How to detect malnutrition in patients effectively?

How to Detect Malnutrition in Patients Effectively?


ScienceDaily (July 30, 2010) — Malnutrition is an important factor, influencing both morbidity and recovery after surgery. The early detection of nutritional risk would allow early intervention, which may prevent later complications.



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A traditional nutritional assessment often includes dietary and medical evaluations to identify significant weight loss over time, significantly low or high body weight (BW), skinfold thickness, serum nutritional factor levels and functional measurements of muscle strength. Individually, these measurements often have limited value in accurately determining a patient's nutritional risk.
As a result, combinations of diverse measurements have been developed into subjective scoring systems (Subjective Global Assessment (SGA) and Nutritional Risk Screening (NRS-2002)) designed to increase the sensitivity and specificity of nutritional status determinations. Scoring systems have been based on objective measurements of nutritional status, such as oral energy intake, BW, weight loss over time, loss of subcutaneous fat, muscle wasting, serum protein levels, and immune competence.
This research, lead by Dr. Seung-Wan Ryu and his colleagues from the Department of Surgery of Keimyung University has recently been published on July 14, 2010 in the World Journal of Gastroenterology. According to the research, the nutritional status in gastric cancer patients after gastrectomy surgery, BW, body mass index (BMI) and fat thickness were significantly reduced, but the total lymphocyte count, albumin, protein, cholesterol and serum iron levels did not decrease during the postoperative period.
From this result, it can be inferred that albumin and serum protein parameters are not as sensitive as anthropometric measurements in the evaluation of nutritional status. Six months after surgery, there was a good correlation between the scoring nutritional assessment tools and the other general nutritional measurement tools (BW, BMI, and anthropometric measurements). However, 12 months after surgery, most patients who were assessed as malnourished by scoring nutritional assessment tools had returned to their preoperative normal nutritional status, although their BW, BMI, and anthropometric measurements still indicated a malnourished status.
Patients with malignant gastrointestinal disease have a high prevalence of malnutrition. In cancer, reduced food intake and an increased energy gap result in the deterioration of nutritional status. It is very important to detect malnourished patients during the preoperative period and postoperative follow-up. The author announced that not only objective nutritional parameters but also subjective scoring assessments have some limitations in the accurate measurement of nutritional status. Therefore, measuring the nutritional status of patients who have undergone gastrectomy requires a combination of objective variables (anthropometric and laboratory measurements) and a subjective scoring system during the postoperative follow-up period.

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The above story is reprinted (with editorial adaptations by ScienceDaily staff) from materials provided by World Journal of Gastroenterology, via EurekAlert!, a service of AAAS.




Journal Reference:

Ryu SW, Kim IH. Comparison of different nutritional assessments in detecting malnutrition among gastric cancer patients. World Journal of Gastroenterology, 2010; 16 (26): 3310 DOI: 10.3748/wjg.v16.i26.3310

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Aging and longevity tied to specific brain region in mice

Aging and Longevity Tied to Specific Brain Region in Mice


ScienceDaily (July 29, 2010) — Researchers watched two groups of mice, both nearing the end of a two-day fast. One group was quietly huddled together, but the other group was active and alert. The difference? The second set of mice had been engineered so their brains produced more SIRT1, a protein known to play a role in aging and longevity.



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"This result surprised us," says the study's senior author Shin-ichiro Imai, MD, PhD, an expert in aging research at Washington University School of Medicine in St. Louis. "It demonstrates that SIRT1 in the brain is tied into a mechanism that allows animals to survive when food is scarce. And this might be involved with the lifespan-increasing effect of low-calorie diets."
Imai explains that the mice with increased brain SIRT1 have internal mechanisms that make them use energy more efficiently, which helps them move around in search of food even after a long fast. This increased energy-efficiency could help delay aging and extend lifespan.
The research findings are published in the July 28 issue of the Journal of Neuroscience.
Imai's past research demonstrated that SIRT1 is at the center of a network that connects metabolism and aging. A form of the gene is found in every organism on earth. The gene coordinates metabolic reactions throughout the body and manages the body's response to nutrition. SIRT1 is activated under low-calorie conditions, which have been shown to extend the life spans of laboratory animals.
The researchers found that the key to the mice's extra activity lies in a small region of the brain called the hypothalamus, which controls basic life functions such as hunger, body temperature, stress response and sleep-wake cycles.
At the start of the research project, the study's lead author Akiko Satoh, PhD, a postdoctoral research associate in developmental biology, saw that mice on low-calorie diets had increased amounts of SIRT1 in specific regions of the hypothalamus and that neurons in the same regions were activated.
So the research team developed mice that continually produced higher amounts of SIRT1 in their brains to see what the effect would be. That's when Satoh observed the mice's unusual level of activity under fasting conditions.
"This is the first time that it has been demonstrated that SIRT1 is a central mediator for behavior adaptation to low-calorie conditions," Satoh says.
Interestingly, these mice, called BRASTO (brain-specific SIRT1-overexpressing) mice, also maintained higher body temperatures after a 48-hour fast than ordinary mice, which experience a drop in body temperature during fasting.
"The BRASTO mice have a better capability to come up with energy to achieve a higher body temperature and increased activity level when food is restricted," says Imai, associate professor of developmental biology and of medicine.
The team also examined mice that had no ability to produce SIRT1 in their brains. During diet-restricting conditions, these mice did not increase their activity, and their body temperature dropped more than normal, giving further evidence that SIRT1 was essential for high-activity, high-temperature responses.
As the researchers looked further into the role of SIRT1 in the hypothalamus, they found that during diet restriction, SIRT1 enhanced the production of a specific neural receptor in the hypothalamus involved in regulating metabolic rate, food intake and insulin sensitivity. Furthermore, mice with increased brain SIRT1 had a higher neural response to the gut hormone, ghrelin, which is known to stimulate the hypothalamus during low-calorie conditions. Both findings add weight to a significant role for SIRT1 in the hypothalamic response to a restricted diet.
The scientists are continuing to study the BRASTO mice to see if they live longer than ordinary mice.
Their work suggests that the brain, and particularly the hypothalamus, might play a dominant role in governing the pace of aging. They believe their studies could eventually provide clues for increasing productive aging in people.
"If we can enhance the function of the human hypothalamus by manipulating SIRT1, we could potentially overcome some health problems associated with aging," Imai says. "One example is anorexia of aging in which elderly people lose the drive to eat. It is possible that enhancing SIRT1 could alleviate behavioral problems like this."

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The above story is reprinted (with editorial adaptations by ScienceDaily staff) from materials provided by Washington University School of Medicine. The original article was written by Gwen Ericson.




Journal Reference:

Satoh A, Brace CS, Ben-Josef G, West T, Wozniak DF, Holtzman DM, Herzog ED, Imai S. SIRT1 promotes the central adaptive response to diet restriction through activation of the dorsomedial and lateral nuclei of the hypothalamus. Journal of Neuroscience, July 28, 2010

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Why fad diets work well for some, but not others

Why Fad Diets Work Well for Some, but Not Others


ScienceDaily (July 28, 2010) — Ever notice some people seem to eat anything they want and never gain a pound, while others seem to gain weight just by looking at fattening foods? You may be seeing things correctly after all. According to research published in the July 2010 issue of Genetics,  this may have a biological cause. Using fruit flies, researchers have found that genes interacting with diet, rather than diet alone, are the main cause of variation in metabolic traits, such as body weight. This helps explain why some diets work better for some people than others, and suggests that future diets should be tailored to an individual's genes rather than to physical appearance.



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"There is no one-size-fits all solution to the diseases of obesity and type-2 diabetes," said Laura K. Reed, Ph.D, a researcher from the Department of Genetics at North Carolina State University, the lead investigator in the work. "Each person has a unique set of genetic and environmental factors contributing to his or her metabolic health, and as a society, we should stop looking for a panacea and start accepting that this is a complex problem that may have a different solution for each individual."
To make this discovery, the scientists studied 146 different genetic lines of fruit flies that were fed four different diets (nutritionally balanced, low calorie, high sugar, and high fat). Researchers then measured a variety of metabolic traits, including body weight, in each group. Flies in some of the genetic lines were highly sensitive to their diets, as reflected by changes in body weight, while flies of other lines showed no change in weight across diets. The scientists were able to ascertain what portion of the total variation in the metabolic traits was determined by genetics alone, by diet alone, or by the interaction between genotype and diet. Results showed that diet alone made a small contribution to the total variation, while genotype and genotype interactions with diet made very large contributions. This study strongly suggests that some individuals can achieve benefits from altering their dietary habits, while the same changes for others will have virtually no effect.
"The summer beach season often serves as a 'gut check' for many in terms of their weight," said Mark Johnston, Editor-in-Chief of the journal Genetics. "This research explains why the one-size-fits-all approach offered by many diet programs can have dramatically different effects for people who try them."

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Weight issues move up need for walkers, canes, other devices

Weight Issues Move Up Need for Walkers, Canes, Other Devices


ScienceDaily (July 29, 2010) — Obese older adults are more likely to use walkers, canes and other mobility devices at a younger age, and may run the risk of using them incorrectly, according to new research from Purdue University.



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"Baby Boomers are coming of age and obesity is an epidemic for this population as well," said Karis Pressler, a doctoral student in sociology and gerontology and the project's lead author. "This research shows that if obesity continues at this rate, we are going to see an increase in the use of assistive devices, which can be costly to individuals and the health-care system. Reliance on assistive devices can affect everyday life in multiple ways, from how you bathe, to how you dress, to how you move.
"If people don't want to be reliant on these devices in the future, they need to realize how obesity heightens one's risk of becoming disabled and affects how a person will compensate for that disability."
Other studies have evaluated the use of assistive devices, but this study is different because it follows more than 1,000 individuals, ages 65 and older, and tracks both their body weight and use of assistive devices for 10 years. The data is from a national survey about Medicare patients. The findings are published in the summer issue of The Gerontologist.
A third of adults older than 65 use at least one device, and lower body disability is what drives and predicts their use, Pressler said. The most popular devices are shower seats and tub stools, grab or handle bars for bathing, walkers, canes or a raised toilet seat.
"Obesity and disability create issues for society, such as in the number of handicap parking spots or availability of larger beds in hospitals and nursing homes. These challenges will escalate as our largest adult population ages," said co-author Kenneth F. Ferraro, a distinguished professor of sociology and director of Purdue's Center on Aging and the Life Course. "Being obese and disabled also fuels a vicious cycle. When you are functionally limited, physical activity is restricted, thereby burning fewer calories, which may lead to additional weight gain. This is another reminder that body weight matters throughout the life course."
Obesity is defined as more than 30 on the body mass index scale, which is a formula that takes height and weight into account. Study participants considered overweight, with a body mass index between 25 and 29.9, did not have the same need for assistive devices. However, the researchers caution that being overweight is a risk factor for obesity, and weight management for a healthy body mass is important.
Researchers also note that when used improperly, the intended assistive solution could make the problem worse. That is why it is important to consult with a health-care professional, such as a physical therapist, about how and when a device should be used, Ferraro said.
"You can buy these devices almost anywhere -- home improvement stores, discount stores or the pharmacy. It's big business," he said. "These older adults, or even their adult children or other caregivers, are just trying to cope by helping adapt to physical changes, but there is no substitute for proper use of the devices. When deciding between a stationary walker and one with wheels, it's best to consult with a specialist to receive the proper fitting and training. It could be dangerous to use or install something improperly, which could even lead to a fall."
Pressler also said there is sometimes a concern about using a device too soon because a mobility tool, such as a walker, could lead to loss of lower body function if used before it is needed.
The idea for this study was sparked by Pressler's observations when she lived in a retirement center for two years as part of Purdue's gerontology program. She will be launching another study to evaluate the social aspect of assistive devices such as how social networks, friendships and relationships may affect how or when people use them.
The current study was supported by Purdue's Center on Aging and the Life Course.

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The above story is reprinted (with editorial adaptations by ScienceDaily staff) from materials provided by Purdue University. The original article was written by Amy Patterson Neubert.




Journal Reference:

K. A. Pressler, K. F. Ferraro. Assistive Device Use as a Dynamic Acquisition Process in Later Life. The Gerontologist, 2010; 50 (3): 371 DOI: 10.1093/geront/gnp170

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Western diet link to ADHD, Australian study finds

Western Diet Link to ADHD, Australian Study Finds


ScienceDaily (July 29, 2010) — A new study from Perth's Telethon Institute for Child Health Research shows an association between ADHD and a 'Western-style' diet in adolescents.



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The research findings have just been published online in the international Journal of Attention Disorders.
Leader of Nutrition studies at the Institute, Associate Professor Wendy Oddy, said the study examined the dietary patterns of 1800 adolescents from the long-term Raine Study and classified diets into 'Healthy' or 'Western' patterns.
"We found a diet high in the Western pattern of foods was associated with more than double the risk of having an ADHD diagnosis compared with a diet low in the Western pattern, after adjusting for numerous other social and family influences," Dr Oddy said.
"We looked at the dietary patterns amongst the adolescents and compared the diet information against whether or not the adolescent had received a diagnosis of ADHD by the age of 14 years. In our study, 115 adolescents had been diagnosed with ADHD, 91 boys and 24 girls."
A "healthy" pattern is a diet high in fresh fruit and vegetables, whole grains and fish. It tends to be higher in omega-3 fatty acids, folate and fibre. A "Western" pattern is a diet with a trend towards takeaway foods, confectionary, processed, fried and refined foods. These diets tend to be higher in total fat, saturated fat, refined sugar and sodium.
"When we looked at specific foods, having an ADHD diagnosis was associated with a diet high in takeaway foods, processed meats, red meat, high fat dairy products and confectionary," Dr Oddy said.
"We suggest that a Western dietary pattern may indicate the adolescent has a less optimal fatty acid profile, whereas a diet higher in omega-3 fatty acids is thought to hold benefits for mental health and optimal brain function.
"It also may be that the Western dietary pattern doesn't provide enough essential micronutrients that are needed for brain function, particularly attention and concentration, or that a Western diet might contain more colours, flavours and additives that have been linked to an increase in ADHD symptoms. It may also be that impulsivity, which is a characteristic of ADHD, leads to poor dietary choices such as quick snacks when hungry."
Dr Oddy said that whilst this study suggests that diet may be implicated in ADHD, more research is needed to determine the nature of the relationship.
"This is a cross-sectional study so we cannot be sure whether a poor diet leads to ADHD or whether ADHD leads to poor dietary choices and cravings," Dr Oddy said.
ADHD is the most commonly diagnosed childhood mental health disorder and has a prevalence of approximately 5%. ADHD is known to be more common in boys.

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Amber L. Howard, Monique Robinson, Grant J. Smith, Gina L. Ambrosini, Jan P. Piek, and Wendy H. Oddy. ADHD Is Associated With a 'Western' Dietary Pattern in Adolescents. Journal of Attention Disorders, 2010; DOI: 10.1177/1087054710365990

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Early predictors of metabolic syndrome in healthy 7-9 year-olds identified

Early Predictors of Metabolic Syndrome in Healthy 7-9 Year-Olds Identified


ScienceDaily (July 12, 2010) — Melinda Sothern, PhD, CEP, Professor of Public Health and Director of Health Promotion at LSU Health Sciences Center New Orleans, will present evidence that supports relationships seen in adolescents between insulin sensitivity and fatty liver, belly fat, and total body fat and identifies additional potential early markers of insulin resistance and metabolic syndrome in healthy 7-9 year-old children, including fat in muscle cells, blood pressure, physical activity, and birth weight.



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Dr. Sothern will present findings of the Early Markers for the Metabolic Syndrome in Youth at 1:00 p.m. Central European Summer Time on July 12, 2010 in Stockholm at the International Congress on Obesity.
The metabolic syndrome develops during childhood and is associated with several early risk factors including low birth weight, identified by Dr. Sothern for the first time in children as young as seven prior to entering puberty, in a preliminary study. Markers that may precede the metabolic syndrome and mechanisms that explain these relationships have yet to be identified. These mechanisms may originate in the intrauterine environment, be exacerbated in susceptible populations, such as African Americans and, be further promoted by a genetic predisposition, particularly among African American children. These abnormalities may work synergistically to create a childhood metabolic syndrome phenotype and may originate earlier in youth than previously proposed.
The purpose of the study was to explore potential correlates of insulin sensitivity, fasting insulin, and insulin resistance, and to determine the best model to predict them in young children. The study of more than 100 healthy children, ages 7-9, found that fat in the liver, abdominal fat, and fat oxidation predicted insulin resistance and appear to be early markers for the metabolic syndrome via a mechanism of impaired lipid metabolism and fat oxidation. Impaired metabolic function may be due, in part, to pre-and post natal factors that are modified by current physical activity. Therefore, race, low or high pregnancy weight and/or birth weight, and low physical activity collectively create a phenotype for poor metabolic function leading to increased risk for insulin resistance in young children.
"Although some of the risk factors cannot be changed, pregnancy weight, birth weight, and physical activity can all be modified and are targets for early intervention to prevent or delay insulin resistance and reduce the risk for metabolic syndrome," noted Dr. Sothern, who is the study's principal investigator.
The research team which also included Drs. Stuart Chalew, LSUHSC Professor of Pediatrics and Head of Pediatric Endocrinology, William Cefalu, Professor and Chief of Endocrinology, Stewart Gordon, Professor of Pediatrics, Julia Volaufova, Professor of Biostatistics, and LSUHSC Research Associate Brian Bennett as well as scientists from the LSU Pennington Biomedical Research Center, the University of Wyoming, and the University of Alabama at Birmingham, concluded that prospective studies are needed to confirm these findings.
Metabolic syndrome is a group of risk factors linked to overweight and obesity that increase the incidence of heart disease, diabetes, and stroke. In general, a person with metabolic syndrome is twice as likely to develop heart disease and five times as likely to develop diabetes as someone without metabolic syndrome. According to the National Institutes of Health, metabolic syndrome is diagnosed when a person has at least three of the following risk factors: abdominal obesity, high triglycerides, low High Density Lipoprotein (HDL), high blood pressure, and high blood sugar. The development metabolic syndrome is closely associated with being overweight, lack of physical activity and genetics and ethnicity.
"A genetic predisposition for metabolic syndrome with risk factors occurring early in life makes it even more important to control the risk factors that we can such as being physically active and maintaining healthy weight," noted Dr. Sothern.

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The more frequently you log on, the more weight you can keep off, study finds

The More Frequently You Log On, the More Weight You Can Keep Off, Study Finds


ScienceDaily (July 28, 2010) — The more people used an interactive weight management website, the more weight loss they maintained, according to a Kaiser Permanente Center for Health Research study published online in the open access Journal of Medical Internet Research.



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The National Institutes of Health-funded study evaluated an Internet-based weight maintenance intervention involving 348 participants. Consistent website users who logged on and recorded their weight at least once a month for two-and-a-half years maintained the most weight loss, the study found.
"Consistency and accountability are essential in any weight maintenance program. The unique part of this intervention was that it was available on the Internet, whenever and wherever people wanted to use it," said study lead author Kristine L. Funk, MS, RD, a researcher at the Kaiser Permanente Center for Health Research in Portland, Ore.
"This study shows that if people use quality weight management websites consistently, and if they stick with their program, they are more likely to keep their weight off," said study co-author Victor J. Stevens, PhD, co-author and senior investigator at the Kaiser Permanente Center for Health Research. "Keeping weight off is even more difficult than losing it in the first place, so the fact that so many people (in the study) were able to maintain a good portion of their weight loss is very encouraging to us."
This internet-based weight maintenance intervention was part of the Weight Loss Maintenance Trial, one of the largest and longest weight maintenance trials ever conducted -- lasting three years and including more than 1,600 people at four study sites across the United States. To enroll in the trial, participants had to be overweight or obese based on their Body Mass Index and taking medication for high blood pressure or high cholesterol. For the first six months, participants tried to lose weight by attending weekly group meetings at which they were weighed, encouraged to keep food diaries, and given extensive information about exercise and healthy eating.
Participants had to lose at least nine pounds to remain in the trial for the weight loss maintenance phase, which lasted an additional two-and-a-half years and included three groups of randomized participants: one with no intervention, one that had monthly contact with a personal health coach, and one that was given unlimited access to a weight-maintenance website created specifically for the trial.
The internet group included 348 participants who were encouraged to log in at least once a week. If they didn't, they received e-mail reminders and follow-up automated phone messages. Once on the website, participants were prompted to record their weight, their minutes of exercise, and the number of days they kept food diaries. If they went longer than seven days without recording a weight, the other parts of the website were disabled until they did record their weight. The website included an interactive bulletin board on which participants could talk with others involved in the study and pose questions to nutrition and exercise experts.
During the first six months of the trial, while they were attending group sessions and before they had access to the website, participants who ended up in the internet group had lost an average of 19 pounds. Once they were given website access, their objective was to keep off as much of that weight as possible. Consistent users who logged in and recorded their weight at least once a month for 24 months maintained the greatest weight loss -- keeping off an average of nine of the 19 pounds they'd lost during the initial weight loss phase of the trial. Those who logged on less consistently -- at least once a month for 14 months -- kept off an average of five pounds. Those who logged on less than that kept off an average of only three pounds of their original weight loss.
At the end of the study, 65 percent of the participants were still logging on to the website. The study authors say they are encouraged by this level of participation because they say it is rare to see that kind of commitment -- even in shorter-term weight maintenance studies that use the internet.
While the study website is no longer available, there are many useful weight management websites that people can access. The study authors advise consumers to look for these important elements:

Sites that encourage accountability by asking users to consistently record weight, exercise, and calories consumed
Sites that include tailored or personalized information
Sites with interactive features that allow users to communicate with each other and with nutrition and exercise experts
Sites with accurate health information.

This study was funded by a grant from the National Health, Lung and Blood Institute, which is part of the National Institutes of Health. Authors include Kristine L. Funk, MS, RD, Victor J. Stevens, PhD, Alan Bauck, Jack Hollis, PhD, and William M. Vollmer, PhD, from the Kaiser Permanente Center for Health Research in Portland, Ore.; Lawrence J. Appel, MD, Janelle W. Coughlin, PhD, Arlene T. Dalcin, RD, from Johns Hopkins University School of Medicine in Baltimore, Md.; Phillip J. Brantley, PhD, Catherine M. Champagne, PhD, Betty M. Kennedy, PhD, and Valerie H. Myers, PhD, from Pennington Biomedical Research Center in Baton Rouge, La.; Jean Harvey-Berino, PhD, RD, from the University of Vermont in Burlington; Gerald J. Jerome, PhD, from Towson University, Department of Kinesiology, Townson, Md.; and Lillian F. Lien, MD, Carmen D. Samuel-Hodge, PhD, and Laura Svetsky, MD, from Duke University Medical Center in Durham, N.C.

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Many knee and hip replacement patients experience weight decrease after surgery

Many Knee and Hip Replacement Patients Experience Weight Decrease After Surgery


ScienceDaily (July 26, 2010) — A Mount Sinai School of Medicine study has found that patients often exhibit a significant decrease in weight and body mass index (BMI) after undergoing knee or hip replacement surgery (arthroplasty). The study is the first of its type to correct for the annual increase in BMI typically found in North Americans between the ages of 29 to 73 years. The study was recently published in Orthopedics.



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A total of 196 Mount Sinai patients who had knee or hip replacement from 2005 -- 2007 to treat osteoarthritis were randomly selected for the study. Mean patient age at surgery was 67.56 years, with about 65 percent female and 35 percent male. Of this group, 19.9 percent demonstrated a clinically significant decrease in weight (defined as the loss of five percent or more of body weight) and BMI following knee or hip replacement. In addition, the mean weight of the group dropped from 79.59 kg (175.47 lbs) to 78.13 kg (172.24 lbs) after surgery.
Significant BMI decrease was found to be greater in knee replacement patients (21.5 percent) than hip replacement patients (16.9 percent). Patients who were obese prior to surgery, with BMI greater than 30, were the most likely to experience significant post-surgery weight reductions.
"Total joint arthroplasties are performed with the intent of relieving a patient's pain and disability," said the study's lead author Michael Bronson, MD, Chief of Joint Replacement Surgery at Mount Sinai School of Medicine. "Both total knee patients and total hip patients experienced a statistically significant and clinically significant corrected weight loss following surgery, which indicates a healthier overall lifestyle."
The incidence of overweight and obese adults has been steadily increasing over the past five decades in the U.S. Lifestyle modification, consisting of changes in patterns of dietary intake, exercise, and other behaviors, is considered the cornerstone of overweight and obesity management. Overweight patients often argue that their osteoarthritis limits their mobility and ability to exercise. Thus, patients may feel frustrated that they are unable to lose weight, and are often hopeful that losing weight would be easier postoperatively.
These results suggest that patients have improved weight parameters when compared to North American adults. Dr. Bronson and his joint replacement team at Mount Sinai believe that additional studies of total knee and total hip arthroplasty postoperative patients, which also incorporate nutritional guidance and long-term fitness goals, may show even more encouraging results.

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Excessive intake of omega 6 and deficiencies in omega 3 induce obesity down the generations

Excessive Intake of Omega 6 and Deficiencies in Omega 3 Induce Obesity Down the Generations


ScienceDaily (July 26, 2010) — Chronic excess of linoleic acid (omega 6), coupled with a deficiency in alpha-linoleic acid (omega 3), can increase obesity down the generations. This has been demonstrated for the first time by Gérard Ailhaud (Université de Nice-Sophia Antipolis) working in collaboration with three CNRS laboratories and one INRA laboratory. The researchers exposed several generations of male and female adult and young mice to a "Western-like" diet of this type, and then assessed the consequences of such a lipid environment in the human diet.



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These findings are published on the website of the Journal of Lipid Research.
Omegas 6 and 3 are essential polyunsaturated fatty acids: they are indispensable to the human body, which cannot produce them itself and must therefore source them from food. Omega 6 are normally found in maize, which is itself consumed in large quantities by the farmed animals eaten by humans (half of our lipid intake comes from meat and dairy products). As for omega 3, they are mainly present in grass, linseed, rapeseed and fatty fish such as salmon, sardine or mackerel (which contain very high levels of alpha-linoleic acid). In the past forty years, there has been a steady rise in obesity over the generations in Western societies. During the same period, the diet in industrialized countries has seen a quantitative increase in the calories ingested (lipids account for 35 to 40% of food intake), high levels of linoleic acid (omega 6) and low levels of alpha-linoleic acid (omega 3). Indeed, the amount of omega 6 consumed during the past forty years has rocketed (+250%) while that of omega 3 has fallen by 40%, thus destabilizing the omega 6/omega 3 ratio when compared with the recommended intakes. While the French Food Safety Agency (AFSSA) recommends an omega 6/omega 3 ratio of 5/1, actual consumption is 15 omega 6 for 1 omega 3. In the USA, this ratio can even reach 40 omega 6 for 1 omega 3.
To perform their experiments, the researchers exposed four generations of mice to a Western-style diet, characterized by these same omega 6/omega 3 ratios. As a result, they saw a gradual increase in fat mass over several generations. They also observed the onset of metabolic disorders such as insulin resistance, which is the first step in the development of type 2 diabetes and a stimulation of the expression of the inflammatory genes involved in obesity.
Thus, in a genetically-stable animal population, exposure to a diet similar to that of developed or developing countries was sufficient to cause the emergence of transgenerational obesity, in line with the data collected in humans. The beneficial role of essential polyunsaturated fatty acids such as omega 6 (linoleic acid) is well-known in the treatment of hypercholesterolemia, and that of omega 3 in cerebral function. But when their intake is unbalanced, these fatty acids can enhance the factors inducing obesity and have serious long-term effects on human health. The agrifood industry needs to take greater account of the implications of these findings.

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Massiera et al. A Western-like fat diet is sufficient to induce a gradual enhancement in fat mass over generations. The Journal of Lipid Research, 2010; 51 (8): 2352 DOI: 10.1194/jlr.M006866

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Weight loss may be associated with improvements in hot flushes in overweight and obese women

Weight Loss May Be Associated With Improvements in Hot Flushes in Overweight and Obese Women


ScienceDaily (July 27, 2010) — Among overweight and obese women with bothersome hot flushes during menopause, an intensive weight loss intervention program may lead to improvements in flushing, according to a report in the July 12 issue of Archives of Internal Medicine, one of the JAMA/Archives journals.



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"Hot flushes are among the most common concerns of women during menopause and persist for five or more years past menopause in as many as one-third of women," the authors write as background to the article. "In multiple observational studies, women with a higher body mass index (BMI; calculated as weight in kilograms divided by height in meters squared) have reported more frequent or severe hot flushes compared with women with a lower BMI."
Alison J. Huang, M.D., from the University of California, San Francisco, and colleagues in a six-month randomized controlled trial, used self-administered questionnaires to assess bothersome hot flushes. The authors studied 338 women (average age 53) who were overweight or obese and had urinary incontinence. Of the participants, 226 were randomized to the intensive weight loss intervention and 112 were randomized to the control group. Approximately half of the women in each group reported being at least slightly bothered by flushing at the beginning of the study. Compared to the control individuals, women randomized to the intervention group reported slightly greater physical activity at baseline but the two study groups did not differ significantly with regard to other characteristics, including flushing.
Women in the intensive intervention group were assigned to a lifestyle and behavior change program designed to produce an average loss of 7 to 9 percent of initial body weight by six months. This included weekly one-hour group sessions with experts in nutrition, exercise and behavior change during which participants were encouraged to increase physical activity to at least 200 minutes per week using brisk walking or activities of a similar intensity. Women were also instructed to follow a reduced-calorie diet (1,200-1,500 calories) and were offered sample meal plans providing appropriate food selections as well as meal-replacement products.
According to the authors, in analyses of all women reporting bothersome hot flushes at the initial stages, decreases in weight, BMI and abdominal circumference were each associated with improvement in self-reported hot flushes during six months. However, there were no significant associations between changes in physical activity, calorie intake, blood pressure or overall self-reported physical and mental functioning and change in bothersome flushing.
Additionally, "among women who were at least slightly bothered by flushing at baseline, the intensive lifestyle intervention was associated with significantly greater decreases in weight, body mass index, abdominal circumference and systolic and diastolic blood pressure relative to the control group," the authors write. "No statistically significant effect of the intervention on self-reported physical activity, total calorie intake or overall physical or mental functioning was observed."
"Our findings indicate that women who are overweight or obese and experience bothersome hot flushes may also experience improvement in these symptoms after pursuing behavioral weight loss strategies; however, improvements in weight or body composition may not be the only mediators of this effect," the authors conclude.

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Alison J. Huang; Leslee L. Subak; Rena Wing; Delia Smith West; Alexandra L. Hernandez; Judy Macer; Deborah Grady; for the Program to Reduce Incontinence by Diet and Exercise Investigators. An Intensive Behavioral Weight Loss Intervention and Hot Flushes in Women. Arch Intern Med, 2010; 170 (13): 1161-1167 [link]

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Hormonal contraceptives have mixed success among overweight women

Hormonal Contraceptives Have Mixed Success Among Overweight Women


ScienceDaily (July 25, 2010) — As obesity continues to be a worldwide health risk, one of its "side effects" could include less effective birth control for overweight and obese women who use hormonal contraceptives.



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Four of seven studies examined in a recent research review comprising 39,531 women suggest that the heaviest women have the highest risk of pregnancy while using the contraceptives. Yet a closer look at the studies, the review authors say, reveals a more complicated picture.
In one study of oral contraceptive pills, women with a body mass index (BMI) in the overweight range (a BMI of 25 or more) had a higher risk of pregnancy that those in the normal weight range. In another study of contraceptive skin patches, higher body weight -- not higher BMI -- was associated with higher risks of pregnancy.
Other contraceptives such as injectable or implantable hormones might "be unaffected by body mass," said lead author Laureen Lopez, Ph.D., of FHI, global health and development organization.
The review appears in the current issue of The Cochrane Library, a publication of The Cochrane Collaboration, an international organization that evaluates research in all aspects of health care. Systematic reviews draw evidence-based conclusions about medical practice after considering both the content and quality of existing trials on a topic.
Many researchers think that metabolic changes associated with obesity -- in particular, the amount of body fat -- could make hormonal birth control less effective. "However, we know little about how overweight women metabolize hormonal contraceptives," said Lopez, "since many studies exclude overweight women."
In the few reports that did include overweight and obese women, some studied overall body weight and others studied BMI, which could affect pregnancy risk in different ways. For instance, BMI studies tend to focus on how body fat might interfere with contraceptive metabolism, while studies of body weight might examine whether a larger woman needs a larger dose of the contraceptive, the authors say.
Women who are obese or overweight also should consider potential health risks from hormonal contraceptives, said Amitasrigowri Murthy, M.D., who directs the reproductive choice program at Bellevue Hospital Center in New York.
Some studies show that estrogen-based contraceptives can increase the risk of heart attack, blood clots, high blood pressure and gallbladder disease in obese women, "who are already at increased risk for these conditions," Murthy said.
Seeking alternatives, some women turn to progesterone-based contraceptives such as the injectable Depo-Provera, Murthy said, "but if you are already overweight or obese, you should know that there is a risk of weight gain in the first year of taking it [Depo-Provera]."
Health-care workers will need better studies to help them guide women as they choose a method of contraception, Lopez and colleagues say: "Given the prevalence of overweight and obesity, the public health impact of any effect on contraceptive efficacy could be substantial."
"The contraceptive methods studied here are still among the most effective when used as recommended," said Lopez. "Moreover, pregnancy is much riskier for women who are obese compared with women of normal weight."

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The above story is reprinted (with editorial adaptations by ScienceDaily staff) from materials provided by Center for Advancing Health. The original article was written by Becky Ham.




Journal Reference:

Lopez et al. Hormonal contraceptives for contraception in overweight or obese women. Cochrane Database of Systematic Reviews Protocols, 2010; DOI: 10.1002/14651858.CD008452.pub2

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Inhibiting fatty acids in immune cells decreases atherosclerosis risk

Inhibiting Fatty Acids in Immune Cells Decreases Atherosclerosis Risk


ScienceDaily (July 23, 2010) — Scientists at Washington University School of Medicine in St. Louis have found a way to significantly reduce atherosclerosis in mice that does not involve lowering cholesterol levels or eliminating other obesity-related problems.



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They report their findings in the July 23 issue of the Journal of Biological Chemistry.
Atherosclerosis is the process through which fatty substances, such as cholesterol and cellular waste products accumulate in the lining of arteries. Those buildups, called plaques, reduce blood flow through the artery and can contribute to heart attack, stroke and even gangrene. It is common in individuals with obesity-related problems such as high blood pressure, high cholesterol and diabetes.
In this study, the research team inhibited atherosclerosis in mice by interfering with production of a substance called fatty acid synthase. This enzyme converts dietary sugars into fatty acids in the liver, where it plays an important role in energy metabolism. But fatty acids also are involved in atherosclerosis.
"The plaques that clog arteries contain large amounts of fatty acids," says senior investigator Clay F. Semenkovich, MD. "We engineered mice that are unable to make fatty acid synthase in one of the major cell types that contribute to plaque formation. On a standard Western diet high in fat, the mice had less atherosclerosis than their normal littermates."
Animals can't survive without fatty acid synthase, so mice in this study were able to make the substance in most of their tissues. They couldn't manufacture it, however, in macrophages, a type of white blood cell that surrounds and kills invading microorganisms, removes dead cells from the body and stimulates the action of other immune cells. Macrophages are dispatched in response to injury, infection and inflammation.
Atherosclerosis is the most common cause of heart disease, which is the leading cause of death in the United States. Semenkovich, the Herbert S. Gasser Professor and chief of the Division of Endocrinology, Metabolism and Lipid Research, says doctors tend to concentrate on treating the surrounding risk factors related to atherosclerosis, such as diabetes and high blood pressure, but he says the blockages themselves cause the most serious, life-threatening problems.
"With the current epidemic of obesity and diabetes, people sometimes forget that it's the blockages in the arteries that really kill people," he says. "We've made progress using statin drugs, for example, that lower cholesterol and fight plaque buildup, but a lot of people who take statins still die from cardiovascular disease. We need better therapies."
These mouse experiments suggest targeting fatty acid synthase in macrophages may provide a potential treatment strategy for humans. The researchers identified factors in the fatty acid pathway that seem to be capable of preventing plaques from blocking arteries in mice. He says those substances -- LXR-alpha and ABCA1 -- eventually may become drug targets.
"It may be possible, for example, to take macrophages out of humans, inhibit fatty acid synthase in those cells, and then infuse the macrophages back into the same person," he says. "From what we've observed in mice, we would hypothesize that approach might prevent or interfere with plaque buildup in people."
Inhibiting fatty acid synthase in macrophages may not keep blood vessels clean forever, according to Semenkovich, but he says it could lower the risk of heart attacks and strokes while people are making lifestyle changes in order to lose weight, gain control of blood sugar levels or lower triglycerides and cholesterol.
"This discovery allows us to separate atherosclerosis from associated conditions such as diabetes and high cholesterol," he says. "In fact, in the mice without fatty acid synthase in their macrophage cells, there were no effects on diabetes. Cholesterol in the blood remained the same. But there were fewer blockages in arteries. If a similar approach worked for humans, it could help prevent heart attacks and strokes and give people a chance to get healthier by losing weight and lowering cholesterol."
This work was funded by grants from the National Institute of Diabetes and Digestive and Kidney Diseases and National Heart, Lung, and Blood Institute of the National Institutes of Health, and by Fellowship Awards from the American Diabetes Association and the American Heart Association.

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J. G. Schneider, Z. Yang, M. V. Chakravarthy, I. J. Lodhi, X. Wei, J. Turk, C. F. Semenkovich. Macrophage fatty acid synthase deficiency decreases diet-induced atherosclerosis. Journal of Biological Chemistry, 2010; DOI: 10.1074/jbc.M110.100321

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Diabetes monitoring device benefits not just people but dogs and other animals, too

Diabetes Monitoring Device Benefits Not Just People but Dogs and Other Animals, Too


ScienceDaily (July 24, 2010) — The treatment of diabetes was revolutionized in 1922 when insulin was isolated from dogs. Since then, significant advances in human medicine have made diabetes more manageable for patients. Now, human medicine has returned the favor and used these advances to help dogs with diabetes.



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A University of Missouri researcher is using a continuous glucose monitoring device -- commonly used in humans with diabetes -- to help treat dogs and other animals. The device, which provides a detailed glucose picture of an animal over several days, will help pet owners manage their pets' diabetes.
"Our research has found that continuous glucose monitoring devices can be used in dogs, cats, cows and horses," said Charles Wiedmeyer, assistant professor of clinical pathology in the MU College of Veterinary Medicine. "Use of this system alleviated the need for multiple blood samples. It also reduces the stress associated with obtaining those samples. This system may provide greater monitoring capabilities in animals with diabetes and promote the diagnostic and research potential of glucose monitoring in veterinary patients."
The device, which is produced by the company, Medtronic, sits under the skin between the shoulder blades of an animal and records blood glucose data every five minutes. Monitoring the blood glucose levels can help veterinarians determine the proper dosage of insulin and how diet is affecting the animal's diabetes.
"Dogs with diabetes are similar to children with diabetes," Wiedmeyer said. "Both rely on caregivers to manage their disease. Both have little control over their diet or when they receive insulin."
Many of the symptoms of diabetes in dogs are similar to the symptoms in humans, including excessive water consumption, increased urination, or unexplained weight loss. For dogs, treatment typically involves insulin shots twice a day. Dogs get complications from diabetes, but they are not as severe as human complications, Wiedmeyer said. Older, female dogs and some breeds, such as schnauzers and poodles, are more prone to diabetes.
Wiedmeyer hopes that companies will start producing continuous glucose monitoring devices specifically designed for animals.
This summer, Wiedmeyer presented his findings at the Friends for Life: International Children with Diabetes Conference in Orlando, Fla. He has published his research in Diabetes Technology and Therapeutics and several veterinary journals.

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Chokeberry extract found to regulate weight gain, blood glucose, and inflammation in rats

Chokeberry Extract Found to Regulate Weight Gain, Blood Glucose, and Inflammation in Rats


ScienceDaily (Apr. 25, 2010) — Chokeberry bushes have for centuries been residents of eastern deciduous forests where their bright red and dark purple fruits continue to be favorite snacks of local bird species. Native Americans have also traditionally eaten dried chokeberries and prepared teas from parts of the plant, and several domesticated varieties now grace contemporary lawns and gardens from coast to coast. However, the chokeberry (Aronia) is enjoying a new claim-to-fame as a potentially powerful antioxidant, and can now be found for sale in the dietary supplement and "health food" aisles of your local pharmacies and grocery stores.



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What makes the humble chokeberry so healthful? Scientists think the answer lies in their unusually high levels of substances called anthocyanins (from the Greek anthos + kyanos meaning dark blue). There are many different anthocyanins in these colorful berries, but they all function as antioxidants -- originally protecting the chokeberry seed from sunshine-induced oxidative stress. And when we eat them, they also appear to protect our bodies from a variety of damaging situations, including exposure to pollution and metabolically-derived free radicals. Indeed, a growing body of scientific literature has shown promising effects of chokeberry consumption on diseases ranging from cancer to obesity. These health-promoting effects may be due to the potent anti-inflammatory properties of anthocyanins, as uncontrolled inflammation is now universally recognized as a common thread in many of our most prevalent and deadly diseases. In addition, certain anthocyanins -- including those found in chokeberry -- have also been shown to improve blood sugar and the function of insulin.
To better understand how chokeberries influence health, Drs. Bolin Qin and Richard Anderson from the US Department of Agriculture in Beltsville, MD studied what happens when prediabetic rats are fed chokeberry extracts for an extended period of time. The results of their research were presented on April 25 at the Experimental Biology 2010 meeting in Anaheim, CA. This presentation is part of the scientific program of the American Society for Nutrition, home of the world's leading nutrition researchers.
The researchers first made 18 male rats "prediabetic" or insulin insensitive by feeding them a fructose-rich diet for 6 weeks. Then they randomized the animals to continue drinking either pure water or water spiked with low or high levels of chokeberry extract (CellBerry®, Integrity Nutraceuticals International). After drinking this water for 6 weeks, the groups were compared in terms of body weight, body fat, blood glucose regulation, and molecular markers for inflammation.
Qin and Anderson found that at the end of the study the rats consuming the chokeberry-spiked water weighed less than the controls; both levels of chokeberry had the same effect in this regard. Similar beneficial effects of chokeberry consumption were found for body fat (specifically, that of the lower abdominal region). They also discovered that animals that had been drinking chokeberry extract had lower blood glucose and reduced levels of plasma triglycerides, cholesterol, and low-density lipoprotein (LDL) cholesterol when compared to the control animals. These alterations would theoretically lead to lower risk for diabetes and cardiovascular disease in humans. And to add even more evidence for a healthful impact of this super-berry, the researchers documented numerous alterations in expression of genes that would likely lead to reduced chronic inflammation and perhaps even lower cancer risk. For instance, drinking chokeberry extract lowered expression of the gene coding for interleukin-6 (IL-6), a protein that normally triggers inflammation following trauma or infection. Chronic overproduction of IL-6 has been documented in many diseases such as diabetes, arthritis, and atherosclerosis and is thought to be a partial cause of these conditions.
Of course, human studies will be needed before scientists can declare whether we derive the same health benefits from the chokeberry, but Qin and Anderson believe that their study "provides evidence that the chokeberry extract inhibits weight gain in insulin-resistant animals and that it modulates multiple genes associated with adipose tissue growth, blood glucose regulation, and inflammatory pathways." A final word to the wise: raw chokeberries are exceptionally bitter, so don't be tempted to harvest the shrubs in your backyard. Instead, look for this unassuming berry in fruit juice blends, jellies, and sweetened syrups.
Drs. Qin and Anderson are federal researchers in the Diet, Genomics, and Immunology Laboratory at the Beltsville Human Nutrition Research Center, a component of the US Department of Agriculture. This study was supported, in part, by Integrity Nutraceuticals International (South Spring Hill, TN).

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Subtle thyroid problem triples the risk of placental separation in birth, study finds

Subtle Thyroid Problem Triples the Risk of Placental Separation in Birth, Study Finds


ScienceDaily (July 22, 2010) — Pregnant women with antibodies that can indicate early thyroid disease are three times as likely to have placental separation during labor, researchers at UT Southwestern Medical Center have found in a study of more than 17,000 women.



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The findings, however, do not indicate that there would be any benefit from routinely screening pregnant women for thyroid problems, the researchers said. The study appears in the August issue of Obstetrics and Gynecology.
"Our work shows a link between anti-TPO antibodies and placental abruption, but that does not necessarily mean that thyroid supplementation would improve the health of the women or babies," said Dr. Brian Casey, professor of obstetrics and gynecology at UT Southwestern and the study's co-lead author.
The thyroid, a small butterfly-shaped gland at the base of the throat, produces hormones that regulate many of the body's metabolic functions. Thyroid disorders can disrupt sleep, mood and mental sharpness, and cause weight gain or loss.
The thyroid uses an enzyme called thyroid peroxidase (TPO) to incorporate iodine into thyroid hormones. Table salt often contains added iodine so people can produce adequate levels of thyroid hormones.
TPO function is disrupted in some autoimmune diseases, when the body creates antibodies against it. As a result, hormone levels decrease and the body's metabolism slows. But when antibody levels are still low, the thyroid can sometimes compensate and produce normal amounts of hormone.
In the current study, the researchers took samples of serum -- the clear, liquid fraction of blood -- from women before 20 weeks of pregnancy, and compared the levels of anti-TPO antibodies with the mothers' and babies' health after birth. Only singleton births were included in the study.
Almost 6 percent of the 17,298 women (1,012 participants) tested positive for the anti-TPO antibody, the researchers found. Ethnicity affected the rate: 8.4 percent of white women were antibody-positive, compared to 6.1 percent of Hispanic women and 2.6 percent of African-American women. The antibody-positive women had normal levels of thyroid hormones.
The researchers found that the rates of birth complications were the same between the antibody-positive and -negative groups, except for placental abruption, a rare but potentially fatal complication in which the placenta separates from the uterus too early. Abruption occurred in 1 percent of antibody-positive women, compared to 0.3 percent of antibody-negative women.
Antibody status made no difference to the health of the babies, including their birth weight, rates of admission to intensive care and so on, the researchers found.
UT Southwestern researchers are participating in a national study, led by Maternal-Fetal Medicine Units Network of the National Institutes of Child Health and Human Development (NICHD), to test whether supplementation with thyroid hormones can improve pregnancy outcomes, Dr. Casey said.
In addition, UT Southwestern researchers are testing for possible relationships between other thyroid-related measurements and birth outcome.
Other UT Southwestern obstetrics and gynecology researchers involved in the study were co-lead author Dr. Mina Abbassi-Ghanavati, assistant instructor; Dr. Donald McIntire, professor; Dr. Lisa Halvorson, associate professor; and Dr. Gary Cunningham, professor. Dr. Catherine Spong of the Eunice Kennedy Shriver National Institute of Child Health and Human Development in Bethesda, Md., also participated.
The study was partially supported by a grant from the NICHD.

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Toxic trio identified as the basis of celiac disease

Toxic Trio Identified as the Basis of Celiac Disease


ScienceDaily (July 22, 2010) — Walter and Eliza Hall Institute scientists have identified the three protein fragments that make gluten -- the main protein in wheat, rye and barley -- toxic to people with coeliac disease.



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Their discovery opens the way for a new generation of diagnostics, treatments, prevention strategies and food tests for the millions of people worldwide with coeliac disease.
When people with coeliac disease eat products containing gluten their body's immune response is switched on and the lining of the small intestine is damaged, hampering their ability to absorb nutrients. The disease is currently treated by permanently removing gluten from the patient's diet.
Dr Bob Anderson, head of the Walter and Eliza Hall Institute's coeliac disease research laboratory, said it had been 60 years since gluten was discovered to be the environmental cause of coeliac disease.
"In the years since, the holy grail in coeliac disease research has been to identify the toxic peptide components of gluten; and that's what we've done," Dr Anderson said.
The research, done in collaboration with Dr Jason Tye-Din, Dr James Dromey, Dr Stuart Mannering, Dr Jessica Stewart and Dr Tim Beissbarth from the institute as well as Professor Jamie Rossjohn at Monash University and Professor Jim McCluskey at the University of Melbourne, is published in the journal Science Translational Medicine.
The study was started by Professor Anderson nine years ago and has involved researchers in Australia and the UK as well as more than 200 coeliac disease patients.
The patients, recruited through the Coeliac Society of Victoria and the Coeliac Clinic at John Radcliffe Hospital, UK, ate bread, rye muffins or boiled barley. Six days later, blood samples were taken to measure the strength of the patients' immune responses to 2700 different gluten fragments. The responses identified 90 fragments as causing some level of immune reaction, but three gluten fragments (peptides) were revealed as being particularly toxic.
"These three components account for the majority of the immune response to gluten that is observed in people with coeliac disease," Dr Anderson said.
This knowledge has already been used by Melbourne-based biotech company, Nexpep Pty Ltd, to develop a 'peptide-based' immunotherapy that aims to desensitise people with coeliac disease to the toxic effects of gluten. Nexpep's Phase 1 trials of the therapy were completed in June and final results are expected in coming months.
The immunotherapy works by exposing people with coeliac disease to small amounts of the three toxic peptides and is based upon the same principles as desensitisation for allergies.
Dr Anderson said although coeliac disease could be managed with a gluten-free diet, compliance with the diet is often challenging and nearly half the people on the diet still have residual damage to their small intestine. "Consequently, the immunotherapy and three other drugs are under development to help people with coeliac disease."
The research was supported by the National Health and Medical Research Council, Coeliac UK, the Coeliac Research Fund, Nexpep Pty Ltd, BTG International and the Victorian Government.

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Vitamins needed to help celiacs stave off bone disease, researchers find

Vitamins Needed to Help Celiacs Stave Off Bone Disease, Researchers Find


ScienceDaily (July 22, 2010) — Children with celiac disease need to include certain must-have vitamins in their diets to stave off weak bones and osteoporosis, say researchers at the University of Alberta.



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A study of 43 children and teens from three to 18 years of age diagnosed with celiac disease showed that they also tended to have low bone density, likely due to poor intake and absorption of vitamins and minerals. That means they should be getting more of bone-boosting vitamins such as K and D in their diets, says Diana Mager, a professor of agricultural, food and nutritional science at the U of A, and one of the researchers on the project.
"Children with celiac disease are at risk for poor bone health, but by adding vitamins K and D to their diets, it can help reduce the risk of fractures and osteoporosis," Mager said.
The study revealed that the children were getting less than 50 per cent of their recommended dietary intake of Vitamin K, and that they also suffered from low levels of Vitamin D, which can be raised through increased exposure to sunlight and by eating fortified dairy products.
Mager also recommends that children with celiac disease include physical activity in their daily routines to build their bone strength and boost their Vitamin D intake by exercising outside.
"Enjoying activities such as walking and running outdoors when there is more sunshine is a great way to contribute to healthy bones," Mager said.

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Muscular heart failure patients may have a better chance at survival, study suggests

Muscular Heart Failure Patients May Have a Better Chance at Survival, Study Suggests


ScienceDaily (July 21, 2010) — University of Alberta research has discovered heart failure patients with more muscle have the potential to increase their length of life.



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Antigone Oreopoulos, a researcher from the U of A's School of Public Health, studied 140 patients with heart failure. Study participants underwent a special scan to measure their muscle mass and body fat.
Oreopoulos' research found that having more muscle was associated with better nutritional status and lower severity of heart failure, while higher body fat was associated with increased inflammation and reduced exercise capacity. This suggests that in patients with heart failure having more muscle mass and lower fat may be beneficial.
Oreopoulos' research was published this month in the journal Mayo Clinic Proceedings.
The study also discovered that testing just the body mass index (BMI) of heart failure patients doesn't accurately measure their body fat status. Oreopoulos found 41 per cent of the participants were inaccurately classified by BMI. Many who had a high body weight but not high body fat were mislabelled as obese and others who did not weigh a lot but had a high amount of body fat were mislabelled as normal by BMI. Oreopoulos says this research has direct implications for weight management guidelines and adds that to date there is a shortage of evidence to guide a clinician's decision about when to recommend weight loss to a patient with heart failure.
While this study provides potential explanations of how muscle and fat could possibly play a role in the survival of heart failure patients, Oreopoulos says there isn't enough evidence to make specific recommendations. Her team plans to conduct treatment studies that examine the effects of intentional weight gain and loss on the survival and quality of life in these patients.

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Subtle thyroid problem triples the risk of placental separation in birth, study finds

Subtle Thyroid Problem Triples the Risk of Placental Separation in Birth, Study Finds


ScienceDaily (July 21, 2010) — Pregnant women with antibodies that can indicate early thyroid disease are three times as likely to have placental separation during labor, researchers at UT Southwestern Medical Center have found in a study of more than 17,000 women.



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The findings, however, do not indicate that there would be any benefit from routinely screening pregnant women for thyroid problems, the researchers said. The study appears in the August issue of Obstetrics and Gynecology.
"Our work shows a link between anti-TPO antibodies and placental abruption, but that does not necessarily mean that thyroid supplementation would improve the health of the women or babies," said Dr. Brian Casey, professor of obstetrics and gynecology at UT Southwestern and the study's co-lead author.
The thyroid, a small butterfly-shaped gland at the base of the throat, produces hormones that regulate many of the body's metabolic functions. Thyroid disorders can disrupt sleep, mood and mental sharpness, and cause weight gain or loss.
The thyroid uses an enzyme called thyroid peroxidase (TPO) to incorporate iodine into thyroid hormones. Table salt often contains added iodine so people can produce adequate levels of thyroid hormones.
TPO function is disrupted in some autoimmune diseases, when the body creates antibodies against it. As a result, hormone levels decrease and the body's metabolism slows. But when antibody levels are still low, the thyroid can sometimes compensate and produce normal amounts of hormone.
In the current study, the researchers took samples of serum -- the clear, liquid fraction of blood -- from women before 20 weeks of pregnancy, and compared the levels of anti-TPO antibodies with the mothers' and babies' health after birth. Only singleton births were included in the study.
Almost 6 percent of the 17,298 women (1,012 participants) tested positive for the anti-TPO antibody, the researchers found. Ethnicity affected the rate: 8.4 percent of white women were antibody-positive, compared to 6.1 percent of Hispanic women and 2.6 percent of African-American women. The antibody-positive women had normal levels of thyroid hormones.
The researchers found that the rates of birth complications were the same between the antibody-positive and -negative groups, except for placental abruption, a rare but potentially fatal complication in which the placenta separates from the uterus too early. Abruption occurred in 1 percent of antibody-positive women, compared to 0.3 percent of antibody-negative women.
Antibody status made no difference to the health of the babies, including their birth weight, rates of admission to intensive care and so on, the researchers found.
UT Southwestern researchers are participating in a national study, led by Maternal-Fetal Medicine Units Network of the National Institutes of Child Health and Human Development (NICHD), to test whether supplementation with thyroid hormones can improve pregnancy outcomes, Dr. Casey said.
In addition, UT Southwestern researchers are testing for possible relationships between other thyroid-related measurements and birth outcome.
Other UT Southwestern obstetrics and gynecology researchers involved in the study were co-lead author Dr. Mina Abbassi-Ghanavati, assistant instructor; Dr. Donald McIntire, professor; Dr. Lisa Halvorson, associate professor; and Dr. Gary Cunningham, professor. Dr. Catherine Spong of the Eunice Kennedy Shriver National Institute of Child Health and Human Development in Bethesda, Md., also participated.
The study was partially supported by a grant from the NICHD.

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Toxic trio identified as the basis of celiac disease

Toxic Trio Identified as the Basis of Celiac Disease


ScienceDaily (July 21, 2010) — Walter and Eliza Hall Institute scientists have identified the three protein fragments that make gluten -- the main protein in wheat, rye and barley -- toxic to people with coeliac disease.



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Their discovery opens the way for a new generation of diagnostics, treatments, prevention strategies and food tests for the millions of people worldwide with coeliac disease.
When people with coeliac disease eat products containing gluten their body's immune response is switched on and the lining of the small intestine is damaged, hampering their ability to absorb nutrients. The disease is currently treated by permanently removing gluten from the patient's diet.
Dr Bob Anderson, head of the Walter and Eliza Hall Institute's coeliac disease research laboratory, said it had been 60 years since gluten was discovered to be the environmental cause of coeliac disease.
"In the years since, the holy grail in coeliac disease research has been to identify the toxic peptide components of gluten; and that's what we've done," Dr Anderson said.
The research, done in collaboration with Dr Jason Tye-Din, Dr James Dromey, Dr Stuart Mannering, Dr Jessica Stewart and Dr Tim Beissbarth from the institute as well as Professor Jamie Rossjohn at Monash University and Professor Jim McCluskey at the University of Melbourne, is published in the journal Science Translational Medicine.
The study was started by Professor Anderson nine years ago and has involved researchers in Australia and the UK as well as more than 200 coeliac disease patients.
The patients, recruited through the Coeliac Society of Victoria and the Coeliac Clinic at John Radcliffe Hospital, UK, ate bread, rye muffins or boiled barley. Six days later, blood samples were taken to measure the strength of the patients' immune responses to 2700 different gluten fragments. The responses identified 90 fragments as causing some level of immune reaction, but three gluten fragments (peptides) were revealed as being particularly toxic.
"These three components account for the majority of the immune response to gluten that is observed in people with coeliac disease," Dr Anderson said.
This knowledge has already been used by Melbourne-based biotech company, Nexpep Pty Ltd, to develop a 'peptide-based' immunotherapy that aims to desensitise people with coeliac disease to the toxic effects of gluten. Nexpep's Phase 1 trials of the therapy were completed in June and final results are expected in coming months.
The immunotherapy works by exposing people with coeliac disease to small amounts of the three toxic peptides and is based upon the same principles as desensitisation for allergies.
Dr Anderson said although coeliac disease could be managed with a gluten-free diet, compliance with the diet is often challenging and nearly half the people on the diet still have residual damage to their small intestine. "Consequently, the immunotherapy and three other drugs are under development to help people with coeliac disease."
The research was supported by the National Health and Medical Research Council, Coeliac UK, the Coeliac Research Fund, Nexpep Pty Ltd, BTG International and the Victorian Government.

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Preterm births higher among overweight and obese mothers, study finds

Preterm Births Higher Among Overweight and Obese Mothers, Study Finds


ScienceDaily (July 20, 2010) — Overweight and obese women are at greater risk of giving birth to a preterm baby compared with normal weight women, finds a study published online in the British Medical Journal.



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The authors believe that overweight and obese women should have counselling before pregnancy so that they are aware of these risks and can try to modify their weight before pregnancy. They also stress the need for appropriate surveillance by health professionals during pregnancy.
Overweight and obesity is now the most common pregnancy complication in many developed countries and also some developing countries. For example, in the United Kingdom, 33% of pregnant women are overweight or obese. In India, 26% of pregnant women are overweight and a further 8% are obese, while in China, 16% are overweight or obese.
Preterm birth and low birth weight are the leading causes of infant death and illness throughout childhood. However, there is still uncertainty about the impact of a mother's weight on both preterm birth and low birth weight.
So a team of researchers in Canada analysed the results of 84 studies to assess the effect of maternal weight on preterm birth (before 37 weeks) and low birth weight (below 2500g) in singleton pregnancies in both developed and developing countries.
They found that the overall risk of preterm birth before 37 weeks was not significantly different among overweight or obese women compared with normal weight women.
However, there was a 30% increased risk of induced preterm birth before 37 weeks among overweight or obese women after accounting for publication bias, which is the tendency for studies to be published only if their results are positive. The heavier the woman, the higher the risk of induced preterm birth before 37 weeks, with very obese women at 70% greater risk than normal weight women.
Overweight or obese women also had a higher risk of early preterm birth (before 32 or 33 weeks). Again, the heavier the woman, the higher the risk of early preterm birth, with very obese women at 82% greater risk than normal weight women.
Although overweight or obese women had a lower risk of delivering a low birth weight baby than normal weight women, especially in developing countries, this effect disappeared after publication bias was taken into account. "Clinicians need to be aware that maternal overweight or obesity is not protective against low birth weight and consider surveillance when indicated," warn the authors.
"Ideally, overweight or obese women should have pregnancy counselling so that they are informed of their perinatal risks and can try to optimise their weight before pregnancy," they conclude.

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Journal Reference:

Sarah D McDonald, Zhen Han, Sohail Mulla, Joseph Beyene, on behalf of the Knowledge Synthesis Group. Overweight and obesity in mothers and risk of preterm birth and low birth weight infants: systematic review and meta-analyses. BMJ, 2010; 341: c3428 DOI: 10.1136/bmj.c3428

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