A new US study found that both red and white wine have the same effect on breast cancer risk, that is they increase the risk by the same amount, which is contrary to studies on heart disease and prostate cancer that suggest red wine may have beneficial effects on disease risk compared to white wine.

The study was the work of lead author Dr Polly Newcomb, head of the Cancer Prevention Program in the Public Health Sciences Division at the Fred Hutchinson Center in Seattle, Washington, and colleagues from other research centers, and is published online in the March issue of Cancer Epidemiology, Biomarkers and Prevention.

Newcomb said in a press statement that she and her colleagues were interested in finding out what effect red wine might have on breast cancer risk, particularly since it has been singled out in other studies as being beneficial, such as on risk of heart disease and prostate cancer.

“The general evidence is that alcohol consumption overall increases breast-cancer risk, but the other studies made us wonder whether red wine might in fact have some positive value,” explained Newcomb.

For the study the researchers interviewed 6,327 women who had breast cancer and 7,558 age-matched controls who did not. All the participants were from Wisconsin, Massachusetts and New Hampshire and aged from 20 to 69.

They asked them how often they drank alcohol (red wine, white wine, spirits/liquor, and beer) and other questions relevant to breast cancer risk, including how old they were when/if they first became pregnant, whether there was any family history of breast cancer, and whether they had used hormonal replacement therapy (HRT).

The frequency of alcohol consumption in both the breast cancer and the control group was the same, and the proportion of women consuming red and white wine was also the same in both groups.

The results showed there was no difference between red and white wine with respect to risk of having breast cancer.

The researchers found that women who had 14 or more drinks a week, regardless of type (red or white wine, spirits/liquor or beer) were 24 per cent more likely to have breast cancer compared with women who did not drink alcohol at all.

Newcomb said that neither red nor white wine appeared to have any benefits.

“If a woman drinks, she should do so in moderation — no more than one drink a day,” she said.

“And if a woman chooses red wine, she should do so because she likes the taste, not because she thinks it may reduce her risk of breast cancer,” added Newcomb.

This is not the first study to find that moderate alcohol consumption increases breast cancer risk for women. For example, a large UK study published last week in the Journal of the National Cancer Institute found that even moderate amounts of alcohol could increase a woman’s chance of developing breast cancer or other cancers by 13 per cent.

The National Cancer Institute, which is part of the National Institutes of Health, sponsored the research.

“No Difference Between Red Wine or White Wine Consumption and Breast Cancer Risk.”
Polly A. Newcomb, Hazel B. Nichols, Jeannette M. Beasley, Kathleen Egan, Linda Titus-Ernstoff, John M. Hampton, and Amy Trentham-Dietz.
Cancer Epidemiology, Biomarkers and Prevention, March 2009 18: 1007-1010.

Long-term use of beta carotene and some other carotenoid-containing dietary supplements may increase the risk of lung cancer, especially among smokers, according to a study by University of North Carolina at Chapel Hill researchers.

The study, which also examined use of retinol, vitamin A, lycopene and lutein, appears in the February issue of the American Journal of Epidemiology.

Researchers used questionnaires to assess use of dietary supplements, including multi-vitamins and individual nutrients, by more than 77,000 Americans over 10 years, and matched the results against data from the Surveillance, Epidemiology and End Results (SEER) cancer registry to track the rates of lung cancer among them.

They found that certain people especially smokers who took dietary supplements containing these nutrients, were at higher risk of developing lung cancer than the general population.

“In the 1980s, studies began showing the link between diet and cancers, and showing that eating fruits and vegetables could lower your risk of certain cancers, including lung cancer,” said Jessie Satia, Ph.D., associate professor of epidemiology and nutrition at the UNC Gillings School of Global Public Health and member of UNC’s Lineberger Comprehensive Cancer Center. “Scientists wondered, then, if you took the beneficial nutrients from fruits and vegetables and gave high doses of them to persons at high risk for lung cancer, such as smokers, if you could decrease the risk of lung cancer.”

However, subsequent clinical trials proved that high doses of beta carotene actually seemed to increase the risk of developing lung cancer, Satia said, and trials in the United States and Sweden were stopped when the increased risk was detected.

“But that was in clinical trials, under controlled circumstances,” Satia said. “We wanted to see if the same results would be found if we looked at use of these supplements in the general population.”

Satia and colleagues from UNC and the University of Washington in Seattle gave questionnaires to men and women, aged 50 to 76, in western Washington state. Participants were asked about their use of multivitamins and individual nutrient supplements over the past 10 years (including frequency and dose), as well as about their health history and risk factors. Participants were followed for the next four years, at which time lung cancer rates were obtained.

The results show that smokers’ risk of developing lung cancer increased with the length of time they took dietary supplements containing beta carotene, retinol and lutein.

“The risk increased the longer the person had taken the supplements,” Satia said. “The amount of time the person took supplements seemed to have a greater effect than the dose. Even a modest dose, if taken for a long time, can increase the risks of lung cancer, especially among smokers.”

For example, the study found that use of retinol and lutein supplements for four years or longer was associated with increases in lung cancer risk of 53 percent and 102 percent, respectively.

The risk for nonsmokers could not be determined because lung cancer cases among nonsmokers was small, Satia said.

“We believe beta-carotene is an antioxidant, but it seems that if you take too much, at some point it can have pro-oxidant effects, which can result in elevated cancer risk.”

Co-authors of the study are: Alyson Littman, Ph.D., research assistant professor of epidemiology at the University of Washington in Seattle; Christopher G. Slatore, M.D., pulmonary and critical care medicine fellow, University of Washington at Seattle; Joseph A. Galanko, Ph.D., research assistant professor of medicine, UNC School of Medicine; Emily White, Ph.D., professor and associate dean of the School of Public Health at the University of Washington and member of the Fred Hutchinson Cancer Research Center.

To see an abstract of the study, see http://aje.oxfordjournals.org.

University of North Carolina at Chapel Hill
210 Pittsboro St., Campus Box 6210
Chapel Hill
NC 27514
United States
http://www.unc.edu

Also Included In: Nutrition / Diet; Clinical Trials / Drug Trials

A landmark report from cancer experts says that many cancers could be prevented throughout the globe if people adopted healthier diets, exercised more and controlled their weight. The overall figures show that about a third of the most common cancers in high-income countries and a quarter in lower-income countries could be prevented in this way; the estimates exclude smoking which alone accounts for about a third of cancers.

The report, titled “Policy and Action for Cancer Prevention” and released today Thursday 26th February, was produced by World Cancer Research Fund (WCRF).

Its overall message is that governments to households and individuals, across all sections of society, should give higher priority to public health and cancer prevention in particular.

The figures show for example that over 40 per cent of bowel and breast cancers in the UK could be prevented if people ate more healthily, exercised more and maintained a healthy weight. The figures for the US are very similar, and there are some similarly important results for lower income countries.

The table below shows the percentage of cancers that would be prevented for the US, UK, Brazil and China, for each of 12 types of cancer and overall.

Cancer type US UK Brazil China
Mouth, pharynx and larynx 63 67 63 44
Oesophagus 69 75 60 44
Lung 36 33 36 38
Stomach 47 45 41 33
Pancreas 39 41 34 14
Gall bladder 21 16 10 6
Bowel 45 43 37 17
Liver 15 17 6 6
Breast 38 42 28 20
Endometrium (womb) 70 56 52 34
Prostate 11 20 n/a n/a
Kidney 24 19 13 8
All 12 cancers combined 34 39 30 27

Two independent teams of experts went through the evidence on how changes in public health policy and interventions might change people’s lifestyle enough to make an impact on these figures. Then 23 world-wide experts made 48 recommendations that different sectors of society such as schools, institutions, media and governments should follow in order to effect the changes necessary, including:

* Schools should give children healthy food and make sure they exercise.

* Unhealthy food should not be available in schools, institutions and workplaces, for instance in vending machines.

* Governments should make local authorities provide widespread walking and cycling paths and routes to encourage people to be more physically active.

* All countries should make laws that incorporate the UN recommendations on breastfeeding.

* Food and drinks processors should put public health as the highest priority at all stages of production.

* Health professionals should become leaders in informing the public about health, especially about what they can do to prevent cancer.

* There should be independently produced guides and food labels to help people make the best choices for their families when buying food.

Chair of the WCRF Panel, Professor Sir Michael Marmot told the press that:

“This report shows that by making relatively straightforward changes, we could significantly reduce the number of cancer cases around the world.”

“When people think of policy reports, they often think they are only relevant to governments. But while governments are important in this, the evidence shows that when it comes to cancer prevention, all groups in society have a role to play,” he added.

“Everyone needs to make public health in general, and cancer prevention in particular, more of a priority,” urged Marmot.

Researchers at Purdue University have precisely measured the impact of a high-fat diet on the spread of cancer, finding that excessive dietary fat caused a 300 percent increase in metastasizing tumor cells in laboratory animals.

The researchers used an imaging technique to document how increasing fat content causes cancer cells to undergo changes essential to metastasis. Then they used another technique to count the number of cancer cells in the bloodstream of mice fed a high-fat diet compared to animals fed a lean diet.

The findings suggest that the combined tools represent a possible new diagnostic technique to determine whether a patient’s cancer is spreading, said Ji-Xin Cheng, an assistant professor in Purdue’s Weldon School of Biomedical Engineering and Department of Chemistry.

“It is generally accepted that diet and obesity are accountable for 30 percent of preventable causes of cancer, but nobody really knows why,” Cheng said. “These findings demonstrate that an increase in lipids leads directly to a rise in cancer metastasis.”

Researchers have theorized that tumor cells need more lipids than ordinary tissues to provide energy and material for tumor growth and metastasis.

“Before this work, however, most of the evidence was anecdotal, but here we present a mechanistic study,” said Thuc T. Le, a National Institutes of Health postdoctoral fellow at Purdue who is working with Cheng.

Findings were detailed in a paper published on Jan. 30 in the journal BMC Cancer. The paper was written by Le; Terry B. Huff, a graduate research assistant in Purdue’s Department of Chemistry; and Cheng. The research is supported by the Purdue Cancer Center.

The researchers implanted a cancerous lung tumor under the skin in each of the mice studied, and the animals were separated into two groups: one fed a high-fat diet and the other a lean diet.

The researchers then used an imaging method called coherent anti-Stokes Raman scattering, or CARS, to document how increasing lipids from fat intake induces changes to cancer cell membranes. Those changes, including processes called membrane phase separation and membrane rounding, enhance cancer metastasis.

“If the cancer cells don’t have excess lipids they stick together and form very tight junctions in tumors, but increasing lipids causes them to take on a rounded shape and separate from each other,” Le said.

The change in shape is critical to the ability of cancer cells to separate and spread throughout the body via the bloodstream.

The researchers then used another technique, called intravital flow cytometry, to count the number of cancer cells in the bloodstream of the mice. The technique works by shining a laser though the skin and into blood vessels, where the dyed cancer cells are visible.

Results showed the increase in lipids had no impact on the original tumors implanted in the mice. However, the rate of metastasis rose a dramatic 300 percent in the mice fed a high-fat diet.

The researchers later also examined the animals’ lungs and counted the number of cancer cells that had migrated to the lungs as a result of metastasis. Those findings supported the other results showing increased metastasis in animals fed a high-fat diet.

The researches used the imaging and cell-counting tools to document that linoleic acid, which is predominant in polyunsaturated fats, caused increasing membrane phase separation, whereas oleic acid, found in monounsaturated fats, did not. Increased membrane phase separation could improve the opportunity of circulating tumor cells to adhere to blood vessel walls and escape to organs far from the original tumor site. The new findings support earlier evidence from other research that consuming high amounts of polyunsaturated fat may increase the risk of cancer spreading.

The findings suggest that combining CARS and intravital flow cytometry represents a possible new diagnostic tool to screen patients for cancer. The tool can be used to count lipid-rich tumor cells circulating in a patient’s blood by shining a laser through the skin and into blood vessels. Because lipids can be detected without the need for dyes, the technique might be developed into a convenient method to diagnose whether a patient’s cancer is spreading aggressively, Cheng said.

“These findings open the possibility of an entirely new, relatively simple method for diagnosing whether cancer is metastasizing,” he said.

Future work will focus on not only how obesity increases metastasis but also how it might play a direct role in initiating the development of cancers.

The research has been funded by the National Institutes of Health.

Writer: Emil Venere

ABSTRACT

Coherent Anti-Stokes Raman Scattering Imaging of Lipids in Cancer Metastasis

Thuc T Le1, Terry B Huff2 and Ji-Xin Cheng*1,2,3

1Weldon School of Biomedical Engineering, Purdue University; 2Department of Chemistry, Purdue University; 3Purdue Cancer Center

Background: Lipid-rich tumours have been associated with increased cancer metastasis and aggressive clinical behaviours. Nonetheless, pathologists cannot classify lipid-rich tumours as a clinically distinctive form of carcinoma due to a lack of mechanistic understanding on the roles of lipids in cancer development. Methods: Coherent anti-Stokes Raman scattering (CARS) microscopy is employed to study cancer cell behaviours in excess lipid environments in vivo and in vitro. The impacts of a high-fat diet on cancer development are evaluated in a Balb/c mice cancer model. Intravital flow cytometry and histology are employed to enumerate cancer cell escape to the bloodstream and metastasis to lung tissues, respectively. Cancer cell motility and tissue invasion capability are also evaluated in excess lipid environments. Results: CARS imaging reveals intracellular lipid accumulation is induced by excess free fatty acids (FFAs). Excess FFAs incorporation onto cancer cell membrane induces membrane phase separation, reduces cell-cell contact, increases surface adhesion, and promotes tissue invasion. Increased plasma FFAs level and visceral adiposity are associated with early rise in circulating tumour cells and increased lung metastasis. Furthermore, CARS imaging reveals FFAs-induced lipid accumulation in primary, circulating, and metastasized cancer cells. Conclusion: Lipid-rich tumours are linked to cancer metastasis through FFAs-induced physical perturbations on cancer cell membrane. Most importantly, the revelation of lipid-rich circulating tumour cells suggests possible development of CARS intravital flow cytometry for label-free detection of early-stage cancer metastasis.

Europeans with the least education have a higher incidence of lung cancer compared with those with the highest education. However, smoking history accounts for approximately half of this risk, according to a study in the February 24 online issue of the Journal of the National Cancer Institute.

Previous studies showed that individuals with a lower socioeconomic status have a higher risk for developing lung cancer. Some studies have also suggested that some of the excess risk of lung cancer is due to smoking.

To further investigate the contribution of smoking to the discrepancy in lung cancer incidence, Gwenn Menvielle, Ph.D., and colleagues examined the association of smoking, diet, education, and lung cancer in 391,251 individuals in the European Prospective Investigation into Cancer and Nutrition study. Menvielle, who conducted the research in The Netherlands at the National Institute for Public Health and the Environment, Bilthoven, and the department of public health of the Erasmus MC, Rotterdam, is now at the Institut National de la Santé et de la Recherche Médicale in Villejuif, France.

The researchers used participants’ highest level of education achieved as an indicator of socioeconomic status and had smoking and diet information from questionnaires completed at study entry.

With a mean follow-up time of 8.4 years, 939 men and 692 women were diagnosed with lung cancer. Men with the lowest education had a 3.62-fold increased risk of lung cancer compared with men with the highest education. Women with the lowest education had a 2.39-fold increased risk compared with women with the highest education. The association between education and cancer risk was greatest in Northern Europe and Germany. When the researchers adjusted the risk models to account for smoking, the excess risk dropped by approximately half. Diet did not appear to contribute to the inequity in lung cancer risk between participants with lowest and highest education.

The authors state that while their model shows that smoking accounts for some of the discrepancy in lung cancer risk, they may not have yet accounted for the full impact of smoking. Therefore, some of the residual inequity in lung cancer risk associated with socioeconomic status may still be due to smoking behavior. Nonetheless, the new data suggest that other factors contribute to the inequality. “In future studies, other risk factors should be considered, perhaps in relation with smoking,” the authors write. “However, we also observed that removing smoking would reduce the population health burden that is associated with social inequality in lung can¬cer considerably, in terms of number of cancers avoided. Therefore, public health policies aiming at reducing smoking rates, especially among persons with low education, are still strongly needed.”

In an accompanying editorial, Michael J. Thun, M.D., of the American Cancer Society in Atlanta, Georgia, writes that Menvielle and colleagues’ effort to disentangle the impact of smoking and socioeconomic status on lung cancer risk is laudable. However, given shifting patterns of smoking in Europe, from a behavior associated more frequently with higher socioeconomic status to one associated with lower socioeconomic status, and geographic differences in that pattern, it is an extremely difficult task.

Thun concurs with the authors’ conclusion that smoking must remain a focus of anti-cancer efforts. He concludes that “…the most effective approach to reducing both the socioeconomic disparities and the overall burden of lung cancer is to implement measures that we already know are effective in reducing tobacco use.”

Citations:

Article: Menvielle G et al. The role of smoking and diet in explaining educational inequalities in lung cancer incidence. Journal of the National Cancer Institute 2009;101: 321-330

Editorial: Thun M. The Evolving Relationship of Social Class to Tobacco Smoking and Lung Cancer. Journal of the National Cancer Institute 2009;101: 285-287

The Journal of the National Cancer Institute is published by Oxford University Press and is not affiliated with the National Cancer Institute. Visit the Journal online at http://jnci.oxfordjournals.org/.

Six studies published in the past year by a Cornell researcher add to growing evidence that an apple a day — as well as daily helpings of other fruits and vegetables — can help keep the breast-cancer doctor away.

In one of his recent papers, published in the Journal of Agricultural and Food Chemistry (57:1), Rui Hai Liu, Cornell associate professor of food science and a member of Cornell’s Institute for Comparative and Environmental Toxicology, reports that fresh apple extracts significantly inhibited the size of mammary tumors in rats — and the more extracts they were given, the greater the inhibition.

“We not only observed that the treated animals had fewer tumors, but the tumors were smaller, less malignant and grew more slowly compared with the tumors in the untreated rats,” said Liu, pointing out that the study confirmed the findings of his preliminary study in rats published in 2007.

In his latest study, for example, he found that a type of adenocarcinoma — a highly malignant tumor and the main cause of death of breast-cancer patients, as well as of animals with mammary cancer — was evident in 81 percent of tumors in the control animals. However, it developed in only 57 percent, 50 percent and 23 percent of the rats fed low, middle and high doses of apple extracts (the equivalent of one, three and six apples a day in humans), respectively, during the 24-week study.

“That reflects potent anti-proliferative [rapid decrease] activity,” said Liu.

The studies highlight the important role of phytochemicals, known as phenolics or flavonoids, found in apples and other fruits and vegetables. Of the top 25 fruits consumed in the United States, Liu reported in the same journal (56:18) that apples provide 33 percent of the phenolics that Americans consume annually.

In a study of apple peel published in the same journal (56:21), Liu reported on a variety of new phenolic compounds that he discovered that also have “potent antioxidant and anti-proliferative activities” on tumors. And in yet another study in the same journal (56:24), he reported on his discovery of the specific modulation effects that apple extracts have on cell cycle machinery. Recently, Liu’s group also reported the finding that apple phytochemicals inhibit an important inflammation pathway (NFkB) in human breast cancer cells.

Breast cancer is the most frequently diagnosed invasive cancer and the second leading cause of cancer deaths in women in the United States, said Liu.

“These studies add to the growing evidence that increased consumption of fruits and vegetables, including apples, would provide consumers with more phenolics, which are proving to have important health benefits. I would encourage consumers to eat more and a wide variety of fruits and vegetables daily.”

The studies were supported, in part, by the American Institute for Cancer Research, the Ngan Foundation and the U.S. Apple Association.

Cornell University
234 Day Hall
Ithaca
NY 14853
United States
http:// www.cornell.edu

The UK is ahead of the US as the world’s leading fast food nation according to research of 9,000 people across 13 countries.

In the UK, 45 per cent of people agreed with the statement “I like the taste of fast food too much to give it up”, compared to 44 per cent in the US.

One in five named “unhealthy food choices” as the cause of obesity, while the same percentage chose “unhealthy food habits like eating at irregular hours”.

Overall, lack of exercise was named the main cause of obesity by 18 per cent of people while 13 per cent blamed “no self discipline” and 11 per cent put it down to “genetics”.

In the UK, unhealthy food choices, lack of exercise and no self-discipline were the highest ranked reasons.

Douglas Smallwood, Chief Executive of Diabetes UK, said: “This survey is a sad indictment of current eating habits in the UK.

“Obesity is one of the leading causes of Type 2 diabetes, a serious condition which can lead to heart disease, kidney failure and blindness. Soaring obesity levels mean that 100,000 new cases are diagnosed every year.

“Diabetes UK urges people to eat a healthy, balanced diet. This does not mean that people have to completely give up fast food but because fast food is high in fat, salt and sugar, it should only be eaten occasionally.”

The study by BBC World and market research firm Synovate aimed to uncover global attitudes to food and obesity across the UK, France, Czech Republic, Romania, USA, Canada, Brazil, United Arab Emirates, Saudi Arabia, Hong Kong, Singapore, Malaysia and Australia.

http://www.diabetes.org.uk

The same vitamin D deficiency that can result in weak bones now has been associated with an increased risk of cardiovascular disease, Framingham Heart Study researchers report in Circulation: Journal of the American Heart Association.

“Vitamin D deficiency is associated with increased cardiovascular risk, above and beyond established cardiovascular risk factors,” said Thomas J. Wang, M.D., assistant professor of medicine at Harvard Medical School in Boston, Mass. “The higher risk associated with vitamin D deficiency was particularly evident among individuals with high blood pressure.”

In a study of 1,739 offspring from Framingham Heart Study participants (average age 59, all Caucasian), researchers found that those with blood levels of vitamin D below15 nanograms per milliliter (ng/mL) had twice the risk of a cardiovascular event such as a heart attack, heart failure or stroke in the next five years compared to those with higher levels of vitamin D.

When researchers adjusted for traditional cardiovascular risk factors such as high cholesterol, diabetes and high blood pressure, the risk remained significant with a 62 percent higher risk of a cardiovascular event in participants with low levels of vitamin D compared to those with higher levels.

Researchers observed the highest rate of cardiovascular disease events in subset analyses dividing 688 participants according to high blood pressure status. After researchers adjusted for conventional cardiovascular risk factors, participants with hypertension and a vitamin D deficiency had about 2 times the risk of having a cardiovascular disease event in five years.

Researchers also found an increase in cardiovascular risk with each level of vitamin D deficiency.

“We found that people with low vitamin D levels had a higher rate of cardiovascular events over the five-year follow-up period,” Wang said. “These results are intriguing and suggestive but need to be followed up with further study.”

Study participants had no prior cardiovascular disease and were tested for vitamin D status and then followed for an average of 5.4 years.

The participants attended the offspring examinations between 1996 and 2001. Researchers obtained medical history, physical examinations and laboratory assessments of vascular risk factors. They also obtained medical records related to cardiovascular disease.

Overall, 28 percent of individuals had levels of vitamin D below15 ng/mL and 9 percent had levels below10 ng/mL. Although levels above 30 ng/mL are considered optimal for bone metabolism, only 10 percent of the study sample had levels in this range, researchers said.

During follow-up:

* 120 participants developed a first cardiovascular event including fatal and nonfatal coronary heart disease;

* 28 participants had fatal or nonfatal cerebrovascular events such as nonhemorrhagic stroke;

* 19 participants were diagnosed with heart failure; and

* 8 had occurrences of claudication, fatigue in the legs during activity.

“Low levels of vitamin D are highly prevalent in the United States, especially in areas without much sunshine,” Wang said. “Twenty to 30 percent of the population in many areas has moderate to severe vitamin D deficiency.”

Most of this is attributed to lack of sun exposure, pigmented skin that prevents penetration of the sun’s rays and inadequate dietary intake of vitamin D enriched foods, researchers said.

“A growing body of evidence suggests that low levels of vitamin D may adversely affect the cardiovascular system,” Wang said. “Vitamin D receptors have a broad tissue distribution that includes vascular smooth muscle and endothelium, the inner lining of the body’s vessels. Our data raise the possibility that treating vitamin D deficiency, via supplementation or lifestyle measures, could reduce cardiovascular risk.

“What hasn’t been proven yet is that vitamin D deficiency actually causes increased risk of cardiovascular disease. This would require a large randomized trial to show whether correcting the vitamin D deficiency would result in a reduction in cardiovascular risk.”

Therfore, Wang doesn’t recommend physicians check for vitamin D deficiency or that those with a known vitamin D deficiency be treated to prevent heart disease at this time.

During the past decade, researchers have studied several other vitamins that initially showed promise in reducing heart disease. But the vitamins didn’t reduce heart disease in subsequent large randomized trials.

“On the flip side, just because other vitamins haven’t succeeded doesn’t preclude the possibility of finding vitamins that might prevent cardiovascular disease,” Wang said. “This is always an area of great interest. Vitamins are easy to administer and in general have few toxic effects.”

The American Heart Association recommends that healthy people get adequate nutrients by eating a variety of foods in moderation, rather than by taking supplements. Food sources of vitamin D include milk, salmon, mackerel, sardines, cod liver oil and some fortified cereals. Vitamin or mineral supplements aren’t a substitute for a balanced, nutritious diet that limits excess calories, saturated fat, trans fat, sodium and dietary cholesterol. This dietary approach has been shown to reduce coronary heart disease risk in healthy people and those with coronary disease.

Benzene concentrations in beverages

Only nine percent of 199 beverage samples had benzene levels above the U. S. Environmental Protection Agency (EPA) limit of 5 parts per billion (ppb) for benzene in drinking water, according to a study by EPA and U. S. Food and Drug Administration (FDA) scientists. It is scheduled for the current issue of ACS’ Journal of Agricultural and Food Chemistry, a bi-weekly journal.

Products containing benzene above the EPA level were reformulated by the manufacturers to minimize or eliminate benzene and one product was discontinued, researchers said. Benzene levels in the reformulated products were 1.1 ppb or less. About 71 percent of beverage samples in the study contained less than 1 ppb. Based on results from the survey and actions taken by the beverage industry, FDA concluded that the levels of benzene found did not pose a safety concern for consumers.

In the study, FDA’s Patricia Nyman and colleagues point out that benzene can form at ppb levels in some beverages that contain a food preservative, benzoate salt, and ascorbic acid (vitamin C). In the early 1990s, the U.S. beverage industry discovered benzene in some beverages and reformulated those products. In 2005, the substance again was found in some beverages, likely because new manufacturers were unaware of the problem, the study says. Some manufacturers also have added vitamin C to drinks in response to consumers’ desire for healthier products.

The study found that product formulation, shelf-life, and storage conditions were important factors affecting benzene formation. The report also describes the in-house validation of FDA’s analytical method for determining benzene in beverages. – JS

ARTICLE: “Survey Results of Benzene in Soft Drinks and Other Beverages by Headspace Gas Chromatography/Mass Spectrometry”

CONTACT:
Patricia Nyman
U.S. Food and Drug Administration
College Park, Md. 20740

Toward solving the mystery of idiosyncratic drug reactions

A mysterious and unpredictable group of side effects from modern medications called idiosyncratic drug reactions (IDRs) likely will persist as a major health care problem unless there is a dramatic increase in research funding, according to a 20-year review of research in the field scheduled for the January issue of ACS’ Chemical Research in Toxicology, a monthly journal.

The review, by Jack Uetrecht, defines IDRs as reactions that happen unexpectedly and with no obvious connection to the known effects of a medication’s ingredients or dosage. Although relatively rare, IDRs make an important contribution to the annual burden of death, illness, and increased health care costs from serious adverse drug reactions. In addition, serious IDRs that appear after a new drug has gone into wide use can force drug companies to withdraw products after R&D investments totaling hundreds of millions of dollars.

Two decades of research have produced significant progress, the report acknowledges. However, medical science still has only a “superficial” understanding of how and why IDRs occur and a growing recognition that the mechanisms behind IDRs may be as complicated as those involved in cancer or diabetes. The review describes a need for increased research funding, with more scientists focusing on IDRs, in order to achieve faster progress. – JS

ARTICLE: “Idiosyncratic Drug Reactions: Past, Present, and Future”

CONTACT:
Jack Uetrecht, M. D., Ph.D.
University of Toronto
Toronto, Canada M5S, 3M2

Discovery of enzyme’s structure may lead to new treatments for celiac disease

Researchers have discovered a new structure for a key enzyme associated with celiac disease, a finding that could lead to the design of new medications for the common digestive disorder, according to an article in Chemical & Engineering News, ACS’ weekly newsmagazine.

Celiac disease is a condition in which the stomach cannot properly digest wheat and other gluten-containing foods. The disease afflicts an estimated 2 million people in the United States alone.

In the article, C&EN Deputy Assistant Managing Editor Stu Borman notes that the disease is believed to occur when the protein gluten interacts with an enzyme called transglutaminase 2 (TG2), triggering an autoimmune reaction that damages the small intestine and causes diarrhea, abdominal pain and other symptoms. As a result, people with the disease are urged to follow a strict gluten-free diet.

Although scientists have previously obtained the X-ray crystal structure of human TG2, they have only revealed its “closed” or inactive form, the article points out. Now, Chaitan Khosla and colleagues at Stanford University report the first-ever determination of the “open” structure of the enzyme, in which its active site is accessible to substrates. The finding that could help scientists design inhibitors of the enzyme that could serve as medications for celiac disease and other related conditions, according to the article.

ARTICLE: “Enzyme opens for business”

The Nursing & Midwifery Council (NMC) and the Healthcare Commission have signed a Memorandum of Understanding (MoU) strengthening public protection where nurses and midwives are involved.

The agreement sets out the levels of cooperation and terms in which the NMC and the Healthcare Commission will work together when carrying out their regulatory duties in England and Wales.

While information sharing remains the primary focus of the agreement, other areas of collaboration may include provision of training and guidance, complaints and cross referrals of concerns, advice to ministers and joint inspections, investigations and/or reviews.

Commenting on the partnership with the Healthcare Commission, Sarah Thewlis, NMC Chief Executive & Registrar said, “As nurses and midwives are the largest group of healthcare professionals in the UK, it’s an extremely positive step to reach this formal agreement with the Healthcare Commission. Forming a closer working relationship will assist in strengthening the NMC’s primary purpose of protecting the public.”

Anna Walker, Chief Executive of the Healthcare Commission said, “We welcome this agreement in ensuring a more joined up approach in improving systems particularly where there are concerns about the safety of patients relating to nursing or midwifery.”

The Nursing and Midwifery Council (NMC) is the UK regulator for two professions, nursing and midwifery. The primary purpose of the NMC is protection of the public. It does this through maintaining a register of all nurses, midwives and specialist community public health nurses eligible to practise within the UK and by setting standards for their education, training and conduct. Currently the number of registrants exceeds 682,000. The Nursing and Midwifery Order 2001 (The Order), sets out the NMC’s role and responsibilities.

The Healthcare Commission is the health watchdog in England. It keeps check on health services to ensure that they are meeting standards in a range of areas. The Commission also promotes improvements in the quality of healthcare and public health in England through independent, authoritative, patient-centred assessments of those who provide services.

Nursing and Midwifery Council