Daging meningkatkan risiko jantung dan kanker

JAMA http://archinte.jamanetwork.com/issue.aspx?journalid=71&issueid=23009

Red Meat Consumption and Mortality
Results From 2 Prospective Cohort Studies

An Pan, PhD; Qi Sun, MD, ScD; Adam M. Bernstein, MD, ScD; Matthias B. Schulze, DrPH; JoAnn E. Manson, MD, DrPH; Meir J. Stampfer, MD, DrPH; Walter C. Willett, MD, DrPH; Frank B. Hu, MD, PhD

Background Red meat consumption has been associated with an increased risk of chronic diseases. However, its relationship with mortality remains uncertain.

Methods We prospectively observed 37 698 men from the Health Professionals Follow-up Study (1986-2008) and 83 644 women from the Nurses' Health Study (1980-2008) who were free of cardiovascular disease (CVD) and cancer at baseline. Diet was assessed by validated food frequency questionnaires and updated every 4 years.

Results We documented 23 926 deaths (including 5910 CVD and 9464 cancer deaths) during 2.96 million person-years of follow-up. After multivariate adjustment for major lifestyle and dietary risk factors, the pooled hazard ratio (HR) (95% CI) of total mortality for a 1-serving-per-day increase was 1.13 (1.07-1.20) for unprocessed red meat and 1.20 (1.15-1.24) for processed red meat. The corresponding HRs (95% CIs) were 1.18 (1.13-1.23) and 1.21 (1.13-1.31) for CVD mortality and 1.10 (1.06-1.14) and 1.16 (1.09-1.23) for cancer mortality. We estimated that substitutions of 1 serving per day of other foods (including fish, poultry, nuts, legumes, low-fat dairy, and whole grains) for 1 serving per day of red meat were associated with a 7% to 19% lower mortality risk. We also estimated that 9.3% of deaths in men and 7.6% in women in these cohorts could be prevented at the end of follow-up if all the individuals consumed fewer than 0.5 servings per day (approximately 42 g/d) of red meat.

Conclusions Red meat consumption is associated with an increased risk of total, CVD, and cancer mortality. Substitution of other healthy protein sources for red meat is associated with a lower mortality risk.

Meat is a major source of protein and fat in most diets. Substantial evidence from epidemiological studies shows that consumption of meat, particularly red meat, is associated with increased risks of diabetes,¹ cardiovascular disease (CVD),² and certain cancers.³ Several studies also suggest an elevated risk of mortality associated with red meat intake. A recent large cohort study⁶ with 10 years of follow-up found that a higher intake of total red meat and total processed meat was associated with an increased risk of mortality. However, this study did not differentiate unprocessed from processed red meat, and diet and other covariates were assessed at baseline only. Furthermore, to our knowledge, no study has examined whether substitution of other dietary components for red meat is associated with a reduced mortality risk.

Therefore, we investigated the association between red meat intake and cause-specific and total mortality in 2 large cohorts with repeated measures of diet and up to 28 years of follow-up: the Health Professionals Follow-up Study (HPFS) and the Nurses' Health Study (NHS). We also estimated the associations of substituting other healthy protein sources for red meat with total and cause-specific mortality.

Perubahan lifestyle mencegah penuaan, penyakit dan 'premature morbidity'

The Lancet Oncology, Volume 14, Issue 11, Pages 1112 - 1120, October 2013

Effect of comprehensive lifestyle changes on telomerase activity and
telomere length in men with biopsy-proven low-risk prostate cancer:
5-year follow-up of a descriptive pilot study

Prof Dean Ornish MD et al

Background
Telomere shortness in human beings is a prognostic marker of ageing,
disease, and premature morbidity. We previously found an association
between 3 months of comprehensive lifestyle changes and increased
telomerase activity in human immune-system cells. We followed up
participants to investigate long-term effects.

Methods
This follow-up study compared ten men and 25 external controls who had
biopsy-proven low-risk prostate cancer and had chosen to undergo active
surveillance. Eligible participants were enrolled between 2003 and 2007
from previous studies and selected according to the same criteria. Men
in the intervention group followed a programme of comprehensive
lifestyle changes (diet, activity, stress management, and social
support), and the men in the control group underwent active surveillance
alone. We took blood samples at 5 years and compared relative telomere
length and telomerase enzymatic activity per viable cell with those at
baseline, and assessed their relation to the degree of lifestyle changes.

Findings
Relative telomere length increased from baseline by a median of 0·06
telomere to single-copy gene ratio (T/S)units (IQR—0·05 to 0·11) in the
lifestyle intervention group, but decreased in the control group (−0·03
T/S units, −0·05 to 0·03, difference p=0·03). When data from the two
groups were combined, adherence to lifestyle changes was significantly
associated with relative telomere length after adjustment for age and
the length of follow-up (for each percentage point increase in lifestyle
adherence score, T/S units increased by 0·07, 95% CI 0·02—0·12,
p=0·005). At 5 years, telomerase activity had decreased from baseline by
0·25 (—2·25 to 2·23) units in the lifestyle intervention group, and by
1·08 (—3·25 to 1·86) units in the control group (p=0·64), and was not
associated with adherence to lifestyle changes (relative risk 0·93, 95%
CI 0·72—1·20, p=0·57).

Interpretation
Our comprehensive lifestyle intervention was associated with increases
in relative telomere length after 5 years of follow-up, compared with
controls, in this small pilot study. Larger randomised controlled trials
are warranted to confirm this finding.

Fitness trumps weight when it comes to the good cholesterol

There's no question that high levels of good cholesterol
- also known as high-density lipoprotein (HDL) - seem to be protective against heart disease. Rather than depositing fat into the blood vessels the way the "bad" cholesterol (low-density lipoprotein (LDL)) does, HDL appears to carry cholesterol away from blood vessels to the liver. From there, the liver processes it
for removal from the body.

However, adequate levels of HDL might not be enough. Several recent
studies have suggested that many cases of heart disease occur in people
with normal levels of HDL cholesterol. Consequently, some researchers
believe that even if people have adequate amounts of HDL cholesterol, it
might not work well. Such HDL may not fulfill this molecule's other
important duties in the body, such as reducing inflammation
and acting as an antioxidant.

Because exercise has the potential to protect against heart disease in a
variety of ways, Christian K. Roberts and his colleagues at UCLA tested
whether HDL in men who weight trained regularly behaved in a healthier
way than HDL in sedentary men. They found that the men who didn't
exercise were more likely than those who weight trained to have
dysfunctional HDL. Having faulty HDL was associated with numerous other
risk factors for heart disease, including high triglycerides and a
higher trunk fat mass. This finding held true regardless of the men's
weight, which suggests that maintaining a "healthy" weight isn't as
important for healthy cholesterol function as being active by regularly
performing strength training.

The article is entitled "Untrained Young Men Have Dysfunctional HDL
Compared to Strength Trained Men Irrespective of Body Weight Status." *
It appears in the Articles in Press section of Journal of Applied
Physiology, published by the American Physiological Society.

*Methodology*

The researchers worked with 90 men between the ages of 18 and 30 who
already had established exercise habits. They separated these
participants into three groups: lean men who weight trained at least
four times each week, overweight men who also weight trained at least
four times each week, and overweight men who had no structured exercise
regimen. The researchers took some basic physical measurements from the
volunteers, including height and weight, waist circumference, blood
pressure, and body composition. They tested the volunteers' muscle
strength and their carotid artery thickness (a sign of heart disease),
and they took a blood sample. The researchers analyzed that sample for a
variety of different molecules present, including cholesterol, insulin,
various markers for heart disease including triglycerides and C-reactive
protein, and sex hormones. They also checked the volunteers' HDL to see
how well it functioned as an antioxidant, a sign of how well their HDL
works in general.

*Results*

The study authors found that HDL functioned better in the participants
who had a regular weight-lifting program, regardless of their
weight-overweight exercisers' HDL has similar effectiveness as an
antioxidant as the lean exercisers' HDL cholesterol. Both groups' HDL
performed significantly better than those who didn't exercise. Such
dysfunctional HDL was associated with numerous other factors associated
with heart disease, such as elevated triglycerides and trunk fat mass.

*Importance of the Findings*

These findings suggest that regular weight training might improve HDL
function and protect against heart disease, even in those who remain
overweight. Although indices of weight were associated with HDL
cholesterol function, differences in fitness, the authors say, may be a
better measure of who has healthier functioning HDL cholesterol, and
therefore, who is at risk of heart disease.

"The role of obesity in the risk of coronary heart disease may indeed be
largely accounted for by differences in fitness," the authors say.

Children With Type 1 Diabetes Helped To Produce Their Own Insulin With Diet Additions

Adding foods rich in specific amino and fatty acids to the diets of youth with Type 1 diabetes kept them producing some of their own insulin for up to two years after diagnosis, said researchers at the Gillings School of Global Public Health at the University of North Carolina at Chapel Hill."

The youth still required supplemental insulin, but they may have reduced risk of diabetes complications by continuing to produce some of their own insulin, said Elizabeth Mayer-Davis, professor of nutrition at Gillings and medicine at UNC's School of Medicine, who led the study of more than 1,300 youth. "This also opens the door for a new approach that could really benefit the lives of these children."

The study, "Nutritional Factors and Preservation of C-Peptide in Youth with Recently Diagnosed Type 1 Diabetes," was published in the July 2013 issue of the journal Diabetes Care.

The participating youngsters, ranging from toddlers up to age 20, are part of a multi-center "SEARCH for Diabetes in Youth," the largest U.S. study of childhood diabetes. Mayer-Davis is national co-chair of SEARCH, funded by the national Centers for Disease Control and Prevention and the National Institutes of Health.

Type 1 diabetes is almost always diagnosed between infancy and young adulthood, according to the American Diabetes Association. The body's pancreas is unable to produce adequate amounts of the hormone insulin, required to metabolize food properly and create energy for the body's cells.

Leucine, one of the branched-chain amino acids researchers looked at, is known to stimulate secretion. It is found in dairy products, meats, soy products, eggs, nuts and products made with whole wheat. Long-chain omega-3 fatty acids are found in fatty fish such as salmon.

The researchers analyzed how much (if any) insulin the subjects were producing up to two years after their diagnosis and compared this with nutritional intake.

Mayer-Davis noted the study reflects subjects eating actual foods rich in these nutrients, not taking supplements.

Risk of hospitalization or death from ischemic heart disease among British vegetarians and nonvegetarians

Risiko kejadian penyakit jantung iskemik 32% lebih rendah pada Vegetarian dibanding non-vegetarian. Antara lain disebabkan 1.indeks massa tubuh lebih kecil ; 2.kolesterol non-HDL lebih rendah ; 3.sistolik lebih rendah.

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Risk of hospitalization or death from ischemic heart disease among British vegetarians and nonvegetarians: results from the EPIC-Oxford cohort study

Francesca L Crowe, Paul N Appleby, Ruth C Travis, and Timothy J Key

Abstract

Background: Few previous prospective studies have examined differences in incident ischemic heart disease (IHD) risk between vegetarians and nonvegetarians.
Objective: The objective was to examine the association of a vegetarian diet with risk of incident (nonfatal and fatal) IHD.
Design: A total of 44,561 men and women living in England and Scotland who were enrolled in the European Prospective Investigation into Cancer and Nutrition (EPIC)–Oxford study, of whom 34% consumed a vegetarian diet at baseline, were part of the analysis. Incident cases of IHD were identified through linkage with hospital records and death certificates. Serum lipids and blood pressure measurements were available for 1519 noncases, who were matched to IHD cases by sex and age. IHD risk by vegetarian status was estimated by using multivariate Cox proportional hazards models.
Results: After an average follow-up of 11.6 y, there were 1235 IHD cases (1066 hospital admissions and 169 deaths). Compared with nonvegetarians, vegetarians had a lower mean BMI [in kg/m2; −1.2 (95% CI: −1.3, −1.1)], non-HDL-cholesterol concentration [−0.45 (95% CI: −0.60, −0.30) mmol/L], and systolic blood pressure [−3.3 (95% CI: −5.9, −0.7) mm Hg]. Vegetarians had a 32% lower risk (HR: 0.68; 95% CI: 0.58, 0.81) of IHD than did nonvegetarians, which was only slightly attenuated after adjustment for BMI and did not differ materially by sex, age, BMI, smoking, or the presence of IHD risk factors.
Conclusion: Consuming a vegetarian diet was associated with lower IHD risk, a finding that is probably mediated by differences in non-HDL cholesterol, and systolic blood pressure.

Effect of Legumes as Part of a Low Glycemic Index Diet on Glycemic Control and Cardiovascular Risk Factors in Type 2 Diabetes Mellitus

Pada diabetesi tipe 2, konsumsi polong (low glicemic index diet) memperbaiki kontrol glikemik dan menurunkan risiko penyakit jantung koroner.

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Effect of Legumes as Part of a Low Glycemic Index Diet on Glycemic Control and Cardiovascular Risk Factors in Type 2 Diabetes Mellitus A Randomized Controlled Trial

David J. A. Jenkins, MD; Cyril W. C. Kendall, PhD; Livia S. A. Augustin, PhD; Sandra Mitchell, RD; Sandhya Sahye-Pudaruth, RD; Sonia Blanco Mejia, MD; Laura Chiavaroli, MSc; Arash Mirrahimi, MSc; Christopher Ireland, BSc; Balachandran Bashyam, PhD; Edward Vidgen, BSc; Russell J. de Souza, ScD; John L. Sievenpiper, MD; Judy Coveney, RD; Lawrence A. Leiter, MD; Robert G. Josse, MD

 

Arch Intern Med. 2012;():1-8. doi:10.1001/2013.jamainternmed.70

Background  Legumes, including beans, chickpeas, and lentils, are among the lowest glycemic index (GI) foods and have been recommended in national diabetes mellitus (DM) guidelines. Yet, to our knowledge, they have never been used specifically to lower the GI of the diet. We have therefore undertaken a study of low-GI foods in type 2 DM with a focus on legumes in the intervention.

Methods  A total of 121 participants with type 2 DM were randomized to either a low-GI legume diet that encouraged participants to increase legume intake by at least 1 cup per day, or to increase insoluble fiber by consumption of whole wheat products, for 3 months. The primary outcome was change in hemoglobin A_1c (HbA_1c) values with calculated coronary heart disease (CHD) risk score as a secondary outcome.

Results  The low-GI legume diet reduced HbA_1c values by −0.5% (95% CI, −0.6% to −0.4%) and the high wheat fiber diet reduced HbA_1c values by −0.3% (95% CI, −0.4% to −0.2%). The relative reduction in HbA_1c values after the low-GI legume diet was greater than after the high wheat fiber diet by −0.2% (95% CI, −0.3% to −0.1%; P < .001). The respective CHD risk reduction on the low-GI legume diet was −0.8% (95% CI, −1.4% to −0.3%; P = .003), largely owing to a greater relative reduction in systolic blood pressure on the low-GI legume diet compared with the high wheat fiber diet (−4.5 mm Hg; 95% CI, −7.0 to −2.1 mm Hg; P < .001).

Conclusion  Incorporation of legumes as part of a low-GI diet improved both glycemic control and reduced calculated CHD risk score in type 2 DM.

Caffeine effective as an analgesic adjuvant

Caffeine effective as an analgesic adjuvant
September 17, 2012
PEARLS 362, July 2012, written by Brian R McAvoy

Clinical question: How effective is caffeine as an analgesic adjuvant for acute pain in adults?

Bottom line: Adding caffeine (at a dose equivalent to a mug of coffee, ie, about 100mg) to a standard dose of common analgesics, such as paracetamol or ibuprofen, increased the number of people with acute pain who experience a good level of pain relief (at least 50% of the maximum) by 5 to 10% (NNT* 15). The most common conditions studied were postoperative dental pain, postpartum pain, menstrual period pain and headache. One serious adverse event was reported with caffeine but was considered unrelated to any study medication. *NNT = number needed to treat to benefit 1 individual.

Caveat: Most comparisons individually demonstrated numerical superiority with caffeine but not statistical superiority.

Context: Caffeine is commonly used as a component in analgesics available from pharmacies without a prescription in the belief that it enhances analgesic efficacy.

Cochrane Systematic Review: Derry CJ et al. Caffeine as an analgesic adjuvant for acute pain in adults. Cochrane Reviews, 2012, Issue 3. Article No. CD009281. DOI: 10.1002/14651858.CD009281.pub2. This review contains 19 studies involving 7238 participants.

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.

Position of the Academy of Nutrition and Dietetics: use of nutritive and nonnutritive sweeteners

J Acad Nutr Diet. 2012 May;112(5):739-58. Epub 2012 Apr 25.
Position of the Academy of Nutrition and Dietetics: use of nutritive and nonnutritive sweeteners.
Fitch C, Keim KS; Academy of Nutrition and Dietetics.

Source
West Virginia University, Morgantown, WV, USA.

Erratum in
J Acad Nutr Diet. 2012 Aug;112(8):1279.

Abstract
It is the position of the Academy of Nutrition and Dietetics that consumers can safely enjoy a range of nutritive sweeteners and nonnutritive sweeteners (NNS) when consumed within an eating plan that is guided by current federal nutrition recommendations, such as the Dietary Guidelines for Americans and the Dietary Reference Intakes, as well as individual health goals and personal preference. A preference for sweet taste is innate and sweeteners can increase the pleasure of eating. Nutritive sweeteners contain carbohydrate and provide energy. They occur naturally in foods or may be added in food processing or by consumers before consumption. Higher intake of added sugars is associated with higher energy intake and lower diet quality, which can increase the risk for obesity, prediabetes, type 2 diabetes, and cardiovascular disease. On average, adults in the United States consume 14.6% of energy from added sugars. Polyols (also referred to as sugar alcohols) add sweetness with less energy and may reduce risk for dental caries. Foods containing polyols and/or no added sugars can, within food labeling guidelines, be labeled as sugar-free. NNS are those that sweeten with minimal or no carbohydrate or energy. They are regulated by the Food and Drug Administration as food additives or generally recognized as safe. The Food and Drug Administration approval process includes determination of probable intake, cumulative effect from all uses, and toxicology studies in animals. Seven NNS are approved for use in the United States: acesulfame K, aspartame, luo han guo fruit extract, neotame, saccharin, stevia, and sucralose. They have different functional properties that may affect perceived taste or use in different food applications. All NNS approved for use in the United States are determined to be safe.

Copyright © 2012 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.

Use of nutritive and nonnutritive sweeteners

J Am Diet Assoc. 2004 Feb;104(2):255-75.
Position of the American Dietetic Association: use of nutritive and nonnutritive sweeteners.
American Dietetic Association.

Erratum in
J Am Diet Assoc. 2004 Jun;104(6):1013.

Sweeteners elicit pleasurable sensations with (nutritive) or without (nonnutritive) energy. Nutritive sweeteners (eg, sucrose, fructose) are generally recognized as safe (GRAS) by the Food and Drug Administration (FDA), yet concern exists about increasing sweetener intakes relative to optimal nutrition and health. Dietary quality suffers at intakes above 25% of total energy (the Institutes of Medicine's suggested maximal intake level). In the United States, estimated intakes of nutritive sweeteners fall below this, although one in four children (ages 9 to 18 years) can surpass this level. Polyols (sugar alcohols), GRAS-affirmed or petitions filed for GRAS, add sweetness with reduced energy and functional properties to foods/beverages and promote dental health. Five nonnutritive sweeteners with intense sweetening power have FDA approval (acesulfame-K, aspartame, neotame, saccharin, sucralose) and estimated intakes below the Acceptable Daily Intake (level that a person can safely consume everyday over a lifetime without risk). By increasing palatability of nutrient-dense foods/beverages, sweeteners can promote diet healthfulness. Scientific evidence supports neither that intakes of nutritive sweeteners by themselves increase the risk of obesity nor that nutritive or nonnutritive sweeteners cause behavioral disorders. However, nutritive sweeteners increase risk of dental caries. High fructose intakes may cause hypertriglyceridemia and gastrointestinal symptoms in susceptible individuals. Thus, it is the position of The American Dietetic Association that consumers can safely enjoy a range of nutritive and nonnutritive sweeteners when consumed in a diet that is guided by current federal nutrition recommendations, such as the Dietary Guidelines for Americans and the Dietary References Intakes, as well as individual health goals. Dietetics professionals should provide consumers with science-based information about sweeteners and support research on the use of sweeteners to promote eating enjoyment, optimal nutrition, and health.

Total Antioxidant Capacity from Diet and Risk of Myocardial Infarction

Pentingnya asupan bahan makanan kaya anti-oksidan untuk pencegahan penyakit jantung koroner

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Total Antioxidant Capacity from Diet and Risk of Myocardial Infarction: A Prospective Cohort of Women

Susanne Rautiainen, MSc, Emily B. Levitan, DrPh, Nicola Orsini, PhD et al

The American Journal of Medicine
Volume 125, Issue 10 , Pages 974-980, October 2012

Abstract

Background
There are no previous studies investigating the effect of all dietary antioxidants in relation to myocardial infarction. The total antioxidant capacity of diet takes into account all antioxidants and synergistic effects between them. The aim of this study was to examine how total antioxidant capacity of diet and antioxidant-containing foods were associated with incident myocardial infarction among middle-aged and elderly women.

Methods
In the population-based prospective Swedish Mammography Cohort of 49-83-year-old women, 32,561 were cardiovascular disease-free at baseline. Women completed a food-frequency questionnaire, and dietary total antioxidant capacity was calculated using oxygen radical absorbance capacity values. Information on myocardial infarction was identified from the Swedish Hospital Discharge and the Cause of Death registries. Hazard ratios (HR) and 95% confidence intervals (CI) were calculated using Cox proportional hazard models.

Results
During the follow-up (September 1997-December 2007), we identified 1114 incident cases of myocardial infarction (321,434 person-years). In multivariable-adjusted analysis, the HR for women comparing the highest quintile of dietary total antioxidant capacity to the lowest was 0.80 (95% CI, 0.67-0.97; P for trend=0.02). Servings of fruit and vegetables and whole grains were nonsignificantly inversely associated with myocardial infarction.

Conclusions
These data suggest that dietary total antioxidant capacity, based on fruits, vegetables, coffee, and whole grains, is of importance in the prevention of myocardial infarction.

Vegetarian Diets: Five Things to Know

Vegetarian nutrition (VN) evidence based nutrition practice guideline.

Assessing Biochemical Data of Adult, Child and Adolescent Vegetarians

Assessing Vitamin B-12 Status of Adult, Child and Adolescent Vegetarians

• For adult, child and adolescent vegetarians, the RD should assess for dietary adequacy of vitamin B-12 intake. If dietary intake of vitamin B-12 is inadequate, then the RD may recommend using MMA if available, as a functional indicator of deficiency. Two research studies measuring MMA levels showed that LOV/LV [lacto-ovo vegetarian/lacto-vegetarian] or omnivorous adolescents (9 to 15 years) who had followed a very restrictive vegetarian diet (macrobiotic) early in life, may be at risk for vitamin B-12 deficiency (41% of adolescents had MMA >290nmol/L and 21% had MMA >410nmol/L). In addition, research studies showed that the prevalence of vitamin B-12 deficiency among healthy, non-pregnant adult vegetarians ranged from 30% to 86%. When vegans and LOV/LV vegetarians were analyzed separately, vegans had even higher proportions of vitamin B-12 deficiency (43% to 88%). Among children (10 months to 11.7 years) and older adults (>55 years), the prevalence of vitamin B-12 deficiency was 55% to 85% and 46.9% to 68%, respectively.
• Fair, Imperative
• Recommendation Strength Rationale. Conclusion statements are Grades I, III, and Consensus

Assessing Food and Nutrient Intake of Adult Vegetarians

Assessing Micronutrient Intake of Adult Vegetarians

• For adult vegetarians, the RD should assess micronutrient intake, particularly vitamin B-12. Research studies measuring MMA levels showed that the prevalence of vitamin B-12 deficiency among healthy, non-pregnant adult vegetarians ranged from 30% to 86%. When vegans, LOV/LV were analyzed separately, vegans had even higher proportions of vitamin B-12 deficiency (43% to 88%). Among older adults (>55 years), the prevalence of vitamin B-12 deficiency was 46.9% to 68%.
• Fair, Imperative

Micronutrient Intake in Adolescent and Adult Vegetarians During Pregnancy

Micronutrient Intake in Pregnant Adolescent and Adult Vegetarians

• For pregnant adolescent and adult vegetarians, the RD should design a nutrition prescription to ensure the DRI for all micronutrients are met. If unable to meet the DRI for recommended levels of micronutrients, particularly iron, folate and zinc, the RD should recommend supplementation to ensure adequate intake. Research indicates that pregnant vegetarians did not meet dietary requirements for at least one of these micronutrients.
• Fair, Conditional

Vitamin B-12 Intake in Pregnant Adolescent and Adult Vegetarians

• For pregnant adolescent and adult vegetarian or vegan patients or clients, the RD should design a nutrition prescription to ensure vitamin B-12 requirements are met by diet and/or supplementation, including prenatal supplements. Two high quality studies report that lacto-ovo vegetarian pregnant women are less likely than non-vegetarian pregnant women to meet dietary requirements for vitamin B-12 intake, and two high quality studies report that pregnant vegetarians had significantly lower serum B-12 concentrations than pregnant non-vegetarians. In addition, twelve studies measuring MMA levels showed that the prevalence of vitamin B-12 deficiency among healthy, non-pregnant adult vegetarians ranged from 30% to 86%. When vegans and LOV/LV were analyzed separately, vegans had even higher proportions of vitamin B-12 deficiency (43% to 88%).
• Fair, Imperative
• Recommendation Strength Rationale. Conclusion statements are Grades I and III

Hyperlipidemia Treatment with a Vegetarian Diet for Adults

Treating Hyperlipidemia with a Vegetarian Diet for Adults

• If consistent with patient or client preference, the RD may recommend and educate on the benefits of a vegetarian diet for adults seeking treatment to lower total cholesterol (TC) and low-density lipoprotein-cholesterol (LDL-C) levels, or if appropriate, to reduce weight. Research shows that various types of vegetarian diets (e.g., vegetarian Ornish, Portfolio diet, ovo-lacto vegetarian and vegan) lower TC from 7.2% to 26.6% and lower LDL-C from 8.7% to 35% (with five of the eight studies that provided comparison data showing a decrease between 10% and 20% for both TC and LDL-C). Vegan diets lower both TC and LDL-C more than other types of vegetarian diets.
• Strong, Conditional
• Recommendation Strength Rationale. Conclusion statement is Grade I

Overweight and Obesity Treatment with a Vegetarian Diet for Adults

Treating Overweight and Obesity with a Vegetarian Diet for Adults

• If consistent with patient or client preference, the RD may recommend and educate on the benefits of the therapeutic use of a vegetarian diet for adults seeking treatment for overweight or obesity. Research indicates that the therapeutic use of a vegetarian diet is effective for treating overweight and obesity in both the short term (less than one year) and longer term (greater than one year), and may perform better than alternative omnivorous diets for the same purpose. Percent weight loss ranged from 3.2% to 9.3% at 12 months across studies.
• Strong, Conditional
• Recommendation Strength Rationale. Conclusion statements are Grades I and III

Type 2 Diabetes Treatment with a Vegetarian Diet for Adults

Treating Type 2 Diabetes with a Vegetarian Diet for Adults

• If consistent with patient or client preference, the RD may recommend and educate on the benefits of the therapeutic use of a vegetarian diet for adults seeking treatment for type 2 diabetes. Research indicates that a vegetarian diet may decrease or maintain blood glucose levels; a vegan diet may decrease hemoglobin A1c (A1c) as well as, or better than, an omnivorous diet. Additionally, a vegetarian diet may reduce diabetes-related co-morbidities (e.g., cardiovascular disease, obesity, and hypertension).
• Fair, Conditional
• Recommendation Strength Rationale. Conclusion statements are Grades II and III

Managing Type 2 Diabetes: New American Diabetes Association Position Statement

Information sourced from Journal Watch:

New Position Statement for Managing Type 2 Diabetes

A one-size-fits-all approach is rejected.

The American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) have published a new position statement entitled, "Management of Hyperglycemia in Type 2 Diabetes: A Patient-Centered Approach." The document outlines basic elements of lifestyle modification, oral agents, noninsulin injectable agents, and insulin, and provides management tips that even experienced clinicians might find helpful. Two aspects of the report are particularly noteworthy:

• Acknowledging "mounting concerns about . . . potential adverse effects [of drug therapies] and new uncertainties regarding the benefits of intensive glycemic control on macrovascular complications," the authors emphasize a patient-centered approach with individualized targets for glycemic control. For example, they recommend more-stringent control (e.g., glycosylated hemoglobin [HbA_1c] target, <7%) for motivated patients with new-onset diabetes and long life expectancies, and less-stringent control (e.g., HbA_1c goal, 8% or even higher) for less-motivated patients with longstanding diabetes, limited life expectancies, and high risk for adverse outcomes from hypoglycemia.
• Because the authors reject a one-size-fits-all approach, they make this important statement: "Utilizing the percentage of diabetic patients who are achieving an HbA_1c <7% as a quality indicator, as promulgated by various health care organizations, is inconsistent with the emphasis on individualization of treatment goals."

Comment: Many clinicians talk about getting their patients with type 2 diabetes "to goal," as if a single, evidence-based target was applicable to every patient. Others talk about being "dinged" by real or imagined organizations if their patients' HbA_1c levels are not in a certain range. In contrast, this position statement supports a more-reasoned approach that involves shared decision making and flexible goals. In a worthwhile accompanying editorial, the author describes the process that resulted in this position statement. One note: Nine of the 10 authors of the statement each have financial ties to numerous pharmaceutical companies.

— Allan S. Brett, MD

Published in Journal Watch General Medicine July 24, 2012

CITATION(S):

Inzucchi SE et al. Management of hyperglycemia in type 2 diabetes: A patient-centered approach. Position statement of the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetes Care 2012 Jun; 35:1364. [Free full-text PDF | PubMed® abstract]

Cefalu WT. American Diabetes Association–European Association for the Study of Diabetes position statement: Due diligence was conducted. Diabetes Care 2012 Jun; 35:1201. [Free full-text PDF | PubMed® abstract]

Copyright © 2012. Massachusetts Medical Society. All rights reserved.

The above message comes from "Journal Watch", who is solely responsible for its content.

Journal Watch: When Metformin Fails, Which Second-Line Type 2 Diabetes Therapy Is Superior?

Information sourced from Journal Watch:

What Therapy Is Best for Diabetes After Metformin Fails?

In three trials, researchers assess options for second-line diabetes therapy.

Metformin is accepted widely as first-line treatment for patients with type 2 diabetes, but no clear guidelines exist on how to proceed when metformin monotherapy fails. In three new industry-supported studies, researchers compared available second-line treatments.

In an open-label study, 1029 adults with glycosylated hemoglobin (HbA_1c) levels between 6.5% and 9.0% while taking metformin were randomized to add either the glucagon-type peptide-receptor agonist exenatide (Byetta; 5–10 µg subcutaneously twice daily) or the sulfonylurea glimepiride (titrated to maximum tolerated daily dose). During 4 years of follow-up, significantly fewer exenatide recipients than glimepiride recipients (41% vs. 54%) reached the primary endpoint of treatment failure (HbA_1c level >9% after 3 months of treatment, or HbA_1c level >7% at two consecutive readings after 6 months of treatment). Significantly more patients in the exenatide group than in the glimepiride group reached a target HbA_1c level of <7% (44% vs. 31%). Patients who received exenatide lost a mean of 3.3 kg, whereas those who received glimepiride gained a mean of 1.2 kg — a significant difference. Hypoglycemia occurred significantly more often in patients taking glimepiride.

In another open-label trial, researchers randomized 515 adults with HbA_1c levels between 7% and 11% while taking metformin to add either once-daily insulin glargine (Lantus; titrated to a fasting glucose level of 72–99 mg/dL) or the dipeptidyl peptidase-4 (DPP-4) inhibitor sitagliptin (Januvia; 100 mg once daily). After 24 weeks, patients who received insulin glargine had a significantly greater reduction in mean HbA_1c level than did those who received sitagliptin (–1.7% vs. –1.1%), and more patients who received insulin glargine reached the HbA_1c target of 7% (68% vs. 42%). Mean body weight increased slightly in the insulin glargine group and decreased slightly in the sitagliptin group, and significantly more hypoglycemic events occurred in the insulin glargine group (4.2 vs. 0.5 per patient-year).

In the third trial, researchers randomized 1551 patients with HbA_1c levels between 6.5% and 10.0% who were taking metformin alone to the DPP-4 inhibitor linagliptin (Tradjenta; 5 mg daily) or to glimepiride (1–4 mg daily, titrated to fasting plasma glucose ≤110 mg/dL). After 2 years, average HbA_1c level was –0.16% in the linagliptin group and –0.36% in the glimepiride group. Thirty percent of patients taking linagliptin and 35% of those taking glimepiride reached HbA_1c levels <7%. Average body weight decreased slightly with linagliptin and rose slightly with glimepiride; hypoglycemic events occurred in 7% of patients taking linagliptin and in 36% of those taking glimepiride.

Comment: The choice of diabetes therapies is complex, involving patient acceptance, efficacy, and safety. These trials were limited to surrogate endpoints, and all were industry-sponsored (by the makers of exenatide, insulin glargine, and linagliptin, respectively); also, the insulin glargine–sitagliptin trial was very brief. Nevertheless, these trials highlight some of the strengths and weaknesses of the various options for second-line diabetes therapy; the long-term effects of these therapies on glucose metabolism and clinical endpoints remain to be elucidated.

— Bruce Soloway, MD

Published in Journal Watch General Medicine July 10, 2012

CITATION(S):

Gallwitz B et al. Exenatide twice daily versus glimepiride for prevention of glycaemic deterioration in patients with type 2 diabetes with metformin failure (EUREXA): An open-label, randomised controlled trial. Lancet 2012 Jun 16; 379:2270. [Medline® Abstract]

Aschner P et al. Insulin glargine versus sitagliptin in insulin-naive patients with type 2 diabetes mellitus uncontrolled on metformin (EASIE): A multicentre, randomised open-label trial. Lancet 2012 Jun 16; 379:2262. [Medline® Abstract]

Gallwitz B et al. 2-year efficacy and safety of linagliptin compared with glimepiride in patients with type 2 diabetes inadequately controlled on metformin: A randomised, double-blind, non-inferiority trial. Lancet 2012 Jun 27; [e-pub ahead of print]. [Medline® Abstract]

Copyright © 2012. Massachusetts Medical Society. All rights reserved.

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Do Probiotics Protect Against Antibiotic-Associated Diarrhea? Systematic Review and Meta-analysis

Probiotik efektif untuk mencegah diare akibat pemberian antibiotik

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Information sourced from BMJ:
BMJ 2012;344:e3359
Research News

All you need to read in the other general journals

Probiotics protect against diarrhoea associated with antibiotics
JAMA 2012;307:1959-69 [PubMed® abstract]

More evidence that probiotics can help prevent diarrhoea associated with antibiotics has emerged from a meta-analysis of randomised trials. The authors found 82 trials after a systematic search but only 63 reported how many people took the probiotics, how many took the control treatment, and how many developed diarrhoea. Across these 63 trials, probiotics were associated with a 42% reduction in the risk of diarrhoea (relative risk 0.58, 95% CI 0.50 to 0.68; number needed to treat 13, 10.3 to 19.1).

Most trials tested probiotic preparations containing lactobacilli, alone or in mixed cultures. The effect looked consistent in multiple different analyses, including two confined to high quality trials and another that looked specifically at adults taking antibiotics for Helicobacter pylori infections (the most commonly reported indication). The authors are confident their results are as robust as they can be given the generally poor quality of the evidence base.

Most trials were underpowered and badly reported. It is still hard to know the precise mix of micro-organisms that is likely to work best and the characteristics of patients most likely to benefit. Details of the antibiotics being taken were missing from many trials, as were reliable assessments of side effects. Still, we have enough encouraging evidence to justify further research to fine tune these results, say the authors. Diarrhoea associated with antibiotics is common and can be life threatening.

© 2012 BMJ Publishing Group Ltd

Purine-rich foods intake and recurrent gout attacks

Konsumsi bahan makanan kaya purin (terutama dari sumber hewani) meningkatkan (lima kali lipat) risiko kambuh gout pada pasien2 gout.

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Ann Rheum Dis doi:10.1136/annrheumdis-2011-201215

Extended report

Purine-rich foods intake and recurrent gout attacks
Yuqing Zhang, Clara Chen, Hyon Choi, et al
Correspondence to Yuqing Zhang, Boston University, Boston University School of Medicine, 715 Albany Street, A203, Boston, Massachusetts MA 02118, USA

Abstract

Objective To examine and quantify the relation between purine intake and the risk of recurrent gout attacks among gout patients.
Methods The authors conducted a case-crossover study to examine associations of a set of putative risk factors with recurrent gout attacks. Individuals with gout were prospectively recruited and followed online for 1 year. Participants were asked about the following information when experiencing a gout attack: the onset date of the gout attack, clinical symptoms and signs, medications (including antigout medications), and presence of potential risk factors (including daily intake of various purine-containing food items) during the 2-day period prior to the gout attack. The same exposure information was also assessed over 2-day control periods.
Results This study included 633 participants with gout. Compared with the lowest quintile of total purine intake over a 2-day period, OR of recurrent gout attacks were 1.17, 1.38, 2.21 and 4.76, respectively, with each increasing quintile (p for trend <0.001). The corresponding OR were 1.42, 1.34, 1.77 and 2.41 for increasing quintiles of purine intake from animal sources (p for trend <0.001), and 1.12, 0.99, 1.32 and 1.39 from plant sources (p=0.04), respectively. The effect of purine intake persisted across subgroups by sex, use of alcohol, diuretics, allopurinol, NSAIDs and colchicine.
Conclusions The study findings suggest that acute purine intake increases the risk of recurrent gout attacks by almost fivefold among gout patients. Avoiding or reducing amount of purine-rich foods intake, especially of animal origin, may help reduce the risk of gout attacks.

Copyright © 2012 BMJ Publishing Group Ltd & European League Against Rheumatism. All rights reserved.
The above message comes from BMJ, who is solely responsible for its content.

A Prospective Study of Weight Training and Risk of Type 2 Diabetes Mellitus in Men

Efek olah raga aerobik untuk pencegahan diabetes telah lama diketahui. Bagaimana efek olah raga beban ?

 

Penelitian ini membuktikan bahwa olah raga beban juga efektif menurunkan risiko diabetes melitus tipe 2. Kombinasi keduanya adalah yang terbaik.

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A Prospective Study of Weight Training and Risk of Type 2 Diabetes Mellitus in Men
Anders Grøntved, MPH, MSc; Eric B. Rimm, ScD; Walter C. Willett, MD, DrPH; Lars B. Andersen, PhD, DrMED; Frank B. Hu, MD, PhD
Arch Intern Med. Published online August 06, 2012. doi:10.1001/archinternmed.2012.3138

Background  The role of weight training in the primary prevention of type 2 diabetes mellitus (T2DM) is largely unknown.
Methods  To examine the association of weight training with risk of T2DM in US men and to assess the influence of combining weight training and aerobic exercise, we performed a prospective cohort study of 32 002 men from the Health Professionals Follow-up Study observed from 1990 to 2008. Weekly time spent on weight training and aerobic exercise (including brisk walking, jogging, running, bicycling, swimming, tennis, squash, and calisthenics/rowing) was obtained from questionnaires at baseline and biennially during follow-up.
Results  During 508 332 person-years of follow-up (18 years), we documented 2278 new cases of T2DM. In multivariable-adjusted models, we observed a dose-response relationship between an increasing amount of time spent on weight training or aerobic exercise and lower risk of T2DM (P < .001 for trend). Engaging in weight training or aerobic exercise for at least 150 minutes per week was independently associated with a lower risk of T2DM of 34% (95% CI, 7%-54%) and 52% (95% CI, 45%-58%), respectively. Men who engaged in aerobic exercise and weight training for at least 150 minutes per week had the greatest reduction in T2DM risk (59%; 95% CI, 39%-73%).
Conclusions  Weight training was associated with a significantly lower risk of T2DM, independent of aerobic exercise. Combined weight training and aerobic exercise conferred a greater benefit.

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.