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.

Central obesity as measured by waist circumference is predictive of severity of lower urinary tract symptoms, sexual dysfunction and components of the metabolic syndrome.

Steven A Kaplan, MD, Harry Fisch, MD, Sandra J Berriman, et al.

Introduction and Objective: Previous studies have demonstrated significant associations between benign prostatic hyperplasia, prostate volume (PV) and components of the metabolic syndrome. Central obesity, a component of the metabolic syndrome, is usually measured by body mass index (BMI). The present analysis tested the hypothesis that use of the simple measurement of waist circumference (WC) (in inches) may be a useful predictor of PV, the severity of lower urinary tract symptoms (LUTS), and other measures of the metabolic syndrome. Methods: Men aged 50-75 years with moderate or severe LUTS (IPSS ≥ 8) with no previous treatment were included in the study. For this analysis, following measurement subjects were divided into three groups according to WC (30 - 36, 36 - 40 and > 40 inches). Baseline parameters including IPSS, PV as measured by transrectal ultrasound, serum PSA, peak flow rate (Qmax), presence of erectile dysfunction (ED) and ejaculatory dysfunction (EjD), as well as the incidence of hypertension, coronary artery disease, and diabetes mellitus were compared among the three WC categories. The statistical significance of the associations between WC and all parameters was assessed in univariate and multivariate analysis of variance. Results: In the 88 consecutive men analyzed (mean age 62.4) there were significant (p < 0.001) positive relationships between WC and PV, PSA, IPSS, ED and EjD. Peak flow rates (Qmax) were inversely related. Higher WC’s were also significantly associated with higher incidences of hypertension, coronary artery disease and diabetes mellitus. Results are summarized in the attached table. P values correspond to the differences between the three WC categories. Conclusions: In this preliminary analysis, increased waist circumference was associated with worsening voiding and sexual function. Moreover, there was a significantly increased incidence of components of the metabolic syndrome. Obese men, in particular those with other features of the metabolic syndrome, are at increased risk of male pelvic dysfunction and can be easily diagnosed by urologists with simple measurement of waist circumference.
Source: American Urological Association Annual Meeting in Anaheim, Calif., May 19-24, 2007.

Frequency and characteristics of pediatric and adolescent visits in naturopathic medical practice.

W Weber, JA Taylor, RL McCarty, A Johnson-Grass

Objectives: This work sought to identify naturopathic physicians in Washington State who frequently provide pediatric care and to describe the conditions treated and therapies recommended for children.
Patients and Methods: A mailed survey of licensed naturopathic physicians residing in Washington State collected demographic information and practice descriptions. For naturopathic physicians treating > or = 5 pediatric patients per week, data were collected on the conditions seen and treatments provided to children during a 2-week period.
Results: Of 499 surveys delivered to providers, 251 surveys were returned (response rate: 50.3%). Among the 204 naturopathic physicians currently practicing, only 31 (15%) saw > or = 5 children per week. For these pediatric naturopathic physicians, pediatric visits constituted 28% of their office practice. Pediatric naturopathic physicians were more likely to be licensed midwives (19.4% vs 0.6%) and treated significantly more patients per week (41.6 vs 20.2) than naturopathic physicians who provided less pediatric care. Eighteen of the 31 pediatric naturopathic physicians returned data on 354 pediatric visits; 30.5% of the visits were by children < 2 years old, and 58.5% were by those < 6 years old. The most common purpose for presentation included health supervision visits (27.4%), infectious disease (20.6%), and mental health conditions (12.7%). Pediatric naturopathic physicians provided immunizations during 18.6% of health supervision visits by children < 2 years old and 27.3% of visits by children between the ages of 2 and 5 years.
Conclusions: Although most naturopathic physicians in Washington treat few children, a group of naturopathic physicians provide pediatric care as a substantial part of their practice. Based on the ages of children seen and the conditions treated, pediatric naturopathic physicians may provide the majority of care for some children. Efforts should be made to enhance collaboration between naturopathic physicians and conventional providers so that optimal care can be provided to children.
Source: Pediatrics, July 2007;120(1):e142-6.

Alzheimer's disease drug discovery from herbs: neuroprotectivity from beta-amyloid (1-42) insult.

DS Kim, JY Kim, YS Han

Objective: To comparatively evaluate selected herbs for their ability to protect neuronal cells from direct betaA(1-42) insult.
Design: Twenty-seven (27) herbs were selected, extracted with aqueous methanol (90%) and chloroform, and the extracts were evaluated for their ability to protect PC12 rat pheochromocytoma and primary neuronal cells from betaA(1-42) insult using both 3-[4,5-dimethylthiazol-2-yl]-2,5-diphenyltetrazolium bromide reduction assay and lactate dehydrogenase efflux assay.
Results: Curcuma aromatia (ul-keum) and Zingiber officinale (ginger) extracts effectively protected cells from betaA(1-42) insult, followed by Ginkgo biloba (ginkgo), Polygonatum sp. (King Solomon's seal), Cinnamum cassia (Chinese cinnamon), Rheum coreanum (Korean rhubarb), Gastrodia elata (gastrodia), and Scutellaria baicalensis (skullcap). Several extracts showed cytotoxicity at high concentration (approximately 150 microg/mL), whereas other extracts did not at all protect cells from betaA(1-42) insult.
Conclusion: Selective herbs may be potentially important resources to discover drug candidates against the onset of Alzheimer's disease.
Source: J Altern Complement Med, April 2007;13(3):333-40.

A single dose of vitamin D enhances immunity to mycobacteria.

AR Martineau, RJ Wilkinson, KA Wilkinson, et al.

Rationale: Vitamin D was used to treat tuberculosis in the pre-antibiotic era. Prospective studies to evaluate the effect of vitamin D supplementation on antimycobacterial immunity have not previously been performed.
Objectives: To determine the effect of vitamin D supplementation on antimycobacterial immunity and vitamin D status.
Methods: A double-blind randomized controlled trial was conducted in 192 healthy adult tuberculosis contacts in London, UK. Participants were randomized to receive a single oral dose of 2.5 mg vitamin D or placebo and followed up at 6 weeks.
Measurements and Main Results: The primary outcome measure was assessed with a functional whole blood assay (BCG-lux assay) that measures the ability of whole blood to restrict luminescence, and thus growth, of recombinant reporter mycobacteria in vitro; the read-out is expressed as a luminescence ratio (luminescence post-infection/baseline luminescence). Interferon-gamma responses to the M. tuberculosis antigens early secretory antigenic target-6 and culture filtrate protein 10 were determined with a second whole blood assay. Vitamin D supplementation significantly enhanced the ability of participants' whole blood to restrict BCG-lux luminescence in vitro compared to placebo (mean luminescence ratio at follow-up 0.57 vs. 0.71 respectively, 95% CI for difference 0.01 to 0.25; P=0.03) but did not affect antigen-stimulated Interferon-gamma secretion.
Conclusions: A single oral dose of 2.5 mg vitamin D significantly enhanced the ability of participants' whole blood to restrict BCG-lux luminescence in vitro without affecting antigen-stimulated Interferon-gamma responses. Clinical trials should be performed to determine whether vitamin D supplementation prevents reactivation of latent tuberculosis infection.
Source: Am J Respir Crit Care Med, Apr. 26, 2007 [Epub ahead of print].

Augmenting immune responses to varicella zoster virus in older adults: a randomized, controlled trial of Tai Chi.

MR Irwin, R Olmstead, MN Oxman.

Objectives: To evaluate the effects of a behavioral intervention, Tai Chi, on resting and vaccine-stimulated levels of cell-mediated immunity (CMI) to varicella zoster virus (VZV) and on health functioning in older adults.
Design: A prospective, randomized, controlled trial with allocation to two arms (Tai Chi and health education) for 25 weeks. After 16 weeks of intervention, subjects were vaccinated with VARIVAX, the live attenuated Oka/Merck VZV vaccine licensed to prevent varicella.
Setting: Two urban U.S. communities between 2001 and 2005.
Participants: A total of 112 healthy older adults aged 59 to 86.
Measurements: The primary endpoint was a quantitative measure of VZV-CMI. Secondary outcomes were scores on the Medical Outcomes Study 36-item Short-Form Health Survey (SF-36).
Results: The Tai Chi group showed higher levels of VZV-CMI than the health education group (P<.05), with a significant rate of increase (P<.001) that was nearly twice that found in the health education group. Tai Chi alone induced an increase in VZV-CMI that was comparable in magnitude with that induced by varicella vaccine, and the two were additive; Tai Chi, together with vaccine, produced a substantially higher level of VZV-CMI than vaccine alone. The Tai Chi group also showed significant improvements in SF-36 scores for physical functioning, bodily pain, vitality, and mental health (P<.05).
Conclusion: Tai Chi augments resting levels of VZV-specific CMI and boosts VZV-CMI of the varicella vaccine.
Source: J Am Geriatr Soc, April 2007;55(4):511-7.

Premenopausal overweight women do not lose bone during moderate weight loss with adequate or higher calcium intake.

CS Riedt, Y Schlussel, N von Thun, et al.

Background: Weight loss is associated with bone loss, but this has not been examined in overweight premenopausal women.
Objective: The aim of this study was to assess whether overweight premenopausal women lose bone with moderate weight loss at recommended or higher than recommended calcium intakes.
Design: Overweight premenopausal women [n = 44; x (+/-SD) age: 38 +/- 6.4 y; body mass index (BMI): 27.7 +/- 2.1 kg/m(2)] were randomly assigned to either a normal (1 g/d) or high (1.8 g/d) calcium intake during 6 mo of energy restriction [weight loss (WL) groups] or were recruited for weight maintenance at 1 g Ca/d intake. Regional bone mineral density and content were measured by dual-energy X-ray absorptiometry, and markers of bone turnover were measured before and after weight loss. True fractional calcium absorption (TFCA) was measured at baseline and during caloric restriction by using a dual-stable calcium isotope method.
Results: The WL groups lost 7.2 +/- 3.3% of initial body weight. No significant decrease in BMD or rise in bone turnover was observed with weight loss at normal or high calcium intake. The group that consumed high calcium showed a strong relation (r = 0.71) between increased femoral neck bone mineral density and increased serum 25-hydroxyvitamin D. No significant effect of weight loss on TFCA was observed, and the total calcium absorbed was adequate at 238 +/- 81 and 310 +/- 91 mg/d for the normal- and high-calcium WL groups, respectively.
Conclusion: Overweight premenopausal women do not lose bone during weight loss at the recommended calcium intake, which may be explained by sufficient amounts of absorbed calcium.
Source: Am J Clin Nutr, April 2007;85(4):972-80.

Childhood adiposity predicts adult-onset current asthma in females: a 25-yr prospective study.

JA Burgess, EH Walters, GB Byrnes, et al.

Few data exist on associations between childhood adiposity and incident asthma in later life. The present authors examined the relationship between childhood body mass index (BMI) and incident asthma beginning in adolescence or in adult life. All subjects included in the study were participants in the Tasmanian Asthma Survey, a large population-based cohort study, and were asthma free at 7 yrs of age. Weight, height and lung function were measured at 7 yrs of age. Asthma status at 7 and 32 yrs of age was ascertained by questionnaire. Odds ratios were calculated for the association between childhood adiposity, expressed as "overweight" or as BMI z-score quartiles at 7 yrs of age, and asthma development after that age. In females, but not in males, there was a significant association between adiposity at 7 yrs of age and current asthma at 32 yrs of age that developed after the age of 21 yrs. The association was not explained by childhood lung function or age at menarche. There was no association between adiposity at 7 yrs of age and asthma that developed after that age and remitted at 32 yrs of age in either sex. Higher body mass index in nonasthmatic young females at 7 yrs of age predicts risk of current asthma developing in adult life.
Source: Eur Respir J, April 2007;29(4):668-75.

Long-term weight losses associated with prescription of higher physical activity goals. Are higher levels of physical activity protective against weight regain?

DF Tate, RW Jeffery, NE Sherwood, RR Wing

Background: High levels of exercise may be necessary for long-term maintenance of weight loss.
Objective: We aimed to determine in a randomized prospective design whether encouraging 2500 kcal physical activity/wk produced greater 30-mo weight losses than did the standard 1000 kcal physical activity/wk prescription.
Design: Overweight adults (n = 202) were randomly assigned to either 18 mo of standard behavioral treatment (SBT) with an exercise goal of 1000 kcal/wk or a high physical activity (HPA) treatment with a goal of 2500 kcal/wk. The HPA treatment included all procedures in the SBT plus encouragement to recruit 1-3 exercise partners and small-group counseling with an exercise coach. Participants were followed for 30 mo.
Results: The HPA group achieved significantly greater exercise levels and weight losses than did the SBT group at 12 and 18 mo (P < 0.01). Weight losses did not differ significantly at 30 mo: 0.90 +/- 8.9 and 2.86 +/- 8.6 kg for the SBT and HPA groups, respectively (P = 0.16). At 30 mo, average exercise levels no longer differed significantly between groups (1390 and 1696 kcal/wk, respectively; P > 0.10). Participants sustaining high exercise levels (>2500 kcal/wk) for 30 mo had significantly (P < 0.001) greater 30-mo weight loss than did those exercising less (12 +/- 8.8 and 0.8 +/- 8.1 kg, respectively).
Conclusions: Although participants in the HPA group sustained the 2500-kcal activity goal during the 18-mo treatment, activity declined once treatment ended, which resulted in no between-group differences in activity or weight loss at 2.5 y. Participants who reported continuing to engage in high levels of exercise maintained a significantly larger weight loss.
Source: Am J Clin Nutr, April 2007;85(4):954-9.

A diet high in fruits and low in meats reduces the risk of colorectal adenomas.

GL Austin, LS Adair, JA Galanko, et al.

Recent evidence suggests overall dietary patterns, rather than specific dietary components, may be a better predictor of colorectal adenomas or cancers. Using cluster analysis, we aimed to assess the association between dietary patterns and colorectal adenomas and whether adjusting for total energy consumption prior to creating clusters affects this relation. Data from a case-control study of 725 individuals undergoing a colonoscopy were utilized. Cases (n = 203) had > or =1 adenoma on colonoscopy, and controls (n = 522) were those who had no adenomas. Dietary data were obtained from an FFQ. Daily intake for 18 different food groups was calculated. The values were transformed into Z-scores. Participants were first clustered without energy adjustment, then again based on their consumption per 1000 kcal (4187 kJ). There was no association between dietary patterns and colorectal adenomas without energy adjustment prior to creating dietary clusters, as clusters formed as a by-product of energy consumption. After adjusting for energy consumption, 3 distinct clusters emerged: 1) high fruit-low meat cluster; 2) high vegetable-moderate meat cluster; and 3) high meat cluster. After adjusting for potential confounders, the high vegetable-moderate meat cluster (odds ratio [OR] 2.17: [95% CI] 1.20-3.90) and high meat cluster (OR 1.70: [95% CI] 1.04-2.80) were at significantly increased odds of having had an adenoma compared with the high fruit-low meat cluster. A high-fruit, low-meat diet appears to be protective against colorectal adenomas compared with a dietary pattern of increased vegetable and meat consumption.
Source: J Nutr, April 2007;137(4):999-1004.