Article Content



1. [check mark] Coffee Is Number One Source of Certain Antioxidants


2. [check mark] Critical Eye on Metabolic Syndrome


3. [check mark] Soy Helps Fracture Risk in Postmenopausal Women


Diabetes Association Statement Casts Critical Eye on Metabolic Syndrome

A recent statement published by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) suggests metabolic syndrome is not really a syndrome, and should not be a diagnosis used in primary care.


If the authors of the statement wanted to spur debate about metabolic syndrome, they may have generated more than they bargained for. Known variously as syndrome X and insulin resistance syndrome, a cluster of symptoms linked to cardiovascular risk has been recognized since first being described in 1988 by Gerald M. Reaven, MD.


Although most clinicians have become aware of the components of metabolic syndrome since then, there is little consensus about its definition and meaning. The 2 most widely accepted definitions of metabolic syndrome have several significant differences. Do the definitions refer to the same condition, or do the differences belie an ambiguity and uncertainty about the diagnosis? For many years, the ADA has raised the alarm over metabolic syndrome without formulating an official position statement. Recently, a group of top diabetes leaders decided to take a hard look at the science.


One of the main questions about metabolic syndrome is whether it is a syndrome at all. Traditionally, a syndrome is defined as a group of signs and symptoms with a common underlying pathology. Some argue that although the signs and symptoms of metabolic syndrome often appear together, they may reflect different disease processes, not a single one.


Other experts contend that the term "syndrome" is used often in medicine, as in "acute coronary syndrome." Acute coronary syndrome can have multiple causes and can manifest itself in a variety of ways. Still, few doubt that it exists.


The ADA/EASD paper points out specific areas of concern about how the diagnosis of metabolic syndrome is currently used. Criteria are ambiguous or incomplete, and the rationale for metabolic syndrome thresholds is ill-defined, the authors write. Although both the third report of the National Cholesterol Education Program's (NCEP) Adult Treatment Panel III (ATP III) and the World Health Organization (WHO) definitions include waist size as a risk factor, for example, there is no consensus on how to measure waist size. Similarly, clinicians are left to wonder whether blood pressure has to be 130 mm Hg systolic and 85 mm Hg diastolic, or 130 mm Hg systolic or 85 mm Hg diastolic? Or both?


The value of including diabetes in the definition is questionable, the paper says, and insulin resistance as the unifying etiology in the syndrome is uncertain. There is no clear basis provided for including or excluding other cardiovascular disease (CVD) risk factors. Moreover, CVD risk value is variable and depends on the specific risk factors that are present.


Ultimately, the CVD risk associated with metabolic syndrome appears to be no greater than the sum of its parts, ADA and EASD conclude. Treatment of the syndrome is no different than the treatment for each of its components. The medical value of diagnosing the syndrome is unclear, the authors say. No doubt others will join the debate shortly.


Source: American Diabetes Association, DOC News


American Heart Association Recommends Kids Get a Jump Start on Heart-Healthy Eating

Kids can get a start on a heart-healthy future before they even learn to crawl, according to new dietary recommendations for children and adolescents released by the American Heart Association. The statement, "Dietary Recommendations for Children and Adolescents: A Guide for Practitioners," was chaired by Samuel S. Gidding, MD, professor of pediatric cardiology at Jefferson Medical College in Philadelphia. It is endorsed by the American Academy of Pediatrics, and focuses on total caloric intake and eating behaviors. Key recommendations for children age 2 and older are to:


* balance dietary calories with physical activity to maintain normal growth;


* 60 minutes of moderate to vigorous physical activity daily;


* eat vegetables and fruits daily, limit juice intake;


* use vegetable oils and soft margarines low in saturated fat and trans fatty acids instead of butter or most other animal fats in the diet;


* eat whole-grain breads and cereals rather than refined grain products;


* reduce the intake of sugar-sweetened beverages and foods;


* use nonfat (skim) or low-fat milk and dairy products daily;


* eat more fish, especially oily fish, broiled or baked;


* reduce salt intake, including salt from processed foods.



Source: American Heart Association


Coffee Is Number One Source of Antioxidants

Coffee provides more than just a morning jolt; that steaming cup of java is also the number one source of certain antioxidants in the US diet, according to a new study by researchers at the University of Scranton (Pa). Their study was described at the 230th national meeting of the American Chemical Society.


"Americans get more of their antioxidants from coffee than any other dietary source. Nothing else comes close," says study leader Joe Vinson, PhD, a chemistry professor at the university. Although fruits and vegetables are promoted as good sources of antioxidants, the new finding is surprising because it represents the first time that coffee has been shown to be the primary source from which most Americans get their antioxidants, Vinson says. Both caffeinated and decaf versions appear to provide similar antioxidant levels, he adds.


High antioxidant levels in foods and beverages do not necessarily translate into levels found in the body. The potential health benefits of these antioxidants ultimately depends on how they are absorbed and utilized in the body, a process that is still poorly understood.


Source: American Chemical Society Meeting


Glucosamine and Chrondrotin Sulfate May Help Other Medications and Knee Arthritis

At the November 2005 American College of Rheumatology meetings, 2 studies of ameliorating knee pain due to osteoarthritis were described that suggested that glucosamine was useful.


In the GAIT trial (Glucosamine/Chondrotin Arthritis Intervention Trial), Dr Daniel Clegg of the University of Utah and his collaborators tested glucosamine and chondrotin sulfate alone and together in reducing joint pain in the knees among 1,258 patients, who were about 59 years old with BMIs of 32 and longstanding symptoms of osteoarthritis. Patients were assigned to glucosamine alone, glucosamine plus chondrotin sulfate or celicoxib, a drug thought to block inflammation. All were also permitted to take a nonsteroidal anti-inflammatory agent, such as aspirin, if pain was too bad. Patients were evaluated at baseline, 4, 8, 16, and 24 weeks for improvement in a pain index and for adverse effects. For all patients, celecoxib was better than placebo. For patients with more pain, the glucosamine and chondrotin sulfate were better than placebo, and so was celecoxib. These agents therefore seem to offer promise in treating moderate to severe pain with osteoarthritis.


In a second, smaller study done in Europe, called GUIDE, which tested glucosamine sulfate against acetominophen, a nonsteroidal anti-inflammatory agent commonly used to alleviate pain in 318 patients with knee osteoarthritis. The patients were randomized to the treatment or control and all patients were allowed to use a painkiller if pain got too severe. Patients taking the glucosamine sulfate had less pain and used less painkillers. Adverse effects did not seem to differ. Although much more work needs to be done, the studies illustrate that these natural products may have some potential as new treatments for knee osteoarthritis. However, because knee osteoarthritis symptoms result from disease, and other medications are also needed, use of these products should be under the direction of a physician.


Source: American College of Rheumatology Meeting


Consumption of Soy May Reduce Risk of Fracture in Postmenopausal Women

Postmenopausal women who consumed high daily levels of soy protein had reduced risk of bone fracture, according to a study in the Archives of Internal Medicine. Women experience accelerated bone loss at a rate of 3% to 5% per year for about 5 to 7 years after menopause, putting them at a high risk for bone fracture. The US Food and Drug Administration and new clinical guidelines advise against the use of hormone therapy as a first-line treatment for the prevention of osteoporosis in postmenopausal women and they emphasize alternatives including exercise and increasing intake of calcium and vitamin D. Some evidence also suggests a potential role for soy in preventing postmenopausal bone loss, however, at least among Chinese women.


Researchers from Vanderbilt University School of Medicine, Nashville, Tennessee examined the relationship between soy food consumption and bone fractures in postmenopausal women. The women were part of the Shanghai Women's Health Study, a study of approximately 75,000 Chinese women aged 40 to 70 years, conducted between March 1997 and May 2000. They found that soy consumption may reduce the risk of fracture in Chinese postmenopausal women, especially among those in the early years following menopause. Those in the highest soy protein intake group who consumed about 13 g or more of soy per day had a 37% reduced relative risk for fracture compared to the lowest intake group. Chinese women in the highest soy isoflavone group also had a 35% reduced relative risk for fracture compared to the lowest isoflavone group. The big question-still unresolved-is what the effects of soy are in American women given the different amounts and products that they consume.


Source: Arch Intern Med. 2005;165:1890-1895