ACOG: Moderate Caffeine Consumption Does Not Cause Miscarriage, Preterm Birth
Moderate caffeine consumption (<200 mg/day) — about a cup of brewed coffee daily — does not appear to increase a woman's risk for miscarriage or preterm birth, according to a statement from the American College of Obstetricians and Gynecologists.
A review of recent studies on caffeine consumption and pregnancy outcomes revealed the following:
Miscarriage: One prospective study showed no increase in miscarriage risk at all levels of caffeine consumption, while another found a doubling of risk for women who consumed more than 200 mg daily.
Preterm birth: Two studies found no association between caffeine intake and preterm birth (average intake in one study, 182 mg/day).
Intrauterine growth restriction: Findings were equivocal; the committee concluded that the relationship between caffeine consumption and IUGR is "undetermined."
Friday, July 23, 2010
Thursday, July 15, 2010
Physical Activity Linked to Lower Risk of Dementia
Medscape Medical News from the Alzheimer's Association International Conference on Alzheimer's Disease (ICAD) 2010
Susan Jeffrey
July 12, 2010 (Honolulu, Hawaii) — A new analysis from the Framingham Study suggests moderate to heavy physical activity is associated with a reduced risk for dementia during more than 20 years of follow-up.
Compared with those with lower levels of activity, participants reporting moderate to heavy physical activity had a 45% lower risk for dementia over time.
"A reduced risk of dementia may be one of the additional health benefits that can actually be derived from maintaining at least moderate physical activity," lead author Zaldy Tan, MD, MPH, from the Brigham and Women's Hospital, VA Boston, and Harvard Medical School, in Massachusetts, concluded.
Dr. Zaldy Tan
Dr. Tan presented the results here at the Alzheimer's Association International Conference on Alzheimer's Disease 2010.
Divergent Findings
Previous findings from the Framingham original cohort have already shown moderate or high physical activity to be associated with a number of positive outcomes, including a reduced risk for stroke and cardiovascular disease, higher high-density lipoprotein cholesterol levels, a reduced risk for colon cancer, and lower overall rates of mortality, Dr. Tan noted.
"Interestingly, while there are many potentially modifiable risk factors that have been linked with Alzheimer's disease and dementia, physical activity seems to be one that is fairly consistent in being shown to be related to the risk of dementia," he said. A recent review showed that 20 of 24 population-based studies showed a link between physical activity and reduced risk for dementia or cognitive decline.
Still, Dr. Tan added, the evidence is not entirely consistent. "There are some studies that seem to show no relationship between physical activity and dementia," he said, including the Bronx Aging Study, the Religious Orders Study, and the Radiation Effects Research Foundation Study.
The present investigation then looked at this relationship in the Framingham Study original cohort — a longitudinal community-based sample of 5209 men and women living in Framingham, Massachusetts, that has been evaluated every 2 years since 1948 for cardiovascular risk factors. A dementia study began in 1975, with the administration of a battery of neuropsychological tests, and 3349 of the original participants free of dementia at that time were enrolled and subsequently assessed every 2 years.
In 1986 to 1987, a survey was introduced to calculate a daily physical activity index (PAI) based on estimated hours spent performing physical activity and weighting each activity by an assigned caloric equivalent. The study population for this current study, then, includes those participants who were both free of dementia in 1986 and 1987 and who had a PAI available, for a total of 1211 Framingham study participants.
Participants were asked to estimate the amount of time they spent in various activities, ranging from sleep and sedentary states; to slight physical activity, such as standing and walking; to moderate activity, including things like housework, climbing stairs, or light sports like golf or bowling; to heavy activity, including heavy household work or more intensive exercise such as jogging.
During a mean follow-up of 9.9 ± 5.5 years, ranging from 0 to 21 years, 242 participants developed dementia. Of these, 193 cases were Alzheimer's disease, defined according to Diagnostic and Statistical Manual of Mental Disorders, 4th Edition/National Institute of Neurological and Communicative Diseases and Stroke/Alzheimer's Disease and Related Disorders Association criteria.
"What we found is that participants who spent at least 1 hour per day of moderate or heavy physical activity had a 45% lower risk of developing dementia," Dr. Tan said.
Susan Jeffrey
July 12, 2010 (Honolulu, Hawaii) — A new analysis from the Framingham Study suggests moderate to heavy physical activity is associated with a reduced risk for dementia during more than 20 years of follow-up.
Compared with those with lower levels of activity, participants reporting moderate to heavy physical activity had a 45% lower risk for dementia over time.
"A reduced risk of dementia may be one of the additional health benefits that can actually be derived from maintaining at least moderate physical activity," lead author Zaldy Tan, MD, MPH, from the Brigham and Women's Hospital, VA Boston, and Harvard Medical School, in Massachusetts, concluded.
Dr. Zaldy Tan
Dr. Tan presented the results here at the Alzheimer's Association International Conference on Alzheimer's Disease 2010.
Divergent Findings
Previous findings from the Framingham original cohort have already shown moderate or high physical activity to be associated with a number of positive outcomes, including a reduced risk for stroke and cardiovascular disease, higher high-density lipoprotein cholesterol levels, a reduced risk for colon cancer, and lower overall rates of mortality, Dr. Tan noted.
"Interestingly, while there are many potentially modifiable risk factors that have been linked with Alzheimer's disease and dementia, physical activity seems to be one that is fairly consistent in being shown to be related to the risk of dementia," he said. A recent review showed that 20 of 24 population-based studies showed a link between physical activity and reduced risk for dementia or cognitive decline.
Still, Dr. Tan added, the evidence is not entirely consistent. "There are some studies that seem to show no relationship between physical activity and dementia," he said, including the Bronx Aging Study, the Religious Orders Study, and the Radiation Effects Research Foundation Study.
The present investigation then looked at this relationship in the Framingham Study original cohort — a longitudinal community-based sample of 5209 men and women living in Framingham, Massachusetts, that has been evaluated every 2 years since 1948 for cardiovascular risk factors. A dementia study began in 1975, with the administration of a battery of neuropsychological tests, and 3349 of the original participants free of dementia at that time were enrolled and subsequently assessed every 2 years.
In 1986 to 1987, a survey was introduced to calculate a daily physical activity index (PAI) based on estimated hours spent performing physical activity and weighting each activity by an assigned caloric equivalent. The study population for this current study, then, includes those participants who were both free of dementia in 1986 and 1987 and who had a PAI available, for a total of 1211 Framingham study participants.
Participants were asked to estimate the amount of time they spent in various activities, ranging from sleep and sedentary states; to slight physical activity, such as standing and walking; to moderate activity, including things like housework, climbing stairs, or light sports like golf or bowling; to heavy activity, including heavy household work or more intensive exercise such as jogging.
During a mean follow-up of 9.9 ± 5.5 years, ranging from 0 to 21 years, 242 participants developed dementia. Of these, 193 cases were Alzheimer's disease, defined according to Diagnostic and Statistical Manual of Mental Disorders, 4th Edition/National Institute of Neurological and Communicative Diseases and Stroke/Alzheimer's Disease and Related Disorders Association criteria.
"What we found is that participants who spent at least 1 hour per day of moderate or heavy physical activity had a 45% lower risk of developing dementia," Dr. Tan said.
Monday, June 28, 2010
Breast Feeding Until 4 months can Protect Infants From Respiratory and G. I. Infections
June 21, 2010 — Breast-feeding until age 4 months is linked to lower rates of respiratory and gastrointestinal (GI) infection morbidity, according to the results of a population-based, prospective, cohort study reported online June 21 in Pediatrics.
"Exclusive breastfeeding seems to decrease the risk of infectious diseases in infancy," Liesbeth Duijts, MD, PhD, from Erasmus Medical Center in Rotterdam, the Netherlands. "However, the World Health Organization has called for more research regarding the benefits for 6 months instead of 4 months of exclusive breastfeeding."
The goal of this study, which was embedded in the Generation R Study, a study from fetal life onward in the Netherlands, was to evaluate the associations of duration of exclusive breast-feeding with upper respiratory tract infections (URTI), lower respiratory tract infections (LRTI), and GI tract infections in infancy.
There were 4164 subjects who completed questionnaires on rates of breast-feeding during the first 6 months (never; partial for < 4 months, not thereafter; partial for 4 - 6 months; exclusive for 4 months, not thereafter; exclusive for 4 months, partial thereafter; and exclusive for 6 months) and doctor-attended URTI, LRTI, and GI infections until age 12 months.
Risks for URTI, LRTI, and GI tract infection until age 6 months were lower in infants who were breast-fed exclusively until age 4 months and partially thereafter vs infants who were never breast-fed. Adjusted odds ratios (ORs) were 0.65 (95% confidence interval [CI], 0.51 - 0.83) for URTI, 0.50 (95% CI, 0.32 - 0.79) for LRTI, and 0.41 (95% CI, 0.26 -0.64) for GI tract infection. The adjusted OR for LRTIs in infants between the ages of 7 and 12 months was 0.46 (95% CI, 0.31 - 0.69).
For infants who were exclusively breast-fed for at least 6 months, trends were similar. However, partial breast-feeding, even for 6 months, was not associated with significantly lower risks for these infections.
"Exclusive breastfeeding until the age of 4 months and partially thereafter was associated with a significant reduction of respiratory and gastrointestinal morbidity in infants," the study authors write. "Our findings support health policy strategies to promote exclusive breastfeeding for at least 4 months, but preferably 6 months, in industrialized countries."
Limitations of this study include questionnaires with breast-feeding data available for only 65% of eligible participants of the Generation R Study and possible misclassification related to questionnaire use.
"Biological, cultural, and social constraints related to breastfeeding habits need to be studied more extensively," the study authors write. "The effects of prolonged and exclusive breastfeeding on infectious diseases at older ages in industrialized countries remain to be studied."
Exclusive breast-feeding until age 4 months and partially thereafter was associated with a significant reduction of respiratory and GI morbidity rates in infants.
The first phase of the Generation R Study was funded by Erasmus Medical Center, Erasmus University Rotterdam, and Netherlands Organization for Health Research and Development (Zon Mw). The present study was supported by an additional grant from Stichting W. H. Kröger (00–048) and AGS Kinderstichting. The study authors have disclosed no relevant financial relationships.
Pediatrics. Published online June 21, 2010.
"Exclusive breastfeeding seems to decrease the risk of infectious diseases in infancy," Liesbeth Duijts, MD, PhD, from Erasmus Medical Center in Rotterdam, the Netherlands. "However, the World Health Organization has called for more research regarding the benefits for 6 months instead of 4 months of exclusive breastfeeding."
The goal of this study, which was embedded in the Generation R Study, a study from fetal life onward in the Netherlands, was to evaluate the associations of duration of exclusive breast-feeding with upper respiratory tract infections (URTI), lower respiratory tract infections (LRTI), and GI tract infections in infancy.
There were 4164 subjects who completed questionnaires on rates of breast-feeding during the first 6 months (never; partial for < 4 months, not thereafter; partial for 4 - 6 months; exclusive for 4 months, not thereafter; exclusive for 4 months, partial thereafter; and exclusive for 6 months) and doctor-attended URTI, LRTI, and GI infections until age 12 months.
Risks for URTI, LRTI, and GI tract infection until age 6 months were lower in infants who were breast-fed exclusively until age 4 months and partially thereafter vs infants who were never breast-fed. Adjusted odds ratios (ORs) were 0.65 (95% confidence interval [CI], 0.51 - 0.83) for URTI, 0.50 (95% CI, 0.32 - 0.79) for LRTI, and 0.41 (95% CI, 0.26 -0.64) for GI tract infection. The adjusted OR for LRTIs in infants between the ages of 7 and 12 months was 0.46 (95% CI, 0.31 - 0.69).
For infants who were exclusively breast-fed for at least 6 months, trends were similar. However, partial breast-feeding, even for 6 months, was not associated with significantly lower risks for these infections.
"Exclusive breastfeeding until the age of 4 months and partially thereafter was associated with a significant reduction of respiratory and gastrointestinal morbidity in infants," the study authors write. "Our findings support health policy strategies to promote exclusive breastfeeding for at least 4 months, but preferably 6 months, in industrialized countries."
Limitations of this study include questionnaires with breast-feeding data available for only 65% of eligible participants of the Generation R Study and possible misclassification related to questionnaire use.
"Biological, cultural, and social constraints related to breastfeeding habits need to be studied more extensively," the study authors write. "The effects of prolonged and exclusive breastfeeding on infectious diseases at older ages in industrialized countries remain to be studied."
Exclusive breast-feeding until age 4 months and partially thereafter was associated with a significant reduction of respiratory and GI morbidity rates in infants.
The first phase of the Generation R Study was funded by Erasmus Medical Center, Erasmus University Rotterdam, and Netherlands Organization for Health Research and Development (Zon Mw). The present study was supported by an additional grant from Stichting W. H. Kröger (00–048) and AGS Kinderstichting. The study authors have disclosed no relevant financial relationships.
Pediatrics. Published online June 21, 2010.
Saturday, June 26, 2010
When Food and Medicines Clash
Americans increasingly view the food they eat as medicine to help lower cholesterol, reduce high blood pressure and control blood sugar. But as with prescribed drugs, the health-improving qualities of foods such as olive oil, nuts and fruit can interact with other medications, causing possible problems.
Pharmacists often warn people not to mix anti-cholesterol drugs known as statins with grapefruit juice. Newer research suggests that other fruit juices, including cranberry and pomegranate, as well as olive oil may also interfere with how statins work in the body. Other laboratory studies show that certain popular teas can block the effect of some medications, including the flu drug Tamiflu. And switching to a low-fat diet, itself a healthy lifestyle change, could reduce the potency of some medications.
Diet can interact with medicine in two main ways. Some foods block the body's ability to absorb certain medications, effectively reducing the dose a person receives. Other foods enhance the absorption of some drugs, which can lead to a possible overdose.
In general, diet will only interact with medications when a person is consuming exceptionally large portions of certain foods, pharmacology and medical experts say. A few teaspoons of olive oil on pasta typically doesn't pose any problems, for instance.
Still, as Americans increasingly select foods based on their health benefits, or take supplements with high doses of nutrients, the likelihood of adverse interactions with medications rises. U.S. sales of supplements, natural and organic foods and functional foods, or foods enhanced beyond normal use like calcium-fortified orange juice, grew to $93.5 billion in 2008 from $47.9 billion in 2000, according to Nutrition Business Journal, a nutrition-industry trade publication.
"For every drug there is, there are unintended side effects. You should expect the same thing when taking nutrients at drug levels," says Patrick Stover, director of the division of nutritional sciences at Cornell University in Ithaca, N.Y.
Other factors also can affect how medicines are absorbed in the body, including a person's age, weight and gender. Such variations, combined with possible interactions with the food we eat, can increase or reduce the effective dose of a medication by as much as 5- to 10-fold, which are "huge effects," Dr. Stover says.
Grapefruit is one of the most extensively studied foods for its impact on medication. Compounds in the fruit can increase the potency of statins and other medications to potentially dangerous levels by inhibiting cytochrome P450, a family of enzymes that break down the drug. Research indicates that drinking just one eight-ounce cup of grapefruit juice a day increases the strength of the drug.
Recently, animal and laboratory studies have suggested that other fruits, including pomegranates, oranges (especially those from Seville), cranberries, grapes and black mulberries, could have a similar, although less robust, effect on statins in the body. Pomegranates and cranberries are frequently touted as healthy foods because of their high quantities of antioxidants, which supposedly remove free radicals from the body and slow the onset of disease and aging.
In the lab, some scientists' work raises similar concern about olive oil and some statins. The oil, a principal part of the Mediterranean diet and believed to lower the risk of heart disease, also appears to contain compounds that inhibit the drug's breakdown, according to researchers in Spain. The effects of olive oil likely aren't as strong as that of grapefruit, but more studies are needed to figure out what quantities might actually impact humans, say experts.
John Thor Arnason, a biologist at the University of Ottawa, and his colleague Brian Foster of Health Canada, a government ministry, have investigated the effect on drugs of more than 450 food products, mainly in animal and laboratory studies.
The scientists continue to study potential food-drug interactions, as do other researchers world-wide.
In one recent study, Dr. Arnason's team examined dozens of different kinds of beers. They found that the "hoppier" or more bitter beers reduced the effect of the cancer drug Tamoxifen, when compared with beers that were less hopped. The study was published this year in the Journal of Agricultural and Food Chemistry.
Another popular compound, the anti-oxidant resveratrol found in red wine, nuts and dark chocolate, is touted for its anti-aging benefits. But resveratrol in large quantities appears to potentially enhance the potency of drugs, other laboratory studies show.
People, especially older adults taking multiple medications, should tell their doctor about dietary supplements, if they are using high-potency juices and teas and drinking lots of wine, Dr. Arnason says. He says that drugs whose labels contain lots of conditions and warnings about possible interactions with other medications are probably more likely also to interact with foods. If a food-drug interaction is suspected, patients should stop taking the food and talk to their doctor immediately.
In work published this year, Drs. Arnason and Foster showed that various herbs including chai hu, Labrador tea, echinacea and goldenseal, can reduce the potency of Tamiflu. The researchers incubated Tamiflu by itself or along with herbs, together with human liver tissue, which is responsible for processing the medication in the body. They found that the drug was less activated in the presence of the herbs.
The herbs are believed to proffer different health benefits. Labrador tea is thought to benefit the nervous system, Chai Hu to treat common cold and fever, and Echinacea is thought to prevent colds and have anti-tumor benefits. Goldenseal is an anti-microbial and anti-inflammatory product.
The researchers also have studied black tea, which is touted for lowering blood pressure, and found that it appears to inhibit an enzyme responsible for the body's processing of many drugs. The result, the researchers found, is that consuming large quantities of black tea could potentially increase the potency of a wide range of medications.
Others researchers have investigated spices. In one study, piperine, one of the main components of black pepper, increased the potency of the antihistamine Allegra in rats by two-fold compared with animals that took the medicine alone, according to a report in April's Journal of Food Sciences.
Much of the research on teas and other foodstuffs—with the exception of grapefruit—haven't been well-studied in humans, so the exact amount that may cause a harmful effect isn't yet known, say researchers.
Whether the alcohol from beer or wine affects the processing of other drugs isn't clear, says Cynthia Kuhn, a professor of pharmacology at Duke University Medical Center. It is dangerous to use alcohol in combination with sedating drugs like antihistamines, or narcotic pain medicines, because of the additive effect in the brain.
But despite strong warnings on some other drug labels that alcohol can interact in the liver to inhibit metabolism of other medications, the evidence "is not strong," says Dr. Kuhn. Alcohol is mainly metabolized by an enzyme called alcohol dehydrogenase, which "has nothing to do with the metabolism of most drugs," she says.
Some drugs, like dilantin, an epilepsy medication, appear to be affected by the amount of fat in the diet, according to a 2004 study.
Such medicines are dissolved only in fats and could therefore become less effective by a significant reduction in fat consumption.
Experts suggest that patients considering major dietary changes, such as switching to a much lower fat diet from a high-fat one, should discuss the move with their doctor.
Write to Shirley S. Wang at shirley.wang@wsj.com
Pharmacists often warn people not to mix anti-cholesterol drugs known as statins with grapefruit juice. Newer research suggests that other fruit juices, including cranberry and pomegranate, as well as olive oil may also interfere with how statins work in the body. Other laboratory studies show that certain popular teas can block the effect of some medications, including the flu drug Tamiflu. And switching to a low-fat diet, itself a healthy lifestyle change, could reduce the potency of some medications.
Diet can interact with medicine in two main ways. Some foods block the body's ability to absorb certain medications, effectively reducing the dose a person receives. Other foods enhance the absorption of some drugs, which can lead to a possible overdose.
In general, diet will only interact with medications when a person is consuming exceptionally large portions of certain foods, pharmacology and medical experts say. A few teaspoons of olive oil on pasta typically doesn't pose any problems, for instance.
Still, as Americans increasingly select foods based on their health benefits, or take supplements with high doses of nutrients, the likelihood of adverse interactions with medications rises. U.S. sales of supplements, natural and organic foods and functional foods, or foods enhanced beyond normal use like calcium-fortified orange juice, grew to $93.5 billion in 2008 from $47.9 billion in 2000, according to Nutrition Business Journal, a nutrition-industry trade publication.
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{/if}"For every drug there is, there are unintended side effects. You should expect the same thing when taking nutrients at drug levels," says Patrick Stover, director of the division of nutritional sciences at Cornell University in Ithaca, N.Y.
Other factors also can affect how medicines are absorbed in the body, including a person's age, weight and gender. Such variations, combined with possible interactions with the food we eat, can increase or reduce the effective dose of a medication by as much as 5- to 10-fold, which are "huge effects," Dr. Stover says.
Grapefruit is one of the most extensively studied foods for its impact on medication. Compounds in the fruit can increase the potency of statins and other medications to potentially dangerous levels by inhibiting cytochrome P450, a family of enzymes that break down the drug. Research indicates that drinking just one eight-ounce cup of grapefruit juice a day increases the strength of the drug.
Recently, animal and laboratory studies have suggested that other fruits, including pomegranates, oranges (especially those from Seville), cranberries, grapes and black mulberries, could have a similar, although less robust, effect on statins in the body. Pomegranates and cranberries are frequently touted as healthy foods because of their high quantities of antioxidants, which supposedly remove free radicals from the body and slow the onset of disease and aging.
In the lab, some scientists' work raises similar concern about olive oil and some statins. The oil, a principal part of the Mediterranean diet and believed to lower the risk of heart disease, also appears to contain compounds that inhibit the drug's breakdown, according to researchers in Spain. The effects of olive oil likely aren't as strong as that of grapefruit, but more studies are needed to figure out what quantities might actually impact humans, say experts.
John Thor Arnason, a biologist at the University of Ottawa, and his colleague Brian Foster of Health Canada, a government ministry, have investigated the effect on drugs of more than 450 food products, mainly in animal and laboratory studies.
The scientists continue to study potential food-drug interactions, as do other researchers world-wide.
In one recent study, Dr. Arnason's team examined dozens of different kinds of beers. They found that the "hoppier" or more bitter beers reduced the effect of the cancer drug Tamoxifen, when compared with beers that were less hopped. The study was published this year in the Journal of Agricultural and Food Chemistry.
Another popular compound, the anti-oxidant resveratrol found in red wine, nuts and dark chocolate, is touted for its anti-aging benefits. But resveratrol in large quantities appears to potentially enhance the potency of drugs, other laboratory studies show.
People, especially older adults taking multiple medications, should tell their doctor about dietary supplements, if they are using high-potency juices and teas and drinking lots of wine, Dr. Arnason says. He says that drugs whose labels contain lots of conditions and warnings about possible interactions with other medications are probably more likely also to interact with foods. If a food-drug interaction is suspected, patients should stop taking the food and talk to their doctor immediately.
In work published this year, Drs. Arnason and Foster showed that various herbs including chai hu, Labrador tea, echinacea and goldenseal, can reduce the potency of Tamiflu. The researchers incubated Tamiflu by itself or along with herbs, together with human liver tissue, which is responsible for processing the medication in the body. They found that the drug was less activated in the presence of the herbs.
The herbs are believed to proffer different health benefits. Labrador tea is thought to benefit the nervous system, Chai Hu to treat common cold and fever, and Echinacea is thought to prevent colds and have anti-tumor benefits. Goldenseal is an anti-microbial and anti-inflammatory product.
The researchers also have studied black tea, which is touted for lowering blood pressure, and found that it appears to inhibit an enzyme responsible for the body's processing of many drugs. The result, the researchers found, is that consuming large quantities of black tea could potentially increase the potency of a wide range of medications.
Others researchers have investigated spices. In one study, piperine, one of the main components of black pepper, increased the potency of the antihistamine Allegra in rats by two-fold compared with animals that took the medicine alone, according to a report in April's Journal of Food Sciences.
Much of the research on teas and other foodstuffs—with the exception of grapefruit—haven't been well-studied in humans, so the exact amount that may cause a harmful effect isn't yet known, say researchers.
Whether the alcohol from beer or wine affects the processing of other drugs isn't clear, says Cynthia Kuhn, a professor of pharmacology at Duke University Medical Center. It is dangerous to use alcohol in combination with sedating drugs like antihistamines, or narcotic pain medicines, because of the additive effect in the brain.
But despite strong warnings on some other drug labels that alcohol can interact in the liver to inhibit metabolism of other medications, the evidence "is not strong," says Dr. Kuhn. Alcohol is mainly metabolized by an enzyme called alcohol dehydrogenase, which "has nothing to do with the metabolism of most drugs," she says.
Some drugs, like dilantin, an epilepsy medication, appear to be affected by the amount of fat in the diet, according to a 2004 study.
Such medicines are dissolved only in fats and could therefore become less effective by a significant reduction in fat consumption.
Experts suggest that patients considering major dietary changes, such as switching to a much lower fat diet from a high-fat one, should discuss the move with their doctor.
Write to Shirley S. Wang at shirley.wang@wsj.com
Tuesday, June 22, 2010
Breast-Feeding Until 4 Months May Protect Infants From Respiratory, GI Infections
From Medscape Medical News
Laurie Barclay, MD
Authors and Disclosures
Physician Rating: 4 stars ( 5 Votes )
Rate This Article:
June 21, 2010 — Breast-feeding until age 4 months is linked to lower rates of respiratory and gastrointestinal (GI) infection morbidity, according to the results of a population-based, prospective, cohort study reported online June 21 in Pediatrics.
"Exclusive breastfeeding seems to decrease the risk of infectious diseases in infancy," Liesbeth Duijts, MD, PhD, from Erasmus Medical Center in Rotterdam, the Netherlands. "However, the World Health Organization has called for more research regarding the benefits for 6 months instead of 4 months of exclusive breastfeeding."
The goal of this study, which was embedded in the Generation R Study, a study from fetal life onward in the Netherlands, was to evaluate the associations of duration of exclusive breast-feeding with upper respiratory tract infections (URTI), lower respiratory tract infections (LRTI), and GI tract infections in infancy.
There were 4164 subjects who completed questionnaires on rates of breast-feeding during the first 6 months (never; partial for < 4 months, not thereafter; partial for 4 - 6 months; exclusive for 4 months, not thereafter; exclusive for 4 months, partial thereafter; and exclusive for 6 months) and doctor-attended URTI, LRTI, and GI infections until age 12 months.
Risks for URTI, LRTI, and GI tract infection until age 6 months were lower in infants who were breast-fed exclusively until age 4 months and partially thereafter vs infants who were never breast-fed. Adjusted odds ratios (ORs) were 0.65 (95% confidence interval [CI], 0.51 - 0.83) for URTI, 0.50 (95% CI, 0.32 - 0.79) for LRTI, and 0.41 (95% CI, 0.26 -0.64) for GI tract infection. The adjusted OR for LRTIs in infants between the ages of 7 and 12 months was 0.46 (95% CI, 0.31 - 0.69).
For infants who were exclusively breast-fed for at least 6 months, trends were similar. However, partial breast-feeding, even for 6 months, was not associated with significantly lower risks for these infections.
"Exclusive breastfeeding until the age of 4 months and partially thereafter was associated with a significant reduction of respiratory and gastrointestinal morbidity in infants," the study authors write. "Our findings support health policy strategies to promote exclusive breastfeeding for at least 4 months, but preferably 6 months, in industrialized countries."
Limitations of this study include questionnaires with breast-feeding data available for only 65% of eligible participants of the Generation R Study and possible misclassification related to questionnaire use.
"Biological, cultural, and social constraints related to breastfeeding habits need to be studied more extensively," the study authors write. "The effects of prolonged and exclusive breastfeeding on infectious diseases at older ages in industrialized countries remain to be studied."
Exclusive breast-feeding until age 4 months and partially thereafter was associated with a significant reduction of respiratory and GI morbidity rates in infants.
The first phase of the Generation R Study was funded by Erasmus Medical Center, Erasmus University Rotterdam, and Netherlands Organization for Health Research and Development (Zon Mw). The present study was supported by an additional grant from Stichting W. H. Kröger (00–048) and AGS Kinderstichting. The study authors have disclosed no relevant financial relationships.
Pediatrics. Published online June 21, 2010
Laurie Barclay, MD
Authors and Disclosures
Physician Rating: 4 stars ( 5 Votes )
Rate This Article:
June 21, 2010 — Breast-feeding until age 4 months is linked to lower rates of respiratory and gastrointestinal (GI) infection morbidity, according to the results of a population-based, prospective, cohort study reported online June 21 in Pediatrics.
"Exclusive breastfeeding seems to decrease the risk of infectious diseases in infancy," Liesbeth Duijts, MD, PhD, from Erasmus Medical Center in Rotterdam, the Netherlands. "However, the World Health Organization has called for more research regarding the benefits for 6 months instead of 4 months of exclusive breastfeeding."
The goal of this study, which was embedded in the Generation R Study, a study from fetal life onward in the Netherlands, was to evaluate the associations of duration of exclusive breast-feeding with upper respiratory tract infections (URTI), lower respiratory tract infections (LRTI), and GI tract infections in infancy.
There were 4164 subjects who completed questionnaires on rates of breast-feeding during the first 6 months (never; partial for < 4 months, not thereafter; partial for 4 - 6 months; exclusive for 4 months, not thereafter; exclusive for 4 months, partial thereafter; and exclusive for 6 months) and doctor-attended URTI, LRTI, and GI infections until age 12 months.
Risks for URTI, LRTI, and GI tract infection until age 6 months were lower in infants who were breast-fed exclusively until age 4 months and partially thereafter vs infants who were never breast-fed. Adjusted odds ratios (ORs) were 0.65 (95% confidence interval [CI], 0.51 - 0.83) for URTI, 0.50 (95% CI, 0.32 - 0.79) for LRTI, and 0.41 (95% CI, 0.26 -0.64) for GI tract infection. The adjusted OR for LRTIs in infants between the ages of 7 and 12 months was 0.46 (95% CI, 0.31 - 0.69).
For infants who were exclusively breast-fed for at least 6 months, trends were similar. However, partial breast-feeding, even for 6 months, was not associated with significantly lower risks for these infections.
"Exclusive breastfeeding until the age of 4 months and partially thereafter was associated with a significant reduction of respiratory and gastrointestinal morbidity in infants," the study authors write. "Our findings support health policy strategies to promote exclusive breastfeeding for at least 4 months, but preferably 6 months, in industrialized countries."
Limitations of this study include questionnaires with breast-feeding data available for only 65% of eligible participants of the Generation R Study and possible misclassification related to questionnaire use.
"Biological, cultural, and social constraints related to breastfeeding habits need to be studied more extensively," the study authors write. "The effects of prolonged and exclusive breastfeeding on infectious diseases at older ages in industrialized countries remain to be studied."
Exclusive breast-feeding until age 4 months and partially thereafter was associated with a significant reduction of respiratory and GI morbidity rates in infants.
The first phase of the Generation R Study was funded by Erasmus Medical Center, Erasmus University Rotterdam, and Netherlands Organization for Health Research and Development (Zon Mw). The present study was supported by an additional grant from Stichting W. H. Kröger (00–048) and AGS Kinderstichting. The study authors have disclosed no relevant financial relationships.
Pediatrics. Published online June 21, 2010
Study points to unsafe sleep practices as contributor to disparity in infant sleep-related deaths
April 15, 2010 - A study conducted by Children's Memorial Research Center reveals that African American infants are far more likely to die from sleep-related causes than any other ethnic group in Illinois. This statistic is most dramatic in Cook County where infants are 12 times more likely to die from sleep-related causes. The difference between the sleep-related death rate for African Americans and other ethnic groups is smaller in Illinois outside of Cook County, though African American infants are still twice as likely to die from sleep-related causes.
Researchers at Child Health Data Lab which is part of the Mary Ann & J. Milburn Smith Child Health Research Program collected information on infant deaths in Illinois due to sudden infant death syndrome, unintentional suffocation in bed and undetermined causes. Although the actual cause of death cannot be pinpointed in many of these cases, research shows that most of these deaths occur when an infant is in an unsafe sleep situation.
“African American infant mortality is much higher than Caucasian infant mortality across the United States,” says Jenifer Cartland, PhD, director of the research center’s Child Health Data Lab. “In Cook County, sleep-related death is responsible for 20 percent of the African American infant mortality, but it might be prevented by assuring that all infants have a safe place to sleep and that parents are well educated about safe sleep practices.”
Karen Sheehan, MD, MPH, Emergency Medicine, at Children’s Memorial says, “The American Academy of Pediatrics recommends that children should be put to sleep on their backs, in a safety-approved crib (or bassinet for younger children) with a firm mattress, and free from any objects (even blankets or toys) that could cover the baby’s face.”
Parents don’t always have all the knowledge or all the resources they need to put their infant to bed safely. Based on the research, 56.7 percent of the deaths occurred while the infant was sharing a bed with an adult and 30 percent occurred when the baby was sleeping alone, but not in a crib or bassinet (such as on a couch or a pillow on the floor). Few of these infants — only 7.5 percent – were found in safe sleep circumstances, that is, in a crib or bassinet with the baby on his or her back.
The alarming difference among ethnic groups raises the question of what should be done. “Many organizations are now coming together to increase safe sleep awareness,” says Cartland. “We need to get babies alone in their cribs and secure more funding for intervention programs, such as making sure all parents have access to safety-approved, low cost cribs and bassinets and increasing parents’ knowledge about safe sleep.”
Children's Memorial’s Child Health Data Lab performs epidemiological research to identify risks to the health of children and adolescents with the goal to improve health and well-being of children and adolescents in Chicago and Illinois. For more information about the research or to learn about sleep related infant death prevention visit American Academy of Pediatrics, SIDS Illinois, or Children's Memorial Hospital’s Child Health Data Lab.
The Understanding Sleep Related Death study is based off the Illinois Death Reporting System, and was conducted by Children’s Memorial Hospital Child Health Data Lab by Jenifer Cartland, PhD in collaboration with data-providing agencies including Cook County Medical Examiner, the Kane and Peoria County Coroners, the Illinois Department of Public Health and the Chicago Policy Department.
Researchers at Child Health Data Lab which is part of the Mary Ann & J. Milburn Smith Child Health Research Program collected information on infant deaths in Illinois due to sudden infant death syndrome, unintentional suffocation in bed and undetermined causes. Although the actual cause of death cannot be pinpointed in many of these cases, research shows that most of these deaths occur when an infant is in an unsafe sleep situation.
“African American infant mortality is much higher than Caucasian infant mortality across the United States,” says Jenifer Cartland, PhD, director of the research center’s Child Health Data Lab. “In Cook County, sleep-related death is responsible for 20 percent of the African American infant mortality, but it might be prevented by assuring that all infants have a safe place to sleep and that parents are well educated about safe sleep practices.”
Karen Sheehan, MD, MPH, Emergency Medicine, at Children’s Memorial says, “The American Academy of Pediatrics recommends that children should be put to sleep on their backs, in a safety-approved crib (or bassinet for younger children) with a firm mattress, and free from any objects (even blankets or toys) that could cover the baby’s face.”
Parents don’t always have all the knowledge or all the resources they need to put their infant to bed safely. Based on the research, 56.7 percent of the deaths occurred while the infant was sharing a bed with an adult and 30 percent occurred when the baby was sleeping alone, but not in a crib or bassinet (such as on a couch or a pillow on the floor). Few of these infants — only 7.5 percent – were found in safe sleep circumstances, that is, in a crib or bassinet with the baby on his or her back.
The alarming difference among ethnic groups raises the question of what should be done. “Many organizations are now coming together to increase safe sleep awareness,” says Cartland. “We need to get babies alone in their cribs and secure more funding for intervention programs, such as making sure all parents have access to safety-approved, low cost cribs and bassinets and increasing parents’ knowledge about safe sleep.”
Children's Memorial’s Child Health Data Lab performs epidemiological research to identify risks to the health of children and adolescents with the goal to improve health and well-being of children and adolescents in Chicago and Illinois. For more information about the research or to learn about sleep related infant death prevention visit American Academy of Pediatrics, SIDS Illinois, or Children's Memorial Hospital’s Child Health Data Lab.
The Understanding Sleep Related Death study is based off the Illinois Death Reporting System, and was conducted by Children’s Memorial Hospital Child Health Data Lab by Jenifer Cartland, PhD in collaboration with data-providing agencies including Cook County Medical Examiner, the Kane and Peoria County Coroners, the Illinois Department of Public Health and the Chicago Policy Department.
Tuesday, June 15, 2010
Substituting Whole Grains for White Rice May Lower Risk for Type 2 Diabetes
Laurie Barclay, MD
June 14, 2010 — Substituting brown rice or other whole grains for white rice is associated with a lower risk for type 2 diabetes, according to results from the Health Professionals Follow-up Study and the Nurses' Health Study (NHS) I and II reported in the June 14 issue of Archives of Internal Medicine.
"Because of differences in processing and nutrients, brown rice and white rice may have different effects on risk of type 2 diabetes mellitus," write Qi Sun, MD, ScD, from the Harvard School of Public Health in Boston, Massachusetts, and colleagues. "We examined white and brown rice consumption in relation to type 2 diabetes risk prospectively in the Health Professionals Follow-up Study and the Nurses' Health Study I and II."
Diet, lifestyle habits, and disease status were prospectively determined and updated for 39,765 men and 157,463 women in these cohorts.
Higher intake of white rice (≥ 5 servings per week vs < 1 per month) was associated with a greater risk for type 2 diabetes, after multivariate adjustment for age, lifestyle, and other dietary risk factors. Pooled relative risk [RR] was 1.17 (95% confidence interval [CI], 1.02 - 1.36). In contrast, the risk for type 2 diabetes was lower with high intake of brown rice (≥ 2 servings per week vs < 1 per month; pooled RR, 0.89; 95% CI, 0.81 - 0.97).
The investigators estimated that replacing 50 g per day of uncooked white rice (one-third serving per day) with the equivalent amount of brown rice was associated with a 16% lower risk for type 2 diabetes (95% CI, 9% - 21%). For replacement with whole grains as a group, diabetes risk was 36% lower (95% CI, 30% - 42%).
"Substitution of whole grains, including brown rice, for white rice may lower risk of type 2 diabetes," the study authors write. "These data support the recommendation that most carbohydrate intake should come from whole grains rather than refined grains to help prevent type 2 diabetes."
Limitations of this study include study populations primarily consisting of working health professionals with European ancestry, measurement error of rice intake assessment related to use of food frequency questionnaires, possible residual confounding, and lack of oral glucose tolerance test data to confirm diabetes diagnoses.
"The current Dietary Guidelines for Americans identifies grains, including rice, as one of the primary sources for carbohydrate intake and recommends that at least half of carbohydrate intake come from whole grains," the study authors conclude. "From a public health point of view, replacing refined grains such as white rice by whole grains, including brown rice, should be recommended to facilitate the prevention of T2D [type 2 diabetes]."
The National Institutes of Health supported this study. Dr. Sun is supported by a postdoctoral fellowship from Unilever Corporate Research.
Arch Intern Med. 2010;170:961-969.
June 14, 2010 — Substituting brown rice or other whole grains for white rice is associated with a lower risk for type 2 diabetes, according to results from the Health Professionals Follow-up Study and the Nurses' Health Study (NHS) I and II reported in the June 14 issue of Archives of Internal Medicine.
"Because of differences in processing and nutrients, brown rice and white rice may have different effects on risk of type 2 diabetes mellitus," write Qi Sun, MD, ScD, from the Harvard School of Public Health in Boston, Massachusetts, and colleagues. "We examined white and brown rice consumption in relation to type 2 diabetes risk prospectively in the Health Professionals Follow-up Study and the Nurses' Health Study I and II."
Diet, lifestyle habits, and disease status were prospectively determined and updated for 39,765 men and 157,463 women in these cohorts.
Higher intake of white rice (≥ 5 servings per week vs < 1 per month) was associated with a greater risk for type 2 diabetes, after multivariate adjustment for age, lifestyle, and other dietary risk factors. Pooled relative risk [RR] was 1.17 (95% confidence interval [CI], 1.02 - 1.36). In contrast, the risk for type 2 diabetes was lower with high intake of brown rice (≥ 2 servings per week vs < 1 per month; pooled RR, 0.89; 95% CI, 0.81 - 0.97).
The investigators estimated that replacing 50 g per day of uncooked white rice (one-third serving per day) with the equivalent amount of brown rice was associated with a 16% lower risk for type 2 diabetes (95% CI, 9% - 21%). For replacement with whole grains as a group, diabetes risk was 36% lower (95% CI, 30% - 42%).
"Substitution of whole grains, including brown rice, for white rice may lower risk of type 2 diabetes," the study authors write. "These data support the recommendation that most carbohydrate intake should come from whole grains rather than refined grains to help prevent type 2 diabetes."
Limitations of this study include study populations primarily consisting of working health professionals with European ancestry, measurement error of rice intake assessment related to use of food frequency questionnaires, possible residual confounding, and lack of oral glucose tolerance test data to confirm diabetes diagnoses.
"The current Dietary Guidelines for Americans identifies grains, including rice, as one of the primary sources for carbohydrate intake and recommends that at least half of carbohydrate intake come from whole grains," the study authors conclude. "From a public health point of view, replacing refined grains such as white rice by whole grains, including brown rice, should be recommended to facilitate the prevention of T2D [type 2 diabetes]."
The National Institutes of Health supported this study. Dr. Sun is supported by a postdoctoral fellowship from Unilever Corporate Research.
Arch Intern Med. 2010;170:961-969.
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