Nutritional advice

Objectives:
There is an ongoing debate on the involvement of systemic copper (Cu) dysfunctions in Alzheimer's disease (AD) and clinical studies comparing Cu levels in serum, plasma and cerebrospinal fluid (CSF) of AD patients with those of healthy controls have delivered non-univocal and often conflicting results. Therefore, this review article has been conducted.

Does blood level of copper increase in Alzheimer’s disease?

Study design:
This review article included 26 studies including a pooled total of 761 AD subjects and 664 controls for serum Cu studies, 205 AD subjects and 167 controls for plasma Cu and of 116 AD subjects and 129 controls for CSF Cu.

Results and conclusions:
The investigators found Alzheimer's disease patients have higher levels of serum copper than healthy controls. Plasma data did not allow conclusions, due to their high heterogeneity, but the meta-analysis of the combined serum and plasma studies confirmed higher copper levels in Alzheimer's disease patients. 

The investigators found the analysis of CSF data revealed no difference between Alzheimer's disease patients and controls.

The investigators concluded Alzheimer's disease patients have higher levels of serum and plasma copper than healthy controls.

Original title:
Copper in Alzheimer's disease: a meta-analysis of serum, plasma, and cerebrospinal fluid studies by Bucossi S, Ventriglia M, […], Squitti R.

Link:
http://www.ncbi.nlm.nih.gov/pubmed/21187586

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Objectives:
Lutein and zeaxanthin are thought to have beneficial effects on protecting the lens against cataract formation, but findings from epidemiologic studies have been inconsistent. Therefore, this review article has been conducted.

Does dietary lutein and zeaxanthin intake reduce age-related cataract risk?

Study design:
This review article included 6 prospective cohort studies, involving 4416 cases and 41999 participants.

Results and conclusions:
The investigators found for comparing the highest with the lowest categories of dietary lutein and zeaxanthin intake, a significant reduced risk for nuclear cataract of 25% [RR = 0.75, 95% CI = 0.65-0.85], but the reduced risk was not significant for cortical cataract [RR = 0.85, 95% CI = 0.53-1.17] and for posterior subcapsular cataract [RR = 0.77, 95% CI = 0.40-1.13]. Significant means, there is an association with a 95% confidence.

The investigators found in dose-response analysis that every 300 μg/d increment in dietary lutein and zeaxanthin intake was significantly associated with a 3% [RR = 0.97, 95% CI = 0.94-0.99] reduction in the risk of nuclear cataract.

The investigators found in dose-response analysis that every 300 μg/d increment in dietary lutein and zeaxanthin intake was non-significantly associated with a 1% [RR = 0.99, 95% CI = 0.95-1.02] reduction in the risk of cortical cataract. Non-significantly means, there is no association with a 95% confidence.

The investigators found in dose-response analysis that every 300 μg/d increment in dietary lutein and zeaxanthin intake was non-significantly associated with a 3% [RR = 0.97, 95% CI = 0.93-1.01] reduction in the risk of posterior subcapsular cataract. Non-significantly because RR of 1 was found in 95% CI of 0.93 to 1.01. RR of 1 means no risk.

The investigators concluded dietary lutein and zeaxanthin intake (at least 300 μg/d) is associated with a reduced risk of age-related cataract, especially nuclear cataract in a dose-response manner, indicating a beneficial effect of lutein and zeaxanthin in age-related cataract prevention.

Original title:
A dose–response meta-analysis of dietary lutein and zeaxanthin intake in relation to risk of age-related cataract by Ma L, Hao ZX, [...], Pan JP.

Link:
http://link.springer.com/article/10.1007/s00417-013-2492-3

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Objectives:
Does a low salt intake reduce blood pressure?

Study design:
This review article included 34 randomized trials with 3230 participants (the median age was 50 (range 22-73)), of which 22 were in hypertensive individuals and 12 in normotensive individuals. Of the 34 trials, 23 used crossover design and 11 used paralleled comparisons. 22 of the 34 trials were double blind, in 11 the observer was blind to blood pressure and one did not report any blinding procedure.

The study duration varied from 4 weeks to 3 years (median 4 weeks). With the usual salt intake the median 24 hour urinary sodium was 160 mmol (range 125-200 mmol), equivalent to a salt intake of 9.4 g/day (range 7.3-11.7 g/day) and the median blood pressure was 141/86 mmHg.

Despite the fact that only 7 out of 34 trials performed intention to treat analysis, the percentage of participants lost to follow-up after randomization was small (6.7% on average).

Results and conclusions:
The investigators found meta-analysis showed that the mean change in urinary sodium (reduced salt v usual salt) was -75 mmol/24 h (equivalent to a reduction of 4.4 g/day salt), and with this reduction in salt intake, the mean change in blood pressure was -4.18 mmHg [95% CI = -5.18 to -3.18, I2 = 75%] for systolic blood pressure and -2.06 mmHg [95% CI = -2.67 to -1.45, I2 = 68%] for diastolic blood pressure.

The investigators found meta-regression showed that age, ethnic group, blood pressure status (hypertensive or normotensive) and the change in 24 hour urinary sodium were all significantly associated with the fall in systolic blood pressure, explaining 68% of the variance between studies.

The investigators found a 100 mmol reduction in 24 hour urinary sodium (equivalent to a reduction 6 g/day salt) was associated with a fall in systolic blood pressure of 5.8 mmHg [95% CI = -2.5 to -9.2,  p = 0.001] after adjustment for age, ethnic group and blood pressure status.
For diastolic blood pressure, age, ethnic group, blood pressure status and the change in 24 hour urinary sodium explained 41% of the variance between studies.

The investigators found meta-analysis by subgroup showed that in people with hypertension the mean effect was -5.39 mmHg [95% CI = -6.62 to -4.15, I2 = 61%] for systolic blood pressure and -2.82 mmHg [95% CI = -3.54 to -2.11, I2 = 52%] for diastolic blood pressure.
In normotensive people, the figures were -2.42 mmHg [95% CI = -3.56 to -1.29, I2 = 66%] and -1.00 mmHg [95% CI = -1.85 to -0.15, I2 = 66%], respectively.

The investigators found further subgroup analysis showed that the decrease in systolic blood pressure was significant in both white and black people and in men and women.

The investigators found meta-analysis of data on hormones and lipids showed that the mean change was:
0.26 ng/mL/h [95% CI = 0.17 to 0.36, I2 = 70%] for plasma renin activity;
73.20 pmol/L [95% CI = 44.92 to 101.48, I2 = 62%] for aldosterone;
187 pmol/L [95% CI = 39 to 336, I2 = 5%] for noradrenaline (norepinephrine);
37 pmol/L [95% CI = -1 to 74, I2 = 12%] for adrenaline (epinephrine);
0.05 mmol/L [95% CI = -0.02 to 0.11, I2 = 0%] for total cholesterol;
0.05 mmol/L [95% CI = -0.01 to 0.12, I2 = 0%] for low density lipoprotein cholesterol (LDL-cholesterol or bad cholesterol);
-0.02 mmol/L [95% CI = -0.06 to 0.01, I2 = 16%] high density lipoprotein cholesterol (HDL-cholesterol or good cholesterol) and:
0.04 mmol/L [95% CI = -0.02 to 0.09, I2 = 0%] for triglycerides.

The investigators concluded a modest reduction in salt intake of 4.4 g/day for 4 or more weeks causes, from a population viewpoint, important falls in blood pressure in people with both raised and normal blood pressure.
Salt reduction is associated with a small physiological increase in plasma renin activity, aldosterone and noradrenaline and no significant change in lipid concentrations.
The current recommendations to reduce salt intake from 9-12 to 5-6 g/day will have a major effect on blood pressure, but a further reduction to 3 g/day will have a greater effect and should become the long term target for population salt intake.

Original title:
Effect of longer term modest salt reduction on blood pressure: Cochrane systematic review and meta-analysis of randomised trials by He FJ, Li J and MacGregor GA.

Link:
http://www.bmj.com/content/346/bmj.f1325

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A daily diet with a maximum of 3 grams salt per day is a diet with a maximum of 0.15 gram salt per 100 kcal.
A daily diet with a maximum of 0.15 gram salt per 100 kcal is a diet with mainly products/meals with a maximum of 0.15 gram salt per 100 kcal.

Objectives:
Previous trials have shown that zinc supplementation can decrease the risk of diarrhea, pneumonia and malaria in children; however, the effects of zinc supplementation on mortality remain unclear. Therefore, this review article has been conducted.

Does zinc supplementation reduce total mortality and cause-specific mortality in preschool children?

Study design:
This review article included 8 RCTs which included 87,854 children and reported 1,558 events of mortality. The population of the trials ranged from 96 to 42,546 and the follow-up for subjects ranged from 6 to 17.6 months.

Egger and Begg tests showed no evidence of publication bias for total mortality [p value for Egger = 0.207, p value for Begg = 0.902].

Results and conclusions:
The investigators found overall, zinc supplementation had no effect on:
total mortality [RR = 0.76, 95% CI = 0.56-1.04, p = 0.084];
diarrhea-related mortality [RR = 0.80, 95% CI = 0.53-1.20, p = 0.276];
pneumonia-related mortality [RR = 0.52, 95% CI = 0.11-2.39, p = 0.399];
malaria-related mortality [RR = 0.90, 95% CI = 0.77-1.06, p = 0.196] or;  

other causes of mortality [RR = 0.98, 95% CI = 0.67-1.44, p = 0.917]. No effect because RR of 1 was found in the 95% CI of 0.67 to 1.44. RR of 1 means no risk/effect/association.

The investigators found subgroup analysis indicated that zinc supplementation was significantly associated with a reduction in total mortality risk if the participants were boys, aged greater than 12 months and the duration of the follow-up period was less than 12 months. Significant means, there is an association with a 95% confidence

The investigators concluded zinc supplementation reduces total mortality risk if the participants are boys, aged greater than 12 months and the duration of the follow-up period is less than 12 months.

Original title:
Effects of zinc supplementation on the incidence of mortality in preschool children: a meta-analysis of randomized controlled trials by Fu W, Ding LR, [...], Zhou YH.

Link:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3823854/

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Objectives:
Does iron supplementation during pregnancy improve maternal haematological status and birth weight?

Study design:
This review article included 48 RCTs (17,793 women) and 44 cohort studies (1,851,682 women).

The dose of iron in RCTs ranged from 10 mg to 240 mg daily. Duration of supplementation varied from 7 to 8 weeks up to 30 weeks during pregnancy.

Significant heterogeneity existed for several outcomes that could not be explained substantially by pre-specified subgroups.

Results and conclusions:
The investigators found iron supplementation during pregnancy increased maternal mean haemoglobin concentration by 4.59 g/L [95% CI = 3.72 to 5.46] compared with controls.

The investigators found iron with folic acid was associated with a significant increase in mean haemoglobin concentration of 10.41 g/L [95% CI = 5.36 to 15.46, I2 = 0%, 9 trials] and reduction in risk of anaemia in the third trimester or at delivery of 56% [95% CI = 0.37 to 0.53, I2 = 44%, 5 trials]. Significant means there is an association with a 95% confidence.

The investigators found iron supplementation during pregnancy significantly reduced the risk of anaemia with 50% [95% CI = 0.42 to 0.59] compared with controls.

The investigators found iron supplementation during pregnancy significantly reduced the risk of iron deficiency (of the mother) with 41% [95% CI = 0.46 to 0.79] compared with controls.

The investigators found iron supplementation during pregnancy significantly reduced the risk of iron deficiency anaemia with 60% [95% CI = 0.26 to 0.60] compared with controls.

The investigators found iron supplementation during pregnancy significantly reduced the risk of low birth weight (2500 g) with 19% [95% CI = 0.71 to 0.93] compared with controls.

However, the investigators found iron supplementation during pregnancy non-significantly reduced the risk of preterm birth with 16% [95% CI = 0.68 to 1.03] compared with controls. Non-significant means there is no association with a 95% confidence.

The investigators found in cohort studies that anaemia in the first or second trimester was significantly associated with a higher risk for low birth weight of 29% [adjusted odds ratio 1.29, 95% CI = 1.09 to 1.53] and preterm birth with 21% [adjusted odds ratio = 1.21, 95% CI = 1.13 to 1.30].

The investigators found in exposure-response analysis that for every 10 mg increase in iron dose/day, up to 66 mg/day, the relative risk of maternal anaemia was significantly 0.88 [95% CI = 0.84 to 0.92, p for linear trend 0.001].

The investigators found in exposure-response analysis that birth weight increased by 15.1 g [95% CI = 6.0 to 24.2, p for linear trend = 0.005] and risk of low birth weight significantly decreased by 3% [relative risk = 0.97, 95% CI = 0.95 to 0.98, p for linear trend 0.001] every 10 mg increase in dose/day.

Furthermore, the investigators found for each 1 g/L increase in mean haemoglobin, birth weight increased by 14.0 g [95% CI = 6.8 to 21.8, p for linear trend = 0.002]. However, mean haemoglobin was not associated with the risk of low birth weight and preterm birth.

The investigators found no evidence of a significant effect on duration of gestation, small for gestational age births and birth length and duration of iron use was not significantly associated with the outcomes after adjustment for dose.

The investigators concluded daily prenatal use of iron substantially improved birth weight in a linear dose-response fashion, probably leading to a reduction in risk of low birth weight. An improvement in prenatal mean haemoglobin concentration linearly increased birth weight and a linear decrease in maternal anaemia with higher doses of iron, up to 66 mg/day.

Original title:
Anaemia, prenatal iron use, and risk of adverse pregnancy outcomes: systematic review and meta-analysis by Haider BA, Olofin I, […], Fawzi WW.

Link:
http://www.bmj.com/content/346/bmj.f3443

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Iron deficiency anaemia occurs when there isn't enough iron in the body. Anaemia is a condition where the amount of haemoglobin in the blood is below the normal level.
Iron deficiency anaemia has been defined as haemoglobin 110 g/L and serum ferritin 12 µg/L.

Objectives:
Several reviews and meta-analyses have examined the effects of iodine on mental development. However, none focused on young children, so they were incomplete in summarizing the effects on this important age group. Therefore, this review article has been conducted.

Is there a relationship between iodine and mental development of children 5 years old and under?

Study design:
This review article included 24 studies (14 cohort en 10 intervention studies).
Studies providing supplementation to women before or during pregnancy tended to give injections of iodized oil of 950 mg; only the studies conducted in China and DR Congo gave lower doses (400 and 475 mg, respectively).
The median sample size per group across the 10 intervention studies was 50 with a range of 7 to 624.

Results and conclusions:
The investigators found that the best estimate to date of the effect size of iodine supplementation on mental development in children 5 years old and under was 0.49, which translated into 7.4 IQ points lost due to iodine deficiency.

The investigators found 6.9 to 10.2 IQ points lower in iodine deficient children compared with iodine replete children.

The investigators concluded, regardless of study design, iodine deficiency has a substantial impact on mental development in children 5 years old and under. To further quantify the importance of iodine for mental development in young children, this review points to the need for well-designed randomized controlled trials with adequate sample sizes as well as studies that assess the effectiveness of iodized salt.

Original title:
Iodine and Mental Development of Children 5 Years Old and Under: A Systematic Review and Meta-Analysis by Bougma K, Aboud FE, […], Marquis GS.

Link:
http://www.mdpi.com/2072-6643/5/4/1384/htm

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Objectives:
The aim of this review article was to assess the relation between the level of habitual potassium intake and the incidence of cardiovascular disease (CVD).

Study design:
This review article included 15 cohort studies involving a total of 247510 male and female participants, 7,066 strokes, 3,058 coronary heart disease (CHD) events and 2,497 total CVD events.
The weighted average follow-up time was 12.2 years (range 5 to 19 years).
There was significant heterogeneity among studies in terms of sample size, duration of observation, number of events and difference in dietary potassium intake between the groups being compared. This heterogeneity led to a reduced statistical power in detecting a possible association between dietary potassium and coronary heart disease and cardiovascular disease.

There was no evidence of publication bias by the Egger test.

Potassium intake was assessed by 24-h dietary recall (n = 2), food frequency questionnaire (n = 6) or 24-h urinary excretion (n = 3).

Results and conclusions:
The investigators found in a pooled analysis, a dietary intake of 1.64g (42 mmol) potassium per day was significantly associated with a 21% lower risk of stroke [RR = 0.79, 95% CI = 0.68 to 0.90, p = 0.0007]. Significant means it can be said with a 95% confidence that a daily intake of 1.64g potassium really decreased the risk of having a stroke.

The investigators found a trend toward an inverse association between higher potassium intake (average weighted difference = 1.38g or 35.3 mmol/day) and risk of coronary heart disease [RR = 0.92, 95% CI = 0.81 to 1.04], which was not statistically significant [p = 0.18].
Not significant means it cannot be said with a 95% confidence that a daily intake of 1.38g potassium really decreased the risk of coronary heart disease with 8%. 

The investigators found a trend toward an inverse relationship between higher potassium intake (average weighted difference = 1.30g or 33.4 mmol/day) and cardiovascular disease risk [RR = 0.85, 95% CI = 0.62 to 1.16], which was not statistically significant [p = 0.31].

The investigators found a trend toward lower risk of CHD [RR = 0.93, 95% CI = 0.87 to 0.99, p = 0.03] and total CVD [RR = 0.74, 95% CI = 0.60 to 0.91, p = 0.0037] that attained statistical significance after the exclusion of a single cohort, based on sensitivity analysis.

The results of meta-regression analyses indicated that potassium intake difference, length of follow-up, quality score, recruitment year and population potassium intake at baseline were not significant sources of heterogeneity in the relationship of the potassium intake effect on the risk of CHD.

The results of meta-regression analyses indicated that the length of follow-up (coefficient: -0.064, 95% CI = -0.112 to -0.015, p = 0.01) and quality score (coefficient: -0.165, 95% CI = -0.287 to -0.043, p = 0.01) were significant sources of heterogeneity.

The investigators concluded that 1.64g dietary potassium per day decreases the risk of having a stroke and might also reduce the risk of coronary heart disease and total cardiovascular disease. This result applies to the general population, not only to specific subgroups at higher risk.
The favorable effects of dietary potassium were documented at least to some extent independently of other factors.
The results of this meta-analysis support recommendations for higher consumption of potassium-rich foods to prevent vascular diseases.

Original title:
Potassium Intake, Stroke, and Cardiovascular Disease : A Meta-Analysis of Prospective Studies by D'Elia L, Barba G, [...], Strazzullo P.

Link:
http://www.sciencedirect.com/science/article/pii/S0735109710049764

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The protective effect of potassium against the risk of stroke may conceivably relate to its blood pressure lowering effect.

Objectives:
There is no published systematic review and meta-analysis regarding the effect of olive oil consumption on cancer occurrence. Therefore, this review article has been conducted.

Does olive oil consumption reduce cancer risk?

Study design:
This review article included 19 case-control studies (13800 cancer patients and 23340 controls).

Random effects meta-analysis was applied in order to evaluate the research hypothesis.
Heterogeneity of the effect-size measures was observed in studies performed in the Mediterranean region (n = 15, p = 0.0002), whereas no heterogeneity was observed in non-Mediterranean studies (n = 4, p = 0.12).

Results and conclusions:
The investigators found when comparing with the lowest, the highest category of olive oil consumption was significantly associated with lower odds of having any type of cancer [log odds ratio = -0.41, 95% CI = -0.53 to -0.29, Cohran's Q = 47.52, p = 0.0002, I2 = 62%].

The investigators found both Mediterranean and non-Mediterranean people reported olive oil intake were less likely to have developed any type of cancer.

The investigators found olive oil consumption was significantly associated with lower odds of developing breast cancer [logOR = -0.4,  95% CI = -0.78 to -0.12] and a cancer of the digestive system [logOR = -0.36, 95% CI = -0.50 to -0.21] compared with the lowest intake.

The investigators concluded olive oil consumption probably reduces risk of any type of cancer, especially breast cancer and cancer of the digestive system. Probably, because this review article only included case-control studies and there was heterogeneity.
The reduced risk is similar to studies performed in Mediterranean as well as non-Mediterranean countries. However, it is still unclear whether olive oil's monounsaturated fatty acid content or its antioxidant components are responsible for its beneficial effects.

Original title:
Olive oil intake is inversely related to cancer prevalence: a systematic review and a meta-analysis of 13800 patients and 23340 controls in 19 observational studies by Psaltopoulou T, Kosti RI, […], Panagiotakos DB.

Link:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3199852/

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