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Meta-analysis concludes vitamin D supplementation could aid chronic pain management
September 30 2016. The September-October 2016 issue of Pain Physician published the outcome of a systematic review and meta-analysis that found a benefit for supplementing with vitamin D in pain relief.
For their analysis, Robert Scragg, MD, PhD of the University of Auckland and his associates selected 19 randomized clinical trials that included 3,436 participants who received a placebo or vitamin D2/ D3 for at least four weeks. In the eight trials that reported the differences in final follow-up pain scores compared to scores obtained at the beginning of the trials, there was a 43% greater average decrease in scores for participants who received vitamin D compared with to the placebo. Participants who had pre-existing pain-related medical conditions at recruitment experienced greater benefits than those recruited from the community or who were deficient in vitamin D. Analysis of other trials found no statistical difference between final pain scores in both groups. In studies that reported pain improvement, participants who received vitamin D were 38% likelier to report improvement in comparison with the placebo groups.
"To our knowledge, this is the first reported quantitative meta-analysis of vitamin D supplementation and pain," the authors announce. "The results of this meta-analysis support the conclusion that vitamin D supplementation may reduce pain scores in the patients with pain conditions. This suggests that vitamin D supplementation could have a role in the management of chronic pain. Further well-designed placebo controlled long-term trials should be conducted to confirm these findings."
Vitamin D reduces anginal episodes in chronic stable angina patients
September 28 2016. The August 2016 issue of the Journal of Clinical and Diagnostic Research published the findings of researchers in Karnataka, India of a reduction in episodes of angina in stable angina patients. The severe chest pain known as angina occurs when blood supply to the heart is inadequate due to cardiovascular disease. Authors Suresh V. Sagarad and colleagues observe that "The clinical benefit of Vitamin D supplementation in chronic stable angina patients with vitamin D insufficiency has not been reported."
The current research involved 20 medically managed chronic stable angina patients with low vitamin D levels and 20 patients with normal levels. Those with low levels of the vitamin were given 60,000 international units (IU) every week for eight weeks.
Participants who received vitamin D experienced a 20% reduction in anginal episodes over 14 days compared to the amount recorded over a 14 day period prior to treatment. Additionally, subjects treated with vitamin D had fewer anginal episodes compared to the untreated group. Vitamin D-treated subjects also had a 17.24% reduction in the use of sublingual nitrates to treat the condition in comparison with pretreatment usage. No changes were observed in the group that did not receive vitamin D. The effects associated with the vitamin were independent of any changes in blood pressure or heart rate."The significant change compared to baseline as well as with group 2 having normal vitamin levels points definitely towards effect of vitamin D supplementation," the authors note in their discussion of the findings. "Supplementation to correct vitamin D levels may have additional cardiovascular benefits. More trials are needed in this direction."
Meta-analysis affirms benefit for omega 3 supplementation in nonalcoholic fatty liver
September 26 2016. A meta-analysis reported this year in Gastroenterology Research and Practice found a benefit for supplementing with omega 3 polyunsaturated fatty acids among individuals with nonalcoholic fatty liver disease (NAFLD), a growing global health concern.
Researchers at Tongji University School of Medicine in Shanghai selected ten randomized, controlled trials concerning the effects of omega 3 that included a total of 577 participants with NAFLD or nonalcoholic steatohepatitis (NASH)--a more serious condition that can develop from NAFLD. The median dose of omega 3 was 2.85 grams per day consumed for a median of 12 months. The control groups received placebos or no treatment.
Ultrasonography of the liver evaluated the change in liver fat in five studies. The team found over three times the odds of improvement in liver fat levels in association with omega 3 intake in comparison with the control subjects. Omega 3 supplementation was also associated with significantly greater reductions in serum gamma-glutamyltransferase (GGT, which is elevated in liver damage) levels compared to the controls. Additionally, high-density lipoprotein (HDL) levels increased to a greater extent in omega-3 supplemented subjects compared to the controls and triglyceride levels were reduced.
"Currently, NASH is rapidly increasing as a cause of end-stage liver disease and hepatic carcinoma," Wenxia Lu and colleagues observe. "At present, there is no registered drug for the treatment of NAFLD, and there is a need to improve therapeutics for this condition.""In this meta-analysis, omega-3 polyunsaturated fatty acids improved liver fat, GGT, triglycerides, and high-density lipoprotein in patients with NAFLD/NASH," they conclude. "Therefore, omega-3 polyunsaturated fatty acids may be a new treatment option for NAFLD."
Progesterone may help protect the lungs during flu
September 23 2016. A report appearing on September 15, 2016 in the journal PLOS Pathogens describes a role for the hormone progesterone in reducing inflammation and improving lung function following infection with influenza.
"Epidemiological and experimental evidence suggest that young adult females suffer a worse outcome than males following influenza A virus infection, which in mice is associated with infection-induced suppression of reproductive hormones and excessive inflammatory immune responses in females," write Sabra L. Klein of Johns Hopkins University and colleagues. "In addition to influenza, young adult females suffer a worse outcome than males from several autoimmune diseases, including multiple sclerosis. Paradoxically, a growing body of literature reveals that exogenous treatment of females (both humans and mice) with either estrogens or progesterone limits inflammation and protects against infectious and autoimmune diseases by decreasing inflammation and promoting repair."
Using progesterone-depleted mice, Dr Klein and associates found that administration of the hormone in an amount similar to that released during the luteal phase of the cycle was associated with protection against lethal and sublethal influenza A virus infection. The animals experienced a reduction in lung inflammation, improved lung function, lung epithelial damage repair, accelerated recovery and an increase in T helper 17 immune cells. The effects observed in the study were determined to be the result of stimulation by progesterone of the production of the epidermal growth factor known as amphiregulin by respiratory epithelial cells. While giving amphiregulin to progesterone-depleted female mice stimulated pulmonary repair and improved the influenza outcome, treating amphiregulin-deficient female mice with progesterone failed to restore protection."This study provides insight into a novel mechanistic role of progesterone in the lungs and illustrates that sex hormone exposure, including through the use of hormonal contraceptives, has significant health effects beyond the reproductive tract," the authors conclude.
Meta-analysis concludes benefit for magnesium in migraine
Researchers in Taiwan analyzed randomized trials that evaluated the effects of intravenous magnesium on acute migraine attacks. Trials that examined the role of orally administered magnesium in migraine prevention were separately analyzed.
In a pooled analysis of 948 participants, it was determined that the risk of experiencing acute migraine within 15 to 45 minutes following an initial infusion of magnesium was 77% lower than the risk associated with standard treatment or saline. Two and 24 hours after magnesium infusion, the risk was 80% and 75% lower, respectively. Pooled analysis of trials that evaluated orally administered magnesium found significant reductions in both migraine frequency and intensity in association with supplementation among 789 subjects.
"Magnesium deficiency has been strongly associated with migraine attacks," note Hsiao-Yean Chiu RN, PhD and colleagues. "Several potential mechanisms have been proposed, such as triggered cortical spreading depression, decreased release of substance P, stimulated cerebral artery spasm, and an imbalance between mitochondrial energy production and demand.""This is the first meta-analysis to evaluate the overall effects of intravenous and oral magnesium on acute migraine attacks and the prophylaxis of migraine, respectively," they announce. "We confirmed that intravenous magnesium has beneficial effects in relieving acute migraine attacks and that oral magnesium supplements alleviate the frequency and intensity of migraine. Thus, we suggest that intravenous and oral magnesium should be considered as adjunctive therapies for managing acute migraine attacks and the prophylaxis of migraines, respectively."
Low vitamin D levels, MS relapses more common in winter
September 19 2016. A study reported in the September 2016 issue of the European Journal of Clinical Nutrition found a correlation between low wintertime vitamin D levels and a greater risk of experiencing relapses and disability among Polish men and women with multiple sclerosis (MS).
The study, which was conducted between January 1 and December 31, 2014, involved 184 relapsing-remitting MS patients who were being treated with immune-modulating drugs and 58 age- and sex-matched control subjects. Serum 25-hydroxyvitamin D levels were measured in February and August 2014 and disability level was assessed in January, June and December and after every relapse. Magnetic resonance imaging was conducted at the beginning and end of the study, as well as during relapses.
Average serum vitamin D levels were lower during winter among all subjects. Having a higher winter serum vitamin D level was associated with a lower risk of MS. Those with severe MS had lower winter vitamin D levels than mild cases or controls, which was particularly evident among females. Vitamin D levels were lower in patients with relapses than among those without relapses in winter as well as summer."The results of the study reveal significantly lower 25(OH)D concentrations in MS patients than controls in winter and suggest that vitamin D may be involved in the regulation of clinical disease activity," write W. Brola and colleagues. "Particularly low levels of vitamin D were observed in winter in females with a longer history of MS and higher level of disability. We conclude that low levels of vitamin D are associated with an increased number of MS relapses and that there is a need for vitamin D supplementation in Poland during the winter season, especially in patients with MS."
Folic acid supplementation associated with decline in kidney disease progression
September 16 2016. The October 1, 2016 issue of JAMA Internal Medicine reported the outcome of a trial of adults with high blood pressure which found that the addition of folic acid to treatment with the antihypertensive drug enalapril delayed the progression of chronic kidney disease.
The study included 15,104 participants in The China Stroke Primary Prevention Trial, which compared the effects of 800 micrograms folic acid added to the ACE inhibitor enalapril to the effects of enalapril alone in the prevention of a first stroke among hypertensive men and women. Eleven percent of the subjects had chronic kidney disease at the beginning of the study.
After a 4 to 4.8 year follow-up, folic acid-supplemented subjects had experienced a slower rate of estimated glomerular filtration rate decline. The risk of experiencing a primary event, which was defined by specific decreases in the kidneys' estimated glomerular filtration rate, was less among participants who received folic acid—a finding that was significant only among those who had chronic kidney disease at the beginning of the study. Among this group there was a 56% lower risk of experiencing a primary event, a 33% lower risk of rapid kidney function decline, and a 38% lower risk of experiencing the primary event plus death from any cause in association with folic acid supplementation compared with enalapril alone."Our study is the first to show significant renal protection from folic acid therapy in a population without folic acid fortification," Xin Xu, MD, PhD, and colleagues announce. "Given the magnitude of renal protection suggested by this study as well as the safety and the low cost, the potential role of folic acid therapy in the clinical management of patients with chronic kidney disease in regions without folic acid fortification should be vigorously examined."
How x-rays cause cancer
September 14 2016. A study reported on September 12, 2016 in Nature Communicationsreveals howx-rays and other forms of ionizing radiation can damage DNA and cause cancer.
In their introduction to the article, Dr Peter Campbell and colleagues note that there appear to be no safe limits for radiation exposure and that medical radiation, in the form of radiation therapy for unrelated cancers or diagnostic radiography that includes CT scans, are leading causes of radiation-induced malignancies.
"To find out how radiation could cause cancer, we studied the genomes of cancers caused by radiation in comparison to tumors that arose spontaneously," Dr Campbell stated. "By comparing the DNA sequences we found two mutational signatures for radiation damage that were independent of cancer type. We then checked the findings with prostate cancers that had or had not been exposed to radiation, and found the same two signatures again. These mutational signatures help us explain how high-energy radiation damages DNA."
"Ionizing radiation probably causes all types of mutational damage, but here we can see two specific types of damage and get a sense of what is happening to the DNA," explained lead author Sam Behjati. "Showers of radiation chop up the genome causing lots of damage simultaneously. This seems to overwhelm the DNA repair mechanism in the cell, leading to the DNA damage we see.""This is the first time that scientists have been able to define the damage caused to DNA by ionizing radiation," coauthor Adrienne M. Flanagan announced. "These mutational signatures could be a diagnosis tool for both individual cases, and for groups of cancers, and could help us find out which cancers are caused by radiation. Once we have better understanding of this, we can study whether they should be treated the same or differently to other cancers."
Sugar industry revealed as sponsor of early research implicating dietary fat in coronary heart disease
September 12 2016. An article appearing on September 12, 2016 in JAMA Internal Medicine brings to light new information on an old topic—the role of diet in coronary heart disease (CHD). By investigating archival documents at the University of Illinois, researchers at the University of California San Francisco discovered that a review published in 1967 in the New England Journal of Medicine that pointed a finger at fat and cholesterol was funded by the Sugar Research Foundation, although this fact was not disclosed. (Full disclosure of all conflicts of interest concerning an article has been required by the New England Journal of Medicine since 1984.)
The 1967 review, titled, "Dietary Fats, Carbohydrates and Atherosclerotic Disease," concluded that there was "no doubt" that the only dietary intervention needed for coronary heart disease prevention was a reduction in cholesterol combined with a switch from saturated to polyunsaturated fats. The Sugar Research Foundation, according to the JAMA Internal Medicine article's authors, contributed articles to be reviewed and received drafts.
"This study suggests that the sugar industry sponsored its first CHD research project in 1965 to downplay early warning signs that sucrose consumption was a risk factor in CHD," write Christin E. Kearns, DDS, MBA and colleagues. "As of 2016, sugar control policies are being promulgated in international, federal, state and local venues. Yet CHD risk is inconsistently cited as a health consequence of added sugars consumption. Because CHD is the leading cause of death globally, the health community should ensure that CHD risk is evaluated in future risk assessments of added sugars. Policymaking committees should consider giving less weight to food industry-funded studies, and include mechanistic and animal studies as well as studies appraising the effect of added sugars on multiple CHD biomarkers and disease development."
Calcium, vitamin D supplementation associated improved stroke recovery
September 9 2016.Findings from a randomized trial reported on August 26, 2016 in the International Journal of Clinical Practice revealed benefits in association with calcium and vitamin D supplementation among stroke patients.
The trial included 53 participants with insufficient vitamin D levels who were receiving usual care for ischemic stroke. Twenty-five subjects received an injection of 600,000 IU vitamin D3 followed by a monthly oral dose of 60,000 IU in addition to 1,000 milligrams calcium daily for six months. Imaging of the brain and blood testing for serum 25-hydroxyvitamin D, parathyroid hormone and other factors were conducted at the beginning of the study. Stroke outcome was assessed and blood testing for vitamin D and parathyroid hormone was repeated at three and six months.
After six months, serum vitamin D levels increased by an average of 18.8 ng/mL in group that received the vitamin, in comparison with a negligible increase in the unsupplemented group. Conversely, parathyroid hormone levels decreased in those who received the supplements while increasing in the remainder of the subjects. "Good outcome" was determined in 44% of supplemented patients compared with 39.3% of those that received usual care. Supplementation with calcium and vitamin D was associated with a 74% lower risk of death over the course of the study in comparison with the usual care group.
"This is the first randomized controlled study assessing the effect of vitamin D and calcium supplementation on ischemic stroke outcomes and points towards a potential benefit," the authors announce.
"Ischemic stroke survivors with suboptimal vitamin D status have a high likelihood of remaining vitamin D deficient/insufficient at 6 months post stroke, if not supplemented," they conclude. "There is a decrease in mortality with vitamin D and calcium supplementation, and a trend towards improvement in disability which needs evaluation in a larger trial."
Vitamin D supplementation could reduce asthma severity
September 7 2016. On September 5, 2016, the Cochrane Library published an analysis of nine randomized trials that provides “high quality evidence” in favor of vitamin D supplementation to reduce the severity of asthma attacks.
“Several clinical trials of vitamin D to prevent asthma exacerbation and improve asthma control have been conducted in children and adults, but a meta-analysis restricted to double-blind, randomized, placebo-controlled trials of this intervention is lacking,” note authors Adrian Martineau and colleagues.
Dr Martineau and his associates selected seven trials that included 435 asthmatic children and two that involved 658 asthmatic adults that tested the effects of six to twelve months of oral vitamin D supplementation in addition to usual medication. They determined that vitamin D supplementation lowered the risk of severe asthma attacks that required an emergency department visit or hospital admission from 6% to approximately 3%. Supplementing with vitamin D also reduced the need for treatment with steroid drugs.
“We found that taking a vitamin D supplement in addition to standard asthma treatment significantly reduced the risk of severe asthma attacks, without causing side effects,” stated Dr Martineau, of Queen Mary University’s Asthma UK Centre for Applied Research. “This is an exciting result, but some caution is warranted. First, the findings relating to severe asthma attacks come from just three trials: most of the patients enrolled in these studies were adults with mild or moderate asthma . . . Second, it is not yet clear whether vitamin D supplements can reduce risk of severe asthma attacks in all patients, or whether this effect is just seen in those who have low vitamin D levels to start with. Further analyses to investigate these questions are on-going, and results should be available in the next few months.”
Increasing vitamin D levels over time associated with reduced homocysteine concentrations
September 5 2016. A study reported on August 22, 2016 in PLOS One uncovered an association between lower homocysteine levels and increasing levels of serum 25-hydroxyvitamin D [25(OH)D] over follow-up.
"Both lower serum 25-hydroxyvitamin D and elevated homocysteine concentrations are potential risk factors for cardiovascular disease," note authors Truong-Minh Pham and colleagues. "A recent analysis of the National Health and Nutrition Examination Survey reported an inverse association of serum 25(OH)D with homocysteine, however, the longitudinal relationship has yet to be investigated."
The investigation included 4,475 participants in a Canadian preventive health program who had measurements of serum vitamin D and homocysteine obtained at enrollment and during at least one follow-up visit. The percentage of subjects who supplemented with vitamin D improved from 40% at the beginning of the study to 79% at follow-up, and the amount supplemented increased from a median of 3,000 international units (IU) at baseline to 7,000 IU.
At the beginning of the study, each 10 nanogram per milliliter (ng/mL) increase in vitamin D was associated with a 0.182 micromole per liter reduction in homocysteine. Rising vitamin D levels over time were associated with a reduction in risk of having high homocysteine, defined as over 13 micromoles per liter. Subjects who experienced increases of 30 ng/mL or more of serum vitamin D over the course of the study had an adjusted 68% lower risk of having elevated homocysteine compared to those who did not experience an increase in vitamin D.
"The present study is the first to reveal that prospective improvements in vitamin
D status decreased the risk of elevated homocysteine concentrations," the authors announced. "Population-based strategies aimed at improving vitamin D status and bone health may also contribute to lowering homocysteine concentrations, and potentially to the primary prevention of cardiovascular disease."
Decreased selenium levels associated with greater liver cancer risk
September 2 2016. The August 2016 issue of the American Journal of Clinical Nutrition reported the finding by European researchers of an association between decreased serum selenium and a higher risk of developing hepatocellular carcinoma (liver cancer).
The case-control study involved participants in the European Prospective Investigation into Cancer and Nutrition (EPIC) study whose serum selenium and selenoprotein levels were measured upon enrollment. Over a ten year average follow-up period, 121 subjects were diagnosed with liver cancer.
For each 20 microgram per liter increase of serum selenium there was a 59% lower risk of developing liver cancer over follow up, and for each 1.5 milligram per liter increase in selenoprotein there was a 63% lower risk.
"We have been able to show that selenium deficiency is a major risk factor for liver cancer," stated study coauthor Professor Lutz Schomburg of the Institute of Experimental Endocrinology at Charité–Universitätsmedizin in Berlin. "According to our data, the third of the population with lowest selenium status have a five- to ten-fold increased risk of developing hepatocellular carcinoma - also known as liver cancer."
"These findings from a large prospective cohort provide evidence that suboptimal selenium status in Europeans may be associated with an appreciably increased risk of hepatocellular carcinoma development," authors David J. Hughes and colleagues conclude.