Nutrients in fruit and vegetables linked to bone health

The findings ``suggest a link between fruit and vegetable consumption and bone health,'' according to investigators led by Dr. Susan A. New of the University of Surrey in Guildford, UK. Their findings are published in the January issue of the American Journal of Clinical Nutrition.

The authors point out that most studies on nutrition and bone health have focused on calcium intake ``and paid less attention to (the role of) other micronutrients.''

As part of their research, New's team had 62 healthy Scottish women, aged 45 to 55 years, fill out detailed dietary questionnaires. Each of the women also underwent bone scanning to determine their respective bone density levels.

The result? According to the researchers, ``intakes of nutrients found in abundance in fruits and vegetables -- namely, potassium, beta-carotene, vitamin C, and magnesium -- were positively associated with bone health.''

Potassium appears to slow the excretion of calcium from the body while increasing rates of bone formation, the authors explain. Vitamin C appears to aid in bone formation, as well, while ``magnesium is extremely important in skeletal metabolism.'' In fact, recent studies suggest that magnesium deficiency may contribute to osteoporosis.

Based on their findings, New and colleagues say further study of the role of micronutrients in bone health ``are warranted.''

SOURCE: American Journal of Clinical Nutrition 2000;71:142-151.

FDA to monitor reactions to herbs, vitamins and supplements

The measures are part of a 10-year FDA plan for implementing a 1994 law governing supplements. Completing the far-reaching agenda would require cooperation from Congress, which must provide funding. Joseph Levitt, director of the FDA's Center for Food Safety and Applied Nutrition, said the agency wanted to make consumers confident that dietary supplements are safe and that claims about their powers are supported by scientific evidence.

``We want consumers to have high confidence in these products in terms of their safety, composition and labeling,'' Levitt said in an interview. Supplements are not subject to the same rigorous testing as drugs, but manufacturers face restrictions on how they can promote the products. They cannot claim a product treats or cures a disease without scientific evidence to prove it.

Last year, the FDA required supplement makers to put more information on their labels. Among its future plans, the FDA wants to expand its monitoring of serious adverse reactions and coordinate and conduct research on supplements' effects, Levitt explained.

``There needs to be a stronger scientific foundation underlying these products,'' Levitt said. He also said that later this month he would announce the agency priorities for this year, adding that he considered publishing so-called ``good manufacturing practices'' an important step. Industry groups have called for such standards specifically for dietary supplements, which now follow manufacturing standards set for foods.

A consumer group welcomed the FDA plan but noted it was only a broad outline and would require a sizable boost in FDA funding from Congress.

``It is a list of what needs to be done, but it doesn't indicate what the agency will do,'' said Bruce Silverglade, director of legal affairs for the Center for Science in the Public Interest, a consumer group. ``It's also a list that will be quite expensive to implement.''

Vegetables lower prostate cancer risk

``I think it's important that men start paying more attention to the foods on their plates, and making sure that there are vegetables on them, and that they eat them,'' said study co-author Dr. Alan R. Kristal in an interview with Reuters Health.

Kristal and colleagues at the University of Washington in Seattle, studied 628 men aged 40 to 64 who had been newly diagnosed with prostate cancer, as well as 602 cancer-free men the same age.

The researchers asked the men about their consumption of 99 food items over a 3 to 5 year period.

When Kristal's team considered total vegetable intake, they found that men who ate 28 or more servings of vegetables per week had a 35% lower risk of prostate cancer compared with men who ate fewer than 14 servings per week.

In addition, men who ate three or more servings of cruciferous vegetables per week had a 41% decreased risk of prostate cancer compared with men who ate less than one serving per week, even after the researchers accounted for total vegetable intake.

``It's a piece of strong evidence that vegetables can protect against prostate cancer,'' Kristal said. He pointed out that cruciferous vegetables, in particular, are high in substances called isothiocyanates, which activate enzymes that detoxify carcinogens.

According to Kristal, vegetables evolved mechanisms to avoid being eaten, such as cytochemicals that are quite bitter and toxic.

``Humans evolved the ability to detoxify these cytochemicals, and the enzyme systems that we use to detoxify cytochemicals are the same enzymes that detoxify naturally occurring carcinogens,'' he explained. ``We think the effect is by upregulating these enzyme systems that has a protective effect against cancer.''

Although the strongest association in the study was between intake of cruciferous vegetables and lowered prostate cancer risk, Kristal noted that eating a variety of vegetables is probably important in lowering the risk.

SOURCE: Journal of the National Cancer Institute 2000;92:61-68.

FDA revises rules on supplement health claims

The changes include a revised definition of the word ''disease'' in response to comments that the previous definition used was too broad and permitted claims about conditions associated with aging, pregnancy, adolescence, and menopause. Serious conditions associated with these life stages, such as the bone-thinning disease osteoporosis common in the elderly, ''will continue to be treated as diseases,'' according to an FDA statement.

The final rule on the types of statements that can be made about the effects of a supplement should not affect the availability of dietary supplements or consumers' access to them, note FDA officials, but it could result in some labeling changes for these products.

The FDA explained that under the Dietary Supplement Health and Education Act of 1994, supplement manufacturers are required to have in their files substantiation of any claims they make about how the product affects the structure or function of the body. They must also notify FDA of claims that they are making within 30 days of marketing a given dietary supplement.

Any express or implied disease claims on a dietary supplement label must be reviewed by the FDA. Supplements ``may not, without prior FDA review, bear a claim that they can prevent, treat, cure, mitigate or diagnose disease.'' The rule does permit health maintenance claims not related to disease, such as ``maintains a healthy circulatory system,'' other non-disease claims such as ``helps you relax,'' or other claims for common, minor symptoms, such as ``for hot flashes.''

FDA officials believe that the final rule ``will ultimately provide consumers with better information on dietary supplement labeling that will help them select appropriate products.''

The final rule was published Thursday in the Federal Register, and becomes effective in 30 days. Products marketed for the first time and any new claims made for existing products after the date of publication will be expected to comply with the rule after that time. Small businesses that already market products will have an additional 17 months, and other companies will have an additional 11 months to bring existing claims into compliance with the new rule.

Risks of newborn circumcision weighed against benefits

However, circumcision remains a safe procedure that has both risks and benefits, according to the report in the January issue of the journal Pediatrics.

For every complication, six circumcised newborns can be expected to avoid urinary tract infections and for every two complications, one case of penile cancer is prevented.

The incidence of sexually transmitted diseases is also lower among circumcised men, the researchers note.

``We're giving parents the best available data on what the risks and benefits are and presenting them in a way that allows parents to come to their own conclusions,'' Dr. Dimitri Christakis, an assistant professor of pediatrics at the University of Washington School of Medicine and the study's lead author, told Reuters Health.

A recent policy statement by the American Academy of Pediatrics recommended that physicians provide parents with unbiased information on the risks and benefits of circumcision. But while the benefits are well documented, the risks remain unclear.

To investigate, Christakis and the team of researchers with the University of Washington in Seattle looked at all hospital records in the state of Washington over a 9-year period. Of the 354,297 boys born between 1987 and 1996, 37% had circumcisions in the hospital.

They found that a complication occurred in 1 out of every 476 circumcisions (0.2%), a finding that was consistent with previous studies. Complications included minor bleeding and damage to the penis that required treatment.

The authors add that the study provides a conservative estimate of the risks involved in circumcision because it did not include complications, such as infections, that developed after leaving the hospital. The study also did not include complications from circumcisions performed outside of a hospital setting, such as those performed as part of a traditional Jewish bris ceremony.

Circumcision ``remains a relatively safe procedure,'' the investigators conclude. Christakis noted that parents may differ in how the study results influence their decision.

``Medicine is increasingly moving toward a joint decision-making model, and parents should be provided with objective information and come to their own conclusion,'' he said. ``The value assigned to the risks and benefits will differ from parent to parent.''

SOURCE: Pediatrics 2000;105:246-249.

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