Selección de Resúmenes de Menopausia

Semana del 2 al 8 de Abril de 2008

Juan Enrique Blümel. Departamento Medicina Sur. Universidad de Chile

 

 

J Nutr Sci Vitaminol (Tokyo). 2008 Feb;54(1):25-9

Development of a simple food frequency questionnaire to estimate intakes of calcium and other nutrients for the prevention and management of osteoporosis.

Uenishi K, Ishida H, Nakamura K.

Laboratory of Physiological Nutrition, Kagawa Nutrition University.

There have been no simple methods to estimate dietary nutrient intakes for the prevention and management of osteoporosis. The aim of this study was to develop and validate a new, simple food frequency questionnaire (FFQ) for dietary intake of calcium and other nutrients relevant to the bone health of adult Japanese women. We developed a 28-item FFQ. To validate this, 208 and 72 adult women aged between 18 and 69 y were recruited for testing reliability and reproducibility, respectively. In the 208 women, moderate-to-high Spearman's correlation coefficients between our FFQ and the conventional diet record method were found in intakes of calcium (r=0.668), sodium chloride (NaCl) (r=0.475), vitamin A (r=0.501), vitamin D (r=0.413), vitamin K (r=0.649), and energy (r=0.471). In the 72 women, coefficients of variance of the four repeated measurements of intakes throughout a year were 14.1% for calcium, 7.3% for NaCl, 21.2% for vitamin A, 13.6% for vitamin D, 36.8% for vitamin K, and 9.6% for energy. In conclusion, the FFQ we developed is a useful tool to evaluate the intake of dietary calcium of adult Japanese women. Although it can also measure intakes of dietary vitamin A, vitamin D, vitamin K, NaCl, and energy, further improvement is needed to measure intakes of these nutrients and energy.

 

 

Curr Med Res Opin. 2008 Apr 2 [Epub ahead of print]

New insights into the role of vitamin D and calcium in osteoporosis management: an expert roundtable discussion.

Bischoff-Ferrari HA, Papapoulos SE, de Papp AE, West JA.

BACKGROUND: Adequate vitamin D and calcium nutrition play a critical role in the maintenance of musculoskeletal health and are considered the first step in osteoporosis treatment.ROUNDTABLE DISCUSSION: In February 2008 Merck Sharp & Dohme sponsored a 2-day, evidence-based expert panel on the benefits of vitamin D for the patient with osteoporosis and the role of vitamin D in combination with antiresorptive therapy for the management of osteoporosis. One of the primary objectives of the meeting was to review new data on the optimal serum 25-hydroxyvitamin D [25(OH)D] levels. The symposium was attended by 29 researchers and clinicians from Europe and the Middle East. The discussion focused on optimizing vitamin D and calcium nutrition and reducing falls and fractures in osteoporotic patients.CONCLUSIONS: Current evidence and expert opinion suggests that optimal serum 25(OH)D concentrations should be at least 50 nmol/L (20 ng/mL) in all individuals. This implies a population mean close to 75 nmol/L (30 ng/mL). In order to achieve this level, vitamin D intake of at least 20 microg daily is required. There is a wider therapeutic window for vitamin D than previously believed, and doses of 800 IU per day, regardless of sun exposure, season or additional multivitamin use, appear to present little risk of toxicity. Apart from fracture and fall prevention, optimization of vitamin D status may also have additional general health benefits. Based on newly emerging data regarding calcium supplementation, and recommendations for increased vitamin D intake, the current recommendations for calcium intake in postmenopausal women may be unnecessarily high. In addition to vitamin D and calcium, treatment of patients with osteoporosis at high risk of fractures should also include pharmacologic agents with proven vertebral and non-vertebral fracture efficacy.

 

 

Am J Epidemiol. 2008 Apr 2 [Epub ahead of print

Age-specific Trends in Mammographic Density: The Minnesota Breast Cancer Family Study.

Kelemen LE, Pankratz VS, Sellers TA, Brandt KR, Wang A, Janney C, Fredericksen ZS, Cerhan JR, Vachon CM.

Department of Health Sciences Research, Mayo Clinic College of Medicine, Rochester, MN.

Mammographic density is a strong risk factor for breast cancer, yet few studies have evaluated density trends, and associated factors, over time. The authors retrieved and digitized mammograms (>/=1 per woman) imaged in 1990-2003 to evaluate percent density (PD) in the Minnesota Breast Cancer Family cohort. Multivariable-adjusted, mixed-effects, repeated-measures models incorporating a natural cubic spline provided estimates of nonlinear trends in PD with age and were used to examine association with covariates. Overall, 5,698 mammograms from 1,689 women with covariate information were digitized. In descriptive analyses, the highest median PD was 33.1% (interquartile range, 21.8%; n = 230) among premenopausal women, 31.0% (interquartile range, 23.2%; n = 175) among women who transitioned from pre- to postmenopause, and 18.7% (interquartile range, 22.2%; n = 1,284) among postmenopausal women. On average, premenopausal compared with postmenopausal women had 1.9% (p = 0.001) higher PD. In repeated-measures analyses, greater declines in PD occurred with menopause and among women with higher baseline PD; current postmenopausal hormone use and higher body mass index modified these declines (p interaction < 0.001). No significant modification of the density change with age was seen with parity/age at first birth, age at menarche, oral contraceptive use, family history of breast or ovarian cancer in a first- or second-degree relative, educational level, smoking status, or alcohol intake were observed. These data suggest that menopause, baseline PD, postmenopausal hormone use, and body mass index predict changes in mammographic density trends during adult life.

 

 

J Clin Endocrinol Metab. 2008 Apr 1 [Epub ahead of print

Effects of Denosumab on Bone Mineral Density and Bone Turnover in Postmenopausal Women.

Bone HG, Bolognese MA, Yuen CK, Kendler DL, Wang H, Liu Y, San Martin J.

Michigan Bone and Mineral Clinic (H.G.B.), Detroit, Michigan 48236; The Bethesda Health Research Center (M.A.B.), Bethesda, MD 20817-1106; University of Manitoba (C.K.Y.), Winnipeg, Manitoba, Canada R3T 2N2; University of British Columbia (D.L.K.), Vancouver, BC, Canada V6T 1Z4; Amgen Inc. (H.W., Y.L., J.S.M.), Thousand Oaks, CA 91320-1799.

Context: Denosumab is an investigational fully human monoclonal antibody against receptor activator of nuclear factor kappa B ligand (RANKL), a mediator of osteoclastogenesis and osteoclast survival. Objective: This study evaluated the ability of denosumab to increase bone mineral density (BMD) and decrease bone turnover markers (BTMs) in early and later postmenopausal women with low BMD. Design and Setting: This 2-year randomized, double-blind, placebo-controlled study was conducted in North America. Participants: Subjects included 332 postmenopausal women with lumbar spine BMD T-scores between -1.0 and -2.5. Interventions: Subjects were randomly assigned to receive denosumab subcutaneously, 60 mg every 6 months, or placebo. Randomization was stratified by time since onset of menopause (</= 5 years or > 5 years). Main Outcome Measures: The primary endpoint was the percent change in lumbar spine BMD by dual-energy x-ray absorptiometry (DXA) at 24 months. Additional endpoints were percent change in volumetric BMD (vBMD) of the distal radius by quantitative computed tomography (QCT); percent change in BMD by DXA for the total hip, 1/3 radius, and total body; hip structural analysis (HSA); percent change in BTMs; and safety. Results: Denosumab significantly increased lumbar spine BMD compared with placebo at 24 months (6.5% vs -0.6%; P<0.0001) with similar results for both strata. Denosumab also produced significant increases in BMD at the total hip, 1/3 radius, and total body (P<0.0001 vs placebo); increased distal radius vBMD (P<0.01); improved HSA parameters; and significantly suppressed serum CTX, TRAP-5b, and P1NP. The overall incidence of adverse events was similar between both study groups. Conclusions: Twice-yearly denosumab increased BMD and decreased BTMs in early and later postmenopausal women.

 

 

Br J Nutr. 2008 Apr 1;:1-5 [Epub ahead of print

Identification of a dietary pattern characterized by high-fat food choices associated with increased risk of breast cancer: the European Prospective Investigation into Cancer and Nutrition (EPIC)-Potsdam Study.

Schulz M, Hoffmann K, Weikert C, Nöthlings U, Schulze MB, Boeing H.

Department of Epidemiology, German Institute of Human Nutrition, Potsdam-Rehbrücke, Arthur-Scheunert-Allee 114-116, Nuthetal 14558, Germany.

Epidemiological studies conducted thus far have mainly used a single-nutrient approach which may not be sufficient in detecting diet-cancer relationships. The aim of the study was to examine the association of a food pattern based on explained variations in fatty acid intake by means of reduced rank regression with breast cancer risk. Study participants were female subjects (n 15 351) of the European Prospective Investigation into Cancer and Nutrition (EPIC)-Potsdam Study free of cancer at baseline and with complete dietary and outcome information followed for an average of 6.0 years. Among those, 137 incident cases of invasive breast cancer were identified. We identified a food pattern characterized by low consumption of bread, and fruit juices, and high consumption of processed meat, fish, butter and other animal fats, and margarine explaining >42 % of total variation in fatty acid intake (SFA, MUFA, n-3 PUFA, n-6 PUFA). Intake of all four fatty acid fractions was positively associated with the pattern score. Adherence to this food pattern adjusted for covariates was associated with a two-fold risk (hazard ratio 2.00; 95 % CI 1.30, 3.09) of breast cancer comparing extreme tertiles of the pattern score. There was no evidence of effect modification by menopausal status, overweight status and use of hormone replacement therapy, respectively. In conclusion, a food pattern characterized by high-fat food choices was significantly associated with increased risk of breast cancer. Given that the food pattern was high in all fatty acid fractions, we found evidence for total dietary fat rather than for specific fatty acids to be associated with breast cancer risk.

 

 

Altern Med Rev. 2008 Mar;13(1):21-33

Vitamin D and fracture reduction: an evaluation of the existing research.

Brown SE.

Director of Osteoporosis Education Project and the Nutrition Education and Consulting Service, Syracuse, NY; medical anthropologist, certified nutrition specialist (CNS); Email: drsbrown@earthlink.net.

This article re-evaluates the literature on vitamin D and fracture reduction, highlighting the relevance of new understandings for fracture prevention. A new set of science-based research guidelines for clinical trials on vitamin D and fracture is proposed. The existing clinical trials on vitamin D and fracture are analyzed, focusing on studies that most closely meet the proposed guidelines. An estimation of the true fracture-reduction potential of therapeutic-level vitamin D supplementation is offered. The analysis outlined in this article leads to a series of striking conclusions. First, most of the available clinical trials and meta-analyses of vitamin D and fracture underestimate the true fracture reduction potential of vitamin D. Second, achievement of vitamin D serum sufficiency levels (now set in the United States, Europe, and many other places at a minimum of 32 ng per mL) could provide for a 50 - to 60 - percent fracture reduction. And third, providing for vitamin D sufficiency is the simplest, most life-supporting, and most cost effective means of significantly reducing the incidence of osteoporotic fractures worldwide. Given the urgent need, the Osteoporosis Education Project (OEP) has initiated a call for universal vitamin D repletion as the primary basis for osteoporotic fracture prevention worldwide.