Category: Prior Clinic Blog
STUDY: Get Moving
JOURNAL: Arterioscler Thromb Vasc Biol 2002;22:1869-1876.
AUTHORS: Dr. Timothy S. Church
ABSTRACT: Exercise is inversely associated with levels of C-reactive protein (CRP), an inflammatory marker directly related to coronary heart disease risk.
COMMENTARY: The investigators found that men who were the most fit tended to have the lowest CRP levels, while those deemed the least fit had the highest levels. The relationship between CRP levels and exercise remained even after adjusting for age and obesity.
Specifically, the authors discovered that people who were in the second-to-lowest category of fitness were 57% less likely to have elevated CRP levels compared with those in the least fit group.
The risk of elevated CRP decreased incrementally with increasing fitness, with most fit subjects being 83% less likely to have elevated CRP levels than least fit subjects.
The relationship between CRP levels and physical activity in women is probably similar to that in men, but more complicated due to the hormonal changes that occur during menopause.
STUDY: Eat your Greens
JOURNAL: Lancet 2003;361:1316
AUTHORS: Dr. Gad Barkai
ABSTRACT: Impaired folate status may increase the risk of Down's syndrome.
COMMENTARY: Mothers of infants with Down's syndrome are believed to have an elevated risk for abnormal folate metabolism that could result in aneuploidy, Dr. Gad Barkai, of Sheba Medical Centre, Tel Hashomer, Israel, and colleagues explain. However, evidence regarding the rate of genetic polymorphisms in mothers with Down's syndrome offspring is inconsistent.
The multinational research team found that Downs' syndrome and neural tube defects (NTD) arise more often in the same families than would be expected from the incidence of each disorder considered separately.
It is on the basis of such an association, and knowledge that folate supplementation reduces the risk of NTD, that they recommend preconception folate supplementation for mothers at risk.
Dr. Barkai's group reviewed the record of 493 families referred to the Sheba Medical Centre between 1971 and 2001 because of prior pregnancies affected by NTD or isolated hydrocephalus. The families included those with at least one sibling in addition to the proband.
Among the 1492 at-risk pregnancies, there were 11 with Down's syndrome. This rate is significantly higher than the 1.87 affected Down's syndrome cases that would be expected among women of the same age in the general population (p < 0.00001), their report indicates.
They also examined data from 516 families who underwent genetic counseling in the Ukraine because of their risk of Down's syndrome. Among 1847 pregnancies, seven families had children affected by NTD. Again, this is a significant increase from the 1.37 cases expected in the general population (p = 0.0005).
Dr. Barkai's team maintains that genomic instability is minimized when maternal plasma folate exceeds 34 nmol/L and homocysteine levels are kept below 7.5 mcg/L. To achieve such levels, folate intake should be no lower than 5 mg/day.
STUDY: Don't Stress Out
JOURNAL: American Journal of Epidemiology 2003;157:14-24.
AUTHORS: Dr. Nancy Dole
ABSTRACT: While studies on the effects of stress during pregnancy have yielded conflicting results, the latest report finds that it may raise a woman's risk of premature delivery.
COMMENTARY: Pregnant women who said they were experiencing high levels of stress from events such as marital separation, problems with in-laws or issues at work were 80% more likely to have a preterm delivery than those who reported low stress levels.
Overall, there were 71 preterm births and 402 full-term births among women reporting high stress, compared with 39 preterm births and 416 full-term births in the low-stress group.
Among those most at risk are women in low socioeconomic groups who may get inadequate prenatal care and have constant worries about critical issues such as paying rent and putting food on the table.
"Stress is a fight-or-flight kind of phenomenon," Heyl said, explaining that pregnant women under stress may have increased steroid secretions in the womb that can stimulate cellular receptors that control uterine contraction and relaxation. "Chronic stress could over-stimulate those receptors," he said.
The new study involved 1,962 pregnant women who were being treated at two prenatal clinics in North Carolina. In addition to their medical exams, the women were instructed to complete and mail in a survey that asked various questions about their psychological state, stressful life events, social support and other issues that might impact their pregnancies.
There's a general feeling that if women recognize the stress in their lives and can do some stress reduction during pregnancy they can change this risk.
JOURNAL: J Natl Cancer Inst 2003;95:825-828.
AUTHORS: Dr. Eva S. Schernhammer
ABSTRACT: Women who work regular night shifts appear to be at increased risk for colorectal cancer.
COMMENTARY: The findings support earlier research showing that women who work night shifts have a higher risk of breast cancer.
The US Bureau of Labor Statistics estimates that about 4% of adults work rotating night shifts.
Shift work is known to disrupt normal melatonin production and increase levels of other hormones such as estrogen.
Malignancies in women are often associated with estrogen levels, but in the case of colon cancer the data are beginning to show that it may be melatonin, not estrogen, that is influencing cancer risk.
The researchers studied 78,586 women who took part in the Nurses' Health Study. The nurses who worked night shifts at least three times a month for 15 years or more had a 35% greater risk of developing colorectal cancer compared with women who did not work rotating night shifts.
STUDY: Get Your Proberry
JOURNAL: BMJ 2003;326:1235-1240.
AUTHORS: Alexander Sutton
ABSTRACT: A meta-analysis of data from randomised clinical trials supports the efficacy of neuraminidase inhibitors for treating and preventing influenza.
COMMENTARY: The analysis of 17 treatment trials and seven prevention trials by researchers at the University of Leicester showed that oseltamivir (Tamiflu; Roche) and zanamivir (Relenza; GlaxoSmithKline) reduced the odds of developing flu by about 70-90% and cut the duration of symptoms by about a day.
The drugs are both effective at reducing the length of symptoms and incidence if properly administered. They have to be given within 48 hours of onset.
Bottom Line is to get your Proberry.