Wednesday, February 22, 2012

Not only is it likely that overuse of diet soda can cause weight gain by altering thyroid function, but now a new study indicates it may increase your risk for stroke and myocardial infarct.

From Medscape Medical News > Neurology

Diet Soda May Heighten Risk for Vascular Events

Allison Gandey


 
February 9, 2011 (Los Angeles, California) — Diet soda may not be the healthier alternative many had hoped. A new study suggests that the popular drinks may increase the risk for stroke, myocardial infarction, and vascular death.

"People who had diet soda every day experienced a 61% higher risk of vascular events than those who reported drinking no soda," lead investigator Hannah Gardener, ScD, an epidemiologist from the University of Miami Miller School of Medicine in Florida, told reporters attending a news conference here at the International Stroke Conference.

Dr. Hannah Gardener
The risk persisted after controlling for metabolic syndrome, peripheral vascular disease, and cardiac disease history (relative risk, 1.48; 95% confidence interval, 1.03 - 2.12).

"This is the first report of this association," said American Stroke Association national spokesperson Larry Goldstein, MD. "I think that it's always good to do things in moderation. People should look at this information and consider it in the context of their other risk factors."

The researchers looked at more than 2500 people from the multiethnic Northern Manhattan Study. Participants were asked to report how much and what kind of soda they drank.

During an average follow-up of 9.3 years, 559 vascular events occurred, including ischemic and hemorrhagic stroke.

The researchers also observed a marginally significant increased risk for vascular events among those who consumed diet soda daily and regular soda once or more a month (adjusted relative risk, 1.74; 95% confidence interval, 0.96 - 3.16).

As reported by Medscape Medical News, previous studies have suggested a link between diet soda consumption and the risk for metabolic syndrome and diabetes. But this is the first time diet drinks have been associated with vascular events.

"This is an observational study and not a prospective randomized trial," Dr. Goldstein, from the Duke Stroke Center, in Durham, North Carolina, pointed out. "This is an association and not yet a proven causal relationship."

The investigators acknowledge that additional studies are needed. The potential mechanisms for the association between diet soda and vascular events remain unknown.

What should clinicians advise patients on the basis of the information we have today? Steven Greenberg, MD, from Harvard Medical School in Boston, Massachusetts, suggests that patients start by concentrating on a healthy diet and regular exercise. "Once the metabolic syndrome is under control and any risk of diabetes, then we can consider cutting back on soda consumption." Dr. Greenberg is the vice chair of the International Stroke Conference Committee, and during an interview he suggested that patients shouldn't rush to eliminate diet drinks.

"I do think this is a wake-up call, though," he said, "and we need to start paying closer attention."

This study was funded by the Javits award from the National Institute of Neurological Disorders and Stroke and the Evelyn McKnight Brain Institute. The researchers have disclosed no relevant financial relationships.
 
American Stroke Association International Stroke Conference. Abstract # P55. News conference February 9, 2011.

Monday, February 20, 2012

Money...politics....pain ....and opioids. The over-prescription and over -use of pain narcotics is problematic on so many levels. Perhaps it's high time that the public, and their doctors, start focusing more on the cause of pain rather than on merely masking symptoms. Let's face it....no one in this country or anywhere else suffers from opioid deficiency.

Chronic Pain Fuels Boom in Opioids



Prescriptions for narcotic painkillers soared so much over the last decade that by 2010 enough were being dispensed to medicate every adult in the U.S. around-the-clock for a month.

Fueling that surge was a network of pain organizations, doctors and researchers that pushed for expanded use of the drugs while taking in millions of dollars from the very companies that made them, a Journal Sentinel/MedPage Today investigation found.

Last year, the Journal Sentinel/MedPage Today found that a University of Wisconsin-Madison based organization had been a national force in helping liberalize the way opioids are prescribed and viewed. During a decade-long campaign that promoted expanded use of opioids -- an agenda that critics say was not supported by rigorous science -- the UW Pain & Policy Studies Group received $2.5 million from makers of opioid analgesics.

After that article was published last April, the UW Pain group said it had decided to stop taking money from the drug industry.

But the UW Pain group is just one link in a network of national organizations and researchers with financial connections to the makers of narcotic painkillers.

Beginning 15 years ago, that network helped create a body of "information" that today is found in prescribing guidelines, patient literature, position statements, books and doctor education courses, all which favored drugs known as opioid analgesics.

Without rigorous scientific evidence to prove that their benefits out weigh potential harm, drugs like OxyContin and Vicodin increasingly have been used to treat a wide array of chronic pain syndromes including low back pain and fibromyalgia.

Current practices reflect a gradual shift from the use of these drugs to treat short-term acute pain such as post-surgical pain, as well as severe pain associated with metastatic cancer or end-of-life pain -- uses that were based on solid evidence that such use was safe and effective.

But the benefit seen for those conditions was extended to treatment of chronic pain syndromes, an extrapolation that had no evidence to back it up.

Caught in the middle are millions of Americans with real pain that can last for years and thousands of doctors who want to help them.

It's a situation that was ripe for the influence of the pharmaceutical industry, said Mark Sullivan, MD, a professor of psychiatry and behavioral sciences at the University of Washington.

By 2010, those firms were selling four times as many prescription painkillers to pharmacies, doctors' offices and hospitals as in 1999.

Led by OxyContin, sales of prescriptions of opioid drugs totaled $8.4 billion in 2011, up from $5.8 billion in 2006, according to data supplied by IMS Health, a drug market research firm.

"We've never really exposed so many people to so much drug for so long," Sullivan said. "We don't really know what the long-term results are."

The Pendulum Swings Back

Several of the pain industry's core beliefs about chronic pain and opioids are not supported by good science and contributed to the growing use of the drugs, a Journal Sentinel/MedPage Today review of records and interviews found.

Among the misconceptions:
  • The risk of addiction is low in patients who obtain their narcotic painkillers legitimately.
  • There is no maximum dose of the drugs that can't be safely prescribed.
  • People who seek more frequent prescriptions or higher doses of the drugs aren't addicts, they are "pseudoaddicts" who just need more pain relief and more opioids.
Underlying those fallacies, critics say, is an even larger one: That the use of narcotic painkillers to treat non-cancer pain lasting many months or years is supported by rigorous science.

Even doctors who have financial relationships with companies that make narcotic painkillers concede that the practice of pain medicine got ahead of the science.

Lynn Webster, MD, a Utah pain specialist who has worked as a consultant and adviser to most of the companies in the opioid analgesic market, said the pain community got some of it wrong.

"We overshot our mark, all well-intended, I believe," Webster, an officer of the American Academy of Pain Medicine, said in an interview. "We certainly have a lot of reverse education that needs to occur."
Some chronic pain sufferers do benefit from the drugs, Webster said.

"The problem is pain is complex," he said. "There is a whole family of opioids and we have not figured out how to best identify the individuals who can benefit long-term.

"I don't think industry was trying to harm anyone. I think industry was trying to fill a need that we as physicians saw."

Others say that Webster is too forgiving in his analysis: they claim that the pharmaceutical industry chose profits over patient safety.

Over the past decade as many as 100,000 Americans have died from opioid overdoses and millions have become addicted to the drugs, said Andrew Kolodny, MD, a New York psychiatrist and opioid addiction specialist who co-founded Physicians for Responsible Opioid Prescribing.

"This is an out of control epidemic, not caused by a virus or a bacteria," said Kolodny, chairman of psychiatry at Maimonides Medical Center in New York. "This epidemic has been caused by a brilliant marketing campaign that dramatically changed the way physicians treat pain."

The pharmaceutical industry's alliance with pain groups is part of familiar playbook.

It has occurred with other organizations, though those financial relationships aren't always fully disclosed, said David Rothman, PhD, president of the Institute on Medicine as a Profession, part of Columbia University College of Physicians & Surgeons.

"They (drug companies) expect a certain return for their money and the sad thing is, they often get it," he said.

Maximum dose

Consider the American Pain Foundation, which has substantial financial ties to companies that make narcotic painkillers: a patient guide available on its web site it claims there is no maximum dose for opioids as long as they are not combined with other drugs such as acetaminophen. The dose of any painkiller, the Foundation claims, can be gradually increased over time.

Critics of the use of opioids for chronic pain say that is a dangerous misinterpretation of information gleaned from the experience of treating cancer pain in hospitalized patients.

It should not be applied to chronic, non-cancer pain sufferers who are not getting their drugs in a hospital setting, said Sullivan, the University of Washington professor.

A philosophy of "no maximum dose" can lead to more people on high doses of the drugs, which, in turn, can result in serious problems, including more falls and fractures in older people, respiratory depression, overdoses and fatalities, he said.

Even when the dose is increased gradually, high doses add more risk, especially in people who take other prescription drugs, use alcohol, have a medical condition such as sleep apnea, or who take an opioid in a manner other than how it is prescribed, Sullivan said.

"Risk goes up with dose, even if it is well done," he said.

An April 2011 paper in the Archives of Internal Medicine found that as dose escalated the risk of opioid-related death increased. For high-dose patients the risk of death was three times greater than in lower-dose patients.

The "no ceiling" dose statement appears in the Pain Foundation's "guide for people living in pain," a publication that received funding from three drug companies.

Two of the companies, Purdue Pharma and Cephalon, were the subject of U.S. Justice Department investigations involving their opioid products.

In 2007, Purdue was accused of misleading doctors by claiming, with no proof, that its narcotic painkiller OxyContin was less addictive, less likely to cause withdrawal and less subject to abuse than other pain medications.

At the time, scores of deaths and an even greater number of addictions were attributed to OxyContin. The company and three of its executives pleaded guilty to various charges. A court imposed fines and restitution payments totaling $635 million.

In 2008, Cephalon settled an investigation of off-label marketing of three of its drugs, including Actiq, a powerful painkilling product manufactured as a lollipop with the drug fentanyl. The drug was approved for use only by cancer patients who no longer were getting pain relief from morphine based drugs. Cephalon allegedly promoted the drug for non-cancer patients with conditions ranging from migraines to injuries. It also promoted Actiq for use in patients who were not opioid-tolerant and for whom it could have been life-threatening.

Cephalon agreed to pay a $425 million penalty.

In recent years the American Pain Foundation has received millions of dollars from industry, including companies that market opioids.They include Purdue, Cephalon and several other opioid companies.

Foundation officials declined to be interviewed for this story.

In an email statement Micke Brown, a registered nurse and spokesperson for the foundation, said it stands by the statements in its pain guide, which was developed by leading pain experts.

"APF along with many from the pain community is concerned (about) the misuse and abuse of these valued medications. Unfortunately, the weight of this complex problem has been placed on the backs of people living with pain."

Addiction Risk

In 1996, the American Academy of Pain Medicine and the American Pain Society, organizations that get substantial funding from drug companies, issued a joint statement endorsing the use of opioids to treat chronic pain and claiming the risk of addiction was low.

The chairman of the group that issued the statement was J. David Haddox, DDS, MD, a physician and paid speaker for Purdue Pharma, maker of the highly-prescribed opioid, OxyContin.

Three years after the chronic pain statement, Haddox became an executive at Purdue.

Doctors on both sides of the debate agree most people who are put on opioids long-term will become physically dependent. The risk of addiction, which is more severe than physical dependence, is significant, they say.

One of the problems in assessing addiction risk is that many of the clinical trials that involved opioids excluded people with mental illness or who had a family history of substance abuse, groups that are more likely to develop addiction.

But many of those people are put on opioid therapy for chronic pain.

Some people are able to come off opioids without much trouble while others will be addicted, said Jane Ballantyne, MD, a professor of anesthesiology and pain medicine at the University of Washington.
"The vast majority of people are somewhere in between," she said.

Part of the problem is that addiction has become more of a lay term defined by differently by different groups. Addiction rates have varied widely in studies.

The National Institute on Drug Abuse says addiction rates among chronic pain patients have ranged from 3% to 40%.

A 2011 study looking at different data also found a substantial problem.

The research involved 705 people on long-term opioid therapy for non cancer pain. It used a new definition known as opioid-use disorder. Thedisorder is similar to addiction, said Joseph Boscarino, PhD, the study's lead author and senior investigator at the Geisinger Clinic in Danville, Pa.

Nearly 35% of those in the study had either moderate or severe opioid-use disorder at some point during their lives.

"It (addiction) is not low," said Boscarino, a professor of psychiatry at Temple University. "It's pretty high."

The 1996 consensus statement was taken down from the web site of the American Academy of Pain Medicine last fall after a doctor complained about it. It should have been reviewed years earlier, said Philip Saigh, executive director of the academy.

Last year, the academy received $1.3 million from the pharmaceutical industry, including unrestricted grants, according information supplied to the Journal Sentinel/MedPage Today.

In addition, the AAPM's "corporate relations council" allows companies that pay up to $25,000 each to gain access to physician leaders associated with the academy. Last year, that program took in $170,000.

Corporate relations council members who pay another $60,000 also can have their educational programs included as satellite dinner symposia at the academy's annual meeting in Palm Springs -- a meeting slated for Feb. 23-26. An academy brochure describes the meeting as an "exclusive venue" for presenting continuing medical education material for doctors.

Saigh said payments by pharmaceutical companies do not give them the right to influence positions or statements made by the academy.

The American Pain Society, which funded the 1996 consensus statement on opioids and chronic pain, received more than $1.6 million in financial support from opioid companies in the last two years, more than 20% of its revenue, according to figures it provided for this story.

Its president, Seddon Savage, MD, an addiction and pain medicine specialist, declined to be interviewed for this story, but provided written responses.

In her statement, Savage, an associate adjunct professor at Dartmouth Medical School, said there is no evidence of the impact the statement had on opioid prescribing. The statement is not an official society document "at this time," she said.

She said it was unfair to say that the society's position on opioids has been influenced by pharmaceutical companies. The society did not advocate for or against the use of opioids, she said.

"For some individuals with pain, opioids relieve disabling suffering and allowed them to re-engage in a life worth living," she said. "For others, opioids can be associated with serious harm."

She said the group's position now is reflected in clinical guidelines issued in 2009. The guidelines were commissioned by the American Pain Society in conjunction with the American Academy of Pain Medicine.

The new guidelines say doctors can consider a trial of opioids for patients with chronic pain, but acknowledge that the evidence for such a "trial" is low-quality or insufficient.

And even that 2009 guideline document is tainted by allegations of pharmaceutical industry influence.

In 2008, Joel Saper, MD, a Michigan pain specialist, resigned from the guidelines committee, in part citing support of the project by the opioid industry.

Saper who has worked as an advisor to numerous drug companies, including those that make headache medications and opioids, provided a copy of his resignation letter to the Journal Sentinel/MedPage Today.

"The sponsoring organizations have received a large amount of funding from the opioid manufacturers over the past decade," wrote Saper, director of the Michigan Head Pain & Neurological Institute, in Ann Arbor.

"Many members of the committee have personally received sizable funding from the opioid industry as well."
Disclosure statements accompanying the guidelines indicate 14 of the 21 people who served on the project had financial ties to companies that make opioids.

In a statement to the Journal Sentinel/MedPage Today, Roger Chou, MD, who chaired the guidelines project, said Saper never brought up any concerns about financial ties to drug companies prior to his letter.
Chou, an associate professor of medicine at Oregon Health & Science University, has no financial relationships with drug companies.

Pseudoaddiction: A Non-starter

Closely tied to the addiction issue is a term -- pseudoaddiction -- that has been widely used in the field of pain medicine.

When patients seek more frequent prescriptions or higher doses of opioids, it often is a sign of addictive behavior. But the pseudoaddiction approach -- essentially taking them at their word -- argues they aren't addicts, they just need more pain relief.

Even doctors who have financial relationships with opioid makers concede that term is not backed up by good science.

"It obviously became too much of an excuse to give patients more medication," said Webster, the Utah pain specialist and officer of the American Academy of Pain Medicine. "It led us down a path that caused harm. It is already something we are debunking as a concept."

The term was coined by Haddox, the doctor who is now a Purdue Pharma executive, and David Weissman, MD, a Medical College of Wisconsin physician, who used it in a 1989 paper in a medical journal. Weissman, now retired, could not be reached for comment.

Haddox, vice president of health policy at Purdue, declined to comment.

In the paper, the two used the term to describe a teenage leukemia patient with pneumonia and chest-wall pain who was being treated at a hospital.

But without adequate evidence, over the years it became an established belief in the world of chronic, non cancer pain.

It can be found throughout the pain literature, ranging from American Pain Foundation documents to documents issued by the Federation of State Medical Boards, the national group representing state medical boards. The FSMB includes pseudoaddition in its , model policy for the use of controlled substances in treating pain.

Steven Weisman, MD, a professor of anesthesiology and pediatrics at Medical College of Wisconsin, said there is one group of patients who might accurately be described as suffering pseudoaddiction -- sickle cell patients who develop chronic degenerative hip and back pain that responds to treatment with morphine.

But even pain specialists such as Russell Portenoy, MD, who has had extensive financial ties to opioid companies, now acknowledge that the concept of pseudoaddiction in chronic pain was not supported by evidence.

"The term has taken on a bit of a life of its own," said Portenoy, chairman of pain medicine and palliative care at Beth Israel Medical Center in New York, "That's a mistake."

Portenoy conceded there has been a lack of evidence supporting the use of opioids in chronic non-cancer pain, but said much of medical care is not based on rigorous evidence.

"This is not a simple story," he said.

Same Tune, Different Words

It reminds Howard Bauchner, MD, editor-in-chief of the Journal of the American Medical Association, of the situation that existed a decade ago with antibiotics.

The drugs were being vastly over-prescribed. They were being given to people with viral-based respiratory infections, against which they were useless. Or they were given to children for undocumented throat infections.

It wasn't until the situation became the focus of public attention that the inappropriate use of the drugs declined, Bauchner said.

"I'm hoping we can write the same story about opioid use in a decade," he said.

Tuesday, February 14, 2012

Eat your vegetables!!!! Eating well is not just for the young as new study indicates doing so is also beneficial to the mortality of older individuals.

No Age Limit on Benefits of Eating Well


Older people who eat properly are likely to live longer.

That's the implication of a study looking at mortality and eating habits among a cohort of nearly 4,000 people 65 and older, according to Luis Afonso, MD, of Wayne State University in Detroit, and colleagues.

After an average follow-up of 13 years, participants with a good diet had lower rates of all-cause and cardiovascular mortality, compared with those who had a poor diet, Afonso and colleagues reported in the Feb. 13 issue of Archives of Internal Medicine.

For the analysis, a good diet was defined as a score of greater than 80 on the U.S. Department of Agriculture's Healthy Eating Index, while a poor score was less than 51 on the 100-point scale. A middling diet, scoring 51 through 80, was defined as "in need of improvement."

The eating index has been shown previously to be associated with a lower risk of cardiovascular disease and its associated risk factors, but its value as a prognostic tool in an older population has not been measured, Alfonso and colleagues noted.

To fill the gap, they looked at outcomes for 3,884 people 65 and older who took part in the Third National Health and Nutrition Examination Survey (NHANES) between 1988 and 1994 and who had dietary information available.

The index itself has 10 dietary components, including such things as intake of fruits and vegetables, salt, meats and beans, and oils, and has been modified since its first version in 1995.

The original index was used for this analysis, Afonso and colleagues reported, in order "to conform to the dietary patterns and risk factors prevalent in the 1980s and 1990s."

The researchers obtained mortality data from national linkage records and death certificates, with an average follow-up of 161.6 months, or 13.4 years.

They found that only 18% of the participants had a diet that was above 80 in the index and those people had a 37% reduction in the risk of death, compared with those whose diets fell into the poor range.
Also:
  • On average, the participants were 73.5 when they took part in the interviews and the average score on the eating index was 68.7.
  • Within the groups, average scores were 85.3 for a good diet, 67.2 for a middling diet, and 43.5 for a poor diet.
  • All told, there were 2,738 deaths, including 1,315 from cardiovascular causes.
  • 62% of those with good diet died, compared with 71% of those in the middling group and 78% of those in the poor group. The differences were significant at P=0.001.
  • For cardiovascular deaths, the rates were 33%, 34%, and 36%, respectively, and the differences remained significant at P=0.001.
  • On a multivariate analysis, eating index scores were inversely associated with all-cause mortality (HR 0.991, 95% CI 0.988 to 0.994, P<0.001).
  • Multivariate results were similar for cardiovascular death (HR 0.993, 95% CI 0.988 to 0.997, P=0.002).
The results are in accordance with broader studies suggesting that a good diet improves mortality outcomes, Afonso and colleagues argued.

"Despite a higher prevalence of comorbidities like hypertension, diabetes, smoking, coronary artery disease, and stroke, along with the advanced age in our study cohort, a good (Healthy Eating Index) score was found to reduce the risk of death," they noted.

The authors did not report any external support for the study. They did not make any financial disclosures, the journal said.

Monday, February 13, 2012

New study shows that how much sleep you are told your child is supposed to get is different than what they do get. Of note to the author's comment about the cost of sleep studies being too high, actigraphy can now be done affordably and done safely at home even with a child.

Shhh! The Kids Need More Sleep -- Or Do They?


Kids don't get the recommended amount of sleep -- and they never have.

That's the conclusion of Australian researchers who tracked changes in sleep recommendations, and what was known about actual sleep time, over more than a century.

The rate of change varied with age, but recommended sleep consistently fell and the changes were significant for eight ages (at values ranging from P=0.03 to P<0.0001):
  • Infants
  • Ages 4 to 8
  • Ages 14 and 15
At the same time, actual sleep also fell, declining by about 0.73 minutes per year over time.
A systematic review of the literature revealed that, since 1897, sleep recommendations for children of all ages have consistently exceeded what was known about actual sleep time, according to Lisa Anne Matricciani and colleagues at the University of South Australia in Adelaide.

In addition, both have also consistently fallen, almost in lockstep, over the years, Matricciani and colleagues reported online and in the March issue of Pediatrics.

The issue has been a matter of concern since the 19th century with observers worried that the stimulation of modern living would overtax children, the researchers noted.

The stimulation itself was usually blamed on whatever new technology was current, from radio and reading to television and the Internet.

On the other hand, those making the recommendations were consistent in admitting they had little or no evidence on which to base their suggestions, Matricciani and colleagues pointed out.

Their literature search turned up 28 studies that made sleep recommendations, and 218 that offered self- and proxy-reported sleep duration for children of various ages.

The analysis showed that, on average, recommended sleep fell about 0.71 minutes per year, or about 70 minutes over the course of the 20th century, Matricciani and colleagues found.

For 173 of some 360 recommended sleep durations, matching data were available on actual sleep. In 144 of those (83%) of the comparisons, recommended sleep exceeded actual sleep, with an average difference of 37 minutes (significant at P<0.001).

The researchers found that recommended sleep duration was almost always higher than actual sleep duration "as if children always needed extra sleep, no matter how much they were actually getting."

A limitation of the study was that in this review, sleep duration was based on reports, rather than on objective measures such as actigraphy and polysomnography.

But those approaches have only been developed recently, are expensive and time-consuming, and have usually been applied only at the individual level, the authors noted.

Although lack of sleep has been associated with a range of adverse consequences, Matricciani and colleagues argued, there is still little understanding of dose-response effects or even the mechanisms that might lead to negative outcomes.

The study had no external support. The journal said the authors reported no financial conflicts.

Wednesday, February 8, 2012

In an interesting new study, babies weened from formula/breast milk developed healthier eating patterns when they started off being able to choose finger foods when compared to those being spoon fed pureed foods.


Baby's First Foods Should Be Finger Foods


Children who begin eating solid finger foods rather than being given pureed baby foods by their parents developed healthier eating patterns, researchers found.

In comparison with parental spoon-feeding, baby-led weaning was associated with a significant preference for carbohydrates (P=0.003), according to Ellen Townsend, PhD, and Nicola J. Pitchford, DPhil, of the University of Nottingham in England.

In fact, children who were introduced to solid foods by feeding themselves preferred carbohydrates over all other types of foods, with a preference rating of 1.82, with 1 being the highest rating and 5 the lowest, while spoon-fed babies preferred sweets, with a rating of 1.81, the researchers reported online in BMJ Open.

"Our findings show that baby-led weaning has a positive impact on the liking for carbohydrates -- foods that form the building blocks of healthy nutrition (i.e., those found at the bottom of the food pyramid)," they observed.

There has been considerable interest in baby-led weaning, which encourages a less controlling parental style and can help ease maternal worries about appropriate feeding, the authors noted.

However, the effects on infant health have not been explored, so Townsend and Pitchford recruited the parents of 155 children, 92 of whom had baby-led weaning while the remainder were spoon-fed with pureed foods.

Parents completed a questionnaire about their weaning style and infants' food preferences, and provided other information such as socioeconomic status.

At the time of the study, children in the baby-led group were significantly younger than the spoon-fed group (32.12 months versus 41.62 months), so the researchers also generated a case-control sample of 74 age-matched participants to control for potential differences in food preferences according to age.

Aside from carbohydrates, the baby-led group also favored protein-based foods and whole meals, although after adjustment these differences compared with the spoon-fed group were no longer significant.

In the case-control sub-sample, increased exposure to carbohydrates was not associated with preference for these foods, which "suggests that for carbohydrates, the only food category with significant group differences, weaning style was more influential than exposure on preference ratings," explained Townsend and Pitchford.

The researchers then examined the effects of type of weaning on BMI, and found that the baby-weaned group were closer to the 50th percentile (48.46 versus 61.44, P=0.009).

The differences in BMI between the groups were not explained by differences in birth weights, which were similar, at slightly over 7 lb.

They also calculated BMI z-scores and found that more children in the spoon-fed group were obese (8 versus 1), but more in the baby-led group were underweight (3 versus 0, P=0.02), a finding that will require more research.

There were no associations between BMI scores and duration of breastfeeding or parental socioeconomic status.

Possible reasons why self-feeding babies showed a preference for carbohydrates included ease of chewing, pleasing presentation, and texture in foods such as toast, the researchers suggested.

Future studies should examine the effects of baby-led weaning in specific groups, such as premature infants or those with medical problems.

In addition, a large trial should more fully explore weaning in conjunction with other early-childhood factors such as breast versus bottle feeding and "picky eating," according to Townsend and Pitchford.

The study was funded by the University of Nottingham School of Psychology. The authors also have received funding from Nutricia/Danone.

Saturday, February 4, 2012

More good news for Vitamin D plus some favorable news about sunlight, both showing evidence to decrease stroke risk according to a new study presented at the American Stroke Association. With other studies not as positive about Vit. D and Ol' Sol, perhaps "moderation is the best policy" may ring true.

Lack of Sunlight, Vitamin D Tied to Stroke Risk


NEW ORLEANS -- Too much sunlight is bad for the skin, but not enough may be a risk factor for stroke, according to a study presented here at the American Stroke Association's International Stroke Conference.

Of the more than 16,000 black and white patients followed, those who lived in areas that had shorter exposure to sunlight had a 56% increased risk of stroke, Leslie McClure, PhD, from the University of Alabama at Birmingham, Ala., and colleagues found.

Interestingly, the protective benefit of sunlight was virtually eliminated in the Southeastern stroke belt and buckle, which comprises parts of the coastal plains of Georgia as well as North and South Carolina, McClure told MedPage Today.

"How do we resolve this paradox that increased sunlight leads to decreased stroke risk, but in the stroke belt where there is lots of sunlight, there is also an increase of stroke?" McClure asked.

The investigators obtained data from 16,529 participants in the REGARDS (Reasons for Geographic and Racial Differences in Stroke) study who were 45 years or older. The participants were interviewed at baseline and surveyed every six months for cardiovascular disease incidence. They also filled out a self-administered questionnaire for residential histories since birth. The average follow-up was five years.

Researchers used sophisticated satellite and ground monitor technology from NASA to calculate sunlight exposure and temperature. They matched these variables to geography and weighted them for the duration at each residential location.

Even after McClure and colleagues controlled for factors such as age, race, education, systolic blood pressure, region, gender, income, physical activity, time spent watching TV, and body mass index, they still found that lack of sunlight exposure and lower temperatures were associated with a risk of stroke. Extreme temperatures also were linked to an increased stroke risk.

"The sun gets a bad rap, but sensible sun exposure is probably the way to go," McClure said.
The study was limited by unmeasured confounders such as air pollution, a single rather than repeated measures of exposures, and potential exposure misclassification.

McClure concluded that the mechanism through which sunlight exposure is related to stroke still needs to be explored. Her colleagues explored one such possibility: Vitamin D exposure.

Vitamin D and Stroke

In their Vitamin D study, researchers found that those with a higher level of vitamin D in their diet had a decreased risk of stroke and cognitive impairment.

Similar to the previous study, Suzanne E. Judd, PhD, from the University of Alabama in Birmingham, and colleagues surveyed roughly 21,400 black and white participants in the REGARDS study every six months for five years to assess the incidence of strokes and cognitive functioning declines. The mean age was 65.

The investigators measured vitamin D by using a food frequency questionnaire. Participants were asked once to give an average dietary intake for a year. Vitamin D supplements also counted toward total intake.

"As people age, their skin loses the ability to make the precursor of vitamin D," Judd told MedPage Today. "In addition, African Americans have a harder time making vitamin D. Consequently, we hypothesized that dietary vitamin D levels might be a good proxy for blood levels in the elderly and in blacks."

Judd and colleagues found that those with higher levels of vitamin D in their diets, when compared with those with lower levels, had an 11% reduction in stroke and a 24% reduction in cognitive impairment after adjustment for age, race, income, education, hypertension, diabetes, high cholesterol, heart disease history, and weight. There was no difference between blacks and whites. However, the 95% confidence intervals (four adjusted models) were fairly wide for the stroke risk.

"There is some evidence that vitamin D is cardioprotective, and it has some role in blood pressure and inflammation. So it makes sense to ask whether vitamin D has protective properties for the brain," Judd said.

In late 2010, the Institute of Medicine (IOM) released recommendations for vitamin D intake, but only as it related to bone health. The IOM had concluded after reviewing nearly 1,000 scientific studies that the evidence for vitamin D's role in reducing cancer, heart disease, and stroke was inconclusive.

The IOM called for more research. As well, Harvard investigators have begun the Vitamin D and Omega-3 Trial (VITAL). This study will involve 20,000 men and women across the U.S. who will be randomized to either vitamin D and fish oil supplements or to placebo.

Judd said the VITAL trial, as well as others like it, are needed to further evaluate the potential of vitamin D as a neuroprotectant.

The study was limited by a one-time assessment of vitamin D status. Also, Judd noted the association of vitamin D with reduced risk of stroke and cognitive impairment could be due to unmeasured confounders, such as that those with higher levels of vitamin D also might have healthier diets.

Both studies were funded by the National Institutes of Health/National Institute of Neurologic Disorders and Stroke.
Neither McClure nor Judd had financial conflicts to report.


From the American Heart Association:
Primary source: International Stroke Conference
Source reference:
Kent ST, et al "The use of ground and satellite data to determine the relationship between long and short-term sunlight exposure with stroke incidence in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study" ISC 2012; Abstract 2591.

Additional source: International Stroke Conference
Source reference:
Judd SE, et al "Vitamin D intake: A novel neuroprotectant?" ISC 2012; Abstract 2212.