In the News

Dietary Supplement Ingredient Database Now Available

Cognitive Behavior Therapy Helps Older Adults With Anxiety Reduce Worry, Improve Mental Health

Cognitive Behavior Therapy, Supportive Stress Management Appear to Reduce Depression After Heart Surgery

Lifestyle Factors Related to Risk of Diabetes Among Older Adults

Dietary Supplement Ingredient Database Now Available

The Dietary Supplement Ingredient Database (DSID), developed to improve estimates of the US population’s nutrient intakes based not only on the beverages and foods people consume but also on their dietary supplement intake, is now available. The DSID will help researchers improve estimates of the US population’s total nutrient intakes.

The database provides statistical estimates—based on chemical analysis—of the nutrient content of selected ingredients in dietary supplements, compared with label-reported ingredient levels. Currently, the DSID provides estimated levels of 18 vitamin and mineral ingredients derived from analytical data for 115 representative unspecified adult multivitamin/multimineral supplements (MVMs). Additional dietary supplement ingredients will be included in future releases of the database.

The DSID was planned and developed by the Agricultural Research Service (ARS) Nutrient Data Laboratory at the Maryland-based Beltsville Human Nutrition Research Center and the National Institutes of Health Office of Dietary Supplements (ODS) and other government collaborators.

To access the DSID, visit http://dietarysupplementdatabase.usda.nih.gov.

Cognitive Behavior Therapy Helps Older Adults With Anxiety Reduce Worry, Improve Mental Health

Older adults with generalized anxiety disorder (GAD) who received cognitive behavior therapy (CBT) had greater improvement on measures of worry, depression, and mental health than patients who received usual care, according to a study in a recent issue of JAMA.

GAD is common in late life, with prevalence up to 7.3% in the community and 11.2% in primary care. Late-life anxiety predicts increased physical disability, memory difficulties, and decreased quality of life. Late-life anxiety is usually treated with medication, but associated risks (eg, falls, hip fractures, memory problems) with some drugs and patient fears of adverse effects limit their usefulness. Two previous studies suggested benefits of CBT in primary care for late-life GAD, but the studies were small and the conclusions were limited. Older adults most often seek treatment for GAD in primary care.

Melinda A. Stanley, PhD, of the Baylor College of Medicine, Houston, Texas, and colleagues conducted the first randomized clinical trial of CBT for late-life GAD in primary care to examine whether CBT would improve outcomes relative to enhanced usual care (EUC). The trial included 134 older adults (average age, 67 years) in two primary care settings with treatment provided for 3 months. Assessments were conducted at the beginning of the trial, posttreatment (3 months), and over 12 months of follow-up, with assessments at 6, 9, 12, and 15 months. Patients were randomized to either CBT (n=70)—which included education and awareness, relaxation training, cognitive therapy, problem-solving skills training, and behavioral sleep management—or EUC (n=64), in which the same therapists telephoned patients biweekly during the first 3 months of the study to provide support and ensure patient safety. Therapists reminded patients to call project staff members if symptoms worsened.

Levels of anxiety, worry, depression, and physical/mental health quality of life were measured via various tests or surveys. The researchers found that CBT, compared with EUC, significantly improved worry severity, depressive symptoms, and general mental health. In intention-to-treat analyses, response rates defined according to worry severity were higher following CBT compared with EUC at 3 months (40.0% vs 21.9%).

Cognitive Behavior Therapy, Supportive Stress Management Appear to Reduce Depression After Heart Surgery

Two nonpharmacological interventions—cognitive behavior therapy (CBT) and supportive stress management—appear more effective than usual care for treating depression after coronary artery bypass surgery, according to a report in a recent issue of Archives of General Psychiatry.

About 1 in every 5 patients experiences a major depressive episode following coronary artery bypass graft (CABG) surgery, and at least that many develop milder forms of depression. "Depression around the time of surgery predicts postoperative complications, longer physical and emotional recovery, worse quality of life and increased rates of cardiac events and mortality [death]," according to the study’s authors and may also be linked to problems with thinking, learning, and memory./p>

Kenneth E. Freedland, PhD, of the Washington University School of Medicine, St Louis, Missouri, and colleagues conducted a randomized clinical trial involving 123 patients who had major or minor depression within 1 year after CABG surgery. Of these, 40 were randomly assigned to usual care as determined by primary care or other physicians, and the other patients were assigned to 1 of 2 treatment groups.

This included 41 patients who underwent 12 weeks of CBT, shown to be an effective treatment for depression in other populations. The individual 50- to 60-minute sessions with a psychologist or social worker involved identifying problems and developing cognitive techniques for overcoming them, including challenging distressing automatic thoughts and changing dysfunctional attitudes. The other 42 patients received 12 weeks of supportive stress management, in which a social worker or psychologist counseled the patient about improving his or her ability to cope with stressful life events. Depressive symptoms were assessed at the beginning of the study and again after 3, 6, and 9 months.

After 3 months, more patients in the cognitive behavior therapy group (71%) and supportive stress management group (57%) experienced remission of their depression than in the usual care group (33%). The differences narrowed at the 6-month follow-up but differed again at 9 months (73% for the cognitive behavior therapy group, 57% for the supportive stress management group, and 35% for the usual care group).

Additionally, CBT was found to be superior to usual care on the majority of secondary psychological outcomes, including anxiety, hopelessness, perceived stress, and the mental component of health-related quality of life. The study found supportive stress management to be superior to usual care for depression in this population, but it had less significant and lasting effects than CBT.

Lifestyle Factors Related to Risk of Diabetes Among Older Adults

Even for older adults, lifestyle factors such as physical activity, dietary habits, tobacco and alcohol use, and the amount of body fat are associated with risk of new-onset diabetes, according to a study published in a recent issue of Archives of Internal Medicine.

While previous studies have found lifestyle factors such as level of physical activity, diet, smoking habits, alcohol use, and body fat levels as risk factors linked to onset of diabetes in younger populations, the combined impact of these factors on risk of diabetes in older adults is largely unknown.

Dariush Mozaffarian, MD, DrPH, of Harvard School of Public Health, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, and colleagues with the Cardiovascular Health Study examined the relationships of lifestyle risk factors with incidence of diabetes during a 10-year period (1989 to 1998) among 4883 men and women aged 65 years or older. At the beginning of the study, the average participant age was 73 years, 58.6% were women, and 11.4% were nonwhite; 95% of nonwhite participants were black. Approximately half of the participants had never smoked.

Low-risk lifestyle groups were defined by physical activity level (leisure time activity and walking pace) above the median (midpoint); dietary score (higher fiber intake and polyunsaturated to saturated fat ratio, lower trans-fat intake, and lower average glycemic index); amount of smoking, if any; alcohol use (predominantly light or moderate); body mass index <25; and waist circumference of ≤34.6 inches for women or ≤36 inches for men.

After adjustment for age, sex, race, educational level, annual income, and other lifestyle factors simultaneously, each lifestyle risk factor was independently associated with incidence of diabetes. Overall, each additional lifestyle factor an individual had in the lower-risk group was associated with a 35% lower risk of diabetes.

Individuals in the low-risk category for only physical activity level and dietary habits (nearly 1 in 4 adults) had a 46% lower incidence of diabetes. Combining low-risk groups for physical activity level, dietary habits, smoking habits, and alcohol use (6% of participants), an 82% lower risk of diabetes was present, and 4 in 5 new cases of diabetes appeared to be attributable to not having these low-risk lifestyle factors. Adding either not being overweight or not having large waist circumference was associated with an 89% lower risk of diabetes.

According to the authors, the study’s findings provide an estimate of the public health burden of combined lifestyle risk factors for incidence of diabetes in older adults. They suggest that even later in life, the majority of cases of diabetes are related to lifestyle factors.