Increased Coffee Consumption Linked to Lower Depression Risk in Women

The more caffeinated coffee women drink, the less likely they are to develop depression, according to a prospective study in the Archives of Internal Medicine.

Some 50,000 Nurses' Health Study participants without depressive symptoms at baseline were followed for roughly 10 years. During that time, about 5% reported physician-diagnosed depression.

Overall, as self-reported caffeinated coffee consumption increased, the risk for depression decreased. In particular, compared with women who drank 1 cup or less a week, those drinking 2 to 3 cups a day had a 15% lower relative risk for depression, and those drinking 4 or more cups a day had a 20% lower risk. No link was seen between other sources of caffeine and depression, or between decaffeinated coffee and depression.

An editorialist says that the while these and other data may provide reassurance that coffee drinking has "no glaringly deleterious health consequences ... it seems premature to recommend coffee consumption."

Archives of Internal Medicine article (Free abstract)

ICAAC: Maggots Make Happy Meal of Diabetic Wounds

By Michael Smith, North American Correspondent, MedPage Today
Published: September 21, 2011
Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco and
Dorothy Caputo, MA, RN, BC-ADM, CDE, Nurse Planner



CHICAGO -- Diabetic patients facing lower limb amputation because of non-healing lesions may get a leg up from the insect world, a researcher said here.
Biosurgery using the sterile larvae of the green blow-fly (Lucilia sericata) may be an alternative to amputation in many cases, according to Lawrence Eron, MD, of the University of Hawaii in Honolulu.
In a series of 37 patients with complicated limb wounds, the approach, which used the larvae to debride the lesion, yielded a successful outcome in 27, Eron reported at the Interscience Conference on Anti-Microbial Agents and Chemotherapy.
The larvae, commonly referred to as maggots, only eat "devitalized" tissue, leaving living tissue alone, Eron said. This makes them ideal to clean up diabetic lesions that have not responded to standard therapy with antibiotics.
But the process might someday be useful in patients earlier in the disease course, he told MedPage Today after his oral presentation.
The use of maggots to clean wounds goes back centuries particularly during wartime, but it had fallen out of favor. Now, Eron said, several groups are trying to see if the larvae have a clinical role in modern medicine, and especially in patients with diabetic limb wounds.
For the analysis, the researchers defined success as complete debridement of devitalized tissue, formation of robust granulation tissue, and at least 50% closure of the wound.
The 37 patients had lesions that had been present in some cases for up to five years and were resistant to all attempts at cure. The lesions included 18 abscesses, six infected ulcers, nine cases of osteomyelitis, and four cases of gangrene.
Eron said the researchers applied 50 to 100 maggots, left them in place for two days, and then removed them, repeating the process an average of five times per wound.
In 73% of the patients, the maggot debridement therapy was successful, although Eron noted that complete closure of the wound was not part of the definition of success. Other methods were used to finish the job.
"There's no question that these little critters are able to debride tissue very efficiently," Eron said.
The 10 failures were linked to excessive inflammation surrounding the wound, bleeding from the wound, fistulae from infected bones that closed after single treatment, and severe peripheral vascular disease.
One patient stopped because of pain, but most patients either couldn't feel the maggots working or found the "creepy-crawly" sensation reassuring, Eron said.
One reason to use the approach, he noted, is cost: a simple uninfected diabetic foot ulcer can cost up to $10,000 to treat, while amputation if treatment fails costs up to $65,000.
In contrast, the medical grade maggots sell for about $100 for about 200, so that an average five-cycle treatment would cost around $500, he said.
"This biosurgery is a different approach that gets us around the problem of antibiotic resistance," Catherine Bennett, PhD, of Deakin University in Melbourne, Australia, who moderated the session at which the research was presented.
"It's a very targeted, selective approach to tissue removal," she told MedPage Today.
She noted that the patients in the study had serious wounds, and it's not clear that the process would be acceptable in patients earlier in the disease course, even if it might be medically advisable.
She said formal trials are needed and "if the evidence is good, it will convince patients as well as physicians."

NSAID Use Linked to Increased Risk for Spontaneous Abortion

Use of any nonaspirin nonsteroidal anti-inflammatory drug during pregnancy increases the risk for spontaneous abortion more than twofold, according to a case-control study in the Canadian Medical Association Journal.Researchers used the Quebec Pregnancy Registry to identify some 4700 women who had a spontaneous abortion by 20 weeks' gestation. Each case was matched to 10 controls who did not have spontaneous abortions. Exposure to a nonaspirin NSAID during pregnancy was noted in some 7.5% of cases, but in only 2.6% of controls. After adjustment for potential confounders such as history of rheumatoid arthritis or systemic lupus, all nonaspirin NSAIDs were associated with a significantly increased risk for spontaneous abortion, the highest being with diclofenac (odds ratio, 3.09). No dose-response effect was found.

Paralyzed Man Stands, Moves With Epidural Stimulation

By Nancy Walsh, Staff Writer, MedPage Today
Published: May 19, 2011


Rob Summers was 20 in the summer before his junior year at Oregon State University in the summer of 2006. A pitcher on the school's baseball team, he went out around midnight to get his gym bag out of his car when a hit-and-run driver jumped the curb, striking him and leaving him paralyzed with an injury to the spinal cord from C7-T1.
Today Summers can stand for several minutes and move his legs, feet, and toes. He has regained some bladder control and sexual functioning, as well as the ability to regulate his body temperature through mechanisms such as perspiration.

These gains are the result of unprecedented treatment -- begun in December 2009 -- using electrical stimulation of the spinal cord.

After 80 sessions of task-specific training, epidural stimulation from an implanted unit allowed Summers to stand, bearing all his weight, for up to 4.25 minutes, Susan Harkema, PhD, of the University of Louisville in Kentucky, V. Reggie Edgerton, PhD, of the University of California Los Angeles, and colleagues reported online in The Lancet.

Summers had previously undergone 26 months of locomotor training with assistance on a treadmill that had failed to produce any changes in electromyographic activity in the legs, the researchers explained.

"This unexpected recovery of supraspinally mediated movement suggests that activity-dependent mechanisms promoted plasticity of anxonal projections that presumably were spared by the injury," observed Grégoire Courtine, PhD, of the University of Zurich in Switzerland, and colleagues in a commentary accompanying the case report.

Animal studies had shown that the spinal cord is capable of generating motor commands without signals from the brain by means of neural networks known as central pattern generators.

In paralyzed humans, epidural stimulation has been shown to induce rhythmic movements of the legs while the patient lies supine.

Most [spinal cord injuries] involve a contusion or compressive injury of the cord that causes a great deal of damage, but leaves a certain number of nerve fibers that connect the brain with the spinal cord," Edward D. Hall, PhD, of the University of Kentucky and the Spinal Cord and Brain Injury Research Center in Lexington, observed in an email to ABC News and MedPage Today.

Harkema's team in Louisville had been doing research to see if spinal cord stimulation could activate neural circuits in the spine and, coupled with sensory input from the legs, permit standing and locomotion. Summers went to Louisville to see if they could help him.

In December of 2009, the team implanted a 16-electrode array over the young man's spinal segments L1-S1.

They also implanted a pulse generator connected to an electrode lead in the abdomen.

The researchers explained that, although Summers was paralyzed below the chest, he was classified as grade B on the American Spinal Injury Association's neurologic impairment scale since he had light touch sensation below the area of the spinal injury. But he had no voluntary control over the muscles of legs and trunk and no ability to contract the bladder.

The investigators tested various amplitudes ranging from 0.5 to 10 V and frequencies of 5 Hz to 40 Hz, in stimulation sessions ranging from 40 minutes to two hours.

Summers has reported tingling sensations at the site of the implanted electrode and in the muscles being activated, but did not experience pain during the stimulation sessions.

Initially, he was able to stand only with 65% body weight support, but over time he progressed to full weight bearing.

In addition to learning to stand unaided, Summers eventually progressed to the extent that he could stand up from a sitting position, which resulted in a marked increase in electromyographic activity.

He then learned task-specific sensory cues such as positioning of the legs, hips, and knees to accomplish step-like movements during 30 Hz to 40 Hz epidural stimulation.

But without the epidural stimulation, no electromyographic activity could be detected when his trainers assisted him in performing these stepping movements.

Hall cautioned that if this approach is shown to help in other patients, it may allow them to walk with the aid of a walker.

"While this will have value, it is important to note that it will not reproduce normal walking," Hall said.

If Summers isn't running around any baseball diamonds, he has a renewed sense of well being and self-esteem. Now 25, he lives in Los Angeles. And last summer, he spent 10 days helping at a baseball camp in Florida.

"One possible explanation for this recovery is that residual supraspinal connections that existed but could not be detected clinically were reactivated or that new supraspinal connections to the spinal networks were formed," Edgarton's group noted in their paper.

"Challenges lie ahead," stated Courtine and colleagues in their commentary and the findings need to be replicated in a clinical trial with sufficient numbers of patients.

Nonetheless, they wrote, "The exceptional results bring new hope in a field that has remained unsatisfying -- with limited progress despite decades of research throughout the world."

Naomi Kleitman, PhD, of the National Institutes of Health in Bethesda, Md., also found Summers' story hopeful. Most people are unaware of the complex circuits in their spine that transmit commands to the body from the brain, she told MedPage Today and ABC News in an email.

"Spinal cord injuries break this vital connection but the sophisticated circuitry of the spinal cord remains, ready to coordinate stepping if it receives the right commands. Harnessing that potential has been the goal of decades of research to understand spinal cord function and to find effective ways to restore function after injury," Kleitman explained.

Scientists find "master switch" gene for obesity

LONDON (Reuters) – Scientists have found that a gene linked to diabetes and cholesterol is a "master switch" that controls other genes found in fat in the body, and say it should help in the search for treatments for obesity-related diseases.
In a study published in the journal Nature Genetics, the British researchers said that since fat plays an important role in peoples' susceptibility to metabolic diseases like obesity, heart disease and diabetes, the regulating gene could be target for drugs to treat such illnesses.
"This is the first major study that shows how small changes in one master regulator gene can cause a cascade of other metabolic effects in other genes," said Tim Spector of King's College London, who led the study.
More than half a billion people, or one in 10 adults worldwide, are obese and the numbers have doubled since the 1980s as the obesity epidemic has spilled over from wealthy into poorer nations.
In the United States, obesity-related diseases already account for nearly 10 percent of medical spending -- an estimated $147 billion a year.
Type 2 diabetes, which is often linked to poor diet and lack of exercise, is also reaching epidemic levels worldwide as rates of obesity rise.
Scientists have already identified a gene called KLF14 as being linked to type 2 diabetes and cholesterol levels, but until now they did know what role it played.
Spector's team analyzed more than 20,000 genes in fat samples taken from under the skin of 800 British female twin volunteers. They found a link between the KLF14 gene and the levels of many other distant genes found in fat tissue, showing that KLF14 acts as a master switch to control these genes.
They then confirmed their findings in 600 fat samples from a separate group of people from Iceland.
In a report of their study, the researchers explained that other genes found to be controlled by KLF14 are linked to a range of metabolic traits, including body mass index, obesity, cholesterol, insulin and glucose levels.
"KLF14 seems to act as a master switch controlling processes that connect changes in the behavior of subcutaneous fat to disturbances in muscle and liver that contribute to diabetes and other conditions," said Mark McCarthy from Britain's Oxford University, who also worked on the study.
"We are working hard...to understand these processes and how we can use this information to improve treatment of these conditions."
(Reporting by Kate Kelland, editing by Mark Heinrich)

Heavy Coffee Intake Linked to Lower Breast Ca Risk

y Charles Bankhead, Staff Writer, MedPage Today
Published: May 13, 2011
Reviewed by Zalman S. Agus, MD; Emeritus Professor
University of Pennsylvania School of Medicine and
Dorothy Caputo, MA, RN, BC-ADM, CDE, Nurse Planner   
Activate MedPage Today's CME feature and receive free CME credit on medical stories like this oneAction Points 
Point out that this study in Sweden found a statistically significant decrease in ER-negative breast cancer among postmenopausal women who had a high daily intake of coffee.


Note that the study is subject to residual confounding by unmeasured variables.
Women who drank at least five cups of coffee daily had a significantly lower risk of postmenopausal breast cancer, an analysis of two large cohort studies suggested.

Overall, the magnitude of the benefit ranged from 20% to more than 50% in unadjusted and adjusted analyses. Analysis of the results by estrogen receptor (ER) status showed that the favorable association pertained only to ER-negative cancers, according to an article published online in Breast Cancer Research.

"Coffee consumption was associated with a strong reduction in breast cancer risk for the ER-negative tumor subtype," Jingmei Li, PhD, of the Karolinska Institute in Stockholm, and co-authors wrote. "This effect was independent of hormone replacement therapy (HRT), smoking, highest education level attained, and average daily alcohol consumption."

"We speculate that coffee might contain compounds that differentially affect breast cancer of different ER subtypes," they added.

Coffee has a paradoxical relationship with breast cancer risk. The beverage's complex mix of caffeine and polyphenols suggests a potential to confer both carcinogenic and chemopreventive characteristics, the authors noted in the introduction to their study.

In general, previous studies have indicated that high coffee consumption might modestly reduce breast cancer risk. However, a meta-analysis of more than 500 reports about coffee's relationship to several types of cancer showed no association with breast cancer (Nutr Cancer 2010; 62: 271-283).

In an effort to add information to the knowledge base, Li and colleagues performed a case-control study of the relationship between coffee consumption and postmenopausal breast cancer. They drew participants from a population-based study of women who were ages 50 to 74, born in Sweden, and residents of the country during 1993 to 1995.

The analysis comprised 2,818 postmenopausal breast cancer patients and 3,111 age-matched controls.

The authors also performed validation analyses based on postmenopausal women who participated in a German case-control study of breast cancer. The analysis included 3,464 patients with breast cancer and 6,657 age-matched controls.

Participants in both studies provided detailed information about breast cancer risk factors, lifestyle factors (such as smoking and diet), and socioeconomic variables.

The initial analysis identified strong associations between breast cancer risk and several variables previously identified in epidemiologic studies: family history of breast cancer, age at menopause, parity, age at first birth, recent body mass index, use of HRT, alcohol consumption, physical activity, and education. Smoking, on the other hand, did not have a significant association with breast cancer risk.

Using data only from the Swedish cohort, the authors performed an age-adjusted analysis, which showed a 20% reduction in the hazard for breast cancer among women who reported drinking more than five cups of coffee daily versus those who averaged less than one cup (P=0.028).

After adjustment for HRT, smoking, education, and alcohol consumption, the effect of coffee consumption on breast cancer risk was no longer significant.

Analyses stratified by tumors' hormone-receptor status resulted in statistically significant reductions in the risk of ER-negative or progesterone (PR)-negative tumors among women who reported drinking more than five cups of coffee daily.

The strongest association between coffee consumption and breast cancer risk was for ER-negative tumors. The combination of ER-negative tumors and heavy coffee consumption resulted in a 57% reduction in the odds for breast cancer (OR 0.43, P=0.0003). Coffee consumption also had a significant association with PR-negative tumors (OR 0.66, P=0.034).

A test for heterogeneity confirmed that the breast cancer benefits of heavy coffee consumption were significantly higher for ER-negative versus ER-positive tumors (P=0.004). The association with PR status no longer remained significant.

Results of the trend analysis in ER-negative cancers led the authors to perform a validation analysis, using data from the German study. The analysis produced a modest overall association between coffee consumption and breast cancer risk, but the association did not achieve statistical significance (OR 0.87, P=0.173).

Analysis of the German data set stratified by cancer subtype confirmed that coffee consumption had the largest protective effect for ER-negative tumors, although the effect was less robust than the one observed in the Swedish cohort and did not achieve statistical significance (OR 0.67, P=0.326).

ACC: CVD Risk Seen in Middle School Students

By Todd Neale, Staff Writer, MedPage Today
Published: April 03, 2011
Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco.   
Action Points 
Note that these studies were published as abstracts and presented at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.


Explain that in this study, children as young as 11 showed worrisome signs of future cardiovascular danger -- with 16% of them found to have low HDL cholesterol levels.


Note that low HDL cholesterol levels were also associated with a higher body mass index, worse lipid profiles, and higher blood pressures.
NEW ORLEANS -- Children as young as 11 show worrisome signs of future cardiovascular danger, two studies of Michigan sixth-graders showed.
The first study of 1,104 students, found that 16% of the adolescents had low HDL cholesterol levels -- 40 mg/dL or less -- Elizabeth Jackson, MD, MPH, of the University of Michigan in Ann Arbor, reported in a poster session at the American College of Cardiology meeting here.

"That in itself was surprising," she said at a press briefing. "That's a significant amount of kids."

And a second study by Jackson's group showed that there were children with poor cardiovascular fitness identified through their heart rate recovery after a three-minute step test.

Both low HDL cholesterol levels and worse heart rate recovery were associated with increased prevalence of traditional cardiovascular risk factors, such as increased body mass index, poorer lipid profiles, and decreased physical activity levels, the researchers found.

Although both variables can be identified relatively easily through screening, Jackson stopped short of urging that all children should be screened for their heart rate recovery and lipid levels.

"With any of these things you have to think about the implications in terms of the community, in terms of parents," she said. "I don't advocate that these measures should be just routinely performed in all children without any input from schools or parents."

According to practice guidelines from the American Academy of Pediatrics, certain children should be screened for dyslipidemia -- including those with a family history of either significant hyperlipidemia or premature heart disease, and overweight children regardless of family history or other cardiovascular risk factors.

Children who are overweight or obese are at risk for abnormal lipid levels, Jackson explained.

According to background from the ACC, the National Heart, Lung and Blood Institute recommends lipid screening in children as early as age 2 if they have a parental history of high cholesterol (total cholesterol >240 mg/dl) or a family history of early heart disease.

In children with low HDL cholesterol in particular, lifestyle modifications should be tried, because studies show -- at least in adults -- that exercise can raise HDL cholesterol levels, Jackson added.

The studies were conducted as part of Project Healthy Schools, a school-based intervention program in southeast Michigan that brings together the University of Michigan, cardiologists, school personnel, and community leaders to educate kids about diet, exercise, and healthy lifestyle choices.

The analyses focused on sixth graders (mean age 11) -- 1,104 students for the HDL cholesterol study and 1,276 for the heart rate recovery study.

Children and their parents completed a standardized questionnaire about dietary, exercise, and sedentary habits, and the children underwent various tests.

Low HDL cholesterol (≤40 mg/dL) was associated strongly with a higher BMI (P=0.001 for trend). In the group of children with low HDL levels, 60.3% were overweight, compared with 28.8% in the group with high levels.

There was a significantly higher percentage of girls in the low HDL cholesterol group than in the high HDL cholesterol group (58.9% versus 49.7%, P=0.027). There were no differences based on age or race.

Children of both sexes with low HDL had higher LDL cholesterol and triglyceride levels, as well as higher systolic and diastolic blood pressures and resting and recovery heart rates (P<0.05 for all).

In addition, students in the low HDL cholesterol group reported getting fewer days of moderate and strenuous physical activity per week (P<0.05 for both).

About half of the children with low HDL had at least two additional components of the metabolic syndrome -- which includes high LDL and triglycerides, elevated blood pressure, and abdominal obesity.

The analysis looking at heart rate recovery found similar relationships with cardiovascular risk factors.

Following a three-minute step test, the researchers measured heart rate recovery in the students and then divided the children into quartiles.

Similar to children with low HDL cholesterol levels, those with the poorest heart rate recovery tended to have a higher BMI (P<0.001 for trend).

Compared with children with the quickest heart rate recovery rates, those with the slowest recovery had higher LDL and triglyceride levels and lower HDL cholesterol levels (P≤0.02 for all).

The least fit children also reported fewer days of moderate and strenuous exercise per week (P≤0.001 for both).

Sporadic Exercise, Even Sex, May Boost MI, Death Risk

By Michael Smith, North American Correspondent, MedPage Today Published: March 22, 2011 Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco.

Earn CME/CE credit for reading medical news

VIDEO SOURCE: JAMA

Couch potatoes beware: Episodic bouts of physical or sexual activity may carry a risk of heart attack or sudden cardiac death, researchers reported.

But the risk drops with regular physical activity, according to Issa Dahabreh, MD, and Jessica Paulus, ScD, both of Tufts Medical Center in Boston.

And because periodic physical and sexual activity tends to be transient and infrequent, the absolute risks involved are small, Dahabreh and Paulus reported in the March 23/30 issue of the Journal of the American Medical Association.

"There is a link between episodic physical activity and sexual activity with the risk of heart attack and death from sudden cardiac events" within one or two hours after the episode, Paulus said in a video prepared for the journal.

Action Points  

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• Explain that episodic bouts of physical or sexual activity may carry a risk of heart attack or sudden cardiac death.
• Note that the risk drops with regular physical activity.

"This risk was sharpest," she said, "for those individuals who were unaccustomed to regular exercise" but it was buffered by habitual exercise. While such events often appear in anecdotes, pinning them down is not easy, the researchers noted, and traditional epidemiological tools are not well suited to the task.
But studies using a case-crossover design, in which the patient acts as his or her own control, can eliminate many confounding factors, they noted.
A systematic review of the literature found 14 such studies investigating the cardiac effects of episodic physical activity, sexual activity, or both, Dahabreh and Paulus reported.
The primary outcomes were myocardial infarction in 10 studies, sudden cardiac death in three, and acute coronary syndrome in one.
The meta-analysis showed:

• Episodic physical activity was associated with more than a threefold increase in the risk of heart attack. The relative risk was 3.45 with a 95% confidence interval from 2.33 to 5.13.
• By the same token, episodic sexual activity was associated with a relative risk of heart attack 2.70 with a 95% confidence interval from 1.48 to 4.91.
• Episodic physical activity was associated with nearly a five-fold increase in the risk of sudden cardiac death. The relative risk was 4.98 with a 95% confidence interval from 1.47 to 16.91.

The triggering effect of such episodes was muted for people who were more active on a regular basis, the researchers found.
In subgroups with the lowest level of habitual exercise, the relative risk for episodic physical activity to trigger an MI ranged from 4.47 to 107, they found, but the range for those in the highest activity groups was from 0.86 to 3.3, "indicating much smaller increases in risk."
They estimated that the relative risk for an MI triggered by episodic physical activity decreased by about 45% for each additional time per week a person was habitually active.
Similarly, in the two studies that looked at the issue with respect to sudden cardiac death, the relative risk fell approximately 30% for each additional time per week a person habitually exercised.
The researchers also estimated that the absolute risk increase for MI associated with an hour of additional physical or sexual activity every week was two to three per 10,000 person-years. For sudden cardiac death the corresponding figure was one per 10,000 person-years.
Dahabreh and Paulus cautioned that the studies in their analysis had significant differences in design and protocols.
They also cautioned that the findings should not be interpreted "as indicating a net harm of physical or sexual activity."
Instead, they concluded, the results suggest that such exposures are associated with a "temporary short-term increase in the risk of acute cardiac events."

Diet Soda Tied to Vascular Risk, With Caveats

By Todd Neale, Staff Writer, MedPage Today Published: February 09, 2011 Reviewed by Michael Mullen, MD; Clinical Instructor of Vascular Neurology, University of Pennsylvania.

 

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LOS ANGELES -- Drinking diet soda -- but not regular soda -- was associated with a greater risk of stroke, MI, or vascular death in an older, multiethnic cohort, researchers found. Individuals who reported drinking diet soda every day were 48% more likely to have a vascular event through more than nine years of follow-up (RR 1.48, 95% CI 1.3 to 2.12), according to Hannah Gardener, ScD, of the University of Miami in Florida.
There was no such association for less-frequent consumption of diet soda or for any level of regular soda consumption, she reported at the American Stroke Association's International Stroke Conference here.
In a separate study, Gardener and her research team also found that individuals who had the highest daily sodium consumption had a nearly threefold increased risk of stroke compared with those who met the American Heart Association target of 1,500 mg a day.
Gardener acknowledged some limitations of the diet soda study, including the use of self-reported dietary data at a single time point, and concluded that the findings are "too preliminary to suggest any dietary advice."
"If and only if the results are confirmed can we suggest that diet soda may not be an optimal substitute for sugar-sweetened beverages, which have been shown to have various health consequences," she said.
Doctors contacted by ABC News and MedPage Today were also hesitant to declare diet sodas the next great health risk, with many attributing the increased vascular risk to other dietary factors that were not measured in the study, such as the types of foods contributing to the total caloric intake.
"Unfortunately, it may be that individuals with poor dietary habits do resort [to] some kind of calorie balancing and continue to eat high-calorie sweet foods but reduce their 'guilt' by drinking diet soda," Howard Weintraub, MD, clinical director of the NYU Center for the Prevention of Cardiovascular Disease, wrote in an e-mail.
The study "adds to the growing evidence of an association between diet sodas and cardiovascular disease," according to Cam Patterson, MD, a cardiologist at the University of North Carolina at Chapel Hill. But, he added, that, although the association cannot be ignored, it is too early to interpret what it means.
"People need to know about this, but it is important for everyone to realize that no general guidelines should be derived from these types of observational studies," Patterson wrote in an e-mail.
"I'll continue to pack a diet soda with my lunch, but I'll look more carefully at what else is in my lunch box, and I'll pay more attention to what I'm doing while I'm drinking my diet soda."
Gardener and her colleagues analyzed data from the Northern Manhattan Study (NOMAS), which includes individuals older than 40 living in New York City.
The current analysis included 2,564 participants. Their mean age was 69; about half were Hispanic, one-fifth were white, and one-quarter were black.
Based on a food frequency questionnaire completed at baseline, 35% of the cohort did not drink either regular or diet soda. Only 24% reported drinking any amount of diet soda.
Diet soda consumption was associated with white race, diabetes, elevated blood sugar, low HDL cholesterol, elevated waist circumference and body mass index, peripheral vascular disease, and metabolic syndrome (P<0.05 for all).
Through an average follow-up of 9.3 years, there were 559 incident vascular events, including 212 strokes, 149 MIs, and 338 vascular deaths.
After adjustment for demographic and behavioral and vascular risk factors -- including BMI -- there was an increased risk of having a vascular event with daily diet soda consumption, but no other levels of consumption of diet or regular soda.
Commenting on the findings, Christopher Cannon, MD, of Brigham and Women's Hospital in Boston, pointed out, however, that the number of participants who drank diet soda daily was small -- 116 -- and that the lack of an association with regular soda consumption was at odds with previous studies.
"This suggests that the finding may be spurious, and needs confirmation in a much larger group of patients," he wrote in an e-mail.
Gardener agreed that confirmation was needed before drawing any definitive conclusions, with further studies that focus on a younger population with more diet soda consumption and that collect diet information at multiple time points.
She and her colleagues also examined the relationship between dietary sodium intake and stroke in the NOMAS cohort.
Although the American Heart Association recommends consuming less than 1,500 mg a day, only 12% of the participants met that goal.
The average daily consumption at baseline was 3,031 mg, with one-fifth of the cohort ingesting more than 4,000 mg a day.
Over a mean follow-up of 10 years, there were 227 strokes.
After adjustment for demographics and behavioral and vascular risk factors -- including hypertension -- every 500 mg/day increase in sodium intake was associated with an 18% relative increase in stroke risk (RR 1.18, 95% CI 1.08 to 1.27).
Those individuals who consumed the most -- more than 4,000 mg/day -- had a 2.67-fold (95% CI 1.31 to 5.41) increased risk compared with those who met the AHA target.
"The results of our study suggest that the new AHA strategic dietary goals will help promote ideal cardiovascular as well as brain health," Gardener said, "and this evidence can be used in campaigns aimed at reducing cardiovascular disease risk by targeting dietary behavior."

Early Introduction of Solid Foods Linked to Risk for Early Childhood Obesity

February 7, 2011 — Early introduction of solid foods is linked to a risk for early childhood obesity, according to the results of a prospective prebirth cohort study reported online February 7 in Pediatrics.
"Parental feeding practices during early infancy, such as the timing of solid food introduction, may be 1 key modifiable determinant of childhood obesity," write Susanna Y. Huh, MD, MPH, from the Division of Gastroenterology and Nutrition, Children's Hospital Boston in Boston, Massachusetts, and colleagues. "Data suggest that the introduction of solid foods earlier than 4 months of age is associated with increased body fat or weight in childhood or with greater weight gain during infancy, which itself predicts later adiposity. Other studies have found no association between the timing of solid food introduction and body fat or an association between delayed introduction of solid foods after 6 months and greater adiposity."
The goal of the study was to evaluate the association between timing of introduction of solid foods during infancy and obesity at age 3 years, defined as a body mass index for age and sex at the 95th percentile or above, using a cohort of 847 children enrolled in Project Viva. Timing of introduction of solid foods was categorized as younger than 4 months, ages 4 to 5 months, and 6 months or older. Logistic regression models were applied separately for infants who were breast-fed for at least 4 months ("breast-fed"; n = 568; 67%) and for infants who were never breast-fed or in whom breast-feeding was stopped before age 4 months ("formula-fed"; n = 279; 32%). These models were adjusted for child and maternal factors, including change in weight-for-age z score from 0 to 4 months as a marker of early infant growth.
Obesity was present in 75 children (9%) at age 3 years. The timing of solid food introduction was not associated with odds of obesity in breast-fed infants, (odds ratio, 1.1; 95% confidence interval [CI], 0.3 - 4.4). However, introducing formula-fed infants to solid foods before age 4 months was associated with a 6-fold increase in odds of obesity at age 3 years, which was not explained by rapid early growth (odds ratio after adjustment, 6.3; 95% CI, 2.3 - 6.9).
"Among infants who were never breastfed or those who stopped breastfeeding before the age of 4 months, the introduction of solids before the age of 4 months was associated with a sixfold increase in the odds of obesity at the age of 3 years," the study authors write.
Limitations of this study include possible residual confounding; some loss of the cohort to follow-up; limited generalizability to more socioeconomically disadvantaged populations; and small numbers in some cells, leading to possible chance results.
"Among infants breastfed for 4 months or longer, the timing of the introduction of solid foods was not associated with the odds of obesity," the study authors conclude. "Increased adherence to guidelines regarding the timing of solid food introduction may reduce the risk of obesity in childhood."
The National Institutes of Health supported this study. The study authors have disclosed no relevant financial relationships.

Pediatrics. Published online February 7, 2011. Abstract

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Authors and Disclosures

Journalist

Laurie Barclay, MD

Freelance writer and reviewer, Medscape, LLC

Disclosure: Laurie Barclay, MD, has disclosed no relevant financial relationships.

Phone App Improves Metabolic Control in Type 1 Diabetes

By Will Boggs MD

NEW YORK (Reuters Health) Feb 04 - Use of the Diabeo software on a mobile phone improves metabolic control in patients with chronic, poorly controlled type 1 diabetes, researchers from France report online in Diabetes Care.
An active electronic log book such the Diabeo system facilitates the management of complex insulin treatment of type 1 patients, improves blood glucose results and quality of life, and assists follow up by physicians "thanks to the transmission of whole data through GPRS (General Packet Radio System) and Internet," Dr. Guillaume Charpentier from Sud-Francilien Hospital, Corbeil-Essonnes, France told Reuters Health in an email.
Dr. Charpentier and colleagues evaluated the efficiency of the Diabeo system in improving metabolic control in a randomized, open-label, parallel-group study of 180 patients with chronic, poorly controlled type 1 diabetes. Voluntis, makers of Diabeo, provided the software, and sanofi-aventis partially funded the trial.
Diabeo software is uploaded onto smart phones with Internet connection that provides bolus calculators using validated algorithms; plasma glucose targets; automatic algorithms for adjusting carbohydrate ratio and basal insulin or pump basal rates; and data transmission to medical staff computers.
Mean HbA1c was 9.07% at baseline. At the end of the 6-month study, HbA1c was significantly lower in the 60 patients allocated to electronic logbook alone (8.63%) and in the 59 patients allocated to electronic logbook plus teleconsultation (8.41%) than in the 61 patients allocated to the usual paper logbook (9.10%).
Only the difference between the electronic logbook plus teleconsultation group and the usual paper logbook group remained statistically significant after adjustment for multiple comparisons.
Similarly, significantly more patients in the electronic logbook plus teleconsultation group (10/59, 17%) than in the paper logbook group (1/61, 1.6%) reached the target HbA1c of 7.5% or less, with patients in the electronic logbook only falling in-between (4/60, 6.7%).
The frequency of symptomatic, non-severe hypoglycemia didn't differ between groups and did not increase from baseline.
Also, quality of life at baseline and endpoint did not differ between the groups.
Total time spent on follow-up was the same among groups, but participants in the electronic logbook only and usual paper logbook groups spent additional time traveling to and from the hospital, waiting for consultations, and carrying out administrative procedures.
Researchers say the software didn't require more time for the patient to manage diabetes. The combined time of launching the software on the smart phone, inputting blood glucose values and meal carbohydrate intake, and reading the software dose recommendation was less than 10 seconds, and transmission of the data was automatic and instantaneous.
"The Diabeo system is now proposed routinely to any patients treated with a basal bolus insulin regimen with either multiple daily injections or pump (that is to say nearly all type 1 patients and some type 2 followed in our center and other co-investigator centers), owning a smart phone or willing to acquire one," Dr. Charpentier said. "There is no specific skill require to use the system except to be able to use a mobile phone in a current manner."
He says that a nationwide study should begin in 2011, enrolling 600 patients, at the request of the health authority in order to obtain reimbursement by national health care insurance.
"The system has been adapted to type 2 patients treated with long acting insulin titration algorithm and automatic coaching about blood glucose monitoring, diet and physical exercise, and hypoglycemic events." He added that it's currently being evaluated through a multicenter randomized trial.
Diabetes Care. Posted online January 25, 2011. Abstract