Health Technology Research Synopsis
138th Issue Date 21 SEP 2012
Compiled By Ralph Turchiano
http://www.healthresearchreport.me www.vit.bz
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Editors Top Five:
Most prescription drugs manufactured overseas — are they safe?
Lights out?….
Age, not underlying diagnosis, key factor in weight gain in children after tonsillectomy
Vitamin C and beta-carotene might protect against dementia
Probiotics to Decontaminate Your Gut?
In This Issue:
Health-care costs at end of life exceed total assets for 25 percent of MEDICARE population
Task Force Reaffirms its Recommendation Against Routine Screening for Ovarian Cancer
Most prescription drugs manufactured overseas — are they safe?
More pregnant women taking high blood pressure drugs, yet safety unclear
Researchers discover mechanism related to negative emotions of cocaine withdrawal
Bad strep throat? It’s probably not strep, most likely viral
Compound Derived From a Mushroom Lengthens Survival Time in Dogs With Cancer, Penn Vet Study Finds
Pregnancy exposures determine risk of breast cancer in multiple generations of offspring
‘Spin’ in media reports of scientific articles
Lights out?….
Age, not underlying diagnosis, key factor in weight gain in children after tonsillectomy
Study implicates marijuana use in pregnancy problems
Vitamin C and beta-carotene might protect against dementia
BYU study says exercise may reduce motivation for food
Gestational exposure to urban air pollution linked to vitamin D deficiency in newborns
Low ghrelin — reducing appetite at the cost of increased stress?
Increased dietary fructose linked to elevated uric acid levels and lower liver energy stores
Study links breast cancer risk to early-life diet and metabolic syndrome
Cleveland Clinic study shows vitamin E may decrease cancer risk
Statins are unlikely to prevent blood clots
Higher levels of BPA in children and teens associated with obesity
Economic freedom report: U.S. continues to slide, drops to 18th
Pacifiers may have emotional consequences for boys
Chronic fatigue syndrome is not linked to suspect viruses
Sesame and rice bran oil lowers blood pressure, improves cholesterol
Obese children have less sensitive taste-buds than those of normal weight
Probiotics to Decontaminate Your Gut?
Nutrient in Eggs and Meat May Influence Gene Expression from Infancy to Adulthood (Choline)
Low calorie cranberry juice lowers blood pressure in healthy adults
A mother’s nutrition–before pregnancy–may alter the function of her children’s genes
Diet high in total antioxidants associated with lower risk of myocardial infarction in women
Health-care costs at end of life exceed total assets for 25 percent of Medicare population
As many as a quarter of Medicare recipients spend more than the total value of their assets on out-of-pocket health care expenses during the last five years of their lives, according to researchers at Mount Sinai School of Medicine. They found that 43 percent of Medicare recipients spend more than their total assets minus the value of their primary residences. The findings appear online in the current issue of the Journal of General Internal Medicine.
The amount of spending varied with the patient’s illness. Those with dementia or Alzheimer’s disease spent the most for health care, averaging $66,155, or more than twice that of patients with gastrointestinal disease or cancer, who spent an average of $31,069. Dementia patients often require special living arrangements, which accounts for the sizeable difference in cost.
“Medicare provides a significant amount of health care coverage to people over 65, but it does not cover co-payments, deductibles, homecare services, or non-rehabilitative nursing home care,” said the study’s lead author, Amy S. Kelley, MD, Assistant Professor of Geriatrics and Palliative Medicine at Mount Sinai School of Medicine. “I think a lot of people will be surprised by how high these out-of-pocket costs are in the last years of life.”
The researchers based their findings on 2002-2008 data that was collected from the Health and Retirement Study, a biennial survey of 26,000 Americans over the age of 50, which is supported by the National Institute on Aging, and the Social Security Administration. They examined 3,209 Medicare recipients during their last five years of life, and compared their out-of-pocket health care expenditures with their total household assets. The study found that the average spending for all participants was $38,688, with more than 75 percent of households spending at least $10,000. The top quarter of participants spent an average of $101,791.
“There are a number of schools of thought on how to rein in Medicare costs, including requiring larger financial contributions from the elderly,” said Dr. Kelley. “Prior to this study there was not a lot of data on the extent of out-of-pocket spending. This information can serve as an important tool to help individuals set realistic expectations for end-of-life health care costs, and for government officials to use in discussing Medicare policies.”
Task Force Reaffirms its Recommendation Against Routine Screening for Ovarian Cancer
Although the mortality rate associated with ovarian cancer is high, the disease is rare, and the majority of women with a positive screening test will have a false-positive result. The United States Preventive Services Task Force (USPSTF) reviewed evidence published since its previous recommendation. The Task Force found adequate evidence that annual screening with transvaginal ultrasonography and testing for the serum tumor marker cancer antigen (CA)-125 in women does not reduce the number of deaths from ovarian cancer. Since there is adequate evidence that screening for ovarian cancer can lead to important harms, including major surgical interventions in women who do not have cancer, the Task Force concludes that there is at least moderate certainty that harms of screening for ovarian cancer outweigh the benefits. Researchers emphasize that the recommendation pertains to asymptomatic women. Women with known risk factors for ovarian cancer (certain genetic mutations, Lynch syndrome, family history) should discuss the benefits and harms of screening with their doctors. Use of oral contraceptives, pregnancy and breastfeeding, bilateral tubal ligation, and removal of the ovaries all reduce the risk for ovarian cancer.
Most prescription drugs manufactured overseas — are they safe?
Most pharmaceutical drugs in Canada are manufactured overseas in countries such as India, China and others, yet how can we be confident the drug supply is safe, writes a drug policy researcher in an opinion piece in CMAJ (Canadian Medical Association Journal).
Alarmed by alerts about potentially harmful products such as nonprescription erectile dysfunction drugs with names like Uprizing 2.0 and Ying Da Wang — most from overseas — Alan Cassels began to think about pharmaceutical drugs sold in Canada. Are they safe? Who regulates them?
“Most Canadians probably don’t know that many of our pharmaceuticals come from places like India and China,” writes Cassels. “How often do our regulators dust off their passports and fly to China or India to ensure that the plants producing pharmaceuticals are clean, follow proper manufacturing techniques and contain what is on the label (and nothing else)?”
He was unable to find out much from Health Canada because information about inspections is not public.
“This situation doesn’t leave me with the warm fuzzies,” he writes. “Especially when we’re dealing with — how can I say this nicely — a federal agency that refuses to even enforce the laws against illegal drug advertising on a bus shelter at the end of my street?”
More pregnant women taking high blood pressure drugs, yet safety unclear
Nearly 5 percent of pregnant women are prescribed drugs to treat high blood pressure, including some drugs that aren’t considered safe for mothers or their babies, according to new research in the American Heart Association’s journal Hypertension.
Use of high blood pressure drugs during pregnancy is becoming increasingly common, said Brian T. Bateman, M.D., lead author and Assistant Professor of anesthesia at Harvard Medical School in Boston, Mass.
“While we know high blood pressure, or hypertension, occurs in about 6 percent to 8 percent of all pregnancies, we know little about how women and their doctors treat the condition,” he said.
Researchers studied a database of more than 1 million Medicaid patients, of whom 48,453 (4.4 percent) filled prescriptions for high blood pressure drugs during their pregnancies.
They found:
Antihypertensive drug use increased from 3.5 percent to 4.9 percent between 2000 and 2006.
Antihypertensive drug users were older than non-users, more likely to have diabetes or kidney disease, and more likely to be Caucasian or African-American than Hispanic or Asian.
Nearly 2 percent of pregnant women filled prescriptions for these drugs during the first trimester; 1.7 percent during the second trimester; and 3.2 percent during the third trimester.
The drugs prescribed included ACE inhibitors and angiotensin receptor blockers — both of which have been shown in studies to have harmful side effects during pregnancy.
Limited information is available about which antihypertensive drugs are safest and most effective for treating high blood pressure during pregnancy, Bateman said. In general, methyldopa and labetalol are the recommended antihypertensives for use during pregnancy. More research on which antihypertensives to prescribe during pregnancy and how to use them safely is urgently needed, he said.
“We know from reports that a number of harmful effects can occur from using ACE inhibitors or angiotensin receptor blockers, especially during the second and third trimester,” Bateman said. “These drugs can cause poor growth, kidney problems and even death of the newborn. If women are taking one of these blood pressure medications and they become pregnant or plan to do so, they and their doctors should discuss treatment choices during pregnancy.”
Researchers discover mechanism related to negative emotions of cocaine withdrawal
Emotional ‘brakes’ stay on after cocaine wears off
PULLMAN, Wash.—Washington State University researchers have found a cellular mechanism that contributes to the lack of motivation and negative emotions of a cocaine addict going through withdrawal. Their discovery, published in the latest Proceedings of the National Academy of Sciences, offers a deeper look into the cellular and behavioral implications of addiction.
Bradley Winters, lead author of the PNAS paper and a freshly minted WSU doctor of neuroscience, says he, his major advisor Yan Dong, and colleagues at WSU, the University of Pittsburgh and the European Neuroscience Institute focused on cells that produce a signaling molecule called cannabinoid receptor 1, or CB1. Its main function is regulating the communication between nerve cells related to the functions like memory, motor control, perception, mood and appetite. Those same functions are affected by THC, the cannabinoid in its namesake cannabis, or marijuana.
“These receptors are not here just to make marijuana fun,” says Winters. “Their main function is changes in how nerve cells communicate with each other.”
The researchers studied the CB1 cells by producing a line of mice in which the cells that make CB1 were labeled fluorescently. The researchers could then identify the cells and target them with glass pipettes 1/100th the width of a human hair and record electrical currents they use to communicate with other nerve cells.
The CB1 cells act like brakes, slowing down activity in a brain region called the nucleus accumbens, which governs emotion and motivation.
“Cocaine causes profound cellular changes in the nucleus accumbens, but no one has ever looked at this type of cell, and these cells are important because they help organize the output,” says Winters.
The researchers found that cocaine increases the excitability of the CB1 cells, in effect stepping on the brakes of emotion and motivation. When an addict is high on cocaine, the brakes are struggling to slow things down. The problem is, they stay on even when the cocaine has worn off.
“As you do cocaine, it speeds everything up, pushing you to a highly rewarding emotional state,” says Winters. “It is kind of like going down a steep hill so you have to start riding that brake really hard. But then after the cocaine wears off and the hill levels out, you’re still riding that brake just as hard. Now you’re going down a regular, low-grade hill but you’re going 2 mph because your foot is still jammed on the brake.”
The result is a drag on the emotions and motivation of an addict in withdrawal — a drag that could be linked to sluggish activation of the nucleus accumbens.
“That state is like, ‘I feel terrible and I don’t want to do anything,'” says Winters. “You have the high and the crashing low and this low that you feel is what brings you back to the drug because you want to feel better and the drug is the only thing you feel motivation for.”
Bad strep throat? It’s probably not strep, most likely viral
When it is strep, penicillin is the antibiotic of choice, say IDSA Group A Streptococcal Throat Infection Guidelines
AT A GLANCE
Most throat infections are not caused by Group A streptococcus, or “strep,” but by viruses, and therefore don’t need antibiotics, according to new guidelines released by the Infectious Diseases Society of America (IDSA).
For confirmed strep infections, penicillin or amoxicillin are the antibiotic of choice, except for those who are allergic.
Children who suffer from strep throat and have recurrent throat infections should not have their tonsils surgically removed for that reason alone.
15 million people see the doctor every year complaining of sore throat, but fewer than a third have strep throat.
[September 10, 2012: ARLINGTON, Va.] – Although people often say they have “strep” throat, most sore throats actually are caused by a virus, not streptococcus bacteria, and shouldn’t be treated with antibiotics, suggest guidelines (http://cid.oxfordjournals.org/content/early/2012/09/06/cid.cis629.full) published by the Infectious Diseases Society of America (IDSA). Antibiotics are ineffective against viruses.
The IDSA’s newly revised guidelines for Group A streptococcal pharyngitis – strep throat – also advise that when a strep infection is confirmed by testing, it should be treated with penicillin or amoxicillin – if the patient does not have an allergy – and not azithromycin or a cephalosporin. Further, the guidelines recommend that children who suffer from recurrent strep throat should not have their tonsils surgically removed solely to reduce the frequency of infection. The guidelines are being published today in the journal Clinical Infectious Diseases.
About 15 million people in the U.S. see the doctor for a sore throat every year and up to 70 percent receive antibiotics, although only a smaller percentage actually have strep throat: approximately 20 to 30 percent of children and just 5 to 15 percent of adults.
The guidelines note that children and adults do not need to be tested for strep throat if they have a cough, runny nose, hoarseness and mouth sores, which are strong signs of a viral throat infection. A sore throat is more likely to be caused by strep if the pain comes on suddenly, swallowing hurts and the sufferer has a fever without the above listed features, but should be confirmed through testing before antibiotics are prescribed, the guidelines note.
If strep is suspected, the guidelines recommend physicians use the rapid antigen detection test, which provides results in a few minutes. If that test is negative, a follow-up throat culture is recommended for children and adolescents, but not for adults. Results of the culture can take up to several days, but antibiotics should not be prescribed unless results are positive, the guidelines note. Because strep throat is uncommon in children three years old or younger, they don’t need to be tested, the guidelines recommend.
“The guidelines promote accurate diagnosis and treatment, particularly in avoiding the inappropriate use of antibiotics, which contributes to drug-resistant bacteria,” said lead author Stanford T. Shulman, MD, chief of the division of infectious diseases at Ann & Robert H. Lurie Children’s Hospital of Chicago and professor of pediatrics at Northwestern University Fineberg School of Medicine. “We recommend penicillin or amoxicillin for treating strep because they are very effective and safe in those who are not allergic, and there is increasing resistance of strep to the broader-spectrum – and more expensive – macrolides, including azithromycin.”
He notes the guidelines recommend against tonsillectomy for children with repeated throat infection except in very specific cases – such as a child who has obstructive breathing – because the risks of surgery are generally not worth the transient benefit.
Serious complications from strep throat – particularly rheumatic fever – have diminished in the United States, but occasionally do occur, so accurate diagnosis is key, Dr. Shulman said.
The voluntary guidelines are not intended to take the place of a doctor’s judgment, but rather to support the decision-making process, which must be individualized according to each patient’s circumstances.
The eight-member Group A streptococcal pharyngitis guidelines panel comprises experts representing a variety of specialties, including adult and pediatric infectious diseases physicians, pediatricians and respiratory diseases authorities. In addition to Dr. Shulman, the panel includes: Alan L. Bisno, Herbert W. Clegg, Michael A. Gerber, Edward L. Kaplan, Grace Lee, Judith M. Martin and Chris Van Beneden.
Compound Derived From a Mushroom Lengthens Survival Time in Dogs With Cancer, Penn Vet Study Finds
PHILADELPHIA — Dogs with hemangiosarcoma that were treated with a compound derived from the Coriolus versicolor mushroom had the longest survival times ever reported for dogs with the disease. These promising findings offer hope that the compound may one day offer cancer patients — human and canine alike — a viable alternative or complementary treatment to traditional chemotherapies.
The study was conducted by two University of Pennsylvania School of Veterinary Medicine faculty. Dorothy Cimino Brown is professor and chair of the Department of Clinical Studies and director of the Veterinary Clinical Investigation Center. Jennifer Reetz is an attending radiologist in the Department of Clinical Studies. They published their findings in an open-access article in the journal Evidence-Based Complementary and Alternative Medicine.
The Coriolus versicolor mushroom, known commonly as the Yunzhi mushroom, has been used in traditional Chinese medicine for more than 2,000 years. The compound in the mushroom that is believed to have immune-boosting properties is polysaccharopeptide, or PSP. In the last two decades, some studies have suggested that PSP also has a tumor-fighting effect.
“There have been a series of studies looking at groups of people with cancer,” Cimino Brown said. “The issue with those studies is that they weren’t necessarily measuring what most people would think is the most clinically important result, which is, do people taking PSP live longer?”
To address this critical question, Cimino Brown and Reetz pursued a study in dogs with naturally occurring hemangiosarcoma, an aggressive, invasive cancer that arises from the blood cells and typically affects the spleen. It commonly strikes golden retrievers and German shepherds.
Fifteen dogs that had been diagnosed with hemangiosarcoma participated in the trial. Divided into three groups of five, each group received a different dose — 25, 50 or 100 mg/kg/day — of I’m-Yunity, a formulation of PSP that has been tested for consistency and good manufacturing processes.
The owners were instructed to give their dog capsules of I’m-Yunity, compounded by Penn pharmacists, daily. Each month, the owners brought their dogs to Penn’s Ryan Veterinary Hospital for follow-up visits. There, the researchers took blood samples and conducted ultrasounds to determine the extent that tumors developed or grew and spread in the dogs’ bodies.
Based on the ultimate endpoints — how quickly the tumors progressed and how long the dogs actually lived — the results of the researchers’ trial suggest that the I’m-Yunity was effectively fighting the tumors.
“We were shocked,” Cimino Brown said. “Prior to this, the longest reported median survival time of dogs with hemangiosarcoma of the spleen that underwent no further treatment was 86 days. We had dogs that lived beyond a year with nothing other than this mushroom as treatment.”
There were not statistically significant differences in survival between the three dosage groups, though the median survival time was highest in the 100 mg group, at 199 days, eclipsing the previously reported median survival time.
The results were so surprising, in fact, that the researchers asked Penn Vet pathologists to recheck the dogs’ tissue biopsies to make sure that the dogs really had the disease.
“They reread the samples and said, yes, it’s really hemangiosarcoma,” Cimino Brown said.
Chemotherapy is available for treating hemangiosarcoma, but many owners opt not to pursue that treatment once their dog is diagnosed.
“It doesn’t hugely increase survival, it’s expensive and it means a lot of back and forth to the vet for the dog,” Cimino Brown said. “So you have to figure in quality of life.”
While I’m-Yunity is not inexpensive, if proven effective, it would offer owners a way of extending their pet’s life without regular trips to the vet. As an added benefit, Cimino Brown and Reetz have found no evidence of adverse effects from the PSP treatment.
The researchers are now getting ready to pursue further trials of I’m-Yunity in dogs with hemangiosarcoma to confirm and refine their results. One trial will compare I’m-Yunity to a placebo for those owners who opt not to pursue chemotherapy in their pet and another will compare the compound to standard-of-care chemotherapy.
Depending on those results, veterinarians could eventually prescribe the compound for treating hemangiosarcoma, and perhaps other cancers, in dogs. The company that manufacturers I’m-Yunity may also pursue large-scale clinical trials in humans.
“Although hemangiosarcoma is a very sad and devastating disease,” Cimino Brown said, “in the long term, if we prove that this works, this treatment can be a really nice alternative for owners to have increased quality time with their pet at the end of its life.”
The study was funded by a grant from Chinese Medicine Holdings LTD
Pregnancy exposures determine risk of breast cancer in multiple generations of offspring
WASHINGTON, DC —Researchers from Georgetown Lombardi Comprehensive Cancer Center demonstrate, in animals, that maternal exposure to a high-fat diet or excess estrogen during pregnancy can increase breast cancer risk in multiple generations of female offspring — daughters, granddaughters and even great-granddaughters.
This study, published online today in Nature Communications, shows for the first time that the risk of some “familial” breast cancers originate from biological alterations caused by maternal diet during pregnancy that not only affect the directly exposed fetus but also the fetal germ cells, transmitting the increased mammary cancer risk to subsequent generations.
This study also provides some hints about the biological mechanisms behind this multi-generational transmission of risk. The researchers found that maternal intake of high-fat diets and excess estrogens changes DNA methylation patterns in the offspring’s breast and make it more sensitive to carcinogens later in life. Importantly, these traits are inheritable.
“We know that maternal diet can have long lasting effects on an offspring’s health, but this study demonstrates, for the first time, that a high fat diet or excess estrogen can affect multiple generations of a rat’s offspring, resulting in an increase in breast cancer not only in their daughters, but granddaughters and great granddaughters,” says the study’s senior investigator, Leena Hilakivi-Clarke, Ph.D., a professor of oncology at Georgetown Lombardi.
The research team, which includes investigators from institutions in Finland and the United States, tested three groups of pregnant rats and their progeny. The two exposed groups of rats were at heightened risk for developing breast cancer, compared to the control group.
In the first group, rats were fed a high fat diet before conception and throughout pregnancy. Breast cancer risk was increased by 55 to 60 percent in the daughters and granddaughters of rats given a high fat diet during pregnancy compared to the offspring of control rats which ate a normal diet during pregnancy. The increased risk did not extend to the great-granddaughters of high-fat fed rats.
“We also found that if the mother was fed a high fat diet before conception and throughout pregnancy, the risk of increased breast cancer was transmitted to granddaughters through either males or females exposed to the high fat diet in utero,” says the study’s lead investigator, Sonia de Assis, Ph.D., a postdoctoral researcher in Hilakivi-Clarke’s laboratory.
In the other group, rats were fed a diet supplemented with estrogen during the last week of pregnancy, and the control rats were fed a normal diet. The researchers found a 50 percent higher incidence of breast tumors in the exposed rats’ daughters, granddaughters, and great-granddaughters, compared to the control group. In this case, increased breast cancer risk was transmitted to granddaughters through the in utero estrogen exposed females only.
Both the high-fat and excess estrogen diets produced breast tissue in the affected generations of female offspring that had more than the normal number of terminal end buds, structures that are the building blocks of mammary epithelial tree and primary targets for carcinogens.
The researchers also documented epigenetic changes in the mammary glands of all three generations of pregnant rats exposed to estrogen.
“Germ cells — cells involved in reproduction — first develop during the fetal period and in utero exposures, such as the ones in our study, could disrupt their normal epigenetic marks and affect how genes are turned on or turned off,” de Assis says. “Those alterations then can be passed on and affect the risk of disease, in this case breast cancer, in subsequent generations.”
Hilakivi-Clarke points out that two-thirds of human familial breast cancers have no known genetic mutations. She says the effect seen from a high-fat diet and excess estrogens may help explain some of those cases and link them to inherited epigenetic changes.
“We know from human studies that daughters whose mothers took the synthetic estrogen diethylstilbestrol (DES) to reduce pregnancy complications, or who had a birth weight of more than 8.8 pounds are at an increased risk of developing breast cancer. Our study suggests their offspring may also be at risk,” Hilakivi-Clarke says.
“This study suggests directions for future research in women. Could a woman’s susceptibility to breast cancer development be determined by what her grandmother ate when she was pregnant, or if she was exposed to high levels of estrogen — perhaps unwittingly, through the environment?” asks de Assis.
The researchers add that there is potential good news — epigenetic inheritance of breast cancer risk might be detectable through blood testing, and that, in particular, the adverse effects of an exposure to excess estrogen in utero is, possibly, reversible.
“Our on-going preclinical studies have found that the increase in breast cancer risk caused by in utero exposure to excess estrogens can be reversed by drugs that reverse epigenetic marks — chemical modifications that turns genes on and off — caused by the exposure . These drugs, called HDAC and DNMT inhibitors, are being used, with success, in humans to treat some cancers,” Hilakivi-Clarke says. Hilakivi-Clarke is one of the inventors on Georgetown University-owned HDAC inhibitor and DNMT inhibitor patents.
“It’s easy to see how this study possibly has human health implications to be considered since fatty foods are endemic in our society, and low levels of chronic exposure to endocrine disruptors — substances that have hormonal activity such as estrogen — have been found in food and drinking water,” says de Assis.
‘Spin’ in media reports of scientific articles
Press releases and news stories reporting the results of randomized controlled trials often contain “spin”—specific reporting strategies (intentional or unintentional) emphasizing the beneficial effect of the experimental treatment—but such “spin” frequently comes from the abstract (summary) of the actual study published in a scientific journal, rather than being related to misinterpretation by the media, according to French researchers writing in this week’s PLOS Medicine.
“Spinning” the reporting of clinical trials could give physicians and patients unrealistic expectations about new treatments. It is important to know the source of “spin” and so French researchers, led by Isabelle Boutron from the Université Paris Descartes, looked for the presence of “spin” in a sample of 70 press releases, and 41 associated news stories, of randomized controlled trials and investigated the source of the “spin”.
The authors found that 33 (47%) of press releases contained “spin” and also identified “spin” in the conclusions of 28 (40%) study abstracts published in scientific journals. Furthermore, 21 (51%) of the associated news stories were reported with “spin”, mainly the same type of ‘”spin”‘ as those identified in the press release and article abstract conclusions. Importantly, “spin” could lead readers to overestimate the benefits of the treatment.
The authors conclude: “Our results highlight a tendency for press releases and the associated media coverage of randomized controlled trials to place emphasis on the beneficial effects of experimental treatments. This tendency is probably related to the presence of “spin” in conclusions of the scientific article’s abstract. ”
They continue: “Our work highlights that this inappropriate reporting could bias readers’ interpretation of research results.”
The authors add: “Consequently, reviewers and editors of published articles have an important role to play in the dissemination of research findings and should be particularly aware of the need to ensure that the conclusions reported are an appropriate reflection of the trial findings and do not overinterpret or misinterpret the results.”
Lights out?….
An international conference at the University of Haifa has called attention to the dangers of exposure to light at night.
“The most important thing for us is to raise awareness of the dangers of artificial light at night and we have already come a long way now that the American Medical Association (AMA) recently announced its new policy recognizing adverse health effects of exposure to light at night and encouraging further research into the matter,” said Prof. Abraham Haim, a leading authority on light pollution, who coordinated the 21st International Congress of Zoology (ICZ) that was held last week at the University of Haifa, Israel.
The panel of world experts discussed “Light Pollution and its Ecophysiological Consequences” and shed new light on the extent of the dangers and harm that night-time artificial lighting causes, emphasizing that it is the short wavelength illumination that we have come to know as “eco-friendly illumination” that is causing the most harm (primarily LED lighting).
The participants were in full agreement that exposure to light at night affects circadian rhythms in nature – humans, animals and plants – which when thrown off can result in various illnesses and adverse symptoms. Prof. Haim presented one of his studies showing the adverse effects of exposure to light at night – particularly short wavelength blue LED – in the blind mole rat and in seeing rats, both of which showed varying levels of damage to their metabolic rates, hormone production, body mass, and oxygen consumption following exposure to LAN, as well as suppressed levels of melatonin production, which is responsible for tumor growth. “We expect to find similar results of damage from human exposure to LED lighting,” Prof. Abraham concluded, and pointed out that “Western youngsters are typically surrounded by this sort of lighting in the confines of their own bedroom: from the smartphone, computer screen, and television.
“Street lights together with industrial, commercial, and public service lighting are responsible for 60 percent of LAN pollution in Berlin,” for example, said Dr. Franz Hölker of the Leibniz Institute of Freshwater Ecology and Inland Fisheries, Germany, who chaired the panel with Noam Leader of the Israel Nature and Parks Authority. “This is intensified under cloudy conditions when the light is reflected back down to the ground,” he noted. Others pointed out that excessive levels of light pollution found in industrial areas greatly endangers surrounding wildlife.
Also participating in the panel were James Hale of the University of Birmingham, UK, and Dr. Rachel Ben-Shlomo and L. Ashkenazi of the University of Haifa. The participants, revealed the harm being done by LAN, to all types of plants and animals (mammals, birds, fishes, reptiles, amphibians, and invertebrates), putting many at risk of extinction.
Age, not underlying diagnosis, key factor in weight gain in children after tonsillectomy
Potentially worrisome weight gains following tonsillectomy occur mostly in children under the age of 6, not in older children, a study by Johns Hopkins experts in otolaryngology- head and neck surgery shows.
Sudden increases in body mass index, or BMI, have been routinely observed for months after some of the more than half-million surgeries performed annually in the United States to remove the sore and swollen tissues at the back of the throat.
The Johns Hopkins study, in 115 children in the Baltimore region, is believed to be the first to dispel long-held beliefs that such weight gains occurred mostly in children whose tonsils were removed as primary treatment for diagnosed sleep apnea, when the swollen, paired tissues partially obstruct breathing and disrupt sleep. It is also believed to be the largest study to analyze weight gain specific to every child’s age group, from 1 through 17.
Although researchers have yet to pinpoint the underlying cause of the weight-gain phenomena, they did find that it happened at the same rate in the 85 children who had the surgery for obstructive sleep apnea as in the 30 who had it due to recurrent episodes of tonsil inflammation.
Senior study investigator, otolaryngologist and sleep medicine expert Stacey Ishman, M.D., M.P.H., says her team’s study findings, scheduled to be presented Sept. 12 at the annual meeting of the American Academy of Otolaryngology—Head and Neck Surgeons in Washington, D.C., should help alleviate rising concerns among many parents whose adolescent children are already overweight that tonsillectomy may aggravate the problem; or start one in normal weight kids. Recent surveys have shown that record numbers of American children, as many as one-third, are overweight or obese.
“Our study results show that parents’ current concerns about weight gain are serious, but only underweight or normal weight children between the ages of 2 and 6 are most likely to gain even more weight, not older children,” says Ishman, an assistant professor at the Johns Hopkins University School of Medicine.
“Parents with overweight adolescent children need not fear tonsillectomy, and those with younger, normal weight and overweight children just really need to closely watch their child’s diet following surgery, and make caloric adjustments,” says Ishman, who has performed hundreds of the roughly 30-minute procedures that typically require a general anesthetic.
In the study, researchers analyzed the medical records of children between the ages of 6 months and 18 years who had had their tonsils removed at the Johns Hopkins Outpatient Center between 2008 and 2011. Researchers looked only at those medical records for children who had been routinely examined for at least six months after their procedure, with detailed measurements of any possible weight gain, which were averaged and compared based on a formula involving age, gender and height. All also had a history of recurrent tonsillitis or obstructive sleep apnea, as strictly determined by an individual sleep study analysis.
Results showed an averaged post-surgical weight gain of 2 to 5 pounds – or a 1.0- to 1.2-point increase in averaged BMI scores—but the gains were not dependent on whether the underlying condition was inflammation or sleep apnea. Only age mattered, researchers say, after discounting gender and height.
Ishman says that while such weight gains might appear small, in these children’s small bodies, whose initial weight was between 22 and 60 pounds (or between 10 to 30 kilos), “a 10 percent weight gain can be quite worrisome.”
Results showed a normal weight, 5-year-old boy, weighing 40 pounds (or 18 kilos) and measuring 42 inches tall, who gained 3 pounds after tonsillectomy, would move from the 68th percentile to the 89th percentile in their age-weight group, and become overweight. For an underweight 5-year-old boy of similar height, originally weighing 34 pounds (15 kilos), the same 3-pound weight gain would shift them from the 24th percentile group to the 28th percentile, moving them closer to a normal weight.
However, she says, in an overweight 10-year-old boy, already weighing 90 pounds (41 kilos) and 55 inches tall, there was no weight gain post tonsillectomy, and he remained in the 92nd percentile group, meaning his poor condition did not worsen.
Ishman says her team’s next steps are to gain a better understanding of why and how children’s age affects weight gain post-tonsillectomy. She already has plans to monitor children immediately after surgery to find out what factors or interventions may help underweight children gain pounds, while helping those who are overweight to not get any bigger.
Since 2002 tonsillectomy has been recommended by the American Academy of Pediatrics as the primary treatment for obstructive sleep apnea, as sleeping aids and drug therapies are not as effective. Studies have shown that if left untreated, sleep apnea can lead to long-term health problems, including increased heart and lung diseases, even death.
Study implicates marijuana use in pregnancy problems
CINCINNATI – New research indicates marijuana-like compounds called endocannabinoids alter genes and biological signals critical to the formation of a normal placenta during pregnancy and may contribute to pregnancy complications like preeclampsia.Study implicates marijuana use in pregnancy problems
A study in the Sept. 14 edition of The Journal of Biological Chemistry offers new evidence that abnormal biological signaling by endocannabinoid lipid molecules produced by the body disrupts the movement of early embryonic cells important to a healthy pregnancy, in particular trophoblast cells that form the placenta. Abnormal placental function is common in preeclampsia – a medical condition of unknown cause that is a danger to mother and child.
The research – from scientists in the Division of Reproductive Sciences at Cincinnati Children’s Hospital Medical Center – analyzed mouse preimplantation embryos mutated to alter endocannabinoid signaling. They found that either silencing or enhancing endocannabinoid signaling adversely affects trophoblast stem cell migration.
“The findings or our investigation raise concerns that exposure to cannabis products may adversely affect early embryo development that is then perpetuated later in pregnancy,” said Sudhansu K. Dey, PhD., principal investigator on the study and division director. “Also, given that endocannabinoid signaling plays a key role in the central nervous system, it would be interesting in future studies to examine whether affected cell migration-related genes in early embryos also participate in neuronal cell migration during brain development.”
Along with co-first authors Huirong Xie and Xiaofei Sun, Dey and other members of the research team studied mouse embryos that had not yet implanted inside the uterus of the mother. Previous research by Dey’s laboratory has shown the timing of critical events in early pregnancy, including when and how well an embryo implants in the uterus, is vital to a healthy pregnancy and birth.
In the current study, researchers conducted DNA microarray analyses to determine how the expression levels of genes important to healthy embryo development were affected in embryos with abnormal endocannabinoid signaling.
In one group of embryos endocannabinoid signaling was silenced by deleting the gene Cnr1, which activates endocannabinoid signaling processes. A second group of mice was mutated to produce elevated endocannabinoid levels similar to that observed in wild type mice treated with tetrahydrocannabinol (THC), the active psychotropic agent in cannabis. This was done by deleting the gene Faah, which breaks down molecules that activate endocannabinoid signaling.
In both groups, the expression of numerous genes known to be important to cell movement and embryo development was lower than in normal wild type mice. This included the development and migration of trophoblast stem cells. Trophoblast cells help anchor the conceptus with the uterus and also form much of the placenta, critical to establishment of maternal-fetal circulation and exchange of nutrients.
Researchers said mouse models developed for the current study (with silenced and elevated endocannabinoid signaling) may help advance more extensive studies on the causes of preeclampsia.
Vitamin C and beta-carotene might protect against dementia
Study examines the influence of antioxidants on the pathogenesis of Alzheimer’s disease
Forgetfulness, lack of orientation, cognitive decline… about 700, 000 Germans suffer from Alzheimer’s disease (AD). Now researchers from the University of Ulm, among them the Epidemiologist Professor Gabriele Nagel and the Neurologist Professor Christine von Arnim, have discovered that the serum-concentration of the antioxidants vitamin C and beta-carotene are significantly lower in patients with mild dementia than in control persons. It might thus be possible to influence the pathogenesis of AD by a person’s diet or dietary antioxidants. 74 AD-patients and 158 healthy controls were examined for the study that has been published in the “Journal of Alzheimer’s Disease” (JAD).
AD is a neurodegenerative disease: Alterations in the brain caused by amyloid-beta-plaques, degeneration of fibrillae and a loss of synapses are held responsible for the characteristic symptoms. Oxidative stress, which constrains the exploitation of oxygen in the human body, is suspected to promote the development of AD. Whereas so called antioxidants might protect against neurodegeneration. In their study, the researchers have investigated whether the serum-levels of vitamin C, vitamin E, beta-carotene as well as lycopene and coenzyme Q10 are significantly lower in the blood of AD-patients. “In order to possibly influence the onset and development of Alzheimer’s disease, we need to be aware of potential risk factors”, says Gabriele Nagel.
Participants were recruited from the cross-sectional study IMCA ActiFE (Activity and Function in the Elderly in Ulm) for which a representative population-based sample of about 1,500 senior citizens has been examined. The 65 to 90 years old seniors from Ulm and the surrounding area underwent neuropsychological testing and answered questions regarding their lifestyle. What is more, their blood has been examined and their body mass index (BMI) was calculated. For the present study, scientists have compared 74 patients with mild dementia (average age 78.9 years) with a control group consisting of 158 healthy, gender-matched persons of the same age. Results are quite interesting: The concentration of vitamin C and beta-carotene in the serum of AD-patients was significantly lower than in the blood of control subjects. Whereas no such difference between the groups could be found for the other antioxidants (vitamin E, lycopene, coenzyme Q10). Potential confounding factors such as education, civil status, BMI, consumption of alcohol and tobacco have been considered in the statistical analysis. Nevertheless, additional parameters such as the storage and preparation of food as well as stressors in the life of participants might have influenced the findings. Therefore, results need to be confirmed in prospective surveys. “Longitudinal studies with more participants are necessary to confirm the result that vitamin C and beta-carotene might prevent the onset and development of Alzheimer’s disease”, says Gabriele Nagel. Vitamin C can for example be found in citrus fruits; beta-carotene in carrots, spinach or apricots.
BYU study says exercise may reduce motivation for food
Research challenges assumption that you can ‘work up an appetite’
It is commonly assumed that you can “work up an appetite” with a vigorous workout. Turns out that theory may not be completely accurate – at least immediately following exercise.
New research out of BYU shows that 45 minutes of moderate-to-vigorous exercise in the morning actually reduces a person’s motivation for food.
Professors James LeCheminant and Michael Larson measured the neural activity of 35 women while they viewed food images, both following a morning of exercise and a morning without exercise. They found their attentional response to the food pictures decreased after the brisk workout.
“This study provides evidence that exercise not only affects energy output, but it also may affect how people respond to food cues,” LeCheminant said.
The study, published online, ahead of print in the October issue of Medicine & Science in Sports & Exercise, measured the food motivation of 18 normal-weight women and 17 clinically obese women over two separate days.
On the first day, each woman briskly walked on a treadmill for 45 minutes and then, within the hour, had their brain waves measured. Electrodes were attached to each participant’s scalp and an EEG machine then measured their neural activity while they looked at 240 images – 120 of plated food meals and 120 of flowers. (Flowers served as a control.)
The same experiment was conducted one week later on the same day of the week and at the same time of the morning, but omitted the exercise. Individuals also recorded their food consumption and physical activity on the experiment days.
The 45-minute exercise bout not only produced lower brain responses to the food images, but also resulted in an increase in total physical activity that day, regardless of body mass index.
“We wanted to see if obesity influenced food motivation, but it didn’t,” LeCheminant said. “However, it was clear that the exercise bout was playing a role in their neural responses to the pictures of food.”
Interestingly, the women in the experiment did not eat more food on the exercise day to “make up” for the extra calories they burned in exercise. In fact, they ate approximately the same amount of food on the non-exercise day.
Larson said this is one of the first studies to look specifically at neurologically-determined food motivation in response to exercise and that researchers still need to determine how long the diminished food motivation lasts after exercise and to what extent it persists with consistent, long-term exercise.
“The subject of food motivation and weight loss is so complex,” Larson said. “There are many things that influence eating and exercise is just one element.”
Bliss Hanlon, a former graduate student at BYU, was the lead author on the study and Bruce Bailey, an associate professor of exercise science, was a co-author on the study
Gestational exposure to urban air pollution linked to vitamin D deficiency in newborns
New study highlights potential importance of vitamin D supplementation in pregnant women
Chevy Chase, MD—Gestational exposure to ambient urban air pollution, especially during late pregnancy, may contribute to lower vitamin D levels in offspring, according to a recent study accepted for publication in The Endocrine Society’s Journal of Clinical Endocrinology and Metabolism (JCEM). According to study authors, this could affect the child’s risk of developing diseases later in life.
Recent data have demonstrated that maternal vitamin D deficiency during pregnancy may have an influence on the development of asthma and allergic diseases in offspring. A number of factors may influence vitamin D supply in women. Exposure to high levels of air pollution has been suggested as a contributor to vitamin D deficiency in adults and children.
“We investigated the associations between gestational exposure to urban air pollutants and vitamin D cord blood serum level,” said Nour Baïz, MASc, of Intitut National de la Santé et de la Recherche Médicale (INSERM) in Paris, France who led the study. “Our findings show for the first time, that exposure to ambient air pollution comparable to current World Health Organization standards might contribute to vitamin D deficiency in newborns.”
In this study, researchers investigated the associations between gestational exposure to urban air pollutants and 25-hydroxyvitamin D cord blood serum level in 375 mother-child pairs. Maternal exposure to urban levels of nitrogen dioxide and particulate matter less than 10 micro meters during the whole pregnancy was a strong predictor of low vitamin D status in newborns. The association between gestational exposure to air pollutants and vitamin D deficiency in newborns was strongest for third-trimester exposures
Low ghrelin — reducing appetite at the cost of increased stress?
Philadelphia, PA, September 13, 2012 – Ghrelin is a hormone released by the lining of the stomach that promotes feeding behavior. Decreasing ghrelin levels could potentially help combat obesity — in fact, a vaccine that lowers ghrelin levels in order to reduce appetite is being studied as a treatment for obesity.
However, many people eat as a way to relieve stress. If low ghrelin levels increase stress, its effectiveness as a treatment for obesity may be reduced. In the current issue of Biological Psychiatry, researchers led by Dr. Zane Andrews of Monash University in Australia show that mice with no ghrelin are more anxious after stress, but that administration of endogenous ghrelin prevents the over-anxious response.
Previous studies have indicated that ghrelin can be either anxiety-causing or anxiety-relieving. This new set of studies now reveals that this dual role in anxiety behavior is context-dependent. Under non-stressed conditions, normal mice show mild anxiety relative to mice without ghrelin. Under acute stress, normal mice mount an appropriate ghrelin response to stress and are less anxious than no-ghrelin mice. In other words, stress-induced ghrelin release targets the body’s stress system to stimulate a hormonal response that will combat the stress.
Ghrelin promotes the drive for food intake and maintains blood glucose during negative energy balance as well as subserving the rewarding nature of food. “We postulate that, under conditions of acute stress, ghrelin limits excessive anxious behavior by promoting the feeling of reward to ensure appropriate food-seeking behavior and maintain energy homeostasis. Consistent with this idea, studies from Jeff Zigman and colleagues showed that elevated ghrelin during calorie restriction produced anxiolytic responses in a test of anxious behavior,” said Andrews.
“We hypothesize that ghrelin suppresses anxiety under acutely stressful conditions to encourage food seeking and maintain appropriate energy homeostasis. Indeed, the importance of ghrelin in controlling stress-induced anxiety might manifest only during conditions of elevated plasma ghrelin, such as negative energy balance and calorie restriction,” he continued. “This phenomenon represents an important evolutionary adaptation that maintains food-seeking behavior in the face of acutely stressful environments.”
“This study highlights the complexity of approaches for reducing the epidemic in obesity,” commented Dr. John Krystal, Editor of Biological Psychiatry. “In this case, low ghrelin levels stimulate anxiety and anxiety is a factor that increases food consumption in humans, particularly sweet and fatty comfort foods. These studies highlight complex relationships between systems in the body and brain that regulate mood and food consumption.”
Increased dietary fructose linked to elevated uric acid levels and lower liver energy stores
Obese patients with type 2 diabetes who consume higher amounts of fructose display reduced levels of liver adenosine triphosphate (ATP)—a compound involved in the energy transfer between cells. The findings, published in the September issue of Hepatology, a journal of the American Association for the Study of Liver Diseases, indicate that elevated uric acid levels (hyperuricemia) are associated with more severe hepatic ATP depletion in response to fructose intake.
This exploratory study, funded in part by grants from the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), also suggests that uric acid levels may serve as a marker for increased fructose consumption and hepatic ATP depletion. Uric acid is produced by the breakdown of purines, natural substances commonly found in foods. According to the authors, increased dietary fructose can alter the body’s metabolism and energy balance. Energy depletion in the liver may be associated with liver injury in patients with non-alcoholic fatty liver disease (NAFLD) and in those at risk for developing this metabolic condition.
Fructose is a simple sugar that fuels the body, and is found in fruits and vegetables. High fructose corn syrup—a mixture of glucose and fructose—is used as a sweetener in consumer food products such as bread, cereal, and soda. Prior research reports that fructose consumption in the U.S. has more than doubled in the past 30 years. In fact, studies have shown that Americans’ fructose intake climbed from 15 grams per day in the early 1900s to 55 grams per day in 1994, which experts believe stems from an increase in soft drink consumption.
“There is an alarming trend of increased rates of obesity, type 2 diabetes and NAFLD in the U.S.,” said lead author Dr. Manal Abdelmalek from Duke University Medical Center. “Given the concurrent rise in fructose consumption and metabolic diseases, we need to fully understand the impact of a high-fructose diet on liver function and liver disease.”
For the present study, 244 obese and diabetic adults from the Look AHEAD Study were evaluated, with dietary fructose consumption estimated by the food frequency questionnaire. Liver ATP and uric acid levels were measured in 105 patients who participated in the Look AHEAD Fatty Liver Ancillary Study. Researchers assessed the change in liver ATP content using an IV fructose challenge in 25 subjects, comparing patients with low fructose consumption (less than 15 grams per day) to those with high fructose consumption (greater than 15 grams per day).
The team found that participants with a high intake of dietary fructose had lower liver ATP levels at baseline and a greater change in ATP content following the fructose challenge than those who consumed a lower amount of fructose. Patients with high uric acid levels (5.5 mg/dL or more) displayed lower ATP stores in response to fructose.
Dr. Abdelmalek concludes, “High fructose consumption and elevated levels of uric acid are associated with more severe depletion of liver ATP. Our findings suggest that increased dietary fructose intake may impair liver “energy balance.” Further research to define the clinical implications of these findings on metabolism and NAFLD is necessary.” The authors highlight the importance of public awareness of the risks associated with a diet high in fructose
Study links breast cancer risk to early-life diet and metabolic syndrome
Striking new evidence suggesting that diet and related factors early in life can boost the risk for breast cancer — totally independent of the body’s production of the hormone estrogen — has been uncovered by a team of researchers at the University of California, Davis.
The findings provide new insights into the processes that regulate normal breast development, which can impact the risk of developing breast cancer later in life. The study will be published Sept. 17 in the early edition of the Proceedings of the National Academy of Sciences.
“It’s long been assumed that circulating estrogens from the ovaries, which underlie normal female reproductive development, were crucial for the onset of breast growth and development,” said Russ Hovey, a UC Davis associate professor of animal science and senior author on the study.
“Our findings, however, suggest that diet and shifts in body metabolism that parallel changes seen during obesity and Type 2 diabetes can also stimulate breast growth entirely independent of estrogen’s effects,” he said.
The studies with mice used a diet supplemented with a form of the fatty acid known as 10, 12 conjugated linoleic acid or 10, 12 CLA, which mimics specific aspects of a broader metabolic syndrome.
In humans, this syndrome is linked to a broad array of changes associated with obesity that can increase the risk of Type 2 diabetes and cardiovascular disease.
The 10, 12 CLA was added to the diet of the test group of mice because it is known to disrupt normal metabolic processes. In this study, the supplement stimulated the mammary ducts to grow, despite the fact that the mice lacked estrogen.
The researchers demonstrated that the diet-induced breast development also increased the formation of mammary tumors in some of the mice.
They ruled out a role for estrogen as the possible cause for how diet increased growth of the breast tissues by giving the supplement to male mice and to female mice in which the function of estrogen was blocked.
The research team also discovered that various mouse strains responded differently to the dietary supplement despite similar metabolic changes, suggesting that there may be a genetic component for how diet and related metabolic changes affect breast cancer risk in different populations, Hovey said.
He noted that results from the study would likely have significant implications for better understanding human breast development before puberty and after menopause, when estrogens are less present.
“The findings of this study are particularly important when we superimpose them on data showing that girls are experiencing breast development at earlier ages, coincident with a growing epidemic of childhood obesity,” Hovey said.
Cleveland Clinic study shows vitamin E may decrease cancer risk
Saturday, September 15, 2012, Cleveland: Cleveland Clinic researchers have discovered that vitamin E may prevent cancer in patients with an under-recognized genetic disorder.
Several genetic mutations are known to be present in Cowden Syndrome (CS) – a disease that predisposes individuals to several types of cancers, including breast and thyroid cancers. One type of mutation in the succinate dehydrogenase (SDH) genes may be responsible for cancer development, according to research by Charis Eng, M.D., Ph.D., Hardis Chair and Director of the Genomic Medicine Institute and Director of its Center for Personalized Genetic Healthcare at Lerner Research Institute, published today in Clinical Cancer Research.
Dr. Eng discovered that mutations in SDH genes, responsible for energy production, result in an accumulation of reactive oxygen species (ROS). These changes damage the cells and make them resistant to apoptosis – our bodies’ natural method of weeding out cancerous cells.
However, when vitamin E was applied to the mutant cells, ROS accumulation decreased, as well as the accompanying cellular damage.
“These findings support the notion that vitamin E may be useful as an anti-cancer therapeutic adjunct or preventive agent, especially for CS patients harboring SDH mutations, and its protective properties should be further explored,” said Dr. Eng.
CS predisposes individuals to several types of cancers – an 85 percent lifetime risk of breast cancer, a 35 percent risk for epithelial thyroid cancer, and increased risk of other cancers as well. Approximately one in 200,000 people are affected by CS.
Statins are unlikely to prevent blood clots
Press release from PLOS Medicine
Despite previous studies suggesting the contrary, statins (cholesterol-lowering drugs) may not prevent blood clots (venous thrombo-embolism) in adults, according to a large analysis by international researchers published in this week’s PLOS Medicine.
In 2009, an additional analysis of data from a randomized controlled trial called the JUPITER trial reported that the statin rosuvastatin halved the risk of venous thromboembolic events among apparently healthy adults. However, this finding was based on a small number of patients who had thromboembolic events (34 vs 60). To gather more evidence about the possible benefits of statins, a group of international researchers led by Kazem Rahimi from the George Centre for Healthcare Innovation at the University of Oxford in the UK, combined the results (performed a meta-analysis) of 29 suitable published and unpublished randomised controlled trials of the effects of statins involving over 100 000 participants and more than 1000 events: Only two studies presented venous thrombotic events in the published report, but such events had been recorded as adverse events in all of the included trials, which the authors were able to include in their analysis.
In the combined analysis, the authors found that venous thrombosis occurred in 0.9% of people taking statins compared to 1% of people not taking statins, which suggests that statins have a very small, if any, effect. These results did not change when the authors excluded the findings of the JUPITER trial. The authors also found that there was no effect at all in people taking high doses and low doses of statins.
The authors conclude: “this study provides a more detailed assessment of the potential effects of statins (or higher dose statins) on venous thromboembolic events than has previously been possible. We were unable to confirm the large proportional reduction in risk suggested by some previous studies.”
The authors add: “However, a more modest but perhaps clinically worthwhile reduction in venous thromboembolic events in some or all types of patient cannot be ruled out.”
In an accompanying Perspective article, Frits Rosendaal from the Leiden University Medical Center in The Netherlands (uninvolved in the study) argues that even if the study cannot provide definite answers to the statin question, some tentative conclusions can be drawn. He says: “Firstly, that for the association between statins and venous thrombosis the methodologically strongest analysis shows at most a very small effect. Secondly, if we do not wish to discard the possibility of a beneficial effect for the whole class, any such effects are limited to rosuvastatin.”
Higher levels of BPA in children and teens associated with obesity
NEW YORK – In a nationally representative sample of nearly 3,000 children and adolescents, those who had higher concentrations of urinary bisphenol A (BPA), a manufactured chemical found in consumer products, had significantly increased odds of being obese, according to a study in the September 19 issue of JAMA, and theme issue on obesity.
Leonardo Trasande, M.D., M.P.P., of the NYU School of Medicine, New York City, presented the findings of the study at a JAMA media briefing.
“In the U.S. population, exposure [to BPA] is nearly ubiquitous, with 92.6 percent of persons 6 years or older identified in the 2003-2004 National Health and Nutrition Examination Survey (NHANES) as having detectable BPA levels in their urine. A comprehensive, cross-sectional study of dust, indoor and outdoor air, and solid and liquid food in preschool-aged children suggested that dietary sources constitute 99 percent of BPA exposure,” according to background information in the article. “In experimental studies, BPA exposure has been shown to disrupt multiple metabolic mechanisms, suggesting that it may increase body mass in environmentally relevant doses and therefore contribute to obesity in humans.” BPA exposure is plausibly linked to childhood obesity, but evidence is lacking.
Dr. Trasande and colleagues conducted a study to examine association between urinary BPA concentrations and body mass in children. The study consisted of a cross-sectional analysis of a nationally representative subsample of 2,838 participants, ages 6 through 19 years, randomly selected for measurement of urinary BPA concentration in the 2003-2008 National Health and Nutrition Examination Surveys. Body mass index (BMI), converted to sex- and age-standardized z scores (indicates how many units [of the standard deviation] a child’s BMI is above or below the average BMI value for their age group and sex) was used to classify participants as overweight (BMI 85th percentile or greater for age/sex) or obese (BMI 95th percentile or greater). The median (midpoint) urinary BPA concentration for participants in the study was 2.8 ng/mL. The prevalence of obesity was 17.8 percent (n = 590), and overweight 34.1 percent (n = 1,047). The BPA concentrations of the participants were divided into quartiles (four groups). Controlling for race/ethnicity, age, caregiver education, poverty to income ratio, sex, serum cotinine level, caloric intake, television watching, and urinary creatinine level, children in the lowest urinary BPA quartile had a lower estimated prevalence of obesity (10.3 percent) than those in quartiles 2 (20.1 percent), 3 (19.0 percent), and 4 (22.3 percent). Compared with the first quartile, participants in the third quartile had approximately twice the odds for obesity. Participants in the fourth quartile had a 2.6 higher odds of obesity.
Further analyses showed this association to be statistically significant in only 1 racial subpopulation, white children and adolescents. The researchers also found that obesity was not associated with exposure to other environmental phenols commonly used in other consumer products, such as sunscreens and soaps.
“To our knowledge, this is the first report of an association of an environmental chemical exposure with childhood obesity in a nationally representative sample,” the authors write.
The researchers note that advocates and policy makers have long been concerned about BPA exposure. “We note the recent FDA ban of BPA in baby bottles and sippy cups, yet our findings raise questions about exposure to BPA in consumer products used by older children. Last year, the FDA declined to ban BPA in aluminum cans and other food packaging, announcing ‘reasonable steps to reduce human exposure to BPA in the human food supply’ and noting that it will continue to consider evidence on the safety of the chemical. Carefully conducted longitudinal studies that assess the associations identified here will yield evidence many years in the future.”
Chronic fatigue syndrome is not linked to suspect viruses
Multi-site blinded study puts to rest the notion that these viruses cause the mysterious ailment
The causes of chronic fatigue syndrome (CFS) have long eluded scientists. In 2009, a paper in the journal Science linked the syndrome—sometimes called myalgic encephalomyelitis (ME)—to infection with a mouse retrovirus called XMRV (xenotropic murine leukemia virus (MLV)-related virus). Given that affected patients often have symptoms consistent with a chronic infection, this viral connection seemed plausible, and the findings were celebrated as a major achievement for a complex disease that afflicts nearly 1 million in the U.S. Another study in early 2010 published in Proceedings of the National Academy of Sciences detected murine retrovirus-like sequences (designated pMLV: polytropic MLV) in CFS/ME patients, which provided further support for a viral theory.
Follow-up investigations by several laboratories were unable to detect XMRV or pMLV in CFS patients. However, none of them examined a sufficiently large population of well-characterized CFS/ME patients to rigorously test the validity of those findings. In the absence of a definitive study, many in the general public may have retained the opinion that XMRV and/or pMLV are responsible for the disease, and some clinicians continue the “off-label” prescription of antiretroviral drugs.
To definitively resolve this issue, the National Institute of Allergy and Infectious Diseases, part of the National Institutes of Health (NIH), commissioned a study under the auspices of the Center for Infection and Immunity at Columbia University’s Mailman School of Public Health, in partnership with the Centers for Disease Control and Prevention, the Food and Drug Administration, and the NIH’s National Cancer Institute and Warren G. Magnuson Clinical Center.
The research is published in mBio.
A total of 293 subjects, 147 with CFS/ME and 146 matched controls, were recruited from six sites across the United States following extensive clinical assessments and laboratory screening. Clinical sites included Brigham and Women’s Hospital (Boston, MA), the Simmaron Research Institute (Incline Village, NV), Miami Veterans Affairs Medical Center (Miami, FL), the Infectious Disease Clinic at Stanford University (Palo Alto, CA), the Levine Clinic (New York, NY), and the Fatigue Consultation Clinic (Salt Lake City, UT).
All CFS/ME patients chosen for the study: 1) were between the ages of 18 and 70; 2) had never suffered from another neurologic or psychiatric illness; 3) met both the “Fukuda” and “Canadian Consensus” criteria for CFS/ME; 4) were suffering from symptoms of a viral infection prior to CFS onset; 5) had reduced scores on the RAND36 quality-of-life survey (vitality subscale <35, social functioning subscale <62.5, role-physical subscale <50) and the Karnofsky Performance Scale (<70%); 6) were not pregnant, lactating, or less than 3 months postpartum to prevent maternity-related fatigue from being confused for CFS/ME.
Control subjects were recruited to match age, sex/gender distribution, race/ethnicity, and geographic location. Controls had no previous contact with individuals with CFS/ME. All potential subjects were then tested for evidence of any metabolic, endocrine, or infectious disease that might cause fatigue. Blood from CFS/ME and control subjects who met this selection criteria was collected for blinded XMRV and/or pMLV analysis using molecular, culture and serological methods, which were previously established in the individual laboratories where evidence of XMRV or pMLV had been reported or ruled out.
None of the laboratories found evidence of XMRV or pMLV in samples from the recruited CFS/ME or control subjects. For quality assurance of the molecular tests, separate positive controls (blood samples intentionally spiked with XMRV/pMLV) and negative controls (blood samples prescreened and lacking the retroviruses) were used and confirmed that the diagnostic assays were functioning properly.
Nine control and nine CFS/ME blood samples were positive for XMRV/pMLV-reactive antibodies. The accuracy of this assay cannot be determined because there are no positive controls in the general population with XMRV serology. Nonetheless, there was no correlation of antibody reactivity in blood from CFS/ME and controls.
Statement from Dr. Mikovits, the author of the Science paper wherein XMRV was first linked to CFS: “I greatly appreciated the opportunity to fully participate in this unprecedented study. Unprecedented because of the level of collaboration, the integrity of the investigators, and the commitment of the NIH to provide its considerable resources to the CFS community for this important study. Although I am disappointed that we found no association of XMRV/pMLV to CFS, the silver lining is that our 2009 Science report resulted in global awareness of this crippling disease and has sparked new interest in CFS research. I am dedicated to continuing to work with leaders in the field of pathogen discovery in the effort to determine the etiologic agent for CFS.”
“Although the once promising XMRV and pMLV hypotheses have been excluded, the consequences of the early reports linking these viruses to disease are that new resources and investigators have been recruited to address the challenge of the CFS/ME”, said W. Ian Lipkin, MD, director of the multi-site study and John Snow Professor of Epidemiology in the Mailman School of Public Health of Columbia University. “We are confident that these investments will yield insights into the causes, prevention and treatment of CFS/ME.”
Economic freedom report: U.S. continues to slide, drops to 18th
Jill Elish
09/18/2012 10:52 am
The United States, long considered a champion of economic freedom, plunged to No. 18 in new rankings published in the 2012 Economic Freedom of the World, an annual report co-authored by Florida State University economics Professor James Gwartney.
The report is published by Canada’s Fraser Institute in cooperation with institutes in 78 other nations and territories. The U.S. publisher is the Cato Institute. The 2012 report, released on Sept. 18, uses 42 different variables derived from sources such as the World Bank and International Monetary Fund to measure the degree to which the institutions and policies of 144 countries are consistent with economic freedom.
“The report indicates that the U.S. is on the wrong track,” Gwartney said. “Freer economies grow more rapidly and achieve higher income levels. Now, for more than a decade, the United States has been expanding the size of government, increasing both debt and regulation, and using subsidies, grants, tax breaks and mandates to centrally plan large sectors of the economy. A system of crony capitalism has emerged. The declining economic freedom rating of the United States provides confirmation of this trend.”
“The report indicates that the U.S. is on the wrong track,” Gwartney said.
The cornerstones of economic freedom are personal choice, voluntary exchange, freedom to compete, and security of private property, according to Gwartney, who has served as an author of the report since its inception in 1996. Gwartney’s co-authors this year are Robert A. Lawson of Southern Methodist University and Joshua Hall of Beloit College.
To determine the rankings, the authors used an index that measures the degree to which countries rely on rule of law and markets rather than political decision-making to allocate resources. The current ratings and rankings are based on data through year-end 2010.
Hong Kong once again topped the rankings of the 144 countries, followed by Singapore, New Zealand and Switzerland. Australia and Canada were tied for fifth.
From 1980 to 2000, the U.S. ranking was third, behind only Hong Kong and Singapore. However, since 2000, the U.S. ranking has slid steadily downward to eighth in 2005, 10th in 2008, and now 18th in 2010. The economic freedom score of the United States now falls below Finland and Denmark, two European welfare states. The United States also trails Mauritius, Chile, Bahrain, the United Arab Emirates, Estonia, Taiwan and Qatar.
The summary ratings of countries range from a low of approximately 3.0 to a high of near 9.0. The U.S. rating has fallen from 8.65 in 2000 to 7.70 in 2010. This approximate 1-point decline may not sound like much, but the report argues that a 1-point change in a country’s rating is associated with between a 1- and a 1.5-percentage-point decline in long-term economic growth.
Historically, the per capita income of the United States has grown at an annual rate of a little more than 2 percent. A 1-percentage-point decline would mean future annual growth of per capita income in the 1 percent range, half the historic average, Gwartney said. The growth rate of per capita income in the United States averaged 2.3 percent in the 1980s and 2.2 percent during the 1990s, but it fell to an annual rate of only 0.7 percent from 2000 to 2010.
“This sluggish growth will be the new norm unless we move away from the policies that are undermining economic freedom,” Gwartney said.
The rankings of other large economies include Japan (20th), Germany (31st), Korea (37th), France (47th), Italy (83rd), Mexico (91st), Russia (95th), Brazil (105th), China (107th) and India (111th).
Venezuela has the lowest level of economic freedom among the 144 countries for which data are available. Myanmar, Zimbabwe, Republic of Congo and Angola round out the bottom five nations.
In addition to the country summary rating, the study also measures economic freedom in five areas: (1) size of government, (2) legal structure and security of property rights, (3) access to sound money, (4) freedom to trade internationally, and (5) regulation of credit, labor and business.
The full 2012 report and data from previous annual reports are available at http://www.freetheworld.com.
Pacifiers may have emotional consequences for boys
MADISON — Pacifiers may stunt the emotional development of baby boys by robbing them of the opportunity to try on facial expressions during infancy.
Three experiments by a team of researchers led by psychologists from the University of Wisconsin–Madison tie heavy pacifier use as a young child to poor results on various measures of emotional maturity.
The study, published today by the journal Basic and Applied Social Psychology, is the first to associate pacifiers with psychological consequences. The World Health Organization and American Academy of Pediatrics already call for limiting pacifier use to promote breast-feeding and because of connections to ear infections or dental abnormalities.
Humans of all ages often mimic — unwittingly or otherwise — the expressions and body language of the people around them.
“By reflecting what another person is doing, you create some part of the feeling yourself,” says Paula Niedenthal, UW–Madison psychology professor and lead author of the study. “That’s one of the ways we understand what someone is feeling — especially if they seem angry, but they’re saying they’re not; or they’re smiling, but the context isn’t right for happiness.”
Mimicry can be an important learning tool for babies.
“We can talk to infants, but at least initially they aren’t going to understand what the words mean,” Niedenthal says. “So the way we communicate with infants at first is by using the tone of our voice and our facial expressions.”
With a pacifier in their mouth, a baby is less able to mirror those expressions and the emotions they represent.
The effect is similar to that seen in studies of patients receiving injections of Botox to paralyze facial muscles and reduce wrinkles. Botox users experience a narrower range of emotions and often have trouble identifying the emotions behind expressions on other faces.
“That work got us thinking about critical periods of emotional development, like infancy,” says Niedenthal, whose work is supported by the French Agence Nationale de la Recherche. “What if you always had something in your mouth that prevented you from mimicking and resonating with the facial expression of somebody?”
The researchers found six- and seven-year-old boys who spent more time with pacifiers in their mouths as young children were less likely to mimic the emotional expressions of faces peering out from a video.
College-aged men who reported (by their own recollections or their parents’) more pacifier use as kids scored lower than their peers on common tests of perspective-taking, a component of empathy.
A group of college students took a standard test of emotional intelligence measuring the way they make decisions based on assessing the moods of other people. Among the men in the group, heavier pacifier use went hand-in-hand with lower scores.
“What’s impressive about this is the incredible consistency across those three studies in the pattern of data,” Niedenthal says. “There’s no effect of pacifier use on these outcomes for girls, and there’s a detriment for boys with length of pacifier use even outside of any anxiety or attachment issues that may affect emotional development.”
Girls develop earlier in many ways, according to Niedenthal, and it is possible that they make sufficient progress in emotional development before or despite pacifier use. It may be that boys are simply more vulnerable than girls, and disrupting their use of facial mimicry is just more detrimental for them.
“It could be that parents are inadvertently compensating for girls using the pacifier, because they want their girls to be emotionally sophisticated. Because that’s a girly thing,” Niedenthal says. “Since girls are not expected to be unemotional, they’re stimulated in other ways. But because boys are desired to be unemotional, when you plug them up with a pacifier, you don’t do anything to compensate and help them learn about emotions.”
Suggesting such a simple and common act has lasting and serious consequences is far from popular.
“Parents hate to have this discussion,” Niedenthal says. “They take the results very personally. Now, these are suggestive results, and they should be taken seriously. But more work needs to be done.”
Sussing out just why girls seem to be immune (or how they may compensate) is an important next step, as is an investigation of what Niedenthal calls “dose response.”
“Probably not all pacifier use is bad at all times, so how much is bad and when?” she asks. “We already know from this work that nighttime pacifier use doesn’t make a difference, presumably because that isn’t a time when babies are observing and mimicking our facial expressions anyway. It’s not learning time.”
But even with more research planned to further explain the new results, Niedenthal is comfortable telling parents to consider occasionally pocketing the pacifier.
“I’d just be aware of inhibiting any of the body’s emotional representational systems,” Niedenthal says. “Since a baby is not yet verbal — and so much is regulated by facial expression — at least you want parents to be aware of that using something like a pacifier limits their baby’s ability to understand and explore emotions. And boys appear to suffer from that limitation.”
Sesame and rice bran oil lowers blood pressure, improves cholesterol
American Heart Association Meeting Report – Abstract 186
September 19, 2012
Study Highlights:
A blend of sesame and rice bran oil reduced blood pressure almost as well as a common medication.
Those who used a combination of both the oil and medication had more than twice the drop in blood pressure compared to either the group taking medication alone, or those only supplementing their diet with the oil blend
EMBARGOED UNTIL 4 pm ET, Wednesday, September 19, 2012
WASHINGTON, DC, September 19, 2012 — People who cooked with a blend of sesame and rice bran oils saw a significant drop in blood pressure and improved cholesterol levels, according to new research presented at the American Heart Association’s High Blood Pressure Research 2012 Scientific Sessions.
The researchers found cooking with a combination of these oils in a variety of ways worked nearly as well as a commonly prescribed high blood pressure medication, and that the use of the oil blend with medication yielded even more impressive results.
“Rice bran oil, like sesame oil, is low in saturated fat and appears to improve a patient’s cholesterol profile,” said Devarajan Sankar, M.D, Ph.D., a research scientist in the Department of Cardiovascular Disease at Fukuoka University Chikushi Hospital in Chikushino, Japan. “Additionally, it may reduce heart disease risk in other ways, including being a substitute for less healthy oils and fats in the diet.”
The 60-day study in New Delhi, India, divided 300 people with mild to moderately high blood pressure into three groups. One group was treated with a commonly used blood pressure lowering medication called a calcium-channel blocker (nifedipine). The second group was given the oil blend and told to use about an ounce each day in their meals.
The final group received the calcium channel blocker and the oil blend.
All three groups, with approximately an equal number of men and women, average age of 57, saw drops in their systolic blood pressure. Systolic blood pressure is the top number in a blood pressure reading and measures the force of blood against your artery walls when the heart is pumping.
Systolic blood pressure dropped an average of 14 points for those using only the oil blend and 16 points for those taking medication. Those using both saw a 36-point drop.
Diastolic blood pressure also dropped significantly: 11 points for those eating the oil, 12 for those on medication and 24 for those using both. Diastolic blood pressure is the bottom number in a blood pressure reading that measures the force of blood against your artery walls when your heart is at rest between beats.
As for cholesterol, those using the oils saw a 26 percent drop in their LDL (“bad” cholesterol) and a 9.5 percent increase in the HDL (“good” cholesterol), while no changes in cholesterol were observed for the patients who used only the calcium-channel blocker. Those who took the calcium channel blocker and the oils had a 27 percent drop in LDL levels and a 10.9 percent increase in the HDL.
Healthier fatty acids and antioxidants, such as sesamin, sesamol, sesamolin and oryzanol, in the oil blends may be responsible for the results, Sankar said. These antioxidants, mono and poly unsaturated oils are compounds found in plants and have been linked with lower blood pressure and total cholesterol in earlier studies.
Additional studies are needed to determine if the oil blend is as beneficial as it seems. The combination was made specifically for this study, and there are no plans to market it commercially, Sankar said. Blending these oils yourself would not necessarily produce these effects.
People with high blood pressure should not stop taking their medications and should speak with their doctors before trying any product that might change their blood pressure to ensure they’re being properly monitored.
Co-authors are.Ravinder Singh, M.B.B.S., and Biprabuddha Chatterjee, M.Sc. Author disclosures are on the manuscript.
No outside funding was received for this research. Adani Wilmar Limited of Gujarat, India, donated the oil blend (VivoTM) for use in the study
Obese children have less sensitive taste-buds than those of normal weight
Blunted ability to identify all five tastes may affect quantity of foods eaten
Obese kids have less sensitive taste-buds than kids of normal weight, indicates research published online in the Archives of Disease in Childhood.
This blunted ability to distinguish all five tastes of bitter, sweet, salty, sour, and umami (savoury) may prompt them to eat larger quantities of food in a bid to register the same taste sensation, suggest the authors.
They base their findings on 94 normal weight and 99 obese children aged between 6 and 18, who were in good health and not taking any medications known to affect taste and smell.
The taste sensitivity of every child was tested using 22 “taste strips” placed on the tongue, to include each of the five taste sensations, at four different levels of intensity, plus two blank strips.
Each child was asked to refrain from eating or drinking anything other than water and not to chew gum for at least an hour before they took the two tests, which involved identifying the different tastes and their intensity.
The sum of all five taste sensations at the four different intensities allowed for a maximum score of 20, with scores ranging from two to 19.
Girls and older children were better at picking out the right tastes.
Overall, the children were best able to differentiate between sweet and salty, but found it hardest to distinguish between salty and sour, and between salty and umami.
And obese children found it significantly more difficult to identify the different taste sensations, scoring an average of 12.6 compared with an average of just over 14 clocked up by children of normal weight.
Obese children were significantly less likely to identify the individual taste sensations correctly, particularly salty, umami, and bitter.
And while both obese and normal weight children correctly identified all the differing levels of sweetness, obese kids rated three out of the four intensity levels lower than kids of normal weight.
Similarly, children of normal weight were better able to distinguish the different taste sensations, the older they were, but this trend was not seen among the obese children.
Exactly why people have differing taste perceptions is unclear, but genes, hormones, acculturation and exposure to different tastes early in life are all thought to play a part, say the authors.
But previous research indicates that heightened sensitivity to different taste sensations may help to reduce the amount of food eaten as less is required to get the same “taste hit.”
Probiotics to Decontaminate Your Gut?
Heavy metals and other toxins frequently contaminate food and water. The culprits read like a litany of bad actors—lead, cadmium, mercury, arsenic, chromium—but their numbers run into the thousands. Microbes have long been enlisted for bioremediation, but they also have the potential to protect us from toxins, according to a minireview in the September Applied and Environmental Microbiology. “Beneficial bacteria are indeed capable of degrading pesticides and sequestering toxic chemicals,” says coauthor Gregor Reid of the Lawson Health Research Institute, London, Ontario.
Indeed, 40 to 60 percent of metals ingested by humans into the gastrointestinal (GI) tract do not breach the intestinal barrier, and host microbiota play an important role in preventing their entry, says coauthor Jeremy Burton, of Lawson. Lactobacilli are prominent denizens of the GI and vaginal tract, and are also frequently used in fermentation, says Burton. That raises the possibility of applying them to other foods to sweep harmful compounds from the gut, and even decontaminating environmental sites. “If the metal is trapped in or on a bacterial cell, it can pass harmlessly from the body via feces,” he explains.
The concept grew out of Reid’s group’s interest in how lactobacilli can improve urogenital health in women. “We realized that lives could be improved by the relatively simple approach of using probiotics that pass through the gut and ascend to the vagina,” says Reid. That led to development of several probiotic yogurts, one of which was transferred to local community kitchens in Tanzania, Kenya, and Rwanda, where it has been shown to help people infected with HIV who were malnourished and suffering from diarrhea.
“As large parts of the world, including Africa’s Lake Victoria [the world’s second largest freshwater lake by surface area], are contaminated by a host of toxic compounds, we thought it would be worth seeing if lactobacilli could counter the toxins,” says Reid.
The researchers hope their minireview will spur discussion of these ideas, and further experimentation. “We are testing this theory in several studies, and would welcome collaborations to explore just how much of a detox effect can be achieved through microbes and food,” says Burton
Low calorie cranberry juice lowers blood pressure in healthy adults
Regularly drinking low-calorie cranberry juice may help get your blood pressure under control, according to new findings presented at the American Heart Association’s High Blood Pressure Research 2012 Scientific Sessions.
In a study that measured the effects of drinking low-calorie cranberry juice, participants drank either low-calorie juice or a placebo drink every day for eight weeks as part of a controlled diet.
Blood pressure was measured at the beginning, mid-point and end of the study. After eight weeks, blood pressure values had significantly dropped from an average of 121/73 mmHg to 118/70 mmHg for those drinking the low-calorie cranberry juice. The placebo group showed no change.
Researchers note that cranberry juice is rich in antioxidants — naturally occurring molecules in fruit, tea, wine and other foods — which have been associated with lower blood pressure in other studies.
Nutrient in Eggs and Meat May Influence Gene Expression from Infancy to Adulthood (Choline)
Implications for Wide Range of Disorders – Hypertension to Mental Health Problems
September 20, 2012
Just as women are advised to get plenty of folic acid around the time of conception and throughout early pregnancy, new research suggests another very similar nutrient may one day deserve a spot on the obstetrician’s list of recommendations.
Consuming greater amounts of choline – a nutrient found in eggs and meat – during pregnancy may lower an infant’s vulnerability to stress-related illnesses, such as mental health disturbances, and chronic conditions, like hypertension, later in life.
In an early study in The FASEB Journal, nutrition scientists and obstetricians at Cornell University and the University of Rochester Medical Center found that higher-than-normal amounts of choline in the diet during pregnancy changed epigenetic markers – modifications on our DNA that tell our genes to switch on or off, to go gangbusters or keep a low profile – in the fetus. While epigenetic markers don’t change our genes, they make a permanent imprint by dictating their fate: If a gene is not expressed – turned on – it’s as if it didn’t exist.
The finding became particularly exciting when researchers discovered that the affected markers were those that regulated the hypothalamic-pituitary-adrenal or HPA axis, which controls virtually all hormone activity in the body, including the production of the hormone cortisol that reflects our response to stress and regulates our metabolism, among other things.
More choline in the mother’s diet led to a more stable HPA axis and consequently less cortisol in the fetus. As with many aspects of our health, stability is a very good thing: Past research has shown that early exposure to high levels of cortisol, often a result of a mother’s anxiety or depression, can increase a baby’s lifelong risk of stress-related and metabolic disorders.
“The study is important because it shows that a relatively simple nutrient can have significant effects in prenatal life, and that these effects likely continue to have a long-lasting influence on adult life,” said Eva K. Pressman, M.D., study author and director of the high-risk pregnancy program at the University of Rochester Medical Center. “While our results won’t change practice at this point, the idea that maternal choline intake could essentially change fetal genetic expression into adulthood is quite novel.”
Pressman, who advises pregnant women every day, says choline isn’t something people think a lot about because it is already present in many things we eat and there is usually no concern of choline deficiency. Though much more research has focused on folate – functionally very similar to choline and used to decrease the risk of neural tube defects like spina bifida – a few very compelling studies sparked her interest, including animal studies on the role of choline in mitigating fetal alcohol syndrome and changing outcomes in Down syndrome.
A long-time collaborator with researchers at Cornell, Pressman joined a team led by Marie Caudill, Ph.D., R.D., professor in the Division of Nutritional Sciences at Cornell, in studying 26 pregnant women in their third trimester who were assigned to take 480 mg of choline per day, an amount slightly above the standard recommendation of 450 mg per day, or about double that amount, 930 mg per day. The choline was derived from the diet and from supplements and was consumed up until delivery.
The team found that higher maternal choline intake led to a greater amount of DNA methylation, a process in which methyl groups – one carbon atom linked to three hydrogen atoms – are added to our DNA. Choline is one of a handful of nutrients that provides methyl groups for this process. The addition of a single methyl group is all it takes to change an individual’s epigenome.
Measurements of cord blood and samples from the placenta showed that increased choline, via the addition of methyl groups, altered epigenetic markers that govern cortisol-regulating genes. Higher choline lessened the expression of these genes, leading to 33 percent lower cortisol in the blood of babies whose mom’s consumed 930 mg per day.
Study authors say the findings raise the exciting possibility that choline may be used therapeutically in cases where excess maternal stress from anxiety, depression or other prenatal conditions might make the fetal HPA axis more reactive and more likely to release greater-than-expected amounts of cortisol.
While more research is needed, Caudill says that her message to pregnant women would be to consume a diet that includes choline rich foods such as eggs, lean meat, beans and cruciferous vegetables like broccoli. For women who limit their consumption of animal products, which are richer sources of choline than plant foods, she adds that supplemental choline may be warranted as choline is generally absent in prenatal vitamin supplements.
“One day we might prescribe choline in the same way we prescribe folate to all pregnant women,” notes Pressman, the James R. Woods Professor in the Department of Obstetrics and Gynecology. “It is cheap and has virtually no side effects at the doses provided in this study. In the future, we could use choline to do even more good than we are doing right now.”
In addition to Pressman and Caudill, several scientists and clinicians from the Division of Nutritional Science and the Statistical Consulting Unit at Cornell and the Cayuga Medical Center in Ithaca, N. Y., participated in the research. The study was funded by the Egg Nutrition Center, the National Cattlemen’s Beef Association, the Nebraska Beef Council, the U.S. Department of Agriculture and the President’s Council of Cornell Women. The funding sources had no role in the study design, interpretation of the data, or publication of the results.
A mother’s nutrition–before pregnancy–may alter the function of her children’s genes
New research in The FASEB Journal shows that diet induces epigenetic changes in female mice before pregnancy that are inherited by her pups
Bethesda, MD—Everyone knows that what mom eats when pregnant makes a huge difference in the health of her child. Now, new research in mice suggests that what she ate before pregnancy might be important too. According to a new research report published online in The FASEB Journal, what a group of female mice ate—before pregnancy—chemically altered their DNA and these changes were passed to her offspring. These DNA alterations, called “epigenetic” changes, drastically affected the pups’ metabolism of many essential fatty acids. These results could have a profound impact on future research for diabetes, obesity, cancer, and immune disorders.
“As parents, we have to understand better that our responsibilities to our children are not only of a social, economical, or educational nature, but that our own biological status can contribute to the fate of our children, and this effect can be long-lasting,” said Mihai Niculescu, M.D., Ph.D., study author from Nutrition Research Institute at the University of North Carolina at Chapel Hill, in Chapel Hill, N.C. “My hope is that, along with many other scientists, we will reveal this tight biological relationship between us as parents, and our children, and how we can improve the lives of our children using our own biological machinery.”
To make this discovery, Niculescu and colleagues split mouse females into two groups before gestation, and fed them either a control diet, or a diet deficient in alpha-linolenic acid or ALA. This was achieved by replacing the type of fats in the diet, while keeping the number of calories the same. The females were bred with mouse males kept on a control diet. Immediately after the moms delivered the pups, each of these two initial groups were further split in two, so that each half of the initial groups received a flaxseed oil supplemented diet (rich in ALA), while the other halves from each group remained on the same diet. Researchers used blood and liver to look at polyunsaturated fatty acid (PUFA) levels and the DNA methylation of a gene called Fads2, which regulates PUFA metabolism. They found that in both the moms and pups, flaxseed oil induced a change in this chemical modification in the Fads2 gene. Flaxseed oil supplementation increased the methylation of this gene, which, in turn, decreased the activation of the gene in pups. However, flaxseed oil was not the only factor with impact upon Fads2 methylation in pups. Results demonstrated that regardless of the flaxseed oil intake, there was a correlation between the methylation of this gene in moms and in their pups, which suggested that pups also inherit this methylation from their moms. The pups’ ability to transform PUFAs in their own livers was influenced by both the mother’s dietary intake, and also by maternal Fads2 methylation status.
“New York City may be laughed at by some for banning large, sugary sodas and for encouraging a healthy diet,” said Gerald Weissmann, M.D., Editor-in-Chief of The FASEB Journal, “This report shows that future generations might not find that funny at all. This report adds to the large body of evidence that an inappropriate diet can produce changes in the function of our DNA and the DNA of our children—a process called epigenetics. As we begin understand the effects of diet on epigenetics, New York may go from being considered a funny ‘nanny-state’ to becoming appreciated as a public health visionary.”
Regular consumption of sugary beverages linked to increased genetic risk of obesity
Researchers from Harvard School of Public Health have found that greater consumption of sugar-sweetened beverages (SSBs) is linked with a greater genetic susceptibility to high body mass index (BMI) and increased risk of obesity. The study reinforces the view that environmental and genetic factors may act together to shape obesity risk.
The study appears September 21, 2012 in an advance online edition of the New England Journal of Medicine.
“Our study for the first time provides reproducible evidence from three prospective cohorts to show genetic and dietary factors—sugar-sweetened beverages—may mutually influence their effects on body weight and obesity risk. The findings may motivate further research on interactions between genomic variation and environmental factors regarding human health,” said Lu Qi, assistant professor in the Department of Nutrition at HSPH and senior author of the study.
In the past three decades, consumption of SSBs has increased dramatically worldwide. Although widespread evidence supports a link between SSBs, obesity and chronic diseases such as diabetes, there has been little research on whether environmental factors, such as drinking sugary beverages, influence genetic predisposition to obesity.
The research was based on data from three large cohorts, 121,700 women in the Nurses’ Health Study, 51,529 men in the Health Professionals Follow-up Study and 25,000 in the Women’s Genome Health Study. All of the participants had completed food-frequency questionnaires detailing their food and drink consumption over time.
The researchers analyzed data from 6,934 women from NHS, 4,423 men from HPFS, and 21,740 women from WGHS who were of European ancestry and for whom genotype data based on genome-wide association studies were available. Participants were divided into four groups according to how many sugary drinks they consumed: less than one serving of SSB per month, between 1-4 servings per month, between 2-6 servings per week, and one or more servings per day. To represent the overall genetic predisposition, a genetic predisposition score was calculated on the basis of the 32 single-nucleotide polymorphisms known to be associated with BMI (weight in kilograms divided by the square of the height in meters).
The results showed that the genetic effects on BMI and obesity risk among those who drank one or more SSBs per day were about twice as large as those who consumed less than one serving per month. The findings suggest that regular consumption of sugary beverages may amplify the genetic risk of obesity. In addition, individuals with greater genetic predisposition to obesity appear to be more susceptible to harmful effects of SSBs on BMI. “SSBs are one of the driving forces behind the obesity epidemic,” says Frank Hu, professor of nutrition and epidemiology at HSPH and a coauthor of this study. “The implication of our study is that the genetic effects of obesity can be offset by healthier food and beverage choices.”
Diet high in total antioxidants associated with lower risk of myocardial infarction in women
New findings reported in the American Journal of Medicine
Philadelphia, PA, September 21, 2012 – Coronary heart disease is a major cause of death in women. A new study has found that a diet rich in antioxidants, mainly from fruits and vegetables, can significantly reduce the risk of myocardial infarction. The study is published in the October issue of The American Journal of Medicine.
“Our study was the first to look at the effect of all dietary antioxidants in relation to myocardial infarction,” says lead investigator Alicja Wolk, DrMedSci, Division of Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden. “Total antioxidant capacity measures in a single value all antioxidants present in diet and the synergistic effects between them.”
The study followed 32,561 Swedish women aged 49-83 from September 1997 through December 2007. The women completed a food-frequency questionnaire in which they were asked how often, on average, they consumed each type of food or beverage during the last year. The investigators calculated estimates of total antioxidant capacity from a database that measures the oxygen radical absorption capacity (ORAC) of the most common foods in the United States (no equivalent database of Swedish foods exists). The women were categorized into five groups of total antioxidant capacity of diet.
During the study, 1,114 women suffered a myocardial infarction. Women in the group with the highest total antioxidant capacity had a 20% lower risk, and they consumed almost 7 servings per day of fruit and vegetables, which was nearly 3 times more than the women with the least antioxidant capacity, who on average consumed 2.4 servings.
Dr. Wolk notes that trials testing high doses of antioxidant supplements have failed to see any benefit on coronary heart disease and, in fact, in one study higher all-cause mortality was reported. “In contrast to supplements of single antioxidants, the dietary total antioxidant capacity reflects all present antioxidants, including thousands of compounds, all of them in doses present in our usual diet, and even takes into account their synergistic effects,” she explains.
In a commentary accompanying the article, Pamela Powers Hannley, MPH, Managing Editor of The American Journal of Medicine, observes that with the industrialization of our food supply, Americans began to consume more total calories and more calories from processed food high in fat and sugar. As a result, obesity rates began to climb steadily. “Although weight-loss diets abound in the US, the few which emphasize increasing intake of fruits and vegetables actually may be on the right track,” she says. “Yet only 14% of American adults and 9.5% of adolescents eat five or more servings of fruits or vegetables a day.”
These reports are done with the appreciation of all the Doctors, Scientist, and otherMedical Researchers who sacrificed their time and effort. In order to give people theability to empower themselves. Without the base aspirations for fame, or fortune. Just honorable people, doing honorable things.