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AvocadoBone fractureRecent studies have indicated that oxidative stress may be a contributing factor in the development of osteoporosis and fractures. A new study investigated the potential association between serum alpha-tocopherol (Vitamin E) concentrations and the risk of hip fractures.

The study, published online in the journal Osteoporosis International, included 21,774 Norwegian men and women aged 65-79 that were part of a community-based health study. Serum Vitamin E concentrations were measured at the beginning of the study and subjects were followed for 11 years.

During the course of the follow up, 1,168 hip fractures were reported in the men and women. After adjusting for smoking, month of blood sample, BMI, education, physical inactivity, self-rated health, and serum 25-hydroxyvitamin D (25(OH)D), serum vitamin E levels showed a linear inverse association with hip fracture risk. Among subjects in the lowest quartile (25%) of serum Vitamin E, the risk of hip fracture was 51% higher than those whose levels were among the top 25%.

In this older population, low serum vitamin E concentrations were associated with an increased risk of hip fractures. These results confirm the findings of two recent cohort studies which also found an increased risk of bone fracture among older adults with low serum vitamin E concentrations. The researchers suggest that in addition to its antioxidant effect, vitamin E could have a direct role in bone remodeling. However, further research is needed to clarify the role of vitamin E in maintaining bone health.

Holvik K et al. Osteoporos Int. 2014 Nov; 25(11):2545-54. doi:10.1007/s00198-014-2802-6.

Michaëlsson K et al. Am J Clin Nutr. 2014 Jan; 99(1):107-14. doi:10.3945/ajcn.113.064691

vitamin-d-sourcesA study published in the American Journal of Clinical Nutrition has shown a reduction in cancer rates among postmenopausal women taking vitamin D combined with calcium.

This four-year, double blind, randomized placebo-controlled study involved over 1,100 postmenopausal women who were divided into three treatment groups: 1) placebo, consisting of both a vitamin D placebo and a calcium placebo; 2) calcium, consisting of either calcium citrate (1400 mg Ca/day) or calcium carbonate (1500 mg Ca/day) plus a vitamin D placebo (Ca-only group); and 3) calcium plus vitamin D, consisting of calcium plus 1000 IU (25 μg) Vitamin D3/day (Ca + D group).

In comparison to the placebo group, the women taking both calcium and vitamin D had a 60% decreased risk of all cancer by the end of the study. There was also a marginal reduction in risk among the women taking calcium only.

This study takes an important step in extending several decades of research involving the role of vitamin D in health and disease. The results further strengthen the case made by many specialists that vitamin D may be a powerful cancer preventive and that it is commonly found lacking in the general population, particularly the elderly.

Joan M Lappe et al. Am J Clin Nutr June 2007. Vol. 85(6):1586-1591

LemonPrevious observational studies have suggested that a higher intake of vitamin C is associated with a reduced risk of cardiovascular disease, primarily through effects on the endothelium (a thin layer of cells lining the interior of blood vessels). The endothelium has many important functions that include maintaining the flexibility of blood vessels and modulating the activity of certain white blood cells that are a significant part of the immune system.

In a recent meta-analysis published in the journal Atherosclerosis, researchers sought to determine the effect of vitamin C supplementation on endothelial function (EF) in adults, and whether the outcome differed by health status, study duration, dose and route of administration.

The study included 44 clinical trials and 1,129 adult participants. Supplemental vitamin C at oral doses of more than 500 mg was associated with significant improvement of endothelial function in subjects with cardio-metabolic disorders. The benefits of supplementation were primarily limited to people with atherosclerosis, diabetes, and heart failure. The study design, duration of supplementation, route of administration and baseline plasma vitamin C did not appear to significantly affect the outcome. There was a significant positive association between dosages greater than 500 mg/day and improvement in endothelial function.

The researchers noted that in addition to its effects on oxidative stress, vitamin C may positively affect nitric oxide, a potent vasodilator, reducing vascular inflammation. The results of this study indicate that vitamin C supplementation may improve endothelial function, especially in adults with a higher cardiovascular risk. Vitamin C supplementation, therefore, could potentially be a useful tool for the secondary prevention of cardiovascular diseases.

Ashor AW et al. Atherosclerosis.2014 Jul; 235(1):9-20.

Magnesium (Mg) is an essential mineral important in the structure and the function of the human body and also as a cofactor for hundreds of enzyme systems that regulate diverse biochemical reactions in the body. Unfortunately, dietary surveys in the US continue to show that older people are particularly susceptible to magnesium deficiency for various reasons, including an inadequate dietary intake, reduced absorption, and greater losses in stools and urine. A poor magnesium status has been associated with reduced physical performance, but to date no trials have established a link between magnesium supplementation and physical performance in the elderly.

In a new study published in the American Journal of Clinical Nutrition, investigators sought to determine whether oral magnesium supplementation could improve physical performance in healthy older women. 124 healthy women (average age: 71.5 years) attending a mild fitness program were randomly assigned into two groups: 54 women in the treatment group were given 300 mg/day of magnesium oxide for 12 weeks, and 77 in the control group received no placebo or intervention. The primary outcome was a change in the Short Physical Performance Battery (SPPB).

The scores for the SPPB did not differ between the two groups at baseline. After 12 weeks, the group taking magnesium had a significantly better total SPPB score than the controls. The treatment group also had a significantly better test score for chair stand times and 4 minute walking speeds. The improvements were more evident in women with dietary magnesium intakes below the RDA.

The findings of this study indicate that magnesium supplementation may play a role in delaying age-related decline in physical performance in healthy older women, especially if dietary intake is below recommended levels.

Nicola Veronese et al. Am J Clin Nutr. 2014 Sep;100(3):974-81. doi: 10.3945/ajcn.113.080168.

Type 2 diabetesType 2 diabetes has become a significant worldwide health care challenge, as it is associated with various health problems and increased mortality risk. There is increasing evidence that vitamin D influences many non-skeletal medical conditions, including heart disease, cancer, certain autoimmune diseases and type-2 diabetes. Observational research has shown that seasonal variation in blood sugar control in the winter may be partly due to vitamin D, since vitamin D levels are generally much lower in the winter.

In a study published in the European Journal of Clinical Nutrition, researchers examined the association between vitamin D status and the incidence of Type 2 diabetes. After a thorough review of the literature, 8 observational studies and 11 randomly controlled trials were included in the review.

Intake of >500 IU/day decreased the risk of type 2 diabetes by 13% when compared to those with a vitamin D intake of <200 IU/day; Adults with the highest vitamin D status (>25 ng/ml or 62.5 mmol/L) had a 43% lower risk of developing type 2 diabetes when compared to those with the lowest serum vitamin D levels (<14 ng/ml or 35 mmol/L). In two trials that included patients with glucose intolerance, vitamin D supplementation improved measures of insulin resistance. No significant effect of vitamin D on glycemic outcomes was evident in the trials that included subjects with normal glucose tolerance at baseline.

The results of this review show that vitamin D may play a role in the prevention of type 2 diabetes, although high-quality studies are needed to determine a potential mechanism between vitamin D concentration and relevant glycemic outcomes.

J Mitri et al. European Journal of Clinical Nutrition (2011) 65:1005–1015.

The attenuation of the number and severity of infections is of importance to athletes. Probiotics use has increased over recent years with beneficial effects believed to include improvements in immune function. Recent research has focused on their effectiveness for reducing the number, duration and severity of infections amongst endurance athletes. At present no research has been undertaken with team sport athletes.

Scientist from University of Otago conducted a randomised controlled trial aimed to determine the effectiveness of probiotics on the number, duration and severity of infections amongst elite union rugby players. Thirty elite rugby union players were allocated randomly to receive either a daily probiotics supplement (containing lactobacillus gasseri, Bifidobacterium bifidium and B. Longum) or a placebo for four weeks. Participants completed a daily diary to identify and rate the severity of any infectious symptoms.

During the probiotic treatment 14/30 participants never experienced a single upper respiratory tract illness (URTI) or gastrointestinal (GI) episode, compared to 6/30 on the placebo supplementation. The duration of infection was also significantly reduced in probiotic supplement group (3.4 days) compared to the placebo group (5.8 days). There was no significant difference in the severity of the symptoms between the two treatment groups.

These results provide evidence for the beneficial effects of daily probiotic supplementation in professional rugby union players who undertake intensive training and competition.

Brylee A Haywood et al. J Science and Medicine in Sport July 2014; Vol. 17(4):356–360

Low-GIMagnesium (Mg) is an essential mineral that has many important roles in the body and is required by over 300 enzymes. Inadequate dietary intake of Mg has been related to many chronic inflammatory or metabolic diseases such as hypertension, metabolic syndrome, type 2 diabetes, osteoporosis, cardiovascular diseases, and even some cancers.

Magnesium is found most abundantly in healthy foods such as whole grains, green leafy vegetables, nuts and legumes. It is estimated that 75% of the U.S. population gets less than the minimum recommended level (RDA) in the diet.

In a new study published in the European Journal of Clinical Nutrition, researchers investigated the potential association between dietary Mg intake and serum C-reactive protein (CRP), a marker of inflammation. Nearly 33,000 adult participants from seven cross-sectional studies were included in the meta-analysis. Magnesium intake in the intervention studies varied from 50-450 mg/day and for relatively short durations up to 4 months.

Evidence from the intervention studies showed a potential beneficial effect of Mg intake on serum CRP levels. In the observational studies included in the review, having a CRP level greater than or equal to 3 mg/L (indicating the presence of inflammation) was 49% more likely in the group with the lowest Mg intake when compared to the group with the highest Mg intake.

This meta-analysis and review supports the connection between low Mg intake and increased markers of inflammation. The researchers suggest that the potential beneficial effect of Mg intake on chronic disease may be at least partly explained by reducing inflammation.

DT Dibaba, P Xun and K He. European Journal of Clinical Nutrition (2014) 68(4):510–516.

PreschoolA new Cochrane Review suggests that zinc supplementation might reduce the overall risk of death in children 6 months to 12 years-old.

Zinc is a trace mineral that is needed for many important functions in the body. Deficiency may cause problems with growth, diarrhea, and immune function. Mild zinc deficiency may be overlooked, since symptoms are not always obvious and may include loss of hair, appetite, weight, and the senses of taste and smell. Severe zinc deficiency contributes to numerous child deaths per year due to diarrhea, pneumonia, and malaria.

In a newly published Cochrane Review, researchers conducted a comprehensive literature search for data on the effects of zinc in children 6 months to 12 years-old. Eighty well-designed clinical trials with a total of 205,401 participants were ultimately identified for inclusion.

The Cochrane review found that giving children zinc supplement might reduce their risk of death in general, particularly their risk of death due to diarrhea. Children given zinc experience less diarrhea than children not given zinc. The review noted that zinc supplements may be associated with increased risk of vomiting.

The author concluded that the benefits of preventive zinc supplementation outweigh the harms in areas where the risk of zinc deficiency is relatively high. Further research should determine optimal intervention characteristics such as supplement dose.

Mayo-Wilson et al. Cochrane Database Syst Rev. 2014 May 15;5:CD009384. doi: 10.1002/14651858.CD009384.pub2

LungRespiratory infectious conditions place a substantial health and economic burden on society. The economic impact of colds has been estimated to be $40 billion dollars in the USA annually. Recent systematic reviews have reported a positive, although modest, effect of probiotics in terms of preventing common cold symptoms. The recent systematic review further evaluated the effect of probiotics, specifically Lactobacillus and Bifidobacterium strains, on the duration of acute respiratory infections in otherwise healthy children and adults.

In the latest review, twenty randomised controlled trials (RCT) were included, of which twelve were considered to have a low risk of bias. The duration of probiotic treatment ranged from 3 weeks to 7 months, although the majority of trials were carried out for approximately 3 months over the winter months.

The meta-analysis revealed significantly fewer numbers of days of illness per person, shorter illness episodes by almost a day, and fewer numbers of days absent from day care/school/work in participants who received a probiotic intervention than in those who had taken a placebo.

In conclusion, this systematic review provides evidence from good-quality RCT that adding probiotics to diet helps reduce the duration of respiratory illness episodes in otherwise healthy children and adults and offers a viable cost-saving option in improving quality of life.

Sarah King et al; Br J Nutr. 2014 Apr 29:1-14

An analysis of 70 trials reveals that omega-3 supplementation may be as effective at reducing blood pressure as other lifestyle intervention.

Nearly 4 out of 10 Australian adults have elevated blood pressure, which is linked to an increased risk of strokes, coronary heart disease, and total mortality.  A recent metaanalysis published in the American Journal of Hypertension analyzed 70 RCT trials to determine the effect of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) on blood pressure.

Weighted differences were used to separate individuals into an EPA+DHA group and a placebo group. All of the studies combined resulted in a 1.52 mm Hg reduction in systolic blood pressure and a 0.99 mm Hg reduction in diastolic blood pressure for the EPA+DHA group over the placebo group.

Additional data was used to further separate these into subgroups for additional analysis. This revealed even stronger effects of EPA+DHA, where a 4.51 mm Hg reduction in systolic blood pressure and a 3.05 mm Hg reduction in diastolic blood pressure were observed among untreated hypertensive subjects. In this subgroup, EPA+DHA treatment was as effective, or more effective, at lowering blood pressure than other lifestyle-intervention including increasing physical activity and restricting alcohol and sodium.

These results continue to build on prior evidence showing that omega-3 fatty acids may play a role in helping individuals control their blood pressure. One of the authors, Dominik Alexander, PhD, noted that “when measuring blood pressure, even small reductions can have a significant clinical impact.” A 2 mm Hg reduction in blood pressure reduces stroke mortality by 6%, coronary heart disease mortality by 4%, and total mortality by 3%.

Overall, available evidence from randomised controlled trials (RCT) indicates that provision of EPA+DHA reduces systolic blood pressure, while provision of ≥2 grams reduces diastolic blood pressure.

Miller, P.E. et al. Am J Hypertens. 2014 Mar 6. [Epub ahead of print] PMID:24610882


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