The current use of estrogens for growth-suppressant therapy in adolescent girls

OBJECTIVE

To assess the current prevalence of growth-suppressant therapy using oral estrogens for tall adolescent girls among U.S. pediatric endocrinologists.

METHODS

A questionnaire was mailed to pediatric endocrinologists practicing in the United States, asking how many patients each clinician had recently treated for tall stature using oral estrogens, whether he/she continued to offer such treatment, reasons for offering or declining to offer it, criteria for initiating and terminating treatment, choice of estrogen, and typical doses, durations, and effects.

RESULTS

Of 411 respondents, 92 (22%) reported having treated 1-5 girls for tall stature during the preceding five years. Only 4 (1%) had treated more than 5 cases during this period. Growth-suppression treatment was currently offered by 137 respondents (33.3%). Reasons for doing so included parents' and patients' concerns about stature and the adverse social effects of unusually tall stature. Reasons for not offering such treatments were that its long-term risks are unknown, that tall stature is not a disease, and a lack of referrals. Few clinicians initiated treatment if predicted mature height was below 183 cm. Treatment was typically terminated based on evidence of epiphyseal fusion, usually within less than two years, although extended treatments were common. Frequently reported adverse effects included weight gain, nausea/vomiting, areolar or nipple pigmentation, headache, and irregular menses.

CONCLUSIONS

Although treatment is less commonly initiated than in the past, many pediatric endocrinologists continue to offer oral estrogens to suppress growth for tall adolescent girls.

Effectiveness of a low-fat vegetarian diet in altering serum lipids in healthy premenopausal women

Few controlled trials have studied cholesterol-lowering diets in premenopausal women. None has examined the cholesterol-lowering effect of a low-fat vegetarian diet, which, in other population groups, leads to marked reductions in serum cholesterol concentrations and, in combination with other life-style changes, a regression of atherosclerosis. We tested the hypothesis that a low-fat, vegetarian diet significantly reduces serum total and low-density lipoprotein (LDL) cholesterol concentrations in premenopausal women. In a crossover design, 35 women, aged 22 to 48, followed a low-fat vegetarian diet deriving approximately 10% of energy from fat for 2 menstrual cycles. For 2 additional cycles, they followed their customary diet while also taking a "supplement" (placebo) pill. Serum lipid concentrations were assessed at baseline and during each intervention phase. Mean serum LDL, high-density lipoprotein (HDL), and total cholesterol concentrations decreased 16. 9%, 16.5%, and 13.2%, respectively, from baseline to the intervention diet phase (p<0.001), whereas mean serum triacylglycerol concentration increased 18.7% (p<0.01). LDL/HDL ratio remained unchanged. Thus, in healthy premenopausal women, a low-fat vegetarian diet led to rapid and sizable reductions in serum total, LDL, and HDL cholesterol concentrations.

Diet and sex-hormone binding globulin, dysmenorrhea, and premenstrual symptoms

OBJECTIVE

To test the hypothesis that a low-fat, vegetarian diet reduces dysmenorrhea and premenstrual symptoms by its effect on serum sex-hormone binding globulin concentration and estrogen activity.

METHODS

In a crossover design, 33 women followed a low-fat, vegetarian diet for two menstrual cycles. For two additional cycles, they followed their customary diet while taking a supplement placebo pill. Dietary intake, serum sex-hormone binding globulin concentration, body weight, pain duration and intensity, and premenstrual symptoms were assessed during each study phase.

RESULTS

Mean (+/- standard deviation [SD]) serum sex-hormone binding globulin concentration was higher during the diet phase (46.7 +/- 23.6 nmol/L) than during the supplement phase (39.3 +/- 19.8 nmol/L, P < .001). Mean (+/- SD) body weight was lower during the diet (66.1 +/- 11.3 kg) compared with the supplement phase (67.9 +/- 12.1 kg, P < .001). Mean dysmenorrhea duration fell significantly from baseline (3.9 +/- 1.7 days) to diet phase (2.7 +/- 1.9 days) compared with change from baseline to supplement phase (3.6 +/- 1.7 days, P < .01). Pain intensity fell significantly during the diet phase, compared with baseline, for the worst, second-worst, and third-worst days, and mean durations of premenstrual concentration, behavioral change, and water retention symptoms were reduced significantly, compared with the supplement phase.

CONCLUSION

A low-fat vegetarian diet was associated with increased serum sex-hormone binding globulin concentration and reductions in body weight, dysmenorrhea duration and intensity, and premenstrual symptom duration. The symptom effects might be mediated by dietary influences on estrogen activity.

Toward improved management of NIDDM: A randomized, controlled, pilot intervention using a lowfat, vegetarian diet

OBJECTIVE

To investigate whether glycemic and lipid control in patients with non-insulin-dependent diabetes (NIDDM) can be significantly improved using a low-fat, vegetarian (vegan) diet in the absence of recommendations regarding exercise or other lifestyle changes.

METHODS

Eleven subjects with NIDDM recruited from the Georgetown University Medical Center or the local community were randomly assigned to a low-fat vegan diet (seven subjects) or a conventional low-fat diet (four subjects). Two additional subjects assigned to the control group failed to complete the study. The diets were not designed to be isocaloric. Fasting serum glucose, body weight, medication use, and blood pressure were assessed at baseline and biweekly thereafter for 12 weeks. Serum lipids, glycosylated hemoglobin, urinary albumin, and dietary macronutrients were assessed at baseline and 12 weeks.

RESULTS

Although the sample was intentionally small in accordance with the pilot study design, the 28% mean reduction in fasting serum glucose of the experimental group, from 10.7 to 7.75 mmol/L (195 to 141 mg/dl), was significantly greater than the 12% decrease, from 9.86 to 8.64 mmol/L (179 to 157 mg/dl), for the control group (P < 0.05). The mean weight loss was 7.2 kg in the experimental group, compared to 3. 8 kg for the control group (P < 0.005). Of six experimental group subjects on oral hypoglycemic agents, medication use was discontinued in one and reduced in three. Insulin was reduced in both experimental group patients on insulin. No patient in the control group reduced medication use. Differences between the diet groups in the reductions of serum cholesterol and 24-h microalbuminuria did not reach statistical significance; however, high-density lipoprotein concentration fell more sharply (0.20 mmol/L) in the experimental group than in the control group (0.02 mmol/L) (P < 0.05).

CONCLUSION

The use of a low-fat, vegetarian diet in patients with NIDDM was associated with significant reductions in fasting serum glucose concentration and body weight in the absence of recommendations for exercise. A larger study is needed for confirmation.

Racial bias in federal nutrition policy, Part II: Weak guidelines take a disproportionate toll

Many diet-related chronic diseases take a disproportionate toll among members of racial minorities. Research shows the prevalence of diabetes, hypertension, cancer, and heart disease is higher among various ethnic groups compared with whites. The Guidelines and the Food Guide Pyramid, however, promote the use of multiple servings of meats and dairy products each day and do not encourage replacing these foods with vegetables, legumes, fruits, and grains. The Dietary Guidelines for Americans encourage a 30% caloric reduction in fat intake and make no provision for further reductions for those who wish to minimize health risks. Abundant evidence has shown that regular exercise combined with diets lower in fat and richer in plant products than is encouraged by the Dietary Guidelines for Americans are associated with reduced risk of these chronic conditions. While ineffective Dietary Guidelines potentially put all Americans at unnecessary risk, this is particularly true for those groups hardest hit by chronic disease.

Racial bias in federal nutrition policy, Part I: The public health implications of variations in lactase persistence

The Dietary Guidelines for Americans from the basis for all federal nutrition programs and incorporate the Food Guide Pyramid, a tool to educate consumers on putting the Guidelines into practice. The Pyramid recommends two to three daily servings of dairy products. However, research has shown that lactase nonpersistence, the loss of enzymes that digest the milk sugar lactose, occurs in a majority of African-, Asian-, Hispanic-, and Native-American individuals. Whites are less likely to develop lactase nonpersistence and less likely to have symptoms when it does occur. Calcium is available in other foods that do not contain lactose. Osteoporosis is less common among African Americans and Mexican Americans than among whites, and there is little evidence that dairy products have an effect on osteoporosis among racial minorities. Evidence suggests that a modification of federal nutrition policies, making dairy-product use optional in light of other calcium sources, may be a helpful public health measure.

Review--animal waste used as livestock feed: dangers to human health

Foodborne illness remains a common and serious problem, despite efforts to improve slaughterhouse inspection and food preparation practices. A potential contributor to this problem that has heretofore escaped serious public health scrutiny is the feeding of animal excrement to livestock, a common practice in some parts of the United States. In 1994, 18% of poultry producers in Arkansas collectively fed more than 1,000 tons of poultry litter to cattle, and the procedure is also common in some other geographic areas as a means of eliminating a portion of the 1.6 million tons of livestock wastes produced in the United States annually. While heat processing reliably kills bacterial pathogens, its use is limited by expense and other factors. Deep-stacking and ensiling are commonly used by farmers to process animal wastes, but the maximal temperatures achieved in stacked poultry litter are typically in the range of 43 to 60 degrees C (110 to 140 degrees F), below the inactivation temperatures of pathogenic salmonella and Escherichia coli species, and far below the USDA's recommended cooking temperatures of 71 to 77 degrees C (160 to 170 degrees F) for potentially manure-tainted meat products. In addition to the spread of potential pathogens, using animal wastes as feed presents the possibility that antibiotic-resistant bacteria may spread from one animal to another and that antibiotics or other chemicals may be passed between animals. Few research reports have addressed the safety of this practice, and those studies that have been published have generally been in controlled and artificial environments, rather than in on-farm conditions. Further microbiological studies are recommended to assess the extent of risk.

Beliefs about dietary factors in breast cancer prevention among American women, 1991 to 1995

OBJECTIVE

To estimate the percentage of American women in various demographic groups who believe or have heard that dietary factors have a role in breast cancer prevention and to assess changes between 1991 and 1995.

METHODS

Telephone surveys were conducted of random samples of 509 women in 1991 and 510 women in 1995. Subjects were asked questions with increasing prompting to gauge their beliefs about the role of dietary factors in breast cancer prevention.

RESULTS

The percentages of women citing dietary factors (reducing intake of fat or meat or increasing intake of vegetables, fruit, fiber, or vegetarian meals) as reducing the risk of developing breast cancer were 20% in 1991 and 23% in 1995. These numbers were lower among young, poor, and less educated women. When specifically prompted to consider dietary steps, the number citing such factors increased to 37% in 1991 and to 52% in 1995.

CONCLUSION

The belief that there is a role for dietary factors in breast cancer is far from universal among American women, although some measures of the awareness of dietary factors increased significantly between 1991 and 1995. Women are more likely to cite mammography and breast self-examination as preventive steps, even though both are designed for detection rather than prevention. Additional efforts are needed to provide information on cancer prevention, particularly to young, poor, and less educated women, and to clarify the role of prevention as distinct from cancer detection.

Animal Laboratory Exercises in Medical School Curricula

The use of laboratory exercises involving animals in medical education is a subject of ongoing interest. Updated information is not often available, however, on the prevalence of such exercises or of alternatives to their use. In May 1994, a questionnaire on the use of animal laboratory exercises and suitable alternatives was sent to the chairpersons of the physiology, pharmacology and surgery departments of each of the 126 US medical schools. In comparison with earlier surveys, the information returned showed that the number of medical schools reporting the use of laboratory animals in physiology appears to have declined from over 50% to 41%, the number of schools reporting the use of laboratory animals in pharmacology courses appears to have declined from 25% to 16%, and the number of schools that reported the use of laboratory animals in surgery courses increased from around 20% to 30%. For the 53 schools that returned information from all three disciplines, 49% reported having no laboratory exercises involving animals in any of these disciplines. Computer programs and films were the most commonly used non-animal alternatives offered in physiology and pharmacology, while operating room experience was the most common alternative offered in surgery courses.

The medical costs attributable to meat consumption

OBJECTIVE

To estimate the medical costs that are attributable to the health effects of meat consumption.

METHODS

The prevalence of hypertension, heart disease, cancer, diabetes, gallstones, obesity, and foodborne illness among omnivores and vegetarians are compared in studies that have controlled for other lifestyle factors, and the corresponding attributable medical costs are calculated in 1992 dollars.

RESULTS

Direct health care costs attributable to meat consumption are estimated to be +2.8-8.5 billion for hypertension, +9.5 billion for heart disease, +0-16.5 billion for cancer, +14.0-17.1 billion for diabetes, +0.2-2.4 billion for gallbladder disease, +1.9 billion for obesity-related musculoskeletal disorders, and +0.2-5.5 billion for foodborne illness. The total direct medical costs attributable to meat consumption for 1992 are estimated at +28.6-61.4 billion.

CONCLUSION

Health care costs attributable to meat consumption are quantifiable and substantial.

Factors that facilitate compliance to lower fat intake

The success of dietary interventions that are prescribed to reduce the risk of heart disease depends on the degree to which patients actually change their diets. A review of research trials using different diets and various means of fostering dietary change to reduce cardiac risk factors identified specific factors that are associated with a greater degree of dietary change. Contrary to the common conception that strict diets are unacceptable to patients, those research studies that set stricter limits on fat intake achieved a greater degree of dietary change than did studies with more modest goals. Additional factors used by studies that achieved a lower fat intake include monitoring dietary intake at least monthly, family involvement, group support, provision of food, initial residential treatment, the use of vegetarian diets, and symptomatic subjects. These factors may be useful to researchers and to clinicians seeking to improve dietary compliance in patients.