Personal Health



Friday, July 9, 2010


Does pollution really increase stroke risk?


By Rachael Myers Lowe

Reuters Health

Friday, July 9, 2010

NEW YORK (Reuters Health) – Living in city smog may be bad for the lungs, but whether it also plays a role in jacking up stroke risk, as studies have suggested, warrants another look, new Canadian research concludes.

Health Canada's Paul Villeneuve and colleagues did find a higher incidence of stroke among residents of the smoggiest areas of Edmonton, Canada, but once income levels were taken into account, "the air pollution effect was lowered and disappeared," the study co-author told Reuters Health.

Previous research has "consistently" shown that short-term exposure to air pollution can increase the risk of stroke-related death, but long-term exposure had not been studied, the Canadian researchers note in the journal Stroke.

To address that question, they looked at environmental and health data gathered between 2003 and 2007, at the neighborhood level, in Edmonton, Alberta, a city surrounded by oil, gas and coal processing plants.

The authors found more than 7,300 hospitalizations for stroke and cross-referenced them to neighborhood pollution levels. Although a first glance at the numbers suggested an association between long-term exposure to smog and strokes, "once we adjusted for neighborhood characteristics such as income, the increased risk disappeared," Villeneuve said.

Only those Edmontonians living in traffic congested areas of the city appeared to face a higher risk of stroke, but smog was only one of any number of explanations. "It could also be explained by the tendency for populations more prone to stroke and with greater need for access to large health care centers to live in higher traffic areas than in remote areas," they write.

The traffic congestion-stroke association could help influence public policy, Dr. Jiu-Chiuan Chen, of the University of Southern California Keck School of Medicine, told Reuters Health.

"From the public health perspective, results of chronic health effect studies (like this one) will have larger impact on environmental regulation, as compared the results of short-term effect studies," said Chen, who has published research on the subject but was not involved in the current study.

US regulators have been keenly interested in "epidemiologic evidence on chronic health effects, especially those emerging health data on the toxicity of traffic-related air pollutants," Chen noted.

The Canadian authors acknowledge their findings contradict not only previous stroke research but also a similar Canadian study into a possible connection between pollution and heart disease. They urge caution in interpreting the results because the reasons for the discrepancies "are not entirely clear."

"Things like affluence are associated with a number of other risk factors for stroke, for example people of lower socio-demographic status may be more likely to smoke or may be more inactive or may have exposure to other things that could increase the risk of stroke," he said.

Villeneuve characterized his research as an interim study. More research is underway, he said, to "disentangle" the risk posed by long-term exposure to air pollution and other more well-established stroke risks such as smoking, physical inactivity, and being overweight.


Stroke, online June 10, 2010.

Early Alzheimer's Identification Method Discovered



Friday, July 9, 2010


ScienceDaily (July 9, 2010) — Abnormal brain images combined with examination of the composition of the fluid that surrounds the spine may offer the earliest signs identifying healthy older adults at risk of developing Alzheimer's disease, well before cognitive problems emerge, a study by researchers at UC Davis has found.

"Our findings indicate that a distinctive pattern of imaging and biomarker deviations from typical adults may be an early warning sign of neurobiological pathology and an early sign of Alzheimer's disease," said Laurel Beckett, a professor of public health sciences at UC Davis and the lead study author. "By the time people get diagnosed with Alzheimer's using cognitive tests, there's already a lot of brain damage. We hope that in the future methods that combine brain imaging and biomarker assessments can push the diagnosis back, while learning more about the mechanisms causing Alzheimer's disease, so we can develop better treatments."

Published in the journal Neurobiology of Aging in June, the study analysis picked out a subgroup of healthy adults who later would experience a decline in memory performance typical of early Alzheimer's disease long before other study participants.


For the study, Beckett and her team used data from the Alzheimer's Disease Neuroimaging Initiative, which provides researchers with access to brain scans, clinical data and other laboratory results from spinal fluid and blood tests from more than 800 older adults. Some study participants began with a clean slate of cognitive health, some with mild cognitive impairment -- a condition that often presages Alzheimer's -- and others with mild or moderate Alzheimer's disease.


The researchers analyzed data from 220 normal older adults who had undergone structural magnetic resonance imaging (MRI) and clinical examinations. About half also provided spinal fluid samples. Among the 96 participants, cluster analysis identified three distinct subgroups of individuals based solely on their baseline imaging and laboratory measures. During the next three years, few of these healthy people showed any cognitive change. But cognitive tests for people in one of the subgroups -- about 10 percent of the sample -- declined at nearly five times the rate as healthy older adults. The researchers believe this group, which had the most extreme MRI and spinal fluid measurements, may represent the earliest stages of subclinical cognitive decline and Alzheimer's disease.


Beckett said that the finding is an important step toward discovering the constellation of imaging and fluid biomarkers that foreshadow cognitive decline, as well as a means of determining whether new treatments are effective.


"The problem with current clinical trials is that we don't know who is on the edge of experiencing dementia. And even if we did, how would we know if a treatment was working, since they haven't shown any clinical problems?" Beckett said. "This method could improve clinical trials for prevention and reduce the numbers of study participants necessary to speed drug discovery -- and eventually change how the pharmaceutical industry and National Institutes of Health conduct Alzheimer's disease clinical trials."


Other study authors include Jasmine Nettiksimmons, Danielle Harvey, Owen Carmichael and Charles DeCarli of UC Davis; James Brewer of UC San Diego; Clifford R. Jack Jr. and Ronald Petersen of the Mayo Clinic College of Medicine; and Leslie Shaw, John Trojanowski and Michael Weiner of UC San Francisco.

The study was funded by the Alzheimer's Disease Neuroimaging Initiative, the National Institutes of Health and the Dana Foundation.

Journal Reference:

J. Nettiksimmons, D. Harvey, J. Brewer, O. Carmichael, C. DeCarli, C.R. Jack Jr, R. Petersen, L.M. Shaw, J.Q. Trojanowski, M.W. Weiner. Subtypes based on cerebrospinal fluid and magnetic resonance imaging markers in normal elderly predict cognitive decline. Neurobiology of Aging, 2010; 31 (8): 1419 DOI: 10.1016/j.neurobiolaging.2010.04.025

Anxiety may worsen prognosis for heart patients


By Anne Harding

Reuters Health

Friday, July 9, 2010

NEW YORK (Reuters Health) – Anxiety increases heart patients' likelihood of suffering a heart attack, stroke, or heart failure, new research shows.

And the link between anxiety and such events can't be explained by health behaviors like smoking, severity of disease, or biological factors such as hormone levels or heart rate, Dr. Elisabeth J. Martens of Tilburg University, the Netherlands, and colleagues found.

"This was quite surprising," Martens told Reuters Health by email. "The next step will be to find out how anxiety disorder leads to poor cardiovascular outcomes."

People with generalized anxiety disorder experience chronic, exaggerated worry and tension. The condition typically is treated with medications and certain kinds of talk therapy.

Martens and her team had previously found an association between depression and risk of heart attacks, strokes and other cardiovascular events in the same group of patients. All were participating in the Heart and Soul Study, an investigation of the relationship between psychological disorders and cardiovascular events in 1,024 California heart disease patients.

Martens and her colleagues found that poor health behaviors-especially physical inactivity-largely explained why depressed patients fared worse.

Because anxiety is closely linked with depression, the researchers decided to look at whether generalized anxiety disorder affected outcomes too. Their analysis included 1,015 patients, 106 of whom had generalized anxiety disorder. All had stable cardiovascular disease, meaning that they had evidence of poor blood flow in their heart, but were not experiencing a worsening of their disease.

During six years of follow-up, 371 cardiovascular events-heart attack, stroke, heart failure, or death--occurred among the study participants. Nearly 10 percent of those with generalized anxiety disorder had a heart-related event in a given year, compared to about 7 percent for those without the disorder.

After the researchers accounted for dozens of factors that might explain why the anxious patients were at greater risk, such as depression, physical activity, whether or not they took prescribed medications, and inflammation, the relationship was still there, with anxiety disorder increasing risk by 74 percent.

In their paper in the Archives of General Psychiatry, Martens and her team propose a few possible explanations for the relationship; surges of "fight-or-flight" hormones due to anxiety could be a factor, they say, while anxious patients might also be less likely to seek out preventive care.

For now, Martens says, the presence of anxiety disorder in heart patients could be used to flag those at particularly high risk.

"Evaluation and treatment of anxiety may also be considered as part of the comprehensive management of patients with CHD," she added. "Anxiety disorder is common and treatable and could, therefore, be an important modifiable risk factor in patients with CHD."


Archives of General Psychiatry, July 2010.

Extremely Obese Children Have 40 Percent Higher Risk of Reflux Disease of Esophagus, Study Finds



Friday, July 9, 2010


ScienceDaily (July 9, 2010) — Extremely obese children have a 40 percent higher risk of gastroesophageal reflux disease (GERD) and children who are moderately obese have a 30 percent higher risk of GERD compared to normal weight children, according to a Kaiser Permanente study published online in the International Journal of Pediatric Obesity.

This large population-based study establishes an association between obesity and GERD in children, an association that has been previously reported in adults. GERD can lead to decreased quality of life, chronic respiratory conditions, and increased risk for cancer of the esophagus (the tube that carries food from the mouth to the stomach) if it persists through adulthood.

Researchers used electronic health records to conduct a cross-sectional study of 690,321 children aged 2 -- 19 years who were members of the Kaiser Permanente Southern California integrated health plan in 2007 and 2008.

About 8 to 25 percent of children in the U.S. may be affected by frequent symptoms of gastroesophageal reflux, depending upon their age and body mass index. GERD is a chronic condition in which the liquid content of the stomach flows up in to the esophagus. This can inflame and damage the lining of the esophagus. GERD may be responsible for an increased occurrence of coughs, asthma, and inflammation of the larynx. Left untreated, GERD may result in chronic esophageal inflammation and lasting damage to the esophagus. Cancer of the esophagus is the nation's fastest growing cancer and is expected to double in frequency in the next 20 years -- unlike most other cancers, which are decreasing in frequency. Researchers suspect this rise is due in part to the nation's obesity epidemic.

"Childhood obesity, especially extreme childhood obesity, comes with a high risk for many serious health consequences such as diabetes, cardiovascular disease and cancer. The takeaway message of our study is that GERD now also is one of the conditions associated with childhood obesity" said study lead author Corinna Koebnick, PhD, a research scientist at the Kaiser Permanente Southern California's Department of Research and Evaluation in Pasadena, Calif.. "Beyond counseling for weight loss, obese children who report symptoms of GERD may need to be treated for the underlying reasons to help avoid persistence of GERD into adulthood and to prevent its complications. "

"Even though some health conditions associated with extreme childhood obesity may not seem important early in life, they can be a significant burden for the patient and a link to other serious conditions later in life. We need to be aware of these links, search for obesity-related conditions and address childhood obesity as a family issue as early as possible," noted Dr. Koebnick.

Previous research into the association between obesity and GERD was hospital-based instead of population-based, included mainly people with asthma, and did not address extreme childhood obesity. In this study, the percentile of the measure of a child's weight in relation to height for age was calculated according to the 2000 U.S. Centers for Disease Control and Prevention recommendation to assign a weight class (normal weight, overweight, moderate and extreme obesity). Children in the study had an average of 2.6 medical visits per year where height and weight were measured.

This study is part of the Kaiser Permanente Southern California Children's Health Study, Kaiser Permanente's ongoing work to identify and treat childhood obesity through research and community programs. Results from the Children's Health Study published in the Journal of Pediatrics in March 2010, reported that extreme obesity is affecting more children at younger ages, with 12 percent of African American teenage girls, 11.2 percent of Hispanic teenage boys, 7.3 percent of boys and 5.5 percent of girls 2 -- 19 years of age now classified as extremely obese.

In February 2010, Kaiser Permanente announced that it was a founding partner of the Partnership for a Healthier America (, a nonprofit, nonpartisan foundation created to catalyze and increase support around First Lady Michelle Obama's campaign to curb childhood obesity in a generation.

Other study authors included: Darios Getahun, MD, Ning Smith, MS, and Steven J. Jacobsen, MD, PhD, from the Kaiser Permanente Department of Research and Evaluation in Pasadena, Calif.; Amy H. Porter, MD, from the Kaiser Permanente Baldwin Park Medical Center; and Jack K. Der-Sarkissian, MD, from the Kaiser Permanente Medical Center, Los Angeles.

When dieting, watch your vitamins: study


By Lynne Peeples

Reuters Health

Friday, July 9, 2010

NEW YORK (Reuters Health) – When weighing the benefits of one weight-loss plan over another, dieters may want to consider what else might be cut with the calories and carbs, suggests a new study.

More than $30 billion a year is spent on weight loss products in the U.S., with one in three adults reportedly trying to trim pounds.

The focus of these popular diets typically rests on both the overall amount of food consumed and the relative quantities of proteins, fats and carbohydrates. Vitamins and minerals tend to be overlooked.

In a comparison of four weight-loss plans, researchers from Stanford University in California found significant differences in the consumption of these nutrients.

"Shifting around the food sources that are good sources of fats versus carbohydrates means more than just changing fat and carbohydrate levels," lead researcher Christopher Gardner told Reuters Health in an email.

Varying amounts of vitamins and minerals tag along, he said. And, as a result, deficiencies can arise that increase the risk of serious health problems, including low blood count, the bone-thinning disease osteoporosis and neurological damage.

In the study, Gardner and his colleagues looked at data from 300 overweight or obese women who were randomly assigned to follow one of four weight-loss diets: Atkins, Zone, LEARN (Lifestyle, Exercise, Attitudes, Relationships, Nutrition) or Ornish.

The women each received three unannounced phone calls around the start of the study and again after 2 months, asking them to recall what they had eaten over the previous 24 hours. These responses were then averaged to get a precise picture of the woman's diet, report the researchers in The American Journal of Clinical Nutrition.

At 2 months, participants across all diets had similarly reduced their daily intake to 1500 calories from an average of 2000 at the start of the study. (Each pound of weight loss requires eating 3,500 fewer calories.)

As expected, the team found differences in what dieters ate consistent with each diet's design. Atkins dieters, for example, reported eating the lowest proportion of carbohydrates (17 percent of their daily calories) and the most fat and protein (28 percent).

Differences were also seen in how much of 12 of the 17 vitamins and minerals measured the dieters were eating, leaving some women at risk of inadequate levels based on national recommendations. Vitamin E posed the biggest problem across all groups: more than 65 percent of women weren't getting enough.

With people eating less, it may come as no surprise that they were also missing out on vitamins and minerals. But for women on the Zone diet, the opposite was true. Risks of inadequacies significantly decreased for vitamins A, E, K and C, while no increased risks were seen for any other vitamins.

The researchers suggest this points to the potential benefits of a diet that encourages moderate but not extreme carbohydrate reductions: down to 40 percent of total calories from traditional recommendations of 45 to 65 percent.

"It isn't just total carbohydrates that Zone recommends be cut back. It is more specifically the added sugars and refined grains," said Gardner. "Keep the greens and beans and veggies. Lose the soda, sweets, and the packaged processed foods."

One potential way to fill in the holes of any diet is through vitamin and mineral supplements, he added. But the researchers found that, of the four diets, only Atkins made this recommendation. And only 3 women in this group took the advice.

"Our bodies work best when vitamin and mineral deficiencies are absent, and healthy food is the best way to get enough of these important nutrients," Dr. Michael Dansinger of Tufts University School of Medicine in Boston, and advisor for the television series "The Biggest Loser," told Reuters Health by email.

"I believe all the eating strategies in the Stanford study are healthy because they improve obesity, diabetes and heart disease risk factors, which are the leading killers in our society," Dansinger said. "However, the Zone diet, and others like it, may have an advantage where vitamins and minerals are concerned."


The American Journal of Clinical Nutrition, online June 23, 2010.

Sweet Way to Detect Prediabetes



Friday, July 9, 2010


ScienceDaily (July 9, 2010) — Having discovered a dramatic increase of an easy-to-detect enzyme in the red blood cells of people with diabetes and prediabetes, Johns Hopkins scientists say the discovery could lead to a simple, routine test for detecting the subtle onset of the disease, before symptoms or complications occur and in time to reverse its course.


Pilot studies, published online April 22 in Diabetes, show the enzyme O-GlcNAcase is up to two to three times higher in people with diabetes and prediabetes than in those with no disease: "That's a big difference, especially in an enzyme that's as tightly regulated as this one is," says Gerald Hart, Ph.D., the DeLamar Professor and director of biological chemistry at the Johns Hopkins School of Medicine.


Building on their previous research, which showed how an abundant but difficult-to-detect sugar switch known as O-GlcNAc (pronounced oh-GLICK-nack) responded to nutrients and stress, the Hopkins team knew this small molecule was elevated in the red cells of patients with diabetes. "The question was whether the elevation happened in the earliest stages of diabetes and therefore might have value as a diagnostic tool," Hart said.

To find out, Kyoungsook Park, a graduate student of biological chemistry working in Hart's lab, focused on levels of O-GlcNAcase, an enzyme that removes O-GlcNAc in red cells. O-GlcNAc modifies many of the cell's proteins to control their functions in response to nutrients and stress. Nutrients, such as glucose and lipids, increase the extent of O-GlcNAc modification of proteins affecting their activities. When the extent of O-GlcNAc attached to proteins becomes too high, as occurs in diabetes, it is harmful to the cell.


First, Park purified human red blood cells by depleting them of their main constituent, hemoglobin. The samples had been collected by two sources -- the National Institute of Diabetes, Digestive and Kidney Diseases, or NIDDK, and Johns Hopkins Diabetes Center in collaboration with Christopher D. Saudek, M.D. -- and characterized as normal (36 samples), prediabetes (13 samples) and type 2 diabetes (53 samples) according to traditional tests that require patient fasting. Defined as normal hemoglobin A1c with impaired fasting glucose, prediabetes is an intermediate state of altered glucose metabolism with a heightened risk of developing type 2 diabetes and other associated complications.


Then, she measured and compared the amount of the enzyme protein within the red cells associated with the sugar molecule, O-GlcNAc.


"When I checked the enzyme levels and saw how dramatically different they were between the prediabetic cells and the controls, I thought I did something wrong," Park says. "I repeated the test five times until I could believe it myself."


Hart speculates that in diabetes and prediabetes, it's not a good thing for the increased amount of sugar to be attached to proteins, so the cell is responding by elevating the enzyme that gets rid of it.


"This is an example of how basic research is directly affecting a serious disease," Hart says, adding that his team's pilot studies encourage further investigation of a method that potentially could fill the void that currently exists for an easy, accurate routine test for prediabetes. "Only a much larger clinical trial will determine if, by measuring O-GlcNAcase, we can accurately diagnose prediabetes."


In addition to Park and Hart, Chistopher D. Saudek, also of Johns Hopkins University School of Medicine, is an author of the paper.


Funding was provided by the NIH NIDDK.


Are air pollutants linked to bowel disease risk?


By Amy Norton

Reuters Health

Friday, July 9, 2010

NEW YORK (Reuters Health) – Young people who live in areas with higher levels of certain air pollutants may be more likely to have inflammatory bowel disease than those living under clearer skies, a new study suggests.

Specifically, people age 23 or younger were about twice as likely to be diagnosed with Crohn's disease if they lived in a region relatively high nitrogen dioxide levels.

The findings, reported in the American Journal of Gastroenterology, do not prove that air pollution is a contributor to inflammatory bowel disease (IBD), the major forms of which are Crohn's disease and ulcerative colitis. In the U.S., Crohn's affects about one in 600 people in the US, and ulcerative colitis affects about one in 400, according to the National Institute of Diabetes and Digestive and Kidney Diseases.

Instead, researchers are instead calling their study a "hypothesis-generating" one that raises the possibility that air pollution could be one of the environmental factors that plays a role in IBD development.

Crohn's disease and ulcerative colitis are marked by chronic inflammation in the intestines, leading to symptoms like abdominal pain and diarrhea.

The precise causes of the conditions are unknown, but the disorders are thought to involve an immune system overreaction that injures the body's own intestinal tissue. In general, researchers suspect that a combination of genetic susceptibility along with exposure to one or more environmental factors is to blame.

Exactly what those environmental factors are remains unclear, however.

It is known that IBD rates rose during the 20th century in industrialized countries, and that rates appear to be increasing in developing nations. Such patterns suggest that factors such as diet and lifestyle changes, or environmental exposures, could be involved.

Air pollution is one possibility, which is why the current study focused on it, explained lead researcher Dr. Gilaad G. Kaplan, a gastroenterologist and assistant professor at the University of Calgary in Alberta, Canada.

Using a UK database of electronic medical records, he and his colleagues identified 367 children and adults diagnosed with Crohn's disease and 591 diagnosed with ulcerative colitis between 2005 and 2008. The researchers matched each of those people to five IBD-free individuals the same age and sex.

They then used air-quality data from government monitors to assess the average yearly levels of three air pollutants in the study subjects' residential areas.

The pollutants included nitrogen dioxide, which is produced largely by vehicles and is highest in urban, high-traffic areas; sulfur dioxide, which is produced through industrial processes, including the burning of coal and oil; and particulate matter, fine particles emitted via car exhaust, as well as power plants and other industrial sources.

Overall, Kaplan's team found no association between IBD and the three air pollutants across the study group as a whole.

However, young people -- those age 23 or younger -- were about twice as likely to be diagnosed with Crohn's disease if they lived in a region in the top 60 percent of nitrogen dioxide levels, versus the bottom 20 percent.

Similarly, people age 25 or younger were twice as likely to have ulcerative colitis if they lived in areas with higher sulfur dioxide levels. However, there was no evidence of a "dose-response" relationship -- that is, the risk of ulcerative colitis climbing steadily as sulfur dioxide levels rose.

That lack of a dose-response, Kaplan told Reuters Health, "makes us a little more cautious about that finding."

Indeed, he urged caution in interpreting the findings as a whole. While he and his colleagues tried to account for other factors -- such as study subjects' smoking habits and socioeconomic status -- they cannot rule out the possibility that something other than air pollution itself accounts for their findings.

"This is an interesting association," Kaplan said. But, he added, the findings do not prove cause-and-effect.

As for why air pollution would affect IBD risk, Kaplan said he could only speculate, based on research into other health conditions, including heart and lung disease. Studies indicate that air pollutants can trigger inflammation in the body; that, Kaplan explained, raises the possibility that in genetically predisposed people, air pollution may trigger an inflammatory response in the intestines that leads to IBD.

Since the current study found a relationship between pollutants and IBD only in young people, the findings also raise the question of whether children and teenagers are particularly susceptible to any effects of air pollution on the risk of the digestive disorders.

Much more research is needed, Kaplan said -- both larger population studies and research in animals to see how exposure to various air pollutants might affect intestinal health.

He added that no one is proposing that air pollution is the environmental cause of IBD; if it does turn out to be a factor, he said, it will likely be one of many players.

But if air pollution is confirmed as a risk factor, there would be important implications, Kaplan said, since air quality is something that can be modified.


 American Journal of Gastroenterology, online June 29, 2010.

Thursday, July 8, 2010



Popular food additive can cause stomach ache


By Rachael Myers Lowe

Reuters Health)

Thursday, July 8, 2010

NEW YORK (Reuters Health) – "Stealth fiber" increasingly added to processed foods, while not a problem for most, can cause gastrointestinal discomfort for some who may not know they're consuming too much of it, Minnesota researchers warn. The fiber is called "inulin."

"Normal fiber foods like wheat bran and legumes are self-limiting, it's hard to over eat them," Joanne Slavin, a registered dietitian in the department of food science and nutrition at the University of Minnesota at St. Paul, told Reuters Health.

Inulin, she explained, may be in chocolate bars, drinks, and snacks around the house, and "before you know it, you may eat more than you can tolerate and have gastrointestinal issues you wouldn't necessarily associate" with those foods.

Inulin is a carbohydrate fiber that occurs naturally in many foods like bananas, wheat, onions and garlic. Found in high concentrations in chicory root, is can be extracted for industrial use. Unlike more familiar carbohydrates, which are broken down in the small intestines and turned into fuel for the body, inulin passes through the small intestines to the colon where it stimulates the growth of "good bacteria" and is fermented by bacteria. In some people it can cause gas, bloating, flatulence, and diarrhea.

Because of its growing popularity as a food additive, Slavin and her colleagues wanted to assess how much inulin it takes to cause gastrointestinal problems.

They designed a study involving 26 healthy men and women aged 18 to 60. After a night of fasting, once a week for five weeks, participants were fed a breakfast of a bagel with cream cheese and orange juice. The orange juice was mixed with a placebo or with 5- or 10-gram doses of two commonly used inulin products -- native inulin and shorter-chain oligofructose.

After their "fiber challenge," participants were called several times over two days and asked about symptoms such as gas/bloating, nausea, flatulence, stomach cramping, diarrhea, constipation and GI rumbling.

Those that got any dose of inulin generally reported "mild symptoms"; the highest scores in every symptom except constipation were reported by those who got 10 grams of oligofructose. The findings are in line with previous research that found the short-chain "sweet" inulin causes faster fermentation in the gut leading to more gas and gastrointestinal symptoms.

Flatulence was the most common symptom reported by all subjects who got fiber although symptoms were "highly variable" among individuals and many subjects did not experience any, the investigators say.

Slavin and colleagues conclude, based on their study, that most healthy people can tolerate up to 10 grams of native inulin and 5 grams of the "sweet" inulin a day.

Food manufacturers, faced with demands to reduce calories, fat, and sodium while increasing fiber and flavor, are increasingly turning to products like inulin. They have discovered they can chemically manipulate the chemical structure of inulin to mimic tastes and textures consumers want in food. "It's like a food manufacturer's nirvana," Slavin said.

Inulin can be found in high fiber breakfast bars, ice creams, and beverages among other processed foods. The label may list inulin, chicory root extract, oligosaccharide, or oligofructose. For example, the Fiber One Chewy Bar with 9 grams of dietary fiber lists chicory root extract as its top ingredient.

Slavin and her colleagues urge continued study of tolerance levels of food additives like inulin because their use is likely to continue to grow and "there is the potential for overuse."

The research was funded by Cargill, Inc. a maker of inulin food additives, which provided the product used in the study.


 Journal of the American Dietetic Association, June 2010

Stress helps fend off cancer in mice, study shows


By Emma Ashburn


Thursday, July 8, 2010

WASHINGTON (Reuters) – Some stress can be good for the body, helping fight off cancer, researchers reported on Thursday.

Experiments with mice showed that animals put into a stressful situation, even fighting with other mice, did a better job of fighting tumors than mice left to chill out.

They said their findings, published in the journal Cell, point to a possible neurological treatment for cancer.

"The way we live, and how we live, may well have a much bigger impact on the prognosis of cancer than we recognized previously," Dr. Matthew During, a professor of neuroscience who worked on the study, said in a telephone interview.

During's team injected mice with melanoma, a type of fast-growing skin cancer, and let the tumors grow. They put some of the mice in a large cage, with lots of toys, space and many more other mice than usual.

Other mice stayed in ordinary lab cages.

After three weeks, tumors shrank almost in half in the mice in the "stimulating" cage and they shrank 77 percent after six weeks. The tumors completely disappeared in 17 percent of the mice, with no other cancer treatment.

Tumors continued to grow in the other mice.

During believes that more than simple stimulation is at work in the mice. The mice in the "enriched" cages were a little stressed out.

"You find some of them with little bite marks and fight marks," said During. "It's not all friendly."

Although common wisdom holds that stress is not healthful, the body's response to stress is complex, and hormones released in response to stress can have positive effects.

To show the benefits were not simply due to exercise, the researchers placed running wheels in the smaller cage. The mice ran up to three times as far as the mice in the large cage, but were not more resistant to cancer.

Brain Chemical

Experiments to see what was happening biologically in the mice showed the stressed mice were producing more of a brain chemical called brain-derived neurotrophic factor.

This compound reduces the production of leptin, a hormone linked with appetite and also associated with melanoma, prostate and breast cancer. The more leptin the mice produced, the smaller their tumors were.

Leptin acts differently in mice than it does in humans, and cancer grows differently in mice injected with tumors than it does in people. But During believes the findings may nonetheless apply to people.

"The key is that we believe that this pathway that we've defined here exists in humans," he said.

"This suggests we can also start considering treating cancer by operating on the brain as well and introducing a gene to activate this pathway," he added.

Up to now, scientists have only studied mice in situations of severe stress. That mice do better in situations of moderate stress has implications for cancer patients, During said.

"We shouldn't be simply avoiding stress and looking for happiness," During said. "We should be getting involved in team sports, getting involved in social groups, where there's sort of an interactive dynamics which are a little bit challenging for us."

(Editing by Maggie Fox and Doina Chiacu)

Toss out the inhaler if you outgrow asthma? Not so fast


By Lynne Peeples

Reuters Health

Thursday, July 8, 2010

NEW YORK (Reuters Health) – Tossing out the inhaler may not always be the best response to outgrowing asthma, new research suggests.

About 1 in every 10 children in the U.S. has the chronic lung disease. If he or she is also among the roughly 1 percent of children with a peanut allergy, using an inhaler could prove lifesaving even after asthma symptoms have disappeared, researchers found.

Children with the common duo of conditions are known to be at a greater risk of life-threatening allergic reactions to peanuts, making it especially important for their asthma to stay well controlled with an inhaled steroid or other anti-inflammatory medication. What has not been clear is what should be done when a youngster with a peanut allergy outgrows their asthma.

Research shows that about 60 to 70 percent of kids with asthma will outgrow it by the time they reach their teens. Normal practice is to withdraw the therapy, lead researcher Dr. Michael Shields of Queen's University of Belfast, in the United Kingdom, noted in an email to Reuters Health. But is this always a wise decision?

If allergic inflammation persists in the airway of a peanut-allergic kid, then maybe not, Shields said.

In the study, he and his colleagues assessed the airways of about 100 British children younger than age 16, all with peanut allergy. They grouped the participants into four categories of asthma history: never wheezed, currently treated for asthma, moderate wheezing but not taking medication, and outgrown asthma.

For each child, the researchers measured the level of nitric oxide in exhaled breath, which is thought to reflect the degree of inflammation in the airways.

All 7 of the kids who had seemingly outgrown their asthma as well as 15 of 20 (75 percent) with untreated wheeze showed high levels of exhaled nitric oxide, indicating on-going inflammation. Levels were not elevated among kids currently treated for asthma or those with no history of wheezing, the researchers report in the journal Pediatric Allergy and Immunology.

Given these findings, they say the term "outgrown" may be misleading.

Shields suggests doctors consider using low levels of inhaled steroids for kids with lingering inflammation, in the hope that this might reduce their risk of a nasty peanut-induced asthmatic attack.

But Dr. Fred Finkelman of Cincinnati Children's Hospital Medical Center in Ohio thinks such advice would be premature. "There are risks to taking all medications, including inhaled corticosteroids," Finkelman told Reuters Health in an email. "And the overall risk of having a large number of individuals taking such a medication might be greater than the potential, undefined decrease in the risk of a severe asthma attack in a very small percentage of people."

About 100 Americans die every year from a severe allergic reaction to food, he added, with peanuts and tree nuts being the most common triggers.

The British researchers also point to some limitations to their findings, including the small number of children with outgrown asthma in the study and the lack of an agreed upon level of exhaled nitric oxide for which treatment should be prescribed.

And Shields noted that the benefits of continued corticosteroid use would be difficult to prove. "This is because, thankfully, severe reactions are quite rare," he said. "And we strongly recommend those with to strictly avoid such exposures."


Pediatric Allergy and Immunology, online June 20, 2010.

Wednesday, July 7, 2010


Monitoring Blood Pressure at Home May Help Keep It Low


By Steven Reinberg
HealthDay Reporter  

HealthDay News

Wednesday, July 7, 2010

WEDNESDAY, July 7 (HealthDay News) -- With proper training, people with high blood pressure may be able to control it more effectively on their own at home than through conventional methods, British researchers contend.

Through telemonitoring of their blood pressure and adjusting their medications according to guidelines agreed upon in advance, patients assigned to self-managed care saw greater reductions in blood pressure after six and 12 months than patients receiving standard care through health professionals, the study found.

"Self-management represents an important new intervention for people with hypertension treated in primary care," said lead researcher Dr. Richard J. McManus, a professor of primary care cardiovascular research and honorary consultant at the University of Birmingham in England.

Self-management should be considered for people with hypertension, particularly if their blood pressure is not controlled with standard care, McManus added.

But the self-managed approach is not without drawbacks, McManus noted.

"Caveats are that not everyone will want to do self-management and that family doctors need to be involved in setting up the titration schedules for individuals to follow," he said.

High blood pressure is a major risk factor for heart attack, heart failure, stroke and renal (kidney) failure, but only half the people treated for it have their blood pressure controlled, according to background information in the study.

For the study, published in the July 8 online edition of The Lancet, McManus's team randomly assigned 527 patients with high blood pressure, also known as hypertension, to either self-managed care or to standard care.

Taking daily blood pressure readings over six months, patients managing their own care saw a drop in systolic blood pressure (the top number in a 120/80 reading) of 12.9 mm Hg, while patients on standard therapy saw only a 9.2 mm Hg drop in systolic pressure, the researchers found.

After a year, systolic pressure in the self-managed group fell 17.6 mm Hg, compared with 12.2 mm Hg in the standard care group.

Patients without diabetes were encouraged to aim for 130/85 mm Hg, and diabetics were to target 130/75 mm Hg, according to the study.

Side effects were generally the same in both groups, except that leg swelling occurred more often in the self-managed group (32 percent versus 22 percent), the researchers note.

The self-managed patients attended two training sessions to learn to use automated sphygmomanometers (blood pressure monitors), and they were also taught how to transmit their blood pressure readings to the doctor via an automated modem device.

Drug-adjustment schedules were agreed to by the patients and their family doctor.

McManus thinks that working actively to control blood pressure is the reason the self-management approach was so successful.

"The effect seems to be due to increased antihypertensive treatment in people who self-manage," he said. For example, patients who missed their targets two months in a row made medication changes.

Dr. Gregg C. Fonarow, professor of medicine and director of the Ahmanson-UCLA Cardiomyopathy Center at the University of California, Los Angeles, said self-management has been shown to improve risk factor control or outcomes in patients with other conditions, such as diabetes and heart failure.

"This exciting new study demonstrates that the combination of telemonitoring of home blood pressure measurements combined with self-management of hypertension following a simple algorithm was more effective than usual care in the primary care setting," Fonarow said.

"This represents a very practical, broadly applicable, likely cost-effective new approach to achieve improved blood pressure control," he said.

More information

For more information on hypertension, visit the U.S. National Library of Medicine.

Custom running shoes might not prevent injuries


By Genevra Pittman

Reuters Health

Wednesday, July 7, 2010

NEW YORK (Reuters Health) – Buying running shoes? A new study suggests that wearing sneakers tailored to your foot shape might not protect you against injuries.

New Balance, the maker of shoes used in the study, helps runners choose the best shoe for them by determining their foot shape, among other factors, in the company's online "Find your Total Fit" feature.

But "simply measuring the foot morphology with (this type of) technique is not sufficient for prescribing footwear if your objective is to prevent injuries," Dr. Bruce Jones, an investigator on the study who manages the injury prevention program at the U.S. Army Public Health Command in Aberdeen Proving Ground, Maryland, told Reuters Health.

Shoe companies market different sneaker models to runners based on how their feet roll and distribute their weight when they hit the ground -- a term referred to as pronation.

Overpronators have feet that roll too far inward on each stride, while the feet of underpronators don't roll enough. Shoes are marketed under the assumption that by adjusting for some of these differences, runners can improve their mechanics and thus prevent injury.

Pronation is generally measured by taking a flat footprint and examining how much of the foot is in contact with the ground when the runner is standing still, a method used by many running specialty stores. But Marine Corps recruits who were fitted for sneakers this way got injured just as frequently as those who were all given a basic shoe made for runners who pronate normally.

Dr. Joseph Knapik, an epidemiologist at Aberdeen, led the study of about 1,400 Marine Corps recruits. The recruits -- both men and women -- all had their foot shape analyzed and were randomly assigned to one of two groups.

One group got a running shoe that was marketed for their type of pronation: runners whose footprints indicated they were overpronators got a motion control shoe, underpronators got a cushion shoe, and those with normal pronation got a stability shoe.

Members of the other group were all assigned stability shoes, regardless of their foot shape and pronation. Then the recruits wore their assigned shoes, alternating with combat boots, for 12 weeks of training.

During the study, Knapik and his colleagues kept track of different kinds of injuries in the recruits, including overuse injuries and injuries to tendons and ligaments as well as bones and muscles.

In every way the study team measured injuries, there was little difference in how often members of the two groups got injured. This was true for both men and women.

In all, about 42 percent of men assigned custom fitted shoes and 41 percent of men in the stability shoe group got injured over the 12-week training period. For women, approximately 37 percent in custom fitted shoes and about 45 percent in stability shoes regardless of their foot type were injured -- a difference that was not statistically significant.

The results are published in The American Journal of Sports Medicine.

The findings agree with similar studies the investigators have done with Army and Air Force recruits. When they combined data from the three studies, there still wasn't a significant difference in injury rates based on shoe assignment.

New Balance representatives could not be reached for comment.

One explanation of the findings, said Dr. Joseph Hamill, an exercise scientist at the University of Massachusetts at Amherst, is that the footprint technique for assigning running shoes doesn't work.

"It's not going to prevent injuries by assigning shoes based on a static measurement," Hamill, who was not involved with the study, told Reuters Health.

To do a more thorough analysis, runners need to be monitored on a treadmill, or with more specialized equipment. But that's often not feasible -- for Marine Corps recruits or for recreational runners. And Jones said it's not clear that technique would be more helpful.

"There's no evidence that dynamic measurements make a difference either," he said. This could be, he added, because people with different foot shapes actually get injured at similar rates to begin with.

The message to runners is not to focus too much on motion control, cushion, and stability labels, Jones said. "What it means," he said, "is that you can choose the shoe you like most and that feels the best."

The study was supported by the Naval Health Research Center. The investigators report that they had no conflicts of interest in this study.


 The American Journal of Sports Medicine, published online June 24, 2010.

Heart tests add to U.S. radiation dose concerns


By Julie Steenhuysen


Wednesday, July 7, 2010

CHICAGO (Reuters) – Heart imaging procedures can deliver a significant amount of radiation to patients, U.S. researchers said on Wednesday, urging patients and doctors to weigh the risks against the benefits.

They said nearly one in 10 adults under the age of 64 had a heart procedure involving radiation over a three-year period in five major healthcare markets.

"For many patients in the United States, there is a substantial cumulative radiation exposure from cardiac procedures," said Dr. Jersey Chen of Yale University School of Medicine, whose study appears in the Journal of the American College of Radiology.

An advanced type of heart stress test called myocardial perfusion imaging, in which doctors inject a radioactive tracer in patients to test blood flow, accounted for 74 percent of radiation exposure from heart scans.

Heart catheterization and stenting -- procedures in which thin tubes are fished through blood vessels to open blocked arteries -- were the second biggest contributor to radiation exposure, Chen said.

More than half of the heart procedures using radiation were done in the doctor's own office, the team found.

"Policymakers have been concerned that there is a rise in physician office imaging and a rise in total use of imaging," Chen said in a telephone interview.

"I think there is legitimate concern that easy availability -- convenience -- makes the threshold for testing lower. Whether it is inappropriate or not, our study can't say."

While doctors disagree over how much, most agree that radiation can cause cancer, and researchers are growing concerned that an explosion in the use of medical imaging is making it more likely that patients may develop cancer.

A report last year by the National Council on Radiation Protection and Measurement found that Americans receive seven times more radiation from diagnostic scans than in 1980.

Chen's team, looking specifically at radiation exposure from heart imaging procedures, studied medical claims records from nearly 1 million patients aged 18 to 64 insured by United Healthcare.

They calculated the annual radiation dose based on three exposure ranges: less than 3 millisieverts a year, the average exposure level for people from the sun and environment; between 3 and 20 millisieverts a year and more than 20 millisieverts a year, the upper safety limit for workers exposed to radiation.

Of those who got heart procedures using radiation, most fell into the middle range but more than 3,000 patients got more than 20 millisieverts a year over the three-year period and 75 people got more than 50 millisieverts a year.

"The average patient who gets a nuclear stress test is going to get 16 millisieverts each time. It's going to increase their risk on a statistical basis," Chen said.

Dr. Pamela Douglas of Duke University in North Carolina and a former president of the American College of Cardiology said doctors need to pay attention to radiation but she said the benefits of these heart tests and procedures should be weighed against the risk that a cancer might develop down the road.

"Let's not get hysterical," she said in a telephone interview.

"Overall, patients with heart disease are doing way better. The procedures are helping people. If we can change them or tweak them to help reduce radiation exposure even more, that would be wonderful."

(Editing by John O'Callaghan)

Diabetics eye obesity surgery to tame blood sugar


By Alicia Chang

AP Science Writer

The Associated Press

Wednesday, July 7, 2010

LOS ANGELES – For nearly a decade, Cristina Iaboni tried to tame her diabetes the usual way, through daily shots of insulin and other medicine.

Still, her blood sugar raged out of control. So Iaboni combed the Internet for another solution and found a doctor who is testing weight loss surgery on diabetics who, like herself, are merely overweight or a tad obese in an attempt to curb the chronic disease.

Scientists in recent years have discovered that diabetes all but disappears in some obese patients soon after the operation. Many were able to achieve normal blood sugar and ditch their medications.

But does the benefit extend to diabetics who are not quite as hefty? Performing surgery on the not-as-obese with the goal of reversing diabetes is provocative. Iaboni's surgeon is one of a handful of doctors around the world stretching the rules to see if the weight loss operation helps.

Iaboni had gastric bypass surgery last fall at New York-Presbyterian/Weill Cornell Medical Center as part of a study. In gastric bypass or stomach stapling surgery, the stomach is reduced to a thumb-sized pouch that holds less food.

Now 50 pounds lighter, she has stopped taking diabetes medications. Her blood sugar is almost normal.

"I didn't care if I lost any weight. I just wanted the diabetes to go away," said the 45-year-old Connecticut mother of two teenagers.

The twin epidemics of obesity and diabetes are fueling an international public health threat. In the United States, one out of five people with obesity-linked Type 2 diabetes are morbidly obese — defined as 100 pounds overweight.

Surgery is generally a last resort after traditional ways to shed the pounds — such as diet and exercise — fail. Even so, there are strict rules for who can go under the knife.

Federal guidelines say surgery candidates must be morbidly obese with a body mass index over 40, or a BMI over 35 plus a weight-related medical problem like diabetes or high blood pressure. Insurers use the cutoffs in deciding whether to pay for the procedure.

BMI is a calculation of height and weight used to estimate body fat. Overweight begins at a measurement of 25, obese at 30 and morbidly obese at 40. A 5-foot-6 person is considered overweight at 155 pounds, obese at 186 pounds and morbidly obese at 248 pounds. The current BMI limits for obesity surgery were set by the National Institutes of Health in 1991.

Dr. Philip Schauer of the Cleveland Clinic is among those pushing the BMI envelope. For a study, he's recruiting 150 overweight and obese Type 2 diabetics with BMIs between 27 and 43. Some will have surgery and their progress will be compared to those who manage their diabetes with medicine. The goal is to see which group can achieve complete remission.

Smaller studies have hinted that stomach stapling and gastric banding — in which an adjustable ring is placed over the top of the stomach to create a small pouch — may work in diabetics who aren't so fat.

"These procedures can cause long-term remission and restore someone to normal blood sugar levels without medication," Schauer said.

How does the surgery help some diabetics beat the disease? Doctors don't exactly know, but there is some evidence that it may not all be due to weight loss. Diabetes occurs when the body can't regulate blood sugar, and some researchers think that the rerouting of the digestive tract after the operation affects the gut hormones involved in blood sugar control.

Last year, 220,000 people had obesity surgery, which can cost between $14,000 and $26,000, according to the American Society for Metabolic and Bariatric Surgery.

The surgery is fairly safe. In a 2009 study, death, serious complications or the need for a repeat procedure occurred in 1 percent who received bands, about 5 percent who had minimally invasive gastric bypass and nearly 8 percent who had traditional bypass.

The American Diabetes Association said there's not enough evidence to generally recommend surgery for diabetics with a BMI lower than 35 outside of an experiment.

That's how Iaboni got the procedure. At 5-foot-5 and 191 pounds, she was obese with a BMI of 31.8, but not heavy enough to qualify for regular surgery under the federal BMI limits. She paid $30,000 for the surgery and hospital stay to be part of the study.

Before the operation, she would be nauseated from the diabetes medications and felt lousy all the time. When people learn that she had surgery, many react in surprise.

"They would say, `You're not heavy. Why would you do this?' People thought I did it for the weight loss," Iaboni said.

Her surgeon, Dr. Francesco Rubino, has been pleased with her progress so far. He has plans to operate on two others as early as this month. Eventually, he hopes to enroll 50 patients with Type 2 diabetes and track if their diabetes goes away after surgery.

"It's important to tell patients this is a promising option, but of course we can't promise this is the cure for diabetes for everybody," he said.

Diabetes treatment is expensive. According to the diabetes association, those with the disease spend on average $11,744 a year on health care. A little over half of that is directly related to diabetes. Expenses include hospital stays, medications and supplies, and doctor visits.

A recent analysis by the North Carolina-based nonprofit RTI International found that gastric bypass and banding are cost-effective methods of reducing complications and death in obese people with diabetes.

The money spent on surgery "appears to provide good value," said Thomas Hoerger, who presented the findings last month at a meeting of health economists.

Some experts question whether achieving normal blood sugar is enough to justify getting surgery. Does the surgery permanently reduce a person's risk of diabetes complications such as nerve, kidney and foot damage?

"I don't believe we're at a point where we can tell people that we know the answer to that," said Dr. Robert Kaplan of the UCLA School of Public Health.


American Diabetes Association,

American Society for Metabolic and Bariatric Surgery,

BMI calculator,

Could Hot Weather Affect Results of a Colorectal Cancer Test?


By Steven Reinberg
HealthDay Reporter
HealthDay News

Wednesday, July 7, 2010

WEDNESDAY, July 7 (HealthDay News) -- An immunochemical test used to detect signs of colorectal cancer is less accurate when done in the summer than in cooler times of the year, Italian researchers report.

Although the particular brand of test used in the study -- the OC-Hemodia test -- is not used in the United States, the findings are of interest to U.S. researchers because immunochemical fecal occult blood tests are gradually replacing the conventional stool test for colorectal cancer, according to the report published in the July 6 online edition of Gut.

Cancers of the colon or rectum generally have a good prognosis when caught early, and the most common, non-invasive way to detect it is a procedure known as the fecal occult blood test, or FOBT, which looks for blood hidden in the stool.

In Italy -- unlike the United States -- the conventional procedure is an immunochemical fecal occult blood test. In this study, researchers noted that blood samples, if present, appeared less stable at higher temperatures -- something that may have implications for similar U.S.-based tests.

However, the study has important limitations in terms of the U.S. population, one expert noted.

Dr. Durado Brooks, director of prostate and colorectal cancer at the American Cancer Society, said that the Italian researchers "looked at only one test, [and] there are a number these tests on the market."

Moreover, the OC-Hemodia test is not approved by the U.S. Food and Drug Administration and is thus not available in the United States, he added.

Brooks also noted that most immunochemical fecal occult blood tests used in the United States require several samples, as opposed to the single sample of the OC-Hemodia test. Therefore, having several samples tested may lessen the problem of inaccurate results, if they exist, he said.

"So how relevant this is to other immunochemical fecal occult blood tests used in the U.S. is open to question," Brooks said. "But I think it's something investigators here might want to consider looking at and whether it is relevant to tests being used in the U.S."

In the United States, the conventional tool for non-invasive colorectal cancer screening was traditionally the guaiac fecal occult blood test, which involves testing stool smears for hidden blood. However, since 2004, the U.S. Food and Drug Administration has approved many immunochemical fecal blood tests for marketing. Many U.S. health systems, in fact, consider a series of the immunochemical screens best practice.

This is partly because conventional FOBTs require complex dietary restrictions that make it hard for some patients to comply. Patients are not supposed to eat meat, cantaloupe, vitamin C, anti-inflammatory drugs, citrus fruits and various other foods and supplements for three days before the test, and false positives can result if the patient inadvertently consumes certain foods, vitamins or drugs in the days before the test.

For the Italian study, lead researcher Dr. Grazia Grazzini, from the screening unit at the Cancer Prevention and Research Institute in Florence, and colleagues looked at the effect of temperature on the accuracy of fecal occult blood tests among individuals in the Italian national screening program in Florence over several seasons.

The investigators included temperature variations between sampling and the return of the test sample, which took about a week. They also accounted for the amount of time that the samples were in the laboratory refrigerator, which was about four days.

In all, they looked at 199,654 tests. Each sample was tested for hemoglobin (Hb) levels, which is the protein in blood that colors it red.

Grazzini's team found that hemoglobin levels were significantly lower in the summer months. Hb levels averaged 27.6 nanograms per milliliter (ng/mL) in spring, 25.2 ng/mL in summer, 29.2 ng/mL in autumn and 29.5 ng/mL in winter.

Accordingly, tests done in summer had a 17 percent lower probability of testing positive for signs of colon cancer compared with tests done in winter. In fact, every one degree Celsius increase in temperature reduced the probability of a positive result by 0.7 percent, the researchers found.

In all, tests done in summer were 13 percent less likely to pick up signs of cancer than tests done in winter, Grazzini's group found. "During the summer, significant [cancerous changes] will be missed," the authors warned, noting that this could have serious implications for the risk of interval cancers, which are cancers that develop between screenings.

"This is the first study that investigated about stability of immunochemical fecal occult blood tests related to ambient temperature. These results will have important implications for the organization of immunochemical fecal occult blood test-based screening programs, particularly in countries with high ambient temperatures," Grazzini stated.

"It is important to consider stability of immunochemical fecal occult blood tests for the quality assurance of the colorectal screening program," Grazzini added. "Immunochemical fecal occult blood tests showed in the past very good performance for early diagnosis of colorectal cancer. For this reason, our results will allow for improving stability of fecal samples and therefore quality of [the] screening program."

Among other things, the researchers recommended refrigerating samples directly after testing and during transportation to a lab.

More information

For more information on colorectal cancer, visit the American Cancer Society.

Tuesday, July 6, 2010


Glucosamine Ineffective for Lower Back Pain Linked to Arthritis


By Steven Reinberg
HealthDay Reporter
HealthDay News

Tuesday, July 6, 2010

TUESDAY, July 6 (HealthDay News) -- The popular supplement glucosamine offers little or no relief for sufferers of chronic lower back pain caused by osteoarthritis, a new study finds.

The Norwegian trial seems to be another knock against glucosamine, with other recent studies showing similar results.

"The study answer the questions: 'I have suffered low back pain for a long time (more than 6 months), will a 6-month intake of glucosamine help me?'" said lead researcher Philip Wilkens, a research fellow in the orthopedic department at the University of Oslo. "And the answer according to this study is no."

On the up side, "glucosamine appears safe to use," he added. "And more research is needed to answer if glucosamine is beneficial to prevent chronic low back pain or have benefits in longer term, like 5 to 10 years."

Osteoarthritis affects more than 20 million Americans, and the number is expected to increase, the researchers note. Glucosamine is a common over-the-counter treatment for osteoarthritis, even though its use has been controversial.

For example, a University of Pittsburgh study presented at a rheumatologists' meeting in October found the supplement did not prevent loss of cartilage in osteoarthritic knees, while studies published in 2008 in Arthritis & Rheumatism and the Annals of Internal Medicine found glucosamine had little or no effect on arthritis of the knee and hips, respectively.

The new report is published in the July 7 issue of the Journal of the American Medical Association.

For the study, Wilkens's team randomly assigned 250 patients with chronic back pain and degenerative lumbar osteoarthritis to 1,500 milligrams daily of glucosamine or an inactive placebo.

The patients' pain was measured using the Roland Morris Disability Questionnaire at 6 weeks, then again at 3, 6 and 12 months. In addition, the researchers evaluated the patients' self-reported quality of life.

At the start of the 6-month trial, patients taking glucosamine scored 9.2 on the pain scale while the patients taking placebo scored 9.7, the researchers note. At the 6-month point, both groups scored 5.0, and after one year the glucosamine group scored 4.8 while the placebo group scored 5.5, Wilkens's group found.

However, the small differences in scores at six months or one year were not statistically significant, the researchers say. Nor were minor differences in quality of life between the two groups deemed significant.

The bottom line, according to Wilkens: "People with chronic low back pain and degenerative osteoarthritis will not benefit more from glucosamine than placebo for treating their back problem."

Dr. Andrew L. Avins, a scientist in the division of research at Kaiser Permanente Northern California and the author of an accompanying journal editorial, said that, "from a clinical standpoint, the study demonstrates that glucosamine does not appear to be better than placebo for patients with chronic low back pain and spinal arthritis."

However, the study found no ill effects from taking the supplement. So, patients who take glucosamine and feel that it is helping them should be reassured that it's at least not harmful, said Avins, who is also professor of medicine, epidemiology & biostatistics at the University of California, San Francisco.

"The larger implications [of this study] are that we still know very little about how to help most patients with chronic low back pain, and we need much more careful, directed research to help make progress in providing relief to patients with back pain," he added.

Even though back pain is an incredibly important public health and quality of life problem, it suffers from insufficient attention and research funding, Avins believes. "In the U.S., we spend far more on treatments of little or questionable value than we spend on research to find effective therapies; it's a poor use of scarce health-care resources," he said.

Dr. Andrew Sherman, an associate professor and vice-chair of the department of rehabilitation medicine at the University of Miami Leonard M. Miller School of Medicine, agreed that the findings should dissuade doctors from recommending glucosamine to patients with back pain.

However, "this [study] is not going to stop people from trying it," he added, and the finding does not mean that glucosamine won't work for other forms of arthritis.

More information

For more information on arthritis, visit the U.S. National Library of Medicine.

Maternal Diet and Genes Interact to Affect Heart Development



Tuesday, July 6, 2010


ScienceDaily (July 6, 2010) — A pregnant mother's diet may be able to interact with the genes her unborn child inherits and influence the type or severity of birth defect according to research funded by the Wellcome Trust and the British Heart Foundation (BHF). The study, published in the journal Human Molecular Genetics, suggests that mothers who eat a high fat diet before and through pregnancy could be inadvertently putting the health of their offspring at risk.


Congenital heart disease is the commonest form of a birth defect. It is already known that children born to mothers who have diabetes or are overweight have an increased risk of congenital heart disease and other birth defects. It is also known that certain genetic changes can result in congenital heart disease. However it is not known if environmental factors such as a mother's diet could interact with these genetic changes to affect the outcome.


To investigate this, a team of researchers at the Wellcome Trust Centre for Human Genetics at the University of Oxford studied the effect a high fat diet might have in mice on their offspring.


The researchers compared healthy mice against those lacking a gene called Cited2. Cited2 deficiency results in heart defects in mice and in humans. It also sometimes results in an especially serious type of heart defect called atrial isomerism, where the left-right asymmetry of the heart is disturbed.


The mice were fed a diet high in fat before and through pregnancy, and the development of their offspring studied using magnetic resonance imaging. The results were then compared to mice from a control group fed with a balanced diet.


Amongst offspring mice that were deficient in Cited2, the risk of atrial isomerism more than doubled, and the risk of cleft palate increased more than seven fold when the mothers were fed a high fat diet. These changes did not happen in the genetically normal offspring of mothers fed a high fat diet, indicating that it is the combination of high fat diet and the genetic defect that is responsible.


The researchers showed that high fat diet and Cited2 deficiency interacted by reducing the expression of another gene called Pitx2. This latter gene is also necessary for heart development and the body's natural asymmetry.


"These are very important findings as we have been able to show for the first time that gene-environment interactions can affect development of the embryo in the womb," says Dr Jamie Bentham, first author of the study.


"We know that poor diet and defective genes can both affect development, but here we have seen the two combine to cause a much greater risk of developing health problems and more severe problems. We are excited by this as it suggests that congenital heart defects may be preventable by measures such as altering maternal diet."


"There is a growing amount of research which suggests that a mother's diet can have a long term impact on the health of her offspring," says BHF Professor Shoumo Bhattacharya. "This is concerning when we also consider the increasing problem of obesity in women of reproductive age. A healthy, balanced diet is important at all times, but our research shows that this is particularly true during pregnancy when diet can potentially affect both the mother and her child."


Professor Jeremy Pearson, Associate Medical Director of the BHF, which part-funded the study, said:

"This research shows that diet during pregnancy can directly affect which genes get switched on in unborn offspring. The study was with mice, but a similar link may exist in humans, leading to some cases of congenital heart disease.


"We already know that if pregnant women lack certain nutrients in the diet, such as folic acid, it can lead to abnormal development in the baby, so it's not surprising that eating too much of something can also cause problems.


"The findings suggest it's wise for pregnant women to stick to a balanced diet and avoid eating too much fatty food. This is good advice for everyone, especially mothers and their children."


Changes in Fat Cells May Pave Way for Type 2 Diabetes


HealthDay News

Tuesday, July 6, 2010

TUESDAY, July 6 (HealthDay News) -- Cellular changes in fat tissue play a major role in the development of type 2 diabetes, a new study shows.

University of Cincinnati researchers found that these changes in fat cells -- not the immune system, as previously thought -- are linked to the "hyperinflammation" seen in obesity-related glucose intolerance and type 2 diabetes. The findings, they said, may eventually lead to the development of new drugs to treat type 2 diabetes and may also offer insights into the formation of aggressive cancers.

"This finding is quite novel because current drug development efforts target immune cells (macrophages, T-cells) to eliminate this hyperinflammation," said Jorge Moscat, the study's principal investigator and chair of UC's cancer and cell biology department, in a university news release. "Our research suggests obesity-related glucose intolerance has nothing to do with the immune system. It may be more effective to target (fat cells)."

In laboratory animals, the researchers found that a gene known as protein kinase C (PKC)-zeta plays a dual role in molecular signaling associated with inflammation. Obesity, they said, can switch the gene from acting as an inflammation regulator to an agent promoting inflammation. PKC-zeta does this by causing fat cells to secrete a substance called interleukin-6 (IL6), which streams to the liver in large quantities to cause insulin resistance.

The study appears in the July 7 issue of the journal Cell Metabolism.

Previous research has linked PKC-zeta to the development of malignant tumors. Researchers say it may do so in a manner similar to the way in which it triggers the inflammation associated with diabetes.

"Now we are trying to understand how PKC-zeta regulates IL6 to better determine how we can manipulate the protein to help prevent diabetes and cancer," Moscat said.

More information

The U.S. National Institute of Diabetes and Digestive and Kidney Diseases has more about type 2 diabetes.

Antioxidants Do Help Arteries Stay Healthy



Tuesday, July 6, 2010


ScienceDaily (July 6, 2010) — Long-term supplementation with dietary antioxidants has beneficial effects on sugar and fat metabolism, blood pressure and arterial flexibility in patients with multiple cardiovascular risk factors. Researchers writing in BioMed Central's open access journal Nutrition and Metabolism report these positive results in a randomized controlled trial of combined vitamin C, vitamin E, coenzyme Q10 and selenium capsules.


Reuven Zimlichman worked with a team of researchers from Wolfson Medical Center, Israel, to carry out the study in 70 patients from the centre's hypertension clinic. He said, "Antioxidant supplementation significantly increased large and small artery elasticity in patients with multiple cardiovascular risk factors. This beneficial vascular effect was associated with an improvement in glucose and lipid metabolism as well as significant decrease in blood pressure."


Previous results from clinical trials into the cardiovascular health effects of antioxidants have been equivocal. In order to shed more light onto the matter, Zimlichman and his colleagues randomised the 70 patients to receive either antioxidants or placebo capsules for six months. Tests at the beginning of the trial, after three months and at the six month mark revealed that the patients in the antioxidant group had more elastic arteries (a measure of increased cardiovascular health) and better blood sugar and cholesterol profiles.


According to Zimlichman, "The findings of the present study justify investigating the overall clinical impact of antioxidant treatment in patients with multiple cardiovascular risk factors."

Journal Reference:

Marina Shargorodsky, Ortal Debbi, Zipora Matas and Reuven Zimlichman. Effect of long-term treatment with antioxidants (vitamin C, vitamin E, coenzyme Q10 and selenium) on arterial compliance, humoral factors and inflammatory markers in patients with multiple cardiovascular risk factors. Nutrition & Metabolism, 2010; (in press) [link]

Blood pressure goals for diabetics -- too tough?


By Julie Steenhuysen


Tuesday, July 6, 2010

CHICAGO (Reuters) – Aggressively controlling blood pressure in diabetics with heart disease may do little to reduce their risks of dying early and may even be dangerous, U.S. researchers said on Tuesday.

They found that using a combination of drugs to keep diabetic patients' top blood pressure readings below 130 offered no benefit over those whose top reading was below 140 -- the cutoff point for high blood pressure.

Normal blood pressure for healthy people is considered to be 120/80 or lower.

"Clearly, patients and doctors work very hard to get diabetic patients' blood pressure to less than 130. Our data would suggest maybe we can stop at two drugs instead of three. And maybe we can spend a little more time talking about diet and exercise and cholesterol," Rhonda Cooper-DeHoff of the University of Florida and colleagues wrote in the Journal of the American Medical Association.

The study is the latest to look at whether treating diabetics aggressively with drugs to control their risk of a heart attack or stroke has any benefit. Several teams have found it in fact can be dangerous for some patients.

A five-year, U.S. government-backed study dubbed ACCORD was stopped temporarily in February 2008 because 20 percent more diabetics with heart problems who got intensive treatment to lower their blood sugar died compared to those treated more conservatively.

The patients getting the tougher treatment were transferred into the gentler group and the trial continued. The latest long-term results, reported at the American Diabetes Association meeting last week, showed using more drugs to control blood pressure did little to prevent heart problems.

Cooper-DeHoff said most of the patients in the ACCORD trial did not have heart disease. Her team looked specifically at 6,400 diabetics with heart disease taking part in an international trial that examined different combinations of several common drug treatments to control blood pressure -- diuretics, calcium channel blockers and ACE inhibitors.

After about five years, they categorized people according to the level of blood pressure control they achieved.

Those with tight control had blood pressure under 130; those with average control had blood pressure under 140 and those whose blood pressure was over 140 were considered uncontrolled.

"What we found was that the tight control group -- those with systolic blood pressure of 130 -- did no better with regard to the overall outcome of death, heart attack or stroke. There was no difference, and in fact those they may have done a little worse," Cooper-DeHoff said in a telephone interview.

But diabetics do need to work on blood pressure control. People in the study whose blood pressure was uncontrolled fared the worst across the board.

"Clearly, we still need to get systolic blood pressure below 140, but less than 130 isn't any better," she said.

(Editing by Maggie Fox and Jerry Norton)


Low Vitamin D Linked to the Metabolic Syndrome in Elderly People



Tuesday, July 6, 2010


ScienceDaily (July 6, 2010) — A new study adds to the mounting evidence that older adults commonly have low vitamin D levels and that vitamin D inadequacy may be a risk factor for the metabolic syndrome, a condition that affects one in four adults. The results were presented at The Endocrine Society's 92nd Annual Meeting in San Diego.


"Because the metabolic syndrome increases the risk of diabetes and cardiovascular disease, an adequate vitamin D level in the body might be important in the prevention of these diseases," said study co-author Marelise Eekhoff, MD, PhD, of VU University Medical Center, Amsterdam.


The researchers found a 48 percent prevalence of vitamin D deficiency. The study consisted of a representative sample of the older Dutch population: nearly 1,300 white men and women ages 65 and older.

Nearly 37 percent of the total sample had the metabolic syndrome, a clustering of high blood pressure, abdominal obesity, abnormal cholesterol profile and high blood sugar.


Subjects with blood levels of vitamin D (serum 25-hydroxyvitamin D) lower than 50 nanomoles per liter, considered vitamin D insufficiency, were likelier to have the metabolic syndrome than those whose vitamin D levels exceeded 50. That increased risk especially stemmed from the presence of two risk factors for the metabolic syndrome: low HDL, or "good" cholesterol, and a large waistline.


There was no difference in risk between men and women, the authors noted.


The study included subjects who were participating in the Longitudinal Aging Study Amsterdam. Although the data were from 1995 and 1996, Eekhoff said they expect that vitamin D inadequacy remains prevalent among whites in the Netherlands.


Using follow-up data from 2009, the researchers plan to study how many of the subjects with low vitamin D levels developed diabetes.


"It is important to investigate the exact role of vitamin D in diabetes to find new and maybe easy ways to prevent it and cardiovascular disease," Eekhoff said.


The study's other authors were Mirjam Oosterwerff, MD, Paul Lips, MD, PhD, and Natasja Van Schoor, PhD, all from VU University Medical Center.


Early pot smoking, depression may be linked


By Amy Norton

Reuters Health

Tuesday, July 6, 2010

NEW YORK (Reuters Health) – Children and teenagers who smoke marijuana may have a somewhat heightened risk of developing depression, a new study suggests -- though whether the drug itself is to blame is not clear.

Several studies have found an association between marijuana use and increased risks of depression and anxiety disorders, but some others have failed to confirm such a link. Moreover, it has been unclear whether marijuana use itself, or some other factor, accounts for the connection seen in some studies.

For the new study, published in the American Journal of Epidemiology, researchers used data collected from more than 50,000 adults in 17 countries taking part in a World Health Organization mental-health study.

Overall, the researchers found a modest association between marijuana smoking before the age of 17 and the odds of suffering depression later on. Across the countries, early marijuana use was linked to a 50 percent increase in the risk of developing a depression "spell" after age 17.

The connection remained when the researchers accounted for a number of other factors, including participants' self-reported recent marijuana use, smoking and drinking habits, and history of mental health problems like phobias and anxiety.

The strength of the marijuana-depression link did weaken, however, when the investigators factored in childhood conduct problems -- like skipping school, getting into fights and shoplifting.

The implication is that such conduct problems may "partially" explain the relationship between early pot smoking and later depression, lead researcher Dr. Ron de Graaf, of the Netherlands Institute of Mental Health and Addiction in Utrecht, told Reuters Health in an email.

Unfortunately, de Graaf said, he and his colleagues lacked information on conduct problems from study participants in certain countries -- including some of those nations where the connection between early pot use and depression was strongest, such as New Zealand and South Africa.

So the full extent to which childhood behavioral problems may explain the pot-depression link is not clear.

The study has other key limitations as well. One is that participants were surveyed at a single point rather than followed over time, which is the best way to gauge which came first -- the drug use or the depression.

Instead, the study participants were screened for depression "spells" -- persistent feelings of sadness and other symptoms, such as appetite changes and sleep problems, that lasted for at least two weeks -- then asked to recall when they had first started having such episodes.

Those who said they were 17 or older when their depression first hit were considered "cases." Across the countries, 9,647 participants met that definition and were compared with the 41,000-plus men and women who had no current or past depression.

Of the depression group, 9 percent said they had smoked marijuana before the age of 17, while the same was true of 7 percent of the comparison group. In general, men and women who said they had used pot before age 17 had a greater chance of having a depression episode at age 17 or later.

This type of study design cannot prove that marijuana itself contributed to the increased risk of depression. It may be, for instance, that young people who are vulnerable to developing depression or other mental health problems are also more likely to use marijuana.

Still, de Graaf said, it is possible that as with other substances, such as alcohol, children's and teenagers' still-developing brains may be more vulnerable to any direct toxic effects of marijuana use.

Some past studies have linked heavy marijuana use, particularly early in life, to an increased risk of schizophrenia-like psychosis.

"Early cannabis (marijuana) use may have important consequences for later mental health," de Graaf said. "We know now -- also from other studies -- that cannabis use is not without negative consequences."

More studies are still needed, however, according to de Graaf -- particularly ones that follow young people over time to see whether marijuana use does precede the development of mental health problems in some kids.


American Journal of Epidemiology, online June 9, 2010.


Virgin Olive Oil and a Mediterranean Diet Fight Heart Disease by Changing How Our Genes Function



Tuesday, July 6, 2010


ScienceDaily (July 6, 2010) — Everyone knows olive oil and a Mediterranean diet are associated with a lower risk for cardiovascular disease, but a new research report published in the July 2010 print issue of the FASEB Journal offers a surprising reason why: These foods change how genes associated with atherosclerosis function.


"Knowing which genes can be modulated by diet in a healthy way can help people select healthy diets," said Maria Isabel Covas, D.Pharm., Ph.D., a researcher involved in the work from the Cardiovascular Risk and Nutrition Research Group at the Institut Municipal d'Investigacio Medica in Barcelona, Spain. "It is also a first step for future nutritional therapies with selected foods."


Scientists worked with three groups of healthy volunteers. The first group consumed a traditional Mediterranean diet with virgin olive oil rich in polyphenols. The second group consumed a traditional Mediterranean diet with an olive oil low in polyphenols. The third group followed their habitual diet. After three months, the first group had a down-regulation in the expression of atherosclerosis-related genes in their peripheral blood mononuclear cells. Additionally, the olive oil polyphenols made a significant impact on the expression of genetic changes influencing coronary heart disease. Results also showed that the consumption of virgin olive oil in conjunction with a Mediterranean diet can positively impact lipid and DNA oxidation, insulin resistance, inflammation, carcinogenesis, and tumor suppression.


"This study is ground breaking because it shows that olive oil and a Mediterranean diet affect our bodies in a far more significant way than previously believed," said Gerald Weissmann, M.D., Editor-in-Chief of the FASEB Journal. "Not only does this research offer more support for encouraging people to change their eating habits, it is an important first step toward identifying drug targets that affect how our genes express themselves."

Journal Reference:

V. Konstantinidou, M.-I. Covas, D. Munoz-Aguayo, O. Khymenets, R. de la Torre, G. Saez, M. del Carmen Tormos, E. Toledo, A. Marti, V. Ruiz-Gutierrez, M. V. Ruiz Mendez, M. Fito. In vivo nutrigenomic effects of virgin olive oil polyphenols within the frame of the Mediterranean diet: a randomized controlled trial. The FASEB Journal, 2010; DOI: 10.1096/fj.09-148452

10,000-plus in U.S. die for lack of cancer screens: CDC

By Maggie Fox

Health and Science Editor


Tuesday, July 6, 2010

WASHINGTON (Reuters) – At least 10,000 people and possibly far more die in the United States each year because they have not been screened for colon or breast cancer, according to a government report released on Tuesday.

But more people are being screened than ever before, the U.S. Centers for Disease Control and Prevention said in the first of a series of new reports on health statistics.

"We are encouraged by a significant increase in colon cancer screening rates over recent years," CDC Director Dr. Thomas Frieden told reporters in a telephone briefing.

But, he added, "more than a third of Americans who need to be screened haven't been screened."

CDC researchers analyzed survey results from the state-level 2008 Behavioral Risk Factor Surveillance Survey for the report, available at

They found colon cancer screening rates rose from 52 percent of those who should get the tests in 2002 to 63 percent in 2008. Americans are advised to get a colon cancer screen, usually in the form of a colonoscopy, starting at age 50 and at age 40 if there is a family history of the disease.

A separate report found that 81 percent of women aged 50 to 74 got mammograms in 2008, virtually the same as in 2006.

"The findings indicated that more than 22 million men and women have not had a potentially life-saving screening test for colorectal cancer and about 7 million women age 50 to 74 have not had a recent mammogram," the CDC said in a statement.

"Any screening is good and the overall increase is the main message there," Frieden said. "Nevertheless, there is a lot more progress we could make with colon cancer screening."

Frieden said there are differences of opinion over how many lives could have been saved by early screening. Colonoscopies can detect and remove pre-cancerous growths before they become tumors and mammograms can catch tumors while they are small and easily removed.

Lives Saved

The American Cancer Society says that more than 106,000 Americans were diagnosed with colon cancer in 2009 and nearly 50,000 died of it.

"What is debated is exactly how many of those would be prevented by colon cancer screening getting as high as can plausibly be expected," Frieden said.

"You can argue for 10,000. You can argue for 30,000," he added. "I think we can certainly say more than 10,000 very comfortably. For every person who dies from preventable colon cancer it is one too many."

In 2009, 194,000 Americans got breast cancer and 40,000 died. "Each year about 12,000 lives are saved as a result of mammography," Frieden said.

If insurance companies stopped requiring co-payments for screening tests, that could help increase the number of people willing to be screened, Frieden said.

The report also showed that people with health insurance are far more likely to be screened for cancer, with 66 percent of those insured getting the recommended breast or colon screening compared to 36 percent of those without.

Currently, about 46 million Americans, or 15 percent of the population, has no health insurance. A new healthcare law signed in March is projected to extend coverage to 32 million more Americans, mainly by requiring them to buy it.

Breast Cancer Gene May Raise Men's Risk, Too


HealthDay News

Tuesday, July 6, 2010

TUESDAY, July 6 (HealthDay News) -- A faulty gene that greatly increases a woman's risk of breast cancer also boosts a man's risk for the disease, a new study finds.

While most people think of breast cancer as a woman's illness, in rare cases men can develop breast tumors as well.

The new study found that men with a faulty BRCA2 gene, long tied to female breast tumors, have a one in 12 chance of developing breast cancer before they're 80.

British researchers analyzed data from 321 families with a faulty BRCA2 gene. They found that 20 men in the families had developed breast cancer between the ages of 29 and 79.

Of the 905 first-degree male relatives (parent or sibling) of known BRCA2 carriers, 16 men (2 percent) had developed the disease. Eight other cases of breast cancer occurred in second-degree male relatives, two of whom were also BRCA carriers.

Based on this data, the researchers calculated that men with a faulty BRCA2 have a 7.1 percent (one in 15) chance of developing breast cancer by age 70, and a 8.4 percent (one in 12) chance of developing the disease by age 80. The overall lifetime risk is between 6 percent and 9 percent.

"These risks are sufficient to increase awareness of breast cancer among men in BRCA2 families and to stress the importance of early presentation with breast symptoms," researchers led by Gareth Evans, of St. Mary's Hospital, Manchester, concluded.

The study appears online July 6 in the Journal of Medical Genetics.

More information

The American Cancer Society has more about male breast cancer.

Monday, July 5, 2010 


Brain patterns may be signs of mental illness risk


By Kate Kelland


Monday, July 5, 2010

LONDON (Reuters) – British scientists believe they have found specific patterns of brain activity in children and young people which could be signs or "markers" of those who will later go on to develop mental illnesses such as schizophrenia.

Researchers from Nottingham University, who presented their study at the Forum for European Neuroscience in Amsterdam, said the patterns suggest it may be possible in future to identify those at risk of becoming ill before they develop symptoms.

"If we can identify people who are at particularly high risk of developing schizophrenia, perhaps using neurocognitive brain markers, then we might be able to reduce that risk and also help them to function better," said Dr Maddie Groom, who worked on the study and gave a briefing to reporters in London.

"If we give them a better start, they may encounter the illness in a more positive way and not get quite so ill."

Hundreds of millions of people worldwide are affected by mental, behavioral and neurological illnesses such as schizophrenia, attention deficit hyperactivity disorder (ADHD), depression, epilepsy and dementia.

Many people who go on to develop diverse mental health problems will have a history of behavioral problems going back to childhood, but experts say the problem with finding them at that stage is that differences then are often extremely subtle.

In one study, Groom and her colleagues investigated looked at the healthy siblings of people with schizophrenia, who also have a very slightly increased risk of developing schizophrenia compared with the general population.

Using brain imaging to read activity levels, the scientists asked the siblings to perform task which involved playing an alien-zapping computer game in which they needed to respond quickly, and crucially, halt the urge to respond if the wrong kind of alien popped up. The task was called a "go, no-go" task.

"When we measured the brain activity of the siblings of people with schizophrenia, their brain activity was reduced at the time when they needed to pay attention to the stimulus, and when they needed to inhibit their response," Groom explained.

She said this suggested the subtle differences in brain activity may act as a risk marker for the disorder.

In a second study, scientists compared brain activity of children with ADHD -- a mental disorder that affects between 8 and 12 percent of children, and 4 percent of adults worldwide.

The researchers used the same "go, no-go" task in various scenarios, including when the children were taking their medication, Ritalin, and when they were not, and then using an additional system of rewards and penalties.

Millions of people take ADHD drugs including Novartis Ritalin, which is known generically as methylphenidate, and Shire Plc's Adderall and Vyvanse. In the United States alone, 2008 sales for these drugs was about $4.8 billion, according to data from IMS Health.

Groom's results showed that children who were taking medication, and children given an incentive, performed better than those who had neither medicines nor incentives.

This suggests, Groom said, that doctors may be able to find new ways to treat children with ADHD using a combination of behavioral strategies and drugs.

(Editing by Jon Boyle)

Do video games cause attention problems in kids?


By Frederik Joelving

Reuters Health

Monday, July 5, 2010

NEW YORK (Reuters Health) – Long hours in front of the television, whether channel surfing or gaming, could make it difficult for kids to concentrate in school, psychologists said Monday.

While researchers are still divided on the issue, the findings jibe with most earlier work on the effects of television watching in kids, they said.

"What we don't know at this point is why TV and video games really would cause attention problems," said Douglas A. Gentile, who worked on the study.

Gentile, who runs the Media Research Lab at Iowa State University in Ames, added that too much screen time had also been linked to increased aggression and, perhaps less surprisingly, expanding waistlines.

He said the new study, published in the journal Pediatrics, was the first to follow over time how video games may impact kids' concentration skills.

While the research doesn't directly prove that long screen time causes the psychological issues, "we know that earlier television watching was not caused by later attention problems," Gentile told Reuters Health.

The researchers followed a group of more than 1,300 school-age children, who, assisted by their parents, logged their TV and gaming hours over a year. They then asked teachers to answer questions about how the children behaved in school -- whether they had difficulty staying on task, for instance, or often interrupted others.

Even after accounting for attention problems when children entered the study, those who watched a lot of TV or played a lot of video games had slightly more problems concentrating on schoolwork.

Specifically, those children who spent more than two hours per day in front of the screen -- the limit recommended by the American Academy of Pediatrics -- increased their odds of exceeding the average level of attention problems by 67 percent.

Extreme cases of attention difficulty sometimes lead to a diagnosis of attention-deficit/hyperactivity disorder (ADHD), which between three and seven percent of school-age children suffer from. The researchers did not diagnose any kids with that condition, however.

They also tested undergraduate students, this time using psychological questionnaires designed to reveal ADHD, such as the Adult ADHD Self-Report Scale.

In these students, exceeding two hours of daily screen time doubled their risk of landing above average in attention problems, although they weren't diagnosed with ADHD.

Gentile said the impact of TV and video games depended on lots of factors, and wasn't necessarily dramatic.

"Not every kid is going to be influenced to the same amount," he said. "No one thing causes our behavior. It's a combination of all the pushes and pulls that we get -- the media is just one variable."

Miriam Mulsow, an expert in ADHD who was not involved in the study, said she did not think TV or video games could cause attention problems or ADHD.

"There are parents out there who are doing the best they can, but are working multiple jobs and can't afford child care," said Mulsow, of Texas Tech University in Lubbock. "What worries me is that those parents will think they cause their children to have ADHD. I don't think that's the case, and I don't think those parents should feel bad."

However, she added, "if a child has a tendency toward attention problems then sitting in front of the TV not getting enough exercise would exacerbate it."

She said she agreed a child shouldn't be allowed to watch more than two hours of TV a day. "I didn't even allow my kids to watch that much," she told Reuters Health.

Gentile said the findings also send a positive message to parents whose kids are plagued by attention problems.

"This study perhaps gives parents a first line of defense because (screen time) is something they can control," he said. "The research suggests that parents actually are in a more powerful position to help their children than they realize."


Pediatrics, online July 5, 2010.

Scientists find blood protein link to Alzheimer's



By Kate Kelland


Monday, July 5, 2010

LONDON (Reuters) – High levels of a blood protein called clusterin are linked to the development of Alzheimer's disease, scientists said on Monday -- a finding which could pave the way for doctors to detect the disease before it takes hold.

Researchers from the Institute of Psychiatry at King's College London said that while doctors are around 5 years away from being able to use the discovery for a test to identify future Alzheimer's sufferers, it was a big step along the way.

Alzheimer's is the most common form of dementia -- a brain-wasting condition that affects around 35 million people around the world -- and despite decades of research, doctors still have few effective weapons against it.

Drugs can relieve some of the symptoms for a while, but patients gradually lose their memories, their ability to navigate and understand the world, and to care for themselves.

This research team used a technique called proteomics, which analyses proteins, to conduct two "discovery phase" studies in 95 patients and found that clusterin appeared to be linked with the early signs of Alzheimer's. The findings were published in the Archives of General Psychiatry journal.

"We found that this clusterin protein was increased in blood as much as 10 years before people had the signs of Alzheimer's disease in their brains," said Simon Lovestone, who led the study. "And even when they had signs of disease in their brains, they still had no clinical signs of the disorder -- so this suggests that this is a really, really early change that occurs in people who are going to get the disease."

Lovestone said it was important to stress there was still a lot more work to do before a test could be used by doctors in clinics, but said such a technique may in future become part of a range of tests to find people with early signs of the disease.

The number of dementia sufferers is expected to balloon in future decades as populations around the world age. Alzheimer's Disease International predicts numbers will almost double every 20 years to 66 million in 2030 and over 115 million in 2050.

"We think this is the first step toward finding a prodromal or preclinical test for the disease," Lovestone said. A prodromal test is one that can detect very early signs of a disease before any specific symptoms are showing.

"If I look toward the future, such tests might be used as part of a staging process. I can imagine people first having a blood test and then those people who have high levels of clusterin might go on to have more intensive investigations."

After their initial study in 95 patients, the researchers then studied clusterin levels in around 700 people, including 464 with Alzheimer's disease, and found a link between higher levels of the protein and severity of disease, rapid progression of the condition and atrophy in the brain area known as the entorhinal cortex, which plays a role in memory.

Lovestone said the next step -- which should take about a year -- would be to develop a better test, since the one they used for the study would not be suitable for use in clinics. "Once we've then designed the better test, we need to look at it in larger groups of people to see if our results are replicated," he said. "That whole process will take between three to five years."

Cocoa Flavanols Improve Vascular and Blood Pressure Measures for Coronary Artery Disease Patients



Monday, July 5, 2010


ScienceDaily (July 5, 2010) — A new study by UCSF cardiologists and researchers found that high concentrations of cocoa flavanols decrease blood pressure, improve the health of blood vessels and increase the number of circulating blood-vessel-forming cells in patients with heart disease. The findings indicate that foods rich in flavanols -- such as cocoa products, tea, wine, and various fruits and vegetables -- have a cardio-protective benefit for heart disease patients.


Findings will be published online July 5th and in the July 13, 2010 issue of the Journal of the American College of Cardiology (JACC).


Flavanols are phytonutrient compounds that are found naturally in apples, grapes, tea, cocoa and cherries, which account for the antioxidant effect provided by red wine and green tea. The study found a protective effect from a cocoa drink with 375 mg of flavanols, but according to researchers, a standard or recommended dosage has not yet been defined to achieve optimal health benefit.


The UCSF team has shown for the first time that one of the possible mechanisms of flavanol's benefit is an increase in the circulation of so-called angiogenic cells in the blood. These cells, also known as early endothelial progenitor cells, are critical for the repair process after vascular injury, and perform function and maintenance roles in the endothelium. Endothelium is the thin layer of cells that line the interior wall of blood vessels.


"Reduced blood vessel function is a hallmark of early development of coronary artery disease," said cardiologist Yerem Yeghiazarians, MD, senior author, associate professor of medicine, and researcher in the Eli and Edythe Broad Center of Regeneration Medicine and Stem Cell Research at UCSF. "If we can improve the health and function of damaged blood vessels, heart disease patients will have a better chance of survival."

In 2005, researchers reported that an increased level of circulating angiogenic cells is associated with a decreased risk of death from cardiovascular causes (New England Journal of Medicine by Werner, N., et al.)

In the current study, the benefit seen from the two-fold increase in circulating angiogenic cells was similar to that achieved by therapy with statins and with lifestyle changes such as exercise and smoking cessation. The benefit demonstrated with cocoa flavanol therapy occurred in addition to the medical regimen already being taken by study participants.


"Our data support the concept that dietary flavanols at the levels provided -- in tandem with current medical therapy -- are safe, improve cardiovascular function, and increase circulating angiogenic cells, which have previously been shown to correlate positively with long-term cardiovascular outcomes" said Yeghiazarians. "Long-term trials examining the effects of high-flavanol diets on cardiovascular health and function are warranted, but these early findings help us understand how these compounds impact the function of damaged blood vessels."


The study included 16 coronary artery disease patients aged 64 years (±three years) who received a high-flavanol cocoa drink (containing 375 mg of flavanols) twice a day over 30 days and then a nutrient-matched low-flavanol cocoa drink (containing 9mg flavanols) twice a day over 30 days.


The study was randomized, controlled and "masked," meaning both the doctors and patients were prevented from knowing which variation of the cocoa drink a patient was drinking at a given time until after the study was completed. The patients continued taking all regular medications for their underlying heart disease during the study period, including statin medications for lowering the cholesterol levels to recommended goals.


Researchers calculated the outcome of the cocoa intervention using blood pressure readings, ultrasound to measure dilation of the brachial artery, and cell assays to calculate the number and behavior of circulating angiogenic cells. The tests showed a 47 percent improvement in vasodilation, or widening rather than constriction, of the brachial artery in the high-flavanol time period compared to the low-flavanol period. In addition, circulating angiogenic cells increased 2.2-fold and systolic blood pressure decreased among the high-flavanol versus low-flavanol periods.


"This is exciting data," Yeghiazarians added. "Our findings demonstrate that a further increase in endothelial function and improvement in blood pressure can be achieved by complementing standard treatment with a flavanol-rich diet. The 80 million Americans impacted by heart disease may be glad to hear this." Notably, the therapy did not influence fasting glucose levels of study participants. (Fasting glucose is the standard for measuring an individual's blood sugar level to diagnose conditions such as diabetes and heart disease).

The study was funded by Mars, Inc., and the American Heart Association.


Corresponding author was Christian Heiss, MD, of UCSF's Division of Cardiology with additional affiliations with the Division of Cardiology, Vascular Medicine and Pulmonology in Dusseldorf, Germany, and the Department of Nutrition at University of California, Davis.


Additional UCSF investigators include Stanton Glantz, PhD; Andrew Boyle, PhD; William Grossman, MD; Shirley Mihardja, PhD; Franca S. Angeli, MD; Nicolas Amabile, MD; Megha Prasad, Sarah Jahn, Melanie Taylor, Wendy May Real, Maelene L. Wong, and Matthew L. Springer, PhD, from UCSF's Cardiovascular Research Institute and the Eli and Edythe Broad Center of Regeneration Medicine and Stem Cell Research.

Other co-authors include Tienush Rassaf, MD, with the Division of Cardiology, Vascular Medicine and Pulmonology in Dusseldorf, Germany; Javier I. Ottaviani, PhD, and Carl L. Keen, PhD, from the Department of Nutrition at the University of California, Davis; and Hagen Schroeter, PhD, from Mars, Inc.

Journal Reference:

Christian Heiss, Sarah Jahn, Melanie Taylor, Wendy May Real, Franca S. Angeli, Maelene L. Wong, Nicolas Amabile, Megha Prasad, Tienush Rassaf, Javier I. Ottaviani, Shirley Mihardja, Carl L. Keen, Matthew L. Springer, Andrew Boyle, William Grossman, Stanton A. Glantz, Hagen Schroeter, and Yerem Yeghiazarians. Improvement of Endothelial Function With Dietary Flavanols Is Associated With Mobilization of Circulating Angiogenic Cells in Patients With Coronary Artery Disease. J Am. Coll. Cardiol, July 13, 2010; 56: 218-224 DOI: 10.1016/j.jacc.2010.03.039

Brain diseases linked to nerve cell junction defects

By Kate Kelland


Monday, July 5, 2010

LONDON (Reuters) – More than 135 brain diseases including autism, chronic pain, schizophrenia and dementia are linked to defects in proteins in the junctions between nerve cells, scientists have found.

Researchers have been able for the first time to map the protein structure of human synapses, the junctions between nerve cells responsible for transmitting information, offering scientists a new way of looking at diseases that affect millions of people around the world.

It also opens potential new ways of finding and developing drugs for brain diseases, and may in future allow doctors to make genetic diagnoses of the conditions, said Seth Grant, the neuroscientist at Cambridge University's Sanger Institute who led the study.

"We now recognize that these synapse proteins are the molecular basis of many brain diseases," he told reporters before presenting his findings at the Forum for European Neuroscience in Amsterdam on Monday. "We know of no other molecular structure which is responsible for more brain diseases -- so we think it's a major discovery."

Grant's team used a technique called proteomics to analyze all the proteins in human brain cells. Humans have around a million billion brains cells and these are connected by synapses, which play a pivotal role because they create circuits that allow the brain to learn and remember things.

The scientists found around 1,500 proteins in human synapses, each of which is encoded by a gene. They then managed to link genetic defects in some of these with key diseases such as autism, bipolar disorder, depression and schizophrenia.

"By understanding the composition of the synapse, we can also ask which proteins are important to diseases, and therefore get a sense of the disease burden that the synapse is involved with," Grant said.

"Rather than thinking that a gene causes a particular disease, what we're seeing now is that the gene mutation disrupts the (protein) complexes that cause the disease. We found that defects in the genes that encode these human synapse proteins are really a major cause of diseases."

In a follow-up study using mice, Grant's team found that by using various drugs to change the proteins in the synapse, the link to disease was also altered.

Grant said his team now planned to investigate whether the links between defects in synapse proteins and disease that they found in mice are also borne out in humans.

"If they are, then it has the potential to radically refocus scientists' approach to the study of brain diseases," he said.

(Editing by David Stamp)