Mitos da doença diverticular do cólon

Nut, Corn, and Popcorn Consumption and the Incidence of Diverticular Disease
Lisa L. Strate, MD, MPH; Yan L. Liu, MS; Sapna Syngal, MD, MPH; Walid H. Aldoori, MD, MPA, ScD; Edward L. Giovannucci, MD, ScD
JAMA. 2008;300(8):907-914.
Context Patients with diverticular disease are frequently advised to avoid eating nuts, corn, popcorn, and seeds to reduce the risk of complications. However, there is little evidence to support this recommendation.
Objective To determine whether nut, corn, or popcorn consumption is associated with diverticulitis and diverticular bleeding.
Design and Setting The Health Professionals Follow-up Study is a cohort of US men followed up prospectively from 1986 to 2004 via self-administered questionnaires about medical (biennial) and dietary (every 4 years) information. Men reporting newly diagnosed diverticulosis or diverticulitis were mailed supplemental questionnaires.
Participants The study included 47 228 men aged 40 to 75 years who at baseline were free of diverticulosis or its complications, cancer, and inflammatory bowel disease and returned a food-frequency questionnaire.
Main Outcome Measures Incident diverticulitis and diverticular bleeding.
Results During 18 years of follow-up, there were 801 incident cases of diverticulitis and 383 incident cases of diverticular bleeding. We found inverse associations between nut and popcorn consumption and the risk of diverticulitis. The multivariate hazard ratios for men with the highest intake of each food (at least twice per week) compared with men with the lowest intake (less than once per month) were 0.80 (95% confidence interval, 0.63-1.01; P for trend = .04) for nuts and 0.72 (95% confidence interval, 0.56-0.92; P for trend = .007) for popcorn. No associations were seen between corn consumption and diverticulitis or between nut, corn, or popcorn consumption and diverticular bleeding or uncomplicated diverticulosis.
Conclusions In this large, prospective study of men without known diverticular disease, nut, corn, and popcorn consumption did not increase the risk of diverticulosis or diverticular complications. The recommendation to avoid these foods to prevent diverticular complications should be reconsidered.
Author Affiliations: University of Washington School of Medicine, Seattle (Dr Strate); Division of Gastroenterology, Department of Medicine, Harborview Medical Center, Seattle (Dr Strate); Departments of Nutrition (Ms Liu and Dr Giovannucci) and Epidemiology (Dr Giovannucci), Harvard School of Public Health, Boston, Massachusetts; Harvard Medical School, Boston (Drs Syngal and Giovannucci); Division of Gastroenterology (Dr Syngal) and Channing Laboratory (Dr Giovannucci), Department of Medicine, Brigham and Women's Hospital, Boston; Division of Population Sciences, Dana Farber Cancer Institute, Boston (Dr Syngal); and Wyeth Consumer Healthcare Inc, Mississauga, Ontario, Canada (Dr Aldoori).

Prevenção Primária e AVC

Primary Prevention of Stroke by Healthy Lifestyle

Stephanie E. Chiuve ScD*, Kathryn M. Rexrode MD, MPH, Donna Spiegelman ScD, Giancarlo Logroscino MD, PhD, JoAnn E. Manson MD, DrPH, and Eric B. Rimm ScD

Background—The combination of healthy lifestyle factors is associated with lower risk of coronary heart disease, diabetes, and total cardiovascular disease. Little is known about the impact of multiple lifestyle factors on the risk of stroke.
Methods and Results—We conducted a prospective cohort study among 43 685 men from the Health Professionals Follow-up Study and 71 243 women from the Nurses' Health Study. Diet and other lifestyle factors were updated from self-reported questionnaires. We defined a low-risk lifestyle as not smoking, a body mass index <25 kg/m2, 30 min/d of moderate activity, modest alcohol consumption (men, 5 to 30 g/d; women, 5 to 15 g/d), and scoring within the top 40% of a healthy diet score. We documented 1559 strokes (853 ischemic, 278 hemorrhagic) among women and 994 strokes (600 ischemic, 161 hemorrhagic) among men during follow-up. Women with all 5 low-risk factors had a relative risk of 0.21 (95% confidence interval [CI], 0.12, 0.36) for total and 0.19 (95% CI, 0.09, 0.40) for ischemic stroke compared with women who had none of these factors. Among men, the relative risks were 0.31 (95% CI, 0.19, 0.53) for total and 0.20 (95% CI, 0.10, 0.42) for ischemic stroke for the same comparison. Among the women, 47% (95% CI, 18 to 69) of total and 54% (95% CI, 15 to 78%) of ischemic stroke cases were attributable to lack of adherence to a low-risk lifestyle; among the men, 35% (95% CI, 7 to 58) of total and 52% (95% CI, 19 to 75) of ischemic stroke may have been prevented.
Conclusion—A low-risk lifestyle that is associated with a reduced risk of multiple chronic diseases also may be beneficial in the prevention of stroke, especially ischemic stroke

Dieta, Ferro e Pressão Arterial

Published 15 July 2008, doi:10.1136/bmj.a258Cite this as: BMJ 2008;337:a258
Research
Relation of iron and red meat intake to blood pressure: cross sectional epidemiological study
Ioanna Tzoulaki, lecturer in epidemiology1, Ian J Brown, research assistant1, Queenie Chan, senior research officer1, Linda Van Horn, professor of preventive medicine2, Hirotsugu Ueshima, professor of medicine3, Liancheng Zhao, professor of epidemiology4, Jeremiah Stamler, professor emeritus2, Paul Elliott, professor1, for the International Collaborative Research Group on Macro-/Micronutrients and Blood Pressure
Correspondence to: I Tzoulaki I.Tzoulaki@imperial.ac.uk
Objective To investigate associations of dietary iron (total, haem, and non-haem), supplemental iron, and red meat with blood pressure.
Design Cross sectional epidemiological study.
Setting 17 population samples from Japan, China, the United Kingdom, and the United States participating in the international collaborative study on macro-/micronutrients and blood pressure (INTERMAP).
Participants 4680 adults aged 40-59.
Main outcome measure Average of eight blood pressure readings.
Results In multiple linear regression analyses dietary total iron and non-haem iron were consistently inversely associated with blood pressure. With adjustment for potential non-dietary and dietary confounders, dietary total iron intake higher by 4.20 mg/4.2 MJ (2 SD) was associated with –1.39 mm Hg (P<0.01) lower systolic blood pressure. Dietary non-haem iron intake higher by 4.13 mg/4.2 MJ (2 SD) was associated with –1.45 mm Hg (P<0.001) lower systolic blood pressure. Differences were smaller for diastolic blood pressure. In most models haem iron intake from food was positively, non-significantly associated with blood pressure. Iron intake from combined diet and supplements yielded smaller associations than dietary iron alone. Red meat intake was directly associated with blood pressure; 102.6 g/24 h (2 SD) higher intake was associated with 1.25 mm Hg higher systolic blood pressure. Associations between red meat and blood pressure persisted after adjustment for multiple confounders.
Conclusion Non-haem iron has a possible role in the prevention and control of adverse blood pressure levels. An unfavourable effect of red meat on blood pressure was observed. These results need confirmation including in prospective studies, clinical trials, and from experimental evidence on possible mechanisms.

Padrão de Dieta, Perda de Peso e Incidência de Diabetes

Low-Fat Dietary Pattern and Risk of Treated Diabetes Mellitus in Postmenopausal Women The Women's Health Initiative Randomized Controlled Dietary Modification Trial Lesley F. Tinker, PhD; Denise E. Bonds, MD, MPH; Karen L. Margolis, MD, MPH; JoAnn E. Manson, MD, DrPH; Barbara V. Howard, PhD; Joseph Larson, MS; Michael G. Perri, PhD; Shirley A. A. Beresford, PhD; Jennifer G. Robinson, MD, MPH; Beatriz Rodríguez, MD, PhD; Monika M. Safford, MD; Nanette K. Wenger, MD; Victor J. Stevens, PhD; Linda M. Parker, DSc Arch Intern Med. 2008;168(14):1500-1511.
Background Decreased fat intake with weight loss and increased exercise may reduce the risk of diabetes mellitus in persons with impaired glucose tolerance. This study was undertaken to assess the effects of a low-fat dietary pattern on incidence of treated diabetes among generally healthy postmenopausal women.
Methods A randomized controlled trial was conducted at 40 US clinical centers from 1993 to 2005, including 48 835 postmenopausal women aged 50 to 79 years. Women were randomly assigned to a usual-diet comparison group (n = 29 294 [60.0%]) or an intervention group with a 20% low-fat dietary pattern with increased vegetables, fruits, and grains (n = 19 541 [40.0%]). Self-reported incident diabetes treated with oral agents or insulin was assessed.
Results Incident treated diabetes was reported by 1303 intervention participants (7.1%) and 2039 comparison participants (7.4%) (hazard ratio, 0.96; 95% confidence interval, 0.90-1.03; P = .25). Weight loss occurred in the intervention group, with a difference between intervention and comparison groups of 1.9 kg after 7.5 years (P < .001). Subgroup analysis suggested that greater decreases in percentage of energy from total fat reduced diabetes risk (P for trend = .04), which was not statistically significant after adjusting for weight loss.
Conclusions A low-fat dietary pattern among generally healthy postmenopausal women showed no evidence of reducing diabetes risk after 8.1 years. Trends toward reduced incidence were greater with greater decreases in total fat intake and weight loss. Weight loss, rather than macronutrient composition, may be the dominant predictor of reduced risk of diabetes.

Ingestão de frutas (vitamina C) e Incidência de Diabetes

Plasma Vitamin C Level, Fruit and Vegetable Consumption, and the Risk of New-Onset Type 2 Diabetes Mellitus
The European Prospective Investigation of Cancer–Norfolk Prospective Study
Anne-Helen Harding, PhD; Nicholas J. Wareham, FRCP, PhD; Sheila A. Bingham, PhD; KayTee Khaw, FRCP; Robert Luben, BSc; Ailsa Welch, PhD; Nita G. Forouhi, FFPH, PhD
Arch Intern Med. 2008;168(14):1493-1499.
Background Epidemiologic studies suggest that greater consumption of fruit and vegetables may decrease the risk of diabetes mellitus, but the evidence is limited and inconclusive. Plasma vitamin C level is a good biomarker of fruit and vegetable intake, but, to our knowledge, no prospective studies have examined its association with diabetes risk. This study aims to examine whether fruit and vegetable intake and plasma vitamin C level are associated with the risk of incident type 2 diabetes.
Methods We administered a semiquantitative food frequency questionnaire to men and women from a population-based prospective cohort (European Prospective Investigation of Cancer–Norfolk) study who were aged 40 to 75 years at baseline (1993-1997) when plasma vitamin C level was determined and habitual intake of fruit and vegetables was assessed. During 12 years of follow-up between February 1993 and the end of December 2005, 735 clinically incident cases of diabetes were identified among 21 831 healthy individuals. We report the odds ratios of diabetes associated with sex-specific quintiles of fruit and vegetable intake and of plasma vitamin C levels.
Results A strong inverse association was found between plasma vitamin C level and diabetes risk. The odds ratio of diabetes in the top quintile of plasma vitamin C was 0.38 (95% confidence interval, 0.28-0.52) in a model adjusted for demographic, lifestyle, and anthropometric variables. In a similarly adjusted model, the odds ratio of diabetes in the top quintile of fruit and vegetable consumption was 0.78 (95% confidence interval, 0.60-1.00).
Conclusions Higher plasma vitamin C level and, to a lesser degree, fruit and vegetable intake were associated with a substantially decreased risk of diabetes. Our findings highlight a potentially important public health message on the benefits of a diet rich in fruit and vegetables for the prevention of diabetes.

Suco de frutas e Incidência de Diabetes

Sugar-Sweetened Beverages and Incidence of Type 2 Diabetes Mellitus in African American Women Julie R. Palmer, ScD; Deborah A. Boggs, MS; Supriya Krishnan, DSc; Frank B. Hu, MD; Martha Singer, MPH; Lynn Rosenberg, ScD Arch Intern Med. 2008;168(14):1487-1492.
Background Type 2 diabetes mellitus is an increasingly serious health problem among African American women. Consumption of sugar-sweetened drinks was associated with an increased risk of diabetes in 2 studies but not in a third; however, to our knowledge, no data are available on African Americans regarding this issue. Our objective was to examine the association between consumption of sugar-sweetened beverages, weight gain, and incidence of type 2 diabetes mellitus in African American women.
Methods A prospective follow-up study of 59 000 African American women has been in progress since 1995. Participants reported on food and beverage consumption in 1995 and 2001. Biennial follow-up questionnaires ascertained new diagnoses of type 2 diabetes. The present analyses included 43 960 women who gave complete dietary and weight information and were free from diabetes at baseline. We identified 2713 incident cases of type 2 diabetes mellitus during 338 884 person-years of follow-up. The main outcome measure was the incidence of type 2 diabetes mellitus.
Results The incidence of type 2 diabetes mellitus was higher with higher intake of both sugar-sweetened soft drinks and fruit drinks. After adjustment for confounding variables including other dietary factors, the incidence rate ratio for 2 or more soft drinks per day was 1.24 (95% confidence interval, 1.06-1.45). For fruit drinks, the comparable incidence rate ratio was 1.31 (95% confidence interval, 1.13-1.52). The association of diabetes with soft drink consumption was almost entirely mediated by body mass index, whereas the association with fruit drink consumption was independent of body mass index.
Conclusions Regular consumption of sugar-sweetened soft drinks and fruit drinks is associated with an increased risk of type 2 diabetes mellitus in African American women. While there has been increasing public awareness of the adverse health effects of soft drinks, little attention has been given to fruit drinks, which are often marketed as a healthier alternative to soft drinks.

Padrões de dieta e Mortalidade: Nurses´Health Study

Dietary Patterns and Risk of Mortality From Cardiovascular Disease, Cancer, and All Causes in a Prospective Cohort of Women. Christin Heidemann, DrPH, MSc; Matthias B. Schulze, DrPH; Oscar H. Franco, MD, DSc, PhD; Rob M. van Dam, PhD; Christos S. Mantzoros, MD, DSc; Frank B. Hu, MD, PhD Circulation. 2008;118:230-237
Background— The impact of overall dietary patterns that reflect actual eating behaviors on mortality caused by cardiovascular or other chronic diseases is largely unknown.
Methods and Results— We prospectively evaluated the relation between dietary patterns and risk of cardiovascular, cancer, and all-cause mortality among 72 113 women who were free of myocardial infarction, angina, coronary artery surgery, stroke, diabetes mellitus, or cancer and were followed up from 1984 to 2002. Dietary patterns were derived by factor analysis based on validated food frequency questionnaires administered every 2 to 4 years. Two major dietary patterns were identified: High prudent pattern scores represented high intakes of vegetables, fruit, legumes, fish, poultry, and whole grains, whereas high Western pattern scores reflected high intakes of red meat, processed meat, refined grains, french fries, and sweets/desserts. During 18 years of follow-up, 6011 deaths occurred, including 1154 cardiovascular deaths and 3139 cancer deaths. After multivariable adjustment, the prudent diet was associated with a 28% lower risk of cardiovascular mortality (95% confidence interval [CI], 13 to 40) and a 17% lower risk of all-cause mortality (95% CI, 10 to 24) when the highest quintile was compared with the lowest quintile. In contrast, the Western pattern was associated with a higher risk of mortality from cardiovascular disease (22%; 95% CI, 1 to 48), cancer (16%; 95% CI, 3 to 30), and all causes (21%; 95% CI, 12 to 32).
Conclusion— Greater adherence to the prudent pattern may reduce the risk of cardiovascular and total mortality, whereas greater adherence to the Western pattern may increase the risk among initially healthy women.

Ingestão de Acido Linolênico e Hipertensão

elsa/dieta/aclinolenicohipertensao

Relationship of Dietary Linoleic Acid to Blood Pressure
The International Study of Macro-Micronutrients and Blood Pressure Study

Hypertension. 2008;52:408-414

Findings from observational and interventional studies on the relationship of dietary linoleic acid, the main dietary polyunsaturated fatty acid, with blood pressure have been inconsistent. The International Study of Macro-Micronutrients and Blood Pressure is an international cross-sectional epidemiological study of 4680 men and women ages 40 to 59 years from 17 population samples in China, Japan, United Kingdom, and United States. We report associations of linoleic acid intake of individuals with their blood pressure. Nutrient intake data were based on 4 in-depth multipass 24-hour dietary recalls per person and 2 timed 24-hour urine collections per person. Systolic and diastolic blood pressures were measured 8 times at 4 visits. With several models to control for possible confounders (dietary or other), linear regression analyses showed a nonsignificant inverse relationship of linoleic acid intake (percent kilocalories) to systolic and diastolic blood pressure for all of the participants. When analyzed for 2238 "nonintervened" individuals (not on a special diet, not consuming nutritional supplements, no diagnosed cardiovascular disease or diabetes, and not taking medication for high blood pressure, cardiovascular disease, or diabetes), the relationship was stronger. With adjustment for 14 variables, estimated systolic/diastolic blood pressure differences with 2-SD higher linoleic acid intake (3.77% kcal) were –1.42/–0.91 mm Hg (P<0.05>

Sal, risco cardiovascular e a cultura brasileira.

Nessa edição do British Medical Journal há artigo original e editorial reproduzido abaixo sobre o efeito da redução do sal a longo prazo: redução em 25% de eventos cardiovasculares. O artigo é de Nancy Cook e equipe com quem trabalhei no Brigham and Women´s Hospital. Para nós, brasileiros, essa é uma questão séria, visto que o consumo de sal é muito elevado, assim como a prevalência de hipertensão arterial e a incidência e mortalidade por doença cerebrovascular. Chegou o momento de pesquisa séria e dirigida ao tema. O artigo original pode ser acessado clicando no título.

BMJ 2007;334 (28 April), doi:10.1136/bmj.39196.679537.47
Fiona Godlee, editor fgodlee@bmj.com
Just over a decade ago, the BMJ found itself in the eye of the storm about dietary salt (BMJ 1996;312:1239-40). We had published the Intersalt study some years previously; it concluded that populations with high average intakes of salt were likely to have higher average blood pressures. But the salt producers' trade organisation, the Salt Institute, had criticised the study's methods and asked the investigators to hand over their raw data for reanalysis. A reanalysis was done—by the original investigators—and published in the BMJ (BMJ 1996;312:1249-53). The findings were the same.
It's worth remembering this skirmish in the war on dietary salt, now that the battle around the evidence linking salt and heart disease has largely been won. At the time we knew that dietary salt was linked to increased blood pressure, and over the next decade the link to actual cardiovascular disease grew stronger. So did the evidence from randomised trials that reducing salt in the diet reduced blood pressure. But still the food industry's fight against restrictions continued.
At the time they could argue that the long term benefits of reducing salt on cardiovascular disease had not been shown in randomised trials—but not any longer. This week the BMJ publishes what may be the final bugle call in the battle of the evidence. Nancy Cook and colleagues followed up people who took part in two randomised trials of dietary salt reduction to see whether reductions in blood pressure converted into reductions in cardiovascular events (doi: 10.1136/bmj.39147.604896.55). They gathered data on three quarters of the original participants and found that, after 10-15 years, the risk of cardiovascular events was more than 25% lower in people who had cut their salt intake for at least 18 months.
Such hard evidence is at last bringing the food industry to the negotiating table. Voluntary limits and food labelling, as adopted by the UK's Food Standards Agency and the European Union, have brought some progress from the industry, as has the "carrot" of growing markets for healthy foods, but they are unlikely to bring enough muscle to bear on a powerful industry practiced in the arts of mitigation and delay. As Francesco Cappuccio says in his editorial (doi: 10.1136/bmj.39175.364954.BE), real progress will need the additional "stick" of legislation. Most salt in developed countries is consumed in bread and processed foods, and much of it is consumed outside the home in canteens and sandwich bars, so a population-wide policy of salt reduction will come only through pressure on the food and catering industries. The current policy—encouraging consumers to make sensible choices—effectively abandons the poor and uninformed, increasing social inequities.
While we wait for mandatory food labelling and firm limits on salt in processed foods across Europe, what can health professionals do to reduce the impact of dietary salt on people's health? Cappuccio suggests that baseline assessment of salt intake should be part of the UK's National Service Framework. A 24 hour urinary collection is cheaper than testing cholesterol. You might try talking salt in your next consultation