Article Content



[check mark] Depression Can Lower Glucose Control in Persons With Diabetes


[check mark] Forget About Ginkgo to Prevent Alzheimer Disease


[check mark] Dial-In to Help Children With Obesity


Vitamins E and C Supplements May Not Be Effective for the Prevention of Cardiovascular Disease in Men

Neither vitamin E nor vitamin C supplements reduced the risk of major cardiovascular events in a large, long-term study of male physicians, according to a new study. Most adults in the United States have taken vitamin supplements in the past year, and research suggests that vitamin E, vitamin C, and other antioxidants reduce cardiovascular disease, perhaps by trapping organic free radicals, by deactivating excited oxygen molecules, or both, to prevent tissue damage. Previous observational studies suggested a role for vitamin E, and some also suggested that vitamin C might be involved in cardiovascular disease prevention. In this study, the Physicians' Health Study II, researchers assessed the effects of using vitamin E and vitamin C supplements on risk of cardiovascular disease events among 14,641 male physicians who were 50 years or older and at low risk of cardiovascular disease at study entry in 1997 and among 754 (5.1%) who had cardiovascular disease then. The physicians were randomized to receive 400 IU of vitamin E every other day or a placebo and 500 mg of vitamin C daily or a placebo.


During the 8 years of follow-up, 1,245 men confirmed major cardiovascular events; a total of 511 myocardial infarctions (heart attacks), 464 strokes, and 509 cardiovascular deaths occurred; and a total of 1,661 men died from all causes. Compared with placebo, neither vitamin E nor vitamin C had an effect on the prevention of major cardiovascular events or mortality, but vitamin E was associated with an increased risk of hemorrhagic stroke. In this large, long-term trial of male physicians, neither vitamin E nor vitamin C supplementation reduced the risk of major cardiovascular events. These data provide no support for the use of these supplements for the prevention of cardiovascular disease in middle-aged and older men.


Source: JAMA


Depression Can Hamper Glucose Control in People With Diabetes

Depression can cause people with diabetes to have higher glucose levels over time compared with individuals without depression, according to a study of older veterans. Researchers analyzed data from 11,525 veterans with type 2 diabetes who received medical care at a Veterans Administration facility in the Southeast. The veterans' average age was 66 years, 98% were male, 48% were white, 27% were African American, and 25% were of other races. Six percent were depressed. Each veteran was evaluated at 3-month intervals from 1997 to 2006, including checks by clinicians of his/her blood Hemoglobin A1c (HbA1c) level, a blood test that measures long-term glucose control. Experts recommend a target level of less than 7%. Over the 4-year period, the HbA1c values in veterans who were depressed averaged 0.13% higher than those of veterans who were not depressed-enough to raise people with diabetes above the desirable range for glucose control, putting them at higher risk. The changes in HbA1c among the depressed participants did not differ based on race or age. Therefore, patients with depression may need especially careful monitoring of their glucose control so that this risk can be minimized.


Source: General Hospital Psychiatry


Pregnancy After Instead of Before Weight Loss Surgery May Reduce Complications

Women who undergo weight loss (bariatric) surgery, lose weight, and later become pregnant may be at lower risk for pregnancy-related diabetes and high blood pressure than those who conceive while obese. These are complications that can seriously affect the mother or her baby. More than 50,000 women a year aged 18 to 45 years undergo bariatric surgery procedures that include gastric bypass surgery, vertical-banded gastroplasty, and other inpatient weight reduction therapy. Others have outpatient laparoscopic adjustable gastric banding procedures. It is usually recommended that women wait for a year after their surgery to conceive; at that point, weight loss is likely to be maximal.


The conclusions are based on a meta-analysis of 75 studies, including 3 that compared the pregnancies of nonobese women to those of obese women as well as to pregnancies of women who had lost weight by bariatric surgery. In one of the studies of laparoscopic gastric banding, a type of bariatric surgery, none of the women who underwent surgery developed gestational diabetes or high blood pressure during their pregnancies, although 22% of obese pregnant women developed diabetes and 3% developed high blood pressure. Thirteen other studies supported these findings. Neonatal outcomes such as preterm delivery, low birth weight, and high birth weight were also likely to be better in pregnancies of women after bariatric surgery than in pregnancies of obese women.


Although no randomized controlled trials specifically assessed pregnancy outcomes after surgery, some maternal and neonatal complications seem lower in pregnancies after bariatric surgery compared with pregnancies in obese women.


In the meta-analysis, nutritional problems during pregnancy after 2 types of bariatric surgeries, gastric bypass and laparoscopic gastric band procedures, were uncommon. Nutritional problems seem to be more frequent and severe in mothers who undergo another bariatric surgical procedure, biliopancreatic diversion surgery, perhaps because dietary supplements are needed to counteract the malabsorption of some nutrients, and yet some women may not have taken them.


The effects of bariatric surgery on a woman's fertility have not been well studied, although a few small studies suggest an improvement in the ability to conceive and deliver a child after bariatric surgery. Also, there seems to be normalization of sex hormones and menstrual irregularities as well as improvement in polycystic ovary syndrome-a health problem that can affect a woman's ability to have children-after bariatric surgery. These findings are consistent with those observed in formerly obese women after non-surgically induced weight loss.


There is no evidence about whether oral contraceptive pills are as effective in women after bariatric surgery as they are in women in general. It was not possible to determine if having bariatric surgery affected the likelihood of needing a cesarean section.


Source: Agency for Healthcare Research and Quality/JAMA


Ginkgo biloba Does Not Seem to Prevent Dementia or Alzheimer Disease

Use of the herb Ginkgo biloba, claimed to have beneficial effects on memory and cognition, was not effective in reducing the rate of dementia or Alzheimer disease (AD) among more than 1,500 elderly study participants after several years of use, according to results of a new study.


Dementia, especially AD, is a prevalent chronic disease currently affecting more than 5 million people in the United States and is a leading cause of age-related disability and long-term care placement, according to background information in the article. Ginkgo biloba is prescribed in some areas of the world for preservation of memory; however, there are no medications approved for the prevention of dementia, and to date, no clinical trial of adequate design and size has evaluated the safety and effectiveness of G biloba in the primary prevention of dementia.


The researchers assessed the effectiveness of G biloba in dementia prevention with a randomized, placebo-controlled clinical trial of 3,069 volunteers from the community who were 75 years or older with normal cognition or mild cognitive impairment who were observed between 2000 and 2008, with a median follow-up of 6.1 years. Volunteers were randomized to receive either a twice-daily dose of 120 mg extract of G biloba (n = 1,545) or placebo and assessed for dementia every 6 months. During the intervention period, 523 participants were diagnosed with dementia. Sixteen percent were in the placebo group and 18% were in the G biloba group, a difference that was not significant (2.9 vs 3.3 dementia cases per 100 persons per year, respectively). Of the total dementia cases, 92% were classified as possible or probable AD or AD with evidence of vascular disease of the brain. The rate of Alzheimer-type dementia also did not differ between the 2 treatment groups (3.0 vs 2.6 of 100 persons per year exposed, respectively). Ginkgo biloba also had no effect on the rate of progression to dementia in participants with moderate cognitive impairment.


The adverse event profiles for G biloba and placebo were similar, and there were no statistically significant differences in the rate of serious adverse events. Based on the results of this trial, G biloba cannot be recommended for the purpose of preventing dementia.


Source: JAMA


Pediatric Obesity May Alter Thyroid Function and Structure

Pediatric obesity may induce alterations in thyroid function and structure in addition to its strong associations with hypertension, cardiovascular disease, and type 2 diabetes, according to a new study. Although some studies have found that thyroid disorders may lead to obesity, this recent study shows that in some cases, it is obesity that may cause thyroid problems. Researchers measured the thyroid hormone levels and thyroid antibodies of 186 overweight and obese children and also performed thyroid ultrasounds over a period of 3 years. The presence of thyroid antibodies would suggest a diagnosis of Hashimoto thyroiditis, an autoimmune disease of the thyroid where T cells attack the cells of the thyroid. In the study, 73 children did not show these antibodies, yet their ultrasound pattern was still suggestive of Hashimoto thyroiditis and state of a low-grade inflammation, which characterizes obesity. Thyroid function returns to normal after weight loss, raising the question of the potential reversibility of the thyroid abnormalities shown on an ultrasound. It remains for future studies to find out if the persistence of thyroid abnormalities in obese children may also progress into chronic thyroid disease in early adulthood questions.


Source: Journal of Clinical Endocrinology & Metabolism