Tuesday, August 26, 2008

Manfaat pemberian vitamin B pada penyakit jantung koroner

Suatu studi observasi melaporkan hubungan antara kadar homosistein dan risiko penyakit kardiovaskuler. Pemberian asam folat dan vitamin B12 diketahui dapat menurunkan kadar homosistein. Penelitian ini ingin mengetahui pengaruh asam folat dan vitamin B6 dan B12 untuk pencegahan sekunder pada pasien penyakit jantung koroner (PJK) dan stenosis klep aorta.
 
Penelitian dilakukan terhadap >3000 pasien yang menjalani prosedur angiografi dan berlangsung selama 7 tahun.
 
Setelah 1 tahun terjadi penurunan kadar homosistein kelompok yang mendapat asam folat dan vitamin B12. Tapi penurunan kadar homosistein ini tidak berpengaruh terhadap mortalitas dan cardiovascular events.
 
Kesimpulan penelitian ini tidak mendukung penggunaan vitamin B untuk preventif sekunder pasien dengan PJK.
 
Abstract
 
JAMA. Vol. 300 No. 7, August 20, 2008;300(7):795-804. © 2008 American Medical Association.
Mortality and cardiovascular events in patients treated with homocysteine-lowering B vitamins after coronary angiography.
Marta Ebbing, MD; Øyvind Bleie, MD, PhD; Per Magne Ueland, MD, PhD et al.
 
Context  Observational studies have reported associations between circulating total homocysteine concentration and risk of cardiovascular disease. Oral administration of folic acid and vitamin B12 can lower plasma total homocysteine levels.

Objective  To assess the effect of treatment with folic acid and vitamin B12 and the effect of treatment with vitamin B6 as secondary prevention in patients with coronary artery disease or aortic valve stenosis.

Design, Setting, and Participants  Randomized, double-blind controlled trial conducted in the 2 university hospitals in western Norway in 1999-2006. A total of 3096 adult participants undergoing coronary angiography (20.5% female; mean age, 61.7 years) were randomized. At baseline, 59.3% had double- or triple-vessel disease, 83.7% had stable angina pectoris, and 14.9% had acute coronary syndromes.

Interventions  Using a 2 x 2 factorial design, participants were randomly assigned to 1 of 4 groups receiving daily oral treatment with folic acid, 0.8 mg, plus vitamin B12, 0.4 mg, plus vitamin B6, 40 mg (n = 772); folic acid plus vitamin B12 (n = 772); vitamin B6 alone (n = 772); or placebo (n = 780).

Main Outcome Measures  The primary end point was a composite of all-cause death, nonfatal acute myocardial infarction, acute hospitalization for unstable angina pectoris, and nonfatal thromboembolic stroke.

Results  Mean plasma total homocysteine concentration was reduced by 30% after 1 year of treatment in the groups receiving folic acid and vitamin B12. The trial was terminated early because of concern among participants due to preliminary results from a contemporaneous Norwegian trial suggesting adverse effects from the intervention. During a median 38 months of follow-up, the primary end point was experienced by a total of 422 participants (13.7%): 219 participants (14.2%) receiving folic acid/vitamin B12 vs 203 (13.1%) not receiving such treatment (hazard ratio, 1.09; 95% confidence interval, 0.90-1.32; P = .36) and 200 participants (13.0%) receiving vitamin B6 vs 222 (14.3%) not receiving vitamin B6 (hazard ratio, 0.90; 95% confidence interval, 0.74-1.09; P = .28).

Conclusions  This trial did not find an effect of treatment with folic acid/vitamin B12 or vitamin B6 on total mortality or cardiovascular events. Our findings do not support the use of B vitamins as secondary prevention in patients with coronary artery disease.

Thursday, August 14, 2008

Diet untuk menurunkan BB

Penelitian ini membandingkan efektivitas dan keamanan diet untuk menurunkan berat badan (BB).
 
Penelitian dilakukan random random terhadap 322 subyek obese selama 2 tahun. Ada 3 jenis diet yang digunakan yaitu 1) rendah lemak, rendah kalori; 2) Mediterranean, rendah kalori; atau 3) rendah karbohidrat, tanpa pembatasan kalori.
 
Kepatuhan mengikuti diet >95% tahun pertama dan >84% tahun kedua.
 
Penurunan BB terbesar dicapai dengan diet rendah lemak. Penurunan terkecil oleh diet rendah lemak rendah kalori. Penurunan rasio kolesterol total terhadap HDL terbaik dicapai dengan diet rendah karbohidrat. Sedangkan untuk penderita diabetes yang terbaik adalah diet Mediterranean.

Abstract
 
N Engl J Med 359(3):229-241, 17 July 2008 © 2008
Weight Loss with a Low-Carbohydrate, Mediterranean, or Low-Fat Diet
Iris Shai, R.D., Ph.D., Dan Schwarzfuchs, M.D., Yaakov Henkin, M.D., Danit R. Shahar, R.D., Ph.D., Shula Witkow, R.D., M.P.H., Ilana Greenberg, R.D., M.P.H., Rachel Golan, R.D., M.P.H., Drora Fraser, Ph.D., Arkady Bolotin, Ph.D., Hilel Vardi, M.Sc., Osnat Tangi-Rozental, B.A., Rachel Zuk-Ramot, R.N., Benjamin Sarusi, M.Sc., Dov Brickner, M.D., Ziva Schwartz, M.D., Einat Sheiner, M.D., Rachel Marko, M.Sc., Esther Katorza, M.Sc., Joachim Thiery, M.D., Georg Martin Fiedler, M.D., Matthias Blüher, M.D., Michael Stumvoll, M.D., Meir J. Stampfer, M.D., Dr.P.H., for the Dietary Intervention Randomized Controlled Trial (DIRECT) Group
 
Background Trials comparing the effectiveness and safety of weight-loss diets are frequently limited by short follow-up times and high dropout rates.
Methods In this 2-year trial, we randomly assigned 322 moderately obese subjects (mean age, 52 years; mean body-mass index [the weight in kilograms divided by the square of the height in meters], 31; male sex, 86%) to one of three diets: low-fat, restricted-calorie; Mediterranean, restricted-calorie; or low-carbohydrate, non–restricted-calorie.
Results The rate of adherence to a study diet was 95.4% at 1 year and 84.6% at 2 years. The Mediterranean-diet group consumed the largest amounts of dietary fiber and had the highest ratio of monounsaturated to saturated fat (P<0.05 for all comparisons among treatment groups). The low-carbohydrate group consumed the smallest amount of carbohydrates and the largest amounts of fat, protein, and cholesterol and had the highest percentage of participants with detectable urinary ketones (P<0.05 for all comparisons among treatment groups). The mean weight loss was 2.9 kg for the low-fat group, 4.4 kg for the Mediterranean-diet group, and 4.7 kg for the low-carbohydrate group (P<0.001 for the interaction between diet group and time); among the 272 participants who completed the intervention, the mean weight losses were 3.3 kg, 4.6 kg, and 5.5 kg, respectively. The relative reduction in the ratio of total cholesterol to high-density lipoprotein cholesterol was 20% in the low-carbohydrate group and 12% in the low-fat group (P=0.01). Among the 36 subjects with diabetes, changes in fasting plasma glucose and insulin levels were more favorable among those assigned to the Mediterranean diet than among those assigned to the low-fat diet (P<0.001 for the interaction among diabetes and Mediterranean diet and time with respect to fasting glucose levels).
Conclusions Mediterranean and low-carbohydrate diets may be effective alternatives to low-fat diets. The more favorable effects on lipids (with the low-carbohydrate diet) and on glycemic control (with the Mediterranean diet) suggest that personal preferences and metabolic considerations might inform individualized tailoring of dietary interventions.

Friday, August 08, 2008

Pengaruh sarapan pada murid sekolah

Apakah sarapan mempengaruhi fungsi kognitif dan emosi murid di sekolah?
 
Penelitian dilakukan secara random pada 104 murid berusia 13-20 tahun.
 
Hasil penelitian menunjukkan peningkatan memori visuospatial pada murid laki2, peningkatan kewaspadaan (alertness) pada semua murid. Murid laki2 merasa emosi lebih positif. Namun tidak ada perubahan pada daya perhatian (sustained attention).
 
Kesimpulan sarapan memberikan efek positif pada murid sekolah.
 
 
PEDIATRICS Vol. 122 No. 2 August 2008, pp. 279-284

ARTICLE

Influence of Having Breakfast on Cognitive Performance and Mood in 13- to 20-Year-Old High School Students: Results of a Crossover Trial

Katharina Widenhorn-Müller, PhDa, Katrin Hille, PhDa, Jochen Klenk, MPHb and Ulrike Weiland, MDa

a Centre for Neuroscience and Learning
b Institute of Epidemiology, Ulm University, Ulm, Germany

OBJECTIVE. The goal was to determine whether breakfast had effects on the cognitive performance and mood of high school students.

METHODS. A crossover trial was performed in boarding schools, involving 104 students between 13 and 20 years of age. The participants were randomly assigned to 2 equal-size groups on the morning of the first testing day. One half of the total sample received a standardized breakfast, whereas the other half received no breakfast. Seven days later, the treatment order was reversed. Measurements of cognitive function included standardized tests of attention and concentration, as well as tests of verbal and spatial memory. In addition, mood was rated with a self-administered questionnaire covering the dimensions of positive and negative affect, information uptake, arousal, and alertness. Statistical analysis consisted of repeated-measures analysis of variance.

RESULTS. Breakfast had no effect on sustained attention among high school students. Visuospatial memory was improved in male students. Self-reported alertness improved significantly in the entire study population. Male students reported feeling more positive after consuming breakfast, compared with the fasting condition.

CONCLUSIONS. This crossover trial demonstrated positive short-term effects of breakfast on cognitive functioning and self-reported alertness in high school students.

Thursday, August 07, 2008

Gemar minum manis menyebabkan diabetes

Penelitian ini mencari hubungan antara minum manis (sugar-sweetened beverages) dengan peningkatan berat badan dan timbulnya diabetes tipe 2.
 
Subyek penelitian adalah 59 ribu wanita Afrika-Amerika yang di follow-up dari tahun 1995 sampai 2001.
 
Hasil penelitian menunjukkan asupan minuman manis (soft drink dan jus buah) meningkatkan risiko diabetes tipe 2. Minum >2 soft drink meningkatkan insiden sebesar 1,24 kali, sedangkan jus buah (sugar-sweetened) meningkatkan insiden sebesar 1,31 kali. Untuk soft drink ada hubungan dengan indeks massa tubuh sedangkan untuk jus buah tidak.
 
Kesimpulan minum manis -baik soft drink maupun jus buah yang dianggap lebih sehat- terbukti meningkatkan risiko diabetes pada wanita Afrika-Amerika.
 
Abstract
 
Sugar-Sweetened Beverages and Incidence of Type 2 Diabetes Mellitus in African American Women

Julie R. Palmer, ScD; Deborah A. Boggs, MS; Supriya Krishnan, DSc; Frank B. Hu, MD; Martha Singer, MPH; Lynn Rosenberg, ScD

Arch Intern Med. 2008;168(14):1487-1492.

Background  Type 2 diabetes mellitus is an increasingly serious health problem among African American women. Consumption of sugar-sweetened drinks was associated with an increased risk of diabetes in 2 studies but not in a third; however, to our knowledge, no data are available on African Americans regarding this issue. Our objective was to examine the association between consumption of sugar-sweetened beverages, weight gain, and incidence of type 2 diabetes mellitus in African American women.

Methods  A prospective follow-up study of 59 000 African American women has been in progress since 1995. Participants reported on food and beverage consumption in 1995 and 2001. Biennial follow-up questionnaires ascertained new diagnoses of type 2 diabetes. The present analyses included 43 960 women who gave complete dietary and weight information and were free from diabetes at baseline. We identified 2713 incident cases of type 2 diabetes mellitus during 338 884 person-years of follow-up. The main outcome measure was the incidence of type 2 diabetes mellitus.

Results  The incidence of type 2 diabetes mellitus was higher with higher intake of both sugar-sweetened soft drinks and fruit drinks. After adjustment for confounding variables including other dietary factors, the incidence rate ratio for 2 or more soft drinks per day was 1.24 (95% confidence interval, 1.06-1.45). For fruit drinks, the comparable incidence rate ratio was 1.31 (95% confidence interval, 1.13-1.52). The association of diabetes with soft drink consumption was almost entirely mediated by body mass index, whereas the association with fruit drink consumption was independent of body mass index.

Conclusions  Regular consumption of sugar-sweetened soft drinks and fruit drinks is associated with an increased risk of type 2 diabetes mellitus in African American women. While there has been increasing public awareness of the adverse health effects of soft drinks, little attention has been given to fruit drinks, which are often marketed as a healthier alternative to soft drinks.


Author Affiliations: Slone Epidemiology Center, Boston University (Drs Palmer, Krishnan, and Rosenberg and Ms Boggs), Department of Nutrition, Harvard School of Public Health (Dr Hu), and Section of Preventive Medicine and Epidemiology, Department of Medicine, Boston University School of Medicine (Ms Singer), Boston, Massachusetts.

Tuesday, August 05, 2008

Kurang vitamin D meningkatkan kematian

Penelitian ini mempertegas temuan sebelumnya bahwa kadar vitamin D serum rendah berhubungan dengan penyakit kardiovaskuler dan penyait lainnya.
 
Dilakukan kohort prospektif terhadap 3258 pasien calon angiografi koroner, median umur 62 tahun. Follow up selama 7,7 tahun.
 
Sebanyak 22,6% pasien meninggal. Pasien yang termasuk kuartil terendah kadar 25-hidroksivitamin D dan 1,25-dihidroksivitamin D mempunyai risiko kematian (all diseases) 2,08 kali lebih besar dibanding pasien yang kadar vitamin D-nya tinggi. Sedangkan Hazard ratio untuk kematian kardiovaskuler adalah 2,22 kali lebih besar.
 
Kesimpulan kadar vitamin D rendah secara independen berhubungan dengan kematian kardiovaskuler dan penyakit lain (all cause).
 
Abstract
 
Independent Association of Low Serum 25-Hydroxyvitamin D and 1,25-Dihydroxyvitamin D Levels With All-Cause and Cardiovascular Mortality

Harald Dobnig, MD; Stefan Pilz, MD; Hubert Scharnagl, PhD; Wilfried Renner, PhD; Ursula Seelhorst, MA; Britta Wellnitz, LLD; Jürgen Kinkeldei, DEng; Bernhard O. Boehm, MD; Gisela Weihrauch, MSc; Winfried Maerz, MD

Arch Intern Med. 2008;168(12):1340-1349.

Background  In cross-sectional studies, low serum levels of 25-hydroxyvitamin D are associated with higher prevalence of cardiovascular risk factors and disease. This study aimed to determine whether endogenous 25-hydroxyvitamin D and 1,25-dihydroxyvitamin D levels are related to all-cause and cardiovascular mortality.

Methods  Prospective cohort study of 3258 consecutive male and female patients (mean [SD] age, 62 [10] years) scheduled for coronary angiography at a single tertiary center. We formed quartiles according to 25-hydroxyvitamin D and 1,25-dihydroxyvitamin D levels within each month of blood drawings. The main outcome measures were all-cause and cardiovascular deaths.

Results  During a median follow-up period of 7.7 years, 737 patients (22.6%) died, including 463 deaths from cardiovascular causes. Multivariate-adjusted hazard ratios (HRs) for patients in the lower two 25-hydroxyvitamin D quartiles (median, 7.6 and 13.3 ng/mL [to convert 25-hydroxyvitamin D levels to nanomoles per liter, multiply by 2.496]) were higher for all-cause mortality (HR, 2.08; 95% confidence interval [CI], 1.60-2.70; and HR, 1.53; 95% CI, 1.17-2.01; respectively) and for cardiovascular mortality (HR, 2.22; 95% CI, 1.57-3.13; and HR, 1.82; 95% CI, 1.29-2.58; respectively) compared with patients in the highest 25-hydroxyvitamin D quartile (median, 28.4 ng/mL). Similar results were obtained for patients in the lowest 1,25-dihydroxyvitamin D quartile. These effects were independent of coronary artery disease, physical activity level, Charlson Comorbidity Index, variables of mineral metabolism, and New York Heart Association functional class. Low 25-hydroxyvitamin D levels were significantly correlated with variables of inflammation (C-reactive protein and interleukin 6 levels), oxidative burden (serum phospholipid and glutathione levels), and cell adhesion (vascular cell adhesion molecule 1 and intercellular adhesion molecule 1 levels).

Conclusions  Low 25-hydroxyvitamin D and 1,25-dihydroxyvitamin D levels are independently associated with all-cause and cardiovascular mortality. A causal relationship has yet to be proved by intervention trials using vitamin D.


Author Affiliations: Division of Endocrinology and Nuclear Medicine, Department of Internal Medicine (Dr Dobnig), and Clinical Institute of Medical and Chemical Laboratory Diagnostics (Drs Scharnagl, Renner, and Maerz and Ms Weihrauch), Medical University of Graz, Graz, Austria; and Department of Public Health, Social and Preventive Medicine, Mannheim Medical Faculty, University of Heidelberg, Heidelberg (Dr Pilz), LURIC Study Nonprofit LLC, Freiburg (Ms Seelhorst and Dr Wellnitz), Synlab Center of Laboratory Diagnostics Stuttgart, Leinfelden-Echterdingen (Dr Kinkeldei), Division of Endocrinology and Diabetes, Department of Internal Medicine, University of Ulm, Ulm (Dr Boehm), and Synlab Center of Laboratory Diagnostics Heidelberg, Eppelheim (Dr Maerz), Germany.