Depressed men and women at increased risk of osteoporosis

The study authors suggest that changes in hormone levels associated with depression may have an effect on bone metabolism, affecting bone strength.

Dr. Ulrich Schweiger and colleagues from the Max Planck Institute of Psychiatry, Munich, Germany, measured bone density in 18 patients who had been hospitalized for major depression 2 years earlier, and in 21 healthy volunteers ('controls') without depression. All participants were over age 40, and had participated in a study of bone density 2 years before. The investigators compared the measurements from that study with bone density 2 years later, to see if depressed patients had lost more bone than nondepressed volunteers.

Bone scans indicated that participants who had been depressed 2 years before lost significantly more bone than nondepressed controls, and men who had been depressed lost more bone than depressed women.

Writing in the January issue of the American Journal of Psychiatry, the authors explained that depression affects the body's hormone regulation, and those changes in turn affect bone density. They note that similar findings have been reported for other body tissues that are affected by hormones.

These connections may help researchers understand why people with major depression are more likely than those without depression to die from a variety of illnesses, note Schweiger and colleagues. ``These alterations of body composition may constitute an important link in explaining the increased mortality from all causes that is observed in women and particularly in men with major depression,'' they conclude.

SOURCE: American Journal of Psychiatry 2000;157:118-120.

Soft drinks contribute to US sugar overload

Much of this sugary overload comes from drinking too many soft drinks, according to the report, published this month in the Journal of the American Dietetic Association.

Consumption of added sweeteners accounts for about 16% of total calories, exceeding dietary recommendations to limit intake to 6% to 10%.

Soft drinks are the greatest source of added sweeteners for everyone except the youngest children and oldest adults, the researchers report. ``The most important source of added sweeteners was regular soft drinks, which contributed one third of intake of added sweeteners,'' they note. Other sources include table sugar, syrups, sweets, sweetened grains such as cereals, and dairy products such as chocolate milk.

According to government researchers, the findings may help to explain rising rates of obesity in the US. For example, evidence suggests that the regular consumption of soft drinks have increased in recent years.

``If... added sweeteners are consumed in addition to more nutritious foods, the diet may be excessive in energy, thereby promoting obesity,'' conclude Dr. Joanne F. Guthrie from the Center for Food Safety and Applied Nutrition at the US Food and Drug Administration, and Joan F. Morton of the Department of Veterans Affairs in Washington, DC.

Another concern is that sweetened foods tend to replace more nutrient-dense foods. For example, studies have shown that soft drinks displace calcium-rich milk in the diets of adolescent girls and adult women.

``Low calcium intakes are a public health concern, so this displacement effect is particularly troubling,'' the authors write.

According to the study, consumption of added sugars is highest in adolescence and declines throughout adulthood. Adolescent males consume about 142 grams of added sweeteners and adolescent females about 98 grams a day. Added sweeteners account for about 20% of total calories for both groups, the study found. This is about double the limit recommended by experts, who advise that sweeteners account for no more than 10% of energy intake.

``Given the increase in consumption of soft drinks and the overall high intakes of added sweeteners by Americans, ongoing monitoring of the impact of intake of added sweeteners on nutrient intake, energy intake, and body weight is important,'' conclude Guthrie and Morton.

The study defines added sugars as ``all sugars used as ingredients in processed and prepared foods,'' and as ``sugars eaten separately or added to foods at the table,'' including non-caloric sweeteners such as saccharin and aspartame.

Sugars found naturally in food, such as fructose in fruit or lactose in milk were not included.

The study findings are based on an analysis of data compiled by the US Department of Agriculture between 1994-1996. The researchers used a survey of the dietary habits of more than 15,010 Americans between the ages of 2 and 65.

SOURCE: Journal of the American Dietetic Association 2000;100:43-48.

Exercise Said Helpful to Diabetics

About 75 percent of people with the most common type of diabetes die of heart attacks or strokes.

Previous studies have found that high blood pressure and low levels of ``good'' cholesterol account for about half of the higher-than-normal risk of cardiovascular disease in diabetics.

This new study - published in Wednesday's Journal of the American Medical Association - tried to determine what role elevated insulin levels play.

Based on their findings, the researchers suggest that exercise, which makes the body more receptive to the effects of insulin, might improve a person's ability to dissolve blood clots and possibly lower the risk of cardivascular disease.

``Exercise ought to be really, really encouraged,'' said Dr. James B. Meigs, an internist at Massachusetts General Hospital in Boston.

The most common form of diabetes - type 2 - afflicts about 14 million Americans. They are resistant to insulin, the protein that helps the body use sugar and other energy sources, and as a result they have elevated insulin levels.

From 1991 to 1995, Meigs and his colleagues studied about 3,000 people enrolled in the Framingham Offspring Study, a long-term examination of risk factors for cardiovascular disease. Participants included diabetics, people with its precursor condition and non-diabetics.

The researchers found that non-diabetics who had elevated insulin levels also had elevated levels of PAI-1 antigen, a chemical that impairs the blood's ability to dissolve clots. The association was the same in diabetics and people with the precursor condition, though their levels of insulin and the antigen were even higher.

From that, Meigs suggested that ``one effect of insulin resistance is to make the blood less able to dissolve clots.''

However, he and two outside experts agreed that is far from a firm conclusion.

``There is no evidence of a cause and effect of anything,'' said Dr. Robert Eckel, an endocrinologist at the University of Colorado Health Sciences Center in Denver.

Dr. Om Ganda of the Joslin Diabetes Center in Boston agreed but said the study still has important implications.

``It really adds to a growing body of evidence that says insulin resistance does contribute to increased risk for heart disease,'' Ganda said.

Meigs said his study should be followed by another looking at the effects of exercise and other ``insulin sensitizing'' techniques.

Beans Linked to Low Cholesterol

Researchers from Cedars-Sinai Medical Center say beans increase blood levels of phytoestrogens or plant estrogens in women. Dr. Bairey Merz says the study shows a "very significant relationship" between increased phytoestrogen levels and lower cholesterol.

Merz says there also may be "positive associations" with phytoestrogens and hormone replacement therapy for women during and after menopause, but more research is needed. Future research will analyze stored blood samples.

Investigators need to compare eating phytoestrogens in plant form to taking supplement capsules because other studies show artificial forms produce less positive results. As Merz says, "This probably means we should be eating beans as opposed to taking supplements in capsule form."

Healthy Foods May Spike Sugar

London-based Zinser says if you had two pieces of toast with jam and a couple of cups of coffee or tea this morning, you probably consumed about a dozen cubes of sugar. And a pasta salad and carton of apple juice that you plan to nibble and sip at lunch will add another 16 cubes.

Fruit juices, she says, "are notoriously high in sugar," so dilute them with water, which should reduce the sugar with little sacrifice in taste. For carbonated drinks, stick to the diet form, which has no sugar, as opposed to the 21 cubes the average pint of normal cola contains.

Zinser says the amount of sugar in meat and fish is negligible -- "just be careful about sauces and condiments, which can contain a lot of sugar." Bagels, muffins, plain loaves of bread and baguettes are low in sugar content, as is cheese, "but do watch out for spreads and processed cheeses, which do contain more sugar."

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