Effect of B-Vitamin Therapy on Progression of Diabetic Nephropathy

Penderita nefropati diabetik sering disertai dengan hiperhomosisteinemia, sehingga diberikan terapi vitamin B untuk menurunkan kadar homosistein.

Tapi ternyata pemberian terapi vitamin B menyebabkan penurunan GFR lebih besar, dan meningkatkan risiko vascular events (myocardial infarction, stroke, revascularization, and all-cause mortality)

 

Effect of B-Vitamin Therapy on Progression of Diabetic Nephropathy

A Randomized Controlled Trial

Andrew A. House, MD; Misha Eliasziw, PhD; Daniel C. Cattran, MD; David N. Churchill, MD; Matthew J. Oliver, MD;Adrian Fine, MD; George K. Dresser, MD; J. David Spence, MD

JAMA. 2010;303(16):1603-1609.

Context  Hyperhomocysteinemia is frequently observed in patients with diabetic nephropathy. B-vitamin therapy (folicacid, vitamin B6, and vitamin B12) has been shown to lower the plasma concentration of homocysteine.
Objective  To determine whether B-vitamin therapy can slow progression of diabetic nephropathy and prevent vascular complications.
Design, Setting, and Participants  A multicenter, randomized, double-blind, placebo-controlled trial (Diabetic Intervention with Vitamins to Improve Nephropathy [DIVINe]) at 5 university medical centers in Canada conducted between May 2001 and July 2007 of 238 participants who had type 1 or 2 diabetes and a clinical diagnosis of diabetic nephropathy.
Intervention  Single tablet of B vitamins containing folic acid (2.5 mg/d), vitamin B6 (25 mg/d), and vitamin B12 (1 mg/d), or matching placebo.
Main Outcome Measures  Change in radionuclide glomerular filtration rate (GFR) between baseline and 36 months. Secondary outcomes were dialysis and a composite of myocardial infarction, stroke, revascularization, and all-cause mortality. Plasma total homocysteine was also measured.
Results  The mean (SD) follow-up during the trial was 31.9 (14.4) months. At 36 months, radionuclide GFR decreased by a mean (SE) of 16.5 (1.7) mL/min/1.73 m2 in the B-vitamin group compared with 10.7 (1.7) mL/min/1.73 m2 in the placebo group (mean difference, –5.8; 95% confidence interval [CI], –10.6 to –1.1; P = .02). There was no difference in requirement of dialysis (hazard ratio [HR], 1.1; 95% CI, 0.4-2.6; P = .88). The composite outcome occurred more often in the B-vitamin group (HR, 2.0; 95% CI, 1.0-4.0; P = .04). Plasma total homocysteine decreased by a mean (SE) of 2.2 (0.4) µmol/L at 36 months in the B-vitamin group compared with a mean (SE) increase of 2.6 (0.4) µmol/L in the placebo group (mean difference, –4.8; 95% CI, –6.1 to –3.7; P < .001, in favor of B vitamins).
Conclusion  Among patients with diabetic nephropathy, high doses of B vitamins compared with placebo resulted in a greater decrease in GFR and an increase in vascular events.

Lemak tak jenuh mengurangi risiko penyakit jantung koroner

Telah diketahui bahwa mengurangi asupan minyak jenuh (saturated fat disingkat SFA) akan menurunkan risiko penyakit jantung koroner (PJK).

Bagaimana efek minyak tak jenuh ganda (polyunsaturated fat disingkat PUFA).

Penelitian ini membuktikan bahwa asupan PUFA ternyata dapat menurunkan risiko PJK.

 

Dianjurkan untuk mengganti minyak SFA dengan minyak PUFA dalam makanan sehari2.

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Abstrak

PLoS Med 7(3):e1000252, 23 March 2010 © 2010 Mozaffarian et al
Effects on Coronary Heart Disease of Increasing Polyunsaturated Fat in Place of Saturated Fat: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Mozaffarian D, Micha R and Wallace S.

Background
Reduced saturated fat (SFA) consumption is recommended to reduce coronary heart disease (CHD), but there is an absence of strong supporting evidence from randomized controlled trials (RCTs) of clinical CHD events and few guidelines focus on any specific replacement nutrient. Additionally, some public health groups recommend lowering or limiting polyunsaturated fat (PUFA) consumption, a major potential replacement for SFA.

Methods and Findings
We systematically investigated and quantified the effects of increased PUFA consumption, as a replacement for SFA, on CHD endpoints in RCTs. RCTs were identified by systematic searches of multiple online databases through June 2009, grey literature sources, hand-searching related articles and citations, and direct contacts with experts to identify potentially unpublished trials. Studies were included if they randomized participants to increased PUFA for at least 1 year without major concomitant interventions, had an appropriate control group, and reported incidence of CHD (myocardial infarction and/or cardiac death). Inclusions/exclusions were adjudicated and data were extracted independently and in duplicate by two investigators and included population characteristics, control and intervention diets, follow-up duration, types of events, risk ratios, and SEs. Pooled effects were calculated using inverse-variance-weighted random effects meta-analysis. From 346 identified abstracts, eight trials met inclusion criteria, totaling 13,614 participants with 1,042 CHD events. Average weighted PUFA consumption was 14.9% energy (range 8.0%–20.7%) in intervention groups versus 5.0% energy (range 4.0%–6.4%) in controls. The overall pooled risk reduction was 19% (RR = 0.81, 95% confidence interval [CI] 0.70–0.95, p = 0.008), corresponding to 10% reduced CHD risk (RR = 0.90, 95% CI = 0.83–0.97) for each 5% energy of increased PUFA, without evidence for statistical heterogeneity (Q-statistic p = 0.13; I2 = 37%). Meta-regression identified study duration as an independent determinant of risk reduction (p = 0.017), with studies of longer duration showing greater benefits.

Conclusions
These findings provide evidence that consuming PUFA in place of SFA reduces CHD events in RCTs. This suggests that rather than trying to lower PUFA consumption, a shift toward greater population PUFA consumption in place of SFA would significantly reduce rates of CHD.

Terapi homeopati = plasebo

Buat mereka yang bersedia mengeluarkan banyak uang untuk terapi homeopati, penelitian berikut ini perlu dicermati.

Penelitian ini mendapatkan bahwa terapi homeopati hanya berefek plasebo.

MJA 192(8):458-460, 19 April 2010 © The Medical Journal of Australia 2010
Homeopathy: what does the "best" evidence tell us? Edzard Ernst.

Abstract

Objective: To evaluate the evidence for and against the effectiveness of homeopathy.
Data sources: The Cochrane Database of Systematic Reviews (generally considered to be the most reliable source of evidence) was searched in January 2010.
Study selection: Cochrane reviews with the term "homeopathy" in the title, abstract or keywords were considered. Protocols of reviews were excluded. Six articles met the inclusion criteria.
Data extraction: Each of the six reviews was examined for specific subject matter; number of clinical trials reviewed; total number of patients involved; and authors' conclusions. The reviews covered the following conditions: cancer, attention-deficit hyperactivity disorder, asthma, dementia, influenza and induction of labour.
Data synthesis: The findings of the reviews were discussed narratively (the reviews' clinical and statistical heterogeneity precluded meta-analysis).
Conclusions: The findings of currently available Cochrane reviews of studies of homeopathy do not show that homeopathic medicines have effects beyond placebo.