First evidence that acidogenic diets increase the risk of type-2-diabetes
MD-FM Thursday November 14, 2013
MD FM — Medical News from around the world with Peter Goodwin.
P1 -- DIABETES: Acidogenic diets are associated with a higher risk of type-2-diabetes in women.
Hello, and to begin with, for women, a diet containing ‘acidogenic’ foods causing a higher “acid load” is associated with a greater risk of type-2 diabetes. That’s according to findings — published in Diabetologia — that further support the benefits of eating fruit and vegetables, which do the opposite…
Yes, more than 66,000 women were followed over 14 years and it’s the FIRST study to demonstrate this link. So, what kind of diet causes a high acid load?
“It can come from various combination of foods but what we usually see is that people who have a large amount of acid in their diet usually have a western diet, which is characterized by a large amount of meat, cheese, pasta, rice...
That was lead study author Guy Fagherazzi, from Paris. Overall, women with the highest acid load in their diets had a 56 per cent increased risk of developing type-2-diabetes compared to those with the lowest acid load. And for women with a BMI under 25 — so those in the “normal weight” range — it was especially pronounced. Several other factors come into play in women who are overweight:
Based on our study, we can just recommend to decrease the consumption of acidogenic food groups, such as processed meat or cheese, and you can always increase the consumption of fruits or vegetables, which are alkaline, and decrease the overall acid score. We have found that the association is stronger in normal weight women but we have still seen this increased risk in overweight women, so I would recommend that for everybody.
Dr Guy Fagherazzi, from Institut Gustave Roussy in Paris.
P2 -- Chronic kidney disease: genetic predisposition causes faster progression in African-American patients.
The American Society of Nephrology’s Kidney week, in Atlanta, heard that for black people with chronic renal disease, high-risk genetic predisposition is partly responsible for much faster disease progression than in white patients…
Renal high-risk gene variants in apo-lipo-protein L1 (APO-L1) were associated with increased progression in black people independent of high blood pressure or diabetes status. That’s the finding of a study, reported in the New England Journal of Medicine, looking at two large prospective, multicentre trials examining the effect of having two copies of APO-L1 variants, one copy, or no copy. Patients with two copies were twice as likely to have kidney disease progression as those with one or no copy. Winfred Williams wrote an editorial on the study:
I think the difference in these studies is that the traditional markers that we look for in terms of allocating risk in chronic kidney disease, for example proteinuria, and also diabetes, which is historically thought to be a huge risk associated with end-stage renal disease in blacks, did not seem to affect your risk for progression, whether you had it or not.
That was Dr Winfred Williams, from Massachusetts General Hospital in Boston, who explained that the high-risk variants are rare in white populations. In the future, molecular classification by a patient’s APOL1 status may eventually become the way to recognise those at risk of progression.
P3 -- Rheumatoid arthritis drug slowed down proteinuria in patients with focal segmental glomerulosclerosis.
And more from the kidney week: a team reported reaching partial or complete remission in five patients with previously treatment-resistant primary or recurrent focal segmental glomerulosclerosis, for which, to date, there’s no specific therapy. The drug they used was ABATACEPT, a selective T-cell co-stimulatory inhibitor currently approved for treating rheumatoid arthritis. According to the new data, published in the New England Journal of Medicine, abatacept significantly slowed down these patients’ proteinuria.
P4 - Radiotherapy during breast cancer surgery can be an alternative to external whole breast irradiation for some patients.
For some patients with breast cancer, single-dose radiotherapy delivered during surgery can be a suitable alternative to the more time-consuming and more toxic fractionated external whole breast irradiation, (EBRT)…
Yes, two studies published this week investigated the long-term outcomes of women receiving either single-dose intra-operative radiotherapy (IORT) or standard EBRT. The TARGIT-A study, in The Lancet, found the risk of local recurrence with IORT was non-inferior to EBRT overall. Lead study author Professor Jayant Vaidya:
When a single dose IORT is given during lumpectomy, the five-year breast cancer outcomes are similar to whole breast radiotherapy, local toxicity is lower and deaths from other causes are reduced: from 4.4 percent to 1.3 percent. These benefits are there! But the most important benefit is: it is so much more convenient for the patient --they don’t have to keep traveling for 6 weeks.
Jayant Vaidya from University College London who said a drastic alternative to EBRT is mastectomy. Results from the ELIOT study, in Lancet Oncology, favoured EBRT, showing that the difference in recurrence was statistically significant and survival rates were comparable. However the team here used a different technique and non-inferiority thresholds so it’s difficult to compare with the TARGIT-A findings. David Azria wrote an editorial in The Lancet and said these data confirm that IORT is a good option but only in patients at low risk of recurrence
The key message is to have an excellent selection of patients. All trials confirm that patients have to present small tumors, less than 2 cm, patients are to be aged more than 60 years old, the grade of the tumor has to be low --grade 1, sometimes grade 2, but it’s better for grade 1 --and positive hormonal expression. These are, I think, the four most important criteria. For the patients who are at higher risk for recurrences.
Professor David Azria, from the Val d’Aurelle Cancer Center in Montpellier, France.
P5 -- Patients on chemotherapy for cancer are at high risk of venous thromboembolism and major bleeding.
Patients with cancer being treasted with chemotherapy are at much higher risk of venous thrombo-embolism and major bleeding than was previously thought — according to a study with over 27,000 patients published in The Oncologist….
Yes, and it’s said to reflect “real-world” settings. Three and a half months after chemotherapy, the overall incidence of venous thrombo-embolism nearly doubled, from eight per cent to 14 per cent at one year. Study author Gary Lyman from Duke University in Durham:
What we found and report is: substantially higher rates of venous thromboembolism -- 2 to 3-fold greater -- than what had been reported in the selected patients in randomized controlled trials. These are all outpatients and, nevertheless, the combination of their cancer, the chemotherapy, sometimes hormonal treatment --all that adds risks and then, most recently, we’ve realized that some of the supportive care measures that we use to maintain patients getting chemotherapy may also contribute...
What makes things more complicated is that patients who developed venous thromboembolism also had higher risks of bleeding: in part due to their tumours but also because of anti-thrombotic therapies. So not all patients with cancer should be put on prophylactic anticoagulants…
You eventually need to decide whether the risk and benefit ratio is favourable for the patient. I think most would agree that if you start seeing a risk from this blood clot of 10, 15, 20 per cent or higher, maybe those are the patients with whom to have a discussion and consider for recommending prophylactic anticoagulation. But there’s no gold standard to this and I think it has to be individualized.
Dr Gary Lyman, from North Carolina.
B1 -- New oral cholera vaccine offers better long-term protection than any oral vaccine tested to date.
Finally, in brief: An investigative oral cholera vaccine has proved more protective at five years post-immunization than any other oral cholera vaccine tested to date. These are the findings of a placebo-controlled study, reported in The Lancet, which tested this modified killed bivalent whole-cell cholera vaccine in over 30,000 people living in a cholera endemic region of India. It showed 65 per cent cumulative protective efficacy, which didn’t appear to decrease over time. And..
B2 - Vitamin D and calcium improve bone mineral density in men on long-term antiepileptic treatment.
For men on long-term anti-epileptic treatment — which is associated with osteoporosis and bone mass loss — vitamin D and calcium supplementation improved bone mineral density in over two-thirds of patients. These results, published in the journal Epilepsia, showed that adding the drug risedronate to the regimen did not further improve bone mineral density. However, it did seem to prevent the appearance of vertebral fractures, which the dietary supplements apparently did not.