Katie Lennon

The severity of childhood metabolic syndrome declined in a study of U.S. adolescents relative to increases in high-density lipoproteins (HDL) and decreases in fasting triglyceride measurements among the individuals examined, reported Arthur M. Lee of the University of Virginia, Charlottesville, and his colleagues.

The metabolic syndrome (MetS) is characterized by central obesity, high fasting glucose, high fasting triglycerides, high blood pressure (BP), and low HDL.

The researchers used regression analysis of individual waves of data from 1999 to 2012 to analyze 5,117 individuals aged 12-19 years. The data came from the Centers for Disease Control and Prevention National Health and Nutrition Examination Survey (NHANES, 1999-2012), a cross-sectional, national, stratified, multistage probability survey conducted in 2-year waves. The severity of MetS was calculated using the Pediatric MetS z score. Patients who were pregnant, had an active hepatitis B infection, had physician-diagnosed diabetes, or were currently using antidiabetic or antihyperlipidemic medication were excluded from the study.

©moodboard/thinkstockphotos.com

Overall, a linear trend of a decreasing MetS z score (P = .030) was found despite the body mass index z score having increased significantly. While fasting triglyceride measurements declined significantly, HDL levels rose significantly.

The researchers also found temporal trends of decreasing total calorie consumption, decreasing carbohydrate consumption, and increasing unsaturated fat consumption.

“The overall decreasing trend in the MetS z score is likely secondary to the increasing trend in HDL measurements and decreasing trend in fasting triglycerides measurements, ” wrote Mr. Lee and his associates. “The increasing trend in HDL and decreasing fasting triglyceride measurements could be attributable in part to trends of decreasing carbohydrate intake and increasing unsaturated fat intake.”

The researchers recommended future studies on individuals with MetS focus on determining, “the causality of lifestyle factors in improvements of MetS severity.”

Read the study in Pediatrics (doi: 10.1542/peds.2015-3177).

klennon@frontlinemedcom.com

The severity of childhood metabolic syndrome declined in a study of U.S. adolescents relative to increases in high-density lipoproteins (HDL) and decreases in fasting triglyceride measurements among the individuals examined, reported Arthur M. Lee of the University of Virginia, Charlottesville, and his colleagues.

The metabolic syndrome (MetS) is characterized by central obesity, high fasting glucose, high fasting triglycerides, high blood pressure (BP), and low HDL.

The researchers used regression analysis of individual waves of data from 1999 to 2012 to analyze 5,117 individuals aged 12-19 years. The data came from the Centers for Disease Control and Prevention National Health and Nutrition Examination Survey (NHANES, 1999-2012), a cross-sectional, national, stratified, multistage probability survey conducted in 2-year waves. The severity of MetS was calculated using the Pediatric MetS z score. Patients who were pregnant, had an active hepatitis B infection, had physician-diagnosed diabetes, or were currently using antidiabetic or antihyperlipidemic medication were excluded from the study.

©moodboard/thinkstockphotos.com

Overall, a linear trend of a decreasing MetS z score (P = .030) was found despite the body mass index z score having increased significantly. While fasting triglyceride measurements declined significantly, HDL levels rose significantly.

The researchers also found temporal trends of decreasing total calorie consumption, decreasing carbohydrate consumption, and increasing unsaturated fat consumption.

“The overall decreasing trend in the MetS z score is likely secondary to the increasing trend in HDL measurements and decreasing trend in fasting triglycerides measurements, ” wrote Mr. Lee and his associates. “The increasing trend in HDL and decreasing fasting triglyceride measurements could be attributable in part to trends of decreasing carbohydrate intake and increasing unsaturated fat intake.”

The researchers recommended future studies on individuals with MetS focus on determining, “the causality of lifestyle factors in improvements of MetS severity.”

Read the study in Pediatrics (doi: 10.1542/peds.2015-3177).

klennon@frontlinemedcom.com

The severity of childhood metabolic syndrome declined in a study of U.S. adolescents relative to increases in high-density lipoproteins (HDL) and decreases in fasting triglyceride measurements among the individuals examined, reported Arthur M. Lee of the University of Virginia, Charlottesville, and his colleagues.

The metabolic syndrome (MetS) is characterized by central obesity, high fasting glucose, high fasting triglycerides, high blood pressure (BP), and low HDL.

The researchers used regression analysis of individual waves of data from 1999 to 2012 to analyze 5,117 individuals aged 12-19 years. The data came from the Centers for Disease Control and Prevention National Health and Nutrition Examination Survey (NHANES, 1999-2012), a cross-sectional, national, stratified, multistage probability survey conducted in 2-year waves. The severity of MetS was calculated using the Pediatric MetS z score. Patients who were pregnant, had an active hepatitis B infection, had physician-diagnosed diabetes, or were currently using antidiabetic or antihyperlipidemic medication were excluded from the study.

©moodboard/thinkstockphotos.com

Overall, a linear trend of a decreasing MetS z score (P = .030) was found despite the body mass index z score having increased significantly. While fasting triglyceride measurements declined significantly, HDL levels rose significantly.

The researchers also found temporal trends of decreasing total calorie consumption, decreasing carbohydrate consumption, and increasing unsaturated fat consumption.

“The overall decreasing trend in the MetS z score is likely secondary to the increasing trend in HDL measurements and decreasing trend in fasting triglycerides measurements, ” wrote Mr. Lee and his associates. “The increasing trend in HDL and decreasing fasting triglyceride measurements could be attributable in part to trends of decreasing carbohydrate intake and increasing unsaturated fat intake.”

The researchers recommended future studies on individuals with MetS focus on determining, “the causality of lifestyle factors in improvements of MetS severity.”

Read the study in Pediatrics (doi: 10.1542/peds.2015-3177).

klennon@frontlinemedcom.com

Benzodiazepine use by elderly adults did not seem to be causally related to an increased risk for dementia and cognitive decline, in a prospective study.

The study included 3,434 individuals aged 65 years or older without dementia. For at least 10 years prior to enrollment in the study, all participants had been members of Group Health, an integrated health delivery system in the Northwest United States that maintains computerized pharmacy data, including names, strengths, dates dispensed, and amounts dispensed of drugs used by its members.

Thirty percent of participants had filled at least one prescription for a benzodiazepine in the 10 years before entering the study, with 3% of participants having used the drug within 6 months of study entry. The researchers categorized patients based on their level of use, with patients falling into the highest-use category having taken at least 121 total standardized daily doses (TSDDs). The median level of use within that group was 375 TSDDs, equivalent to slightly over a year of daily use.

©Spectral-Design/Thinkstock

In 2004, the study began continuous enrollment to replace those who developed dementia, died, or dropped out. Participants were assessed for cognitive function upon beginning participation in the study and every 2 years afterward. All participants were followed until the earliest onset of dementia, disenrollment from Group Health, or their last study visit before Sept. 30, 2012.

The researchers found no association between the use of benzodiazepines at the TSDD level defined as highest use in this study and dementia (hazard ratio, 1.07) or Alzheimer’s disease (HR, 0.95), compared with nonuse. “When we split the highest category of benzodiazepine use into two groups, the hazard ratio for dementia was 1.11 (0.78-1.58) for 121-364 TSDDs and 1.03 (0.73-1.44) for greater than or equal to 365 TSDDs. Findings for Alzheimer’s disease were similar,” said Shelly L. Gray, Pharm.D., professor of pharmacy at the University of Washington School of Pharmacy, Seattle, and her colleagues.

A slightly increased risk for dementia for study participants classified as low users (taking 1-30 TSDDs) or moderate users (taking 31-120 TSDDs) of benzodiazepine was found, when compared with nonusers. Low users of benzodiazepine were also at increased risk for Alzheimer’s disease (HR, 1.27).

“In conclusion, we found a slightly higher risk of dementia in people with the lowest benzodiazepine use but no increased risk in those with the highest level of exposure. … Overall, our pattern of findings does not support the theory that cumulative benzodiazepine use at the levels observed in our population is causally related to an increased risk for dementia or cognitive decline. … Nonetheless, given the mixed evidence regarding benzodiazepines and risk of dementia and that these drugs are associated with many adverse events, health care providers are still advised to avoid benzodiazepines in older adults to prevent important adverse health outcomes, withdrawal, and dependence,” according to the researchers.

Read the study in the BMJ (doi: 10.1136/bmj.i90).

klennon@frontlinemedcom.com

Benzodiazepine use by elderly adults did not seem to be causally related to an increased risk for dementia and cognitive decline, in a prospective study.

The study included 3,434 individuals aged 65 years or older without dementia. For at least 10 years prior to enrollment in the study, all participants had been members of Group Health, an integrated health delivery system in the Northwest United States that maintains computerized pharmacy data, including names, strengths, dates dispensed, and amounts dispensed of drugs used by its members.

Thirty percent of participants had filled at least one prescription for a benzodiazepine in the 10 years before entering the study, with 3% of participants having used the drug within 6 months of study entry. The researchers categorized patients based on their level of use, with patients falling into the highest-use category having taken at least 121 total standardized daily doses (TSDDs). The median level of use within that group was 375 TSDDs, equivalent to slightly over a year of daily use.

©Spectral-Design/Thinkstock

In 2004, the study began continuous enrollment to replace those who developed dementia, died, or dropped out. Participants were assessed for cognitive function upon beginning participation in the study and every 2 years afterward. All participants were followed until the earliest onset of dementia, disenrollment from Group Health, or their last study visit before Sept. 30, 2012.

The researchers found no association between the use of benzodiazepines at the TSDD level defined as highest use in this study and dementia (hazard ratio, 1.07) or Alzheimer’s disease (HR, 0.95), compared with nonuse. “When we split the highest category of benzodiazepine use into two groups, the hazard ratio for dementia was 1.11 (0.78-1.58) for 121-364 TSDDs and 1.03 (0.73-1.44) for greater than or equal to 365 TSDDs. Findings for Alzheimer’s disease were similar,” said Shelly L. Gray, Pharm.D., professor of pharmacy at the University of Washington School of Pharmacy, Seattle, and her colleagues.

A slightly increased risk for dementia for study participants classified as low users (taking 1-30 TSDDs) or moderate users (taking 31-120 TSDDs) of benzodiazepine was found, when compared with nonusers. Low users of benzodiazepine were also at increased risk for Alzheimer’s disease (HR, 1.27).

“In conclusion, we found a slightly higher risk of dementia in people with the lowest benzodiazepine use but no increased risk in those with the highest level of exposure. … Overall, our pattern of findings does not support the theory that cumulative benzodiazepine use at the levels observed in our population is causally related to an increased risk for dementia or cognitive decline. … Nonetheless, given the mixed evidence regarding benzodiazepines and risk of dementia and that these drugs are associated with many adverse events, health care providers are still advised to avoid benzodiazepines in older adults to prevent important adverse health outcomes, withdrawal, and dependence,” according to the researchers.

Read the study in the BMJ (doi: 10.1136/bmj.i90).

klennon@frontlinemedcom.com

Benzodiazepine use by elderly adults did not seem to be causally related to an increased risk for dementia and cognitive decline, in a prospective study.

The study included 3,434 individuals aged 65 years or older without dementia. For at least 10 years prior to enrollment in the study, all participants had been members of Group Health, an integrated health delivery system in the Northwest United States that maintains computerized pharmacy data, including names, strengths, dates dispensed, and amounts dispensed of drugs used by its members.

Thirty percent of participants had filled at least one prescription for a benzodiazepine in the 10 years before entering the study, with 3% of participants having used the drug within 6 months of study entry. The researchers categorized patients based on their level of use, with patients falling into the highest-use category having taken at least 121 total standardized daily doses (TSDDs). The median level of use within that group was 375 TSDDs, equivalent to slightly over a year of daily use.

©Spectral-Design/Thinkstock

In 2004, the study began continuous enrollment to replace those who developed dementia, died, or dropped out. Participants were assessed for cognitive function upon beginning participation in the study and every 2 years afterward. All participants were followed until the earliest onset of dementia, disenrollment from Group Health, or their last study visit before Sept. 30, 2012.

The researchers found no association between the use of benzodiazepines at the TSDD level defined as highest use in this study and dementia (hazard ratio, 1.07) or Alzheimer’s disease (HR, 0.95), compared with nonuse. “When we split the highest category of benzodiazepine use into two groups, the hazard ratio for dementia was 1.11 (0.78-1.58) for 121-364 TSDDs and 1.03 (0.73-1.44) for greater than or equal to 365 TSDDs. Findings for Alzheimer’s disease were similar,” said Shelly L. Gray, Pharm.D., professor of pharmacy at the University of Washington School of Pharmacy, Seattle, and her colleagues.

A slightly increased risk for dementia for study participants classified as low users (taking 1-30 TSDDs) or moderate users (taking 31-120 TSDDs) of benzodiazepine was found, when compared with nonusers. Low users of benzodiazepine were also at increased risk for Alzheimer’s disease (HR, 1.27).

“In conclusion, we found a slightly higher risk of dementia in people with the lowest benzodiazepine use but no increased risk in those with the highest level of exposure. … Overall, our pattern of findings does not support the theory that cumulative benzodiazepine use at the levels observed in our population is causally related to an increased risk for dementia or cognitive decline. … Nonetheless, given the mixed evidence regarding benzodiazepines and risk of dementia and that these drugs are associated with many adverse events, health care providers are still advised to avoid benzodiazepines in older adults to prevent important adverse health outcomes, withdrawal, and dependence,” according to the researchers.

Read the study in the BMJ (doi: 10.1136/bmj.i90).

klennon@frontlinemedcom.com

Older depressed adults with a high volume of white matter hyperintensities (WMH) are more at risk for functional decline than both older adults who have not been diagnosed with depression and older adults with low volumes of WMH, according to a study.

At the beginning of this research project 381 individuals aged 60 years and older responded to the Duke Depression Evaluation Schedule’s questions about their functional limitations. This same group, which comprised 244 patients with major depression and 137 individuals who had never been depressed (the controls), also underwent magnetic resonance imaging to identify their total volume of WMH (periventricular and deep white) at baseline. The median length of follow-up for the study’s participants was 5 years, with some individuals having been studied for as many as 16 years.

©Dundanim/shutterstock.com

“We estimated linear mixed models to measure the associations between white matter lesion volume [seen through brain imaging as hyperintensities] at baseline and change in functional status over time for each participant, controlling for age, sex, race, years of education, [Mini-Mental State Exam] score, and self-reported hypertension at the time of study enrollment,” said Dr. Celia F. Hybels and her colleagues of the department of psychiatry and behavioral sciences, Duke University Medical Center, Durham, N.C.

Those study participants who were both depressed and had a higher volume of WMH at baseline were at greatest risk for functional decline. As for the group of individuals who had never been depressed, the ones with a higher WMH volume at the beginning of the study “had a more accelerated rate of functional decline,” compared with the others in the control group. In contrast to the depressed patients with a higher volume of WMH at baseline, the depressed patients with a lower WMH volume at baseline appeared to experience functional decline at a similar rate as those in the control group with lower WMH volume.

This study found that “depression is a modifier in the association between WMH and functional decline in older adults, which suggests one pathway by which older depressed adults develop disability. Those older adults with increased WMH volume who were also depressed had a sharper increase in the number of limitations over time, compared with older adults with a lower volume of WMH who were also depressed and with older adults without a history of depression. That depression is a moderator in the association between white matter pathology and functional decline suggests a unique contribution of depression,” the researchers said.

The researchers suggested that follow-up studies use physical performance to measure the functional status of individuals instead of self-report.

Read the study in The American Journal of Geriatric Psychiatry (doi: 10.1016/j.jagp.2015.03.001).

klennon@frontlinemedcom.com

Older depressed adults with a high volume of white matter hyperintensities (WMH) are more at risk for functional decline than both older adults who have not been diagnosed with depression and older adults with low volumes of WMH, according to a study.

At the beginning of this research project 381 individuals aged 60 years and older responded to the Duke Depression Evaluation Schedule’s questions about their functional limitations. This same group, which comprised 244 patients with major depression and 137 individuals who had never been depressed (the controls), also underwent magnetic resonance imaging to identify their total volume of WMH (periventricular and deep white) at baseline. The median length of follow-up for the study’s participants was 5 years, with some individuals having been studied for as many as 16 years.

©Dundanim/shutterstock.com

“We estimated linear mixed models to measure the associations between white matter lesion volume [seen through brain imaging as hyperintensities] at baseline and change in functional status over time for each participant, controlling for age, sex, race, years of education, [Mini-Mental State Exam] score, and self-reported hypertension at the time of study enrollment,” said Dr. Celia F. Hybels and her colleagues of the department of psychiatry and behavioral sciences, Duke University Medical Center, Durham, N.C.

Those study participants who were both depressed and had a higher volume of WMH at baseline were at greatest risk for functional decline. As for the group of individuals who had never been depressed, the ones with a higher WMH volume at the beginning of the study “had a more accelerated rate of functional decline,” compared with the others in the control group. In contrast to the depressed patients with a higher volume of WMH at baseline, the depressed patients with a lower WMH volume at baseline appeared to experience functional decline at a similar rate as those in the control group with lower WMH volume.

This study found that “depression is a modifier in the association between WMH and functional decline in older adults, which suggests one pathway by which older depressed adults develop disability. Those older adults with increased WMH volume who were also depressed had a sharper increase in the number of limitations over time, compared with older adults with a lower volume of WMH who were also depressed and with older adults without a history of depression. That depression is a moderator in the association between white matter pathology and functional decline suggests a unique contribution of depression,” the researchers said.

The researchers suggested that follow-up studies use physical performance to measure the functional status of individuals instead of self-report.

Read the study in The American Journal of Geriatric Psychiatry (doi: 10.1016/j.jagp.2015.03.001).

klennon@frontlinemedcom.com

Older depressed adults with a high volume of white matter hyperintensities (WMH) are more at risk for functional decline than both older adults who have not been diagnosed with depression and older adults with low volumes of WMH, according to a study.

At the beginning of this research project 381 individuals aged 60 years and older responded to the Duke Depression Evaluation Schedule’s questions about their functional limitations. This same group, which comprised 244 patients with major depression and 137 individuals who had never been depressed (the controls), also underwent magnetic resonance imaging to identify their total volume of WMH (periventricular and deep white) at baseline. The median length of follow-up for the study’s participants was 5 years, with some individuals having been studied for as many as 16 years.

©Dundanim/shutterstock.com

“We estimated linear mixed models to measure the associations between white matter lesion volume [seen through brain imaging as hyperintensities] at baseline and change in functional status over time for each participant, controlling for age, sex, race, years of education, [Mini-Mental State Exam] score, and self-reported hypertension at the time of study enrollment,” said Dr. Celia F. Hybels and her colleagues of the department of psychiatry and behavioral sciences, Duke University Medical Center, Durham, N.C.

Those study participants who were both depressed and had a higher volume of WMH at baseline were at greatest risk for functional decline. As for the group of individuals who had never been depressed, the ones with a higher WMH volume at the beginning of the study “had a more accelerated rate of functional decline,” compared with the others in the control group. In contrast to the depressed patients with a higher volume of WMH at baseline, the depressed patients with a lower WMH volume at baseline appeared to experience functional decline at a similar rate as those in the control group with lower WMH volume.

This study found that “depression is a modifier in the association between WMH and functional decline in older adults, which suggests one pathway by which older depressed adults develop disability. Those older adults with increased WMH volume who were also depressed had a sharper increase in the number of limitations over time, compared with older adults with a lower volume of WMH who were also depressed and with older adults without a history of depression. That depression is a moderator in the association between white matter pathology and functional decline suggests a unique contribution of depression,” the researchers said.

The researchers suggested that follow-up studies use physical performance to measure the functional status of individuals instead of self-report.

Read the study in The American Journal of Geriatric Psychiatry (doi: 10.1016/j.jagp.2015.03.001).

klennon@frontlinemedcom.com

Few adults who reported subjective memory complaints discussed such issues with a health care provider, a study conducted by telephone involving more than 10,276 people shows.

Just under a quarter (22.9%) of the respondents reported discussing their memory problems with a health care professional. Even those who reported having a routine check-up within a year of the date they were surveyed were only sightly more likely to discuss their memory problem with a health care professional, compared with those who had not seen a doctor within the past year. Specifically, 25.2% of those in the former group reported taking such an action, reported Mary L. Adams of On Target Health Data.

©Yestock/thinkstockphotos.com

The respondents were aged 45 years or older and lived in 21 states. Those who reported subjective memory complaints were more likely to live in California and identify as Hispanic. They also were more likely to be aged 75 or older and currently smoke than respondents not reporting subjective memory complaints.

Respondents with functional difficulties were significantly more likely to have engaged in a conversation about their memory issues with a health care professional than those who had not reported functional difficulties, with 34.4% of the former group having discussed their memory problems with a health care professional. A similar percentage of survey respondents who had been diagnosed with depression reported having talked to a health care professional about memory problems (33.2%).

Among the respondents who said memory complaints interfere with working, volunteering, or engaging in social activities sometimes, usually, or always, the rates were 33.8%, 38.9%, and 51.3%, respectively. Another study finding was that as age increased, the likelihood of discussing memory problems with a health care professional decreased.

The study findings suggest that “routine check-ups are a missed opportunity for assessing and discussing memory problems for the majority of adults aged 45 or older with [subjective memory problems],” Ms. Adams wrote. The results “highlight the need for the cognitive assessment required in the Affordable Care Act for Medicare recipients, and also suggest the need and potential benefit of cognitive assessment among adults younger than 65.”

Read the study in Preventing Chronic Disease (2016 Jan 28. doi: 10.5888/pcd13.150471).

klennon@frontlinemedcom.com

Few adults who reported subjective memory complaints discussed such issues with a health care provider, a study conducted by telephone involving more than 10,276 people shows.

Just under a quarter (22.9%) of the respondents reported discussing their memory problems with a health care professional. Even those who reported having a routine check-up within a year of the date they were surveyed were only sightly more likely to discuss their memory problem with a health care professional, compared with those who had not seen a doctor within the past year. Specifically, 25.2% of those in the former group reported taking such an action, reported Mary L. Adams of On Target Health Data.

©Yestock/thinkstockphotos.com

The respondents were aged 45 years or older and lived in 21 states. Those who reported subjective memory complaints were more likely to live in California and identify as Hispanic. They also were more likely to be aged 75 or older and currently smoke than respondents not reporting subjective memory complaints.

Respondents with functional difficulties were significantly more likely to have engaged in a conversation about their memory issues with a health care professional than those who had not reported functional difficulties, with 34.4% of the former group having discussed their memory problems with a health care professional. A similar percentage of survey respondents who had been diagnosed with depression reported having talked to a health care professional about memory problems (33.2%).

Among the respondents who said memory complaints interfere with working, volunteering, or engaging in social activities sometimes, usually, or always, the rates were 33.8%, 38.9%, and 51.3%, respectively. Another study finding was that as age increased, the likelihood of discussing memory problems with a health care professional decreased.

The study findings suggest that “routine check-ups are a missed opportunity for assessing and discussing memory problems for the majority of adults aged 45 or older with [subjective memory problems],” Ms. Adams wrote. The results “highlight the need for the cognitive assessment required in the Affordable Care Act for Medicare recipients, and also suggest the need and potential benefit of cognitive assessment among adults younger than 65.”

Read the study in Preventing Chronic Disease (2016 Jan 28. doi: 10.5888/pcd13.150471).

klennon@frontlinemedcom.com

Few adults who reported subjective memory complaints discussed such issues with a health care provider, a study conducted by telephone involving more than 10,276 people shows.

Just under a quarter (22.9%) of the respondents reported discussing their memory problems with a health care professional. Even those who reported having a routine check-up within a year of the date they were surveyed were only sightly more likely to discuss their memory problem with a health care professional, compared with those who had not seen a doctor within the past year. Specifically, 25.2% of those in the former group reported taking such an action, reported Mary L. Adams of On Target Health Data.

©Yestock/thinkstockphotos.com

The respondents were aged 45 years or older and lived in 21 states. Those who reported subjective memory complaints were more likely to live in California and identify as Hispanic. They also were more likely to be aged 75 or older and currently smoke than respondents not reporting subjective memory complaints.

Respondents with functional difficulties were significantly more likely to have engaged in a conversation about their memory issues with a health care professional than those who had not reported functional difficulties, with 34.4% of the former group having discussed their memory problems with a health care professional. A similar percentage of survey respondents who had been diagnosed with depression reported having talked to a health care professional about memory problems (33.2%).

Among the respondents who said memory complaints interfere with working, volunteering, or engaging in social activities sometimes, usually, or always, the rates were 33.8%, 38.9%, and 51.3%, respectively. Another study finding was that as age increased, the likelihood of discussing memory problems with a health care professional decreased.

The study findings suggest that “routine check-ups are a missed opportunity for assessing and discussing memory problems for the majority of adults aged 45 or older with [subjective memory problems],” Ms. Adams wrote. The results “highlight the need for the cognitive assessment required in the Affordable Care Act for Medicare recipients, and also suggest the need and potential benefit of cognitive assessment among adults younger than 65.”

Read the study in Preventing Chronic Disease (2016 Jan 28. doi: 10.5888/pcd13.150471).

klennon@frontlinemedcom.com

A long recovery from disorientation following electroconvulsive therapy (ECT) seems to be a sign that the therapy has effectively treated an elderly patient with major depression, suggests a longitudinal cohort study conducted in Norway.

The study comprised 57 Norwegian-speaking inpatients, aged 60-85 years, who had major depressive disorders. To enter the study, a patient needed to have a minimum baseline score of 18 on the 17-item Hamilton Rating Scale for Depression (HRSD₁₇). Among the study’s exclusion criteria were a diagnosis of dementia, Parkinson’s disease, schizophrenia, or schizoaffective disorder, and any use of ECT during the previous 6 months. All study participants received the seizure-inducing ECT twice a week. The intensity of therapy varied per patient and session, with age and sex of a patient having been among the criteria used to determine the intensity of each stimulus administered. Treatments continued until a patient achieved remission or the patient’s benefits plateaued. The maximum number of sessions was 16.

Two assessors used the questions included in the HRSD₁₇ to assess the decline in depression symptom severity for each patient every Wednesday between every second ECT session. A patient who achieved an HRSD₁₇ score of 7 or less was considered to be in remission. The patient’s postictal reorientation time (PRT) following ECT therapy was recorded at the first and third treatments. “Assessments of the PRTs were timed relative to the assessments of depressive symptoms during the ECT course. Hence, the PRT at the third treatment was recorded 2 days after the second assessment of symptom severity,” wrote Tor Magne Bj<scaps>ø</scaps>lseth and colleagues. The PRT was defined as the minutes that passed until the patients were able to correctly answer four of five questions about themselves, their location, and the time. A maximum PRT score of 50 minutes was assigned to any patient who took more than 40 minutes to recover from disorientation.

While the researchers did not see a significant association between the mean PRT and the outcome of ECT, they observed that the patients with longer PRTs during early ECT sessions were likely to experience greater declines in depression symptoms.

The researchers also found that “a greater increment in [ECT] dosage rendered a smaller absolute and relative decline in PRT.”

An additional finding suggesting that ECT is beneficial for elderly patients with major depressive disorder was that the study participants’ HRSD₁₇ scores on average declined by 14.7 points from baseline to the end of their ECT sessions.

“Our results indicate that a longer PRT reflects a more efficacious seizure and that the speed of recovery from disorientation may supplement [electroencephalogram] characteristics in tailoring stimulus dosing for elderly patients, at least early in the treatment course of formula-based ECT. It remains to be established whether our findings are generalizable beyond the elderly population and beyond formula-based methods. Further research is also warranted to clarify how the PRT may be utilized to guide stimulus dosing,” the researchers wrote.

Read the study in Journal of Affective Disorders (doi: 10.1016/j.jad.2015.10.013).

klennon@frontlinemedcom.com

A long recovery from disorientation following electroconvulsive therapy (ECT) seems to be a sign that the therapy has effectively treated an elderly patient with major depression, suggests a longitudinal cohort study conducted in Norway.

The study comprised 57 Norwegian-speaking inpatients, aged 60-85 years, who had major depressive disorders. To enter the study, a patient needed to have a minimum baseline score of 18 on the 17-item Hamilton Rating Scale for Depression (HRSD₁₇). Among the study’s exclusion criteria were a diagnosis of dementia, Parkinson’s disease, schizophrenia, or schizoaffective disorder, and any use of ECT during the previous 6 months. All study participants received the seizure-inducing ECT twice a week. The intensity of therapy varied per patient and session, with age and sex of a patient having been among the criteria used to determine the intensity of each stimulus administered. Treatments continued until a patient achieved remission or the patient’s benefits plateaued. The maximum number of sessions was 16.

Two assessors used the questions included in the HRSD₁₇ to assess the decline in depression symptom severity for each patient every Wednesday between every second ECT session. A patient who achieved an HRSD₁₇ score of 7 or less was considered to be in remission. The patient’s postictal reorientation time (PRT) following ECT therapy was recorded at the first and third treatments. “Assessments of the PRTs were timed relative to the assessments of depressive symptoms during the ECT course. Hence, the PRT at the third treatment was recorded 2 days after the second assessment of symptom severity,” wrote Tor Magne Bj<scaps>ø</scaps>lseth and colleagues. The PRT was defined as the minutes that passed until the patients were able to correctly answer four of five questions about themselves, their location, and the time. A maximum PRT score of 50 minutes was assigned to any patient who took more than 40 minutes to recover from disorientation.

While the researchers did not see a significant association between the mean PRT and the outcome of ECT, they observed that the patients with longer PRTs during early ECT sessions were likely to experience greater declines in depression symptoms.

The researchers also found that “a greater increment in [ECT] dosage rendered a smaller absolute and relative decline in PRT.”

An additional finding suggesting that ECT is beneficial for elderly patients with major depressive disorder was that the study participants’ HRSD₁₇ scores on average declined by 14.7 points from baseline to the end of their ECT sessions.

“Our results indicate that a longer PRT reflects a more efficacious seizure and that the speed of recovery from disorientation may supplement [electroencephalogram] characteristics in tailoring stimulus dosing for elderly patients, at least early in the treatment course of formula-based ECT. It remains to be established whether our findings are generalizable beyond the elderly population and beyond formula-based methods. Further research is also warranted to clarify how the PRT may be utilized to guide stimulus dosing,” the researchers wrote.

Read the study in Journal of Affective Disorders (doi: 10.1016/j.jad.2015.10.013).

klennon@frontlinemedcom.com

A long recovery from disorientation following electroconvulsive therapy (ECT) seems to be a sign that the therapy has effectively treated an elderly patient with major depression, suggests a longitudinal cohort study conducted in Norway.

The study comprised 57 Norwegian-speaking inpatients, aged 60-85 years, who had major depressive disorders. To enter the study, a patient needed to have a minimum baseline score of 18 on the 17-item Hamilton Rating Scale for Depression (HRSD₁₇). Among the study’s exclusion criteria were a diagnosis of dementia, Parkinson’s disease, schizophrenia, or schizoaffective disorder, and any use of ECT during the previous 6 months. All study participants received the seizure-inducing ECT twice a week. The intensity of therapy varied per patient and session, with age and sex of a patient having been among the criteria used to determine the intensity of each stimulus administered. Treatments continued until a patient achieved remission or the patient’s benefits plateaued. The maximum number of sessions was 16.

Two assessors used the questions included in the HRSD₁₇ to assess the decline in depression symptom severity for each patient every Wednesday between every second ECT session. A patient who achieved an HRSD₁₇ score of 7 or less was considered to be in remission. The patient’s postictal reorientation time (PRT) following ECT therapy was recorded at the first and third treatments. “Assessments of the PRTs were timed relative to the assessments of depressive symptoms during the ECT course. Hence, the PRT at the third treatment was recorded 2 days after the second assessment of symptom severity,” wrote Tor Magne Bj<scaps>ø</scaps>lseth and colleagues. The PRT was defined as the minutes that passed until the patients were able to correctly answer four of five questions about themselves, their location, and the time. A maximum PRT score of 50 minutes was assigned to any patient who took more than 40 minutes to recover from disorientation.

While the researchers did not see a significant association between the mean PRT and the outcome of ECT, they observed that the patients with longer PRTs during early ECT sessions were likely to experience greater declines in depression symptoms.

The researchers also found that “a greater increment in [ECT] dosage rendered a smaller absolute and relative decline in PRT.”

An additional finding suggesting that ECT is beneficial for elderly patients with major depressive disorder was that the study participants’ HRSD₁₇ scores on average declined by 14.7 points from baseline to the end of their ECT sessions.

“Our results indicate that a longer PRT reflects a more efficacious seizure and that the speed of recovery from disorientation may supplement [electroencephalogram] characteristics in tailoring stimulus dosing for elderly patients, at least early in the treatment course of formula-based ECT. It remains to be established whether our findings are generalizable beyond the elderly population and beyond formula-based methods. Further research is also warranted to clarify how the PRT may be utilized to guide stimulus dosing,” the researchers wrote.

Read the study in Journal of Affective Disorders (doi: 10.1016/j.jad.2015.10.013).

klennon@frontlinemedcom.com

The Food and Drug Administration has granted 510K clearance to Gore Medical for a new biomaterial for hernia repair, according to a Gore statement.

Gore describes the product – GORE SYNECOR Biomaterial – as having a “unique structure,” which prevents surgeons from having to choose between using a “permanent material” and an “absorbable, nonpermanent material” when deciding which biomaterial to use for a hernia repair.

GORE SYNECOR Biomaterial is composed of the following:

• Dense monofilament polytetrafluoroethylene macroporous knit.

• GORE BIO-A Web, “a tissue scaffold with proven outcomes in contaminated hernia repair. providing rapid vascularization and ingrowth in complex repairs.”

• Nonporous PGA/TMC film.

No precertification is required for surgeons to implant GORE SYNECOR Biomaterial.

For more information about the new product, visit www.goremedical.com.

klennon@frontlinemedcom.com

The Food and Drug Administration has granted 510K clearance to Gore Medical for a new biomaterial for hernia repair, according to a Gore statement.

Gore describes the product – GORE SYNECOR Biomaterial – as having a “unique structure,” which prevents surgeons from having to choose between using a “permanent material” and an “absorbable, nonpermanent material” when deciding which biomaterial to use for a hernia repair.

GORE SYNECOR Biomaterial is composed of the following:

• Dense monofilament polytetrafluoroethylene macroporous knit.

• GORE BIO-A Web, “a tissue scaffold with proven outcomes in contaminated hernia repair. providing rapid vascularization and ingrowth in complex repairs.”

• Nonporous PGA/TMC film.

No precertification is required for surgeons to implant GORE SYNECOR Biomaterial.

For more information about the new product, visit www.goremedical.com.

klennon@frontlinemedcom.com

The Food and Drug Administration has granted 510K clearance to Gore Medical for a new biomaterial for hernia repair, according to a Gore statement.

Gore describes the product – GORE SYNECOR Biomaterial – as having a “unique structure,” which prevents surgeons from having to choose between using a “permanent material” and an “absorbable, nonpermanent material” when deciding which biomaterial to use for a hernia repair.

GORE SYNECOR Biomaterial is composed of the following:

• Dense monofilament polytetrafluoroethylene macroporous knit.

• GORE BIO-A Web, “a tissue scaffold with proven outcomes in contaminated hernia repair. providing rapid vascularization and ingrowth in complex repairs.”

• Nonporous PGA/TMC film.

No precertification is required for surgeons to implant GORE SYNECOR Biomaterial.

For more information about the new product, visit www.goremedical.com.

klennon@frontlinemedcom.com

Both single-dose and two-dose meningococcal CRM-conjugate vaccine series (MenACWY-CRM) were immunogenic, but antibody responses were greater in patients after two doses, especially for patients aged 2-5 years old, according to a new study.

The multicenter, randomized, observer-blind, placebo-controlled study, conducted in the United States between October 2012 and May 2014, included 713 subjects who were up to date with their routine childhood immunizations. The subjects were broken into two age groups: children aged 2-5 years and children aged 6-10 years. The two age groups were randomized 1:1 to receive two doses of MenACWY-CRM or one dose of placebo followed by one dose of MenACWY-CRM, 2 months apart. Immunogenicity was measured using serum bactericidal activity with human complement.

©DesignPics/Thinkstock.com

The researchers’ primary objective was to assess the noninferiority and superiority of antibody responses of the two doses, compared with the single dose against Neisseria meningitidis serogroups A,C, W, and Y, at 1-month after the last vaccination. Among the exclusion criteria for participation in the study were previous or suspected disease caused by N. meningitidis or immunization with any investigational or licensed vaccines containing meningococcal antigens.

Noninferiority of two doses of MenACWY-CRM, compared with a single dose, was demonstrated for all four serogroups. Additionally, at 1 month after the last vaccination, the superiority of receiving the two doses over the single dose was demonstrated for serogroups C and Y, for patients in the 2- to 5-year-old age cohort, while the superiority of two doses over one dose was demonstrated for the serogroup Y, for patients in the 6- to 10-year-old cohort.

The safety profile of the vaccine was similar in both groups. Medically attended adverse events that were considered to have been “possibly or probably related to the study vaccine” occurred in five subjects (as six events) in the 2- to 5-year-old age cohort and three subjects (as three events) in the 6- to 10-year-age cohort. One subject in the cohort aged 6-10 years withdrew from the study, because of vomiting and diarrhea, “which were considered to be unrelated to the study vaccine.” Eight serious adverse events were reported by five subjects, with one of the events “considered to be possibly related to the study vaccine.” That event was idiopathic thrombocytopenia, which occurred in a 6-year-old who received the single dose.

“[B]oth the single-dose and the two-dose primary series of MenACWY-CRM are immunogenic and have an acceptable safety profile in 2- to 10-year-old children. The two-dose primary series induced a higher immune response than [did] a single dose, although this difference in response decreases over time,” Dr. William Johnston Jr. of Alabama Clinical Therapeutics in Birmingham and his colleagues said.

Read the study in the Pediatric Infectious Disease Journal (doi: 10.1097/INF.0000000000000931).

klennon@frontlinemedcom.com

Both single-dose and two-dose meningococcal CRM-conjugate vaccine series (MenACWY-CRM) were immunogenic, but antibody responses were greater in patients after two doses, especially for patients aged 2-5 years old, according to a new study.

The multicenter, randomized, observer-blind, placebo-controlled study, conducted in the United States between October 2012 and May 2014, included 713 subjects who were up to date with their routine childhood immunizations. The subjects were broken into two age groups: children aged 2-5 years and children aged 6-10 years. The two age groups were randomized 1:1 to receive two doses of MenACWY-CRM or one dose of placebo followed by one dose of MenACWY-CRM, 2 months apart. Immunogenicity was measured using serum bactericidal activity with human complement.

©DesignPics/Thinkstock.com

The researchers’ primary objective was to assess the noninferiority and superiority of antibody responses of the two doses, compared with the single dose against Neisseria meningitidis serogroups A,C, W, and Y, at 1-month after the last vaccination. Among the exclusion criteria for participation in the study were previous or suspected disease caused by N. meningitidis or immunization with any investigational or licensed vaccines containing meningococcal antigens.

Noninferiority of two doses of MenACWY-CRM, compared with a single dose, was demonstrated for all four serogroups. Additionally, at 1 month after the last vaccination, the superiority of receiving the two doses over the single dose was demonstrated for serogroups C and Y, for patients in the 2- to 5-year-old age cohort, while the superiority of two doses over one dose was demonstrated for the serogroup Y, for patients in the 6- to 10-year-old cohort.

The safety profile of the vaccine was similar in both groups. Medically attended adverse events that were considered to have been “possibly or probably related to the study vaccine” occurred in five subjects (as six events) in the 2- to 5-year-old age cohort and three subjects (as three events) in the 6- to 10-year-age cohort. One subject in the cohort aged 6-10 years withdrew from the study, because of vomiting and diarrhea, “which were considered to be unrelated to the study vaccine.” Eight serious adverse events were reported by five subjects, with one of the events “considered to be possibly related to the study vaccine.” That event was idiopathic thrombocytopenia, which occurred in a 6-year-old who received the single dose.

“[B]oth the single-dose and the two-dose primary series of MenACWY-CRM are immunogenic and have an acceptable safety profile in 2- to 10-year-old children. The two-dose primary series induced a higher immune response than [did] a single dose, although this difference in response decreases over time,” Dr. William Johnston Jr. of Alabama Clinical Therapeutics in Birmingham and his colleagues said.

Read the study in the Pediatric Infectious Disease Journal (doi: 10.1097/INF.0000000000000931).

klennon@frontlinemedcom.com

Both single-dose and two-dose meningococcal CRM-conjugate vaccine series (MenACWY-CRM) were immunogenic, but antibody responses were greater in patients after two doses, especially for patients aged 2-5 years old, according to a new study.

The multicenter, randomized, observer-blind, placebo-controlled study, conducted in the United States between October 2012 and May 2014, included 713 subjects who were up to date with their routine childhood immunizations. The subjects were broken into two age groups: children aged 2-5 years and children aged 6-10 years. The two age groups were randomized 1:1 to receive two doses of MenACWY-CRM or one dose of placebo followed by one dose of MenACWY-CRM, 2 months apart. Immunogenicity was measured using serum bactericidal activity with human complement.

©DesignPics/Thinkstock.com

The researchers’ primary objective was to assess the noninferiority and superiority of antibody responses of the two doses, compared with the single dose against Neisseria meningitidis serogroups A,C, W, and Y, at 1-month after the last vaccination. Among the exclusion criteria for participation in the study were previous or suspected disease caused by N. meningitidis or immunization with any investigational or licensed vaccines containing meningococcal antigens.

Noninferiority of two doses of MenACWY-CRM, compared with a single dose, was demonstrated for all four serogroups. Additionally, at 1 month after the last vaccination, the superiority of receiving the two doses over the single dose was demonstrated for serogroups C and Y, for patients in the 2- to 5-year-old age cohort, while the superiority of two doses over one dose was demonstrated for the serogroup Y, for patients in the 6- to 10-year-old cohort.

The safety profile of the vaccine was similar in both groups. Medically attended adverse events that were considered to have been “possibly or probably related to the study vaccine” occurred in five subjects (as six events) in the 2- to 5-year-old age cohort and three subjects (as three events) in the 6- to 10-year-age cohort. One subject in the cohort aged 6-10 years withdrew from the study, because of vomiting and diarrhea, “which were considered to be unrelated to the study vaccine.” Eight serious adverse events were reported by five subjects, with one of the events “considered to be possibly related to the study vaccine.” That event was idiopathic thrombocytopenia, which occurred in a 6-year-old who received the single dose.

“[B]oth the single-dose and the two-dose primary series of MenACWY-CRM are immunogenic and have an acceptable safety profile in 2- to 10-year-old children. The two-dose primary series induced a higher immune response than [did] a single dose, although this difference in response decreases over time,” Dr. William Johnston Jr. of Alabama Clinical Therapeutics in Birmingham and his colleagues said.

Read the study in the Pediatric Infectious Disease Journal (doi: 10.1097/INF.0000000000000931).

klennon@frontlinemedcom.com

Insufficient omega-6 polyunsaturated fatty acids (n-6 PUFA), excess trans fat and, to a lesser extent, excess saturated fat, are significant causes of coronary heart disease, suggests a global study published online Jan. 20.

“Our analysis provides, for the first time, a rigorous comparison of global CHD burdens attributable to insufficient n-6 PUFA versus higher saturated fat. In 80% of nations, n-6 PUFA–attributable CHD burdens were at least twofold higher than saturated fat–attributable burdens. This suggests that focus on increasing healthful n-6 rich vegetable oils may provide important public health benefits,” Qianyi Wang, Sc.D., and her colleagues said.

©Marcelo Wain/iStockphoto.com

The researchers estimated national intakes of saturated fat, n-6 PUFA, and trans fat based on country-specific dietary surveys, food availability data, and for trans fat, industry reports on fats/oils and packaged foods. The effects of dietary fats on CHD mortality were derived from meta-analyses of prospective cohorts, and CHD mortality rates were derived from the 2010 Global Burden of Diseases Study. Absolute and proportional attributable CHD mortality were computed using a comparative risk assessment framework.

The researchers estimated insufficient n-6 PUFA consumption having been replaced by carbohydrate or saturated fat consumption was responsible for 711,800 CHD deaths per year, accounting for 10% of total global CHD mortality and for 187 CHD deaths per year per 1 million adults. The most absolute CHD deaths per year – 547 per 1 million adults – attributable to insufficient n-6 PUFA occurred in Eastern Europe, while Oceania had the highest proportion of n-6 PUFA–attributable CHD deaths. East Asia had both the fewest absolute – 74 per 1 million adults – and lowest proportion – 6.7% – of CHD deaths attributable to inadequate consumption of n-6 PUFA.

Excess consumption of saturated fat as a replacement for n-6 PUFA caused an estimated 250,900 CHD deaths per year, accounting for 3.6% of CHD deaths and 66 CHD deaths per year per 1 million adults.

The researchers estimated that excess trans fat consumption caused 537,200 CHD deaths per year, representing 7.7% of global CHD mortality and 141 CHD deaths per year per 1 million adults. High-income nations generally had higher trans fat–attributable CHD mortality than lower-income nations. The highest trans fat–attributable absolute CHD mortality occurred in Egypt, with 1,120 deaths per year per 1 million adults. Canada, Pakistan, and the United States all had more than 475 deaths per year per 1 million adults because of excess consumption of trans fat. Such deaths accounted for more than 17% of corresponding national CHD mortality.

Sub-Saharan Africa and the Caribbean had the lowest estimated trans fat–attributable CHD mortality, with excess consumption of trans fat accounting for less than 5% of CHD deaths in these regions.

Additional findings of this study included mean global changes in dietary intakes of saturated fat, n-6 PUFA, and trans fat, and corresponding changes in CHD deaths occurring between 1990 and 2010. Specifically, global proportional CHD mortality attributable to insufficient n-6 PUFA and higher saturated fat consumption decreased by 9% and 21%, respectively. Such decreases occurred in concert with a 0.5% increase in consumption of n-6 PUFA and a 0.2% decrease in consumption of saturated fat. In high-income countries, trans fat consumption declined in parallel with policy strategies to reduce industrial trans fat production. In contrast, global proportional CHD deaths attributable to higher trans fat increased by 4% as global mean dietary intakes of trans fat increased by 0.1%.

“Growing evidence indicates that lowering saturated fat provides convincing cardiovascular benefits only when replaced by PUFA, whereas cardiovascular benefits of n-6 PUFA are similar whether replacing saturated fat or total carbohydrates,” said Dr. Wang of the Harvard T.H. Chan School of Public Health, Boston.

Read the study in the Journal of the American Heart Association (doi: 10.1161/JAHA.115.002891).

klennon@frontlinemedcom.com

Insufficient omega-6 polyunsaturated fatty acids (n-6 PUFA), excess trans fat and, to a lesser extent, excess saturated fat, are significant causes of coronary heart disease, suggests a global study published online Jan. 20.

“Our analysis provides, for the first time, a rigorous comparison of global CHD burdens attributable to insufficient n-6 PUFA versus higher saturated fat. In 80% of nations, n-6 PUFA–attributable CHD burdens were at least twofold higher than saturated fat–attributable burdens. This suggests that focus on increasing healthful n-6 rich vegetable oils may provide important public health benefits,” Qianyi Wang, Sc.D., and her colleagues said.

©Marcelo Wain/iStockphoto.com

The researchers estimated national intakes of saturated fat, n-6 PUFA, and trans fat based on country-specific dietary surveys, food availability data, and for trans fat, industry reports on fats/oils and packaged foods. The effects of dietary fats on CHD mortality were derived from meta-analyses of prospective cohorts, and CHD mortality rates were derived from the 2010 Global Burden of Diseases Study. Absolute and proportional attributable CHD mortality were computed using a comparative risk assessment framework.

The researchers estimated insufficient n-6 PUFA consumption having been replaced by carbohydrate or saturated fat consumption was responsible for 711,800 CHD deaths per year, accounting for 10% of total global CHD mortality and for 187 CHD deaths per year per 1 million adults. The most absolute CHD deaths per year – 547 per 1 million adults – attributable to insufficient n-6 PUFA occurred in Eastern Europe, while Oceania had the highest proportion of n-6 PUFA–attributable CHD deaths. East Asia had both the fewest absolute – 74 per 1 million adults – and lowest proportion – 6.7% – of CHD deaths attributable to inadequate consumption of n-6 PUFA.

Excess consumption of saturated fat as a replacement for n-6 PUFA caused an estimated 250,900 CHD deaths per year, accounting for 3.6% of CHD deaths and 66 CHD deaths per year per 1 million adults.

The researchers estimated that excess trans fat consumption caused 537,200 CHD deaths per year, representing 7.7% of global CHD mortality and 141 CHD deaths per year per 1 million adults. High-income nations generally had higher trans fat–attributable CHD mortality than lower-income nations. The highest trans fat–attributable absolute CHD mortality occurred in Egypt, with 1,120 deaths per year per 1 million adults. Canada, Pakistan, and the United States all had more than 475 deaths per year per 1 million adults because of excess consumption of trans fat. Such deaths accounted for more than 17% of corresponding national CHD mortality.

Sub-Saharan Africa and the Caribbean had the lowest estimated trans fat–attributable CHD mortality, with excess consumption of trans fat accounting for less than 5% of CHD deaths in these regions.

Additional findings of this study included mean global changes in dietary intakes of saturated fat, n-6 PUFA, and trans fat, and corresponding changes in CHD deaths occurring between 1990 and 2010. Specifically, global proportional CHD mortality attributable to insufficient n-6 PUFA and higher saturated fat consumption decreased by 9% and 21%, respectively. Such decreases occurred in concert with a 0.5% increase in consumption of n-6 PUFA and a 0.2% decrease in consumption of saturated fat. In high-income countries, trans fat consumption declined in parallel with policy strategies to reduce industrial trans fat production. In contrast, global proportional CHD deaths attributable to higher trans fat increased by 4% as global mean dietary intakes of trans fat increased by 0.1%.

“Growing evidence indicates that lowering saturated fat provides convincing cardiovascular benefits only when replaced by PUFA, whereas cardiovascular benefits of n-6 PUFA are similar whether replacing saturated fat or total carbohydrates,” said Dr. Wang of the Harvard T.H. Chan School of Public Health, Boston.

Read the study in the Journal of the American Heart Association (doi: 10.1161/JAHA.115.002891).

klennon@frontlinemedcom.com

Insufficient omega-6 polyunsaturated fatty acids (n-6 PUFA), excess trans fat and, to a lesser extent, excess saturated fat, are significant causes of coronary heart disease, suggests a global study published online Jan. 20.

“Our analysis provides, for the first time, a rigorous comparison of global CHD burdens attributable to insufficient n-6 PUFA versus higher saturated fat. In 80% of nations, n-6 PUFA–attributable CHD burdens were at least twofold higher than saturated fat–attributable burdens. This suggests that focus on increasing healthful n-6 rich vegetable oils may provide important public health benefits,” Qianyi Wang, Sc.D., and her colleagues said.

©Marcelo Wain/iStockphoto.com

The researchers estimated national intakes of saturated fat, n-6 PUFA, and trans fat based on country-specific dietary surveys, food availability data, and for trans fat, industry reports on fats/oils and packaged foods. The effects of dietary fats on CHD mortality were derived from meta-analyses of prospective cohorts, and CHD mortality rates were derived from the 2010 Global Burden of Diseases Study. Absolute and proportional attributable CHD mortality were computed using a comparative risk assessment framework.

The researchers estimated insufficient n-6 PUFA consumption having been replaced by carbohydrate or saturated fat consumption was responsible for 711,800 CHD deaths per year, accounting for 10% of total global CHD mortality and for 187 CHD deaths per year per 1 million adults. The most absolute CHD deaths per year – 547 per 1 million adults – attributable to insufficient n-6 PUFA occurred in Eastern Europe, while Oceania had the highest proportion of n-6 PUFA–attributable CHD deaths. East Asia had both the fewest absolute – 74 per 1 million adults – and lowest proportion – 6.7% – of CHD deaths attributable to inadequate consumption of n-6 PUFA.

Excess consumption of saturated fat as a replacement for n-6 PUFA caused an estimated 250,900 CHD deaths per year, accounting for 3.6% of CHD deaths and 66 CHD deaths per year per 1 million adults.

The researchers estimated that excess trans fat consumption caused 537,200 CHD deaths per year, representing 7.7% of global CHD mortality and 141 CHD deaths per year per 1 million adults. High-income nations generally had higher trans fat–attributable CHD mortality than lower-income nations. The highest trans fat–attributable absolute CHD mortality occurred in Egypt, with 1,120 deaths per year per 1 million adults. Canada, Pakistan, and the United States all had more than 475 deaths per year per 1 million adults because of excess consumption of trans fat. Such deaths accounted for more than 17% of corresponding national CHD mortality.

Sub-Saharan Africa and the Caribbean had the lowest estimated trans fat–attributable CHD mortality, with excess consumption of trans fat accounting for less than 5% of CHD deaths in these regions.

Additional findings of this study included mean global changes in dietary intakes of saturated fat, n-6 PUFA, and trans fat, and corresponding changes in CHD deaths occurring between 1990 and 2010. Specifically, global proportional CHD mortality attributable to insufficient n-6 PUFA and higher saturated fat consumption decreased by 9% and 21%, respectively. Such decreases occurred in concert with a 0.5% increase in consumption of n-6 PUFA and a 0.2% decrease in consumption of saturated fat. In high-income countries, trans fat consumption declined in parallel with policy strategies to reduce industrial trans fat production. In contrast, global proportional CHD deaths attributable to higher trans fat increased by 4% as global mean dietary intakes of trans fat increased by 0.1%.

“Growing evidence indicates that lowering saturated fat provides convincing cardiovascular benefits only when replaced by PUFA, whereas cardiovascular benefits of n-6 PUFA are similar whether replacing saturated fat or total carbohydrates,” said Dr. Wang of the Harvard T.H. Chan School of Public Health, Boston.

Read the study in the Journal of the American Heart Association (doi: 10.1161/JAHA.115.002891).

klennon@frontlinemedcom.com