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    <recommendedItem id="20100101_19_431"
                     title="Down a Beer to Improve Bone Health? Not So Fast"
                     score="0.012"
                     href="http://www.medpagetoday.com/PrimaryCare/DietNutrition/tb/18347?impressionId=1265740038790"
                     
      &lt;p&gt;A flagon of ale may indeed be a good source of dietary silicon, a recent study showed, but experts say any attempt to link beer drinking to bone health is not based on scientific data.&lt;/p&gt;
&lt;p&gt;The study of 100 commercial beers in the February issue of the &lt;em&gt;Journal of the Science of Food and Agriculture&lt;/em&gt;, by Charles Bamforth, PhD, DSc, and Troy Casey, of the University of California Davis, examined the silicon content that results from different ingredients and brewing processes.&lt;/p&gt;
&lt;p&gt;Although a press release issued with the study prominently mentioned the link between silicon and bone health, the study itself did not look at bone mineral density or analyze any patient data at all, according to several researchers contacted by &lt;em&gt;MedPage Today&lt;/em&gt; and ABC News.&lt;/p&gt;
&lt;p&gt;The authors wrote that they explored the silicon content in beer because the popular beverage has been identified as one of the richest potential sources of dietary silicon in the Western diet. The average intake is 20 to 50 mg/day.&lt;/p&gt;
&lt;p&gt;The beers sampled contained an average of 29.4 mg/L of silicon, with a range of 6.4 to 56.4 mg/L. Beers made from a barley-based grist (as opposed to wheat-based beers ) and brews containing more hops had the highest silicon levels.&lt;/p&gt;
&lt;p&gt;The beer type with the overall highest silicon level was India Pale Ale, with an average of 41.2 mg/L. Other ales came in second with 32.8 mg/L.&lt;/p&gt;
&lt;p&gt;Nonalcoholic beers, light lagers, and wheat beers had the least silicon.&lt;/p&gt;
&lt;p&gt;In the end, the authors concluded that &quot;beer is a substantial source of silicon in the diet&quot; and that &quot;beers containing high levels of malted barley and hops are richest in silicon,&quot; but they did not attempt to establish a link between beer drinking and bone health.&lt;/p&gt;
&lt;p&gt;Experts contacted for comment on the study also cautioned the public against establishing any such connection.&lt;/p&gt;
&lt;p&gt;&quot;To conclude any bone health benefits from this study would require a great leap,&quot; Tim Byers, MD, MPH, deputy director of the University of Colorado Cancer Center in Aurora, wrote in an e-mail.&lt;/p&gt;
&lt;p&gt;Other researchers noted that previous studies have shown an association between alcohol consumption and an increased risk of fracture.&lt;/p&gt;
&lt;p&gt;That&apos;s probably because of a greater chance of falling after drinking, according to Walter Willett, MD, DrPH, of the Harvard School of Public Health.&lt;/p&gt;
&lt;p&gt;In fact, Stephen Richardson, MD, an endocrinologist at NYU Langone Medical Center, noted that &quot;alcohol consumption is a risk factor for osteoporosis.&quot;&lt;/p&gt;
&lt;p&gt;Still, there is some evidence supporting a positive link between overall dietary silicon and bone health.&lt;/p&gt;
&lt;p&gt;A 2004 cross-sectional study in the &lt;em&gt;Journal of Bone and Mineral Research&lt;/em&gt; that used data from the Framingham Offspring cohort found a significant association between greater dietary silicon intake, including that from beer, and higher bone mineral density in the hip in men and premenopausal women.&lt;/p&gt;
&lt;p&gt;The researchers concluded: &quot;These findings suggest that higher dietary silicon intake in men and younger women may have salutary effects on skeletal health, especially cortical bone health, that has not been previously recognized.&quot;&lt;/p&gt;
&lt;p&gt;Another study by the same group published last year in the &lt;em&gt;American Journal of Clinical Nutrition&lt;/em&gt; found that moderate consumption of alcohol, including beer, wine, and liquor, was associated with higher bone mineral density in men and postmenopausal women.&lt;/p&gt;
&lt;p&gt;However, it also showed that men who drank too much liquor were more likely to have lower spine and hip bone mineral density.&lt;/p&gt;
&lt;p&gt;The relationship between beer and bone mineral density appeared to be mediated by silicon, the researchers concluded.&lt;/p&gt;
&lt;p&gt;Bottom line: considering the increased fracture risk and the various other problems associated with drinking too much alcohol, experts agree that guzzling beer is not strategy for improving bone health.&lt;/p&gt;
&lt;p&gt;&quot;In the absence of bone density values or preferably fracture incidence, it would be premature to tout beer as a preventative or treatment,&quot; Richardson said.&lt;/p&gt;
&lt;p&gt;David Katz, MD, MPH, of the Yale School of Public Health, agreed.&lt;/p&gt;
&lt;p&gt;&quot;This is NOT a reason to drink beer,&quot; he said in an e-mail. &quot;This is simply a bit of good news for those who do drink beer already  --  yours truly among them!&quot;&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The authors did not make any financial disclosures.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;&lt;p&gt;&lt;em&gt;This article was developed in collaboration with ABC News. &lt;/em&gt;&lt;img src=&quot;http://www.medpagetoday.com/upload/2009/10/1/14357_1.jpg&quot; mce_src=&quot;http://www.medpagetoday.com/upload/2009/10/1/14357_1.jpg&quot; alt=&quot;&quot;&gt;&lt;/p&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_235"
                     title="Congenital Anomalies Linked to Mom&apos;s Diabetes (CME/CE)"
                     score="-0.002"
                     href="http://www.medpagetoday.com/OBGYN/Pregnancy/tb/18065?impressionId=1265740038790"
                     
      &lt;p&gt;Pregestational maternal diabetes was associated with an increased risk of a major congenital anomaly, but obesity itself was not, a cross-sectional study found.&lt;/p&gt;
&lt;p&gt;In a multivariable logistic model, the major contributor to a rising rate of congenital anomalies was maternal pregestational diabetes (OR 3.8, 95% CI 2.1 to 6.6), according to Joseph R. Biggio, Jr., MD, and colleagues from the University of Alabama at Birmingham.&lt;/p&gt;
&lt;p&gt;&quot;Because hyperglycemia is a major contributor to developmental malformations, interventions to address obesity and identify women at risk for diabetes and hyperglycemia should be considered in efforts to reduce the occurrence of congenital anomalies,&quot; they wrote in the February issue of &lt;em&gt;Obstetrics &amp;amp; Gynecology.&lt;/em&gt;&lt;/p&gt;
&lt;p&gt;Maternal obesity has been linked with numerous problems, including preeclampsia, gestational diabetes, fetal and neonatal death, and birth trauma, but scientists have disagreed over whether it also contributes to the risk of fetal malformations, the researchers noted.&lt;/p&gt;
&lt;p&gt;To help settle the issue, Biggio and colleagues used a perinatal database in their university health system that included all women with singletons delivered between 1991 and 2004.&lt;/p&gt;
&lt;p&gt;They divided the cohort into three time periods  --  1991 to 1994, 1995 to 1999, and 2000 to 2004, with a total of 41,902 pregnancies.&lt;/p&gt;
&lt;p&gt;For their primary analysis, they defined maternal obesity as a first prenatal visit weight greater than 200 lb, because during the earlier epochs many women did not have body mass index (BMI) calculated. For their secondary analyses they used BMI greater than 29 kg/m&lt;sup&gt;2&lt;/sup&gt; as the criterion for obesity.&lt;/p&gt;
&lt;p&gt;In each epoch, there were increases in mean maternal weight, mean BMI, the proportion of women weighing more than 200 lb, the proportion with a BMI greater than 29 kg/m&lt;sup&gt;2&lt;/sup&gt;, and the prevalence of pregestational diabetes (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.001 for all).&lt;/p&gt;
&lt;p&gt;Univariable analysis determined that the rate of major anomalies, particularly involving the cardiac and pulmonary systems, also increased during each time period.&lt;/p&gt;
&lt;p&gt;But there was no independent association between congenital anomalies and maternal obesity using either definition, during any of the three time periods or during the study overall.&lt;/p&gt;
&lt;p&gt;Although no direct association was seen between congenital malformations and maternal obesity, the investigators reported that the proportion of anomalies that could be attributed to obesity increased from 0% to 23% during the overall study period.&lt;/p&gt;
&lt;p&gt;The proportion of anomalies that could be attributed to diabetes ranged from 58% to 76%.&lt;/p&gt;
&lt;p&gt;Moreover, for obese women with diabetes the proportion of anomalies attributed to diabetes increased sharply, from 48% in the first epoch to 74% in the third epoch.&lt;/p&gt;
&lt;p&gt;In contrast, for the obstetric population as a whole, the population-attributable risk of congenital malformation related to obesity rose from near zero in the first epoch to 6.1% in the third epoch, while that related to diabetes increased from 3.3% to 9.2%, the investigators reported.&lt;/p&gt;
&lt;p&gt;During the course of the study there was a nearly 15-lb increase in maternal weight and a 30% increase in the proportion of women whose BMI exceeded 29 kg/m&lt;sup&gt;2&lt;/sup&gt;.&lt;/p&gt;
&lt;p&gt;There also was a nearly twofold increase in the rate of major anomalies  --  and a 250% increase in the prevalence of diabetes.&lt;/p&gt;
&lt;p&gt;The authors observed that there has been much interest in the effects of maternal obesity on birth defects.&lt;/p&gt;
&lt;p&gt;Although the pathophysiologic basis for this possible association have not been identified, hypotheses have included increased serum insulin, lower levels of folic acid, chronic hypoxia, and increased inflammatory mediators.&lt;/p&gt;
&lt;p&gt;&quot;Our study provides evidence that the defects may not be due solely to the maternal obesity per se but may be due to undiagnosed diabetes,&quot; the investigators wrote.&lt;/p&gt;
&lt;p&gt;From a public health standpoint, the study findings suggest that efforts to reduce the prevalence of congenital anomalies should be focused less on obesity and aimed more closely at correcting hyperglycemia.&lt;/p&gt;
&lt;p&gt;&quot;If euglycemia could be achieved before pregnancy, or at least embryogenesis and organogenesis, the majority of these anomalies could potentially be avoided,&quot; they observed.&lt;/p&gt;
&lt;p&gt;They also suggested that even women of normal weight, but with other diabetes risk factors, could benefit from closer attention to glycemic control.&lt;/p&gt;
&lt;p&gt;A weakness of the study was the fact that detailed data on glycemic control was not available in the perinatal database, &quot;and therefore we cannot comment on the association between glycemic control and anomaly rates,&quot; the investigators wrote.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The study was supported in part by the National Institute of Child Health and Human Development.&lt;/p&gt;&lt;p&gt;The authors did not report any potential conflicts of interest.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20090101_1_231"
                     title="Vitamin D Supplements in Utero Linked to Better Pediatric Bones"
                     score="-0.005"
                     href="