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Vitamin D supplements recommended for women over 75 years old

MD-FM Thursday April 10, 2014


 

SARAH:

MD-FM –the latest medical news from around the world. Here’s Peter Goodwin

 

 

SEGMENT 1: OSTEOPOROSIS: Persistent vitamin D insufficiency associated with higher hip fracture risks in women over 75

 

PETER:

Hello, and with me is Sarah Maxwell. To begin with: Swedish researchers have found that in women over 75 persistent vitamin D insufficiency was associated with a higher 10-year risk of having hip fractures. 

 

SARAH:

Yes: that’s according to the first study, a population level analysis, to assess vitamin D levels at different time points over 5 years. Previous studies had used single vitamin D measurements. The incidence of hip fractures within 10 years was significantly lower in women whose vitamin D levels were considered normal at baseline and who maintained them over time. Senior author Kristina Akesson:

 

AKESSON:

What’s new is that we’ve actually seen that it’s the sustained low levels of vitamin D that were associated with hip fracture risk –that’s the fracture that increases with increasing age. And we thought that probably the other fractures would be as well but they weren’t and that’s probably because they have a lower incidence.

 

SARAH:

That was Professor Kristina Akesson, from the Clinical and Molecular Osteoporosis Research Unit at Lund University, who’s Chair of the International Osteoporosis Foundation’s “Capture the Fracture” Campaign. Did she think all women beyond a certain age should be monitored over time for vitamin D levels?

 

AKESSON:

Probably you don’t necessarily need to have testing but probably those who are the oldest, who are the most frail –they are probably the ones who would benefit from having supplement with vitamin D. So it doesn’t make much difference when you are 55, for example, this is mainly for the very old.

 

SARAH:

Kristina Akesson, from Sweden, who reminded us that current recommendations are that seniors need 800 to 1000 IU/day of vitamin D to protect against fractures from falls.

 

 

SEGMENT 2: Drinking more fat-free and low-fat milk may decrease progression of knee osteoarthritis in women

 

PETER:

And the importance of dairy intake for bone health came up again in a large study published in Arthritis Care & Research. It reported that increasing fat-free or low-fat milk consumption may slow the progress of knee osteoarthritis in women. The authors found that eating a lot of cheese, on the other hand, was associated with an increase in knee osteoarthritis progression. Yogurt apparently had no impact either way.

 

 

SEGMENT 3: Gastric banding can overturn diabetes in non-obese patients

 

PETER:

Diabetes now: Gastric banding was apparently safe and effective as a method of correcting diabetes in patients who are overweight but not obese:

 

SARAH:

Yes that’s what a randomized study published in The Lancet Diabetes and Endocrinology showed. It included 50 patients with BMIs between 25 and 30, who’d been diagnosed with diabetes in the past five years. First author John Wentworth gave us the details:

 

WENTWORTH:

After two years, we found that the surgery indeed helped people lose about 11 kilos of body weight and that weight loss was strongly associated with diabetes remission. So that we found that half of the group that we gave the lap band to did not have diabetes after the surgery, whereas only two people in the control arm that received the best possible advice and medical management of their diabetes entered diabetes remission. So there was a really distinct and dramatic difference in terms of glucose control as a result of the weight loss from the surgery.

 

SARAH:

That was Dr. John Wentworth, from Monash University, in Melbourne, Australia. And he concluded:

 

WENTWORTH:

I think we need to reassess where we draw the line in terms of weight categories that is eligible for surgery to promote weight loss.

 

SARAH:

Dr.Wentworth added that the earlier patients had gastric banding, the better their chances of remission.

 

WENTWORTH:

The general message is the earlier the better and I think that if you have to operation before you get diabetes you’ll be even better off.

 

SARAH:

He said the study isn’t over –participants need to continue being monitored:

 

WENTWORTH:

Gastric band surgery does work in the right hands but you need to have good follow up and we must remember that diabetes is a lifelong disease and two years of remission or three years or remission is probably not worth the surgery whereas, if we can extend people to go five or ten years in diabetes remission, then that, I think, is going to make a big impact on their risk of the problems that diabetes causes.

 

 

SEGMENT 4: Circulating tumour cell count: strong prognostic and predictive marker in metastatic breast cancer

 

PETER: New data published in the Lancet Oncology confirm the prognostic value of circulating tumor cell (CTC) counts for patients with metastatic breast cancer…

 

SARAH:

Yes the authors collected data on nearly 2000 patients from 17 European centers and showed that the CTC count was a strong prognostic factor when used at the beginning of the metastatic disease. And it can also be used as a predictive marker of treatment outcome. Co-author Jean-Yves Pierga:

 

PIERGA:

If you assess the CTC level just after one cycle of chemotherapy, so that means after 3 or 4 weeks of treatment, if you have a clear decrease of the CTC level of the patient, you have nearly the same prognostic than a patient who had no CTC at the beginning. On the other hand, if a patient still has a high level of CTC just after one cycle of treatment, her prognostic remains clearly very poor.

 

SARAH:

That was Professor Jean-Yves Pierga from the Institut Curie, in Paris. He said checking for CTCs was much better for predicting treatment outcomes than the traditional serum markers currently used in practice. But it costs much more.  

 

PIERGA:

That’s the issue with the development of new markers… So of course it’s working, the level of evidence is really high, but what remains open and the evaluation is still ongoing, is: is it really worth the price?

 

SARAH:

Jean Yves Pierga from France. And, incidentally, MD-FM recently heard, from Cambridge University in the UK, that checking for circulating tumor DNA is also, potentially, a powerful way of predicting your patient’s progress.

 

 

SEGMENT 5: A successful weight-loss program tailored for male football fans

 

PETER:

A weight-loss program specifically tailored for male soccer fans, and delivered by trained coaches from professional football clubs, helped participants to lose significant amounts of weight…

 

SARAH:

Yes: among the 750 overweight or obese men involved in the program, at one year those randomized to the intervention had lost around 5 kilos more than to those put on a waiting list. Sally Wyke, co-author of the Lancet study:

 

WYKE:

We’re absolutely delighted: that difference is really big, it’s bigger than any other trials that have been designed for men and... What they really enjoyed was the football club setting... They knew that they were going to be with men just like them, they were going to have football in common, they were of a similar age, they knew that the men were all going to be quite big and they knew also that they were going to get an insider view of the football club.

 

SARAH:

That was Professor Sally Wyke, Deputy Director of the Institute of Health and Wellbeing, at Glasgow University, in the UK. And she explained that although male obesity is rising faster than female obesity, men are usually more reluctant to enter weight loss programs:

 

WYKE:

Studies have shown that the ways that men go about what we call “performing their masculinity” are certainly not to go to weight watchers and not to diet --dieting is something that is just not seen as a male thing. And yet, actually, many men are unhappy with their weight and they are keen to do something but what is offered isn’t appropriate for them. So we were able to develop an evidence-based, research-based program, which was gender-sensitized around what we thought would appeal to men.

 

SARAH:

Sally Wyke, from Scotland, whose team is now contemplating adapting the program to rugby-football fans!

 

 

IN BRIEF 1: Painkillers associated with increased risks of atrial fibrillation in the elderly

 

PETER:

Finally, in brief:  in adults who are 55 and older, the use of painkillers and anti-inflammatories may be linked to a higher risk of atrial fibrillation in the following 30 days. That’s according to a large population study published in the British Medical Journal Open. Previous studies had already shown a link between non-steroidal anti-inflammatory drugs and an increase in cardiovascular problems including myocardial infarctions.

 

 

IN BRIEF 2: Beans, peas, chickpeas and lentils can reduce LDL-cholesterol levels

 

PETER:

Eating one serving (130 grams) a day of beans, peas, chickpeas or lentils could reduce your LDL-cholesterol –and give you the corresponding protection from cardiovascular diseases –by five to six per cent. This is what the authors of a meta-analysis published in the Canadian Medical Association Journal report. And they add that this means that most people in North America would have to more than double their consumption of these foods, known collectively as “pulses,” to derive the cardiovascular benefits.

 

PETER:

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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