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

Dose response relationship between physical activity and mental health: The Scottish Health Survey.

Hamer M, Stamatakis E, Steptoe A

Objectives: Regular physical activity is thought to be associated with better mental health, although there is lack of consensus regarding the optimal amount and type of activity to achieve these benefits. We examined the association between mental health and physical activity behaviors among a representative sample of men and women from the Scottish Health Surveys.

Methods: Self reported physical activity was measured and the General Health Questionnaire (GHQ-12) was administered in order to obtain information on current mental health. Participants were 19 842 men and women. We calculated risk estimates per category of physical activity sessions per week using logistic regression models.

Results: Psychological distress (based on a score of 4 or more on the GHQ-12) was evident in 3200 participants. Any form of daily physical activity was associated with a lower risk of psychological distress after adjustment for age, gender, social economic group, marital status, body mass index, long standing illness, smoking, and survey year (OR = 0.59, 95% CI, 0.52-0.66, P < 0.001). A dose-response relationship was apparent, with moderate reductions in psychological distress with less frequent activity (OR = 0.67, 0.61-0.75). Different types of activities including domestic (housework and gardening), walking, and sports were all independently associated with lower odds of psychological distress, although the strongest effects were observed for sports (OR=0.67, 0.54-0.82).

Conclusion: Mental health benefits were observed at a minimal level of at least 20 minutes per week of any physical activity, although a dose-response pattern was demonstrated with greater risk reduction for activity at a higher volume and/or intensity.

Source: Br J Sports Med. 2008 Apr 10 [Epub ahead of print].

Antibiotics for adults with clinically diagnosed acute rhinosinusitis: a meta-analysis of individual patient data.

Young J, De Sutter A, Merenstein D, et al.

Background: Primary-care physicians continue to overprescribe antibiotics for acute rhinosinusitis because distinction between viral and bacterial sinus infection is difficult. We undertook a meta-analysis of randomized trials based on individual patients' data to assess whether common signs and symptoms can be used to identify a subgroup of patients who benefit from antibiotics.

Methods: We identified suitable trials--in which adult patients with rhinosinusitis-like complaints were randomly assigned to treatment with an antibiotic or a placebo--by searching the Cochrane Central Register of Controlled Trials, Medline, and Embase, and reference lists of reports describing such trials. Individual patients' data from 2547 adults in nine trials were checked and re-analyzed. We assessed the overall effect of antibiotic treatment and the prognostic value of common signs and symptoms by the number needed to treat (NNT) with antibiotics to cure one additional patient.

Findings: 15 patients with rhinosinusitis-like complaints would have to be given antibiotics before an additional patient was cured (95% CI NNT[benefit] 7 to NNT[harm] 190). Patients with purulent discharge in the pharynx took longer to cure than those without this sign; the NNT was 8 patients with this sign before one additional patient was cured (95% CI NNT[benefit] 4 to NNT[harm] 47). Patients who were older, reported symptoms for longer, or reported more severe symptoms also took longer to cure but were no more likely to benefit from antibiotics than other patients.

Interpretation: Common clinical signs and symptoms cannot identify patients with rhinosinusitis for whom treatment is clearly justified. Antibiotics are not justified even if a patient reports symptoms for longer than 7-10 days.

Source: Lancet. 2008 Mar 15;371(9616):908-14.

Adherence to a DASH-style diet and risk of coronary heart disease and stroke in women.

Fung TT, Chiuve SE, McCullough ML, et al.

Background: The Dietary Approaches to Stop Hypertension (DASH) diet has been shown to lower blood pressure, but little is known about its long-term effect on cardiovascular end points. Our objective was to assess the association between a DASH-style diet adherence score and risk of coronary heart disease (CHD) and stroke in women.

Methods: In this prospective cohort study, diet was assessed 7 times during 24 years of follow-up (1980-2004) with validated food frequency questionnaires. A DASH score based on 8 food and nutrient components (fruits, vegetables, whole grains, nuts and legumes, low-fat dairy, red and processed meats, sweetened beverages, and sodium) was calculated. Lifestyle and medical information was collected biennially with a questionnaire. The Cox proportional hazard model was used to adjust for potential confounders. The study population comprised 88,517 female nurses aged 34 to 59 years without a history of cardiovascular disease or diabetes in 1980. The main outcome measures were the numbers of confirmed incident cases of nonfatal myocardial infarction, CHD death, and stroke.

Results: We documented 2129 cases of incident nonfatal myocardial infarction, 976 CHD deaths, and 3105 cases of stroke. After adjustment for age, smoking, and other cardiovascular risk factors, the relative risks of CHD across quintiles of the DASH score were 1.0, 0.99, 0.86, 0.87, and 0.76 (95% confidence interval, 0.67-0.85) (P<.001 for trend). The magnitude of risk difference was similar for nonfatal myocardial infarction and fatal CHD. The DASH score was also significantly associated with lower risk of stroke (multivariate relative risks across quintiles of the DASH score were 1.0, 0.92, 0.91, 0.89, and 0.82) (P=.002 for trend). Cross-sectional analysis in a subgroup of women with blood samples showed that the DASH score was significantly associated with lower plasma levels of C-reactive protein (P=.008 for trend) and interleukin 6 (P=.04 for trend).

Conclusion: Adherence to the DASH-style diet is associated with a lower risk of CHD and stroke among middle-aged women during 24 years of follow-up.

Source: Arch Intern Med. 2008 Apr 14;168(7):713-20.

Maximal oxygen intake and independence in old age.

Shephard RJ

This brief review examines the likelihood that a deterioration of aerobic fitness will lead to a loss of independence in old age. The rate of deterioration of maximal aerobic power observed in middle-aged adults continues unabated during the retirement years. Loss of independence seems likely if maximal oxygen intake falls below a threshold of 18 ml/[kg.min] in men, and 15 ml/[kg.min] in women, reached at 80-85 years. A regular program of aerobic exercise can slow or reverse the functional deterioration, reducing the individual's biological age by 10 or more years, and potentially postponing dependency by a similar amount. There remains a need to clarify the importance of decreasing aerobic fitness relative to other potential causes of dependency, but from the practical viewpoint regular aerobic activity should be commended to seniors, since it can address many of the issues of both functional loss and chronic disease.

Source: Br J Sports Med 2008 August 1;45(3):295-305.

A pilot study of Rhodiola rosea (Rhodax) for generalized anxiety disorder (GAD).

Bystritsky A, Kerwin L, Feusner JD

Background: Rhodiola rosea is an herbal supplement that many in the general population in Russia and elsewhere in the world have used for decades to alleviate everyday anxiety, depression, and insomnia. Whether R. rosea is effective in reducing similar symptoms in clinical samples is unknown. The goal of this pilot study was to evaluate whether R. rosea is effective in reducing symptoms of generalized anxiety disorder (GAD).

Method: Ten (10) participants with a DSM-IV diagnosis of GAD, recruited from the UCLA Anxiety Disorders Program and between the ages of 34 and 55, were enrolled in this study from November 2005 to May 2006. Participants received a total daily dose of 340 mg of R. rosea extract for 10 weeks. Assessments included the Hamilton Anxiety Rating Scale (HARS), the Four-Dimensional Anxiety and Depression Scale, and the Clinical Global Impressions of Severity/Improvement Scale.

Results: Individuals treated with R. rosea showed significant decreases in mean HARS scores at endpoint (t=3.27, p=0.01). Adverse events were generally mild or moderate in severity, the most common being dizziness and dry mouth.

Conclusions: Significant improvement in GAD symptoms was found with R. rosea, with a reduction in HARS scores similar to that found in clinical trials. These preliminary findings warrant further exploration of treatment with R. rosea in clinical samples.

Source: J Altern Complement Med. 2008 Mar;14(2):175-80.

Lupus erythematosus and herbal medicine.

Yarnell E, Abascal K

Numerous herbal medicines show promise for helping people with systemic lupus erythematosus as well as discoid lupus. Herbs that can both suppress and enhance various aspects of the immune system, known as immunomodulators, are particularly interesting in these settings. Trametes versicolor (cloud mushroom, yun zhi), Cordyceps sinensis (cordyceps, duong chong xiao cao), Ganoderma lucidum (reishi, ling zhi), Centella asiatica (gotu kola), and Urtica dioica (nettles) have all been investigated as immunomodulators in relation to lupus. Tripterygium wilfordii (lei gong teng, thundergod vine) is the best-studied of the herbs that suppress the immune system and thereby relieve symptoms of lupus. Artemisia annua and Artemisia apiacea (sweet Annie, qing hao) are also being studied in this regard, as is Nelumbo nucifera (lotus). Additionally, phytoestrogens such as coumestrol may be valuable in treating lupus, though D-canavanine-containing seeds or sprouts of Medicago sativa (alfalfa) should be avoided. Linum usitatissimum (flax) seeds, as well as immunomodulators and thundergod vine, have all shown promise in patients with lupus nephritis.

Source: Alternative & Complementary Therapies. 2008 Feb 1;14(1):9-12.