Dietary Glycemic Load and Index and Risk of Coronary Heart Disease in a Large Italian Cohort The EPICOR Study

Diet tinggi glycemic load (GL) dan tinggi glycemic index (GI) berhubungan dengan timbulnya penyakit jantung koroner (PJK) pada perempuan, tetapi tidak pada lelaki.

Arch Intern Med 170(7):640-647, 12 April 2010 © 2010 to the American Medical Association
Dietary Glycemic Load and Index and Risk of Coronary Heart Disease in a Large Italian Cohort-The EPICOR Study. Sabina Sieri, Vittorio Krogh, Franco Berrino, et al. 

Background  Dietary glycemic load (GL) and glycemic index (GI) in relation to cardiovascular disease have been investigated in a few prospective studies with inconsistent results, particularly in men. The present EPICOR study investigated the association of GI and GL with coronary heart disease (CHD) in a large and heterogeneous cohort of Italian men and women originally recruited to the European Prospective Investigation into Cancer and Nutrition study.

Methods  We studied 47 749 volunteers (15 171 men and 32 578 women) who completed a dietary questionnaire. Multivariate Cox proportional hazards modeling estimated adjusted relative risks (RRs) of CHD and 95% confidence intervals (CIs).

Results  During a median of 7.9 years of follow-up, 463 CHD cases (158 women and 305 men) were identified. Women in the highest carbohydrate intake quartile had a significantly greater risk of CHD than did those in the lowest quartile (RR, 2.00; 95% CI, 1.16-3.43), with no association found in men (P = .04 for interaction). Increasing carbohydrate intake from high-GI foods was also significantly associated with greater risk of CHD in women (RR, 1.68; 95% CI, 1.02-2.75), whereas increasing the intake of low-GI carbohydrates was not. Women in the highest GL quartile had a significantly greater risk of CHD than did those in the lowest quartile (RR, 2.24; 95% CI, 1.26-3.98), with no significant association in men (P = .03 for interaction).

Conclusion  In this Italian cohort, high dietary GL and carbohydrate intake from high-GI foods increase the overall risk of CHD in women but not men.

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Salam sehat,
Dr. David Fadjar Putra, MS
Spesialis Gizi Klinik
@
www.kliniknutrisi.com
kliniknutrisi.blogspot.com

Effects of treatment in women with gestational diabetes mellitus: systematic review and meta-analysis

Diabetes dalam kehamilan perlu penanganan untuk mengurangi risiko komplikasi perinatal.

BMJ 340:c1395, 1 April 2010 © Horvath et al 2010
Effects of treatment in women with gestational diabetes mellitus: systematic review and meta-analysis. Karl Horvath, Klaus Koch, Klaus Jeitler, et al. 

Objective To summarise the benefits and harms of treatments for women with gestational diabetes mellitus.

Design Systematic review and meta-analysis of randomised controlled trials.

Data sources Embase, Medline, AMED, BIOSIS, CCMed, CDMS, CDSR,CENTRAL, CINAHL, DARE, HTA, NHS EED, Heclinet, SciSearch, severalpublishers' databases, and reference lists of relevant secondary literature up to October 2009.

Review methods Included studies were randomised controlled trials of specific treatment for gestational diabetes compared with usual care or "intensified" compared with "less intensified" specific treatment.

Results Five randomised controlled trials matched the inclusion criteria for specific versus usual treatment. All studies used a two step approach with a 50 g glucose challenge test or screening for risk factors, or both, and a subsequent 75 g or 100 g oral glucose tolerance test. Meta-analyses did not show significant differences for most single end points judged to be of directclinical importance. In women specifically treated for gestational diabetes, shoulder dystocia was significantly less common (odds ratio 0.40, 95% confidence interval 0.21 to 0.75), and one randomised controlled trial reported a significant reduction of pre-eclampsia (2.5 v 5.5%, P=0.02). For the surrogate end point of large for gestational age infants, the odds ratio was 0.48 (0.38 to 0.62). In the 13 randomised controlled trials of different intensities of specific treatments, meta-analysis showed a significant reduction of shoulder dystocia in women with more intensive treatment (0.31, 0.14 to 0.70).

Conclusions Treatment for gestational diabetes, consisting of treatment to lower blood glucose concentration alone or with special obstetric care, seems to lower the risk for some perinatal complications. Decisions regarding treatment should take into account that the evidence of benefit is derived from trials for which women were selected with a two step strategy (glucose challenge test/screening for risk factors and oral glucose tolerance test).

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Salam sehat,
Dr. David Fadjar Putra, MS
Spesialis Gizi Klinik
@
www.kliniknutrisi.com
kliniknutrisi.blogspot.com

Vitamin D deficiency is highly prevalent in COPD and correlates with variants in the vitamin D-binding gene

Defisiensi vitamin D sering terjadi pada COPD, dan berhubungan dengan beratnya serangan.

Dianjurkan pemberian suplemen vitamin D pada penderita COPD berat, terutama bagi penderita dengan varian gen rs7041.

Thorax 65:215-220, March 2010 © 2010 BMJ Publishing Group Ltd & British Thoracic Society
Vitamin D deficiency is highly prevalent in COPD and correlates with variants in the vitamin D-binding gene. Wim Janssens, Roger Bouillon, Bart Claes, et al. 

Abstract

Introduction Vitamin D deficiency has been associated with many chronic illnesses, but little is known about its relationship with chronic obstructive pulmonary disease (COPD).

Objectives Serum 25-hydroxyvitamin D (25-OHD) levels were measured in 414 (ex)-smokers older than 50 years and the link between vitamin D status and presence of COPD was assessed. The rs7041 and rs4588 variants in the vitamin D-binding gene (GC) were genotyped and their effects on 25-OHD levels were tested.

Results In patients with COPD, 25-OHD levels correlated significantly with forced expiratory volume in 1 s (FEV₁) (r=0.28, p<0.0001). Compared with 31% of the smokers with normal lung function, as many as 60% and 77% of patients with GOLD (Global Initiative for Obstructive Lung Disease) stage 3 and 4 exhibited deficient 25-OHD levels <20 ng/ml (p<0.0001). Additionally, 25-OHD levels were reduced by 25% in homozygous carriers of the rs7041 at-risk T allele (p<0.0001). This correlation was found to be independent of COPD severity, smoking history, age, gender, body mass index, corticosteroid intake, seasonal variation and rs4588 (p<0.0001). Notably, 76% and 100% of patients with GOLD stage 3 and 4 homozygous for the rs7041 T allele exhibited 25-OHD levels <20 ng/ml. Logistic regression corrected for age, gender and smoking history further revealed that homozygous carriers of the rs7041 T allele exhibited an increased risk for COPD (OR 2.11; 95% CI 1.20 to 3.71; p=0.009).

Conclusion Vitamin D deficiency occurs frequently in COPD and correlates with severity of COPD. The data warrant vitamin D supplementation in patients with severe COPD, especially in those carrying at-risk rs7041 variants.

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Salam sehat,
Dr. David Fadjar Putra, MS
Spesialis Gizi Klinik
@
www.kliniknutrisi.com
kliniknutrisi.blogspot.com