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[check mark] Study Suggests Obese Women Should Gain Less Weight During Pregnancy


[check mark] Low Blood Sugar May Affect Chronic Kidney Disease Patients


[check mark] Aspartame Deemed Safe by the European Union Panel


Study Suggests Obese Women Should Not Gain Weight During Pregnancy

A new study challenges the prevailing wisdom that, to improve pregnancy outcomes, all women, even those who are obese, should gain weight during pregnancy. The study, the first of its kind, found that obese pregnant women who followed a well-balanced diet and gained little or no weight had maternal-fetal outcomes that were equal to or better than those who gained substantial weight. For years, doctors and other healthcare providers have managed pregnant patients according to guidelines issued by the American College of Obstetricians and Gynecologists. In 1986, the American College of Obstetricians and Gynecologists stated, "Regardless of how much women weigh before they become pregnant, gaining between 26 and 35 lb during pregnancy can improve the outcome of pregnancy and reduce their chances of having the pregnancy end in fetal death." In 1990, the Institute of Medicine (IOM) recommended that overweight women gain at least 15 lb during pregnancy.


The current study was undertaken to test whether these guidelines make a difference in maternal-fetal outcomes among obese women. In the study, conducted at several hospitals, the researchers followed up 232 obese pregnant women, all of whom had a body mass index of 30 kg/m2 or greater. Half of the women followed conventional prenatal nutritional guidelines, which is essentially "eat to appetite" (control group). The other half were placed on a well-balanced, nutritionally monitored program, which included a daily food diary (study group). The average weight gain in the control group was 31 lb, compared with 11 lb in the study group. Twenty-three extremely obese patients lost weight during their pregnancy.


There were no fetal deaths and no growth-restricted infants in the study group. Also, there were fewer babies weighing more than 10 lb in the eat-to-appetite group than in the control group. (A birth weight >10 lb poses significant hazards to both infants and mothers.) Moreover, women in the study group gained less weight, had fewer cesarean deliveries, were less likely to develop gestational diabetes, and retained less weight after they delivered than women in the control group.


The researchers concluded that obese pregnant women may be placed on a healthy, well-balanced, monitored nutritional program without adverse maternal-fetal outcomes.


The IOM and the National Research Council have recently reexamined and updated their 1990 recommendations for weight gain during pregnancy. The IOM-National Research Council findings released at the end of May were essentially the same as the 1990 guidelines, except for obese pregnant women. Based on the recently released guidelines for pregnancy weight gain, the IOM now advocates that obese pregnant women should limit their weight gain to between 11 and 20 lb. This recommendation may still be excessive for the extremely obese pregnant patient. The present study agrees with the new IOM guidelines about counseling and monitoring pregnant obese women.


Source: The Journal of the National Medical Association


Low Blood Sugar: A Killer for Kidney Disease Patients?

Low blood sugar, or hypoglycemia, poses a serious health threat for patients with chronic kidney disease (CKD), according to a recent study that indicates that hypoglycemia may account for some portion of the excess heart-related deaths seen in CKD patients.


Glucose control is the key to preventing end-stage renal disease in CKD patients with diabetes. However, managing diabetes in CKD patients can be complicated, as patients' reduced kidney function can affect how they react to antidiabetes medications. Difficulties with managing their diabetes can predispose CKD patients to episodes of hypoglycemia, a condition that can cause severe health complications, including dizziness, disorientation, slurred speech, convulsions, and death.


The researchers examined the incidence of hypoglycemia among CKD patients and whether the condition might contribute to CKD patients' deaths and assessed the incidence of hypoglycemia in CKD patients relative to non-CKD patients, both with and without diabetes. They also examined the association of hypoglycemia with subsequent near-term deaths (1 day after blood glucose measurement).


Analysis included information from 243,222 individuals cared for at the Veterans Health Administration. The incidence of hypoglycemia was higher in patients with CKD versus without, both among patients with diabetes and among those without. The risk of hypoglycemia was highest in individuals with both CKD and diabetes.


Hypoglycemia increased patients' near-term mortality risk. There was a reduced risk of near-term death in individuals with CKD relative to those without attenuation in the risk of death, which might have related to an increased quality of care in these patients with CKD relative to diabetic patients without CKD. Although details on the therapy were not included in this study, the findings are consistent with others that have shown that putting patients on intensive glucose-lowering medications can lead to an increased incidence of hypoglycemia and does not prolong their survival.


Source: Clinical Journal of the American Society Nephrology


European Commission Updates Opinion That Aspartame Is Safe

Following a request from the European Commission, the Panel on Food Additives and Nutrient Sources Added to Food was asked to deliver a scientific opinion on the results of a long-term carcinogenicity study with prenatal exposure to the artificial sweetener aspartame, performed by The Cesare Maltoni Cancer Research Center of the European Ramazzini Foundation (ERF) and published in June 2007.The authors concluded that the results of their study not only confirm, but also reinforce their first experimental demonstration (published in 2005 and 2006) of aspartame's multipotential carcinogenicity at a dose level close to the human acceptable daily intake. Based on the results of this study, the authors further postulated that when life-span exposure to aspartame begins during fetal life, its carcinogenic effects are increased. The panel's assessment of the ERF carcinogenicity study with prenatal exposure on aspartame was directed toward establishing the relevance of the reported findings to human health. In carrying out its assessment, the main information available to the panel was the published paper, in which the presentation of pathological findings was restricted to the incidence of malignant tumors, total number of malignant tumors per group, incidence of lymphomas/leukemias, and incidence of mammary carcinomas. Further data from this study were requested by European Food Safety Authority in April 2007, January 2008, and July 2008 to aid the interpretation of the study. On February 19, 2009, the Ramazzini Institute submitted to European Food Safety Authority some of the requested data. Overall, the panel concluded, on the basis of all the evidence currently available including the last published study from the Ramazzini group, that there is no indication of any genotoxic or carcinogenic potential of aspartame and that there is no reason to revise the previously established acceptable daily intake for aspartame of 40 mg/kg body weight per day.


The panel specifically concluded the following:


* Evaluation of aggregated malignant tumor incidences as evidence of carcinogenic potential of the test compound can only be performed based on a thorough consideration of all tumor data including onset and data on nonneoplastic, hyperplastic, and preneoplastic lesions, but these data were not provided by the authors; only limited information on the presence of inflammatory changes in the lungs of animals with lymphomas and leukemias was provided by the ERF in the additional submission.


* Most lymphomas and leukemia observed appeared to have developed in rats suffering from inflammatory changes in the lungs, which is characteristic for chronic respiratory disease. In accordance with the previous view of the European Union panel, these changes were not considered to be related to the treatment with aspartame.


* The increase in incidence of mammary carcinoma is not considered indicative of a carcinogenic potential of aspartame because the incidence of mammary tumors in female rats is rather high and varies considerably between carcinogenicity studies. The panel also noted that an increased incidence of mammary carcinomas was not reported in the previous ERF study with aspartame, which used much higher doses of the compound.



Source: European Food Safety Authority