High Caffeine Intake During Pregnancy Reduced Fetal Length

Posted on May 30, 2010 by wngai
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Tea and coffee are the most widely-consumed beverages.  However, the effect of caffeine intake during pregnancy on fetal growth is not unclear. 

According to a study published online April 28 in the American Journal of Clinical Nutrition, caffeine intake of 6 or more units per day during pregnancy is associated with impaired fetal length growth.

The goal of the study was to evaluate the associations of maternal caffeine intake from coffee and tea with fetal growth measured during each trimester of pregnancy and with the risks for adverse birth outcomes.

The study recruited 7,346 pregnant women in Netherlands from 2001 to 2005.  Questionnaires were used to determine coffee and tea consumption in the first, second, and third trimesters. Serial ultrasound studies were used to determine fetal growth characteristics and hospital record were reviewed to determine the birth outcomes.

Participants were categorized into different tiers (less than 2 units, 2 to 3.9 units, 4 to 5.9 units, and 6 or more units per day) based on the amount of caffeine consume.  One unit of caffeine consumption is equivalent to 1 cup of 125ml coffee or 90mg of caffeine. 

The results indicated that higher caffeine consumption was associated with smaller first-trimester crown-rump length, second- and third-trimester femur length, and birth length (P for trend < .05). The risk of having a small-for-gestational-age infant at birth was increased in mothers who consumed at least 6 caffeine units per day.

This study suggested that pegnant women should not consume ≥6 caffeine units (.540 mg) per day during pregnancy.

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Source: online Am J Clin Nutr, April 28, 2010.

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Infertility and Use of Fertility Drugs Increases Risk for Autism

Posted on May 30, 2010 by wngai
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Preliminary results of a study (Nurses Health Study II) suggest that a history of fertility problems and the use of ovulation-inducing drugs (OIDs) are associated with an almost 2-fold increased risk of having a child with autism spectrum disorder (ASD). 

The investigators at the Havard School of Public Health compiled data from 3,985 participants (aged 25 to 42 years old), who had their first child between 1993 and 2003, on their history of infertility, use of OIDs (oral or injected), and the incidence of their child having ASD. 

The results indicated that the risk of having a child with ASD was increased (91% increase in risk) in women who have a history of infertility and used OID.  

Table. Risk for ASD by OID Use and Infertility Status (N = 3985)

Variable No. of ASD Cases Adjusted Odds Ratio* P Value
No prior OID or INF 57 1.0  
INF only 16 1.58 .12†
INF and OID 36 1.91 .007†
INF vs no INF 52 1.81 .005
OID vs no OID 38 1.58 .04
Stratified: effect of OID among women with INF 36 1.28 .44

ASD = autism spectrum disorder; INF = infertility; OID = ovulation-inducing drug

*Adjusted for nurses’ age at baseline, age at first birth, parity, race, income, marital status, spouse’s education, pregnancy complications, twin births, prior miscarriages, prior induced abortions, and body mass index.

†Compared with no prior OID or INF. 

Women who have infertility, but would like to conceive can also consider herbal medicine. 

The study, however, was able to find whether autism is also related to women who do not have fertility problems, but take OID. 

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Source: 9th Annual International Meeting for Autism Research (IMFAR): Abstract 103.002. Presented May 20, 2010.

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Which Herbal and Non-Herbal Supplements Interact with Warfarin?

Posted on May 30, 2010 by wngai
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The safety of warfarin use can be compromised by many popular herbal and nonherbal supplements taken by individuals.  Eight of the 10 most widely used supplements interact with warfarin, and many of these were associated with significant changes in the international normalized ratio (INR). 

Of these, cranberry, garlic, ginkgo, and saw palmetto have been linked to increased rates of bleeding, whereas others have been shown to cause changes in prothrombin times, which would result in a need to alter warfarin doses. 

In a study presented at the Heart Rhythm Society 2010, researchers evaluated the top 20 herbal and top 20 nonherbal supplements based on 2008 sales data on their potential to interact with warfarin. They searched numerous databases for relevant case reports and clinical trials documenting supplement-drug interaction, including changes in INR, bleeding risks, and thromboembolic events. 

Of the 40 most commonly used herbal and nonherbal supplements, more than 50% have a direct or indirect interaction with warfarin. 

Glucosamine, essential fatty acids, multiherb products, and primrose oil can increase prothrombin times, while coenzyme Q10, soy, melatonin, ginseng, and St John’s wort can decrease prothrombin times. 

Patients who are taking warfarin are strongly advised to disclose all their herbal supplements and non-herbal supplements to their doctors.  This will avoid unnecessary bleeding and clotting risk. 

New drug, such as Pradaxa, might able provide similar protection as warfarin, but without all these interactions when it become widely available in the future. 

Readers are also advised to check the Herbs and Drug Interaction article for more information. 

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Source: Heart Rhythm Society 2010 Scientific Sessions, 2010

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Chocolate lowers Blood Pressure and Cardiovascular Risk

Posted on May 15, 2010 by wngai
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The largest observational study indicated that individuals who ate the most chocolate – around 7.5 g per day or 1 small square of a 100-g bar– had a 39% lower risk of myocardial infarction (MI) and stroke than individuals who ate a small amount of chocolate (1.7 g per day). 

The study shows that habitual consumption of chocolate can lower risk of heart disease and stroke.  The risk reduction is stronger for stroke than for MI, because chocolate has pronounced effect on blood pressure (BP) and BP is a higher risk factor for stroke than for MI.

The study followed 19,357 people, aged between 35 and 65, who were participants in the Potsdam arm of the European Prospective Investigation into Cancer (EPIC).  

At the start of the study (1994-1998), individuals received body check-up (including blood pressure, height and weight measurements) and were asked about their diet, lifestyle and health, including how frequently they ate 50-g bars of chocolate.  In the 8 years follow-up until December 2006, the participants were asked whether they had a heart attack or stroke.  

During the eight years, people in the top quartile of chocolate consumption (around 7.5g of chocolate a day) had a blood pressure that was about 1/0.9 mmHg (systolic/diastolic) lower than those in the bottom quartile.  

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Vitamin E Beneficial to patients with Nonalcoholic Fatty Liver

Posted on May 15, 2010 by wngai
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A new study (PIVENS trial) indicated that patients with nonalcoholic fatty liver might benefits from natural form of vitamin E (800 IU/day), but not from pioglitazone (Actos).  

Nonalcoholic fatty liver or Nonalcoholic Steatohepatitis (NASH) currently affects about 4% of the American population and there is no approved therapy.  About 15% of patients with NASH progress to cirrhosis and patients with NASH experience fatty liver disease, insulin resistance, and obesity.

The new study is a multicenter trial involving 247 nondiabetic adults with biopsy-proven NASH. Patients were allocated to the following 3 arms: 

  • 80 patients to the insulin-sensitizer pioglitazone (Actos) (30 mg once daily)
  • 84 patients to vitamin E (800 IU/day)
  • 83 patients to placebo 

After 96 weeks, patients in the vitamin E therapy arm was associated with a significantly higher rate of improvement in NASH when compared with placebo (43% vs 19%; P = .001; number needed to treat, 4.2).

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“Added sugars” in diet increase triglycerides and lower HDL

Posted on May 15, 2010 by wngai
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It has been well known that high-fat diet can worsen serum lipids, but it is less clear whether added sugar might also affect lipid level.  

A new study, based on more than 6,000 US adults participated in the 1999-2006 National Health and Nutrition Examination Survey (NHANES), discovered that increased intake of sugar-sweetened food, increased elevated triglycerides and reduced HDL-cholesterol level. 

The analysis also found that there has been a big jump in consumption of added sugar compared with NHANES data over last 30 years, from 10.6% to 15.8% of daily calories. 

The NHANES sample consisted of 3,088 non-pregnant women and 3,025 men who didn’t have “extremely high” triglyceride levels.  The study also collected data on sugary intake by asking the participants to recall their 24-hour dietary intake. 

The results showed that persons who consumed the most added sugar showed significantly increased risks of having low HDL-C (<40 mg/dL for men; <50 mg/dL for women) and high TG (>150 mg/dL), compared with those who consumed the least. 

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Low-level Smoke Increases Atherosclerosis and Lipids in Children and Teenagers

Posted on May 15, 2010 by wngai
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We all knew that tobacco smoke is bad to the lungs, but no one will ever think the second-hand smoke will increase cholesterol level and cause heart disease.

A new study indicated that healthy children and teenagers frequently exposed to tobacoo smoke have artery changes associated with preclinical atherosclerosis and increase lipid levels (apoB).  The result indicated that children should not be exposed to tobacco smoke at all.

The study involved 494 healthy 13-year-old children who were recruited as infants into Finland’s Special Turku Coronary Risk Factor Intervention Project (STRIP), which began in 1990.

Carotid and arotic artery thickness and brachial-artery flow-mediated dilation were measured using high-resolution ultrasound while long-term smoke exposure levels were estimated by measuring blood levels of cotinine, a byproduct of nicotine that indicates how much tobacco smoke was encountered over the past few days.

Based on the cotinine level, the participants were divided into three levels of tobacco exposure: high (163 participants), intermediate (171), and low (160).

The results showed that as the exposure to cigarette increased, the carotid/aorta artery wall thickness also increased and the brachial artery flow-mediated dilation decreased. In addition, lipid levels such as apoB and apoB/apoA-I ratio (proatherogenic/antiatherogenic lipoproteins) also increased with increases in cotinine level.

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Folate and Vitamin B6 Lower Cardiovascular Risk

Posted on May 9, 2010 by wngai
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According to a study published in the April 15 online version of Stroke, dietary intakes of folate and vitamin B6 reduce the risk of mortality from stroke and any cardiovascular disease in women and reduce the risk of heart failure in men. 

The study analyzed the food consumption of 23,119 men and 35,611 women (aged 40-79 years) for 14 years.   Participants were classified into quintiles based on their intake of folate, vitamin B6 and vitamin B12.  

When compared with participants in the lowest quintiles, participants in the highest quintiles of folate and vitamin B6 intake were associated with significantly fewer deaths from heart failure in men and significantly fewer deaths from stroke, heart disease and cardiovascular disease in women. 

By contrast, vitamin B12 intake was not associated with reduced mortality risk. 

The researchers suspected the benefits effects of vitamin B6 and folate might be related to the reduction of blood homocysteine concentrations. 

Source: Stroke (April 15, 2010) 

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Nutraceutical combo shows promise in lowering lipid level

Posted on May 9, 2010 by wngai
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A new study showed that a nutraceutical containing berberine, red yeast rice and policosanol was able to lower total and LDL cholesterol and improved endothelial-dependent flow-mediated coronary dilation.

Berberine (黃連素) has long been used in traditional Chinese medicine to lower lipids and treat diabetes, but has not been studied in hypercholesterolemia.

In the new study, Italian researchers randomized 50 hypercholesterolemic patients to either the nutriceutical pills or placebo for a six-week period.

After 6 weeks of treatment, patients in the nutraceutical group, but not in the placebo group experienced a significant reduction in total and LDL reduction.  The lipid-lowering effects of the nutraceutical combination were similar to those achieved by standard statin therapy.

Furthermore, 3% of the patients in the nutraceutical group experienced an improvement in flow-mediated dilation.

In a secondary analysis, researchers found that patients, who have insulin resistance at baseline, have significantly improvement in insulin sensitivity.  No adverse effects were seen in both groups over the course of the study.

Change from baseline at 6 weeks

Measurement Nutraceutical Placebo P
Total cholesterol (mmol/L) -1.14 -0.03 <0.001
LDL-C (mmol/L) -1.06 -0.04 <0.001
Flow-mediated dilation (%) 3 0 <0.05

Source: oral poster at EuroPREVENT 2010

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FDA Approves the First Immunotherapy, Provenge, for Metastatic Prostate Cancer

Posted on May 9, 2010 by wngai
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For men with advanced metastatic prostate cancer that did not respond to hormone therapy, there is a new hope for improved survival.  FDA has approved an immunotherapy sipuleucel-T (Provenge, Dendreon), for the treatment of asymptomatic or minimally symptomatic metastatic, castration-resistant prostate cancer (mCRPC). 

The new treatment is an immunotherapy that is made from the patient’s own white blood cells and stimulates a patient’s immune system to respond against the cancer. 

In the phase 3 IMPACT study, men who had been treated with Provenge (n=341) had a median survival of 25.8 months, compared with median survival of 21.8 months among men who had been treated with placebo (n=171).

In other words, the new therapy offered a 4.1 month median survival advantage and a 24.1% reduction in the risk of death (hazard ratio, 0.759; P = 0.017) when compared with placebo.

The most common adverse reactions reported with the new products are chills, fatigue, fever, back pain, nausea, joint ache, and headache.  Majority of adverse reactions were mild or moderate.  Serious adverse reactions which were reported in approximately one quarter of the patients included acute infusions and stroke.

Cerebrovascular events, included hemorrhagic and ischemic strokes, were observed in 3.5% of patients in the Provenge, compared with 2.6% of patients in the placebo control group. 

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