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Study highlights:
In a large study in Japan, women who reported eating more foods containing the B-vitamins folate and B-6 were less likely to die from stroke and heart disease.
Japanese men reporting diets high in these B vitamins were less likely to die of heart failure.

DALLAS, 2010 — Eating more foods containing the B-vitamins folate and B-6 lowers the risk of death from stroke and heart disease for women and may reduce the risk of heart failure in men, according to Japanese research reported in Stroke: Journal of the American Heart Association.

“Japanese people need more dietary intake of folate and vitamin B-6, which may lead to the prevention of heart disease,” said Hiroyasu Iso, M.D., professor of public health at Osaka University.

The findings on the value of B vitamins were consistent with studies in Europe and North America, although the dietary consumption of vitamin B-6 is generally lower in Japan than in the United States.

Researchers analyzed data from 23,119 men and 35,611 women (ages 40–79) who completed food frequency questionnaires as part of the large Japan Collaborative Cohort (JACC) Study. During a median 14 years of follow-up, 986 died from stroke, 424 from heart disease and 2,087 from all diseases related to the cardiovascular system.

Investigators divided participants into five groups based on their intake of folate, vitamin B-6 and vitamin B-12. Comparing those with the diets lowest and highest for each nutrient, they found that higher consumption of folate and vitamin B-6 was associated with significantly fewer deaths from heart failure in men, and significantly fewer deaths from stroke, heart disease and total cardiovascular diseases in women. Vitamin B-12 intake was not associated with reduced mortality risk.

The protective effects of folate and vitamin B-6 didn’t change when researchers adjusted for the presence of cardiovascular risk factors, nor when they eliminated supplement users from the analysis.
Folate and vitamin B-6 may help guard against cardiovascular disease by lowering homocysteine levels, the investigators said. Homocysteine is an amino acid in the blood that’s affected by diet and heredity. Folic acid and other B vitamins help break down homocysteine in the body.

A direct causal link hasn’t been established, but evidence has shown that too much homocysteine may damage the inner lining of arteries and promote the formation of blood clots.

Sources of folate include vegetables and fruits, whole or enriched grains, fortified cereals, beans and legumes. Sources of vitamin B-6 include vegetables, fish, liver, meats, whole grains and fortified cereals.

Co-authors include: Renzhe Cui, M.D.; Chigusa Date, M.D.; Shogo Kikuchi, M.D.; Akiko Tamakoshi, M.D.; and the JACC study group. Author disclosures and funding sources are on the manuscript.

The norovirus, best known for causing diarrhea and vomiting on board cruise ships, can cause problems on airplanes as well, researchers have found.

On October 8, 2008, a flight from Boston to Los Angeles was diverted to Chicago shortly after take off after multiple passengers suffered acute gastrointestinal illness, including vomiting and diarrhea, thought to be caused by the highly contagious norovirus. The ill passengers were members of a tour company’s New England fall foliage bus tour who were returning home to California.

In Chicago, the airline passengers not from the tour group boarded a different plane and continued their trip west, while the tour group remained in Chicago overnight. Several were hospitalized.

A subsequent investigation by the U.S. Centers for Disease Control and Prevention in Atlanta and the New Hampshire Department of Health in Concord found 6 confirmed and 9 probable cases of norovirus infection among tour group members on the plane, as well as 1 confirmed and 6 probable cases of norovirus infection in the non-tour group airline passengers.

“The symptoms and timing of illness” (within 48 hours of the flight) among non-tour group passengers was consistent with norovirus transmission on the airplane, Dr. Daniel Fishbein, the CDC researcher who led the investigation, told Reuters Health. The same strain of norovirus was recovered from stool samples of both the tour group members and one of the ill non-tour group passengers.

Sitting in an aisle seat or near a tour group member were strong risk factors for becoming ill, which suggests to investigators that transmission occurred either directly through person-to-person contact or indirectly via contamination of armrests, tray tables, or seat controls.

“This is the first time passenger-to-passenger transmission (of norovirus) has been documented on an airplane,” Dr. Aron Hall, a CDC epidemiologist involved in the investigation, told Reuters Health by email. Hall said only three other norovirus outbreaks on airplanes have been reported in the medical literature.

In an email to Reuters Health, Dr. John Holmes, of the University of Otago in Dunedin, New Zealand, who last year published a paper on a norovirus outbreak on an airplane, noted that the compact layout of bathroom facilities on aircraft hinder good hand-washing techniques that can prevent spread of norovirus and also pose problems for crew cleaning up after contamination from vomiting or diarrhea.

He said travelers can avoid mid-air infection by carrying a small vial of alcohol hand sanitizer to be applied while using aircraft toilets and before eating. “Do not put your fingers into your mouth after you have touched aircraft seats, fittings or other surfaces that may be contaminated,” he advised.

Holmes, an official with the New Zealand Health Ministry, said people who feel nauseated should postpone travel. He said ill travelers often are unwilling to postpone trips because airlines and tour companies are reluctant to rebook without extra charges.

Fishbein and colleagues suggest that travelers buy traveler’s insurance, so ill people might feel less compelled to travel. Motion-sensing or foot-operated faucets, soap dispensers and drains in plane lavatories could reduce spread of disease.

SOURCE: Clinical Infectious Diseases.

Cocoa-rich dark chocolate could be prescribed for people with liver cirrhosis in future, following the latest research to show potential health benefits of chocolate.

Spanish researchers said on Thursday that eating dark chocolate capped the usual after-meal rise in abdominal blood pressure, which can reach dangerous levels in cirrhotic patients and, in severe cases, lead to blood vessel rupture.

Antioxidants called flavanols found in cocoa are believed to be the reason why chocolate is good for blood pressure because the chemicals help the smooth muscle cells of the blood vessels to relax and widen.

A study of 21 patients with end-stage liver disease found those given a meal containing 85 percent-cocoa dark chocolate had a markedly smaller rise in blood pressure in the liver, or portal hypertension, than those given white chocolate.

“This study shows a clear association between eating dark chocolate and (lower) portal hypertension and demonstrates the potential importance of improvements in the management of cirrhotic patients,” said Mark Thursz, a professor of hepatology at London’s Imperial College.

The results were presented at the annual meeting of the European Association for the Study of the Liver in Vienna and follow a number of earlier scientific studies suggesting that dark chocolate also promotes heart health.

Cirrhosis is scarring of the liver as a result of long-term damage. It is caused by various factors, including hepatitis infection and alcohol abuse.

(Reporting by Ben Hirschler; editing by Philippa Fletcher)

U.S. officials report a continuing decline in food-related illnesses caused by several common bacteria, including the most virulent form of E. coli.

But Vibrio, a pathogen most often acquired from oysters which can cause severe illness or even death, is on the rise, while rates of Salmonella infection have remained flat in recent years.

“Overall, this year’s report shows a reduction in the number of illnesses due to many of these important pathogens over the past 10 to 15 years,” said Dr. Chris Braden, acting director of the Division of Foodborne, Waterborne and Environmental Diseases at the U.S. Centers for Disease Control and Prevention (CDC).

“This reflects the impact of measures to prevent foodborne illness, but additional measures are needed,” he said at a Thursday press conference.

The preliminary 2009 data comes from the interagency FoodNet system, which tracks laboratory-confirmed illness from nine bacteria in 10 states. The findings are published in the April 16 issue of the CDC journal Morbidity and Mortality Weekly Report.

Infections caused by Campylobacter, Listeria, Salmonella, Shiga-toxin-producing E. coli (STEC) 0157, Shigella and Yersinia, have declined overall since 1996.

But decreases in the incidence of infections caused by Salmonella, Listeria and Campylobacter have essentially plateaued since 2004, causing some concern.

“Salmonella continues to be a challenge. It is the most commonly diagnosed foodborne illness,” Braden said. “Its incidence has declined by 10 percent since 1996, but it is the furthest of any of the pathogens for the goals we have set for reduction.”

Not all Salmonella infections are transmitted by food. Some occur from direct contact with baby chicks, turtles, frogs or their environment and from drinking contaminated water, Braden added.

Shigella and E.coli infections have decreased significantly since 2006.

“Infections of STEC 0157 [E. coli] , which causes one of the most severe forms of illness, showed an early decline, then plateaued,” Braden said. “Then, in 2009, it decreased by 25 percent compared with the previous three years and has reached its lowest level since 2004. The decrease may be due to continuing efforts to decrease contamination of ground beef and leafy green vegetables consumed raw.”

Although the incidence of Vibrio-related illness is up, the pathogen causes only a small percentage of overall foodborne illness, Braden said.

“The illnesses are typically attributed to temperature exposure of the shellfish after they’re harvested so we have been trying to improve the practices in the industry in that regard,” said Donald Kraemer, deputy director of the U.S. Food and Drug Administration’s Office of Food Safety. “States have, within the last couple of years, implemented some controls but unfortunately we haven’t seen the numbers come down so we are taking a look at why that is.”

But officials emphasized that consumers can implement protective measures in their own homes.

“Consumers can always protect themselves if they follow our four safe-handling guidelines: clean, separate, cook and chill,” said Dr. David Goldman, assistant administrator of the Office of Public Health Science, part of the U.S. Department of Agriculture’s Food Safety and Inspection Service. “This provides some extra measure of safety.”

SOURCES: 2010 press teleconference with Chris Braden, M.D., acting director, Division of Foodborne, Waterborne and Environmental Diseases, U.S. Centers for Disease Control and Prevention; David Goldman, M.D., assistant administrator, Office of Public Health Science, U.S. Department of Agriculture Food Safety and Inspection Service; Donald Kraemer, deputy director, Office of Food Safety, U.S. Food and Drug Administration;