Nut Consumption and Survival in Patients With Stage III Colon Cancer: Results From CALGB 89803 (Alliance) Prospective study of nut consumption, long-term weight change, and obesity risk in women. Soy Consumption, Markers of Inflammation, and Endothelial Function Nut Consumption in Relation to Cardiovascular Disease Incidence and Mortality Among Patients With Diabetes Mellitus Impact of a home-based activity and dietary intervention in people with slowly progressive neuromuscular diseases. Design and methods for testing a simple dietary message to improve weight loss and dietary quality The 2015 Dutch food-based dietary guidelines Non-alcoholic fatty liver disease in the Asia-Pacific region: definitions and overview of proposed guidelines. Effects of a Mediterranean-Style Diet on Cardiovascular Risk Factors Metformin versus dietary treatment in nonalcoholic hepatic steatosis: a randomized study Pistachio Nut Consumption and Serum Lipid Levels The introduction of allergenic foods and the development of reported wheezing and eczema in childhood: the Generation R study. Postprandial oxidative stress is modified by dietary fat: evidence from a human intervention study. Sentinel lymph node biopsy for patients with early-stage breast cancer: American Society of Clinical Oncology clinical practice guideline update. British Dietetic Association evidence-based guidelines for the dietary management of irritable bowel syndrome in adults. AN INVESTIGATION OF POLLEN EXTRACTS FROM DIFFERENT DECIDUOUS TREES IN PATIENTS WITH SPRINGTIME ALLERGY IN SWEDEN The non-effect of pirenzepine in dietary resistant irritable bowel syndrome Current definitions of acute lung injury and the acute respiratory distress syndrome do not reflect their true severity and outcome Prospective study of peripregnancy consumption of peanuts or tree nuts by mothers and the risk of peanut or tree nut allergy in their offspring. Association of 1-y changes in diet pattern with cardiovascular disease risk factors and adipokines: results from the 1-y randomized Oslo Diet and Exercise Study. Effects of adjunctive exercise on physiological and psychological parameters in depression: a randomized pilot trial. Effect of fixed‐dose combinations of ezetimibe plus rosuvastatin in patients with primary hypercholesterolemia: MRS‐ROZE (Multicenter Randomized Study of ROsuvastatin and eZEtimibe) Multicenter Study of Repeat Epinephrine Treatments for Food-Related Anaphylaxis
Purpose Observational studies have reported increased colon cancer recurrence and mortality in patients with states of hyperinsulinemia , including type 2 diabetes , obesity , sedentary lifestyle , and high glycemic load diet . Nut intake has been associated with a lower risk of type 2 diabetes , metabolic syndrome , and insulin resistance . However , the effect of nut intake on colon cancer recurrence and survival is not known . Patients and Methods We conducted a prospect i ve , observational study of 826 eligible patients with stage III colon cancer who reported dietary intake on food frequency question naires while enrolled onto a r and omized adjuvant chemotherapy trial .  Using Cox proportional hazards regression , we assessed associations of nut intake with cancer recurrence and mortality . Results After a median follow-up of 6.5 years , compared with patients who abstained from nuts , individuals who consumed two or more servings of nuts per week experienced an adjusted hazard ratio ( HR ) for disease-free survival of 0.58 ( 95 % CI , 0.37 to 0.92 ; Ptrend = .03 ) and an HR for overall survival of 0.43 ( 95 % CI , 0.25 to 0.74 ; Ptrend = .01 ) . In subgroup analysis , the apparent benefit was confined to  tree nut intake ( HR for disease-free survival , 0.54 ; 95 % CI , 0.34 to 0.85 ; Ptrend = .04 ; and HR for overall survival , 0.47 ; 95 % CI , 0.27 to 0.82 ; Ptrend = .04 ) . The association of total nut intake with improved outcomes was maintained across other known or suspected risk factors for cancer recurrence and mortality . Conclusion Diets with a higher consumption of nuts may be associated with a significantly reduced incidence of cancer recurrence and death in patients with stage III colon cancer BACKGROUND Data concerning the long-term association between nut consumption and weight change in a free-living population are sparse . OBJECTIVE The objective was to determine the relation between nut consumption and long-term weight change . DESIGN The participants were 51,188 women in the Nurses ' Health Study II aged 20 - 45 y , who had no cardiovascular disease , diabetes , or cancer . We prospect ively evaluated the dietary intake of nuts and subsequent weight changes from 1991 to 1999 . RESULTS Women who reported eating nuts > or = 2 times/wk had slightly less mean ( + /- SE ) weight gain ( 5.04 + /- 0.12 kg ) than did women who rarely ate nuts ( 5.55 + /- 0.04 kg ) ( P for trend < 0.001 ) . For the same comparison , when total nut consumption was subdivided into peanuts and tree nuts , the results were similar ( ie , less weight gain in women eating either peanuts or tree nuts > or = 2 times/wk ) . The results were similar in normal-weight , overweight , and obese participants . In multivariate analyses in which lifestyle and other dietary factors were controlled for , we found that greater nut consumption ( > or = 2 times/wk compared with never/almost never ) was associated with a slightly lower risk of obesity ( hazard ratio : 0.77 ; 95 % CI : 0.57 , 1.02 ; P for trend = 0.003 ) . CONCLUSIONS Higher nut consumption was not associated with greater body weight gain during 8 y of follow-up in healthy middle-aged women . Instead , it was associated with a slightly lower risk of weight gain and obesity . The results of this study suggest that incorporating nuts into diets does not lead to greater weight gain and may help weight control OBJECTIVE —To determine the effects of soy consumption on markers of inflammation and endothelial function in postmenopausal women with the metabolic syndrome . RESEARCH DESIGN AND METHODS —This r and omized cross-over clinical trial included 42 postmenopausal women with the metabolic syndrome . Participants were r and omly assigned to consume a control diet ( Dietary Approaches to Stop Hypertension [ DASH ] ) , soy protein diet , or soy nut diet , each for 8 weeks . Red meat in the DASH diet ( one serving/day ) was replaced by soy protein in the soy protein diet and by soy nut in the soy nut diet . RESULTS —For nitric oxide levels , the difference from the control diet was 9.8 % ( P < 0.01 ) on the soy nut and −1.7 % ( P = 0.10 ) on the soy protein diets . The difference from the control diet for serum E-selectin was −11.4 % ( P < 0.01 ) on the soy nut consumption and −4.7 % ( P = 0.19 ) on the soy protein diet . Soy nut consumption reduced interleukin-18 compared with the control diet ( difference from the control diet : −9.2 % , P < 0.01 ) , but soy protein did not ( difference from the control diet : −4.6 % , P = 0.14 ) . For C-reactive protein , the difference from the control diet was −8.9 % ( P < 0.01 ) on the soy nut diet and −1.6 % ( P < 0.01 ) on the soy protein diet . CONCLUSIONS —Short-term soy nut consumption reduced some markers of inflammation and increased plasma nitric oxide levels in postmenopausal women with the metabolic syndrome Rationale : The evidence regarding the potential health benefits of nut consumption among individuals with type 2 diabetes mellitus is limited . Objective : To examine intake of total and specific types of nuts , including tree nuts and peanuts , in relation to subsequent risk of cardiovascular disease ( CVD ) , including coronary heart disease and stroke , and all-cause and cause-specific mortality among individuals with diabetes mellitus . Methods and Results : This prospect i ve analysis included 16 217 men and women with diabetes mellitus at baseline or diagnosed during follow-up ( Nurses ’ Health Study : 1980–2014 , Health Professionals Follow-Up Study : 1986–2014 ) .  Nut consumption was assessed using a vali date d food frequency question naire and up date d every 2 to 4 years . During 223 682 and 254 923 person-years of follow-up , there were 3336 incident CVD cases and 5682 deaths , respectively . Higher total nut consumption was associated with a lower risk of CVD incidence and mortality . The multivariate-adjusted hazard ratios ( 95 % CIs ) for participants who consumed 5 or more servings of total nuts per week ( 1 serving=28 g ) , compared with those who consumed < 1 serving per month , were 0.83 ( 0.71–0.98 ; P trend=0.01 ) for total CVD incidence , 0.80 ( 0.67–0.96 ; P trend=0.005 ) for coronary heart disease incidence , 0.66 ( 0.52–0.84 ; P trend < 0.001 ) for CVD mortality , and 0.69 ( 0.61–0.77 ; P trend < 0.001 ) for all-cause mortality .  Total nut consumption was not significantly associated with risk of stroke incidence or cancer mortality . For specific types of nuts , higher tree nut consumption was associated with lower risk of total CVD , coronary heart disease incidence , and mortality because of CVD , cancer , and all causes , whereas peanut consumption was associated with lower all-cause mortality only ( all P trend < 0.001 ) . In addition , compared with participants who did not change the consumption of total nuts from pre- to post-diabetes mellitus diagnosis , participants who increased consumption of total nuts after diabetes mellitus diagnosis had an 11 % lower risk of CVD , a 15 % lower coronary heart disease risk , a 25 % lower CVD mortality , and a 27 % lower all-cause mortality . The associations persisted in subgroup analyses stratified by sex/cohort , body mass index at diabetes mellitus diagnosis , smoking status , diabetes mellitus duration , nut consumption before diabetes mellitus diagnosis , or diet quality . Conclusions : Higher consumption of nuts , especially tree nuts , is associated with lower CVD incidence and mortality among participants with diabetes mellitus . These data provide novel evidence that supports the recommendation of incorporating nuts into healthy dietary patterns for the prevention of CVD complications and premature deaths among individuals with diabetes mellitus OBJECTIVE To determine whether a home-based activity and dietary intervention can increase activity level , reduce caloric intake , and impact positively components of metabolic syndrome  in a disabled population . DESIGN Testing occurred at 3 points during the 6-month intervention period ( baseline , 3mo , 6mo ) and at 6 months postintervention . Each test point included laboratory testing of anthropometric and metabolic variables and 3 days of home-based activity and dietary monitoring . A personally tailored activity and dietary prescription based on baseline testing was implemented during the 6-month intervention period . SETTING Human performance laboratory of a university and each subject 's home . PARTICIPANTS Twenty adult volunteer ambulatory subjects with several types of slowly progressive neuromuscular disease ( NMD ) . INTERVENTION Using a pedometer , subjects were instructed to increase number of steps by 25 % over their baseline determined from home monitoring . An individualized dietary prescription was provided focusing on problematic issues identified from the baseline dietary profile . MAIN OUTCOME MEASURES Body composition , physical activity , dietary intake , energy expenditure , gait efficiency , metabolic variables , and quality of life . RESULTS At the end of the protocol , mean step count increased approximately 27 % above baseline ( P=.001 ) and caloric intake decreased over 300kcal/d ( P=.002 ) . Body fat percentage significantly decreased ( from 33.3%+/-1.5 % to 32.6%+/-1.6 % , P=.032 ) . Gait efficiency did not change , and metabolic variables did not show statistically significant improvement , although 2 of the 5 subjects originally meeting the criteria for metabolic syndrome at baseline no longer met the criteria at the end of the intervention period . Six months after completing the protocol , caloric intake remained significantly reduced ( P=.02 ) , but although mean step count remained elevated , it was not statistically significant . CONCLUSIONS Using a home-based protocol , people with NMD can increase activity and reduce caloric intake . Although this 6-month program showed positive changes , it was insufficient to affect risk factors associated with metabolic syndrome . It remains to be seen if a program longer than 6 months or a more rigorous program could lead to a reduction in the risk factors associated with metabolic syndrome Background The current food pyramid guidelines have been criticized because of their complexity and the knowledge required for users to underst and the recommendations . Simplification of a dietary message to focus on a single key aspect of dietary quality , e.g. , fiber intake , may make the message much easier to comprehend and adhere , such that respondents can achieve greater weight loss , better dietary quality and overall metabolic health . Methods and design This is a r and omized controlled clinical trial with two equal sized arms . In total , 240 obese adults who meet diagnostic criteria for the metabolic syndrome will be r and omized to one of the two conditions : 1 ) a high fiber diet and 2 ) the American Heart Association ( AHA ) diet .  In the high fiber diet condition , patients will be given instruction only on achieving daily dietary fiber intake of 30 g or more . In the AHA diet condition , patients will be instructed to make the several dietary changes recommended by the AHA 2006 guidelines . The trial examines participant weight loss and dietary quality as well as changes in components of the metabolic syndrome , inflammatory biomarkers , low-density lipoprotein cholesterol levels , insulin levels , and glycosolated hemoglobin . Potential mediators , i.e. , diet adherence and perceived ease of the diet , and the intervention effect on weight change will also be examined . Discussion sThe purpose of this paper is to outline the study design and methods for testing the simple message of increasing dietary fiber . If the simple dietary approach is found efficacious for weight loss ; and , improves dietary quality , metabolic health , and adherence , it might then be used to develop a simple public health message . Trial registration The objective of this study was to derive food-based dietary guidelines for the Dutch population . The dietary guidelines are based on 29 systematic review s of English language meta-analyses in PubMed summarizing r and omized controlled trials and prospect i ve cohort studies on nutrients , foods and food patterns and the risk of 10 major chronic diseases : coronary heart disease , stroke , heart failure , diabetes , breast cancer , colorectal cancer , lung cancer , chronic obstructive pulmonary disease , dementia and depression . The committee also selected three causal risk factors for cardiovascular diseases or diabetes : systolic blood pressure , low-density lipoprotein cholesterol and body weight . Findings were categorized as strong or weak evidence , inconsistent effects , too little evidence or effect unlikely for experimental and observational data separately . Next , the committee selected only findings with a strong level of evidence for deriving the guidelines . Convincing evidence was based on strong evidence from the experimental data either or not in combination with strong evidence from prospect i ve cohort studies . Plausible evidence was based on strong evidence from prospect i ve cohort studies only . A general guideline to eat a more plant food-based dietary pattern and limit consumption of animal-based food and 15 specific guidelines have been formulated . There are 10 new guidelines on legumes , nuts , meat , dairy produce , cereal products , fats and oils , tea , coffee and sugar-containing beverages . Three guidelines on vegetables , fruits , fish and alcoholic beverages have been sharpened , and the 2006 guideline on salt stayed the same . A separate guideline has been formulated on  nutrient supplements .  Completely food-based dietary guidelines can be derived in a systematic and transparent way Non-alcoholic fatty liver disease ( NAFLD ) is the most common liver disorder in Western industrialized countries , affecting 20 - 40 % of the general population . Large population -based surveys in China , Japan , and Korea indicate that the prevalence of NAFLD is now 12 % to 24 % in population subgroups , depending on age , gender , ethnicity , and location ( urban versus rural ) . There is strong evidence that the prevalence of NAFLD has increased recently in parallel with regional trends in obesity , type 2 diabetes , and metabolic syndrome ; and that further increases are likely . The relationship between NAFLD , central obesity , diabetes , and metabolic syndrome is clearly evident in retrospective and prospect i ve Asian studies , but the strength of association with these metabolic risk factors is only appreciated when regional definitions of anthropometry are used . Pathological definition of NAFLD , particularly its activity and the extent of liver fibrosis , requires histological examination , but liver biopsy is often not appropriate in this disorder for logistic reasons . An alternative set of operational definitions is proposed here . Clinicians need guidelines as how best to diagnose and manage NAFLD and its associated metabolic disorders in countries with scant healthcare re sources . The Asia-Pacific Working Party ( APWP ) for NAFLD was convened to collate evidence and deliberate these issues . Draft proposals were presented and discussed at Asia-Pacific Digestive Week at Cebu , Philippines , in late November 2006 , and are published separately in this issue of the Journal as an Executive Summary . The present document review s the reasoning and evidence behind the APWP-NAFLD proposals for definition , assessment , and management of NAFLD in the Asia-Pacific region Context Some experts attribute a low incidence of heart disease in Mediterranean countries to dietary habits . Contribution In this multicenter , 3-group trial , investigators r and omly assigned 772 adults at high risk for cardiovascular disease to a low-fat diet or to a Mediterranean diet supplemented with either virgin olive oil ( 1 L per week ) or nuts ( 30 g per day ) . After 3 months , the Mediterranean diet groups had lower mean plasma glucose level , systolic blood pressure , and total cholesterolhigh-density lipoprotein cholesterol ratio than the low-fat diet group . Caution s The Mediterranean diet groups received more nutritional education than the low-fat diet group . Implication s Mediterranean diets supplemented with olive oil or nuts may improve cardiovascular risk factors . The Editors Cardiovascular disease is the main cause of death in industrialized countries , but incidence rates have marked geographic differences . The low incidence of coronary heart disease ( CHD ) in Mediterranean countries has been partly ascribed to dietary habits ( 1 - 3 ) . Recent findings from large European cohort studies ( 4 - 6 ) suggest that a high degree of adherence to the Mediterranean diet is associated with a reduction in mortality . In small clinical studies , the Mediterranean diet or some of its components have reduced blood pressure ( 7 ) and have improved lipid profiles ( 8 , 9 ) and endothelial function ( 10 ) . Moreover , a recent cross-sectional study ( 11 ) and a 2-year feeding trial ( 12 ) have shown that adherence to the Mediterranean diet is associated with reduced markers of vascular inflammation . These beneficial effects on surrogate markers of cardiovascular risk add biological plausibility to the epidemiologic evidence that supports a protective effect of the Mediterranean diet . Olive oil , a rich source of monounsaturated fatty acids , is a main component of the Mediterranean diet . Virgin olive oil retains all the lipophilic components of the fruit , -tocopherol , and phenolic compounds with strong antioxidant and anti-inflammatory properties ( 13 , 14 ) . Tree nuts , which are also typical in the Mediterranean diet , have a favorable fatty acid profile and are a rich source of nutrients and other bioactive compounds that may beneficially influence the risk for CHD , such as fiber , phytosterols , folic acid , and antioxidants ( 15 ) . Frequent nut intake has been associated with decreased CHD rates in prospect i ve studies ( 15 ) . Walnuts differ from all other nuts through their high content of polyunsaturated fatty acids , particularly -linolenic acid , a plant n-3 fatty acid ( 16 ) , which may confer additional antiatherogenic properties ( 17 ) . Therefore , we design ed a large-scale feeding trial in high-risk participants to assess the effects of 2 Mediterranean diets , one supplemented with virgin olive oil and the other supplemented with mixed nuts , compared with a low-fat diet on cardiovascular outcomes . We report the results of a 3-month intervention on intermediate markers of cardiovascular risk in the first 772 participants who were recruited into the trial . Supplement . Original Version ( PDF ) Methods Study Design The Prevencin con Dieta Mediterrnea ( PREDIMED ) Study is a large , parallel-group , multicenter , r and omized , controlled , 4-year clinical trial that aims to assess the effects of the Mediterranean diet on the primary prevention of cardiovascular disease ( www.predimed.org ) . An estimated 9000 high-risk participants ( > 5000 participants are already recruited ) will be assigned to 3 interventions : Mediterranean diet with virgin olive oil , Mediterranean diet with mixed nuts , or low-fat diet . The main outcome is an aggregate of cardiovascular events ( cardiovascular death , nonfatal myocardial infa rct ion , or nonfatal stroke ) . The anticipated completion date of the trial is December 2010 . We design ed our present study to assess the 3-month effects of the dietary interventions on surrogate markers of cardiovascular risk in participants entering the study during the first 6 months of recruitment . The institutional review boards of the 10 participating centers approved the study protocol . Participants and Recruitment From October 2003 to March 2004 , we selected 930 potential participants in primary care centers affiliated with 10 teaching hospitals across Spain . Eligible participants were community-dwelling men , 55 to 80 years of age , and women , 60 to 80 years of age , who fulfilled at least 1 of 2 criteria : type 2 diabetes or 3 or more CHD risk factors ( current smoking , hypertension [ blood pressure > 140/90 mm Hg or treatment with antihypertensive drugs ] , low-density lipoprotein [ LDL ] cholesterol level 4.14 mmol/L [ 160 mg/dL ] [ or treatment with hypolipidemic drugs ] , high-density lipoprotein [ HDL ] cholesterol level 1.04 mmol/L [ 40 mg/dL ] , body mass index [ BMI ] 25 kg/m2 , or a family history of premature CHD ) . Exclusion criteria were history of cardiovascular disease , any severe chronic illness , drug or alcohol addiction , history of allergy or intolerance to olive oil or nuts , or low predicted likelihood of changing dietary habits according to the stages-of-change model ( 18 ) . The primary care physicians based participants ' eligibility on review of clinical records and a screening visit . They obtained a list of c and i date s from computer-based records of patients who attended each participating center and review ed their clinical records to exclude those who did not meet eligibility criteria . They then invited suitable c and i date s by telephone to attend a screening visit . The visit included an interview with administration of a 26-item question naire to inquire about medical conditions and risk factors related to eligibility . Of the eligible c and i date s who met entry requirements , 95 % agreed to participate and provided informed consent . R and omization and Intervention After the screening visit , each center r and omly assigned eligible participants to 1 of 3 diet groups by using a computer-generated r and om-number sequence . The coordinating center constructed the r and omization table , and participants were r and omly assigned into blocks of 50 participants balanced by center , sex , and age group ( < 70 years and 70 years ) . We concealed allocation into the intervention groups by using closed envelopes with correlative numbers by prespecified subgroups of sex and age . The baseline examination included the administration of a 14-item question naire , an extension of a previously vali date d question naire ( 19 ) , that assessed the degree of adherence to the traditional Mediterranean diet . We assigned values of 0 or 1 to each item ( Appendix Table 1 ) . We also administered a 137-item vali date d food frequency question naire ( 20 ) ; the vali date d Spanish version ( 21 ) of the Minnesota Leisure Time Physical Activity Question naire ; and a 47-item question naire about education , lifestyle , history of illnesses , and medication use . We performed anthropometric and blood pressure measurements and obtained sample s of fasting blood and spot urine . We repeated all examinations at 3 months . The same dietitian delivered the interventions to the 3 r and omized groups in each center . On the basis of the assessment of individual Mediterranean diet scores , the dietitian gave personalized dietary advice during a 30-minute session to each participant , with recommendations on the desired frequency of intake of specific foods . We advised participants who were allocated to the low-fat diet to reduce intake of all types of fat , and we gave them a leaflet with written recommendations according to the American Heart Association guidelines ( 22 ) . For total fat intake , these recommendations were opposite to those given to participants in the 2 Mediterranean diet groups , who received instructions intended to increase the 14-item Mediterranean diet score , including increased consumption of vegetable fats and oils . We did not suggest any energy restriction . While the participants who were allocated to the low-fat diet did not receive further intervention , those assigned the 2 Mediterranean diet groups had access to more intense intervention in 2 ways . First , they were given a free provision of typical Mediterranean fatty foods ( olive oil or nuts ) . Depending on group assignment , participants were given either free virgin olive oil ( 15 L [ 1 L/wk ] for 3 months ) or free sachets of walnuts , hazelnuts , and almonds ( 1350 g of walnuts [ 15 g/d ] , 675 g of hazelnuts [ 7.5 g/d ] , and 675 g of almonds [ 7.5 g/d ] for 3 months ) . To improve adherence and account for family needs , participants in the corresponding Mediterranean diet groups were given excess olive oil or additional 1000-g packets of nuts . We analyzed the nutrient composition of the olive oil and nuts used in the study by st and ard methods in a reference laboratory ( Appendix Table 2 ) ) . Second , 1 week after inclusion , the dietitian delivered a 1-hour group session with up to 20 participants , with separate sessions for each Mediterranean diet group . Each group session consisted of informative talks and provision of written material s with elaborate descriptions of typical Mediterranean foods and seasonal shopping lists , meal plans , and cooking recipes . Throughout the study , all participants had free and continuous access to their center dietitian for advice and consultation . Measurements Trained personnel measured weight and height by using calibrated scales and a wall-mounted stadiometer , respectively ; waist circumference midway between the lowest rib and the iliac crest by using an anthropometric tape ; and blood pressure in triplicate with a vali date d semiautomatic oscillometer ( Omron HEM-705CP , Hoofddorp , the Netherl and s ) . We calculated energy and nutrient intake from Spanish food composition tables ( 23 ) . At the 3-month visit and when consulted by participants , dietitians assessed any adverse effects from the interventions by administering a checklist of symptoms and gave advice on how to remedy them . The checklist included mouth symptoms ; bloating , fullness , or indigestion ; altered bowel Objective : We aim ed at evaluating whether the addition of low-dose metformin to dietary treatment could be an effective approach in nondiabetic patients with nonalcoholic fatty liver disease ( NAFLD ) . Methods : We carried out a 6-month prospect i ve study in a series of overweight or obese patients with ultrasonographic diagnosis of hepatic steatosis . In total , 50 patients were enrolled and r and omized into two groups : the first group ( n=25 ) was given metformin ( 1 g per day ) plus dietary treatment and the second group ( n=25 ) was given dietary treatment alone . Results : At the end of the study , the proportion of patients with echographic evidence of fatty liver was reduced in both the metformin ( P<0.0001 ) and the diet group ( P=0.029 ) . Moreover , patient body mass index and waist circumference significantly decreased in both groups ( P<0.001 ) . Fasting glucose , insulin resistance ( evaluated as homeostasis model assessment of insulin resistance ( HOMA-IR ) ) and serum adiponectin decreased in both groups , although these changes reached statistical significance only in the metformin group . In this group , HOMA-IR decreased from 3.3±1.6 to 2.4±1.2 ( P=0.003 ) , whereas it decreased from 3.2±1.6 to 2.8±1.1 ( not significant , NS ) in the diet group . Similarly , the proportion of patients with impaired fasting glucose declined from 35 to 5 % ( P=0.04 ) in the metformin and from 32 to 12 % ( NS ) in the diet group . At baseline , ∼40 % of patients in both groups met the diagnostic criteria of metabolic syndrome . This proportion decreased to 20 % in the metformin group ( P=0.008 ) and to 32 % in the diet group ( NS ) . Conclusions : In our 6-month prospect i ve study , both low-dose metformin and dietary treatment alone ameliorated liver steatosis and metabolic derangements in patients with NAFLD . However , metformin was more effective than dietary treatment alone in normalizing several metabolic parameters in these patients Objective : Clinical and epidemiological studies have reported the beneficial effects of tree nuts and peanuts on serum lipid levels . We studied the effects of consuming 15 % of the daily caloric intake in the form of pistachio nuts on the lipid profiles of free-living human subjects with primary , moderate hypercholesterolemia ( serum cholesterol greater than 210 mg/dL ) . Methods : Design : R and omized crossover trial . Setting : Outpatient dietary counseling and blood analysis . Subjects : 15 subjects with moderate hypercholesterolemia . Intervention : Fours weeks of dietary modification with 15 % caloric intake from pistachio nuts . Measures of Outcome : Endpoints were serum lipid levels of total cholesterol , HDL-C , LDL-C , VLDL-C , triglycerides and apolipoproteins A-1 and B-100 . BMI , blood pressure , and nutrient intake ( total energy , fat , protein , and fiber ) were also measured at baseline , during , and after dietary intervention . Results : No statistically significant differences were observed for total energy or percent of energy from protein , carbohydrate or fat . On the pistachio nut diet , a statistically significant decrease was seen for percent energy from saturated fat ( mean difference , −2.7 % ; 95 % CI , −5.4 % to −0.08 % ; p = 0.04 ) . On the pistachio nut diet , statistically significant increases were seen for percent energy from polyunsaturated fat ( mean difference , 6.5 % ; 95 % CI , 4.2 % to 8.9 % ; p<.0001 ) and fiber intake ( mean difference , 15 g ; 95 % CI , 8.4 g to 22 g ; p = 0.0003 ) . On the pistachio diet , statistically significant reductions were seen in TC/HDL-C ( mean difference , −0.38 ; 95 % CI , −0.57 to −0.19 ; p = 0.001 ) , LDL-C/HDL-C ( mean difference , −0.40 ; 95 % CI , −0.66 to −0.15 ; p = 0.004 ) , B-100/A-1 ( mean difference , −0.11 ; 95 % CI , −0.19 to −0.03 ; p = 0.009 ) and a statistically significant increase was seen in HDL-C ( mean difference , 2.3 ; 95 % CI , 0.48 to 4.0 ; p = 0.02 ) . No statistically significant differences were seen for total cholesterol , triglycerides , LDL-C , VLDL-C , apolipoprotein A-1 or apolipoprotein B-100 . No changes were observed in BMI or blood pressure . Conclusion : A diet consisting of 15 % of calories as pistachio nuts ( about 2–3 ounces per day ) over a four week period can favorably improve some lipid profiles in subjects with moderate hypercholesterolemia and may reduce risk of coronary disease OBJECTIVE To examine whether the timing of introduction of the allergenic foods cow 's milk , hen 's egg , peanuts , tree nuts , soy , and gluten is associated with  eczema and wheezing in children 4 years of age or younger . DESIGN Population -based prospect i ve cohort study from fetal life until young adulthood . SETTING Rotterdam , the Netherl and s , from April 2002 through January 2006 . PARTICIPANTS A total of 6905 preschool children participating in the Generation R study . MAIN EXPOSURE Timing of introduction of cow 's milk , hen 's egg , peanuts , tree nuts , soy , and gluten collected by question naires at 6 and 12 months of age . MAIN OUTCOME MEASURES Information on the outcomes eczema and wheezing were obtained by questions from the age-adapted version of the " International Study of Asthma and Allergies in Childhood " core question naire and question naire data on parentally reported physician diagnosis for eczema . RESULTS Of 6905 children ,  wheezing was reported in 31 % at age 2 years and in 14 % at ages 3 and 4 years . Eczema was reported in 38 % , 20 % , and 18 % of children at the ages of 2 , 3 , and 4 years , respectively . The introduction of cow 's milk , hen 's egg , peanuts , tree nuts , soy , and gluten before the age of 6 months was not significantly associated with eczema or wheezing at any age after adjustment for potential confounders ( P > .10 for all comparisons ) . The results did not alter after stratification according to the child 's history of cow 's milk allergy and parental history of atopy . CONCLUSION This study does not support the recommendation for delayed introduction of allergenic foods after age 6 months for the prevention of eczema and wheezing Previous evidence supports the concept that increased oxidative stress may play an important role in MetS ( metabolic syndrome)-related manifestations . Dietary fat quality has been proposed to be critical in oxidative stress and the pathogenesis of the MetS. In the present study , we investigated whether oxidative stress parameters are affected by diets with different fat quantity and quality during the postpr and ial state in subjects with the MetS. Patients were r and omly assigned to one of four isoenergetic diets distinct in fat quantity and quality for 12 weeks : a high-saturated-fatty-acid ( HSFA ) diet , a high-mono-unsaturated-fatty-acid ( HMUFA ) diet and two low-fat/high-complex carbohydrate diets [ supplemented with 1.24 g/day of long-chain n-3 polyunsaturated fatty acid ( LFHCC n-3 ) or with 1 g/day of sunflower oil high in oleic acid ( LFHCC ) as placebo ] . The HMUFA diet enhanced postpr and ial GSH ( reduced glutathione ) levels and the GSH/GSSH ( oxidized glutathione ) ratio , compared with the other three diets . In addition , after the HMUFA-rich  diet postpr and ial lipid peroxide levels , protein carbonyl concentrations , SOD ( superoxide dismutase ) activity and plasma H2O2 levels were lower compared with subjects adhering to the HSFA-rich diet . Both LFHCC diets had an intermediate effect relative to the HMUFA and HSFA diets . In conclusion , our data support the notion that the HMUFA diet improves postpr and ial oxidative stress in patients with the MetS. These findings suggest that the postpr and ial state is important for underst and ing the possible cardioprotective effects associated with mono-unsaturated dietary fat , particularly in subjects with the PURPOSE To provide evidence -based recommendations to practicing oncologists , surgeons , and radiation therapy clinicians to up date the 2005 clinical practice guideline on the use of sentinel node biopsy ( SNB ) for patients with early-stage breast cancer . METHODS The American Society of Clinical Oncology convened an Up date Committee of experts in medical oncology , pathology , radiation oncology , surgical oncology , guideline implementation , and advocacy . A systematic review of the literature was conducted from February 2004 to January 2013 in Medline . Guideline recommendations were based on the review of the evidence by Up date Committee . RESULTS This guideline up date reflects changes in practice since the 2005 guideline . Nine r and omized clinical trials ( RCTs ) met systematic review criteria for clinical questions 1 and 2 ; 13 cohort studies informed clinical question 3 . RECOMMENDATIONS Women without sentinel lymph node ( SLN ) metastases should not receive axillary lymph node dissection ( ALND ) .  Women with one to two metastatic SLNs planning to undergo breast-conserving surgery with whole-breast radiotherapy should not undergo ALND ( in most cases ) . Women with SLN metastases who will undergo mastectomy should be offered ALND . These three recommendation are based on RCTs . Women with operable breast cancer and multicentric tumors , with ductal carcinoma in situ ( DCIS ) who will undergo mastectomy , who previously underwent breast and /or axillary surgery , or who received preoperative/neoadjuvant systemic therapy may be offered SNB . Women who have large or locally advanced invasive breast cancer ( tumor size T3/T4 ) , inflammatory breast cancer , or DCIS ( when breast-conserving surgery is planned ) or are pregnant should not undergo SNB . These recommendations are based on cohort studies and /or informal consensus . In some cases , up date d evidence was insufficient to up date previous recommendations BACKGROUND Irritable bowel syndrome ( IBS ) is a chronic debilitating functional gastrointestinal disorder . Diet and lifestyle changes are important management strategies . The aim of these guidelines is to systematic ally review key aspects of the dietary management of IBS , with the aim of providing evidence -based guidelines for use by registered dietitians . METHODS Questions relating to diet and IBS symptom management were developed by a guideline development group . These included the role of milk and lactose , nonstarch polysaccharides ( NSP ) , fermentable carbohydrates in abdominal bloating , probiotics and empirical or elimination diets . A comprehensive literature search was conducted and relevant studies from January 1985 to November 2009 were identified using the electronic data base search engines : Cinahl , Cochrane Library , Embase , Medline , Scopus and Web of Science . Evidence statements , recommendations , good practice points and research recommendations were developed . RESULTS Thirty studies were critically appraised . A dietetic care pathway was produced following a logical sequence of treatment and formed the basis of these guidelines . Three lines of dietary management were identified . first line :  Clinical and dietary assessment , healthy eating and lifestyle management  with some general advice on lactose and NSP . Second line : Advanced dietary interventions to improve symptoms based on NSP , fermentable carbohydrates and probiotics . Third line : Elimination and empirical diets . Research recommendations were also identified relating to the need for adequately powered and well design ed r and omised controlled trials . CONCLUSIONS These guidelines provide evidence -based details of how to achieve the successful dietary management of IBS Allergy to pollen from deciduous trees is a common cause of  allergic rhinitis and asthma during the spring in Sweden . Juhlin-Dannfelt discovered ( z ) that patients with these disorders often get allergic symptoms from eating nuts or raw fruits . Using intracutaneous tests ( i. c. tests ) and , in some cases , provocation tests and Prausnitz-Kiistner tests , he could also detect the kind of tree pollen which usually caused the symptoms , i. e. mainly hirch but also hazel , alder , ash , sailowwillow and oak . Humoral reagins of the IgE class directed against different allergens can be detected with the radioallergosorbent test ( RAST ) ( 4 ) . This test can also be used to study allergenic activities and to obtain information on relationships between various allergens . In the present investigation the RAST , i. c. tests and provocation tests have been used to study pollen extracts from different deciduous trees . The present study has been made in order to compare the extracts and illustrate whether they have any allergens in common Summary No subjective or objective evidence of beneficial effect was observed from the use of Pirenzipine in irritable bowel syndrome ( TBS ) patients who had not responded to a high fibre diet Background : Despite intensive research , there are no universally accepted clinical definitions for acute lung injury ( ALI ) or the acute respiratory distress syndrome ( ARDS ) . A recent joint American-European Consensus Conference on ARDS formally defined the difference between ALI and ARDS based on the degree of oxygenation impairment . However , this definition may not reflect the true prevalence , severity and prognosis of these syndromes . Methods : During a 22-month period , 56 consecutive mechanically ventilated patients who met the American-European Consensus definition for ARDS [ arterial oxygen tension/fractional inspired oxygen ( PaO2/FIO2≤ 200 mmHg regardless of the level of positive end-expiratory pressure ( PEEP ) , bilateral pulmonary infiltrates , and no evidence of left heart failure ] were admitted into the intensive care units ( ICU ) of the Hospital del Pino , Las Palmas , Spain , and prospect ively studied . The diagnosis of ALI and ARDS was made by a PEEP-FIO2 trial , 24 h after patients met the Consensus inclusion criteria . Patients were classified as having ALI–24 h if the PaO2/FIO2 was > 150 mmHg with PEEP = 5 cmH2O , and ARDS–24 h if the PaO2 /FIO2 was ≤ 150 mmHg with PEEP ≥ 5 cmH2O . Results : Overall mortality was 43 % ( 24 of 56 ) . However , 24 h after inclusion , PaO2 response to PEEP 5 cmH2O allowed the separation of our patients into two different groups : 31 patients met our ALI–24 h criteria ( PaO2/FIO2 > 150 mmHg ) and their mortality was 22.6 % ; 25 patients met our ARDS–24 h criteria ( PaO2/FIO2≤ 150 mmHg ) and their mortality was 68 % ( p = 0.0016 ) . The differences in the respiratory severity index during the first 24 h of inclusion , PaO2/FIO2 ratio at baseline and at 24 h , maximum plateau airway pressure , maximum level of PEEP , and number of organ system failures during the ICU stay were statistically significant . Conclusions : Since the use of PEEP in the American-European Consensus criteria for ARDS is not m and atory , that definition does not reflect the true severity of lung damage and outcome . Our data support the need for guidelines based on a specific method of evaluating oxygenation status before the American-European Consensus definition is adopted IMPORTANCE The etiology of the increasing childhood prevalence of peanut or tree nut ( P/TN ) allergy is unknown . OBJECTIVE To examine the association between peripregnancy consumption of P/TN  by mothers and the risk of P/TN allergy in their offspring . DESIGN , SETTING , AND PARTICIPANTS Prospect i ve cohort study . The 10,907 participants in the Growing Up Today Study 2 , born between January 1 , 1990 , and December 31 , 1994 , are the offspring of women who previously reported their diet during , or shortly before or after , their pregnancy with this child as part of the ongoing Nurses ' Health Study II . In 2006 , the offspring reported physician-diagnosed food allergy . Mothers were asked to confirm the diagnosis and to provide available medical records and allergy test results . Two board-certified pediatricians , including a board-certified allergist/immunologist , independently review ed each potential case and assigned a confirmation code ( eg , likely food allergy ) to each case . Unadjusted and multivariable logistic regression analyses were used to evaluate associations between peripregnancy consumption of P/TN by mothers and incident P/TN allergy in their offspring . EXPOSURE Peripregnancy consumption of P/TN . MAIN OUTCOMES AND MEASURES Physician-diagnosed P/TN allergy in offspring . RESULTS Among 8205 children , we identified 308 cases of food allergy ( any food ) , including 140 cases of P/TN allergy . The incidence of P/TN allergy in the offspring was significantly lower among children of the 8059 nonallergic mothers who consumed more  P/TN  in their peripregnancy diet ( ≥ 5 times vs < 1 time per month : odds ratio = 0.31 ; 95 % CI , 0.13 - 0.75 ; P(trend ) = .004 ) . By contrast , a nonsignificant positive association was observed between maternal peripregnancy P/TN consumption and risk of P/TN allergy in the offspring of 146 P/TN-allergic mothers ( P(trend ) = .12 ) . The interaction between maternal peripregnancy P/TN consumption and maternal P/TN allergy status was statistically significant ( P(interaction ) = .004 ) . CONCLUSIONS AND RELEVANCE Among mothers without P/TN allergy , higher peripregnancy consumption of P/TN was associated with lower risk of P/TN allergy in their offspring . Our study supports the hypothesis that early allergen exposure increases tolerance and lowers risk of childhood food allergy BACKGROUND We hypothesized that favorable changes in dietary patterns would lead to a reduction in body size and an improvement in metabolic status . OBJECTIVE The objective was to study changes in diet patterns relative to changes in body size , blood pressure , and circulating concentrations of lipids , glucose , insulin , adiponectin , and other cytokines in the context of a 1-y r and omized intervention study . DESIGN For 1 y , 187 men aged 45 + /- 2 y , approximately 50 % of whom met the criteria of the metabolic syndrome , were r and omly assigned to a diet protocol ( n = 45 ) , an exercise protocol ( n = 48 ) , a protocol of diet plus exercise ( n = 58 ) , or a control protocol ( n = 36 ) . A previously defined a priori diet score was created by summing tertile rankings of 35 food group variables ; a higher score generally reflected recommended dietary changes in the trial ( mean + /- SD at baseline : 31 + /- 6.5 ; range : 15 - 47 ) . RESULTS Over the study year , the diet score increased by approximately 2 + /- 5.5 in both diet groups , with a decrease of an equivalent amount in the exercise and control groups . The weight change was -3.5 + /- 0.6 kg/10-point change in diet score ( P < 0.0001 ) , similarly within each intervention group , independently of the change in energy intake or baseline age and smoking status . Weight change was attenuated but remained significant after adjustment for intervention group and percentage body fat . Subjects with an increased diet score had more favorable changes in other body size variables , systolic blood pressure , and blood lipid , glucose , insulin , and adiponectin concentrations . Change in diet score was unrelated to resistin and several cytokines . CONCLUSION The change toward a more favorable diet pattern was associated with improved body size and metabolic profile OBJECTIVE Major depressive disorder ( MDD ) is associated with decreased physical activity and increased rates of the metabolic syndrome ( MetS ) , a risk factor for the development of type 2 diabetes and cardiovascular disorders . Exercise training has been shown to improve cardiorespiratory fitness and metabolic syndrome factors . Therefore , our study aim ed at examining whether patients receiving an exercise program as an adjunct to inpatient treatment will benefit in terms of physiological and psychological factors . METHOD Fourty-two in patients with moderate to severe depression were included . Twenty-two patients were r and omized to additional 3x weekly exercise training ( EXERCISE ) and compared to treatment as usual ( TAU ) . Exercise capacity was assessed as peak oxygen uptake ( VO2peak ) , ventilatory anaerobic threshold ( VAT ) and workload expressed as Watts ( W ) . Metabolic syndrome was defined according to NCEP ATPIII panel criteria . RESULTS After 6 weeks of treatment , cardiorespiratory fitness ( VO2peak , VAT , Watt ) , waist circumference and HDL cholesterol were significantly improved in EXERCISE participants . Treatment response expressed as ≥50 % MADRS reduction was more frequent in the EXERCISE group . CONCLUSIONS Adjunctive exercise training in depressed in patients  improves physical fitness , MetS factors , and psychological outcome . Given the association of depression with cardiometablic disorders , exercise training is recommended as an adjunct to st and ard antidepressant treatment Summary Aim We aim ed to compare the effects of fixed‐dose combinations of ezetimibe plus rosuvastatin to rosuvastatin alone in patients with primary hypercholesterolemia , including a subgroup analysis of patients with diabetes mellitus ( DM ) or metabolic syndrome ( MetS ) . Method This multicenter eight‐week r and omized double‐blind phase III study evaluated the safety and efficacy of fixed‐dose combinations of ezetimibe 10 mg plus rosuvastatin , compared with rosuvastatin alone in patients with primary hypercholesterolemia . Four hundred and seven patients with primary hypercholesterolemia who required lipid‐lowering treatment according to the ATP III guideline were r and omized to one of the following six treatments for 8 weeks : fixed‐dose combinations with ezetimibe 10 mg daily plus rosuvastatin ( 5 , 10 , or 20 mg daily ) or rosuvastatin alone ( 5 , 10 , or 20 mg daily ) . Results Fixed‐dose combination of ezetimibe plus rosuvastatin significantly reduced LDL cholesterol , total cholesterol , and triglyceride levels compared with rosuvastatin alone . Depending on the rosuvastatin dose , these fixed‐dose combinations of ezetimibe plus rosuvastatin  provided LDL cholesterol , total cholesterol , and triglyceride reductions of 56%–63 % , 37%–43 % , and 19%–24 % , respectively . Moreover , the effect of combination treatment on cholesterol levels was more pronounced in patients with DM or MetS than in non‐DM or non‐MetS patients , respectively , whereas the effect of rosuvastatin alone did not differ between DM vs non‐DM or MetS vs non‐MetS patients . Conclusion Fixed‐dose combinations of ezetimibe and rosuvastatin provided significantly superior efficacy  to rosuvastatin alone in lowering LDL cholesterol , total cholesterol , and triglyceride levels . Moreover , the reduction rate was greater in patients with DM or OBJECTIVE : We sought to establish the frequency of receiving > 1 dose of epinephrine in children who present to the emergency department ( ED ) with food-related anaphylaxis . PATIENTS AND METHODS : We performed a medical chart review at Boston hospitals of all children presenting to the ED for food-related acute allergic reactions between January 1 , 2001 , and December 31 , 2006 . We focused on causative foods , clinical presentations , and emergency treatments . RESULTS : Through r and om sampling and appropriate weighting , the 605 review ed cases represented a study cohort of 1255 patients . These patients had a median age of 5.8 years ( 95 % confidence interval [ CI ] : 5.3–6.3 ) , and the cohort was 62 % male . A variety of foods provoked the allergic reactions , including peanuts ( 23 % ) , tree nuts ( 18 % ) , and milk ( 15 % ) . Approximately half ( 52 % [ 95 % CI : 48–57 ] ) of the children met diagnostic criteria for food-related anaphylaxis . Among those with anaphylaxis , 31 % received 1 dose and 3 % received > 1 dose of epinephrine before their arrival to the ED . In the ED , patients with anaphylaxis received antihistamines ( 59 % ) , corticosteroids ( 57 % ) , epinephrine ( 20 % ) . Over the course of their reaction , 44 % of patients with food-related anaphylaxis received epinephrine , and among this subset of patients , 12 % ( 95 % CI : 9–14 ) received > 1 dose . Risk factors for repeat epinephrine use included older age and transfer from an outside hospital . Most patients ( 88 % ) were discharged from the hospital . On ED discharge , 43 % were prescribed self-injectable epinephrine , and only 22 % were referred to an allergist . CONCLUSIONS : Among children with food-related anaphylaxis who received epinephrine , 12 % received a second dose . Results of this study support the recommendation that children at risk for food-related anaphylaxis carry 2 doses of epinephrine
There was no effect on waist circumference , high-density lipoprotein cholesterol or blood pressure with the direction of effect favouring tree nuts for waist circumference .
Pooled analyses show a MetS benefit of tree nuts through modest decreases in triglycerides and fasting blood glucose with no adverse effects on other criteria across nut types .
OBJECTIVE To provide a broader evidence summary to inform dietary guidelines of the effect of tree nuts on criteria of the metabolic syndrome ( MetS ) .