Evidence from randomised controlled trials does not support current dietary fat guidelines : A systematic review and meta-analysis
- Authors: Harcombe, Zoe , Baker, Julien , DiNicolantonio, James , Grace, Fergal , Davies, Bruce
- Date: 2016
- Type: Text , Journal article
- Relation: Open Heart Vol. 3, no. 2 (2016), p. e000409
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- Description: OBJECTIVES: National dietary guidelines were introduced in 1977 and 1983, by the USA and UK governments, respectively, with the ambition of reducing coronary heart disease (CHD) mortality by reducing dietary fat intake. A recent systematic review and meta-analysis by the present authors, examining the randomised controlled trial (RCT) evidence available to the dietary committees during those time periods, found no support for the recommendations to restrict dietary fat. The present investigation extends our work by re-examining the totality of RCT evidence relating to the current dietary fat guidelines. METHODS: A systematic review and meta-analysis of RCTs currently available, which examined the relationship between dietary fat, serum cholesterol and the development of CHD, was undertaken. RESULTS: The systematic review included 62 421 participants in 10 dietary trials: 7 secondary prevention studies, 1 primary prevention and 2 combined. The death rates for all-cause mortality were 6.45% and 6.06% in the intervention and control groups, respectively. The risk ratio (RR) from meta-analysis was 0.991 (95% CI 0.935 to 1.051). The death rates for CHD mortality were 2.16% and 1.80% in the intervention and control groups, respectively. The RR was 0.976 (95% CI 0.878 to 1.084). Mean serum cholesterol levels decreased in all intervention groups and all but one control group. The reductions in mean serum cholesterol levels were significantly greater in the intervention groups; this did not result in significant differences in CHD or all-cause mortality. CONCLUSIONS: The current available evidence found no significant difference in all-cause mortality or CHD mortality, resulting from the dietary fat interventions. RCT evidence currently available does not support the current dietary fat guidelines. The evidence per se lacks generalisability for population-wide guidelines.
Evidence of altered cardiac electrophysiology following prolonged androgenic anabolic steroid use
- Authors: Sculthorpe, Nicholas , Grace, Fergal , Jones, Peter , Davies, Bruce
- Date: 2010
- Type: Text , Journal article
- Relation: Cardiovascular Toxicology Vol. 10, no. 4 (2010), p. 239-243
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- Description: The non-therapeutic use of androgenic anabolic steroids (AAS) is associated with sudden cardiac death. Despite this, there is no proposed mechanism by which this may occur. Signal-averaged ECG (SAECG) allows the assessment of cardiac electrical stability, reductions of which are a known risk factor for cardiac arrhythmias. The aim of the present study was to examine cardiac electrical stability using SAECG in a group (n = 15) of long-term AAS users (AAS use 21.3 +/- 3.1 years) compared with a group (n = 15) of age-matched weight lifters (WL) and age-matched sedentary controls [C (n = 15)]. AS, WL and C underwent SAECG analysis at rest and following an acute bout of exercise to volitional exhaustion. SAECGs were analyzed using a 40 Hz filter and were averaged over 200 beats. Results indicate a non-significant trend for increased incidence of abnormal SAECG measures at rest in AS (P = 0.55). However, AS demonstrated a significantly higher incidence of abnormalities of SAECG following exercise than C or WL (P < 0.05). In conclusion, the higher incidence of abnormal SAECG measurements immediately post-exercise in the AAS group places them at a greater risk of sudden death. The present study provides a strong contraindication to the use of AAS.
Anabolic steroid use : Patterns of use and detection of doping
- Authors: Graham, Michael , Davies, Bruce , Grace, Fergal , Kicman, Andrew , Baker, Julien
- Date: 2008
- Type: Text , Journal article
- Relation: Sports Medicine Vol. 38, no. 6 (2008), p. 505-525
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- Description: Anabolic-androgenic steroids (AAS) were the first identified doping agents that have ergogenic effects and are being used to increase muscle mass and strength in adult males. Consequently, athletes are still using them to increase physical performance and bodybuilders are using them to improve size and cosmetic appearance. The prevalence of AAS use has risen dramatically over the last two decades and filtered into all aspects of society. Support for AAS users has increased, but not by the medical profession, who will not accept that AAS use dependency is a psychiatric condition. The adverse effects and potential dangers of AAS use have been well documented. AAS are used in sport by individuals who have acquired knowledge of the half-lives of specific drugs and the dosages and cycles required to avoid detection. Conversely, they are used by bodybuilders in extreme dosages with the intention of gaining muscle mass and size, with little or no regard for the consequences. Polypharmacy by self-prescription is prevalent in this sector. Most recently, AAS use has filtered through to 'recreational street drug' users and is the largest growth of drugs in this subdivision. They are taken to counteract the anorexic and cachectic effects of the illegal psychotropic street drugs. Screening procedures for AAS in World Anti-Doping Agency accredited laboratories are comprehensive and sensitive and are based mainly on gas chromatography-mass spectrometry, although liquid chromatography-mass spectrometry is becoming increasingly more valuable. The use of carbon isotope mass spectrometry is also of increasing importance in the detection of natural androgen administration, particularly to detect testosterone administration. There is a degree of contentiousness in the scenario of AAS drug use, both within and outside sport. AAS and associated doping agents are not illegal per se. Possession is not an offence, despite contravening sporting regulations and moral codes. Until AAS are classified in the same capacity as street drugs in the UK, where possession becomes a criminal offence, they will continue to attract those who want to win at any cost. The knowledge acquired by such work can only assist in the education of individuals who use such doping agents, with a view to minimizing health risks and hopefully once again create a level playing field in sport.
Direct hits to the head during amateur boxing is associated with a rise in serum biomarkers for brain injury
- Authors: Graham, Michael , Myers, T. , Evans, Peter , Davies, Bruce , Cooper, Stephen , Bhattacharya, Kaushik , Grace, Fergal , Baker, Julien
- Date: 2011
- Type: Text , Journal article
- Relation: International Journal of Immunopathology and Pharmacology Vol. 24, no. 1 (2011), p. 119-125
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- Description: Boxing exposes participants to the physiological response to high intensity exercise and also to direct body and brain trauma. Amateur boxing is increasing and females have also been included in the Olympics. The aim of this study is to assess the stress response and possible brain injury incurred during a match by measuring serum biomarkers associated with stress and cellular brain injury before and after combat. Sixteen male amateur boxers were studied retrospectively. The study population was divided into two groups: (a) a group that received predominantly punches to the head (PTH) and (b) a group that received predominantly punches to the body (PTB). Blood samples were taken before and five minutes after each contest. They were analysed for S-100B, neuron-specific enolase (NSE), creatine kinase (CK) and cortisol. The PTH group received direct contacts to the head (not blocked, parried or avoided) and to the body (n=8, age: 17.6 +/- 5.3, years; height: 1.68 +/- 0.13, meters; mass: 65.4 +/- 20.3, kg). The PTB group received punches to the body including blocked and parried punches, but received no direct punches to the head, (n=8, mean +/- SD, age: 19.1 +/- 3.2 years; height: 1.70 +/- 0.75, meters; mass: 68.5 +/- 15 kg). Significant increases (P<0.05) were observed between pre- and post-combat serum concentrations in serum concentrations in PTH of S-100B (0.35 +/- 0.61 vs. 0.54 +/- 0.73, mug.L-1) NSE (19.7 +/- 14 vs.31.1 +/- 26.6, ng.ml-1) and cortisol (373 +/- 202 vs. 756 +/- 93, nmol.L-1). Significant increases (P<0.05) of creatine kinase were recorded in both groups. This study demonstrates significant elevations in neurochemical biomarkers in boxers who received direct blows to the head. However, further work is required to quantify this volumetric brain damage and long term clinical sequelae.
Evidence from randomised controlled trials did not support the introduction of dietary fat guidelines in 1977 and 1983 : A systematic review and meta-analysis
- Authors: Harcombe, Zoe , Baker, Julien , Cooper, Stephen , Davies, Bruce , Sculthorpe, Nicholas , DiNicolantonio, James , Grace, Fergal
- Date: 2015
- Type: Text , Journal article
- Relation: Open Heart Vol. 2, no. 1 (2015), p. 1-9
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- Description: OBJECTIVES: National dietary guidelines were introduced in 1977 and 1983, by the US and UK governments, respectively, with the ambition of reducing coronary heart disease (CHD) by reducing fat intake. To date, no analysis of the evidence base for these recommendations has been undertaken. The present study examines the evidence from randomised controlled trials (RCTs) available to the US and UK regulatory committees at their respective points of implementation. METHODS: A systematic review and meta-analysis were undertaken of RCTs, published prior to 1983, which examined the relationship between dietary fat, serum cholesterol and the development of CHD. RESULTS: 2467 males participated in six dietary trials: five secondary prevention studies and one including healthy participants. There were 370 deaths from all-cause mortality in the intervention and control groups. The risk ratio (RR) from meta-analysis was 0.996 (95% CI 0.865 to 1.147). There were 207 and 216 deaths from CHD in the intervention and control groups, respectively. The RR was 0.989 (95% CI 0.784 to 1.247). There were no differences in all-cause mortality and non-significant differences in CHD mortality, resulting from the dietary interventions. The reductions in mean serum cholesterol levels were significantly higher in the intervention groups; this did not result in significant differences in CHD or all-cause mortality. Government dietary fat recommendations were untested in any trial prior to being introduced. CONCLUSIONS: Dietary recommendations were introduced for 220 million US and 56 million UK citizens by 1983, in the absence of supporting evidence from RCTs.
Effects of long-term anabolic androgenic steroid administration on respiratory function
- Authors: Gething, Alex , Grace, Fergal , Davies, Bruce , Baker, Julien
- Date: 2011
- Type: Text , Journal article
- Relation: Research in Sports Medicine Vol. 19, no. 4 (2011), p. 231-244
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- Description: The purpose of this study was to investigate the effects of resistance training and long-term anabolic androgenic steroids (AASs) administration on respiratory function. Subject groups consisted of AAS users (n = 9) who were still using AAS at time of testing (SU); AAS users (n = 6) who had been abstinent for > 3 months (SA), bodybuilding controls (n = 8) (BC), and (n = 8) sedentary male controls (SC). FEV(1), FVC, and PEF were measured. The results found that all subjects were within normal range, and there were no differences between groups. Maximum inspiratory pressure (MIP), and grip strength were both significantly greater in SU (P < 0.05) compared with SC; no significant difference was found between the other groups. Their MIP and grip strength was significantly correlated (r = 0.57; P < 0.05). The data from this study suggest that the combination of resistance training and AAS administration produce a significant increase in MIP in a cohort of long-term AAS users.
Exercise, science and designer doping : Traditional and emerging trends
- Authors: Graham, M. R. , Davies, Bruce , Grace, Fergal , Baker, Julien
- Date: 2012
- Type: Text , Journal article
- Relation: Journal of Sports Medicine and Doping Studies Vol. 2, no. 3 (2012), p.
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- Description: The list of doping agents is enormous, and for the majority, any beneficial sporting effect is contentious. WADA and UK Anti-Doping have difficulty detecting the peptide hormones, Growth Hormone (GH), insulin and Erythropoietin (Epo), because they require blood analysis. Only in the last two years has an athlete been convicted of taking GH, which is still being used as a doping agent because the window for detection is so brief. This positive test was not contested, which suggests that science may be winning the war on drugs. Athletes appear to have ceased taking insulin, because of its life-threatening acute effects, and in recent years no adverse analytical findings have been reported for this drug. “Older” doping agents, which are known to enhance performance in sport, include testosterone and their derivatives, anabolic steroids. The pharmaceutical industry continues to manufacture new medicines, pushing back the boundaries in combating wasting disease states and the ageing process, but is inadvertently producing the latest generation of doping agents. This will challenge anti-doping scientists. WADA’s banned list also includes insulin-like growth factor-1, fibroblast growth factors, hepatocyte growth factor, mechano growth factors, platelet-derived growth factor, vascular-endothelial growth factor which may promote muscle, tendon or ligament development, vascularisation, energy utilisation, regenerative capacity and fibre type. Athletes will use whatever they believe works, but can only use what is available. Internet companies offer these anabolic products that but their veracity cannot be proven. There are questions that need to be answered? Are these products available to athletes, do they enhance performance, are athletes really taking them and are they so difficult to detect. The internet has made them available to anyone with a credit card and it appears that if they are cycled correctly, unless an athlete is caught in possession of them, the opportunity of proving a case of doping is almost impossible.