Mg In Men Research Articles

Predictors of Long-Term and High-Dose Use of Zolpidem in Veterans.

Prescriptions for sedative hypnotics are routinely initiated and renewed to treat insomnia, despite evidence supporting nonpharmacologic treatments as comparable and more favorable over time. We used national Veterans Health Administration data to assess patient characteristics associated with high-dose and long-term zolpidem use. The study included outpatients with new zolpidem prescriptions (January 1, 2013, to June 3, 2014). We defined high-dose use as use of doses above those recommended in the 2013 FDA safety warning (> 5 mg for women, > 10 mg for men) and defined long-term use as at least 180 days of continued supply. We fit separate logistic regression models by sex to evaluate how patient factors, adjusting for facilities, predicted high-dose and long-term use. Of 139,525 new zolpidem users, < 1% of men and 41% of women used high doses within 180 days of initiation, and 20% continued to use zolpidem long-term. Prior-year use of other sleep medications was associated with both high-dose and long-term use. Substance abuse/dependence was associated with high-dose use in women (odds ratio = 1.20, P < .001). Although long-term use was less likely in those over the age of 85 years, about 1 in 5 users aged 65 to 85 continued long-term. In both sexes, individuals of Hispanic ethnicity and nonwhite races were less likely to use long-term, whereas those with ICD-9-CM-defined psychiatric and sleep disorder diagnoses were more likely to use long-term. Zolpidem use at a higher-than-recommended dose was common in women who were new zolpidem users. In both sexes, 1 in 5 users continued to use zolpidem for at least 180 days. Efforts to improve access to effective nonpharmacologic treatment alternatives may benefit from attention to subpopulations with higher risk of high-dose and long-term use.

Design of a randomized controlled trial of zinc supplementation to improve markers of mortality and HIV disease progression in HIV-positive drinkers in St. Petersburg, Russia

BackgroundRussia continues to have an uncontrolled HIV epidemic and its per capita alcohol consumption is among the highest in the world. Alcohol use among HIV-positive individuals is common and is associated with worse clinical outcomes. Alcohol use and HIV each lead to microbial translocation, which in turn results in inflammation. Zinc supplementation holds potential for lowering levels of biomarkers of inflammation, possibly as a consequence of its impact on intestinal permeability. This paper describes the protocol of a double-blinded randomized placebo-controlled trial of zinc supplementation in St. Petersburg, Russia.MethodsParticipants (n = 254) were recruited between October 2013 and June 2015 from HIV and addiction clinical care sites, and non-clinical sites in St. Petersburg, Russia. Participants were randomly assigned, to receive either zinc (15 mg for men; 12 mg for women) or placebo, daily for 18 months. The following outcomes were assessed at 6, 12, and 18 months: (1) mortality risk (primary outcome at 18 months); (2) HIV disease progression; (3) cardiovascular risk; and (4) microbial translocation and inflammation. Adherence was assessed using direct (riboflavin) and indirect (pill count, self-report) measures.ConclusionGiven the limited effectiveness of current interventions to reduce alcohol use, zinc supplementation merits testing as a simple, low-cost intervention to mitigate the consequences of alcohol use in HIV-positive persons despite ongoing drinking.

Multicenter extension and switch study evaluating the safety of long-term treatment with abiraterone acetate fine particle formulation (AAFP) in patients with metastatic castration-resistant prostate cancer (mCRPC): The STAAR-E study.

181 Background: The STAAR-study results showed novel AAFP 500 mg is therapeutically equivalent to originator abiraterone acetate (OAA) 1000 mg in men with mCRPC (Stein et al. Urologic Oncol). This STAAR-extension study evaluates the safety of ≤ 1 year of additional AAFP treatment in men with mCRPC. Methods: Patients were enrolled in the extension if they had: 1) mCRPC; 2) successfully completed 84 days of treatment with either AAFP + methylprednisolone (MP) or OAA + prednisone (PDN) in the STAAR-study; and 3) received their last dose of STAAR-study treatment &lt; 45 days of starting this extension study. All patients continued or switched to AAFP 500 mg QD + 4 mg MP BID. Serum testosterone and PSA levels are measured at 6 and 12 months. Safety evaluations include adverse event (AE) incidence, clinical laboratory test results, and vital signs. Results: 20 patients were enrolled in the ongoing study (11 were switched to AAFP from OAA and 9 continued on AAFP). Median age is 76.5 years, and median AAFP treatment duration (STAAR + STAAR-E) is 178 days as of 8/16/17. Ten patients have been treated with AAFP &gt; 9 months; 3 of these for &gt; 1 year. Three patients discontinued due to progressive disease (n=1), fatigue (n=1), and a fall (non-AAFP related) resulting in death (n=1). No adverse events related to liver enzyme or bilirubin increases have been reported (Table). Conclusions: In this extension study in men with mCRPC, the safety profile of AAFP, regardless of prior treatment with OAA or AAFP, is consistent with that of OAA reported in the literature. Based on these results, longer-term treatment with AAFP + MP has acceptable safety, and patients on OAA + PDN treatment can switch to AAFP + MP successfully. Clinical trial information: NCT02962284. [Table: see text]

Trial of Prazosin for Post-Traumatic Stress Disorder in Military Veterans

BackgroundIn randomized trials, prazosin, an α1-adrenoreceptor antagonist, has been effective in alleviating nightmares associated with post-traumatic stress disorder (PTSD) in military veterans.MethodsWe recruited veterans from 13 Department of Veterans Affairs medical centers who had chronic PTSD and reported frequent nightmares. Participants were randomly assigned to receive prazosin or placebo for 26 weeks; the drug or placebo was administered in escalating divided doses over the course of 5 weeks to a daily maximum of 20 mg in men and 12 mg in women. After week 10, participants continued to receive prazosin or placebo in a double-blind fashion for an additional 16 weeks. The three primary outcome measures were the change in score from baseline to 10 weeks on the Clinician-Administered PTSD Scale (CAPS) item B2 (“recurrent distressing dreams”; scores range from 0 to 8, with higher scores indicating more frequent and more distressing dreams); the change in score from baseline to 10 weeks on the Pittsburgh Sleep Quality Index (PSQI; scores range from 0 to 21, with higher scores indicating worse sleep quality); and the Clinical Global Impression of Change (CGIC) score at 10 weeks (scores range from 1 to 7, with lower scores indicating greater improvement and a score of 4 indicating no change).ResultsA total of 304 participants underwent randomization; 152 were assigned to prazosin, and 152 to placebo. At 10 weeks, there were no significant differences between the prazosin group and the placebo group in the mean change from baseline in the CAPS item B2 score (between-group difference, 0.2; 95% confidence interval [CI], −0.3 to 0.8; P=0.38), in the mean change in PSQI score (between-group difference, 0.1; 95% CI, −0.9 to 1.1; P=0.80), or in the CGIC score (between-group difference, 0; 95% CI, −0.3 to 0.3; P=0.96). There were no significant differences in these measures at 26 weeks (a secondary outcome) or in other secondary outcomes. At 10 weeks, the mean difference between the prazosin group and the placebo group in the change from baseline in supine systolic blood pressure was a decrease of 6.7 mm Hg. The adverse event of new or worsening suicidal ideation occurred in 8% of the participants assigned to prazosin versus 15% of those assigned to placebo.ConclusionsIn this trial involving military veterans who had chronic PTSD, prazosin did not alleviate distressing dreams or improve sleep quality. (Funded by the Department of Veterans Affairs Cooperative Studies Program; PACT ClinicalTrials.gov number, NCT00532493.)

Treatment of Vitamin and Mineral Deficiencies After Biliopancreatic Diversion With or Without Duodenal Switch: a Major Challenge.

Vitamin and mineral deficiencies are a major concern after biliopancreatic diversion (BPD) and BPD with duodenal switch (BPD/DS). Evidence-based guidelines how to prevent or how to treat deficiencies in these patients are currently lacking. The aim of the current study is to give an overview of postsurgical deficiencies and how to prevent and treat these deficiencies. Retrospective evaluation of a 1-year structured monitoring and treatment schedule for various deficiencies in 34 patients after BPD or BPD/DS. Patients were introduced into the program 12-90months after surgery. Vitamin B1, B6, B9, and B12 deficiencies could be prevented by mean daily doses of 2.75mg, 980μg, 600μg, and 350μg, respectively. However, many patients continued to develop deficiencies of vitamin A, D, iron, calcium, and zinc despite major dose adjustments. Current observations suggest that at least total daily doses of 200mg Fe in premenopausal women and 100mg in men, 100mg of Zinc, 3000mg of calcium, and weekly doses of at least 50,000IU solubilized vitamin A and vitamin D are needed to prevent the occurrence of major deficiencies. Exceptionally high supplementation doses are needed to prevent and treat vitamin and mineral deficiencies in patients after BPD or BPD/DS. Further refinement and simplification of treatment schedules is needed. Focus on improvement of compliance to treatment is recommended.

A Phase 3 Study to Evaluate the 1-Year Efficacy and Safety of Udenafil 75 mg Once Daily in Patients With Erectile Dysfunction

IntroductionOnce-daily administration of phosphodiesterase type 5 inhibitors has been shown to correct erectile dysfunction (ED). AimTo evaluate the long-term efficacy and safety after once-daily oral administration of udenafil 75 mg in men with ED. MethodsThis clinical trial was an open-label, fixed-dose, 24-week extension study (DA8159_EDDL_III) of a 24-week double-blinded efficacy and safety study of once-daily udenafil (parent study: DA8159_EDD_III). Subjects received udenafil 75 mg once daily for 24 weeks during this extension study, and the follow-up visit occurred during the 4-week ED treatment-free period. Main Outcome MeasuresSubjects were asked to complete the International Index of Erectile Function questionnaire and the Global Assessment Questionnaire at the 24-week extension and after the 4-week ED treatment-free period, and the development of adverse drug reactions was investigated. ResultsIn total, 302 subjects were enrolled in this extension study. Improvement was shown with an increased erectile function (EF) domain score compared with baseline (14.60 ± 4.57) at extension week 48 (23.98 ± 5.44) and a slight increase in EF domain score compared with the last time point (week 24) of the parent study (P < .001). The Global Assessment Questionnaire showed a high improvement rate of 95.4% at the extension 48-week time point. For shift to normal, almost half the subjects (45.1%) recovered “normal” EF, and 14.2% of subjects reported normal erections after the 4-week ED treatment-free period. The occurrence rate of adverse drug reactions was 8%, which consisted mainly of flushing and headache. ConclusionOnce-daily dosing of udenafil 75 mg showed excellent efficacy and safety with long-term administration and allowed a more spontaneous sexual life.

Ascorbic acid intake and oxalate synthesis.

In humans, approximately 60mg of ascorbic acid (AA) breaks down in the body each day and has to be replaced by a dietary intake of 70mg in women and 90mg in men to maintain optimal health and AA homeostasis. The breakdown of AA is non-enzymatic and results in oxalate formation. The exact amount of oxalate formed has been difficult to ascertain primarily due to the limited availability of healthy human tissue for such research and the difficulty in measuring AA and its breakdown products. The breakdown of 60mg of AA to oxalate could potentially result in the formation of up to 30mg oxalate per day. This exceeds our estimates of the endogenous production of 10-25mg oxalate per day, indicating that degradative pathways that do not form oxalate exist. In this review, we examine what is known about the pathways of AA metabolism and how oxalate forms. We further identify how gaps in our knowledge may be filled to more precisely determine the contribution of AA breakdown to oxalate production in humans. The use of stable isotopes of AA to directly assess the conversion of vitamin to oxalate should help fill this void.

Effect of Megestrol Acetate and Testosterone on Body Composition and Hormonal Responses in COPD Cachexia.

Background: Underweight chronic obstructive pulmonary disease (COPD) patients with involuntary weight loss have a poor prognosis; no effective therapy is currently available. We conducted the first clinical trial seeking to determine whether combination therapy with an appetite stimulant and an anabolic steroid would have beneficial effects on body composition for patients with COPD cachexia. Methods: We conducted a 12-week pilot study in which 4 men and 5 women (age 64±10 y, forced expiratory volume in 1 second [FEV1] 31±9 %pred., body mass index [BMI] 18±3 kg/m2) with low-normal testosterone levels (average 532±45ng/dl in men and 12.4±5.3ng/dl in women) and weight loss ≥10 lbs over the previous year were treated with oral megestrol acetate 800mg/day plus weekly testosterone enanthate injections, initially 125 mg in men and 40 mg in women, with doses subsequently adjusted targeting circulating nadir testosterone levels of 850 and 300 ng/dl, respectively. Results: On treatment, nadir testosterone level increases averaged 160±250 ng/dl (NS) in men and 322±49 (p<0.001) ng/dl in women. Body weight increased in all individuals, with average end-intervention weight gain of 3.1±2.2 kg (p<0.005). Two women and 2 men had COPD exacerbations and did not complete the 12-week study. In the 5 individuals who completed, dual energy x ray absorptiometry (DEXA) scans revealed an average 2.0±1.5 kg lean mass and 2.3±1.7 kg fat mass increase (each p<0.05). No adverse effects of treatment were detected. Conclusions: Combination therapy reversed the trajectory of involuntary weight loss and increased lean mass in cachectic COPD patients. Though the interventions were apparently well tolerated, participant drop-out rate was high. Larger randomized placebo-controlled long-term studies with functional outcomes are needed.

Drug treatment of alopecia

Alopecia is the term used to describe hairless areas of the scalp. They can follow a specific pattern, be diffuse or circumscript. Androgenetic alopecia (AGA) follows a pattern: in men thinning of temples and vertex up to total baldness; in women thinning of the midline or parietal area. Lack of iron or cytostatic drugs cause diffuse alopecia, while in autoimmune diseases such as alopecia areata or lichen planus bizarre shapes of hairless areas are observed. For therapy, the following medications are used: topical minoxidil solution for AGA of men and women; systemic finasteride 1 mg for men with AGA; topical diphencyprone immunotherapy for alopecia areata; systemic antimycotic agents for tinea capitis; antibiotics such as clindamycin and rifampicin for folliculitis decalvans; systemic corticosteroids and isotretinoin for folliculitis et perifolliculitis capitis abscedens et suffodiens; topical corticosteroids for lichen planus and Kossard's frontal fibrosing alopecia.

Estimation of dietary iron bioavailability from food iron intake and iron status.

Currently there are no satisfactory methods for estimating dietary iron absorption (bioavailability) at a population level, but this is essential for deriving dietary reference values using the factorial approach. The aim of this work was to develop a novel approach for estimating dietary iron absorption using a population sample from a sub-section of the UK National Diet and Nutrition Survey (NDNS). Data were analyzed in 873 subjects from the 2000–2001 adult cohort of the NDNS, for whom both dietary intake data and hematological measures (hemoglobin and serum ferritin (SF) concentrations) were available. There were 495 men aged 19–64 y (mean age 42.7±12.1 y) and 378 pre-menopausal women (mean age 35.7±8.2 y). Individual dietary iron requirements were estimated using the Institute of Medicine calculations. A full probability approach was then applied to estimate the prevalence of dietary intakes that were insufficient to meet the needs of the men and women separately, based on their estimated daily iron intake and a series of absorption values ranging from 1–40%. The prevalence of SF concentrations below selected cut-off values (indicating that absorption was not high enough to maintain iron stores) was derived from individual SF concentrations. An estimate of dietary iron absorption required to maintain specified SF values was then calculated by matching the observed prevalence of insufficiency with the prevalence predicted for the series of absorption estimates. Mean daily dietary iron intakes were 13.5 mg for men and 9.8 mg for women. Mean calculated dietary absorption was 8% in men (50th percentile for SF 85 µg/L) and 17% in women (50th percentile for SF 38 µg/L). At a ferritin level of 45 µg/L estimated absorption was similar in men (14%) and women (13%). This new method can be used to calculate dietary iron absorption at a population level using data describing total iron intake and SF concentration.

AB1112 Is Dietary Potassium Important in Rheumatoid Arthritis? Preliminary Observations

BackgroundPotassium (K+), predominantly intracellular, has several critical physiological functions. Dietary K+ is considered important in hypertension and stroke but its role in RA though sparsely described remains speculative.ObjectivesTo estimate intake...

Estimating distributions of usual 24‐hour sodium excretion from timed‐spot urines in adults 18‐39 years (632.11)

We developed and tested calibration equations from spot urine specimens to estimate the distribution of usual 24h sodium excretion (24UNa). A convenience sample of 407 adults, 18‐39 y, (54% female, 48% black) collected each void in a separate container for 24h; 133 collected a second 24h urine 4‐11 d later. We selected 4 timed voids (morning [M], afternoon [A], evening [E], overnight [O]) from each 24h collection. Participants were randomly assigned to test (n=247) or validation (n=160) groups. Total sodium excreted in each of the 4 one‐spot and 6 combined two‐spot (e.g., M+A) urines from the test groups were used with covariates to develop sex‐specific equations for predicting 24UNa using Fuller’s error‐in‐the‐equation measurement error model. Equations applied to the validation data were used to estimate usual 24UNa distributions with the Iowa State University method. Mean bias in predicting the median of 24UNa with one‐spot urines ranged from ‐69 to 1617 mg for men and ‐72 to ‐9 mg for women, and with two‐spot urines from ‐124 to 115 mg and ‐50 to 9 mg, respectively. Mean bias in predicting percentiles (5th, 25th, 50th, 75th, and 95th) did not differ from 0 (p=0.06‐0.90) for men or women using an O void or combined E+O urine. Our method to estimate population distribution of 24UNa, which uses timed‐spot urine specimens and accounts for day‐to‐day variation and covariance between measurement errors, merits further investigation.

Dietary intake of trace elements, minerals, and vitamins of patients on chronic hemodialysis

We aimed to estimate dietary intakes of trace elements, minerals, and vitamins in hemodialysis patients (HDP) of three centers in one metropolitan and two urban areas of Italy. Daily dietary intake was assessed using a 3-day diet diary in 128 HDP. Mean daily intakes of trace elements were as follows: zinc, 7.6 ± 5.4 mg; copper, 14.3 ± 11.8 mg; selenium, 28.3 ± 18.1 μg; and iron, 7.2 ± 4.1 mg (7.8 ± 2.6 mg in women, 6.9 ± 2.4 mg in men). The distribution of patients by daily intakes of trace elements showed most were under the recommended values, with the exception of copper intake, which was much higher. Mean daily intakes of minerals were as follows: magnesium, 174.4 ± 94.3 mg; phosphorus, 842.6 ± 576.8 mg; calcium, 371.8 ± 363.7 mg; potassium, 1,616.2 ± 897.3 mg; and sodium, 1,350 ± 1,281 mg. Mean daily intakes of vitamins were as follows: vitamin A, 486.1 ± 544.6 μg; vitamin B1, 0.86 ± 0.7 mg; vitamin B2, 1.1 ± 0.7 mg; vitamin B3, 13.3 ± 8.1 mg; vitamin C, 47.8 ± 50.3 mg; and vitamin E, 9.5 ± 3.6 mg. The distribution of patients by daily intakes of vitamins showed most were under the recommended values. Daily intakes of trace elements and vitamins were similar among the three centers and did not differ between dialysis and non-dialysis days. Many HDP have daily dietary intakes of trace elements and vitamins below the recommended values, whereas the intake of copper is much higher.

Comparison of alfuzosin 10 mg with or without propiverine 10 mg, 20 mg in men with lower urinary tract symptom and an overactive bladder: randomised, single-blind, prospective study

The efficacy and safety of treatment with alfuzosin 10mg plus propiverine 10 or 20mg in men with lower urinary tract symptoms (LUTS) and an overactive bladder were investigated. In this parallel-arm, prospective, multicentre, single-blind study, men who were ≥40years old, had an International Prostate Symptom Score (IPSS) of ≥8, an Overactive Bladder Symptom Score (OABSS) of ≥3 and an OABSS urgency item score of ≥2 were randomised in a 1:1:1 ratio to receive alfuzosin 10mg alone (Group A) or with propiverine 10mg (Group B) or 20mg (Group C) for 8weeks. Four and 8 weeks after commencing treatment, OABSS was measured along with IPSS, maximal urinary flow rate (Qmax ) and postvoid residual volume (PVR). Adverse events were recorded. A total of 135 men, including 43 in Group A, 48 in Group B and 44 in Group C, completed the study. Relative to baseline, all groups demonstrated significant reductions in OABSS and the IPSS after eight treatment weeks (p<0.005). The improvement of OABSS in Group C was significantly greater than Group A and B (Group A: 0.70±1.94; Group B: 2.50±2.98; Group C: 4.30±3.40; p<0.005). An observed improvement of Qmax and PVR in the three groups did not achieve statistical significance. Overall adverse event rates were higher in Group C but not significant compared with others. In patients with LUTS and overactive bladder, combined therapy with alfuzosin 10mg plus propiverine 20mg was significantly more effective than alfuzosin monotherapy and propiverine 10mg combined therapy in terms of improving OABSS while not significantly affecting Qmax or PVR.

DIETARY CALCIUM INTAKE IN GROUPS OF ACTIVE AND SEDENTARY ELDERLY IN THE CITY OF SANTOS, SAO PAULO, BRAZIL

Introduction: Currently, 10% of the Brazilian population is more than 60 years old. Calcium is an essential element to the body, it is produced endogenously and only acquired through daily intake of foods that contain it. The inadequate intake of this nutrient increases the risk of osteoporosis, as well as other diseases, such as hypertension and colon cancer. Therefore, the present study had the objective of evaluating the consumption of dietary calcium by active and sedentary elderly in the city of Santos/SP- Brazil. Methods: Seventy elderly people of both genders were evaluated, on an average age of 69 and 75 years old for active and sedentary groups respectively. For nutritional assessment, we used 24-hour Dietary Recall and the quantification of calcium intake was done by software Avanutri 4.0. Weight, height and Body Mass Index (BMI) were measured for the assessment of body composition. Results: The data of calcium intake were compared with the recommendations advocated by DRI, which is of 1,200mg/day. Both groups consumed lower amounts of the recommended. However, the group of active elderly had a greater consumption (625,3 and 546,1mg for men and women respectively) in relation to the group of sedentary elderly (517,9 and 501,5mg for men and women, respectively), but there was no statistical difference between the groups. The low consumption may reflect on bone health and other bodily mechanisms of the evaluated groups. Therefore, nutritional education work is indispensable to inform the population.

Novel Developments in the Pharmacological Management of Insomnia

Advances in the basic science of sleep/wake neurophysiology are driving the exploration of new pharmacologic approaches with continued improvement in efficacy and safety.

Sleep and pulmonary intensive care: Insomnia and the paradox of

The International Classification of Sleep Disorders of the American Academy of Sleep Medicine describes insomnia secondary to drugs or substances, highlighting some of the features which characterize it: (a) the iatrogenic nature (b) the diverse range of effects on sleep structure by the different substances, (c) the failure or the partiality of knowledge about it. FG, male, 82 years old, suffering from prostate cancer-treatment with bicalutamide (50 mg/day orally) and leuprorelin (3.75 mg sc per month), is hospitalized in urology for the evidence of two bladder neoplasms. Pre-treated with blood transfusions of G.R. concentrated, is undergoing surgery, in the postoperative setting is further transfused IIa and presents in the day, in the absence of subjectivity and objectivity in character infectious diseases, insomnia and severe decompensated respiratory acidosis associated with acute respiratory failure type II, which progresses despite medical therapy and oxygen-therapy. Speaking to counseling should be the day for the worsening of the clinical picture, is in the differential diagnosis TRALI with bilateral pleural effusions and it starts with the noninvasive mechanical ventilation with interface oro-nasal and oxygen. The urgency in making a HRCT allows you to exclude the commitment interstitial and to confirm the bilateral pleural effusions. Then, are performed in succession, two thoracentesis, right and left, in the course of non-invasive mechanical ventilation, with the respectively extraction of 1000 and 1700 ml of pleural fluid, which turns out to be a transudate. Meanwhile, ventilatory treatment allows a progressive compensation of respiratory failure, the follow-up ultrasound shows the gradual reformation of the pleural effusion bilaterally. The diagnostic analysis is then focused on insomnia marked: you run a PSG in the course of therapy and proves increase of latency, sleep fragmentation and made surface with marked reduction of N2 and especially REM sleep. While the bilateral recurrent hydrothorax is treated with the placement of pleural drainage, a series of investigations in blood chemistry are performed, designed to confirm the suspicion of a clinical condition consistent with the immediacy of insomnia and hydrothorax by drugs and / or substances (surgical stress-Cortisol-CRH-bicalutamide-leuprorelin-FSH-LH-DHEA). Discontinuation of treatment with bicalutamide and dose adjustment of leuprorelin have permission to remove the pleural drainage through exhaustion of recurrence hydro-thorax bilateral. The patient was discharged in XLIIIa day. The knowledge and the cultural-methodological approach of the Sleep Medicine are almost always a real added value for a proper understanding of reality from respiratory clinics proposals in the various forms in which it manifests itself. The clinical case presented is paradigmatic of how Pulmonology intensivist is intimately hawksbill terms of pathophysiology and clinical interpretation, with the Sleep Medicine and how it is useful to have both the same cultural and methodological approaches. 1. Spitz A, Young JM, Larsen L, Mattia-Goldberg C, Donnelly J, Chwalisz K. “Efficacy and safety of leuprolide acetate 6-month depot for suppression of testosterone in patients with prostate cancer”. Prostate Cancer Prostatic Dis. 2011 Oct 25. doi: 10.1038/pcan.2011.50. 2. Tanaka N, Fujimoto K, Hirao Y, Shimizu K, Tsujimoto S, Samma S. “Endocrine response to a single injection of goserelin 3.6 mg or leuprolide 3.75 mg in men with prostate cancer. Arch Androl. 2007 Mar-Apr;53(2):87-90. 3. Ferrari B, Pezzuto A, Coppola F. “Massive ascites and hydrothorax after leuprolide acetate administration in a down-regulated woman undergoing assisted reproduction”. Fertil Steril. 2007 Oct;88(4):968.e9-11. Epub 2007 Apr 16. 4. Lodde M, Lacombe L, Fradet Y. “Salvage therapy with bicalutamide 150 mg in non metastatic castration-resistant prostate cancer”. Urology. 2010 Nov;76(5):1189-93. Epub 2010 Mar 29. 5. Akaza H. “Combined androgen blockade for prostate cancer: review of efficacy, safety and cost-effectiveness”. Cancer Sci. 2011 Jan;102(1):51-6. doi: 10.1111/j.1349-7006.2010.01774.x. Epub 2010 Nov 22. Review. 6. Labrie F. “Hormonal therapy of prostate cancer”. Prog Brain Res. 2010;182:321-41.

Evidence of revising calcium Dietary Reference Intakes (DRIs) for Korean elderly

Recently bone health is an important issue in public health aspect and calcium is the most critical nutrient to influence bone mass and bone mineral density, and consequently bone fracture. Calcium DRIs of Korea are much lower than those of US/Canada which have been revised recently. Since the requirement of calcium in Asians may be different from Caucasian, it would be desirable for Korean DRIs for calcium to be established by Korean data; however, little data of high quality exist. Based on 2008–2010 Korea National Health and Nutrition Examination Survey data, most women aged 65 and more have bone health problems such as osteoporosis and osteopenia. In women and men aged 65 and more, higher calcium intake was significantly associated with higher bone mineral density as well as lower incidence of osteoporosis. Means of the highest quartile calcium intake, which are 750 mg for women and 930mg for men, are much higher than the present Estimated Average Requirements (EAR) of elderly women and men, which are 570 mg and 560 mg, respectively. Therefore, it seems valid to increase calcium EAR for Korean elderly. (This research was supported by a fund(2012‐E35004–00) by Research of Korea Centers for Disease Control and Prevention)

Abstract P267: Relationship of Coffee Consumption and its Urinary Biomarker to Blood Pressure: The Intermap Study

Background: Coffee, one of the most commonly consumed beverages, is complex, with substantial differences in chemical composition among cups, depending on the origin of the product, how it is processed and prepared. Studies suggest that coffee consumption may help prevent several chronic diseases, e.g., Alzheimer’s disease, type 2 diabetes, and breast cancer. After caffeine, the second most abundant compound in coffee is trigonelline, also known as N -Methylnicotinic acid (NMNA), a niacin-related compound. Coffee contains about 10-40 mg of niacin per 100 g (the daily recommended dose of niacin is 14 mg for women and 16 mg for men). The influence of coffee on blood pressure (BP) is not clear; only the effect of caffeine has been studied extensively. Objective: To investigate associations of coffee consumption with the level of its urinary biomarker NMNA, and their relationships with BP among 2,157 US men and women ages 40-59 from the International Collaborative Study on Macro-/Micronutrients and Blood Pressure (INTERMAP). Methods: The INTERMAP Study is a cross-sectional epidemiologic investigation with standardized quality-controlled methods; four 24-hour dietary recalls; 2 timed 24-hour urine collections, 8 BP measurements, and questionnaire data were accrued. Proton nuclear magnetic resonance ( 1 H-NMR) spectroscopy was performed to obtain urinary metabolite profiles for all participants. Urinary NMNA was calculated from area under the curve of a triplet at δ 8.84 in each spectrum, and was expressed as a relative integral. Associations of BP with consumption of coffee and urinary NMNA, were assessed by multiple linear regression; possible confounders included age, gender, population sample, 24-hr urinary sodium and potassium excretions, and dietary variables. Results: Mean coffee consumption was 400 mg/day; relative urinary NMNA integral was 0.001. Sex-age-sample adjusted correlation (r) between urinary NMNA level and coffee consumption was 0.76 for mg/day; r between NMNA and niacin intake was 0.08; r between coffee and niacin, 0.16. There was a non-significant positive association between coffee intake and BP in all regression models adjusted for confounders including height and weight; data for relation of NMNA with BP were qualitatively similar to the foregoing. With adjustment for possible confounders, differences in systolic blood pressure (SBP) were 0.5 mm Hg (95% CI, -0.7 to 1.6) for coffee intake higher by 2 SD, 900 mg/day. Differences in SBP for 2 SD urinary NMNA integral were similar, 0.5 mm Hg (-0.6 to 1.7). For hypertensive participants, difference in SBP was 2.3 mm Hg (-0.7 to 5.4) for coffee intake 2 SD higher, and 2.7 mm Hg (-0.4 to 5.7) for urinary NMNA integral 2 SD higher. Conclusion: Higher coffee intake may raise BP, especially among hypertensive persons. Urinary NMNA apparently is a good biomarker for validation of coffee consumption among free-living people.

Intakes and sources of isoflavones, lignans, enterolignans, coumestrol and soya-containing foods in the Norfolk arm of the European Prospective Investigation into Cancer and Nutrition (EPIC-Norfolk), from 7 d food diaries, using a newly updated database.

A diet rich in phyto-oestrogens has been suggested to protect against a variety of common diseases but UK intake data on phyto-oestrogens or their food sources are sparse. The present study estimates the average intakes of isoflavones, lignans, enterolignans and coumestrol from 7 d food diaries and provides data on total isoflavone, lignan and phyto-oestrogen consumption by food group. Development of a food composition database for twelve phyto-oestrogens and analysis of soya food and phyto-oestrogen consumption in a populationbased study. Men and women, aged 40–79 years, from the general population participating in the Norfolk arm of the European Prospective Investigation into Cancer and Nutrition (EPIC-Norfolk) between 1993 and 1997, with nutrient and food data from 7 d food diaries. A subset of 20 437 participants. The median daily phyto-oestrogen intake for all men was 1199 mg (interquartile range 934–1537mg; mean 1504mg, SD 1502mg) and 888mg for all women (interquartile range 710–1135 mg; mean 1205 mg, SD 1701mg). In soya consumers, median daily intakes were higher: 2861 mg in men (interquartile range 1304–7269mg; mean 5051mg, SD 5031mg) and 3142 mg in women (interquartile range 1089–7327mg; mean 5396 mg, SD 6092 mg). In both men and women, bread made the greatest contribution to phyto-oestrogen intake – 40?8% and 35?6%, respectively. In soya consumers, vegetable dishes and soya/goat’s/sheep’s milks were the main contributors – 45?7% and 21?3% in men and 38?4% and 33?7% in women, respectively. The ability to estimate phyto-oestrogen intake in Western populations more accurately will aid investigations into their suggested effects on health.