A modified portfolio diet complements medical management to reduce cardiovascular risk factors in diabetic patients with coronary artery disease.

BACKGROUND & AIMS: Secondary prevention can improve outcomes in high risk patients. This study investigated the magnitude of cardiovascular risk reduction associated with consumption of a modified portfolio diet in parallel with medical management. DESIGN: 30 patients with type II diabetes, 6 weeks post bypass surgery received dietary counseling on a Modified Portfolio Diet (MPD) (low fat, 8 g/1000 kcal viscous fibres, 17 g/1000 kcal soy protein and 22 g/1000 kcal almonds). Lipid profiles, endothelial function and markers of glycemic control, oxidative stress and inflammation were measured at baseline and following two and four weeks of intervention. Seven patients with no diet therapy served as time controls. RESULTS: Consumption of the MPD resulted in a 19% relative reduction in LDL (1.9 ± 0.8 vs 1.6 ± 0.6 mmol/L, p < 0.001) with no change in HDL cholesterol. Homocysteine levels dropped significantly (10.1 ± 2.7 vs 7.9 ± 4 µmol/L, p = 0.006) over the study period. Flow mediated dilatation increased significantly in treated patients (3.8 ± 3.8% to 6.5 ± 3.6%, p = 0.004) while remaining constant in controls (p = 0.6). Endothelial progenitor cells numbers (CD34+, CD 133+ and UEA-1+) increased significantly following MPD consumption (p < 0.02) with no difference in migratory capacity. In contrast, time controls showed no significant changes. CONCLUSION: Dietary intervention in medically managed, high risk patients resulted in important reductions in risk factors. Clinical Trials registry number NCT00462436.

Prevalence and predictors of selenium and vitamin E supplementation in a urology population.

OBJECTIVES: Preclinical and epidemiological studies have suggested the use of supplements such as selenium and vitamin E for prostate cancer (PCa) prevention; however, clinical trials have not demonstrated clear benefit in patients. This study aims to investigate the current prevalence and predictors for use of these supplements in men in a urology population. DESIGN, SUBJECTS, AND OUTCOMES MEASURED: Three hundred and twelve (312) men visiting the Princess Margaret Hospital Ambulatory Urology Clinic were enrolled in this University Health Network Research Ethics Board-approved questionnaire-based study investigating supplement use, reasons for use and demographic characteristics. RESULTS: It was observed that 13.5% and 20.8% of the participants are currently using selenium and vitamin E, respectively, while 10.6% and 15.7% previously used selenium and vitamin E, respectively. Both education (percentage of users comparing less than college education versus college or above education: selenium: 14% versus 28%; p=0.008, vitamin E: 26% versus 41%; p=0.013) and health literacy (mean scores±standard error of the mean of users versus nonusers: selenium question 1: 1.4507±0.09576 versus 1.6083±0.07211; p=0.023, selenium question 2: 2.8750±0.04395 versus 2.7106±0.03774; p=0.000, selenium question 3: 1.4583±0.08377 versus 1.7064±0.06278; p=0.025, vitamin E question 1: 2.8036±0.04545 versus 2.7179±0.04097; p=0.010, vitamin E question 2: 1.5446±0.06698 versus 1.7077±0.07241; p=0.006) are predictors of selenium and vitamin E use on univariable analysis. On multivariable analysis education (selenium odds ratio=2.095, 95% confidence interval=1.019-4.305, p=0.044; vitamin E odds ratio=1.855, 95% confidence interval=1.015-3.338, p=0.045) remains a significant predictor of selenium and vitamin E use. Examining the data on use by education, it was found that more men with a higher education attributed their use of selenium to urologist advice (24%), and those with a lower education attributed their use of selenium to naturopath/homeopath advice (28%). CONCLUSIONS: Many men who visit urology clinics use selenium and vitamin E despite the lack of clinical support for chemoprevention. Education and health literacy are important variables in determining the use of these supplements in these men. This information may aid in addressing the needs of the diverse patient population using these supplements for the prevention of PCa.