Are You a Diet Myth Victim?


Find out if you have harmful “health foods” hiding in plain sight as the National Kidney Foundation Busts 5 Common Diet Myths. Extend your spring cleaning to the kitchen pantry and tip the scale in the direction of your weight loss goals.

  1. Olive oil and canola oil are lower calorie choices. While these oils have health benefits, they are not any lower calorie than vegetable oil. All of these oils are 100% fat. Put oil in a spray bottle to lightly coat the pan without adding layers of fat and calories.
  2. Granola and trail mix are healthy snacks. Store bought granolas and trail mixes are often loaded with ingredients that make them more of a high calorie treat. If you’re craving something savory, reach for unsalted nuts instead. Almonds, walnuts and peanuts are very low in sodium, high in protein and fiber and they contain the healthy kind of fat that doesn’t raise cholesterol. Nuts are also very low on carbohydrates so they’re an excellent snack choice, even for diabetics. Craving something sweet? Make your own granola and trail mix at home to limit the calories, sugar and fat. Compare nutrition labels between store bought brands to determine which product is a better fit for your dietary and nutritional needs. Instead of eating a whole bowl, add a small amount of granola to plain yogurt to add crunch, or make your own oatmeal to get the health benefits of eating oats without the added sugar in granola. Fresh and dried fruit (without any added sugar) are also healthier sweet snack alternatives. As with anything, moderation is key!
    THIS RECOMMENDATION IS NOT APPROPRIATE FOR THOSE ON DIALYSIS OR THOSE WHO ARE ON A POTASSIUM RESTRICTION.
  3. Salads are always a healthy low-fat choice. That’s not necessarily true when there are added nuts, croutons, tortillas, dried fruits, cheese and high fat dressings. When eating salads that have those added items, you lose the low cal benefit and can end up eating much more fat than you wanted to. When loaded with these “extras”, some salads can actually contain more fat and calories than a hamburger. As a general rule, if you’re looking to lose weight, try to limit the number of non-vegetable ingredients in your salad, as these often add calories, sugar and fat.
  4. Salad dressings just add to the taste but not to the fat content. They can be very high in fat so put dressings on the side when eating out. Look for low fat, low cal dressings or make your own with natural ingredients –fresh lemon, spices, small amounts of oil and vinegar.
  5. Sugar free desserts are better for you than their sugary counterparts. “Sugar-free” products typically do not contain any sucrose or table sugar, but this doesn’t mean they are carbohydrate or fat-free. It’s important to read the nutrition label completely to find out what ingredients are in these items and how these may fit into your dietary plan and nutrition needs. In some instances you may be better off with a smaller portion of the regular variety of an item that contains sugar than the sugar-free product. It’s all about portion control.

If you’re looking to lose weight, check with a dietitian or doctor about a diet plan that’s right for you before making any dietary changes.  Also, if you have diabetes or chronic kidney disease, ask your clinician if you are eligible for a Medical Nutrition Therapy consultation with a dietitian.

Source:National Kidney Foundation.

Using Adult Criteria to Diagnose Pediatric MS.


The 2010 McDonald criteria for multiple sclerosis can be used in children older than 10 who do not present with acute disseminated encephalomyelitis.

The 2010 McDonald criteria for multiple sclerosis (MS) simplified the imaging criteria in adults who present with a typical demyelinating event. The 2010 criteria maintained high sensitivity and specificity while reducing the required number of T2 lesions and permitting the MS diagnosis when there are “clinically silent,” simultaneous gadolinium-enhancing and nonenhancing lesions.

Investigators have now tested the 2010 criteria in children younger than 16 who presented with an acute demyelinating event at 23 centers. Participants were enrolled within 90 days of symptom onset and followed for a mean 4.2 years. All had magnetic resonance imaging scans at baseline and 3, 6, and 12 months later; many had subsequent annual scans. Acute disseminated encephalomyelitis was defined by polyfocal deficits plus encephalopathy. Of 209 participants, 34 met criteria for clinically definite MS with clinical dissemination in time and space. Of the remaining 175 participants, 159 had monophasic demyelinating syndromes, 4 had recurrent demyelination not meeting criteria for time and space dissemination, and 12 were subsequently diagnosed with neuromyelitis optica spectrum disorder or nondemyelinating disorders .

McDonald criteria were positive in 58 children, including all 34 children with a second clinical relapse, but also 10 children who were diagnosed with acute disseminated encephalomyelopathy (ADEM) and did not have a second clinical event. In the full cohort, sensitivity was 100%, specificity was 86%, positive predictive value (PPV) was 59%, and negative predictive value (NPV) was 100%. After excluding the 10 cases of ADEM, test sensitivity was 100%, specificity 89%, PPV 71%, and NPV 100%. For patients aged 11 to 16, sensitivity was 100%, specificity 85%, PPV 72%, NPV 100%. For patients younger than 11 years, sensitivity was 100%, specificity 87%, PPV 32%, NPV100%.

Comment: This analysis shows that the 2010 McDonald criteria are sensitive and specific for pediatric MS but should not be applied to an ADEM presentation or to children younger than 11 years. ADEM can present with simultaneous enhancing and nonenhancing lesions, which can lead to a false-positive MS diagnosis. Although none of the ADEM patients with small, new lesions had a second clinical event, additional time would be needed to determine the true significance of this finding. Overall, the accuracy of initial diagnosis was high but not perfect, as 6% with initial diagnoses of acute demyelinating syndromes were subsequently found to have other disorders.

 

Source: Journal Watch Neurology

 

Is Losartan as Good as Candesartan for HF?


A registry study suggests that it is, although the data contain many gaps.

Angiotensin-receptor blockers (ARBs) are recommended for patients with heart failure (HF) and left ventricular systolic dysfunction who do not tolerate angiotensin-converting enzyme inhibitors. Although the recommendation assumes a class effect of ARBs, some observational data suggest that, compared with other ARBs, losartan is associated with higher mortality in HF patients.

In an analysis of Danish National Patient Registry data, investigators identified 6479 individuals aged 45 or older (mean age, 72; 55% men; left ventricular ejection fractions unknown) who were hospitalized with HF during 1998–2008 and who had not received an ARB within the previous 3 years. They compared outcomes in losartan recipients with those in candesartan recipients.

Unadjusted all-cause mortality was higher with losartan (10.7 per 100 person-years) than with candesartan (9.0 per 100 person-years); however, after multivariable adjustment, neither all-cause nor cardiovascular mortality differed significantly between the two groups. Compared with high doses of candesartan, the risk for death was significantly higher in patients receiving low or intermediate doses of losartan (hazard ratios, 2.79 and 1.39, respectively) or low doses of candesartan (HR, 2.12).

Comment: In this observational study in patients hospitalized with heart failure, outcomes with losartan did not differ significantly from outcomes with candesartan. Unfortunately, patients with substantial left ventricular systolic dysfunction — for whom this issue is particularly germane — could not be identified. Furthermore, the dose findings are likely confounded by unmeasured factors that affect tolerance of higher doses. Despite its weaknesses, this study provides modest support to a class effect of angiotensin-receptor blockers for HF. This is relevant because losartan is now available in generic form and is considerably less expensive than candesartan.

Source:  Journal Watch Cardiology

 

 

 

 

High-Dose Losartan Not Associated with Increased Mortality in Heart Failure Patients .


In patients with heart failure, high doses of the angiotensin-receptor blocker losartan do not increase mortality risk compared with another ARB, candesartan, a JAMA study finds. (A 2011 analysis found greater all-cause mortality with losartan.)

Using national databases, Danish researchers studied roughly 6500 patients who were hospitalized for heart failure and filled new prescriptions for either losartan or candesartan. During nearly 20,000 person-years of follow-up, some 2400 patients died.

Overall, there was no significant difference in all-cause mortality between the two treatments. In addition, when analyzed according to dose, high-dose losartan did not confer greater mortality risk than high-dose candesartan. Low- and intermediate-dose losartan, however, did raise mortality risk.

The authors conclude: “These findings do not support the hypothesis of differential effects of specific ARBs in patients with heart failure.”

Source: JAMA