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An analysis looks at the impact of diet on bone mineral density. Also, an examination of which antidepressants in pregnancy may increase the risk of birth defects. Plus: Is the mortality rate of cervical cancer underestimated?
Analysis of data from the Women’s Health Initiative (WHI) suggests that eating an inflammatory diet may affect some women’s risk of bone loss and hip fracture. The findings, which do not prove causality, were published in The Journal of Bone and Mineral Research.
For the study, researchers from Ohio State University evaluated the association between dietary inflammatory index (DII) and risk of hip, lower-arm and total fracture using longitudinal data from WHI. The researchers also looked at changes in bone mineral density (BMD) and DII scores.
The DII is a measure of the inflammatory potential of diet and takes into consideration 28 factors such as energy, carbohydrate, protein, total fat, alcohol, fiber, cholesterol, saturated fat, mono-unsaturated fat, and poly-unsaturated fat. DII scores were calculated from baseline food frequency questionnaires (FFQ) completed by 160,191 WHI participants with a mean age of 63 who had no history of hip fracture at study enrollment. A DII change score was calculated using Year 3 FFQs.
Multivariable Cox proportional hazard models were used to compute hazard ratios (HR) for fractures and stratified by age and race/ethnicity. Pair-wise comparisons of changes in hip BMD, measured by dual-energy X-ray absorptiometry from baseline and years 3 and 6 were analyzed by quartile of baseline DII scores in a subgroup of 10,290 women.
Over 3 years, the authors found that mean DII scores improved significantly (P<0.01) but the change was not associated with fracture risk. Baseline DII score was only associated with hip fracture risk in younger white women (HR QR: 1.48; 95% confidence interval [CI] 1.09, 2.01; P=0.01). By Year 6, women the least inflammatory DII scores had less loss of hip BMD (P=0.01) despite lower baseline hip BMD in comparison with women with the most inflammatory DII scores.
A less inflammatory dietary pattern, the researchers concluded, was associated with less BMD loss in postmenopausal women. A more inflammatory diet was associated with increased hip fracture risk only in white women younger than age 63.
Antidepressants and impact on birth defects
Results of a new Canadian study published in the British Journal of Medicine suggest that using certain types of antidepressants during pregnancy may increase risk of birth defects.
Researchers used data from the Quebec Pregnancy Cohort and included all pregnancies that had a diagnosis of depression or anxiety or an exposure to antidepressants in the 12 months prior to the pregnancy and resulted in a live-born singleton. They compared individual use of various antibiotic types and classes including selective serotonin reuptake inhibitors (SSRIs), tricyclic antidepressants (TCAs), and serotonin-norepinephrine reuptake inhibitors (SNRIs) with non-exposure during the first trimester. Any organ-specific malformation in addition to overall major congenital malformations found in the first year of life were identified.
The cohort consisted of 18,487 women. With specific types of antidepressant, only citalopram increased the risk of major congenital malformations (adjusted OR, [aOR] 1.36, 95% confidence interval [CI] 1.08 to 1.73; 88 exposed cases), but an increased risk trend was seen for the most frequently used antidepressants. Drugs with a serotonin reuptake inhibition effect (SNRIs, SSRIs, and the most used TCA amitriptyline) were found to increase the risk of some organ-specific malformations. Paroxetine was found to the increase the risk of ventricular/atrial septal defects (aOR 1.92, 95% CI 1.40 to 2.62) and the risk of cardiac defects (aOR 1.45, 95% CI 1.12 to 1.88). Tricyclic antidepressants were linked to digestive defects (aOR 2.55, 95% CI 1.40 to 4.66) and eye, ear, face, and neck defects (aOR 2.45, 95% CI 1.05 to 5.72). Venlaflaxine was tied to respiratory defects (aOR 2.17, 95% CI 1.07 to 4.38). Citalopram saw an increased risk of craniosynostosis (aOR 3.95, 95% CI 2.08 to 7.52) and musculoskeletal defects (aOR 1.92, 95% CI 1.40 to 2.62).
The investigators concluded that antidepressants that affected serotonin reuptake consumed during embryogenesis increased the risk of certain organ-specific malformations in pregnant women with depression.
Is the cervical cancer mortality rate underestimated?
A new study in Cancer indicates that the estimated rate of death from cervical cancer may be higher than previously thought.
Researchers used National Center for Health Statistics county mortality data, stratifying estimates of deaths from cervical cancer by age, state, year, and race. Data stratified the same way, on the prevalence of hysterectomy in women aged 20 years or older, were used to remove women who were not at risk from the denominator. They computed age-specific and age-standardized mortality rates and Joinpoint regression was used to analyze the trends in mortality rates.
Following correction, age-standardized rates of cervical cancer were higher for both white and black women. The uncorrected rate for black women was 5.7 per 100,000 (95% confidence interval [CI], 5.5 – 6.0), while the corrected rate was 10.1 per 100,000 (95% CI, 9.6 – 10.6). Among white women, the uncorrected rate was 3.2 per 100,000 (95% CI, 3.1 – 3.2) and an uncorrected rate of 4.7 per 100,000 (95% CI, 4.6 – 4.8). The difference between the races was underestimated by 44% without the correction. The highest corrected rate of 37.2 per 100,000 was found among black women aged 85 years or older. Following the correction, a trend analysis showed that white women’s rate of death had decreased by 0.8% per year while black women had an annual decrease of 3.6% (P < .05).
The investigators concluded that cervical cancer mortality has been underestimated overall and particularly in black women. They urged public health efforts to focus on encouraging appropriate screening and adequate treatment in older black women.