STUDY:

JOURNAL: J Natl Cancer Inst 2003;95:132-141.

AUTHORS: Dr. Joanne F. Dorgan

ABSTRACT: Adolescent girls who follow a low-fat diet have reduced sex hormone levels that may decrease their risk of breast cancer in adulthood.

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COMMENTARY: However, whether these findings translate into a lower risk of breast cancer later in life is not clear, according to the report published in the January 15th issue of the Journal of the National Cancer Institute.

Reduced levels of estrogens and progesterones might slow down the rate of cell division, thereby decreasing the likelihood of carcinogenic mutations, lead author Dr. Joanne F. Dorgan, from the Fox Chase Cancer Center in Philadelphia, said in a statement.

Elevated body fat is another risk factor for premenopausal breast cancer, although it is not clear how excess fat may contribute to the risk.

To investigate the relationship between fat intake during puberty and blood levels of hormones associated with breast cancer, the research team studied 286 girls between 8 and 10 years of age. The girls were already enrolled in a study to evaluate the ability of a diet to lower levels of LDL cholesterol.

About half of the patients attended individual and group nutrition counseling sessions on how to follow a low fat diet, in which 28% of calories came from fat and 8% came from saturated fat. The other half received written material on nutrition from the American Heart Association, but did not take part in nutrition counseling.

After 5 years, the girls in the counseling group had lower levels of several estrogens that have been linked to breast cancer. For instance, estradiol levels were about 30% lower and estrone levels were about 20% lower, the study found. Levels of progesterone were also lower, the findings indicate.

Finally, girls in the counseling group reported eating fewer calories, less fat and saturated fat, and more fiber, compared with girls in the other group.

"These results suggest that the modest reductions in total fat, saturated fat, and perhaps energy intake during adolescence may alter the function of the hypothalamic-pituitary-ovarian axis, which regulates ovarian hormone production," the researchers note. Whether these differences ultimately influence breast cancer risk is currently unknown.

STUDY:

JOURNAL: Arch Intern Med. 2003;163:59-64

AUTHORS: Susanne Oksbjerg Dalton

ABSTRACT: Selective serotonin reuptake inhibitors (SSRIs) are associated with an increased risk of gastrointestinal (GI) bleeding, especially when combined with nonsteroidal anti-inflammatory drugs (NSAIDs), according to the results of a population-based cohort study published in the Jan. 13 issue of the Archives of Internal Medicine.

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COMMENTARY: "Serotonin is thought to play an important role in hemostasis, mainly through an enhancing effect on adenosine diphosphate and thrombin," write Susanne Oksbjerg Dalton, MD, from the Institute of Cancer Epidemiology at the Danish Cancer Society in Copenhagen, and colleagues.

"The SSRIs in therapeutic doses consistently deplete serotonin after several weeks of treatment."

Using the Pharmaco-Epidemiologic Prescription Database of North Jutland, Denmark, the investigators identified 26,005 users of antidepressants in that county from January 1, 1991, to December 31, 1995. Data from the Hospital Discharge Register allowed comparisons of hospitalizations for upper GI bleeding among users of antidepressant medications and among those who did not receive prescriptions for antidepressants.

During periods of SSRI use without use of other drugs increasing risk of upper GI bleeding, there were 55 episodes of upper GI bleeding. The risk was 3.6 times that of nonusers of antidepressants (95% confidence interval [CI], 2.7 - 4.7), corresponding to a rate difference of 3.1 per 1,000 treatment years. With concurrent use of SSRIs and NSAIDs, the risk ratio was 12.2 (95% CI, 7.1 - 19.5), and with SSRIs and low-dose aspirin, it was 5.2 (95% CI, 3.2 - 8.0).

With use of non-SSRIs, the risk ratio for upper GI bleeding was 2.3 (95% CI, 1.5 - 3.4).

Antidepressants not known to affect the serotonin receptor had no significant effect on the risk of upper GI bleeding. After discontinuation of SSRIs, the risk of upper GI bleeding returned to normal. However, users of non-SSRIs had increased risks of GI bleeding even after discontinuing the drug.



"SSRIs increase the risk of upper GI bleeding, and this effect is potentiated by concurrent use of NSAIDs or low-dose aspirin, whereas an increased risk of upper GI bleeding could not be attributed to other types of antidepressants," the authors write.

"We interpret the increase in risk of upper GI bleeding in users of non-SSRIs cautiously because of the similarity of the risk estimates between periods of current and former use in these persons. However, more studies of the association between antidepressant drugs and upper GI bleeding are clearly warranted owing to the high prevalence of use of these drugs, resulting in an appreciable absolute risk and, thus, considerable public health implications."

STUDY:

JOURNAL: JAMA 2003;289:323-330.

AUTHORS: Dr. Anne McTiernan

ABSTRACT: In a recent study, postmenopausal women who began an exercise program of brisk walking or cycling lowered levels of abdominal fat by about 6% and lost weight, regardless of body weight or age. Not surprisingly, the most active women lost the most body fat and the most weight.

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COMMENTARY: In contrast, women who performed only daily stretching exercises actually experienced a slight increase in intra-abdominal fat and weight after 1 year, researchers report in the January 15th issue of the Journal of the American Medical Association.

The study has implications for the soaring rates of obesity in the US. Nearly two thirds of the adult population are now considered overweight or obese.

In the current study, Dr. Anne McTiernan from the Fred Hutchinson Cancer Research Center in Seattle, and colleagues assessed the outcomes of 168 sedentary women, between 50 and 70 years of age, who were randomized to perform moderate-intensity exercises or stretching. All of the women had a body mass index over 25.

The exercisers walked on a treadmill or cycled on a stationery bicycle for at least 45 minutes, 5 days a week, for 1 year. Weight training was recommended but not required. Women in the control group performed a series of stretching exercises 1 day a week for the year.

The most active women, or those who exercised more than 3 hours and 15 minutes a week, lost about 7% of intra-abdominal fat, compared with a loss of 6% among intermediate exercisers, as measured by CT scan.

Those who exercised less than 2 hours and 15 minutes a week lost 3.4% of their intra-abdominal fat, while women in the control group gained 0.1% intra-abdominal fat, the study found.

Body weight decreased by an average of 1.3 kg in the exercise group, while body weight rose slightly in the control group.

STUDY: Vit A and Weak Bones

JOURNAL: N Engl J Med 2003;348:287-294,347-349.

AUTHORS: Dr. Karl Michaelsson

ABSTRACT: High serum retinol levels are associated with an increased risk of fracture in men.

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COMMENTARY: The findings suggest that vitamin A levels in fortified foods and vitamin supplements may need to be reassessed since they are a major contributor to serum retinol levels, the study authors note.

Dr. Karl Michaelsson of University Hospital in Uppsala, Sweden and colleagues, studied 2322 men, between 49 and 51 years of age, who were followed for 30 years.

The researchers found that men with the highest serum retinol levels were 1.64 and 2.47 times more likely to sustain any fracture and a hip fracture, respectively, than their peers with lower levels.

In contrast, levels of beta-carotene, a precursor to vitamin A, were not associated with fracture risk.

These findings are in agreement with those from animal and epidemiologic studies, which first suggested that that vitamin A may inhibit new bone formation and increase the risk of fractures.

In the study, men with the highest fracture risk had more than 75.62 micrograms/dL of retinol in their blood samples at the start of the study. During the study period, 266 men sustained fractures.

In an accompanying editorial, Dr. Paul Lips, from Vrije Universiteit Medical Center in Amsterdam, the Netherlands, comments that "vitamin A supplementation and fortification of food with vitamin A may be harmful in Western countries, where the life expectancy is high and the prevalence for osteoporosis is increasing."

I always use beta carotene with my patients as this is the safe alternative to Vit A. The study showed not correlation between beta carotene and fracture.

Just don't use high doses of pure vitamin A.

STUDY: One electric toothbrush tops study

JOURNAL: Cochrane Collaboration’s Oral Health report

AUTHORS: William Shaw

ABSTRACT: Only one type of electric toothbrush clearly does a better job of cleaning teeth than the old-fashioned manual kind, according to the first comprehensive attempt to evaluate the devices used by an estimated 55 million Americans.

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COMMENTARY: ELECTRIC BRUSHES with bristles that spin in both directions are the sole kind offering sufficient proof of any advantage over regular toothbrushes, according to the report from the Cochrane Collaboration, an independent nonprofit group based in Oxford, England, that evaluates medical practices.

“The others were not worse, but they were just not any better” than manual brushes, said William Shaw, a professor of orthodontics at the University of Manchester in England, who helped coordinate the report of the Cochrane Collaboration’s Oral Health report.

To evaluate electric toothbrushes, six reviewers combed through every published study on the devices and asked manufacturers for any unpublished results they had. The team then combined 29 studies it considered to be well designed, yielding data involving 2,547 people in North America, Europe and Israel.

BRAUN ORAL-B TOPS STUDY

Of five types of brushes examined, only the “rotational oscillation” design of the Braun Oral-B device was clearly more effective than manual toothbrushes, the researchers concluded. Compared to manual brushes, that design removed about 11 percent more of the build-up on teeth known as plaque, and reduced by about 17 percent the development of gum disease, or gingivitis. None of the other brushes evaluated — the Philips Sonicare, the Interplak, the Teledyne Aqua Tech, the Ultrasonex, the Rowenta Dentiphant and the Rowenta Plaque Dentacontrol Plus — performed better than manual brushes, Shaw said. Michele Szynal, a spokeswoman for Gillette Co., which makes the Braun Oral-B, said the company is “thrilled” by the findings. “This basically confirms four decades of our own research,” she said.

The Braun product is the choice of 41 percent of Americans who use electric toothbrushes, according to Gillette.

STUDY: Survey finds a majority continuing hormone therapy

JOURNAL: Express Scripts

AUTHORS:

ABSTRACT: More than half of women taking hormone replacement therapy stuck with it last year despite reports that show it can raise the risk of heart disease, cancer and stroke, a new survey found.

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COMMENTARY: Studies released over the summer indicated significant health risks associated with HRT, 36 percent of women stopped their treatments, the survey by pharmacy benefit manager Express Scripts found.

But 57 percent continued using HRT, the St. Louis-based company found. And even though the studies found no extra risk for women taking estrogen alone, 22.6 percent of those surveyed stopped taking an estrogen product, Express Scripts said.

For its report, Express Scripts surveyed a sample of 372,777 women who used HRT or osteoporosis drugs. The company compared use patterns last year before and after the announcement, and during similar periods in 2001.

The Food and Drug Administration strengthened warning labels on all women’s hormone replacement therapy products to take account of last year’s findings.

An estimated 10 million women were taking HRT at the time last year’s reports were released.

The risk to an individual woman is small, but accumulates when many women take the drugs over time. The FDA says the overall risks to women outweigh the benefits of the drugs, but recommends that each woman consult with her doctor about what to do.

The studies used only Wyeth’s PremPro and related products, but the FDA said there was no reason to believe that other HRT products would not have similar effects.

HRT was, until last year, widely prescribed to treat not only the immediate symptoms of menopause such as hot flashes, but also to prevent heart disease and osteoporosis.

STUDY: Study supports belief that diet is to blame for adolescent acne.

JOURNAL: Cordain, L. et al. Acne vulgaris: a disease of western civilization. Archives of Dermatology, 138, 123 - 321, (2002).

AUTHORS: Cordain

ABSTRACT: US scientists are throwing a lifeline to acne-ridden adolescents. A controversial new study suggests that avoiding a sugary Western diet could help to treat the teenage scourge.

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COMMENTARY: Anecdotal evidence has long linked chocolate and chips to pubescent spots, but scientists have never proved the connection. Then anthropologist Kim Hill at the University of New Mexico in Albuquerque stumbled on a remote community in Paraguay, who eat manioc (cassava), peanuts and meat. "I've travelled to remote tribes all over South America and I've never seen acne," Hill says. Teenagers in a second community of remote islanders, in Papua New Guinea, are also spotless, it turns out.

Genetics cannot explain the perfect skin of the two unrelated groups, maintains team leader Loren Cordain of Colorado State University. He blames today's refined foods, such as bread, rice and cakes, for the pimples suffered by 95% of westernized teenagers."The theory makes sense," comments acne expert Alan Shalita of State University of New York.

Yet it flies in the face of 1970s and 1980s studies that failed to find a link between diet and spots. Based on these, most dermatologists have "pooh-poohed" the idea, says Shalita.Skin researcher Richard Bojar of the University of Leeds, UK remains unconvinced. The non-westernised groups might also get more beneficial sun or exercise, he points out. "There's not much data and a lot of hypothesis," he says. "They need to go on and test it."

STUDY:

JOURNAL: Am J Cardiol 2002;90:1150-1153.

AUTHORS: Dr. Momiyama

ABSTRACT: New research from Japan suggests that green tea use may reduce the risk of myocardial infarction (MI). Although study subjects who drank one or more cups of green tea were no less likely to have coronary artery disease (CAD) than were those who did not drink green tea, they were much less likely to have an MI.

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COMMENTARY: "We found...that MI was less prevalent in green tea drinkers, suggesting that regular green tea intake may be playing a protective role against the development of MI in Japanese," study coauthor Dr. Yukihiko Momiyama, of the National Defense Medical College in Saitama.

The study involved 393 patients who underwent angiography to rule out CAD. Many of the participants had risk factors for CAD, including hypertension, high cholesterol and diabetes.

Dr. Momiyama's team did not detect a link between the number of cups of green tea a person drank each day and the risk or severity of CAD. However, those who drank at least one cup of green tea per day were 42% less likely to have a MI than people who did not drink green tea.

For many years, researchers have been trying to determine why CAD is less common in Japan than in the West. Although there are probably many factors that explain the difference, some scientists suspect that use of green tea--a common beverage in Japan--may protect against CAD.

Green tea is known to contain high levels of flavonoids, compounds that have been shown to neutralize free radicals. By protecting against oxidative damage, flavonoids may decrease the risk of CAD and stroke, the researchers explain.

Several reports have found that people who consume high levels of flavonoids are less likely to die from CAD; and another study linked high flavonoid consumption to a reduced risk of MI.

STUDY:

JOURNAL:

AUTHORS: Dr. Karl Citek

ABSTRACT: Sunglasses in all price ranges appear to maintain their ability to protect wearers from harmful ultraviolet rays after a season of cleaning, new research shows.

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COMMENTARY: Researchers based at Pacific University in Forest Grove, Oregon, found that subjecting six pairs of non-prescription sunglasses to nine months of cleaning--either using soap and face tissues or a lens cleaner and soft cloths--did not diminish the ability of the sunglasses to shield wearers from harmful UV rays.

However, the researchers did discover that not all of the glasses protect wearers to begin with: one less expensive pair let through more than the minimum allowable amount of UVB, the most harmful form of ultraviolet light.

The limits of UV absorption are set by the American National Standards Institute, a nonprofit organization that coordinates a system of voluntary standards in the US.

While these results suggest that UV protection can last through cleaning, consumers should still be careful to buy sunglasses that start out with enough UV protection, study author Researchers based at Pacific University in Forest Grove, Oregon, found that subjecting six pairs of non-prescription sunglasses to nine months of cleaning--either using soap and face tissues or a lens cleaner and soft cloths--did not diminish the ability of the sunglasses to shield wearers from harmful UV rays.

However, the researchers did discover that not all of the glasses protect wearers to begin with: one less expensive pair let through more than the minimum allowable amount of UVB, the most harmful form of ultraviolet light.

The limits of UV absorption are set by the American National Standards Institute, a nonprofit organization that coordinates a system of voluntary standards in the US.

While these results suggest that UV protection can last through cleaning, consumers should still be careful to buy sunglasses that start out with enough UV protection.

"To ensure that non-prescription sun eyewear has adequate UV protection, we recommend that consumers purchase recognizable brand name eyewear from reputable stores and optical shops, and not from roadside stands," Citek said.

UV rays have been shown to cause eye diseases such as cataracts, a gradual clouding of the lens of the eye, and have been implicated in the development of age-related eye damage known as macular degeneration.

STUDY:

JOURNAL: American Journal of Epidemiology 2002;156:824-831.

AUTHORS: Dr. Chisato Nagata

ABSTRACT: A new study from Japan provides additional evidence for the health benefits of a diet rich in fish oil and soy products.

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COMMENTARY: According to the report, men and women who consumed the highest levels of soy were least likely to die of any cause during the study. Omega-3 fatty acids found in fish oil and fatty fish such as salmon and mackerel were also associated with a lower risk of death among women, but not men.

Fish and soy are staples of the diet in Japan, which has the highest reported life expectancy in the world, note researchers in a recent issue of the American Journal of Epidemiology.

Numerous studies have demonstrated that dietary soy, which contains plant estrogens known as phytoestrogens, may inhibit some forms of cancer and lower the risk of heart disease. Fish oil is associated with reduced levels of inflammation in the body, reduced clotting and improved blood cholesterol levels.

But the relationship between these compounds and longevity is not clear. To investigate, researchers from Gifu University in Japan reviewed food records of nearly 30,000 Japanese adults. About 2,000 died over the 7-year course of the study.

An analysis of diet records revealed that adults who were in the top 25% based on their consumption of soy foods were less likely to die during the study than their peers who consumed the least soy. Omega-3 fatty acids were associated with a lower risk of dying from all causes among women but not among men.

More research is needed on the relationship between these compounds and specific diseases such as cancer, stroke and heart disease.

STUDY: Children more sensitive to radiation than adults, experts warn

JOURNAL: National Cancer Institute and Society for Pediatric Radiology

AUTHORS: Dr. Tom Slovis

ABSTRACT: Too many kids are needlessly exposed to the scans’ radiation, say specialists developing new guidelines that aim to cut by a third unnecessary CT scans of children’s brains

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COMMENTARY: CT SCANS are computer-enhanced X-rays that can provide a better view of all parts of the body, not just the brain — have revolutionized medicine. But the scans, more popularly known as CAT scans, do emit significantly more radiation than a standard X-ray, and children are more sensitive to radiation than adults.

Yet with the number CT scans increasing sevenfold in the last decade, up to 3 million a year now are being performed on U.S. children. There’s little guidance on when they’re truly necessary or when other exams will do.

So specialists have begun a nationwide effort to curb unnecessary child CT scans — and ensure that when one is needed, hospitals use a child-appropriate radiation dose instead of the higher adult dose too often used.

Radiation from a single CT scan still is relatively low — and certainly not high enough to warrant skipping a scan if a child may be seriously ill or injured, such as after a car crash, specialists warn.

Recent research suggests lower radiation doses than once thought — as low as 10 to 20 REMs — may somewhat increase people’s risk of getting cancer decades later. Exposure is cumulative, and children are likely to need numerous exams over the course of their lives that will add up.

Simply adjusting the dose can lower children’s radiation absorption. For example, a child given a typical adult-dose brain CT scan will absorb 6 REMs of radiation, and 2 to 3 REMS for abdominal CT. Adjust the scanner to a pediatric setting, and that child will absorb 3 REMS from a brain CT and 0.6 REMS to the abdomen. (A standard chest X-ray, in contrast, provides about 0.01 REM.)

CT scans are needed if children have any of the following risk factors: is age 2 or younger; has a skull fracture or deformity; has a bicycle-related injury; is dizzy, has a behavior change or problems with vision or other senses; or scores less than 15 on a standard neurological exam called the Glasgow Coma Score.