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MD-FM Thursday January 9, 2014

 

 

Sarah:

MD-FM, Medical News from around the world with Peter Goodwin.

 

P1 = Quitting smoking cuts risk of cataract

 

PETER:

Hello, and with me is Sarah Maxwell. We have a health-giving edition of the programme today: beginning with another incentive you can suggest to motivate your patients to stop smoking, it can help them avoid losing their vision:

 

SARAH:

Yes, a New Year article in JAMA Ophthalmology points out that smoking cessation can halve your risk of needing a cataract extraction later in life. The researchers looked at 40 000 Swedish men between the ages of 45 and 79 years and found there was a dose dependent risk of cataract over twenty years. Those who had ever smoked had a 21 per cent increased risk and for the heavy smokers it was much higher. Principal investigator Birgitta Ejdervik Lindblad told us that good things happened when smokers quit:

 

Birgitta Ejdervik Lindblad:

“Well we could find that the risk decreased with time. It was statistically significant, and the more you smoked per day the longer it took before the risk decreased. But even about heavy smokers, they smoked more than 15 cigarettes a day, when they were smoking they had a 42 per cent increased risk of cataract extraction and after more than 20 years since smoking cessation the risk had decreased to 21 per cent. It was not the same as never smoking but they could see that the risk decreased.”

 

SARAH:

Dr Lindblad from Örebro University Hospital, in Sweden. And she suggested that knowing about the risk of going blind could help some of your patients quit smoking:

 

Birgitta Ejdervik Lindblad

“It’s never too late to stop smoking.  You should encourage your patient to stop smoking. Apart from other diseases smoking is associated with many ocular diseases and I think the increased risk of cataract is one reason to encourage people to stop smoking.”

 

SARAH:

Birgitta Lindblad

 

 

P2 = Mediterranean diet protects against diabetes

 

PETER:

The so-called Mediterranean Diet, rich in fish, whole grains, red wine, fruit, and vegetables, is widely believed to protect against a number of diseases. Well, a new study has now tried to eliminate potentially confounding variables and get clear information about one disease area

 

SARAH:

That’s right and the message seems to be that a Mediterranean diet plus olive oil can protect you against diabetes.

This new study, published in the Annals of Internal Medicine, divided 3 500 volunteers into one of three diets: a Mediterranean diet plus 50 millilitres of extra virgin olive oil each day; a Mediterranean diet plus 30 grams of mixed nuts daily; or a control diet giving advice on eating less fat, and more: beans, fish, fruits, and vegetables and avoiding red or processed meat, butter, and sweets. Miguel Martınez-Gonzalez told us the whole idea was to change only one variable at a time, so they didn’t give advice on calorie control or physical activity:

 

Miguel Martınez-Gonzalez:

“We found a 40 per cent reduction in the risk of diabetes after a mean follow up of four years in the first group compared to the control group and non significant 18 per cent reduction in the risk of diabetes in the second group compared to the control group. So we merged the two Mediterranean diet groups together we found a 30 per cent reduction in the risk of diabetes. This is the first time that in a randomised trial with more than 3 500 participants a reduction in the risk of new cases of diabetes is observed without doing anything to reduce total calorie intake or to increase physical activity”

 

PETER

I can’t help wondering, though, if any benefit of a Mediterranean diet might be because it’s satisfying, so you don’t go munching away on sweets and deserts and loading up the calories?

 

SARAH

Well apparently not. Dr Martinez told us there wasn’t any noticeable weight gain in any of the three groups, so they were all, presumably, eating the same quantities of calories. He was keen to acknowledge that calorie reduction and physical activity are, of course, vital for preventing type-II diabetes, but it was now clear that overall diet can make a big difference too, and the dietary pattern they chose was one that patients can enjoy

 

Miguel Martınez-Gonzalez:

“I think that the Mediterranean diet is attractive, it is enjoyable, so this is good news especially this aspect of higher intake of fat make it more palatable so you can get very good adherence to this dietary pattern in your patients. It is easily adopted by your patients. Our participants were very happy to follow this dietary pattern.”

 

SARAH:

Professor Miguel Martınez-Gonzalez, Chair of the Department of Preventive Medicine at the University of Navarra in Spain. 

 

 

P3 = Meta-analysis finds dietary fibre protective against heart disease

 

PETER:

And the British Medical Journal carries a report that dietary fibre can prevent heart disease. There have been plenty of studies on the association between fibre and cardiovascular disease, but there are many different types of dietary fibre and not all studies are big enough to get the numbers you need to make definite recommendations. This might now have changed with a systematic review and meta-analysis of 22 cohort studies showing that, overall, seven grams daily of dietary fibre can cut heart disease by nine per cent and that this effect is dose dependent. Victoria Burley gave MDFM her take on the latest dietary recommendation coming out of her findings:

 

Victoria Burley:

“It’s not really very different from all the general healthy eating advice it’s not different at all in fact that people have been suggesting for the last two decades since the early 1990s people have been advised to consume in the region of 20 to 25 grams of dietary fibre a day and to get that through their “five-a-day”, fruit and veg, but also to try and use wherever possible the whole grain versions of cereal foods the whole grain bread, the higher fibre breakfast cereals and I think we’ve kind of lost the way a bit with dietary fibre: we all get hung up on whether we should be eating high carbohydrate or high fat diets and so on to maintain body weight but actually the evidence is remarkably consistent that people should be getting a good intake of dietary fibre and to do that from consuming a wide range of sources is what doctors should be recommending.”

 

PETER

Dr Victoria Burley from the Nutritional Epidemiology Group at Leeds University in England.

 

P4  = Vitamin E found safe and effective to slow mild to moderate Alzheimer’s Disease progression

 

PETER:

Delaying the progression of Alzheimer’s Disease, and a cheap, easily available, agent to do it now. A report has just been published in the Journal of the American Medical Association, JAMA.

 

SARAH:

Yes, Vitamin E has a recognised role for treating moderately severe Alzheimer’s Disease, but it’s efficacy has not been well assessed in mild-to moderate disease, where interventions could potentially make a big difference in terms of the patient’s level of independence and the amount of caregiver time needed. From Minneapolis in the USA Maurice Dysken has been telling MDFM about his group’s comparison trial looking at patients randomised to Vitamin E, the drug memantine, both of these, or placebo.

 

Maurice Dysken:

“What we found with vitamin E alone compared to placebo was that there was a delay in progression by about six months over the average  period of time patients were in the study which was a little over two years. We found that only in the vitamin E group. We did not find it in the memantine group alone or the combination compared to placebo ”

 

SARAH:

Dr Dysken’s research sponsored by the VA Cooperative Studies Program also found reassuring data on the question of toxicity in the group of patients with mild-to-moderate Alzheimer’s Disease treated with Vitamin E:

 

Maurice Dysken:

“We were very concerned about safety in large part because of a publication in 2005, a meta-analysis that suggested there was increased mortality in doses of vitamin E above 400 international units. We have good safety data from our study, out of six hundred and thirteen patients who were randomised 128 died during the study and we found that the mortality was least in the vitamin E group”

 

SARAH

While the new study does not offer full proof of the efficacy of vitamin E in this setting, Maurice Dysken told us there are clinical implications coming from the study:

 

Maurice Dysken:

“I would say that it should be considered and offered to patients with mild to moderate Alzheimers disease. I would say also that…it’s very important to point out that, this is not a prevention trial: we’re not saying that this is going to be useful more for patients who are worried about having Alzheimers, but actually do not have the illness. We’re recommending that this be done under the guidance of a primary care provider”

 

SARAH:

Dr Maurice Dysken of the Geriatric Research and Clinical Center in Minneapolis, Minnesota.

 

 

P5 = Slerostin inhibitor romosozumab: a new way of treating osteoporosis

PETER:

Osteoporosis next and a new molecular drug that activates bone formation without bone resorption. Too good to be true?

 

SARAH:

Well not so: there’s an impressive study now in the New England Journal of Medicine looking at treatment with romosozumab in post menopausal women with low bone mineral density compared with two standard osteoporosis drugs. Romosozumab binds to sclerostin, an inhibitor of osteoblast activity. Dr Michael McClung and his colleagues in Portland Oregon looked at 400 women with different doses and schedules:

 

Michael McClung:

“Over the 12 months time, significant increases in bone density with all the doses of romosozumab were observed in the spine and in the hip region and with the largest dose of romosozumab the increase in the spine of 11.3 per cent over the 12 month time period was much larger than seen with the comparators alendronate or teriperatide and was the greatest increase that we’ve observed in bone density in a 12 month interval with any treatment that we’ve ever evaluated”

 

SARAH:

Dr McClung explained that teriparatide stimulates bone formation and resorption while the bisphosphonates decrease the activity of bone metabolism, and prevent the progression of bone loss but can’t stimulate growth of new bone. Romosozumab, on the other hand, modulates all the bone growth parameters in the desired direction.   

 

PETER

And sclerostin is only found in bone cells, so any drug targeting it could be rather specific and hopefully have few toxicities?

 

SARAH

Right, and Dr McClung said they were expecting rososozumab to be safe.  And in the study they reported few adverse events of any kind.  So how did he see this agent potentially being used? 

 

Michael McClung:

“Further trials documenting its effect on protecting patients from fractures, which is the major objective of treatment, are already under way. So assuming that all goes well, for patients with severe osteoporosis who truly are in need of skeletal reconstruction, then the use of a drug like romosozumab for an interval of perhaps a year to markedly activate bone formation and to rebuild the skeleton would be useful. For patients with milder forms of osteoporosis the drugs we currently have like denosumab and bisphosphonates would likely still be the preferred treatment.”

 

SARAH:

Dr Michael McClung, Director of the Oregon Osteoporosis Center in Portland.

 

 

PETER:

Finally, in brief:

 

B1 = Big bellies bring Barrett’s Oesophagus risk

 

A high proportion of abdominal fat compared to subcutaneous fat was found to be associated with increased risk of Barrett’s oesophagus in a case-control study using CT scanning reported in the journal Gut.  Patients with Barrett’s oesophagus were twice as likely to be in the group with the biggest bellies: in the top one third in terms of their visceral to subcutaneous fat ratios. 

The investigators conclude that large amount of abdominal fat relative to subcutaneous fat is associated with a significant increase in the risk of Barrett’s.

 

And...

 

B2 = International study finds environment more significant than genes in causing cancer

 

Eating animal products, smoking and drinking alcohol had the strongest correlations with cancer risk in a massive study published in Nutrients.  Smoking and eating animal products explained half of all cancer rates internationally while factors like alcohol, virus infections and sunlight added to the global cancer burden. Cereal consumption and income were protective for some cancers and the researchers conclude that environmental causes of cancer contribute much more to cancer risk than genetic factors. So you can prevent cancer and this can help you decide how.

That's all from MDFM for now. Sarah Maxwell and I will be back with more next week. So until then from me, Peter Goodwin, goodbye!

 

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