Effect of B-Vitamin Therapy on Progression of Diabetic Nephropathy

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

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

 

Effect of B-Vitamin Therapy on Progression of Diabetic Nephropathy

A Randomized Controlled Trial

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

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

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

Lemak tak jenuh mengurangi risiko penyakit jantung koroner

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

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

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

 

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

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Abstrak

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

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

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

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

Terapi homeopati = plasebo

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

Penelitian ini mendapatkan bahwa terapi homeopati hanya berefek plasebo.

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

Abstract

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

Terlalu banyak minum cola dapat menurunkan kesuburan

Terlalu banyak minum cola dapat menurunkan kualitas dan kuantitas sperma

American Journal of Epidemiology 171(8):883-891, published online 25 March 2010 © The Author 2010
Caffeine Intake and Semen Quality in a Population of 2,554 Young Danish Men. Tina Kold Jensen, Shanna H. Swan, Niels E. Skakkebæk, Sanne Rasmussen and Niels Jørgensen. 

Caffeine Intake and Semen Quality in a Population of 2,554 Young Danish Men

The authors examined the association between semen quality and caffeine intake among 2,554 young Danish men recruited when they were examined to determine their fitness for military service in 2001–2005. The men delivered a semen sample and answered a questionnaire including information about caffeine intake from various sources, from which total caffeine intake was calculated. Moderate caffeine and cola intakes (101–800 mg/day and <14 0.5-L bottles of cola/week) compared with low intake (<100 mg/day, no cola intake) were not associated with semen quality. High cola (>14 0.5-L bottles/week) and/or caffeine (>800mg/day) intake was associated with reduced sperm concentration and total sperm count, although only significant for cola. High-intake cola drinkers had an adjusted sperm concentration and total sperm count of 40 mill/mL (95% confidence interval (CI): 32, 51) and 121 mill (95% CI: 92, 160), respectively, compared with 56 mill/mL (95% CI: 50, 64) and 181 mill (95% CI: 156, 210) in non-cola-drinkers, which could not be attributed to the caffeine they consumed because it was <140 mg/day. Therefore, the authors cannot exclude the possibility of a threshold above which cola, and possibly caffeine, negatively affects semen quality. Alternatively, the less healthy lifestyle of these men may explain these findings.

Mengurangi konsumsi garam akan mencegah stroke dan serangan jantung

Mengurangi konsumsi garam akan mencegah stroke dan serangan jantung, sehingga dapat menurunkan biaya pemeliharaan kesehatan.

Annals of Internal Medicine, vol. 152 no. 8 481-7

Abstract

Background: Sodium consumption raises blood pressure, increasing the risk for heart attack and stroke. Several countries, including the United States, are considering strategies to decrease population sodium intake.

Objective: To assess the cost-effectiveness of 2 population strategies to reduce sodium intake: government collaboration with food manufacturers to voluntarily cut sodium in processed foods, modeled on the United Kingdom experience, and a sodium tax.

Design: A Markov model was constructed with 4 health states: well, acute myocardial infarction (MI), acute stroke, and history of MI or stroke.

Data Sources: Medical Panel Expenditure Survey (2006), Framingham Heart Study (1980 to 2003), Dietary Approaches to Stop Hypertension trial, and other published data.

Target Population: U.S. adults aged 40 to 85 years.

Time Horizon: Lifetime.

Perspective: Societal.

Outcome Measures: Incremental costs (2008 U.S. dollars), quality-adjusted life-years (QALYs), and MIs and strokes averted.

Results of Base-Case Analysis: Collaboration with industry that decreases mean population sodium intake by 9.5% averts 513 885 strokes and 480 358 MIs over the lifetime of adults aged 40 to 85 years who are alive today compared with the status quo, increasing QALYs by 2.1 million and saving $32.1 billion in medical costs. A tax on sodium that decreases population sodium intake by 6% increases QALYs by 1.3 million and saves $22.4 billion over the same period.

Results of Sensitivity Analysis: Results are sensitive to the assumption that consumers have no disutility with modest reductions in sodium intake.

Limitation: Efforts to reduce population sodium intake could result in other dietary changes that are difficult to predict.

Conclusion: Strategies to reduce sodium intake on a population level in the United States are likely to substantially reduce stroke and MI incidence, which would save billions of dollars in medical expenses.

Kombinasi terapi lipid tidak efektif

Penelitian ini membuktikan bahwa terapi dislipidemia dengan kombinasi statin dan fenofibrat tidak efektif

N Engl J Med 362(17):1563-1574, 29 April 2010 © 2010 to the Massachusetts Medical Society
Effects of Combination Lipid Therapy in Type 2 Diabetes Mellitus-The ACCORD Study Group. Henry N. Ginsberg, Marshall B. Elam, Laura C. Lovato, et al. 

ABSTRACT

Background We investigated whether combination therapy with a statin plus a fibrate, as compared with statin monotherapy, would reduce the risk of cardiovascular disease in patients with type 2 diabetes mellitus who were at high risk for cardiovascular disease.

Methods We randomly assigned 5518 patients with type 2 diabetes who were being treated with open-label simvastatin to receive either masked fenofibrate or placebo. The primary outcome was the first occurrence of nonfatal myocardial infarction, nonfatal stroke, or death from cardiovascular causes. The mean follow-up was 4.7 years.

Results The annual rate of the primary outcome was 2.2% in the fenofibrate group and 2.4% in the placebo group (hazard ratio in the fenofibrate group, 0.92; 95% confidence interval [CI], 0.79 to 1.08; P=0.32). There were also no significant differences between the two study groups with respect to any secondary outcome.Annual rates of death were 1.5% in the fenofibrate group and 1.6% in the placebo group (hazard ratio, 0.91; 95% CI, 0.75 to 1.10; P=0.33). Prespecified subgroup analyses suggested heterogeneity in treatment effect according to sex, with a benefit for men and possible harm for women (P=0.01 for interaction), and a possible interaction according to lipid subgroup, with a possible benefit for patients with both a high baseline triglyceridelevel and a low baseline level of high-density lipoprotein cholesterol (P=0.057 for interaction).

Conclusions The combination of fenofibrate and simvastatin did not reduce the rate of fatal cardiovascular events, nonfatal myocardial infarction, or nonfatal stroke, as compared with simvastatin alone. These results do not support the routine use of combination therapy with fenofibrate and simvastatin to reduce cardiovascular risk in the majority of high-risk patients with type 2 diabetes.

Gula menyebabkan dislipidemia

Asupan karbohidrat diketahui berhubungan dengan dislipidemia. Dislipidemia akan meningkatkan risiko kardiovaskuler.

Penambahan gula dalam makanan atau minuman juga berhubungan dengan dislipidemia.

Abstrak

JAMA 303(15):1490-1497, 21 April 2010 © 2010 American Medical Association Caloric Sweetener Consumption and Dyslipidemia Among US Adults. Jean A. Welsh, Andrea Sharma, Jerome L. Abramson, Viola Vaccarino, Cathleen Gillespie, Miriam B. Vos.

Context Dietary carbohydrates have been associated with dyslipidemia, a lipid profile known to increase cardiovasculardisease risk. Added sugars (caloric sweeteners used as ingredients in processed or prepared foods) are an increasing and potentially modifiable component in the US diet. No known studies have examined the association between the consumption of added sugars and lipid measures.

Objective To assess the association between consumption of added sugars and blood lipid levels in US adults.

Design, Setting, and Participants Cross-sectional study among US adults (n = 6113) from the National Health and Nutrition Examination Survey (NHANES) 1999-2006. Respondents were grouped by intake of added sugars using limits specified in dietary recommendations (<> 5%-<10%, src="http://jama.ama-assn.org/math/ge.gif" alt="≥" border="0">25% of total calories). Linear regression was used to estimate adjusted mean lipid levels. Logistic regression was used to determine adjusted odds ratios of dyslipidemia. Interactions between added sugars and sex were evaluated.

Main Outcome Measures Adjusted mean high-density lipoprotein cholesterol (HDL-C), geometric mean triglycerides, and mean low-density lipoprotein cholesterol (LDL-C) levels and adjusted odds ratios of dyslipidemia, including low HDL-C levels (<40 mg/dL for men; <50> (150 mg/dL), high LDL-C levels (130 mg/dL), or high ratio of triglycerides to HDL-C (>3.8). Results were weighted to be representative of the US population.

Results A mean of 15.8% of consumed calories was from added sugars. Among participants consuming less than 5%, 5% to less than 10%, 10% to less than 17.5%, 17.5% to less than 25%, and 25% or greater of total energy as added sugars, adjusted mean HDL-C levels were, respectively, 58.7, 57.5, 53.7, 51.0, and 47.7 mg/dL (P < .001 for linear trend), geometric mean triglyceride levels were 105, 102, 111, 113, and 114 mg/dL (P < .001 for linear trend), and LDL-C levels modified by sex were 116, 115, 118, 121, and 123 mg/dL among women (P = .047 for linear trend). There were no significant trends in LDL-C levels among men. Among higher consumers (10% added sugars) the odds of low HDL-C levels were 50% to more than 300% greatercompared with the reference group (<5%>

Conclusion In this study, there was a statistically significant correlation between dietary added sugars and blood lipid levels among US adults.