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.