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Khaw, K. T.; Sneyd, M. J.; Compston, J.
doi: 10.1136/bmj.305.6848.273pmid: 1392857
OBJECTIVE--To examine the relation between bone density and indices of calcium metabolism including parathyroid hormone and 25-hydroxyvitamin D concentrations in middle aged women. DESIGN--A cross sectional study. SETTING AND SUBJECTS--138 women volunteers aged 45-65 with no known osteoporosis and unselected for disease status recruited for a dietary assessment study from the community using general practice registers. Volunteer rate was 20%. MAIN OUTCOME MEASURE--Bone mineral density measured with dual energy x ray absorptiometry. RESULTS--Bone density at the lumbar spine and neck and trochanteric regions of the femur was inversely related to serum intact parathyroid hormone concentrations and positively related to serum 25-hydroxyvitamin D concentrations. These associations were independent of possible confounding factors, including age, body mass index, cigarette smoking habit, menopausal status, and use of diuretics and postmenopausal hormone replacement therapy. These associations were apparent throughout the whole distribution of bone density and 25-hydroxyvitamin D and parathyroid hormone concentrations within the normal range, suggesting a physiological relation. CONCLUSIONS--The findings are consistent with the hypothesis that parathyroid hormone and 25-hydroxyvitamin D concentrations influence bone density in middle aged women. Findings from this study together with other work suggest that the role of vitamin D in osteoporosis should not be neglected. The associations with parathyroid hormone also indicate plausible biological mechanisms. The roughly 5-10% difference in bone density between top and bottom tertiles of serum 25-hydroxyvitamin D concentrations, though not large in magnitude, may have considerable public health implications in terms of prevention of osteoporosis and its sequelae, fractures.
Lindberg, G.; Råstam, L.; Gullberg, B.; Eklund, G. A.
doi: 10.1136/bmj.305.6848.277pmid: 1392858
OBJECTIVE--To determine whether total serum cholesterol concentration predicts mortality from injuries including suicide. DESIGN--Cohort study of men and women who had their serum cholesterol concentration measured as part of a general health survey in Värmland, Sweden in 1964 or 1965 and were followed up for an average of 20.5 years. SUBJECTS--Adults participating in health screening in 1964-5 (26,693 men and 27,692 women). The study sample was restricted to subjects aged 45-74 years during any of the 20.5 years of follow-up. MAIN OUTCOME MEASURES--Serum cholesterol concentration. Deaths from all injuries and suicides during three periods of follow up (0-6 years, 7-13 years, and 14-21 years) according to the Swedish mortality register in subjects aged 45-74. Adjustment was made for prevalent cancer (identified from the Swedish cancer register) at the time of a suicide. RESULTS--A strong negative relation between cholesterol concentration and mortality from injuries was found in men during the first seven years of follow up. The relative risk in the lowest 25% of the cholesterol distribution was 2.8 (95% confidence interval 1.52 to 4.96) compared with the top 25%. Most of the excess risk was caused by suicide with a corresponding relative risk of 4.2 (p for trend = 0.001). Correction for prevalent cancer did not change the results. Events occurring during the latter two thirds of the 20.5 years of follow up were not predicted. In women no relation between cholesterol concentration and mortality from injuries was found. CONCLUSIONS--Together with observations from intervention trials the findings support the existence of a relation between serum cholesterol concentration and suicide. The causality of such a relation is, however, not resolved.
Chua, A.; Keating, J.; Hamilton, D.; Keeling, P. W.; Dinan, T. G.
doi: 10.1136/bmj.305.6848.280pmid: 1392859
OBJECTIVE--To determine whether central serotonin receptors are involved in the pathophysiology of non-ulcer dyspepsia. DESIGN--Between subjects study of solid phase gastric emptying and prolactin response to buspirone challenge. SUBJECTS--12 patients fulfilling criteria for non-ulcer dyspepsia and 12 age and sex matched controls. MAIN OUTCOME MEASURES--Solid phase gastric emptying measured by scintigraphic assessment of the movement of a standard meal labelled with technetium-99m and indium-111; responsiveness of central serotonin 1A receptors measured by the prolactin release following challenge with oral buspirone 60 mg. RESULTS--Solid phase gastric emptying was significantly delayed in the patients with non-ulcer dyspepsia (t 1/2 = 90.6 (SD 14.5) minutes in patients and 54.6 (10.7) minutes in controls; 95% confidence interval 24.7 to 46.7 minutes, p < 0.001). Prolactin release was significantly greater in patients compared with controls (1272.7 (1039.9) mU/l v 292.9 (136.1) mU/l; 352.1 to 1607.5 mU/l, p < 0.01). Gastric emptying and prolactin release were significantly correlated (r = 0.59, p = 0.04) in the patients but not in the controls (r = 0.23). CONCLUSION--Central serotonin 1A receptors may have a role in the pathophysiology of non-ulcer dyspepsia of the dysmotility subtype.
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