoglobin A1c (HbA1c) values, and we assessed the association between patients' characteristics, including HbA1c, and heart failure.
Findings
In a cohort of 20 985 patients with mean age of 38·6 years (SD 13·3) at baseline, 635 patients (3%) were admitted to hospital with a primary or secondary diagnosis of heart failure during a median follow-up of 9·0 years (IQR 7·3—11·0), with an incidence of 3·38 events per 1000 patient-years (95% CI 3·12—3·65). Incidence increased monotonically with HbA1c, with a range of 1·42—5·20 per 1000 patient-years between patients in the lowest (<6·5%) and highest (≥10·5%) categories of HbA1c. In a Cox regression analysis, with adjustment for age, sex, duration of diabetes, cardiovascular risk factors, and baseline or intervening acute myocardial infarction and other comorbidities, the hazard ratio for development of heart failure was 3·98 (95% CI 2·23—7·14) in patients with HbA1c of 10·5% or higher compared with a reference group of patients with HbA1c of less than 6·5%. Risk of heart failure increased with age and duration of diabetes. Other modifiable factors associated with increased risk of heart failure were smoking, high systolic blood pressure, and raised body-mass index. In a subgroup of 18 281 patients (87%) with data for blood lipids, higher HDL cholesterol was associated with lower risk of heart failure, but there was no association with LDL cholesterol.
Interpretation
The positive association between HbA1c and risk of heart failure in fairly young patients with type 1 diabetes indicates a potential for prevention of heart failure with improved glycaemic control.

Chocolate consumption and cardiometabolic disorders

Konsumsi coklat menurunkan risiko penyakit jantung dan stroke.

Perlu diperjelas jenis coklat apa yang membawa efek baik.

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BMJ 343:d4488, 29 August 2011 © 2011 BMJ Publishing Group Ltd.
Chocolate consumption and cardiometabolic disorders: systematic review and meta-analysis.

driana Buitrago-Lopez, Jean Sanderson, Laura Johnson, et al.

Abstract

Objective To evaluate the association of chocolate consumption with the risk of developing cardiometabolic disorders.
Design Systematic review and meta-analysis of randomised controlled trials and observational studies.
Data sources Medline, Embase, Cochrane Library, PubMed, CINAHL, IPA, Web of Science, Scopus, Pascal, reference lists of relevant studies to October 2010, and email contact with authors.
Study selection Randomised trials and cohort, case-control, and cross sectional studies carried out in human adults, in which the association between chocolate consumption and the risk of outcomes related to cardiometabolic disorders were reported.
Data extraction Data were extracted by two independent investigators, and a consensus was reached with the involvement of a third. The primary outcome was cardiometabolic disorders, including cardiovascular disease (coronary heart disease and stroke), diabetes, and metabolic syndrome. A meta-analysis assessed the risk of developing cardiometabolic disorders by comparing the highest and lowest level of chocolate consumption.
Results From 4576 references seven studies met the inclusion criteria (including 114 009 participants). None of the studies was a randomised trial, six were cohort studies, and one a cross sectional study. Large variation was observed between these seven studies for measurement of chocolate consumption, methods, and outcomes evaluated. Five of the seven studies reported a beneficial association between higher levels of chocolate consumption and the risk of cardiometabolic disorders. The highest levels of chocolate consumption were associated with a 37% reduction in cardiovascular disease (relative risk 0.63 (95% confidence interval 0.44 to 0.90)) and a 29% reduction in stroke compared with the lowest levels.
Conclusions Based on observational evidence, levels of chocolate consumption seem to be associated with a substantial reduction in the risk of cardiometabolic disorders. Further experimental studies are required to confirm a potentially beneficial effect of chocolate consumption.

Dietary fiber intake and risk of breast cancer

Meningkatkan asupan serat dapat menurunkan risiko kanker payudara

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American Journal of Clinical Nutrition 94(3):900-905, September 2011 © 2011 American Society for Nutrition
Dietary fiber intake and risk of breast cancer: a meta- analysis of prospective cohort studies.

Jia-Yi Dong, Ka He, Peiyu Wang, and Li-Qiang Qin.

Background: Observational and preclinical studies suggest that dietary fiber intake may reduce the risk of breast cancer, but the results are inconclusive.
Objective: We aimed to examine the association between dietary fiber intake and risk of breast cancer by conducting a meta-analysis of prospective cohort studies.
Design: Relevant studies were identified by a PubMed database search through January 2011. Reference lists from retrieved articles were also reviewed. We included prospective cohort studies that reported RRs with 95% CIs for the association between dietary fiber intake and breast cancer risk. Both fixed- and random-effects models were used to calculate the summary risk estimates.
Results: We identified 10 prospective cohort studies of dietary fiber intake and risk of breast cancer involving 16,848 cases and 712,195 participants. The combined RR of breast cancer for the highest compared with the lowest dietary fiber intake was 0.89 (95% CI: 0.83, 0.96), and little evidence of heterogeneity was observed. The association between dietary fiber intake and risk of breast cancer did not significantly differ by geographic region, length of follow-up, or menopausal status of the participants. Omission of any single study had little effect on the combined risk estimate. Dose-response analysis showed that every 10-g/d increment in dietary fiber intake was associated with a significant 7% reduction in breast cancer risk. Little evidence of publication bias was found.
Conclusion: This meta-analysis provides evidence of a significant inverse dose-response association between dietary fiber intake and breast cancer risk.

Effect of Dietary Protein Supplementation on Blood Pressure

Protein dari kedele maupun susu dapat menurunkan tekanan sistolik pada pasien pre-hipertensi dan hipertensi stage 1.

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Circulation 124(5):589-595, 2 August 2011 © 2011 American Heart Association, Inc.
Effect of Dietary Protein Supplementation on Blood Pressure.

Jiang He, Marion R. Wofford, Kristi Reynolds, et al.

Background—Observational studies have reported an inverse association between dietary protein intake and blood pressure (BP). We compared the effect of soy protein, milk protein, and carbohydrate supplementation on BP among healthy adults.
Methods and Results—We conducted a randomized, double-blind crossover trial with 3 intervention phases among 352 adults with prehypertension or stage 1 hypertension in New Orleans, LA, and Jackson, MS, from September 2003 to April 2008. The trial participants were assigned to take 40 g/d soy protein, milk protein, or carbohydrate supplementation each for 8 weeks in a random order. A 3-week washout period was implemented between the interventions. Three BPs were measured at 2 baseline and 2 termination visits during each of 3 intervention phases with a random-zero sphygmomanometer. Compared with carbohydrate controls, soy protein and milk protein supplementations were significantly associated with −2.0 mm Hg (95% confidence interval −3.2 to −0.7 mm Hg,P=0.002) and −2.3 mm Hg (−3.7 to −1.0 mm Hg, P=0.0007) net changes in systolic BP, respectively. Diastolic BP was also reduced, but this change did not reach statistical significance. There was no significant difference in the BP reductions achieved between soy or milk protein supplementation.
Conclusions—The results from this randomized, controlled trial indicate that both soy and milk protein intake reduce systolic BP compared with a high-glycemic-index refined carbohydrate among patients with prehypertension and stage 1 hypertension. Furthermore, these findings suggest that partially replacing carbohydrate with soy or milk protein might be an important component of nutrition intervention strategies for the prevention and treatment of hypertension.

Intake of Probiotic Food and Risk of Preeclampsia in Primiparous Women

Penilitian kohort di Norwegia mendapatkan bahwa asupan probiotik setiap hari berhubungan dengan penurunan risiko pre-eklampsia pada primipara

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Am J Epidemiol published online 5 August 2011 ©
Intake of Probiotic Food and Risk of Preeclampsia in Primiparous Women: The Norwegian Mother and Child Cohort Study.

Anne Lise Brantsæter, Ronny Myhre, Margaretha Haugen et al.

 

Abstract

Probiotics have been suggested to modify placental trophoblast inflammation, systemic inflammation, and blood pressure, all potentially interesting aspects of preeclampsia. The authors examined the association between consumption of milk-based probiotic products in pregnancy and development of preeclampsia and its subtypes. The study was performed in the Norwegian Mother and Child Cohort Study by using a prospective design in 33,399 primiparous women in the years 2002–2008. The intake of milk-based products containing probiotic lactobacilli was estimated from a self-reported food frequency questionnaire. Preeclampsia diagnoses were obtained from the Norwegian Medical Birth Registry. Intake of probiotic milk products was associated with reduced risk of preeclampsia. The association was most prominent in severe preeclampsia (adjusted odds ratio (OR) = 0.79, 95% confidence interval (CI): 0.66, 0.96). With probiotic intakes divided into categories representing no, monthly, weekly, or daily intake, a lower risk for preeclampsia (all subtypes) was observed for daily probiotic intake (OR = 0.80, 95% CI: 0.66, 0.96). Lower risks for severe preeclampsia were observed for weekly (OR = 0.75, 95% CI: 0.57, 0.98) and daily (OR = 0.61, 95% CI: 0.43, 0.89) intakes. These results suggest that regular consumption of milk-based probiotics could be associated with lower risk of preeclampsia in primiparous women.

Effect of a Dietary Portfolio of Cholesterol-Lowering Foods

JAMA 306(8):831-839, 24 August 2011 © 2011 American Medical Association
Effect of a Dietary Portfolio of Cholesterol-Lowering Foods Given at 2 Levels of Intensity of Dietary Advice on Serum Lipids in Hyperlipidemia.

David J. A. Jenkins, Peter J. H. Jones, Benoit Lamarche, et al.

 

Context Combining foods with recognized cholesterol-lowering properties (dietary portfolio) has proven highly effective in lowering serum cholesterol under metabolically controlled conditions.

Abstract

 

Objective To assess the effect of a dietary portfolio administered at 2 levels of intensity on percentage change in low-density lipoprotein cholesterol (LDL-C) among participants following self-selected diets.
Design, Setting, and Participants A parallel-design study of 351 participants with hyperlipidemia from 4 participating academic centers across Canada (Quebec City, Toronto, Winnipeg, and Vancouver) randomized between June 25, 2007, and February 19, 2009, to 1 of 3 treatments lasting 6 months.
Intervention Participants received dietary advice for 6 months on either a low− saturated fat therapeutic diet (control) or a dietary portfolio, for which counseling was delivered at different frequencies, that emphasized dietary incorporation of plant sterols, soy protein, viscous fibers, and nuts. Routine dietary portfolio involved 2 clinic visits over 6 months and intensive dietary portfolio involved 7 clinic visits over 6 months.
Main Outcome Measures Percentage change in serum LDL-C.
Results In the modified intention-to-treat analysis of 345 participants, the overall attrition rate was not significantly different between treatments (18% for intensive dietary portfolio, 23% for routine dietary portfolio, and 26% for control; Fisher exact test, P = .33). The LDL-C reductions from an overall mean of 171 mg/dL (95% confidence interval [CI], 168-174 mg/dL) were −13.8% (95% CI, −17.2% to −10.3%; P < .001) or −26 mg/dL (95% CI, −31 to −21 mg/dL; P < .001) for the intensive dietary portfolio; −13.1% (95% CI, −16.7% to −9.5%; P < .001) or –24 mg/dL (95% CI, −30 to −19 mg/dL; P < .001) for the routine dietary portfolio; and −3.0% (95% CI, −6.1% to 0.1%; P = .06) or −8 mg/dL (95% CI, −13 to −3 mg/dL; P = .002) for the control diet. Percentage LDL-C reductions for each dietary portfolio were significantly more than the control diet (P < .001, respectively). The 2 dietary portfolio interventions did not differ significantly (P = .66). Among participants randomized to one of the dietary portfolio interventions, percentage reduction in LDL-C on the dietary portfolio was associated with dietary adherence (r = −0.34, n = 157, P < .001).
Conclusion Use of a dietary portfolio compared with the low−saturated fat dietary advice resulted in greater LDL-C lowering during 6 months of follow-up.

Red meat consumption and risk of type 2 diabetes

Konsumsi daging merah berhubungan dengan peningkatan risiko diabetes tipe 2.

Mengubah asupan protein dari daging menjadi kacang2an, low fat dairy, dan biji2an menurunkan risiko diabetes tipe 2 sebesar 16-35%

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Am J Clin Nutr October 2011 © 2011 American Society for Nutrition
Red meat consumption and risk of type 2 diabetes:

3 cohorts of US adults and an updated meta-analysis. An Pan, Qi Sun, Adam M Bernstein, Matthias B Schulze et al.

Abstract

Background: The relation between consumption of different types of red meats and risk of type 2 diabetes (T2D) remains uncertain.
Objective: We evaluated the association between unprocessed and processed red meat consumption and incident T2D in US adults.
Design: We followed 37,083 men in the Health Professionals Follow-Up Study (1986–2006), 79,570 women in the Nurses' Health Study I (1980–2008), and 87,504 women in the Nurses' Health Study II (1991–2005). Diet was assessed by validated food-frequency questionnaires, and data were updated every 4 y. Incident T2D was confirmed by a validated supplementary questionnaire.
Results: During 4,033,322 person-years of follow-up, we documented 13,759 incident T2D cases. After adjustment for age, BMI, and other lifestyle and dietary risk factors, both unprocessed and processed red meat intakes were positively associated with T2D risk in each cohort (all P-trend <0.001). The pooled HRs (95% CIs) for a one serving/d increase of unprocessed, processed, and total red meat consumption were 1.12 (1.08, 1.16), 1.32 (1.25, 1.40), and 1.14 (1.10, 1.18), respectively. The results were confirmed by a meta-analysis (442,101 participants and 28,228 diabetes cases): the RRs (95% CIs) were 1.19 (1.04, 1.37) and 1.51 (1.25, 1.83) for 100 g of unprocessed red meat and for 50 g of unprocessed red meat, respectively. We estimated that substitutions of one serving of nuts, low-fat dairy, and whole grains per day for one serving of red meat per day were associated with a 16–35% lower risk of T2D.
Conclusion: Our results suggest that red meat consumption, particularly processed red meat, is associated with an increased risk of T2D.

Early or late parenteral nutrition ?

Early or late parenteral nutrition ?

 

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Abstract

 

N Engl J Med 2011; 365:506-517

Early versus Late Parenteral Nutrition in Critically Ill Adults
Michael P. Casaer, M.D., Dieter Mesotten, M.D., Ph.D., Greet Hermans, M.D., Ph.D., Pieter J. Wouters, R.N., M.Sc., Miet Schetz, M.D., Ph.D., Geert Meyfroidt, M.D., Ph.D., Sophie Van Cromphaut, M.D., Ph.D., Catherine Ingels, M.D., Philippe Meersseman, M.D., Jan Muller, M.D., Dirk Vlasselaers, M.D., Ph.D., Yves Debaveye, M.D., Ph.D., Lars Desmet, M.D., Jasperina Dubois, M.D., Aime Van Assche, M.D., Simon Vanderheyden, B.Sc., Alexander Wilmer, M.D., Ph.D., and Greet Van den Berghe, M.D., Ph.D.

BACKGROUND
Controversy exists about the timing of the initiation of parenteral nutrition in critically ill adults in whom caloric targets cannot be met by enteral nutrition alone.
METHODS
In this randomized, multicenter trial, we compared early initiation of parenteral nutrition (European guidelines) with late initiation (American and Canadian guidelines) in adults in the intensive care unit (ICU) to supplement insufficient enteral nutrition. In 2312 patients, parenteral nutrition was initiated within 48 hours after ICU admission (early-initiation group), whereas in 2328 patients, parenteral nutrition was not initiated before day 8 (late-initiation group). A protocol for the early initiation of enteral nutrition was applied to both groups, and insulin was infused to achieve normoglycemia.
RESULTS
Patients in the late-initiation group had a relative increase of 6.3% in the likelihood of being discharged alive earlier from the ICU (hazard ratio, 1.06; 95% confidence interval [CI], 1.00 to 1.13; P=0.04) and from the hospital (hazard ratio, 1.06; 95% CI, 1.00 to 1.13; P=0.04), without evidence of decreased functional status at hospital discharge. Rates of death in the ICU and in the hospital and rates of survival at 90 days were similar in the two groups. Patients in the late-initiation group, as compared with the early-initiation group, had fewer ICU infections (22.8% vs. 26.2%, P=0.008) and a lower incidence of cholestasis (P<0.001). The late-initiation group had a relative reduction of 9.7% in the proportion of patients requiring more than 2 days of mechanical ventilation (P=0.006), a median reduction of 3 days in the duration of renal-replacement therapy (P=0.008), and a mean reduction in health care costs of €1,110 (about $1,600) (P=0.04).
CONCLUSIONS
Late initiation of parenteral nutrition was associated with faster recovery and fewer complications, as compared with early initiation.

Midlife overweight and obesity increase late-life dementia risk

Overweight dan obesitas meningkatkan risiko dementia, penyakit Alzheimer, dan dementia vaskuler. Faktor genetik dan lingkungan pada tahun awal kehidupan juga berperan.

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Neurology 76(18):1568-1574, 3 May 2011 © 2011 by AAN Enterprises, Inc.
Midlife overweight and obesity increase late-life dementia risk. W.L. Xu, A.R. Atti, M. Gatz, N.L. Pedersen, B. Johansson, and L. Fratiglioni.

Objective: The relation of overweight to dementia is controversial. We aimed to examine the association of midlife overweight and obesity with dementia, Alzheimer disease (AD), and vascular dementia (VaD) in late life, and to verify the hypothesis that genetic and early-life environmental factors contribute to the observed association.
Methods: From the Swedish Twin Registry, 8,534 twin individuals aged ≥65 (mean age 74.4) were assessed to detect dementia cases (DSM-IV criteria). Height and weight at midlife (mean age 43.4) were available in the Registry. Data were analyzed as follows: 1) unmatched case-control analysis for all twins using generalized estimating equation (GEE) models and 2) cotwin matched case-control approach for dementia-discordant twin pairs by conditional logistic regression taking into account lifespan vascular disorders and diabetes.
Results: Among all participants, dementia was diagnosed in 350 subjects, and 114 persons had questionable dementia. Overweight (body mass index [BMI] >25–30) and obesity (BMI >30) at midlife were present in 2,541 (29.8%) individuals. In fully adjusted GEE models, compared with normal BMI (20–25), overweight and obesity at midlife were related to dementia with odds ratios (ORs) (95% CIs) of 1.71 (1.30–2.25) and 3.88 (2.12–7.11), respectively. Conditional logistic regression analysis in 137 dementia-discordant twin pairs led to an attenuated midlife BMI-dementia association. The difference in ORs from the GEE and the matched case-control analysis was statistically significant (p = 0.019).
Conclusions: Both overweight and obesity at midlife independently increase the risk of dementia, AD, and VaD. Genetic and early-life environmental factors may contribute to the midlife high adiposity–dementia association.

Long term effects of very low energy diet on obstructive sleep apnoea

Diet sangat rendah kalori memperbaiki apnea-hipopnea index pada penderita obstructive sleep apnoea (OSA)

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BMJ 342:d3017, 1 June 2011 © 2011 BMJ Publishing Group Ltd.
Longer term effects of very low energy diet on obstructive sleep apnoea in cohort derived from randomised controlled trial: prospective observational follow-up study.

Kari Johansson, Erik Hemmingsson, Richard Harlid, et al..

Abstract

Objective To determine whether initial improvements in obstructive sleep apnoea after a very low energy diet were maintained after one year in patients with moderate to severe obstructive sleep apnoea.
Design Single centre, prospective observational follow-up study.
Setting Outpatient obesity clinic in a university hospital in Stockholm, Sweden.
Participants 63 men aged 30-65 with body mass index (BMI) 30-40 and moderate to severe obstructive sleep apnoea defined as an apnoea-hypopnoea index ≥15 (events/hour), all treated with continuous positive airway pressure.
Intervention A one year weight loss programme, consisting of an initial very low energy diet for nine weeks (seven weeks of 2.3 MJ/day and two weeks of gradual introduction of normal food) followed by a weight loss maintenance programme.
Main outcome measure Apnoea-hypopnoea index, the main index for severity of obstructive sleep apnoea. Data from all patients were analysed (baseline carried forward for missing data).
Results Of 63 eligible patients, 58 completed the very low energy diet period and started the weight maintenance programme and 44 completed the full programme; 49 had complete measurements at one year. At baseline the mean apnoea-hypopnoea index was 36 events/hour. After the very low energy diet period, apnoea-hypopnoea index was improved by −21 events/hour (95% confidence interval −17 to −25) and weight by −18 kg (−16 to −19; both P<0.001). After one year the apnoea-hypopnoea index had improved by −17 events/hour (−13 to −21) and body weight by −12 kg (−10 to −14) compared with baseline (both P<0.001). Patients with severe obstructive sleep apnoea at baseline had greater improvements in apnoea-hypopnoea index (−25 events/hour) compared with patients with moderate disease (−7 events/hour, P<0.001). At one year, 30/63 (48%, 95% confidence interval 35% to 60%) no longer required continuous positive airway pressure and 6/63 (10%, 2% to 17%) had total remission of obstructive sleep apnoea (apnoea-hypopnoea index <5 events/hour). There was a dose-response association between weight loss and apnoea-hypopnoea index at follow-up (β=0.50 events/kg, 0.11 to 0.88; P=0.013).
Conclusion Initial improvements in obstructive sleep apnoea after treatment with a very low energy diet can be maintained after one year in obese men with moderate to severe disease. Those who lose the most weight or have severe sleep apnoea at baseline benefit most.

Video game playing increases food intake in adolescents

Main video game meningkatkan nafsu makan pada remaja

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American Journal of Clinical Nutrition © 2011 to American Society for Nutrition
Video game playing increases food intake in adolescents: a randomized crossover study.

Jean-Philippe Chaput, Trine Visby, Signe Nyby, et al.

Background: Video game playing has been linked to obesity in many observational studies. However, the influence of this sedentary activity on food intake is unknown.
Objective: The objective was to examine the acute effects of sedentary video game play on various components of energy balance.
Design: With the use of a randomized crossover design, 22 healthy, normal-weight, male adolescents (mean ± SD age: 16.7 ± 1.1 y) completed two 1-h experimental conditions, namely video game play and rest in a sitting position, followed by an ad libitum lunch. The endpoints were spontaneous food intake, energy expenditure, stress markers, appetite sensations, and profiles of appetite-related hormones.
Results: Heart rate, systolic and diastolic blood pressures, sympathetic tone, and mental workload were significantly higher during the video game play condition than during the resting condition (P < 0.05). Although energy expenditure was significantly higher during video game play than during rest (mean increase over resting: 89 kJ; P < 0.01), ad libitum energy intake after video game play exceeded that measured after rest by 335 kJ (P < 0.05). A daily energy surplus of 682 kJ (163 kcal) over resting (P < 0.01) was observed in the video game play condition. The increase in food intake associated with video game play was observed without increased sensations of hunger and was not compensated for during the rest of the day. Finally, the profiles of glucose, insulin, cortisol, and ghrelin did not suggest an up-regulation of appetite during the video game play condition.
Conclusion: A single session of video game play in healthy male adolescents is associated with an increased food intake, regardless of appetite sensations.

Selenium and the Course of Mild Graves' Orbitopathy

Pemberian selenium pada pasien Grave's memperbaiki kualitas hidup, mengurangi orbitopati, dan memperlambat perjalanan penyakit.

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Selenium and the Course of Mild Graves' Orbitopathy
Claudio Marcocci, M.D., George J. Kahaly, M.D., Gerasimos E. Krassas, M.D., Luigi Bartalena, M.D., Mark Prummel, M.D., Matthias Stahl, M.D., Maria Antonietta Altea, M.D., Marco Nardi, M.D., Susanne Pitz, M.D., Kostas Boboridis, M.D., Paolo Sivelli, M.D., George von Arx, M.D., Maarten P. Mourits, M.D., Lelio Baldeschi, M.D., Walter Bencivelli, Ph.D., and Wilmar Wiersinga, M.D. for the European Group on Graves' Orbitopathy
N Engl J Med 2011; 364:1920-1931

BACKGROUND
Oxygen free radicals and cytokines play a pathogenic role in Graves' orbitopathy.
METHODS
We carried out a randomized, double-blind, placebo-controlled trial to determine the effect of selenium (an antioxidant agent) or pentoxifylline (an antiinflammatory agent) in 159 patients with mild Graves' orbitopathy. The patients were given selenium (100 μg twice daily), pentoxifylline (600 mg twice daily), or placebo (twice daily) orally for 6 months and were then followed for 6 months after treatment was withdrawn. Primary outcomes at 6 months were evaluated by means of an overall ophthalmic assessment, conducted by an ophthalmologist who was unaware of the treatment assignments, and a Graves' orbitopathy–specific quality-of-life questionnaire, completed by the patient. Secondary outcomes were evaluated with the use of a Clinical Activity Score and a diplopia score.
RESULTS
At the 6-month evaluation, treatment with selenium, but not with pentoxifylline, was associated with an improved quality of life (P<0.001) and less eye involvement (P=0.01) and slowed the progression of Graves' orbitopathy (P=0.01), as compared with placebo. The Clinical Activity Score decreased in all groups, but the change was significantly greater in the selenium-treated patients. Exploratory evaluations at 12 months confirmed the results seen at 6 months. Two patients assigned to placebo and one assigned to pentoxifylline required immunosuppressive therapy for deterioration in their condition. No adverse events were evident with selenium, whereas pentoxifylline was associated with frequent gastrointestinal problems.
CONCLUSIONS
Selenium administration significantly improved quality of life, reduced ocular involvement, and slowed progression of the disease in patients with mild Graves' orbitopathy.

Effects of low-dose, controlled-release, phentermine plus topiramate combination on weight and associated comorbidities in overweight and obese adults

Obat baru untuk obesitas

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The Lancet 377 (9774):1341-1352, 16 April 2011 © Elsevier Ltd
Effects of low-dose, controlled-release, phentermine plus topiramate combination on weight and associated comorbidities in overweight and obese adults (CONQUER): a randomised, placebo-controlled, phase 3 trial. Kishore M Gadde, David B Allison, Donna H Ryan et al.

Background
Obesity is associated with a reduction in life expectancy and an increase in mortality from cardiovascular diseases, cancer, and other causes. We therefore assessed the efficacy and safety of two doses of phentermine plus topiramate controlled-release combination as an adjunct to diet and lifestyle modification for weight loss and metabolic risk reduction in individuals who were overweight and obese, with two or more risk factors.
Methods
In this 56-week phase 3 trial, we randomly assigned overweight or obese adults (aged 18—70 years), with a body-mass index of 27—45 kg/m2 and two or more comorbidities (hypertension, dyslipidaemia, diabetes or prediabetes, or abdominal obesity) to placebo, once-daily phentermine 7·5 mg plus topiramate 46·0 mg, or once-daily phentermine 15·0 mg plus topiramate 92·0 mg in a 2:1:2 ratio in 93 centres in the USA. Drugs were administered orally. Patients were randomly assigned by use of a computer-generated algorithm that was implemented through an interactive voice response system, and were stratified by sex and diabetic status. Investigators, patients, and study sponsors were masked to treatment. Primary endpoints were the percentage change in bodyweight and the proportion of patients achieving at least 5% weight loss. Analysis was by intention to treat.
Findings
Of 2487 patients, 994 were assigned to placebo, 498 to phentermine 7·5 mg plus topiramate 46·0 mg, and 995 to phentermine 15·0 mg plus topiramate 92·0 mg; 979, 488, and 981 patients, respectively, were analysed. At 56 weeks, change in bodyweight was −1·4 kg (least-squares mean −1·2%, 95% CI −1·8 to −0·7), −8·1 kg (−7·8%, −8·5 to −7·1; p<0·0001), and −10·2 kg (−9·8%, −10·4 to −9·3; p<0·0001) in the patients assigned to placebo, phentermine 7·5 mg plus topiramate 46·0 mg, and phentermine 15·0 mg plus topiramate 92·0 mg, respectively. 204 (21%) patients achieved at least 5% weight loss with placebo, 303 (62%; odds ratio 6·3, 95% CI 4·9 to 8·0; p<0·0001) with phentermine 7·5 mg plus topiramate 46·0 mg, and 687 (70%; 9·0, 7·3 to 11·1; p<0·0001) with phentermine 15·0 mg plus topiramate 92·0 mg; for ≥10% weight loss, the corresponding numbers were 72 (7%), 182 (37%; 7·6, 5·6 to 10·2; p<0·0001), and 467 (48%; 11·7, 8·9 to 15·4; p<0·0001). The most common adverse events were dry mouth (24 [2%], 67 [13%], and 207 [21%] in the groups assigned to placebo, phentermine 7·5 mg plus topiramate 46·0 mg, and phentermine 15·0 mg plus topiramate 92·0 mg, respectively), paraesthesia (20 [2%], 68 [14%], and 204 [21%], respectively), constipation (59 [6%], 75 [15%], and 173 [17%], respectively), insomnia (47 [5%], 29 [6%], and 102 [10%], respectively), dizziness (31 [3%], 36 [7%], 99 [10%], respectively), and dysgeusia (11 [1%], 37 [7%], and 103 [10%], respectively). 38 (4%) patients assigned to placebo, 19 (4%) to phentermine 7·5 mg plus topiramate 46·0 mg, and 73 (7%) to phentermine 15·0 mg plus topiramate 92·0 mg had depression-related adverse events; and 28 (3%), 24 (5%), and 77 (8%), respectively, had anxiety-related adverse events.
Interpretation
The combination of phentermine and topiramate, with office-based lifestyle interventions, might be a valuable treatment for obesity that can be provided by family doctors.

Adolescent BMI Trajectory and Risk of Diabetes versus Coronary Disease

Peningkatan Index massa tubuh (IMT) pada remaja, meningkatkan risiko penyakit terkait obesitas (diabetes dan penyakit jantung koroner) di usia dewasa.

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Adolescent BMI Trajectory and Risk of Diabetes versus Coronary Disease
Amir Tirosh, M.D., Ph.D., Iris Shai, R.D., Ph.D., Arnon Afek, M.D., M.H.A., Gal Dubnov-Raz, M.D., Nir Ayalon, M.D., Barak Gordon, M.D., Estela Derazne, M.Sc., Dorit Tzur, M.B.A., Ari Shamis M.D., M.P.A., Shlomo Vinker, M.D., and Assaf Rudich, M.D., Ph.D.
N Engl J Med 2011; 364:1315-1325 April 7, 2011

BACKGROUND
The association of body-mass index (BMI) from adolescence to adulthood with obesity-related diseases in young adults has not been completely delineated.
METHODS
We conducted a prospective study in which we followed 37,674 apparently healthy young men for incident angiography-proven coronary heart disease and diabetes through the Staff Periodic Examination Center of the Israeli Army Medical Corps. The height and weight of participants were measured at regular intervals, with the first measurements taken when they were 17 years of age.
RESULTS
During approximately 650,000 person-years of follow-up (mean follow-up, 17.4 years), we documented 1173 incident cases of type 2 diabetes and 327 of coronary heart disease. In multivariate models adjusted for age, family history, blood pressure, lifestyle factors, and biomarkers in blood, elevated adolescent BMI (the weight in kilograms divided by the square of the height in meters; mean range for the first through last deciles, 17.3 to 27.6) was a significant predictor of both diabetes (hazard ratio for the highest vs. the lowest decile, 2.76; 95% confidence interval [CI], 2.11 to 3.58) and angiography-proven coronary heart disease (hazard ratio, 5.43; 95% CI, 2.77 to 10.62). Further adjustment for BMI at adulthood completely ablated the association of adolescent BMI with diabetes (hazard ratio, 1.01; 95% CI, 0.75 to 1.37) but not the association with coronary heart disease (hazard ratio, 6.85; 95% CI, 3.30 to 14.21). After adjustment of the BMI values as continuous variables in multivariate models, only elevated BMI in adulthood was significantly associated with diabetes (β=1.115, P=0.003; P=0.89 for interaction). In contrast, elevated BMI in both adolescence (β=1.355, P=0.004) and adulthood (β=1.207, P=0.03) were independently associated with angiography-proven coronary heart disease (P=0.048 for interaction).
CONCLUSIONS
An elevated BMI in adolescence — one that is well within the range currently considered to be normal — constitutes a substantial risk factor for obesity-related disorders in midlife. Although the risk of diabetes is mainly associated with increased BMI close to the time of diagnosis, the risk of coronary heart disease is associated with an elevated BMI both in adolescence and in adulthood, supporting the hypothesis that the processes causing incident coronary heart disease, particularly atherosclerosis, are more gradual than those resulting in incident diabetes. (Funded by the Chaim Sheba Medical Center and the Israel Defense Forces Medical Corps.)

Serum 25-hydroxyvitamin D and glycated haemoglobin levels in women with gestational diabetes mellitus

Kurang vitamin D pada ibu hamil menyebabkan diabetes mellitus pada kehamilan

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MJA 194(7):334-337, 4 April 2011 © The Medical Journal of Australia 2011
Serum 25-hydroxyvitamin D and glycated haemoglobin levels in women with gestational diabetes mellitus. Sue Lynn Lau, Jenny E Gunton, Neil P Athayde, Karen Byth and N Wah Cheung.

Abstract
Objective: To test the hypothesis that lower 25-hydroxyvitamin D (25[OH]D) levels in late pregnancy are associated with poorer glucose control in gestational diabetes mellitus (GDM).
Design and setting: Retrospective cross-sectional study, in a GDM clinic at a tertiary referral centre.
Patients: Women attending the GDM clinic at Westmead Hospital from 1 February 2007 to 1 February 2008, excluding those with prepregnancy glucose intolerance.
Main outcome measures: Levels of glycated haemoglobin (HbA1c) and 25(OH)D measured during the third trimester; maternal age, ethnicity, body mass index (BMI) and occupational status; and results of oral glucose tolerance testing (OGTT).
Results: 147 women with a mean gestational age of 35 ± 2 weeks were included, of whom 41% had insufficient or deficient levels of 25(OH)D (≤ 50 nmol/L). Ethnicity, occupational status and season significantly influenced 25(OH)D levels (P < 0.01 for all) but BMI did not. 25(OH)D levels were inversely associated with fasting and 2-hour blood glucose levels during OGTT (Spearman r = − 0.16; P = 0.05 for both) and with log[HbA1c] (Spearman r = −0.32; P < 0.001). BMI and insulin doses were also associated with HbA1c levels. Multivariable analysis identified 25(OH)D and blood glucose levels during the OGTT as independent predictors of HbA1c levels.
Conclusions: Lower 25(OH)D levels are independently associated with poorer glycaemic control. Future randomised trials are needed to determine whether vitamin D plays a role in glycaemic control in GDM. Regardless, maternal vitamin D insufficiency has adverse effects including neonatal hypocalcaemia and rickets. The 41% prevalence of inadequate 25(OH)D levels in the women in our study is unacceptably high. We propose routine 25(OH)D testing of all pregnant women at screening for GDM or earlier, and treatment of women who are found to be deficient.

National, regional, and global trends in systolic blood pressure since 1980

Tekanan darah populasi di Asia Tenggara meningkat

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The Lancet 377(9765):568-577, 12 February 2011 © 2011 Elsevier Limited
National, regional, and global trends in systolic blood pressure since 1980: systematic analysis of health examination surveys and epidemiological studies with 786 country-years and 5.4 million participants. Goodarz Danaei, Mariel M Finucane, John K Lin et al on behalf of the Global Burden of Metabolic Risk Factors of Chronic Diseases Collaborating Group (Blood Pressure).

Background
Data for trends in blood pressure are needed to understand the effects of its dietary, lifestyle, and pharmacological determinants; set intervention priorities; and evaluate national programmes. However, few worldwide analyses of trends in blood pressure have been done. We estimated worldwide trends in population mean systolic blood pressure (SBP).
Methods
We estimated trends and their uncertainties in mean SBP for adults 25 years and older in 199 countries and territories. We obtained data from published and unpublished health examination surveys and epidemiological studies (786 country-years and 5·4 million participants). For each sex, we used a Bayesian hierarchical model to estimate mean SBP by age, country, and year, accounting for whether a study was nationally representative.
Findings
In 2008, age-standardised mean SBP worldwide was 128·1 mm Hg (95% uncertainty interval 126·7—129·4) in men and 124·4 mm Hg (123·0—125·9) in women. Globally, between 1980 and 2008, SBP decreased by 0·8 mm Hg per decade (−0·4 to 2·2, posterior probability of being a true decline=0·90) in men and 1·0 mm Hg per decade (−0·3 to 2·3, posterior probability=0·93) in women. Female SBP decreased by 3·5 mm Hg or more per decade in western Europe and Australasia (posterior probabilities ≥0·999). Male SBP fell most in high-income North America, by 2·8 mm Hg per decade (1·3—4·5, posterior probability >0·999), followed by Australasia and western Europe where it decreased by more than 2·0 mm Hg per decade (posterior probabilities >0·98). SBP rose in Oceania, east Africa, and south and southeast Asia for both sexes, and in west Africa for women, with the increases ranging 0·8—1·6 mm Hg per decade in men (posterior probabilities 0·72—0·91) and 1·0—2·7 mm Hg per decade for women (posterior probabilities 0·75—0·98). Female SBP was highest in some east and west African countries, with means of 135 mm Hg or greater. Male SBP was highest in Baltic and east and west African countries, where mean SBP reached 138 mm Hg or more. Men and women in western Europe had the highest SBP in high-income regions.
Interpretation
On average, global population SBP decreased slightly since 1980, but trends varied significantly across regions and countries. SBP is currently highest in low-income and middle-income countries. Effective population-based and personal interventions should be targeted towards low-income and middle-income countries.
Funding
Funding Bill & Melinda Gates Foundation and WHO.

National, regional, and global trends in serum total cholesterol since 1980

Kadar kolesterol total orang Asia meningkat.

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The Lancet 377(9765):578-586, 12 February 2011 © 2011 Elsevier Limited
National, regional, and global trends in serum total cholesterol since 1980: systematic analysis of health examination surveys and epidemiological studies with 321 country-years and 3.0 million participants. Farshad Farzadfar, Mariel M Finucane, Goodarz Danaei et al on behalf of the Global Burden of Metabolic Risk Factors of Chronic Diseases Collaborating Group (Cholesterol).

Background
Data for trends in serum cholesterol are needed to understand the effects of its dietary, lifestyle, and pharmacological determinants; set intervention priorities; and evaluate national programmes. Previous analyses of trends in serum cholesterol were limited to a few countries, with no consistent and comparable global analysis. We estimated worldwide trends in population mean serum total cholesterol.
Methods
We estimated trends and their uncertainties in mean serum total cholesterol for adults 25 years and older in 199 countries and territories. We obtained data from published and unpublished health examination surveys and epidemiological studies (321 country-years and 3·0 million participants). For each sex, we used a Bayesian hierarchical model to estimate mean total cholesterol by age, country, and year, accounting for whether a study was nationally representative.
Findings
In 2008, age-standardised mean total cholesterol worldwide was 4·64 mmol/L (95% uncertainty interval 4·51—4·76) for men and 4·76 mmol/L (4·62—4·91) for women. Globally, mean total cholesterol changed little between 1980 and 2008, falling by less than 0·1 mmol/L per decade in men and women. Total cholesterol fell in the high-income region consisting of Australasia, North America, and western Europe, and in central and eastern Europe; the regional declines were about 0·2 mmol/L per decade for both sexes, with posterior probabilities of these being true declines 0·99 or greater. Mean total cholesterol increased in east and southeast Asia and Pacific by 0·08 mmol/L per decade (−0·06 to 0·22, posterior probability=0·86) in men and 0·09 mmol/L per decade (−0·07 to 0·26, posterior probability=0·86) in women. Despite converging trends, serum total cholesterol in 2008 was highest in the high-income region consisting of Australasia, North America, and western Europe; the regional mean was 5·24 mmol/L (5·08—5·39) for men and 5·23 mmol/L (5·03—5·43) for women. It was lowest in sub-Saharan Africa at 4·08 mmol/L (3·82—4·34) for men and 4·27 mmol/L (3·99—4·56) for women.
Interpretation
Nutritional policies and pharmacological interventions should be used to accelerate improvements in total cholesterol in regions with decline and to curb or prevent the rise in Asian populations and elsewhere. Population-based surveillance of cholesterol needs to be improved in low-income and middle-income countries.
Funding
Bill & Melinda Gates Foundation and WHO.

Timing of Solid Food Introduction and Risk of Obesity in Preschool-Aged Children

Menyapih bayi dengan makanan padat terlalu awal meningkatkan risiko obesitas saat usia 3 tahun.

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Pediatrics 127(23):e544-e551, March 2011 © 2011 American Academy of Pediatrics
Timing of Solid Food Introduction and Risk of Obesity in Preschool-Aged Children.

Susanna Y. Huh, Sheryl L. Rifas-Shiman, Elsie M. Taveras, Emily Oken, Matthew W. Gillman.

OBJECTIVE To examine the association between timing of introduction of solid foods during infancy and obesity at 3 years of age.
METHODS We studied 847 children in Project Viva, a prospective pre-birth cohort study. The primary outcome was obesity at 3 years of age (BMI for age and gender 95th percentile). The primary exposure was the timing of introduction of solid foods, categorized as <4, 4 to 5, and 6 months. We ran separate logistic regression models for infants who were breastfed for at least 4 months("breastfed") and infants who were never breastfed or stopped breastfeeding before the age of four months ("formula-fed"), adjusting for child and maternal characteristics, which included change in weight-for-age zscore from 0 to 4 months–a marker of early infant growth.
RESULTS In the first 4 months of life, 568 infants (67%) were breastfed and 279 (32%) were formula-fed. At age 3 years, 75 children (9%) were obese. Among breastfed infants, the timing of solid food introduction was not associated with odds of obesity (odds ratio: 1.1 [95% confidence interval: 0.3–4.4]). Among formula-fed infants, introduction of solid foods before 4 months was associated with a sixfold increase in odds of obesity at age 3 years; the association was not explained by rapid early growth (odds ratio after adjustment: 6.3 [95% confidence interval: 2.3–6.9]).
CONCLUSIONS Among formula-fed infants or infants weaned before the age of 4 months, introduction of solid foods before the age of 4 months was associated with increased odds of obesity at age 3 years.

Effects of a restricted elimination diet on the behaviour of children with attention-deficit hyperactivity disorder (INCA study): a randomised controlled trial

Diet memperbaiki ARS skor pada anak penderita ADHD

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The Lancet 377(9764):494-503, 5 February 2011
Effects of a restricted elimination diet on the behaviour of children with attention-deficit hyperactivity disorder (INCA study): a randomised controlled trial.
Lidy M Pelsser, Klaas Frankena, Jan Toorman et al.

Background
The effects of a restricted elimination diet in children with attention-deficit hyperactivity disorder (ADHD) have mainly been investigated in selected subgroups of patients. We aimed to investigate whether there is a connection between diet and behaviour in an unselected group of children.
Methods
The Impact of Nutrition on Children with ADHD (INCA) study was a randomised controlled trial that consisted of an open-label phase with masked measurements followed by a double-blind crossover phase. Patients in the Netherlands and Belgium were enrolled via announcements in medical health centres and through media announcements. Randomisation in both phases was individually done by random sampling. In the open-label phase (first phase), children aged 4—8 years who were diagnosed with ADHD were randomly assigned to 5 weeks of a restricted elimination diet (diet group) or to instructions for a healthy diet (control group). Thereafter, the clinical responders (those with an improvement of at least 40% on the ADHD rating scale [ARS]) from the diet group proceeded with a 4-week double-blind crossover food challenge phase (second phase), in which high-IgG or low-IgG foods (classified on the basis of every child's individual IgG blood test results) were added to the diet. During the first phase, only the assessing paediatrician was masked to group allocation. During the second phase (challenge phase), all persons involved were masked to challenge allocation. Primary endpoints were the change in ARS score between baseline and the end of the first phase (masked paediatrician) and between the end of the first phase and the second phase (double-blind), and the abbreviated Conners' scale (ACS) score (unmasked) between the same timepoints. Secondary endpoints included food-specific IgG levels at baseline related to the behaviour of the diet group responders after IgG-based food challenges. The primary analyses were intention to treat for the first phase and per protocol for the second phase. INCA is registered as an International Standard Randomised Controlled Trial, number ISRCTN 76063113.
Findings
Between Nov 4, 2008, and Sept 29, 2009, 100 children were enrolled and randomly assigned to the control group (n=50) or the diet group (n=50). Between baseline and the end of the first phase, the difference between the diet group and the control group in the mean ARS total score was 23·7 (95% CI 18·6—28·8; p<0·0001) according to the masked ratings. The difference between groups in the mean ACS score between the same timepoints was 11·8 (95% CI 9·2—14·5; p<0·0001). The ARS total score increased in clinical responders after the challenge by 20·8 (95% CI 14·3—27·3; p<0·0001) and the ACS score increased by 11·6 (7·7—15·4; p<0·0001). In the challenge phase, after challenges with either high-IgG or low-IgG foods, relapse of ADHD symptoms occurred in 19 of 30 (63%) children, independent of the IgG blood levels. There were no harms or adverse events reported in both phases.
Interpretation
A strictly supervised restricted elimination diet is a valuable instrument to assess whether ADHD is induced by food. The prescription of diets on the basis of IgG blood tests should be discouraged.

Risk of Gestational Diabetes Mellitus in Relation to Maternal Egg and Cholesterol Intake

Konsumsi telur lebih dari 3 per minggu meningkatkan risiko diabetes mellitus dalam kehamilan (gestational diabetes mellitus).

 

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Am. J. Epidemiol. (2011)doi: 10.1093/aje/kwq425

 

Risk of Gestational Diabetes Mellitus in Relation to Maternal Egg and Cholesterol Intake
Chunfang Qiu, Ihunnaya O. Frederick, Cuilin Zhang, Tanya K. Sorensen,Daniel A. Enquobahrie and Michelle A. Williams

 

Higher egg and cholesterol intakes are associated with increased risk of type 2 diabetes mellitus. However, their association with gestational diabetes mellitus (GDM) has not been evaluated. The authors assessed such associations in both a prospective cohort study (1996–2008; 3,158 participants) and a case-control study (1998–2002; 185 cases, 411 controls). A food frequency questionnaire was used to assess maternal diet. Multivariable models were used to derive relative risks and 95% confidence intervals. Compared with no egg consumption, adjusted relative risks for GDM were 0.94, 1.01, 1.12, 1.54, and 2.52 for consumption of ≤1, 2–3, 4–6, 7–9, and ≥10 eggs/week, respectively (P for trend = 0.008). Women with high egg consumption (≥7/week) had a 1.77-fold increased risk compared with women with lower consumption (95% confidence interval (CI): 1.19, 2.63). The relative risk for the highest quartile of cholesterol intake (≥294 mg/day) versus the lowest (<151 mg/day) was 2.35 (95% CI: 1.35, 4.09). In the case-control study, the adjusted odds ratio for consuming ≥7 eggs/week versus <7 eggs/week was 2.65 (95% CI: 1.48, 4.72), and the odds of GDM increased with increasing cholesterol intake (P for trend = 0.021). In conclusion, high egg and cholesterol intakes before and during pregnancy are associated with increased risk of GDM.

Association of alcohol consumption with selected cardiovascular disease outcomes: a systematic review and meta-analysis

Hasil meta analisis dari 84 studi menyimpulkan bahwa konsumsi alkohol dalam jumlah kecil menurunkan risiko penyakit kardiovaskuler

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BMJ 2011; 342:d671 doi: 10.1136/bmj.d671 (Published 22 February 2011)

Research

Association of alcohol consumption with selected cardiovascular disease outcomes: a systematic review and meta-analysis

Paul E Ronksley, doctoral student, Susan E Brien, postdoctoral fellow, Barbara J Turner, professor of medicine and director, Kenneth J Mukamal, associate professor of medicine, William A Ghali, scientific director and professor

Abstract

Objective To conduct a comprehensive systematic review and meta-analysis of studies assessing the effect of alcohol consumption on multiple cardiovascular outcomes.
Design Systematic review and meta-analysis.
Data sources A search of Medline (1950 through September 2009) and Embase (1980 through September 2009) supplemented by manual searches of bibliographies and conference proceedings.
Inclusion criteria Prospective cohort studies on the association between alcohol consumption and overall mortality from cardiovascular disease, incidence of and mortality from coronary heart disease, and incidence of and mortality from stroke.
Studies reviewed Of 4235 studies reviewed for eligibility, quality, and data extraction, 84 were included in the final analysis.
Results The pooled adjusted relative risks for alcohol drinkers relative to non-drinkers in random effects models for the outcomes of interest were 0.75 (95% confidence interval 0.70 to 0.80) for cardiovascular disease mortality (21 studies), 0.71 (0.66 to 0.77) for incident coronary heart disease (29 studies), 0.75 (0.68 to 0.81) for coronary heart disease mortality (31 studies), 0.98 (0.91 to 1.06) for incident stroke (17 studies), and 1.06 (0.91 to 1.23) for stroke mortality (10 studies). Dose-response analysis revealed that the lowest risk of coronary heart disease mortality occurred with 1–2 drinks a day, but for stroke mortality it occurred with ≤1 drink per day. Secondary analysis of mortality from all causes showed lower risk for drinkers compared with non-drinkers (relative risk 0.87 (0.83 to 0.92)).
Conclusions Light to moderate alcohol consumption is associated with a reduced risk of multiple cardiovascular outcomes.

Metabolic syndrome and cognitive decline in French elders: the Three City Study

Adakah hubungan antara sindroma metabolik dan penurunan kognitif?

Penelitian ini menyimpulkan ada hubungan bermakna antara sindroma metabolik - baik secara keseluruhan maupun komponennya (hipertrigliseridemia, kolesterol HDL rendah dan diabetes) - dengan penurunan kognitif.

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Neurology 76(6):518-525, 8 February 2011 © 2011 by AAN Enterprises, Inc.
Metabolic syndrome and cognitive decline in French elders: the Three City Study. C. Raffaitin, C. Féart, M. Le Goff.

Abstract
Objective: To examine associations between metabolic syndrome (MetS) and its individual components with risk of cognitive decline on specific cognitive functions.
Methods: Participants were 4,323 women and 2,764 men aged 65 and over enrolled in the longitudinal Three-City Study. Cognitive decline, defined as being in the worst quintile of the distribution of the difference between baseline score and either 2- or 4-year follow-up, was assessed by the Mini-Mental State Examination (MMSE, global cognitive function), the Isaacs Set Test (IST, verbal fluency), and the Benton Visual Retention Test (BVRT, visual working memory). MetS was defined by National Cholesterol Education Program–Adult Treatment Panel III criteria (at least 3 of 5 cardio-metabolic abnormalities: hypertension, high waist circumference, hypertriglyceridemia, low high-density lipoprotein [HDL] cholesterol, hyperglycemia). Proportional hazards models were adjusted for age, gender, educational level, center, baseline cognitive score, APOE4 genotype, and other potential confounders.
Results: MetS at baseline was associated with an increased risk of cognitive decline on MMSE (hazard ratio [HR] = 1.22 [1.08–1.37]; p = 0.001) and BVRT (HR = 1.13 [1.01–1.26]; p = 0.03) but not on IST (HR = 1.11 [0.95–1.29]; p = 0.18). Among MetS components, hypertriglyceridemia and low HDL cholesterol were significantly associated with higher decline on MMSE; diabetes, but not elevated fasting glycemia, was significantly associated with higher decline on BVRT and IST.
Conclusions: MetS as a whole and several of its components had a negative impact on global cognitive decline and specific cognitive functions in older persons.

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Body-Mass Index and Mortality among 1.46 Million White Adults

Penelitian ini menegaskan bahwa berat badan lebih (maupun kurang) diukur dari nilai indeks massa tubuh (IMT) meningkatkan mortalitas. Mortalitas terendah adalah IMT 20,0 sampai 24,9.

 

Namun penelitian ini adalah pada subyek Kaukasia. Bagaimana untuk orang Asia ?

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ORIGINAL ARTICLE
Body-Mass Index and Mortality among 1.46 Million White Adults
Amy Berrington de Gonzalez, D.Phil., Patricia Hartge, Sc.D., James R. Cerhan, Ph.D., Alan J. Flint, Dr.P.H., Lindsay Hannan, M.S.P.H., Robert J. MacInnis, Ph.D., Steven C. Moore, Ph.D., Geoffrey S. Tobias, B.S., Hoda Anton-Culver, Ph.D., Laura Beane Freeman, Ph.D., W. Lawrence Beeson, Dr.P.H., Sandra L. Clipp, M.P.H., Dallas R. English, Ph.D., Aaron R. Folsom, M.D., D. Michal Freedman, Ph.D., Graham Giles, Ph.D., Niclas Hakansson, Ph.D., Katherine D. Henderson, Ph.D., Judith Hoffman-Bolton, Jane A. Hoppin, Sc.D., Karen L. Koenig, Ph.D., I-Min Lee, Sc.D., Martha S. Linet, M.D., Yikyung Park, Sc.D., Gaia Pocobelli, M.S., Arthur Schatzkin, M.D., Howard D. Sesso, Sc.D., Elisabete Weiderpass, Ph.D., Bradley J. Willcox, M.D., Alicja Wolk, Dr.Med.Sci., Anne Zeleniuch-Jacquotte, M.D., Walter C. Willett, M.D., Dr.P.H., and Michael J. Thun, M.D.
N Engl J Med 2010; 363:2211-2219

BACKGROUND
A high body-mass index (BMI, the weight in kilograms divided by the square of the height in meters) is associated with increased mortality from cardiovascular disease and certain cancers, but the precise relationship between BMI and all-cause mortality remains uncertain.
METHODS
We used Cox regression to estimate hazard ratios and 95% confidence intervals for an association between BMI and all-cause mortality, adjusting for age, study, physical activity, alcohol consumption, education, and marital status in pooled data from 19 prospective studies encompassing 1.46 million white adults, 19 to 84 years of age (median, 58).
RESULTS
The median baseline BMI was 26.2. During a median follow-up period of 10 years (range, 5 to 28), 160,087 deaths were identified. Among healthy participants who never smoked, there was a J-shaped relationship between BMI and all-cause mortality. With a BMI of 22.5 to 24.9 as the reference category, hazard ratios among women were 1.47 (95 percent confidence interval [CI], 1.33 to 1.62) for a BMI of 15.0 to 18.4; 1.14 (95% CI, 1.07 to 1.22) for a BMI of 18.5 to 19.9; 1.00 (95% CI, 0.96 to 1.04) for a BMI of 20.0 to 22.4; 1.13 (95% CI, 1.09 to 1.17) for a BMI of 25.0 to 29.9; 1.44 (95% CI, 1.38 to 1.50) for a BMI of 30.0 to 34.9; 1.88 (95% CI, 1.77 to 2.00) for a BMI of 35.0 to 39.9; and 2.51 (95% CI, 2.30 to 2.73) for a BMI of 40.0 to 49.9. In general, the hazard ratios for the men were similar. Hazard ratios for a BMI below 20.0 were attenuated with longer-term follow-up.
CONCLUSIONS
In white adults, overweight and obesity (and possibly underweight) are associated with increased all-cause mortality. All-cause mortality is generally lowest with a BMI of 20.0 to 24.9.