Major Study Highlights Weight Differences Among 3-19 Year-Olds with Type 1 and 2 Diabetes

June 22, 2009

June 22, 2009 (EurekAlert) - A major study of three to 19 year-olds has provided vital data on the weight problems faced by the growing number of children and young people with type 1 diabetes, which is more prevalent in younger age groups than type 2 diabetes.

The findings of the SEARCH for Diabetes in Youth Study Group, published online by Pediatric Diabetes, show that children and youths with type 1 diabetes are more likely to be overweight than those without diabetes.

Researchers from six clinical centres across the USA took part in the study, which compared data from 3,953 diabetics, aged between three and 19, taking part in the SEARCH study, with data for 7,666 non-diabetic children and youths from a national US study.

"The links between type 2 diabetes and excess weight are well documented, but are less clear in type 1 diabetes which affects less than 10 per cent of people with diabetes but is more common in children and young people" explains lead researcher Dr Lenna Liu from the Center for Child Health, Behavior and Development at Seattle Children's Hospital USA.

"When people have diabetes their blood glucose can become too high" she continues. "In type 1 diabetes, this happens because an autoimmune process has destroyed the insulin-producing beta cells in the pancreas, allowing glucose levels to rise. Type 2 diabetes occurs when not enough insulin is being produced or the insulin is not working properly. Traditionally a disease in overweight adults, type 2 diabetes is increasingly being seen in younger patients as childhood obesity levels increase."

The population-based study looked at a racially and ethnically diverse group of children and young people with diabetes and compared them with the non-diabetic control group.

Most of the children and youths who took part in the study had type 1 diabetes (89 %) and tended to be younger – 49% of the type 1 group were aged three to 11, compared to 7% of the type 2 group.

The type 1 diabetes subjects were equally split between male and female and three-quarters (75%) were non-Hispanic White, 12% were Hispanic, 9% were African American, 4% were Asian/Pacific Islanders and 1% were American Indian.

Key findings included:

• Non-Hispanic White males aged from three to 11 with type 1 diabetes were more likely to be overweight/obese than females (34% versus 27%) while females were more likely to be overweight/obese when they were 12-19 years of age (37% versus 29%).


• African American females were significantly more likely to be overweight/obese in both age groups than males (54/55% versus 36/36%) but there were no significant differences between Hispanic males and females.


• More than a fifth of the children and youths with type 1 diabetes (22%) were overweight, compared with 10% of those with type 2 diabetes and 16% of those without diabetes.


• When this was broken down by race/ethnicity, 28% of Hispanic children and youths with type 1 diabetes were overweight, as were 24% of Asian/Pacific Islanders, 23% of African Americans, 21% of non-Hispanic Whites and 15% of American Indians.


• The figures for children and youths with type 2 diabetes showed that 15% of Asian/Pacific Islanders were overweight, as were 14% of non-Hispanic Whites and 11% of Hispanics.


• Approximately one in eight children and youths with type 1 diabetes (13%) were obese, less than the 79% of subjects with type 2 diabetes and the 17% without diabetes.


• When this was broken down by race/ethnicity, 20% of African American children and youths with type 1 diabetes were obese, as were 17% of Hispanics, 17% of Asian/Pacific Islanders and 11% of non-Hispanic Whites.


• The figures for children and youths with type 2 diabetes showed that 91% of African Americans were obese, as were 88% of American Indians and 75% of Hispanics.

"Knowing the prevalence of overweight and obesity in children and young people with type 1 and type 2 diabetes is very important as it helps us to identify those individuals - by age, gender or race/ethnicity - who face the greatest risk of the clinical complications associated with excess weight," says Dr Liu.

"We feel that further studies are critical to help us to better understand how weight causes complications in the growing number of children and young people with diabetes and influences the diagnosis and treatment they receive."

Posted by dlife at 10:31 AM | Comments (1)

Symptoms of Depression in Obese Children Linked to Elevated Cortisol

June 10, 2009

June 10, 2009 (Newswise) - A new study connects abnormalities of the “stress” hormone cortisol with symptoms of depression in obese children, and confirms that obesity and depression often occur together, even in children. The results were presented at The Endocrine Society’s 91st Annual Meeting in Washington, D.C.

“There is evidence in adults that abnormal regulation of cortisol plays a role in both obesity and depression,” said the study’s lead author, Panagiota Pervanidou, MD, of Athens University Medical School in Athens, Greece. “Our study indicates that cortisol abnormalities may underlie obesity and depression starting in childhood.”

Cortisol is a steroid hormone that helps the body respond to stress but also has other functions, including converting fat, protein and carbohydrates into energy. Normally, levels of this hormone peak in the early morning, start to drop in late morning and reach their low point at night.

However, depressed adults have slightly elevated cortisol levels at night—“the endocrine equivalent of chronic stress,” Pervanidou said. This chronic elevation of cortisol contributes to development of the metabolic syndrome, which includes abdominal obesity and other risk factors for diabetes and cardiovascular disease.

In this new study, Pervanidou and colleagues measured cortisol five times a day in the saliva of 50 obese children and teenagers as well as in their blood in the morning. The 20 boys and 30 girls, ages 8 to 15 years, were patients in the Athens University pediatric obesity clinic and did not have a prior diagnosis of depression. All subjects completed the Children’s Depression Inventory (CDI), a questionnaire that assesses self-reported symptoms of depression.

Cortisol levels in the saliva in the afternoon and evening correlated positively with symptoms of depression, the authors reported. The more depressive symptoms that subjects reported, the higher the cortisol levels at those times.

This finding indicates that obesity and depression may not only be related to behavior but also may have a hormonal link, according to Pervanidou. Because obesity and depression often co-occur, she said that prevention and screening should focus on both disorders and should start in childhood.

“We recommend that obese children be screened for depression and anxiety, especially female adolescents, who have the highest risk,” she said. “In addition, children with a diagnosis of depression should be evaluated for disordered eating, because these patients frequently develop obesity or anorexia.”

Posted by dlife at 05:41 PM | Comments (0)

Childhood Obesity Increases Early Signs of Cardiovascular Disease

June 10, 2009 ( Posted by dlife at 05:37 PM | Comments (0)

Researchers Present New Strategies to Prevent Childhood Obesity

June 09, 2009

June 9, 2009 (Newswise) - Researchers from the Keck School of Medicine of the University of Southern California (USC) will present new findings and strategies for combating childhood obesity at the 5th Biennial Childhood Obesity Conference being held June 9-12 in Los Angeles.

Researchers will participate in oral discussions on using wireless body networks and interactive multimedia to promote physical activity in children, and the link between childhood obesity and type 2 diabetes.

USC experts are available at the meeting to discuss their findings and to provide commentary on issues related to childhood obesity.

Using technology to monitor and prevent obesity

Donna Spruijt-Metz, Ph.D., associate professor, Department of Preventive Medicine at the Keck School of Medicine, will present an overview of the KNOWME NETWORKS study—a program to develop a Mobile Body Area Network that monitors obesity indicators in minority youth.

The network, developed in conjunction with the USC Viterbi School of Engineering, will use a set of wearable wireless sensors that measure physical activity, stress, location in time and space, body fat and a number of other factors. Data will be immediately transmitted to a secure server for storage and analyses. The KNOWME device will be calibrated for the specific user, and researchers will be able to “ping” a participant who remains sedentary for too long, Spruijt-Metz says.

Her presentation includes findings of a study led by colleague Michael I. Goran, Ph.D., professor of preventive medicine, physiology and biophysics and pediatrics, and director of the USC Childhood Obesity Research Center at the Keck School of Medicine. The study looks at the impact of a computer-based education program on promoting physical activity in fourth-grade students.

Two Los Angeles County schools used interactive CD-ROMS for an eight-week long health curriculum, while two control schools received educational CD-ROMS not related to health. Researchers found that the program had a significant impact on obesity reduction in girls, but not in boys.

The results reflect the fact that girls and boys have very different activity levels and attitudes about activity, and that interventions will need to be tailored more specifically, Spruijt-Metz says. However, she believes the study also indicates that technology is an important tool in preventing obesity in youth.

“Technology gives us more objective and reliable measures than self-reporting,” she says. “It is particularly appealing because it offers immediate feedback and will allow interventionists and health professionals to respond directly to the child’s behavior as part of the intervention.”

The oral presentation will take place Wednesday, June 10, at 10:30 a.m. (Session: Can Interactive Media Games Really Increase Physical Activity and Reduce Overweight and Obesity in Children?)

Type 2 diabetes

Francine Kaufman, M.D., professor of pediatrics at the Keck School of Medicine, head of the division of endocrinology and metabolism at Childrens Hospital Los Angeles and author of the popular book “Diabesity,” will participate in a discussion that will address prevention as well as treatment of type 2 diabetes, high blood pressure and lipid disorders in children and teens who are overweight or obese.

The plenary session will take place Thursday, June 11, at 10:30 a.m. (Session: Preventing the Co-Morbidities of Childhood Obesity).

Posted by dlife at 05:19 PM | Comments (0)

LSUHSC Researchers First to Document Early Signs for Diabetes in Kids as Young as 7

June 08, 2009

June 8, 2009 (EurekAlert) - Research conducted under the direction of Melinda Sothern, PhD, Professor and Director of Health Promotion at the LSU Health Sciences Center New Orleans School of Public Health, showing early signs of diabetes in healthy children as young as seven years old will be presented at the American Diabetes Association 2009 Annual Scientific Session Meeting in New Orleans. Dr. Sothern's group is the first to document previously unknown markers for obesity, heart disease and diabetes, collectively called the Metabolic Syndrome, in children this young. Posters will be presented on Saturday, June 6, 2009, and Brian Bennett, a Research Associate in Dr. Melinda Sothern's laboratory will make the oral presentation, Early Markers for the Metabolic Syndrome in Youth, on Monday, June 8, 2009 at 9:30 a.m. at the Ernest N. Morial Convention Center, Room 343. Dr. Sothern will be there for the presentation.

Data reported are from 118 healthy children, age 7 - 9 years old, enrolled in LSUHSC's ongoing Study of Insulin-sensitivity in Louisiana Low-birth-weight Youth (SILLY). LSUHSC's Dr. Sothern is the principal investigator of the NIH-funded study which is investigating the importance of birth weight to diabetes.

The increasing prevalence of type 2 diabetes mellitus in children parallels the pediatric obesity epidemic. According to the American Academy of Pediatrics, over the past two decades, the prevalence of children who are obese has doubled, while the number of adolescents who are obese has tripled. And according to the National Health and Nutrition Examination Survey, 31.9% of children and adolescents were overweight (BMI at or above the 85th percentile) and 16.3% were obese (BMI at or above 95th percentile).

Insulin resistance/poor insulin sensitivity is closely associated with increased total body fat and may precede development of the metabolic syndrome and type 2 diabetes. Indicators of impaired insulin sensitivity have yet to be clearly identified in children prior to puberty.

The LSUHSC researchers found that the child's current fat weight is the strongest predictor for poor insulin sensitivity which is a risk factor for type 2 diabetes. LDL (bad cholesterol) was also strongly associated with insulin sensitivity in the prediction model. Previously unidentified Metabolic Syndrome markers discovered by Dr. Sothern's team include:

Fat in the liver cells and fat in the skeletal (leg) muscle cells also predict poor insulin sensitivity and high insulin resistance (pre-diabetes) along with an impaired fat burning ability in the muscles.
These relationships were only found after the researchers considered the child's current fat weight, so the strongest predictor is whether or not these young children are currently overweight or obese.
The fat in the skeletal muscle became less important after Dr. Sothern's team considered the mother's weight prior to and during pregnancy, whether the child was breast-fed, and the current physical activity level of these young children.
"This means that if the mother has a healthy weight gain during pregnancy and the child is breast-fed and physically active, the fat may not accumulate in the skeletal muscle and/or liver and the child may not experience an impaired fat burning ability in the muscle. All of these factors are significantly associated with poor insulin sensitivity that may eventually lead to type 2 diabetes in adolescence or young adulthood. We hope to conduct future prospective studies in this cohort of healthy children to confirm this finding," notes Dr. Melinda Sothern, LSU Health Sciences Center New Orleans Professor of Public Health and study leader.

Collectively, fat oxidation (how well the body is able to utilize fat as a fuel), blood pressure, and lipids (HDL and LDL) were identified as the best physiologic predictors of insulin sensitivity.

Arlette Soros, MD, an LSUHSC Pediatrics fellow who is a member of Dr. Sothern's research team, is presenting results of the first study to examine why some children become hypoglycemic (low blood sugar) during insulin sensitivity testing. She will report that children who are lean and have less fat in their skeletal muscle are more likely to get hypoglycemia. Also those with the best insulin sensitivity were the most likely to get low blood sugar.

"We are not sure why this is but think they may be more fit and less prone to diabetes," concludes Dr. Sothern.

Posted by dlife at 04:54 PM | Comments (0)

More Ontario Children Are Getting Diagnosed with Diabetes: ICES Study

June 8, 2009 (EurekAlert) - Ontario children are more likely to get diagnosed with diabetes than their American counterparts. A study out of the Institute for Clinical Evaluative Sciences (ICES) has found a 3 per cent increase per year in the rate of diabetes in Ontario children from 1994 to 2004.

Childhood diabetes is a chronic disease that can cause major health problems. Most children with diabetes have Type 1, where their pancreas does not make insulin. But a growing number of children are getting diagnosed with Type 2 diabetes, in which the body produces enough insulin but is resistant to its effect, usually because of genetic disposition and obesity.

"It is concerning that we are seeing more children in Ontario diagnosed with this serious chronic disease - we need to better understand why this happening and ensure that adequate healthcare resources are available to diagnose and treat these children and youth," says principal investigator and ICES Scientist, Dr. Astrid Guttmann.

The study of all Ontario children from 1994 to 2004 found:

Overall, rates of diabetes in Ontario are higher than those reported in the U.S. but in the same range of countries with similar latitude.
From 1994 to 2004 there has been an increase of approximately 3 per cent annually in the rate of diabetes in children of all ages.
The highest incidence rate is in 10-to 14-year-olds.
Some of this difference may be due to genetic susceptibility but also environmental changes, such as the rise in obesity amongst children.
The incidence overall has gone from 24.5/100,000 in 1994 to 32.3/100,000 in 2003
"More work needs to be done to track Type 1 versus Type 2 diabetes as diagnosis and management strategies are very different, and clearly we need to better understand why this disease is becoming more common amongst children," says Guttmann.

Posted by dlife at 11:50 AM | Comments (0)

Type 1 Diabetes Cases in Children Under 5 to Double by 2020

May 27, 2009

May 27, 2009 (EurekAlert) - Cases of type 1 diabetes in children under five years across Europe will double by 2020 (from 2005 levels) if present trends continue. Numbers in children older than five will also increase substantially. The findings are discussed in an Article published Online First and in an upcoming edition of The Lancet, written by Dr Chris Patterson, Queen's University, Belfast, UK, and Prof Gyula Soltész, Pécs University, Pécs, Hungary, and colleagues.

Type 1 diabetes is caused by insulin deficiency (and thus must be treated with insulin injections), whereas type 2 diabetes is caused by reduced insulin sensitivity along with some insulin deficiency. In the general population, type 1 diabetes cases represent only 10% of total diabetes cases. However among children the numbers of cases of type 1 diabetes is higher than type 2 in most countries. To predict the future burden of type 1 diabetes, the authors analysed diabetes data from 20 centres in 17 European countries, which had registered 29311 cases of type 1 diabetes during the period 1989-2003.

The researchers found that the overall increase in incidence of type 1 diabetes was 3.9% per year; while the annual increase in the 0—4 years age group was 5.4%, with a 4.3% rise in the 5—9 years age group, and a 2.9% rise in 10—14—year-olds. There were estimated to have been approximately 15,000 new cases in Europe in 2005, divided among the 0—4 years, 5—9 years, and 10—14 in the ratio 24%, 37% and 34% respectively. A total of 24,400 new cases is predicted in 2020, with a doubling in the number of cases in children aged under 5 years and a more even distribution across age groups than at present (29%, 37%, and 34% respectively). If present trends continue, the total number of cases (new and existing) in European children under 15 years is predicted to rise from 94,000 in 2005 to 160,000 in 2020—a 70% increase.

The changes over time are so rapid, say the authors, that they clearly cannot be because of genetic factors alone. They discuss modern lifestyle habits as possible contributory factors, such as increased weight and height development and increased caesarean section births. The higher increases are seen in Eastern Europe, where lifestyle habits are also changing more rapidly than in the richer European countries.

The authors conclude: "The predicted rise in childhood type 1 diabetes in Europe during the next 20 years, and the raised proportion of cases diagnosed at younger ages than were before, could result in more cases presenting with ketoacidosis and needing hospital admission. More patients with severe diabetes complications presenting at younger ages than before are also likely, and appropriate care from diagnosis, and maintenance of good metabolic control are crucial for delay or prevention of these adverse complications. In the absence of any effective means to prevent type 1 diabetes, European countries need to ensure appropriate planning of services and that resources are in place to provide high-quality care for the increased numbers of children who will be diagnosed with diabetes in future years."

In an accompanying Comment, Dr Dana Dabelea, Colorado School of Public Health, University of Colorado, Denver, CO, USA, says the findings from this and other studies suggest 'that the incidence of type 1 diabetes is increasing even faster than before, pointing towards harmful changes in the environment in which contemporary children live'. She also discusses the findings specific to children under 5, and the concerns that younger age of onset of type 1 diabetes is usually associated with more acute symptoms. The consequences of longer exposure to altered metabolism due to diabetes and the increasing economic costs of the disease are also looked at.

She concludes: "It is imperative that efforts directed at surveillance of diabetes in young people continue and expand, not only to understand its complex aetiology, but also because of its increasing public health importance."

Posted by dlifenews at 10:03 AM | Comments (0)

Telemedicine May Improve Care for School Children with Diabetes

May 21, 2009

May 21, 2009 (EurekAlert) - Type 1 diabetes is the most common chronic childhood disease. The management of this serious medical condition includes regular fingerstick glucose measurements, multiple daily injections of insulin, and frequent insulin dose adjustments. Because children spend a great deal of their time in school, school nurses often supervise medical decisions and diabetes care. Some researchers believe that the use of telecommunication technology may make diabetes care easier for some children. A new study soon to be published in the Journal of Pediatrics explores the effectiveness of telemedicine in helping school nurses and children manage diabetes care.

Dr. Roberto Izquierdo and colleagues from SUNY Upstate Medical University in Syracuse, NY, studied 41 children between the ages of 5 and 14 years with type 1 diabetes. All of the children received routine care, and 23 of the 41 children were also enrolled in a telemedicine intervention program. As a part of routine care, letters containing instructions for each child's diabetes care were sent to the school nurses, who also attended an annual diabetes education program. Additionally, all children visited the diabetes center at SUNY Medical University every three months, and parents, children, and school nurses communicated with the center via phone as needed. In addition to receiving regular care, the 23 children enrolled in the telemedicine intervention program attended video conferences with the school nurse and the diabetes center monthly to discuss treatment orders. Their glucose readings were sent to the center via the telemedicine unit, and the diabetes nurse practitioners at the center made adjustments to insulin treatments as needed.

During the initial six month period of use, the telemedicine group experienced improved blood sugar control and fewer visits to the Emergency Department and/or hospitalizations due to their diabetes. The telemedicine program was well accepted by the participants, with more than 90% stating they would use the program again. According to Dr. Izquierdo, "Children in the telemedicine treatment group were more apt to feel better about their diabetes." He also notes that the children who used the telemedicine program were more likely to complete the prescribed diabetes care related tasks, which can lead to improved management of the disease. Dr. Izquierdo and his colleagues are hopeful that school telemedicine programs could improve diabetes care in the future.

Posted by dlifenews at 10:52 AM | Comments (0)

Parents Failing to Recognize Their Children's Risk for Obesity May Be Contributing to Epidemic

March 18, 2009

March 18, 2009 (EurekAlert) - With 17 percent of US children between ages 2 and 19 classified as obese, new research shows that parents may not be recognizing their own children's risk factors. A new study in the Journal of the American Academy of Nurse Practitioners shows that parents are likely to misperceive their child's weight – especially those parents who are overweight themselves.

Since parents are the most influential factor in laying the foundation for early childhood weight problems, researchers set out to assess the disconnect that exists between a parents' perception of their child's weight and the obvious physical appearance of their child. Looking at several studies which examine parental perceptions of childhood obesity generated from the United Kingdom, Australia, Italy, and the United States, Jessica Doolen, MSN, FNP, Patricia T. Alpert, DrPH, APN, FAANP, and Sally K. Miller, PhD, APN, FAANP, found that parents were more likely to misperceive their child's weight, regardless of the child's age. Across the literature, mothers failed to accurately recognize the weight of their at-risk-for-overweight or overweight children.

In a comparison of two studies they examined, they found that in the UK only 1.9 percent of parents with children at risk for overweight and 17.1 percent of parents with overweight children accurately identified their child as being at risk for or overweight. In another study, the researchers made note of an interesting finding in the study conducted in Westchester County, New York. In that study the parents who had concern for their child's excess weight, 76 percent thought this concern was similar to concerns about sunburn, while 67 percent found concerns about weight similar to prolonged television watching.

The researchers noted several common themes from their analyses. Parents' inability to recognize their child's risk for obesity was especially pronounced if the parents themselves were overweight. Also, children of more highly educated parents were less likely to be overweight or at risk. Cultural influences also affected parents' perceptions of children's weight, with black women being more satisfied with their larger size than white women.

A multitude of risk factors put children at risk for weight gain, and parental misperception may be one of them. "If parents do not recognize their child as at risk for overweight or overweight, they cannot intervene to diminish the risk factors for pediatric obesity and its related complications," the authors conclude.

Posted by dlifenews at 10:23 AM | Comments (0)

Longer Bouts of Exercise Help Prevent Childhood Obesity

March 18, 2009 (EurekAlert) - Children who exercise in bouts of activity lasting five minutes or longer are less likely to become obese than those whose activity levels are more sporadic and typically last less than five minutes each, Queen's University researchers have discovered.

Led by Kinesiology and Health Studies professor Ian Janssen, the new study supports Canada's Physical Activity Guidelines for Children and Youth, which call for children to accumulate at least 90 minutes of moderate-to-vigorous physical activity over the course of the day, in bouts of at least five to 10 minutes' duration. Until now there has been no scientific evidence to support the recommendation of sustained, rather than sporadic exercise.

"Even in 60-minute physical education classes or team practices, children are inactive for a large portion of the time and this would not necessarily count as sustained exercise," says Dr. Janssen. "When children engage in longer periods of sustained physical activity, there is a smaller likelihood that they will be overweight or obese."

The findings appear in the May issue of the American Journal of Preventive Medicine.

Conducted by Dr. Janssen and graduate student Amy Mark, the study analyzed data from 2,498 youth aged eight to 17, who participated in the National Health and Nutrition Examination Survey. Sporadic (one to four minutes), short (five to nine minutes) and medium-to-long (10 minutes and longer) bouts of moderate-to-vigorous physical activity were measured using motion sensors. Participants' body mass index (BMI) was used to classify them as normal weight or obese.

Two-thirds of the physical activity measured in the young people took place in short, sporadic sessions that lasted less than five minutes. Within the most active children, 25 percent of those who tended to accumulate their physical activity in bouts were overweight or obese, compared with 35 percent in those who tended to accumulate their activity in a sporadic manner.

"Our findings have important public health implications with respect to the promotion of physical activity in young people," says Dr. Janssen, noting that current U.S. and international guidelines do not stipulate how daily physical activity should be accumulated.

The researchers say that further studies will be required to determine the optimal length of exercise time, and to examine the influence of bouts of physical activity on other aspects of health.

Posted by dlifenews at 10:16 AM | Comments (0)

Child And Adolescent Obesity: Family-Based Programs Including Behavior Therapy Can Work

January 20, 2009

January 20, 2009 (EurekAlert) - Family-based lifestyle interventions that not only modify diet and physical activity but also include behaviour therapy programs can help obese children lose weight and maintain that loss for at least six months. This Cochrane Review also found that in adolescents the effect lasts for at least 12 months. Adding weight controlling drugs orlistat or sibutramine to behaviour change programs for adolescents may provide additional benefits.

hese findings mark a change in opinion. A systematic review performed in 2003 could not find enough data to draw any conclusions about the effects of different programs. This time the researchers identified 64 randomised controlled trials involving 5230 participants, enabling them to see some definite effects.

"It is now clear that family-based, lifestyle interventions that include a behavioural program aimed at changing diet and physical activity provide significant and clinically meaningful decreases in overweight and obesity in both children and adolescents compared with standard care or self help regimes," says lead researcher Hiltje Oude Luttikhuis, who works at Beatrix Children's Hospital and the Department of Epidemiology in Groningen, Netherlands.

The worldwide obesity epidemic in young people is continuing to gain pace. The International Obesity Taskforce now claims that, worldwide, 10% of 5-17 year olds are overweight and 2-3% are obese. Paediatric obesity rates now stand at 30% for the Americas and 20% for Europe. Socio-economically disadvantaged children in developed countries and children of higher socio-economic status in developing countries are more likely to be overweight. "This highlights the importance of effective treatment strategies for children and young people already affected by the problem of obesity," states Oude Luttikhuis's collaborator, Professor Louise Baur, a paediatrician at The Children's Hospital at Westmead, and the University of Sydney.

There are many questions left unanswered. "We need to find out what types or aspects of different interventions work better for different groups of children, depending on their age, gender, socioeconomic background, faith or ethnic groups. The importance of self-esteem in influencing how successful an intervention will be, and whether there are any characteristics of individual families or patients that could help identify success, require further effort by researchers," says Oude Luttikhuis.

Posted by dlifenews at 03:09 PM | Comments (0)

School-Based Physical Activity: Has Benefits Even If It Doesn't Help Lose Weight

January 20, 2009 (EurekAlert) - School-based health and exercise programs have positive outcomes despite having little effect on children's weight or the amount of exercise they do outside of school, say Cochrane Researchers who carried out a systematic review of studies on physical activity programs in schools.

The research shows that school-based programs increased the time children spent exercising and reduced the time spent watching television. Programs also reduced blood cholesterol levels and improved fitness – as measured by lung capacity. However, programs made little impact on weight, blood pressure or leisure time activities.

Physical inactivity is a key factor behind 1.9 million deaths every year and almost a quarter of all cases of coronary heart disease. People who are overweight as children are more likely to develop heart disease as adults. Exercise helps to maintain a healthy weight, yet studies show most children do not do enough exercise to give any health benefit. The World Health Organisation has identified schools as important settings for promotion of physical activity among children.

The researchers reviewed data from 26 studies of physical activity promotion programs in schools in Australia, South America, Europe and North America. Most studies tried to encourage children to exercise by explaining the health benefits and changing the school curriculum to include more physical activity for children during school hours. Programs included teacher training, educational materials and providing access to fitness equipment.

"Given that there are at least some beneficial effects, we would recommend that schools continue their health promotion programs. These activities should also be supported by public health unit staff, and parents and teachers as positive role models," says lead researcher, Maureen Dobbins, who works at the School of Nursing at McMaster University in Ontario, Canada.

Dobbins believes that schools should make spaces in their timetables to create environments that encourage pupils to engage in physical activity each day as well as having an ethos that encourages increased duration of moderate to vigorous activity each week. "Schools have great opportunities to help pupils learn how to promote health and minimise the risk of acquiring a chronic disease. Providing a healthy structure to their day should enable them to develop healthier lifestyles that may track in adulthood," she says.

She also suggests an explanation for why some programs often don't improve physical health measures such as weight and blood pressure. "Physical activity classes may be too closely associated with school work, so for some students this makes them feel like they are being made to do more work. Perhaps the key is to promote physical activity by getting children and adolescents to 'play' in ways that promote better fitness levels, while at the same time represent fun and adventurous activities," says Dobbins.

Posted by dlifenews at 02:53 PM | Comments (0)

Early Childhood Diet May Influence Future Health

January 14, 2009

January 14, 2009 (EurekAlert) - If you have trouble keeping weight off and you're wondering why – the surprising answer may well be the cheeseburgers you ate – when you were a toddler.

Surprising new research by University of Calgary, Faculty of Kinesiology researcher Dr. Raylene Reimer, published in an international journal, indicates a direct connection between an adult's propensity to put on weight and our early childhood diet.

Reimer is a leader in a growing field of study that examines the developmental origins of health and disease. Researchers in this area believe our pre-natal and early childhood environment influences our future risk of developing conditions like cardio vascular disease, obesity and diabetes.

"My research has shown that the food we eat changes how active certain genes in our body are – what we call genetic expression. In particular we believe that our diet has a direct influence on the genes that control how our bodies store and use nutrients," says Reimer. "There's a growing body of work that indicates a relationship between our health as adults and our early diet, and even our mother's diet. This research shows for the first time that our early childhood diet may have a huge impact on our health as adults."

Reimer's study published in the current Journal of Physiology (London,) compares three groups of rats. At a very young age the rats were weaned onto three separate diets. One group was fed a high protein diet; one group was fed a high fibre diet and a third group was fed a control diet. When the rats became adults, they were switched to a high fat, high sugar diet, which reflects the reality of the typical western diet.

The results were astonishing. The group of rats who were reared on the high protein diet as packed on much more weight and body fat than the rats who had 'grown up' eating the high-fibre diet, who put on the least amount of weight and body fat.

"I believe this study clearly shows that the composition of early childhood diet may have a direct lifelong impact on genes that control metabolism and obesity risk," says Reimer. "This study clearly indicates that diet composition alone can change the trajectory of circulating satiety hormones and metabolic pathways that influence how we gain weight or control blood sugar as adults."

Posted by dlifenews at 02:26 PM | Comments (0)

Nutritious Fast-Food Kids' Meals Are Scarce, Researchers Find

December 22, 2008

December 22, 2008 (EurekAlert) - EAST LANSING, Mich. — Only 3 percent of kids' meals served at fast-food restaurants met federal dietary guidelines in the first study to examine the nutrient quality of such meals in a major U.S. metropolitan market.

The small percentage of meals that did meet dietary guidelines included fruit as a side dish and milk, and nearly all were deli-sandwich meals. They also had about one-third the fat, one-sixth the added sugars, twice the iron and three times the amount of vitamin A and calcium as did meals not meeting the criteria.

"This report is the first to characterize and compare the nutrient quality of all combinations of fast-food kids' meals in a major metropolitan market," Hoerr said. "Because 25 percent of children aged 4 to 8 years consume fast food on a typical day, the diet quality of kids' meals offered by fast-food companies contributes significantly to their overall health and well-being.

"Two trends motivate the need for an evaluation of the nutrient quality of fast-food kids' meals: the increased prevalence of childhood obesity and the amount of food consumed away from home."

The team assessed the quality of kids' meals in the fourth largest U.S. city by using nutrient values provided by the major fast food companies, the seven nutrient criteria from the National School Lunch Program (NSLP) and dietary guidelines for sodium, fiber, added sugar and trans fat.

"We chose Houston because its fast-food restaurants include 12 of the 13 national and regional fast-food companies, represented by 477 restaurants that sell kids meals," O'Donnell said. "Virtually every meal combination is offered in this market, so it provides a pretty comprehensive snapshot of what's out there."

Of the meals that did not meet the NSLP guidelines, more than 65 percent exceeded guidelines for total fat, 75 percent were deficient in calcium, 82 percent were deficient in iron and 85 percent were deficient in vitamin A.

The choice of main entree by itself didn't influence the nutrient content of typical meals studied, the group found, but side choices did. Raisins appeared to be the most nutritious fruit side, due to their high iron content.

"This suggests that parents should carefully read the nutrition information to determine what is included in these meals," Hoerr said. "Sparing use of dipping sauces and other condiments will also help to keep sodium, added sugars and fat low."

Although only a small percentage of the meals met NSLP guidelines, researchers believe fast-food kids' meals can be designed to taste good and meet a basic level of nutrient quality.

"Fast-food companies are not required to produce meals that meet the nutrient protocol of the NSLP, so finding even a small percentage of meals that met the protocol is encouraging," Mendoza said. "Further, 42 percent of all the meal combinations in the study met four or more of the criteria."

Hoerr and her colleagues agree it is the responsibility of the restaurant industry to develop and market more nutritious kids' meal options and for parents to choose healthy kids' meals for their children.

"Through public policy efforts and purchasing choices, parents, physicians, consumer groups, policymakers and public health professionals can deliver a strong, united message to fast-food companies that kids' meals are most desirable when they are nutritious as well as tasty," Hoerr said.

Posted by dlifenews at 11:59 AM | Comments (0)

Tweens and Teens Double Use of Diabetes Drugs

November 03, 2008

November 3, 2008 (Newswise) - America’s tweens and teens more than doubled their use of type 2 diabetes medications between 2002 and 2005, with girls between 10 and 14 years of age showing a 166 percent increase. One likely cause: Obesity, which is closely associated with type 2 diabetes.

The finding is included in a study of chronic medication use in children ages 5 to 19 released today in the journal Pediatrics by researchers from the Saint Louis University School of Medicine, pharmacy benefit manager Express Scripts (Nasdaq: ESRX) and the Kansas Health Institute.

In addition to diabetes, the study found that utilization patterns for blood pressure, cholesterol, attention-deficit disorder and attention-deficit/hyperactivity disorder (ADD/ADHD), asthma and depression medications increased at varying levels during the four year period.

“Our study findings indicate that these increased levels of chronic medication use are symptoms of broader underlying issues affecting children today,” said Emily R. Cox, Ph.D., RPh, senior director of research at Express Scripts. “These trends are worrisome given that many of these therapies are treating conditions with modifiable risk factors and if not addressed, many of these children will carry these chronic conditions into adulthood.”

For example, the use of asthma medications increased 46.5 percent and ADD/ADHD medication use increased 40.4 percent. Cholesterol and blood pressure medications saw a more moderate growth of 15 percent and 1.8 percent, respectively.

Except for asthma medication, older teens age 15-19 years old account for the largest percentage of children taking these medications.

The bad news, according to Donna R. Halloran, M.D., MSPH, assistant professor of pediatrics at Saint Louis University School of Medicine, is that there is more disease, due in large part to the increasing prevalence of childhood obesity.

“Our findings show that childhood obesity not only has long-term health implications, but also impacts children’s immediate health,” Halloran said.

However, she says, the rise of prescription use also indicates that more children are being diagnosed and doctors are increasingly using medication to treat these conditions.

“Our findings indicate that we, the doctors, are doing a better job of screening children and diagnosing chronic conditions,” Halloran said. “A great example of this is blood pressure, where there has been a big push to identify and treat children in need.”

In several cases, the rates of growth were dramatically higher among girls than boys. While boys still take more medications for chronic conditions, the gap has become narrower due to these increases.

The huge increase in type 2 diabetes medication use was driven largely by girls who saw a 147 percent increase over the four year period, compared to boys who saw a 39 percent increase in medicine use. Researchers say they cannot explain this pattern, which is not consistent with the patterns of obesity among boys and girls. However, increased physician office visits and therefore screening rates – particularly for females – could be one contributing factor.

Researchers say the greater increase of girls prescribed ADD/ADHD medication (63 percent versus 33 percent) may be attributed to increased efforts by physicians to identify ADHD in females following studies that suggested that inattentive ADHD, which is much less likely to be identified and treated, was more common in girls than boys.

Another example of a higher increase among females was seen in antidepressants where the number of females between 15 and 19 taking the medicine increased by 6.8 percent, while for males in the same age group, utilization declined slightly. This increase in antidepressant use among older teen girls was a striking exception to decreases for boys and girls ages 5 to 9 and boys ages 10 to 14. It also occurred despite a public health advisory released by the Food and Drug Administration in October 2003 regarding antidepressant use by children. Among all children, the prevalence of antidepressant use had been increasing prior to the advisory, after which it decreased.

Unlike the other medications studied, children ages 5 to 9 accounted for the largest increase in the use of asthma controller medication among the three age groups at 67.3 percent as compared to 38.8 percent for the 10 to 14 age group and 34.7 percent for the 15 to 19 age group.

The researchers noted that this exception could be explained by concerns over the long-term side effects of these medications in children and/or greater physician office visits, and therefore greater likelihood of prescribing.

The database used in conducting the study consists of ambulatory administrative pharmacy claims and eligibility information for over 3.5 million commercially insured children enrolled with Express Scripts between 2002 and 2005.

The study is available at http://pediatrics.aappublications.org/cgi/reprint/122/5/e1053

Express Scripts, Inc. is one of the largest pharmacy benefit management (PBM) companies in North America, providing PBM services to millions of consumers through facilities in 13 states and Canada. Express Scripts serves thousands of client groups, including managed-care organizations, insurance carriers, third-party administrators, employers and union-sponsored benefit plans. Express Scripts is headquartered in St. Louis, Missouri. More information can be found at http://www.express-scripts.com.

Established in 1836, Saint Louis University School of Medicine has the distinction of awarding the first medical degree west of the Mississippi River. The school educates physicians and biomedical scientists, conducts medical research, and provides health care on a local, national and international level. Research at the school seeks new cures and treatments in five key areas: cancer, liver disease, heart/lung disease, aging and brain disease, and infectious disease.

Posted by dlife at 10:17 AM | Comments (0)

Nine Out Of 10 Children With Diabetes Lack Support At School

September 08, 2008

September 8, 2008 (Press Release) - Novo Nordisk, together with the International Society for Pediatric and Adolescent Diabetes (ISPAD), today presented the results from the largest international survey exploring the psychosocial aspects of childhood diabetes. The DAWN Youth (Diabetes, Attitudes, Wishes and Needs) survey draws an alarming portrait of the various challenges that children with diabetes face at school:

Six out of 10 children with diabetes do not manage their diabetes successfully in school (according to their physicians)

Nine out of 10 cannot rely on a school nurse to assist them with their diabetes during school

Indications are that children with diabetes drop out of school earlier than others.

In addition, the survey highlights the lack of awareness and appropriate measures taken such as available school nurses or school staff to answer to the needs of children with diabetes in a school environment. And the consequences of poor diabetes management are frightening: if the blood sugar level is too high or too low the child can feel ill, lose concentration or in worst case, suffer from an insulin shock. Poorly regulated diabetes can, in the long run, lead to severe complications to the heart or kidneys. All this can easily be prevented by good and proper diabetes care and support.

“The situation for children with diabetes in school today is unacceptable. The risks that children face due to poor support in school environments are serious and life-threatening. The DAWN Youth survey results indeed highlight the importance of dealing with the problems of diabetes in relation to children. The conditions for children with diabetes in school can only be changed when parents, school staff and healthcare providers work together – each taking their part of the responsibility,” says Professor Thomas Danne, secretary general of ISPAD.
Need for unified action

Diabetes is one of the most common chronic diseases in childhood and can strike children at any age. Today, more than 200 children a day develop diabetes and the disease poses a severe burden for these children and their families as it affects them physically, mentally and socially. Therefore, children with diabetes need permanent attention from their families and surroundings.

“It is very important to involve families and the education system, starting from primary school. An example for all: we should replace automatic snack vendors with the option of eating fruit and vegetables. We can summarise this lifestyle in a slogan, so that it is easier to understand for children: more sport and nature, less snacks,” declares Italian Senator Emanuela Baio, secretary of the Senate President’s Committee and member of the Parliamentary Committee for Children.

Drawing on coordinated research and advocacy across countries, a variety of initiatives are being facilitated via the DAWN Youth initiative to promote access to adequate education and psychosocial support to families affected by diabetes worldwide. For example, the US DAWN Youth has given substantial support to the training aspects of the American Diabetes Association’s ‘Safe at School’ programme. The programme offers advocacy training for school nurses, school policymakers, educators, parents and other advocates on challenges and strategies in school diabetes care.

“Novo Nordisk strongly believes that all children with diabetes have a right to equal access to education as well as a safe environment at school. Novo Nordisk will continue supporting initiatives that highlight conditions of children with diabetes, raise childhood diabetes awareness and continue to give children with diabetes and their parents a voice,” says Lise Kingo, executive vice president and chief of staffs at Novo Nordisk.

About the DAWN Youth survey
The DAWN Youth survey was carried out in 2007–2008 in order to gather information on diabetes and its influence on the lives of children and young people with diabetes. Schools have been one of the focus areas in the survey. The respondents in the survey were young people with diabetes, parents or caregivers of at least one child with diabetes, and healthcare professionals. 9,200 respondents from 13 different countries participated in the survey.

For more information and background about the DAWN Youth initiative please visit dawnyouth.com.

Posted by dlife at 09:00 AM | Comments (0)

New Study Demonstrates Glucose Device Rapidly Alleviates Major Symptom of Type 1 Diabetes in Children

August 28, 2008

August 28, 2008 (Newswise) - Hypoglycemia, a low blood sugar condition common in people with diabetes, occurs when doses of insulin or oral medications are not balanced properly by food ingestion. Sometimes known as “insulin reaction,” hypoglycemia can occur in both type 1 and type 2 diabetics, including those who are not insulin-dependent.

A study sponsored by Toronto, Ontario-based Generex Biotechnology suggests that a novel glucose-delivering device, Glucose RapidSpray™, provides a higher degree of glycemic control in children with type 1 diabetes, as well as greater compliance.

On the surface, hypoglycemia is “easy” to treat since patients need only consume an appropriate dose of glucose to counteract their low blood sugar. In practice, however, the condition is difficult to treat, particularly in children younger than five years of age, because of difficulties in administering the correct glucose dose as well as patient compliance. Some children with hypoglycemia have difficulty swallowing, which makes administration of oral glucose agents problematic. Another factor is the child’s body weight, typically quite low, which requires small, precise glucose dosages. Also of concern is the potential for hyperglycemic (high blood sugar) rebound, caused by too-high dosing and a counter-regulatory hormone response.

Researchers at Morozovskaya Children City Clinical Hospital in Moscow, Russia and the University Campus Bio-Medico, Rome, Italy presented data at the 44th annual meeting of the European Association for the Study of Diabetes (EASD) in Rome on September 8th. The abstract, entitled, “Glucose RapidSpray™ for a New Management of Hypoglycemia in Children up to 5 Years of Age with Type 1 Diabetes,” demonstrated how this new approach to hypoglycemia treatment that could change the way this disorder is managed in millions of pediatric diabetes patients worldwide.

The EASD Annual Meeting, which brings together more than 12,000 delegates in the healthcare industry, is a premier platform for professional exchange in the field of diabetes. The EASD brings together scientists, physicians, laboratory workers, nurses and students from all over the world who are interested in diabetes and related subjects.

The study involves administration of precise doses of glucose through the Glucose RapidSpray™ (GRS) device, developed by Generex Biotechnology, during the first signs of hypoglycemia in children with type 1 diabetes. The goal of the study was to improved metabolic control as measured by hemoglobin (HbA1c) over a six-month follow up period. HbA1c, also known as glycated hemoglobin, is a measure of blood sugar control over a long period of time, typically the past two to three months.

The Glucose RapidSpray configuration during the study consisted of a 10-milliliter bottle containing ten grams of glucose solution plus artificial flavors and an excipient to facilitate buccal absorption of glucose. The device works by delivering a fine spray containing glucose in quantities as small as half a gram.

The study randomized twenty-seven children with type 1 diabetes into two groups. One group received Glucose RapidSpray on an as-needed basis depending on hypoglycemic symptoms. The control group treated hypoglycemia using traditional methods that include sugar pills, fruit juice, and candies.

Investigators noted HbA1c, number and types of hypoglycemic episodes, compliance, and quality of life in the test subjects at the beginning of the study, at three months, and at the end of the study (six months).

The groups were similar in characteristics at the beginning of the study. At three months both groups showed a significant improvement in HbA1c, but improvement was similar between groups.

However, at six months there was a statistically significant difference in the improvement of the HbA1c in the Glucose RapidSpray-treated group compared with the control group (0.98% vs. 0.60% difference, respectively, p<0.02). Those receiving treatment through Glucose RapidSpray also had a tendency towards for fewer hypoglycemic episodes during the day (p=0.09). Children appeared to comply with GRS treatment more readily, and parents felt more comfortable managing hypoglycemic episodes using the device compared with conventional sources of glucose.

Professor Paolo Pozzilli of the University Campus Bio-Medico in Rome added, "It is a very interesting result which offers a new opportunity for managing early signs of hypoglycaemia to parents of young children with type 1 diabetes. It also underlines how joint projects between two Universities can work well together."

“The benefits of Glucose RapidSpray are striking given the difficulty of managing hypoglycemic episodes in very young children,” noted Anna E. Gluskin, CEO of Generex Biotechnology. “We expect this study will lead to greater awareness of this simple, effective, inexpensive device for fine-tuning blood sugar levels in insulin-dependent diabetics.”

Posted by dlife at 03:21 PM | Comments (0)

Obesity on the Kids’ Menus at Top Chains

August 04, 2008

August 4, 2008 (CSPI News Release) - Nearly every single possible combination of the children’s meals at KFC, Taco Bell, Sonic, Jack in the Box, and Chick-fil-A is too high in calories, according to the nonprofit Center for Science in the Public Interest, which today released the results of an investigation into the nutritional quality of kids’ meals at 13 top restaurant chains. Ninety-three percent of 1,474 possible choices at the 13 chains exceed 430 calories—an amount that is one-third of what the Institute of Medicine recommends that children aged four through eight should consume in a day.

Chili’s has 700 possible kids’ meal combinations, but 658, or 94 percent, of those are too high in calories, including one comprised of country-fried chicken crispers, cinnamon apples, and chocolate milk (1,020 calories) and another comprised of cheese pizza, homestyle fries, and lemonade (1,000 calories). Burger King has a “Big Kids” meal with a double cheeseburger, fries, and chocolate milk (910 calories), and Sonic has a “Wacky Pack” with 830 calories worth of grilled cheese, fries, and a slushie.

KFC has a wide variety of side items, but there are few meal combinations that keep a reasonable ceiling on calories, according to the study. One example of a high-cal combo KFC kid’s meal (the chain calls them “Laptop Meals”) has popcorn chicken, baked beans, biscuit, Teddy Grahams, and fruit punch, which has 940 calories. (KFC has since dropped Baked Cheetos from its kids’ meals, and some outlets vary the number of chicken strips or sides.)

Most of the kids’meals (93 percent) at McDonald’s and Wendy’s are too high in calories, as are the possibilities at Burger King (92 percent), Dairy Queen (89 percent), Arby’s (69 percent), and Denny’s (60 percent—though its kids’ meals don’t include drinks). (Since CSPI’s study was completed, Burger King has introduced one new children’s meal with macaroni and cheese, apple “fries,” and 1 percent milk, which has a reasonable 420 calories.)

Subway’s kids’ meals came out on top. Only a third of its Fresh Fit for Kids meals, which include a mini-sub, juice box, and one of several healthful side items (apple slices, raisins, or yogurt), exceed the 430-calorie threshold. Subway is the only chain that doesn’t offer soft drinks with kids’ meals.

“Parents want to feed their children healthy meals but America’s chain restaurants are setting parents up to fail,” said CSPI nutrition policy director Margo G. Wootan. “McDonald’s, Burger King, KFC, and other chains are conditioning kids to expect burgers, fried chicken, pizza, French fries, macaroni and cheese, and soda in various combination at almost every lunch and dinner.”

Besides being almost always too high in calories, 45 percent of the kids’ meals at the 13 chains studied by CSPI are too high in saturated and trans fat, and 86 percent are too high in sodium. That’s alarming, according to CSPI, because a quarter of children between the ages of five and ten show early signs of heart disease, such as high LDL (the “bad” cholesterol) or elevated blood pressure.

“People may not get a heart attack until their 50s or 60s, but arteries begin to clog in childhood,” said Wootan. “Most of these kids’ meals appear to be designed to put America’s children on the fast-track to obesity, disability, heart attack, or diabetes.”

Though the overwhelming majority of chain restaurant kids’ meals are nutritionally poor, calorie counts on menus and menu boards would help parents assemble healthier meals for their children. If Arby’s kids’ meals had calorie counts, parents could see that substituting a fruit cup and a juice box for fries and a soda would cut a popcorn chicken meal from 720 calories to 420. If Denny’s listed calories on menus, parents could see the surprising difference between the calories in Big Dipper French Toastix (770) and Smiley-Alien Hotcakes (without meat, 370).

CSPI has advocated laws or regulations that require chain restaurants to list calories on menus and menu boards. They’ve already begun appearing in New York City. San Francisco, King County (Seattle), WA., Multnomah County (Portland), OR, and Santa Clara County, CA, also have passed menu labeling policies. Similar policies have been introduced in over 20 other states and localities over the last two years. California’s legislature may be on the verge of passing a statewide menu labeling bill, which lobbyists for the chain restaurant industry are fighting tooth and nail. The California Center for Public Health Advocacy, an advocacy group leading the fight for menu labeling legislation in that state, collaborated with CSPI on the study released today.

CSPI only scrutinized the chains that have dedicated children’s menus (19 out of the top 25 chains) and that provide nutrition information on their web sites or elsewhere (13 chains). Applebee’s, T.G.I. Friday’s, Outback Steakhouse, Olive Garden, Red Lobster, and IHOP do not disclose nutrition information for most menu items even upon request.

Posted by dlife at 03:51 PM | Comments (0)

Sun Exposure And Vitamin D Levels May Play Strong Role In Risk Of Type 1 Diabetes In Children

June 05, 2008

June 5, 2008 (Press Release) - Sun exposure and vitamin D levels may play a strong role in risk of type 1 diabetes in children, according to new findings by researchers at the Moores Cancer Center at University of California, San Diego (UCSD) and the Department of Family and Preventive Medicine. This association comes on the heels of similar research findings by this same group regarding vitamin D levels and several major cancers.

Findings by this same group regarding vitamin D levels and several major cancers.

In this new study, the researchers found that populations living at or near the equator, where there is abundant sunshine (and ultraviolet B irradiance) have low incidence rates of type 1 diabetes. Conversely, populations at higher latitudes, where available sunlight is scarcer, have higher incidence rates. These findings add new support to the concept of a role of vitamin D in reducing risk of this disease.

Ultraviolet B (UVB) exposure triggers photosynthesis of vitamin D3 in the skin. This form of vitamin D also is available through diet and supplements.

"This is the first study, to our knowledge, to show that higher serum levels of vitamin D are associated with reduced incidence rates of type 1 diabetes worldwide," said Cedric F. Garland, Dr. P.H., professor of Family and Preventive Medicine in the UCSD School of Medicine, and member of the Moores UCSD Cancer Center.

The study is published June 5 in the online version of the scientific journal Diabetologia.

Type 1 diabetes is the second most common chronic disease in children, second only to asthma. Every day, 1.5 million Americans deal with type 1 diabetes and its complications. About 15,000 new cases are diagnosed in the United States each year, where this disease is the main cause of blindness in young and middle-aged adults and is among the top reasons for kidney failure and transplants in youth and midlife.

"This research suggests that childhood type 1 diabetes may be preventable with a modest intake of vitamin D3 (1000 IU/day) for children, ideally with 5 to 10 minutes of sunlight around noontime, when good weather allows," said Garland. "Infants less than a year old should not be given more than 400 IU per day without consulting a doctor. Hats and dark glasses are a good idea to wear when in the sun at any age, and can be used if the child will tolerate them."

The association of UVB irradiance to incidence of type 1 diabetes remained strong even after the researchers accounted for per capita healthcare expenditure. This was an important consideration because regions located near the equator tend to have lower per capita healthcare expenditures, which could result in under-reporting of type 1 diabetes.

The researchers created a graph with a vertical axis for diabetes incidence rates, and a horizontal axis for latitude. The latitudes range from -60 for the southern hemisphere, to zero for the equator, to +70 for the northern hemisphere. They then plotted incidence rates for 51 regions according to latitude. The resulting chart was a parabolic curve that looks like a smile.

In the paper the researchers call for public health action to address widespread vitamin D inadequacy in U.S. children.

"This study presents strong epidemiological evidence to suggest that we may be able to prevent new cases of type 1 diabetes," said Garland. "By preventing this disease, we would prevent its many devastating consequences."

Posted by dlife at 09:44 AM | Comments (0)

Kids Growing Up on Grown Up Drugs: New Research Shows Treatments for Adult Ailments Rapidly Rising in Children

May 15, 2008

Lifestyle Factors Pushing Children's Use of Prescription Drugs for Health Conditions Once Seen Primarily in Adults

May 15, 2008 (PRNewswire-FirstCall) -- Health problems long considered adult conditions and caused in large part by lifestyle factors are rapidly afflicting children and leading to a surge in pediatric use of prescription drugs to treat these ills.

New research released today by Medco Health Solutions, Inc. NYSE: MHS shows that the number of children taking medications to treat type 2 diabetes, sleep problems and gastrointestinal disorders such as heartburn has more than doubled in a seven-year span. Based on this data, there are now approximately 1.2 million children in the U.S. taking these traditionally adult medications.

The analysis, which reviewed prescription claims of about 600,000 insured children ages 19 and under, also reveals that heart disease-related conditions are creeping into childhood. While the prevalence rate is still quite small, the use of medications to treat high cholesterol and high blood pressure in children is on the rise.

"It's a 21st century reality that pediatricians are treating more and more young people suffering from conditions like type 2 diabetes once associated almost exclusively with adults," states Dr. Renee Jenkins, FAAP, President of the American Academy of Pediatrics. "Lifestyle changes such as diet and exercise should always be recommended to patients and evaluated by physicians before they prescribe any medications."

According to the research, use of type 2 diabetes medications saw the greatest spike, rising more than 150 percent from 2001 to 2007; girls led the way with a three-fold increase. The prevalence of children on proton pump inhibitors (PPIs) -- medications used to treat heartburn and gastrointestinal reflux disease (GERD) -- rose 137 percent in the same time frame. Prescription sleep aid use showed the slowest growth over the seven-year period, up 34 percent among all children; but was almost twice as high (62 percent) for children ages 10-19. One encouraging sign is that the prevalence of children on hypnotics actually declined from 2006 to 2007, suggesting that physicians and parents may be rethinking the use of these medications in children.

Adding Pediatric Pressures to an Overburdened Health Care System

This research also raises serious questions about how well-equipped our health care system is for dealing with these growing numbers of young people afflicted with adult conditions. According to a recent study in The Journal of Pediatrics, the number of practicing pediatric endocrinologists, specialists who treat diabetes patients, is not keeping pace with the growth in the prevalence of childhood diabetes. The study found that there is only one endocrinologist available for every 290 children with diabetes and every 17,000 obese children who may be at risk for developing diabetes. Studies have also shown shortages in other pediatric subspecialties which could severely impact the care necessary for children with cardiovascular and gastrointestinal problems.

"Our pediatric specialist care system is already overtaxed; we could be facing a real crisis if these adult conditions become increasingly prevalent in children and require specialized care," said Dr. Robert Epstein, Medco's chief medical officer. "We're also looking at potentially hundreds of millions of dollars in added health care costs with children developing chronic conditions early in life that could extend into their adulthood."

Rx for Safe Medication Use

With increasing medication use among the pediatric population, ensuring that prescription drugs are being utilized safely and properly in children is of paramount concern. Medco provides several safety nets for pediatric patients including a comprehensive drug utilization review (DUR) system that puts every prescription a child is on through a comprehensive clinical rules set. The system assesses if the drug and the dose is appropriate given the patient's age. In addition, the system fires an alert if a new medication were to interact negatively with another prescription, putting the child at risk for an adverse drug event. Medco's advanced pharmacy practice also has specialist pharmacists trained and uniquely experienced in caring for patients with specific chronic conditions such as diabetes, and gastrointestinal, cardiovascular and neurological problems, that can assist children and their families in better managing their treatments and health conditions should an issue arise.

Posted by dlifenews at 11:39 AM | Comments (0)

More Kids with Diabetes, Few Specialized Docs to Care for Them

March 10, 2008

March 10, 2008 (Newswise) - The rate of childhood obesity in the United States has more than doubled in the past 20 years, bringing with it more children at risk for developing type 1 and even type 2 diabetes.

Despite this growing trend, the number of board-certified pediatric endocrinologists – those physicians who specialize in caring for children with diabetes and obese children at risk for the disease – is not keeping pace with demand for their specialized care, say researchers at the University of Michigan C.S. Mott Children’s Hospital.

Results from a new study published in the March issue of The Journal of Pediatrics show that at the national level, for every 290 children with diabetes, there is only one board-certified pediatric endocrinologist available to care for them. It also finds that the ratio of obese children to board-certified pediatric endocrinologists is about 17,000 to one.

“Although the American Diabetes Association recommends that all children with diabetes be cared for by a pediatric endocrinologist as part of a diabetes team, there is a current shortage of pediatric endocrinologists in this country,” says study lead author Joyce Lee, M.D., MPH, a pediatric endocrinologist and member of the Child Health Evaluation and Research (CHEAR) Unit in the U-M Division of General Pediatrics. “This problem will likely only worsen due to the recent epidemic of childhood obesity.”

Currently, 16.5 percent of American children ages 6 to 19 are obese. These children are at an increased risk for developing diseases previously thought to be limited to adults, including type 2 diabetes, high blood pressure and high cholesterol. As a result, more children than ever before are being referred to pediatric specialists, such as pediatric endocrinologists who can screen, evaluate and manage children at risk for developing diabetes.

“Even if just a small fraction of obese children are referred to a pediatric endocrinologist for evaluation, the overall ratio of one pediatric endocrinologist to 17,000 obese children makes providing the necessary care extremely challenging,” says Lee, assistant professor in the Department of Pediatrics and Communicable Diseases at the U-M Medical School.

The bottom line: pediatric endocrinologists currently do not have the capabilities to see even a fraction of the large number of children with diabetes or at risk for diabetes. “The epidemic of childhood obesity has undoubtedly created new challenges for our health care, and we need to reassess the current system to ensure children with diabetes or at risk for diabetes receive appropriate care,” Lee notes.

Using data from the American Board of Pediatrics and the National Survey of Children’s Health, Lee and her colleagues compared the number of board certified pediatric endocrinologists by region to obese children and children with diabetes in those same areas.

Their research revealed that there are an estimated 229,249 children with diabetes, and only 790 board-certified pediatric endocrinologists in the country. And, in two states – Montana and Wyoming – there are no board-certified pediatric endocrinologists.

Further complicating matters, Lee and her colleagues found that the geographic distribution of children with diabetes and obesity does not match the geographic distribution of board-certified pediatric endocrinologists.

According to study results, the area with the greatest supply of pediatric endocrinologists was in the Northeast. In comparison, the Midwest fared the worst with regard to the supply of pediatric endocrinologists. The geographic disparity was even greater for ratios of children with obesity to board-certified pediatric endocrinologists by state, ranging from about 5,000 to one in Massachusetts to about 99,000 to one in Mississippi.

While the American Board of Pediatrics reports that the number of medical fellows entering the field of pediatric endocrinology since 1997 has increased annually by 12 percent – with about 76 pediatricians entering the field from 2005 to 2006 – Lee cautions that it is still not enough of an increase to meet growing demand for care.

“The increases in the endocrinology workforce are incremental. Ultimately, the pediatric endocrine workforce shortage raises the question of how health care delivery for U.S. children with diabetes and children at risk for diabetes should ideally be organized,” says Lee.

She notes that a critical reassessment of the current system of health care delivery for obese children is needed, along with the creation of sustainable models of care to effectively improve health outcomes for obese children who are at risk for developing chronic diseases in childhood.

To learn more about childhood obesity and diabetes care offered at C.S. Mott Children’s Hospital, visit these Web sites:

• Pediatric endocrinology, diabetes and metabolism services: http://www2.med.umich.edu/departments/mott/clinics/dsp_cliniclist.cfm?group_id=ENDO
• Pediatric Comprehensive Weight Management Center: http://www.med.umich.edu/MPOWER/index.shtml

In addition to Lee, U-M C.S. Mott Children’s Hospital co-authors are: Matthew M. Davis, M.D., M.A.P.P., associate professor of general pediatrics and internal medicine, and associate professor of public policy at the Gerald R. Ford School of Public Policy; Ram K. Menon, M.D., professor, Department of Pediatrics and Communicable Diseases, and director of Pediatric Endocrinology; and Gary L. Freed, M.D., MPH, Percy and Mary Murphy Professor of Pediatrics and Child Health Delivery, and chief of the Division of General Pediatrics.

Lee’s work on this study was supported by the Clinical Sciences Scholars Program at the University of Michigan.

Reference: The Journal of Pediatrics, March 2008, Vol. 152, No. 3.

Posted by dlife at 03:06 PM | Comments (1)

Overweight Hispanic Children Shown To Have Vascular Inflammation

February 27, 2008

February 27, 2008 (Joslin Diabetes Center) — Overweight Hispanic children with normal blood glucose (sugar) levels showed elevated markers for blood vessel inflammation that may predispose them to developing both type 2 diabetes and cardiovascular disease, says a new study led by researchers from the Joslin Diabetes Center.

The study, published in the March issue of Diabetes Care, is the first to focus on Hispanic children, already known to be at high risk for developing type 2 diabetes as a result of both genetic and lifestyle factors.

“Our findings suggest that these children are not only at risk for type 2 diabetes, but also for cardiovascular disease,” said Dr. A. Enrique Caballero, lead investigator.

The study looked at 38 Hispanic children and adolescents, ages 10 through 18. Twenty-one were obese but with normal blood glucose levels, so they had not yet developed diabetes. The rest were considered lean. As a group, the obese subjects had significantly higher percentages of body fat than the lean group and were already showing signs of insulin resistance, meaning the insulin that their bodies produce is not working well and as a consequence their pancreases were being forced to work harder to produce more insulin to maintain normal blood sugar levels.

Overall, the obese group exhibited increased blood markers for subclinical or asymptomatic inflammation of the inner layer of blood vessels. “They are already exhibiting problems with circulation,” said Caballero, Director of the Latino Diabetes Initiative, Clinical Investigator, Staff Endocrinologist and Director, Medical Affairs, Professional Education at Joslin Diabetes Center, as well as an Assistant Professor of Medicine at Harvard Medical School. “There is an inflammatory process going on in the vessels.”

Such problems suggest these children may be at increased risk of developing cardiovascular problems at a young age, he said.

Subclinical vascular inflammation is a key element in the development of cardiovascular disease and is closely associated with insulin resistance. It also predicts the development of type 2 diabetes.

Earlier studies in overweight or obese children and adolescents showed similar vascular abnormalities, but were conducted primarily in non-Hispanic children.

Caballero wanted to study Hispanic children because they had not previously been studied and because they are a high-risk population for type 2 diabetes.

“We have found that overweight Hispanic children and adolescents have elevated markers of endothelial dysfunction and vascular inflammation closely related to excess body fat and increased insulin resistance,” the paper concluded. “This. . . may increase their risk of developing type 2 diabetes and cardiovascular disease, further emphasizing the need for obesity prevention strategies.”

Caballero said such strategies must be culturally appropriate.

“Even if these abnormalities may not be that different than those in Caucasian children, the strategies to prevent heart disease and diabetes need to be culturally oriented,’’ he said. “They need to be tailored to the population.”

Caballero stressed that the findings do not mean that such children will definitely develop type 2 diabetes or cardiovascular problems, but said the idea is to step in early to make sure they don’t.

“The problem is serious enough to warrant attention and a prevention strategy,” he said.

The research was funded by a grant from Sanofi Aventis and a National Institutes of Health grant for general clinical research at Beth Israel Deaconess Medical Center.

In addition to Dr. Caballero, other researchers participating in the study included: Dr. Ludivina Robles-Osorio, Valeria Montagnani, RN, Dr. Geetha Soodini, Dr. Sriurai Porramatikul, Dr. Osama Hamdy and Dr. Edward S. Horton from the Joslin and Kelb Bousquet-Santos and Dr. Antonio C.L. Nobrega from Fluminense Federal University in Brazil.

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