HHAL MEDICAL NEWS JANUARY 2013
Vitamin D Linked to Cognitive Acuity
Whereas some studies suggest that
low Vitamin D has associates with cognitive decline among older adults, the relationship is not well understood. Cedric
Annweiler, from Angers University Hospital (France), and colleagues studied data from 498 community-dwelling women who participated
in the Toulouse cohort of the Epidemiology of Osteoporosis study. Among this population,
women who developed Alzheimer's disease had lower baseline vitamin D intakes (an average of 50.3 micrograms per week)
than those who developed other dementias (an average of 63.6 micrograms per week) or no dementia at all (an
average of 59.0 micrograms per week), findings that suggest that higher vitamin D dietary intake associates with a lower risk
of developing Alzheimer's disease. Separately, Yelena Slinin, from the VA Medical Center (Minnesota, USA), and colleagues
analyzed data collected on 257 community-dwelling older women who had vitamin D levels measured during the Study of Osteopathic
Fractures and who underwent standardized assessment for cognitive function, revealing that low vitamin D levels among older
women are associated with higher odds of global cognitive impairment and a higher risk of global cognitive decline.
Exercise Minutes Per Week as a Vital
Sign?
By Christine Sadlowski
Asking about patients' weekly exercise time as part of vital sign checks is being
tested in pilot programs by Kaiser Permanente and others, according to an Associated Press report.
In
the first year of the program, fewer than a third of participants reported meeting physical activity guidelines of least 2 hours
of moderately vigorous exercise per week. The story cites recent research that suggests physical activity may be even more
important for health and longevity than other factors, such as obesity.
Associated Press story
The Effect of Milk Intake on
Vitamin D and Iron Levels in Children
Consuming 2 cups of milk per day is sufficient to maintain healthy vitamin D levels without depleting
iron levels for most children at northern latitudes.
Cow's milk consumption increases vitamin D levels; however, cow's milk can deplete iron stores
in young children. The amount of intake required for sufficient stores of vitamin D and iron is poorly understood. Investigators
recruited healthy children aged 2 to 5 years through a primary care practice research network in Toronto, Canada, over a 2-year
period. They performed a cross-sectional analysis of the relationship between cow's milk and stores of vitamin D and iron.
Cow's milk intake was assessed based on parental report. Serum 25-hydroxyvitamin D and ferritin levels were measured,
and skin pigmentation , vitamin D supplementation, and season were noted.
Among 1311 children, higher cow's milk consumption was
associated with higher 25-hydroxyvitamin D (P 0.0001) levels and
lower serum ferritin (P<0.0001) levels
in a dose-dependent fashion. Two cups (500 mL) of cow's milk per day maintained 25-hydroxyvitamin D levels >75 nmol/L
with minimal negative effect on serum ferritin for most children. However, during the winter, children with darker skin types
were vitamin D deficient at 2 cups of milk per day.
Original article
Medline abstract
B Vitamin for Bone Health
Previously, studies have investigated
the role of B vitamins to maintain bone health. Z Dai, from National University of Singapore (Singapore), and colleagues analyzed
data from 63,257 men and women, ages 45 to 74 years, enrolled in the Singapore Chinese Health Study. The researchers found
that those women with the highest quartile intake of Vitamin B6 (0.78-1.76 mg/1,000 kcal/day) had a 22 % reduction in hip
fracture risk, as compared to women in the lowest quartile intake (0.37-0.61 mg/1,000 kcal/day). Dietary intakes of the other
B vitamins of interest were not related to hip fracture risk; and no correlative effects were seen in men. The study authors
conclude that: “Our findings suggest that maintaining adequate intake of pyridoxine
may prevent osteoporotic fractures among elderly women.”
Folic
Acid Supplements Unlikely to Heighten Cancer Risks, Meta-Analysis Finds
Despite
concerns that folic acid could increase the risks for cancer, a Lancet meta-analysis finds little supporting evidence.
Commentators say the question isn't resolved yet, however.
Researchers examined patient-level
data from 13 randomized trials of folic acid supplementation including a total of 50,000 patients with treatment lasting,
on average, 5 years. During the duration of treatment, they found no evidence of elevated risk for cancer overall, or for
individual cancer types; nor did they find an effect trend with longer treatment duration. There was also no evidence of a
decreased risk.
The typical supplementation doses (2.0 mg/day) were an order of magnitude
higher than those typically delivered by national flour fortification programs (roughly 0.2 mg/day in the U.S.).
Commentators
advise caution in interpreting the findings. They argue that folate's relationship with cancer is complex and that longer
follow-up is needed.
Adding Calcium & Vitamin D Helps to Achieve Weight Management Goals
A number of previous studies suggest that higher calcium and/or vitamin D intake may associate with lower body weight
and better metabolic health. Wei Zhu, from the Shanghai Institute of Health Sciences (China), and colleagues enrolled 53 overweight
and obese men and women with very low calcium consumption in a twelve-week long study. All subjects followed an energy-restricted
diet (~500 kcal/d); half the participants were given supplemental calcium (600 mg elemental calcium ) and vitamin D (125 IU
D3). The researchers observed a significantly greater decrease in fat mass loss in the calcium + D group, as compared to the
S- control group. Further, the calcium + D group exhibited greater decrease in visceral fat mass and visceral fat area. The
study authors conclude that: “Calcium plus vitamin D3 supplementation for 12 weeks augmented body fat and visceral fat
loss in very-low calcium consumers during energy restriction.”
http://www.nutraingredients-usa.com/Research/Calcium-plus-vitamin-D-may-slash-body-fat-levels/
B Vitamins May Reduce Risk of Colorectal Cancer
Involving a total of 88,045 postmenopausal women who were recruited between 1993 and 1998; The Women's Health Initiative
Observational Study covers the time period in which the United States introduced mandatory fortification of grain products
with folic acid (a bioavailable form of folate). Stefanie Zschabitz, from Fred Hutchinson Cancer Research Center (Washington,
USA), and colleagues analyzed the diagnosis of 1,003 incident colorectal cancer cases in the study group that were ascertained
as of 2009. The researchers observed that women with the highest average intakes of riboflavin (vitamin B2, over 3.97 mg per
day) were at a 20% lower risk of colorectal cancer (as compared to women with the lowers average intakes at less than 1.8
mg). Additionally, the highest intakes of pyridoxine (Vitamin B6, over 3.88 mg per day) were found to lower the risk by 20%
(as compared to women with the lowers average intakes at less than 1.52 mg). The study authors conclude that: “Vitamin
B-6 and riboflavin intakes from diet and supplements were associated with a decreased risk of [colorectal cancer] in postmenopausal
women.”
Do Folic Acid and B12 Cause Cancer?
Excess cancer incidence and cancer mortality occurred
in a follow-up of two clinical trials of folic acid and B12 supplements for cardiovascular risk reduction.
Two
recent prospective, randomized clinical trials in Norway were designed to assess cardiovascular risk reduction from supplementation
with folic acid (0.8 mg/day) and vitamin B12 (0.4 mg/day), with or without vitamin B6 (40
mg/day), in patients with ischemic heart disease. As in other secondary-prevention trials, the supplements did not reduce
cardiovascular events or mortality, but folic acid plus B12 was associated with a statistically nonsignificant
increase in cancer rate over a mean of 39 months. This finding prompted the current analysis of data on 6837 patients followed
for 3 years after the trials were completed.
During the trials and follow-up period,
those randomized to folic acid plus vitamin B12 (but not B6) had an excess risk
for incident cancer (hazard ratio [HR], 1.21), cancer mortality (HR, 1.38), and all-cause mortality (HR, 1.18). Analyses of
serum folate and cobalamin levels suggested that folic acid and not B12 conferred the increased risk. Lung cancers
accounted for the largest organ-specific tumor rate. The authors noted a high rate of smoking in the study population (39%).
The highest rates of cancer mortality (HR, 4.57) occurred in those with genetic variants of 5,10-methylenetetrahydrofolate
reductase (MTHFR).
Ebbing M et al. Cancer incidence and mortality
after treatment with folic acid and vitamin B12. JAMA 2009 Nov 18; 302:2119.
Metformin for Antipsychotic-Induced Adverse Effects in Women with Schizophrenia
The medication reversed amenorrhea, promoted weight loss,
and improved insulin resistance.
Metformin has been
used successfully to treat polycystic ovary syndrome (PCOS), restore menstruation in amenorrheic obese women, and improve
antipsychotic-associated weight gain and insulin resistance in schizophrenia patients. Based on these observations, investigators
in China examined effects of metformin in 84 physically healthy, non–substance-abusing outpatients experiencing amenorrhea
in their first year of treatment for first-episode schizophrenia.
Weight gain of greater
than 10%, measured from initiation of antipsychotic treatment to study entry, occurred in 70% of patients. Antipsychotics
were clozapine, olanzapine, risperidone, or sulpiride; doses were relatively stable for the preceding 6 months. In a randomized,
double-blind protocol, patients received metformin (1000 mg/day) or placebo plus their antipsychotic medications for up to
6 months.
Menstruation resumed in 66.7% of metformin recipients (within 3 months of starting metformin)
and in 4.8% of placebo recipients — a significant difference. Significantly more metformin recipients than placebo recipients
lost more than 10% of their baseline weight (28.6% vs. 2.4%) by 6 months. Mean insulin resistance index and levels of insulin,
prolactin, and luteinizing hormone also decreased significantly with metformin compared with placebo. Normalization of weight,
insulin resistance, and levels of prolactin and luteinizing hormone contributed to the increased probability of return of
menses.
Certain Antidepressants Linked to QT Prolongation
Use of
the antidepressants citalopram,
escitalopram, and amitriptyline is associated with increased risk for
modest QT prolongation, according to a BMJ study.
Researchers assessed the electronic health
records of nearly 40,000 patients treated with at least one antidepressant who also underwent electrocardiogram 14 to 90 days
after the prescription.
Increasing doses of citalopram, escitalopram, and amitriptyline were associated with QT prolongation,
but the other drugs studied did not show a similar risk. Bupropion, on the other hand, was associated with QT shortening.
The authors write: "Selective serotonin
reuptake inhibitors such as sertraline may be associated with less risk than citalopram, and therefore might be preferred
in individuals with other risk factors. For escitalopram, our data are less definitive, but suggest that some risk may need
to be considered for this drug as well."
BMJ article
Research ties insulin to higher mortality risk
in diabetes
Type 2 diabetes patients who were on insulin treatment had an 89% higher risk of all-cause mortality and 116% higher
risk of cancer-related death than nonusers, a study revealed. However, researchers noted diabetes patients on insulin did
not have a higher overall risk of cancer. The findings appear in PLoS One. FoodConsumer.org
Folic Acid Supplements Unlikely to Heighten Cancer Risks, Meta-Analysis
Finds
Despite concerns that folic acid could
increase the risks for cancer, a Lancet meta-analysis finds little supporting evidence. Commentators
say the question isn't resolved yet, however.
Researchers
examined patient-level data from 13 randomized trials of folic acid supplementation including a total of 50,000 patients with
treatment lasting, on average, 5 years. During the duration of treatment, they found no evidence of elevated risk for cancer
overall, or for individual cancer types; nor did they find an effect trend with longer treatment duration. There was also
no evidence of a decreased risk.
The typical supplementation doses (2.0
mg/day) were an order of magnitude higher than those typically delivered by national flour fortification programs (roughly
0.2 mg/day in the U.S.).
Commentators advise caution in interpreting
the findings. They argue that folate's relationship with cancer is complex and that longer follow-up is needed.
Lancet article
Only Substantial Obesity Is Associated with All-Cause Mortality
In a meta-analysis, being modestly overweight was somewhat protective.
The reported relation of overweight or obesity to mortality for any given follow-up
has been inconsistent, because studies have used varying definitions and categories of normal weight and obesity. In this
meta-analysis, researchers identified 97 studies, mostly from the U.S., Europe, and Australia (2.88 million participants and
>270,000 deaths), in which weight categories were standardized. Participants were categorized by body-mass index (BMI)
as normal weight (18.5 to <25 kg/m2), overweight (25 to <30), grade 1 obese (30 to <35),
grade 2 obese (35 to <40) and grade 3 obese ( 40).
Compared with normal-weight participants, all-cause mortality
was significantly lower for overweight participants (hazard ratio, 0.94), was similar for grade 1 obesity (HR, 0.95), and
was significantly higher for grade 2 and grade 3 obesity (HR, 1.29). Results were similar when analysis was limited to studies
that were considered to be appropriately adjusted (neither overadjusted for possible causal pathways between obesity and mortality,
nor underadjusted for age, sex, and smoking status).
Esomeprazole for Unexplained Chest Pain?
In
a randomized trial, only a small proportion of patients benefited.
Operating on the premise that acid reflux can cause nonspecific
chest pain, clinicians often prescribe proton-pump inhibitors (PPIs) for patients with unexplained chest pain. Industry-sponsored
researchers assessed the efficacy of this intervention in 599 patients (mean age, 47) with at least 2 weeks of unexplained
chest pain; all patients had negative exercise tolerance tests, no obvious cardiopulmonary or musculoskeletal causes of chest
pain, and no formal diagnoses of gastroesophageal reflux disease. Patients were divided into two groups — 314 patients
with minimal or no heartburn or regurgitation ( 1 day/week [stratum 1]) and 285 patients with frequent heartburn or regurgitation ( 2 days/week [stratum
2]). Patients were enrolled only if their presenting chest pain was perceived as different from the background heartburn or
regurgitation.
Patients were randomized to esomeprazole (Nexium;
40 mg twice daily) or placebo. In stratum 1, the primary efficacy outcome (absence of chest pain during the fourth week of
treatment) occurred in 39% of esomeprazole recipients and 26% of placebo recipients — a significant difference (P=0.02).
By contrast, in stratum 2, responses were similar in the esomeprazole and placebo groups (27% and 24%; P=0.54).
Medline abstract
Research ties insulin to higher mortality risk in diabetes
Type 2 diabetes patients who were on insulin treatment
had an 89% higher risk of all-cause mortality and 116% higher risk of cancer-related death than nonusers, a study revealed.
However, researchers noted diabetes patients on insulin did not have a higher overall risk of cancer. The findings appear
in PLoS One. FoodConsumer.org
Exercise for a longer life span
Less than half of the U.S. adult population meets the guidelines
of 150 minutes of moderate to vigorous physical activity/week, making chronic disease and premature mortality major concerns.
Measuring leisure-time physical activity across the adult life span for gender and ethnicity, researchers report it increases
longevity, adding 2.3-5.6 hours of life for every hour of moderate physical activity for non-Hispanics. American Journal of Preventive Medicine
Physical activity extends life expectancy, researchers find
Participation in at least two and a half hours of moderate
activity a week added almost six years to black women's life expectancy, Canadian researchers found. They said that white
men who were physically active at age 20 were expected to have an extra two and a half years of life compared with inactive
peers. The findings appear in the American Journal of Preventive Medicine. HealthDay News
Targeting uric acid in chronic kidney
disease
Hyperuricemia is common in chronic kidney disease (CKD), and experimental evidence suggests that uric acid itself may
contribute to hypertension, local inflammation and kidney disease progression. The authors review experimental evidence linking
hyperuricemia to CKD and highlight gaps in our knowledge with a focus on studies that have examined the potential nephroprotective
effect of treating elevated uric acid levels in patients with CKD.
Diabetes raises risk of sudden cardiac death in men
Data on 2,641 middle-aged men found those with prediabetes were 1.51 times as likely as those with normal glucose
levels to suffer sudden cardiac death, while patients with type 2 diabetes had more than a twofold increased risk of sudden
cardiac death. The results appear in Diabetes Care. DailyRx.com
Hypertension treatment by body size
Hypertension in normal-weight and obese patients might be mediated by different mechanisms. Thiazide-based treatment
gives less cardiovascular protection in normal-weight than obese patients, but amlodipine-based therapy is equally effective
across body mass index subgroups and thus offers superior cardiovascular protection in non-obese hypertension.
Link between pneumonia and cardiovascular
disease?
An important number of patients have new cardiac arrhythmia during and after hospitalization for pneumonia. Additional
research is needed to determine whether use of cardioprotective medications will improve outcomes for patients hospitalized
with pneumonia. At-risk patients hospitalized with pneumonia should be monitored for cardiac arrhythmias during the hospitalization.
Obese children show higher risk of current
health concerns
Overweight
and obese children were more likely to have three or more reported medical, developmental or mental conditions compared with
those at a healthier weight, according to a study in the journal Academic Pediatrics. Obese children had a higher risk of
emotional and behavioral problems, attention-deficit/hyperactivity disorder, depression, developmental delays, asthma, allergies,
headaches and ear infections, among other problems, the study found.Yahoo/Asian News International
Body mass index and long-term mortality
Body
mass index (BMI) has been accepted as a short-term predictor of mortality, but not for predicting long-term mortality in nursing
home residents. This Italian study looked at the correlation between BMI, Mini Nutritional Assessment scores and serum albumin
levels. The five-year mortality rate was 63%. BMI seems to be the best of the three measures for predicting five-year mortality,
and a higher BMI coincided with lower mortality risk. (Free abstract only.) Journal of the American Medical Directors Association
In Patients with Hyperlipidemia, Exercise and Statins Both Lengthen
Life
Moderate fitness
or statin use led to about the same 10-year mortality.
Both taking statins and increasing physical activity lower
mortality in patients at risk for cardiovascular disease, but few data exist on the comparative or synergistic effects of
these interventions. Researchers followed more than 10,000 military veterans (97% men; 52% black) with dyslipidemia who received
care through the U.S. Veterans Administration and underwent exercise tolerance tests between 1986 and 2011. Each patient was
assigned to one of four fitness strata, based on peak exercise capacity at cohort entry (from
5.0 to >9.0 metabolic equivalents [MET]) and was classified as a statin user (for at least 3 months) or nonuser.
Patients were followed prospectively for a median of 10 years.
After adjustment for potential confounders, statin use and better fitness
were associated independently with lower mortality. Among nonusers, the most-fit patients had significantly lower mortality
than the least-fit patients (adjusted hazard ratio, 0.37). Similarly, among statin users, the most-fit patients had significantly
lower mortality than the least-fit patients (AHR, 0.32). Moderately fit nonusers (exercise tolerance, 5.1–7.0 MET) had
mortality risk approximately equivalent to the least-fit statin users.
Kokkinos
PF et al. Lancet 2012 Nov 28;
Hearing Loss in the Elderly Associated with Cognitive Declines
Even mild hearing loss is independently associated with increased rates of cognitive decline in the elderly, according
to a JAMA
Internal Medicine study.
Some 2000 older adults without cognitive impairment had their
hearing and cognition tested and were followed an average of 6 years with further cognitive testing. Those with hearing loss
at baseline had rates of cognitive decline that were roughly 30% to 40% higher than those with normal hearing; incident cognitive
impairment was almost 25% higher among the hearing-impaired during follow-up. Both incident cognitive impairment and the rate
of cognitive decline were associated with hearing loss severity at baseline. Hearing aid use was associated with a trend toward
attenuation of the effect, but it was not statistically significant.
The authors speculate that the effect may derive from increased
social isolation or decreased cognitive stimulation.
The journal also presents data showing that concurrent hearing and vision
impairment among people over age 80 is almost twice as high as previously estimated (11.3% versus 6.6%).
JAMA Internal Medicine article on hearing loss
Do Beta-Blockers Reduce
Dementia Risk?
The preliminary results of a new study
to be presented at a conference in March are causing scientists to ask if beta-blockers, a class of drugs commonly used to
treat high blood pressure and heart conditions, can reduce dementia risk. The study
found autopsies of elderly men revealed those who took beta-blockers had fewer brain changes normally associated with Alzheimer's
and other types of dementia.c
http://www.medicalnewstoday.com/printerfriendlynews.php?newsid=254647
Study Shows Heart Calcium Scan Predictive Of
Diabetes-Related Death From Cardiovascular Disease
People with Type 2 diabetes have two to four times the risk of cardiovascular disease compared
to people without the disease. The best way for doctors to predict which diabetes patients are at the greatest risk for heart disease is to use a coronary artery calcium (CAC) test in addition to the most commonly used assessment tool,
according to researchers at Wake Forest Baptist Medical Center.
http://www.medicalnewstoday.com/printerfriendlynews.php?newsid=254380
Lacunar Stroke Does Not Justify Long-Term
Dual Antiplatelet Therapy
In the SPS3 trial, clopidogrel added to aspirin increased bleeding and
mortality without providing a compensatory benefit.
Long-term
dual antiplatelet therapy has not been rigorously assessed in patients with specific ischemic stroke subtypes other than that
associated with atrial fibrillation The antiplatelet arm of the multicenter Secondary Prevention of Small Subcortical Strokes
(SPS3) trial was designed to compare aspirin with or without clopidogrel specifically in patients with lacunar stroke —
a small subcortical infarct caused by intrinsic small-vessel disease.
Patients qualified
for SPS3 if they were aged 30 and had experienced a recent symptomatic lacunar
stroke, defined as a typical clinical syndrome along with a compatible magnetic resonance imaging lesion. At a median of about
2 months after the qualifying stroke, 3020 patients were randomized to aspirin (325 mg daily) and either clopidogrel (75 mg
daily) or placebo. Researchers followed patients for an average of 3.4 years and the trial was stopped 10 months early because
of futility and evidence of harm in the dual antiplatelet group.
The composite primary
outcome of any ischemic stroke or intracerebral hemorrhage occurred at an annual rate of 2.5% with aspirin plus clopidogrel
versus 2.7% with aspirin alone — a nonsignificant difference. Lacunar strokes were the most common type of recurrent
ischemic stroke (71%) and occurred with essentially equal frequency in both groups. Dual antiplatelet therapy significantly
increased the risks for major hemorrhage (hazard ratio, 1.97) and death (HR, 1.52) compared with aspirin alone.
with Risk for Acute Kidney Injury
Common
antihypertensive agents are associated with increased risk for kidney injury when used concurrently with NSAIDs, according
to a BMJarticle.
Using U.K. national databases, researchers followed half a million patients who were prescribed antihypertensives
over a mean of roughly 6 years. The incidence of kidney injury in the entire cohort was 7 per 10,000 person-years. Patients
receiving "triple therapy" (an NSAID plus a diuretic plus either an angiotensin-converting–enzyme inhibitor
or angiotensin-receptor blocker) had a 31% increased risk for hospitalization for acute kidney injury, relative to those not
taking NSAIDs. "Double therapy" (an NSAID plus either a diuretic, ACE inhibitor, or ARB) was not associated with
increased risk.
Editorialists note that the confidence interval around the
double therapy estimate was wide, and thus the evidence for the absence of risk was not strong. The study's authors urge
caution, especially early in the course of treatment when risk seems highest and patients may be taking NSAIDs for arthritis
or flu-like syndromes.
BMJ article
Can Diet Beat Depression?
Research into diet and depression should follow the model of studies into diet and cardiovascular risk.
According to an opinion piece in BioMed Central's open access journal BMC
Medicine
this week.
The authors, from the universities of Las Palmas and
Navarra, assess the evidence into links between diet and depression and find it lacking. "Depression is similar in many
aspects to heart disease" they explained. "Both are associated with low-grade inflammation, endothelial dysfunction
and worse lipid profiles. This tends to suggest that the underlying causes, such as a diet high in trans fats, are also the
same."
Though there is plenty of evidence that there is an
association, and that fast food increases risk of depression (while the Mediterranean diet decreases it), most of these studies
do not show causality. Almudena Sanchez-Villegas continued, "It is difficult to be sure that the diet is responsible
for depression - it could be that depressed people make bad food choices. Other study problems include 'confounders'
which may influence dietary habits, such as marital status, exercise, alcohol (or smoking), medical conditions and social
networks. Or simply genetics."
Miguel A Martinez-Gonzßlez concluded,
"To address these issues we need long term, randomised clinical studies similar to ones successfully conducted for diet
and cardiovascular disease risk. Only then will we really understand the impact of diet of depression."
http://www.medicalnewstoday.com/printerfriendlynews.php?newsid=254567
New Understanding
Of Metformin's Action Offers New Drug Targets For Diabetes
A team, led by senior author
Morris J. Birnbaum, MD, PhD, the Willard and Rhoda Ware Professor of Medicine, with the Institute for Diabetes, Obesity, and
Metabolism, Perelman School of Medicine, University of Pennsylvania, found that the diabetes drug metformin works in a different
way than previously understood. Their research in mice found that metformin suppresses the liver hormone glucagon's ability
to generate an important signaling molecule, pointing to new drug targets. The findings were published online in Nature.
For fifty years, one of the few classes of therapeutics effective in reducing
the overactive glucose production associated with diabetes has been the biguanides, which includes metformin, the most frequently
prescribed drug for type 2 diabetes. The inability of insulin to keep liver glucose output in check is a major factor in the
high blood sugar of type 2 diabetes and other diseases of insulin resistance.
"Overall, metformin
lowers blood glucose by decreasing liver production of glucose," says Birnbaum.
"But we didn't really
know how the drug accomplished that."
http://www.medicalnewstoday.com/printerfriendlynews.php?newsid=254636
Fructose Effect
On Brain May Explain Link To Obesity
A new, preliminary imaging study that compares the effects of
fructose and glucose on the brain has found differences that may explain why diets high in fructose may be behind the obesity
epidemic.
Upon examining brain magnetic resonance imaging (MRI) scans of adult volunteers, first study author
Kathleen A. Page of Yale University School of Medicine in the US, and colleagues, found ingestion of glucose but not fructose
reduced blood flow and brain activity in regions of the brain that regulate appetite, and ingestion of glucose but not fructose,
led to higher levels of hormones that produce feelings of fullness and satiety.
http://www.medicalnewstoday.com/printerfriendlynews.php?newsid=254512
Estimating Bleeding Risk with Anticoagulation in Patients
with Atrial Fibrillation
The HAS-BLED
score outperformed the ATRIA score.
"HAS-BLED"
is a recently developed and validated scoring system to assess bleeding risk in patients with atrial fibrillation (AF) who
are receiving anticoagulant therapy. It assigns 1 point to each of the following nine risk factors: hypertension, abnormal
renal function, abnormal liver function, previous stroke, bleeding history or predisposition, history of labile international
normalized ratio (INR), age 65, concomitant aspirin or nonsteroidal anti-inflammatory drug therapy, and substantial alcohol
intake. In this study from Spain, researchers compared the predictive value of HAS-BLED with that of another recently published
scoring system ("ATRIA"; JW Gen Med Sep 29 2011) in 937 anticoagulated AF patients. The average duration of observation
was nearly 3 years, during which the overall rate of major hemorrhage was 3.2% annually.
HAS-BLED performed significantly better than ATRIA. Annual
incidences of major bleeding by HAS-BLED score were 0% for 0 points, 1% for 1 point, 2% for 2 points, 6% for 3 to 4 points,
and 16% for 5 to 6 points (no patients scored >6 points).
FDA Approves First OTC Treatment for Overactive Bladder
in Women
The
FDA has approved an over-the-counter patch to treat overactive bladder in women 18 and older. The patch, which is applied
to the skin every 4 days, delivers 3.9 mg/day of the anticholinergic oxybutynin (Oxytrol).
Approval for OTC use was based on nine
studies comprising more than 5000 adults with overactive bladder in which patients demonstrated they understood the product
label and could use the patch appropriately. Side effects included constipation, dry mouth, and skin irritation at the application
site.
Oxytrol for men with overactive bladder will still be available by prescription only.
FDA news release
FDA Advisory Panel Recommends Limits on Drugs Containing Hydrocodone
An FDA advisory panel voted 19 to 10 on Friday to restrict access to hydrocodone-containing drugs, such as Vicodin,
the New
York Timesreports. The painkillers would be moved from a schedule III substance to a schedule II.
If the FDA and the Department of Health
and Human Services accept the recommendations, patients would need a written prescription from a physician for each refill.
Nurse practitioners and physicians assistants could no longer prescribe the drugs.
The move aims to crack down on abuse of hydrocodone. Some
panelists were concerned that patients with chronic pain would have trouble getting the drugs and that restricting one type
of drug could just lead to more abuse of other drugs, such as heroin.
New York Times story
Folate for Treatment-Resistant Depression
Supplementing SSRIs with the biologically
available form of folate increases response but not
remission rates.
Papakostas GI et al. Am J Psychiatry 2012 Dec 1; 169:1267
Nelson JC. Am J Psychiatry
2012 Dec 1; 169:1223
Fructose and Glucose Ingestion Affect Appetite Pathways
in the Brain Differently
Fructose also resulted in lower peak levels
of satiety hormones.
Page KA et al. JAMA 2013 Jan 2; 309:63
Short-Term Correction of Vitamin D Deficiency in Healthy
Young Women
January 3, 2013 |
Allan S. Brett, MD |
General Medicine
Supplementation raised 25-hydroxyvitamin
D levels substantially, but with no physical benefits.
Goswami R et al. J Clin Endocrinol Metab 2012 Dec 97:4709
Low Total-Fat Intake Is Associated with Lower Weight, Body-Mass
Index, and Waist Circumference
A meta-analysis backs up observations
about fat intake.
Hooper
L et al. BMJ 2012 Dec 6; 345:e7666
Better Cognitive Functioning in the Elderly Linked to More-Intense
Physical Activity
In a community sample of well-functioning adults over age 60, peak intensity of physical activity, rather than overall
quantity, was the better predictor of higher levels of cognitive performance.
Brown BM et al. Transl Psychiatry 2012
Nov 20; 2:e191
Thyroid Function and Risk for AF: A Linear Relation
Patients with even subclinical hyperthyroidism
had excess risk for atrial fibrillation.
Selmer C et al. BMJ 2012 Nov 27; 345:e7895
Low-Dose Aspirin and Dementia in Older Women
Does low-dose acetylsalicylic acid prevent
cognitive decline in women with high cardiovascular risk?
Kern S et al. BMJ Open 2012 Oct 3; 2:e001288
Should "Continue Statins" Be Added to the Pre-Op
Checklist?
A large retrospective study confirms that
statin use is associated with lower risk for
postoperative acute kidney injury.
Brunelli SM et al.
Am J Med
2012 Dec 125:1195
Rosner MH. Am J Med 2012 Dec 125:1153
Do Beta-Blockers Reduce Dementia Risk?
http://mnt.to/l/4b4T
Vascular Function In Young Black Men Improved By Strength Training
http://mnt.to/l/49Yz
Study Shows
Heart Calcium Scan Predictive Of Diabetes-Related Death From
Cardiovascular Disease
http://mnt.to/l/49Xs
Can Diet Beat Depression?
http://mnt.to/l/4b3g
Scientists Uncover Itch-Specific Nerve Cells In Skin
http://mnt.to/l/4b32
New Understanding
Of Metformin's Action Offers New Drug Targets For Diabetes
http://mnt.to/l/4b4G
Low Testosterone Levels Eliminated By New Hormone
http://mnt.to/l/4b2D
Cholesterol Medicine Affects Energy Production In Muscles
http://mnt.to/l/4b3N
Statin
Treatment Associated With Muscle Pain
http://mnt.to/l/4b46
Walking
Reduces Stroke Risk Among Women
http://mnt.to/l/4b4B
Diagnosing
Pre-Menstrual Syndrome
http://mnt.to/l/49YC
Cut Down On Alcohol For Healthy Weight
http://mnt.to/l/4b3v
Attempting
To Fight Obesity By Targeting Taste Receptors In The Gut
http://mnt.to/l/49Yr
Fructose
Effect On Brain May Explain Link To Obesity
http://mnt.to/l/4b28Discovery Of Protein That Could
Be Key To
Fighting And Preventing Obesity
http://mnt.to/l/4b4X
Important
Factor Identified In Fat Storage And Energy Metabolism
http://mnt.to/l/4b4C
Chronic Inflammation, Suppression Of Cell Regeneration, And Neuronal Cell Loss Contribute
To Wide
Range Of Motor And Cognitive Deficits
http://mnt.to/l/4b4h
Potential
Neuroprotective Response Induced By Antidepressant Drug
http://mnt.to/l/4b4f
Low Testosterone Levels Eliminated By New Hormone
http://mnt.to/l/4b2D
Basic Research Reveals Mice On Viagra Resistant To Obesity
http://mnt.to/l/4bgB
Fast
Food Restaurants Serve Extremely Unhealthy Meals
http://mnt.to/l/4bh7
Gastric Banding
A Successful Long-Term Solution To Obesity
http://mnt.to/l/4bds
How Quitting
Sugar Impacts On Body Weight
http://mnt.to/l/4bcz
In Seniors Over 75, Diet
May Not Impact Certain Health Outcomes
http://mnt.to/l/4bc2
Discovery Of Surprising Connections Between Our Well-Being And Giving, Getting, And Gratitude
http://mnt.to/l/4bhs
Body Clock
Synchronisation Studied In 'Jet-Lagged' Fruit Flies
http://mnt.to/l/4bg6
Stroke Risk Up
As Temperatures Drop
http://mnt.to/l/4bhT
Nations That Consume A Lot Of Milk....Also Win A Lot Of Nobel Prizes
http://mnt.to/l/4bcm
Vitamin D Levels
In Children Most Likely Determined By Supplements Taken And Consumption
Of Cow's Milk
http://mnt.to/l/4bbY
One Form Of Neuron Turned Into Another In The Brain
http://mnt.to/l/4bhG
Challenging
Long-Held Belief That Low Blood Flow To The Premature Brain Necessarily
Kills Brain Cells
http://mnt.to/l/4bgL
Multi Tasking
And Age Related Changes To The Brain
http://mnt.to/l/4bg7
Grape Seed Extract Effective In Colorectal Cancer Treatment
http://mnt.to/l/4bhP
Effectively
Treating Colorectal Cancer With Grape Seed Extract, Even As Cancer
Gets More Aggressive
http://mnt.to/l/4bfG
Amyloid
Beta And Mild Cognitive Impairment
http://mnt.to/l/4bcH
Amyloid Beta And Mild Cognitive Impairment
http://mnt.to/l/4bcH
Amyloid Beta And Mild Cognitive Impairment
http://mnt.to/l/4bcH
No Decline In Breast Cancer Mortality Since 1992 In Women Over 85
http://mnt.to/l/4bf3
Worry- Two Hours A Day Lost To Stress Of Modern Life
http://mnt.to/l/4brD
Low Vitamin D Levels Linked To High Risk Of Premenopausal Breast Cancer
http://mnt.to/l/4bqK
Fighting Triple-Negative Breast Cancer With The Help Of Vitamin D
http://mnt.to/l/4bkh
The Good, The Bad - And The Ugly Cholesterol That Causes Heart Disease
http://mnt.to/l/4bjg
Could Carrots Reduce Risk Of Type-2 Diabetes?
http://mnt.to/l/4bjY
A Likely Link Between Stress And Heart Disease: Viral Reactivation
http://mnt.to/l/4bkV
Facebook Activity May Reveal Clues To Mental Illness
http://mnt.to/l/4brw
Flaxseed In Dairy Cow's Feed Makes For More Nutritious Dairy Products And The Cows Love It
http://mnt.to/l/4bqM
Folic Acid
Supplements Not Linked To Increased Cancer Risk
http://mnt.to/l/4bqm
A Blend Of
Soy & Dairy Proteins Promotes Muscle Protein Synthesis When Consumed
After Exercise
http://mnt.to/l/4bpc
Increased Fruit
And Veg Consumption Associated With Positive Mood
http://mnt.to/l/4bmR
Single-Larger-Portion-Size
And Dual-Column Nutrition Labeling May Help Consumers
Make Better Food Choices
http://mnt.to/l/4bm5
Late Lunching Can Slow Weight Loss
http://mnt.to/l/4bsS
Poor Sleep Causes Memory Loss And Forgetfulness
http://mnt.to/l/4brx
Boosting 'Slow
Wave' Sleep Could Restore Memory As We Age
http://mnt.to/l/4br7
Snoring May
Be Early Sign Of Future Health Risks
http://mnt.to/l/4bpY
Snoring Can
Affect The Carotid Artery
http://mnt.to/l/4bqt
Cholesterol Plays Key Role In Cell Signaling
http://mnt.to/l/49ZY
Cholesterol
Helps Regulate Key Signaling Proteins In The Cell
http://mnt.to/l/49WG
Consuming Avocado With A Burger May Neutralize Interleukin-6
http://mnt.to/l/49Zv
