Clinical Briefs
September 30, 1999
Clinical Briefs
Dietary Supplementation After MI
The role of dietary supplements in preventing cardiovascular disease is still a matter of intense scrutiny and debate. Both vitamin E (alpha tocopherol) and n-3 polyunsaturated fatty acids as are commonly found in marine vertebrates (PUFA) have stimulated interest from the private and professional sectors, due to their association with reduced risk of coronary heart disease, primarily as reported in observational population studies. Few prospective interventional trials have examined the secondary prevention effects of either of these agents.
The investigators studied the effects of 300 mg synthetic vitamin E given once daily, 850 mg PUFA given in a gelatin capsule once daily, both agents combined, or placebo in a large group (n = 11,324) of men and women recently recovered from an acute MI. Treatment was continued over 3.5 years.
Only PUFA was associated with favorable changes in cardiovascular risk. PUFA recipients enjoyed a 15% reduced incidence of cumulative rate of all-cause death, nonfatal MI, and non-fatal stroke. Also, only the PUFA was associated with a 20% reduction of the combined end point of cardiovascular death, nonfatal MI, and nonfatal stroke. The combination of vitamin E and PUFA did not show superior outcome to PUFA alone.
The authors note that the amount of PUFA used corresponds to a large amount of fish (100 g daily); also, the amount of vitamin E, though less than that used in some other trials, is still greater than that which can be realistically ingested on the basis of diet alone.
GISSI-Prevenzione Investigators. In Press.
Characteristics of the Night-Eating Syndrome
Night-eating syndrome (nes) was initially characterized in 1995 by evening hyperphagia, insomnia, and morning anorexia. Estimates of the prevalence of this disorder suggest 1.5% in the general population, but is dramatically more common among obese persons, ranging from 8.9% in an obesity clinic, to more than 25% of severely obese persons. This report compiles information from two studies intended to examine both the behavioral characteristics and the neuroendocrine status of affected individuals.
The Weight and Eating Disorders Program of the University of Pennsylvania School of Medicine recruited volunteers through a local newspaper ad seeking persons with morning anorexia, evening overeating, and insomnia. Through this method, a total of 53 individuals (including controls) was studied.
Night eaters had 9.3 eating episodes per 24 hours, compared with 4.2/24 h in the BMI and age-matched control group. By 6 p.m., night eaters had consumed 37% of their total daily caloric intake vs. 74% in the control group. Mood of the night eaters scored statistically significantly lower than that of the controls, and mood of the night eaters fell progressively after 4 p.m. Night awakenings were more than 10 times as frequent among night eaters.
Plasma melatonin levels were lower among night eaters than controls, and leptin levels rose less nocturnally in night eaters.
Birketvedt and colleagues have made interesting observations in this hereto-fore scantily described group.
Birketvedt GS, et al. JAMA 1999;282: 657-663.
Excercise-Induced Anaphylaxis
The symptoms complex of exercise-induced anaphylaxis (EIA)—flushing, generalized pruritus with urticaria, upper respiratory obstruction, and (rarely) cardiovascular collapse—mimic that of allergen-induced anaphylaxis. The natural history of the disorder has been poorly detailed to date.
Shadick and associates identified 279 subjects with EIA, of whom more than 70% were female. Most commonly, aerobic activities like jogging, brisk walking, tennis, racquetball, and dancing produced symptoms, although such activities as raking leaves, volleyball, and horseback riding were also occasionally reported.
The most common symptoms were generalized pruritus, urticaria, flushing, and angioedema; occasionally, tachycardia, loss of consciousness, headache, colic, and respiratory obstruction were described. Almost one-third of individuals experienced fainting or loss of consciousness.
Over a 10-year observation period, most individuals reported a decline in frequency of attacks.
Nonetheless, an average of 8.3 attacks occurred in the year immediately preceding the study (decreased from an average of 14.5 attacks in the year prior to initiation of the survey). Thirty-seven percent of subjects reported that food also triggered or contributed to an attack, most commonly shellfish, alcohol, and tomatoes. Most subjects were able to successfully control attacks using antihistamines or epinephrine.
Shadick et al conclude that EIA tends to remain stable or decrease over time, and that persons generally successfully manage symptoms by restructuring exercise, avoiding food triggers, and pharmacotherapy.
Shadick NA, et al. J Allergy Clin Immunol 1999;104:123-127.
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