Friday, January 11, 2008

2.5 bottles of wine a week can save your life

Not three? Probable middle-class effect in the results again

People who drink up to almost 2.5 bottles of wine a week have a lower risk of premature death than those who abstain from alcohol, research has suggested. Moderate drinkers are less likely than either teetotallers or heavy drinkers to die of heart disease and other causes, and the protective effect is magnified if they also take plenty of exercise, scientists have found. A weekly consumption of up to 14 drinks --- classified as a glass of wine, a bottle of beer or a single measure of spirits ? offers the greatest health benefits, a 20-year study of almost 12,000 Danish men and women has concluded.

The healthiest were those who were moderate drinkers and moderately or very physically active. Their risk of dying from heart disease was about half that of inactive nondrinkers. Martin Gronbaek, of the University of Southern Denmark in Copenhagen, who led the research, said: "Our study shows that being both physically active and drinking a moderate amount of alcohol is important for lowering the risk of both fatal ischaemic heart disease (IHD) and death from all causes. For both men and women, being physically active was associated with a significantly lower risk for both fatal IHD and all-cause mortality than being physically inactive, and drinking alcohol was associated with a lower risk of fatal IHD than abstaining. "A weekly moderate alcohol intake reduced the risk of all-cause mortality among both men and women, whereas the risk among heavy drinkers was similar to nondrinkers."

In the study, published in the European Heart Journal, a team led by Professor Gronbaek, Berit Heitmann and Jane Ostergaard Pedersen, analysed data collected by the Copenhagen City Heart Study, a long-running research cohort assembled in the 1970s to investigate cardiovascular health.

In the mid1970s, almost 20,000 Danish men and women from the same area of Copenhagen were selected randomly from electoral rolls. About 70 per cent agreed to participate, and 11,914 adults eventually answered detailed questionnaires between 1981 and 1983 about many aspects of their behaviour that were considered possible influences on cardiovascular health, including exercise and drinking habits. The goal was to follow up a large group of ordinary people over a long period to find out whether different behaviours among a people of broadly similar social background were associated with any health effects.

There have been 5,901 deaths, including 1,242 from ischaemic heart disease. Ms Ostergaard Pedersen said: "The lowest risk of death from all causes was observed among the physically active moderate drinkers and the highest risk among the physically inactive non and heavy drinkers."


Elective Caesarean for Term Infants Hikes Respiratory Risks

This is not a strong study methodologically but the differences observed are large and orderly so it would seem to be an argument against "frivolous" caesareans. Journal article here

Waiting a little longer for an elective caesarean may be key to avoiding neonatal respiratory problems in term infants, according to investigators here. Babies delivered by elective caesarean from 37 through 39 weeks carry a two- to fourfold increased risk of overall and serious respiratory morbidity compared with babies delivered vaginally or by emergency caesarean, Anne K. Hansen, M.D., of Aarhus University Hospital, and colleagues, reported in an observational study in BMJ Online. The relative risk in their prospective cohort decreased with even small amounts of increasing gestational age, so that waiting until 39 weeks' gestation halved the 37-week risk, the researchers added. Yet even at 39 weeks an increase in morbidity remained, possibly due to a lack of hormones associated with labor.

If no medical indication is present, the investigators said, evidence-based information about the risks and benefits for mothers and newborns becomes all the more important for adequate counseling.

Respiratory morbidity included transitory tachypnea of the newborn, respiratory distress syndrome, persistent pulmonary hypertension of the newborn, and serious respiratory morbidity (oxygen therapy for more than two days, nasal continuous positive airway pressure, or need for mechanical ventilation).

The study included 34,458 live-born singleton babies without birth defects and with gestational ages of 37 to 41 weeks who were born from January 1998 through December 2006 at the Aarhus hospital. In an intention-to-treat methodology, the infants were categorized in two groups, elective caesarean section and intended vaginal delivery (all vaginal deliveries and emergency caesareans). Of these, 2,687 infants (7.8%) were delivered by an elective caesarean. Compared with newborns given intended vaginal delivery, a fourfold increased risk of respiratory morbidity was found for elective caesarean infants delivered at 37 weeks of gestation (OR: 3.9, 95% CI: 2.4 to 6.5). The risks decreased with increasing gestation. At 38 weeks, the risk was three times greater (OR: 3.0, 95% CI: 2.1 to 4.3), and at 39 weeks, the risk was almost double (OR: 1.9, 95% CI: 1.2 to 3.0).

For example, at 37 weeks, 2.8% of infants delivered by intended vaginal delivery had general respiratory problems compared with 10% of those delivered by caesarean. At 38 weeks, the proportion was 1.7% compared with 5.1%, and at 39 weeks it was 1.1% versus 2.1%. The increased risks of serious respiratory morbidity showed the same pattern but with higher odds ratios than those for general respiratory problems. For elective caesarean at 37 weeks, the researchers reported a fivefold increased respiratory risk (OR: 5.0, 95% CI: 1.6 to 16.0).

These results remained essentially unchanged after exclusion of pregnancies complicated by diabetes, pre-eclampsia, and intrauterine growth retardation, or by breech presentation, they wrote.

The mechanisms behind these findings are not known, the investigators said, but the lack of hormones associated with labor could explain the association. During spontaneous labor there is a decrease in the secretion of fetal lung liquid and an increase in its absorption while the release of surfactant is stimulated. This may be mediated by a raised level of catecholamines in the infant in response to rupture of the membranes and labor. This surge, however, is absent when caesareans are carried out before labor, they wrote.

One study limitation, the researchers noted, was the fact that information on the type of delivery was validated by research midwives before data entry, and information on respiratory problems was provided by neonatologists. However, they said, variation may have existed in the use of the international classification of diseases.

The authors noted that while waiting until 39 weeks of gestation halves the 37-week risk, there may be other consequences. Carrying out elective caesareans at greater gestational ages "may result in higher rates of intrapartum caesareans because some women would go into spontaneous labor (in our population 25% of spontaneous intended vaginal deliveries started before 39 weeks' gestation)," they wrote. "Compared with elective caesarean sections, intrapartum caesarean sections may carry an increased risk of complications such as uterine rupture in women with previous caesarean section, infections, or even maternal mortality."



Just some problems with the "Obesity" war:

1). It tries to impose behavior change on everybody -- when most of those targeted are not obese and hence have no reason to change their behaviour. It is a form of punishing the innocent and the guilty alike. (It is also typical of Leftist thinking: Scorning the individual and capable of dealing with large groups only).

2). The longevity research all leads to the conclusion that it is people of MIDDLING weight who live longest -- not slim people. So the "epidemic" of obesity is in fact largely an "epidemic" of living longer.

3). It is total calorie intake that makes you fat -- not where you get your calories. Policies that attack only the source of the calories (e.g. "junk food") without addressing total calorie intake are hence pissing into the wind. People involuntarily deprived of their preferred calorie intake from one source are highly likely to seek and find their calories elsewhere.

4). So-called junk food is perfectly nutritious. A big Mac meal comprises meat, bread, salad and potatoes -- which is a mainstream Western diet. If that is bad then we are all in big trouble.

5). Food warriors demonize salt and fat. But we need a daily salt intake to counter salt-loss through perspiration and the research shows that people on salt-restricted diets die SOONER. And Eskimos eat huge amounts of fat with no apparent ill-effects. And the average home-cooked roast dinner has LOTS of fat. Will we ban roast dinners?

6). The foods restricted are often no more calorific than those permitted -- such as milk and fruit-juice drinks.

7). Tendency to weight is mostly genetic and is therefore not readily susceptible to voluntary behaviour change.

8). And when are we going to ban cheese? Cheese is a concentrated calorie bomb and has lots of that wicked animal fat in it too. Wouldn't we all be better off without it? And what about butter and margarine? They are just about pure fat. Surely they should be treated as contraband in kids' lunchboxes! [/sarcasm].

9). And how odd it is that we never hear of the huge American study which showed that women who eat lots of veggies have an INCREASED risk of stomach cancer? So the official recommendation to eat five lots of veggies every day might just be creating lots of cancer for the future! It's as plausible (i.e. not very) as all the other dietary "wisdom" we read about fat etc.

10). And will "this generation of Western children be the first in history to lead shorter lives than their parents did"? This is another anti-fat scare that emanates from a much-cited editorial in a prominent medical journal that said so. Yet this editorial offered no statistical basis for its opinion -- an opinion that flies directly in the face of the available evidence.

Even statistical correlations far stronger than anything found in medical research may disappear if more data is used. A remarkable example from Sociology:
"The modern literature on hate crimes began with a remarkable 1933 book by Arthur Raper titled The Tragedy of Lynching. Raper assembled data on the number of lynchings each year in the South and on the price of an acre's yield of cotton. He calculated the correlation coefficient between the two series at -0.532. In other words, when the economy was doing well, the number of lynchings was lower.... In 2001, Donald Green, Laurence McFalls, and Jennifer Smith published a paper that demolished the alleged connection between economic conditions and lynchings in Raper's data. Raper had the misfortune of stopping his analysis in 1929. After the Great Depression hit, the price of cotton plummeted and economic conditions deteriorated, yet lynchings continued to fall. The correlation disappeared altogether when more years of data were added."
So we must be sure to base our conclusions on ALL the data. But in medical research, data selectivity and the "overlooking" of discordant research findings is epidemic.

"What we should be doing is monitoring children from birth so we can detect any deviations from the norm at an early stage and action can be taken". Who said that? Joe Stalin? Adolf Hitler? Orwell's "Big Brother"? The Spanish Inquisition? Generalissimo Francisco Franco Bahamonde? None of those. It was Dr Colin Waine, chairman of Britain's National Obesity Forum. What a fine fellow!


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