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.

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.

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.

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.

Dietary Intervention in Infancy and Later Signs of Beta-Cell Autoimmunity

Paparan dini terhadap protein tertentu pada bayi dengan genetic susceptibility untuk diabetes tipe 1 akan meningkatkan risiko timbulnya autoimun terhadap sel beta.

Penelitian ini menguji hipotesis bahwa susu formula protein terhidrolisa akan menurunkan insiden timbulnya autoantibodi untuk bayi2 tersebut.

Terbukti intervensi diet pada bayi2 tersebut mempengaruhi marker autoimun terhadap sel beta yang dalam jangka panjang akan menuju pada timbulnya diabetes tipe 1.

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N Engl J Med 363:1900-1908, 11 November 2010 © 2010 to the Massachusetts Medical Society
Dietary Intervention in Infancy and Later Signs of Beta-Cell Autoimmunity.
Mikael Knip, Suvi M. Virtanen, Karri Seppa, et al.

BACKGROUND
Early exposure to complex dietary proteins may increase the risk of beta-cell autoimmunity and type 1 diabetes in children with genetic susceptibility. We tested the hypothesis that supplementing breast milk with highly hydrolyzed milk formula would decrease the cumulative incidence of diabetes-associated autoantibodies in such children.
METHODS
In this double-blind, randomized trial, we assigned 230 infants with HLA-conferred susceptibility to type 1 diabetes and at least one family member with type 1 diabetes to receive either a casein hydrolysate formula or a conventional, cow's-milk–based formula (control) whenever breast milk was not available during the first 6 to 8 months of life. Autoantibodies to insulin, glutamic acid decarboxylase (GAD), the insulinoma-associated 2 molecule (IA-2), and zinc transporter 8 were analyzed with the use of radiobinding assays, and islet-cell antibodies were analyzed with the use of immunofluorescence, during a median observation period of 10 years (mean, 7.5). The children were monitored for incident type 1 diabetes until they were 10 years of age.
RESULTS
The unadjusted hazard ratio for positivity for one or more autoantibodies in the casein hydrolysate group, as compared with the control group, was 0.54 (95% confidence interval [CI], 0.29 to 0.95), and the hazard ratio adjusted for an observed difference in the duration of exposure to the study formula was 0.51 (95% CI, 0.28 to 0.91). The unadjusted hazard ratio for positivity for two or more autoantibodies was 0.52 (95% CI, 0.21 to 1.17), and the adjusted hazard ratio was 0.47 (95% CI, 0.19 to 1.07). The rate of reported adverse events was similar in the two groups.
CONCLUSIONS
Dietary intervention during infancy appears to have a long-lasting effect on markers of beta-cell autoimmunity — markers that may reflect an autoimmune process leading to type 1 diabetes.

N-3 Fatty Acids and Cardiovascular Events after Myocardial Infarction

Asam lemak omega3 terbukti mempunyai efek protektif untuk penyakit kardiovaskuler. Penelitian ini ingin melihat efek protektif untuk pasien yang sudah mengalami infark miokard.

Ternyata pemberian omega3 dosis kecil dalam bentuk EPA, DHA maupun ALA tidak menurunkan kejadian kardiovaskuler bagi pasien yang sudah mengalami infark miokard.

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N Engl J Med 363:2015-2026, 18 November 2010 © 2010 to the Massachusetts Medical Society
N-3 Fatty Acids and Cardiovascular Events after Myocardial Infarction.

Daan Kromhout, Erik J. Giltay, and Johanna M. Geleijnse, for the Alpha Omega Trial Group.

BACKGROUND
Results from prospective cohort studies and randomized, controlled trials have provided evidence of a protective effect of n−3 fatty acids against cardiovascular diseases. We examined the effect of the marine n−3 fatty acids eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) and of the plant-derived alpha-linolenic acid (ALA) on the rate of cardiovascular events among patients who have had a myocardial infarction.
METHODS
In a multicenter, double-blind, placebo-controlled trial, we randomly assigned 4837 patients, 60 through 80 years of age (78% men), who had had a myocardial infarction and were receiving state-of-the-art antihypertensive, antithrombotic, and lipid-modifying therapy to receive for 40 months one of four trial margarines: a margarine supplemented with a combination of EPA and DHA (with a targeted additional daily intake of 400 mg of EPA–DHA), a margarine supplemented with ALA (with a targeted additional daily intake of 2 g of ALA), a margarine supplemented with EPA–DHA and ALA, or a placebo margarine. The primary end point was the rate of major cardiovascular events, which comprised fatal and nonfatal cardiovascular events and cardiac interventions. Data were analyzed according to the intention-to-treat principle, with the use of Cox proportional-hazards models.
RESULTS
The patients consumed, on average, 18.8 g of margarine per day, which resulted in additional intakes of 226 mg of EPA combined with 150 mg of DHA, 1.9 g of ALA, or both, in the active-treatment groups. During the follow-up period, a major cardiovascular event occurred in 671 patients (13.9%). Neither EPA–DHA nor ALA reduced this primary end point (hazard ratio with EPA–DHA, 1.01; 95% confidence interval [CI], 0.87 to 1.17; P=0.93; hazard ratio with ALA, 0.91; 95% CI, 0.78 to 1.05; P=0.20). In the prespecified subgroup of women, ALA, as compared with placebo and EPA–DHA alone, was associated with a reduction in the rate of major cardiovascular events that approached significance (hazard ratio, 0.73; 95% CI, 0.51 to 1.03; P=0.07). The rate of adverse events did not differ significantly among the study groups.
CONCLUSIONS
Low-dose supplementation with EPA–DHA or ALA did not significantly reduce the rate of major cardiovascular events among patients who had had a myocardial infarction and who were receiving state-of-the-art antihypertensive, antithrombotic, and lipid-modifying therapy.

Vitamin C - vitamin E dan katarak

Suplementasi vitamin C dan vitamin E tidak berguna menurunkan risiko katarak

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Age-Related Cataract in a Randomized Trial of Vitamins E and C in Men
William G. Christen, ScD; Robert J. Glynn, ScD; Howard D. Sesso, ScD; Tobias Kurth, MD; Jean MacFadyen, BA;Vadim Bubes, PhD; Julie E. Buring, ScD; JoAnn E. Manson, MD; J. Michael Gaziano, MD

Arch Ophthalmol. 2010;128(11):1397-1405. doi:10.1001/archophthalmol.2010.266

Objective  To test whether supplementation with alternate-day vitamin E or daily vitamin C affects the incidence of age-related cataract in a large cohort of men.
Methods  In a randomized, double-masked, placebo-controlled trial, 11 545 apparently healthy US male physicians 50years or older without a diagnosis of cataract at baseline were randomly assigned to receive 400 IU of vitamin E or placebo on alternate days and 500 mg of vitamin C or placebo daily.
Main Outcome Measure  Incident cataract responsible for a reduction in best-corrected visual acuity to 20/30 or worse based on self-report confirmed by medical record review.
Application to Clinical Practice  Long-term use of vitamin E and C supplements has no appreciable effect on cataract.
Results  After 8 years of treatment and follow-up, 1174 incident cataracts were confirmed. There were 579 cataracts in the vitamin E–treated group and 595 in the vitamin E placebo group (hazard ratio, 0.99; 95% confidence interval, 0.88-1.11). For vitamin C, there were 593 cataracts in the treated group and 581 in the placebo group (hazard ratio, 1.02; 95% confidence interval, 0.91-1.14).
Conclusion  Long-term alternate-day use of 400 IU of vitamin E and daily use of 500 mg of vitamin C had no notable beneficial or harmful effect on the risk of cataract.

Perlukah suplementasi DHA pada ibu hamil ?

Suplementasi DHA pada ibu hamil tidak mengurangi tingkat depresi post partum ibu maupun meningkatkan fungsi kognitif dan bahasa pada anaknya

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JAMA 304(15):1675-1683, 20 October 2010 © 2010 American Medical Association
Effect of DHA Supplementation During Pregnancy on Maternal Depression and Neurodevelopment of Young Children
A Randomized Controlled Trial
Maria Makrides, BSc, BND, PhD; Robert A. Gibson, BSc, PhD; Andrew J. McPhee, MBBS; Lisa Yelland, BSc;Julie Quinlivan, MBBS, PhD; Philip Ryan, MBBS, BSc; and the DOMInO Investigative Team

JAMA. 2010;304(15):1675-1683. doi:10.1001/jama.2010.1507
Context  Uncertainty about the benefits of dietary docosahexaenoic acid (DHA) for pregnant women and their children exists, despite international recommendations that pregnant women increase their DHA intakes.
Objective  To determine whether increasing DHA during the last half of pregnancy will result in fewer women with highlevels of depressive symptoms and enhance the neurodevelopmental outcome of their children.
Design, Setting, and Participants  A double-blind, multicenter, randomized controlled trial (DHA to Optimize Mother Infant Outcome [DOMInO] trial) in 5 Australian maternity hospitals of 2399 women who were less than 21 weeks' gestation with singleton pregnancies and who were recruited between October 31, 2005, and January 11, 2008. Follow-up of children (n = 726) was completed December 16, 2009.
Intervention  Docosahexaenoic acid–rich fish oil capsules (providing 800 mg/d of DHA) or matched vegetable oilcapsules without DHA from study entry to birth.
Main Outcome Measures  High levels of depressive symptoms in mothers as indicated by a score of more than 12 on the Edinburgh Postnatal Depression Scale at 6 weeks or 6 months postpartum. Cognitive and language development in children as assessed by the Bayley Scales of Infant and Toddler Development, Third Edition, at 18 months.
Results  Of 2399 women enrolled, 96.7% completed the trial. The percentage of women with high levels of depressive symptoms during the first 6 months postpartum did not differ between the DHA and control groups (9.67% vs 11.19%; adjusted relative risk, 0.85; 95% confidence interval [CI], 0.70-1.02; P = .09). Mean cognitive composite scores (adjusted mean difference, 0.01; 95% CI, –1.36 to 1.37; P = .99) and mean language composite scores (adjusted mean difference, –1.42; 95% CI, –3.07 to 0.22; P = .09) of children in the DHA group did not differ from children in the control group.
Conclusion  The use of DHA-rich fish oil capsules compared with vegetable oil capsules during pregnancy did not result in lower levels of postpartum depression in mothers or improved cognitive and language development in their offspring during early childhood.

Long-term Effects of a Lifestyle Intervention on Weight and Cardiovascular Risk Factors in Individuals With Type 2 Diabetes Mellitus

Intensive lifestyle intervention bagi penderita diabetes tipe 2 dalam jangka panjang dapat menurunkan berat badan, memperbaiki tingkat fitness, memperbaiki kontrol glikemik, dan menurunkan risiko kardiovaskuler

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Arch Intern Med 170(17):1566-1575, 27 September 2010 © 2010 to the American Medical Association
Long-term Effects of a Lifestyle Intervention on Weight and Cardiovascular Risk Factors in Individuals With Type 2 Diabetes Mellitus-Four- Year Results of the Look AHEAD Trial. The Look AHEAD Research Group.

Background  Lifestyle interventions produce short-term improvements in glycemia and cardiovascular disease (CVD) riskfactors in individuals with type 2 diabetes mellitus, but no long-term data are available. We examined the effects of lifestyle intervention on changes in weight, fitness, and CVD risk factors during a 4-year study.
Methods  The Look AHEAD (Action for Health in Diabetes) trial is a multicenter randomized clinical trial comparing theeffects of an intensive lifestyle intervention (ILI) and diabetes support and education (DSE; the control group) on the incidence of major CVD events in 5145 overweight or obese individuals (59.5% female; mean age, 58.7 years) with type 2 diabetes mellitus. More than 93% of participants provided outcomes data at each annual assessment.
Results  Averaged across 4 years, ILI participants had a greater percentage of weight loss than DSE participants (–6.15% vs –0.88%; P < .001) and greater improvements in treadmill fitness (12.74% vs 1.96%; P < .001), hemoglobin A1clevel (–0.36% vs –0.09%; P < .001), systolic (–5.33 vs –2.97 mm Hg; P < .001) and diastolic (–2.92 vs –2.48 mm Hg;P = .01) blood pressure, and levels of high-density lipoprotein cholesterol (3.67 vs 1.97 mg/dL; P < .001) and triglycerides (–25.56 vs –19.75 mg/dL; P < .001). Reductions in low-density lipoprotein cholesterol levels were greater in DSE than ILI participants (–11.27 vs –12.84 mg/dL; P = .009) owing to greater use of medications to lower lipid levels in the DSE group. At 4 years, ILI participants maintained greater improvements than DSE participants in weight, fitness, hemoglobin A1c levels, systolic blood pressure, and high-density lipoprotein cholesterol levels.
Conclusions  Intensive lifestyle intervention can produce sustained weight loss and improvements in fitness, glycemiccontrol, and CVD risk factors in individuals with type 2 diabetes. Whether these differences in risk factors translate to reduction in CVD events will ultimately be addressed by the Look AHEAD trial.

Alcohol and Acute Ischemic Stroke Onset

Sehabis minum alkohol risiko stroke meningkat.

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Stroke. 2010;41:1845.© 2010 American Heart Association, Inc.

Original Contributions;Clinical Science

Alcohol and Acute Ischemic Stroke Onset
The Stroke Onset Study
Elizabeth Mostofsky, MPH; Mary R. Burger, MD; Gottfried Schlaug, MD, PhD; Kenneth J. Mukamal, MD, MPH;Wayne D. Rosamond, PhD Murray A. Mittleman, MD, DrPH

From the Cardiovascular Epidemiology Research Unit (E.M., K.J.M., M.A.M.), Department of Medicine, Department of Neurology (G.S.), and the Division of General Medicine & Primary Care (K.J.M.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass; the Department of Epidemiology (E.M., M.A.M.), Harvard School of Public Health, Boston, Mass.; Cincinnati Children's Hospital Medical Center Heart Institute (M.R.B.), Cincinnati, Ohio; and the Department of Epidemiology (W.D.R.), University of North Carolina School of Public Health, Chapel Hill, NC.

Abstract
Background and Purpose— Previous research suggests that regular heavy alcohol consumption increases the risk for ischemic stroke, whereas frequent light to moderate alcohol intake may decrease the risk. However, the risk of ischemic stroke associated with transient exposure to alcohol remains unclear. In this study, we used a case–crossover approach to test the hypothesis that alcohol consumption affects the acute risk of ischemic stroke, to determine the length of time between alcohol intake and the onset of symptoms (induction time), and to examine whether the risk varies by the type of alcohol.
Methods— In this multicenter study, we interviewed 390 patients (209 men, 181 women) between January 2001 and November 2006 (median 3 days after stroke). Alcohol consumption in the hour before stroke symptoms was compared with its expected frequency based on the usual frequency of alcohol consumption over the prior year.
Results— Of the 390 patients, 248 (64%) reported alcohol consumption in the prior year, 104 within 24 hours and 14 within 1 hour of stroke onset. The relative risk of stroke in the hour after consuming alcohol was 2.3 (95% CI, 1.4 to 4.0; P=0.002). The relative risks were similar for different types of alcoholicbeverages and when the sample was restricted to those who were not simultaneously exposed to other potential triggers.
Conclusions— The risk of stroke onset is transiently elevated in the hour after alcohol ingestion.

Homocysteine-Lowering by B Vitamins Slows the Rate of Accelerated Brain Atrophy in Mild Cognitive Impairment

Suplemen vitamin B6, B12 dan asam folat akan menurunkan kadar homosistein. Penurunan kadar homosistein akan memperlambat atrofi otak, sehingga menjaga fungsi kognitif pada usia lanjut. Apakah suplemen ini dapat juga mencegah Alzheimer?

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Homocysteine-Lowering by B Vitamins Slows the Rate of Accelerated Brain Atrophy in Mild Cognitive Impairment: A Randomized Controlled Trial
A. David Smith, Stephen M. Smith, Celeste A. de Jager1, Philippa Whitbread, Carole Johnston, Grzegorz Agacinski, Abderrahim Oulhaj, Kevin M. Bradley, Robin Jacoby, Helga Refsum

Background
An increased rate of brain atrophy is often observed in older subjects, in particular those who suffer from cognitive decline. Homocysteine is a risk factor for brain atrophy, cognitive impairment and dementia. Plasma concentrations of homocysteine can be lowered by dietary administration of B vitamins.
Objective
To determine whether supplementation with B vitamins that lower levels of plasma total homocysteine can slow the rate of brain atrophy in subjects with mild cognitive impairment in a randomised controlled trial (VITACOG, ISRCTN 94410159).
Methods and Findings
Single-center, randomized, double-blind controlled trial of high-dose folic acid, vitamins B6 and B12in 271 individuals (of 646 screened) over 70 y old with mild cognitive impairment. A subset (187) volunteered to have cranial MRI scans at the start and finish of the study. Participants were randomly assigned to two groups of equal size, one treated with folic acid (0.8 mg/d), vitamin B12(0.5 mg/d) and vitamin B6 (20 mg/d), the other with placebo; treatment was for 24 months. The main outcome measure was the change in the rate of atrophy of the whole brain assessed by serial volumetric MRI scans.
Results
A total of 168 participants (85 in active treatment group; 83 receiving placebo) completed the MRI section of the trial. The mean rate of brain atrophy per year was 0.76% [95% CI, 0.63–0.90] in the active treatment group and 1.08% [0.94–1.22] in the placebo group (P = 0.001). The treatment response was related to baseline homocysteine levels: the rate of atrophy in participants with homocysteine >13 µmol/L was 53% lower in the active treatment group (P = 0.001). A greater rate of atrophy was associated with a lower final cognitive test scores. There was no difference in serious adverse events according to treatment category.
Conclusions and Significance
The accelerated rate of brain atrophy in elderly with mild cognitive impairment can be slowed by treatment with homocysteine-lowering B vitamins. Sixteen percent of those over 70 y old have mild cognitive impairment and half of these develop Alzheimer's disease. Since accelerated brain atrophy is a characteristic of subjects with mild cognitive impairment who convert to Alzheimer's disease, trials are needed to see if the same treatment will delay the development of Alzheimer's disease.

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

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

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Stroke. 2010;41:1371

Weight of the Obesity Epidemic
Rising Stroke Rates Among Middle-Aged Women in the United States
Amytis Towfighi, MD; Ling Zheng, PhD Bruce Ovbiagele, MD

From the Department of Neurology (A.T., L.Z.), University of Southern California, Los Angeles, Calif; and the Department of Neurology (B.O.), University of California at Los Angeles, Los Angeles, Calif.

Background and Purpose— Recent US nationally representative data revealed that among individuals aged 45 to 54 years, women's stroke prevalence was double that of men's. The purpose of this study was to determine if the sex disparity existed previously.
Methods— We assessed sex-specific stroke and vascular risk factor prevalence among individuals aged 35 to 64 years who participated in the National Health and Nutrition Examination Surveys (NHANES), a cross-sectional, nationally representative survey conducted in 2 waves: 1988 to 1994 (n=7234) and 1999 to 2004 (n=6499).
Results— Women aged 35 to 54 years who participated in NHANES from 1999 to 2004 were 3 times more likely to have experienced a stroke compared with similarly aged women in NHANES 1988 to 1994 (1.8% versus 0.6%,P=0.003), but stroke prevalence among men did not change (0.9% versus 1.0%, nonsignificant). Among women, the prevalence of obesity (15.2% versus 17.9%, P=0.08), morbid obesity (12.8% versus 17.5%, P=0.003), abdominal obesity (47.4% versus 58.9%, P<0.0001), hypertriglyceridemia (22.91% versus 26.78%, P=0.035), and hypertension (33.04% versus 37.43%, P=0.03) was lower in NHANES 1988 to 1994 compared with the morerecent NHANES wave. Higher waist circumference was the only independent stroke risk factor for women aged 35 to 54 years in NHANES 1999 to 2004 (OR per 15-cm increase in waist circumference=1.02, 95% CI 1.00 to 1.04).
Conclusions— Stroke prevalence among women aged 35 to 54 years has tripled over the past 2 decades, at the same time remaining stable among men. Prevalence of obesity and 3 metabolic syndrome components increased; they may be key factors in the increase in women's stroke prevalence.

Low-Carbohydrate Diets and All-Cause and Cause-Specific Mortality

Diet rendah karbohidrat kaya sayuran menurunkan risiko kematian termasuk kematian akibat penyakit kardiovaskuler. Sebaliknya, diet rendah karbohidrat kaya sumber hewani meningkatkan risiko kematian pada pria dan wanita.

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Annals of Internal Medicine

September 7, 2010 vol. 153 no. 5 289-298

 

Low-Carbohydrate Diets and All-Cause and Cause-Specific Mortality
Two Cohort Studies
Teresa T. Fung, ScD; Rob M. van Dam, PhD; Susan E. Hankinson, ScD;Meir Stampfer, MD, DrPH; Walter C. Willett, MD, DrPH; and Frank B. Hu, MD, PhD

Abstract

Background: Data on the long-term association between low-carbohydrate diets and mortality are sparse.
Objective: To examine the association of low-carbohydrate diets with mortality during 26 years of follow-up in women and 20 years in men.
Design: Prospective cohort study of women and men who were followed from 1980 (women) or 1986 (men) until 2006. Low-carbohydrate diets, either animal-based (emphasizing animal sources of fat and protein) or vegetable-based (emphasizing vegetable sources of fat and protein), were computed from several validated food-frequency questionnaires assessed during follow-up.
Setting: Nurses' Health Study and Health Professionals' Follow-up Study.
Participants: 85 168 women (aged 34 to 59 years at baseline) and 44 548 men (aged 40 to 75 years at baseline) without heart disease, cancer, or diabetes.
Measurements: Investigators documented 12 555 deaths (2458 cardiovascular-related and 5780 cancer-related) in women and 8678 deaths (2746 cardiovascular-related and 2960 cancer-related) in men.
Results: The overall low-carbohydrate score was associated with a modest increase in overall mortality in a pooled analysis (hazard ratio [HR] comparing extreme deciles, 1.12 [95% CI, 1.01 to 1.24]; P for trend = 0.136). The animal low-carbohydrate score was associated with higher all-cause mortality (pooled HR comparing extreme deciles, 1.23 [CI, 1.11 to 1.37]; P for trend = 0.051), cardiovascular mortality (corresponding HR, 1.14 [CI, 1.01 to 1.29]; P for trend = 0.029), and cancer mortality (corresponding HR, 1.28 [CI, 1.02 to 1.60]; P for trend = 0.089). In contrast, a higher vegetable low-carbohydrate score was associated with lower all-cause mortality (HR, 0.80 [CI, 0.75 to 0.85]; P for trend ≤ 0.001) and cardiovascular mortality (HR, 0.77 [CI, 0.68 to 0.87]; P for trend < 0.001).
Limitations: Diet and lifestyle characteristics were assessed with some degree of error. Sensitivity analyses indicated that results were probably not substantively affected by residual confounding or an unmeasured confounder. Participants were not a representative sample of the U.S. population.
Conclusion: A low-carbohydrate diet based on animal sources was associated with higher all-cause mortality in both men and women, whereas a vegetable-based low-carbohydrate diet was associated with lower all-cause and cardiovascular disease mortality rates.

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

Asupan omega 3 dapat menurunkan tingkat depresi pada remaja pria

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PEDIATRICS Vol. 126 No. 3 September 2010, pp. e623-e630

Fish and n-3 Polyunsaturated Fatty Acid Intake and Depressive Symptoms: Ryukyus Child Health Study

Kentaro Murakami, PhDa,Yoshihiro Miyake, MD, PhDb,Satoshi Sasaki, MD, PhDa,Keiko Tanaka, DDS, PhDb,Masashi Arakawa, PhDc
a Department of Social and Preventive Epidemiology, School of Public Health, University of Tokyo, Tokyo, Japan;
b Department of Public Health, Faculty of Medicine, Fukuoka University, Fukuoka, Japan; and
c Field Science for Health and Recreation, Faculty of Tourism Sciences and Industrial Management, University of the Ryukyus, Okinawa, Japan

BACKGROUND Epidemiologic evidence on the role of fish and long-chain n-3 polyunsaturated fatty acid intake on depression during adolescence is sparse.
OBJECTIVE We examined the association between fish, eicosapentaenoic acid (EPA), and docosahexaenoic acid (DHA) intake and depressivesymptoms in a group of adolescents.
SUBJECTS AND METHOD This cross-sectional study, conducted in all public junior high schools in Naha City and Nago City, Okinawa, Japan, included3067 boys and 3450 girls aged 12 to 15 years (52.3% of the eligible sample). Dietary intake was assessed by using a validated, self-administered diet-history questionnaire. Depressive symptoms were defined as present when participants had a Center for Epidemiologic Studies Depression scale score of 16.
RESULTS The prevalence of depressive symptoms was 22.5% for boys and 31.2% for girls. For boys, fish intake was inversely associated with depressive symptoms (adjusted odds ratio [OR] for depressive symptoms in the highest [compared with the lowest] quintile of intake: 0.73 [95% confidence interval (CI): 0.55–0.97]; P for trend = .04). EPA intake showed an inverse associationwith depressive symptoms (OR: 0.71 [95% CI: 0.54–0.94]; P = .04). DHA intake also showed a similar inverse, albeit nonsignificant, association (OR: 0.79 [95% CI: 0.59–1.05]; P = .11). Inaddition, intake of EPA plus DHA was inversely associated with depressive symptoms (OR: 0.72 [95% CI: 0.55–0.96]; P = .08). Conversely, no such associations were observed among girls.
CONCLUSIONS Higher intake of fish, EPA, and DHA was independently associated with a lower prevalence of depressive symptoms in early male, but not female, adolescents.

Fruit and vegetable intake and incidence of type 2 diabetes mellitus

Asupan sayuran bardaun hijau dapat menurunkan risiko diabetes tipe 2 sebesar 14%

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BMJ 2010; 341:c4229

Research

Fruit and vegetable intake and incidence of type 2 diabetes mellitus: systematic review and meta-analysis
Patrice Carter, research nutritionist1, Laura J Gray, research associate in medical statistics2, Jacqui Troughton, senior research associate3,Kamlesh Khunti, professor of primary care diabetes and vascular medicine2,Melanie J Davies, professor of diabetes medicine1

Abstract
Objective To investigate the independent effects of intake of fruit and vegetables on incidence of type 2 diabetes.
Design Systematic review and meta-analysis.
Data sources Medline, Embase, CINAHL, British Nursing Index (BNI), and the Cochrane library were searched for medical subject headings and keywords on diabetes, prediabetes, fruit, and vegetables. Expert opinions were sought and reference lists of relevant articles checked.
Study selection Prospective cohort studies with an independent measure of intake of fruit, vegetables, or fruit and vegetables and data on incidence of type 2 diabetes.
Results Six studies met the inclusion criteria; four of these studies also provided separate information on the consumption of green leafy vegetables. Summary estimates showed that greater intake of green leafy vegetables was associated with a 14% (hazard ratio 0.86, 95% confidence interval 0.77 to 0.97) reduction in risk of type 2 diabetes (P=0.01). The summary estimates showed no significant benefits of increasing the consumption of vegetables, fruit, or fruit and vegetables combined.
Conclusion Increasing daily intake of green leafy vegetables could significantly reduce the risk of type 2 diabetes and should be investigated further.

Intake of artificially sweetened soft drinks and risk of preterm delivery

Minuman mengandung pemanis (artifisial) meningkatkan risiko kelahiran prematur.

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Am J Clin Nutr 92: 626-633, 2010. First published June 30, 2010; doi:10.3945/ajcn.2009.28968
American Journal of Clinical Nutrition, doi:10.3945/ajcn.2009.28968
Vol. 92, No. 3, 626-633, September 2010

ORIGINAL RESEARCH COMMUNICATION

Intake of artificially sweetened soft drinks and risk of preterm delivery: a prospective cohort study in 59,334 Danish pregnant women

Thorhallur I Halldorsson, Marin Strøm, Sesilje B Petersen and Sjurdur F Olsen

Background: Sugar-sweetened soft drinks have been linked to a number of adverse health outcomes such as high weight gain. Therefore, artificially sweetened soft drinks are often promoted as an alternative. However, the safety of artificial sweeteners has been disputed, and consequences of high intakes of artificial sweeteners for pregnant women have been minimally addressed.
Objective: We examined the association between intakes of sugar-sweetened and artificially sweetened soft drinks and preterm delivery.
Design: We conducted prospective cohort analyses of 59,334 women from the Danish National Birth Cohort (1996–2002). Soft drink intake was assessed in midpregnancy by using a food-frequency questionnaire. Preterm delivery ( lt 37 wk) was the primary outcome measure. Covariate information was assessed by telephone interviews.
Results: There was an association between intake of artificially sweetened carbonated and noncarbonated soft drinks and an increased risk of preterm delivery (P for trend: le 0.001, both variables). In comparison with women with no intake of artificially sweetened carbonated soft drinks, the adjusted odds ratio for women who consumed ge 1 serving of artificially sweetened carbonated soft drinks/d was 1.38 (95% CI: 1.15, 1.65). The corresponding odds ratio for women who consumed ge 4 servings of artificially sweetened carbonated soft drinks/d was 1.78 (95% CI: 1.19, 2.66). The association was observed for normal-weight and overweight women. A stronger increase in risk was observed for early preterm and moderately preterm delivery than with late-preterm delivery. No association was observed for sugar-sweetened carbonated soft drinks (P for trend: 0.29) or for sugar-sweetened noncarbonated soft drinks (P for trend: 0.93).
Conclusions: Daily intake of artificially sweetened soft drinks may increase the risk of preterm delivery. Further studies are needed to reject or confirm these findings.

Obesity in Early Adulthood as a Risk Factor for Psoriatic Arthritis

Obesitas merupakan faktor risiko psoriasis, demikian juga untuk artritis psoriasis.

Kelebihan lemak berhubungan dengan peningkatan kadar sitokin inflamasi. Peningkatan sitokin inflamasi berhubungan dengan psoriasis.

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Obesity in Early Adulthood as a Risk Factor for Psoriatic Arthritis
Razieh Soltani-Arabshahi, MD; Bob Wong, PhD; Bing-Jian Feng, PhD; David E. Goldgar, PhD; Kristina Callis Duffin, MD;Gerald G. Krueger, MD

Arch Dermatol. 2010;146(7):721-726. doi:10.1001/archdermatol.2010.141
Objective  To study whether obesity increases the risk of psoriatic arthritis (PsA), given that obesity is a risk factor for psoriasis and is associated with more severe disease.
Design  Case series. We used Cox regression analysis to study the relationship between obesity and PsA while controlling for age at psoriasis onset, current body mass index (BMI), sex, family history of psoriasis, worst-ever body surface area (BSA) involvement, Koebner phenomenon, and nail involvement.
Setting  Dermatology clinics at the University of Utah School of Medicine.
Patients  Volunteer sample of patients with dermatologist-diagnosed psoriasis enrolled in the Utah Psoriasis Initiative from November 2002 to October 2008 (943 subjects; 50.2% women, 49.8% men).
Main Outcome Measures  Physician diagnosis of PsA from self-report questionnaire.
Results  In our subjects, we found that BMI at age 18 years was predictive of PsA (odds ratio [OR], 1.06) (P < .01)over and above control variables. Other variables that were predictors of PsA included younger age at psoriasis onset (odds ratio [OR], 0.98) (P < .01), female sex (OR, 1.45) (P = .01), higher worst-ever BSA involvement with psoriasis (OR, 1.01) (P = .04), Koebner phenomenon (OR, 1.59) (P < .01), and nail involvement (OR, 1.76) (P < .01). Current BMI and family history of psoriasis were not significant predictors of PsA.
Conclusions  This study suggests that obesity at age 18 years increases the risk of developing PsA. Adiposity is associated with higher levels of inflammatory cytokines known to be associated with psoriasis. This inflammatory milieu could increase the risk of PsA in predisposed subjects. Prevention and early treatment of obesity may decrease the risk of PsA.

Lingkar pinggang membesar = risiko kematian meningkat

Pada pria, lingkar pinggang (LP) >=120cm menghadapi risiko kematian dua kali lebih besar dibanding LP <90.

Pada wanita LP >=110cm menghadapi risiko kematian dua kali lebih besar dibanding LP <75cm.

LP semakin besar akan meningkatkan risiko kematian.

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Waist Circumference and All-Cause Mortality in a Large US Cohort

Eric J. Jacobs, PhD; Christina C. Newton, MSPH; Yiting Wang, PhD; Alpa V. Patel, PhD; Marjorie L. McCullough, ScD;Peter T. Campbell, PhD; Michael J. Thun, MD; Susan M. Gapstur, PhD

Arch Intern Med. 2010;170(15):1293-1301. doi:10.1001/archinternmed.2010.201

Background  Waist circumference (WC), a measure of abdominal obesity, is associated with higher mortality independent of body mass index (BMI). Less is known about the association between WC and mortality within categories of BMI or for the very high levels of WC that are now common.
Methods  We examined the association between WC and mortality among 48 500 men and 56 343 women, 50 years or older, in the Cancer Prevention Study II Nutrition Cohort. A total of 9315 men and 5332 women died between 1997 and the end of follow-up in 2006.
Results  After adjustment for BMI and other risk factors, very high levels of WC were associated with an approximately2-fold higher risk of mortality in men and women (among men, relative risk [RR] = 2.02; 95% confidence interval [CI], 1.71-2.39 for WC >=120 cm compared with <90 cm; among women, RR = 2.36; 95% CI, 1.98-2.82 for WC >=110 cmcompared with <75 cm). The WC was positively associated with mortality within all categories of BMI. In men, a 10-cm increase in WC was associated with RRs of 1.16 (95% CI, 1.09-1.23), 1.18 (95% CI, 1.12-1.24), and 1.21 (95% CI, 1.13-1.30) within normal (18.5 to <25), overweight (25 to <30), and obese (>=30) BMI categories, respectively. In women, corresponding RRs were 1.25 (95% CI, 1.18-1.32), 1.15 (95% CI, 1.08-1.22), and 1.13 (95% CI, 1.06-1.20).
Conclusion  These results emphasize the importance of WC as a risk factor for mortality in older adults, regardless ofBMI.