ACOG: Moderate Caffeine Consumption Does Not Cause Miscarriage, Preterm Birth
Moderate caffeine consumption (<200 mg/day) — about a cup of brewed coffee daily — does not appear to increase a woman's risk for miscarriage or preterm birth, according to a statement from the American College of Obstetricians and Gynecologists.
A review of recent studies on caffeine consumption and pregnancy outcomes revealed the following:
Miscarriage: One prospective study showed no increase in miscarriage risk at all levels of caffeine consumption, while another found a doubling of risk for women who consumed more than 200 mg daily.
Preterm birth: Two studies found no association between caffeine intake and preterm birth (average intake in one study, 182 mg/day).
Intrauterine growth restriction: Findings were equivocal; the committee concluded that the relationship between caffeine consumption and IUGR is "undetermined."
Friday, July 23, 2010
Thursday, July 15, 2010
Physical Activity Linked to Lower Risk of Dementia
Medscape Medical News from the Alzheimer's Association International Conference on Alzheimer's Disease (ICAD) 2010
Susan Jeffrey
July 12, 2010 (Honolulu, Hawaii) — A new analysis from the Framingham Study suggests moderate to heavy physical activity is associated with a reduced risk for dementia during more than 20 years of follow-up.
Compared with those with lower levels of activity, participants reporting moderate to heavy physical activity had a 45% lower risk for dementia over time.
"A reduced risk of dementia may be one of the additional health benefits that can actually be derived from maintaining at least moderate physical activity," lead author Zaldy Tan, MD, MPH, from the Brigham and Women's Hospital, VA Boston, and Harvard Medical School, in Massachusetts, concluded.
Dr. Zaldy Tan
Dr. Tan presented the results here at the Alzheimer's Association International Conference on Alzheimer's Disease 2010.
Divergent Findings
Previous findings from the Framingham original cohort have already shown moderate or high physical activity to be associated with a number of positive outcomes, including a reduced risk for stroke and cardiovascular disease, higher high-density lipoprotein cholesterol levels, a reduced risk for colon cancer, and lower overall rates of mortality, Dr. Tan noted.
"Interestingly, while there are many potentially modifiable risk factors that have been linked with Alzheimer's disease and dementia, physical activity seems to be one that is fairly consistent in being shown to be related to the risk of dementia," he said. A recent review showed that 20 of 24 population-based studies showed a link between physical activity and reduced risk for dementia or cognitive decline.
Still, Dr. Tan added, the evidence is not entirely consistent. "There are some studies that seem to show no relationship between physical activity and dementia," he said, including the Bronx Aging Study, the Religious Orders Study, and the Radiation Effects Research Foundation Study.
The present investigation then looked at this relationship in the Framingham Study original cohort — a longitudinal community-based sample of 5209 men and women living in Framingham, Massachusetts, that has been evaluated every 2 years since 1948 for cardiovascular risk factors. A dementia study began in 1975, with the administration of a battery of neuropsychological tests, and 3349 of the original participants free of dementia at that time were enrolled and subsequently assessed every 2 years.
In 1986 to 1987, a survey was introduced to calculate a daily physical activity index (PAI) based on estimated hours spent performing physical activity and weighting each activity by an assigned caloric equivalent. The study population for this current study, then, includes those participants who were both free of dementia in 1986 and 1987 and who had a PAI available, for a total of 1211 Framingham study participants.
Participants were asked to estimate the amount of time they spent in various activities, ranging from sleep and sedentary states; to slight physical activity, such as standing and walking; to moderate activity, including things like housework, climbing stairs, or light sports like golf or bowling; to heavy activity, including heavy household work or more intensive exercise such as jogging.
During a mean follow-up of 9.9 ± 5.5 years, ranging from 0 to 21 years, 242 participants developed dementia. Of these, 193 cases were Alzheimer's disease, defined according to Diagnostic and Statistical Manual of Mental Disorders, 4th Edition/National Institute of Neurological and Communicative Diseases and Stroke/Alzheimer's Disease and Related Disorders Association criteria.
"What we found is that participants who spent at least 1 hour per day of moderate or heavy physical activity had a 45% lower risk of developing dementia," Dr. Tan said.
Susan Jeffrey
July 12, 2010 (Honolulu, Hawaii) — A new analysis from the Framingham Study suggests moderate to heavy physical activity is associated with a reduced risk for dementia during more than 20 years of follow-up.
Compared with those with lower levels of activity, participants reporting moderate to heavy physical activity had a 45% lower risk for dementia over time.
"A reduced risk of dementia may be one of the additional health benefits that can actually be derived from maintaining at least moderate physical activity," lead author Zaldy Tan, MD, MPH, from the Brigham and Women's Hospital, VA Boston, and Harvard Medical School, in Massachusetts, concluded.
Dr. Zaldy Tan
Dr. Tan presented the results here at the Alzheimer's Association International Conference on Alzheimer's Disease 2010.
Divergent Findings
Previous findings from the Framingham original cohort have already shown moderate or high physical activity to be associated with a number of positive outcomes, including a reduced risk for stroke and cardiovascular disease, higher high-density lipoprotein cholesterol levels, a reduced risk for colon cancer, and lower overall rates of mortality, Dr. Tan noted.
"Interestingly, while there are many potentially modifiable risk factors that have been linked with Alzheimer's disease and dementia, physical activity seems to be one that is fairly consistent in being shown to be related to the risk of dementia," he said. A recent review showed that 20 of 24 population-based studies showed a link between physical activity and reduced risk for dementia or cognitive decline.
Still, Dr. Tan added, the evidence is not entirely consistent. "There are some studies that seem to show no relationship between physical activity and dementia," he said, including the Bronx Aging Study, the Religious Orders Study, and the Radiation Effects Research Foundation Study.
The present investigation then looked at this relationship in the Framingham Study original cohort — a longitudinal community-based sample of 5209 men and women living in Framingham, Massachusetts, that has been evaluated every 2 years since 1948 for cardiovascular risk factors. A dementia study began in 1975, with the administration of a battery of neuropsychological tests, and 3349 of the original participants free of dementia at that time were enrolled and subsequently assessed every 2 years.
In 1986 to 1987, a survey was introduced to calculate a daily physical activity index (PAI) based on estimated hours spent performing physical activity and weighting each activity by an assigned caloric equivalent. The study population for this current study, then, includes those participants who were both free of dementia in 1986 and 1987 and who had a PAI available, for a total of 1211 Framingham study participants.
Participants were asked to estimate the amount of time they spent in various activities, ranging from sleep and sedentary states; to slight physical activity, such as standing and walking; to moderate activity, including things like housework, climbing stairs, or light sports like golf or bowling; to heavy activity, including heavy household work or more intensive exercise such as jogging.
During a mean follow-up of 9.9 ± 5.5 years, ranging from 0 to 21 years, 242 participants developed dementia. Of these, 193 cases were Alzheimer's disease, defined according to Diagnostic and Statistical Manual of Mental Disorders, 4th Edition/National Institute of Neurological and Communicative Diseases and Stroke/Alzheimer's Disease and Related Disorders Association criteria.
"What we found is that participants who spent at least 1 hour per day of moderate or heavy physical activity had a 45% lower risk of developing dementia," Dr. Tan said.
Monday, June 28, 2010
Breast Feeding Until 4 months can Protect Infants From Respiratory and G. I. Infections
June 21, 2010 — Breast-feeding until age 4 months is linked to lower rates of respiratory and gastrointestinal (GI) infection morbidity, according to the results of a population-based, prospective, cohort study reported online June 21 in Pediatrics.
"Exclusive breastfeeding seems to decrease the risk of infectious diseases in infancy," Liesbeth Duijts, MD, PhD, from Erasmus Medical Center in Rotterdam, the Netherlands. "However, the World Health Organization has called for more research regarding the benefits for 6 months instead of 4 months of exclusive breastfeeding."
The goal of this study, which was embedded in the Generation R Study, a study from fetal life onward in the Netherlands, was to evaluate the associations of duration of exclusive breast-feeding with upper respiratory tract infections (URTI), lower respiratory tract infections (LRTI), and GI tract infections in infancy.
There were 4164 subjects who completed questionnaires on rates of breast-feeding during the first 6 months (never; partial for < 4 months, not thereafter; partial for 4 - 6 months; exclusive for 4 months, not thereafter; exclusive for 4 months, partial thereafter; and exclusive for 6 months) and doctor-attended URTI, LRTI, and GI infections until age 12 months.
Risks for URTI, LRTI, and GI tract infection until age 6 months were lower in infants who were breast-fed exclusively until age 4 months and partially thereafter vs infants who were never breast-fed. Adjusted odds ratios (ORs) were 0.65 (95% confidence interval [CI], 0.51 - 0.83) for URTI, 0.50 (95% CI, 0.32 - 0.79) for LRTI, and 0.41 (95% CI, 0.26 -0.64) for GI tract infection. The adjusted OR for LRTIs in infants between the ages of 7 and 12 months was 0.46 (95% CI, 0.31 - 0.69).
For infants who were exclusively breast-fed for at least 6 months, trends were similar. However, partial breast-feeding, even for 6 months, was not associated with significantly lower risks for these infections.
"Exclusive breastfeeding until the age of 4 months and partially thereafter was associated with a significant reduction of respiratory and gastrointestinal morbidity in infants," the study authors write. "Our findings support health policy strategies to promote exclusive breastfeeding for at least 4 months, but preferably 6 months, in industrialized countries."
Limitations of this study include questionnaires with breast-feeding data available for only 65% of eligible participants of the Generation R Study and possible misclassification related to questionnaire use.
"Biological, cultural, and social constraints related to breastfeeding habits need to be studied more extensively," the study authors write. "The effects of prolonged and exclusive breastfeeding on infectious diseases at older ages in industrialized countries remain to be studied."
Exclusive breast-feeding until age 4 months and partially thereafter was associated with a significant reduction of respiratory and GI morbidity rates in infants.
The first phase of the Generation R Study was funded by Erasmus Medical Center, Erasmus University Rotterdam, and Netherlands Organization for Health Research and Development (Zon Mw). The present study was supported by an additional grant from Stichting W. H. Kröger (00–048) and AGS Kinderstichting. The study authors have disclosed no relevant financial relationships.
Pediatrics. Published online June 21, 2010.
"Exclusive breastfeeding seems to decrease the risk of infectious diseases in infancy," Liesbeth Duijts, MD, PhD, from Erasmus Medical Center in Rotterdam, the Netherlands. "However, the World Health Organization has called for more research regarding the benefits for 6 months instead of 4 months of exclusive breastfeeding."
The goal of this study, which was embedded in the Generation R Study, a study from fetal life onward in the Netherlands, was to evaluate the associations of duration of exclusive breast-feeding with upper respiratory tract infections (URTI), lower respiratory tract infections (LRTI), and GI tract infections in infancy.
There were 4164 subjects who completed questionnaires on rates of breast-feeding during the first 6 months (never; partial for < 4 months, not thereafter; partial for 4 - 6 months; exclusive for 4 months, not thereafter; exclusive for 4 months, partial thereafter; and exclusive for 6 months) and doctor-attended URTI, LRTI, and GI infections until age 12 months.
Risks for URTI, LRTI, and GI tract infection until age 6 months were lower in infants who were breast-fed exclusively until age 4 months and partially thereafter vs infants who were never breast-fed. Adjusted odds ratios (ORs) were 0.65 (95% confidence interval [CI], 0.51 - 0.83) for URTI, 0.50 (95% CI, 0.32 - 0.79) for LRTI, and 0.41 (95% CI, 0.26 -0.64) for GI tract infection. The adjusted OR for LRTIs in infants between the ages of 7 and 12 months was 0.46 (95% CI, 0.31 - 0.69).
For infants who were exclusively breast-fed for at least 6 months, trends were similar. However, partial breast-feeding, even for 6 months, was not associated with significantly lower risks for these infections.
"Exclusive breastfeeding until the age of 4 months and partially thereafter was associated with a significant reduction of respiratory and gastrointestinal morbidity in infants," the study authors write. "Our findings support health policy strategies to promote exclusive breastfeeding for at least 4 months, but preferably 6 months, in industrialized countries."
Limitations of this study include questionnaires with breast-feeding data available for only 65% of eligible participants of the Generation R Study and possible misclassification related to questionnaire use.
"Biological, cultural, and social constraints related to breastfeeding habits need to be studied more extensively," the study authors write. "The effects of prolonged and exclusive breastfeeding on infectious diseases at older ages in industrialized countries remain to be studied."
Exclusive breast-feeding until age 4 months and partially thereafter was associated with a significant reduction of respiratory and GI morbidity rates in infants.
The first phase of the Generation R Study was funded by Erasmus Medical Center, Erasmus University Rotterdam, and Netherlands Organization for Health Research and Development (Zon Mw). The present study was supported by an additional grant from Stichting W. H. Kröger (00–048) and AGS Kinderstichting. The study authors have disclosed no relevant financial relationships.
Pediatrics. Published online June 21, 2010.
Saturday, June 26, 2010
When Food and Medicines Clash
Americans increasingly view the food they eat as medicine to help lower cholesterol, reduce high blood pressure and control blood sugar. But as with prescribed drugs, the health-improving qualities of foods such as olive oil, nuts and fruit can interact with other medications, causing possible problems.
Pharmacists often warn people not to mix anti-cholesterol drugs known as statins with grapefruit juice. Newer research suggests that other fruit juices, including cranberry and pomegranate, as well as olive oil may also interfere with how statins work in the body. Other laboratory studies show that certain popular teas can block the effect of some medications, including the flu drug Tamiflu. And switching to a low-fat diet, itself a healthy lifestyle change, could reduce the potency of some medications.
Diet can interact with medicine in two main ways. Some foods block the body's ability to absorb certain medications, effectively reducing the dose a person receives. Other foods enhance the absorption of some drugs, which can lead to a possible overdose.
In general, diet will only interact with medications when a person is consuming exceptionally large portions of certain foods, pharmacology and medical experts say. A few teaspoons of olive oil on pasta typically doesn't pose any problems, for instance.
Still, as Americans increasingly select foods based on their health benefits, or take supplements with high doses of nutrients, the likelihood of adverse interactions with medications rises. U.S. sales of supplements, natural and organic foods and functional foods, or foods enhanced beyond normal use like calcium-fortified orange juice, grew to $93.5 billion in 2008 from $47.9 billion in 2000, according to Nutrition Business Journal, a nutrition-industry trade publication.
"For every drug there is, there are unintended side effects. You should expect the same thing when taking nutrients at drug levels," says Patrick Stover, director of the division of nutritional sciences at Cornell University in Ithaca, N.Y.
Other factors also can affect how medicines are absorbed in the body, including a person's age, weight and gender. Such variations, combined with possible interactions with the food we eat, can increase or reduce the effective dose of a medication by as much as 5- to 10-fold, which are "huge effects," Dr. Stover says.
Grapefruit is one of the most extensively studied foods for its impact on medication. Compounds in the fruit can increase the potency of statins and other medications to potentially dangerous levels by inhibiting cytochrome P450, a family of enzymes that break down the drug. Research indicates that drinking just one eight-ounce cup of grapefruit juice a day increases the strength of the drug.
Recently, animal and laboratory studies have suggested that other fruits, including pomegranates, oranges (especially those from Seville), cranberries, grapes and black mulberries, could have a similar, although less robust, effect on statins in the body. Pomegranates and cranberries are frequently touted as healthy foods because of their high quantities of antioxidants, which supposedly remove free radicals from the body and slow the onset of disease and aging.
In the lab, some scientists' work raises similar concern about olive oil and some statins. The oil, a principal part of the Mediterranean diet and believed to lower the risk of heart disease, also appears to contain compounds that inhibit the drug's breakdown, according to researchers in Spain. The effects of olive oil likely aren't as strong as that of grapefruit, but more studies are needed to figure out what quantities might actually impact humans, say experts.
John Thor Arnason, a biologist at the University of Ottawa, and his colleague Brian Foster of Health Canada, a government ministry, have investigated the effect on drugs of more than 450 food products, mainly in animal and laboratory studies.
The scientists continue to study potential food-drug interactions, as do other researchers world-wide.
In one recent study, Dr. Arnason's team examined dozens of different kinds of beers. They found that the "hoppier" or more bitter beers reduced the effect of the cancer drug Tamoxifen, when compared with beers that were less hopped. The study was published this year in the Journal of Agricultural and Food Chemistry.
Another popular compound, the anti-oxidant resveratrol found in red wine, nuts and dark chocolate, is touted for its anti-aging benefits. But resveratrol in large quantities appears to potentially enhance the potency of drugs, other laboratory studies show.
People, especially older adults taking multiple medications, should tell their doctor about dietary supplements, if they are using high-potency juices and teas and drinking lots of wine, Dr. Arnason says. He says that drugs whose labels contain lots of conditions and warnings about possible interactions with other medications are probably more likely also to interact with foods. If a food-drug interaction is suspected, patients should stop taking the food and talk to their doctor immediately.
In work published this year, Drs. Arnason and Foster showed that various herbs including chai hu, Labrador tea, echinacea and goldenseal, can reduce the potency of Tamiflu. The researchers incubated Tamiflu by itself or along with herbs, together with human liver tissue, which is responsible for processing the medication in the body. They found that the drug was less activated in the presence of the herbs.
The herbs are believed to proffer different health benefits. Labrador tea is thought to benefit the nervous system, Chai Hu to treat common cold and fever, and Echinacea is thought to prevent colds and have anti-tumor benefits. Goldenseal is an anti-microbial and anti-inflammatory product.
The researchers also have studied black tea, which is touted for lowering blood pressure, and found that it appears to inhibit an enzyme responsible for the body's processing of many drugs. The result, the researchers found, is that consuming large quantities of black tea could potentially increase the potency of a wide range of medications.
Others researchers have investigated spices. In one study, piperine, one of the main components of black pepper, increased the potency of the antihistamine Allegra in rats by two-fold compared with animals that took the medicine alone, according to a report in April's Journal of Food Sciences.
Much of the research on teas and other foodstuffs—with the exception of grapefruit—haven't been well-studied in humans, so the exact amount that may cause a harmful effect isn't yet known, say researchers.
Whether the alcohol from beer or wine affects the processing of other drugs isn't clear, says Cynthia Kuhn, a professor of pharmacology at Duke University Medical Center. It is dangerous to use alcohol in combination with sedating drugs like antihistamines, or narcotic pain medicines, because of the additive effect in the brain.
But despite strong warnings on some other drug labels that alcohol can interact in the liver to inhibit metabolism of other medications, the evidence "is not strong," says Dr. Kuhn. Alcohol is mainly metabolized by an enzyme called alcohol dehydrogenase, which "has nothing to do with the metabolism of most drugs," she says.
Some drugs, like dilantin, an epilepsy medication, appear to be affected by the amount of fat in the diet, according to a 2004 study.
Such medicines are dissolved only in fats and could therefore become less effective by a significant reduction in fat consumption.
Experts suggest that patients considering major dietary changes, such as switching to a much lower fat diet from a high-fat one, should discuss the move with their doctor.
Write to Shirley S. Wang at shirley.wang@wsj.com
Pharmacists often warn people not to mix anti-cholesterol drugs known as statins with grapefruit juice. Newer research suggests that other fruit juices, including cranberry and pomegranate, as well as olive oil may also interfere with how statins work in the body. Other laboratory studies show that certain popular teas can block the effect of some medications, including the flu drug Tamiflu. And switching to a low-fat diet, itself a healthy lifestyle change, could reduce the potency of some medications.
Diet can interact with medicine in two main ways. Some foods block the body's ability to absorb certain medications, effectively reducing the dose a person receives. Other foods enhance the absorption of some drugs, which can lead to a possible overdose.
In general, diet will only interact with medications when a person is consuming exceptionally large portions of certain foods, pharmacology and medical experts say. A few teaspoons of olive oil on pasta typically doesn't pose any problems, for instance.
Still, as Americans increasingly select foods based on their health benefits, or take supplements with high doses of nutrients, the likelihood of adverse interactions with medications rises. U.S. sales of supplements, natural and organic foods and functional foods, or foods enhanced beyond normal use like calcium-fortified orange juice, grew to $93.5 billion in 2008 from $47.9 billion in 2000, according to Nutrition Business Journal, a nutrition-industry trade publication.
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{/if}"For every drug there is, there are unintended side effects. You should expect the same thing when taking nutrients at drug levels," says Patrick Stover, director of the division of nutritional sciences at Cornell University in Ithaca, N.Y.
Other factors also can affect how medicines are absorbed in the body, including a person's age, weight and gender. Such variations, combined with possible interactions with the food we eat, can increase or reduce the effective dose of a medication by as much as 5- to 10-fold, which are "huge effects," Dr. Stover says.
Grapefruit is one of the most extensively studied foods for its impact on medication. Compounds in the fruit can increase the potency of statins and other medications to potentially dangerous levels by inhibiting cytochrome P450, a family of enzymes that break down the drug. Research indicates that drinking just one eight-ounce cup of grapefruit juice a day increases the strength of the drug.
Recently, animal and laboratory studies have suggested that other fruits, including pomegranates, oranges (especially those from Seville), cranberries, grapes and black mulberries, could have a similar, although less robust, effect on statins in the body. Pomegranates and cranberries are frequently touted as healthy foods because of their high quantities of antioxidants, which supposedly remove free radicals from the body and slow the onset of disease and aging.
In the lab, some scientists' work raises similar concern about olive oil and some statins. The oil, a principal part of the Mediterranean diet and believed to lower the risk of heart disease, also appears to contain compounds that inhibit the drug's breakdown, according to researchers in Spain. The effects of olive oil likely aren't as strong as that of grapefruit, but more studies are needed to figure out what quantities might actually impact humans, say experts.
John Thor Arnason, a biologist at the University of Ottawa, and his colleague Brian Foster of Health Canada, a government ministry, have investigated the effect on drugs of more than 450 food products, mainly in animal and laboratory studies.
The scientists continue to study potential food-drug interactions, as do other researchers world-wide.
In one recent study, Dr. Arnason's team examined dozens of different kinds of beers. They found that the "hoppier" or more bitter beers reduced the effect of the cancer drug Tamoxifen, when compared with beers that were less hopped. The study was published this year in the Journal of Agricultural and Food Chemistry.
Another popular compound, the anti-oxidant resveratrol found in red wine, nuts and dark chocolate, is touted for its anti-aging benefits. But resveratrol in large quantities appears to potentially enhance the potency of drugs, other laboratory studies show.
People, especially older adults taking multiple medications, should tell their doctor about dietary supplements, if they are using high-potency juices and teas and drinking lots of wine, Dr. Arnason says. He says that drugs whose labels contain lots of conditions and warnings about possible interactions with other medications are probably more likely also to interact with foods. If a food-drug interaction is suspected, patients should stop taking the food and talk to their doctor immediately.
In work published this year, Drs. Arnason and Foster showed that various herbs including chai hu, Labrador tea, echinacea and goldenseal, can reduce the potency of Tamiflu. The researchers incubated Tamiflu by itself or along with herbs, together with human liver tissue, which is responsible for processing the medication in the body. They found that the drug was less activated in the presence of the herbs.
The herbs are believed to proffer different health benefits. Labrador tea is thought to benefit the nervous system, Chai Hu to treat common cold and fever, and Echinacea is thought to prevent colds and have anti-tumor benefits. Goldenseal is an anti-microbial and anti-inflammatory product.
The researchers also have studied black tea, which is touted for lowering blood pressure, and found that it appears to inhibit an enzyme responsible for the body's processing of many drugs. The result, the researchers found, is that consuming large quantities of black tea could potentially increase the potency of a wide range of medications.
Others researchers have investigated spices. In one study, piperine, one of the main components of black pepper, increased the potency of the antihistamine Allegra in rats by two-fold compared with animals that took the medicine alone, according to a report in April's Journal of Food Sciences.
Much of the research on teas and other foodstuffs—with the exception of grapefruit—haven't been well-studied in humans, so the exact amount that may cause a harmful effect isn't yet known, say researchers.
Whether the alcohol from beer or wine affects the processing of other drugs isn't clear, says Cynthia Kuhn, a professor of pharmacology at Duke University Medical Center. It is dangerous to use alcohol in combination with sedating drugs like antihistamines, or narcotic pain medicines, because of the additive effect in the brain.
But despite strong warnings on some other drug labels that alcohol can interact in the liver to inhibit metabolism of other medications, the evidence "is not strong," says Dr. Kuhn. Alcohol is mainly metabolized by an enzyme called alcohol dehydrogenase, which "has nothing to do with the metabolism of most drugs," she says.
Some drugs, like dilantin, an epilepsy medication, appear to be affected by the amount of fat in the diet, according to a 2004 study.
Such medicines are dissolved only in fats and could therefore become less effective by a significant reduction in fat consumption.
Experts suggest that patients considering major dietary changes, such as switching to a much lower fat diet from a high-fat one, should discuss the move with their doctor.
Write to Shirley S. Wang at shirley.wang@wsj.com
Tuesday, June 22, 2010
Breast-Feeding Until 4 Months May Protect Infants From Respiratory, GI Infections
From Medscape Medical News
Laurie Barclay, MD
Authors and Disclosures
Physician Rating: 4 stars ( 5 Votes )
Rate This Article:
June 21, 2010 — Breast-feeding until age 4 months is linked to lower rates of respiratory and gastrointestinal (GI) infection morbidity, according to the results of a population-based, prospective, cohort study reported online June 21 in Pediatrics.
"Exclusive breastfeeding seems to decrease the risk of infectious diseases in infancy," Liesbeth Duijts, MD, PhD, from Erasmus Medical Center in Rotterdam, the Netherlands. "However, the World Health Organization has called for more research regarding the benefits for 6 months instead of 4 months of exclusive breastfeeding."
The goal of this study, which was embedded in the Generation R Study, a study from fetal life onward in the Netherlands, was to evaluate the associations of duration of exclusive breast-feeding with upper respiratory tract infections (URTI), lower respiratory tract infections (LRTI), and GI tract infections in infancy.
There were 4164 subjects who completed questionnaires on rates of breast-feeding during the first 6 months (never; partial for < 4 months, not thereafter; partial for 4 - 6 months; exclusive for 4 months, not thereafter; exclusive for 4 months, partial thereafter; and exclusive for 6 months) and doctor-attended URTI, LRTI, and GI infections until age 12 months.
Risks for URTI, LRTI, and GI tract infection until age 6 months were lower in infants who were breast-fed exclusively until age 4 months and partially thereafter vs infants who were never breast-fed. Adjusted odds ratios (ORs) were 0.65 (95% confidence interval [CI], 0.51 - 0.83) for URTI, 0.50 (95% CI, 0.32 - 0.79) for LRTI, and 0.41 (95% CI, 0.26 -0.64) for GI tract infection. The adjusted OR for LRTIs in infants between the ages of 7 and 12 months was 0.46 (95% CI, 0.31 - 0.69).
For infants who were exclusively breast-fed for at least 6 months, trends were similar. However, partial breast-feeding, even for 6 months, was not associated with significantly lower risks for these infections.
"Exclusive breastfeeding until the age of 4 months and partially thereafter was associated with a significant reduction of respiratory and gastrointestinal morbidity in infants," the study authors write. "Our findings support health policy strategies to promote exclusive breastfeeding for at least 4 months, but preferably 6 months, in industrialized countries."
Limitations of this study include questionnaires with breast-feeding data available for only 65% of eligible participants of the Generation R Study and possible misclassification related to questionnaire use.
"Biological, cultural, and social constraints related to breastfeeding habits need to be studied more extensively," the study authors write. "The effects of prolonged and exclusive breastfeeding on infectious diseases at older ages in industrialized countries remain to be studied."
Exclusive breast-feeding until age 4 months and partially thereafter was associated with a significant reduction of respiratory and GI morbidity rates in infants.
The first phase of the Generation R Study was funded by Erasmus Medical Center, Erasmus University Rotterdam, and Netherlands Organization for Health Research and Development (Zon Mw). The present study was supported by an additional grant from Stichting W. H. Kröger (00–048) and AGS Kinderstichting. The study authors have disclosed no relevant financial relationships.
Pediatrics. Published online June 21, 2010
Laurie Barclay, MD
Authors and Disclosures
Physician Rating: 4 stars ( 5 Votes )
Rate This Article:
June 21, 2010 — Breast-feeding until age 4 months is linked to lower rates of respiratory and gastrointestinal (GI) infection morbidity, according to the results of a population-based, prospective, cohort study reported online June 21 in Pediatrics.
"Exclusive breastfeeding seems to decrease the risk of infectious diseases in infancy," Liesbeth Duijts, MD, PhD, from Erasmus Medical Center in Rotterdam, the Netherlands. "However, the World Health Organization has called for more research regarding the benefits for 6 months instead of 4 months of exclusive breastfeeding."
The goal of this study, which was embedded in the Generation R Study, a study from fetal life onward in the Netherlands, was to evaluate the associations of duration of exclusive breast-feeding with upper respiratory tract infections (URTI), lower respiratory tract infections (LRTI), and GI tract infections in infancy.
There were 4164 subjects who completed questionnaires on rates of breast-feeding during the first 6 months (never; partial for < 4 months, not thereafter; partial for 4 - 6 months; exclusive for 4 months, not thereafter; exclusive for 4 months, partial thereafter; and exclusive for 6 months) and doctor-attended URTI, LRTI, and GI infections until age 12 months.
Risks for URTI, LRTI, and GI tract infection until age 6 months were lower in infants who were breast-fed exclusively until age 4 months and partially thereafter vs infants who were never breast-fed. Adjusted odds ratios (ORs) were 0.65 (95% confidence interval [CI], 0.51 - 0.83) for URTI, 0.50 (95% CI, 0.32 - 0.79) for LRTI, and 0.41 (95% CI, 0.26 -0.64) for GI tract infection. The adjusted OR for LRTIs in infants between the ages of 7 and 12 months was 0.46 (95% CI, 0.31 - 0.69).
For infants who were exclusively breast-fed for at least 6 months, trends were similar. However, partial breast-feeding, even for 6 months, was not associated with significantly lower risks for these infections.
"Exclusive breastfeeding until the age of 4 months and partially thereafter was associated with a significant reduction of respiratory and gastrointestinal morbidity in infants," the study authors write. "Our findings support health policy strategies to promote exclusive breastfeeding for at least 4 months, but preferably 6 months, in industrialized countries."
Limitations of this study include questionnaires with breast-feeding data available for only 65% of eligible participants of the Generation R Study and possible misclassification related to questionnaire use.
"Biological, cultural, and social constraints related to breastfeeding habits need to be studied more extensively," the study authors write. "The effects of prolonged and exclusive breastfeeding on infectious diseases at older ages in industrialized countries remain to be studied."
Exclusive breast-feeding until age 4 months and partially thereafter was associated with a significant reduction of respiratory and GI morbidity rates in infants.
The first phase of the Generation R Study was funded by Erasmus Medical Center, Erasmus University Rotterdam, and Netherlands Organization for Health Research and Development (Zon Mw). The present study was supported by an additional grant from Stichting W. H. Kröger (00–048) and AGS Kinderstichting. The study authors have disclosed no relevant financial relationships.
Pediatrics. Published online June 21, 2010
Study points to unsafe sleep practices as contributor to disparity in infant sleep-related deaths
April 15, 2010 - A study conducted by Children's Memorial Research Center reveals that African American infants are far more likely to die from sleep-related causes than any other ethnic group in Illinois. This statistic is most dramatic in Cook County where infants are 12 times more likely to die from sleep-related causes. The difference between the sleep-related death rate for African Americans and other ethnic groups is smaller in Illinois outside of Cook County, though African American infants are still twice as likely to die from sleep-related causes.
Researchers at Child Health Data Lab which is part of the Mary Ann & J. Milburn Smith Child Health Research Program collected information on infant deaths in Illinois due to sudden infant death syndrome, unintentional suffocation in bed and undetermined causes. Although the actual cause of death cannot be pinpointed in many of these cases, research shows that most of these deaths occur when an infant is in an unsafe sleep situation.
“African American infant mortality is much higher than Caucasian infant mortality across the United States,” says Jenifer Cartland, PhD, director of the research center’s Child Health Data Lab. “In Cook County, sleep-related death is responsible for 20 percent of the African American infant mortality, but it might be prevented by assuring that all infants have a safe place to sleep and that parents are well educated about safe sleep practices.”
Karen Sheehan, MD, MPH, Emergency Medicine, at Children’s Memorial says, “The American Academy of Pediatrics recommends that children should be put to sleep on their backs, in a safety-approved crib (or bassinet for younger children) with a firm mattress, and free from any objects (even blankets or toys) that could cover the baby’s face.”
Parents don’t always have all the knowledge or all the resources they need to put their infant to bed safely. Based on the research, 56.7 percent of the deaths occurred while the infant was sharing a bed with an adult and 30 percent occurred when the baby was sleeping alone, but not in a crib or bassinet (such as on a couch or a pillow on the floor). Few of these infants — only 7.5 percent – were found in safe sleep circumstances, that is, in a crib or bassinet with the baby on his or her back.
The alarming difference among ethnic groups raises the question of what should be done. “Many organizations are now coming together to increase safe sleep awareness,” says Cartland. “We need to get babies alone in their cribs and secure more funding for intervention programs, such as making sure all parents have access to safety-approved, low cost cribs and bassinets and increasing parents’ knowledge about safe sleep.”
Children's Memorial’s Child Health Data Lab performs epidemiological research to identify risks to the health of children and adolescents with the goal to improve health and well-being of children and adolescents in Chicago and Illinois. For more information about the research or to learn about sleep related infant death prevention visit American Academy of Pediatrics, SIDS Illinois, or Children's Memorial Hospital’s Child Health Data Lab.
The Understanding Sleep Related Death study is based off the Illinois Death Reporting System, and was conducted by Children’s Memorial Hospital Child Health Data Lab by Jenifer Cartland, PhD in collaboration with data-providing agencies including Cook County Medical Examiner, the Kane and Peoria County Coroners, the Illinois Department of Public Health and the Chicago Policy Department.
Researchers at Child Health Data Lab which is part of the Mary Ann & J. Milburn Smith Child Health Research Program collected information on infant deaths in Illinois due to sudden infant death syndrome, unintentional suffocation in bed and undetermined causes. Although the actual cause of death cannot be pinpointed in many of these cases, research shows that most of these deaths occur when an infant is in an unsafe sleep situation.
“African American infant mortality is much higher than Caucasian infant mortality across the United States,” says Jenifer Cartland, PhD, director of the research center’s Child Health Data Lab. “In Cook County, sleep-related death is responsible for 20 percent of the African American infant mortality, but it might be prevented by assuring that all infants have a safe place to sleep and that parents are well educated about safe sleep practices.”
Karen Sheehan, MD, MPH, Emergency Medicine, at Children’s Memorial says, “The American Academy of Pediatrics recommends that children should be put to sleep on their backs, in a safety-approved crib (or bassinet for younger children) with a firm mattress, and free from any objects (even blankets or toys) that could cover the baby’s face.”
Parents don’t always have all the knowledge or all the resources they need to put their infant to bed safely. Based on the research, 56.7 percent of the deaths occurred while the infant was sharing a bed with an adult and 30 percent occurred when the baby was sleeping alone, but not in a crib or bassinet (such as on a couch or a pillow on the floor). Few of these infants — only 7.5 percent – were found in safe sleep circumstances, that is, in a crib or bassinet with the baby on his or her back.
The alarming difference among ethnic groups raises the question of what should be done. “Many organizations are now coming together to increase safe sleep awareness,” says Cartland. “We need to get babies alone in their cribs and secure more funding for intervention programs, such as making sure all parents have access to safety-approved, low cost cribs and bassinets and increasing parents’ knowledge about safe sleep.”
Children's Memorial’s Child Health Data Lab performs epidemiological research to identify risks to the health of children and adolescents with the goal to improve health and well-being of children and adolescents in Chicago and Illinois. For more information about the research or to learn about sleep related infant death prevention visit American Academy of Pediatrics, SIDS Illinois, or Children's Memorial Hospital’s Child Health Data Lab.
The Understanding Sleep Related Death study is based off the Illinois Death Reporting System, and was conducted by Children’s Memorial Hospital Child Health Data Lab by Jenifer Cartland, PhD in collaboration with data-providing agencies including Cook County Medical Examiner, the Kane and Peoria County Coroners, the Illinois Department of Public Health and the Chicago Policy Department.
Tuesday, June 15, 2010
Substituting Whole Grains for White Rice May Lower Risk for Type 2 Diabetes
Laurie Barclay, MD
June 14, 2010 — Substituting brown rice or other whole grains for white rice is associated with a lower risk for type 2 diabetes, according to results from the Health Professionals Follow-up Study and the Nurses' Health Study (NHS) I and II reported in the June 14 issue of Archives of Internal Medicine.
"Because of differences in processing and nutrients, brown rice and white rice may have different effects on risk of type 2 diabetes mellitus," write Qi Sun, MD, ScD, from the Harvard School of Public Health in Boston, Massachusetts, and colleagues. "We examined white and brown rice consumption in relation to type 2 diabetes risk prospectively in the Health Professionals Follow-up Study and the Nurses' Health Study I and II."
Diet, lifestyle habits, and disease status were prospectively determined and updated for 39,765 men and 157,463 women in these cohorts.
Higher intake of white rice (≥ 5 servings per week vs < 1 per month) was associated with a greater risk for type 2 diabetes, after multivariate adjustment for age, lifestyle, and other dietary risk factors. Pooled relative risk [RR] was 1.17 (95% confidence interval [CI], 1.02 - 1.36). In contrast, the risk for type 2 diabetes was lower with high intake of brown rice (≥ 2 servings per week vs < 1 per month; pooled RR, 0.89; 95% CI, 0.81 - 0.97).
The investigators estimated that replacing 50 g per day of uncooked white rice (one-third serving per day) with the equivalent amount of brown rice was associated with a 16% lower risk for type 2 diabetes (95% CI, 9% - 21%). For replacement with whole grains as a group, diabetes risk was 36% lower (95% CI, 30% - 42%).
"Substitution of whole grains, including brown rice, for white rice may lower risk of type 2 diabetes," the study authors write. "These data support the recommendation that most carbohydrate intake should come from whole grains rather than refined grains to help prevent type 2 diabetes."
Limitations of this study include study populations primarily consisting of working health professionals with European ancestry, measurement error of rice intake assessment related to use of food frequency questionnaires, possible residual confounding, and lack of oral glucose tolerance test data to confirm diabetes diagnoses.
"The current Dietary Guidelines for Americans identifies grains, including rice, as one of the primary sources for carbohydrate intake and recommends that at least half of carbohydrate intake come from whole grains," the study authors conclude. "From a public health point of view, replacing refined grains such as white rice by whole grains, including brown rice, should be recommended to facilitate the prevention of T2D [type 2 diabetes]."
The National Institutes of Health supported this study. Dr. Sun is supported by a postdoctoral fellowship from Unilever Corporate Research.
Arch Intern Med. 2010;170:961-969.
June 14, 2010 — Substituting brown rice or other whole grains for white rice is associated with a lower risk for type 2 diabetes, according to results from the Health Professionals Follow-up Study and the Nurses' Health Study (NHS) I and II reported in the June 14 issue of Archives of Internal Medicine.
"Because of differences in processing and nutrients, brown rice and white rice may have different effects on risk of type 2 diabetes mellitus," write Qi Sun, MD, ScD, from the Harvard School of Public Health in Boston, Massachusetts, and colleagues. "We examined white and brown rice consumption in relation to type 2 diabetes risk prospectively in the Health Professionals Follow-up Study and the Nurses' Health Study I and II."
Diet, lifestyle habits, and disease status were prospectively determined and updated for 39,765 men and 157,463 women in these cohorts.
Higher intake of white rice (≥ 5 servings per week vs < 1 per month) was associated with a greater risk for type 2 diabetes, after multivariate adjustment for age, lifestyle, and other dietary risk factors. Pooled relative risk [RR] was 1.17 (95% confidence interval [CI], 1.02 - 1.36). In contrast, the risk for type 2 diabetes was lower with high intake of brown rice (≥ 2 servings per week vs < 1 per month; pooled RR, 0.89; 95% CI, 0.81 - 0.97).
The investigators estimated that replacing 50 g per day of uncooked white rice (one-third serving per day) with the equivalent amount of brown rice was associated with a 16% lower risk for type 2 diabetes (95% CI, 9% - 21%). For replacement with whole grains as a group, diabetes risk was 36% lower (95% CI, 30% - 42%).
"Substitution of whole grains, including brown rice, for white rice may lower risk of type 2 diabetes," the study authors write. "These data support the recommendation that most carbohydrate intake should come from whole grains rather than refined grains to help prevent type 2 diabetes."
Limitations of this study include study populations primarily consisting of working health professionals with European ancestry, measurement error of rice intake assessment related to use of food frequency questionnaires, possible residual confounding, and lack of oral glucose tolerance test data to confirm diabetes diagnoses.
"The current Dietary Guidelines for Americans identifies grains, including rice, as one of the primary sources for carbohydrate intake and recommends that at least half of carbohydrate intake come from whole grains," the study authors conclude. "From a public health point of view, replacing refined grains such as white rice by whole grains, including brown rice, should be recommended to facilitate the prevention of T2D [type 2 diabetes]."
The National Institutes of Health supported this study. Dr. Sun is supported by a postdoctoral fellowship from Unilever Corporate Research.
Arch Intern Med. 2010;170:961-969.
New Ads Try to Shock Men Into Going to See the Doctor
Public Health Push Strikes Darkly Humorous Tone to Attack Problem: Men Avoid Care That Could Prevent Future Ills
By LAURA LANDRO
When it comes to their health, men are the weaker sex: They don't get checkups as often as women, are hospitalized more often with preventable illnesses, and they die younger.
Now, just in time for Father's Day, public-health officials are trying to change that. A darkly humorous ad campaign being launched this week aims to tackle the serious issue of an aging generation of men in denial of their health risks.
Laura Landro discusses why some men avoid going to the doctor, and why public health officials have launched a new, darkly funny ad campaign that aims to convince those men to see a physician.
In one TV spot, a family is gathered in their new house with the real-estate broker, who predicts they will have many happy years there. "Except for you," she says to the dad, "because you'll be gone three years from now...struck down by the same disease that got your father."
In a parting shot the broker adds: "Sadly, it could have been detected early with a simple test....but you didn't have it."
About 57% of men have visited the doctor within the past year, compared with about 74% of women, according to surveys by the federal Agency for Healthcare Research and Quality (AHRQ). Black and Hispanic men are even less likely than white men to have routine checkups. At the same time, men are hospitalized at significantly higher rates than women for preventable conditions such as congestive heart failure and complications of diabetes and pneumonia that can be prevented with a vaccination.
While there is no scientific evidence as to why men avoid doctors, many physicians attribute it to a macho culture which equates doctor visits with weakness, reluctance to undergo tests such as rectal and prostate exams and fear of finding out that something might be wrong.
The Department of Health and Human Services is launching a new public service ad campaign aimed at convincing men to get more preventive checkups.
"Most men who are young think they are immortal, and unless they've gone to war they never feel their lives are at risk," says heart surgeon Mehmet Oz, whose medical TV show and website, doctoroz.com, will promote the campaign and link to the ads. In addition to targeting men, he says, the aim is to persuade families to nudge them into getting checkups.
Women tend to be more engaged in their health care from puberty as they visit gynecologists and, later, obstetricians for childbearing. But even excluding reproductive needs, women are more likely to seek care than men, says Carolyn Clancy, director of the AHRQ, which worked with the Ad Council on the public-service campaign. The gender differences are obvious early, she says: In one study of 8- and 9-year-old campers with headaches, girls were more likely than boys to see the camp nurse.
A list of recommended preventive screenings for men will be available this week at AHRQ.gov/healthymen, or by calling 1-800-358-9295. All men should have their body-mass index assessed to screen for obesity; starting at 35, they should have their cholesterol checked regularly, and a blood-pressure check is recommended every two years. Men with high blood pressure or high cholesterol should also be screened for diabetes. Men aged 65 to 75 need a test for an abdominal aortic aneurysm if they have ever smoked. At 50, they should get a colorectal-cancer screening test, unless there is a family history of the disease, in which case patients may need to be screened earlier.
[MANHEALTH]
Men are also urged to talk to their doctor about being screened for depression if they have felt "down, hopeless or sad" over a two-week period or have felt "little pleasure or interest in doing things." And depending on their sexual habits—-a list of risk factors is available on the website—-men should be screened for sexually transmitted diseases including HIV.
The screening recommendations were developed by the U.S. Preventive Services Task Force, which uses scientific evidence of their effectiveness to determine whether to recommend a test for routine use. Medicare and private insurers may cover other tests, such as prostate-cancer screening; AHRQ advises men to talk to their doctors about diseases for which tests aren't routinely recommended including prostate and skin cancers.
Striking a long-term relationship with a primary care doctor can help ease men out of their fear and avoidance, and make it easier to spot changes and diagnose problems, says Sharon Orrange, an internist and assistant professor at University of Southern California in Los Angeles.
One of her patients, Kevin Ash, now 53, began getting regular checkups after he was 40; Dr. Orrange picked up on some symptoms over time, and diagnosed him with pernicious anemia, an inability to absorb vitamin B-12 which results in a decrease in red blood cells and can cause damage to nerves and organs. The deficiency can be treated with injections of the vitamin.
[manHealth2] Agency for Healthcare Research and Quality / Ad Council
A new ad campaign takes aim at men who avoid checkups and urges their families to push them to act.
"Guys are more afraid of finding something is wrong, so it's easier not to go to the doctor," says Mr. Ash, who says he was initially worried about getting a blood test because it might have shown cancer. "One of the best feelings is to have a doctor who knows you, and who you are not afraid to say anything to, and vice versa."
As men age they are also at higher risk for a number of other issues such as osteoporosis, says John Morley, an endocrinologist and geriatrics specialist at Saint Louis University School of Medicine in Missouri. Dr. Morley, who recommends that by 70, all men should have their bone-mineral density measured. (The U.S. task force recommends osteoporosis screenings only for women over 65.)
He says men who experience erectile dysfunction should also be screened for its most common cause, vascular disease, which if left untreated, can put men at high risk for heart attack or stroke.
By LAURA LANDRO
When it comes to their health, men are the weaker sex: They don't get checkups as often as women, are hospitalized more often with preventable illnesses, and they die younger.
Now, just in time for Father's Day, public-health officials are trying to change that. A darkly humorous ad campaign being launched this week aims to tackle the serious issue of an aging generation of men in denial of their health risks.
Laura Landro discusses why some men avoid going to the doctor, and why public health officials have launched a new, darkly funny ad campaign that aims to convince those men to see a physician.
In one TV spot, a family is gathered in their new house with the real-estate broker, who predicts they will have many happy years there. "Except for you," she says to the dad, "because you'll be gone three years from now...struck down by the same disease that got your father."
In a parting shot the broker adds: "Sadly, it could have been detected early with a simple test....but you didn't have it."
About 57% of men have visited the doctor within the past year, compared with about 74% of women, according to surveys by the federal Agency for Healthcare Research and Quality (AHRQ). Black and Hispanic men are even less likely than white men to have routine checkups. At the same time, men are hospitalized at significantly higher rates than women for preventable conditions such as congestive heart failure and complications of diabetes and pneumonia that can be prevented with a vaccination.
While there is no scientific evidence as to why men avoid doctors, many physicians attribute it to a macho culture which equates doctor visits with weakness, reluctance to undergo tests such as rectal and prostate exams and fear of finding out that something might be wrong.
The Department of Health and Human Services is launching a new public service ad campaign aimed at convincing men to get more preventive checkups.
"Most men who are young think they are immortal, and unless they've gone to war they never feel their lives are at risk," says heart surgeon Mehmet Oz, whose medical TV show and website, doctoroz.com, will promote the campaign and link to the ads. In addition to targeting men, he says, the aim is to persuade families to nudge them into getting checkups.
Women tend to be more engaged in their health care from puberty as they visit gynecologists and, later, obstetricians for childbearing. But even excluding reproductive needs, women are more likely to seek care than men, says Carolyn Clancy, director of the AHRQ, which worked with the Ad Council on the public-service campaign. The gender differences are obvious early, she says: In one study of 8- and 9-year-old campers with headaches, girls were more likely than boys to see the camp nurse.
A list of recommended preventive screenings for men will be available this week at AHRQ.gov/healthymen, or by calling 1-800-358-9295. All men should have their body-mass index assessed to screen for obesity; starting at 35, they should have their cholesterol checked regularly, and a blood-pressure check is recommended every two years. Men with high blood pressure or high cholesterol should also be screened for diabetes. Men aged 65 to 75 need a test for an abdominal aortic aneurysm if they have ever smoked. At 50, they should get a colorectal-cancer screening test, unless there is a family history of the disease, in which case patients may need to be screened earlier.
[MANHEALTH]
Men are also urged to talk to their doctor about being screened for depression if they have felt "down, hopeless or sad" over a two-week period or have felt "little pleasure or interest in doing things." And depending on their sexual habits—-a list of risk factors is available on the website—-men should be screened for sexually transmitted diseases including HIV.
The screening recommendations were developed by the U.S. Preventive Services Task Force, which uses scientific evidence of their effectiveness to determine whether to recommend a test for routine use. Medicare and private insurers may cover other tests, such as prostate-cancer screening; AHRQ advises men to talk to their doctors about diseases for which tests aren't routinely recommended including prostate and skin cancers.
Striking a long-term relationship with a primary care doctor can help ease men out of their fear and avoidance, and make it easier to spot changes and diagnose problems, says Sharon Orrange, an internist and assistant professor at University of Southern California in Los Angeles.
One of her patients, Kevin Ash, now 53, began getting regular checkups after he was 40; Dr. Orrange picked up on some symptoms over time, and diagnosed him with pernicious anemia, an inability to absorb vitamin B-12 which results in a decrease in red blood cells and can cause damage to nerves and organs. The deficiency can be treated with injections of the vitamin.
[manHealth2] Agency for Healthcare Research and Quality / Ad Council
A new ad campaign takes aim at men who avoid checkups and urges their families to push them to act.
"Guys are more afraid of finding something is wrong, so it's easier not to go to the doctor," says Mr. Ash, who says he was initially worried about getting a blood test because it might have shown cancer. "One of the best feelings is to have a doctor who knows you, and who you are not afraid to say anything to, and vice versa."
As men age they are also at higher risk for a number of other issues such as osteoporosis, says John Morley, an endocrinologist and geriatrics specialist at Saint Louis University School of Medicine in Missouri. Dr. Morley, who recommends that by 70, all men should have their bone-mineral density measured. (The U.S. task force recommends osteoporosis screenings only for women over 65.)
He says men who experience erectile dysfunction should also be screened for its most common cause, vascular disease, which if left untreated, can put men at high risk for heart attack or stroke.
Friday, June 11, 2010
Why Do People Get More Skin Cancer on Their Left Side?
by: Susan Kreimer | from: AARP Bulletin | June 1, 2010
A new study confirms what many dermatologists have suspected all along: Sun exposure while driving may account for more skin cancer on the left side than on the right.
Sunscreen, then, isn’t just for sun worshipers, gardeners and other outdoor types. It’s important even when driving.
The ultraviolet radiation that passes through window glass, sunroofs or convertible tops may contribute to melanoma and other skin cancers.
In this study—appearing in the Journal of the American Academy of Dermatology—left-sided skin cancer was more common in men.
Senior researcher Scott Fosko, M.D., head of dermatology at Saint Louis University, says the damage builds up over time. “You can see many effects with chronic exposure.”
Researchers reviewed the charts of skin cancer patients at the university in 2004. Of 890 patients with skin cancer, 52.6 percent had skin cancer on the left side of the face or body. They found there were significantly more skin cancers on the left side of the body in men—especially on exposed areas of the head and neck.
The researchers speculated that perhaps older generations of women—the average age of those in the study was 68—tended to be passengers sitting on the right side and men tended to drive more.
What about people in countries who drive on the left side of the road? An older Australian study found that precancerous sun spots were more common on the right side of the faces of Australian men, who typically drove, and the left side of the faces of Australian women, who were usually passengers. The study backs up the theory that exposure while driving explains the difference.
Alan Lewis, M.D., director of dermatology surgery at Tulane University in New Orleans, says the latest study was a good one. “When you’re going outdoors for any reason, you should definitely think about applying a sunscreen with an SPF 30 or higher,” he says. Check the label to make sure it blocks both UVA and UVB rays.
Even while indoors near a window, wearing sunscreen is a good idea, says Sarah Tuttleton Arron, M.D., director of the skin cancer unit at the University of California at San Francisco.
“A little bit of UV exposure is like a little bit of smoking, so I recommend sun protection all the time,” she says, adding that tinted car windows with UV-protection can also contribute to your safety.
A new study confirms what many dermatologists have suspected all along: Sun exposure while driving may account for more skin cancer on the left side than on the right.
Sunscreen, then, isn’t just for sun worshipers, gardeners and other outdoor types. It’s important even when driving.
The ultraviolet radiation that passes through window glass, sunroofs or convertible tops may contribute to melanoma and other skin cancers.
In this study—appearing in the Journal of the American Academy of Dermatology—left-sided skin cancer was more common in men.
Senior researcher Scott Fosko, M.D., head of dermatology at Saint Louis University, says the damage builds up over time. “You can see many effects with chronic exposure.”
Researchers reviewed the charts of skin cancer patients at the university in 2004. Of 890 patients with skin cancer, 52.6 percent had skin cancer on the left side of the face or body. They found there were significantly more skin cancers on the left side of the body in men—especially on exposed areas of the head and neck.
The researchers speculated that perhaps older generations of women—the average age of those in the study was 68—tended to be passengers sitting on the right side and men tended to drive more.
What about people in countries who drive on the left side of the road? An older Australian study found that precancerous sun spots were more common on the right side of the faces of Australian men, who typically drove, and the left side of the faces of Australian women, who were usually passengers. The study backs up the theory that exposure while driving explains the difference.
Alan Lewis, M.D., director of dermatology surgery at Tulane University in New Orleans, says the latest study was a good one. “When you’re going outdoors for any reason, you should definitely think about applying a sunscreen with an SPF 30 or higher,” he says. Check the label to make sure it blocks both UVA and UVB rays.
Even while indoors near a window, wearing sunscreen is a good idea, says Sarah Tuttleton Arron, M.D., director of the skin cancer unit at the University of California at San Francisco.
“A little bit of UV exposure is like a little bit of smoking, so I recommend sun protection all the time,” she says, adding that tinted car windows with UV-protection can also contribute to your safety.
Hospital Room Modifications May Result in Better Care
By SUZANNE SATALINE
A nurse's assistant stocks a two-way cabinet designed to reduce traffic in patient rooms.
PRINCETON, N.J.—The room's soft white lighting illuminates a wall of etched glass and blond wood. There's hand-laid tile in the shower and the couch unfolds, letting family members stay. Even the shape of this hospital room is quirky, with walls that hide wires and tubing and slant so the occupant will better see the leafy treetops through large windows.
It's peaceful, perhaps practical, and it could be the hospital patient room of the future.
The staff at the University Medical Center at Princeton will soon assign one patient at a time to this newly built room, designed partly with staff input, housed on a post-surgical floor. Designed using research funded with a $2.8 million grant from the Robert Wood Johnson Foundation, the room has ushered Princeton into the growing field of health-care design.
Architects and health-care centers are seeking to prove that a room's layout and accessories can help patients heal faster and cut down on mishaps and staff error, as some research has shown.
"Once we put patients in here, we'll see if everything is right," says Susan G. Lorenz, Princeton's chief nursing officer, who helped design the room.
More hospitals have started to rethink how patient rooms can improve the occupant's health. They're seeking to reduce the spread of infections, the rise in patient falls, and the healing benefits of outdoor views. Patient falls are common in hospitals, and 10% of fatal falls by older adults happen there, according to data compiled by the Institute for Healthcare Improvement. Single rooms are becoming standard, Ms. Lorenz said, because research shows that the privacy reduces infection rates and enhances communication between staff and patients.
Hospital officials say they'll know if features in the model room have improved care in roughly 18 months, when researchers compare data with what they collect from the existing rooms, the control group.
If the design elements work, the single-bed room will be copied for all the rooms in the center's new 237-bed replacement hospital, a $447 million construction project rising nearby in Plainsboro, said Barry Rabner, president and CEO of Princeton HealthCare System, the hospital's parent.
Staff at Princeton, a nonprofit that's separate from the university of that name, hopes to find that patients fall less often because the toilet is near the head of the bed, making the path to the bathroom shorter than in a typical room, says Ms. Lorenz, who earned a Ph.D. in hospital design. A specially designed grab rail on the wall shine a light where patients will be stepping.
She'll also be measuring if having a separate sink near the door prompts more staff members to wash their hands, a major source of spreading hospital infections.
The room's bed can sink low to the ground, also to reduce falls, and weigh a patient without getting them to rise and step aboard a scale, she said.
But the room is a work in progress: The paper-towel holder is terrible, she decreed, with paper coming out by the dozens, and the staff has said the sink in the new room must be changed because the raised bowl will be a slippery and dangerous grabbing spot for elderly patients.
The room has two-way cabinets, allowing housekeeping staff to resupply the linen and medicines from the hallway, and letting clinical staff grab them from inside the patient's room. That may help reduce traffic in patient rooms and therefore, infection rates. But Lopa Patel, a floor nurse, said that staff must still walk in and out, fetching antibiotics and narcotics from elsewhere.
Princeton has joined about 50 hospitals world-wide as health-care design labs, a project of the Center for Health Design in Concord, Calif., that is researching how design has helped patients and staff, says Rosalyn Cama, a health-care designer and member of the center's board of directors. Ms. Cama is a consultant for Princeton's project.
Many hospitals have developed mock patient rooms, usually outside the hospital, to study a room's features. By building the real thing on a patient floor, Princeton has given researchers an ideal way to test if design ideas work, said Kirk Hamilton, an associate architecture professor at Texas A&M University.
"Over the last decade there's been a resurgence in the recognition that patient towers had aged and not kept up," said Mr. Hamilton, editor of Health Environment Research and Design Journal, which is interested in publishing the results of Princeton's findings. "Princeton is one of those that has made a commitment to do measurement."
Some patients will be assigned to the room at random, hospital officials said, other times, staff will admit patients with certain characteristics, such as people 65 years and older who have a condition that would put them at risk of falling. These patients would be matched to similar patients in traditional rooms, to observe how the model room performs in comparison.
Patients will have to give their consent before participating in any part of the research. Patients in the model room will be billed at the same rate as in a traditional room.
The new room draws the attention of patients and visitors. Renee Shields wandered in last week, on a break from caring for her 87-year-old mother, a former nurse at the hospital and now a patient after a fall. Ms. Shields lay on the bed, enthused about the large tiled shower and fold-out couch, and liked that the digital clock beamed the day of the week.
"It's hotel-like" she said. "I wonder if health-care costs are going to go up. Everybody will want to come to Princeton."
Write to Suzanne Sataline at Suzanne.Sataline@wsj.com
A nurse's assistant stocks a two-way cabinet designed to reduce traffic in patient rooms.
PRINCETON, N.J.—The room's soft white lighting illuminates a wall of etched glass and blond wood. There's hand-laid tile in the shower and the couch unfolds, letting family members stay. Even the shape of this hospital room is quirky, with walls that hide wires and tubing and slant so the occupant will better see the leafy treetops through large windows.
It's peaceful, perhaps practical, and it could be the hospital patient room of the future.
The staff at the University Medical Center at Princeton will soon assign one patient at a time to this newly built room, designed partly with staff input, housed on a post-surgical floor. Designed using research funded with a $2.8 million grant from the Robert Wood Johnson Foundation, the room has ushered Princeton into the growing field of health-care design.
Architects and health-care centers are seeking to prove that a room's layout and accessories can help patients heal faster and cut down on mishaps and staff error, as some research has shown.
"Once we put patients in here, we'll see if everything is right," says Susan G. Lorenz, Princeton's chief nursing officer, who helped design the room.
More hospitals have started to rethink how patient rooms can improve the occupant's health. They're seeking to reduce the spread of infections, the rise in patient falls, and the healing benefits of outdoor views. Patient falls are common in hospitals, and 10% of fatal falls by older adults happen there, according to data compiled by the Institute for Healthcare Improvement. Single rooms are becoming standard, Ms. Lorenz said, because research shows that the privacy reduces infection rates and enhances communication between staff and patients.
Hospital officials say they'll know if features in the model room have improved care in roughly 18 months, when researchers compare data with what they collect from the existing rooms, the control group.
If the design elements work, the single-bed room will be copied for all the rooms in the center's new 237-bed replacement hospital, a $447 million construction project rising nearby in Plainsboro, said Barry Rabner, president and CEO of Princeton HealthCare System, the hospital's parent.
Staff at Princeton, a nonprofit that's separate from the university of that name, hopes to find that patients fall less often because the toilet is near the head of the bed, making the path to the bathroom shorter than in a typical room, says Ms. Lorenz, who earned a Ph.D. in hospital design. A specially designed grab rail on the wall shine a light where patients will be stepping.
She'll also be measuring if having a separate sink near the door prompts more staff members to wash their hands, a major source of spreading hospital infections.
The room's bed can sink low to the ground, also to reduce falls, and weigh a patient without getting them to rise and step aboard a scale, she said.
But the room is a work in progress: The paper-towel holder is terrible, she decreed, with paper coming out by the dozens, and the staff has said the sink in the new room must be changed because the raised bowl will be a slippery and dangerous grabbing spot for elderly patients.
The room has two-way cabinets, allowing housekeeping staff to resupply the linen and medicines from the hallway, and letting clinical staff grab them from inside the patient's room. That may help reduce traffic in patient rooms and therefore, infection rates. But Lopa Patel, a floor nurse, said that staff must still walk in and out, fetching antibiotics and narcotics from elsewhere.
Princeton has joined about 50 hospitals world-wide as health-care design labs, a project of the Center for Health Design in Concord, Calif., that is researching how design has helped patients and staff, says Rosalyn Cama, a health-care designer and member of the center's board of directors. Ms. Cama is a consultant for Princeton's project.
Many hospitals have developed mock patient rooms, usually outside the hospital, to study a room's features. By building the real thing on a patient floor, Princeton has given researchers an ideal way to test if design ideas work, said Kirk Hamilton, an associate architecture professor at Texas A&M University.
"Over the last decade there's been a resurgence in the recognition that patient towers had aged and not kept up," said Mr. Hamilton, editor of Health Environment Research and Design Journal, which is interested in publishing the results of Princeton's findings. "Princeton is one of those that has made a commitment to do measurement."
Some patients will be assigned to the room at random, hospital officials said, other times, staff will admit patients with certain characteristics, such as people 65 years and older who have a condition that would put them at risk of falling. These patients would be matched to similar patients in traditional rooms, to observe how the model room performs in comparison.
Patients will have to give their consent before participating in any part of the research. Patients in the model room will be billed at the same rate as in a traditional room.
The new room draws the attention of patients and visitors. Renee Shields wandered in last week, on a break from caring for her 87-year-old mother, a former nurse at the hospital and now a patient after a fall. Ms. Shields lay on the bed, enthused about the large tiled shower and fold-out couch, and liked that the digital clock beamed the day of the week.
"It's hotel-like" she said. "I wonder if health-care costs are going to go up. Everybody will want to come to Princeton."
Write to Suzanne Sataline at Suzanne.Sataline@wsj.com
Thursday, June 10, 2010
Calorie Counts in Restaurants Goes National
New York Menu Sets New Standard
by DEVLIN BARRETT
Sen. Kirsten Gillibrand wants to put U.S. on a N.Y. diet.
When out-of-towners come to New York, they often notice the calorie counts prominently displayed in chain restaurants. Those same displays will eventually be on menus across the country, part of a broader effort by Ms. Gillibrand to spread New York's diet and safety standards to the entire U.S.
The nation's eating habits are no longer purely a cultural debate; the health-care legislation passed this year means that more than ever, taxpayers will have a financial stake in the average American's health and diet.
Journal Community
All the more reason, Ms. Gillibrand said, for the calorie-count rule to go beyond the five boroughs. The calorie rule goes into effect next year as part of the health-care legislation, and will apply to chain restaurants with 20 locations or more.
Ms. Gillibrand, a mother of two, is also pushing for public schools across the country to ban trans-fats in food, just as New York City banned them in 2008. And she's advocating legislation that would spur grocery stores to open in underserved areas.
"Every place is different, but these are broad, common-sense ideas that would help all families," said the senator. "It doesn't matter whether you're living in New York or Des Moines, Iowa, trans-fats will give you heart disease."
Such efforts can rankle those who think the measures are micromanaging consumer choices.
Radley Balko, a senior editor at the libertarian magazine Reason who covers the obesity debate, pointed out that for years customers at fast-food chains have been able to request the nutritional content of items on the menu.
"The problem hasn't been that people can't get this information," he said. "I think what the public-health people want is to smack people in the head with it. What's next? At some point they are going to want to dictate what restaurants put on their menus."
Ms. Gillibrand's supporters, including Rachael Ray, the television personality best known for her 30-minute meals, argue the country's obesity epidemic requires concrete steps to protect children from a lifetime of unhealthy eating habits.
City Council Speaker Christine Quinn, who has worked with the senator on the food initiatives, said what's good for New York "is definitely good for the rest of the country, everybody knows that. Whether they're willing or brave enough to admit it is a different question."
The Democratic senator's positions on food highlight one of the quirks of her work in Congress: She is the first New York senator in decades to sit on the Agriculture Committee.
That may seem an odd fit, but Manhattan Borough President Scott Stringer said she has redefined the role to focus on getting healthy, fresh food to large urban areas, which he insisted will be an important issue for years to come.
by DEVLIN BARRETT
Sen. Kirsten Gillibrand wants to put U.S. on a N.Y. diet.
When out-of-towners come to New York, they often notice the calorie counts prominently displayed in chain restaurants. Those same displays will eventually be on menus across the country, part of a broader effort by Ms. Gillibrand to spread New York's diet and safety standards to the entire U.S.
The nation's eating habits are no longer purely a cultural debate; the health-care legislation passed this year means that more than ever, taxpayers will have a financial stake in the average American's health and diet.
Journal Community
All the more reason, Ms. Gillibrand said, for the calorie-count rule to go beyond the five boroughs. The calorie rule goes into effect next year as part of the health-care legislation, and will apply to chain restaurants with 20 locations or more.
Ms. Gillibrand, a mother of two, is also pushing for public schools across the country to ban trans-fats in food, just as New York City banned them in 2008. And she's advocating legislation that would spur grocery stores to open in underserved areas.
"Every place is different, but these are broad, common-sense ideas that would help all families," said the senator. "It doesn't matter whether you're living in New York or Des Moines, Iowa, trans-fats will give you heart disease."
Such efforts can rankle those who think the measures are micromanaging consumer choices.
Radley Balko, a senior editor at the libertarian magazine Reason who covers the obesity debate, pointed out that for years customers at fast-food chains have been able to request the nutritional content of items on the menu.
"The problem hasn't been that people can't get this information," he said. "I think what the public-health people want is to smack people in the head with it. What's next? At some point they are going to want to dictate what restaurants put on their menus."
Ms. Gillibrand's supporters, including Rachael Ray, the television personality best known for her 30-minute meals, argue the country's obesity epidemic requires concrete steps to protect children from a lifetime of unhealthy eating habits.
City Council Speaker Christine Quinn, who has worked with the senator on the food initiatives, said what's good for New York "is definitely good for the rest of the country, everybody knows that. Whether they're willing or brave enough to admit it is a different question."
The Democratic senator's positions on food highlight one of the quirks of her work in Congress: She is the first New York senator in decades to sit on the Agriculture Committee.
That may seem an odd fit, but Manhattan Borough President Scott Stringer said she has redefined the role to focus on getting healthy, fresh food to large urban areas, which he insisted will be an important issue for years to come.
Thursday, June 3, 2010
Breast-Feeding Linked to Lower Incidence of Fever After Immunizations
May 19, 2010 — Breast-feeding is linked to a lower incidence of fever after immunizations, according to the results of a prospective cohort study reported online May 17 in Pediatrics.
"Immune response to some vaccines is different among breastfed infants compared with those who are not breastfed," write Alfredo Pisacane, MD, from Università Federico II in Napoli, Italy, and colleagues. "The objective of this study was to evaluate the effects of breastfeeding on the risk for fever after routine immunizations."
At a pediatric vaccination center in Naples, Italy, mothers of infants scheduled for routine vaccinations were told how to measure and record infant temperature on the evening that the immunization was administered and for the next 3 days. On the third day after vaccination, mothers were phoned to determine the incidence of fever. After adjustment for vaccine dose, maternal educational level and smoking status, and number of other children in the household, multivariate analyses allowed estimation of the relative risk for fever in relationship to the type of breast-feeding.
Of 460 infants recruited, outcome data were available for 450 (98%). Fever was reported in 30 (25%) of exclusively breast-fed infants, in 48 (31%) of partially breast-fed infants, and in 94 (53%) of infants who were not breast-fed at all (P < .01). Among infants who were exclusively breast-fed, the relative risk for fever was 0.46 (95% confidence interval [CI], 0.33 - 0.66), and it was 0.58 (95% CI, 0.44 - 0.77) among partially breast-fed infants.
"The protection conferred by breastfeeding persisted even when considering the role of several potential confounders," the study authors write. "In this study, breastfeeding was associated with a decreased incidence of fever after immunizations."
Limitations of this study include body temperatures taken by the mothers rather than by health professionals and the possibility that fever after immunization could be an infective episode.
"Breastfeeding seems to be associated with a reduced risk for fever after immunization, but additional, well organized studies are needed," the study authors conclude. "The design of such studies should include more objective research methods, such as measurements taken by health care professionals at the same time of the day or night, and should evaluate the role of mild intercurrent infections by medical monitoring."
The study authors have disclosed no relevant financial relationships.
Pediatrics. Published online May 17, 2010.
"Immune response to some vaccines is different among breastfed infants compared with those who are not breastfed," write Alfredo Pisacane, MD, from Università Federico II in Napoli, Italy, and colleagues. "The objective of this study was to evaluate the effects of breastfeeding on the risk for fever after routine immunizations."
At a pediatric vaccination center in Naples, Italy, mothers of infants scheduled for routine vaccinations were told how to measure and record infant temperature on the evening that the immunization was administered and for the next 3 days. On the third day after vaccination, mothers were phoned to determine the incidence of fever. After adjustment for vaccine dose, maternal educational level and smoking status, and number of other children in the household, multivariate analyses allowed estimation of the relative risk for fever in relationship to the type of breast-feeding.
Of 460 infants recruited, outcome data were available for 450 (98%). Fever was reported in 30 (25%) of exclusively breast-fed infants, in 48 (31%) of partially breast-fed infants, and in 94 (53%) of infants who were not breast-fed at all (P < .01). Among infants who were exclusively breast-fed, the relative risk for fever was 0.46 (95% confidence interval [CI], 0.33 - 0.66), and it was 0.58 (95% CI, 0.44 - 0.77) among partially breast-fed infants.
"The protection conferred by breastfeeding persisted even when considering the role of several potential confounders," the study authors write. "In this study, breastfeeding was associated with a decreased incidence of fever after immunizations."
Limitations of this study include body temperatures taken by the mothers rather than by health professionals and the possibility that fever after immunization could be an infective episode.
"Breastfeeding seems to be associated with a reduced risk for fever after immunization, but additional, well organized studies are needed," the study authors conclude. "The design of such studies should include more objective research methods, such as measurements taken by health care professionals at the same time of the day or night, and should evaluate the role of mild intercurrent infections by medical monitoring."
The study authors have disclosed no relevant financial relationships.
Pediatrics. Published online May 17, 2010.
Wednesday, April 28, 2010
Is Medical Advice on the Internet Reliable?
Not all Web-based information is accurate.
More patients are turning to the Internet for medical advice. To determine the accuracy of online medical information, researchers in the U.K. used key words to search Google for advice about five common pediatric topics: measles-mumps-rubella (MMR) vaccine and autism, HIV infection and breast-feeding, mastitis and breast-feeding, infant sleep position, and management of green vomit. The first 100 websites listed in the results for each search were evaluated.
Thirty-nine percent of the websites gave accurate information (consistent with current U.K. recommendations), 11% provided inaccurate information (inconsistent with current U.K. recommendations), and 49% did not provide pertinent advice. Information on the MMR vaccine and autism and HIV and breast-feeding was correct in only 65% and 51% of sites, respectively. The websites on the other topics were accurate more than 94% of the time. All government sites were accurate. However, news sites were accurate only 55% of the time, and sponsored sites (sites that pay premiums to be featured prominently in results lists of search engines) were never accurate.
Comment: Online medical information is highly variable and often inaccurate. Learn the best sources of information for your patients, and recommend government-sponsored sites when available.
— F. Bruder Stapleton, MD
Published in Journal Watch Pediatrics and Adolescent Medicine April 28, 2010
Citation(s):
Scullard P et al. Googling children's health: Reliability of medical advice on the internet. Arch Dis Child 2010 Apr 6; [e-pub ahead of print]. (http://dx.doi.org/10.1136/adc.2009.168856)
More patients are turning to the Internet for medical advice. To determine the accuracy of online medical information, researchers in the U.K. used key words to search Google for advice about five common pediatric topics: measles-mumps-rubella (MMR) vaccine and autism, HIV infection and breast-feeding, mastitis and breast-feeding, infant sleep position, and management of green vomit. The first 100 websites listed in the results for each search were evaluated.
Thirty-nine percent of the websites gave accurate information (consistent with current U.K. recommendations), 11% provided inaccurate information (inconsistent with current U.K. recommendations), and 49% did not provide pertinent advice. Information on the MMR vaccine and autism and HIV and breast-feeding was correct in only 65% and 51% of sites, respectively. The websites on the other topics were accurate more than 94% of the time. All government sites were accurate. However, news sites were accurate only 55% of the time, and sponsored sites (sites that pay premiums to be featured prominently in results lists of search engines) were never accurate.
Comment: Online medical information is highly variable and often inaccurate. Learn the best sources of information for your patients, and recommend government-sponsored sites when available.
— F. Bruder Stapleton, MD
Published in Journal Watch Pediatrics and Adolescent Medicine April 28, 2010
Citation(s):
Scullard P et al. Googling children's health: Reliability of medical advice on the internet. Arch Dis Child 2010 Apr 6; [e-pub ahead of print]. (http://dx.doi.org/10.1136/adc.2009.168856)
Tuesday, April 27, 2010
Higher Depression Scores Linked to Greater Chocolate Consumption
A study linking depression to chocolate consumption has been receiving a lot of press attention. The study appears in the current Archives of Internal Medicine.
Some 900 adults in California who weren't taking antidepressants completed a depression scale and also reported how much chocolate they consumed. Those who screened positive for depression ate about eight servings of chocolate per month, while those without depression ate just five servings a month — a statistically significant difference. Consumption of fat, calories, carbohydrates, and caffeine did not appear to explain the difference between the groups.
The authors emphasize that given the study's cross-sectional design, conclusions cannot be made regarding causality or the direction of the association.
Archives of Internal Medicine article
Some 900 adults in California who weren't taking antidepressants completed a depression scale and also reported how much chocolate they consumed. Those who screened positive for depression ate about eight servings of chocolate per month, while those without depression ate just five servings a month — a statistically significant difference. Consumption of fat, calories, carbohydrates, and caffeine did not appear to explain the difference between the groups.
The authors emphasize that given the study's cross-sectional design, conclusions cannot be made regarding causality or the direction of the association.
Archives of Internal Medicine article
Anti-Aging Foods
It is becoming more and more obvious, and undeniable that you are what you eat- study after study demonstrating the link between a certain overall lifestyle or particular food and improved health are making news headlines on a weekly basis. Foods that we eat today will have both an immediate and long term effect on our bodies and fortunately (although many might argue that it is easier to be told) decisions regarding what we eat are individual. So the question that just about everyone wants the answer to, where is the fountain of youth can actually be answered quite simply- in your local supermarket or farmers market.
Taking care of what you eat and including foods rich in certain nutrients can help you look and feel your best. Supermarket Guru has compiled a list of favorites that can be found in your local market.
Avocados, usually thought of as a vegetable are a fruit rich in monounsaturated fats that may help to reduce the “bad” LDL cholesterol in the blood. Avocados are a good source of vitamin E, an antioxidant that protects skin from ultraviolet light, prevents damage from free radicals and allows for efficient cell communication. Avocados are also rich in potassium which is necessary for proper nerve and muscle function as well as maintaining calcium levels and helping to lower blood pressure.
Dark leafy greens, such as collard greens, kale and spinach are all full of antioxidants. The antioxidants found in leafy greens, lutein and zeaxanthin are vital in maintaining eye health and preventing macular degeneration. Leafy greens are also rich in vitamin K which allows for normal blood clotting (keeps bruising at bay), protects against osteoporosis and prevents oxidative cell damage.
Garlic, famous for its strong smell and flavor produced by the presence of allicin; a sulfur containing compound that promotes antioxidant activity as well as acting as an antiviral, antibacterial and antifungal. Scientific studies have demonstrated garlic’s blood pressure lowering capabilities and its positive effects on cholesterol levels. Garlic also contains compounds known to reduce inflammation and improve overall health.
Herbs and Spices not only pack a flavorful punch, but are also rich in ‘anti-aging’ compounds. Parsley, oregano, basil, turmeric and cinnamon are only a few of the many herbs and spices that are great sources of antioxidants, vitamins, minerals and other bioactive compounds that keep our bodies functioning in tip top shape. The deeper the color and fresher the herbs and spices, the better. Studies have shown that on a per gram fresh weight basis, herbs rank even higher in antioxidant activity than many fruits and vegetables.
Taking care of what you eat and including foods rich in certain nutrients can help you look and feel your best. Supermarket Guru has compiled a list of favorites that can be found in your local market.
Avocados, usually thought of as a vegetable are a fruit rich in monounsaturated fats that may help to reduce the “bad” LDL cholesterol in the blood. Avocados are a good source of vitamin E, an antioxidant that protects skin from ultraviolet light, prevents damage from free radicals and allows for efficient cell communication. Avocados are also rich in potassium which is necessary for proper nerve and muscle function as well as maintaining calcium levels and helping to lower blood pressure.
Dark leafy greens, such as collard greens, kale and spinach are all full of antioxidants. The antioxidants found in leafy greens, lutein and zeaxanthin are vital in maintaining eye health and preventing macular degeneration. Leafy greens are also rich in vitamin K which allows for normal blood clotting (keeps bruising at bay), protects against osteoporosis and prevents oxidative cell damage.
Garlic, famous for its strong smell and flavor produced by the presence of allicin; a sulfur containing compound that promotes antioxidant activity as well as acting as an antiviral, antibacterial and antifungal. Scientific studies have demonstrated garlic’s blood pressure lowering capabilities and its positive effects on cholesterol levels. Garlic also contains compounds known to reduce inflammation and improve overall health.
Herbs and Spices not only pack a flavorful punch, but are also rich in ‘anti-aging’ compounds. Parsley, oregano, basil, turmeric and cinnamon are only a few of the many herbs and spices that are great sources of antioxidants, vitamins, minerals and other bioactive compounds that keep our bodies functioning in tip top shape. The deeper the color and fresher the herbs and spices, the better. Studies have shown that on a per gram fresh weight basis, herbs rank even higher in antioxidant activity than many fruits and vegetables.
Monday, April 19, 2010
E. Coli Infections Dropped Last Year
By BETSY MCKAY
Infections from a dangerous form of E. coli bacteria dropped significantly last year, in a sign new food-safety measures are starting to pay off, federal health officials reported Thursday.
But food-poisoning rates for most common pathogens have budged little since 2004, with rare exceptions, including that of vibrio, a pathogen found in oysters and clams. Officials said they were trying to figure out why the rate of vibrio infections rose 21% in 2009.
The preliminary numbers were drawn from a national monitoring program for infections in 10 states and released by the U.S. Centers for Disease Control and Prevention. Officials said the data underscored the need to work more aggressively to plug holes in the nation's food-safety system.
Legislation that would give the government new powers to police food safety and prevent contamination is working its way through Congress.
The rate of infections from E. coli O157, which can cause bloody diarrhea, kidney failure and death, fell 12% in 2009, hitting its lowest level since 2004 and reaching the government's health target for 2010, the CDC said.
Officials credited new measures to monitor ground-beef processing and produce-growing practices for the decline. For example, as of July all components of raw ground beef are tested, said David Goldman, a USDA food safety and inspection service official.
Salmonella was the most common form of food poisoning identified in the report, the CDC said.
The pathogen has vexed food-safety officials in recent years, cropping up unexpectedly in a growing number of sources, including peanuts in early 2009. While the rate of infections declined 6.2% in 2009, at 15.19 for every 100,000 people, it remained far above a government target of 6.80 for 2010.
"We're quite a ways from that objective. It just shows us we're going to need a concentrated effort on salmonella," said Chris Braden, acting director of the CDC's division of food-borne, water-borne and environmental diseases.
"Salmonella is difficult to control because it can contaminate so many different types of new food," he said.
Measures are being taken to reduce salmonella, officials said, with a new effort to improve the safety of eggs that goes into effect this summer.
The rate of infections caused by shigella bacteria, which causes diarrhea, declined nearly 40%. But those infections are spread mostly by person-to-person contact, commonly in day-care centers, rather than through food. The CDC said the decline could be due in part to regular year-to-year fluctuations.
Officials said they were puzzled about the increase in the rate of vibrio infections, which remained rare but can be deadly. They said they haven't seen a significant increase in shellfish consumption and efforts were under way to improve industry practices.
The CDC estimates there are 76 million cases of food-borne infections annually, resulting in 325,000 hospitalizations and 5,000 deaths.
Infections from a dangerous form of E. coli bacteria dropped significantly last year, in a sign new food-safety measures are starting to pay off, federal health officials reported Thursday.
But food-poisoning rates for most common pathogens have budged little since 2004, with rare exceptions, including that of vibrio, a pathogen found in oysters and clams. Officials said they were trying to figure out why the rate of vibrio infections rose 21% in 2009.
The preliminary numbers were drawn from a national monitoring program for infections in 10 states and released by the U.S. Centers for Disease Control and Prevention. Officials said the data underscored the need to work more aggressively to plug holes in the nation's food-safety system.
Legislation that would give the government new powers to police food safety and prevent contamination is working its way through Congress.
The rate of infections from E. coli O157, which can cause bloody diarrhea, kidney failure and death, fell 12% in 2009, hitting its lowest level since 2004 and reaching the government's health target for 2010, the CDC said.
Officials credited new measures to monitor ground-beef processing and produce-growing practices for the decline. For example, as of July all components of raw ground beef are tested, said David Goldman, a USDA food safety and inspection service official.
Salmonella was the most common form of food poisoning identified in the report, the CDC said.
The pathogen has vexed food-safety officials in recent years, cropping up unexpectedly in a growing number of sources, including peanuts in early 2009. While the rate of infections declined 6.2% in 2009, at 15.19 for every 100,000 people, it remained far above a government target of 6.80 for 2010.
"We're quite a ways from that objective. It just shows us we're going to need a concentrated effort on salmonella," said Chris Braden, acting director of the CDC's division of food-borne, water-borne and environmental diseases.
"Salmonella is difficult to control because it can contaminate so many different types of new food," he said.
Measures are being taken to reduce salmonella, officials said, with a new effort to improve the safety of eggs that goes into effect this summer.
The rate of infections caused by shigella bacteria, which causes diarrhea, declined nearly 40%. But those infections are spread mostly by person-to-person contact, commonly in day-care centers, rather than through food. The CDC said the decline could be due in part to regular year-to-year fluctuations.
Officials said they were puzzled about the increase in the rate of vibrio infections, which remained rare but can be deadly. They said they haven't seen a significant increase in shellfish consumption and efforts were under way to improve industry practices.
The CDC estimates there are 76 million cases of food-borne infections annually, resulting in 325,000 hospitalizations and 5,000 deaths.
Sunday, April 18, 2010
Teen Girls' Drinking May Lead to Breast Problems Later
By Kathleen Doheny, HealthDay
Frequent alcohol consumption by teenage girls may increase the chances that they will develop non-cancerous breast disease in their 20s and possibly breast cancer later in life.
Research published online April 12 in the journal Pediatrics found that girls who drank the most alcohol during their teen years — daily or nearly every day — were five times more likely to develop benign breast disease as young adults than were their peers who never drank or drank less than once a week.
Benign breast disease (BBD) includes a number of nonmalignant conditions. Fibroadenoma, a noncancerous tumor, is the most common in those aged 30 and younger. Study co-author Catherine Berkey, a biostatistician at Harvard Medical School in Boston, said that benign breast disease is known to boost the risk for breast cancer.
So does that mean that teens who drink alcohol are increasing their breast cancer risk early in life?
"Our study may suggest that teen drinking increases the risk for breast cancer, whether in all females or in those who go on to develop BBD, but longer-term follow-up is certainly required" to confirm it, she said.
A unique aspect of Berkey's study was that the girls assessed their drinking habits while they were teenagers. Other studies have based their conclusions on adult women's recalling their teenage drinking many years later.
"Our new study is the first in which alcohol data were collected during adolescence, with continued follow-up in the females as they develop disease," she said.
The study involved 6,899 women who had become participants in the "Growing Up Today Study" when they were 9 to 15 years old. Information on alcoholic beverage consumption was collected in a follow-up survey when the participants were 16 to 23 years old, and a survey done when they were 18 to 27 years old included questions on breast disease.
In all, 147 participants reported having benign breast disease, with 67 cases having been confirmed by biopsy.
When Berkey and her colleagues looked at the diagnoses of benign breast disease and drinking, they found that risk for benign breast disease rose along with the frequency of alcohol consumption: from a 1.5 increased risk for drinking one or two days per week, to a three times greater risk for those drinking three to five days per week, and to a 5.5 times greater risk for drinking six or seven days per week, when compared with those who never drank or who drank less than once per week.
Even once-a-week drinkers may not be absolutely safe, Berkey noted. "I suspect there may be some small additional BBD risk for even small amounts of alcohol consumed during adolescence," she said.
Teen years are a critical time for potential cancer-producing exposures, she said, because the mammary glands are undergoing rapid growth during that period.
Berkey said she suspects the link is due to alcohol increasing total estrogen levels, raising the likelihood of benign breast disease.
"For me, this is not a surprise," said Dr. Patricia Ganz, director of cancer prevention and control research at the Jonsson Comprehensive Cancer Center at the University of California, Los Angeles. Regular alcohol consumption is known to increase a woman's risk for both breast cancer and benign breast disease, she said, and "certain forms of BBD increase the risk of breast cancer."
And though she described the new study as excellent, she cautioned that the sample size was relatively small.
"I wouldn't scare (teens) and say, 'You are going to get breast cancer if you drink,'" Ganz said. But, on the other hand, she added: "The public health message is, these young girls shouldn't be drinking anyway."
Frequent alcohol consumption by teenage girls may increase the chances that they will develop non-cancerous breast disease in their 20s and possibly breast cancer later in life.
Research published online April 12 in the journal Pediatrics found that girls who drank the most alcohol during their teen years — daily or nearly every day — were five times more likely to develop benign breast disease as young adults than were their peers who never drank or drank less than once a week.
Benign breast disease (BBD) includes a number of nonmalignant conditions. Fibroadenoma, a noncancerous tumor, is the most common in those aged 30 and younger. Study co-author Catherine Berkey, a biostatistician at Harvard Medical School in Boston, said that benign breast disease is known to boost the risk for breast cancer.
So does that mean that teens who drink alcohol are increasing their breast cancer risk early in life?
"Our study may suggest that teen drinking increases the risk for breast cancer, whether in all females or in those who go on to develop BBD, but longer-term follow-up is certainly required" to confirm it, she said.
A unique aspect of Berkey's study was that the girls assessed their drinking habits while they were teenagers. Other studies have based their conclusions on adult women's recalling their teenage drinking many years later.
"Our new study is the first in which alcohol data were collected during adolescence, with continued follow-up in the females as they develop disease," she said.
The study involved 6,899 women who had become participants in the "Growing Up Today Study" when they were 9 to 15 years old. Information on alcoholic beverage consumption was collected in a follow-up survey when the participants were 16 to 23 years old, and a survey done when they were 18 to 27 years old included questions on breast disease.
In all, 147 participants reported having benign breast disease, with 67 cases having been confirmed by biopsy.
When Berkey and her colleagues looked at the diagnoses of benign breast disease and drinking, they found that risk for benign breast disease rose along with the frequency of alcohol consumption: from a 1.5 increased risk for drinking one or two days per week, to a three times greater risk for those drinking three to five days per week, and to a 5.5 times greater risk for drinking six or seven days per week, when compared with those who never drank or who drank less than once per week.
Even once-a-week drinkers may not be absolutely safe, Berkey noted. "I suspect there may be some small additional BBD risk for even small amounts of alcohol consumed during adolescence," she said.
Teen years are a critical time for potential cancer-producing exposures, she said, because the mammary glands are undergoing rapid growth during that period.
Berkey said she suspects the link is due to alcohol increasing total estrogen levels, raising the likelihood of benign breast disease.
"For me, this is not a surprise," said Dr. Patricia Ganz, director of cancer prevention and control research at the Jonsson Comprehensive Cancer Center at the University of California, Los Angeles. Regular alcohol consumption is known to increase a woman's risk for both breast cancer and benign breast disease, she said, and "certain forms of BBD increase the risk of breast cancer."
And though she described the new study as excellent, she cautioned that the sample size was relatively small.
"I wouldn't scare (teens) and say, 'You are going to get breast cancer if you drink,'" Ganz said. But, on the other hand, she added: "The public health message is, these young girls shouldn't be drinking anyway."
Friday, April 16, 2010
Standardized Screening May Help Idenetify Suicidal Adolescents
April 15, 2010 — Standardized screening for suicide risk in primary care can detect adolescents with suicidal ideation, allowing referral to a behavioral healthcare center before a fatal or serious suicide attempt is made, according to the results of a study reported online April 12 and published in the May print issue of Pediatrics.
"Several associations and federal agencies have called for depression screening in pediatric primary care," writes Matthew B. Wintersteen, PhD, from Thomas Jefferson University in Philadelphia, Pennsylvania. "Screening for suicide risk is a natural adjunct to this call....To our knowledge, this is the first study to prospectively examine the impact of standardized screening for suicide risk on detection and referral rates in pediatric primary care."
The goals of the study were to evaluate whether brief standardized screening for suicide risk in pediatric primary care practices could improve detection of youth with suicidal ideation, maintain improved rates of detection and referral, and be duplicated in other practices.
Two primary care clinics (clinic A and clinic B) were selected as intervention clinics, and a third clinic (clinic C) asked about participating in the study and was offered the intervention. At these 3 clinics, physicians underwent brief training in detecting suicide risk, and 2 standardized questions for adolescents aged 12.0 to 17.9 years were added to their existing electronic medical chart psychosocial interview. Data without identifiers were extracted during intervention trials and for the same dates of the preceding year, and referral rates were determined from social work records.
The intervention was associated with doubling of the rates of inquiry about suicide risk, which resulted in a 219% increase overall (clinic A odds ratio [OR], 2.04; 95% confidence interval [CI], 1.56 - 2.51; clinic B OR, 3.20; 95% CI, 2.69 - 3.71; and clinic C OR, 1.85; 95% CI, 1.38 - 2.31).
In clinic A, the rate of case detection increased nearly 5-fold (OR, 4.99; 95% CI, 4.20 - 5.79), was maintained for a 6-month period after the intervention was implemented (OR, 4.38; 95% CI, 3.74 - 5.02), and was replicated in both clinic B (OR, 5.46; 95% CI, 3.36 - 7.56) and clinic C (OR, 3.42; 95% CI, 2.33 - 4.52). Across all 3 clinics, case detection rate increased by 392%. The rate of increase of referral rates of suicidal youth to outpatient behavioral healthcare centers was commensurate to that of the detection rates.
"Standardized screening for suicide risk in primary care can detect youth with suicidal ideation and prompt a referral to a behavioral health care center before a fatal or serious suicide attempt is made," Dr. Wintersteen writes.
Limitations of this study include suicidal ideation based on history, not necessarily on present thoughts; and inability to determine the impact of the brief training in suicide risk.
"The findings from this study are particularly timely after the recent recommendation of the US Preventive Services Task Force to routinely screen youth for a major depressive disorder," Dr. Wintersteen concludes. "In addition, the American Academy of Child and Adolescent Psychiatry along with the American Academy of Pediatrics Task Force on Mental Health also released a joint article in which routine behavioral health screening in primary care was recommended....Both reports cautioned against screening when psychotherapy followup was not readily available."
The American Foundation for Suicide Prevention supported this study. Dr. Wintersteen has disclosed no relevant financial relationships.
Pediatrics. Published online April 12, 2010. Abstract
"Several associations and federal agencies have called for depression screening in pediatric primary care," writes Matthew B. Wintersteen, PhD, from Thomas Jefferson University in Philadelphia, Pennsylvania. "Screening for suicide risk is a natural adjunct to this call....To our knowledge, this is the first study to prospectively examine the impact of standardized screening for suicide risk on detection and referral rates in pediatric primary care."
The goals of the study were to evaluate whether brief standardized screening for suicide risk in pediatric primary care practices could improve detection of youth with suicidal ideation, maintain improved rates of detection and referral, and be duplicated in other practices.
Two primary care clinics (clinic A and clinic B) were selected as intervention clinics, and a third clinic (clinic C) asked about participating in the study and was offered the intervention. At these 3 clinics, physicians underwent brief training in detecting suicide risk, and 2 standardized questions for adolescents aged 12.0 to 17.9 years were added to their existing electronic medical chart psychosocial interview. Data without identifiers were extracted during intervention trials and for the same dates of the preceding year, and referral rates were determined from social work records.
The intervention was associated with doubling of the rates of inquiry about suicide risk, which resulted in a 219% increase overall (clinic A odds ratio [OR], 2.04; 95% confidence interval [CI], 1.56 - 2.51; clinic B OR, 3.20; 95% CI, 2.69 - 3.71; and clinic C OR, 1.85; 95% CI, 1.38 - 2.31).
In clinic A, the rate of case detection increased nearly 5-fold (OR, 4.99; 95% CI, 4.20 - 5.79), was maintained for a 6-month period after the intervention was implemented (OR, 4.38; 95% CI, 3.74 - 5.02), and was replicated in both clinic B (OR, 5.46; 95% CI, 3.36 - 7.56) and clinic C (OR, 3.42; 95% CI, 2.33 - 4.52). Across all 3 clinics, case detection rate increased by 392%. The rate of increase of referral rates of suicidal youth to outpatient behavioral healthcare centers was commensurate to that of the detection rates.
"Standardized screening for suicide risk in primary care can detect youth with suicidal ideation and prompt a referral to a behavioral health care center before a fatal or serious suicide attempt is made," Dr. Wintersteen writes.
Limitations of this study include suicidal ideation based on history, not necessarily on present thoughts; and inability to determine the impact of the brief training in suicide risk.
"The findings from this study are particularly timely after the recent recommendation of the US Preventive Services Task Force to routinely screen youth for a major depressive disorder," Dr. Wintersteen concludes. "In addition, the American Academy of Child and Adolescent Psychiatry along with the American Academy of Pediatrics Task Force on Mental Health also released a joint article in which routine behavioral health screening in primary care was recommended....Both reports cautioned against screening when psychotherapy followup was not readily available."
The American Foundation for Suicide Prevention supported this study. Dr. Wintersteen has disclosed no relevant financial relationships.
Pediatrics. Published online April 12, 2010. Abstract
Saturday, April 3, 2010
Exercise with Anxiety and Depression
Regular physical activity is good therapy for both depression and anxiety, and it will also help improve your mood and self-esteem. Exercise will also help you reduce your stress, sleep better, and feel more energized. The key to maximizing the benefits of exercise is to follow a well-designed program that you can stick to over the long-term.
Getting Started
* Talk with your health care provider about integrating regular exercise into your treatment plan.
* Take all medications as recommended by your physician.
* The primary goal of your program is to find activities that you enjoy and will do on a regular basis. Choose environments that are comfortable and familiar to you and avoid situations that increase anxiety.
* If your fitness level is low, start with shorter sessions (even 5 to 10 minutes) and gradually build up to 20 to 60 minutes of aerobic activity, at least four or more days per week.
* At least two days per week, follow a strength-training program with one to three sets of exercises for the major muscle groups, with 10 to 15 repetitions.
* Mind-body activities, such as yoga and tai chi, are particularly effective for reducing anxiety and enhancing relaxation.
Exercise Cautions
* If you take medication, be aware of how it might affect your response to exercise. For example, some anti-psychotic medications can cause dehydration or gait disturbances, while certain antidepressants can cause fatigue, dizziness and weight gain.
* If you have been inactive, consider joining structured, supervised program to help develop a routine that you will continue to do on a regular basis.
Your exercise program should be designed to maximize the benefits with the fewest risks of aggravating your health or physical condition. Consider contacting a certified health and fitness professional* who can work with you and your health care provider to establish realistic goals and design a safe and effective program that addresses your specific needs.
For more information, visit www.exerciseismedicine.org or e-mail eim@acsm.org.
Getting Started
* Talk with your health care provider about integrating regular exercise into your treatment plan.
* Take all medications as recommended by your physician.
* The primary goal of your program is to find activities that you enjoy and will do on a regular basis. Choose environments that are comfortable and familiar to you and avoid situations that increase anxiety.
* If your fitness level is low, start with shorter sessions (even 5 to 10 minutes) and gradually build up to 20 to 60 minutes of aerobic activity, at least four or more days per week.
* At least two days per week, follow a strength-training program with one to three sets of exercises for the major muscle groups, with 10 to 15 repetitions.
* Mind-body activities, such as yoga and tai chi, are particularly effective for reducing anxiety and enhancing relaxation.
Exercise Cautions
* If you take medication, be aware of how it might affect your response to exercise. For example, some anti-psychotic medications can cause dehydration or gait disturbances, while certain antidepressants can cause fatigue, dizziness and weight gain.
* If you have been inactive, consider joining structured, supervised program to help develop a routine that you will continue to do on a regular basis.
Your exercise program should be designed to maximize the benefits with the fewest risks of aggravating your health or physical condition. Consider contacting a certified health and fitness professional* who can work with you and your health care provider to establish realistic goals and design a safe and effective program that addresses your specific needs.
For more information, visit www.exerciseismedicine.org or e-mail eim@acsm.org.
Friday, March 26, 2010
Up to 1/3 of Breast Cancer Can Be Avoided
Associated Press
BARCELONA, Spain — Up to a third of breast cancer cases in Western countries could be avoided if women ate less and exercised more, researchers at a conference said, renewing a sensitive debate about how lifestyle factors affect the disease.
Better treatments, early diagnosis and mammogram screenings have dramatically slowed breast cancer, but experts said the focus should now shift to changing behaviors like diet and physical activity.
"What can be achieved with screening has been achieved. We can't do much more," Carlo La Vecchia, head of epidemiology at the University of Milan, said in an interview. "It's time to move on to other things."
Mr. La Vecchia spoke Thursday at a European breast cancer conference in Barcelona. He cited figures from the International Agency for Research on Cancer, which estimates that 25 to 30% of breast cancer cases could be avoided if women were thinner and exercised more. The agency is part of the World Health Organization.
His comments are in line with recent health advice that lifestyle changes in areas such as smoking, diet, exercise and sun exposure can play a significant role in risk for several cancers.
Dr. Michelle Holmes of Harvard University, who has studied cancer and lifestyle factors, said people might wrongly think their chances of getting cancer depend more on their genes than their lifestyle.
"The genes have been there for thousands of years, but if cancer rates are changing in a lifetime, that doesn't have much to do with genes," she told The Associated Press in a phone interview from Cambridge, Massachusetts.
Breast cancer is the most common cancer in women. In Europe, there were about 421,000 new cases and nearly 90,000 deaths in 2008, the latest available figures. The United States last year saw more than 190,000 new cases and 40,000 deaths.
A woman's lifetime chance of getting breast cancer is about one in eight. Obese women are up to 60% more likely to develop any cancer than normal-weight women, according to a 2006 study by British researchers.
Many breast cancers are fueled by estrogen, a hormone produced in fat tissue. So experts suspect that the fatter a woman is, the more estrogen she's likely to produce, which could in turn fuel breast cancer. Even in slim women, experts believe exercise can help reduce the cancer risk by converting more fat into muscle.
Yet any discussion of weight and breast cancer is considered sensitive because some may misconstrue that as the medical establishment blaming women for their disease.
Tara Beaumont, a clinical nurse specialist at Breast Cancer Care, a British charity, said her agency has always been careful about giving lifestyle advice. She noted that three of the major risk factors for breast cancer — gender, age and family history — are clearly beyond anyone's control.
"It is incredibly difficult to isolate specific factors. Therefore women should in no way feel that they are responsible for developing breast cancer," she said.
Yet Karen Benn, a spokeswoman for Europa Donna, a patient-focused breast cancer group, said it was impossible to ignore the increasingly stronger links between lifestyle and breast cancer.
"If we know there are healthier choices, we can't not recommend them just because people might misinterpret the advice and feel guilty," she said. "If we are going to prevent breast cancer, then this message needs to get out, particularly to younger women."
That means avoiding becoming overweight as an adult. Robert Baan, a cancer expert with the international cancer research agency, said it isn't clear if women who lose weight can lower their risk to the level of a woman who was never fat.
The American Cancer Society Web site says the connection between weight and cancer risk is complex. It says risk appears to increase for women who gain weight as adults, but not for women who have been overweight since childhood. The cancer society recommends 45 to 60 minutes of physical activity five or more days a week to reduce the risk of breast cancer.
Drinking less alcohol might also help. Experts estimate that having more than a couple of drinks a day can boost the risk of breast cancer by 4 to 10 percent.
After studies several years ago linked hormone-replacement therapy to cancer, millions of women abandoned the treatment, leading to a sharp drop in breast cancer rates. Experts said a similar reduction might be seen if women ate healthier and exercised more.
Dr. Holmes, the Harvard expert, said changing diet and nutrition is arguably easier than tackling other breast cancer risk factors.
In the 1980s and 1990s, breast cancer rates steadily increased, paralleling a rise in obesity and the use of estrogen-containing hormones after menopause.
Mr. La Vecchia said countries like Italy and France — where obesity rates have been stable for the past two decades — show that weight can be controlled at a population level.
"It's hard to lose weight, but it's not impossible," he said. "The potential benefit of preventing cancer is worth it."
Copyright 2010 Associated Press
BARCELONA, Spain — Up to a third of breast cancer cases in Western countries could be avoided if women ate less and exercised more, researchers at a conference said, renewing a sensitive debate about how lifestyle factors affect the disease.
Better treatments, early diagnosis and mammogram screenings have dramatically slowed breast cancer, but experts said the focus should now shift to changing behaviors like diet and physical activity.
"What can be achieved with screening has been achieved. We can't do much more," Carlo La Vecchia, head of epidemiology at the University of Milan, said in an interview. "It's time to move on to other things."
Mr. La Vecchia spoke Thursday at a European breast cancer conference in Barcelona. He cited figures from the International Agency for Research on Cancer, which estimates that 25 to 30% of breast cancer cases could be avoided if women were thinner and exercised more. The agency is part of the World Health Organization.
His comments are in line with recent health advice that lifestyle changes in areas such as smoking, diet, exercise and sun exposure can play a significant role in risk for several cancers.
Dr. Michelle Holmes of Harvard University, who has studied cancer and lifestyle factors, said people might wrongly think their chances of getting cancer depend more on their genes than their lifestyle.
"The genes have been there for thousands of years, but if cancer rates are changing in a lifetime, that doesn't have much to do with genes," she told The Associated Press in a phone interview from Cambridge, Massachusetts.
Breast cancer is the most common cancer in women. In Europe, there were about 421,000 new cases and nearly 90,000 deaths in 2008, the latest available figures. The United States last year saw more than 190,000 new cases and 40,000 deaths.
A woman's lifetime chance of getting breast cancer is about one in eight. Obese women are up to 60% more likely to develop any cancer than normal-weight women, according to a 2006 study by British researchers.
Many breast cancers are fueled by estrogen, a hormone produced in fat tissue. So experts suspect that the fatter a woman is, the more estrogen she's likely to produce, which could in turn fuel breast cancer. Even in slim women, experts believe exercise can help reduce the cancer risk by converting more fat into muscle.
Yet any discussion of weight and breast cancer is considered sensitive because some may misconstrue that as the medical establishment blaming women for their disease.
Tara Beaumont, a clinical nurse specialist at Breast Cancer Care, a British charity, said her agency has always been careful about giving lifestyle advice. She noted that three of the major risk factors for breast cancer — gender, age and family history — are clearly beyond anyone's control.
"It is incredibly difficult to isolate specific factors. Therefore women should in no way feel that they are responsible for developing breast cancer," she said.
Yet Karen Benn, a spokeswoman for Europa Donna, a patient-focused breast cancer group, said it was impossible to ignore the increasingly stronger links between lifestyle and breast cancer.
"If we know there are healthier choices, we can't not recommend them just because people might misinterpret the advice and feel guilty," she said. "If we are going to prevent breast cancer, then this message needs to get out, particularly to younger women."
That means avoiding becoming overweight as an adult. Robert Baan, a cancer expert with the international cancer research agency, said it isn't clear if women who lose weight can lower their risk to the level of a woman who was never fat.
The American Cancer Society Web site says the connection between weight and cancer risk is complex. It says risk appears to increase for women who gain weight as adults, but not for women who have been overweight since childhood. The cancer society recommends 45 to 60 minutes of physical activity five or more days a week to reduce the risk of breast cancer.
Drinking less alcohol might also help. Experts estimate that having more than a couple of drinks a day can boost the risk of breast cancer by 4 to 10 percent.
After studies several years ago linked hormone-replacement therapy to cancer, millions of women abandoned the treatment, leading to a sharp drop in breast cancer rates. Experts said a similar reduction might be seen if women ate healthier and exercised more.
Dr. Holmes, the Harvard expert, said changing diet and nutrition is arguably easier than tackling other breast cancer risk factors.
In the 1980s and 1990s, breast cancer rates steadily increased, paralleling a rise in obesity and the use of estrogen-containing hormones after menopause.
Mr. La Vecchia said countries like Italy and France — where obesity rates have been stable for the past two decades — show that weight can be controlled at a population level.
"It's hard to lose weight, but it's not impossible," he said. "The potential benefit of preventing cancer is worth it."
Copyright 2010 Associated Press
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