Internal Medicine World ReportJanuary 2006
Volume 0
Issue 0

Type 2 Diabetes Independent Risk for Urinary Incontinence

Type 2 diabetes is independently associated with an increased risk of urinary incontinence in women, according to a new analysis of data from 81,845 participants in the Nurses' Health Study. The multivariate risks of prevalent and incident incontinence were 28% and 21% greater in women with type 2 diabetes, respectively, than in those without type 2 diabetes. And women with type 2 diabetes had nearly double the risk of developing severe incontinence during follow-up compared with those without the disease. The risks of prevalent and incident incontinence increased significantly with the duration of diabetes (J Am Geriatr Soc. 2005; 53:1851-1857).

Long-Term Moderate Alcohol Intake Mitigates Diabetes Risk

Moderate alcohol consumption has been shown to decrease the risk of type 2 diabetes in older women. A total of 16,330 women aged 49 to 70 years who were free from diabetes at study baseline were ?followed for a mean of 6.2 years while their alcohol intake was monitored. Com?pared with nondrinkers, the risk of diabetes was reduced by 14% in women who consumed 5 to 30 g/week of alcohol, by 34% in those who consumed 30 to 70 g/week, by 9% in those who drank 70 to 140 g/week, by 36% in those who drank 140 to 210 g/week, and by 31% in those who drank >210 g/week. The association between alcohol consumption and diabetes risk was not influenced by the type of beverage consumed. However, risk of diabetes was influenced by lifetime alcohol consumption in a U-shaped fashion (Diabetes Care. 2005; 28: 2933-2938).

Sleep Apnea Can Lead to Stroke

Sleep-disordered breathing is associated with a greater likelihood of stroke. In a cross-sectional analysis of 1475 persons in the general population, the risk of stroke was >4 times greater in those with an apnea?hypopnea index of >=20 than in those without sleep-disordered breathing (apnea hypoxia index, <5). In a separate prospective analysis of 1189 persons in the general population, those with an apnea? hypopnea index >=20 had an in??creas?ed risk of a first-ever stroke during the next 4 years (unadjusted odds ratio, 4.31; P = .02). After factoring in age, sex, and body mass index, the odds ratio for first-ever stroke was still elevated, but no longer to a statistically significant extent (Am J Respir Crit Care Med. 2005; 172:1447-1451).

Vitamin D Supplementation Prevents Falls in the Elderly

Vitamin D supplementation decreases the risk of falls among older people living in residential care facilities. A group of 625 adults (mean age, 83.4 years) living in assisted-care facilities were randomized to receive vitamin D supplementation or placebo for 2 years. The initial vitamin D dose was 10,000 IU, given once weekly, then switched to 1000 IU daily. None of the participants had a vitamin D deficiency at baseline. Intention-to-treat analysis re?vealed that the risk of falling was 27% lower in the vitamin D group than in the placebo group. The odds ratio for ever falling was 0.82 and for ever sustaining a fracture was 0.69 in the vitamin D group compared with the placebo group. Among persons who took at least one half of the prescribed vitamin D capsules, the incident rate ratio for falls was 0.63 and the odds ratio for ever falling was 0.70 and for ever having a fracture 0.68 (J Am Geriatr Soc. 2005;53: 1881-1888).

High-Fat Dairy Foods Lessen Risk of Colorectal Cancer

High intakes of high-fat dairy foods and conjugated linoleic acid (CLA) may de?crease the risk of colorectal cancer, based on a study of 60,708 women who were followed for a mean of 14.8 years. Multivariate analysis revealed that women who consumed >=4 servings of high-fat dairy foods daily had a 41% lower risk of colorectal cancer compared with women who consumed <1 serving daily. Each increment of 2 servings of high-fat dairy foods per day was associated with a 13% reduction in colorectal cancer risk. In addition, women in the 2 highest quartiles of CLA intake had a 29% lower risk of colorectal cancer than those in the 2 lowest quartiles (Am J Clin Nutr. 2005;82:894-900).

Osteoporosis Linked to Coronary Artery Disease

Low bone mineral density (BMD) independently predicts angiographically documented coronary artery disease (CAD). The finding emerged from a study of 209 pa?tients (89% women) who underwent dual-energy x-ray absor?ptiometry and coronary angiography examinations within a 12-month period. Signi?ficant CAD was defined as >=50% luminal narrowing in a major coronary artery. Predictors of significant CAD on univariate analysis were hypertension, smoking, diabetes, high fasting glucose level, ?dyslipidemia, family history of CAD, and low BMD. Predictors of ?significant CAD on multivariate analysis were hypertension, family history of CAD, fasting glucose level, and osteoporosis as defined by World Health Organization criteria. The odds ratio for the prediction of significant CAD was highest for osteoporosis (5.6; P <.001) compared with other multivariate CAD risk factors (Am J Cardiol. 2005;96:1059-1063).

Skin Cancer Risk Elevated in Patients with RA

Patients with rheumatoid arthritis (RA) are at increased risk of nonmelanoma skin cancer (NMSC). Self-reported information about skin cancers was obtained from 15,789 patients with RA and 3639 patients with osteoarthritis (OA) who responded to semiannual questionnaires. In a multivariate model, higher risk of NMSC was associated with increasing age, male gender, and white race. The risk of NMSC was 19% higher in patients with RA than in patients with OA (P = .042). Among those with RA, an increased hazard ratio (HR) for NMSC was associated with the use of prednisone (HR, 1.28; P = .014) and tumor necrosis factor inhibitors, either alone (HR, 1.24; P = 0.89) or in combination with methotrexate (HR, 1.97; P = .001). There were no associations between the use of methotrexate or leflunomide monotherapy and the risk of NMSC (J Rheumatol. 2005;32:2130-2135).

High Serum Uric Levels May Ward Off Parkinson's Disease

High serum uric acid levels are associated with a significantly decreased risk of Parkinson's disease. Serum uric acid levels were measured in 4696 persons aged >=55 years who were followed for a mean of 9.4 years. The risk of Parkinsonism decreased by 29% for each standard deviation increase in serum uric acid concentration. Statistical analysis suggested a dose-response relationship between serum uric acid level and Parkinson's disease risk (P = .040 for trend over quartiles). The researchers concluded that the natural antioxidant and free radical scavenger effects of uric acid may protect against the development of this disease (Ann Neurol. 2005;58:797-800).

Micronutrients Improve Quality of Life in Heart Failure Patients

Long-term micronutrient supplementation improves left ventricular (LV) function and quality of life in older patients with heart failure (HF). A group of 30 patients (mean age, 75.4 years) with HF were randomized to receive capsules containing high-dose calcium, zinc, copper, selenium, and other micronutrients or a placebo. After 9 months, mean LV volumes decreased 13.1% in the supplement group and remained unchanged in the placebo group (P <.05); mean LV ejection fraction increased 5.3% in the supplement group and again remained unchanged in the placebo group (P <.05). Patients taking micronutrients also had a significant improvement in quality-of-life scores (P <.05), whereas in those receiving placebo, quality-of-life scores deteriorated slightly (Eur Heart J. 2005;26:2238-2244).

Psychotherapy May Benefit Diabetes Control in Adolescents

Intensive, home-based psychotherapy decreases diabetes-related stress and may improve metabolic control in adolescents with poorly controlled type 1 diabetes. A group of 127 youngsters (aged 10-17 years) with type 1 diabetes and chronically poor metabolic control were randomized to receive intensive, home-based psychotherapy or no psychotherapy for about 6 months. Participation in intensive psy?cho?therapy was associated with significantly decreased self-reported diabetes-re?lated stress. The beneficial effects of psycho?therapy were independent of age, gender, and ethnicity. Structural equation modeling suggested that the psychotherapy im?pro?ved metabolic control by enhancing ad?her?ence with diabetes treatment regimens (Pediatrics. 2005;116: e826-e832).

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