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

Editor’s note: Dr. Alex Vasquez, editor of Naturopathy Digest, referenced the following study in the May 2007 issue of ND. Read “Naturopathic Solutions to America’s Epidemics of Violence and Neurobehavioral Disorders, Part Two.

Impact of prenatal chlorpyrifos exposure on neurodevelopment in the first 3 years of life among inner-city children.

VA Rauh, R Garfinkel , FP Perera, et al.

Objective: The purpose of this study was to investigate the impact of prenatal exposure to chlorpyrifos on 3-year neurodevelopment and behavior in a sample of inner-city minority children.

Methods: As part of an ongoing prospective cohort study in an inner-city minority population, neurotoxicant effects of prenatal exposure to chlorpyrifos were evaluated in 254 children through the first 3 years of life. This report examined cognitive and motor development at 12, 24, and 36 months (measured with the Bayley Scales of Infant Development II) and child behavior at 36 months (measured with the Child Behavior Checklist) as a function of chlorpyrifos levels in umbilical cord plasma.

Results: Highly exposed children (chlorpyrifos levels of >6.17 pg/g plasma) scored, on average, 6.5 points lower on the Bayley Psychomotor Development Index and 3.3 points lower on the Bayley Mental Development Index at 3 years of age compared with those with lower levels of exposure. Children exposed to higher, compared with lower, chlorpyrifos levels were also significantly more likely to experience Psychomotor Development Index and Mental Development Index delays, attention problems, attention-deficit/hyperactivity disorder problems, and pervasive developmental disorder problems at 3 years of age.

Conclusions: The adjusted mean 36-month Psychomotor Development Index and Mental Development Index scores of the highly and lower exposed groups differed by only 7.1 and 3.0 points, respectively, but the proportion of delayed children in the high-exposure group, compared with the low-exposure group, was 5 times greater for the Psychomotor Development Index and 2.4 times greater for the Mental Development Index, increasing the number of children possibly needing early intervention services.

Source: Pediatrics, Dec 2006;118(6): e1845-e1859.

Prolonged effect of calcium supplementation on risk of colorectal adenomas in a randomized trial.

MV Grau, JA Baron, RS Sandler

Background: Calcium supplementation has been shown to decrease the risk of recurrence of colorectal adenomas in randomized trials. However, the duration of this protective effect after cessation of active supplementation is not known.

Methods: In the Calcium Polyp Prevention Study, 930 subjects with a previous colorectal adenoma were randomly assigned from November 1988 through April 1992 to receive placebo or 1200 mg of elemental calcium daily for 4 years. The Calcium Follow-up Study was an observational phase of the trial that tracked adenoma occurrence for an average of 7 years after the end of randomized treatment and gathered information regarding the use of medications, vitamins, and supplements during that time. We obtained follow-up information for 822 subjects, 597 of whom underwent at least one colonoscopy after the end of study treatment and are included in this analysis. Generalized linear models were used to compute relative risks (RRs) and 95% confidence intervals (CIs) for the effect of randomized calcium treatment on risk of adenoma recurrence during the first 5 years after study treatment ended and during the subsequent 5 years. Statistical tests were two-sided.

Results: During the first 5 years after randomized treatment ended, subjects in the calcium group still had a substantially and statistically significantly lower risk of any adenoma than those in the placebo group (31.5% versus 43.2%; adjusted RR = 0.63, 95% CI = 0.46 to 0.87, P = .005) and a smaller and not statistically significant reduction in risk of advanced adenomas (adjusted RR = 0.85, 95% CI = 0.43 to 1.69, P = .65). However, the randomized treatment was not associated with the risk of any type of polyp during the next 5 years. The findings were broadly similar when the analysis was restricted to subjects who did not report use of any calcium supplements after the treatment phase of the trial ended.

Conclusion: The protective effect of calcium supplementation on risk of colorectal adenoma recurrence extends up to 5 years after cessation of active treatment, even in the absence of continued supplementation.

Source: J Natl Cancer Inst, Jan. 17, 2007;99(2):129-36.

Consumption of dairy products and risk of Parkinson’s disease.

H Chen, E O’Reilly, ML McCullough, et al.

The authors prospectively investigated the association between intake of dairy products and risk of Parkinson’s disease among 57,689 men and 73,175 women from the American Cancer Society’s Cancer Prevention Study II Nutrition Cohort. A total of 250 men and 138 women with Parkinson’s disease were identified during follow-up (1992-2001). Dairy product consumption was positively associated with risk of Parkinson’s disease: Compared with the lowest intake quintile, the corresponding relative risks for quintiles 2-5 were 1.4, 1.4, 1.4, and 1.6 (95 percent confidence interval (CI): 1.1, 2.2; p for trend = 0.05). A higher risk among dairy product consumers was found in both men and women, although the association in women appeared nonlinear. Meta-analysis of all prospective studies confirmed a moderately elevated risk of Parkinson’s disease among persons with high dairy product consumption: For extreme intake categories, relative risks were 1.6 (95 percent CI: 1.3, 2.0) for both sexes, 1.8 for men (95 percent CI: 1.4, 2.4), and 1.3 for women (95 percent CI: 0.8, 2.1). These data suggest that dairy consumption may increase the risk of Parkinson’s disease, particularly in men. More studies are needed to further examine these findings and to explore underlying mechanisms.

Source: Am J Epidemiol, May 1, 2007;165(9): 998-1006.

New approach in asthma treatment using excitatory modulator.

BX Hoang, DG Shaw, S Levine, et al.

The impact of a herbal extract with excitatory modulator activity in the management of asthma was studied. An open and selective 3-year follow-up of 14 chronic refractory asthmatics aged between 22 and 70 was used. Participants received an extract of Sophora flavescens Ait. Medication use, a diary card of symptoms and respiratory function were recorded. The study was retrospective and all patients gave written informed consent. The quality of life, clinical symptoms and respiratory function improved during all periods of measurement. The use of inhaled corticosteroid and beta-agonists were reduced or eliminated. There were no significant adverse reactions reported. Therefore the extract of S. flavescens as an excitatory modulator appears to be a safe and may be an effective alternative treatment for refractory chronic asthma.

Source: Phytother Res, Feb. 13, 2007 [Epub ahead of print], doi: 10.1002/ptr.2107.

Tea consumption and basal cell and squamous cell skin cancer: results of a case-control study.

JR Rees, TA Stukel, AE Perry, et al.

Background: Tea constituents, including polyphenols, are hypothesized to have chemopreventive properties, and inhibit the induction of skin cancers in animal models.

Objective: To explore the association between regular tea consumption (>or=1 cup/d for >or=1 month) and the incidence of squamous cell (SCC) and basal cell (BCC) carcinomas.

Methods: A population-based case-control study of 770 individuals with BCC, 696 with SCC, and 715 age- and sex-matched control subjects.

Results: After adjustment for age, sex, and lifetime history of painful sunburns, ever having consumed tea regularly was associated with a significantly lower risk of SCC (odds ratio [OR] = 0.70; 95% confidence interval [CI] 0.53-0.92), especially among long-term drinkers (>or=47 years consumption: SCC, OR = 0.49; 95% CI 0.29-0.83; P for trend = .008) and among those consuming >or=2 cups/d (OR = 0.65; 95% CI 0.44-0.96; P for trend = 0.013). After adjustment for age and sex, ever having consumed tea regularly was weakly associated with BCC risk (OR = 0.79; 95% CI 0.63-0.98).

Limitations: Our case-control study was susceptible to recall bias and to confounding by unknown cancer risk factors associated with tea consumption.

Conclusions: Our findings support the existence of an inverse association between tea consumption and skin carcinogenesis.

Source: J Am Acad Dermatol, May 2007; 56(5):781-5. doi: 10.1016/j.jaad.2006.11.038.

Treatment of acute and chronic rhinosinusitis in the United States, 1999-2002.

HJ Sharp, D Denman, S Puumala, DA Leopold

Objective: To generalize the prescribing trends of a statistically defined sample of patient visits because of acute or chronic rhinosinusitis in the United States, using reported diagnostic codes from the International Classification of Diseases, Ninth Revision, Clinical Modification.

Design: Four-year prospective study.

Setting: Public use data from the National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey collected by the National Center for Health Statistics.

Results: The most frequently recommended medications for treatment of both acute and chronic rhinosinusitis are antibiotic agents, followed by antihistamines; nasal decongestants; corticosteroids; and antitussive, expectorant, and mucolytic agents, respectively. In addition, corticosteroids are used for the treatment of chronic rhinosinusitis.

Conclusions: The use of prescription antibiotics far outweighs the predicted incidence of bacterial causes of acute and chronic rhinosinusitis. Frequency of antibiotic class used was not congruent with reported antimicrobial efficacy of the respective classes. Despite contradictory efficacies reported in the literature, inhaled corticosteroids were frequently used to treat acute rhinosinusitis. Antibiotics and inhaled nasal corticosteroids are being used more often than their published efficacies would encourage.

Source: Arch Otolaryngol Head Neck Surg, March 2007;133(3):260-5.

Overweight/obesity and attention deficit and hyperactivity disorder tendency among adolescents in China.

LT Lam, L Yang

Objective: This study aims to investigate whether there is any association between attention deficit hyperactivity disorder (ADHD) tendency and overweight/obesity among adolescents.

Design: This study was a population-based health survey utilizing a two-stage random cluster sampling design.

Subjects: Subjects were recruited from the total population of adolescents who attended high school years 1, 2 and 3 with ages ranging from 13 to 17 years.

Measurements: Individual body weight and height were measured by medical professionals. Overweight and obesity were determined according to the CDC classification. ADHD tendency was assessed via a structured personal interview using a standardised scale.

Results: In all, 1429 students were recruited with 85 (6.3%) classified overweight and 42 (3.1%) obese with a mean BMI score of 19.1 (s.e.=0.15). For ADHD tendency, the average score was 15.48 (s.e.=0.28) with a median score of 16.0. There was a significant association between ADHD tendency and obesity among these adolescent (t=2.18, P=0.040), after adjusting for the potential confounding factors. However, the association between ADHD tendency and overweight did not reach a significant level.

Conclusion: ADHD tendency is associated with overweight/obesity among adolescents. Clinician should be aware of the increased risk of ADHD among obese adolescents. ADHD should be assessed and proper treatment should be provided in the management of obese.

Source: Int J Obes (Lond), April 2007;31 (4):584-90. doi: 10.1038/sj.ijo.0803526.

Effects of folic acid supplementation on hearing in older adults: a randomized, controlled trial.

J Durga, P Verhoef, LJ Anteunis, et al.

Background: Age-related hearing loss is a common chronic condition of elderly persons. Low folate status has been associated with poor hearing.

Objective: To determine whether folic acid supplementation slows age-related hearing loss.

Design: Double-blind, randomized, placebo-controlled trial conducted from September 2000 to December 2004.

Setting: The Netherlands.

Participants: 728 older men and women recruited from municipal and blood bank registries with plasma total homocysteine concentrations 13 micromol/L or greater serum and vitamin B12 concentrations 200 pmol/L or greater at screening, and no middle ear dysfunction, unilateral hearing loss, or pathologic ear conditions unrelated to aging.

Interventon: Daily oral folic acid (800 microg) or placebo supplementation for 3 years.

Measurements: 3-year change in hearing thresholds, assessed as the average of the pure-tone air conduction thresholds of both ears of the low (0.5-kHz, 1-kHz, and 2-kHz) and high (4-kHz, 6-kHz, and 8-kHz) frequencies.

Results: Initial median hearing thresholds were 11.7 dB (interquartile range, 7.5 to 17.5 dB) for low frequencies and 34.2 dB (interquartile range, 22.5 to 50.0 dB) for high frequencies. Sixteen participants (2%) were lost to follow-up. After 3 years, thresholds of the low frequencies increased by 1.0 dB (95% CI, 0.6 to 1.4 dB) in the folic acid group and by 1.7 dB (CI, 1.3 to 2.1 dB) in the placebo group (difference, -0.7 dB [CI, -1.2 to -0.1 dB]; P = 0.020). Folic acid supplementation did not affect the decline in hearing high frequencies.

Limitations: The strict criterion for participation on the basis of serum homocysteine concentrations limits extrapolation to the general population. Folic acid fortification of food was prohibited in the Netherlands during the study, so baseline folate levels in participants were about half of those found in the U.S. population.

Conclusions: Folic acid supplementation slowed the decline in hearing of the speech frequencies associated with aging in a population from a country without folic acid fortification of food. The effect requires confirmation, especially in populations from countries with folic acid fortification programs. Clinicaltrials.gov identifier: NCT00110604.

Source: Ann Intern Med, Jan. 2, 2007; 146(1):1-9.

Effect of spearmint (Mentha spicata Labiatae) teas on androgen levels in women with hirsutism.

M Akdogan, MN Tamer, E Cure, et al.

Mentha spicata Labiatae, known as spearmint, and Mentha piperita Labiatae, known as peppermint, can be used for various kinds of illnesses in herbal medicine and flavoring in industry. M. spicata Labiatae grows on the Anamas plateau of Yenithornarbademli town of Isparta, located in southwest part of Turkey. In this town, clinicians thought that consumption of tea steeped with M. spicata or M. piperita caused a diminished libido. Because antiandrogenic effects of spearmint and peppermint were found previously in rats, it was decided to observe the effect of this herbal tea on the androgen levels in hirsute women. Twenty-one female hirsute patients, 12 with polycystic ovary syndrome and 9 with idiopathic hirsutism were included to the study. They were took a cup of herbal tea which was steeped with M. spicata for 5 days twice a day in the follicular phase of their menstrual cycles. After treatment with spearmint teas, there was a significant decrease in free testosterone and increase in luteinizing hormone, follicle-stimulating hormone and estradiol. There were no significant decreases in total testosterone or dehydroepiandrostenedione sulphate levels. Spearmint can be an alternative to antiandrogenic treatment for mild hirsutism. Further studies are needed to test the reliability of these results and the availability of spearmint as a drug for hirsutism.

Source: Phytother Res, May 2007;21(5): 444-7. doi: 10.1002/ptr.2074.

Mind-set matters: exercise and the placebo effect.

AJ Crum, EJ Langer

In a study testing whether the relationship between exercise and health is moderated by one’s mind-set, 84 female room attendants working in seven different hotels were measured on physiological health variables affected by exercise. Those in the informed condition were told that the work they do (cleaning hotel rooms) is good exercise and satisfies the Surgeon General’s recommendations for an active lifestyle. Examples of how their work was exercise were provided. Subjects in the control group were not given this information. Although actual behavior did not change, 4 weeks after the intervention, the informed group perceived themselves to be getting significantly more exercise than before. As a result, compared with the control group, they showed a decrease in weight, blood pressure, body fat, waist-to-hip ratio, and body mass index. These results support the hypothesis that exercise affects health in part or in whole via the placebo effect.

Source: Psychol Sci, Feb 2007;18(2):165-71.

Assessing depression following two ancient Indian interventions: effects of yoga and ayurveda on older adults in a residential home.

MN Krishnamurthy, S Telles

The effects of yoga and ayurveda on geriatric depression were evaluated in 69 persons older than 60 who were living in a residential home. Participants were stratified by age and gender and randomly allocated to three groups: Yoga, Ayurveda, or Wait-list Control. The 15-item Geriatric Depression Scale was used to assess depressive symptoms prior to the intervention, and after 3 months and 6 months post-intervention. Participation in one of the three groups lasted 24 weeks. The yoga program (7 hours 30 minutes per week) included physical postures, relaxation techniques, regulated breathing, devotional songs, and lectures. The Ayurveda Group received an herbal preparation twice daily for the whole period. The depression symptom scores of the Yoga Group at both 3 and 6 months decreased significantly, from a group average baseline of 10.6 to 8.1 and 6.7, respectively (p < .001, paired t-test). The other groups showed no change. Hence, an integrated approach of yoga including the mental and philosophical aspects in addition to the physical practices was useful for institutionalized older persons.

Source: J Gerontol Nurs, Feb 2007;33(2):17-23.

Effects of a low-glycemic-load vs. low-fat diet in obese young adults: a randomized trial.

CB Ebbeling, MM Leidig, HA Feldman, MM Lovesky, DS Ludwig

Context: The results of clinical trials involving diet in the treatment of obesity have been inconsistent, possibly due to inherent physiological differences among study participants.

Objective: To determine whether insulin secretion affects weight loss with 2 popular diets.

Design, Setting, and Participants: Randomized trial of obese young adults (aged 18-35 years; n=73) conducted from September 2004 to December 2006 in Boston, Mass., and consisting of a 6-month intensive intervention period and a 12-month follow-up period. Serum insulin concentration at 30 minutes after a 75-g dose of oral glucose was determined at baseline as a measure of insulin secretion. Outcomes were assessed at 6, 12, and 18 months. Missing data were imputed conservatively.

Interventions: A low-glycemic-load (40% carbohydrate and 35% fat) vs low-fat (55% carbohydrate and 20% fat) diet.

Main Outcome Measures: Body weight, body fat percentage determined by dual-energy X-ray absorptiometry, and cardiovascular disease risk factors.

Results: Change in body weight and body fat percentage did not differ between the diet groups overall. However, insulin concentration at 30 minutes after a dose of oral glucose was an effect modifier (group x time x insulin concentration at 30 minutes: P = .02 for body weight and P = .01 for body fat percentage). For those with insulin concentration at 30 minutes above the median (57.5 µIU/mL; n = 28), the low-glycemic-load diet produced a greater decrease in weight (–5.8 vs –1.2 kg; P = .004) and body fat percentage (–2.6% vs –0.9%; P = .03) than the low-fat diet at 18 months. There were no significant differences in these end points between diet groups for those with insulin concentration at 30 minutes below the median level (n = 28). Insulin concentration at 30 minutes after a dose of oral glucose was not a significant effect modifier for cardiovascular disease risk factors. In the full cohort, plasma high-density lipoprotein cholesterol and triglyceride concentrations improved more on the low-glycemic-load diet, whereas low-density lipoprotein cholesterol concentration improved more on the low-fat diet.

Conclusions: Variability in dietary weight loss trials may be partially attributable to differences in hormonal response. Reducing glycemic load may be especially important to achieve weight loss among individuals with high insulin secretion. Regardless of insulin secretion, a low-glycemic-load diet has beneficial effects on high-density lipoprotein cholesterol and triglyceride concentrations but not on low-density lipoprotein cholesterol concentration.

Source: JAMA, May 16, 2007;297:2092-2102.

Effects of aromatherapy acupressure on hemiplegic shoulder pain and motor power in stroke patients: a pilot study.

BC Shin, MS Lee

Objectives: The aim of this study was to determine if aromatherapy acupressure, compared to acupressure alone, was effective in reducing hemiplegic shoulder pain and improving motor power in stroke patients. This work was a randomized, controlled trial.

Subjects: Thirty (30) stroke patients with hemiplegic shoulder pain participated in this study.

Intervention: Subjects were randomly assigned to either an aromatherapy acupressure group (N = 15) or an acupressure group (N = 15), with aromatherapy acupressure using lavender, rosemary, and peppermint given only to the former group. Each acupressure session lasted 20 minutes and was performed twice daily for 2 weeks.

Outcomes Measures: Shoulder pain and motor power were the outcome measures used in this study.

Results: The pain scores were markedly reduced in both groups at post-treatment, compared to pretreatment (both aroma acupressure and acupressure group, p < 0.001). A nonparametric statistical analysis revealed that the pain score differed significantly between the 2 groups at post-treatment (p < 0.01). The motor power significantly improved at post-treatment, compared to pretreatment, in both groups (p < 0.005). However, there was no intergroup difference between two groups.

Conclusions: These results suggest that aromatherapy acupressure exerts positive effects on hemiplegic shoulder pain, compared to acupressure alone, in stroke patients.

Source: J Altern Complement Med, March 2007;13(2):247-52. doi: 10.1089/acm.2006.6189.