Diet and Physical Activity for the Prevention of Noncommunicable Diseases in Low- and Middle-Income Countries: A Systematic Policy Review.


Abstract

Background

Diet-related noncommunicable diseases (NCDs) are increasing rapidly in low- and middle-income countries (LMICs) and constitute a leading cause of mortality. Although a call for global action has been resonating for years, the progress in national policy development in LMICs has not been assessed. This review of strategies to prevent NCDs in LMICs provides a benchmark against which policy response can be tracked over time.

Methods and Findings

We reviewed how government policies in LMICs outline actions that address salt consumption, fat consumption, fruit and vegetable intake, or physical activity. A structured content analysis of national nutrition, NCDs, and health policies published between 1 January 2004 and 1 January 2013 by 140 LMIC members of the World Health Organization (WHO) was carried out. We assessed availability of policies in 83% (116/140) of the countries. NCD strategies were found in 47% (54/116) of LMICs reviewed, but only a minority proposed actions to promote healthier diets and physical activity. The coverage of policies that specifically targeted at least one of the risk factors reviewed was lower in Africa, Europe, the Americas, and the Eastern Mediterranean compared to the other two World Health Organization regions, South-East Asia and Western Pacific. Of the countries reviewed, only 12% (14/116) proposed a policy that addressed all four risk factors, and 25% (29/116) addressed only one of the risk factors reviewed. Strategies targeting the private sector were less frequently encountered than strategies targeting the general public or policy makers.

Conclusions

This review indicates the disconnection between the burden of NCDs and national policy responses in LMICs. Policy makers urgently need to develop comprehensive and multi-stakeholder policies to improve dietary quality and physical activity.

Discussion

Despite the global disease burden of NCDs in LMICs, policies that address at least one risk factor for NCDs were found in a minority of the LMICs reviewed, and only a handful of them comprehensively tackled NCDs through integrated action on various risk factors. Even if the 24 countries with unknown existence of a NCD prevention policy actually have such a policy, the proportion with countries tackling a risk factor would amount to 56% (78/140). This finding is discouraging, because in 2004, all countries expressed a strong commitment to action to address lifestyle, diet, and physical activity [20]. Our results show that, in spite of that official commitment, most LMICs are poorly prepared to tackle the NCD increase and that little progress has been made in recent years. This finding is consistent with the results of Alwan et al. [23], who reported the results of a survey in 2010 that was limited to countries with high NCD-related mortality.

Most of the policies in our review were poorly accessible and were only obtained after an extensive search or through personal contacts. Such a situation is certainly not favorable for benchmarking and communication of policies. In agreement with Sridhar et al. [88], we argue how better sharing of best practices and lessons learned with regard to policy development is needed to address the current NCD pandemic. Additional instruments and platforms to share lessons learned in policy development and implementation are needed. Policy databases with links to documents were created previously, but are restricted to nutrition action [89] or the European region [26]. An open-access, full-text global repository of initiatives and policies to address NCDs would be a great step forward. It could also contribute to global leadership and shared accountability in the global fight against NCDs, an issue that is long overdue [90]. Ideally, such a policy database would be connected to surveillance data on the main NCD risk factors, as suggested previously [23], and would facilitate tracking progress in the coming years. We are ready to organize such an open-access repository and invite interested policy makers to contact us for an update of the current database.

Priority setting and clear articulation of what needs to be done by stakeholders is a second key issue that emerged in this analysis. Countries seasoned in the fight against NCDs develop comprehensive strategies that focus on critical risk factors and what is expected of stakeholders [91]. In the present analysis, the level of detail and outlining of the organization of policy actions to undertake was generally discouraging. Only a minority of the policies reviewed surpassed description of policy actions and included a budget, implementation plan, time frame, and devolvement of responsibility for strategies to combat specific risk factors. Various policies describe strategies and actions for NCD prevention as “the need to develop and review dietary guidelines and recommendations for people suffering from nutrition-related NCDs” or use generic statements such as “create awareness of healthy eating lifestyle to control NCDs.” Such general statements are not informative, and clear actions need to be outlined in the policies to mobilize stakeholders for effective action [92].

Since its inception during the 1992 International Conference on Nutrition [93], the approach to streamline nutrition action in national policies has had limited success, partly because of the lack of strong leadership and commitment to lead concerted action involving various stakeholders [94]. The current scientific evidence and international experience in the fight against NCDs consistently indicates the need for comprehensive and integrated action on various risk factors [95]. Mobilization of the main actors—in particular, governments, international agencies, the private sector, civil society, health professionals, and individuals—is imperative [96]. An important limitation of most policies included in the analysis is the absence of plans, mechanisms, and incentives to foster multi-stakeholder and cross-sector collaboration. The food and nonalcoholic beverage industry, for instance, can play a role in the promotion of healthier lifestyles. However, before engaging with the private sector, government agencies should be aware of the need to manage potential conflicts of interest between the government and the private sector and should try to address these by defining clear roles, responsibilities, and targets to be achieved as a result of their collaboration [97]. Most strategies encountered in the policies were directed towards government agencies and consumers, and few were targeted at the business community, international agencies, or civil society. The United Nations Political Declaration on NCDs makes a strong call for multi-stakeholder partnerships to be leveraged for effective prevention of NCDs. Policy makers in LMICs may need additional support for the development of multi-stakeholder collaborations to address the burden imposed by NCDs as well as their root causes.

In our review of governmental policies relating to NCD prevention in LMICs, strategies to increase fruit and vegetable intake were the most frequent dietary action for NCD prevention. This is hardly surprising, as fruit and vegetable interventions were taken up early on in LMICs, primarily to address prevailing micronutrient deficiencies such as vitamin A deficiency [98]. Many of these experiences, however, are restricted to the development of food-based dietary guidelines or incentives targeted towards the agricultural sector. Policy measures to achieve better diet will require constructively engaging much more with a wider range of stakeholders, in particular the food industry, retail, and the catering sector [99]. The difficulty of developing a comprehensive policy response and integrated package of strategies is not restricted to NCDs alone, and has previously been observed in an in-depth analysis of high-burden countries for child malnutrition [100]. We also note that various countries have developed strategies to reduce total fat intake, despite convincing evidence that it is the reduction of saturated and trans-fatty acids in particular, and not total fat intake, that is effective to address NCDs [101].

Most strategies encountered in the policy documents focused on consumers and aimed to prevent NCDs through awareness creation, education (i.e., labeling), or changing individuals’ behavior. The traditional approach to addressing lifestyle changes in individuals has met with very limited success. It is widely accepted that the environmental context drives individual diets and lifestyle [102] and that programs need to incorporate environmental determinants (i.e., the quantity, quality, or price of dietary choices, or the built environment for physical activity) in order to be effective. Such policy measures, in particular those addressing the private sector, were poorly elaborated in the policy documents [103].

A key issue is the actual implementation of policy measures in relation to what was articulated in the documents. The findings of this review indicate that few LMICs have made significant steps in the development of a comprehensive set of strategies to address NCDs. Although an in-depth evaluation of actual implementation, effects, and resources allocated has not been opportune to date, we hope that our findings provide baseline data and encourage countries to develop monitoring and evaluation mechanisms to assess policy response in due time. Documenting the effectiveness of population-based NCD prevention policies will be a critical factor of success to ensure effective action in LMICs [4].

For this review, we were able to assess documents in all languages received. Because of language constraints, however, two of the documents [74],[87] were coded by only one researcher. To assess the content of the policy of Iran, we relied on translations by experienced senior Iranian researchers. All other policy documents were obtained in Spanish, Portuguese, French, or English and were analyzed accordingly by the research team. For China and the Russian Federation, appropriate English versions of the policies were obtained from the Chinese Centers for Disease Control and the United States Department of Agriculture, respectively. Despite indications of availability of relevant policies in the European region [26], language limitations did not allow us to search the websites of a number of countries such as Azerbaijan, Belarus, and the Russian Federation.

The restriction of our review to only national policies presents a number of limitations. The mere presence or absence of policies or strategies for NCDs in a policy document does not necessarily reflect concrete action. Conversely, nutritional interventions have been implemented in some countries without a policy being developed and published [104]. In addition, this review assessed the contents of the policy documents as they were published and did not capture local or regional activities, or initiatives that emerged after the publication of the policies. The findings from a survey in countries with a high burden of NCDs, such as Thailand and South Africa, illustrate this discrepancy [23]. The contents might have been modified over time in response to new scientific findings, emerging nutritional challenges, or changes in the countries’ priorities [91]. In addition, it is important to point out that we extracted only actions that explicitly referred to one of the risk factors analyzed. Generic statements such as “development of food-based dietary guidelines” or “establishment of fiscal measures for a healthy diet” were hence not coded.

The present review shows that the policy response to address current NCD challenges through diet and physical inactivity in LMICs is inadequate since endorsement of the Global Strategy on Diet, Physical Activity and Health [20]. LMICs urgently need to scale up interventions and develop integrated policies that address various risk factors for NCD prevention through multi-stakeholder collaboration and cross-sector involvement. Clear and prioritized actions are needed to harness the NCD epidemic. Such actions need to be documented in policy documents that are publicly available to share lessons learned, promote engagement with the stakeholders, and stimulate accountability and leadership in the fight against the burden of NCDs in LMICs. The establishment of an open-access and publicly accessible database of policy documents with regular systematic reviews of policy development might prove to be an incentive in this regard.

Source: PLOS

 

 

 

8 Summer Beverages to Avoid.


soda

Story at-a-glance

  • Many of the most popular “summer” drinks come with a hefty downside, like exorbitant amounts of sugar or artificial sweeteners
  • Summer drinks better off avoided include regular and diet soda, wine coolers, beer, lemonade, sports and energy drinks, and frozen coffees
  • Carbonated water with mint leaves, fresh green vegetable juice, coconut water, iced green tea and iced dark-roast organic coffee are examples of delicious summer beverages that give your health a boost

A tall, cool beverage goes hand-in-hand with a hot summer day, but many of the most popular “summer” drinks come with a hefty downside, like exorbitant amounts of sugar.

It’s alarmingly easy to sip and slurp your way through hundreds of grams of excess sugar just by enjoying a cool drink once or twice a day – and that’s only the start.

There are plenty of options to quench your thirst and even satisfy your sweet tooth that will actually support your health at the same time (I’ll get to those later), so there’s no reason to sabotage your health (and your waistline) with these dietary disasters.

8 Top Summer Beverages to Avoid

1. Soda (Regular or Diet)

Drinking soda is in many ways as bad as smoking. Most sodas contain far too much sugar, or even worse, artificial sweeteners.

For instance, the chemical aspartame, often used as a sugar substitute in diet soda, has over 92 different side effects associated with its consumption including brain tumors, birth defects, diabetes, emotional disorders and epilepsy/seizures. Plus, each sip of soda exposes you to:

  • Phosphoric acid, which can interfere with your body’s ability to use calcium, leading to osteoporosis or softening of your teeth and bones.
  • Benzene. While the federal limit for benzene in drinking water is 5 parts per billion (ppb), researchers have found benzene levels as high as 79 ppb in some soft drinks, and of 100 brands tested, most had at least some detectable level of benzene present. Benzene is a known carcinogen.
  • Artificial food colors, including caramel coloring, which has been identified as carcinogenic. The artificial brown coloring is made by reacting corn sugar with ammonia and sulfites under high pressures and at high temperatures.
  • Sodium benzoate, a common preservative found in many soft drinks, which can cause DNA damage. This could eventually lead to diseases such as cirrhosis of the liver and Parkinson’s.

2. Wine Coolers

Wine coolers are alcoholic beverages made to taste much more like fruit juice than alcohol, which is why they’re a popular drink of choice on a warm summer day. But in order to make them taste sweet, manufacturers typically add fruit juice and sugar to the wine, which is usually the cheapest available grade. Some “wine” coolers aren’t even made from wine but the far cheaper “malt” instead.

These coolers can also contain artificial food colors, artificial flavors and even artificial sweeteners like aspartame. And, of course, they also contain alcohol, which is very similar to fructose both in its addictive properties and the kind of damage it can do to your health.

While I don’t recommend drinking alcohol (it is a neurotoxin that can poison your brain as well as disrupt your hormonal balance), if you’re going to have an alcoholic beverage, a glass of red or white wine is far preferable to a heavily (or artificially) sweetened wine cooler.

3. Beer

The “usual” problems associated with beer – its alcohol content and hefty amount of empty calories – are only the tip of the iceberg for why you should limit your consumption. It turns out that the yeast and all that’s used to make beer work together to make beer another powerful uric acid trigger.

Uric acid is a normal waste product found in your blood. High levels of uric acid are normally associated with gout, but it has been known for a long time that people with high blood pressure or kidney disease, and those who are overweight, often have high uric acid levels as well. It used to be thought that the uric acid was secondary in these conditions, and not the cause.

But research by Dr. Richard Johnson indicates that it could be a lead player in the development of these conditions, rather than just a supporting actor, when its levels in your body reach 5.5 mg per dl or higher. At this level, uric acid is associated with an increased risk for developing high blood pressure, as well as diabetes, obesity and kidney disease.

The classic “beer belly syndrome” is actually quite similar to metabolic syndrome, and includes abdominal obesity, hypertriglyceridemia (high triglycerides), high blood pressure, and even insulin resistance, so minimizing or eliminating beer consumption is also something to definitely consider when you’re watching your weight and trying to improve your health.

4. Lemonade and Fruit Juices

For many, nothing says “summer” like a cold glass of lemonade, but this, and other fruit juices, is usually just another source of sugar you’re better off without.

Lemonade is typically a concoction of sugar or high fructose corn syrup, water, and flavorings. It may or may not contain small amounts of actual lemon juice. In terms of its impact on your health, lemonade and fruit juice will act much like soda, exposing you to excessive amounts of fructose that will increase your risk of weight gain and chronic degenerative diseases. Lemonade is simply soda’s evil twin in disguise! However, if you make fresh lemonade or limeade then it is fine because these are the lowest fruits in fructose. Just be sure if you use a sweetener that you stick to stevia and avoid sugar and artificial sweeteners.

5. Sweetened Teas

Sweet tea is another popular summer beverage, and one that’s often confused as “healthy” because of the tea. While teacan be a good source of antioxidants, sweetened tea is another source of extra sugar that will decimate your health. While the actual sugar content of sweetened teas obviously varies, it’s not unusual to find sweet tea recipes that contain 22 percent sugar, which is twice the amount in a can of soda.1

In the Southern US, sweet tea is not an occasional treat, it’s more of a daily staple, making the health risks even steeper.

6. Energy Drinks

The US energy drink market is expected to reach nearly $20 billion in 2013, which is close to a 160 percent increase from 2008.2 While many choose them for the quick energy boost they provide, consuming large quantities of caffeine in energy drinks can have serious health consequences, especially in children and teens, including caffeine toxicity, stroke, anxiety, arrhythmia, and in some rare cases death. Drinking energy drinks has also been compared to “bathing” teeth in acid because of their impact on your tooth enamel.3

If a lack of energy and fatigue state is compelling you to drink energy drinks, please realize that this is likely a result of certain lifestyle choices, such as not enough healthy food, processed foods and sugar, and not enough exercise and sleep, plus an overload of stress. Increasing your energy levels, then, is as easy as remedying these factors.

7. Sports Drinks

Sports drinks are especially popular in the summer months, when many believe they are necessary to restore your electrolyte balance during exercise or other outdoor activities. They basically “work” because they contain high amounts of sodium (processed salt), which is meant to replenish the electrolytes you lose while sweating. But only a very small portion of exercisers work out hard enough that a sports drink might be necessary; typically they aren’t even necessary during amarathon, let alone during most regular workouts.4

Additionally, the leading brands of sports drinks on the market typically contain as much as two-thirds the sugar of sodas and more sodium. They also often contain high-fructose corn syrup (HFCS) or artificial sweeteners (they can lead to impaired kidney function, depression, headaches, infertility, brain tumors, and a long list of other serious health problems), artificial flavors and food coloring, which has been connected to a variety of health problems, including allergic reactions, hyperactivity, decreased IQ in children, and numerous forms of cancer.

Also, sports drinks are up to 30 times more erosive to your teeth than water. And brushing your teeth won’t help because the citric acid in the sports drink will soften your tooth enamel so much it could be damaged by brushing.

8. Frappes and Other Frozen/Iced Coffees

An iced coffee sounds innocent enough, until you start adding in the copious amounts of sweeteners (sugar, HFCS and artificial sweeteners may all apply) and flavorings that turn ordinary coffee into a treat that more closely resembles a hyped up milkshake. Some leading coffee drinks from restaurants like Dunkin’ Donuts and Seattle’s Best contain 100 grams of sugar or more, which is more than 2.5 times the amount of sugar an adult man should consume in a day!5

Delicious and Refreshing Summer Drinks That BOOST Your Health

I know what you’re thinking… you’re not going to give up the simple pleasure of enjoying a cool, tasty beverage on a hot summer day. And I should hope not! But you needn’t assume that sugar-laden soda, lemonade, sweet tea or frappes are your only options. By thinking outside the box, you can satisfy your craving for a delicious cool beverage in a way that will actually support instead of hinder your health.

Instead Of … Choose …
Soda Sparkling mineral water… spruce it up with fresh lemon or lime juice, a drop or two of natural peppermint extract, liquid stevia, cucumber slices or a few crushed mint leaves.

If you’re adventurous, there are mint-flavored chlorophyll drops on the market that can be added to a glass of water. Chlorophyll may help flush toxins out of your blood and improves your breath.

Wine Coolers A small glass of white or red wine, ideally organic and biodynamic, on occasion.
Beer Try adding whole gingerroot to chilled carbonated water for a spicy alternative.
Lemonade or Fruit Juice Here’s a recipe for a refreshing homemade fruit drink that’s actually good for you. You can even throw in frozen berries instead of ice cubes.
Another tasty option is to blend some homemade kefir with frozen blueberries, raspberries or any fruit you enjoy. Kefir is a fermented milk beverage that contains beneficial bacteria that give your immune system a boost, among many other health benefits.

To make kefir all you need is one-half packet of kefir starter granules in a quart of raw milk, which you leave at room temperature overnight.

Sweetened Tea Iced green tea is a great pick-me-up that’s high in antioxidants. Although green tea contains caffeine, it also contains a naturally calming amino acid called L-theanine, which balances out caffeine’s adverse effects.

If you want it sweet, you can add natural liquid stevia, which is an herb that has no downsides for your health.

Another option is Tulsi tea (aka Holy Basil), which has a naturally delicious taste – slightly sweet and a bit spicy.

Energy Drinks For the ultimate refreshing vitamin-rich energy drink, make up some green juice from fresh, organic veggies like spinach, parsley, cucumbers and celery.

Add a pinch of sea salt and some lemon juice for a very refreshing beverage that is heavy on nutrition and virtually guaranteed to give you lasting energy.

Sports Drinks Try coconut water, which is a powerhouse of natural electrolytes, vitamins, minerals, trace elements, amino acids, enzymes, antioxidants and phytonutrients, and is low in sugar but pleasantly sweet.

It’s great for post-exercise rehydration, but also has anti-inflammatory properties, protects your heart and urinary tract, is a digestive tonic, improves your skin and eyes, supports good immune function, and can even help balance your blood glucose and insulin levels.

Look for a brand that has no additives, or purchase a young coconut and drain the coconut water yourself.

Frappes and Frozen Coffee Drinks Organic dark-roast coffee served over ice (without additives like milk or sugar) is refreshing and may even lower your risk for type 2 diabetes, Parkinson’s disease, dementia, stroke, and cancers of the liver, kidney and prostate.

When consumed in this healthful manner, coffeemay even lower your blood glucose level and increase the metabolic activity and/or numbers of beneficial Bifidobacteria in your gastrointestinal tract.

 

Source: mercola.com

 

Why Are Foods and Supplements Made for Children Packed with Hazardous Chemicals, Hidden Aspartame and GMOs?


Story at-a-glance

  • The documentary Killer at Large investigates the topic of obesity, a problem of truly epic proportions where misinformation is a major driver of its skyward trend
  • Conventional diet and health recommendations are grossly flawed. Obesity and related health problems are directly attributable to improper diet—a diet too high in carbs and poor-quality proteins, and too low in healthy fats
  • Calorie counting has been firmly debunked by science. It is FAR more important to look at the source of the calories than counting them. You get fat because you eat the wrong kind of calories
  • First and foremost, a healthy diet is based on fresh whole, preferably organic foods, and foods that have been minimally processed
  • As a parent, one of the best gifts you can give your child is a strong nutritional start. The first years of life represent a time of rapid development, during which your child’s language, cognitive, social and motor skills are developed.
  • During the first three years of life, the brain also grows at its fastest rate, and this represents a crucial window of development during which proper nutrition is essential.
  • If your child does not get healthy foods (and ideally breast milk) during this time, his future intelligence could be impacted.
  • A 2010 study1 revealed just how big an impact a poor nutritional start can have on your kids. Those who ate a predominantly processed food diet at age 3 had lower IQ scores at age 8.5. For each measured increase in processed foods, participants had a nearly two point decrease in IQ.
  • As you might suspect, the opposite also held true, with those eating healthier diets experiencing higher IQ levels.
  • As a parent, it is important to carefully consider the types of foods you give your child at home and in restaurants, as research has shown that repeated exposure builds taste preferences very quickly.
  • Potentially reduced IQ is not the only health risk your child faces if he eats a diet consisting mainly of processed foods and snacks.
  • A junk food diet can also set the stage for obesity, asthma, eczema, and a variety of allergies, behavioral problems—from hyperactivity to aggression—as well as inflammatory conditions and autoimmune diseases. In fact, many of the top diseases plaguing the United States are diet-related, including heart disease, diabetes and cancer.
  • The National Institutes of Health even states that four of the six leading causes of death in the US are linked to unhealthy diets.
  • So the importance of proper nutrition simply cannot be overstated. Yet despite all this knowledge, food and beverage companies and even supplement makers are foisting products on children that are FAR from health-promoting, making your role as an educated parent all the more important…
  • At a recent shareholder meeting, nine-year old Hannah Robertson had some pointed questions for Don Thompson, CEO of McDonald’s Corp2.
  • “Something that I don’t think is fair is when big companies try to trick kids into eating food that isn’t good for them by using toys and cartoon characters,” Hannah told the attendees at the meeting.
  • “If parents haven’t taught their kids about healthy eating then the kids probably believe that junk food is good for them because it might taste good… I make cooking videos with my mom that show kids that eating healthy can be fun and yummy.
  • We teach them that eating a rainbow of fruits and veggies makes kids healthier, smarter and happier because that is the truth… Mr. Thompson, don’t you want kids to be healthy so they can live a long and happy life?”
  • Thompson’s reply? “… [W]e don’t sell junk food, Hannah,” he said. He also denied marketing to children. His response left her unimpressed, and rightfully so, if you ask me. Children are clearly a primary market for McDonald’s. In fact, America’s 52 million kids under the age of 12 represent one of the most powerful markets for American businesses, influencing adult spending worth $700 billion a year.
  • Children age 2-11 now see an average of more than 10 television food ads per day, and 98 percent of food advertisements viewed by children are for products that are high in fat, sugar or sodium, like McDonald’s and other fast food joints
  • child-supplement

·         Girl Scolds McDonald’s CEO

Absurd Lies Told By McDonald’s CEO

A related article3 pointed out the many lies spouted by McDonald’s CEO during this shareholder’s meeting, including but not limited to:

  • Claiming “chicken nugget Happy Meals and fat-free milk” are healthy…

Chicken McNuggets contain roughly 30 ingredients, including: sodium phosphates, sodium acid pyrophosphate, sodium aluminum phosphate, monocalcium phosphate and calcium lactate. The “fat-free milk” Thompson touted numerous times is actually chocolate milk, containing 10 grams of added sugar…

  • “We provide high-quality food, we always have. It’s real beef, it’s real chicken, it’s real tomatoes, real lettuce, real fruit, real smoothies, real dairy, real eggs.”

Really? The “real eggs” in an Egg McMuffin are “ prepared with” the following: Liquid Margarine: Liquid Soybean Oil and Hydrogenated Cottonseed and Soybean Oils, Water, Partially Hydrogenated Soybean Oil, Salt, Soy Lecithin, Mono and Diglycerides, Sodium Benzoate and Potassium Sorbate (Preservatives), Artificial Flavor, Citric Acid, Vitamin A Palmitate, Beta Carotene (Color).

  • “Globally, we follow guidelines on responsible marketing to children.”

… Just last month, McDonald’s was fined $1.6 million by the consumer protection agency in Sao Paulo [Brazil] for violating local laws on targeting children… A report from Yale University found that… “Although McDonald’s pledged to improve food marketing to children, they increased their volume of TV advertising from 2007 to 2009.” Preschoolers saw 21 percent more McDonald’s ads and older children viewed 26 percent more ads in 2009 compared to 2007…

  • “And we are not marketing food to kids.”

Two words: Happy Meals.

The author, Michele Simon, a public health lawyer specializing in industry marketing and lobbying tactics, suggests adding your voice by signing the petition created by Corporate Accountability International, urging CEO Don Thompson to stop marketing McDonald’s to children.

What’s in That Big Mac?

A cross-sectional study of 1,877 adults and 330 school-age kids who regularly ate at fast-food chains revealed that meals consumed at these restaurants were very high in calories, and that both children and adults underestimated the amount of calories their meals contained. As reported by Time Healthland4:

“The investigators collected receipts from the participants in order to calculate how many calories the participants consumed from their meals. They also asked the volunteers to estimate the number of calories they had just ordered. At the time of the study, none of the restaurant chains included calorie information on their menus, as many now do.”

On average, each adult fast-food meal came out to 836 calories, teens’ meals were about 756 calories, and kids consumed a whopping 733 calories in one sitting. But it’s not all about calories per se, because a calorie is NOT a calorie. What matters most is the source of those calories, and this is where fast food fails miserably. The ingredients used simply cannot be compared to whole, unprocessed foods.

As a general rule, “food” equals “live nutrients.” Nutrients, in turn, feed your cells, optimize your health, and sustain life. Obesity, diabetes, high cholesterol, hypertension and heart attacks are hallmark diseases associated with a fast food diet – a CLEAR indication that it does not provide the appropriate nutrition for your body. And, if lack of healthful nutrition isn’t enough of a deterrent, perhaps the fact that some fast foods have been found to be impervious to decomposition, even after more than a decade, will get you to reconsider feeding it to your children.

Thompson denies McDonald’s sells junk food. However, looking at the lists of ingredients in McDonald’s meals, I find this to be an undefendable stance. When you consider the fact that a large number of the ingredients in a fast food meal exist nowhere in nature, but are rather concocted in a lab, it’s just not ‘real food’; it’s junk. As just one example, what kind of bread can lie out for years on end without developing so much as a trace of mold? According to McDonald’s website5, their hamburger buns consist of:

“Enriched flour (bleached wheat flour, malted barley flour, niacin, reduced iron, thiamin mononitrate, riboflavin, folic acid, enzymes), water, high fructose corn syrup, sugar, yeast, soybean oil and/or partially hydrogenated soybean oil, contains 2% or less of the following: salt, calcium sulfate, calcium carbonate, wheat gluten, ammonium sulfate, ammonium chloride, dough conditioners (sodium stearoyl lactylate, datem, ascorbic acid, azodicarbonamide, mono- and diglycerides, ethoxylated monoglycerides, monocalcium phosphate, enzymes, guar gum, calcium peroxide, soy flour), calcium propionate and sodium propionate (preservatives), soy lecithin.”

Interestingly, analyzing this list of ingredients offers clues not only for how these buns remain unblemished for years on end, but also to some of the health ramifications you may experience when eating a McDonald’s hamburger. For example, if you’ve ever felt it just “sitting” in your gut like a brick, perhaps the plaster of Paris, aka calcium sulfate6 isn’t quite as digestible as you’d hoped. Or if you’ve had to run to the bathroom shortly after your meal, perhaps the ammonium sulfate and the ammonium chloride are to blame. Both of these chemicals cause gastrointestinal irritation with symptoms such as nausea, vomiting and diarrhea.

Processed Food Contains Many Potentially Dangerous Ingredients

Fast food hamburgers are not the only type of heavily processed food that is questionable in terms of whether or not it should be considered real food. The following are just a few more examples, but you get the idea – any time a food is heavily processed, it typically ceases to be beneficial for your child’s health. Many processed foods also contain dangerous MSG, to give the otherwise bland mixture some flavor.

  • Chicken McNuggets, for example, have made it into mainstream news because of the potentially hazardous additives they contain.
  • Soda can contain any number of health harming substances, from high fructose corn syrup (HFCS) to benzene andaspartame.
  • French Fries are loaded with the worst types of fat on the planet — typically highly refined and genetically modified omega 6 oils, such as corn, canola, and soybean oils.
  • Breakfast cereals are little more than disguised forms of high fructose corn syrup and many are loaded with genetically engineered grains.

Diet Soda Found to Be as Bad as Meth or Crack Cocaine for Your Teeth

A recent article in the New York Daily News7 highlighted study8 findings that a steady consumption of diet soda can result in the same type of tooth decay and erosion as that caused by methamphetamines and crack cocaine:

“The report, which was recently published in the journal General Dentistry9, found that a woman in her 30s who drank two liters of diet soda every day for three to five years had eroded teeth similar to those of a 29-year-old meth addict and a 51-year-old longtime crack user. ‘You look at it side-to-side with ‘meth mouth’ or ‘coke mouth,’ it is startling to see the intensity and extent of damage more or less the same,’ said Dr. Mohamed Bassiouny, a professor of restorative dentistry at the Temple University School of Dentistry in Philadelphia.

Diet and regular soda are highly acidic, like methamphetamine and crack cocaine. Paired with poor dental hygiene, the citric and phosphoric acid in soda can lead to substantial damage and decay, Bassiouny said.”

The American Beverage Association (ABA), which represents soft drink manufacturers, issued a statement noting that the woman did not receive dental health services for more than 20 years, and that “To single out diet soda consumption as the unique factor in her tooth decay and erosion — and to compare it to that from illicit drug use — is irresponsible.” The ABA also stated that these findings do not justify never drinking soda again; rather you should be aware that soda is highly acidic, and that you should rinse your mouth after drinking it, and brush your teeth twice a day.

I disagree. Soda, whether regular or diet, has no positive place in a healthy diet. There’s simply no reason to ever give your child soda. To learn more, please see this previous article, where I review my many reasons for this hardcore stance.

Why Do Kids’ Vitamins Contain Aspartame, GMOs, and Hazardous Chemicals?

Another industry that is shockingly irresponsible when it comes to children’s nutrition is that of dietary supplements. Take Flintstones Vitamins, for example, which is marketed as the “Pediatricians’ #1 Choice” of supplement for kids. A recent article by GreenMedInfo.com10 reveals several of the horrid ingredients in this well-known kids vitamin—ingredients that can have adverse health effects severe enough to warrant a trip to the hospital.

Flintstones Vitamins is produced by the pharmaceutical company Bayer. I’ve revealed some of the many skeletons in Bayer’s closet in the past — including their numerous drug-related lawsuits and intentional selling of AIDS-infected drugs in Europe and Asia. With that in mind, perhaps it’s not so surprising to find that their wildly successful kids vitamin contains some shockingly unhealthy ingredients, including:

Aspartame, perhaps the most dangerous artificial sweetener on the market, aspartameconverts into toxic methanol and formaldehyde in your body. The featured article lists over 40 adverse health effects of aspartame11 found in the biomedical literature, including neurotoxicity and carcinogenicity Cupric Oxide, listed as the ‘nutritional’ source of ‘copper,’ supplying “100% of the Daily Value (Ages 4+). However, the European Union’s Dangerous Substance Directive listsCupric Oxide as a Hazardous substance, classified as both “Harmful (XN)” and “Dangerous for the environment” (N)
Coal tar artificial coloring agents (FD&C Blue #2, Red #40, Yellow #6). All of these are well-known for their adverse effects on children and are banned in certain European countries for this very reason Zinc Oxide. Also widely used in sunscreens, the EU’s Dangerous Substance Directive classifies it as an environmental Hazard, “Dangerous for the environment (N).” It causes the death of phytoplankton (the plankton absorbs it until they burst)
Sorbitol. Higher amounts have been linked to gastrointestinal disturbances from abdominal pain to more serious conditions such as irritable bowel syndrome Ferrous Fumarate, the form of iron used in Flintstones Vitamins, is actually an industrial mineral not found in nature as food. It is extremely toxic, and accidental overdose of products containing this form is “a leading cause of fatal poisoning in children under 6”
Hydrogenated soybean oil. This is one of the most harmful ingredients in processed foods. Part of the problem with hydrogenated soybean oil relates to the health hazards of soy itself. An added hazard factor is the fact that the majority of soybeans are genetically engineered. Hydrogenated soybean oil has been linked to over a dozen adverse health effects, from coronary artery disease to cancer, violent behavior and fatty liver disease Genetically engineered corn starch.According to the featured article, the ‘vitamin C’ listed as ascorbic acid in Flintstones is likely produced from GMO corn. (Bayer’s Ag-biotech division, Bayer CropScience, donated $381,600 to defeat California’s Prop. 37 GMO labeling bill)

Kids Chemotherapy Rebranded as ‘Superformula’

Yet another area where kids are being increasingly targeted for brainwashing is with regards to pharmaceuticals. One of the most shocking and recent examples is the rebranding of chemotherapy as ‘superformula’ for children. As reported by iO9.com12:

“Chemotherapy is never fun, but A.C.Camargo Cancer Center in São Paulo is trying to make it easier for children to accept the treatment. They’re rebranding the treatment as “superformula” and using comics to help kids understand chemo…. [T]he cancer center is working with ad agency JWT, which also works with Warner Bros. The idea was to help children believe in the power of chemotherapy to make them ultimately better. They’re not just covering the chemo cases with superhero logos; they’re also giving pediatric cancer patients comic books in which the heroes experience something similar to cancer and must receive a similar treatment formulated by doctors. And in the comics, the cases for the treatment bags look just like the cases the kids get over their own chemo bags.”

How Do You Determine Whether or Not a Supplement Is a Good Choice?

To optimize your child’s health, your BEST solution is to choose the highest quality foods possible, and serve a wide variety of whole locally grown minimally processed organic foods. But how do you pick a high quality supplement, should you or your child need one? For starters, make sure it has the following characteristics:

  • It is as close as possible to its natural (whole food) form, and ideally certified organic
  • Use independent third-party labs that check the raw materials for contaminants and correct dosage.
  • Follows industry standards for quality assurance including ISO 9001, ISO 17025 and Good Manufacturing Processes (GMP) certifications.
  • The utmost care has been taken in all phases of its production, from growing its ingredients, to manufacturing, testing for potency and quality control.
  • It works! I always try to select from companies that have a long track record of providing high-quality products that produce good clinical results.

Your Child’s Healthy Diet Is Up to You

Children will simply not know which foods are healthy unless you, as a parent, teach it to them. Remember, wholesome food is “live” food, and the hallmark of live food is the fact that it will wilt and decompose. The fact that fast food burgers, buns, and fries do not decompose, even after a decade, is a clear sign that it’s just not real food and serves no beneficial purpose as part of your diet. It’s very simple: Kids need real nutrients, not man-made chemicals that are nonexistent in natural food! These substitutes are NOT equivalent to the real deal.

Food is a part of crucial lifestyle choices first learned at home, so you need to educate yourself about proper nutrition and the dangers of junk food and processed foods in order to change the food culture of your entire family. To give your child the best start at life, and help instill healthy habits that will last a lifetime, you must lead by example. If you’re not sure where to start, I recommend reading my nutrition plan first. This will provide you with the foundation you need to start making healthy food choices for your family.

The simplest way back toward health, for children and adults alike, is to focus on WHOLE foods — foods that have not been processed or altered from their original state; food that has been grown or raised as nature intended, without the use of chemical additives, pesticides and fertilizers. You, a family member, or someone you pay will need to invest time in the kitchen cooking fresh wholesome meals from these whole foods so that you can break free from the processed food diet that will ultimately make you sick.

By doing this, and eating meals together as a family, your children will receive the proper nutrition their bodies need during the important developmental years while also developing a love for whole fresh foods that will last them a lifetime.

Keep Fighting for Labeling of Genetically Engineered Foods

While California Prop. 37 failed to pass last November, by a very narrow margin, the fight for GMO labeling is far from over. The field-of-play has now moved to the state of Washington, where the people’s initiative 522, “The People’s Right to Know Genetically Engineered Food Act,” will require food sold in retail outlets to be labeled if it contains genetically engineered ingredients.

Remember, as with CA Prop. 37, they need support of people like YOU to succeed. Prop. 37 failed with a very narrow margin simply because we didn’t have the funds to counter the massive ad campaigns created by the No on 37 camp, led by Monsanto and other major food companies. Let’s not allow Monsanto and its allies to confuse and mislead the people of Washington and Vermont as they did in California. So please, I urge you to get involved and help in any way you can.

  • No matter where you live in the United States, please donate money to these labeling efforts through the Organic Consumers Fund.
  • Sign up to learn more about how you can get involved by visiting Yeson522.com!
  • For timely updates on issues relating to these and other labeling initiatives, please join the Organic Consumers Association on Facebook, or follow them on Twitter.
  • Talk to organic producers and stores and ask them to actively support the Washington initiative.

Source: mercola.com

 

 

Rapid Blood-Pressure Lowering in Patients with Acute Intracerebral Hemorrhage..


Whether rapid lowering of elevated blood pressure would improve the outcome in patients with intracerebral hemorrhage is not known. Methods We randomly assigned 2839 patients who had had a spontaneous intracerebral hemorrhage within the previous 6 hours and who had elevated systolic blood pressure to receive intensive treatment to lower their blood pressure (with a target systolic level of <140 mm Hg within 1 hour) or guideline-recommended treatment (with a target systolic level of <180 mm Hg) with the use of agents of the physician`s choosing. The primary outcome was death or major disability, which was defined as a score of 3 to 6 on the modified Rankin scale (in which a score of 0 indicates no symptoms, a score of 5 indicates severe disability, and a score of 6 indicates death) at 90 days. A prespecified ordinal analysis of the modified Rankin score was also performed. The rate of serious adverse events was compared between the two groups. Results Among the 2794 participants for whom the primary outcome could be determined, 719 of 1382 participants (52.0%) receiving intensive treatment, as compared with 785 of 1412 (55.6%) receiving guideline-recommended treatment, had a primary outcome event (odds ratio with intensive treatment, 0.87; 95% confidence interval [CI], 0.75 to 1.01; P=0.06). The ordinal analysis showed significantly lower modified Rankin scores with intensive treatment (odds ratio for greater disability, 0.87; 95% CI, 0.77 to 1.00; P=0.04). Mortality was 11.9% in the group receiving intensive treatment and 12.0% in the group receiving guideline-recommended treatment. Nonfatal serious adverse events occurred in 23.3% and 23.6% of the patients in the two groups, respectively. Conclusions In patients with intracerebral hemorrhage, intensive lowering of blood pressure did not result in a significant reduction in the rate of the primary outcome of death or severe disability. An ordinal analysis of modified Rankin scores indicated improved functional outcomes with intensive lowering of blood pressure.

Source: NEJM

 

 

Short-term vs Conventional Glucocorticoid Therapy in Acute Exacerbations of Chronic Obstructive Pulmonary Disease: The REDUCE Randomized Clinical Trial.


International guidelines advocate a 7- to 14-day course of systemic glucocorticoid therapy in acute exacerbations of chronic obstructive pulmonary disease (COPD). However, the optimal dose and duration are unknown. OBJECTIVE To investigate whether a short-term (5 days) systemic glucocorticoid treatment in patients with COPD exacerbation is noninferior to conventional (14 days) treatment in clinical outcome and whether it decreases the exposure to steroids. DESIGN, SETTING, AND PATIENTS REDUCE (Reduction in the Use of Corticosteroids in Exacerbated COPD), a randomized, noninferiority multicenter trial in 5 Swiss teaching hospitals, enrolling 314 patients presenting to the emergency department with acute COPD exacerbation, past or present smokers (>/=20 pack-years) without a history of asthma, from March 2006 through February 2011. INTERVENTIONS Treatment with 40 mg of prednisone daily for either 5 or 14 days in a placebo-controlled, double-blind fashion. The predefined noninferiority criterion was an absolute increase in exacerbations of at most 15%, translating to a critical hazard ratio of 1.515 for a reference event rate of 50%. MAIN OUTCOME AND MEASURE Time to next exacerbation within 180 days. RESULTS Of 314 randomized patients, 289 (92%) of whom were admitted to the hospital, 311 were included in the intention-to-treat analysis and 296 in the per-protocol analysis. Hazard ratios for the short-term vs conventional treatment group were 0.95 (90% CI, 0.70 to 1.29; P = .006 for noninferiority) in the intention-to-treat analysis and 0.93 (90% CI, 0.68 to 1.26; P = .005 for noninferiority) in the per-protocol analysis, meeting our noninferiority criterion. In the short-term group, 56 patients (35.9%) reached the primary end point; 57 (36.8%) in the conventional group. Estimates of reexacerbation rates within 180 days were 37.2% (95% CI, 29.5% to 44.9%) in the short-term; 38.4% (95% CI, 30.6% to 46.3%) in the conventional, with a difference of -1.2% (95% CI, -12.2% to 9.8%) between the short-term and the conventional. Among patients with a reexacerbation, the median time to event was 43.5 days (interquartile range [IQR], 13 to 118) in the short-term and 29 days (IQR, 16 to 85) in the conventional. There was no difference between groups in time to death, the combined end point of exacerbation, death, or both and recovery of lung function. In the conventional group, mean cumulative prednisone dose was significantly higher (793 mg [95% CI, 710 to 876 mg] vs 379 mg [95% CI, 311 to 446 mg], P < .001), but treatment-associated adverse reactions, including hyperglycemia and hypertension, did not occur more frequently. CONCLUSIONS AND RELEVANCE In patients presenting to the emergency department with acute exacerbations of COPD, 5-day treatment with systemic glucocorticoids was noninferior to 14-day treatment with regard to reexacerbation within 6 months of follow-up but significantly reduced glucocorticoid exposure. These findings support the use of a 5-day glucocorticoid treatment in acute exacerbations of COPD.

Source: JAMA

 

Randomized controlled trial of trigeminal nerve stimulation for drug-resistant epilepsy..


To explore the safety and efficacy of external trigeminal nerve stimulation (eTNS) in patients with drug-resistant epilepsy (DRE) using a double-blind randomized controlled trial design, and to test the suitability of treatment and control parameters in preparation for a phase III multicenter clinical trial.

METHODS: This is a double-blind randomized active-control trial in DRE. Fifty subjects with 2 or more partial onset seizures per month (complex partial or tonic-clonic) entered a 6-week baseline period, and then were evaluated at 6, 12, and 18 weeks during the acute treatment period. Subjects were randomized to treatment (eTNS 120 Hz) or control (eTNS 2 Hz) parameters.
RESULTS: At entry, subjects were highly drug-resistant, averaging 8.7 seizures per month (treatment group) and 4.8 seizures per month (active controls). On average, subjects failed 3.35 antiepileptic drugs prior to enrollment, with an average duration of epilepsy of 21.5 years (treatment group) and 23.7 years (active control group), respectively. eTNS was well-tolerated. Side effects included anxiety (4%), headache (4%), and skin irritation (14%). The responder rate, defined as >50% reduction in seizure frequency, was 30.2% for the treatment group vs 21.1% for the active control group for the 18-week treatment period (not significant, p = 0.31, generalized estimating equation [GEE] model). The treatment group experienced a significant within-group improvement in responder rate over the 18-week treatment period (from 17.8% at 6 weeks to 40.5% at 18 weeks, p = 0.01, GEE). Subjects in the treatment group were more likely to respond than patients randomized to control (odds ratio 1.73, confidence interval 0.59-0.51). eTNS was associated with reductions in seizure frequency as measured by the response ratio (p = 0.04, analysis of variance [ANOVA]), and improvements in mood on the Beck Depression Inventory (p = 0.02, ANOVA).
CONCLUSIONS: This study provides preliminary evidence that eTNS is safe and may be effective in subjects with DRE. Side effects were primarily limited to anxiety, headache, and skin irritation. These results will serve as a basis to inform and power a larger multicenter phase III clinical trial. CLASSIFICATION OF EVIDENCE: This phase II study provides Class II evidence that trigeminal nerve stimulation may be safe and effective in reducing seizures in people with DRE.

Source: Neurology

Wireless Motility Capsule Versus Other Diagnostic Technologies for Evaluating Gastroparesis and Constipation: A Comparative Effectiveness Review..


To systematically review the evidence comparing wireless motility capsule (WMC) with other diagnostic tests used for the evaluation of gastroparesis and slow-transit constipation, in terms of diagnostic accuracy, accuracy of motility assessment, effect on treatment decisions, effect on patient-centered outcomes, harms, and effect on resource utilization. Data sources. We searched Medline ® and Embase ® from inception through July 2012. Additionally, we scanned reference lists of relevant articles and queried experts. Review methods. We included studies in any language that compared WMC with other diagnostic tests among patients with suspected gastroparesis or slow-transit constipation. Two reviewers independently assessed articles for eligibility, serially abstracted data from relevant articles, independently evaluated study quality, and graded the strength of the evidence (SOE). We summarized results qualitatively rather than quantitatively because of the heterogeneity of studies. Results. We included 12 studies (18 publications). Seven studies evaluated diagnosis of gastric emptying delay; we found low SOE that WMC alone was comparable to scintigraphy for diagnostic accuracy, accuracy of motility assessment, effect on treatment decisions, and effect on resource utilization. Sensitivity of WMC compared with gastric scintigraphy ranged from 59 to 86 percent and specificity ranged from 64 to 81 percent. We found two studies evaluating WMC as an add-on to other testing. The SOE was low for diagnostic accuracy and for the accuracy of motility assessment by WMC in combination with other modalities. The addition of WMC increased diagnostic yield. Nine studies analyzed colon transit disorders and provided moderate SOE for diagnostic accuracy, accuracy of motility assessment, and harms. WMC was comparable to radiopaque markers (ROM), with concordance ranging between 64 percent and 87 percent. Few harms were reported. The evidence was insufficient to justify conclusions about effects of WMC on treatment decisions and resource utilization. Conclusions. WMC is comparable in accuracy to current modalities in use for detection of slowtransit constipation and gastric emptying delay, and is therefore another viable diagnostic modality. Little data are available to determine the optimal timing of WMC for diagnostic algorithms.

Source: AHRQ Comparative Effectiveness Review.

Response of chronic cough to acid-suppressive therapy in patients with gastroesophageal reflux disease..


Epidemiologic and physiologic studies suggest an association between gastroesophageal reflux disease (GERD) and chronic cough. However, the benefit of antireflux therapy for chronic cough remains unclear, with most relevant trials reporting negative findings. This systematic review aimed to reevaluate the response of chronic cough to antireflux therapy in trials that allowed us to distinguish patients with or without objective evidence of GERD.

METHODS: PubMed and Embase systematic searches identified clinical trials reporting cough response to antireflux therapy. Datasets were derived from trials that used pH-metry to characterize patients with chronic cough.
RESULTS: Nine randomized controlled trials of varied design that treated patients with acid suppression were identified (eight used proton pump inhibitors [PPIs], one used ranitidine). Datasets from two crossover studies showed that PPIs significantly improved cough relative to placebo, albeit only in the arm receiving placebo fi rst. Therapeutic gain in seven datasets was greater in patients with pathologic esophageal acid exposure (range, 12.5%-35.8%) than in those without (range, 0.0%-8.6%), with no overlap between groups.
CONCLUSIONS: A therapeutic benefit for acid-suppressive therapy in patients with chronic cough cannot be dismissed. However, evidence suggests that rigorous patient selection is necessary to identify patient populations likely to be responsive, using physiologically timed cough events during reflux testing, minimal patient exclusion because of presumptive alternative diagnoses, and appropriate power to detect a modest therapeutic gain. Only then can we hope to resolve this vexing clinical management problem.

Source: Chest

 

Randomised study comparing 48 and 96 weeks peginterferon alpha-2a therapy in genotype D HBeAg-negative chronic hepatitis B. .


Treatment with peginterferon alpha-2a (PegIFN) for 48 weeks is the standard of care for selected HBeAg-negative patients chronically infected with hepatitis B virus (HBV), but with limited treatment efficacy. A study was undertaken to investigate whether treatment extension to 96 weeks improves the outcome in this patient population.

METHODS: 128 HBeAg-negative patients (120 genotype D) were randomised to weekly 180 mug PegIFN for 48 weeks (group A, n=51), 180 mug PegIFN for 48 weeks followed by 135 mug weekly for an additional 48 weeks (group B, n=52) or 180 mug PegIFN plus lamivudine (100 mg/day) for 48 weeks then 135 mug PegIFN for 48 weeks (group C, n=25). Endpoints were alanine aminotransferase normalisation plus HBV DNA <3400 IU/ml (primary), HBV DNA <2000 IU/ml and HBsAg clearance at 48 weeks after treatment.
RESULTS: Forty-eight weeks after treatment, six patients in group A and 13 in group B achieved alanine aminotransferase normalisation plus HBV DNA <3400 IU/ml (11.8% vs 25.0%, p=0.08), 6 vs 15 patients had HBV DNA <2000 IU/ml (11.8% vs 28.8%, p=0.03), 0 vs 3 achieved HBsAg clearance (0% vs 5.8%, p=0.24) and 0 vs 5 had HBsAg <10 IU/ml (0% vs 9.6%, p=0.06). While extended PegIFN treatment was the strongest independent predictor of response, the combination with lamivudine did not improve responses. Discontinuation rates were similar among the groups (19.6%, 23.1%, 32.0%, p=0.81) and were mostly due to PegIFN-related adverse events.
CONCLUSIONS: In HBeAg-negative genotype D patients with chronic hepatitis B, PegIFN treatment for 96 weeks was well tolerated and the post-treatment virological response improved significantly compared with 48 weeks of treatment.

Source: gut

 

Blood-pressure targets in patients with recent lacunar stroke: the SPS3 randomised trial. .


Lowering of blood pressure prevents stroke but optimum target levels to prevent recurrent stroke are unknown. We investigated the effects of different blood-pressure targets on the rate of recurrent stroke in patients with recent lacunar stroke.

METHODS: In this randomised open-label trial, eligible patients lived in North America, Latin America, and Spain and had recent, MRI-defined symptomatic lacunar infarctions. Patients were recruited between March, 2003, and April, 2011, and randomly assigned, according to a two-by-two multifactorial design, to a systolic-blood-pressure target of 130-149 mm Hg or less than 130 mm Hg. The primary endpoint was reduction in all stroke (including ischaemic strokes and intracranial haemorrhages). Analysis was done by intention to treat. This study is registered with ClinicalTrials.gov, number NCT 00059306.
FINDINGS: 3020 enrolled patients, 1519 in the higher-target group and 1501 in the lower-target group, were followed up for a mean of 3.7 (SD 2.0) years. Mean age was 63 (SD 11) years. After 1 year, mean systolic blood pressure was 138 mm Hg (95% CI 137-139) in the higher-target group and 127 mm Hg (95% CI 126-128) in the lower-target group. Non-significant rate reductions were seen for all stroke (hazard ratio 0.81, 95% CI 0.64-1.03, p=0.08), disabling or fatal stroke (0.81, 0.53-1.23, p=0.32), and the composite outcome of myocardial infarction or vascular death (0.84, 0.68-1.04, p=0.32) with the lower target. The rate of intracerebral haemorrhage was reduced significantly (0.37, 0.15-0.95, p=0.03). Treatment-related serious adverse events were infrequent.
INTERPRETATION: Although the reduction in stroke was not significant, our results support that in patients with recent lacunar stroke, the use of a systolic-blood-pressure target of less than 130 mm Hg is likely to be beneficial.

Source: Lancet