Patrick Campbell

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A Harvard Medical School-led team purports their research has determined the "ideal" daily intake of fruits and vegetables for preventing cardiovascular events. 

Investigators noted high amounts of inconsistency within dietary guidance can often cause confusion among patients and found consuming 2 servings of fruit and 3 servings of vegetables daily was linked to the greatest overall longevity and a 12% reduction in risk of death from cardiovascular disease.

“While groups like the American Heart Association recommend four to five servings each of fruits and vegetables daily, consumers likely get inconsistent messages about what defines optimal daily intake of fruits and vegetables such as the recommended amount, and which foods to include and avoid,” said lead study author Dong D. Wang, MD, ScD, an epidemiologist, nutritionist, and member of the medical faculty at Harvard Medical School and Brigham and Women’s Hospital, 

Few topics have been as exhaustively studied or debated as dietary science and the role of nutrition in cardiovascular and overall health. Spurred by an interest in describing the ideal diet, wang and a team of 10 colleagues designed the current study as a meta-analysis of cohort studies to assess the effects of diet on long-term mortality in patients free from cardiovascular disease, cancer, and diabetes at baseline.

Funded by the National Institutes of Health and the American Heart Association, investigators designed their study as an analysis of data from 66,719 women from the Nurses’ Healthy Study (NHS) and 42,016 men from the Health Professionals Follow-up Study (HFPS). Of note, the NHS cohort was enrolled between 1984-2014 while HPFS patients were enrolled from 1986-2014.

Patients enrolled in both of the studies completed semiquantitative food frequency questionaries at baseline and again every 2-4 years. Using this data and information from the National Death Index, investigators hoped to identify any dose-response relationships between intake of fruits and vegetables and mortality. With an interest in verifying the results of their initial analyses, investigators also conducted a dose-response meta-analysis using data from the aforementioned cohorts and 24 other prospective studies.

During the follow-up period, which lasted 2,855,065 person-years, a total of 33,898 deaths occurred within the NHS and HFPS cohorts. In adjusted analyses, results indicated nonlinear inverse associations of fruit and vegetable intake with total mortality and cause-specific mortality attributable to cancer, cardiovascular disease, and respiratory disease (

 for all <.001). Further analysis indicated intake of 5 servings per day of fruit and vegetables or 2 servings of fruit and 3 servings of vegetables was associated with the lowest mortality and greater intake beyond that level was not associated with additional risk reduction.

Specifically, when compared to those consuming 2 servings per day, daily intake of 5 servings of fruits and vegetables was associated with a 13% reduction in risk of mortality (HR, 0.87; 95% CI, 0.85-0.90), a 12% reduction in risk of death from cardiovascular disease (HR, 0.88; 95% CI, 0.83-0.94), a 10% reduction in risk of death from cancer (HR, 0.90; 95% CI, and a 35% reduction in risk of death from respiratory disease (HR, 0.65; 95% CI, 0.59-0.72).

In their dose-response meta-analysis, which included more than 145,000 deaths and 1,892,885 participants, results pointed to a similar effect. Additional analysis suggested higher intakes of most subgroups of fruits and vegetables were associated with lower mortality, but investigators noted this did not extend to starchy vegetables. Furthermore, consumption of fruit juices and potatoes was not associated with total or cause-specific mortality.

“This amount likely offers the most benefit in terms of prevention of major chronic disease and is a relatively achievable intake for the general public,” Wang added. “We also found that not all fruits and vegetables offer the same degree of benefit, even though current dietary recommendations generally treat all types of fruits and vegetables, including starchy vegetables, fruit juices and potatoes, the same.”

Fruit and Vegetable Intake and Mortality: Results From 2 Prospective Cohort Studies of US Men and Women and a Meta-Analysis of 26 Cohort Studies

Articles

A major analysis suggests 2 servings of fruit and 3 servings of vegetables daily was linked to the greatest overall longevity and a 12% reduction in risk of death from cardiovascular disease.

Harvard Study Calculates "Ideal" Fruit and Vegetable Intake for Heart Health

As the push for more robust and a greater variety of obesity treatments reaches a fever pitch, the conversation has begun to evolve and include the question about who should be in charge of prescribing new medications for 

While the answer for years has been clinicians specializing in bariatric surgery, the explosion in obesity prevalence has meant that responsibility now extends to other specialties, including endocrinology, internal medicine, and sometimes cardiologists. With subcutaneous semaglutide 

 and up for FDA approval as early as June, this question is being pushed to the forefront.

STEP 1, which randomized obese patients to semaglutide plus lifestyle intervention or place, indicated the 2.4 mg dose of semaglutide was associated with a 14.9% reduction in body weight and 86.4% of patients receiving the GLP1-RA achieved weight loss of 5% or more. In STEP 3, which included a more intense lifestyle intervention, results demonstrated a 16% reduction in body weight with semaglutide and suggested more than 75% of participants receiving semaglutide saw reductions in body weight of 10% or greater.

For more perspective on who should be responsible for engaging with these patients and initiating therapy with an agent like subcutaneous semaglutide, 

 reached out to Thomas Wadden, PhD, professor of Psychology at the Perelman School of Medicine and principal investigator in the STEP program.

After providing insight into the results of the STEP 1 and STEP 3 trials, Dr. Wadden discusses who he believes the responsibility for prescribing these medications will fall unto if semaglutide receives approval as a weight loss agent.

Who is Responsible for Prescribing Weight Loss Medications to Obese Patients with Thomas Wadden, PhD

Women with type 1 diabetes had a shorter reproductive life span than their counterparts without 

, according to the results of a new study.

An analysis of data from the Pittsburgh Epidemiology of Diabetes Complications (EDC) and Study of Women’s Health Across the Nation (SWAN) studies, results indicate women with type 1 diabetes before menarche had a shorter reproductive period than women without diabetes.

"This study found that women with the onset of type 1 diabetes before menarche were at increased risk for a shorter reproductive lifespan. Thus, these women are not only at risk for premature ovarian aging because of early onset type 1 diabetes, they are also at increased risk for cardiovascular disease, osteoporosis, and early mortality because of early natural menopause. Understanding these risks and targeting appropriate risk-reducing strategies are key to optimizing the health and quality of life of these women,” said Stephanie Faubion, MD, medical director of the North American Menopause Society, 

While the role of insulin in regulating female reproductive function has been well-documented, investigators identified what they saw as a gap in knowledge related to the onset of type 1 diabetes and the age of natural menopause. With this in mind, a team of 8 investigators from the University of Pittsburgh birthed the current study with the aim of filling that knowledge gap.

To do so, investigators designed the current study to use data from the Pittsburgh EDC study for women with type 1 diabetes and the SWAN study for women without diabetes. From the Pittsburgh EDC study, investigators identified 105 women diagnosed with childhood-onset type 1 diabetes between 1950-1980. From the SWAN study, investigators identified a reference cohort of 175 women with no diabetes.

Of note, women were excluded if they did not reach natural menopause, if they underwent a hysterectomy or oophorectomy before menopause, or received sex hormone therapy during the menopausal transition. For the purpose of analysis, historical and Women’s Ischemic Syndrome Evaluation hormonal algorithms were used to assess menopause status of participants. For both studies, length of reproductive lifespan was calculated by subtracting the age at menarche from the age at natural menopause.

Compared to those without diabetes, women in the type 1 diabetes cohort were younger, more likely to be white, more likely to be never smokers, have a lower BMI, and higher levels of HDL-C (

 <.05). In adjusted analyses, women with type 1 diabetes were older at menarche our younger at natural menopause. Further analysis suggested women with type 1 diabetes experienced 2.5 fewer reproductive years than their counterparts without diabetes. Investigators pointed out findings from these analyses were restricted to a subgroup of 80 women who were diagnosed with type 1 diabetes before reaching menarche.

“The present study identified the subgroup of women with type 1 diabetes who have a high likelihood of experiencing early age at natural menopause so that efforts to unearth the biologic rationale and target potential prevention practices would be better focused,” wrote investigators.

Women with Type 1 diabetes (T1D) experience a shorter reproductive period compared with nondiabetic women: the Pittsburgh Epidemiology of Diabetes Complications (EDC) study and the Study of Women’s Health Across the Nation (SWAN),”

Journal of the North American Menopause Society.

An analysis of data from 2 major studies suggests women with childhood-onset type 1 diabetes experienced 2.5 fewer reproductive years than their counterparts without diabetes. 

Type 1 Diabetes Shortens Reproductive Lifespan in Women

Could the presence of kidney stones help clinicians identify patients at risk for osteoporosis? A new study from Stanford University has uncovered a possible link between kidney stone disease and risk of 

An analysis of more than half a million patients with kidney stones disease, results indicate nearly 1-in-4 patients received a diagnosis of osteoporosis or suffered a bone fracture and suggest screening of these patients for increased risk remains subpar.

"We hope this work raises awareness regarding the possibility of reduced bone strength in patients with kidney stones. In our future work, we hope to identify which patients with kidney stones are at higher risk for osteoporosis or fracture to help guide bone density screening efforts by clinicians in this population," said lead investigator Calyani Ganesan, MD, a nephrology fellow at Stanford University, 

With osteoporosis and fractures posing a serious threat to the well-being and quality of life of aging adults, Ganesan and colleagues from Stanford University sought to determine whether kidney stone disease was associated with increased risk of osteoporosis. Investigators designed their analysis as a retrospective cohort study using data from the Veterans Health Administration database.

Patients were considered to have kidney stone disease if they had at least one inpatient encounter that included ICD-9 and ICD-10 codes for kidney or ureteral stones. In total, investigates identified 531,431 patients with kidney stone disease treated. Between January 1, 2007-December 31, 2015. Of these, 125,427 had a diagnosis of osteoporosis or fracture in the 5 years preceding or 5 years following index stone diagnosis. Of the 125,527, 32,613 (6.1%) were diagnosed with osteoporosis.

In adjusted models, results suggested presence of type 2 diabetes (OR, 1.07; 95% CI, 1.05-1.09), metastatic cancer (OR, 1.15; 95% CI, 1.11-1.20), enteric disease (OR, 1.19; 95% CI, 1.08-1.31), hypogonadism (OR, 1.22; 95% CI, 1.14-1.29), and primary hyperparathyroidism (OR, 1.59; 95% CI, 1.43-1.76) were associated with increased risk of receiving a diagnosis of fracture or osteoporosis after index stone diagnosis.

When assessing rates of dual-energy X-ray absorptiometry (DXA) among those with no history of osteoporosis or fracture before a kidney stone diagnosis, investigators found just 9.1% (n=42,329) of patients meeting these criteria underwent DXA in the 5 years following their initial diagnosis. Of those who did undergo DXA, 20% were subsequently diagnosed with osteoporosis, 19% (n=8055) were diagnosed with a non-hip fracture, and 2.4% (n=1008) were diagnosed with a hip fracture. Investigators pointed out 85% of patients who were screened and later diagnosed with osteoporosis were men.

Further analysis indicated odds of being screened with DXA were greater among patients with a history of hypogonadism (OR = 2.07; 95% CI 1.95–2.20) or primary hyperparathyroidism (OR = 4.99; 95% CI 4.57–5.44). Additionally, results suggested patients had decreased odds of undergoing DXA if they had a history of metastatic cancer (OR, 0.93; 95% CI, 0.88-0.98).

“Our findings provide support for wider use of bone mineral density screening in patients with kidney stone disease, including middle-aged and older men, for whom efforts to mitigate risks of osteoporosis and fractures are not commonly emphasized,” wrote investigators.

Osteoporosis, Fractures, and Bone Mineral Density Screening in Veterans With Kidney Stone Disease,

An analysis of data from the Veterans Health Administration is providing insight into the apparent increase in risk of fracture or osteoporosis among older adults with kidney or ureteral stones.

Patrick Campbell

Articles

Harvard Study Calculates "Ideal" Fruit and Vegetable Intake for Heart Health

Who is Responsible for Prescribing Weight Loss Medications to Obese Patients with Thomas Wadden, PhD

Type 1 Diabetes Shortens Reproductive Lifespan in Women

Study Links Kidney Stones to Fracture Risk in Older Adults