Tag Archives: mortality

July 19, 2016 · 4:47 PM

No Clear Survival Differences Seen Between Diabetes Drugs

"How about this one?"

“How about this one?”

A multinational group of researchers tried to determine which drugs for type 2 diabetes were better at prolonging life and preventing cardiovascular deaths. They reviewed the existing literature (i.e., they did a meta-analysis of prior clinical studies.

There are no clear winners. Placebo worked as well as the eight drug classes examined!

Unfortunately, the abstract doesn’t say how long the clinical studies lasted, only mentioning that they were at least 24 weeks long. It’s quite possible it would take at least three to five years to see an effect on death rates.

Click the source link at the bottom of the page for details at MPT.

Selected quotes:

“Eight different diabetes drug classes examined in a meta-analysis failed to demonstrate improved cardiovascular or all-cause mortality compared with placebo.Researchers analyzed 301 randomized clinical trials of patients with type 2 diabetes, and found that, metformin outperformed some other drug classes for its effect on hemoglobin A1c levels, there were no significant differences in mortality — including when placebo was included as a drug class.”

***

“A central finding in this meta-analysis was that despite more than 300 available clinical trials involving nearly 120,000 adults and 1.4 million patient-months of treatment, there was limited evidence that any glucose-lowering drug stratified by coexisting treatment prolonged life expectancy or prevented cardiovascular disease,” the authors wrote.”

***

“The authors wrote that their findings are consistent with guidelines from the American Diabetes Association, which — like the algorithm from the American Association of Clinical Endocrinologists — recommend that metformin monotherapy be used for the initial treatment of patients with type 2 diabetes. “Based on this review, clinicians and patients may prefer to avoid sulfonylureas or basal insulin for patients who wish to minimize hypoglycemia, choose GLP-1 receptor agonists when weight management is a priority, or consider SGLT-2 inhibitors based on their favorable combined safety and efficacy profile,” the authors wrote.”

Source: No Clear Survival Benefit Seen Among Diabetes Drugs | Medpage Today

Open wide!

Open wide!

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March 26, 2012 · 2:00 AM

Is It More Important To Be Fit, Or Healthy Weight?

Men live longer if they maintain or improve their fitness level over time, according to research out of the Cooper Clinic in Dallas, Texas.  Part of that improved longevity stems from reduced risk of death from cardiovascular disease (e.g., heart attack and stroke). 

Compared with men who lose fitness with aging, those who maintained their fitness had a 30% lower risk of death; those who improved their fitness had a 40% lower risk of death.  Fitness was judged by performance on a maximal treadmill exercise stress test.

Body mass index over time didn’t have any effect on all-cause mortality but was linked to higher risk of cardiovascular death.  The researchers, however, figured that losses in fitness were the more likely explanation for higher cardiovascular deaths.  In other words, as men age, it’s more important to maintain or improve fitness than to lose excess body fat or avoid overweight.

Steve Parker, M.D.

Reference: Lee, Duck-chul, et al.  Long-term effects of changes in cardiorespiratory fitness and bodly mass index on all-cause and cardiovascular disease mortality in men.  Circulation, 124 (2011): 2,483-2,490

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March 20, 2012 · 8:37 AM

Meat and Mortality

Red meat and processed meat consumption are associated with “modest” increases in overall mortality and deaths from cancer and cardiovascular disease, according to National Institutes of Health researchers.  This goes for both sexes.

Data are from the huge NIH-AARP Diet and Heart Study, a prospective cohort trial involving  over 550,000 U.S. men and women aged 50-71 at the time of enrollment.  Food consumption was determined by questionnaire.  Over the course of 10 years’ follow-up, over 65,000 people died.  Investigators looked to see if causes of death were related to meat consumption.

What do they mean by red meat, processed meat, and white meat?

Red meat:  all types of beef and pork (wasn’t there a U.S. ad campaign calling pork “the other white meat”?}

White meat:  chicken, turkey, fish

Processed meat:  bacon, red meat sausage, poultry sausage, luncheon meats (red and white), cold cuts (red and white), ham, regular hotdogs, low-fat poultry hotdogs, etc.

What did they find?

See the first paragraph above.

Studies like this typically look at the folks who ate the very most of a given type of food, those who ate the very least, then compare differences in deaths between the two groups.  That’s what they did here, too.  For instance, the people who ate the very most red meat ate 63 grams per 1000 caories of food daily.  Those who ate the least ate 10 grams per 1000 cal of food daily.  That’s about a six-fold difference.  Many folks eat 2000 calories a day.  The high red meat eaters on 2000 cals a day would eat 123 grams, or 4.4 ounces of red meat.  The low red meat eaters on 2000 cals/day ate 20 grams, or 0.7 ounces.

The heavy consumers of processed meats ate 23 grams per 1000 cal of food daily.  The lowest consumers ate 1.6 grams per 1000 cal.

Comparing these two quintiles of high and low consumption of red and processed meats, overall mortality was 31-36% higher for the heavy red meat eaters, and 16-25% higher for the heavy processed meat eaters.  (The higher numbers in the ranges are for women.)  Similar numbers were found when looking at cancer deaths and cardiovascular deaths (heart attacks, strokes, ruptured aneurysms, etc).

It’s not proof that heavy consumption of red and processed meats is detrimental to longevity, but it’s suggestive.  The “Discussion” section of the article reviews potential physiological mechanisms for premature death.

The researchers called these differences “modest.”  I guess they use “modest” since most people eat somewhere between these extreme quintiles.  The numbers incline me  to stay out of that “highest red and processed meat consumer” category, and lean more towards white meat and fish.

The study at hand is from 2009.  Another research report in Archives of Internal Medicine this month supported similar conclusions. (Click for Zoë Harcombe’s critique of the study.)

The traditional Mediterranean diet and Advanced Mediterranean Diet are naturally low in red and processed meats, but not designed specifically for folks with diabetes.

Steve Parker, M.D. 

Reference:  Sinha, Rashmi, et al.  Meat intake and mortality: a prospective study of over half a million people.  Archives of Internal Medicine, 169 (2009): 562-571.

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October 28, 2011 · 6:21 AM

Does Loss of Excess Weight Improve Longevity?

High WHR

Intentional weight loss didn’t have any effect either way on risk of death, according to recent research out of Baltimore.  Surprising, huh?

Obesity tends to shorten lifespan, mostly due to higher rates of cancer and cardiovascular disease like heart attacks and strokes.  Doctors and dietitians all day long recommend loss of excess weight, figuring it will reduce the risk of obesity-related death and disease.  Many of them are unaware that’s not necessarily the case.  It’s called the “obesity paradox“: some types of overweight and obese patients actually seem to do better (e.g., live longer) if they’re above the so-called healthy body mass index of 18.5 to 24.9.  For instance: those with heart failure, coronary artery disease, and advanced kidney disease.

It’s never really been clear whether the average obese person (body mass index over 30) improves his longevity by losing some excess weight.  That’s what the study at hand is about.

Methodology

Baltimore-based investigators followed the health status of 585 overweight or obese older adults over the course of 12 years.  Half of them were randomized to an intentional weight loss intervention.  All of them had a high blood pressure diagnosis.  Average age was 66.  Average body mass index was 31.  Details of the weight-loss intervention are unclear, but it was probably along the lines of “eat less, exercise more.”

What Did They Find?

The weight-loss group lost and maintained an average of 4.4 kg (9.7 lb) over the 12 years of the study.  This is about 5% of initial body weight, the minimal amount thought to be helpful for improvement in weight-related medical and metabolic problems.  Most of the weight loss was over the first three years.

The men assigned to the weight-loss program had about half the risk of dying over the course of the study, compared to the men not assigned to weight loss.  The authors don’t seem to put much stock in it, however, stating that “…no significant difference overall was found in all-cause mortality between older overweight and obese adults who were randomly assigned to an intentional weight-loss intervention and those who were not.” 

Comments

With regards to the men losing weight, we’re only talking about 100-150 test subjects, a relatively small number.  So I understand why the researchers didn’t make a big deal of the lower mortality: it may not be reproducible.

This same research group did a similar study of 318 arthritis patients and intentional weight loss, finding a 50% lower death rate over eight years.

The authors reviewed many similar studies done by other teams, noting increased death rates from weight loss in some studies, and lesser death rates in others. 

When the studies are all over the place like this, it usually means there’s no strong association either way.  Nearly all the pertinent studies were done on relatively healthy, middle-aged and older folks.  The most reliable thing you can say about the issue is that loss of excess fat weight doesn’t increase your odds of premature death. 

 Remember that patients with coronary heart disease, congestive heart failure, or advanced kidney disease tend to live longer if they’re overweight or at least mildly obese.  It’s the obesity paradox.  Will they live longer or die earlier if they go on a weight-loss program?  We don’t know.

We do know that intentional weight loss helps:

  • prevent type 2 diabetes
  • maintain reasonable blood pressures (avoiding high blood pressure)
  • improves lower limb functional ability

Maybe that’s enough.

Steve Parker, M.D.

Reference: Shea, M.K., et al.  The effect of intentional weight loss on all-cause mortality in older adults: results of a randomized controlled weight-loss trial.  American Journal of Clinical Nutrition, 94 (2011): 839-846.

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January 7, 2011 · 7:48 AM

Low-Carb Diets Killing People?

Animal-based low-carb diets are linked to higher death rates, according to a recent study in the Annals of Internal Medicine.  On the other hand, a vegetable-based low-carb diet was associated with a lower mortality rate, especially from cardiovascular disease.

As always, “association is not causation.”

It’s just a matter of time before someone asks me, “Haven’t you heard that low-carb diets cause premature death?”  So I figured I’d better take a close look at the new research by Fung and associates.

It’s pretty weak and unconvincing.  I have little to add to the cautious editorial by William Yancy, Matthew Maciejewski, and Kevin Schulman published in the same issue of Annals.

The study at hand was observational over many years, using data from the massive Nurses’ Health Study and Health Professionals’ Follow-up Study.  To find the putative differences in mortality, the researchers had to compare the participants eating the most extreme diets.  The 80% of study participants eating in between the extremes  were neutral in terms of death rates.

They report that “…the overall low-carbohydrate diet score was only weakly associated with all-cause mortality.”  Furthermore,

These results suggest that the health effects of a low-carbohydrate diet may depend on the type of protein and fat, and a diet that includes mostly vegetable sources of protein and fat is preferable to a diet with mostly animal sources of protein and fat.

In case you’re wondering, all these low-carb diets derived between 35 and 42% of energy (total calories) from carbohydrate, with an average of 37%.  Anecdotally, many committed low-carbers chronically derive 20% of calories form carbohydrate (100 g of carb out of 2,000 calories/day).  The average American eats 250 g of carb daily, 50-60% of total calories.

Yancy et al point out that “Fung and coworkers did not show a clear dose-response relationship in that there was not a clear progression of risk moving up or down the diet deciles.”  If animal proteins and fats are lethal, you’d expect to see some dose-response relationship, with more deaths as animal consumption gradually increases over the deciles.

ResearchBlogging.orgThe Fung study is suggestive but certainly not definitive.  Anyone predisposed to dietarycaution who wants to eat lower-carb might benefit from eating fewer animal sources of protein and fat, and more vegetable sources.  Fung leaves it entirely up to you to figure out how to do that. Compared to an animal-based low-carb diet, the healthier low-carb diet must subsitute more low-carb vegetables and higher-fat plants like nuts, seeds, seed oils and olive oil, and avocadoes, for example.  What are higher-protein plants?  Legumes?

You can see how much protein and fat are in your favorite vegetables at the USDA Nutrient Database.

The gist of Fung’s study dovetails with the health benefits linked to low-meat diets such as traditional Mediterranean and DASH.  On the other hand, if an animal-based low-carb diet helps keep a bad excess weight problem under control, it too may by healthier than the standard American diet.

See the Yancy editorial for a much more detailed and cogent analysis.  As is so often the case, “additional studies are needed.”

Steve Parker, M.D.

Reference: Fung TT, van Dam RM, Hankinson SE, Stampfer M, Willett WC, & Hu FB (2010). Low-carbohydrate diets and all-cause and cause-specific mortality: two cohort studies. Annals of internal medicine, 153 (5), 289-98 PMID: 20820038

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June 25, 2009 · 9:57 AM

Which Components of the Mediterranean Diet Prolong Life?

We're pro-life

We're pro-life

Researchers at Harvard and the University of Athens (Greece) report that the following specific components of the Mediterranean diet are associated with lower rates of death:

  • moderate ethanol (alcohol) consumption
  • low meat and meat product intake
  • high vegetable consumption
  • high fruit and nut consumption
  • high ratio of monounsaturated fat to saturated fat
  • high legume intake

Minimal, if any, contribution to mortality was noted with high cereal, low dairy, or high fish and seafood consumption. 

The researchers examined diet and mortality data from over 23,000 adult participants in the Greek portion of the European Prospective Investigation into Cancer and nutrition.  You’ll be hearing more about the EPIC study for many years.  Over an average follow-up of 8.5 years, 1,075 of participants died.  652 of these deaths were of participants in the lower half of Mediterranean diet adherence; 423 were in the upper half.

Alcohol intake in Greece is usually in the form of wine at mealtimes. 

The beneficial “high ratio of monounsaturated fat to saturated fat” stems from high consumption of olive oil and low intake of meat. 

It’s not clear if these findings apply to other nationalities or ethnic groups.  Other research papers have documented the health benefits of the Mediterranean diet in at least eight other countries over three continents. 

The researchers don’t reveal in this report the specific causes of death.  I expect those data, along with numbers on diabetes, stroke, and dementia, to be published in future articles, if not published already.  Prior Mediterranean diet studies indicate lower death rates from cardiovascular disease and cancer.   

Steve Parker, M.D.

Reference:  Trichopoulou, Antonia, et al.  Anatomy of health effects of the Mediterranean diet: Greek EPIC prospective cohort study.  British Medical Journal, 338 (2009): b2337.  DOI: 10.1136/bmj.b2337.

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