Vitamins C, E may reduce pre-eclampsia risk

The finding ``may have substantial implications for the future management of pregnancy,'' write a team of British researchers led by Dr. Lucy Chappell, of St. Thomas' Hospital in London. Their findings are published in the September 4th issue of The Lancet.

Pre-eclampsia, which features a substantial rise in maternal blood pressure and signs of kidney trouble, can serve as a 'warning' sign of eclampsia -- a potentially lethal rise in blood pressure.

The authors point out that 'free radicals' -- the destructive by-products of normal metabolic processes -- can cause oxidative stress to cells lining arteries, and could be ''promoters'' of pre-eclampsia. They theorized that supplementation with anti-oxidants like vitamins C and E that ''mop up'' free radicals might reduce risks for pre-eclampsia in pregnant women at high risk.

To test this theory, they had 283 pregnant women at high risk for developing pre-eclampsia take vitamin C (1,000 mg/day) and vitamin E (400 IU/day) or a 'dummy' placebo, starting at between 16 to 22 weeks of pregnancy and continuing until delivery.

According to the researchers, vitamin supplementation reduced risks for pre-eclampsia by 61%, with 17% of women assigned to placebo developing pre-eclampsia compared with just 8% of those in the supplementation group.

But in a journal editorial, Drs. James Roberts and Carl Hubel caution against generalizing this new data.

The editorialists, both researchers at the University of Pittsburgh in Pennsylvania, expect that vitamin C and E supplementation ``will undoubtedly'' be widely adopted before its safety and efficacy are confirmed by larger studies. They remind readers of a similar scenario that occurred when calcium and aspirin were reported to prevent pre-eclampsia, based on results from small studies --results that were not confirmed in larger trials.

Roberts and Hubel believe that the antioxidant vitamins represent ``a relevant target for future clinical trials.'' They note that the large doses of vitamins used in the study could have side effects and that larger trials should include a demonstration of safety, ``especially for the infant.''

SOURCE: The Lancet 1999;354:788-789, 810-816.

Low-fat diet has no effect on breast cancer survival

However, breast cancer patients on a high protein diet, where the protein sources include poultry and dairy products but not red meat, did fare better than women who ate less protein, Dr. Michelle D.Holmes and colleagues at Harvard Medical School in Boston report in the September 1st issue of the journal Cancer.

``If there is a detrimental effect of high fat diet on breast (cancer) survival, it most likely is modest at best,'' they write. ``Reduced fat consumption for women already diagnosed with breast carcinoma is unlikely to be of substantial benefit.''

The researchers based their findings on questionnaires filled out by 1,982 women who were diagnosed with breast cancer between 1976 to 1990. The women were all participants in the Nurses' Health Study, a large ongoing study of more than 120,000 registered nurses.

Holmes and her colleagues found that the amount of fat in a woman's diet after a diagnosis of breast cancer was not related to her risk of dying from the disease. However, the group of women who ate the most fat before being diagnosed did have a 70% greater risk of death than the women who ate the least fat, the researchers report.

Furthermore, compared to other breast cancer patients, the researchers detected a 35% lower risk of dying among women who consumed the most protein and a 30% reduction in those who ate the most poultry. This connection was strongest in women whose cancer was confined to the breast.

The researchers did not detect any link between how much red meat a woman ate and her odds of dying from breast cancer. 834,2,2 They did find, however, that women who ate the most vegetables were less likely to die from breast cancer.

In an interview with Reuters Health, Holmes said that the findings are preliminary, but she noted, ``It would be exciting to think that diet could potentially help breast cancer.''

``Replacing red meat with poultry, dairy, and fish products and increasing intake of vegetables may promote survival in women with breast carcinoma,'' she and her colleagues conclude in the report.

In an editorial that accompanies the study, Dr. James R. Marshall, of the Arizona Cancer Center in Tucson, states that the study is important, but also calls into question some of its conclusions.

``Modest measurement error can cause strong, risk-altering diet variables to bias estimates of the effects of other diet variables,'' Marshall writes. ``The measurement error that obscured the data used here is not modest, but substantial. Substantial biases abound,'' he concludes.

In a response to the editorial, Holmes acknowledges the validity of some of the criticism, but she stands by her team's results. In the interview, she noted that measurements of dietary intake are always imperfect. However, she noted that the same measuring methods have accurately predicted an association between a high-fat diet and heart disease.

``We are reassured by the fact that we can predict heart disease'' with these methods, Holmes said.

SOURCE: Cancer 1999;86:751-755, 825-834.

Flea collars may expose children to chemicals

Flea collars help keep pests off dogs and cats, but little is known about their effect on human health, according to Dr. Janice Chambers, the director of the Center for Environmental Health Sciences at the Mississippi State University College of Veterinary Science.

In the first part of an ongoing study, which Chambers presented Sunday at the annual meeting of the American Chemical Society in New Orleans, the researchers rubbed white gloves on dogs wearing one of two popular flea collars to measure how much of the chemicals remained on their fur.

In dogs wearing one type of collar, insecticide levels declined for several days after the collar was first placed on the dog. In those wearing another type of collar, the chemical residue was lower, but it remained steady for a few weeks, Chambers told Reuters Health in an interview.

``What we do not know is how much (insecticide) would be accumulated in people,'' she said.

To find out, the researchers are analyzing chemical exposure in adults and children ages 4 to 12 who have dogs that wear flea collars. In this part of the study, which is still in progress, the investigators are testing urine samples to see how much insecticide people absorb, Chambers explained.

Although it is possible that chemicals from flea collars may be harmful to people, the Mississippi researcher cautioned against jumping to conclusions.

``We really don't know if there is reason for concern,'' she said.

In the meantime, however, parents may want to discourage children from hugging or sleeping in the same bed with a pet for a few days after putting on a new flea collar, advised Chambers.

Although pets can take pills that protect against fleas and ticks, it is important to make sure that flea collars are safe, since the flea medications are too expensive for many pet owners, she said.

Vitamin C reduces effects of chronic stress

``Under times of chronic stress we probably need to have more vitamin C,'' said study lead author Dr. P. Samuel Campbell, of the University of Alabama in Huntsville. He presented the findings Sunday at the annual meeting of the American Chemical Society, held in New Orleans.

Previous studies have shown that stress can impair the body's immune response, increasing the risk of infectious illness. To determine if vitamin C supplementation might counter the damaging effects of stress, the authors fed mice either 100 mg or 200 mg of vitamin C daily for 3 weeks -- a dosage equivalent to several grams per day in humans. At the same time, they subjected the rats to emotional stress by restraining them from all movement for a period of 1 hour each day.

As expected, blood samples from the rats showed increased levels of antibodies associated with stress. However, rats fed 200 mg of vitamin C displayed lower-than-expected blood levels of the stress hormone cortisol -- indicating that some type of immune suppression had taken place.

The findings have important implications for the prevention of stress-related illness in athletes and anyone under high amounts of physical stress. In an interview with Reuters Health, Campbell added that ``someone who is under a lot of emotional stress'' may also benefit from increased vitamin C consumption. However, he speculated that the daily requirement for vitamin C may vary under different environmental conditions, similar to how caloric needs change with physical activity.

The findings also suggest that current guidelines on recommended vitamin C intake may be too low. The researchers note that the US recommended daily allowance (RDA) for vitamin C is currently set at 60 mg per day. But Campbell's team believes that our ancestors consumed much more of the vitamin daily, in a diet rich in fruits.

``If so,'' Campbell said in a statement, ``the physiological constitution we have inherited may require doses far larger than the present RDA to keep us healthy under varying environmental conditions, including stress.''

Brisk walking can reduce heart attack risk

``The study suggests that one third of heart attacks in women can be prevented by walking vigorously,'' the study's lead author, Dr. JoAnn E. Manson, of Brigham and Women's Hospital and Harvard Medical School in Boston, Massachusetts, told Reuters Health in an interview.

It may not be surprising that women in the study who exercised vigorously for at least 1.5 hours per week reduced their risk of heart attack by 30% to 40%, but women who walked 3 hours each week at a pace of 20 minutes per mile achieved the same reduction, according to Manson and her colleagues. And women who walked briskly for 5 or more hours a week cut their heart attack risk nearly in half, they found.

Manson's team also found that sedentary women who began exercising during the study period were able to reduce their risk of heart attack.

``There is an epidemic of sedentary lifestyle in the US,'' Manson said, noting that about 60% of Americans do not exercise regularly.

``It's never too late to start exercising,'' she said. ``The key is to get up off the couch and start moving.''

The findings should add support to federal guidelines that recommend that everyone should participate in 30 minutes of moderate exercise on most days of the week, according to Manson.

The researchers based the findings on 72,488 women in the Nurses' Health Study who were ages 40 to 65 in 1986. At several times between 1980 and 1992, the women filled out questionnaires about their physical activity.

While there has been growing evidence that exercise can reduce the risk of heart disease, according to Manson, few studies have included women and few have focused on the benefits of walking, which is the most popular type of exercise among women. But even though the study included only women, ``there is no reason to believe that (these findings) wouldn't apply to men,'' Manson said.

Although the researchers note that vigorous exercise is appropriate for some people, they conclude that these findings ''indicate that enormous public health benefits would accrue from the adoption of regular moderate-intensity exercise by those who are currently sedentary.''

Dr. Gerald Fletcher, a national spokesperson for the American Heart Association and professor of medicine at the Mayo Medical School in Jacksonville, Florida, said in a statement: ''Brisk walking is an excellent form of exercise for both women and men, especially as they age and their risk for knee and other injuries increases.''

``These findings are right in line with the exercise recommendations of the American Heart Association, which are at least 30 to 60 minutes of moderate-intensity exercise 3 to 6 days a week,'' he added.

Health experts recommend seeking a physician's advice before beginning any exercise program.

SOURCE: The New England Journal of Medicine 1999;341:650-658.

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