In The News: July 2014

An article published online in the European Journal of Cancer reports the results of two meta-analyses conducted by researchers at the German Cancer Research Center in Heidelberg, which affirm a protective effect for higher levels of vitamin D against the risk of dying from breast cancer as well as colorectal cancer.*

The researchers selected five studies that involved 4,413 breast cancer patients and five studies that included 2,330 colorectal cancer patients. Analysis of the selected studies uncovered a 38% average lower risk of dying from any cause and a 42% lower risk of dying from breast cancer when the highest versus lowest categories of serum 25-hydroxyvitamin D levels were compared. For colorectal cancer, the risk averaged 29% lower for all-cause mortality and 35% lower for disease-specific death among the highest groups.

Editor’s Note: Authors Haifa Maalmi and colleagues note, “The rather consistent results found in our meta-analyses suggest vitamin D supplementation might bear a potential to improve prognosis among colorectal and breast cancer patients, a suggestion that should be followed up and tested in randomized controlled trials.”

The Journal of Primary Care & Community Health published an article by researchers affiliated with Philadelphia’s Metropolitan Area Neighborhood Nutrition Alliance (MANNA), which reports a health savings benefit for nutritious meal delivery to men and women with chronic ailments.*

The study compared 65 MANNA clients with 633 Medicaid patients with chronic illnesses who did not receive the services. Subjects in the MANNA group received three nutritionally balanced meals per day that employed Medical Nutrition Therapy (MNT) to improve nutritional status, disease-fighting ability, and quality of life. Health care costs for all participants were assessed for the six months prior to and six months following the beginning of the meal deliveries.

Average monthly health care costs including inpatient costs and hospital admissions decreased among the MANNA clients during the three months after the meal service was initiated, demonstrating a health benefit for improved nutrition.

Editor’s Note: In the months after receiving the meals, the group’s monthly healthcare costs were an average of 31% lower than costs incurred by participants who did not receive the meals.

An article published in The FASEB Journal presents University of North Carolina researchers’ findings of a variance in the requirement for choline among people of different genders and ethnic backgrounds.*

Kerry-Ann da Costa, PhD, and colleagues gave 79 men and women a 10-day diet that provided 550 mg choline per day, which is the Institute of Medicine’s adequate intake level. This was followed by a diet containing only 50 mg choline daily for up to six weeks, during which changes associated with the development of liver or muscle dysfunction were monitored. DNA samples were evaluated for 200 variations in 10 genes related to choline metabolism in order to determine their relationship with deficiency symptoms.

The researchers observed several single nucleotide polymorphisms (SNPs) associated with choline deficiency-related organ dysfunction in women when they consume a diet low in choline, as well as variants that affect choline requirements.

Editor’s Note: Other SNPs were identified with muscle damage. Variation in SNPs that affect choline requirement was observed among Europeans, Mexicans, Asian Americans, and people of African descent.

The results of a meta-analysis published online in the International Journal of Cancer support a reduced risk of colorectal cancer among men and women with a higher intake of calcium.*

Edward L. Giovannucci, ScD, of Harvard School of Public Health, and colleagues selected 21 publications reporting 20 prospective observational studies for their analysis. Analysis of overall intake of calcium, which involved studies that included a total of 1,415,597 participants among whom 12,305 cases of colorectal cancer occurred, uncovered an 8% lower risk of the disease in association with each 300 mg per day increase in calcium intake. Those whose consumption of calcium averaged 1,000 mg per day had an 18% lower risk of the disease compared to those whose intake was 250 mg, and among those whose intake was 1,750 mg, the risk was 26% lower.

Editor’s Note: Analysis of studies that examined supplemental calcium, which included 8,839 colorectal cancer cases among 920,837 subjects, revealed a 9% lower risk of the disease in association with each 300 mg per day increase.

A study presented at the annual meeting of the American College of Cardiology and published in the New England Journal of Medicine reported that giving surgery patients aspirin may cause more harm than good.*

The study involved just over 10,000 patients undergoing non-cardiac surgery. Half received 200 mg of aspirin right before surgery, while half received a placebo. The aspirin group continued to take 100 mg of aspirin for a month following the operation.

Researchers found that 7% of patients in the aspirin group, or 351 people, had a heart attack or died within 30 days of surgery, compared to 7.1% (355) of those who received a placebo, indicating no benefit to taking aspirin. More significantly, 230 patients in the aspirin group experienced major bleeding versus 188 who took a placebo.

There was no difference in the outcomes for patients who regularly took a daily aspirin compared to those who took it specifically before surgery.

“You’re not preventing heart attacks and mortality, but you are increasing the risk of significant bleeding,” said study leader Dr. P.J. Devereaux.

Editor’s Note: The take-home lesson based on these study results is to discontinue aspirin two days before surgery in consultation with your doctor if aspirin has been prescribed to you. A second related study, also published in the New England Journal of Medicine, found that the drug clonidine, which is given to 20% of patients with atherosclerosis (hardening of the arteries) is also ineffective and potentially harmful.

An article appearing in the Journal of Nutrition reveals a lower risk of prostate cancer in men with genetic variants indicative of higher vitamin E status. “Genetic variants in genes involved in vitamin E transport or metabolism may be important determinants of potential beneficial effects of vitamin E supplementation on prostate cancer risk,” authors Jacqueline M. Major and associates note.*

The study included participants in the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial, which enrolled over 155,000 men and women between 1993 and 2001. The current investigation compared 483 men diagnosed with prostate cancer and 542 matched control subjects who had genotype data on three vitamin E-related variants available. The researchers found that the presence of a specific single nucleotide polymorphism was associated with a 25% lower risk of prostate cancer in comparison with the more common genotype.

Editor’s Note: As potential mechanisms for vitamin E, the authors emphasize its antioxidant properties that can protect against oxidative damage or inhibit lipid peroxidation within the cells. They also discuss the vitamin’s modifying effect on inflammation.

The results of a meta-analysis conducted by researchers at Sweden’s Karolinska Institute indicate improved survival among women with breast cancer who had a higher intake of vitamin C from supplements or food sources, according to the European Journal of Cancer.*

For their analysis, Holly R. Harris and her colleagues selected nine reports describing 10 observational studies that included a total of 17,696 women diagnosed with breast cancer. Among this group, there were 1,558 deaths attributable to the disease and 2,791 total deaths. Studies examined the effect of supplementing with vitamin C following breast cancer diagnosis and/or the effect of vitamin C obtained in the diet.

When the studies reporting the effects of vitamin C supplementation were evaluated, the use of supplements was associated with a 19% lower risk of total mortality and a 15% lower risk of dying from breast cancer in comparison with no use.

Editor’s Note: Analysis of vitamin C from food sources uncovered a 27% lower risk of mortality and a 22% lower risk of breast cancer death in association with each 100 mg per day increase. Comparison of high versus low dietary intake resulted in a 20% lower risk of dying and a 23% reduction in the risk of breast cancer mortality among women whose intake was categorized as high.

The results of a meta-analysis published online in the American Journal of Hypertension add evidence to a blood pressure-reducing effect for the omega-3 fatty acids eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA).*

Paige E. Miller and colleagues analyzed 70 randomized trials that compared the effects of EPA and/or DHA to a placebo. The average dose of EPA plus DHA was 3.8 grams per day, which was supplied by fish oil in the majority of the studies.

Analysis of hypertensive subjects who were not receiving treatment for their condition found an average reduction of 4.51 mmHg in systolic blood pressure and a 3.05 mmHg reduction in diastolic pressure among those who received EPA and DHA in comparison with a placebo. In the meta-analysis of all studies, EPA plus DHA was associated with an average reduction in systolic and diastolic blood pressure of 1.52 mmHg and 0.99 mmHg.

Editor’s Note: When the analysis was restricted to EPA/DHA from supplements alone, systolic blood pressure was lowered by an average of 1.75 mmHg and diastolic by 1.11 mmHg. Diastolic blood pressure was found to be significantly reduced when the dosage of EPA/DHA exceeded 2 grams per day.

Greater willingness on the part of physicians to order vitamin D tests for preventive care has led to a surge in deficiency diagnoses, according to a study published in the Southern Medical Journal.*

Utilizing date from The National Ambulatory Medical Care and National Hospital Ambulatory Medical Care surveys, Karen Huang and colleagues determined that between 2007 and 2010 approximately 7.5 million outpatient visits were associated with vitamin D deficiency diagnoses. “From 2007 to 2010, we noted that the number of diagnoses for vitamin D deficiency rapidly increased and tripled from 2008 to 2010,” Dr. Huang reported.

“We believe this increase in visits with a diagnosis of vitamin D deficiency, but without a diagnosis of weak or fractured bones, suggests that a lot of doctors now are checking patients for this deficiency so that they can help prevent the patients from developing weak bones,” she concluded.

Editor’s Note: The researchers found that females were 2.6 times likelier than males to be diagnosed with low vitamin D levels, and that those aged 65 and older were nearly 3 times as likely to be deficient than younger patients.

A review and meta-analysis published in the British Medical Journal concluded an association between a higher serum level of vitamin D and a lower risk of death from any cause over follow-up periods ranging from 0.3 to 29 years. The international team of researchers also uncovered a reduction in the risk of premature death in association with the use of vitamin D3 supplements.*

Rajiv Chowdhury and colleagues selected 73 observational cohort studies that reported serum 25-hydroxyvitamin D levels and the cause of deaths that occurred among 849,412 men and women over follow-up. The analysis uncovered a 35% higher risk of death from cardiovascular disease or from any cause over follow-up among those whose vitamin D levels were in the lowest one-third of subjects in comparison with those whose levels were among the highest third.

Editor’s Note: Analysis of 22 randomized controlled trials of vitamin D supplements, involving a total of 30,716 participants, revealed an 11% lower risk of dying over three to seven years of follow up among those who received vitamin D3 in comparison with a placebo or no treatment.

An article published online in The Journal of Sexual Medicine reveals that lifestyle changes may be as good as prescription medication for treating erectile dysfunction (ED) in older men.*

In an investigation of 810 men aged 35 to 80 years at the beginning of the study, Gary A. Wittert, MD, and his associates at the University of Adelaide in Australia documented the presence of erectile dysfunction in 23.2% of the subjects. During the following five-year period, 31.7% developed ED, yet the condition went into remission among 29%.

Predictors of the development of ED included having a lower income, the presence of significant abdominal fat, depression, diabetes, obstructive sleep apnea, voiding lower urinary tract symptoms, and other factors. Predictors of its remission included employment and the absence of lower urinary tract symptoms, angina, diabetes, and disordered lipids.

Editor’s Note: “The good news is, our study also found that a large proportion of men were naturally overcoming erectile dysfunction issues,” Dr Wittert concluded. “The remission rate of those with erectile dysfunction was 29%, which is very high. This shows that many of these factors affecting men are modifiable, offering them an opportunity to do something about their condition.”