naturopathydigest.com -- Critical Research

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Critical Research

Critical Research is a regular feature in Naturopathy Digest. Each month, we provide abstracts from studies published in the top peer-reviewed journals; each abstract includes the complete citation and an online link to the journal. Whenever possible, this link directs you to a page where you can order the full text of the study, if desired.

This Month's Featured Abstract

Folate status in women of childbearing age, by race/ethnicity – United States, 1999-2000, 2001-2002, and 2003-2004.

Statement from the Centers for Disease Control and Prevention (CDC).

Fortification of enriched cereal-grain products with folic acid to help prevent pregnancies affected by a neural tube defect (NTD) (e.g., spina bifida or anencephaly) became mandatory in the United States in January 1998. Data from the 1999-2000 National Health and Nutrition Examination Survey (NHANES) indicated that median serum folate concentrations in nonpregnant women of childbearing age had increased substantially, compared with concentrations during a period (1988-1994) before fortification was mandated. This report uses NHANES data to update those findings and assess trends in serum folate and red blood cell (RBC) folate levels by race/ethnicity from the 1999--2000 survey through the 2003-2004 survey. The results of these comparisons indicated that median serum folate concentrations among nonpregnant women of childbearing age decreased 16% from 1999-2000 through 2003-2004, and RBC folate concentrations decreased 8%. All women of childbearing age who are capable of becoming pregnant should consume 400 microg of folic acid daily to reduce the occurrence of NTD-affected pregnancies.
Source: MMWR Morb Mortal Wkly Rep Jan 5, 2007;55(51-52):1377-80.

Adult fat intake associated with the presence of children in households: findings from NHANES III.

Helena H. Laroche, MD, Timothy P. Hofer, MD, MSc and Matthew M. Davis, MD, MAPP

Background: Increasing prevalence of obesity and lifestyle-related chronic disease is fundamentally tied to Americans' poor eating habits. Family environment, including the presence of children, may affect adults' diet behavior.
Objective: To compare dietary fat intake between adults with and without minor children in the home.
Design: Secondary analysis of cross-sectional survey data from the National Health and Nutrition Examination Survey III (NHANES III) public use dataset.
Subjects: Adults aged 17 to 65 years with and without children younger than 17 years old in the home. Outcome variables: Intake of total fat, saturated fat, and kilocalories based on a 24-hour dietary recall and a selection of high-fat foods from a food frequency questionnaire.
Methods: Linear and logistic regression, accounting for the sample weights and complex survey design.
Results: The presence of children in the household was associated with significantly higher adjusted total fat consumption for adults (4.9 g/24 hours [95% CI: 0.8, 9.1]) and significantly higher adjusted saturated fat consumption (1.7 g/24 hours [0.3, 3.3]). Adults with children ate many high-fat foods more frequently than adults without children, including salty snacks, pizza, cheese, beef, ice cream, cakes/cookies, bacon/sausage/processed meats, and peanuts.
Conclusions: The presence of children in the home may affect adults' diets. Providers should emphasize dietary discretion for the entire family.
Source: J Am Board Fam Med. Jan-Feb 2007;20(1):9-15.

Impact of smoking cessation on bone mineral density in postmenopausal women.

Cheryl Oncken, MD, MPH, Karen Prestwood, MD, Alison Kleppinger, MS, et al.

Background: Although clinical guidelines recommend smoking cessation to improve bone health, the impact of short-term smoking cessation (i.e., 1 year) on bone mineral density (BMD) is not known. We examined the effects of smoking cessation on BMD measurements, markers of bone turnover, and hormone profiles in postmenopausal women.
Methods: Postmenopausal women (n = 152) who smoked at least 10 cigarettes per day were randomly assigned to behavioral counseling and either nicotine or placebo patch for smoking cessation (3-month treatment with a 1-month taper) and followed for an additional year. The BMD at various sites (hip, spine, wrist, and total body), serum and urine biochemical markers of bone turnover, and sex hormones were measured at baseline and again one year after smoking treatment. Women who continuously abstained from smoking between the end of treatment and one year later (quitters) (n = 42) were compared with women who completed the study and continued to smoke (n = 77).
Results: Femoral trochanter BMD increased by 2.9% among quitters vs. 0.6% among continued smokers (p = 0.02). Total hip BMD increased by 1.52% among quitters vs. 0.43% among continued smokers (p = 0.03). Changes in BMD at the femoral neck, radius, spine, and total body did not significantly differ between groups. The effects of smoking cessation on bone were mediated in part by weight gain. Smoking cessation was also associated with an increase in bone alkaline phosphatase.
Conclusions: Smoking cessation, relative to continued smoking, increases BMD at the femoral trochanter and total hip in postmenopausal women.
Source: J Womens Health, December 2006;15(10):1141-50.

Low micronutrient levels as a predictor of incident disability in older women.

Benedetta Bartali, Richard D. Semba, Edward A. Frongillo, et al.

Background: The role of nutritional status in the disablement process is still unclear. The objective of this study was to assess whether low concentrations of nutrients predict the development and course of disability.
Methods: Longitudinal study including community-dwelling women 65 years or older enrolled in the Women's Health and Aging Study I. In total, 643 women were assessed prospectively at 6-month intervals from 1992 to 1995.
Results: Incidence rates of disability in activities of daily living (ADLs) during three years of follow-up. Incidence rates in the lowest quartile of each selected nutrient were compared with those in the upper quartiles. The hazard ratios were estimated from Cox models adjusted for potential confounders. Women in the lowest quartile of serum concentrations of vitamin B(6) (hazard ratio [HR], 1.31; 95% confidence interval [CI], 1.03-1.67), vitamin B(12) (HR, 1.40; 95% CI, 1.12-1.74), and selenium (HR, 1.38; 95% CI, 1.12-1.71) had significantly higher risk of disability in ADLs during three years of follow-up compared with women in the upper three quartiles.
Conclusions: Low serum concentrations of vitamins B(6) and B(12) and selenium predict subsequent disability in ADLs in older women living in the community. Nutritional status is one of the key factors to be considered in the development of strategies aimed at preventing or delaying the disablement process.
Source: Arch Intern Med, Nov 27, 2006;166(21):2335-40.

Relation of higher folate intake to lower risk of Alzheimer disease in the elderly.

Jose A Luchsinger, Ming-Xin Tang, Joshua Miller, et al.

Background: Higher intake of folate and vitamins B6 (pyridoxine hydrochloride) and B12 (cyanocobalamin) may decrease the risk of Alzheimer disease (AD) through the lowering of homocysteine levels.
Objective: To relate intake of folate and vitamins B6 and B12 to AD risk.
Design and Patients: We followed up 965 persons 65 years or older without dementia at baseline for a mean +/- SD period of 6.1 +/- 3.3 person-years after the administration of a semiquantitative food frequency questionnaire. Total, dietary, and supplement intake of folate and vitamins B6 and B12 and kilocalorie intake were estimated from the questionnaire responses. We related energy-adjusted intake of folate and vitamins B6 and B12 to incident AD using the Cox proportional hazards regression model. Main Outcome Measure: Incident AD.
Results: We found 192 cases of incident AD. The highest quartile of total folate intake was related to a lower risk of AD (hazard ratio, 0.5; 95% confidence interval, 0.3-0.9; P=.02 for trend) after adjustment for age, sex, education, ethnic group, the epsilon4 allele of apolipoprotein E, diabetes mellitus, hypertension, current smoking, heart disease, stroke, and vitamin B6 and B12 levels. Vitamin B6 and B12 levels were not related to the risk of AD.
Conclusions: Higher folate intake may decrease the risk of AD independent of other risk factors and levels of vitamins B6 and B12. These results require confirmation with clinical trials.
Source: Arch Neurol, Jan. 2007;64(1):86-92.

Massage therapy for osteoarthritis of the knee: a randomized controlled trial.

Adam I. Perlman, MD, MPH, Alyse Sabina, MD, Anna-Leila Williams, PA-C, MPH

Background: Massage therapy is an attractive treatment option for osteoarthritis (OA), but its efficacy is uncertain. We conducted a randomized, controlled trial of massage therapy for OA of the knee.
Methods: Sixty-eight adults with radiographically confirmed OA of the knee were assigned either to treatment (twice-weekly sessions of standard Swedish massage in weeks 1-4 and once-weekly sessions in weeks 5-8) or to control (delayed intervention). Primary outcomes were changes in the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain and functional scores and the visual analog scale of pain assessment. The sample provided 80% statistical power to detect a 20-point difference between groups in the change from baseline on the WOMAC and visual analog scale, with a 2-tailed alpha of .05.
Results: The group receiving massage therapy demonstrated significant improvements in the mean (SD) WOMAC global scores (-17.44 [23.61] mm; P < .001), pain (-18.36 [23.28]; P < .001), stiffness (-16.63 [28.82] mm; P < .001), and physical function domains (-17.27 [24.36] mm; P < .001) and in the visual analog scale of pain assessment (-19.38 [28.16] mm; P < .001), range of motion in degrees (3.57 [13.61]; P = .03), and time to walk 50 ft (15 m) in seconds (-1.77 [2.73]; P < .01). Findings were unchanged in multivariable models controlling for demographic factors.
Conclusions: Massage therapy seems to be efficacious in the treatment of OA of the knee. Further study of cost effectiveness and duration of treatment effect is clearly warranted.
Source: Arch Intern Med, Dec. 11, 2006;166(22):2533-8.