Coffee and Cigarettes May Protect Against Liver Disease

Coffee and cigarette smoking may protect against the rare liver disease Primary Sclerosing Cholangitis (PSC), study shows.

In a new study from Norway published inClinical Gastroenterology and Hepatology, both coffee consumption and cigarette smoking are shown to potentially protect against primary sclerosing cholangitis (PSC). This is a chronic liver disease caused by chronic inflammation of the bile ducts.

The findings are of great interest against a backdrop of increasing knowledge on coffee as a possible protective agent in other liver diseases.

The cross-sectional study was conducted by researchers at the Norwegian PSC Research Center based at Oslo University Hospital and the University of Oslo.

The study was conducted using a questionnaire about environmental exposures, and included 240 PSC patients and 245 controls.

Coffee

The study shows showed that the PSC patients had lower coffee consumption both currently and in the early adulthood, suggesting that coffee consumption could protect against the development of the disease. PSC patients who drank coffee, however, had lower levels of liver enzymes in the blood, thus suggesting a beneficial effect in the liver.

Cigarettes

Regarding cigarette smoking, only 20% of the patients reported ever daily cigarette smoking, compared with 43% of the healthy controls. In addition, cigarette smokers acquired the disease on average 10 years later than non-smokers. Taken together, these observations confirm and strengthen previous observations of smoking as a possible protective factor in PSC.

About PSC

While PSC is not a common disease, it is a severe condition affecting mostly young adults (30-40 years), and with a high risk of associated cancer of the bile ducts.

Few treatment options are available and PSC is one of the most important reasons for liver transplantation. While the possible protective effect of smoking against PSC seems rather unique to this particular liver disease, coffee consumption has been shown to protect against multiple other liver conditions including liver cirrhosis and liver cancer -- and now for the first time also against PSC.

Tomado de:Oslo University Hospital. "Coffee and cigarettes may protect against liver disease." ScienceDaily, 14 Dec. 2013. Web. 21 Dec. 2013.

An Apple a Day Keeps the Doctor Away

 Prescribing an apple a day to all adults aged 50 and over would prevent or delay around 8,500 vascular deaths such as heart attacks and strokes every year in the UK -- similar to giving statins to everyone over 50 years who is not already taking them -- according to a study in the Christmas edition of The BMJ.

The researchers conclude that the 150 year old public health message: "An apple a day keeps the doctor away" is able to match more widespread use of modern medicine, and is likely to have fewer side effects. The research takes into account people who are already appropriately taking statins to reduce their risk of vascular disease and therefore the authors stress that no-one currently taking statins should stop, although by all means eat more apples.

In the United Kingdom, lifestyle changes are the recommended first step to prevent heart disease. However, trial data suggest that statins can reduce the risk of vascular events, irrespective of a person's underlying risk of cardiovascular disease. As such, calls are being made for greater use of statins at a population level, particularly for people aged 50 years and over.

Using mathematical models a team of researchers at the University of Oxford set out to test how a 150 year old proverb might compare with the more widespread use of statins in the UK population. They analysed the effect on the most common causes of vascular mortality of prescribing either a statin a day to those not already taking one or an apple a day to everyone aged over 50 years in the UK.

The researchers assumed a 70% compliance rate and that overall calorie intake remained constant.

They estimate that 5.2 million people are currently eligible for statin treatment in the UK and that 17.6 million people who are not currently taking statins would be offered them if they became recommended as a primary prevention measure for everyone over 50.

They calculate that offering a daily statin to 17.6 million more adults would reduce the annual number of vascular deaths by 9,400, while offering a daily apple to 70% of the total UK population aged over 50 years (22 million people) would avert 8,500 vascular deaths.

However, side-effects from statins mean that prescribing statins to everyone over the age of 50 is predicted to lead to over a thousand extra cases of muscle disease (myopathy) and over ten thousand extra diagnoses of diabetes.

Additional modelling showed a further 3% reduction in the annual number of vascular deaths when either apples or statins were prescribed to everybody aged over 30. However the number of adverse events is predicted to double.

"This study shows that small dietary changes as well as increased use of statins at a population level may significantly reduce vascular mortality in the UK," say the authors.

"This research adds weight to calls for the increased use of drugs for primary prevention of cardiovascular disease, as well as for persevering with policies aimed at improving the nutritional quality of UK diets," they conclude.

Dr Adam Briggs of the BHF Health Promotion Research Group at Oxford University said: "The Victorians had it about right when they came up with their brilliantly clear and simple public health advice: "An apple a day keeps the doctor away." It just shows how effective small changes in diet can be, and that both drugs and healthier living can make a real difference in preventing heart disease and stroke.

While no-one currently prescribed statins should replace them for apples, we could all benefit from simply eating more fruit."

Tomado de BMJ-British Medical Journal. "An apple a day keeps the doctor away." ScienceDaily, 17 Dec. 2013. Web. 21 Dec. 2013

Daily iron supplementation improved cognitive, physical performance in children with anemia

Children with anemia who received daily iron supplementation demonstrated improved cognitive performance and physical outcomes with few adverse effects, according to results of a systemic review and meta-analysis

Daily iron supplementation also improved hematologic outcomes, reducing the risk for anemia by 50% and the risk for iron deficiency by 79%.

Researchers used electronic databases, including MEDLINE and Embase, to search for randomized and quasi-randomized trials that evaluated the effects of daily iron supplementation in children aged 5 to 12 years.

Their analysis included 32 relevant studies, 31 of which were conducted in low- or middle-income settings. The most common study site was India (n=7), followed by Thailand (n=4), Indonesia (n=2) and Kenya (n=2).

The studies included a combined 7,089 children. Of them, 3,837 received oral iron supplementation at least 5 days per week. The other 3,252 children served as controls.

Nine of the studies assessed global cognitive performance.

Results showed children who received iron supplementation demonstrated higher global cognitive scores at the end of the intervention period compared with controls (standardized mean difference [SMD]=0.50; 95% CI, 0.11-0.90). Researchers also observed improvement among children who were anemic at baseline (SMD=0.29; 95% CI, 0.07-0.51).

IQ scores also improved in children with anemia who received iron supplementation (mean difference [MD]=4.55; 95% CI, 0.16-8.94).

All children who received iron supplementation demonstrated improvements in age-adjusted height, and those with anemia who received daily supplementation demonstrated improvements in age-adjusted weight.

Seven studies that included 1,763 children showed daily iron supplementation reduced risk for anemia (RR=0.50; 95% CI, 0.39-0.64). Four studies that included 1,020 children showed daily supplementation reduced risk for iron deficiency (RR=0.21; 95% CI, 0.07-0.63).

Researchers found that children who received iron were not at increased risk for malaria or gastrointestinal adverse effects compared with children who did not receive supplementation.

“Anemia and iron deficiency were prevalent in the included studies (69% and 59%, respectively, in the control groups. Thus, routine daily iron supplementation is likely to benefit cognitive performance in primary school-aged children in developing settings where anemia is prevalent and testing hemoglobin before iron supplementation may not be feasible,” the researchers wrote. “Daily iron supplementation could benefit educational attainment and economic potential at the individual level and, in settings where anemia is prevalent, population level.”

Low M. Can Med Assoc J. 2013;doi:10.1503/cmaj.130628.

Tomado de Healio.com

Venous Thromboembolism and Travel

The association between venous thromboembolism (VTE) and travel was recognized as early as the 1950s, when John Homans, MD, best remembered in connection with Homans’ sign—pain in the calf on active or passive dorsiflexion of the foot that may signal deep venous thrombosis (DVT)—advised that “physicians should be alert to recognize the significance of lameness after airplane flights, automobile trips and other occasions of a prolonged seated position.”¹This article will review the risk of developing VTE associated with travel.

The notion that prolonged travel in a sedentary position increases the risk of VTE seems easy to accept, and clinicians are accustomed to asking about recent travel when they suspect VTE. However, symptomatic VTE after air travel is rare, as demonstrated in a cohort study of 8755 employees of large international companies and organizations.² A total of 22 symptomatic, objectively confirmed VTE events occurred within 8 weeks after 102,429 long-haul flights, defined as 4 hours or longer. This corresponded to an absolute risk of 1 VTE event per 4656 long-haul flights.

A systematic review by Philbrick and colleagues also found a low rate of symptomatic VTE after air travel, with an incidence of 0.5 pulmonary embolisms per 1 million travelers presenting on the day of arrival in the airport, and 27 VTEs (pulmonary embolism and DVT) per 1 million travelers presenting within 2 weeks of arrival.³ When ultrasounds are performed routinely in travelers, the rate of diagnosed DVT may be as high as 1.2%, but the majority of cases are asymptomatic. The risk of an asymptomatic DVT progressing to clinically significant disease is currently unknown.

While some large studies have documented a positive relationship between travel and VTE, others have not. Chandra and colleagues conducted a meta-analysis of observational studies to clarify the conflicting evidence.⁴ In the 14 included studies, the pooled relative risk for VTE associated with travel was 2.0 (95% CI, 1.5-2.7). However, there was significant heterogeneity, with 7 studies reporting an association between travel and VTE, and the other 7 reporting no association. The authors conducted a sub-analysis to exclude 8 case-control studies that had a certain bias in selecting the control participants. In the remaining 6 studies, the relative risk for VTE associated with travel was 2.8 (95% CI, 2.2-3.7). These results appear to resolve the conflicting data and point to an elevated risk of VTE with travel.

The Chandra meta-analysis also reported a significant travel dose-response relationship. The risk for VTE rose by 18% for each 2-hour increase in travel by any mode, and by 26% for each 2-hour increase in travel by air.⁴ The Philbrick systematic review also documented a dose-response relationship, with greatest risk for DVT occurring with flights longer than 8 hours.³

The data on VTE associated with car or train trips is less clear. In the Chandra meta-analysis, the risk of VTE with air travel was slightly higher than for ground travel, but the difference was not statistically significant.⁴ In the Philbrick systematic review, only air travel was associated with VTE, although not all studies assessed other modes of travel.³

Other than flight duration, baseline clinical factors may also influence the risk of VTE. A prospective cohort study monitored travelers with surveillance ultrasound within 24 hours after long flights (average duration, 12.4 hours).⁵ Eleven of the 389 high-risk travelers (previous history of DVT, known coagulation disorder, severe obesity, limited mobility, cancer, large varicose veins) were found to have DVT. In contrast, DVT was not found in any of the 355 low-risk travelers.

In conclusion, symptomatic VTE after travel is not a common event. But considering the popularity of air travel, it is important to recognize the elevated risk of VTE associated with long air flights, especially among patients with other risk factors for VTE. Patients at high risk for DVT induced by prolonged travel should be identified and counseled before they start their journeys.

Tomado de: medpagetoday.com