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    <recommendedItem id="20100101_19_440"
                     title="Soft Drinks Linked to Pancreatic Cancer Risk (CME/CE)"
                     score="0.015"
                     href="http://www.medpagetoday.com/HematologyOncology/OtherCancers/tb/18354?impressionId=1265783343945"
                     
      &lt;p&gt;Regular consumers of sugary soft drinks are at higher risk for pancreatic cancer than fruit juice drinkers or the general population, a new Singaporean study has found.&lt;/p&gt;
&lt;p&gt;Chinese men and women living in Singapore who drank two or more soft drinks per week were 87% more likely to contract pancreatic cancer after the researchers adjusted for factors such as smoking (95% CI 1.10 to 3.15), according to the report published Feb. 8 in &lt;em&gt;Cancer Epidemiology, Biomarkers &amp;amp; Prevention.&lt;/em&gt;&lt;/p&gt;
&lt;p&gt;&quot;In this large prospective cohort of Chinese men and women in Singapore, those who reported regular soft drink consumption were at increased risk of pancreatic cancer when compared with those who largely abstained,&quot; Mark Pereira, PhD, of the School of Public Health at the University of Minnesota, and colleagues wrote. &quot;There was no association between consumption of juice and risk of pancreatic cancer.&quot;&lt;/p&gt;
&lt;p&gt;While pancreatic cancer is relatively rare, it is one of the most deadly cancers, with less than 5% of patients surviving five years after diagnosis. Although rates have generally plateaued in the U.S., they continue to climb in some Asian countries, including Singapore.&lt;/p&gt;
&lt;p&gt;&quot;This increase may reflect demographic and socioeconomic shifts as well as a transition towards a more westernized lifestyle and diet,&quot; the authors wrote.&lt;/p&gt;
&lt;p&gt;Research has shown that insulin promotes pancreatic cancer cell growth, and some researchers think sugary foods could result in blood sugar and insulin fluctuations that expose the pancreas to high concentrations of insulin.&lt;/p&gt;
&lt;p&gt;While fruit juices contain sugar, soft drinks are the major sources of added sugar in the U.S. diet and major contributors to hyperglycemia and hyperinsulinemia.&lt;/p&gt;
&lt;p&gt;Pereira and colleagues followed 60,524 men and women who enrolled in the Singapore Chinese Health Study between April 1993 and December 1998 and were followed for 14 years.&lt;/p&gt;
&lt;p&gt;At enrollment, the participants completed a 146-question food frequency questionnaire, which contained three items related to soft drinks and juice. The questions asked the participants how much, if any, they drank of soft drinks such as Coca-Cola and 7-Up, orange juice, and other fruit and vegetable juices.&lt;/p&gt;
&lt;p&gt;The dietary data was later cross-referenced with records from the Singapore Cancer Registry and the Singapore Registry of Births and Deaths, to determine which of the participants had died of pancreatic cancer and whether it might be related to their soft drink or juice consumption.&lt;/p&gt;
&lt;p&gt;Overall, researchers found that 140 participants had contracted pancreatic cancer.&lt;/p&gt;
&lt;p&gt;The results were largely consistent with three of four previous U.S. studies on the links between pancreatic cancer and soft drinks. Three of the U.S. studies found an association between soft drinks and cancer.&lt;/p&gt;
&lt;p&gt;The author acknowledged that soft drink consumers are more likely than abstainers to participate in other unhealthy behaviors, including smoking and overeating, which makes it difficult to determine that soft drink consumption is an independent risk factor for pancreatic cancer.&lt;/p&gt;
&lt;p&gt;For instance, smokers in their study were at higher risk for pancreatic cancer. &quot;We could not rule out the possibility of residual confounding by factors associated with the habit of drinking soft drinks or other unascertained factors such as waist circumference,&quot; they wrote.&lt;/p&gt;
&lt;p&gt;They also noted that the study was limited in statistical power because pancreatic cancer is rare, which limited the sample size of cancer cases. &quot;Also, because we were unable to collect repeated dietary measurements in this study, we were unable to account for changes in consumption of soft drinks and juices,&quot; they wrote, &quot;especially when the diagnosis of diabetes occurred after the baseline interview.&quot;&lt;/p&gt;
&lt;p&gt;&lt;em&gt; &lt;/em&gt;&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 funded by the National Cancer Institute.&lt;/p&gt;&lt;p&gt;The authors reported no financial conflicts of interest.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_279"
                     title="Low-Carb Diet Edges Low Fat Plus Weight-Loss Drug (CME/CE)"
                     score="0.004"
                     href="http://www.medpagetoday.com/PrimaryCare/DietNutrition/tb/18131?impressionId=1265783343945"
                     
      Weight loss was the same and blood pressure control was more effective with a low-carbohydrate diet than a low-fat regimen supplemented by the diet drug orlistat (Xenical, Alli), a randomized trial found.&lt;br&gt;
&lt;br&gt;Among 146 overweight or obese outpatients, both treatment plans led to weight loss of about 10% after 48 weeks, with similar improvements in glycemic and blood lipid measures, according to William S. Yancy Jr., MD, MHS, of Duke University, and colleagues.&lt;br&gt;
&lt;br&gt;But mean systolic and diastolic blood pressure declined by 5.9 and 4.5 mm Hg, respectively, in the low-carb diet compared with a slight increase in patients on the low-fat diet plus orlistat (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.001 for both measures), the researchers reported in the Jan. 25 issue of &lt;em&gt;Archives of Internal Medicine&lt;/em&gt;.&lt;br&gt;
&lt;br&gt;Both interventions also included small-group sessions with a dietitian every two weeks for the first six months. Yancy and colleagues indicated that participants with the best attendance at these meetings seemed to benefit the most.&lt;p&gt;&lt;/p&gt;
&lt;p&gt;Mean weight loss was 14% to 15% among participants who attended at least 80% of the sessions.&lt;/p&gt;
&lt;p&gt;This latter finding &quot;may indicate the usefulness of these sessions, signify motivated participants, or both,&quot; the researchers wrote.&lt;/p&gt;
&lt;p&gt;&quot;How to identify these select individuals [with high attendance] a priori and how to move more individuals into this category is vital to reversing the obesity epidemic,&quot; they added.&lt;/p&gt;
&lt;p&gt;Yancy and colleagues indicated that the study was the first head-to-head, randomized trial comparing a low-carb diet with a low fat regimen plus orlistat (now readily available over-the-counter).&lt;/p&gt;
&lt;p&gt;Participants were recruited from outpatient clinics attached to the VA Medical Center in Durham. Their mean age was 52 and they had a mean body mass index of 39.3. Only slightly more than one-quarter of patients in each group were women.&lt;/p&gt;
&lt;p&gt;Low-carb dieters could eat as much meat and eggs as they liked, along with up to 112 g of hard cheese, 0.48 L of leafy greens and other low-carbohydrate vegetables, and half as much in other vegetables such as asparagus and broccoli. There was no specific caloric limit.&lt;/p&gt;
&lt;p&gt;Participants assigned to the low-fat diet were told to keep total fat to less than 30% of total caloric content and saturated fat less than 10%.&lt;/p&gt;
&lt;p&gt;Cholesterol intake was to be less than 300 mg/day. Patients in this group were encouraged to reduce total caloric intake by 500 to 1,000 kcal less than the estimated weight-maintenance level. Pocket guides, handouts, and individual assistance were provided to help patients meet these goals.&lt;/p&gt;
&lt;p&gt;Patients in the low-fat group also received orlistat at 120 mg before meals three times daily.&lt;/p&gt;
&lt;p&gt;Mean weight loss with the low-fat diet plus orlistat after 48 weeks was 8.5%, compared with 9.5% in the low-carb diet group (&lt;em&gt;P&lt;/em&gt;=0.60), Yancy and colleagues reported.&lt;/p&gt;
&lt;p&gt;Body weight in kilograms and waist circumference also declined slightly more with the low-carb diet but, again, the difference was not statistically significant.&lt;/p&gt;
&lt;p&gt;Total cholesterol declined by an average of 8.9 mg/dL with the low-fat diet plus orlistat, versus a decrease of 3.8 mg/dL in the low-carb group (&lt;em&gt;P&lt;/em&gt;=0.29). A similar but also nonsignificant difference was seen in LDL cholesterol. Triglyceride levels actually declined more with the low-carb diet but that, too, was not statistically significant.&lt;/p&gt;
&lt;p&gt;A nonsignificant trend was also seen for the low-carb diet to be associated with greater improvements in fasting glucose, fasting insulin, and glycated hemoglobin levels.&lt;/p&gt;
&lt;p&gt;The sole significant difference between outcomes, apart from blood pressure, was in serum urea nitrogen, which increased by a mean of 3.19 mg/dL with the low-carb diet and by 1.23 mg/dL with low fat plus orlistat (&lt;em&gt;P&lt;/em&gt;=0.01).&lt;/p&gt;
&lt;p&gt;Both diets appeared to be successful in terms of adherence, on average. Those on the low-fat diet cut their saturated fat intake by half and total fat by 40%. Participants assigned to the low-carb diet reduced their mean daily carbohydrate intake from 262 g/day at baseline to just 62 g/day at their final evaluation at week 48.&lt;/p&gt;
&lt;p&gt;Total caloric intake declined by 29% in each group from baseline.&lt;/p&gt;
&lt;p&gt;Yancy and colleagues noted that participants were not paid or given food or access to exercise facilities. &quot;Our goal was to design the interventions so that they closely mimicked a weight-loss program that could be instituted in an outpatient clinic,&quot; they wrote.&lt;/p&gt;
&lt;p&gt;But in an accompanying editorial, Robert F. Kushner, MD, of Northwestern University in Chicago, questioned whether either regimen was truly practical in ordinary practice.&lt;/p&gt;
&lt;p&gt;In particular, he pointed to the apparently considerable role of the dietitian-led counseling sessions. Currently, he noted, such sessions &quot;are not a covered benefit by most health plans for the treatment of obesity and most primary care practice offices do not have the resources to conduct group sessions.&quot;&lt;/p&gt;
&lt;p&gt;Kushner also observed that primary care physicians were not directly involved in the treatment plans.&lt;/p&gt;
&lt;p&gt;He suggested that more emphasis should be placed on engaging and empowering primary care physicians in treating obesity.&lt;/p&gt;
&lt;p&gt;&quot;Healthcare reform and training is needed to allow primary care physicians to tackle the obesity crisis,&quot; Kushner wrote.&lt;/p&gt;
&lt;p&gt;One limitation to the study, the authors noted, was that patients were not charged for orlistat. &quot;This could have increased dietary adherence, group session attendance, and/or participant retention compared with the [low-carb diet],&quot; they wrote.&lt;/p&gt;
&lt;p&gt;Another limitation was the lack of blinding in the study, they said.&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;Funding for the study came from the Department of Veterans Affairs.&lt;/p&gt;&lt;p&gt;Yancy and another study author have received research funding from the Robert C. Atkins Foundation. Atkins developed the low-carbohydrate diet program that bears his name. No other potential conflicts of interest were reported by study authors or Kushner.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20090101_10_129"
                     title="Link Between Fructose Consumption in Mice and Weight Gain"
                     score="-0.005"
                     href="