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Comparison and Effectiveness of Behavioral Cardiovascular Interventions in High Risk Latinos

Background:

Cardiovascular disease (CVD) is the leading cause of death among Latinos. The use of promotoras, in conjunction with interpersonal and printed nutrition and exercise information can aid in healthy changes in Spanish speaking communities.8 Designing and delivering culturally appropriate interventions are critical for behavioral and nutritional success of Latinos.

Objective:

This literature review will provide information of the evidence-based behavioral intervention strategies developed for and tested with Latinos in order to inform clinicians of options for supporting improved cardiovascular outcomes in high risk Latinos.

Methods:

A literature search was performed in Pubmed that generated 110 RCT initial studies, four of which met the inclusion criteria after assessment for eligibility based on the following criteria: behavioral lifestyle intervention study, more than 1 CVD risk factor, biological outcomes reported (BP, Cholesterol, LDL, HDL, BMI and others), greater than 18 years old, and sample with 30% greater Hispanics.

Results:

All the studies used promotoras to deliver culturally appropriate interventions that combined nutritional and physical activity classes, walking routes and/or support groups. Hayashi et al showed statistically significant intervention effects, for reduce systolic blood pressure, 10-year CHD Risk score and an increase in physical activity (p<0.05). The reduction was by 6 points, making nutritional and physical counseling clinically relevant to potential reduction in blood pressure and improving CVD in Latinos. Furthermore, Balcazar et al demonstrated a reduction in the intervention’s cholesterol levels compared to the control group (p<0.05).  Most studies demonstrated no significant changes in LDL, HDL or BMI.

Conclusion:

This literature review provides initial evidence that culturally appropriate interventions such as using promotoras, bilingual materials/classes, appropriate cultural diet, exercise modifications and establishing a social support network provides potentially efficacious strategies for cardiovascular improvement in high risk Latinas.

Eicosapentaenoic Acid Enriched Enteral Nutrition Improves Lean Body Mass in Esophageal, Head and Neck Cancer Patients

OBJECTIVE: Cachexia is a nutrient deficient condition affecting millions of cancer patients. Cancers of the upper gastrointestinal tract, head and neck are often the most severely affected. Currently, there is no established therapy for cachexia, although several potential anti-cachectic agents are being explored. A meta-analysis was conducted to review the effect of eicosapentaenoic acid (EPA) enriched enteral nutrition on lean body mass (LBM) in esophageal, head and neck cancer patients at risk for progression of cachexia.

METHODS: An evidence based review was conducted beginning with a Pubmed database literature search using the terms ‘EPA esophageal cancer’, ‘Eicosapentaenoic acid esophageal cachexia’, ‘Eicosapentaenoic acid esophageal’, ‘Eicosapentaenoic acid cachexia head and neck cancer’, and ‘EPA cachexia head and neck cancer’ for human clinical trials. The results were reviewed for relevance and the data from original research was abstracted for amount of EPA enriched formula supplemented, EPA intake, method of intake, LBM measurements, study design, intervention duration, and population characteristics.

RESULTS: Three trials were identified that met the criteria and were reviewed.  EPA supplementation in enteral nutrition was provided at concentrations ranging between 1.6 g/day and 2.2 g/day for a time span ranging between 3 weeks and 14 weeks. Two randomized clinical trials showed maintenance of > 1.5 kg LBM relative to the control group while a single arm trial showed a gain of 3.2 kg LBM in patients. Differences in results could be attributed to variability in the degree of cachexia, the contents of each enteral nutrition formula, duration of supplementation, and cancer treatments that subjects in each trial were undergoing.

CONCLUSIONS: All three trials showed a trend in EPA enriched enteral nutrition improving the loss of LBM in esophageal, head and neck cancer patients at risk for cachexia progression. This type of formula should therefore be considered in treatment of these types of cancers and possibly, in the treatment of other seriously ill patients with cachexia.

You Are What You Eat: RCTs show a low glycemic index diet improves facial acne

An evidence-based literature review was conducted in order to identify human clinical trials that assess the effect of a low glycemic index diet on facial acne severity (Acne vulgaris). Of the twenty-one studies identified, three met the inclusion criteria of randomized-controlled clinical trials (RCTs) with a primary endpoint of changes in number and severity of acne lesions and were included for final analysis.7-9 During the trials, mean glycemic load in control groups ranged from 157 to 207, and mean glycemic load in intervention groups ranged from 102 to 130. In two studies, improvement in acne severity at the end of the trial between the control and intervention groups reached significance. In one trial, the difference between the two groups did not reach significance, however, the intervention group experienced a much greater magnitude of facial acne improvement than the control group. The results of this systematic review of RCTs strongly indicate that a low glycemic index diet improves the severity of facial acne.

Ingestion of monosodium glutamate (MSG) in adult male rats reduces sperm count, testosterone, and disrupts testicular histology

Objective: Monosodium glutamate (MSG) is a widely used food additive with controversial side effects. Though neonatal administration of MSG has been shown to affect fertility via arcuate nucleus ablation, the body of work involving the effects of adult MSG administration on male rat fertility has yet to be collectively assessed.

Design: Systematic review.

Methods: A PubMed search using terms “monosodium glutamate” in addition to “male fertility” or “male reproduction” or “sperm” or “testes” was performed. Inclusion criteria included: English language, adult administration of MSG, male reproductive outcomes, and control groups. Additional studies were identified via reference lists of relevant articles.

Results: Of 167 records originally identified, six studies remained after removal of duplicates and studies not meeting inclusion criteria. Data ranges included: cohort sizes of 24 – 32 animals, dosing from 0 to 4 g/kg, MSG administration duration of 10 – 56 days, and weight 75 – 200g. In MSG fed rats compared to controls: Sperm count was lower in three of four studies, serum testosterone concentration was lower in two of two studies, testicular component weights or size was decreased in two of three studies, and abnormal testicular and sperm histology was observed in five of six studies.

Conclusion: Adult intake of MSG can negatively impact sperm count and serum testosterone concentrations as well as testicular morphology and histology in rats. Further investigation of this effect should be evaluated in humans for such a popular flavor enhancer.