Friday, January 22, 2010
Friday, January 22, 2010
FRIDAY, Jan. 22 (HealthDay News) -- Obesity increases the risk of developing a common and virulent form of kidney cancer, a new study finds.
Researchers looked at 1,640 patients, average age 62, with kidney tumors and found that obese patients were 48 percent more likely to develop a clear-cell renal cell cancer (RCC) than those with a body-mass index(BMI) of less than 30, the cutoff for obesity. The odds of developing RCC increased by 4 percent for every extra BMI point.
Malignant tumors with clear-cell RCC were found in 67 percent of obese patients with malignant tumors, compared with 57 percent of non-obese patients with malignant tumors. Obese and non-obese patients had similar rates for other kinds of malignant tumors, including papillary, chromophobe and collecting duct.
"We also looked at other health and lifestyle factors, like diabetes, hypertension and smoking. This showed that the only other factors that were independent predictors of clear-cell RCC were male gender and tumor size," study author Dr. William T. Lowrance, of the Memorial Sloan-Kettering Cancer Center in New York City, said in a news release.
He and his colleagues concluded that BMI is an independent predictor of clear-cell RCC and that the odds of having clear-cell RCC increase as BMI increases.
The study was published in the January issue of the journal BJUI.
"A number of studies have suggested that obesity could be a risk factor for RCC, but the exact reason is unknown. Researchers suggest it might be secondary to hormonal changes, decreased immune function, hypertension or diabetes in obese patients," Lowrance said.
The American Cancer Society has more about kidney cancer.
By Joene Hendry
Friday, January 22, 2010
NEW YORK (Reuters Health) – Depression is a major health issue for breast cancer survivors, but new research hints that regular exercise and drinking green tea may help.
Exercising regularly and drinking green tea "may play an important role in the prevention of depression among breast cancer survivors," report Dr. Xiao Ou Shu, at Vanderbilt University Medical Center, in Nashville, Tennessee, and colleagues.
They examined depression-related factors in 1,399 Chinese women who were 54 years old on average and treated for breast cancer in Shanghai, China between April 2002 and December 2006. Six months after their diagnosis, the researchers assessed the women's physical activity levels; food, tea, and alcohol consumption; cigarette smoking; and use of herbal medicines and supplements.
In depression evaluations at 18-months post-diagnosis, the investigators noted distinct benefits among the women who reported some sort of exercise (62 percent of the total). At this time, exercisers were about 20 percent less likely to be either mildly or clinically depressed, the researchers report in the Journal of Clinical Oncology.
They noted just 84 cases of mild or clinical depression among 437 vigorous exercisers (19.2 percent), but 161 cases among the 528 non-exercisers (30.5 percent).
Plus, compared with non-exercising women, the likelihood of depression was 28 percent lower among women who exercised more than 2 hours a week and 42 percent lower among those who increased their post-diagnosis exercise time.
Tea drinking also seemed to lessen depression. Compared with the 1,216 women who did not drink tea, among the 183 women who did, depression risk was about 36 percent lower. The vast majority of the tea drinkers -- 90 percent -- drank green tea.
The exercise and tea-drinking benefits remained when Shu's group allowed for multiple other risk factors for depression.
No other factors seemed to alter depression risk.
Although exercise and drinking green tea seemed to lower depression in this group of Chinese women, breast cancer survivors "should not overdose themselves," Shu cautioned in an email to Reuters Health.
He noted that excessive exercise and tea drinking may not have the same benefit on mood. Also, further investigations are necessary to clarify these findings since women in other countries, who may undergo different breast cancer treatment regimens, may react differently.
Source: Journal of Clinical Oncology, online January 4, 2010
Friday, January 22, 2010
THURSDAY, Jan. 21 (HealthDay News) -- High levels of vitamin D in the blood appear to be linked to lower risks of colorectal cancer, although it's not clear if higher intake of the vitamin actually prevents the disease, researchers say.
Still, the findings are food for thought: Scientists found that those with the highest levels of vitamin D in their blood had as much as a 40 percent lower risk for developing colorectal cancer than those with the lowest levels.
The research, published online Jan. 21 in BMJ, is based on a study of more than 520,000 people from 10 countries in Western Europe. The study participants gave blood samples and filled out diet and lifestyle questionnaires between 1992 and 1998. They were then tracked for several more years to see what happened to them.
During the follow-up period, 1,248 were diagnosed with colorectal cancer. These participants were compared with a similar group of 1,248 people who were not diagnosed with the disease.
The researchers cautioned that it's not clear if there are risks from consuming high levels of vitamin D, which is available in supplements. It's also not known whether supplements are necessary if people reach certain levels through a healthy diet, exercise and moderate exposure to sunlight.
The study authors noted that current recommendations for preventing colorectal cancer include exercising, not smoking, reducing obesity and abdominal fat, and limiting consumption of alcohol and red and processed meats.
The U.S. Office of Dietary Supplements has more on vitamin D.
Thursday, January 21, 2010
Thursday, January 21, 2010
ScienceDaily (Jan. 21, 2010) — Protein supplements don't improve performance or recovery time and, according to a recent study, such supplements are inefficient for most athletes. "They are often poorly used or unnecessary by both high-level athletes and amateurs," says Martin Fréchette, a researcher and graduate of the Université de Montréal Department of Nutrition.
Fréchette submitted questionnaires to 42 athletes as part of his master's thesis. Sportsmen were asked about their use of supplements while keeping a journal of their eating habits for three days. They came from a variety of disciplines including biathlon, cycling, long-distance running, swimming, judo, skating and volleyball.
Nine athletes out of 10 reported food supplements on a regular basis. They consume an average of 3,35 products: energy drinks, multi-vitamins, minerals and powdered protein supplements. Fréchette found their knowledge of food supplements to be weak.
"The role of proteins is particularly misunderstood," he warns. "Only one out of four consumers could associate a valid reason, backed by scientific literature, for taking the product according."
Despite the widespread use of protein supplements, 70 percent of athletes in Fréchette's study didn't feel their performance would suffer if they stopped such consumption. "More than 66 percent of those who believed to have bad eating habits took supplements. For those who claimed to have 'good' or 'very good' eating habits that number climbs to 90 percent."
Fréchette stresses that supplements come with certain risks. "Their purity and preparation aren't as controlled as prescription medication," he says. "Sports supplements often contain other ingredients than those listed on the label. Some athletes consume prohibited drugs without knowing."
Other studies have shown that 12 to 20 percent of products regularly used by athletes contain prohibited substances. Fréchette observed a particular interest by the athletes on the efficiency, legality and safety of those drugs.
"No less than 81 percent of athletes taking supplements already had sufficient protein from their diet," says Fréchette. "The use of multivitamins and minerals can make up for an insufficient intake of calcium, folate yet not for lack of potassium."
What's more, consumers of supplements had levels of sodium, magnesium, niacin, folate, vitamin A and iron that exceeded the acceptable norms. "This makes them susceptible to health problems such as nausea, vision trouble, fatigue and liver anomalies," says Fréchette.
By Gene Emery
Thursday, January 21, 2010
BOSTON (Reuters) – Shaving 3 grams off the daily salt intake of Americans could prevent up to 66,000 strokes, 99,000 heart attacks and 92,000 deaths in the United States, while saving $24 billion in health costs per year, researchers reported on Wednesday.
The benefit to the U.S. population would be comparable to cutting smoking by 50 percent, significantly lowering obesity rates and giving cholesterol drugs to virtually everyone to prevent heart attacks, said Dr. Kirsten Bibbins-Domingo of the University of California, San Francisco and colleagues.
Such a goal, they said, is readily attainable.
Salt, which contributes to high blood pressure and heart disease, is widely overused in the United States, with 75 to 80 percent coming from processed food. Men typically consume 10.4 grams per day. For women, the average is 7.3 grams. Its use is rising.
A reduction of 1 gram would prevent 11,000 to 23,000 strokes, 18,000 to 35,000 heart attacks and 15,000 to 32,000 deaths from any cause, the researchers reported in New England Journal of Medicine.
Women would benefit the most.
"Even if the federal government were to bear the entire cost of a regulatory program designed to reduce salt consumption, the government would still be expected to realize cost savings for Medicare, saving $6 to $12 in health expenditures for each dollar spent on the regulatory program," the researchers wrote.
In a commentary, Dr. Lawrence Appel and Cheryl Anderson of Johns Hopkins University in Baltimore said the new study may be underestimating the benefits.
They said it did not take into account how it would help children or the fact that lower salt intake may reduce the risk of stomach cancer, kidney disease, congestive heart failure and osteoporosis.
(Editing by Mohammad Zargham)
Thursday, January 21, 2010
ScienceDaily (Jan. 21, 2010) — Bacteria that produce compounds to reduce inflammation and strengthen host defences could be used to treat inflammatory bowel disease (IBD). Such probiotic microbes could be the most successful treatment for IBD to date, as explained in a review published in the February issue of the Journal of Medical Microbiology.
IBD is inflammation of the gastro-intestinal tract that causes severe watery and bloody diarrhoea and abdominal pain. It is an emerging disease that affects 20 out of 100,000 genetically susceptible people in Europe and North America. The most common manifestations of IBD are Crohn's disease and ulcerative colitis. While the exact causes are unclear, IBD is known to be the result of an overactive immune response that is linked to an imbalance of the normal types of bacteria found in the gut.
Several recent studies have identified butyric acid as a potential therapeutic agent for IBD. Some gut bacteria produce butyric acid naturally in the intestines, but in IBD patients some of these strains are heavily depleted. Trials in mice have shown that injecting one such strain Faecalibacterium prausnitzii into the digestive tract is effective at restoring normal levels of gut bacteria and treating the symptoms of IBD. In addition, novel identified butyrate-producing strains, such as Butyricicoccus pullicaecorum, have been shown to exert similar effects.
Butyric acid has well-known anti-inflammatory effects and is able to strengthen intestinal wall cells -- making it an ideal therapeutic agent against IBD. In addition to butyric acid, it is hypothesized that strains such as F. prausnitzii and B.pullicaecorum secrete other anti-inflammatory compounds that may enhance the therapeutic effect.
Prof. Filip Van Immerseel, a medical microbiologist from Ghent University in Belgium said that a new treatment for IBD would be welcomed. "Conventional drug therapy has limited effectiveness and considerable side effects. Probiotics are live bacterial supplements or food ingredients, which when taken in sufficient numbers confer health benefits to the host," he said. Previous trials of probiotics to treat IBD using mainly lactic acid bacteria have given mixed results. "Now we realise that lactic acid is used for growth by a certain population of bacteria that produce butyric acid, which could explain why some of the older studies had a positive outcome. Recent trials focussing on butyric acid-producing bacterial strains have been extremely promising and could lead to a new treatment for IBD."
Developing an effective probiotic treatment for IBD will not be easy, however. "As butyric acid-producing bacteria are naturally depleted in IBD patients, we will need to identify strains that are able to colonize the gut without being outcompeted. Many bacterial species produce butyric acid and possibly other anti-inflammatory molecules so it's a case of finding which is the most robust under these conditions," said Prof. Van Immerseel.
Thursday, January 21, 2010
WEDNESDAY, Jan. 20 (HealthDay News) -- The first blood test to reliably detect early-stage colorectal cancer and polyps may help identify patients who would gain most from colonoscopy, say Israeli researchers who developed the screen.
The blood test checks for levels of CD24 protein, which is produced early in colorectal cancer development and may play a role in the spread of tumor cells, say the team, who will present their findings Sunday at the Gastrointestinal Cancers Symposium in Orlando, Fla.
"Screening is effective for early colorectal cancer detection and prevention, but for a range of reasons, many people are reluctant to undergo colonoscopy. Most people, however, are willing to have a blood test," lead author Sarah Kraus, head of a research laboratory at Tel Aviv Souraski Medical Center, said in a news release from the American Society of Clinical Oncology (ASCO), which helped organize the meeting.
"The CD24 blood test holds promise for identifying the patients at risk for colorectal cancer and could help guide the best use of colonoscopy resources," she said.
Kraus and her colleagues tested the new blood test in 150 patients undergoing colonoscopy. They found that the test was 92.3 percent sensitive (accurate detection of an abnormality) and specific (able to differentiate certain diseases from other diseases) for detecting colorectal cancer, and 84.2 percent sensitive and 89.2 percent specific for detecting polyps that may develop into cancer.
Additional, larger studies to confirm the findings are needed before the new blood test could be used for colorectal cancer screening, Kraus cautioned.
Another study to be presented at the meeting found that post-surgical (adjuvant) treatment with XELOX -- a combination of capecitabine and oxaliplatin -- was more effective than standard 5-fluorouracil and leucovorin (5-FU/LV) therapy for slowing progression of stage III colon cancer in patients of all ages, including those 70 and older.
The phase III study included almost 1,900 patients. After three years, there was no disease progression in 71 percent of patients who received XELOX and 67 percent of patients who received 5-FU/LV, a statistically significant difference, according to the researchers.
Among patients younger than 70, there was no disease progression in 72 percent of the XELOX group and in 69 percent of the 5-FU/LV group. Among patients older than 70, the figures were 66 percent and 60 percent, respectively, the researchers found.
"These findings indicate that patients with stage III colon cancer benefit more from the newer, XELOX adjuvant treatment regimen than from the traditional adjuvant chemotherapy, and that this benefit persists among older patients," lead author Dr. Daniel G. Haller, professor of medicine and of gastrointestinal oncology at the Abramson Cancer Center,
University of Pennsylvania, said in an ASCO news release.
"While treatment decisions should be made on an individual basis, these findings shed important new light on how we can best treat otherwise healthy patients age 70 and older," Haller added.
The American Cancer Society has more about colorectal cancer.
By Joene Hendry
Thursday, January 21, 2010
NEW YORK (Reuters Health) – Strength training improves hand grip and arm function in people who have suffered a stroke without causing increased muscle spasticity or pain, according to combined data from multiple studies.
Stroke commonly weakens muscles and may temporarily cause muscle spasm and pain.
There is some controversy surrounding strength training in stroke patients, as some rehabilitation groups feel that strengthening stroke-weakened muscles will also increase spasticity and pain. But that's not what Dr. Janice J. Eng and Dr. Jocelyn E. Harris, of University of British Columbia in Vancouver, Canada, found.
They pooled results from 13 studies that recorded how strength training exercises, versus no strengthening intervention, affected overall arm strength and function in 517 stroke patients with mild to moderately impaired movement of the upper limbs.
On average, strength training lasted for about one hour on 2 to 3 days a week for 4 weeks, although some of the training periods extended as long as 19 weeks. Most interventions used small weights, resistance bands, and gym-type pulley weights to build muscle.
The combined results suggest, "strengthening does not increase spasticity on a permanent basis," Eng told Reuters Health in an email. Rather, strengthening may actually reduce muscle spasticity, she added.
None of the studies analyzed reported side effects and those that measured spasticity prior to strength training reported no increase in spasticity over the course of training.
In six studies (a total of 306 participants), strength training led to moderate or large improvement in hand grip strength, Eng and Harris report.
In 11 studies (a total of 465 participants) training resulted in a small improvement in arm function.
However, five studies involving 210 participants showed no improvement in activities of daily living, for example picking up a small object. This finding, Eng said, calls for a re-examination of stroke rehabilitation efforts to "ensure that strength training not only improves function, but also activities of daily living."
Source: Stroke, January 2010
By Steven Reinberg
Thursday, January 21, 2010
THURSDAY, Jan. 21 (HealthDay News) -- Twenty percent of U.S. children and teens have abnormal lipid levels, an indication of too much bad cholesterol, too little good cholesterol or high triglycerides, federal health officials report.
These abnormal levels can raise the risk for heart disease, which is the leading cause of death in the United States, according to the U.S. Centers for Disease Control and Prevention.
"Obesity may be linked to these high levels," said report author Ashleigh May, an epidemic intelligence service officer with the CDC.
"Forty-three percent of obese youth are eligible for therapeutic lifestyle counseling, and 22 percent of overweight youth were also eligible," she added.
Doctors need to be aware of lipid screening guidelines and treatments, especially for obese and overweight youth, May said, because abnormal lipid levels can lead to heart disease down the road.
"We really need to identify youth early who have these abnormal lipid levels so we can reduce their risk for later heart disease," May said.
The report is published in the Jan. 22 issue of the CDC's Morbidity and Mortality Weekly Report.
Using data from the National Health and Nutrition Examination Survey, May's team looked at lipid levels among 3,125 youths aged 12 to 19 who participated in the survey from 1999 to 2006.
Specifically, the researchers looked at levels of LDL, or "bad," cholesterol; HDL, or "good," cholesterol; and triglycerides.
May and her colleagues found that children and teens who were overweight or obese were more likely to have abnormal lipid levels compared with youths who were normal weight.
In fact, 22 percent of overweight children and teens and 43 percent of obese children and teens had abnormal lipid levels, compared with 14 percent of their normal weight counterparts.
In addition, 32 percent of these young people are candidates for lipid screening, according to American Academy of Pediatrics guidelines.
The guidelines recommend screening for young people with a family history of high cholesterol or premature cardiovascular disease, or having at least one major risk factor for heart disease, such as smoking, high blood pressure, diabetes, or being overweight or obese.
The researchers also found:
Typically, heart disease develops in adulthood. But its risk factors, such as abnormal lipid levels and overweight/obesity, often emerge during childhood and adolescence.
Over the past 30 years, obesity among American's children has increased from 5 percent to more than 17 percent, according to the CDC.
Commenting on the report, Dr. Gregg C. Fonarow, a professor of cardiology at the University of California, Los Angeles, said that, "There is growing evidence that atherosclerotic vascular disease can begin at an early age and that treatment of abnormal blood lipid levels in youth may reduce the lifetime risk of cardiovascular disease."
Current guidelines recommend lipid screening among obese youth, Fonarow noted.
"It is highly notable that one in five youths in the U.S. have abnormal lipid levels and among obese youth, nearly half had at least one abnormal lipid level," he said.
"There is a clear need for aggressive preventive public health measures such as providing quality nutrition at schools, promoting physical activity in schools and the community, and implementing childhood obesity prevention programs," Fonarow added.
Detecting these abnormal lipid levels can lead to appropriate counseling of children and their families, he said. Only a few would need cholesterol-lowering medications such as statins, he added.
"Therapeutic lifestyle modification with healthy eating, exercise and a goal of achieving a healthy body weight is the foundation of management of abnormal lipid levels in youth," Fonarow said. Less than 1 percent of youth would require statin medications based on current guideline recommendations."
For more information on cholesterol, visit the U.S. National Library of Medicine.
By Julie Steenhuysen
Thursday, January 21, 2010
CHICAGO (Reuters) – Newer digital mammograms may deliver significantly lower radiation doses than conventional film mammograms, especially for women with larger and denser breasts, U.S. researchers said on Thursday.
A study of nearly 50,000 women that compared digital mammography systems to film mammograms found the radiation dose was about 22 percent lower on average with the newer digital mammography exams.
"The ability to reduce the radiation dose for many women is another step forward for breast cancer screening with mammography - which saves thousands of lives each year," Edward Hendrick of the University of Colorado-Denver and a consultant to General Electric's GE Medical Systems, said in a statement.
The results were part of the Digital Mammography Imaging Screening Trial of 49,528 women, which in 2005 found that digital mammograms detected up to 28 percent more cancers than film mammograms in women under 50 who have not gone through menopause and in women with dense breast tissue.
Dr. Carol Lee, chairwoman of the American College of Radiology Breast Imaging Commission, said the previous study showed that the performance of digital was equivalent or slightly better in certain groups.
What is new, she said, is "that can be achieved with overall a lower radiation dose."
Both film and digital mammograms make X-ray images of the breast, but digital mammograms are collected and stored on a computer, making them easier to access than conventional film mammograms.
Lee said generally, the radiation dose from film or digital breast mammograms is not large enough to be worrisome, and women should not skip getting a recommended mammogram if digital mammography is not available in their area.
But in general, she said, lowering the radiation dose is preferable. "We certainly want to keep radiation dose as low as possible and still achieve the desired goal of a good image," Lee said in a telephone interview.
In the study, researchers used digital mammography equipment made by Fischer Imaging Corp, Fujifilm Medical Systems, GE Healthcare and Hologic Inc.
Lee, who was not involved in the research, said only the systems made by GE and Hologic are still available, and said companies have made significant advances in the technology since the data in the study were collected, suggesting the newer machines may deliver an even lower radiation dose.
"Unfortunately, studies and information lag behind the actual practice," Lee said.
Besides lower radiation exposure and better performance for certain women, Lee said digital mammography offers the same kinds of advantages that digital photographs have over pictures taken with older film technology.
"You can zoom in. You can change the contrast level and things like that. When you took a picture with your old film camera, what you took is what you got," she said.
The study was funded in part by the National Cancer Institute and published in the American Journal of Roentgenology.
Thursday, January 21, 2010
ScienceDaily (Jan. 21, 2010) — Low vitamin D blood levels are associated with a significantly higher risk of relapse attacks in patients with multiple sclerosis (MS) who develop the disease during childhood, according to a study conducted by researchers from the University of California, San Francisco.
"We have known for some time that vitamin D insufficiency is a risk factor for developing MS, but this is the first study to assess whether vitamin D levels influence the disease course of those who already have MS," said lead author Ellen Mowry, MD, MCR, a clinical instructor of neurology at the UCSF Multiple Sclerosis Center.
The study, which is now published online in the Annals of Neurology, demonstrates that an increase in vitamin D levels by 10 nanograms per milliliter of blood (ng/mL) corresponds with a 34 percent decrease in the rate of subsequent relapses.
In other words, raising the vitamin D level of a person with MS by 15 ng/mL, which requires about 2,000 international units of vitamin D supplementation a day, could theoretically cut a patient's relapse rate in half, explained Mowry.
"Although we do not yet know if vitamin D supplementation will be beneficial for MS patients, the fact that there is a clear association between vitamin D levels and relapse rate provides strong rationale for conducting a clinical trial to measure the potential impact of supplementation," she said.
"This is an exciting finding because it indicates that it is very possible for vitamin D supplementation to have a profound impact on the course of this disease," said senior author Emmanuelle Waubant, MD, PhD, an associate professor of neurology at UCSF and director of the Regional Pediatric MS Center at UCSF Children's Hospital. Waubant said she expects similar findings in adult patients with MS.
Multiple sclerosis is a chronic and often disabling disease that affects the central nervous system, which comprises the brain, spinal cord and optic nerves. A type of autoimmune disorder, MS causes the body's own defense system to break down a substance called myelin, which surrounds and protects nerve fibers.
Although MS occurs most commonly in adults, a small proportion of cases are diagnosed in children and adolescents. According to the National MS Society, two to five percent of all people with MS experience their first symptoms before the age of 18.
The researchers measured vitamin D levels through blood samples from 110 patients whose MS symptoms began at age 18 or younger. The patients were seen at either UCSF Children's Hospital or the State University of New York Stony Brook's Regional Pediatric MS Center of Excellence -- two of six multidisciplinary referral centers in the United States sponsored by the National MS Society.
After providing the initial blood sample, patients were followed for an average of 1.7 years, during which the researchers recorded the total number of relapses each patient experienced. According to Mowry, a relapse or flare-up of MS causes new neurologic symptoms or the worsening of old ones, such as impaired vision, problems with balance, or numbness. Relapses can be very mild or severe enough to interfere with a person's ability to function.
During the follow-up period, the researchers assessed the patients' relapse rates and vitamin D levels after controlling for such factors as age, gender, race, ethnicity, use of MS treatments and the duration of follow-up care.
"If we are able to confirm that vitamin D supplementation is an effective treatment, my hope is that it will help improve the quality of life for all MS patients," Mowry said.
In addition to a randomized clinical trial of vitamin D supplementation in MS patients, Mowry said further studies are also needed to determine the mechanism by which vitamin D affects inflammatory processes and, in turn, eases symptoms of MS.
Additional co-authors from UCSF include Dorothee Chabas, MD, PhD; Jonathan Strober, MD; Jamie McDonald, BS; Jorge Oksenberg, PhD, and Peter Bacchetti, PhD. Co-authors from other institutions are Lauren Krupp, MD; Maria Milazzo, MS, CPNP, and Anita Belman, MD, all of the Pediatric MS Center, State University of New York at Stony Brook.
The study was supported by a National MS Society Sylvia Lawry Fellowship Award and an additional grant from the National MS Society.
Wednesday, January 20, 2010
Wednesday, January 20, 2010
WEDNESDAY, Jan. 20 (HealthDay News) -- Common wisdom holds apples to be a healthy snack, and a new study agrees, finding that a component of fruit called pectin boosts levels of friendly germs in the digestive system.
Microbiologists at the University of Denmark's National Food Institute tested the effect of apple consumption by feeding rats a diet of whole apples as well as apple-derived products such as apple juice and puree.
The researchers then checked the bacteria in the guts of the rats to see if consuming apples affected levels of "friendly" bacteria, which are bacteria that are beneficial for digestive health and may reduce the risk of some diseases.
The study findings were published online Jan. 20 in the journal BMC Microbiology.
"In our study we found that rats eating a diet high in pectin, a component of dietary fiber in apples, had increased amounts of certain bacteria that may improve intestinal health," study co-researcher Andrea Wilcks said in a news release from the journal's publisher.
"It seems that when apples are eaten regularly and over a prolonged period of time, these bacteria help produce short-chain fatty acids that provide ideal pH conditions for ensuring a beneficial balance of microorganisms. They also produce a chemical called butyrate, which is an important fuel for the cells of the intestinal wall," Wilcks added.
The study authors noted that more research is needed to determine whether the findings in rats apply to humans.
The U.S. National Institutes of Health has details on friendly bacteria.
Wednesday, January 20, 2010
ScienceDaily (Jan. 20, 2010) — Bonn researchers have discovered an elementary mechanism which regulates vital immune functions in healthy people. In situations of hunger which mean stress for the body's cells, the body releases more antimicrobial peptides in order to protect itself. The scientists will publish their results in the journal Nature.
T cells, B cells, antibodies are known as the 'SWAT team' of our immune system that intervenes when viruses and bacteria make us ill. With 'heavy molecular artillery' they wipe out intruders effectively. However, at the same time the defence systems cause collateral damage in the body's own tissue, which has to be repaired first.
In order for the immune system not to be consistently in a state of red alert and possibly cause chronic inflammation this way, there is a second defence system switched in series between body and outside world. This is absolutely necessary because on the barrier tissue such as lungs and skin there are trillions of bacteria. The majority of these microorganisms have been living with our body's cells as good neighbours for millions of years. There's more to come: the complex symbiosis of very different microorganisms supplies us with important natural substances such as vitamin B12.
Good germs, bad germs
At the same time there are always a few mischief-makers among the numerous peaceful bacteria which can make us sick. In this situation, even before the pathogenic germs invade our body, a mechanism is set in motion which acts completely independently of the classic immune defence systems. The biomedical researchers from the LIMES Institute at the University of Bonn have been able to show in fruit flies but also in human tissue that this natural immune defence system is linked directly to the metabolic status via the insulin signalling pathway.
If we have not eaten for a while or have to climb many stairs, the energy level of our cells drops and with it the level of insulin. The researchers from Bonn have now discovered that in the case of a low insulin level the FOXO transcription factor is activated. A transcription factor can switch genes on and off. FOXO switches genes for immune defence proteins on when energy is needed. These antimicrobial peptides (AMP) -- not to be confused with antibodies -- are subsequently jettisoned by the body's cells. They destroy possible pathogens by dissolving their cell walls.
'This happens every minute every day,' the director of studies Prof. Michael Hoch from the LIMES Institute explains. 'What is fascinating about this is that a function of the immune system directly depends on how much and what we eat.' In situations of hunger which mean stress for the body cells, the body releases antimicrobial peptides as a precaution in order to protect itself. 'The barrier between body and outside world is apparently fortified in a potentially dangerous situation in which we have too little energy,' Professor Hoch presumes.
Ancient defence mechanism helps us to get old?
FOXO and the antimicrobial peptide genes which it switches on occur in almost all groups of animals. That is why the researchers believe that the direct link between the food supply and the immunological defence probably developed during the early stage of evolution of metazoan organisms.
The research of the Bonn biologists could also be clinically relevant. For a number of common diseases such as type II diabetes or obesity (adiposity) are the result of an increased intake of calories. Furthermore, such diseases are accompanied by increased inflammation of the barrier tissue, a disturbed immune system and an overall reduced life span. 'Our results present new starting points for understanding of these diseases,' Professor Joachim Schultze from the LIMES Institute, who also is involved in the research project, says.
The scientists at LIMES will concentrate next on the relationship between calorie intake and life span. Examinations of nematodes, fruit flies and mice have shown that a reduced calorie intake can increase life span. Professor Hoch says: 'We now want to find out whether this is due to an foxo-dependent improvement of the barrier functions of the natural immune system.'
Becker et al. FOXO-dependent regulation of innate immune homeostasis. Nature, 2010; 463 (7279): 369 DOI: 10.1038/nature08698
By Mike Stobbe
AP Medical Writer
The Associated Press
Wednesday, January 20, 2010
ATLANTA – Tests of the first two oral drugs developed for treating multiple sclerosis show that both cut the frequency of relapses and may slow progression of the disease, but with side effects that could pose a tough decision for patients.
Two experts not involved in the studies said the drugs appear effective but with potentially dangerous side effects. It's too soon to know if the pills will be approved by the government or widely adopted by physicians, they said.
About 2.5 million people around the world have multiple sclerosis, a neurological disease that can cause muscle tremors, paralysis and problems with speech, memory and concentration. The studies involve the most common form of the disease, in which people are well for a while and then suffer periodic relapses.
Current treatments can reduce the duration and severity of symptoms but require daily or regular shots or infusions.
The new studies tested two types of pills. Cladribine, made by Merck Serono, is already sold to treat a rare blood cancer. For MS, it would be taken eight to 10 days a year. Fingolimod is a daily MS pill being developed by Novartis.
The research found that patients on the pills were about half as likely to suffer relapses of symptoms as those who took dummy pills or a commonly prescribed shot for MS.
But they also found both drugs significantly lowered immune defenses that allowed latent herpes viruses to rage in some patients — in one study, two people died of unchecked herpes infections.
The side effects detailed in the new studies are giving some physicians pause.
"There is a price tag attached" to the new medications, said Dr. Silva Markovic-Plese, an MS researcher at the University of North Carolina.
The studies were being published in Thursday's New England Journal of Medicine.
There is no cure for MS, but steroids can reduce the duration and severity of symptoms in the short term, and seven treatments on the market have had success in reducing recurrence of symptoms.
All involve daily or regular injections. So a pill is appealing: Even healthy people can have trouble giving themselves shots, so it can be a nightmare for patients with faltering coordination and concentration.
"Right now I have to think very hard when I make coffee," said Ivana Vuletic, a 49-year-old Chapel Hill, N.C. woman with MS. "I would be greatly relieved if I didn't have to prick myself or be pricked" with needles, she said.
Still, she said she wouldn't take the new pills if their side effects were too dangerous.
Vuletic is on her third MS drug in about four years, and her illness has gotten worse. The MS injections have led to pocked skin and other problems so she is leery of new treatments' side effects.
The new studies reveal the trade-offs:
In that study, 9 percent of those on fingolimod had serious side effects, compared to 6 percent of those on Avonex. Two people on fingolimod died of herpes infections; six had eye swelling and eight had skin cancers.
All three studies were funded by Novartis or Merck Serono, the pill manufacturers.
Doctors are likely to turn first to current options until the pills' side effects are better understood, said Dr. Neil Lava, the director of Emory University's multiple sclerosis clinic.
Physicians are mindful of what happened with Tysabri, an MS drug that was approved in November 2004 and pulled from the market the next year after cases of a rare but lethal brain inflammation in some patients. It was reintroduced in 2006, but doctors are still monitoring for side effects, Lava said.
Wednesday, January 20, 2010
ScienceDaily (Jan. 20, 2010) — Chicken sold in supermarkets, restaurants and other outlets may place young women at risk of urinary tract infections (UTI), McGill researcher Amee Manges has discovered. Samples taken in the Montreal area between 2005 and 2007, in collaboration with the Public Health Agency of Canada and the University of Guelph, provide strong new evidence that E. coli (Escherichia coli) bacteria originating from these food sources can cause common urinary tract infections.
Eating contaminated meat or food does not directly lead to a UTI. While some E. coli such as O157:H7 can cause serious intestinal disease, these E. coli bacteria can live in the intestine without causing problems. In women however, the bacteria can travel from the anus to the vagina and urethra during sex, which can lead to the infection.
The research team is also investigating whether livestock may be passing antimicrobial-resistant bacteria on to humans. This is due to the use of antibiotics to treat or prevent disease in the animals and to enhance their growth, which may lead them to develop resistance to the medication. When animals are slaughtered and their meat is processed for sale, the meat can be contaminated with these bacteria.
"These studies might open the door to discussions with policymakers," Manges said, "about how antibiotics are used in agriculture in Canada. It's certainly something we need to continue studying."
The public should not be alarmed. Manges advises that consumers should cook meat thoroughly and prevent contamination of other foods in the kitchen.
Although some infections caused by these E. coli are resistant to some antibiotics, the infections can still be treated. Manges hopes that understanding how these bacteria are transmitted will help reduce infections. She also hopes more attention will be focused on how meat is produced in Canada. Her research is part of a broader study concerning food safety and is financed through funding by the Government of Canada, Public Health Agency of Canada, in collaboration with the Laboratory for Foodborne Zoonoses, specifically the Canadian Integrated Program for Antimicrobial Resistance Surveillance, and also the Division de l'inspection des aliments, Ville de Montréal.
Tuesday, January 19, 2010
Tuesday, January 19, 2010
TUESDAY, Jan. 19 (HealthDay News) -- Adding fish oil to intravenous solutions proved beneficial for intensive care patients with the potentially lethal blood infection known as sepsis, a new study finds.
The study, published Jan. 19 in the journal Critical Care, compared 13 patients who received fish oil in the normal IV nutrient solution given to patients with sepsis, and 10 patients who received traditional solutions. The patients who received the fish oil had lower levels of inflammatory chemicals in their blood, achieved better lung function, and had a shorter hospital stay.
"This is the first study of this particular fish oil solution in septic patients in the ICU. The positive results are important since they indicate that the use of such an emulsion in this group of patients will improve clinical outcomes, in comparison with the standard mix," researcher Philip Calder, of the University of Southampton in England, said in a news release.
"Recently, there has been increased interest in the fat and oil component of vein-delivered nutrition, with the realization that it not only supplies energy and essential building blocks, but may also provide bioactive fatty acids," Calder said.
"Traditional solutions use soybean oil, which does not contain the omega-3 fatty acids contained in a fish oil that act to reduce inflammatory responses. In fact, soybean oil is rich in omega-6 acids that may actually promote inflammation in an excessive or unbalanced supply," he explained.
The U.S. Institute of General Medical Sciences has more about sepsis.
Tuesday, January 19, 2010
ScienceDaily (Jan. 19, 2010) — Researchers at the Ludwig Institute for Cancer Research (LICR) at the University of California, San Diego School of Medicine and Moores UCSD Cancer Center have shown one way in which gliomas, a deadly type of brain tumor, can evade drugs aimed at blocking a key cell signaling protein, epidermal growth factor receptor (EGFR),that is crucial for tumor growth. In a related finding, they also proved that a particular EGFR mutation is important not only to initiate the tumor, but for its continued growth or "maintenance" as well.
The findings, which appear during the week of January 18 in an online early edition of the Proceedings of the National Academy of Sciences, provide both new insights into the behavior of gliomas as well as potential new drug targets and treatment strategies.
"The results suggest that the expression of EGFR is required for tumors to keep growing, and we've shown for the first time that there are mechanisms that the tumor is using to circumvent the need for the receptor," said Frank Furnari, PhD, associate professor of medicine at the UCSD School of Medicine and associate investigator at the San Diego branch of the LICR, adding that other cancers may use similar tactics. "We need to find out more about the signaling pathways that brain tumors use to get around targeted therapeutics, such as those directed at EGFR."
In aggressive gliomas, extra copies of the EGFR gene are produced, and half of such tumors also carry an EGFR mutation, which ramps up tumor growth and portends a poor prognosis. Clinical trials of anti-EGFR agents have been disappointing; brain tumors may respond initially, but later become resistant to the drugs. To better understand why, Furnari, Webster Cavenee, PhD, professor of medicine and director of San Diego's LICR branch, and their group wanted to find out if the mutant EGFR was needed by tumors for their continued growth.
The team -- including postdoctoral fellows Akitake Mukasa, MD, PhD, and Jill Wykosky, PhD -- created a genetic system in mice in which they could control the expression of mutated EGFR, turning it off and on with the drug tetracycline.
They found that the tumors' growth would stop for a period of time when tetracycline blocked EGFR, much like what is seen in patients who respond to EGFR inhibitors. But the tumors would start to grow again, even without EGFR, meaning something else was driving tumor growth.
The researchers examined individual tumors that had sidestepped or "escaped" the need for mutant EGFR to sustain their growth. In some cases, tumors that would normally have killed mice in 20 days were stable for months with the blocked expression of mutant EGFR. The scientists used microarray technology to test for genes that had not been previously expressed in the tumors but were now overexpressed in tumors that no longer required EGFR. They finally found one, KLHDC8 which, when inhibited, halted tumor growth.
"That finding makes us think that this gene would be a reasonable target," Cavenee said. "About half of the individual tumors that didn't need mutant EGFR to grow expressed that gene and, if we silenced the gene, those tumors did not grow."
Cavenee thinks this could be a model for the behavior of other tumors. "If the tumors use the same strategy to get around receptor inhibitors, then targeting that alternate pathway plus the receptor up front should give a longer response because it's hitting the primary event plus the escape route," he said.
Now the research team is searching for other genes expressed in tumors that can escape EGFR dependence, and looking for biological pathways that might be involved.
Other contributors include: Keith L. Ligon, MD, PhD, Dana-Farber Cancer Institute, and Lynda Chin, MD, Dana-Farber and Brigham and Women's Hospital.
Funding support came from the SUMITOMO Life Social Welfare Services Foundation, The Paul Taylor American Brain Tumor Association, the National Institutes of Health, the National Foundation for Cancer Research and the Goldhirsh Foundation.
By Rachael Myers Lowe
Tuesday, January 19, 2010
NEW YORK (Reuters Health) – Follow-up colonoscopy is both overused and underused, two new studies indicate.
Too often, patients at high-risk for colorectal cancer don't receive timely "surveillance" colonoscopy but there is also over-utilization among low-risk patients who are unlikely to develop colon cancer, researchers found.
"This misuse wastes health care resources and risks development of cancers in high-risk patients that might have been preventable," Dr. Robert Schoen, of the University of Pittsburgh School of Medicine, and senior investigator on both studies, said in a written statement.
"We want people to get screened" for colorectal cancer with colonoscopy, Schoen told Reuters Health. "The issue is in the repeated colonoscopies," he said.
Colonoscopy involves inserting a thin, flexible scope into the colon to look for cancer or polyps, which are growths that can become cancerous. With colonoscopy, the entire length of the colon can be inspected and any growths discovered can be immediately removed. It is considered the most sensitive way to screen for colon cancer.
Schoen and colleagues analyzed data on 3,627 participants in a large National Cancer Institute-sponsored cancer screening trial and found "substantial overuse" of surveillance colonoscopy among people at low-risk for colorectal cancer and "significant underuse" among those at high-risk.
Specifically, among 1,029 patients with no precancerous colorectal growths at their initial exam, 58 percent underwent a follow-up exam an average of every 3.9 years, although the recommendation would be to do so every 5 to 10 years. The researchers were unable to identify medical reasons for the premature follow up exams.
The researchers also found that within 5 years of the initial colonoscopy exam, only 58.4 percent of patients with advanced precancerous growths had a follow-up colonoscopy, despite the recommendation that they do so every 3 years.
"This is a clear example of an intervention not being utilized in relation to the risk," said Schoen, whose study appears in the latest issue of the journal Gastroenterology.
The other study, published in the journal GIE: Gastrointestinal Endoscopy, shows that colorectal cancer may still occur, despite regular colonoscopy. In this study, Schoen and associates examined the timing and effectiveness of follow-up colonoscopy in 1,297 patients with a history of precancerous colorectal growths who had follow-up colonoscopy as recommended and were followed for up to 10 years.
Despite following the recommended surveillance schedule, nine people were diagnosed with colorectal cancer during the follow-up period.
The test is "not perfect -- it's never going to be perfect," Schoen told Reuters Health.
"This study," he added in a statement, "emphasizes that patients with a history of advanced polyps are at particular risk and should be monitored closely with timely surveillance examinations."
In a written commentary, Dr. John Allen of the University of Minnesota School of Medicine in Minneapolis notes that both the overuse and underuse of surveillance colonoscopy is further evidence of a broken healthcare system in the United States.
He points to many contributing factors: The science identifying who should get special surveillance is unclear; the payment system encourages overuse; and patients at high risk get lost in a poorly coordinated medical record keeping system.
Allen urges a dramatic change in the way medicine is practiced and paid for. A "game changer," as he put it, would throw out fee-for-service payments for each procedure, which encourages overuse, and replace it with payments based on quality care and outcomes.
In an interview with Reuters Health, Allen said there are examples of regional organizations that have successfully implemented quality care systems such as Intermountain Healthcare, Geisinger Health Systems, Mayo Clinic and Kaiser Permanente.
Allen also urges more accountability through the development of publicly available community based registries that look beyond procedures to factor in resource use, complications and patient outcomes.
Sources: Gastroenterology, January 2010; Gastrointestinal Endoscopy, January 2010
Tuesday, January 19, 2010
ScienceDaily (Jan. 19, 2010) — Giving people living in nursing facilities vitamin D can reduce the rate of falls, according to a new Cochrane Review. This finding comes from a study of many different interventions used in different situations. In hospitals, multifactorial interventions and supervised exercise programs also showed benefit.
Older people living in nursing facilities or who have been admitted to hospital are much more likely to suffer a fall than those living in the community. In these settings, falls fairly often result in head injuries and fractures, with rates of hip fracture more than ten times higher in nursing facilities than in the community. It is important to try to prevent falls to avoid unnecessary stress for older people and their families, and to reduce pressure on staff and resources. However, prevention is complicated as falls usually happen for several or many different reasons.
"Many of the preventive measures used to avoid falls in older people are combined in what are called multifactorial interventions, so it can be very difficult to separate out the effects of all the different measures," said lead researcher Ian Cameron, who is based at Sydney Medical School at the University of Sydney in Ryde, Australia.
The current review included 41 trials involving 25,422 older people, who were mostly women. Five trials tested the effects of giving vitamin D to patients in nursing facilities, where it was found to be an effective measure for preventing falls. The researchers found that multifactorial interventions, which often incorporated exercise, medication, or environmental factors including appropriate equipment, reduced the risk of falls in hospitals. In nursing homes, the effects of multifactorial interventions were not significant overall. However, the researchers concluded that multifactorial interventions provided by multidisciplinary teams in these facilities may reduce the rate and risk of falls.
"In our review, we saw limited evidence that these combined interventions work, but we could more confidently recommend them if they were delivered by a multidisciplinary team," said Cameron. "Currently, there's no one component of any of these programmes that stands out as more important than any other and we're also missing data on whether increased supervision or new technologies such as alarm systems are of any benefit."
Tuesday, January 19, 2010
TUESDAY, Jan. 19 (HealthDay News) -- Scientists think they have uncovered at least one of the reasons why omega-3 fatty acids are good for your heart.
The more omega-3 that patients with coronary heart disease consumed, the slower their telomeres shrank. Telomeres are structures at the end of a chromosome that get shorter the more times a cell divides, making them a marker of biological age.
"We're certainly not saying that this is the reason for all the benefits of omega-3 fatty acids, but it is a new pathway linking omega-3 fatty acids to biological aging in these patients," said study lead author Dr. Ramin Farzaneh-Far, an assistant professor of medicine at the University of California, San Francisco.
The findings are published in the Jan. 20 issue of the Journal of the American Medical Association.
"What they're really saying is that there is quite an impact of omega-3s on cell support and cell functioning," said Dr. Suzanne Steinbaum, a preventive cardiologist at Lenox Hill Hospital in New York City and a spokeswoman for the American Heart Association. "If you supplement with omega-3s or eat omega-3s, your cells stay healthier, your cells age less quickly."
Said Farzaneh-Far: "Cardiologists have known for about 20 years that increased dietary intake of omega-3 fatty acids are beneficial for patients with coronary artery disease, particularly those who have had a prior heart attack. It reduces the risk of subsequent heart attacks and death."
But the reasons for that benefit have not been well defined, said John Bowman, an associate professor of pharmacy practice at Texas A&M Health Science Center Irma Lerma Rangel College of Pharmacy. "We don't know the exact cellular mechanisms," he said.
Omega-3 fatty acids are plentiful in fatty fish like salmon, mackerel, herring, lake trout, sardines and albacore tuna, according to the American Heart Association.
For the new study, the researchers followed about 600 patients in the San Francisco Bay Area with coronary artery disease. Blood levels of omega-3 fatty acids and telomere length were measured at the beginning of the study and again about five years later.
"That allowed us to measure the change in telomere length over five years and see if that bore any association with levels of omega-3 fatty acids at the beginning of the study," Farzaneh-Far said.
And, indeed, there was a relationship.
"We found that as blood levels of omega-3 went up, the rate at which telomeres shortened decreased," Farzaneh-Far said. "To the extent that that is a marker of biological aging, the rate of biological aging went down."
The findings don't change current recommendations regarding omega-3 fatty acids or what people should be doing.
"The American Heart Association recommends that those with coronary heart disease get about a gram a day of omega-3 fatty acids," said Farzaneh-Far. "Our study certainly doesn't suggest any change in that."
Dr. Melissa Tracy, medical director of cardiac rehabilitation at the University of Miami Miller School of Medicine, said the new study gives "some additional support to the use of omega-3 fatty acids." But, she noted, it's unclear how far these findings could be extrapolated to other groups of people, such as those who don't have coronary artery disease.
"There are other extraneous circumstances which can impact telomere length," she said.
And, Tracy added, "we should try to do as much with our own bodies that we can. I am an advocate of proper diet, exercise, for optimizing your lifestyle, meaning reducing stress and getting enough sleep."
The American Heart Association has more on omega-3 fatty acids.
By Julie Steenhuysen
Tuesday, January 19, 2010
CHICAGO (Reuters) – A diet rich in omega-3 fatty acids helps keep the DNA of heart patients from unraveling, which may help explain why fish oil is so beneficial after a heart attack, U.S. researchers said Tuesday.
"Cardiologists have known for a long time now that omega-3 fish oil seems to be beneficial for patients with coronary heart disease," said Dr. Ramin Farzaneh-Far of the University of California, San Francisco, whose study was published in the Journal of the American Medical Association.
"A number of studies over the last 20 years or so have shown that after patients have had a heart attack, taking fish oil through diet or supplements is able to reduce the risk of a subsequent heart attack or death from coronary heart disease," Farzaneh-Far said in a telephone interview.
What has not been clear is why fish oil is so beneficial.
"In this study, we decided to look at a new mechanism by which omega-3 fatty acids might work," Farzaneh-Far said.
The team focused on telomere length -- the length of protective caps on the ends of chromosomes that carry DNA.
Fraying or shortening of these protective caps can lead to premature aging and cancer, a new understanding of aging that helped Elizabeth Blackburn and the two other Americans win the 2009 Nobel Prize in Medicine.
Farzaneh-Far and colleagues measured the length of telomeres in blood cells in 608 heart attack patients to see if there was any association between the levels of omega-3 fatty acids and the change in telomere length over time.
"We found a very clear association that increasing levels of the amount of omega-3 fish oil in the blood was associated with a decrease in the rate of biological aging," Farzaneh-Far said.
Those with the highest levels of omega-3 fatty acids had the longest telomeres, while patients with low levels of the compounds had shorter telomeres, he said.
None of the patients were given supplements and the team did not collect dietary information, so it is not clear just how much fish oil it took to have an effect. While fish oil is a primary source of omega-3 fatty acids, they are also found in walnuts, flaxseed oil and leafy green vegetables.
The findings offer a biological explanation for why fish oil helps heart patients.
It may be that omega-3 fatty acids counteract oxidative stress -- a cell-damaging chemical reaction that can shorten telomeres, Farzaneh-Far said.
Or it may be that fish oil increases the production of telomerase -- an enzyme that lengthens and repairs shortened telomeres.
"Both of those mechanisms have to be proven," he said.
Farzaneh-Far said the team only studied the effects of fish oil and cellular aging in heart patients, so it is not clear if the association would hold true in healthy people.
"There is no reason to think that it wouldn't. But we haven't shown that," he said.
(Editing by Cynthia Osterman)
Tuesday, January 19, 2010
NEW YORK (Reuters Health) – Type 2 diabetes is much more common among Canada's native people than their non-native counterparts, and women of childbearing age are particularly at risk, new research shows.
What's more, there's a "striking difference" in the age at which the two groups develop the disease, Dr. Ronald Dyck of the University of Saskatchewan in Saskatoon and his colleagues found. New cases peaked among native individuals -- who are known in Canada as First Nations people -- when they were in their 40s, while Canada's non-indigenous adults typically develop type 2 diabetes at age 70 or later.
The findings suggest, Dyck and his team say, that there may be "fundamental differences" in how and why First Nations and non-First Nations individuals develop type 2 diabetes. But the reasons behind this difference are still unclear.
In Saskatchewan in 1937, not a single case of diabetes was detected among 1,500 First Nations people who participated in a tuberculosis survey, Dyck and his team note in the Canadian Medical Association Journal. By 1990, nearly 10 percent of the province's native people had diabetes; by 2006, the proportion was over 20 percent.
To better understand this "evolving epidemic," the researchers looked at over 8,000 First Nations adults and about 82,000 non-First Nations adults living in Saskatchewan who developed type 2 diabetes between 1980 and 2005.
The rise in diabetes prevalence over that time was similar among all study participants, roughly doubling among women and tripling among men. But while type 2 diabetes was equally common among non-native men and women in 1980, with about 2 percent of both groups having the disease, the 1980 prevalence of diabetes for First Nations adults was nearly 10 percent for women and 5 percent for men. By 2005, 20 percent of First Nations women and 16 percent of First Nations men had type 2 diabetes, compared to around 6 percent of non-First Nations men and women.
In 2005, the researchers found, nearly half of First Nations women 60 and older had type 2 diabetes and over 40 percent of men 60 and older did, compared to less than 25 percent of non-First Nations men and fewer than 20 percent of women in this age group.
Given that the gender difference in diabetes rates among First Nations adults was due to a particularly high rate of the disease among women 20 to 49 years old, Dyck and his colleagues say, gestational (pregnancy-related) diabetes could be a contributing factor.
While it's not clear how much of the increased rate of diabetes among indigenous Canadians is due to genes or environment, they add, "what is clear is that the rapid appearance of type 2 diabetes among First Nations people and other indigenous and developing populations has been precipitated by environmental rather than genetic factors."
It's worth noting, the researchers say, that rates of type 2 diabetes are also higher among the United States' indigenous population.
Prevalence among Native Americans varies widely from region to region, but overall around 17 percent of Native American adults have type 2 diabetes, compared to around 7 percent of non-Hispanic whites and Asian Americans and around 12 percent of Mexican-Americans and Puerto Ricans, according to 2007 statistics from the National Institute of Diabetes and Digestive and Kidney Diseases.
Source: Canadian Medical Association Journal, 2010.
Tuesday, January 19, 2010
(HealthDay News) -- A stress fracture occurs from overuse, when muscles become too weak to absorb the continued stress of physical activity, causing a small crack in a bone.
The American Academy of Orthopaedic Surgeons offers these suggestions to help prevent a stress fracture:
By Amy Norton
Tuesday, January 19, 2010
NEW YORK (Reuters Health) – For people with a strong family history of pancreatic cancer, having a relative who was diagnosed before the age of 50 may further raise the risk of developing the deadly disease, a new study finds.
About 3 percent of all cases of pancreatic cancer are what's known as familial pancreatic cancer, where the disease has affected two or more first-degree relatives -- siblings or a parent and child. Researchers have found mutations in several genes that seem to be associated with the cancer.
In the new study, investigators found that among these families, the age at which affected relatives were diagnosed was an important factor in other family members' risk of developing the cancer.
Compared with the general population, people in families affected by familial pancreatic cancer had a six-fold higher risk of developing the disease.
But the risk was increased nine-fold when a family member had been diagnosed with the disease before the age of 50, the researchers report in the Journal of the National Cancer Institute.
The findings should help in counseling people at high genetic risk of pancreatic cancer -- giving a clearer picture of an individual's likelihood of developing the disease, said researcher Dr. Alison P. Klein, of Johns Hopkins School of Medicine in Baltimore.
The results may also help researchers figure out which individuals might benefit most from pancreatic cancer screening to detect suspicious growths early.
Pancreatic cancer has a dismal prognosis, with only about 5 percent of patients still alive five years after diagnosis.
This is largely because the cancer is rarely caught early; its symptoms, which include weight loss, pain in the upper abdomen and jaundice, usually arise only after the cancer has spread.
As it stands, however, people from families affected by hereditary pancreatic cancer are not routinely screened. Researchers are still trying to determine which tests can reliably detect early cancer in people without symptoms, and which individuals within these families are at particular risk.
"Right now, there's no well-established screening program," Klein told Reuters Health. She and her colleagues at Hopkins are currently studying the effectiveness of endoscopic ultrasound, where an ultrasound probe is passed through the mouth and threaded down into the small intestine, where it is aimed at the pancreas.
The current findings, the researchers say, suggest that clinical trials should focus on families with young-onset pancreatic cancer.
The study included more than 9,000 individuals from 1,718 families enrolled in a pancreatic cancer registry begun in 1994. Some families had a history of familial pancreatic cancer, while others had a history of "sporadic" pancreatic cancer -- where the disease had not affected a pair of first-degree relatives.
Overall, 29 people from familial pancreatic cancer families developed the cancer after entering the study, as did 8 people from families with sporadic pancreatic cancer.
Klein's team found that a family history of early-onset cancer did not seem to alter the risk of people in families with sporadic cancer, but it was important when it came to familial pancreatic cancer.
They estimate, for example, that for a family member with one or two first-degree relatives with pancreatic cancer, and at least one relative whose disease was diagnosed at age 40, the odds of developing pancreatic cancer by age 80 are about 16 percent.
Those odds dropped to 7 percent, however, if relatives had been diagnosed no earlier than age 60 and to 3 percent if the cutoff were age 80.
The average American, Klein noted, has about a 1 percent chance of developing pancreatic cancer in his or her lifetime.
Source: Journal of the National Cancer Institute, online January 12, 2010.
Tuesday, January 19, 2010
TUESDAY, Jan. 19 (HealthDay News) -- Overdoses from prescription painkillers are increasing in the United States, a new study shows.
Researchers examined pharmacy files on 9,940 adults who took opioids such as oxycodone and hydrocodone for at least three months between 1997 and 2005. The patients, who were insured and members of the Group Health Cooperative in Washington, were prescribed the drugs for chronic pain due to non-cancer causes, including conditions of the back or neck, headaches, jaw pain, pain in the extremities, arthritis and menstrual pain or injuries.
Fifty-one patients overdosed on the drugs; six of the overdoses were fatal, the researchers found.
The risk of overdosing increased with the amount of drug prescribed, according to the study. Those given higher doses had nearly nine times the chance of overdosing as those given lower doses of opioids.
"The rate of overdose was strongly related to dose," said senior study author Michael Von Korff, a senior investigator at the Group Health Research Institute in Seattle. "For patients currently receiving higher-dose regimens, their rate of overdose was almost 2 percent per year, which is a lot."
Patients who were depressed, had a history of substance abuse or who were also taking sedative-hypnotics, such as sleeping pills, had a higher risk of overdosing.
The study is published in the Jan. 19 issue of the Annals of Internal Medicine.
One reason for the greater reliance on opioids is a recognition among physicians that chronic pain is a serious problem, hindering people from working, sleeping and enjoying their lives, Von Korff said.
Use of the drugs also increased after two prominent pain management societies said that pain had been under-medicated because of fears of addiction, said A. Thomas McLellan, deputy director of the White House Office of National Drug Control Policy, who co-authored an editorial accompanying the study.
"That may have been a correct conclusion but, oh baby, did that lead to a dramatic change in practice," McLellan said. "Opioids are now among the most available and the most prescribed class of drugs."
Today, about 3 percent of the U.S. population are long-term users of opioids such as oxycodone, hydrocodone, codeine, morphine and methadone, according to background information in the article. "Our research suggests the rate of use doubled between 1997 and 2005, and probably doubled in the eight or nine years prior to that," Von Korff said.
The greater availability of the drugs has led to an increase in abuse, McLellan noted. Opioids are frequently "diverted," meaning one person gets the prescription and then gives it or sells it to another. A recent study found that less than half of those who died due to accidental overdose had actually received the drugs from a physician.
Yet less was known about the risk of overdosing in patients receiving the drugs from their physicians for pain, Von Korff said.
Among patients in the study, the cause of the overdoses varied. Medical records showed eight people accidentally took too much. Six were suicide attempts, while three had also obtained additional opioids from non-medical sources.
But in most cases, the reason for the overdose was unclear, including whether patients were taking the medications as intended when they overdosed, or if they had accidentally -- or intentionally -- taken more than was prescribed.
Symptoms of people who overdosed were delirium, loss of consciousness, confusion, respiratory problems and falling.
Because of the risks, physicians should closely monitor patients who are on long-term opioid therapy, prescribe as low a dose as possible to control pain and frequently re-evaluate whether the benefit of the drug is worth the risk.
"We need to consider what can be done to maintain the medical benefits of prescribed opiates -- you don't want to reduce appropriate availability -- while recognizing there are public health side effects," McLellan said.
Patient education and patient contracts, in which patients pledge to not share the drugs with others and to only use as necessary, have been shown to help, McLellan said.
"Patients must assume more responsibility for the storage and proper use of these medications, and doctors and dentists must recognize there are public health as well as individual patient implications," McLellan added.
The National Institute on Drug Abuse has more on opioids.
Monday, January 18, 2010
Monday, January 18, 2010
NEW YORK (Reuters Health) – Obese people are more likely to develop kidney stones than normal weight individuals, but severe obesity doesn't seem to further increase risk, research in the Journal of Urology shows.
Kidney stones are solidified deposits of minerals and acid salts. "Passing" the stones in the urine can be extremely painful. Rarely, a person will require surgery or other types of treatment if they are unable to pass the stone on their own.
Studies have shown a rise in kidney stone disease paralleling the increase in obesity, Dr. Brian R. Matlaga of Johns Hopkins University in Baltimore and his colleagues write. It's unclear why weight would affect kidney stone rates, although researchers have a number of theories involving different levels of substances in the blood among the obese.
Matlaga's team analyzed 2002-2006 records for more than 95,000 people included in a national private insurance database.
The researchers identified 3,257 people with kidney stones. Men were twice as likely as women to have kidney stones, while the risk of stones increased with age.
They used the body mass index (BMI) - a standard measure used to gauge how fat or thin a person is - to classify patients' weight. (You can use http://www.nhlbisupport.com/bmi/ to calculate your own BMI.)
Among people classified as either normal weight (BMI 18.5-24.9) or overweight (BMI 25-29.9) but not obese, about one in 40 had been diagnosed with kidney stones, compared to about one in 20 of those classified as obese (BMI above 30). But there was no significant difference in risk among obese individuals, no matter how heavy they were.
Those who were obese were more likely than the non-obese to undergo kidney stone removal, but those who were severely obese were no more likely to undergo these procedures than their normal weight peers.
It's possible, the researchers note, that the heaviest people were more likely to have their kidney stones treated with medication than surgery.
"Dietary modification and weight loss should be encouraged in the obese population for a multitude of reasons but also to reduce stone risk," they conclude.
Source: The Journal of Urology, February 2010.
Monday, January 18, 2010
ScienceDaily (Jan. 18, 2010) — A diabetes epidemic is affecting First Nations people, especially women in their prime reproductive years, according to a new study in CMAJ (Canadian Medical Association Journal). The incidence of diabetes was more than 4 times higher in First Nations women compared to non-First Nations women and more than 2.5 times higher in First Nations compared to non-First Nations men.
The study looked at 8275 First Nations and 82 306 non-First Nations cases in Canada's province of Saskatchewan from 1980 to 2005.
Rising rates of diabetes have accompanied an epidemic of obesity that may be associated with the loss of traditional lifestyles. In 1937, diabetes was not detected in a tuberculosis survey of 1500 First Nations people but by 1990, almost 10% of the province's native people had diabetes, a rate that had doubled by 2006 to 20%.
New diabetes cases peaked in First Nations people between ages 40-49 compared with a non-First Nations peak of age 70 plus. First Nations women in particular suffered from diabetes, especially between ages 20-49.
"Diabetes is a disease of young First Nations adults with a marked predilection for women; in contrast, diabetes is a disease of ageing non-First Nations adults that is more common in men," write Dr. Roland Dyck, Royal University Hospital in Saskatoon, Saskatchewan and coauthors.
The authors suggest several reasons for the high rate in women. Higher overweight/obesity rates in First Nations women and high rates of gestational diabetes, a predictor of type 2 diabetes in certain women, may be factors. As well, gestational diabetes is linked to an increase in the risk of type 2 diabetes in children.
These upward trends will likely continue, especially as children and teenagers that make up almost half the First Nations population become adults. The authors urge prevention initiatives targeted to pregnant women, children and young adults to help reduce diabetes rates.
"What is clear is that the rapid appearance of type 2 diabetes particularly among First Nations people and other indigenous and developing populations has been precipitated by environmental rather than genetic factors," state the authors. "Its long term solution will require effective primary prevention initiatives that are population-based and driven by public health and community initiatives."
Roland Dyck MD, Nathaniel Osgood PhD, Ting Hsiang Lin PhD, Amy Gao BSc, Mary Rose Stang PhD. Epidemiology of diabetes mellitus among First Nations and non-First Nations adults. Canadian Medical Association Journal, DOI: 10.1503cmaj.090846
By Anne Harding
Monday, January 18, 2010
NEW YORK (Reuters Health) – People with severe forms of the inflammatory skin disease psoriasis are more likely to die of heart-related causes and stroke than those without the condition, new research shows.
In fact, for people with the severe form of psoriasis, the condition is a bigger risk factor for heart- and stroke-related death than high blood pressure, Dr. Joel M. Gelfand of the University of Pennsylvania School of Medicine in Philadelphia, one of the researchers on the study, told Reuters Health.
The findings "should be a very strong message" for people with severe psoriasis to get other risk factors like high blood pressure, high cholesterol, and excess weight under control, Gelfand said.
In psoriasis, cells build up on the skin surface and form itchy and sometimes painful scales and red patches. Joint inflammation may also occur. Up to one in 25 of adults have psoriasis, and about one in five of those have severe disease that warrants treatment with powerful inflammation-suppressing drugs like methotrexate.
Because such drugs carry a high risk of side effects, Gelfand noted, most people with severe psoriasis actually go untreated. "In the last 10 years or so there's been an explosion in new drugs approved for psoriasis," he added. "They're too new to know what their full use will be in the psoriasis population."
Gelfand and his colleagues first reported in 2006 that severe psoriasis upped a person's heart attack risk. The illness has since been linked to an increased risk of stroke.
In the current study, he and his colleagues matched 3,603 patients with severe psoriasis to 14,330 people who were free from the disease and followed them for about three years, on average. Three percent (108) of those with severe psoriasis died of heart- or stroke-related causes, compared with about two percent (301) of those without psoriasis.
People with severe psoriasis were nearly 60 percent more likely to die of causes related to heart disease or stroke than those without the disease, the researchers found.
Even once Gelfand and his team accounted for smoking, high blood pressure, and diabetes, the psoriasis patients' risk of death due to these causes was still 57 percent higher, suggesting that the skin disease in and of itself was the link.
This meant that there was one extra death per 283 people with severe forms of psoriasis per year, compared to those without the disease.
The relationship among factors that increase heart and blood vessel disease risk and psoriasis is very complex, Gelfand noted; for example, smoking and obesity both boost psoriasis risk, while people with psoriasis are known to be more likely to develop diabetes, which in turn ups heart disease risk.
Genes that make people susceptible to psoriasis have been linked to heart disease as well, he added, and the type of inflammation associated with heart- and stroke-related disease is very similar to that involved in psoriasis.
Teasing out the reasons for the link, and figuring out whether treating psoriasis could reduce heart disease risk, will require more research, he and his colleagues conclude.
Source: European Heart Journal, online December 27, 2009.
Monday, January 18, 2010
NEW YORK (Reuters Health) – Doctors should screen children and teens between 6 and 18 years for extra pounds, a federal task force recommends.
For children who are found to be obese based on their body mass index (BMI), a standard measure of the relationship between height and weight, the task force also calls for referrals to a comprehensive program that includes dietary advice, physical activity, and behavioral counseling to promote weight loss.
The new recommendations update earlier ones from 2005. Skyrocketing rates of obesity have reached between 12 and 18 percent in 2- to 19-year-olds, increasing up to 6-fold since the 1970s, members of the United States Preventive Services Task Force report in the February issue of the journal Pediatrics. Obesity is linked to the early development of diabetes and high blood pressure.
For their update, the task force reviewed 13 studies of behavioral intervention in 1258 obese children and adolescents.
Moderate- to high-intensity programs, involving more than 25 hours of contact with the child and/or the family over a six-month period, resulted in a decrease in BMI 12 months after the beginning of the intervention.
In addition to dietary and physical activity counseling, effective programs included behavioral-management techniques such as self-monitoring and eating management. However, the programs only worked in children who followed through on treatment.
Harms of screening -- for example, adverse effects on growth, eating-disorder pathology, or mental health issues -- were judged to be minimal.
It is unclear if the recommendations can be applied to children who are overweight but not obese. And there was no convincing support for interventions that lasted less than 25 hours per six months, or for screening children below age 6.
Yet some experts take issue with what they consider the narrow age bracket of the recommendation.
"The USPSTF falls short of the mark in not recognizing the developmental trajectory of obesity in childhood," writes Dr. Sandra G. Hassink, from the Dupont Hospital for Children in Wilmington, Delaware, in a related commentary.
Hassink urges pediatricians to screen all children. "Working with families to screen for high-risk nutrition and activity behaviors that contribute to obesity in early childhood must be part of that task," she writes.
Source: Pediatrics, online January 18, 2010.
By Ed Edelson
Monday, January 18, 2010
MONDAY, Jan. 18 (HealthDay News) -- Erectile dysfunction is a strong warning sign that a man might be at increased risk for heart attack, stroke and other cardiovascular problems, a long-running study indicates.
"We saw that adjusting for age and Framingham [Heart Study] risk factors, men with erectile function still had a 40 percent increased risk," said Andre Araujo, director of epidemiology at New England Research Institutes and lead author of a report published online Jan. 19 in the Journal of the American College of Cardiology.
Though adding erectile dysfunction to the list of known risk factors determined by the Framingham Heart Study -- cholesterol, smoking, high blood pressure -- doesn't improve the prediction of future cardiovascular trouble, it can be a quick, free addition to risk assessment, Araujo said.
"If a man presents with erectile dysfunction, the physician should work him up for cardiovascular disease," he said. "It is low cost -- indeed, no cost -- with no risk associated with it."
The study is the latest of several that have linked erectile dysfunction to cardiovascular disease. That is to be expected, Araujo said, because the same artery-blocking conditions that reduce blood flow to the heart and brain can also reduce flow to the penis.
The study followed 1,057 men, aged 40 to 70, for an average of 12 years. Overall, 37 percent of the men with erectile dysfunction were in the high-risk category according to the Framingham standards, compared with 17 percent of men without erectile dysfunction.
Once the link to cardiovascular problems was established, "we started modeling to see if we added erectile dysfunction to the Framingham risk profile we could reclassify some men," Araujo said. "In fact, it doesn't do much."
The reason is that the Framingham risk profile is hard to improve on, he said. Over the years, studies of a number of diagnostic techniques -- including computerized tomography scanning and various molecular markers, such as inflammation-related C-reactive protein -- have been shown not to improve on the Framingham profile's predictive power.
But those other measures are either costly, require blood tests or carry some risk, whereas erectile dysfunction can be determined by a simple question, Araujo said.
So doctors should ask the question, said Dr. R. Parker Ward, a cardiologist and an associate professor of medicine at the University of Chicago, who has done several studies on erectile dysfunction and cardiovascular risk.
"Why not ask a simple question in the office that will reveal a diagnosis very clearly?" Ward said. "It is cheaper and easier than doing a lipid profile or measuring high blood pressure."
It's information that men should offer to their doctors, Araujo said. "Self-reported erectile dysfunction matches what urologists say about the question," he said. "We should get the message out: If you have an erectile problem, see your doctor."
Having a doctor ask the question or a man offer the information can lead to preventive therapy that can be lifesaving, Araujo said.
"One of the first signals that a guy has cardiovascular disease is often sudden death," he said.
The U.S. National Kidney and Urologic Diseases Information Clearinghouse has more on erectile dysfunction.