Personal Health

 

 

Friday, June 25, 2010

 

Early exposure to cow's milk has benefits: study

 

By Lynne Peeples

Reuters Health

Friday, June 25, 2010

NEW YORK (Reuters Health) – A taste of cow's milk during the first two weeks of life may protect a child from later developing an allergy to the milk's protein, a new study suggests.

Cow's milk protein allergy is the most common and most dangerous among the family of dairy allergies and intolerances, with reactions including rash, respiratory and gastrointestinal symptoms, even shock or death.

The finding that giving cow's milk very early in life might boost tolerance came as a surprise to lead researcher Dr. Yitzhak Katz of Tel Aviv University in Israel. He and his colleagues simply set out to improve on current estimates of the number of children with the allergy, and to determine how often it is accompanied by an allergy to soy. "We weren't even looking for a risk factor," he told Reuters Health.

Of 13,000 infants studied, the team found that 66 (0.5 percent) tested positive for the milk allergy -- far fewer than would be expected based on previous population estimates of 1 to 3 percent, they note in the Journal of Allergy and Clinical Immunology.

The researchers also found no link between cow's milk and soy allergies, despite some earlier estimates that up to 1 in 3 children with the first allergy also suffered from the second.

"Soy is a reasonable feeding alternative for children with cow's milk allergy," noted Katz.

But what his team found next most intrigued him. Infants who were first fed cow's milk at the age of 15 days or more had 19 times the risk of developing cow's milk allergy relative to those exposed earlier -- during the first two weeks of life.

Due to common difficulties in digesting the sugar content of cow's milk, some pediatricians have discouraged its introduction until a certain age, Dr. Kari Nadeau of Stanford University in California, who was not involved in the study, told Reuters Health.

Now, it seems there might also be benefits to an earlier start. "It's nice to know that if you do give small amounts of cow's milk to children at an early age," Nadeau said, "it could help prevent their immune system from later viewing this milk protein as a foreign substance and reacting unnaturally to it."

Nadeau noted that further research is needed to pinpoint the most optimal "window of opportunity" and to see how well the exposed babies do as they grow older.

She also cautioned that early feeding of cow's milk is no guarantee that a child won't get the allergy. "At any point in time, if a child starts developing a rash or vomiting to a food," she said, "they should always get checked out by an allergist."

Katz added that the findings should not be interpreted as discouraging breastfeeding. Rather, he recommends simply complementing it with cow's milk early on.

"Let Dad enjoy some midnight infant bonding," he said, "while he delivers a dose or two of cow's milk protein."

Source: http://link.reuters.com/zuv24m

 Journal of Allergy and Clinical Immunology, online June 11, 2010.

Virus Works With Gene to Cause Crohn's-Like Illness

 

ScienceDaily

Friday, June 25, 2010

 

ScienceDaily (June 25, 2010) — Scientists have shown that a specific virus can interact with a mutation in the host's genes to trigger disease. The observation may help explain why many people with disease risk genes do not actually develop disease.

 

Researchers at Washington University School of Medicine in St. Louis found that three factors were necessary in mice to create a condition similar to the human bowel disorder Crohn's disease: a mutated gene, exposure to a damaging chemical and infection with a specific virus. The report appears in Cell.

 

Complex diseases like Crohn's are influenced by both genetic and environmental factors; other examples include cancer, heart disease, diabetes, Alzheimer's disease, multiple sclerosis and Parkinson's disease.

 

Studies of these conditions have shown that having a gene linked to disease does not always lead directly to that disease. This has prompted searches for other factors that interact with genes to trigger complex diseases, including exposure to toxins or infection with microorganisms. Researchers say the new findings suggest that viruses may provide some of the missing links between genes, environment and disease.

 

"We've provided a very specific example of a virus triggering a complex disease -- if the mice don't have the virus, they don't get the symptoms," says co-senior author Herbert W. "Skip" Virgin, MD, PhD, the Edward Mallinckrodt Professor and head of Pathology and Immunology. "Many viruses infect nearly 100 percent of people, and when their genes interact with our genes, they may be contributing to such diseases."

 

Virgin and co-senior author Thaddeus S. Stappenbeck, MD, PhD, associate professor of pathology and immunology and of developmental biology, also found evidence that viruses' roles in complex diseases may be difficult to detect.

 

Crohn's disease, which affects approximately 500,000 Americans, causes diarrhea, abdominal pain and infections, and can lead to complications requiring surgery. Some people with Crohn's have mutations in their Atg16L1 gene, but the mutations are much more prevalent than the disease.

 

"In Western society, about half of all copies of Atg16L1 contain the mutation linked to Crohn's," Stappenbeck says. "That means both copies of this gene are mutated in about one in every three persons. And yet Crohn's occurs in a small fraction of these individuals."

 

In an earlier study, Stappenbeck and Virgin learned that mice with mutated Atg16L1 have abnormalities in Paneth cells, which help regulate the gut microbial communities that aid digestion.

 

When the model was recreated in a more stringently controlled environment, the Paneth cell abnormalities did not reoccur until researchers infected the mice with a mouse norovirus. Versions of this virus that infect humans are infamous for causing difficult-to-control outbreaks of diarrhea on cruise ships, and cause a significant portion of gastroenteritis cases worldwide.

 

When they also fed the mice dextran sodium sulfate (DSS), a chemical used to simulate gut injury, additional Crohn's-like pathologies appeared, but only in the presence of the mouse norovirus.

 

"We don't know the details of why DSS works with the virus to help create the model, and we have no evidence as yet that dietary toxins play a similar role in the creation of human Crohn's disease," Stappenbeck says. "Given how similar the model's symptoms and responses to treatment are to human disease, though, those are issues we will be investigating."

 

Stappenbeck notes that the study also doesn't prove that human noroviruses cause Crohn's disease.

 

"It suggests that they might be a place to look," he says. "But it's worth emphasizing that we needed the additional damage from DSS, together with the virus and the mutant gene, to trigger the symptoms."

 

Scientists have found several genes that influence risk of Crohn's disease. Stappenbeck suggests that there are likely to be several paths to developing the disease that include multiple environmental risk factors.

 

When scientists gave the mice a broad-spectrum antibiotic, their symptoms stopped. Researchers speculate that the virus and the gene's effects on Paneth cells may be changing the gut microbial community in harmful ways, triggering Crohn's-like pathology. It's possible that the antibiotic, which does not affect viruses, clears out the maladjusted community of gut microbes.

 

"More immediately, this tells us that how a complex disease responds to antibiotics can't be used to rule out a part for viral contributors in causing that disease," Virgin says. "If we hadn't already been aware of the virus' role as a trigger for symptoms, the model's response to the antibiotic would have led us to pin the blame on gut microbes and stop looking at viruses."

 

A closely related strain of mouse norovirus with only slight genetic differences could not cause symptoms. According to Virgin, the two strains would have been indistinguishable to conventional tests for viral infection, which are based on the types of antibodies found in the blood.

 

"Our results show that we can't rely on these tests to determine if a particular strain of virus helps trigger a complex disease," Virgin says.

 

Virgin and Stappenbeck plan multiple follow-up investigations, including a more detailed look at how norovirus infection alters the microbial community in the gut of the mice and continued efforts to identify new viruses that infect humans.

 

"Viruses are extra genes present in the host," Virgin says. "Until we understand how those extra genes interact with our own DNA, we may not be able to assemble a complete picture of how what's in our genes affects what happens to our health."

 

Journal Reference:

Cadwell K, Patel KK, Maloney NS, Liu T-C, Ng ACY, Storer CE, Head RD, Xavier R, Stappenbeck TS, Virgin HW. Virus plus susceptibility gene interaction determines Crohn's disease gene Atg16L1 phenotypes in intestine. Cell, June 25, 2010

Diabetes May Double Risk of Heart Attack, Stroke

By Steven Reinberg
HealthDay Reporter
HealthDay News

Friday, June 25, 2010

THURSDAY, June 24 (HealthDay News) -- Diabetes appears to double the risk of dying from a heart attack, stroke or other heart condition, a new study finds.

The researchers implicate diabetes in one of every 10 deaths from cardiovascular disease, or about 325,000 deaths a year in industrialized countries.

"We have known for decades that people with diabetes are more likely to have heart attacks," said researcher Nadeem Sarwar, a lecturer in cardiovascular epidemiology at the University of Cambridge in England.

"But, in spite of decades of research, several questions have persisted as to how much higher this risk is, whether it's explained by things we already know of, and whether the risk is different in different people," he said.

These findings, Sarwar added, highlight the need to prevent and control diabetes, a disease in which blood sugar levels are too high.

The report is published in the June 26 issue of The Lancet, and Sarwar plans to present the findings at the American Diabetes Association's meeting, June 25 to 29 in Orlando, Fla.

For the study, Sarwar's team collected data on 698,782 people who participated in an international consortium. The participants were followed for 10 years through 102 surveys done in 25 countries.

The researchers found that having diabetes nearly doubled the risk of suffering from various diseases involving the heart and blood vessels. But this risk was only partially due to the usual culprits -- cholesterol, blood pressure and obesity, Sarwar said.

This suggests that diabetes may cause cardiovascular disease by a different mechanism, the study authors noted.

"This is a particularly exciting finding in terms of drug development and new therapeutic targets," Sarwar said.

In addition, the researchers found that higher-than-normal blood sugar in people without diabetes was not strongly related to having a heart attack or stroke.

In light of this finding, blood sugar levels are probably not a good indicator for identifying people at risk for heart attack or stroke, the researchers pointed out.

Cardiovascular disease, the leading cause of death around the world, accounts for some 17 million deaths every year, according to background information in the study.

Diabetes expert Dr. Hertzel C. Gerstein, professor of medicine at McMaster University in Canada and author of an accompanying journal editorial, said, "This study confirms that diabetes is a major problem that doubles the risk of heart attacks, stroke and death."

More than one in 10 adults in North America suffers from diabetes, and almost the same number of people have blood sugar levels that put them on the road to becoming diabetic, he noted.

"We are really in the midst of a major epidemic," Gerstein said.

Most of the problems result from the disease not being controlled, he explained. If people with diabetes work with their health care providers to learn about their condition and regulate it, their risks will be lower, he said.

"Make sure you understand about your diabetes and make sure you have a good health care team that can help you do the things you need to do to keep the disease under control and to prevent serious problems," Gerstein advised.

Dr. Gregg C. Fonarow, a professor of medicine and director of the Ahmanson-UCLA Cardiomyopathy Center at the University of California, Los Angeles, said more work is needed to prevent and treat diabetes.

"This study highlights the need for more aggressive individual efforts and public health measures to prevent diabetes," Fonarow said. "For patients with diabetes, statin therapy, ACE inhibitors and blood pressure control have all been demonstrated to substantially reduce the risk of vascular events."

More information

For more information on diabetes, visit the American Diabetes Association.

Compound Found in Red Wine Neutralizes Toxicity of Proteins Related to Alzheimer's

 

ScienceDaily

Friday, June 25, 2010

 

ScienceDaily (June 25, 2010) — An organic compound found in red wine -- resveratrol -- has the ability to neutralize the toxic effects of proteins linked to Alzheimer's disease, according to research led by Rensselaer Professor Peter M. Tessier. The findings, published in the May 28 edition of the Journal of Biological Chemistry, are a step toward understanding the large-scale death of brain cells seen in certain neurodegenerative diseases.

 

"We've shown how resveratrol has very interesting selectivity to target and neutralize a select set of toxic peptide isoforms," Tessier said. "Because resveratrol picks out the clumps of peptides that are bad and leaves alone the ones that are benign, it helps us to think about the structural differences between the peptide isoforms."

 

Isoforms are different packing arrangements of a particular peptide.

 

Deformations of a particular peptide -- the Aβ1-42 peptide -- have been linked to Alzheimer's disease. Improperly folded peptides have been shown to collect in accumulations called "plaques" within the brain. Those plaques are often found near areas of cell death in diseased brains.

 

It is not clear that resveratrol is able to cross the blood-brain barrier, Tessier said. However, the molecule has garnered interest in recent years for its potential impact on cancer and aging.

 

In their research, Tessier and his co-authors generated peptides packed together in five unique isoforms, or "arrangements" (monomer, soluble oligomer, non-toxic oligomer, fibrillar intermediates and amyloid fibrils). In their experiments, three of these arrangements were toxic to human cells, two were not.

 

Next, the researchers introduced resveratrol. The resveratrol reacted with the toxic arrangements of the Aβ1-42 peptide, neutralizing their toxicity.

 

It did not affect the non-toxic arrangements. "The surprise is that this molecule can target some of these packing arrangements that are toxic and rearrange them into packing arrangements that are not toxic. For those forms that are non-toxic, it doesn't change them," Tessier said.

 

Intriguingly, Tessier said, one of the toxic arrangements (the soluble oligomer) and one of the non-toxic arrangements (the non-toxic oligomer) were indistinguishable by various methods. And yet the resveratrol only affected the toxic arrangement.

 

The point, Tessier concludes, is that the seemingly identical non-toxic and toxic arrangements must have some distinguishing feature yet to be discovered, raising questions for future study.

 

"We have two things that look very similar, but one is toxic and the other isn't," Tessier said. "What is it that makes the bad one bad and the good one good?"

The research produced several other findings, Tessier said, including reliable methods of generating the arrangements Tessier's team produced, and formation of one arrangement which had previously been unknown.

Journal Reference:

A. R. A. Ladiwala, J. C. Lin, S. S. Bale, A. M. Marcelino-Cruz, M. Bhattacharya, J. S. Dordick, P. M. Tessier. Resveratrol selectively remodels soluble oligomers and fibrils of amyloid a  into off-pathway conformers. Journal of Biological Chemistry, 2010; DOI: 10.1074/jbc.M110.133108


Could breathing car exhaust trigger a stroke?

 

By Genevra Pittman

Reuters Health

Friday, June 25, 2010

NEW YORK (Reuters Health) – A Danish study hints that air pollution from car exhaust might trigger strokes, although much more study is needed to confirm this, the study team notes.

In the study, short-term exposure to certain pollutants affected admission rates for mild, "ischemic" strokes at hospitals around Copenhagen, Denmark. Ischemic stroke, the most common type of stroke, occurs when a clot disrupts blood flow to the brain.

The Danish findings, reported in the European Heart Journal, follow another recent study that showed a link between long-term exposure to traffic-related pollution and stroke death rates in the United Kingdom.

"The key observation is that the traffic-generated air pollution seems to be the primary source of the exposure," Dr. Jiu-Chiuan Chen, of the Keck School of Medicine of the University of Southern California, Los Angeles, told Reuters Health.

Stroke is the second leading cause of the death worldwide, accounting for about 4.4 million deaths every year. In the United States, about 700,000 people suffer a stroke every year, costing the country an estimated $43 billion dollars.

Dr. Zorana Andersen, of the Danish Cancer Society in Copenhagen, and colleagues used a background air pollution monitor to measure the amount of small polluting particles produced by cars over four years. Then they compared the levels of these particles on certain days with the number of hospital admissions for different kinds of strokes at nine hospitals within 15 kilometers (about 9 miles) of the monitor.

Over the course of the study, about 7,500 people were hospitalized for a stroke.

Short-term exposure to these particles was linked to hospital admissions for minor, ischemic strokes that happened a few days after exposure.

Among patients with mild, ischemic strokes who did not have heart abnormalities that would make them stroke-prone, the researchers estimated a 21 percent increase in hospital admissions following exposure. They calculated that 147 new cases of these strokes per year can be attributed to small, traffic-generated particles.

Short- and long-term exposure to air pollution probably have different impacts that both contribute to stroke risk, Chen said. Long-term exposure has been shown to increase the buildup of fatty deposits in the arteries.

Exactly how short-term exposure might increase the risk of stroke is still unknown, and the data do not show that air pollution definitely causes strokes, Andersen said.

"Our data suggest that exposure to increased levels of air pollution over several days can trigger stroke hospitalization," Andersen told Reuters Health in an email. "But we don't know yet how air pollution triggers stroke."

"This finding does add to our current knowledge of the effects of exposure to ambient air pollution" on cardiovascular health, said Chen, who was not involved in the study. "It's a profound public health problem."

Andersen said the problem is not limited to the elderly or others who might normally be at risk for stroke, but that air pollution could potentially trigger strokes in otherwise healthy people. However, there are ways that people can take precautions to protect their health.

"Reduced exposure to air pollution can be accomplished, to a limited extent, by personal choices," such as taking roads with less traffic or avoiding living in a traffic-heavy area, she said.

Source: http://link.reuters.com/hyb34m

 European Heart Journal, online June 10, 2010.

Red Wine Compound Could Point to Treatment for Eye Diseases

 

HealthDay News

Friday, June 25, 2010

FRIDAY, June 25 (HealthDay News) -- A compound found in red wine and grapes inhibits the growth of new blood vessels (angiogenesis) associated with eye diseases, such as age-related macular degeneration and diabetic retinopathy, researchers have found.

Resveratrol, which is produced by a variety of plants to fight bacterial and fungal infections, is found in particularly high levels in grape skin and at lower levels in blueberries, peanuts and other plant-based foods.

Previous research has shown that resveratrol can decrease the effects of aging and act as an anti-cancer agent. In this new study, researchers found that resveratrol inhibits harmful blood vessel growth in the eye. They also identified the specific pathway through which the compound achieves this effect and found that specific inhibitors could reverse the angiogenesis-blocking power of resveratrol.

The study appears in the July issue of the American Journal of Pathology.

The findings may improve understanding of angiogenesis in eye disease, cancer and atherosclerosis and lead to new treatments for these conditions, Dr. Rajendra S. Apte, of Washington University School of Medicine in St. Louis, and colleagues stated in a news release from the journal's publisher.

More information

The U.S. National Eye Institute has more about age-related macular degeneration.

Small Amount of Common Preservative Increases Toxins from Harmful Bacteria in Food, Study Finds

 

ScienceDaily

Friday, June 25, 2010

 

ScienceDaily (June 25, 2010) — In response to consumer demand for more natural food, the food industry has reduced the amount of preservatives in food over recent years. A common preservative is acetic acid, which is used to stop bacterial growth in dressings, sauces, cheese and pickles.

 

However, new research shows that a small amount of acetic acid does not have the intended effect, but rather the opposite -- it increases the amount of toxin from the harmful bacteria in the food.

 

"In my studies I saw that a small amount of acetic acid caused the bacteria to become stressed, which meant they reacted by producing more toxin. However, if a large amount of acetic acid is added, as was done in the past, the acidity is greatly increased and the bacteria do not survive," explains Nina Wallin Carlquist, Doctor of Philosophy in Engineering at the Division of Applied Microbiology, Lund University.

 

She recently defended a thesis on the subject, in which she studied two of the most common food poisoning bacteria, Staphylococcus aureus and Campylobacter jejuni.

 

The Staphylococcus were used in the acetic acid study. A common vehicle for staphylococcal food poisoning is pork meat. Therefore Nina Wallin Carlquist also chose to study how these bacteria behave in different types of pork meat at room temperature: boiled and smoked ham, Serrano ham and salami. The bacteria could get into the food in the first place from an infected cut on the finger of the person who has handled the meat, for example.

 

Her results show that it only took a few hours for the bacteria to multiply in the boiled and smoked ham. In the Serrano ham, it took a week before the number of bacteria increased and on the salami they did not survive at all.

 

"A possible explanation is that the bacteria could not survive the salami's combination of acidity, salt, fat and dryness. However, there are other bacteria that thrive on salami. The Serrano ham is manufactured and stored at room temperature over long periods, which means it is important that the staff have good hygiene so that the Staphylococcus cannot get a foothold," comments Nina Wallin Carlquist.

 

A starting point was to study how the bacteria behave in food. This type of research is otherwise usually carried out in a controlled environment in laboratories where a pure culture of a certain type of bacteria is studied.

 

According to Nina Wallin Carlquist this provides far from the whole picture because the bacteria are affected by other micro-organisms in the food and also by how much fat, acid and salt the food contains.

 

"If we know more about what it is in the food that enables the bacteria to thrive, we can then adapt the composition of the food product and thereby improve food safety. This is a new way to approach food safety," explains Nina Wallin Carlquist.

 

The other bacterium, Campylobacter jejuni, is becoming the next big problem after salmonella. Like salmonella, the bacteria occur naturally in chicken, without harming the host animal.

 

However, if the contents of the intestines come into contact with the meat during slaughter, the meat can become infected. If the chicken is then not properly cooked the consumer may suffer food poisoning.

 

"It would be best if the chickens did not get infected with these bacteria to begin with. In my studies I have therefore found out how the bacteria become established in the intestines. In the long term, these results could help in the drawing up of guidelines for hygiene procedures on poultry farms or in developing a vaccine for the animals," says Nina Wallin Carlquist.

 

Thursday, June 24, 2010

 

Gut Bacteria Could Be Key Indicator of Colon Cancer Risk

 

ScienceDaily

Thursday, June 24, 2010

 

ScienceDaily (June 24, 2010) — The human body contains more bacteria than it does cells. These bacterial communities can have a positive effect on our health, by training our immune systems and helping to metabolize the foods we eat. But they can also set us up to develop digestive disorders, skin diseases, and obesity.

 

Now a new study by researchers at the University of North Carolina at Chapel Hill School of Medicine suggests that a shift in the balance between the "good" bacteria and the "bad" bacteria that populate our gut could be a harbinger of colon cancer.

 

The findings, which will appear online in the May/June 2010 issue of the journal Gut Microbes, could lead to strategies to identify people who are at high risk as well as ways to manipulate the microbiota to prevent colon cancer.

 

"We think something happens to tip the balance away from the beneficial bacteria and in favor of microbes that make toxic metabolites and are detrimental to our health," said senior study author Temitope Keku, PhD, research associate professor of medicine at UNC.

 

"By pinpointing these bacterial culprits, we can not only identify people at risk, but also suggest that they include the good bacteria in their diet," added Keku. "And what a great way to address colon cancer -- you could know your risk and lower it by eating your yogurt every day."

 

Researchers have known for decades that the bacteria harbored in our bodies are not innocent bystanders but rather active participants in health and disease. Yet only recently have molecular methods evolved to the point that they can identify and characterize all of our microbial residents.

 

Keku and her colleagues used these methods to determine the different bacteria groups contained within biopsies from 45 patients undergoing colonoscopies. They uncovered a higher bacterial diversity and richness in individuals found to have adenomas than in those without these colorectal cancer precursors. In particular, a group called Proteobacteria was in higher abundance in cases than in controls, which was interesting considering that is the category where E. coli and some other common pathogens reside.

 

It is still not clear whether alterations in bacterial composition cause adenomas, or if adenomas cause this altered balance. In order to tell if it is the chicken or the egg, Keku plans to conduct more mechanistic studies, such as testing whether certain groups of bacteria promote cancer growth in animal models. She is also expanding the study to analyze samples from 600 patients using next-generation sequencing technology.

 

The ultimate goal may be to determine if the differences found in the mucosa lining the colon also exist in the luminal or fecal matter that passes through the colon. If so, it could mean less invasive screening for cancer and even more cancers being caught earlier, when survival rates are higher.

 

"We have come a long way from the time when we didn't know our risk factors and how they impact our chances of getting colon cancer," said Keku. "But now that we can look at bacteria and their role, it opens up a whole new world and gives us a better understanding of the entire gamut of factors involved in cancer -- diet, environment, genes, and microbes."

 

The UNC research was funded in part by the National Institutes of Health. Study co-authors from UNC include Xiang Jun Shen, John F. Rawls, Thomas Randall, Lauren Burcal, Caroline N. Mpande, Natascha Jenkins, Biljana Jovov, Zaid Abdo and Robert S. Sandler.

Journal Reference:

Xiang Jun Shen, John F. Rawls, Thomas A. Randall, Lauren Burcall, Caroline Mpande, Natascha Jenkins, Biljana Jovov, Zaid Abdo, Robert S. Sandler and Temitope O. Keku. Molecular characterization of mucosal adherent bacteria and associations with colorectal adenomas. Gut Microbes, 2010; 1 (3) [link]


Is obesity a factor in rising stroke rates in women?

 

By Lynne Peeples

Reuters Health

Thursday, June 24, 2010

NEW YORK (Reuters Health) – Stroke rates among women in their late 30s to early 50s have tripled over the past two decades and researchers suspect a parallel rise in obesity may be playing a role.

"The alarming increase in obesity among middle-aged women may point to an important modifiable reason that stroke could be on the rise," Dr. Ralph Sacco, chairman of neurology at the University of Miami, Florida, who was not involved in the study, told Reuters Health in an email.

In a previous analysis of U.S. stroke data from 1999 to 2004, researchers found that 45- to 54-year-old women were more than twice as likely as similarly aged men to suffer a stroke.

This prompted Dr. Amytis Towfighi and colleagues of the University of Southern California in Los Angeles to dig deeper to see if this represented a real trend and, if so, whether they could uncover any explanations.

They looked to data on about 10,000 men and women aged 35 to 54 from the National Health and Nutrition Examination Surveys. Information was collected from representative slices of the U.S. population in two waves: 1988 through 1994 and 1999 through 2004.

The researchers found no significant difference in stroke rates between the sexes during the first time period: 0.9 percent for men and 0.6 percent for women. However, a difference arose during the later period, when the number of women who reported suffering a stroke jumped to 1.8 percent, while the rate among men stayed the same.

This finding challenges the traditional thinking that men have similar or higher stroke rates compared to their female counterparts, the researchers point out in the journal Stroke.

In trying to decipher what may have contributed to the upward trend in stroke among women, they saw that women in the second wave were more likely to be obese, as well as have high blood pressure and high levels of harmful blood fats called triglycerides, compared to women in the first wave.

More of the women in the later time period were also on blood pressure and lipid-lowering medications, reflecting improved efforts to control stroke risk factors in recent years.

"The obesity epidemic is likely counteracting many of the advances in stroke preventive measures," Towfighi told Reuters Health.

Her advice for preventing stroke centers on a basic healthy lifestyle: exercise regularly, maintain a healthy weight, eat fruits and vegetables, abstain from smoking, and drink alcohol in moderation.

Sacco, who is president-elect of the American Heart Association (AHA), agrees. "It is never too late to start eating right and increasing physical activity in our daily routine," he said.

Source: http://link.reuters.com/vub93m

 Stroke, online May 27, 2010.

Small fraction of Americans meet salt guidelines

Mike Stobbe

AP Medical Writer

The Associated Press

Thursday, June 24, 2010

ATLANTA – Most U.S. adults should eat less than a teaspoon of salt each day, but a new government report says just 1 in 18 meet that goal.

"This is not good news," said Janelle Peralez Gunn of the Centers for Disease Control and Prevention, lead author of a new study released Thursday.

Health officials currently say no adult should eat more than a teaspoon of salt each day. They go on to advise that 70 percent of adults - including people with high blood pressure, all African-Americans and everyone over 40 - should actually limit their salt intake to a more restrictive two-thirds of a teaspoon.

Sodium increases the risk of high blood pressure, which is major cause of heart disease and stroke. Salt - or sodium chloride - is the main source of sodium for most people.

Overall, only 1 in 10 adults meet the teaspoon standard, said the CDC study. But for those who should be even stingier, only 1 in 18 manage to do it.

The research repeated what others have found, that the vast majority of dietary salt comes from processed and restaurant foods. And it concluded that salt was most commonly found in cold cuts and other meats, and in baked goods and other items counted as grain-based products.

"It's not a matter of Americans taking a salt shaker and adding salt to their food," said Linda Van Horn, a Northwestern University medical school professor who chairs the American Heart Association's Nutrition Committee.

Salt reduction has become a recent focus of public health campaigns. New York City, the heart association and nearly three dozen other groups have been trying to persuade food manufacturers and chain restaurants to reduce salt content by more than 50 percent over the next 10 years. The CDC and federal health agencies also have had sodium-reduction talks with food companies.

The CDC study is based on a national survey of nearly 4,000 adults ages 20 and older in the years 2005 and 2006. They had their blood pressure taken and answered questions about what they ate.

The participants tended to consume roughly 1 1/2 teaspoons of salt each day. People in the more restrictive group - those at increased risk of high blood pressure - were eating twice as much as they should have, the study found.

One in three U.S. adults has high blood pressure, and the government estimates that nine in 10 will develop it in their lifetime.

Online:

The CDC report: http://www.cdc.gov/mmwr

Brain Stimulation Seems to Boost Language Skills in Alzheimer's Patients

By Steven Reinberg
HealthDay Reporter
HealthDay News

Thursday, June 24, 2010

THURSDAY, June 24 (HealthDay News) -- People with Alzheimer's who are losing their language skills may see some improvement by using a technique called repetitive transcranial magnetic stimulation (rTMS), early research by an Italian team suggests.

The noninvasive procedure delivers a series of rapid magnetic pulses at frequencies up to 100 Hz to the brain. Earlier studies have found that these pulses can change brain activity, depending on the frequency, the researchers explained.

Though "preliminary," the new findings "hold considerable promise, not only for advancing our understanding of brain plasticity mechanisms, but also for designing new rehabilitation strategies in patients with neurodegenerative disease," according to lead researcher Maria Cotelli, from IRCCS Centro San Giovanni di Dio Fatebenefratelli in Brescia.

The report is published in the June 24 online edition of the Journal of Neurology, Neurosurgery and Psychiatry.

For the study, Cotelli's team tried rTMS in 10 patients with moderate Alzheimer's disease. The researchers randomly assigned the patients to four weeks of rTMS at 20 Hz or two weeks of a dummy treatment followed by two weeks of rTMS. Pulses were delivered to the prefrontal lobes of the brain.

The people in the study had their memory, executive functions and language tested at the start of the study, after two and four weeks of treatment, and again after eight weeks.

After two weeks, the researchers found a significant difference between the two test groups in terms of their ability to understand spoken language.

Among people who underwent rTMS, the number of correct answers on a comprehension test went from 66 percent to more than 77 percent, while among those who did not receive the treatment the scores remained unchanged.

After the last two weeks of treatment, those who had not received rTMS initially showed improvement in language comprehension, the researchers noted.

Moreover, the improvement among those in both groups remained two months after the treatments.

rTMS did not change other language abilities or cognitive functions, including memory. This suggests that in this context rTMS is specifically related to language comprehension, Cotelli's group says.

How rTMS might work is not clear, the researchers noted. This stimulation may change activity in the brain and readjust unhealthy patterns caused by disease or damage, they speculated.

There is some evidence for this theory. Imaging studies of people with congenital or acquired brain damage show certain areas of the brain seem to be plastic and cortical activity can be "reorganized," Cotelli's group added.

"Our findings provide initial evidence for the persistent beneficial effects of rTMS on sentence comprehension in Alzheimer's disease patients," Cotelli said. "Rhythmic rTMS, in conjunction with other therapeutic interventions, may represent a novel approach to the treatment of language dysfunction in Alzheimer's disease patients."

One expert believes the findings are interesting, but they need to be replicated and extended before their value can truly be known.

Catherine M. Roe, a research instructor in neurology at the Washington University School of Medicine in St. Louis, called it "an intriguing study."

The results do seem to suggest that two to four weeks of rTMS treatment improved scores on a sentence-comprehension test among people with Alzheimer's disease, at least in the short term, she said.

However, "before concluding that the effects of the treatment are long-lasting, I think it would be important to also include in a study like this a group of participants who only received placebo treatment," Roe said.

As with all new research, it is also important to see whether the results can be shown in a larger, and different, group of people to see whether the effect is reliable, she added.

"We also need to keep in mind that we don't know whether improvement in scores on a sentence test will translate into improvement in day-to-day language comprehension," Roe said.

More information

For more information on Alzheimer's disease, visit the Alzheimer's Association.

Antihypertensive Drugs May Protect Against Alzheimer's Disease

 

ScienceDaily

Thursday, June 24, 2010

 

ScienceDaily (June 24, 2010) — Researchers at Mount Sinai School of Medicine have found that the drug carvedilol, currently prescribed for the treatment of hypertension, may lessen the degenerative impact of Alzheimer's disease and promote healthy memory functions.

 

The new findings are published in two studies in the current issues of Neurobiology of Aging and the Journal of Alzheimer's Disease.

 

"These studies are certainly very exciting, and suggest for the first time that certain antihypertensive drugs already available to the public may independently influence memory functions while reducing degenerative pathological features of the Alzheimer's disease brain," said study author Giulio Maria Pasinetti, MD, PhD, Saunders Family Professor of Neurology and Director of the Center of Excellence for Novel Approaches to Neurotherapeutics at Mount Sinai School of Medicine.

 

Dr. Pasinetti's team found for the first time that carvedilol, a blood pressure lowering agent, is capable of exerting activities that significantly reduce Alzheimer's disease-type brain and memory degeneration. This benefit was achieved without blood pressure lowering activity in mice genetically modified to develop Alzheimer's disease brain degeneration and memory impairment. These data were published in Neurobiology of Aging.

 

In a second study published in the Journal of Alzheimer's Disease, the research team led by Dr. Pasinetti assessed how mice learned new tasks and information and recall of past information chemically stored in the brain. They found that carvedilol treatment was capable of promoting memory function, based on assessments of learning new tasks and information and recall of past information, which is already chemically stored in the brain.

 

In the study, one group of mice received carvedilol treatment and the other group did not. The scientists conducted behavioral and learning tests with each group of mice, and determined that it took the mice in the carvedilol significantly less time to remember tasks than the other group.

 

"Ongoing clinical research is in progress to test the benefits of carvedilol, which may prove to be an effective agent in the treatment of symptoms of Alzheimer's disease," said Dr. Pasinetti. "We look forward to further studying this drug in the human population."

Skin condition linked to cancer risk: study

By Genevra Pittman

Reuters Health

Thursday, June 24, 2010

NEW YORK (Reuters Health) – People with the skin condition atopic dermatitis may be at greater risk of getting cancer than those without it, new research hints.

But it's unclear whether this increased risk is related to the medication patients take for the condition, or the condition itself, the researchers emphasize.

Atopic dermatitis is a type of eczema, or skin inflammation, that arises from an allergic reaction. It affects roughly 20 percent of children, according to the National Institutes of Health, but often goes away in adulthood. It causes itchy rashes that get crusty and scaly with scratching.

There have been conflicting theories about whether these kinds of frequent rashes that drive the immune system into action would make it more or less likely for someone with atopic dermatitis to develop cancer.

To investigate, Dr. Alejandro Arana, of the Bridgewater, New Jersey-based company Risk Management Resources and colleagues analyzed the medical records of about 4.5 million people in the UK and followed their medical history for an average of almost 7 years.

They report, in the British Journal of Dermatology, that about 1.5 percent of those individuals had atopic dermatitis and just under 3 percent were diagnosed with some kind of cancer during the study period. People in the study with atopic dermatitis were on average 12 to 15 years younger than those without atopic dermatitis.

Overall, people without atopic dermatitis were more likely to get cancer than people with the skin condition. There were 129,272 first cancer cases in people without atopic dermatitis (about 33 cases per 10,000 persons per year) and 700 first cancer cases (about 42 cases per 10,000 persons per year) in those with atopic dermatitis.

But when the investigators took out the effect of age differences and looked within each specific age group, the pattern switched. At every age, the rate of cancer was higher among patients with atopic dermatitis.

That general pattern held when Arana and his colleagues looked specifically at lymphoma, melanoma, and non-melanoma skin cancer. When examined by age group, people with atopic dermatitis were about 1.5 times more likely to be diagnosed with some kind of cancer during the study than people without atopic dermatitis.

But the results don't prove that having atopic dermatitis causes cancer, the investigators emphasize.

"These are difficult studies to do well and sometimes it's difficult to understand what they mean," Dr. David Margolis, a dermatologist at the University of Pennsylvania Health System who was not involved with the study told Reuters Health. Among patients with atopic dermatitis, the overall cancer risk was still low, he emphasized. "I think people just need to put their results in perspective," he said.

"The age specific risk differences seen in this study are small," Arana told Reuters Health in an email, "but doctors should always be aware of recent investigations and take cancer primary prevention measures in (atopic dermatitis) patients."

The findings also don't separate the effect of medication from the effect of the skin condition itself. Typical treatment for atopic dermatitis includes hydrocortisone lotions, wet dressings, and sometimes prescription medications. In 2005, the FDA issued an advisory that two of these medications, Elidel and Protopic, might carry a cancer risk.

The current study was funded by a grant from the pharmaceutical company Novartis, which markets Elidel, and two of its co-authors are Novartis employees.

Arana said that this study should be taken in the larger context of research on the possible link between atopic dermatitis and cancer. "We cannot establish a cause and effect relationship from one study alone," he told Reuters Health. "Each study should be seen as a brick in the wall of knowledge."

"This is another helpful study along the way that might help (give) some clarity in the future," Margolis added.

Source: http://link.reuters.com/tuf93m

 British Journal of Dermatology, online June 9, 2010.

Moldy Homes a Serious Risk for Severe Asthma Attacks in Some

 

ScienceDaily

Thursday, June 24, 2010

 

ScienceDaily (June 24, 2010) — Exposure to high levels of fungus may increase the risk of severe asthma attacks among people with certain chitinase gene variants, according to a study from Harvard Medical School, Harvard Pilgrim Health Care Institute and Brigham and Women's Hospital.

 

The research was published online on the American Thoracic Society's journal Web site ahead of the print edition of the American Journal of Respiratory and Critical Care Medicine.

 

"We found that the interaction between environmental mold exposure and certain variants of chitinase genes were positively associated with severe asthma exacerbations requiring hospitalization," said lead researcher, Ann Wu, assistant professor at the at Harvard Medical School and Harvard Pilgrim Health Care Institute.

 

Chitinases break down chitin, a component in many fungi, and are induced during allergic inflammation. It has been suggested by past research that these could be biomarkers of inflammation. Moreover, certain variants of chitinase genes are known to be expressed more heavily in people with asthma.

 

The researchers used data from the Childhood Asthma Management Program, a multicenter trial that enrolled children between the ages of 5 and 12 with mild to moderate persistent asthma. Mold measures were taken in the subjects' homes at the beginning of the study, and homes were classified as having greater or less than 25,000 mold colonies per gram of household dust.

 

"This level of mold in dust is high for a residential environment. However, it is not likely to be easily recognized. Studies have shown that homes that have problems with dampness (e.g. visible mold on walls/ceilings, water collection in basement, etc.) have higher levels of mold, but there is no specific level that is currently accepted to 'cause' problems," said Dr. Wu.

 

Finally, using blood samples, the researchers genotyped all the single nucleotide polymorphisms -- SNPs, or variants in which just a single "letter" of the DNA code in a given gene is different -- of chitinase genes and a chitinase-like gene within the study population.

 

They then analyzed the appearance of different variations of chitinase genes with level of mold exposure and number of hospital visits from severe asthma exacerbations. They found that certain variants of the chitinase gene CHIT1, in conjunction with high mold exposure, were associated with increased risk of severe asthma attacks.

 

"Our results support increasing evidence that CHIT1, which is primarily expressed in the lung, plays an important role in the pathophysiology of asthma in the proper environmental context of exposure to chitin, which was approximated by mold levels," said Dr. Wu. "To our knowledge this was the first study to examine the effect of mold levels on the association of SNPs in the genes of both chitinases and chitinase-like proteins with asthma and allergy-related phenotypes."

 

Chitinases may play a role in future targets for asthma therapy. Inhibition of chitinase enzymatic activity has been demonstrated to prevent hyper-responsiveness and inflammation in mice. It is plausible, said Wu, that therapeutics designed to block chitinase enzyme activity may prevent hyper-responsiveness and inflammation related to asthma.

 

"Future research should focus on expanding and replicating these findings," she said. "The focus should be on mechanisms of chitinases and chitinase-like proteins in allergic inflammation. Additionally, finding other genes that may interact with mold exposure will also be important. We plan to find a population to replicate these findings. Additionally, we are preparing to perform a Genome-Wide Association Study in this same population to identify other genes that may interact with mold exposure."

 

Wednesday, June 23, 2010

 

Lowering Homocysteine Levels With Folic Acid and Vitamin B12 Does Not Appear to Reduce Risk of Heart Attack, Stroke, Study Finds

 

ScienceDaily

Wednesday, June 23, 2010

 

ScienceDaily (June 23, 2010) — Patients who had experienced a heart attack and lowered their blood homocysteine levels with folic acid and vitamin B12 supplementation did not have an associated lower risk of heart attack, coronary death or stroke, according to a study in the June 23/30 issue of JAMA. However, the researchers did find that folic acid supplementation did not increase the risk of cancer, which has been speculated.

 

Blood homocysteine levels are positively associated with cardiovascular disease, but it is uncertain whether the association is causal, according to background information in the article. A meta-analysis of prospective studies indicated that, after adjustment for known risk factors, a 25 percent lower than usual homocysteine concentration was associated with an 11 percent lower risk of coronary heart disease and 19 percent lower risk of stroke. "Daily supplementation with folic acid typically lowers homocysteine levels by about 25 percent, and the addition of vitamin B12 lowers it by a further 7 percent," the authors write. Other research has suggested supplementation with folic acid may offer a protective effect against stroke.

 

Jane M. Armitage, F.R.C.P., of the University of Oxford, United Kingdom, and colleagues with the Study of the Effectiveness of Additional Reductions In Cholesterol and Homocysteine (SEARCH) trial assessed the effects of lowering homocysteine levels with folic acid plus vitamin B12 in 12,064 survivors of myocardial infarction (heart attack) in secondary care hospitals in the United Kingdom between 1998 and 2008. Patients were randomized to receive either 2 mg. folic acid plus 1 mg. vitamin B12 daily or matching placebos. The primary outcomes measured included first major vascular event, defined as major coronary event (coronary death, heart attack, or coronary revascularization), fatal or nonfatal stroke, or noncoronary revascularization.

 

Patients who received the study vitamins reduced homocysteine by an average of 3.8 ΅mol/L (28 percent). During 6.7 years of follow-up, major vascular events occurred in 1,537 of 6,033 participants (25.5 percent) allocated folic acid plus vitamin B12 vs. 1,493 of 6,031 participants (24.8 percent) allocated placebo. "There was no evidence of any benefit beginning to emerge with more prolonged treatment and follow-up," the authors write.

 

Receipt of study vitamins also was not associated with a significant effect on any stroke (vitamins, 4.5 percent vs. placebo, 4.4 percent); noncoronary revascularizations (vitamins, 3.0 percent vs. placebo, 2.5 percent); or major coronary events (vitamins, 20.4 percent vs. placebo, 19.6 percent). There were no apparent differences in the numbers of deaths attributed to vascular causes or nonvascular causes.

 

New primary cancers (excluding non-melanoma skin cancer) were diagnosed in 11.2 percent of the participants allocated folic acid plus vitamin B12 vs. 10.6 percent allocated placebo, with this difference not being significant.

 

"Taken together with the previous homocysteine-lowering trials, the results of SEARCH indicate that folic acid supplementation has no significant adverse effects on cancer or other major health outcomes, even if it also produces no beneficial effects on cardiovascular disease. In addition, these results highlight the importance of focusing on drug treatments (e.g., aspirin, statins, and antihypertensive therapy) and lifestyle changes (in particular, stopping smoking and avoiding excessive weight gain) that are of proven benefit, rather than lowering homocysteine with folic acid-based vitamin supplements, for the prevention of cardiovascular disease," the authors conclude.

Journal Reference:

Study of the Effectiveness of Additional Reductions in Cholesterol and Homocysteine (SEARCH) Collaborative Group. Effects of Homocysteine-Lowering With Folic Acid Plus Vitamin B12 vs Placebo on Mortality and Major Morbidity in Myocardial Infarction Survivors: A Randomized Trial. JAMA, 2010; 303 (24): 2486-2494 [link]


Insufficient vitamin D tied to severe asthma attacks

 

Reuters Health

Wednesday, June 23, 2010

 

NEW YORK (Reuters Health) – Asthmatic children with relatively low vitamin D levels in their blood may have a greater risk of suffering severe asthma attacks than those with higher levels of the vitamin, a new study suggests.

The study, which followed more than 1,000 children with asthma for four years, found those with vitamin-D "insufficiency" at the outset were more likely to have an asthma attack that required a trip to the hospital.

Over the four-year study, 38 percent of children with insufficient vitamin D levels went to the emergency room or were hospitalized for an asthma exacerbation. The same was true of 32 percent of children with sufficient levels of the vitamin.

When the researchers considered other factors -- including the severity of the children's asthma at the study's start, their weight and their family income -- vitamin D insufficiency itself was linked to a 50 percent increase in the risk of severe asthma attacks.

Researchers led by Dr. Augusto A. Litongua, of Harvard Medical School in Boston, report the findings in the Journal of Allergy & Clinical Immunology.

As it stands, people are considered to have an overt deficiency in vitamin D when blood levels drop below 11 nanograms per milliliter (ng/mL). But there is debate over how the optimal vitamin D level should be defined -- and what the daily recommended intake of the vitamin should be for children and adults.

Some experts believe that vitamin D blood levels above 30 ng/mL are desirable for overall health, and that levels between deficiency and 30 ng/mL should be viewed as "insufficient."

For their study, Litongua and his colleagues considered children with vitamin D levels of 30 ng/mL or lower to be insufficient in the vitamin.

The researchers based their findings on 1,024 children with mild-to-moderate asthma who were part of a clinical trial testing two inhaled asthma medications -- budesonide and nedocromil. Using blood samples taken at the start of the trial, Litongua's team found that 35 percent of the children had vitamin D insufficiency, and 65 percent had sufficient levels.

Overall, the researchers found no evidence that sufficient vitamin D levels protected kids from moderate asthma symptoms; in fact, children with low levels of the vitamin tended to report fewer moderate symptoms.

However, these children were at greater risk of severe asthma attacks.

While the findings point to an association between vitamin D status and asthma exacerbations, they do not prove that vitamin D is responsible -- or, by extension, that taking the vitamin will prevent asthma attacks.

It is biologically plausible that vitamin D would affect the severity of asthma attacks, according to Litongua and his colleagues.

Vitamin D may be best known for its role in healthy bone development and maintenance, but it is also needed for normal nerve, muscle and immune system function. Some studies have linked low vitamin D levels to a higher risk of type 1 or "insulin-dependent" diabetes in children and, in adults, heart disease and certain cancers.

The effects of vitamin D on the immune system, which include the inflammatory response to infections, might help explain why higher levels of the vitamin were linked to a lower risk of severe asthma exacerbations, according to Litongua's team.

They say it's also possible that vitamin D enhances the effects of anti-inflammatory steroid hormones -- both the body's natural supply and the synthetic corticosteroids used to treat asthma.

In this study, the beneficial association between vitamin D and asthma attacks was mainly seen in children who were on budesonide, a corticosteroid.

The American Academy of Pediatrics recommends that infants, children and teenagers get 400 IU of vitamin D each day. Milk, breakfast cereals and orange juice fortified with the vitamin are the main food sources, though some fatty fish naturally contain high amounts of vitamin D. Experts recommend vitamin pills for children who do not get enough of the vitamin from food.

Vitamin D is naturally synthesized in the skin when it is exposed to sunlight, but long winters and sun avoidance in the summer mean that many kids may not get enough vitamin D this way. In addition, vitamin D synthesis is less efficient in people with darker skin, and African Americans are at higher risk of deficiency than whites.

Overweight children and adults also appear to be at elevated risk of deficiency because vitamin D is stored in body fat. The more vitamin D that gets sequestered into fat tissue, the less active vitamin there is in the blood.

Source:  http://www.jacionline.org/article/S0091-6749(10)00657-3/abstract

Journal of Allergy & Clinical Immunology, online June 10, 2010.

High Levels of Fructose, Trans Fats Lead to Significant Liver Disease, Says Study

 

ScienceDaily

Wednesday, June 23, 2010

 

ScienceDaily (June 23, 2010) — Scientists at Cincinnati Children's Hospital Medical Center have discovered that a diet with high levels of fructose, sucrose, and of trans fats not only increases obesity, but also leads to significant fatty liver disease with scar tissue.

 

Moreover, the researchers conducted the study in a new mouse model of obesity and liver disease that so closely models human disease they will now be able to test therapies to determine their effectiveness, according to Rohit Kohli, M.D., a gastroenterologist at Cincinnati Children's Hospital Medical Center and the study's main author.

 

"Fructose consumption accounts for approximately 10.2 percent of calories in the average diet in the United States and has been linked to many health problems, including obesity, cardiovascular disease and liver disease," says Dr. Kohli.

 

"We've developed a mouse model that is very close to human disease, allowing us to better understand the process involved in the development and progression of obesity-related fatty liver disease."

 

The study also includes preliminary data on a simple blood test for a biomarker that differentiates the stages of disease in this model. Physicians currently monitor the progression of fatty liver disease by taking liver biopsies, which are invasive procedures.

 

The study, which was conducted with scientists from the Metabolic Disease Institute at the University of Cincinnati, is published online in the journal Hepatology.

 

The study was conducted in mice, some of which were fed a normal diet of rodent chow and some a 16-week diet of fructose and sucrose-enriched drinking water and trans-fat solids. Their liver tissue was then analyzed for fat content, scar tissue formation (fibrosis), and the biological mechanism of damage. This was done by measuring reactive oxygen stress, inflammatory cell type and plasma levels of oxidative stress markers, which are known to play important roles in the development of obesity-related liver disease and its progression to end-stage liver disease.

 

The investigators found that mice fed the normal calorie chow diet remained lean and did not have fatty liver disease. Mice fed high calorie diets (trans-fat alone or a combination of trans-fat and high fructose) became obese and had fatty liver disease.

 

"Interestingly, it was only the group fed the combination of trans-fat and high fructose which developed the advanced fatty liver disease which had fibrosis," says Dr. Kohli. "This same group also had increased oxidative stress in the liver, increased inflammatory cells, and increased levels of plasma oxidative stress markers."

 

Dr. Kohli hopes to further investigate the mechanism of liver injury caused by high fructose and sucrose enriched drinking water and study a therapeutic intervention of antioxidant supplementation. Antioxidants are natural defenses against oxidative stress and may reverse or protect against advanced liver damage, according to Dr. Kohli.

 

The investigators also would like to use this model to better understand human fatty liver disease and perform clinical trials using novel therapeutic and monitoring tools.

 

"Our data suggest that supplementation with pharmaceuticals agents should be tested on our new model to establish whether one is able to reverse or protect against progressive liver scarring and damage," says Dr. Kohli.

 

The study was supported by grants from the National Institutes of Health and the Children's Digestive Health and Nutrition Foundation.

Journal Reference:

Rohit Kohli, Michelle Kirby, Stavra A. Xanthakos, Samir Softic, Ariel E. Feldstein, Vijay Saxena, Peter H. Tang, Lili Miles, Michael V. Miles, William F. Balistreri, Stephen C. Woods, Randy J. Seeley. High-fructose medium-chain-trans-fat diet induces liver fibrosis & elevates plasma coenzyme Q9 in a novel murine model of obesity and NASH. Hepatology, 2010; DOI: 10.1002/hep.23797

Study Clears Cell Phone Towers of Childhood Cancer Connection

By Steven Reinberg
HealthDay Reporter
HealthDay News

Wednesday, June 23, 2010

TUESDAY, June 22 (HealthDay News) -- Living near a cell phone tower while you're pregnant doesn't raise your baby's risk of developing a childhood cancer, British researchers report.

"These results are reassuring with respect to cancer risk in young children and living near mobile phone base stations," said lead researcher Dr. Paul Elliott, a professor of epidemiology and public health medicine at Imperial College London.

"There is public concern about possible effects of mobile phone mast emissions on the health of children," Elliott said. "This large national study found no association between mobile phone base station exposures and risk of early childhood cancers."

As the use of mobile phones has increased, so have fears that exposure to the radio waves they emit can cause cancer. The results of a recent major, international study were inconclusive, and earlier reports of cancer clusters near cell phone towers are hard to interpret, because of the small numbers and possible biases, the researchers noted in the report, published June 23 in bmj.com. They also noted that no radiobiological explanations have been shown for these cancers.

For the study, Elliott's team collected data on 1,397 children with leukemia or brain, or central nervous system tumors, who ranged in age from less than a year to 4 years.

For comparison, the researchers identified a control group of children who did not have cancer and matched them to the others by sex and date of birth. The researchers also noted the distance the children lived from a cell tower at birth and the power output of each tower.

The researchers found no association between risk of early childhood cancers and the mother's estimated exposure to cell phone towers during pregnancy.

"It would seem to be very unlikely that there is any serious risk to young children from cancers resulting from proximity to a mobile phone mast," said John Bithell, an honorary research fellow in the Childhood Cancer Research Group at the University of Oxford and author of an accompanying editorial.

The study, like virtually all previous studies, finds no association between childhood leukemia or cancers of the brain or central nervous system and supposed exposure to radio frequency fields from a cell phone tower, Bithell said.

Exposure levels from cell phone towers are much lower than those from a hand-held mobile phone, and no biological effects from exposure to radio frequency fields have been demonstrated experimentally, he added.

However, health effects can take time to appear, and studies of cancers in adults might be more revealing, he said.

But for now, "the medical profession should encourage their patients not to worry about this possibility," Bithell said.

"Although proximity to a mast may be aesthetically distressing, anxiety and moving house are a bigger health hazard than any associated physical effect," he said. "Above all, the risks of using a mobile phone inappropriately, -- for too long, at work or while driving -- should be considered far more seriously."

More information

For more information on cell phone and cancer, visit the U.S. National Cancer Institute.

Mothers' High Blood Sugar in Pregnancy Is Linked to Children's Reduced Insulin Sensitivity

 

ScienceDaily

Wednesday, June 23, 2010

 

ScienceDaily (June 23, 2010) — Children of mothers whose blood glucose (sugar) was high during pregnancy are more likely to have low insulin sensitivity -- a risk factor for type 2 diabetes -- even after taking into consideration the children's body weight, a new study shows. The results were presented June 22 at The Endocrine Society's 92nd Annual Meeting in San Diego.

 

"We know that children born to women with type 2 diabetes or gestational diabetes, or who have high blood sugar during pregnancy are at risk of becoming diabetic themselves. This study suggests that the children's increased risk appears to be due, at least in part, to their prenatal exposure to relatively high maternal blood glucose," said study co-author Paula Chandler-Laney, PhD, a postdoctoral fellow at the University of Alabama at Birmingham.

 

Chandler-Laney and her colleagues studied 21 children ages 5 to 10 years and measured the children's sensitivity to insulin, the hormone that regulates sugar in the blood. They also evaluated the pregnancy medical records of the children's mothers to determine maternal blood sugar concentration during the oral glucose tolerance test.

 

The researchers found an inverse association between maternal blood sugar during pregnancy and the child's insulin sensitivity, meaning that the higher the mother's blood sugar levels during pregnancy, the lower her child's insulin sensitivity. Low insulin sensitivity is a major risk factor for type 2 diabetes.

Obesity lowers insulin sensitivity, but the children's reduced insulin sensitivity was independent of their amount of body fat, the authors reported.

 

In addition, children exposed to high blood sugar levels in the womb also were more likely to have exaggerated insulin secretion after a meal, independent of their reduced insulin sensitivity. Relatively high insulin secretion is also associated with increased risk for later development of type 2 diabetes, Chandler-Laney explained.

 

None of the children had high blood sugar, but puberty would further lower their insulin sensitivity, she noted.

 

"High maternal blood glucose during pregnancy may have lasting effects on children's insulin sensitivity and secretion, potentially raising the risk for type 2 diabetes," Chandler-Laney said. "Obstetricians, pediatricians, and pregnant women should all be aware of the potential far-reaching consequences that elevated blood sugar during pregnancy can have on children's health."

 

More children, higher stroke risk for women?

 

By Amy Norton

Reuters Health

Wednesday, June 23, 2010

NEW YORK (Reuters Health) – Women who have given birth to several children may have a faster rate of plaque build-up in the neck arteries than those with fewer or no children, hints a new study.

The significance of the finding -- including whether it translates into a greater long-term risk of stroke -- is not clear.

But some past studies have found that the more children a woman has, the higher her risk of heart disease or stroke later on. And that relationship appears to be only partly explained by factors such as weight gain and lifestyle habits.

These latest findings, reported in the journal Stroke, suggest there may be something about pregnancy itself that contributes to progression in the intima-media thickness, or IMT, of the carotid arteries in the neck. An increase in IMT over time serves as a marker of plaque buildup in the arteries.

"We think that some of the many biological changes that accompany pregnancy may be involved," lead researcher Dr. Michael R. Skilton, of the Baker IDI Heart & Diabetes Institute in Melbourne, Australia, told Reuters Health in an email.

For example, he said, blood cholesterol levels go up during pregnancy, as does resistance to the hormone insulin -- which, outside of pregnancy, is a precursor to type 2 diabetes. Pregnancy also alters levels of sex hormones, including estrogen and testosterone, and creates a state of inflammation in the body.

Some or all of those changes may contribute to a concurrent increase in carotid IMT, according to Skilton and his colleagues.

However, the researchers say further studies are needed before women's pregnancy history can be considered a factor in the risk of stroke or heart disease.

According to Skilton, all women should still focus on maintaining a healthy lifestyle -- a well-balanced diet, regular exercise, not smoking -- and controlling any of the traditional risk factors for heart disease and stroke that they may have. Some of those include high blood pressure, high cholesterol, obesity and diabetes.

For the study, Skilton and his colleagues used data from an ongoing project that began following a group of Finnish children and teenagers in 1980. That larger study is aimed at identifying risk factors for cardiovascular disease that take shape early in life.

Skilton's team focused on 1,800 study participants who had ultrasound scans of their carotid arteries in 2001 and 2007, when the group ranged in age from their 20s through mid-40s.

The researchers looked at whether there was any relationship between the number of children women had in the six-year gap between ultrasounds and the progression in carotid IMT.

Overall, the study found, the average carotid IMT increased in both women and men over the study period -- by an average of roughly 7 micrometers per year for women, and 9 micrometers for men.

Similarly, for every child a woman had during the six-year period, her IMT progression increased by 7.5 micrometers.

So the IMT increase associated with childbirth is on par with what's seen over one year of "normal aging," Skilton said.

The number of children women had was related to certain changes in traditional cardiovascular risk factors over the study period. Women who'd had two or more children tended to put on more abdominal fat than other women, and as a group they showed a dip in levels of "good" HDL cholesterol.

However, those changes did not fully explain the connection between pregnancy and carotid IMT progression.

Future studies should try to undercover the mechanisms that underlie the relationship, according to Skilton.

"Once we have identified the mechanism via which pregnancy can influence the health of the blood vessels," he said, "we would like to see whether or not we can find prevention strategies that are suitable for use during pregnancy that could reduce the risks."

Source: http://stroke.ahajournals.org/cgi/content/abstract/STROKEAHA.110 .579219v1

Stroke, online June 10, 2010.

Tuesday, June 22, 2010

 

Well-Defined Quantity of Antioxidants in Diet Can Improve Insulin Resistance, Study Finds

 

ScienceDaily

Tuesday, June 22, 2010

 

ScienceDaily (June 22, 2010) — A diet rich in natural antioxidants improves insulin sensitivity in insulin-resistant obese adults and enhances the effect of the insulin-sensitizing drug metformin, a preliminary study from Italy finds.

 

The results are being presented at The Endocrine Society's 92nd Annual Meeting in San Diego.

 

"The beneficial effects of antioxidants are known, but we have revealed for the first time one of their biological bases of action -- improving hormonal action in obese subjects with the metabolic syndrome," said principal author Antonio Mancini, MD, an endocrinology researcher at Catholic University of the Sacred Heart in Rome.

 

The metabolic syndrome is a cluster of metabolic risk factors for developing diabetes, heart disease and stroke. People with this syndrome cannot efficiently use insulin, the hormone that regulates glucose (sugar) in the blood.

 

Some evidence exists that oxidative stress may play a role in the metabolic syndrome, according to Mancini. Oxidative stress, a biochemical mechanism which can lead to damage to blood particles and to cells, results from an imbalance between an excessive amount of oxidants and decreased antioxidant defenses. Oxidative stress also plays a part in aging.

 

Antioxidants, which are found naturally in fruits, vegetables, legumes and nuts, include vitamins E and C, selenium and carotenoids, such as beta-carotene. Past research shows that antioxidants can prevent oxidative damage to cells and in some cases also help repair damage.

 

Mancini and his colleagues studied the effects of dietary antioxidants on insulin resistance, with partial financial support from MIUR, the Italian Department for University and Research. The study included 16 men and 13 women, ages 18 to 66 years, who were obese and insulin-resistant, but were not yet diabetic.

 

The researchers randomly assigned the subjects to one of four treatment groups. All groups ate a low-calorie, Mediterranean-type diet averaging 1,500 calories daily, containing only 25 percent from protein foods, with the rest made up of low-glycemic-index carbohydrates (carbs that do not raise blood sugar levels quickly or greatly, such as whole grains). Group A only ate this kind of diet, and group B ate the same diet plus took the drug metformin. For groups C and D, the researchers prescribed a diet enriched in antioxidant, with a calculated intake, 800 to 1,000 milligrams a day, coming from fruits and vegetables, but group D also took metformin.

 

Despite similar weight loss in all the groups, only the two groups receiving the antioxidant diet (groups C and D) had a significant decrease in insulin resistance, the authors reported. Group D had the best improvement in insulin resistance on some measures of insulin response to an oral glucose tolerance test, according to the abstract.

 

Subjects reported no adverse effects from the antioxidant diet, Mancini said. When asked about the risk of adding more antioxidants to a diet, he stated, "We think that a total antioxidant level of 800 to 1,000 milligrams a day is safe and probably not close to the maximum tolerable level."

 

Thyroid Function at High End of Normal Tied to Miscarriage Risk

 

HealthDay News

Tuesday, June 22, 2010

TUESDAY, June 22 (HealthDay News) -- Testing in the upper half of what is currently considered a normal range for thyroid function can nonetheless be problematic for pregnant women, who face an increased risk for miscarriage as a result, new research suggests.

The study is the first to link what has previously been considered normal thyroid function to miscarriage risk, according to co-investigator Dr. Alex Stagnaro-Green, a senior associate dean for education at the George Washington University School of Medicine and Health Sciences in Washington, D.C.

The newly observed risk does not involve the presence of thyroid peroxidase antibodies, something that prior research has linked to a threat for miscarriage. An underactive thyroid has also been associated with risk of miscarriage, the study authors noted in a news release from the Endocrine Society.

"There has been an ongoing discussion as to whether or not the normal range for thyroid function tests is too broad," Stagnaro-Green said in the news release. "This study provides clear evidence that the normal range for thyroid function tests during pregnancy needs to be redefined."

The findings are scheduled for presentation Tuesday at the Endocrine Society Annual Meeting and Expo in San Diego.

The researchers' concerns center on the use of the thyroid stimulating hormone blood test. Since 2007, pregnant women reading above the upper limit of 2.5 milli-international units per liter (mIU/L) in the first trimester and 3 mIU/L in the second and third trimesters have been deemed to have an "underactive thyroid," and thus a higher risk for miscarriage.

However, the authors pointed out that many doctors do not actually follow this guideline, instead relying on the non-pregnant "normal range" marker of 4.5 or 5 mIU/L as an upper limit.

Stagnaro-Green and colleagues sought to get a handle on what range is, in fact, safe for pregnant women, by tracking the first-trimester thyroid tests and pregnancy outcomes of more than 4,100 women attending two community hospitals in Italy.

The team found that having a high-end normal-range thyroid reading (above 2.5, but below 5) did not increase the risk for having a pre-term delivery, however, miscarriage rates among women with a high-normal range were "significantly higher" (about 6 percent versus 3.6 percent) than for women with the recommended below-2.5 thyroid reading for pregnant women.

"This leads us to think that all pregnant women should be screened for thyroid function and any abnormalities treated," Stagnaro-Green concluded in the news release.

More information

For more on thyroid disease in pregnancy, visit the U.S. National Endocrine and Metabolic Diseases Information Service.

Cavities in Baby Teeth May Come From Poor Food Choices

 

HealthDay News

Tuesday, June 22, 2010 

TUESDAY, June 22 (HealthDay News) -- Obesity and increased consumption of sugary drinks appear to be linked to rising rates of cavities in very young children, a U.S. study has found.

Researchers looked at 65 children, aged 2 to 5, who received treatment for cavities in baby teeth and found that nearly 28 percent of those kids had a body-mass index that indicated they were overweight or obese.

That rate is 5 percent higher than the estimated national average for childhood overweight or obesity, the study authors explained in a news release from the University at Buffalo, in New York.

The researchers also found that about 71 percent of the children had a daily caloric intake higher than the normal 1,200 calories for their age group.

The preliminary findings were to be presented Tuesday at the Endocrine Society's annual meeting in San Diego.

"We hypothesized that poor nutritional choices may link obesity and dental decay in young children, but there is very little published data associating these two health issues," first study author Dr. Kathleen Bethin, an associate professor of pediatrics at the University at Buffalo and director of the pediatric endocrinology and diabetes fellowship program at Women and Children's Hospital of Buffalo, said in the news release.

"The main point of our findings is that poor nutrition may link obesity to tooth decay. Thus the dental office . . . may be an ideal place to educate families about nutrition and the risks of obesity and dental decay," Bethin stated.

She added that there was "no difference in total calories consumed by the overweight and healthy weight kids, so the problem isn't overeating, per se, just making the wrong food choices."

An estimated 5 percent to 10 percent of youngsters in the United States have early childhood cavities and childhood obesity has more than tripled in the past three decades, affecting nearly one in five kids by 2008, according to Healthy People 2010.

More information

The U.S. Office of Disease Prevention and Health Promotion has more about taking care of your child's teeth.

Six months of breast milk best for babies

 

By Rachael Myers Lowe

Reuters Health

Tuesday, June 22, 2010

NEW YORK (Reuters Health) – Babies are less likely to develop a respiratory or gastrointestinal infection if they are exclusively breastfed for at least 6 months, according to a Dutch study.

These findings, reported in the journal Pediatrics, support the World Health Organization (WHO) recommendation that infants be breastfed exclusively for 6 months and support "current health-policy strategies that promote exclusive breastfeeding for 6 months in industrialized countries," the researchers conclude.

Dr. Henriλtte A. Moll and colleagues at the Erasmus Medical Center in Rotterdam analyzed health data on roughly 4,100 infants born in Rotterdam between 2002 and 2006.

They looked at whether the babies were breast fed, and until what age; whether they were given other foods and at what age, and whether they were treated for any common infections such as serious colds, ear or throat infections, pneumonia, bronchitis, or stomach flu.

In the first 6 months of life, nearly half of all the infants had a respiratory tract infection and nearly 8 percent had a gastrointestinal infection. Between 7 months and a year, 37 percent of the infants had a respiratory tract infection and 9 percent had a stomach bug.

"We observed protective effects of breastfeeding on infectious diseases mainly in the first 6 months of life," the researchers report. "Exclusive breastfeeding until age 6 months tended to be more protective, than exclusive breastfeeding until age 4 months."

In the first 6 months, exclusive breastfeeding cut the risk of respiratory tract infections by about two-thirds, while exclusive breastfeeding for 4 months cut the risk by one third to a half. The reduction in risk from exclusive breastfeeding for 6 months was less pronounced in the second half of the first year of life.

Exclusive breastfeeding -- whether 4 or 6 months -- appeared to have a less dramatic effect in reducing the risk of developing gastrointestinal infections, especially in the second half of the first year.

The study pulled data from a large population of children that allowed the researchers to adjust for factors that could have an impact on infection rates such as family history of asthma, mite allergies, and smoking in the household.

Breastfeeding rates have been trending upward since 1993 in the United States, with the steepest jump seen most recently among African American women. According to the Centers for Disease Control and Prevention, 77 percent of infants born between 2005 and 2006 were breastfed at some point compared to 60 percent in 1993.

The largest drop-off in breastfeeding occurs when women return to work, a fact Moll believes must be addressed by "translating the study results into practice."

She favors extending maternity leave to 4 to 6 months after the birth of a child and creating for working women "adequate facilities to continue breastfeeding." Failing that, breast pumps can be used to express mother's milk for use later.

A recent study found that $13 billion could be saved annually if 90 percent of U.S. mothers would exclusively breastfeed for 6 months. The findings were disputed by the infant formula industry group, International Formula Council, which said the researchers failed the account for the many costs of breastfeeding such as training mothers, time off from the job and setting aside space at the worksite.

Not so, says Dr. Ruth Lawrence, chair of American Academy of Pediatrics' Section on Breastfeeding.

"From a practical standpoint, it's to an employers benefit to facilitate breastfeeding," she told Reuters Health, adding that the study by Moss and colleagues adds to research that shows that breastfed babies are healthier babies.

"Absenteeism of parents of bottle-fed babies is extremely high and that's costly to an industry and it's a lot cheaper to facilitate breastfeeding," Lawrence said.

Source: http://link.reuters.com/sef53m

Pediatrics, July 2010.

More Evidence That B Vitamins Alone Won't Counter Heart Risks 

 

By Madonna Behen
HealthDay Reporter
HealthDay News

Tuesday, June 22, 2010

TUESDAY, June 22 (HealthDay News) -- A new study by British researchers provides the most conclusive evidence to date that taking vitamins to reduce levels of the blood protein known as homocysteine doesn't lower the risk of heart problems.

Homocysteine has been a buzzword among heart disease experts since the early 1990s when scientists noticed that people with elevated levels had an increased risk of heart disease. Because folic acid and other B vitamins are known to lower homocysteine, researchers theorized that taking a daily supplement might lead to heart-related benefits.

The study of more than 12,000 heart attack survivors showed that taking a daily folic acid and vitamin B12 supplement for nearly seven years lowered homocysteine levels by an average of 28 percent, but failed to reduce the risk of heart attack, coronary death or stroke. Seven previous large-scale trials that looked at whether lowering homocysteine levels with folic acid-based supplements might yield heart benefits came to similar conclusions.

"These results have been combined into a meta-analysis with the other large trials and, collectively, the results are conclusively negative," said Dr. Jane M. Armitage, professor of clinical trials and epidemiology at the University of Oxford and a principal author of the report, published in the June 23/30 issue of the Journal of the American Medical Association.

"Our findings suggest that some other factor is associated with both higher homocysteine levels and with increased risk of heart attacks and strokes," Armitage added. "One possibility is that both these things are associated with impaired kidney function."

For their study, Armitage and her co-authors recruited 12,064 heart attack survivors in the United Kingdom between 1998 and 2008. Roughly half of the patients took a tablet containing 2 milligrams (mg) of folic acid and 1 mg of vitamin B12 daily, while the other half took placebos. During 6.7 years of follow-up, there was no difference in the rate of heart attacks, strokes or coronary death between the two groups.

Some previous studies have raised concerns that large doses of folic acid might increase the risk of certain cancers, but the Oxford study found no increased risk of any form of cancer. A planned collaborative meta-analysis of all the large folic acid supplementation trials "should be able to provide even more reliable evidence about any effects on site-specific cancer," the study authors wrote.

"These results highlight the importance of focusing on drug treatments (e.g., aspirin, statins and antihypertensive therapy) and lifestyle changes (in particular, stopping smoking and avoiding excessive weight gain) that are of proven benefit," the researchers concluded.

That viewpoint is in line with what most U.S. doctors have increasingly come to believe, American experts said.

"The findings can really be seen as putting the idea firmly to rest that lowering homocysteine itself can be beneficial," said Dr. Ronald M. Krauss, a senior scientist at Children's Hospital Oakland Research Institute in Oakland, Calif.

Krauss added that the study illustrates that even if a substance is associated with the risk of disease, "you can't automatically assume that changing the levels of that substance is going to have the expected effect on risk."

More information

For more on preventing heart disease, visit the U.S. National Library of Medicine.

Software cuts CT radiation dose in half: study

 

By Julie Steenhuysen

Reuters

Tuesday, June 22, 2010

CHICAGO (Reuters) – A new software program that enhances the quality of CT images allowed doctors to cut in half the radiation dose needed for a colon scan and still produce clear images, U.S. researchers said on Monday.

A series of recent studies has suggested that computed tomography or CT scans can increase a person's lifetime risk of cancer, especially younger people who have multiple scans.

"This new technique allows us to use far less radiation than even a typical abdominal CT scan without compromising image quality," said Dr. Daniel Johnson of the Mayo Clinic in Scottsdale, Arizona, whose study appears in the American Journal of Roentgenology.

CT scans of the colon, sometimes called a virtual colonoscopy, are meant to replace the more invasive test in which a camera is inserted into the rectum and threaded through the colon to look for signs of cancer.

The scans have been shown to be effective, but concerns about radiation exposure have scared many doctors off.

"One of the reasons people say not to get a virtual colonoscopy is because of radiation dose. This is a method you could use to minimize that concern," Dr. Amy Hara of Mayo, who worked on the study, said in a telephone interview.

"The fact that we can now screen patients with an increasingly lower dose can allay concerns, attract more patients to be screened and ultimately save tens of thousands of lives each year," Johnson said in a statement.

Medical equipment makers General Electric, Siemens AG and Philips have been working on ways to reduce the amount of radiation required to produce an image.

Johnson studied a technique launched by GE in 2008 called Adaptive Statistical Iterative Reconstruction or ASIR.

The software allows radiologists to reduce the noise or "fuzz" in an image, making for a clearer picture with less radiation. The team studied image quality using both standard and reduced radiation doses in a "phantom" or dummy colon and in 18 patients.

They saw no significant difference in image quality between the patients who got the test with the standard dose, and those who got less radiation with the ASIR technique. And the phantom study showed much less fuzz when images were made with ASIR.

GE provided the software for the study. Hara said other equipment makers are testing similar products, but so far, GE appears to be in the lead with the technology.

In May, researchers at the International Society for Computed Tomography conference in San Francisco presented the first results of studies using GE's next-generation version of ASIR, which may allow doctors to cut the radiation dose by 80 percent, the company said last month.

(Editing by Maggie Fox and Todd Eastham)

Gaining Weight Later in Life Ups Diabetes Risk

By Serena Gordon
HealthDay Reporter
HealthDay News

Tuesday, June 22, 2010

TUESDAY, June 22 (HealthDay News) -- Gaining weight when you're over age 50, especially around the waist, significantly increases your risk of type 2 diabetes, new research suggests.

Compared to people whose weight remained stable after age 50, people who gained the most weight after 50 (more than 20 pounds) nearly tripled their risk of developing type 2 diabetes, according to the study in the June 23/30 issue of the Journal of the American Medical Association.

"People over the age of 65 are at the highest risk of developing type 2 diabetes, and they have the highest rates of morbidity and mortality from heart disease, which can be related to diabetes. This is really a key clinic and public health issue," said study author Mary Biggs, a research scientist at the University of Washington in Seattle.

"We showed a strong relationship between increasing weight and waist circumference with the risk of type 2 diabetes," she said. "It's important as we get older to try to maintain an optimal weight."

Nearly 24 million Americans have some form of diabetes, according to the American Diabetes Association (ADA). Each year, more than 1.5 million Americans are newly diagnosed with the disease, according to the ADA. Most people who have diabetes have type 2 disease. Being overweight is a significant risk factor for developing type 2 diabetes, no matter what your age.

What hasn't been well-studied, according to Biggs and her colleagues, is how body composition and changing weight affects the risk of diabetes in older adults.

Using data from the Cardiovascular Health Study conducted from 1989 to 2007, the researchers reviewed information on nearly 4,200 people over the age of 65.

At the start of the study, none of the study participants had been diagnosed with diabetes. Statistics on body-mass index (BMI), waist circumference, waist-to-hip ratio and more were collected at the start of the study and over the course of an average of 12 years.

The researchers found that those with the highest levels of baseline measurements had a 4.3 times higher risk of diabetes than those with the lowest measurements.

And, certain measurements posed an even greater risk of diabetes. For example, men older than 65 with a BMI above 28.7 (25 to 29.9 is overweight, and above 29.9 is considered obese) had a 5.6 times higher risk of diabetes than someone with a BMI below 23.3. In women, the risk was 3.7 times higher, the study found.

Biggs said that although there was a difference between men and women, it didn't reach the level of "statistical significance" in this study. If such a difference holds up in further research, Dr. Loren Wissner Greene, an endocrinologist at NYU Langone Medical Center, said the difference would likely stem from the fact that men tend to have more fat around their mid-sections, which is a known risk factor for diabetes.

"Visceral fat more closely relates to insulin resistance, and women tend not to have as much visceral fat," she said.

Waist circumference was also strongly associated with risk of type 2 diabetes. In men, those with waists above 104.6 centimeters had 5.1 times the risk of diabetes, compared to their slimmer counterparts with a waist circumference of less than 89.1 centimeters. In women, the increased risk was 3.6 times higher for those with a waist circumference of 101.1 centimeters, compared to women with a waist measurement of 78.6 centimeters.

A changing weight over mid-life also had a significant impact on diabetes risk. In people who were normal weight at age 50, an increase of 13 to 20 pounds increased the risk of diabetes at age 65 or older by 1.3 times. If the weight gain was more than 20 pounds, the risk increased by 3.2 times.

The effect was even more significant for those who were overweight or obese at age 50, and who gained more weight. The researchers also found that the more weight the study volunteers gained, the greater the risk of diabetes.

"Weight gain increases the risk of diabetes at any age," said Greene.

Both experts recommended trying to keep your weight steady as you age.

More information

For advice on preventing weight gain, visit the U.S. Centers for Disease Control and Prevention.

Acid reflux may disrupt sleep

 

By Amy Norton

Reuters Health

Tuesday, June 22, 2010

NEW YORK (Reuters Health) – Chronic acid reflux may frequently wake people up at night, even when it doesn't cause heartburn symptoms, a small study suggests.

The study, of 39 adults with gastroesophageal reflux disease (GERD) and nine GERD-free adults, found that those with the digestive disorder tended to wake up more often during the night -- an average of three times per night, versus just under twice per night for their GERD-free counterparts.

Their sleep disruptions were often related to reflux episodes, as measured by a probe that was placed in the esophagus overnight.

Yet, the study found, most of the awakenings were not spurred by perceived heartburn symptoms; GERD patients reported sensing symptoms in only 16 percent of their sleep disruptions.

The findings, though based on a small group of patients, suggest that GERD may be contributing to poor sleep more often than has been suspected, said senior researcher Dr. Ronnie Fass, chief of gastroenterology at the Southern Arizona VA Health Care System in Tucson.

In an interview, Fass pointed out that when doctors evaluate patients for nighttime GERD problems, they typically ask about symptoms. However, the current findings suggest that "some wakings will be symptomatic, but many will not be," he said.

Fass suggested that people with GERD tell their doctors if they are waking up frequently during the night, even if they do not feel that heartburn symptoms are the cause.

Then they might see whether gaining better control of the GERD improves their sleep, Fass said.

Some ways of managing GERD include weight loss, if needed; avoiding foods that spur symptoms and eating smaller, more frequent meals; and, for nighttime problems, raising the head of the bed 6 to 8 inches using wooden blocks under the bedposts.

Medications for symptom relief include antacids and acid-reducing drugs known as H2 blockers -- such as ranitidine (Zantac) and cimetidine (Tagamet). Another class of drugs, known as proton-pump inhibitors (PPIs), can be prescribed to help prevent acid reflux episodes, particularly in people with more-severe GERD.

The current study, published in the journal Clinical Gastroenterology & Hepatology, was partly funded by Takeda Pharmaceuticals, which makes the PPI medication Prevacid. Fass serves as a consultant and researcher for the company.

The findings are based on 39 middle-aged adults with GERD who had been having at least three heartburn episodes per week for the previous three months, along with nine healthy adults.

All participants underwent overnight sleep monitoring, where a device worn on the wrist recorded their movements and a probe placed in the esophagus measured instances of acid reflux. Those on H2 blockers stopped using the medications at least three days prior to entering the study, and any PPI use was stopped at least three weeks beforehand.

Overall, the study found, 90 percent of GERD patients woke up at least once during overnight monitoring, with the majority of the awakenings (52 percent) being associated with an acid-reflux episode.

In the healthy comparison group, 78 percent woke up at least once, but never in relation to acid reflux.

Fass and his colleagues also found that in GERD patients, the reflux episodes usually came not before, but after they woke up. If the acid reflux usually happened after, and most awakenings were not accompanied by heartburn symptoms, it is not clear why GERD patients tended to wake up more often, according to the researchers.

One possibility, they say, is that nervous-system activity that helps stimulate acid reflux actually rouses people from sleep before the reflux occurs. Why these episodes would so often be symptom-free is also unclear, but one theory is that sleep reduces the sensitivity of the esophagus to stomach acid.

However, Fass and his colleagues note, some past studies have found that the large majority of acid reflux episodes seen in GERD, regardless of the time of day, may actually not trigger clear symptoms.

Source: http://link.reuters.com/reb53m

 Clinical Gastroenterology & Hepatology, online May 31, 2010.

Hormone Raises Desire for Fattening Foods

 

By Ed Edelson
HealthDay Reporter
HealthDay News

Tuesday, June 22, 2010

TUESDAY, June 22 (HealthDay News) -- You're dieting, and you know you should stay away from high-calorie snacks. Yet, your eyes keep straying toward that box of chocolates, and you wish there was a pill to restrain your impulse to inhale them.

Such a pill might one day be a real possibility, according to findings presented Tuesday at the Endocrine Society's annual meeting in San Diego. It would block the activity of ghrelin, the "hunger hormone" that stimulates the appetite centers of the brain.

The study, reported by Dr. Tony Goldstone, a consultant endocrinologist at the British Medical Research Council Clinical Sciences Center at Imperial College London, showed that ghrelin does raise the desire for high-calorie foods in humans.

"It's been known from animal and human work that ghrelin makes people hungrier," Goldstone said. "There has been a suspicion from animal work that it can also stimulate the rewards pathways of the brain and may be involved in the response to more rewarding foods, but we didn't have evidence of that in people."

The study that provided such evidence had 18 healthy adults look at pictures of different foods on three mornings, once after skipping breakfast and twice about 90 minutes after having breakfast. On one of the breakfast-eating mornings, all the participants got injections -- some of salt water, some of ghrelin. Then they looked at pictures of high-calorie foods such as chocolate, cake and pizza, and low-calorie foods such as salads and vegetables.

The participants used a keyboard to rate the appeal of those pictures. Low-calorie foods were rated about the same, no matter what was in the injections. But the high-calorie foods, especially sweets, rated higher in those who got ghrelin.

"It seems to alter the desire for high-calorie foods more than low-calorie foods," Goldstone said of ghrelin.

That effect was especially pronounced when the participants fasted overnight before the study was done. "We know that when you fast, you tend to crave high-calorie foods more," Goldstone said. "We mimicked that effect."

So a pill that blocked ghrelin's activity could be useful for dieters, and several drug companies already are working to develop one, he said. It wouldn't be something you could pop when a tempting dish appeared, because the blocking effect would take some time to happen, but it could be part of an overall weight-loss regimen, Goldstone said.

"If developed, it might have the particular effect of blocking the desire for high-calorie foods," he said.

The study results come as no surprise, said Alain Dagher, an associate professor of neurology at McGill University in Montreal, who has been studying ghrelin.

In his research, MRI scans of animals found that "ghrelin increases the brain response to food," Dagher said. "So, it's not surprising that a single injection in humans supports a shift to high-calorie foods in general."

Dagher is continuing his studies. "We've been trying to get more specific about exactly how ghrelin acts on the brain, which brain regions it affects and how those effects translate to eating," he said.

Ghrelin might not play a role in causing obesity, but it might act to keep people obese by reducing their ability to lose weight, Dagher said.

More information

To learn what ghrelin is and does, visit the University of Edinburgh.

 

Monday, June 21, 2010

 

Lemurs Lose Weight With 'Life-Extending' Supplement Resveratrol

 

ScienceDaily

Monday, June 21, 2010

 

ScienceDaily (June 21, 2010) — The anti-obesity properties of resveratrol have been demonstrated for the first time in a primate. Researchers writing in the open access journal BMC Physiology studied the compound, generated naturally by plants to ward off pathogens, which has received much interest as a dietary supplement for its supposed life-extending effects.

 

Fabienne Aujard, from the Centre National de la Recherche Scientifique, Paris, France, worked with a team of researchers to investigate the effect of dietary supplementation with resveratrol on the weight, metabolism and energy intake of six mouse lemurs.

 

She said, "The physiological benefits of resveratrol are currently under intensive investigation, with recent work suggesting that it could be a good candidate for the development of obesity therapies. We've found that lemurs eating a diet supplemented with the compound decreased their energy intake by 13% and increased their resting metabolic rate by 29%."

 

The researchers demonstrated that a four-week resveratrol supplementation was associated with a decrease in food intake and a reduction in seasonal body-mass gain. The response to resveratrol supplementation also involved significant changes in the animals' body temperatures. According to Dr Aujard, "These results provide novel information on the potential effects of resveratrol on energy metabolism and control of body mass in a primate."

Journal Reference:

Alexandre Dal-Pan, Stephane Blanc and Fabienne Aujard. Resveratrol suppresses body mass gain in a seasonal non-human primate model of obesity. BMC Physiology, 2010; (in press) [link]

 

Breast Milk Reduces Infections in Babies

 

By Serena Gordon
HealthDay Reporter

HealthDay News

Monday, June 21, 2010

MONDAY, June 21 (HealthDay News) -- Breast-feeding seems to provide an immune system boost to infants, helping to prevent respiratory and gastrointestinal illnesses in babies, according to new research.

Babies who were breast-fed exclusively for 4 months, and then partially until they were 6 months old, had a reduced risk of respiratory and gastrointestinal infections compared to babies who had never been breast-fed, the Dutch team found.

"Exclusive breast-feeding reduces respiratory and gastrointestinal infections in infancy," said the study's senior author, Dr. Henriette Moll, a professor of pediatrics at Erasmus Medical Center's Sophia's Children's Hospital in Rotterdam.

"Our results support health policy strategies to promote exclusive breast-feeding for at least 4 months and preferably 6 months in industrialized countries. This is in line with the World Health Organization recommendations for 6 months of exclusive breast-feeding," said Moll.

Results of this study are published online June 21 and in the July print issue of Pediatrics.

Respiratory and gastrointestinal infections are the most common sources of illness in children, with respiratory illnesses affecting as many as 32.1 percent of infants and gastrointestinal illnesses occurring in up to 26.3 percent of infants, according to estimates in the study. Upper respiratory illnesses include colds, ear infections and throat infections, while lower respiratory infections include pneumonia, bronchitis and bronchiolitis.

Factors that may increase the risk of a baby developing a respiratory or gastrointestinal infection include birth weight, gestational age, race, socioeconomic status, the number of siblings, day-care attendance and whether or not a parent smokes, the study noted.

One factor that appeared to be protective was breast-feeding.

To assess the level of protection that breast-feeding might provide, the researchers mailed questionnaires to Dutch women whose infants were aged 6 to 12 months. The women were already participating in a long-term study designed to follow women and their offspring from early pregnancy through young adulthood.

Researchers received complete information about breast-feeding and infectious diseases contracted by the infants from almost 4,200 of the women, according to the study.

Twenty-nine percent of the infants were breast-fed for less than four months, while 25 percent were breast-fed from four to six months. Thirty-four percent breast-fed for six months or longer, and 12 percent didn't breast-feed at all. Only 1.4 percent of the babies who were breast-fed for six months were breast-fed exclusively during that time.

The researchers found that when infants were breast-fed exclusively for four months and then at least partially thereafter, the risk of respiratory and gastrointestinal illnesses was significantly reduced. Compared to babies who were never breast-fed, the risk of lower respiratory infections dropped by 50 percent, the risk of upper respiratory infections were reduced 35 percent and the risk of gastrointestinal illnesses dropped by 59 percent, according to the study.

Moll said that breast-feeding exclusively until 6 months appeared to provide even more benefit, but the number of babies who were breast-fed exclusively for that length of time was too low to reach statistical significance.

She said it wasn't clear from this study exactly why the breast-fed babies were better able to fend off infection, but suspects that some of the components of breast milk provide an immune system boost. For example, one component of breast milk is Iga (immune globulin A), a substance that is normally secreted at the lining of the respiratory tract and may have antimicrobial properties, according to Moll.

Adding formula or solid food to the diet might blunt the effect of the breast milk by disrupting the balance of nutrients provided by breast milk, said Moll.

"Respiratory and GI infections are very common in infants, and breast-feeding seems to positively impact the incidence of these infections," said Dr. Michael Green, an infectious disease specialist with Children's Hospital of Pittsburgh.

"Unless there is a medical contraindication, like an HIV infection, there's no absolute reason not to breast-feed and certainly lots and lots of great reasons to do so, and this study confirms the baby will get infectious disease benefits," said Green. But, he added that some women and families have a hard time breast-feeding, and they shouldn't be made to feel bad if they can't breast-feed for a long time.

He recommended that breast-feeding education be included as part of prenatal education so that women are well-prepared to breast-feed and know what problems they might encounter as well as how to deal with them.

More information

Learn more about the benefits of breast-feeding from the National Women's Health Information Center.

Induced labor may double the odds of C-section

 

By Amy Norton

Reuters Health

Monday, June 21, 2010

NEW YORK (Reuters Health) – First-time mothers who have their labor induced may face a greater risk of needing a cesarean section than those who go into labor naturally, a new study finds.

In a study of 7,800 first-time mothers who gave birth at one U.S. medical center, researchers found that those who had their labor induced were twice as likely to ultimately need a C-section.

Of all women in the study, 44 percent had their labor induced -- and the researchers estimate that failed induction accounted for 20 percent of the C-sections performed.

The findings, reported in the journal Obstetrics & Gynecology, firm up the link seen in past studies between labor induction and an increased risk of C-section. By definition, labor induction is performed before a woman's body is ready for spontaneous labor, and in some cases there will be problems with labor progression that necessitate a C-section.

The connection is important because while cesarean section is a generally safe procedure, it requires a longer recovery time than vaginal birth, and does present certain risks, such as blood clots, infection at the incision site or in the lining of the uterus, and breathing problems in the baby.

Moreover, the rates of both labor induction and C-section have been on an upward trend in the U.S. since the 1990s. Labor inductions have risen from just under 10 percent of births in 1990 to 22 percent in 2006; and in 2007, C-sections were done in almost one-third of all births.

The current findings suggest that putting more limits on so-called "elective" inductions would help lower the number of C-sections performed nationally, according to lead researcher Dr. Deborah B. Ehrenthal of the Christiana Care Health System in Newark, Delaware.

There are circumstances in which labor induction may be advisable. There is good evidence, for example, that inducing labor benefits mom and baby when pregnancy goes beyond 41 weeks, Ehrenthal told Reuters Health in an interview.

Normally, pregnancy lasts about 40 weeks, and prolonged or "post-term" pregnancy carries an increased risk of certain complications, including stillbirth.

According to the American College of Obstetrics and Gynecology (ACOG), labor induction may also be warranted in certain other circumstances -- such as when a mother has pregnancy-related high blood pressure or diabetes, or when the mother's "water breaks" but labor does not spontaneously begin.

In general, elective labor induction refers to those done with no clear medical reason. It may be done for convenience, for example, or in cases where late pregnancy is causing significant physical discomfort or when a woman wants to ensure that her own doctor delivers the baby.

Of the labor inductions performed in this study, 40 percent were elective. The findings were based on women's medical records, and Ehrenthal said that her team considered any induction without a documented maternal or fetal indication to be elective. The precise reasons for those elective inductions are unknown.

It is not possible to tell what the "right" number of labor inductions in this study group -- or among pregnant women in general -- should be, according to Ehrenthal. "Were we doing the right number 15 years ago, or are we doing the right number now? We don't know," she said.

According to Ehrenthal, the bottom line for pregnant women is that they should understand the reasons for and potential risks of all forms of delivery. "It's really important to have a frank discussion with your doctor about all of your options for delivery," she said.

Dr. Caroline Signore, a scientist with the U.S. National Institute of Child Health and Human Development who wrote an editorial published with the study, agreed that women contemplating an elective labor induction should be aware of the relatively higher risk of C-section.

In an interview, she also pointed out that when first-time moms have a C- section, they often have repeat cesareans with any future pregnancies. So limiting the need for C-section in first-time pregnancies is particularly important.

Signore said that the rate of labor induction in this study -- at 44 percent -- was striking.

Even among the 4,600 women in the study considered "low risk" for needing a labor induction -- because they were not post-term, were free of diabetes, high blood pressure and obesity, and the fetus was not overly large -- 29 percent had their labor induced. (The portion of those that were elective was not reported.)

Among these low-risk women, one-quarter of those who had a labor induction ended up needing a C-section, versus 14 percent of those who had a natural labor.

According to Signore, it is not clear why national rates of labor induction -- and elective labor induction in particular -- have risen so significantly since the 1990s.

But the current findings, she said, underscore a widespread need for medical centers and providers to try to cut rates of "inappropriate" labor induction. "Labor induction performed for no medical reason is an area for us to target," Signore said.

In her editorial, Signore also points out that according to ACOG guidelines, elective inductions and elective C-sections should not be scheduled before the 39th week of pregnancy, in order to reduce the odds of complications associated with relatively earlier birth.

However, she adds, recent studies suggest that this guideline is "not followed rigorously."

A study published last month, for example, found that as the U.S. national rate of labor induction rose between 1992 and 2003, so did the proportion of births occurring at the earlier end of full-term -- that is, in the 37th or 38th week.

In 2003, the study found 30 percent of all full-term singleton births occurred during the 37th or 38th week, versus 19 percent in 1992. The researchers concluded that labor inductions performed before the 39th week were a "likely cause" of that trend.

Source: http://journals.lww.com/greenjournal/

Obstetrics & Gynecology, July 2010.

Flame Retardant May Up Risk of Thyroid Problems in Pregnancy

 

HealthDay News

Monday, June 21, 2010

MONDAY, June 21 (HealthDay News) -- Exposure to flame-retardant chemicals may reduce a pregnant woman's levels of certain thyroid hormones that play a critical role in fetal brain development, a new study shows.

Polybrominated diphenyl ether (PBDE) flame retardants are used in a large number of consumer products, including cars, electronics and home furnishings. PBDEs are found in the blood of most Americans, according to data collected by the U.S. Centers for Disease Control and Prevention.

In the new study, published online June 21 and in an upcoming print issue of the journal Environmental Health Perspectives, researchers from the University of California, Berkeley, measured thyroid hormone levels in 270 women, most of them Mexican-American, and found that those with higher PBDE levels had lower levels of thyroid-stimulating hormone.

Women with the highest levels of the flame retardant in their blood were more likely to have subclinical hyperthyroidism, which is defined as below-normal levels of thyroid-stimulating hormone with normal levels of the thyroid hormone thyroxine (T4), the researchers found.

"Women with low [thyroid-stimulating hormone] may be above their natural set-point for the T4 thyroid hormone, which means that their thyroids may not be functioning normally," study author Jonathan Chevrier, of the Center for Children's Environmental Health Research at University of California, Berkeley, said in a news release from the journal's publisher.

"Elevated T4 in pregnancy has been associated with increased risks of miscarriage, premature birth and intrauterine growth retardation," study co-author Brenda Eskenazi added.

"A mother's thyroid hormones affect her developing baby throughout her pregnancy, and they are essential for fetal brain development," Eskenazi, director of the Center for Children's Environmental Health Research, stated in the news release.

More information

The U.S. Agency for Toxic Substance and Disease Registry has more about PBDEs.

Early menopause raises heart disease risk

 

Reuters

Monday, June 21, 2010

WASHINGTON (Reuters) – Women who go through menopause early, before age 46, may have more than twice the risk of having a heart attack, stroke or other cardiovascular event later in life, researchers reported on Monday.

The risk was the same even when women took hormone replacement therapy, which doctors once prescribed expressly to prevent heart disease, the researchers said at a meeting of the Endocrine Society in San Diego.

"It is important for women to know that early menopause is a potential risk factor for cardiovascular disease, the number one killer of American women," Dr. Melissa Wellons of the University of Alabama at Birmingham, who led the study, said in a statement.

"They can then work harder to improve their modifiable risk factors, such as high cholesterol and blood pressure, by exercising and following a healthy diet," Wellons said.

Doctors should routinely ask older women when they experienced menopause, she said. The average age of menopause is 51.

Her team studied more than 2,500 women who were 45 to 84 when the study started in 2000. Nearly 28 percent of them reported early menopause; 446 women or 18 percent had natural menopause and 10 percent had menopause caused by having their ovaries removed.

None of the women had a heart attack, stroke, chest pain known as angina, heart bypass surgery or a suddenly stopped heart before the age of 55.

But after that, the women who had early menopause were more likely to have had one of these things happen than the others. They were more than two times as likely to have one of these heart events, even when the researchers accounted for any extra weight gain.

Nearly 6 percent of women who went though menopause early had some sort of heart event, compared to 2.6 percent of women who had not gone through menopause or who went through it after age 47, they told the meeting.

"Our study is observational; therefore, we cannot conclude that early menopause somehow causes future cardiovascular disease," Wellons said. "However, our findings do support the possible use of age at menopause as a marker of future heart and vascular disease risk."

Before 2002, doctors widely prescribed hormone replacement therapy, or HRT, to lower the risk of heart disease or osteoporosis, both of which go up sharply after menopause.

But use of HRT plummeted in 2002 after the publication of the Women's Health Initiative study, which found an increased risk of ovarian cancer, breast cancer, strokes and other problems from hormone therapy. Studies have also found HRT does not protect against heart disease.

Sales of U.S. market leader Wyeth's combined estrogen-progestin therapy Prempro have fallen by about 50 per cent since 2001 to around $1 billion a year. Wyeth is now owned by Pfizer.

(Editing by Bill Trott)

More Than Half of Pediatricians Make Diagnostic Errors: Survey

 

By Jenifer Goodwin
HealthDay Reporter
HealthDay News

Monday, June 21, 2010

MONDAY, June 21 (HealthDay News) -- You're not the only one who can't always tell if your child has a viral illness or a bacterial infection that calls for antibiotics: Pediatricians say this is the most common diagnostic error they make, a new study shows.

Other common missed or mistaken diagnoses include those involving medication side effects, psychiatric disorders, appendicitis, asthma and ear infections, according to the study.

Researchers surveyed more than 700 pediatricians and pediatric trainees (residents and fellows), and found that more than half reported misdiagnosing a child once or twice a month. That included about 77 percent of the pediatric trainees.

Nearly half said that once or twice a year, those misdiagnoses were significant enough to cause harm.

Researchers did not ask the extent of the harm, however, and said they didn't have enough information to gauge the seriousness of it. But previous research cited in the study shows that 32 percent of pediatric malpractice claims are due to diagnostic errors.

"These are perceptions and much more research has to be done to really delineate how often this happens," said senior study author Dr. Geeta Singhal, an assistant professor of pediatrics at Baylor College of Medicine in Houston. The research is published in the July issue of Pediatrics.

The survey was conducted among pediatricians at three sites in Cincinnati and Houston. Diagnostic errors include those that are delayed, wrong or missed.

Pediatricians most often cited a failure to gather information through medical history, exam or chart review as the cause of errors. Other causes of misdiagnoses included failure of parents to seek care for their child in a timely manner, failure to follow-up on abnormal lab tests and parents ignoring follow-up recommendations.

To reduce errors, physicians said closer follow-up of patients, improved teamwork between members of the health-care team and more time spent with patients during appointments would help. Improving access to information through electronic health records and diagnostic decision-support tools would also avert some errors, pediatricians said.

Since pediatricians aren't always right, Singhal said, parents who are unsure of a diagnosis should be encouraged to ask for more information or seek a second opinion.

"It's important to me as a pediatrician and as a mom to empower our patients and our families to ask good questions of their physicians," Singhal said. "If they are not comfortable with the diagnosis, it's OK to ask the doctor to elaborate more or help them understand better."

With so many of the misdiagnoses involving viral versus bacterial infection, families should also try not to push for antibiotics if the doctor doesn't feel there's a need, Singhal said.

Dr. Daniel Neuspiel, a liaison on the American Academy of Pediatrics' Steering Committee on Quality Improvement and Management, said the findings weren't surprising.

"We know that errors of all sorts are rampant in health care," said Neuspiel, director of ambulatory pediatrics at Levine Children's Hospital in Charlotte, N.C. "The main issue is not lack of knowledge, but that our systems in health care are set up in an antiquated way that allows for flaws to easily occur. The way we work, and I speak for myself as well in my own practice, relies too heavily on memory. Most of the time, I get things right, but not infrequently, I and other well-meaning pediatricians do make errors."

Neuspiel suggested that the medical profession could learn from other industries in which errors can mean life and death, including airlines, automakers and the building industry. "One thing they have done, and I think health care is starting to learn, is the importance of having more standard processes in place," Neuspiel said.

That includes clinical practice guidelines that offer evidence-based, standardized approaches to problems; greater reliance on checklists to ensure proper steps were followed in making a diagnosis; comprehensive electronic health records that automatically flag pediatricians about prescription errors (such as dosage or drug interactions) or remind doctors about tests that should be scheduled and followed-up on.

More information

The Nemours Foundation has tips for how parents can effectively talk to their child's doctor.

Sunday, June 20, 2010

 

PCBs May Weaken Kids' Vaccination Response

 

HealthDay News

Sunday, June 20, 2010

SUNDAY, June 20 (HealthDay News) -- Children exposed early in life to polychlorinated biphenyls (PCBs) may have a reduced immune response to tetanus and diphtheria vaccines, a new study indicates.

The findings suggest that exposure to the environmental pollutants in the first years of life (a critical time in immune system development) could undermine the effectiveness of childhood vaccinations and possibly weaken immune system responses to infection, the Danish and U.S. researchers reported.

They studied 587 children born between 1999 and 2001 on the Faroe Islands, located in the North Atlantic between Norway and Iceland. Residents of the islands have widely varying PCB exposure because of different patterns of consumption of PCB-contaminated foods, such as pilot whale blubber.

The children's mothers provided blood samples at 32 weeks of pregnancy and breast-milk samples four to five days after birth. The children were vaccinated against tetanus and diphtheria at 3, 5 and 12 months and received booster shots at 5 years. Blood samples were collected from the children at 12 or 18 months, before and after vaccinations at age 5, and again at age 7.

The blood and milk samples taken from the mothers were analyzed for PCBs, and the children's blood samples were analyzed for PCBs and/or diphtheria and tetanus antibody concentrations.

The researchers found that higher PCB concentrations, particularly in children at 18 months, were associated with lower concentrations of diphtheria and tetanus antibodies at ages 5 and 7. Some children had antibody levels lower than what's needed to protect against the two diseases.

The study was published online June 20 in advance of print publication in the journal Environmental Health Perspectives.

More information

The U.S. Agency for Toxic Substances and Disease Registry has more about PCBs.

Stomach Hormone Ghrelin Increases Desire for High-Calorie Foods, Study Finds

 

ScienceDaily

Sunday, June 20, 2010

 

ScienceDaily (June 20, 2010) — The "hunger" hormone ghrelin, which acts in the brain to stimulate hunger and increase food intake, heightens the appeal of high-calorie foods over low-calorie foods, according to a study being presented at The Endocrine Society's 92nd Annual Meeting in San Diego.

 

"It raises the possibility that drugs that block the action of ghrelin may help reduce cravings for high-calorie foods and so help people lose weight," said lead author Tony Goldstone, MD, PhD, a consultant endocrinologist with the MRC Clinical Sciences Centre at Imperial College London in the U.K.

 

The results also suggest, according to Goldstone, that an increased release of ghrelin from the stomach into the blood may explain why a person who skips breakfast also finds high-calorie foods more appealing than low-calorie foods.

 

In the new study, healthy, nonobese adults -- 13 men and 5 women -- viewed pictures of food on three separate mornings: once after skipping breakfast and twice about 90 minutes after eating breakfast. On one of the visits when subjects ate breakfast, they received an injection of salt water (as a control) 40 minutes before viewing the food pictures, and on the other visit with breakfast, they received an injection of ghrelin. Neither the volunteers nor the investigators were aware of which injection was given on which visit.

 

Pictures of high-calorie foods included chocolate, cake and pizza. Among the low-calorie foods pictured were salads, vegetables and fish. Using a keypad, the subjects rated how appealing they found each food picture.

 

The appeal of low-calorie foods did not differ significantly between visits. High-calorie foods were of similar appeal to low-calorie foods when subjects ate breakfast and then received a salt-water injection. However, high-calorie foods, especially sweet foods, were of greater appeal when subjects fasted and when they received ghrelin after eating breakfast.

 

"Ghrelin mimicked fasting in biasing food appeal toward high-calorie foods," Goldstone said. "Changes in which foods we prefer to eat when missing meals may be explained by changes in the levels of ghrelin in our blood to help regulate our overall calorie intake."

 

Goldstone's group obtained functional magnetic resonance images -- MRIs -- of brain activity while subjects rated how much the food pictures appealed to them. After analyzing these images, the researchers expect to identify the brain "reward" systems through which ghrelin affects food preferences.

 

The U.K. Medical Research Council helped fund this study, as did the Wellcome Trust, European Union NuSISCO (Nutrient Sensing in Satiety Control and Obesity), U.K. National Institute for Health Research and Imperial College Healthcare Charity.

 

'Junk Food' Sugar May Help Some Fat Cells Proliferate

 

By Amanda Gardner
HealthDay Reporter
HealthDay News

Sunday, June 20, 2010

SUNDAY, June 20 (HealthDay News) -- New research suggests that the ubiquitous sugar known as fructose may cause certain fat cells in children to multiply faster, which might play a key role in childhood and adult obesity.

Fructose is a component of high-fructose corn syrup, which is widely used in a variety of foods, including soft drinks, candy and many processed foods.

But although the new studies did use cells taken from children, they were performed only in test tubes and experts called for caution in interpreting the findings.

"You can't draw a conclusion based on a single study, and this study was not done in humans [only human cells]. We need to take that into consideration," said Keri Gans, a spokeswoman for the American Dietetic Association.

That said, childhood (and adult) obesity is a legitimate and growing concern around the world. This condition ups the risk for heart disease, type 2 diabetes and a host of other diseases. Some of this is already being played out among young people.

"We're seeing more type 2 diabetes in children, and that's due to children being overweight," Gans said. "What's even scarier is that children are increasing their risk for developing heart disease earlier."

Experts have noted a rise in blood pressure and cholesterol levels in overweight children.

"The fear is that this generation might be the first generation that might not outlive their parents," Gans said.

According to the research, which is to be presented Sunday at the Endocrine Society's annual meeting in San Diego, high-fructose corn syrup is becoming more prevalent in American foods than sucrose.

The authors, led by doctoral candidate Georgina Coade at the University of Bristol in Britain, extracted pre-adipocytes -- the cells that eventually turn into fat cells -- from 32 children who were normal weight and were still pre-pubescent.

The cells were both subcutaneous fat cells (those just below the skin) and visceral cells (those deeper in the abdomen).

The cells were soaked in a solution of normal level glucose, high-level glucose or in high fructose and were allowed to mature.

According to the researchers' calculations, fat cells that grew in fructose divided and multiplied more than those soaked in glucose -- but this was true only for visceral fat.

On the other hand, both visceral and subcutaneous fat cells exposed to glucose displayed increased insulin resistance, a risk factor and property of diabetes.

But Dr. James Rippe, a consultant for the Corn Refiners Association, founder and director of Rippe Health Evaluation and chairman of the Center for Lifestyle Medicine at the University of Central Florida, pointed out that high-fructose corn syrup, which has been implicated in the diabetes and obesity epidemics, is not equivalent to pure fructose.

"It's a very unfortunate and common error. They're not the same thing," he said. "High fructose corn syrup is half fructose and half glucose."

Still, Gans said, "the main message is we're talking about sugar, and the bottom line is too much sugar of any kind is going to give you too many calories, and too many calories lead to weight gain, and that's where the problem lies."

Dr. Neslihan Gungor, an associate professor of pediatrics at Texas A&M Health Science Center College of Medicine and a pediatric endocrinologist at Scott & White Hospital in Temple, Texas, reiterated the importance of remembering that the findings came only from laboratory study.

"We still must see whether or not the findings are observed in the human body," she said. "It wouldn't be fair to take these results and apply them to the whole human organism."

More information

There's more on childhood obesity at the U.S. Centers for Disease Control and Prevention.

Higher Testosterone Tied to Heart Trouble in Older Men

 

HealthDay News

Sunday, June 20, 2010

SUNDAY, June 20 (HealthDay News) -- Among older men, having a high testosterone level is associated with a raised risk of heart disease or a heart attack, new research suggests.

The finding, from a new U.S. National Institutes of Health-funded study, concerns men over the age of 65 and is based on a tracking of hormone levels and heart disease among nearly 700 community-dwelling men.

Study author Dr. Kristen Sueoka, a resident physician at the University of California, San Francisco, is scheduled to present the finding Sunday at the Endocrine Society's Annual Meeting and Expo, held in San Diego.

"The study finding contradicts smaller studies that have shown that testosterone levels are not associated with higher rates of cardiovascular disease," Sueoka said in a news release from the Endocrine Society.

"Many in the general public are using testosterone supplements for various medical problems, including low sex drive and mood disorders, which are not life-threatening. These men may unknowingly be placing themselves at higher risk for cardiovascular disease," she added.

None of the study participants were on any testosterone replacement therapy at the time of the study. Over an average of four years of follow-up, the study authors found that 100 of the men (14 percent) experienced either a heart attack, unstable angina (considered a pre-heart attack warning sign), and/or angioplasty or bypass surgery to clear clogged arteries.

The research team further noted that men at the highest end of the testosterone spectrum had more than twice the risk for coronary disease than men with the lowest testosterone levels.

"One day testosterone measurements may be used to help predict which men are more likely to develop cardiovascular disease," Sueoka suggested. "But we need more studies to confirm that high testosterone is a risk factor for heart disease."

More information

For more on risk factors for heart disease, visit the American Heart Association.

Saturday, June 20, 2010

 

Poor Control of Diabetes May Be Linked to Low Vitamin D

 

ScienceDaily

Saturday, June 20, 2010

 

ScienceDaily (June 19, 2010) — Vitamin D deficiency is highly prevalent in patients with Type 2 diabetes and may be associated with poor blood sugar control, according to a new study.

 

The results are being presented at The Endocrine Society's 92nd  Annual Meeting in San Diego.

 

"This finding supports an active role of vitamin D in the development of Type 2 diabetes," said study co-author Esther Krug, MD, an assistant professor of medicine at The Johns Hopkins University School of Medicine and an endocrinologist at Sinai Hospital, Baltimore.

 

Krug and her colleagues reviewed the medical charts of 124 patients with Type 2 diabetes who came to an endocrine outpatient clinic for specialty care from 2003 to 2008. Patients' age ranged from 36 to 89 years. All patients had a single measurement of their serum 25-hydroxyvitamin D levels as part of their evaluation at the clinic. The researchers divided the patients into quartiles based on vitamin D level.

 

Despite receiving regular primary care visits before referral to the endocrine clinic, 91 percent of patients had either vitamin D deficiency (defined as a level below 15 nanograms per deciliter, or ng/dL) or insufficiency (15 to 31 ng/dL), the authors reported. Only about 6 percent of patients were taking vitamin D supplements at their first visit.

 

Additionally, the investigators found an inverse relationship between the patients' blood levels of vitamin D and their hemoglobin A1c value, a measure of blood sugar control over the past several months. Lower vitamin D levels were discovered in patients with higher average blood sugars as measured by HbA1c, Krug said. Compared with whites, blacks had a higher average A1c and lower average vitamin D level.

 

"Since primary care providers diagnose and treat most patients with Type 2 diabetes, screening and vitamin D supplementation as part of routine primary care may improve health outcomes of this highly prevalent condition," she said.