Waiting for Mom to tell you to eat your veggies? New study shows that remote coaching via smart phone app is just as effective in getting you to eat your fruits and veggies as was your Mom making you sit at the table until you did so.

Eat More Veggies? There's an App for That

By Kristina Fiore, Staff Writer, MedPage TodayPublished: May 30, 2012

Reviewed by Zalman S. Agus, MD; Emeritus Professor, Perelman School of Medicine at the University of Pennsylvania and Dorothy Caputo, MA, BSN, RN, Nurse Planner

A mobile device that connects patients to a coach can help the patients eat more fruits and vegetables and spend less time sitting around, researchers found.

Patients who focused on these two behaviors and uploaded their daily dietary intake and exercise habits to a remote coach saw their daily fruit and vegetable intake rise from an average of 1.2 servings at baseline to 5.5 servings at the end of the trial phase, while their sedentary leisure time fell from 219.2 minutes to 89.3 minutes. In addition, their percentage of calories from saturated fat fell from 12% to 9.5%, noted Bonnie Spring, PhD, of Northwestern University, and colleagues.

The study "demonstrates the feasibility of changing multiple unhealthy diet and activity behaviors simultaneously, efficiently, and with minimal face-to-face contact by using mobile technology, remote coaching, and incentives," they wrote in the May 28 issue of Archives of Internal Medicine.

To test which combinations of diet and activity advice would be most helpful in the context of remote coaching, the researchers randomized 204 adults with elevated saturated fat and low fruit and vegetable intake, lots of sedentary leisure time, and little physical activity to one of four sets of objectives:

• Increase fruit and vegetable intake and physical activity
• Increase fruit and vegetable intake and decrease sedentary leisure time
• Decrease fat and sedentary leisure time
• Decrease fat and increase physical activity

All of the treatments involved three weeks of remote coaching. Patients used a handheld mobile device to send their coaches information on dietary intake, activity, and sedentary time. They were advised to carry the device around and record their behaviors immediately, earning money for those updates during the treatment phase and a follow-up period.

They also communicated as needed with their coaches via phone or email.

Among the 200 patients who completed 20 weeks of follow-up, the investigators found that those who increased their fruits and vegetables and decreased their sedentary time had significantly better improvements in healthy behaviors as measured by the Composite Diet Activity Improvement Score than any of the other three groups (P<0.001).

The superiority of that regimen was evident after just one week and was maintained through the end of the 3-week treatment phase and through the end of follow-up, the researchers reported. At the end of follow-up, the healthy eating and activity patterns were maintained, with means of 2.9 servings of fruits and vegetables, 125.7 minutes of sedentary time, and 9.9% of calories from saturated fat, they wrote.

They said the saturated fat intake was not targeted, but was likely a product of reduced unhealthy snacking during sedentary time.

In fact, the degree to which patients decreased their sedentary time positively correlated with the degree to which they also reduced their fat intake (P=0.04), they found. There were no other significant correlations between behaviors.

"Reduced screen time may be an important behavioral target, not only to reverse direct adverse effects of prolonged sitting, but also to disrupt pairing of screen time with high-fat snacking," they wrote.

Traditional dieting -- decreasing fat intake and increasing physical activity -- was the worst intervention, improving significantly less than the three other strategies (P<0.001).

The study may be limited to those with entrenched unhealthy dietary and activity behaviors, and by the fact that it relied on self-reported data. Also, only a quarter of the sample was male, the researchers cautioned.

Still, they concluded that the study shows remote coaching via a mobile device that focuses on improving fruit and vegetable intake and lowering sedentary time can help patients achieve healthy behaviors that last.

In an accompanying commentary, William Riley, PhD, of the National Heart, Lung, and Blood Institute, said the study contributes to "the empirical evidence of the value of these technologies."

But, Riley cautioned, "many more research contributions such as this are needed to establish that technologically delivered multiple risk factor interventions improve outcomes."

The study was supported by the National Institutes of Health and the Robert H. Lurie Comprehensive Cancer Center.
Neither the researchers nor the editorialist reported any conflicts of interest.

Primary source: Archives of Internal Medicine
Source reference:
Spring B, et al "Multiple behavior changes in diet and activity: A randomized controlled trial using mobile technology" Arch Intern Med 2012; 172(10): 789-796.
Additional source: Archives of Internal Medicine
Source reference:
Riley WT "Leveraging technology for multiple risk factor interventions" Arch Intern Med 2012; 172(10): 796-798.

For those of you living in warmer climates, and/or for those of you concerned about the environmental changes taking place, a new report finds a rise in the heat related death toll. Maybe we need to do more than keep cool.

Global Warming: More Killer Heat Waves?

 

By Todd Neale, Senior Staff Writer, MedPage TodayPublished: May 23, 2012

If climate change continues on its current course, the number of heat-related deaths will rise as temperatures climb during the summer, according to a report from the Natural Resources Defense Council (NRDC), an environmental advocacy group.

The organization projected on the basis of peer-reviewed data that global warming -- expected to increase average temperatures in North America by 4º to 11ºF by 2099 -- will be responsible for an extra 150,000 deaths tied to excessive heat events in the 40 largest U.S. cities by the end of this century.

The hardest hit, in terms of excess heat-related deaths by the end of 2099, are estimated to be:

• Louisville, Ky. (18,988)
• Detroit (17,877)
• Cleveland (16,625)
• Memphis, Tenn. (10,154)
• Jacksonville, Fla. (8,141)

The estimates were based on two studies by Larry Kalkstein, PhD, a professor of geography and regional studies at the University of Miami in Florida, and colleagues, published in the last few years in Weather, Climate, and Society and Natural Hazards.

The researchers studied two baseline time periods -- 1975 to 1995 and 1975 to 2004. They included 1996 to 2004 to account for the greater use of preventive measures against heat-related deaths during those years. When making projections into the future, they did not make adjustments for the growth or aging of the population in order to keep the estimates conservative, Kalkstein said on a conference call with reporters.

The NRDC report based on the data from the two studies focused on two variables -- excessive heat event days and death attributable to extreme heat.

"Excessive heat event days occur when a location's temperature, dew point temperature, cloud cover, wind speed, and surface atmospheric pressure throughout the day combine to cause or contribute to heat-related deaths in that location," according to the report.

Aside from temperature, there are several factors that contribute to the number of excessive heat event days, including geography, urban structure, green space, the use of local warning and preventive measures, and the resiliency of the local residents.

Most vulnerable during these heat waves are seniors and young children, particularly those living in cities with a variable climate. Cities with relatively hot temperatures interspersed by spikes of extended extreme heat will see more health-related deaths than cities that are consistently hot, like Miami, Kalkstein explained.

According to the estimates from Kalkstein's data, the average number of excessive heat event days per summer across all 40 cities was 233 from 1975 to 1995. By 2099, that was projected to increase to 1,918 per summer, assuming a continued reliance on fossil fuels and no significant policy interventions.

Accompanying that increase is a rise in the average number of heat-related deaths per summer from 1,332 from 1975 to 2004 to 4,608 per summer by 2099. All but three of the 40 cities would see more deaths by the end of the century.

Adding up all of the excess heat-related deaths would yield an extra 150,322 heat-related deaths attributable to climate change.

Kalkstein noted that there are measures that cities can take to mitigate the threat of extreme heat, including opening air-conditioned shelters when the National Weather Service calls an excessive heat warning; having a special hotline that people can call to get advice on dealing with heat-related illness; and increasing the number of staff in emergency rooms during heat waves.

He singled out Philadelphia as being particularly proactive in dealing with excessive heat events, noting that the city has volunteer block captains who go door to door checking on vulnerable individuals during heat waves.

Analysis: Exercise with a weight control diet for those who are pregnant is healthy for both baby and mom-to-be., though may or may-not produce better clinical outcomes.

Weight-Control Diet for Mom Builds a Better Baby

 

By Rita Baron-Faust, Contributing Writer, MedPage TodayPublished: May 17, 2012
Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco.

A healthy, calorie-controlled diet to reduce excess weight gain during pregnancy is not only safe for mother and baby but also can improve pregnancy outcomes compared with exercise alone or a combination of the two, a meta-analysis showed.

 

The analysis of randomized trials conducted among more than 7,000 women showed that a calorie-restricted healthy diet limited gestational weight gain by a mean difference of -3.84 kg, or about 8.4 lbs. (95% CI 11.5 lbs. to 5.4 lbs., P<0.001) compared with other interventions, and improved pregnancy outcomes for mother and baby, the researchers wrote online in BMJ. 

Although adhering to a diet produced the biggest benefits, any of the interventions limited excess weight gain during pregnancy by -1.42 kg, around 3.1 lbs. (95% CI 2 lbs. to 4.1 lbs., P<0.001) compared with controls, wrote Shakila Thangaratinam, PhD, MRCOG, of the University of London, and co-authors.

One explanation for the effectiveness of diet could be that "interventions with one main component like diet may be delivered to a higher standard compared to the mixed group (and) the simplicity and perceived safety of diet than other methods," Thangaratinam wrote in an email to MedPage Today.

Noting that obesity during early childhood can persist into adulthood, and that prenatal visits are an ideal time to motivate expectant mothers to make lifestyle changes to improve outcomes for themselves and their babies, the authors decided to investigate which weight management interventions were the most effective and safe during pregnancy.

Retaining postpartum weight is also associated with adverse health outcomes in later pregnancies, Thangaratinam noted in her interview.

To collect relevant studies, the team conducted a literature search of databases (including Medline and the Cochrane Database of Systematic Reviews) and ranked the outcomes, primarily weight changes in the mother and baby.

They selected 44 relevant, randomized controlled clinical trials conducted among 7,278 women in institutions in the U.K., Poland, the Netherlands, and Switzerland, including women with gestational diabetes.

The trials involved three interventions: diet, physical activity, and a mixed approach that may have included behavioral counseling.

Overall, there was a reduction in preeclampsia by 26% (RR 0.74, 95% CI 0.60 to 0.92; P=0.006). Trends towards reduction in gestational diabetes, gestational hypertension, and preterm delivery were deemed not significant.

Only the dietary intervention produced a 33% reduced risk of preeclampsia (RR 0.67, 95% CI 0.53 to 0.85; P<0.001) and a 61% reduced risk of gestational diabetes (RR 0.39, 95% CI 0.23 to 0.69; P=0.001). It also produced nonsignificant reductions in gestational hypertension (RR 0.30, 95% CI 0.10 to 0.88; P=0.03) and preterm delivery (RR 0.68, 95% CI 0.48 to 0.96; P=0.03).

Among women with gestational diabetes, "although a positive benefit was reported for preeclampsia and gestational hypertension, the quality of evidence for these measures was rated as low or very low," noted Lucilla Poston, PhD, of St. Thomas Hospital in London, in an accompanying editorial.

There were no differences in these outcomes with physical activity alone and the mixed approach intervention compared with controls.

Poston disagreed with the authors' conclusion that diet and exercise interventions improved pregnancy outcomes. "This excellent review does not show with any degree of certainty that interventions in pregnancy have been shown to improve clinical outcomes, especially reducing high birth weight, which is one of the most important problems," she commented in an email interview with MedPage Today.

In fact, compared with controls, there was a nonsignificant reduction (mean difference -50 g or 1.76 oz, 95% CI 100g or 5.5 oz to 0 g) in birth weights.

As for safety to the baby, 15 of the trials (involving 3,905 newborns) showed trends towards reductions in intrauterine death, birth trauma, and hyperbilirubinemia. The overall risk of shoulder dystocia during birth was reduced by 61% with all interventions compared with the control group. There were no differences between the groups for respiratory distress syndrome or admission to a neonatal intensive care unit.

It would be premature to change guidelines for weight gain in pregnancy based on this analysis, said Poston in her interview.

"Some of the studies were small and of low quality. The authors did not include evidence for an effect on postpartum weight retention (presumably through lack of adequate data), which has been shown to be robustly associated with excessive gestational weight gain," Poston wrote in her BMJ editorial.

Limitations of this analysis included lack of data on risk factors such as age, ethnicity, and socioeconomic status.

This study was funded by the National Institute for Health Research Health Technology Assessment U.K. program.
The authors declared that they had no competing interests.

Primary source: BMJ
Source reference:
Thingaratinam S "Effects of interventions in pregnancy on maternal weight and obstetric outcomes: meta-analysis of randomised evidence" BMJ 2012; 344: e2088.
Additional source: BMJ
Source reference:
Poston L, Chappell L "How should women be advised on weight management in pregnancy? BMJ 2012; 344: e274.

A new study finds that treatment for acute back pain may decrease or remove the complaint of pain, but additional and/or other treatment may be required for the chronic, longer term disability that develops in the 65-90% of population that develops acute low back pain.

Low Back Pain Eases but Doesn't Vanish

 

By Rita Baron-Faust, Contributing Writer, MedPage TodayPublished: May 14, 2012

Reviewed by Zalman S. Agus, MD; Emeritus Professor, Perelman School of Medicine at the University of Pennsylvania and Dorothy Caputo, MA, BSN, RN, Nurse Planner

Symptoms of acute and persistent low back pain improved significantly in the first 6 weeks after treatment, but even at 1 year there was lingering chronic pain and disability, a major meta-analysis by Australian and Brazilian researchers found.

Mean pain scores (52 out of a maximum of 100, 95% CI 48 to 57) at baseline were reduced by almost half after 6 weeks (12 out of 100, 95% CI 9 to 15) but pain lingered for months, the researchers reported online in CMAJ. The study encompassed data from prospective cohort studies conducted among more than 11,000 people in a dozen countries.

Outcomes were found to be similar across all cohorts, with improvement gradually slowing and "even at 1 year, patients had low to moderate levels of pain and disability," wrote Christopher G. Maher, PhD, of the University of Sydney, and colleagues.

While the data did not include the exact nature of the back pain nor the treatments, "the important conclusion that can be drawn from the data is that much of the apparent benefits of any treatment for low back pain are likely to be unrelated to the effects of specific interventions," wrote Rachelle Buchbinder, MBBS, PhD, of Monash University in Malvern, in an accompanying commentary.

About 80-90% of the population gets l0w back pain at some point in time and about 25% would report having back pain in the past week, Buchbinder noted in an e-mail to MedPage Today.

Current treatments are aimed at symptom relief and "we are not going to get more effective treatments until we better understand the pathoanatomical basis of back pain," Maher said in an email interview. 

Recovery was measured in 19 (56.6%) of the included inception cohorts (meaning the patients were enrolled when the episode of low back pain was first reported). The majority of acute back pain patients had recovered by 12 weeks. Among those with persistent low back pain, less than half had recovered by one year, the investigators said.

The pooled estimates of the clinical course of pain and disability were determined with mixed linear models. Acute low back pain cohorts were defined as those with a mean or median pain duration of less than 6 weeks; persistent low back pain was defined as pain duration of more than 6 weeks at study entry.

"The clinical course of pain and disability in the acute pain cohorts was similar and the difference not statistically different (p=0.20). However, the clinical course of pain was more favorable than the clinical course of disability in the persistent pain cohorts (p=0.002)," Maher's team reported.

The mean reduction in pain and disability scores within the first month was 58%.

It is difficult to prevent low back pain and, while a minority of people become disabled by their pain, the idea "that disability, rather than low back pain, persists is an important pointer for improving our interventions," Buchbinder noted in her commentary.

Many patients are getting out-of-date treatments rather than treatments that are known to be effective, Maher remarked in his email to MedPage Today.

Both authors concluded that back pain, like other health problems, should now be regarded as a chronic and long-term, and that patients should be better educated about its nature and the likelihood of recurrence.

"Back pain should be considered as a chronic recurring condition which means that we should reconsider how we manage it. A one-off visit when it (the pain) is bad is not likely to provide the best outcome," said Maher.

There was no specific funding for this study.
Christopher Maher is supported by the Australia Research Council. Co-authors reported support from Australia's National Health and Medical Research Council, the University of Sydney, and Fundação de Amparo a Pesquisa do Estado de São Paulo, Brazil.

Primary source: CMAJ
Source reference:
Costa OP, et al "The prognosis of acute and persistant low-back pain: A meta-analysis" CAMJ 2012; DOI: 10.1503/cmaj.111271.

Additional source: CMAJ
Source reference:
Buchbinder R, Underwood M "Progosis in people with back pain" CMAJ 2012; DOI: 10.1503/cmaj.120627.

Mom on toddler injuries - Old: "Don't run with that lollipop in your mouth!" New: "Don't run with that sippy-cup in your mouth!"

Binky, Sippy Cup Can be Source of Trip to the ER

 

By Rita Baron-Faust, Contributing Writer, MedPage TodayPublished: May 14, 2012

Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco.

More than 45,000 U.S. children under age 3 required emergency treatment after suffering injuries sustained from seemingly harmless bottles, pacifiers, or sippy cups over the last 2 decades, according to a database review.

The vast majority of the estimated injuries occurred after the toddler fell (86.1%, 95% CI 33,103 to 45,097) in the home, usually while drinking from a baby bottle, which caused lacerations or contusions to the mouth or face, reported Sarah Keim, PhD, from the Research Institute at Nationwide Children's Hospital in Columbus, Ohio, and colleagues in Pediatrics.

Almost all infants and toddlers use bottles, pacifiers (often referred to as a binky), and sippy cups for supplying nutrition, comfort, and convenience, but parents don't always include these items as part of a baby-proofing scheme. "Parents do a lot of things to baby proof their home and make sure children's toys are safe, but often don't give a second thought to these products," Keim told MedPage Today.

This study is the first to use a nationally representative sample to examine injuries associated with these products, the authors stated.

They analyzed data from the National Electronic Injury Surveillance System (NEISS) and found that an estimated 45,398 children under age 3 were treated in emergency departments for bottle-, pacifier-, or sippy cup-related injuries between 1991 and 2010, amounting to one child being treated every 4 hours.

The children were stratified according to gender and age, from less than 1 year, 1 year, and ages 2 to 3.

The analysis found that 66.4% of injuries (95% CI 25,538 to 34,740) occurred in children younger than 1 year because of falls while using a bottle (57.5%) or a pacifier (33.8%).

Compared with younger children, 1-year-olds were 7.62 times more likely to fall (95% CI 4.84 to 12.02). At this age, children are just learning to walk, are unsteady on their feet, and are prone to falls, Keim noted. Most injuries occurred among boys (61.2%), who tend to be more active, she added.

The most commonly injured body regions were the mouth (71%), followed by the head, face, or neck (19.6%).

Overall, most injuries involved a bottle (65.8%, 95% CI 25,245 to 34,525), followed by a pacifier (19.9%, 95% CI 7,108 to 10,935), and a cup with a drinking spout lid (14.3%, 95% CI 4,454 to 8,512).

Although lacerations were the main diagnosis across all products, pacifiers were associated with a higher likelihood of soft tissue injuries (OR 1.86, 95% CI 1.12 to 3.10) and dental injuries (OR 3.25, 95% CI 1.75 to 6.04) than bottles or sippy cups.

"With older children, one reason for falling could be not paying attention to where they are walking while drinking from a bottle or sippy cup, which could be compared to adults being distracted by texting while walking," Keim suggested to MedPage Today.

The national data likely underestimated the number of injuries because of a lack of reporting, Keim said. "Some pediatricians and dentists see some of these injuries in their practice, and many minor injuries are also treated at home," she said.

Data from the NEISS came from a network of around 100 hospitals, representing a stratified probability sample of 6,100 hospitals with ≥6 beds and a 24-hour emergency department. Population estimates used to calculate injury rates were derived from the U.S. Census Bureau.

No national rate could be calculated for 2010 because population estimates were unavailable, but actual injuries treated in EDs were estimated at 2,194.

The study was limited by a lack of comparable data for injuries treated outside the emergency department and a lack of comparison data of injuries that were unrelated to these products. The authors also had no information on which product characteristics were most involved in the injuries.

In 2005, the American Academy of Pediatrics issued guidelines recommending pacifier use as one mechanism for preventing sudden infant death syndrome (SIDS).

At the time, the Academy cited evidence from case-controlled studies that the arousal threshold may be reduced for infants put to sleep sucking on a pacifier. But the AAP stressed that suffocation by soft bedding and by infants sleeping on their stomachs were stronger risk factors.

Since the "Back to Sleep" campaign was initiated by the National Institute of Child Health and Human Development in 1994, the rate of SIDS has since dropped by 50%, but has lately plateaued. An AAP report noted earlier this year that sharing a bed with a parent has emerged as a prominent risk factor.

However, since SIDS remains the leading cause of death among infants, the AAP still recommends pacifier use at bedtime as a preventive measure until age 6 months, Keim noted.

Given the number of injuries from bottles, pacifiers, and sippy cups, Keim and co-authors advised that children not use these products beyond intended ages recommended by the AAP, and parents help their children transition to a lidless drinking cup around age 1.

The authors also recommend that parents encourage children to sit while they drink or eat, rather than walk around with a bottle or cup during the day and 'graze,' not only as a way of reducing accidents but also to develop better eating habits.

The authors have no relevant financial relationships to disclose.
There was no external funding for this story.

Primary source: Pediatrics
Source reference:
Keim S, et al "Injuries associated with bottles, pacifiers, and sippy cups in the United States, 1991-2010" Pediatrics 2012; 129; DOI: 10.1542/peds.2011-3348.

In new study, medicine discovers what holistic CAM providers have known all along - probiotics may help prevent antibiotic induced diarrhea. Truth be told, probiotics have many beneficial health outcomes.

Probiotics May Prevent Antibiotic Diarrhea

 

By Crystal Phend, Senior Staff Writer, MedPage TodayPublished: May 08, 2012

Reviewed by Dori F. Zaleznik, MD; Associate Clinical Professor of Medicine, Harvard Medical School, Boston and Dorothy Caputo, MA, BSN, RN, Nurse Planner

 

Probiotics appear to fight diarrhea that occurs as a common side effect of antibiotic treatment, a meta-analysis affirmed.

 

Probiotic administration was associated with a 42% reduced relative risk of antibiotic-associated diarrhea (P<0.001), Susanne Hempel, PhD, of RAND Health in Santa Monica, Calif., and colleagues found.

The number needed to treat to prevent one case of diarrhea from antibiotic use was just 13, they reported in the May 9 issue of the Journal of the American Medical Association.

Antibiotics lead to diarrhea in as many as 30% of patients, which is an important cause of nonadherence to the drugs.

"Potentially, probiotics maintain or restore gut microecology during or after antibiotic treatment through receptor competition, competition for nutrients, inhibition of epithelial and mucosal adherence of pathogens, introduction of lower colonic pH favoring the growth of nonpathogenic species, stimulation of immunity, or production of antimicrobial substances," the group suggested.

In children, probiotics have proven effective in preventing antibiotic-induced diarrhea and treating acute infectious diarrhea.

Most of the evidence, though, has accrued in adult trials almost universally underpowered to show the kind of impact seen in Hempel's analysis.

The meta-analysis included 82 randomized controlled trials, 57 of which used Lactobacillus-based interventions alone or in combination with other genera of probiotics (32 with Bifidobacterium). All but two trials used probiotics to prevent rather than treat existing antibiotic-associated diarrhea.

The effect on diarrhea risk could be pooled from 63 of the trials, with a total of 11,811 participants, and remained significant at P<0.001 when excluding any individual trial.

The trials where Lactobacillus probiotics was used exclusively were associated with reduced risk of antibiotic-associated diarrhea, similar to that in the overall analysis (pooled RR 0.64, P=0.004), with a number needed to treat of 14.

The 16 trials using only yeast as the probiotic, such as Saccharomyces boulardii [cerevisiae] or Hansen CBS 5926, also showed significantly reduced risk of antibiotic-associated diarrhea with a pooled relative risk of 0.48 (P<0.001) and number needed to treat of 10.

The researchers also looked for Streptococcus, Enterococcus, and Bacillus probiotic studies but found few.

Pooled results from three older trials using Enterococcus [Streptococcus] faecium SF68 showed a relative risk of 0.51 (P<0.001) and a number needed to treat of 12.

The difference between the different probiotic types wasn't significant (P=0.45) and didn't appear to explain away heterogeneity. Nor did the head-to-head comparison trials point to a clear winner.

The exact strains of the probiotic bugs used, though, were poorly documented, Hempel's group cautioned.
The analysis turned up no evidence of publication bias; no difference in probiotic treatment effect by conflict of interest status of the trials; and similar findings looking only at double-blind trials, or only at those with placebo control.

Nor did results vary for adults versus children, outpatient versus inpatient care, or by duration of antibiotic treatment.

In addition to unexplained heterogeneity among included trials and poorly documented probiotics, limitations of the study included lack of information from experts about published or unpublished studies.

"Determining which populations would benefit most from adjunct probiotics therapy is an ongoing challenge; it must be considered that antibiotic-associated diarrhea does not occur in the majority of patients and when it occurs, it is usually self-limiting," Hempel's group wrote.

Little data was available on probiotic-specific adverse events. In rare cases reported decades ago, serious adverse effects like fungemia and bacterial sepsis were reported with probiotics, the researchers noted.

The RAND Corporation internally funded the review, building on the literature database established for a contracted evidence report on the safety of probiotics commissioned by the Agency for Healthcare Research and Quality, and funded jointly by the National Institutes of Health and the FDA Center for Food Safety and Applied Nutrition.
The researchers reported having no conflicts of interest.

Primary source: Journal of the American Medical Association
Source reference:
Hempel S, et al "Probiotics for the prevention and treatment of antibiotic-associated diarrhea: a systematic review and meta-analysis" JAMA 2012; 307: 1959-1969; DOI: 10.1001/jama.2012.3507.
 

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Good news for those with diabetes as new study indicates weight loss can prevent or cure the disease. Toward that goal, a low glycemic index - high fiber diet will greatly help.

Science News

... from universities, journals, and other research organizations

Losing Weight When Obese Can Prevent or Cure Diabetes, Whatever the Initial BMI, Study Suggests

ScienceDaily (May 6, 2012) — Lowering your BMI by five units can dramatically reduce your risk of diabetes, whatever your initial weight, says new research presented at the International Congress of Endocrinology/European Congress of Endocrinology in Florence, Italy. The findings show that even severely obese patients with diabetes can potentially rid themselves of the disease.

Addressing diabetes is a major priority for health providers worldwide given the vast global prevalence (approx. six to seven per cent of the world's population; around 285 million people) and its severe complications including amputations and heart disease. Surgery for weight loss has an unexpectedly rapid and substantial therapeutic effect on diabetes rates. Understanding why weight loss has such a dramatic effect on diabetes is the focus of this study by Associate Professor Markku Peltonen from the National Institute for Health and Welfare, Finland and colleagues from the University of Gothenburg, Sweden.

The researchers enrolled the 2010 patients from the Swedish Obese Subjects study who had received bariatric surgery and 2037 obese controls receiving conventional (non-surgical) obesity treatment.

They were assessed for BMI and diabetes at baseline (before surgery in the surgical group), and at two and 10 year follow-up.

Among patients with BMI<35, 35-40 and 40-45 who did not lose weight after two years, type 2 diabetes incidence rates were 6.5%, 7.7% and 9.3% respectively. Among those with initial BMI 35-40, 40-45 and ≥45 who lost at least five BMI units after two years, type 2 diabetes incidence rates were 2.4%, 2.0% and 3.4% respectively, clearly showing that lower rates of diabetes can be found among obese patients who have lost five BMI units through any means. Further analysis showed that the rate of patients cured of diabetes after losing five BMI units was independent of the starting BMI at all BMI levels measured. This trend was also observed after 10 years post surgery.

The findings suggest that losing five BMI units, the equivalent of approx. 16kg for a 180cm tall 35 year old man weighing 130kg (BMI 40), can make a real difference to your health by reducing your likelihood of having type 2 diabetes. Furthermore, it suggests that this is true for all patients, as even those who were severely obese showed dramatic improvements.

Associate Professor Markku Peltonen, Director of Department at the National Institute for Health and Welfare, Finland, said:

"Our findings show that, whatever your starting weight, losing five BMI units can dramatically reduce your risk of having type 2 diabetes after two and ten years.

"Dropping five BMI units is no mean feat, as the human body is not very good at losing weight. But patients of any weight should take encouragement that by doing so they can really improve their chances of a healthy future."

Yet another study concludes: Jogging = Longer & Happier Life! Though for some, your knees might not be so happy.

Joggers Live Longer, Possibly Happier, Lives

 

By Peggy Peck, Executive Editor, MedPage TodayPublished: May 04, 2012

Reviewed by Dori F. Zaleznik, MD; Associate Clinical Professor of Medicine
Harvard Medical School, Boston.

DUBLIN -- For those who diligently lace up their running shoes and brave the elements to jog at least an hour a week, there is a very real reward -- an average of six more years of life, Danish researchers found.

Jogging was associated with a 44% reduction in the relative risk of death over 35 years compared with deaths among non-joggers, according to Peter Schnohr, MD, chief cardiologist from the Copenhagen City Heart study.

And the benefit was observed for both men and women.
That reduction translated into an "age-adjusted survival benefit of 6.2 years in men and 5.6 years in women," Schnohr reported here at EuroPRevent 2012.

And that longer life is often a happier life, he said, since joggers reported an overall sense of well-being.

"This is definitely good news, especially for those who have questioned whether simply jogging could be beneficial," said Ian Graham, MD, of Dublin's Trinity College, who co-chaired the program committee for the meeting.

"The results of our research allow us to definitively answer the question of whether jogging is good for your health," Schnohr said in a prepared statement. "We can say with certainty that regular jogging increases longevity. The good news is that you don't actually need to do that much to reap the benefits."

Moreover, even elderly people can add years to life by jogging. "A 70-year-old will benefit and I think the benefit may be even greater for older people," Schnohr said in an interview.

In this analysis the optimum benefit was realized for those who jogged at a slow-to-average pace between an hour and two and half hours done in two to three sessions over the course of a week.

The key, Schnohr said, appears to be moderation, much like the benefit observed with alcohol.
The jogging benefit is just the latest in a long list of studies from Schnohr and colleagues -- more than 750 papers -- mined from the 19,329 participants in the Copenhagen City Heart Study, which is a prospective cardiovascular population study begun in 1976.

When the study began, participants ranged in age from 20 to 79.

All participants underwent examinations over 2-year time frames beginning in 1976, 1981, 1991, and finally in 2001. In addition to assessments of cholesterol, blood pressure, blood glucose, and BMI, patients were also asked about smoking, alcohol consumption, education, and income.

The 1,878 participants in the jogging substudy (1,116 men) were also asked about jogging frequency and pace.

The researchers tracked the data using a personal identification number in the Danish Central Register. The authors compared deaths in joggers to deaths among non-joggers from the main study cohort.

During 35 years of follow-up there were 122 deaths among joggers versus 10,158 deaths among non-joggers.

Schnohr said said he had no relevant disclosures.

Primary source: European Association for Cardiovascular Prevention & Rehabilitation
Source reference:

Schnohr P "Jogging -- healthy or hazard symposium: Assessing prognosis: a glimpse of the future" EuroPRevent 2012.

In another case of "you are what you eat" a new study shows that eating berries may delay cognitive decline, once again demonstrating the anti-inflammatory properties of the flavinoids found in food.

From Medscape Medical News > Neurology

Eating Berries Linked to Delay in Cognitive Decline

Fran Lowry

May 1, 2012 — Increased consumption of blueberries and strawberries appears to slow cognitive decline in older women, according to an analysis of data from the Nurses' Health Study (NHS).

"Increasing berry intake appears to slow memory decline by up to 2.5 years," lead author, Elizabeth E. Devore, ScD, from the Channing Laboratory, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, told Medscape Medical News. "By this, we mean that women eating the most berries vs. little to no berries had memory differences equivalent to women 2.5 years apart in age."

The news study was published online April 25 in the Annals of Neurology.

Berries and Flavonoids
 
In their prospective, observational study, which was funded by the National Cancer Institute and the California Strawberry Commission, Dr. Devore and her team evaluated long-term intake of berries and flavonoids in relation to memory decline in 16,010 older women who were participants in the NHS.

The NHS encompasses a large population cohort of 121,700 female registered nurses aged 30 to 55 years who completed health and lifestyle questionnaires starting in 1976.

Between 1995 and 2001, cognitive function was measured every 2 years in study participants aged 70 and older. The mean age of the women in the current analysis was 74, and their mean body mass index was 26 kg/m².

"Experimental data show that berry supplementation enhances neuronal function and survival and ameliorates age-related cognitive impairment in rodents," Dr. Devore noted.

Berries are particularly high in a subclass of flavonoids called anthocyanidins, which can cross the blood-brain barrier and localize in the hippocampus, known to be an area of the brain involved in learning and memory, she said.

"Flavonoids have powerful antioxidant and anti-inflammatory properties, and both oxidative stress and inflammation are thought to be important contributors to cognitive impairment. So increased flavonoid consumption could be a potential strategy for reducing cognitive decline in older adults," she said.

The researchers found that greater intakes of blueberries and strawberries were associated with slower rates of cognitive decline.

After adjustment for age and education, greater consumption of blueberries was highly associated with slower decline in the global score (P trend = .010), the verbal score (P trend = .016), and the Telephone Interview of Cognitive Status (P trend = .027).

The mean difference in rate of global decline was 0.04 standard unit over the study period (95% confidence interval [CI], 0.01 - 0.07) in women who had 1 or more servings of blueberries per week vs those who ate less than 1 serving per week.

They also found that a greater intake of strawberries was related to slower decline in the global and verbal scores after adjustment for age (P trend for global score = .021) and education (P trend for verbal score = .014).

Women who ate 2 or more servings of strawberries per week had an average decline in the global score that was 0.03 standard unit less over the study follow-up period compared with women who had less than 1 serving per week (95% CI, 0.00 - 0.06).

Overall in the study population, the researchers found that 1 year of age was associated with a mean decline of 0.02 standard unit on the global score over the follow-up period.

"Thus, the mean differences that we observed comparing extreme categories of blueberry and strawberry intakes were equivalent to approximately 1.5 to 2.5 years of cognitive aging," Dr. Devore explained.

"Women with higher berry intake appeared to have delayed their cognitive aging by up to 2.5 years."
However, she cautioned that although the study controlled for other health factors, the possibility that the preserved cognition in those who ate more berries may be also influenced by other lifestyle choices, such as exercising more, cannot be ruled out.

The study does, however, have strengths, she said. "It is the first large epidemiologic study of long-term berry and flavonoid intake in relation to memory decline, utilizing information from over 16,000 older women. In addition, we collected information on berry intake over 20 years prior to initial memory testing, which enabled us to analyze long-term patterns of berry intake."

For now, however, doctors can tell their patients that eating berries may delay memory decline. "Specifically, eating 1 or more servings per week of blueberries or 2 or more servings per week of strawberries appears to be associated with memory benefits," Dr. Devore said.

Remain Skeptical
 
Commenting on this study for Medscape Medical News, David Knopman, MD, from the Mayo Clinic, Rochester, Minnesota, and a spokesperson for the American Academy of Neurology, agreed that the study did have its strengths, including the fact that mid-life dietary practices were assessed at the time, not retrospectively, and its inclusion of a very large number of women who had had 3 cognitive assessments.

However, he said he still has concerns about the study.

"The concerns that I have about the report stem primarily from the fact that studies of associations between dietary habits and health outcomes are notoriously difficult to replicate," Dr. Knopman said. "Second, the possibility of residual confounding by general health behavior, levels of physical activity, socioeconomic status is a possibility that cannot be discounted. The authors acknowledge this.

I would note that inclusion of physical activity and household annual income in the statistical models that they used attenuated the associations to the point that they were no longer significant.

 

"Further, I would note that inclusion of physical activity and household annual income in the statistical models that they used attenuated the associations to the point that they were no long significant at the p < 0.05 level for 2 of 3 of the cognitive outcomes," he said.

"The authors presented the results but did not comment on these analyses in the text of their article or in the abstract. I think that the authors should have said: 'When controlling for other health-related variables, the associations were attenuated and raise questions about the specificity of our findings.' Therefore, I remain skeptical that these results reflect what the authors say they do," Dr. Knopman said.

The study was funded by the National Cancer Institute and the California Strawberry Commission. Dr. Devore and Dr. Knopman have disclosed no relevant financial relationships.