This randomized controlled trial examined the impact of 25-hydroxy- vitamin D levels and high-dose vitamin D supplementation on isolated systolic hypertension. This was a parallel group, double-blind, placebo-controlled randomized trial. Primary care clinics and hospital clinics were utilized and participants were 70 years and older with systolic hypertension, as well as baseline 25-hydroxyvitamin D levels less than 30 ng/mL. The intervention was 100,000 U of oral cholecalciferol or matching placebo every 3 months for 1 year. The measurements included office blood pressure, arterial stiffness, endothelial function, cholesterol level, insulin resistance, and b-type natriuretic peptide level during 12 months. 159 participants were randomized. Mean baseline office systolic blood pressure was 163/78 mmHg. Mean baseline 25-hydroxyvitamin D level was 18 ng/mL. 25-hydroxyvitamin D levels increased in the treatment group compared with the placebo group. No significant treatment effect was seen for mean office blood pressure. No significant treatment effect was evident for any secondary outcome, including arterial stiffness, cholesterol levels, and others. There was no excess of adverse events in the treatment group and the total number of falls was non-significantly lower in the group receiving vitamin D. JAMA Intern Med. 2013 August. PMID: 23939263

Diabetes is a risk factor for dementia, but it is unknown whether higher glucose levels increase the risk of dementia in people without diabetes. 35,264 clinical measurements of glucose levels and 10,208 measurements of glycated hemoglobin levels from 2067 participants without dementia were taken to examine the relationship between glucose levels and the risk of dementia. Participants were from the Adult Changes in Thought study and include 839 men and 1228 women whose mean age at baseline was 76 years, 232 participants had diabetes and 1835 did not. The authors fit Cox regression models, stratified according to diabetes status and adjusted for age, sex, study cohort, educational level, level of exercise, blood pressure, and other factors. The results showed that during a mean follow-up of 6.8 years, dementia developed in 524 participants. Among participants without diabetes, higher average glucose levels within the preceding 5 years were related to an increased risk of dementia. Among participants with diabetes, higher average glucose levels were also related to an increased risk of dementia. The authors conclude that higher glucose levels may be a risk factor for dementia, even among persons without diabetes. N Engl J Med. 2013 August. PMID: 23924004

Early intestinal microbiota exerts important stimuli for immune develop- ment and a reduced microbial exposure and Caesarean section (CS) have been associated with the development of allergic disease. In this study, the authors addressed how microbiota development in infants is affected by mode of delivery, and relate differences in colonization patterns to the maturation of a balanced Th1/Th2 immune response. The study was designed such that the postnatal intestinal colonization patter was investigated in 24 infants, born vaginally (15) or by CS (9). The intestinal microbiota were characterized using pyrosequencing of 16S rRNA genes at 1 week, and 1, 3, 6, 12, and 24 months after birth. Venous blood levels of Th1- and Th2- associated chemokines were measured at 6, 12, and 24 months. The results showed that infants born through CS had lower total microbiota diversity during the first 2 years of life. CS delivered infants also had a lower abundance and diversity of the Bacteroidetes phylum and were less often colonized by the Bacteroidetes phylum. Infants born through CS had significantly lower levels of Th1- associated chemokines CXCL10 and CXCL11 found in the blood. Gut 2013 August. PMID: 23926244

In women with polycystic ovarian syndrome (PCOS), hyperinsulinaemia stimulates ovarian cytochrome P450c17α activity that stimulates ovarian androgen production. The objective of this study was to compare whether timed caloric intake differentially influences insulin resistance and hyperandrogenism in lean PCOS women. A total of 60 lean PCOS women (BMI 23.5-24) were randomized into two isocaloric maintenance diets with different meal timing distribution: a breakfast diet of 980 kcal breakfast, 640 kcal lunch and 190 kcal dinner, or a dinner diet of 190 kcal breakfast, 640 kcal lunch and 980 kcal dinner for 90 days. In the breakfast diet group, a significant decrease was observed in both glucose area under the curse, insulin area under the curve by 7 and 54% respectively. In the breakfast group, free testosterone decreased by 50% and sex hormone-binding globulin increased by 105%. Gonadotropin-releasing hormone-stimulated peak serum 17OHP decreased by 39%. No change in these parameters was observed in the dinner group. Women in the breakfast group had an increased ovulation rate. In lean PCOS women, a high caloric intake at breakfast with reduced intake at dinner results in improved insulin sensitivity indices, which ameliorates hyperandrogenism and improves ovulation rate. Clin Sci (Lond). 2013 Nov. PMID: 23688334

The Gleason grade is used for pathological scoring of the differen- tiation of prostate cancer. This study examined 1207 Physicians’ Health Study and Professionals Follow-up Study participants diagnosed with prostate cancer from 1982 to 2004 and treated with prostatectomy. They compared the distribution of grade and clinical stage across the pre-PSA and PSA screening eras. The authors reviewed grade using the ISUP 2005 revised criteria. The proportion of advanced staged tumors dropped more than six-fold, from the earliest period, 19.9% stage ≥T3, to latest, 3% stage T3, none T4. The proportion of Gleason score ≥8 decreased substantially less from 25.3% to 17.6%. A significant interaction between stage and diagnosis date predicting grade suggests that the relationship between grade and stage varies by time period. As the dramatic shift in stage since the introduction of PSA screening was accompanied by a more modest shift in Gleason grade, these findings suggest that grade may be established early in tumour pathogenesis. The authors conclude that this has implications for the understanding of tumour progression and prognosis and may help patients diagnosed with lower grade disease feel more comfortable choosing active surveillance. Cancer Res. 2013 August. PMID: 23946472

This study was a prospective cohort study evaluating the effect on Clostridium difficile infections following antibiotic administration (CDIAA) of a probiotic added to existing C. difficile infection (CDI) standard preventative measure in 31,832 hospitalized patients receiving antibiotics. Phase I (1580) measured the impact of standard preventative measures alone. In Phase II, 50 to 60 × 109 cfu daily dose of oral Lactobacillus acidophilus CL1285 and L. casei LBC80R probiotic formula was administered to all patients receiving antibiotics. Phase III included the same intervention after a move to a new hospital facility. Phases II and III included 4968 patients. During Phase IV, 25,284 patients were submitted to the same regimen but outcome data were compared to those of similar hospitals in Quebec. At the end of Phase III, CDIAA had decreased from more than 18 cases per 1000 patient admissions in Phase I to less than 5 cases. Reductions of CDI cases (73%) were observed. CDI recurrence rate was reduced by 39%. During the following 6 years, the CDI rate averaged 2.71 cases per 10,000 patient-days compared to 8.50 cases per 10,000 patient-days in equivalent hospitals located in Quebec. Curr Med Res Opin. 2013 August. PMID: 23931498

Electronic cigarettes (e-cigarettes) are becoming popular since their introduction a few years ago. This study was a prospective 12-month randomized, controlled trial that evaluated smoking reduction and abstinence in 300 smokers not intending to quit, experimenting two different nicotine strengths of a popular e-cigarette, compared to its non-nicotine choice. One group (n = 100) received 7.2mg nicotine cartridges for 12 weeks, the second group (n = 100) received 6 weeks of 7.2mg followed by 6 weeks of 5.4mg, and the third group (n = 100) received no-nicotine cartridges for 12 weeks. The study consisted of nine visits during which cig/day use and exhaled carbon monoxide levels were measured. Smoking reduction and abstinence rates were calculated. The results showed that there were declines in cig/day use and exhaled carbon monoxide in all three groups, with no consistent differences among study groups. Smoking reduction was documented in 22.3% and 10.3% at week-12 and week-52 respectively. Withdrawal symptoms were infrequently reported. The authors conclude that in smokers not intending to quit, the use of e-cigarettes, with or without nicotine, decrease cigarette consumption and elicited enduring tobacco abstinence with minimal side effects. PLoS One. June 2013. PMID: 23826093.

This study analyzed data from two case-control studies from Italy between 1983 and 2008, including 362 and 326 pancreatic cancer cases and 1552 and 652 hospital controls. A Mediterranean Diet Score (MDS) summarizing the major characteristics of the Mediterranean diet was used in the two studies separately and overall. Two further scores of adherence to the diet were applied in the second study, using the Mediterranean Dietary Pattern Adherence Index (MDP) and the Mediterranean Adequacy Index (MAI). The results showed that the odds ratios for increasing levels of scores (indicating increasing adherence) were estimated using multiple logistic regression models. Odds ratio for a MDS score of 6 compared with less than 3 was 0.57 in the first study, 0.51 in the second study, and 0.48 overall. A trend of decreasing risk was observed also for the MDP and MAI the odds ratios for the highest versus the lowest quintile being 0.44 for MDP and 0.68 for the MAI. The results were consistent across strata of age, sex, education, body mass index, alcohol drinking, tobacco smoking, and diabetes. The authors conclude that the Mediterranean diet is favourably associated with decreased pancreatic cancer risk. Br J Cancer. 2013 August. PMID: 23928660