September 29, 2009 (EurekAlert) - Researchers studying a large sample of adolescent American boys have found an association between metabolic syndrome, which is a complication of obesity, and elevated liver enzymes that mark potentially serious liver disease.The link between metabolic syndrome and the suspected liver disease did not appear in adolescent girls, said study leader Rose C. Graham, M.D., a pediatric gastroenterologist at The Children's Hospital of Philadelphia. There were ethnic differences among the boys as well, she added, between Hispanic and non-Hispanic males.

The study appears in the October 2009 print edition of the Journal of Pediatric Gastroenterology and Nutrition.

Metabolic syndrome is of concern as a risk factor for cardiovascular disease and type 2 diabetes, and is estimated to occur in 22 percent of U.S. adults and 4 percent of U.S. adolescents. It is defined by insulin resistance, increased waist circumference, high blood pressure, and abnormal measures of high density lipoprotein ("good cholesterol") and triglycerides in the blood. The criteria are similar for pediatric metabolic syndrome, although there is some dispute over details of the definition.

In adults, researchers have shown an association between metabolic syndrome and a group of diseases called nonalcoholic fatty liver disease (NAFLD), which at its most severe, may progress to irreversible liver damage. The purpose of the current study was to investigate to what extent metabolic syndrome in adolescents was associated with elevated levels of the liver enzyme alanine aminotransferase (ALT), a marker of NAFLD.

Graham and colleagues analyzed a nationally representative sample of 1,323 U.S. adolescents, aged 12 to 19, from the National Health and Nutrition Examination Survey. They found a strong association between metabolic syndrome and elevated ALT levels in adolescent males, but not in adolescent females.

While looking more carefully at this association in boys, they found that among Hispanic males, this association largely coincided with being obese, as measured by body mass index. The researchers expected to find this correlation, because for all ethnicities, obesity was already known to be a risk factor for both metabolic syndrome and NAFLD. However, they also found that among non-Hispanic adolescent boys, metabolic syndrome and high ALT levels were associated with each other, independent of obesity. "Something else seems to be going on, in addition to the effects of obesity," said Graham. "Some unknown factors may be at work here."

The finding may have implications for treatment, she added. Currently, the only known treatment for NAFLD is weight loss. "If some adolescents with metabolic syndrome may be susceptible to this liver disease regardless of whether or not they are obese, there may be other treatments yet to be discovered."

NAFLD is increasingly being recognized among overweight teenagers. "Our findings suggest that NAFLD in adolescents merits closer attention, and its treatment may require more than just weight loss," said Graham.

September 28, 2009 (EurekAlert) - For physicians treating patients with diabetes, practical support is important in improving glycemic control. Researchers writing in the open access journal BMC Public Health found that setting goals and pro-active follow-up helped patients achieve good glycemic control. In this study, empathic listening and eliciting patient preferences were not associated with differences in glycemic control outcomes.Jochen Gensichen, from University Hospital Jena, Germany, worked with a team of researchers to correlate 3897 patients' views on their doctors' levels of practical and communicative support with those patient's glycosylated haemoglobin levels. He said, "Despite improvements in the quality of diabetes care over the last decade, considerable room for improvement remains. Two possible areas where care could be improved are in doctor-patient communication and levels of practical support offered. We sought to assess the effects of these factors on glycemic control".

The researchers found that physicians' characteristic level of practical support was associated with more favorable glycemic control outcomes. Contrary to their expectations, physicians' level of communicative support was not associated with differences in glycemic control, although practical and communicative support were correlated. According to Gensichen, "These results suggest that physicians who typically offer higher levels of practical support for diabetes self-management have patients who achieve more favorable glycemic control at follow-up. While patient ratings of physicians' communicative support were not associated with glycemic control, measures of communicative and practical support were correlated so these two forms of support may be viewed as complementary".

September 25, 2009 (EurekAlert) - Teenagers' attitudes to diet and weight are shaped by their social class, according to new research funded by the Economic and Social Research Council.Policymakers have long insisted on the importance of understanding young people's health and eating habits but this is the first study to show how everyday practices and perceptions of different social classes contribute to variation in the diet, weight and health of teenagers.

'It is evident that children are moulded according to their parents' expectations about behaviour,' says Dr Wendy Wills of the University of Hertfordshire, who led the research. The study reveals the ideals and beliefs of both family life and parenting by looking at the diet, weight and health of middle class teenagers, their parents and comparing them with an earlier study of working class families.

Middle class families look towards their children's future, expecting young teenagers' tastes to develop and have a good body shape to actively participate in adult life. Parents expressed concern that if children were overweight they would have poor health in later life. They also felt that being overweight would affect the children's self-esteem and ability to take part in life's opportunities.

In working class families, concern for the future is dominated by more pressing concerns about everyday life. 'In the context of risk and insecurity for working class families, the ideal body shape has little value,' says Dr Wills.

Although working class families express the desire to improve the diet and lifestyle of their children, they sometimes lack the social and cultural abilities as well as money to make such changes happen.

At the same time, the independence of teenagers to make their own food choices and take responsibility for their health is seen as an important sign of being working class. This contrasts with middle class families where parents supervise and control young teenagers' food choices on a daily basis.

Middle class teenagers saw obesity as the result of being lazy, unhealthy or unable to control a desire for 'bad foods'. Middle class parents feel a moral urgency to ensure their children to stay an 'acceptable' size. Being seen to be 'respectable' in this regard is a significant sign of middle class distinctions.

The findings of the study have proved important for understanding why inequalities in diet, health and weight continue to persist. NHS Health Scotland have used to them to help Health Boards implement child healthy weight initiatives and the Department of Health's new Healthy Living social marketing initiative also uses the project's research.

However, policymakers should not expect quick results, the study warns. 'Given the complex, embedded nature of familiar practices and beliefs,' says Dr Wills, 'policy and practice targets need to be realistic in terms of the timescale needed for achieving change.'

September 24, 2009 (EurekAlert) - Diabetes prevalence is highest in the Southern and Appalachian states and lowest in the Midwest and the Northeast of America. Researchers writing in BioMed Central's open access journal Population Health Metrics have used two public data sources to investigate the prevalence of diagnosed and undiagnosed diabetes mellitus at the State level.Goodarz Danaei, from the Harvard School of Public Health, Boston, worked with a team of researchers to combine the data from the National Health and Nutrition Examination Survey and the Behavioral Risk Factor Surveillance System. He said, "Diabetes mellitus is the sixth leading cause of death in the United States, accounting for approximately 70,000 annual deaths. To our knowledge, this is the first study to estimate what the true level of diabetes disease is in every state and how the different states perform in terms of diagnosed vs. undiagnosed diabetes".

Age-standardized diabetes prevalence was highest in Mississippi, West Virginia, Louisiana, Texas, South Carolina, Alabama and Georgia, ranging from 15.8% to 16.6% for men and 12.4% to 14.8% for women. The lowest prevalences were found in Vermont, Minnesota, Montana, and Colorado, just 7% for women in the Northeast and some Western states. These results currently provide the only estimates of total diabetes and undiagnosed diabetes in U.S. states. According to Danaei, "States like Minnesota and Alabama with the highest estimated diabetes prevalence in our analysis also have the highest levels of blood pressure and cardiovascular disease risk. This concentration of cardiovascular risks and diabetes points to the need for lifestyle and health care interventions in these states".

The researchers hope their figures will provide motivation, guidance, and benchmarks for designing, implementing, and evaluating diabetes prevention and state level control programs at the state level.

September 23, 2009 (EurekAlert) - The commercial failure of Exubera® (Pfizer, New York, NY), the first inhaled insulin product to come to market, led other companies such as Eli Lilly-Alkermes to halt studies of similar drug delivery in development intended to compete for a share of the lucrative diabetes market. Does this signal defeat for efforts to deliver insulin via the lungs? The science and circumstances behind the Lilly-Alkermes decision to discontinue trials of the AIR® inhaled insulin product are explored in a special supplement to Diabetes Technology & Therapeutics, a peer-reviewed journal published by Mary Ann Liebert, Inc. (www.liebertpub.com). The supplement is available free online at www.liebertpub.com/diaThe supplement presents the data on AIR inhaled insulin that has been made available by Eli Lilly (Indianapolis, IN) and Alkermes (Cambridge, MA), co-developers of the drug. Eight articles describe various protocols in which the effectiveness and safety of AIR were compared to traditional insulin injections in patients with type 1 or type 2 diabetes. These studies represent noninferiority trials, in which AIR was evaluated for its potential to be at least as safe and effective as subcutaneous (SC) insulin across a range of parameters.

Satish K. Garg, MD, Professor of Medicine and Pediatrics at the University of Colorado Denver, and Editor-in-Chief of Diabetes Technology & Therapeutics, and colleagues report the results of a 2-year Phase 3 trial conducted in 385 patients, in an article entitled, "Two-Year Efficacy and Safety of AIR Inhaled Insulin in Patients with Type 1 Diabetes: An Open-Label Randomized Controlled Trial." The study found AIR to be inferior to SC insulin (in a noninferiority clinical trial design) in its ability to maintain optimal blood glucose levels over time, based on measurements of glycosylated hemoglobin (HbA1c).

Similarly, Angel L. Comulada, MD, FACE, Instituto de Endocrinología, Diabetes & Metabolismo, Toa Baja, Puerto Rico, and coworkers demonstrated inferiority of AIR in their study of 500 patients with type 1 diabetes over 6 months. They report their findings in the article "Efficacy and Safety of AIR Inhaled Insulin Compared to Insulin Lispro in Patients with Type 1 Diabetes Mellitus in a 6-Month, Randomized, Noninferiority Trial."

"The question now remains whether this route of delivering insulin has been exhausted or if it still remains to be explored," write Satish Garg, MD and William Kelly, BS from the University of Colorado Denver in the Editorial "Insulin Delivery via Lungs-Is It Still Possible?" MannKind Corporation recently filed a New Drug Application with the FDA for Technosphere® Insulin. It offers faster onset of action with lower postprandial blood glucose excursions especially in the first two hours and is weight neutral, according to the Editorial.

September 22, 2009 (EurekAlert) - The SwitchTM programme, 'Switch what you Do, View, and Chew', has been shown to be capable of promoting children's fruit and vegetable consumption and lowering 'screen time'. Researchers writing in the open access journal BMC Medicine tested the programme and report that it offers promise for use in youth obesity prevention.Douglas Gentile, a psychology professor from Iowa State University, USA, worked with a team of researchers to evaluate the intervention in a group of 1,323 children and their parents from 10 schools. He said, "Reversing the pediatric obesity epidemic has been established as a critical priority. We tested Switch, a family-, school-, and community-based intervention aimed at changing the key behaviors of physical activity, television viewing/screen time, and nutrition".

The Switch programme features three components, Community, School and Family. The Community component is designed to promote awareness of the importance of healthy lifestyles using paid advertising (such as billboards) and unpaid media (such as letters to the editors of print publications). The School component reinforces the Switch messages by providing teachers with materials and methods to integrate key health concepts into the school day. Finally in the Family component, participating families receive monthly packets containing behavioral tools to assist families in altering their health behaviors.

Gentile said, "Family components are critical for youth obesity prevention programs because parents directly and indirectly influence children's activity and nutrition behaviors. Parents also influence the physical and social environments that are available to their children. The School and Community components are essential to integrate the programme into the places where families live, work and play".

The intervention yielded encouraging results, with the experimental group showing significant differences from the control group in both screen time and fruit and vegetable consumption. According to Gentile, "Although modest, these results are not trivial. The effects remained significant at the 6-month follow-up evaluation, indicating maintenance of these differences over time. Such maintenance may contribute to reduced weight risks in the future".

September 22, 2009 (Newswise) - Researchers have long suspected that overweight people tend to have large fat deposits in their pancreases, but they've been unable to confirm or calculate how much fat resides there because of the organ's location.Until now.

Scientists at UT Southwestern Medical Center are the first in the U.S. to use an imaging technique called magnetic resonance spectroscopy (MRS) to measure the amount of pancreatic fat in humans.

Though scientists worldwide already use MRS to investigate a number of diseases including breast cancer and epilepsy, the UT Southwestern group has successfully used the noninvasive method to measure pancreatic fat.

Findings from a new UT Southwestern study available online and in a future issue of the Journal of Clinical Endocrinology and Metabolism suggest that measuring pancreatic fat content in people could one day serve as an effective clinical tool to identify those at high risk of diabetes and monitor interventions designed to prevent the disease.

"These are very early results, but if they hold true, pancreatic MRS would be a fast and noninvasive test to screen people at risk for diabetes either because they're obese or they have a family history of type 2 diabetes, or metabolic syndrome," said Dr. Ildiko Lingvay, assistant professor of internal medicine at UT Southwestern and lead author of the study. "It could potentially tell physicians which patients are most likely to develop diabetes in the near future and thus are in need of more aggressive interventions."

MRS is a specialized technique similar to magnetic resonance imaging (MRI). It uses no radiation and is completely noninvasive. The test generally takes 20 to 30 minutes. Whereas an MRI can tell clinicians where a tumor is located, MRS can tell those physicians whether the tumor is malignant by providing biochemical information about specific tissues in the body rather than simply detecting the existence of those tissues, Dr. Lingvay said.

For this study, researchers used MRS to measure the amount of pancreatic fat in 79 adult volunteers. The research team obtained duplicate measurements one to two weeks apart from 33 study participants to make sure the results could be replicated over time.

The volunteers were divided into four groups according to their body mass index (BMI) and glucose tolerance. BMI is a weight-to-height ratio commonly used in to gauge obesity. A normal BMI is between 18.5 and 25; someone with a BMI of 40 or more is considered morbidly obese. All participants underwent numerous physical measurements including height, weight and blood pressure in addition to extensive clinical evaluations.

Using MRS, the researchers found that the overweight and obese volunteers had significantly more pancreatic fat than did those in the lean group. The volunteers who had similar BMIs but had already developed either pre-diabetes or diabetes had even more pancreatic fat.

MRS has not been approved for routine clinical use, but Dr. Lingvay said this research shows that it could be a very valuable tool for studying the pancreas without a biopsy. "This technology represents a good opportunity for clinicians to pursue research that hasn't been possible because of the lack of advanced tools," she said.

The next step, Dr. Lingvay said, is to determine whether reducing the amount of fat in the pancreas lowers diabetes risk.

Other UT Southwestern researchers involved in the study included Dr. Victoria Esser, associate professor of internal medicine; Jaime Legendre, recipient of a Clinical Research Fellowship from the Doris Duke Charitable Foundation; Dr. Angela Price, postdoctoral clinician trainee in internal medicine; Kristen Wertz, research associate in internal medicine; Beverley Adams Huet, assistant professor of clinical sciences; Dr. Song Zhang, assistant professor of clinical sciences; Dr. Roger Unger, professor of internal medicine; and Dr. Lidia Szczepaniak, former assistant professor of internal medicine and radiology.
The study was supported by the National Institutes of Health and the Doris Duke Charitable Foundation.

September 22, 2009 (Newswise) - Obesity is an important factor contributing to chemotherapy resistance and increasing relapse rates among children with leukemia, according to recent findings published online first in Cancer Research, a journal of the American Association for Cancer Research.Obesity is associated with increased incidence and mortality of many types of cancer. Leukemia is the most common cancer in children, affecting more than 2,000 children each year in the United States alone, according to background materials in the study.

Given the increasing prevalence of obesity worldwide, these findings could have important implications for cancer treatment and may help explain the increased leukemia relapse rate in obese patients, according to the study's lead researcher Steven D. Mittelman, M.D., Ph.D. Mittelman is the fellowship research director with the Division of Endocrinology at Childrens Hospital Los Angeles, and assistant professor of pediatrics, physiology and biophysics at the Keck School of Medicine, University of Southern California.

"Obesity could increase cancer incidence and mortality through a variety of ways. It may impair the immune system's ability to stop cancer, or predispose cells to become cancerous," Mittelman suggested. "Once you have cancer, and if you are obese, the fat cells themselves may impair the ability of chemotherapy to fight cancerous cells."

This study was inspired by a previous study led by a colleague, Anna Butturini, M.D., associate professor of clinical pediatrics in the Division of Hematology-Oncology at Childrens Hospital, which showed that obese children diagnosed with leukemia have a 50 percent higher chance of relapsing compared with lean children.

Using preclinical models, Mittelman and colleagues investigated the reason why obese children were more at risk of relapse. They developed a mouse model of obesity and leukemia, cultured fat and leukemia cells together, and treated the leukemia cells with traditional chemotherapy drugs used in children - vincristine, nilotinib, daunorubicin and dexamethasone.

Obese mice with leukemia had higher relapse rates than lean mice after treatment with the first-line chemotherapeutic agent vincristine. The chemotherapy treatments all worked less effectively in culture when fat cells were nearby. When the mice relapsed from the leukemia, the researchers found leukemia "hiding out" in the fat tissue during chemotherapy, according to Mittelman.

"These four drugs attack leukemia cells by different routes, so when we saw fat cells blocking them we realized there could be an important mechanism promoting their ability to live and divide," he said. "We were surprised to find leukemia cells in the fat tissue."

David Hockenbery, M.D., member of the Fred Hutchinson Cancer Research Center and professor of internal medicine at the University of Washington, said "this study provides striking experimental support for the clinical observations that obesity is associated with poor prognosis in multiple cancers."

The researchers demonstrated that co-culture of leukemia cells with adipocytes diminishes response to multiple chemotherapeutic agents. Therefore, adipose tissue may function as a "safe haven" for leukemia cells during therapy, according to Hockenbery. Based on the finding that adipocytes accumulate chemotherapeutic drugs, he advised that careful attention be paid to dose adjustments based on pharmacokinetic measurements.

"In addition, by highlighting a potential communication between adipocyte and leukemia cells, this research will stimulate efforts to find a diffusible factor that protects leukemia cells from chemotherapy," said Hockenbery.

More research is needed to figure out how fat cells are a part of the tumor microenvironment and how they block potentially lifesaving treatments, according to Mittelman. The researchers are currently conducting additional studies to evaluate other chemotherapeutics, how obesity may or may not affect treatment and the effect of fat cells found in bone marrow on leukemia.

September 16, 2009 (Newswise) - Vitamin D appears to boost health from head to toe, according to the September issue of Mayo Clinic Health Letter. But, so far, there's no consensus on what level of vitamin D is optimal for good health.Recent reports on vitamin D suggest that it offers many benefits, especially for older adults. Findings point to improved balance, reduction in the risk of bone fractures, and better thinking skills such as planning, organizing and abstract thinking. Low levels of vitamin D are associated with diabetes, cardiovascular disease, multiple sclerosis and other autoimmune disorders, infections such as tuberculosis, and periodontal disease. Low vitamin D levels also may affect certain cancers, including colon, breast and prostate cancers.

Vitamin D is the only vitamin that the body can manufacture itself. The only requirement is sunshine, specifically ultraviolet B rays. About 10 to 15 minutes of exposure two to three times a week during nonpeak sun hours is considered adequate. But the sunshine approach doesn't work for everyone. With age, the body is less efficient at processing vitamin D. Other barriers are darker skin and living in northern climates. Using sunscreen -- still recommended to prevent skin cancer -- also reduces absorption of ultraviolet B rays.

Food sources are usually an excellent way to obtain vitamins, but choices are limited for vitamin D. Rich sources are fatty fish, fish-liver oils, liver and egg yolks. Milk fortified with vitamin D is another option.
With limited food choices, consumers may opt to rely on vitamin D supplements. The current daily recommended dose of vitamin D for adults 50 and older is 400 to 600 international units (IU). But many researchers believe that a higher amount is warranted because of the many health benefits. The National Osteoporosis Foundation recommends a daily intake of 800 to 1,000 IU per day for adults over age 50. The upper daily limit considered safe for use is 2,000 IU per day, but there's debate about this level. Very large doses of vitamin D taken over time can cause ill effects, including nausea, vomiting, poor appetite, constipation, weakness and weight loss.

September 15, 2009 (Newswise) - A new study shows that parents are more likely to understand a body mass index (BMI) chart if it's color-coded, like a traffic light, than the standard charts currently in use."We think that better communication of BMI from doctor to parent could lead to parents earlier awareness of their child's weight status in time to help them make important lifestyle changes," says Eliana Perrin, M.D., M.P.H., senior and corresponding author of the study and assistant professor of pediatrics at the University of North Carolina at Chapel Hill School of Medicine.

In the study, published in the September/October 2009 issue of journal Academic Pediatrics, a sample of 163 parents of children seen at pediatric clinics at UNC and Vanderbilt University were tested to assess their understanding of BMI, their health literacy and their math abilities.

"Childhood obesity is an American epidemic that bears enormous health and economic costs to everyone," says Perrin, also a Research Fellow at the UNC Center for Health Promotion and Disease Prevention. "Health professionals need more effective ways of communicating our messages to parents if we want to stem this tide. We have to keep trying to help people understand the concerns their children face now and in the future."

The BMI portion of the test included some questions that parents were asked to answer using a standard BMI chart and other questions in which they were asked to use a color-coded BMI chart. While the standard chart expresses BMI only in terms of percentiles and their ranges (for example, it shows that a 6-year-old boy with a BMI of 20 falls above the 95th percentile for weight), the color-coded chart uses familiar stop light colors. Green indicates the healthiest zone for BMI, yellow indicates more risk, and red indicates unhealthy BMI zones.

Parents were more than four times as likely to answer the same questions correctly when using color-coded BMI charts than when using standard charts. The color-coded charts were most helpful to parents with the lowest math abilities (those at the kindergarten through 5th grade level). In this group correct answers increased from 51 percent to 81 percent when they used color-coded charts. The study concluded that parents consistently performed better with color-coded charts than standard BMI charts, with those of lowest math skills reaping the largest benefit.

"This study shows the value of simplified communication tools. It's important that parents - all parents - understand what their doctors are telling them. It's one step in a long road to preventing obesity, but parents often don't know when their children are overweight or gaining weight too fast, and they don't want a complicated chart," Perrin said.

The color-coded chart used in the study was developed by UNC researchers in the Department of Pediatrics and at the Center for Health Promotion and Disease Prevention.

First author of the study is Matthew D. Oettinger, a fourth-year medical student at UNC. The other UNC authors are Joanne P. Finkle, J.D., R.N., Denise Esserman, Ph.D., Lisa Whitehead, M.D., and Steven R. Pattishall, also a fourth-year medical student. The Vanderbilt authors are Russell L. Rothman, M.D., M.P.P. and Thomas K. Spain, medical student.