Wednesday, September 24, 2008


Latest abstract below. They found that the closer you stick to what they regard as a typical Mediterranean diet (oil not butter; More vegetables and less meat; plenty of garlic; red wine rather than beer etc.) the longer you live, though only by a small amount. For all we know, however, it could be that it is people who are careful of their health who are most likely to stick to such a heavily-hyped diet and that people who are more careful of their health live longer anyway. And the pesky facts about Australia are ignored too. Australia has exceptionally long life expectancies despite being as gastronomically different from Southern Europe as it is geographically distant. The usual Australian diet is about as "wrong" as you can get by Mediterranean standards.

And let me get REALLY pesky here. Have you ever seen Mediterranean people (particularly Southern Italians) in later life? They are mostly shaped like barrels. So how does that fit in with the obesity war?

Adherence to Mediterranean diet and health status: meta-analysis

By Sofi F et al.

OBJECTIVE: To systematically review all the prospective cohort studies that have analysed the relation between adherence to a Mediterranean diet, mortality, and incidence of chronic diseases in a primary prevention setting.

DESIGN: Meta-analysis of prospective cohort studies.

DATA SOURCES: English and non-English publications in PubMed, Embase, Web of Science, and the Cochrane Central Register of Controlled Trials from 1966 to 30 June 2008. Studies reviewed Studies that analysed prospectively the association between adherence to a Mediterranean diet, mortality, and incidence of diseases; 12 studies, with a total of 1 574,299 subjects followed for a time ranging from three to 18 years were included.

RESULTS: The cumulative analysis among eight cohorts (514,816 subjects and 33,576 deaths) evaluating overall mortality in relation to adherence to a Mediterranean diet showed that a two point increase in the adherence score was significantly associated with a reduced risk of mortality (pooled relative risk 0.91, 95% confidence interval 0.89 to 0.94). Likewise, the analyses showed a beneficial role for greater adherence to a Mediterranean diet on cardiovascular mortality (pooled relative risk 0.91, 0.87 to 0.95), incidence of or mortality from cancer (0.94, 0.92 to 0.96), and incidence of Parkinson's disease and Alzheimer's disease (0.87, 0.80 to 0.96).

CONCLUSIONS: Greater adherence to a Mediterranean diet is associated with a significant improvement in health status, as seen by a significant reduction in overall mortality (9%), mortality from cardiovascular diseases (9%), incidence of or mortality from cancer (6%), and incidence of Parkinson's disease and Alzheimer's disease (13%). These results seem to be clinically relevant for public health, in particular for encouraging a Mediterranean-like dietary pattern for primary prevention of major chronic diseases.

BMJ. 2008 Sep 11;337:a1344


Arthritis surgery now found to be useless. Opening up an arthritic joint, cleaning out the junk and smoothing out the rough bits should so SOME good, right? 'Fraid not. Once again a proper controlled study detonates assumptions

A Randomized Trial of Arthroscopic Surgery for Osteoarthritis of the Knee

By Alexandra Kirkley, M.D. et al.


Background: The efficacy of arthroscopic surgery for the treatment of osteoarthritis of the knee is unknown.

Methods: We conducted a single-center, randomized, controlled trial of arthroscopic surgery in patients with moderate-to-severe osteoarthritis of the knee. Patients were randomly assigned to surgical lavage and arthroscopic d‚bridement together with optimized physical and medical therapy or to treatment with physical and medical therapy alone. The primary outcome was the total Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score (range, 0 to 2400; higher scores indicate more severe symptoms) at 2 years of follow-up. Secondary outcomes included the Short Form-36 (SF-36) Physical Component Summary score (range, 0 to 100; higher scores indicate better quality of life).

Results: Of the 92 patients assigned to surgery, 6 did not undergo surgery. Of the 86 patients assigned to control treatment, all received only physical and medical therapy. After 2 years, the mean (~SD) WOMAC score for the surgery group was 874~624, as compared with 897~583 for the control group (absolute difference [surgery-group score minus control-group score], -23ñ605; 95% confidence interval [CI], -208 to 161; P=0.22 after adjustment for baseline score and grade of severity). The SF-36 Physical Component Summary scores were 37.0~11.4 and 37.2~10.6, respectively (absolute difference, -0.2~11.1; 95% CI, -3.6 to 3.2; P=0.93). Analyses of WOMAC scores at interim visits and other secondary outcomes also failed to show superiority of surgery.

Conclusions: Arthroscopic surgery for osteoarthritis of the knee provides no additional benefit to optimized physical and medical therapy.

NEJM, 2008, Volume 359:1097-1107 Number 11

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