Primecuts – This Week In The Journals

February 3, 2014

By Elizabeth Park, MD

Peer reviewed

Super Bowl fever also hit Times Square this week as tens of thousands of people headed to the New York metropolitan area for the Super Bowl. The Super Bowl is more than just a football game. Like Thanksgiving, it’s the day for friends and family to get together, sit down in front of TV with accompanying chips, pizza, chicken wings and beer. You can easily consume 2000 calories during the game, interrupting your New Year’s diet plan.

Speaking of diet, recently there has been a randomized trial that supports dietary intervention in decreasing the risk of atherosclerotic diseases, including peripheral artery disease (PAD). Traditional recommendations for PAD reduction include smoking cessation, low fat and low salt diet, optimal management of chronic disease including hypertension and diabetes. Ruiz-Canela et al. published an analysis of a randomized trial, PREDIMED, a multicenter, randomized, blinded, primary prevention dietary trial conducted in Spain between 2003-2010, with a total of 7447 participants. Its primary end point was a composite of myocardial infarction, stroke, and death. Participants were men and women without clinical PAD or baseline cardiovascular disease but with diabetes or at least 3 cardiovascular risk factors. They were randomized to 1 of 3 groups: a Mediterranean diet supplemented with extra-virgin olive oil; a Mediterranean diet supplemented with nuts or; counseling on a low-fat diet (control group). Both Mediterranean diet interventions were associated with a lower risk of PAD compared to the control group with HR 0.34 (95% CI, 0.2-0.58) for the extra-virgin olive oil group and HR 0.50 (95% CI, 0.30-0.81) for the nuts group compared with the control group, adjusted for classic atherosclerotic risk factors. The number needed to treat to prevent 1 PAD case per year was 336 (95% CI, 269-566) and 448 (95% CI, 316-1536) for the Mediterranean diet supplemented with extra-virgin olive oil and the Mediterranean diet plus nuts group respectively. This was the first randomized primary prevention trial supporting previous observational studies in support of dietary interventions to decrease the  risk of PAD. However, given the number needed to treat is quite high to prevent 1 clinically symptomatic case per year, it may be hard to apply to clinical practice despite its benefit [1].

After explaining to your patients what exactly a Mediterranean diet is, you could also increase their awareness of childhood obesity by discussing its rising prevalence. Children with body mass index (BMI) at or above 95th percentile among children (age 6-11) increased from 4.2% in 1963-1965 to 15.3% in 1999-2000. Cunningham et al. examined the incidence of childhood obesity in an attempt to better understand its epidemiology. Researchers evaluated data from a large longitudinal study of children (the Early Childhood Longitudinal Study, Kindergarten Class of 1998-1999) to obtain a representative prospective cohort of 7738 participants who were then followed over 10 years between 1998 and 2007. The prevalence of obesity was defined as the proportion of all children in each age group who were obese. The incidence was defined as the occurrence of a new case of obesity in a child who was not previously obese. Data interpretation showed the prevalence of obesity increased with age, reaching 20.8% by eighth grade (mean age 14.1 years), while the incidence of obesity was highest at the youngest ages (5.4% among kindergartners) and declined through eighth grade. The incidence of obesity was 4 times as high among children who had been overweight at the age of 5 years compared to those with a normal weight at that age (RR 4.04, 95% CI, 3.29-4.96). The authors suggest that the course of obesity may be already established at very young age [2].

Would you like to know what’s new in oncology? Researchers have found that there might be a new therapeutic target in human colorectal cancer. Past research has shown enrichment of cancer-initiating cells (CICs, with the key property unique to CICs being self-renewal) in tumors that survive therapy poses a challenge in the treatment of cancer. A study by Kreso et al. specifically looked at human colorectal CIC function. They found that CIC function is dependent on the regulator BMI-1 which is strongly linked to self-renewal and maintenance of stem cells. The treatment of primary colorectal cancer xenografts with small molecule-mediated BMI-1 inhibition (via a compound called PTC-209) resulted in impairment of tumor growth. These findings may potentially be used to develop new therapeutic treatment of colorectal cancer by inhibiting self-renewal ability of CICs [3].

Is magnetic resonance enterography (MRE) a reliable tool to monitor therapy in patients with Crohn’s? A recent article from Gastroenterology can help you answer this question. The study done by Ordas et al. was a prospective multicenter study of 48 patients with active Crohn’s, examining patients who underwent ileocolonoscopy and MRE at baseline and 12 weeks after treatment with steroid or tumor necrosis factor inhibitor (specifically adalimumab). The primary end points for the study were determining the accuracy of MRE in identifying ulcer healing (defined as the disappearance of ulcers on endoscopic exam) and the endoscopic remission (quantified using Crohn’s Disease Endoscopic Index of Severity <3.5). MRE identified ulcer healing with 90% accuracy (area under the curve [AUC] 0.83, 95% CI, 0.713-0.953, P<0.001) and endoscopic remission with 83% accuracy (AUC 0.864, 95% CI, 0.75-0.987, P<0.001), supporting the reliability of MRE as a tool in assessing response to treatment in patient with Crohn’s [4].

Also in the literature this week:

1. In postmenopausal women with low bone mineral density, romosozumab (a monoclonal antibody binding to sclerostin—an soteocyte-derived inhibitor of osteoblast activity) was associated with significant increased bone density and decreased bone resorption at 12 months [5].

2. A systematic review from the British Medical Journal suggests that patients with acute myocardial infarction (MI) presenting during off-hours (weekends and nights) have higher mortality and patients with ST-elevation MI have longer door to balloon times, voicing the need for efforts to improve systems of care, regardless of time of the day or day of the week [6].

3. Can antioxidants be harmful? Recent research published in Science suggests that exogenous antioxidants (via supplementing the diet with N-acetylcysteine [NAC] and vitamin E) accelerated lung cancer progression in mice. RNA sequencing showed the above antioxidants reduced expression of endogenous antioxidant genes, thereby producing changes in tumor transcriptome profiles. Researchers raise concern that antioxidants may accelerate the growth of early tumors or precancerous lesions in high risk populations including smokers and COPD patients using NAC [7].

4. Neck pain is a common condition affecting about 4.9% population, ranked 4th highest in terms of disability (measured by years lived with disability) and 21st in terms of overall burden (estimated as disability adjusted life years) from the Global Burden of Disease 2010 study [8].

Dr. Elizabeth Park is a 2nd year resident at NYU Langone Medical Center

Peer reviewed by Arnab Ghosh, MD, Contributing Editor, Clinical Correlations

Image courtesy of Google Images


1. Ruiz-Canela M, Estruch R, Corella D et al. Association of Mediterranean Diet With Peripheral Artery Disease: The PREDIMED Randomized Trial. JAMA. 2014; 311(4):415-417.

2. Cunningham SA, Kramer MR, Venkat Narayan KM et al. Incidence of Childhood Obesity in the United States. N Engl J Med. 2014; 370:403-411.

3. Kreso A, Galen P, Pedley N et al. Self-renewal as a Therapeutic Target in Human Colorectal Cancer, Nature Medicine. 2014; 20:29-36.

4. Ordas I, Rimola J, Rodriguez S et al. Accuracy of Magnetic Resonance Enterography in Assessing Response to Therapy and Mucosal Healing in Patients With Crohn’s Disease. Gastroenterology. 2014; 146: 374-382.

5. Michael R. McClung MR, Grauer A, Boonen S et al. Romosozumab in Postmenopausal Women with Low Bone Mineral Density. N Engl J Med 2014; 370:412-420.

6. Sorita A ,Ahmed A ,Starr SR et al. Off-hour presentation and outcomes in patients with acute myocardial infarction: systematic review and meta-analysis. BMJ 2014;348:f7393

7. Savin VI, Ibrahim MX, Larsson E et al. Antioxidants Accelerate Lung Cancer Progression in Mice. Sci Transl Med. 2014;29(6):221ra15

8. Hoy D, March L, Woolf A et al. Clinical and epidemiological research: Extended report: The global burden of neck pain: estimates from the Global Burden of Disease 2010 study. Ann Rheum Dis annrheumdis-2013-204431Published Online First: 30 January 2014