Milk and other dairy foods and risk of hip fracture in men and women.

The role of dairy foods for hip fracture prevention remains controversial. In this study, among US men and women, a glass of milk per day was associated with an 8% lower risk of hip fracture. This contrasts with a reported increased risk with higher milk intake in Swedish women. INTRODUCTION: The purpose of this study was to examine whether higher milk and dairy food consumption are associated with risk of hip fracture in older adults following a report of an increased risk for milk in Swedish women. METHODS: In two US cohorts, 80,600 postmenopausal women and 43,306 men over 50 years of age were followed for up to 32 years. Cox proportional hazards models were used to calculate the relative risks (RR) of hip fracture per daily serving of milk (240 mL) and other dairy foods that were assessed every 4 years, controlling for other dietary intakes, BMI, height, smoking, activity, medications, and disease diagnoses. RESULTS: Two thousand one hundred thirty-eight incident hip fractures were identified in women and 694 in men. Each serving of milk per day was associated with a significant 8% lower risk of hip fracture in men and women combined (RR = 0.92, 95% confidence interval (CI) 0.87 to 0.97). A suggestive inverse association was found for cheese in women only (RR = 0.91, CI 0.81 to 1.02). Yogurt consumption was low and not associated with risk. Total dairy food intake, of which milk contributed about half, was associated with a significant 6% lower risk of hip fracture per daily serving in men and women (RR = 0.94, CI 0.90 to 0.98). Calcium, vitamin D, and protein from non-dairy sources did not modify the association between milk and hip fracture, nor was it explained by contributions of these nutrients from milk. CONCLUSIONS: In this group of older US adults, higher milk consumption was associated with a lower risk of hip fracture.

Association between Dietary Sodium Intake and Cognitive Function in Older Adults.

OBJECTIVE: To examine the association of dietary sodium intake with cognitive function in community-dwelling older adults. DESIGN: Cross-sectional study. SETTING: Southern California community. PARTICIPANTS: White men (n=373) and women (n=552), aged 50-96 years from the Rancho Bernardo Study, a longitudinal study of cardiovascular disease risk factors and healthy aging. MEASUREMENTS: During the 1992-1996 research clinic visit, a food frequency questionnaire was used to determine daily sodium intake; cognitive function was assessed with Trails Making Test, part B (Trails B), Mini-Mental State Exam (MMSE), and Verbal Fluency Test (VFT); and medical, clinical and demographic information was obtained. Linear regression was used to assess the association between calorie-adjusted sodium intake and cognitive test scores with adjustment for demographic, behavioral and health measures. Logistic regression examined the odds of having cognitive impairment by sodium intake. RESULTS: Lower sodium intake was associated with poorer performance on Trails B (p=0.008) and MMSE (p=0.003) after controlling for age, sex, and education. Associations did not differ by sex, but there was a significant interaction by age for the Trails B: older (≥80 years), but not younger, adults showed worse performance with lower sodium intake (p=0.03). Associations remained significant after additional adjustment for smoking, alcohol intake, exercise, body weight, cardiovascular risk factors, kidney function, diuretic medication use, and diet quality. Lower daily sodium intake was associated with increased odds of cognitive impairment on the MMSE (score < 26; OR per SD decrease = 1.12, 95% CI 1.08, 1.16). Concluson: Lower sodium intake was associated with worse cognitive function in older community-dwelling adults. For the maintenance of cognitive health, older adults may be advised to avoid very low sodium diets.

Protein intake and risk of hip fractures in postmenopausal women and men age 50 and older.

In this study, we followed postmenopausal women and men aged 50 and above for up to 32 years and found no evidence that higher protein intake increased the risk of hip fracture. Protein intake from specific sources was inversely associated with risk, but these associations appeared to differ by gender. INTRODUCTION: We examined the association between intakes of total and specific sources of protein and hip fracture risk in postmenopausal women and men over 50 years of age. Our hypothesis was that a higher protein intake would not be associated with a higher risk of hip fractures. METHODS: In this analysis, we followed 74,443 women in the Nurses' Health Study between 1980 and 2012 and 35,439 men from the Health Professionals Follow-up Study between 1986 and 2012. Health and lifestyle information and hip fractures were self-reported on biennial questionnaires. Protein was assessed approximately every 4 years with a food frequency questionnaire. Relative risks (RR) were computed for hip fracture by quintiles of total, animal, dairy, and plant protein intakes using Cox proportional hazard models, adjusting for potential confounders. RESULTS: During follow-up, we ascertained 2156 incident hip fractures in women and 595 fractures in men. Among men, we observed significant inverse associations for each 10 g increase of total protein (RR = 0.92, 95% CI = 0.85-0.99) and animal protein (RR = 0.91, 95% CI = 0.85-0.98) intakes. Total and animal proteins were not significantly associated with hip fractures in women. Both plant (RR = 0.88, 95% CI 0.79-0.99 per 10 g) and dairy protein (RR = 0.92, 95% CI 0.86-0.97) were associated with significantly lower risks of hip fracture when results for men and women were combined. None of these associations were modified by BMI, smoking, physical activity, age, or calcium intake. CONCLUSION: We found no evidence that higher protein intake increases risk of hip fracture in these Caucasian men and women. Protein intake from specific sources was inversely associated with risk, but these associations appeared to differ by gender.

Healthful dietary patterns and long-term weight change among women with a history of gestational diabetes mellitus.

BACKGROUND/OBJECTIVE: Diet represents a key strategy for the prevention of obesity and type 2 diabetes among women with a history of gestational diabetes mellitus (GDM), although effective dietary patterns to prevent weight gain in the long term are largely unknown. We sought to evaluate whether improvement in overall diet quality is associated with less long-term weight gain among high-risk women with prior GDM. SUBJECTS/METHODS: Women with a history of GDM (N=3397) were followed from 1991 to 2011, or until diagnosis of type 2 diabetes or other chronic disease. Usual diet was assessed via food frequency questionnaire every 4 years from which we calculated the Alternative Healthy Eating Index (aHEI-2010), Alternate Mediterranean Diet (AMED) and Dietary Approaches to Stop Hypertension (DASH) dietary pattern scores. Weight, lifestyle and health-related outcomes were self-reported every 2 years. We estimated the change in dietary score with change in body weight using linear regression models adjusting for age, baseline body mass index (BMI), baseline and simultaneous change in physical activity and smoking status and other risk factors. RESULTS: Women were followed up to 20 years, gaining an average 1.9 kg (s.d.=7.0) per 4-year period. Women in the highest quintile (Q5) of diet change (most improvement in quality) gained significantly less weight per 4-year period than the lowest quintile (Q1; decrease in quality), independent of other risk factors (4-year weight change, aHEI-2010: Q5=1.30 kg vs Q1=3.27 kg; AMED: Q5=0.94 kg vs Q1=2.56 kg, DASH: Q5=0.64 kg vs Q1=2.75 kg). Significant effect modification by BMI (p-interactions <0.001) indicated a greater magnitude of weight change among women with a higher baseline BMI for all three patterns. CONCLUSIONS: Increased diet quality was associated with less weight gain, independent of other lifestyle factors. Post-partum recommendations on diet quality may provide one strategy to prevent long-term weight gain in this high-risk group.

Mediterranean diet and mortality risk in metabolically healthy obese and metabolically unhealthy obese phenotypes.

BACKGROUND: The Mediterranean diet has been consistently associated with reduced mortality risk. Few prospective studies have examined whether the benefits from a Mediterranean diet are equally shared by obese individuals with varying metabolic health. OBJECTIVE: The objective of this study was to investigate the association between Mediterranean diet, metabolic phenotypes and mortality risk in a representative obese US population. METHODS: Data from 1739 adults aged 20-88 years were analyzed from participants of the National Health and Nutrition Examination Survey III, 1988-1994 followed up for deaths until 31 December 2011 in a prospective cohort analysis. Mediterranean Diet Scores (MDS) were created to assess the adherence to Mediterranean diet. Participants were classified as metabolically healthy obese (MHO) phenotype (0 or 1 metabolic abnormality) or metabolically unhealthy obese (MUO) phenotype (two or more metabolic abnormalities), based on high glucose, insulin resistance, blood pressure, triglycerides, C-reactive protein and low high-density lipoprotein cholesterol. RESULTS: The MHO phenotype (n=598) was observed in 34.8% (s.e., 1.7%) of those who were obese (mean body mass index was 33.4 and 34.8 in MHO and MUO phenotypes, respectively). During a median follow-up of 18.5 years, there were 77 (12.9%) and 309 (27.1%) deaths in MHO and MUO individuals, respectively. In MHO individuals, the multivariable-adjusted hazard ratio (HR) of all-cause mortality in the highest tertile compared with the first tertile of MDS was 0.44 (95% confidence interval (CI), 0.26-0.75; P for trend <0.001), after adjustment for potential confounders. A five-point (1 s.d.) increment in the adherence to MDS was associated with a 41% reduction in the risk of all-cause mortality (HR, 0.59; 95% CI, 0.37-0.94). Similar findings were obtained when we restricted our analyses to those with or without prevalent diabetes mellitus and hypertension. We did not observe mortality risk reduction in either individuals with MUO phenotype or all obese participants combined. CONCLUSIONS: Adherence to a Mediterranean dietary pattern appears to reduce mortality in the MHO phenotype, but not among the MUO phenotype in an obese population.

Dietary patterns and risk of hip fractures in postmenopausal women and men over 50 years.

UNLABELLED: We followed 74,540 postmenopausal women and 35,451 men above age 50 for up to 30 years. Neither the prudent pattern, characterized by higher intakes of whole grains, fruits, and vegetables, nor the Western pattern, characterized by higher intakes of red/processed meats, and refined grains were associated with hip fracture risk. INTRODUCTION: We examined the association between predominant dietary patterns and risk of hip fractures in postmenopausal women and men over 50 years. METHODS: We used data from 74,540 women in the Nurses' Health Study followed between 1980 and 2010, and 35,451 men from the Health Professionals Follow-up Study followed between 1986 and 2012 for this analysis. Health and lifestyle information was assessed every 2 years. Diet was assessed approximately every 4 years with a food frequency questionnaire. Two major dietary patterns were previously derived using principal component analysis. The prudent pattern is characterized by higher intakes of fruits, vegetables, whole grains, and poultry, and the Western pattern is characterized by higher intakes of red and processed meats, sweets, and refined grains. We computed relative risks (RR) for hip fracture by dietary pattern scores using Cox proportional hazards models, adjusting for potential confounders. RESULTS: During follow-up, there were 1891 hip fractures in women and 596 in men. No association was observed between the prudent or Western pattern and risk of hip fractures in either men or women. We also did not find an association among lean (body mass index (BMI) <25) or overweight (BMI ≥25) individuals or among those with higher or lower levels of physical activity. CONCLUSION: Neither the prudent nor the Western dietary pattern was associated with risk of hip fractures in postmenopausal women or men over 50 years of age.

Amiodarone-induced thyroid dysfunction in the Hong Kong Chinese population.

OBJECTIVE: To determine the frequency, risk factors, clinical features, and management of amiodarone-induced thyroid dysfunctions. DESIGN: Retrospective study. SETTING: A regional hospital in Hong Kong. PATIENTS: Patients who had been prescribed amiodarone for at least 6 months from 1 October 2005 to 30 September 2007. RESULTS: A total of 390 patients (mean age, 70 years; standard deviation, 9 years; 54% male) with a median follow-up of 43 (interquartile range, 25-69) months were studied. Hypothyroidism developed in 87 (22%) of the patients (mean age, 72 years; standard deviation, 7 years; 56% male) and thyrotoxicosis in 24 (6%) of the patients (65 years; 11 years; 54% male). Increased baseline thyrotropin (thyroid-stimulating hormone) level appeared to be predictive of amiodarone-induced hypothyroidism, in which a thyroid-stimulating hormone level of 4 mIU/L or above was associated with a 4.7-fold increase in the risk (95% confidence interval, 1.9-11.7; P<0.001). Compared with those who remained euthyroid on amiodarone, thyrotoxicosis developed in younger patients. In these patients, the classical symptoms of thyroid dysfunction were frequently absent, although worsening of underlying arrhythmias, their cardiac condition, weight loss, and over-warfarinisation were suggestive of amiodarone-induced thyrotoxicosis. In both amiodarone-induced thyrotoxicosis and hypothyroidism, the disease course was benign. Patients with the former showed a good response to anti-thyroid drugs and steroid therapy. CONCLUSIONS: Amiodarone-induced thyroid dysfunction is common among our population. As the clinical presentations are usually vague and atypical, regular biochemical monitoring of thyroid function is warranted, particularly in patients with elevated baseline thyroid-stimulating hormone level. The disease course of amiodarone-induced thyrotoxicosis is usually benign and remits with timely administration of anti-thyroid medications, with or without corticosteroids.

48 weeks pegylated interferon alpha-2a is superior to 24 weeks of pegylated interferon alpha-2b in achieving hepatitis B e antigen seroconversion in chronic hepatitis B infection.

BACKGROUND/AIM: Although 48-week therapy with pegylated-interferons has been shown to be effective for the treatment of chronic hepatitis B virus infection, the efficacy of a shorter duration of therapy with pegylated interferons is unknown. METHOD: We reviewed 53 hepatitis B e antigen positive Chinese patients treated with 48 weeks of pegylated interferon alpha-2a or 24 weeks of pegylated interferon alpha-2b. Sustained virological response was defined as hepatitis B e antigen seroconversion and hepatitis B virus DNA <10(5) copies/mL at week 72. RESULTS: Twenty-nine patients were treated with 48 weeks of pegylated-interferon-alpha-2a and 24 patients with 24 weeks of pegylated-interferon-alpha-2b. At the end-of-therapy, hepatitis B e antigen seroconversion and hepatitis B virus DNA <10(5) copies/mL were similar between the two groups of patients [9/29 (31.0%) vs. 2/24 (8.3%), respectively, P = 0.09]. At week 72, 10 of the 29 patients (34.5%) treated with 48 weeks of pegylated-interferon-alpha-2a compared with two of the 24 patients (8.3%) treated with 24 weeks of pegylated-interferon-alpha-2b had sustained virological response (P = 0.04). By logistic analysis, 48 weeks of pegylated-interferon-alpha-2a was independently associated with sustained virological response (P = 0.04 adjusted hazards-ratio 9.37). CONCLUSION: Further studies are required to determine the optimal duration of therapy with pegylated interferons in chronic hepatitis B.

Dietary patterns and risk of nonfatal acute myocardial infarction in Costa Rican adults.

OBJECTIVE: To investigate the association between dietary patterns and risk of a first nonfatal acute myocardial infarction (MI) in Costa Rican adults. DESIGN: Population-based case-control study. SUBJECTS: A total of 496 incident MI cases and 518 population-based randomly selected controls matched to the cases by age (+/-5 years), gender, and county of residence. Subjects were interviewed with a validated food frequency questionnaire. Dietary patterns were identified by factor analysis. Odds ratios (OR) and 95% confidence intervals (CI) were obtained using multivariate conditional logistic regression adjusted for several recognized risk factors for MI. RESULTS: Two diet patterns were identified, 'vegetable' characterized by increased intake of vegetables and fruits, and 'staple', characterized by an increased use of palm oil for cooking, and intake of refined grains (mostly white rice and white bread), legumes, coffee, added sugar, and red meat. Compared to the lowest quintile of the staple diet pattern, the highest quintile was associated with an increased risk of MI (OR: 3.70, 95% CI: 2.30-5.97). Adjusting for potential confounders did not change the results (OR: 3.53, 95% CI: 1.98-6.31). Consistently, an increasing staple pattern score was associated with lower HDL cholesterol (P for trend <0.02) and alpha-linolenic acid in adipose tissue (P for trend <0.0001). The vegetable pattern was not associated with MI. CONCLUSIONS: The staple dietary pattern of Costa Rican adults is associated with low plasma HDL cholesterol, low alpha-linolenic acid in adipose tissue, and increased risk of MI.

Dietary patterns and the risk of coronary heart disease in women.

BACKGROUND: Although substantial information on individual nutrients or foods and risk of coronary heart disease (CHD) is available, little is known about the role of overall eating pattern. METHODS: Using dietary information from a food frequency questionnaire in 1984 from the Nurses' Health Study, we conducted factor analysis and identified 2 major dietary patterns-"prudent" and "Western"-and calculated factor scores of each pattern for individuals in the cohort. We used logistic regression to examine prospectively the associations between dietary patterns and CHD risk among 69 017 women aged 38 to 63 years in 1984 without history of major chronic diseases. RESULTS: The prudent pattern was characterized by higher intakes of fruits, vegetables, legumes, fish, poultry, and whole grains, while the Western pattern was characterized by higher intakes of red and processed meats, sweets and desserts, french fries, and refined grains. Between 1984 and 1996, we documented 821 CHD cases. After adjusting for coronary risk factors, the prudent diet score was associated with a relative risk (RR) of 0.76 (95% confidence interval (CI), 0.60-0.98; P for trend test,.03) comparing the highest with lowest quintile. Extreme quintile comparison yielded an RR of 1.46 (95% CI, 1.07-1.99; P for trend test,.02) for the Western pattern. Those who were jointly in the highest prudent diet quintile and lowest Western diet quintile had an RR of 0.64 (95% CI, 0.44-0.92) compared with those with the opposite pattern profile. CONCLUSION: A diet high in fruits, vegetables, whole grains, legumes, poultry, and fish and low in refined grains, potatoes, and red and processed meats may lower risk of CHD.

Association between dietary patterns and plasma biomarkers of obesity and cardiovascular disease risk.

BACKGROUND: Although the effects of individual foods or nutrients on the development of diseases and their risk factors have been investigated in many studies, little attention has been given to the effect of overall dietary patterns. OBJECTIVE: Our objective was to examine the associations of 2 major dietary patterns, Western and prudent, with biomarkers of obesity and cardiovascular disease (CVD) risk. DESIGN: We used factor analysis to define major dietary patterns for a subsample of men (n = 466) from the Health Professionals Follow-up Study by using dietary information collected from food-frequency questionnaires (FFQs) in 1994. We calculated partial correlation coefficients between pattern scores and biomarker values adjusted for age, smoking status, energy and alcohol intake, physical activity, hours of television watching, and body mass index. RESULTS: We derived 2 major dietary patterns that were generally reproducible over time. The first pattern (prudent) was characterized by higher intakes of fruit, vegetables, whole grains, and poultry. The second pattern (Western) was characterized by higher intakes of red meats, high-fat dairy products, and refined grains. Using pattern scores from 1994 and adjusting for potential confounders, we found significant positive correlations between the Western pattern and insulin, C-peptide, leptin, and homocysteine concentrations, and an inverse correlation with plasma folate concentrations. The prudent pattern was positively correlated with plasma folate and inversely correlated with insulin and homocysteine concentrations. CONCLUSION: Major dietary patterns are predictors of plasma biomarkers of CVD and obesity risk, suggesting that the effect of overall diet on CVD risk may be mediated through these biomarkers.

Leisure-time physical activity, television watching, and plasma biomarkers of obesity and cardiovascular disease risk.

The benefits of physical activity in reducing cardiovascular disease (CVD) are thought to be mediated through changes in blood lipids, insulin sensitivity, and thrombogenic factors. Few studies have addressed the effects of both long-term physical activity and inactivity on these factors. The authors assessed associations between long-term leisure-time physical activity, television watching, and biomarkers of CVD risk among 468 healthy male health professionals. Prior to blood collection in 1993-1994, physical activity and television watching were assessed biennially from 1986 to 1994 by a questionnaire. Physical activity was expressed as metabolic equivalents-hours per week. Multivariate linear regression analyses showed that metabolic equivalents-hours in 1994 were significantly associated with high density lipoprotein cholesterol (HDL cholesterol) (positively) and with leptin and C-peptide (inversely). The average number of hours of television watching assessed in 1994 was significantly positively associated with low density lipoprotein cholesterol and significantly inversely associated with HDL cholesterol and apolipoprotein A1. Average hours of television watching per week assessed in 1988-1994 was positively associated with leptin levels (p < 0.01). The associations of television watching and vigorous activity with leptin and HDL cholesterol were independent of each other. In conclusion, physical activity and television watching were significantly associated with several biochemical markers of obesity and CVD risk.