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Clinicians with an interest in women's health review the latest papers of significance from international research teams

Alcohol consumption and weight gain in older women
Wang L, Lee IM, Manson JE et al. Arch Intern Med 2010; 170(5): 453-61

The impact of any calorie source is of concern in view of the obesity epidemic. The authors undertook a prospective cohort study among 19,220 healthy US women aged 38.9 years or older, who had a baseline BMI within the normal range of 18.5kg/m2 to less than 25kg/m2.

Alcoholic beverage consumption was reported on a baseline questionnaire. Body weight was self-reported on baseline and eight annual follow-up questionnaires, for 12.9 years. A total of 7,942 (41.3 per cent) initially normal weight women became overweight or obese and 732 (3.8 per cent) became obese.

The researchers found an inverse association between the amount of alcohol consumed at baseline and weight gain. After adjusting for age, baseline BMI, smoking status, non-alcohol energy intake, physical activity level, and other lifestyle and dietary factors, the RR of becoming overweight or obese across total alcohol intake of 0g per day was 1.00. For >0-<5g per day, it was 0.96, for 5-<15g per day, 0.86, for 15-<30g per day, 0.70, and for 30g per day or more, 0.73 (p for trend <.001).

The corresponding RR of becoming obese was 1.00, 0.75, 0.43, 0.39 and 0.29 respectively (p for trend <.001). Compared with non-drinkers, initially normal weight women who consumed a light to moderate amount of alcohol gained less weight and had a lower risk of becoming overweight or obese.
Miss Margaret Rees is reader in reproductive medicine and honorary consultant in medical gynaecology at John Radcliffe Hospital, Oxford

Oral contraception, HRT use and potential risk of NHL
Lu Y, Sullivan-Halley J, Henderson K et al. Cancer Epidemiol Biomarkers Prev 2010; 19(3): 893

This study evaluated whether use of the oral contraceptive pill or HRT is associated with B-cell non-Hodgkin lymphoma (NHL) in the prospective California Teachers Study cohort of more than 170,000 women followed up for 12 years.

Women who used oral contraceptives had marginally lower risk of B-cell NHL than never-users. HRT did not increase risk. Furthermore, HRT use decreased the risk of B-cell NHL among women with both ovaries removed, but not among those who retained at least part of an ovary. MR

HRT and asthma onset
Romieu I, Fabre A, Fournier A et al. Thorax 2010 Feb 8; doi: 10.1136/thx.2009.116079

Epidemiological studies have suggested that female hormones might play a part in asthma, and HRT might increase the risk of asthma in postmenopausal women. The authors studied 57,664 women in the E3N cohort in France between 1990 and 2002.

The researchers found that HRT was related to an increased risk of asthma onset (HR = 1.20, 95% CI 0.98 to 1.46) among recent users. The increase in risk of asthma onset was only significant in estrogen alone users, particularly in never-smokers and women reporting allergic disease before the onset of asthma. MR

Dietary fish intake and AF
Berry JD, Prineas RJ, van Horn L et al. Am J Cardiol 2010; 105(6): 844-8

Fish oil appears to have promising cardiovascular benefits. However, experimental and clinical trial data have suggested an association between fish oil intake and AF. The authors studied the association between dietary fish intake and incident AF in 44,720 postmenopausal women from the Women's Health Initiative clinical trials who were not enrolled in the dietary modification intervention arm and without AF at baseline.

The dietary intake of non-fried fish and omega-3 fatty acid intake were estimated from a food frequency questionnaire at study entry. Incident AF was determined by follow-up ECG at three and six years. A total of 378 incident cases of AF occurred during the follow-up period.

In the age-adjusted models, no association was found between dietary non-fried fish intake and incident AF. Similar findings were observed in the multivariate models and the subgroup analyses. In conclusion, no evidence of an association between fish or omega-3 fatty acid intake and incident AF was found in this large cohort. MR

Estrogen and cardiomyopathy
Kuo BT, Choubey R, Novaro GM. Gend Med 2010; 7(1): 71-7

Takotsubo cardiomyopathy, also known as transient apical ballooning syndrome, apical ballooning cardiomyopathy, stress-induced cardiomyopathy, broken-heart syndrome and stress cardiomyopathy, is a type of non-ischaemic cardiomyopathy in which there is a sudden temporary myocardial weakening.

First described in Japan, the bulging of the apex of the heart with preserved function of the base led to the name 'tako tsubo', or octopus trap.

Takotsubo cardiomyopathy has been reported with increasing frequency, most commonly in postmenopausal women. However, the relationship of this syndrome to estrogen is unclear. The authors identified 18 consecutive cases presenting at the Cleveland Clinic, Florida, between January 2006 and December 2008. Of these, 16 were postmenopausal and none was taking HRT.

The authors then searched the MEDLINE database from January 1990 to March 2008 and identified 13 women, none of whom was taking HRT. The limited data suggest that lack of estrogen is involved in this rare syndrome, but further research on the condition is awaited. MR

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