Coenzyme Q10 Supplementation in Reducing Inflammation: An Umbrella Review.

Objective: The purpose of this study was to review meta-analyses on the effectiveness of coenzyme Q10 supplementation in reducing inflammation through changes in the inflammatory biomarkers C-reactive protein, interleukin 6 (IL-6), and tumor necrosis factor alpha (TNF-α). Methods: An umbrella review of all published meta-analyses was performed. A PubMed search from January 1, 1980, to December 31, 2021, was conducted using the following search strategy: "(coenzyme q10 OR CoQ10 OR ubiquinone OR ubiquinol) AND (meta-analysis OR systematic review)". Only English language publications that provided quantitative statistical analysis on coenzyme Q10 supplementation and markers of inflammation were retrieved. Results: Seven meta-analyses were retrieved for inclusion in this umbrella review, and for all 3 inflammatory biomarker marker groups, the median intake of supplemental coenzyme Q10 was 200 mg/d for a median duration of 12 weeks. For C-reactive protein, only 3 of the 7 meta-analyses presented with statistically significant reductions, while statistically significant reductions in IL-6 and TNF-α for were observed in 4 of the 5 meta-analyses and 3 of the 4 meta-analyses, respectively. However, statistically significant heterogeneity was observed in the majority of these meta-analyses. Conclusion: The majority of included meta-analyses showed that coenzyme Q10 supplementation significantly decreased the proinflammatory cytokines IL-6 and TNF-α. However, heterogeneity was observed in the majority of these meta-analyses, and therefore the results should be interpreted with caution.

Effectiveness of Fiber Supplementation for Constipation, Weight Loss, and Supporting Gastrointestinal Function: A Narrative Review of Meta-Analyses.

OBJECTIVE: The purpose of this narrative review is to determine whether published meta-analyses support the use of fiber supplementation in the treatment of constipation, weight loss, and dietary support for gastrointestinal disorders such as irritable bowel syndrome (IBS) and inflammatory bowel disease. METHODS: A PubMed search from January 1, 1980, to July 31, 2019, was conducted with the following search strategy: (fiber OR fibre) AND (meta-analysis OR systematic review) AND (constipation OR body weight OR obesity OR irritable bowel syndrome OR inflammatory bowel disease). Meta-analyses that provided quantitative statistical analysis with a measured effect size were retrieved and accepted into this review. The following was extracted and entered into an Excel spreadsheet: number of publications included in the meta-analysis, number of total participants, fiber type and daily dose, pooled treatment effects for clinical endpoints, or summary relative risks. RESULTS: Eighteen meta-analyses support dietary fiber supplementation for patients with constipation, weight loss, and IBS, but the significant heterogeneity and publication bias undermine the support for using dietary fiber supplementation in these conditions. CONCLUSION: This narrative review of meta-analyses finds some benefits for recommending fiber supplementation to patients with constipation, obesity, and IBS, but significant heterogeneity and publication bias undermine this support.

The Benefits of Dietary Fiber Intake on Reducing the Risk of Cancer: An Umbrella Review of Meta-analyses.

OBJECTIVE: The purpose of this study was to review previously published meta-analyses on the effectiveness of dietary fiber on reducing the incidence of cancer. METHODS: An umbrella review of all published meta-analyses was performed. A PubMed search from January 1, 1980 to June 30, 2017 was conducted using the following search strategy: (fiber OR fibre) AND (meta-analysis OR systematic review) AND (cancer OR carcinoma). Only English-language publications that provided quantitative statistical analysis on cancer were retrieved. RESULTS: Nineteen meta-analyses comparing highest vs lowest dietary fiber intake were retrieved for inclusion in this umbrella review. There was a statistically significant reduction in the relative risk (RR) of colorectal, esophageal, gastric, and pancreatic cancer (RR = 0.52-0.88); however, statistically significant heterogeneity was observed in the meta-analyses on esophageal, gastric, and pancreatic cancer. There was a statistically significant reduction in the RR of breast cancer (RR = 0.85-0.93). CONCLUSION: This review suggests that those consuming the highest amounts of dietary fiber may benefit from a reduction in the incidence of developing colorectal cancer, and there also appears to be a small reduction in the incidence of breast cancer.

Dietary Fiber Intake and Type 2 Diabetes Mellitus: An Umbrella Review of Meta-analyses.

OBJECTIVE: The purpose of this study was to review previously published meta-analyses on the effectiveness of dietary fiber on type 2 diabetes. METHODS: An umbrella review of all published meta-analyses was performed. A PubMed search from January 1, 1980, to April 30, 2017, was conducted using the following search strategy: (fiber OR glucan OR psyllium) AND (meta-analysis OR systematic review). Only English-language publications that provided quantitative statistical analysis on type 2 diabetes, fasting blood glucose concentrations, or glycosylated hemoglobin were retrieved. RESULTS: Sixteen meta-analyses were retrieved for inclusion in this umbrella review. In the meta-analyses comparing highest versus lowest dietary fiber intake, there was a statistically significant reduction in the relative risk (RR) of type 2 diabetes (RR = 0.81-0.85), with the greatest benefit coming from cereal fibers (RR = 0.67-0.87). However, statistically significant heterogeneity was observed in all of these meta-analyses. In the meta-analyses of supplementation studies using ß-glucan or psyllium fibers on type 2 diabetic participants, statistically significant reductions were identified in both fasting blood glucose concentrations and glycosylated hemoglobin percentages. CONCLUSION: This review suggests that those consuming the highest amounts of dietary fiber, especially cereal fiber, may benefit from a reduction in the incidence of developing type 2 diabetes. There also appears to be a small reduction in fasting blood glucose concentration, as well as a small reduction in glycosylated hemoglobin percentage for individuals with type 2 diabetes who add ß-glucan or psyllium to their daily dietary intake.

Dietary Fiber Is Beneficial for the Prevention of Cardiovascular Disease: An Umbrella Review of Meta-analyses.

OBJECTIVE: The purpose of this study was to review previously published meta-analyses on the effectiveness of dietary fiber on cardiovascular disease. METHODS: An umbrella review of all published meta-analyses was performed. A PubMed search from January 1, 1980, to January 31, 2017, was conducted using the following search strategy: (fiber OR glucan OR psyllium OR fructans) AND (meta-analysis OR systematic review). Only English-language publications that provided quantitative statistical analysis on cardiovascular disease, lipid concentrations, or blood pressure were retrieved. RESULTS: Thirty-one meta-analyses were retrieved for inclusion in this umbrella review, and all meta-analyses comparing highest versus lowest dietary fiber intake reported statistically significant reductions in the relative risk (RR) of cardiovascular disease mortality (RR = 0.77-0.83), as well as the incidences of cardiovascular disease (RR = 0.72-0.91), coronary heart disease (RR = 0.76-0.93), and stroke (RR = 0.83-0.93). Meta-analyses on supplementation studies using ß-glucan or psyllium fibers also reported statistically significant reductions in both total serum and low-density lipoprotein cholesterol concentrations. CONCLUSION: This review suggests that individuals consuming the highest amounts of dietary fiber intake can significantly reduce their incidence and mortality from cardiovascular disease. Mechanistically, these beneficial effects may be due to dietary fibers' actions on reducing total serum and low-density lipoprotein cholesterol concentrations between 9.3 to 14.7 mg/dL and 10.8 to 13.5 mg/dL, respectively.

Therapeutic benefits of glutamine: An umbrella review of meta-analyses.

Glutamine may be an essential amino acid in patients with catabolic disease, as it has been demonstrated that circulating glutamine levels drop during critical illness and following major surgery; this may result in an increase in secondary infection risk, recovery time and mortality rates. However, there is much discrepancy in the literature with regards to randomized controlled studies, and therefore, the present study is an umbrella review of published meta-analyses, conducted to examine the effectiveness of glutamine's role as a therapeutic agent. A search using PubMed, Cochrane Library and CINAHL from January 1st, 1980 to December 31st, 2016 was conducted using the following strategy: 'Glutamine AND (meta-analysis OR systematic review)' and publications were retrieved, which provided quantitative statistical analysis of pooled treatment effects on the relative risks of infectious complications, mortality and length of stay in hospital. A total of 22 meta-analyses were entered into the current umbrella review. As displayed in Tables I, II and III, these analyses are split into three groups, based on different parameters. Of the 19 meta-analyses investigating the effects of infectious complications, 15 identified statistically significant reductions in complications, with relative risks ranging between 0.42 and 0.93. In addition, 12 of the 18 meta-analyses analyzing the length of hospital stays presented statistically significant reductions in the length of stay, with reductions ranging between 0.19 to 4.73 days. Only 4 of the 15 meta-analyses studying mortality effects identified statistically significant reductions in mortality with relative risks ranging between 0.64 and 1.28. Statistically significant heterogeneity was observed in 16 of 22 meta-analyses, and publication bias was observed in five of 11 meta-analyses. Glutamine supplementation for critically ill or surgical patients through parenteral or enteral routes appears to reduce the rate of hospital acquired infectious complications and shortening of the length of stay in hospital. Furthermore, glutamine supplementation appeared to reduce the rate of in-patient mortality, but the majority of meta-analyses did not reach statistical significance. However, researchers must appreciate the positive results with caution in light of the fact that there exists statistically significant heterogeneity for the majority of meta-analyses, and statistically significant publication bias in almost half.

Health Benefits of Dietary Whole Grains: An Umbrella Review of Meta-analyses.

OBJECTIVE: The purpose of this study is to review the effectiveness of the role of whole grain as a therapeutic agent in type 2 diabetes, cardiovascular disease, cancer, and obesity. METHODS: An umbrella review of all published meta-analyses was performed. A PubMed search from January 1, 1980, to May 31, 2016, was conducted using the following search strategy: (whole grain OR whole grains) AND (meta-analysis OR systematic review). Only English language publications that provided quantitative statistical analysis on type 2 diabetes, cardiovascular disease, cancer, and weight loss were retrieved. RESULTS: Twenty-one meta-analyses were retrieved for inclusion in this umbrella review, and all the meta-analyses reported statistically significant positive benefits for reducing the incidence of type 2 diabetes (relative risk [RR] = 0.68-0.80), cardiovascular disease (RR = 0.63-0.79), and colorectal, pancreatic, and gastric cancers (RR = 0.57-0.94) and a modest effect on body weight, waist circumference, and body fat mass. Significant reductions in cardiovascular and cancer mortality were also observed (RR = 0.82 and 0.89, respectively). Some problems of heterogeneity, publication bias, and quality assessment were found among the studies. CONCLUSION: This review suggests that there is some evidence for dietary whole grain intake to be beneficial in the prevention of type 2 diabetes, cardiovascular disease, and colorectal, pancreatic, and gastric cancers. The potential benefits of these findings suggest that the consumption of 2 to 3 servings per day (~45 g) of whole grains may be a justifiable public health goal.

Therapeutic Benefits of l-Arginine: An Umbrella Review of Meta-analyses.

OBJECTIVE: l-Arginine is a semi-essential amino acid that is the substrate for nitric oxide production by vascular endothelial and immune cells. Nitric oxide production by these cells is essential for both blood pressure regulation and immune regulation. However, there is much discrepancy in the literature when it comes to randomized controlled studies, and so this umbrella review of published meta-analyses was performed to examine the efficacy of l-arginine's role as a therapeutic agent. METHODS: There was an overall search of the literature from January 1, 1980 through December 31, 2015 of three separate databases-PubMed, Cochrane Library, and Cumulative Index to Nursing and Allied Health Literature-using the following search strategy: (arginine) AND (meta-analysis OR systematic review). Only English language publications were retrieved that provided quantitative statistical analysis of outcomes on blood pressure and immune function. RESULTS: The 7 meta-analyses that were included in this umbrella review reported significant positive benefits for reducing systolic and diastolic blood pressure in hypertensive adults by 2.2 to 5.4 mm Hg and 2.7 to 3.1 mm Hg, respectively, reducing diastolic blood pressure in pregnant women with gestational hypertension by 4.9 mm Hg, and reducing the length of stay in the hospital for surgical patients; in addition, 2 of the 3 meta-analyses indicated a 40% reduction in the incidence of hospital-acquired infections. However, these positive results should be considered with caution because statistically significant heterogeneity was observed in 5 of the 7 meta-analyses. CONCLUSIONS: Some evidence appears to support the benefit of l-arginine supplementation for reducing systolic and diastolic blood pressure in hypertensive adults and reducing the incidence of hospital-acquired infections and the length of stay in the hospital for surgical patients. Given the limitations of the included studies, interpretations should be made with caution.

Betaine supplementation decreases plasma homocysteine in healthy adult participants: a meta-analysis.

OBJECTIVE: Betaine supplementation has been shown to be an effective agent for decreasing plasma homocysteine in healthy adults. Studies in healthy volunteers show that 6 g/d of betaine lowers plasma homocysteine concentrations by 5% to 20%. The purpose of this study was to perform a meta-analysis of randomized placebo-controlled trials that used daily betaine supplementation to identify the range in betaine's effects on lowering homocysteine. METHODS: Five randomized controlled trials published between 2002 and 2010 were identified using MEDLINE and a manual search. All 5 studies used health adult participants who were supplemented with at least 4 g/d of betaine for between 6 and 24 weeks. A meta-analysis was carried out using a random-effects model, and the overall effect size was calculated for changes in plasma homocysteine. RESULTS: The pooled estimate of effect for betaine supplementation on plasma homocysteine was a reduction of 1.23 µmol/L, which was statistically significant (95% confidence interval, - 1.61 to - 0.85; P = .01). CONCLUSION: Supplementation with at least 4g/d of betaine for a minimum of 6 weeks can lower plasma homocysteine.

Correlation of preadmission organic chemistry courses and academic performance in biochemistry at a midwest chiropractic doctoral program.

PURPOSE: Organic chemistry has been shown to correlate with academic success in the preclinical years of medicine, dentistry, and graduate physiology. The purpose of this study is to examine the relationship between undergraduate organic chemistry grades and first-semester biochemistry grades at a Midwest chiropractic doctoral program. METHODS: Students enrolled in a first-semester biochemistry course who had completed the prerequisite courses in organic chemistry offered at this same institution were entered into the study. The total grade for each of the three courses was calculated using the midterm and final exam raw scores with a weighting of 50% each. Analysis consisted of obtaining correlation coefficients between the total grades of organic 1 with biochemistry and organic 2 with biochemistry. Using the biochemistry total grade, the students were divided into quartiles and course grades for both organic chemistry 1 and 2 were calculated. RESULTS: For the 109 students in the study, the correlation coefficient between the biochemistry and organic chemistry 1 and biochemistry and organic chemistry 2 courses was r = 0.744 and r = 0.725, respectively. The difference in organic chemistry grades between those in the first and fourth quartiles was 63.2% and 86.9% for organic chemistry 1 (p < .001) and 60.9% and 79.4% for organic chemistry 2 (p < .001). CONCLUSION: This study shows that organic chemistry can be used as an indicator of future academic success in a chiropractic biochemistry course. Knowledge of such a relationship could prove useful to identify students who may potentially run into academic difficulty with first-year biochemistry.

Male and female differences in variability with estimating body fat composition using skinfold calipers.

OBJECTIVE: Obesity is a major health problem in the United States. Skinfold measurements are routinely used in assessing outcomes in the management of obesity. The purpose of this study was to determine if sex differences in skinfold measurements would be apparent in intraobserver and interobserver reliability as well as validity when compared with bioelectrical impedance analysis (BIA) measurements. METHODS: To determine intraobserver and interobserver variability, 71 male and 45 female subjects (chiropractic students) were assessed by 4 separate observers who each took 4 separate skinfold measurements. Bioelectrical impedance analysis was later conducted using a foot-to-foot technique. The average sums of the skinfold measurement and their standard deviations were calculated, and correlation coefficients between skinfold measurements and BIA techniques for male and female subjects were plotted separately to assess validity. RESULTS: Men tended to have greater amounts of intraobserver and interobserver variability when compared with women, but these differences were not significant. In regard to validity, there was no significant difference between skinfold measurements and BIA when estimating percentage body fat for men; but the difference was significant for women, where BIA underestimated by 3.4%. CONCLUSIONS: The differences observed in variability could be explained by the fact that there is a difference in skinfold compressibility between men and women. Physicians who are using skinfold calipers for body composition assessment should take into account these small potential differences when evaluating total body fatness.

Educating chiropractic students about intraobserver and interobserver variability through the use of skinfold measurement.

PURPOSE: Skinfold measurements taken by novice observers are fraught with high rates of intraobserver variability and even higher rates of interobserver variability, and therefore having students collect and analyze skinfold measurements is an ideal way to present the concepts of both measurement and physiological variability. METHODS: Students in a 1st trimester clinical biochemistry laboratory were assembled into groups of four, and within each group the students were asked to volunteer to be either a subject, a data recorder, or one of two observers. To demonstrate intraobserver versus interobserver variability the subject was assessed by four separate observers who each took four separate skinfold measurements. The skinfold measurement obtained from each separate observation was based on the sum of four skinfold sites. The average sums of the skinfold measurement (in mm) and standard deviations were calculated and posted for postlaboratory discussion. RESULTS: Skinfold measurements were taken on 76 1st-trimester chiropractic students (46 males and 30 females). The average intraobserver and interobserver variability across all 76 participants was 4.8 +/- 2.3 mm and 10.0 +/- 6.3 mm, respectively, representing a twofold increase in variability, which was statistically significant (p < .0001). The noticeable differences between intraobserver and interobserver variability provided a great back drop for postlab discussion, which was the intended purpose of performing this demonstration project. CONCLUSION: Measuring skinfold thickness can prove to be a useful and inexpensive method for easily and safely demonstrating the concepts of variability to students.

High-dose folic acid supplementation effects on endothelial function and blood pressure in hypertensive patients: a meta-analysis of randomized controlled clinical trials.

OBJECTIVE: Folic acid supplementation has been shown to be an effective agent for improving endothelial function, a prognostic factor for cardiovascular disease; but its effects on systolic and diastolic blood pressure in hypertensive individuals has been met with mixed results. Therefore, the purpose of this study was to provide a comprehensive meta-analysis of randomized controlled trials to investigate the effect of high-dose folic acid supplementation on blood pressure and endothelial function in hypertensive patients. METHODS: Twelve randomized controlled trials published between 1970 and December 2007 were identified using Medline and a manual search. All 12 studies used hypertensive subjects who were supplemented with at least 5000 mug/d of folic acid for between 2 and 16 weeks. Three separate meta-analyses were carried out using a random-effects model, and the overall effect sizes were calculated for changes in systolic and diastolic blood pressures and for changes in endothelial function as measured through the percentage of change in flow-mediated dilation. RESULTS: The pooled estimate of effect of folic acid supplementation on systolic and diastolic blood pressure was -2.03 mm Hg (95% confidence interval [CI], -3.63 to -0.43; P = .04) and 0.01 mm Hg (95% CI, -1.12 to 1.13; not significant), respectively. The pooled estimate of effect of folic acid supplementation on change in flow-mediated dilation was 1.61% (95% CI, 1.27 to 1.96; P = .000). CONCLUSION: Based upon the studies used in this meta-analysis, supplementation with at least 5000 mug/d of folic acid, for a minimum of 6 weeks, can lower systolic blood pressure slightly; but the real clinical benefit is achieved through improved endothelial function.

Vitamin C supplementation lowers serum low-density lipoprotein cholesterol and triglycerides: a meta-analysis of 13 randomized controlled trials.

OBJECTIVE: Vitamin C has been shown to be an effective therapeutic for reducing total serum cholesterol, but epidemiologic studies have determined that low-density lipoprotein (LDL) cholesterol and high-density lipoprotein (HDL) cholesterol are actually better predictive measures of coronary heart disease risk. Therefore, the purpose of this study was to provide a comprehensive meta-analysis of randomized controlled trials to investigate the effect of vitamin C supplementation on LDL and HDL cholesterol as well as triglycerides in patients with hypercholesterolemia. METHODS: Thirteen randomized controlled trials published between 1970 and June 2007 were identified using Medline and a manual search. From the 13 trials, 14 separate group populations with hypercholesterolemia and who were supplemented with at least 500 mg/d of vitamin C for between 3 and 24 weeks were entered into the meta-analysis. This meta-analysis used a random-effects model; and the overall effect sizes were calculated for changes in LDL and HDL cholesterol, as well as triglyceride concentrations. RESULTS: The pooled estimate of effect for vitamin C supplementation on LDL and HDL cholesterol was -7.9 mg/dL (95% confidence interval [CI], -12.3 to -3.5; P = .000) and 1.1 mg/dL (95% CI, -0.2 to 2.3; not significant), respectively. The pooled estimate of effect for vitamin C supplementation on triglycerides was -20.1 mg/dL (95% CI, -33.3 to -6.8; P < .003). CONCLUSION: Supplementation with at least 500 mg/d of vitamin C, for a minimum of 4 weeks, can result in a significant decrease in serum LDL cholesterol and triglyceride concentrations. However, there was a nonsignificant elevation of serum HDL cholesterol.

The efficacy of vitamin C supplementation on reducing total serum cholesterol in human subjects: a review and analysis of 51 experimental trials.

OBJECTIVE: Observational studies in humans have shown an inverse relationship between plasma vitamin C concentration and total serum cholesterol. However, experimental studies have shown inconsistent results regarding the ability of vitamin C to reduce total serum cholesterol. METHODS: Published reports of trials studying the effects of vitamin C on serum lipids were identified by a search of Medline from 1966 to 2004. Data from 51 experimental studies comprising of 1666 pooled subjects were selected for analysis. RESULTS: A very strong negative association was observed between baseline total serum cholesterol and the percent change in cholesterol (r = -0.585, p<0.001). When subjects were divided into 4 groups based on their baseline total serum cholesterol levels, the following weighted mean percent changes in cholesterol from baseline were observed: normal cholesterol (<199mg/dl): 0.91+/-6.8% (n=508); borderline high cholesterol (200-239mg/dl): 3.90+/-5.78% (n=605); high cholesterol (240-279mg/dl): 11.40+/-7.96% (n=300); severe cholesterol (>280mg/dl): 14.30+/-8.36% (n=253). A significant inverse relationship was found between the baseline plasma vitamin C concentrations and mean percent change in total cholesterol from baseline (r = -0.500, p<0.005). It was also observed that the high and severe baseline cholesterol groups possessed lower baseline plasma vitamin C concentrations than those in the normal cholesterol groups (0.79 and 0.55 versus 1.24 mg/dl respectively). CONCLUSION: This finding strengthens the hypothesis that the cholesterol lowering and cardio-protective benefit of vitamin C supplementation may be in its ability to elevate plasma vitamin C concentrations in those patients who initially possess lower than normal vitamin C plasma concentrations.

Is vitamin C an effective antihypertensive supplement? A review and analysis of the literature.

OBJECTIVE: Hypertension is a common condition with high mortality from associated diseases. Epidemiological evidence suggests that a dietary deficiency of vitamin C may be a risk factor for hypertension. However the literature on vitamin C interventional trials appears divided on the efficacy of vitamin C utilization clinically. METHODS: A literature search and review of published trials using vitamin C in treating patients with hypertension was undertaken. Relevant references were located using MEDLINE (1966-2005) and the bibliographies of located articles. RESULTS: Thirteen trials making up 14 separate groups were identified and analyzed providing a pooled population of 284 hypertensive patients (52% female), with a weighted mean age of 58.8 +/- 9.5 years. Median vitamin C dose and study intervention duration was 500mg/day and 6 weeks respectively. The weighted mean baseline and post treatment systolic blood pressures across all 14 groups were 149.6 +/- 11.1 and 145.7 +/- 11.0 mmHg respectively. This represented a systolic blood pressure decrease of 3.9 mmHg. Seven of the 14 groups ascertained statistically significant reductions (p < .05) in systolic blood pressures. However only 2 of the 14 groups found significant reductions in diastolic blood pressure. The weighted mean baseline and post treatment diastolic blood pressures across all 14 groups were 84.6 +/- 4.4 and 82.5 +/- 4.1 mmHg respectively. This represented a diastolic blood pressure decrease of 2.1 mmHg. CONCLUSION: Vitamin C supplementation in hypertensive patients appears to possess modest effects on reducing systolic blood and diastolic blood pressure.

A review of studies of garlic (Allium sativum) on serum lipids and blood pressure before and after 1994: does the amount of allicin released from garlic powder tablets play a role?

OBJECTIVE: To identify studies measuring garlic powder tablets effects on systolic and diastolic blood pressure and to investigate if studies published prior to January 1994 would perform better than those published later. METHODS: Using MEDLINE (January 1966 through December 2004) studies involving human subjects that examined the effect of garlic (Allium sativum) on serum lipids and blood pressure were obtained. Studies that were conducted using garlic in the form of garlic powder tablets were included in the data extraction. Correlation coefficients were calculated for total serum cholesterol, systolic and diastolic blood pressure with respect to date of publication. Trials published prior to January 1994 were placed into an "earlier" group and compared to the "latter" group of studies published from January 1994 onward. RESULTS: Eighteen trials were identified whereupon the inverse associations between total serum cholesterol, systolic and diastolic blood pressures with respect to time of publication were correlated (-0.614, -0.627, and -0.587 respectively, p < 0.05). No significant associations were observed between systolic and diastolic blood pressure with respect to total serum cholesterol (0.388 and 0.431 respectively). The following differences between the earlier and later groups were observed for total serum cholesterol (31.4 +/- 19.0 vs. 3.5 +/- 5.8 mg/dl, p = .004); systolic blood pressure (11.0 +/- 9.2 vs. 2.0 +/- 4.4 mmHg, p = .133) and diastolic blood pressure (5.8 +/- 3.4 vs. 0.9 +/- 2.4 mmHg, p = .018). CONCLUSIONS: Publications published prior to January 1994 performed better than those published after January 1994, suggesting that allicin may be responsible for the antihypertensive effects of garlic powder tablets. However, a lack of correlation between changes in total serum cholesterol and blood pressure suggests that other organo-sulfur compounds may also play a role in the antihyper-tensive mechanisms of garlic.

A model to aid in the prediction of discharge location for stroke rehabilitation patients.

OBJECTIVE: To determine which demographic and medical factors recorded on admission to a rehabilitation unit best predict discharge accommodation outcomes. DESIGN: Retrospective chart review. SETTING: Inpatient rehabilitation unit in an academic hospital in southwestern Ontario, Canada. PARTICIPANTS: One hundred four stroke patients (54 women, 50 men; mean age, 72.0y) admitted to the rehabilitation unit over a 4-year period. INTERVENTIONS: All patients underwent evaluations by the physical therapy, occupational therapy, social work, speech pathology, and psychology departments. Patients were divided into 2 groups: (1) no change in premorbid accommodation and (2) change in premorbid accommodation. MAIN OUTCOME MEASURES: Demographic, clinical, and housing information (premorbid, discharge) and functional data (FIM trade mark instrument, Chedoke-McMaster Stroke Assessment [CMSA] Impairment Inventory, Berg Balance Scale [BBS]) were recorded for each patient. RESULTS: Of 104 patients, 24 were discharged with a change in premorbid accommodation. Change in discharge location was significantly associated with age, gender, and the presence of premorbid social support (P<.01), but not with type of premorbid living arrangement. Statistically significant differences were noted between total FIM scores (P<.001), BBS scores (P<.001), and the postural component of the CMSA Impairment Inventory (P<.03). A logistic regression model, predicting 67% of the variance, was created to predict discharge accommodations. CONCLUSIONS: Patients admitted to the rehabilitation unit can be scored to obtain their predicted chance of being discharged with a change from their premorbid accommodations. The equation is relatively easy to calculate and is based on data that are commonly collected in rehabilitation.

The incidence and consequences of falls in stroke patients during inpatient rehabilitation: factors associated with high risk.

OBJECTIVES: To determine the incidence of falls on a stroke rehabilitation unit; to assess the frequency and nature of injuries; and to identify risk factors predictive of falls, functional outcomes, and impairments. DESIGN: Retrospective cohort study. SETTING: An inpatient stroke rehabilitation unit. PARTICIPANTS: Two hundred thirty-eight consecutive stroke patient admissions. INTERVENTIONS: Incident reports completed on patients who experienced a fall while on the unit were reviewed and resultant injuries categorized (abrasions, lacerations, fractures). MAIN OUTCOME MEASURES: Stroke impairments and admission functional assessments, FIM instrument, Berg Balance Scale (BBS), and Chedoke-McMaster (CM) Stroke Impairment Inventory of fallers were compared with nonfallers. RESULTS: Of the 238 patients, 88 (37%) experienced at least 1 fall, and almost half of these (45 patients [19%]) experienced at least 2 falls. A total of 180 falls were reported over the 5-year period. Of the 180 reported falls, 33% occurred when patients were using their wheelchairs. Injuries occurred in 22% of the reported falls. These consisted of contusions (49%) and abrasions (41%), primarily of the upper (30.8%) and lower (25.6%) extremities. Only 1 fracture was reported. Fallers tended to have lower admission BBS scores (50% of patients with a score <30 fell vs 18% with a score >30, P <.01) and a lower score on the admission arm, leg, and foot components of the CM (P <.05). Patients who fell were also more likely to be apraxic (P <.014) and suffer from cognitive deficits (P <.01). Repeat fallers had lower admission FIM scores (P <.01) when compared with nonfallers. CONCLUSION: Although patients undergoing stroke rehabilitation experienced a significant number of falls, the incidence of serious injury was small. Patients who experienced at least 1 fall had significantly lower BBS, FIM, and CM arm, leg, and foot scores compared with nonfallers. These data suggest that groups of stroke patients who are at risk for falls within the rehabilitation setting can be identified by using a variety of impairment and functional assessments. This information may be potentially useful for designing interventions directed at reducing fall frequency among stroke survivors.