This study investigated the associations of cardiorespiratory fitness (CRF) and different measures of adiposity with cardiovascular disease (CVD) and all-cause mortality in men. Data from men with documented or suspected coronary heart disease (CHD) in the Aerobics Center Longitudinal Study (N = 9,563) were analyzed using baseline body mass index (BMI), CRF (quantified as the duration of a symptom-limited maximal treadmill exercise test), waist circumference (WC), and percent body fat (BF). After adjustment for age, examination year, and multiple baseline risk factors, men with low fitness had a higher risk of all-cause mortality in the BMI categories of normal weight (hazard ratio [HR] 1.60; 95% CI 1.24-2.05), obese class I (HR 1.38; 95% CI 1.04-1.82), and obese class II/III (HR 2.43; 95% CI 1.55-3.80) but not overweight compared with the normal-weight and high-fitness reference group. A similar pattern was noted for WC and percent BF tertiles and for CVD mortality. Among men with high fitness, there were no significant differences in CVD and all-cause mortality risk across BMI, WC, and percent BF categories. Therefore, using adiposity to assess mortality risk in patients with CHD may be misleading unless fitness is considered. Mayo Clin Proc. 2012 Apr 11. PMID: 22503065

This systematic review and meta-analysis was conducted to evaluate the efficacy and safety of zinc for the treatment of the common cold. Electronic databases and other sources for studies published through to September 2011 were searched and 17 randomized controlled trials comparing orally administered zinc with placebo or no treatment were included (N = 2,121). Compared to placebo, subjects receiving zinc had a shorter duration of cold symptoms (mean difference -1.65 days; 95% CI -2.50 to -0.81); however, heterogeneity was high (I2 = 95%). Zinc shortened the duration of cold symptoms in adults (mean difference -2.63; 95% CI -3.69 to -1.58), but no significant effect was seen among children (mean difference -0.26; 95% CI -0.78 to 0.25). Heterogeneity remained high in all subgroup analyses, including by age, dose of ionized zinc, and zinc formulation. The occurrence of adverse events (RR 1.24; 95% CI 1.05-1.46), bad taste (RR 1.65; 95% CI 1.27-2.16), and nausea (RR 1.64; 95% CI 1.19-2.27) were more common in the zinc group than in the placebo group. Therefore, oral zinc formulations may shorten the duration of common cold symptoms but large high-quality trials are needed before definitive recommendations can be made. CMAJ. 2012 May 7. PMID: 22566526

Acupuncture, hypnotherapy, and aversive smoking are the most frequently studied alternative smoking cessation aids. Although these aids are often used as alternatives to pharmacotherapies for smoking cessation, their efficacy is unclear. The current random effect meta-analysis was conducted on randomized controlled trials to determine the efficacy of alternative smoking cessation aids. The Cochrane Library, EMBASE, Medline, and PsycINFO databases were systematically searched through December 2010 and only trials that reported cessation outcomes as point prevalence or continuous abstinence at six or 12 months were included. Overall, 14 trials were identified, six that investigated acupuncture (N = 823), four that investigated hypnotherapy (N = 273), and four that investigated aversive smoking (N = 99). The estimated mean treatment effects were as follows: acupuncture (OR 3.53; 95% CI 1.03-12.07), hypnotherapy (OR 4.55; 95% CI 0.98-21.01), and aversive smoking (OR 4.26; 95% CI 1.26-14.38). The authors concluded that these results suggest that acupuncture and hypnotherapy may help smokers quit. While aversive smoking may help smokers quit, it is important to note that no recent trials have investigated this intervention. Further, more evidence is needed to determine whether alternative interventions are as efficacious as pharmacotherapies. Am J Med. 2012 Apr 11. PMID: 22502956

The current randomized, masked, placebo-controlled study was performed to explore the efficacy of combination therapy with omega-3 fatty acids plus citalopram versus citalopram plus placebo (olive oil). Forty-two subjects participated in this nine-week study of combination therapy (two 1 g capsules containing a blend of 900 mg eicosapentaenoic acid, 200 mg docosahexaenoic acid, and 100 mg of other omega-3 fatty acids twice daily plus citalopram) versus monotherapy (two 1 g capsules of olive oil per day plus citalopram) in the initial treatment of individuals with major depressive disorder (MDD). Results revealed that the combination therapy demonstrated significantly greater improvement in Hamilton Depression Rating scale scores over time (P = 0.008) beginning at week four (P = 0.014). The authors concluded that combination therapy was more effective than monotherapy in decreasing signs and symptoms of MDD during the eight weeks of active treatment; however, combination therapy did not seem to enhance the speed of the initial antidepressant response. These results suggest that there may be an advantage to combining omega-3 fatty acids with a selective serotonin uptake inhibitor in the initial treatment of individuals with MDD. J Clin Psychopharmacol. 2012 Feb;32(1):61-4. PMID: 22198441.

This retrospective cohort study involving 934 147 residents of British Columbia (10 827 first-time users of bisphosphonates and 923 320 nonusers) was conducted to examine the risk of inflammatory ocular adverse events in a pharmacoepidemiologic cohort study. The incidence rate among first-time users was 29/10 000 person-years for uveitis and 63/10 000 person-years for scleritis. In contrast, the incidence among people who did not use oral bisphosphonates was 20/10 000 person-years for uveitis and 36/10 000 for scleritis (number needed to harm: 1100 and 370, respectively). First-time users had an elevated risk of uveitis (adjusted RR 1.45; 95% CI 1.25-1.68) and scleritis (adjusted RR 1.51; 95% CI 1.34-1.68). The rate ratio for the propensity-scoreadjusted analysis did not change the results (uveitis RR 1.50 and 95% CI 1.29-1.73; scleritis RR1.53 and 95% CI 1.39-1.70). The authors concluded that people using oral bisphosphonates for the first time might be at a higher risk of scleritis and uveitis compared to people with no bisphosphonate use. Therefore, patients taking bisphosphonates should be familiar with the signs and symptoms of these conditions so that they can immediately seek assessment by an ophthalmologist if necessary. CMAJ. 2012 Apr 2. PMID: 22470169

Telomere erosion has been suggested as a potential mechanism linking stress to cellular aging, disease, and mortality in humans. This prospective longitudinal study was conducted to examine telomere erosion in relation to children’s exposure to violence. Repeated telomere measurements were conducted in children while they experienced stress and violence was assessed as exposure to maternal domestic violence, frequent bullying victimization, and physical maltreatment by an adult. Participants were 236 children with one or more violence exposures recruited from the Environmental-Risk Longitudinal Twin Study, a nationally representative 1994-1995 birth cohort. Each child’s mean relative telomere length was measured in baseline and follow-up DNA samples using the quantitative PCR method for T/S ratio (the ratio of telomere repeat copy numbers to single-copy gene numbers). Compared with their counterparts, the children who experienced two or more kinds of violence exposure showed significantly more telomere erosion between age-five baseline and age-ten follow-up measurements, even after adjusting for sex, socioeconomic status, and body mass index (P=0.015). The authors concluded that this finding supports a mechanism linking childhood stress with telomere maintenance, which is observed at a young age and has potential impact for life-long health. Mol Psychiatry. 2012 Apr 24. PMID: 22525489

Major Depressive Disorder (MDD) is a highly recurrent disease and stress-responsive system dysfunction seems to persist after remission. In patients with chronic and recurrent depressive episodes, state related hypothalamic-pituitary-adrenal (HPA)- axis dysregulation might be a risk factor for prospective recurrence. This study examined the predictive effect of cortisol on consecutive episodes in remitted recurrently depressed patients. Cortisol was assessed in the saliva of 55 remitted recurrently depressed patients who were followed prospectively for 5.5 years after remission. Lower mean morning cortisol levels predicted earlier time to recurrence over 5.5 years after correction for residual symptoms (P = 0.015); residual symptoms and childhood trauma slightly confounded this association. Lower cortisol levels were associated with having experienced traumatic childhood life events (42.3% in patients with lower cortisol versus 19.2% in patients with higher cortisol). The authors concluded that these data provide further support for the predictive role of HPA axis dysregulation (i.e. lower morning cortisol levels) on recurrence in recurrently depressed patients. They also suggested that childhood trauma is associated with having lower cortisol levels and that it might have long-term consequences for dealing with stress and the HPA-axis. Psychiatry Res. 2012 Apr 11. PMID: 22503382

Type 2 diabetes (T2DM) may increase the risk of Parkinson’s disease (PD). This cohort study evaluated the role of oral anti-hyperglycemic agents (OAA) in any diabetes-PD linkage. A representative cohort of 800,000 was obtained from the Taiwan National Health Insurance database. Those with T2DM were matched with those diabetes-free by birth-date and gender for the comparison of PD incidence. Related to diabetes-free, the hazard ratio (HR) was 2.18 (95% CI 1.27-3.73) for T2DM without OAAs and 1.30 (95% CI 0.77-2.19) with OAAs. For sulfonylurea alone, the PD incidence densities (PID, per 10,000 person-years) increased from 58.3 (95% CI 46.6-70.1) to 83.2 (95% CI 68.6-97.7), with similar findings by gender, but little difference if metformin was used. The metformin-alone HR was 0.95 (95% CI 0.53-1.71), sulfonylurea-alone 1.57 (95% CI 1.15-2.13), and combined therapy 0.78 (95% CI 0.61-1.01) and these differences persisted when incident PD was excluded for four years after T2DM diagnosis. The use of metformin first, in those without insulin, provided an HR of 0.40 (0.17-0.94). The authors concluded that incident PD risk in T2DM increases 2.2-fold and sulfonylureas further increase risk by 57%, which is avoided by combination with metformin. Parkinsonism Relat Disord. 2012 Apr 10. PMID: 22498320

Loneliness is a predictor of mortality and increased cardiovascular morbidity. Since inflammation is a potential pathway through which loneliness might impact health, this study was conducted to investigate the relationship between loneliness and inflammatory interleukin-6 (IL-6), interleukin-1 receptor antagonist (IL-1Ra), and monocyte chemotactic protein-1 (MCP-1) responses to standardized mental stress. A secondary purpose was to evaluate whether individual variations in cortisol responses influenced the hypothesized relationship between loneliness and inflammation. Saliva samples and blood were taken from 524 healthy middle-aged men and women from the Whitehall II cohort at baseline, immediately after stress tasks, and 45 min later. Greater loneliness (measured with the revised UCLA loneliness scale) was associated with larger IL-6 (P = 0.044) and IL-1Ra (P = 0.006) responses to psychological stress and higher MCP-1 (P < 0.001) levels in women (but not men), independently of age, grade of employment, body mass index, and smoking status. Cortisol responsiveness was inversely related to loneliness in women; the odds of being a cortisol responder decreased with increasing loneliness (P = 0.008). Therefore, the impact of loneliness on health in women may be mediated in part through dysregulation of inflammatory and neuroendocrine systems. Psychoneuroendocrinology. 2012 Apr 11. PMID: 22503139

Cognitive behavioral therapy is a promising treatment for chronic fatigue syndrome (CFS), but its availability is restricted. This open label study investigated the effectiveness of the first dedicated internet-based therapeutic program for adolescents with CFS [Fatigue In Teenagers on the interNET (FITNET)]. Adolescents aged 12-18 years with CFS were randomly assigned to FITNET or usual care in a 1:1 ratio at one tertiary treatment centre in the Netherlands. Primary outcomes of school attendance, fatigue severity, and physical functioning were assessed at six months of full school attendance. Sixty-eight of 135 adolescents were assigned to FITNET and 67 to usual care, and 67 and 64, respectively, were analyzed. FITNET was significantly more effective than usual care for all dichotomized primary outcomes (75% vs 16%; RR 4.8; 95% CI 2.7-8.9; p<0.0001), absence of severe fatigue (85% vs 27%; RR 3.2; 95% CI 2.1-4.9; p<0.0001), and normal physical functioning (78% vs 20%; RR 3.8; 95% CI 2.3-6.3; p<0.0001). No serious adverse events were reported. The authors concluded that FITNET offers a readily accessible and highly effective treatment for adolescents with CFS and that these results justify its implementation on a broader scale. Lancet. 2012 Feb 29. PMID: 22385683.